A Hospital-based Approach to Stopping Youth Violence

In this podcast, Anne Marks, executive director of the Youth ALIVE! hospital-based anti-violence program in Oakland, discusses the history and mission of Youth ALIVE!, its partnerships with local public health and law enforcement agencies, and how funding under the Minority Youth Violence Prevention Initiative is increasing the organization's capacity to serve high-risk minority youth.

The following is a transcript:

RAPHAEL POPE-SUSSMAN: Hi, this is Raphael Pope-Sussman with the Center for Court Innovation. Today we're speaking with Anne Marks, executive director of Youth ALIVE!, and training director for the National Network of Hospital-based Violence Intervention Programs. Anne, thank you for speaking with us today, and welcome.

ANNE MARKS: Thanks.

POPE-SUSSMAN: Tell me a bit about Youth Alive.

MARKS: Youth ALIVE! is an almost 25-year-old violence prevention intervention and youth leadership organization. We are a home-grown organization. We began with a group of students 25 years ago in East Oakland who were dealing with violence in and around their school, and in their community who wanted to do something about it, and they developed a series of workshops, which they peer lead to this day, to talk to young people about gang, gun, family, and dating violence and what people can do to make themselves safer and to make choices that are healthier.

Starting with those young people is how we began. We incorporated it to support their vision and their work. They also do a number of community engagement and organizing and advocacy activities, and from there, we actually had a staff person working in that program, who founded our Caught in the Crossfire program.

Sherman Spears was, as a young man, a victim of violence. He was a gunshot victim and found that that moment was pivotal in his life, and he wanted to make sure that he was there for people who dealt with that in the future. Whereas his options at the time were to retaliate or to just die, he wanted to find another way out, and so he found a way to start working in violence prevention, so he started the Caught in the Crossfire program to help respond immediately after a young person has experienced trauma, gunshot, stabbing, assault, to help them get on a different path with a peer who can relate to them to support them.

That program then later incorporated not just people who had been recently assaulted, but also people who had recently experienced the trauma of incarceration, so we've been working with youth and young adults for some time through that program. That program has actually been replicated in dozens of communities, and we support those programs through our National Network of Hospital-based Violence Intervention Programs.

The last thing that we do at Youth ALIVE! is, we work not just with young people who have been injured, but we work with the families and friends left behind when someone has been killed by violence. We respond to every single homicide in the city of Oakland to provide the family and friends with support. We do that work in the memory of Khadafy Washington, who was the murdered son of the founder of that project, the Khadafy Washington project.

POPE-SUSSMAN: A lot of your work really focuses on trauma and responding to trauma.

MARKS: Absolutely.

POPE-SUSSMAN: Can you tell me a bit about the Screening Tool for Awareness and Relief of Trauma, and what the origin of that is?

MARKS: So START, we call it the Screening Tool for Awareness and Relief of Trauma. It's really just that. It's a start for addressing trauma. The metaphor that we think to look at this is that, trauma is something that hurts, and START is not a cure. START is aspirin that helps relieve the pain of trauma. It doesn't make it go away. It's not the same thing as engaging in long-term therapy or other support, but it's something that can help people feel better and get some relief. How it works is we do a brief screening with someone around different symptoms of trauma, how it may actually be affecting their life. What their actual experiences of trauma are are actually irrelevant to how we do this, so we don't need to know the details of what happened to them to be able to say, "are these things affecting your life?"

For example, issues with focusing, issues with sleep, things that can really impact how you live. Then, based on how the respondent answers these questions, we give them a series of one to three different tools that are brief. We can usually get through this interview in 10-25 minutes, and give them tools they can walk away with, things they can take home. Maybe it's a plan on how to sleep better, maybe it's a relaxation exercise they didn't have before, so when they leave, they'll have something that will make their lives better.

The goal with START is two things. One, give people some relief, but the other is that when they have this relief, either they will go home, and because they have some relief, they'll be able to kick in their own resilience and their own coping skills and strategies, and turn their life into a better direction. And, the second thing is, maybe the experience of something actually being beneficial to them, that positive experience will actually make them want to continue to get care and believe that change and improvement is possible in their lives.

There have been a lot of tools out there that address trauma, and trauma is something that, historically there have been three groups that have been treated for trauma: veterans of wars, refugees, and survivors of domestic violence. What is in fact true right here, in America, and particularly here in Oakland, is that the vast majority of people who are affected by violence are actually young men of color who are affected by street violence. They are overwhelmingly the victims of street violence, community violence, and yet none of these tools have ever been developed with their needs in mind, and none of them had ever been developed understanding that, given the poor treatment they had had at the hands of a lot of institutions that are set up to "care for them," that the likelihood of someone attaching to long-term services was not necessarily something you could count on. So, how to give someone something when you, maybe this might be the only time you interact with them that can actually help them, was really important to us.

POPE-SUSSMAN: What's the strategy for evaluating the efficacy of this tool?

MARKS: This tool we use internally, and then we have a couple community partners that use it as well. Because there's a screen that is part of the tool, what we're able to do is, 30-45 days after we've given them the tool, we can do follow-up phone calls where we ask them again, questions about their symptoms that they're having and then also ask them questions about qualitatively, have they used any of the tools since then and has it helped them in any way.

POPE-SUSSMAN: Are there plans to study that on a larger level?

MARKS: Yes, we're working right now with a couple of clinics. One operated by Kaiser Permanente Vallejo and another operated by the county Alameda Health System in East Oakland, as sites to do a randomized control trial to compare and show the efficacy of this, not just sort of in people's symptoms but potentially how it affects their other health concerns. We think that will be important for the science for how this goes down. So we can really show the effectiveness of it. I will say, internally it's been very surprisingly dramatic just the responses that we've gotten from individuals who have received this. We developed this over two years through a series of focus groups with young men who were gunshot victims, and then a series of 69 structured interviews with young men who we didn't know, who came in just from all parts of Oakland to do an interview, and it was profound, the impact it had.

We feel very hopeful that this is going to be something that we can publish and show the efficacy of so that other people can use it, but we have lots of partners who are involved in the development of it who are going to use it right now.

POPE-SUSSMAN: So, Minority Youth Violence Prevention Initiative. Can you talk about how that is allowing you to expand the work that you do?

MARKS: Yeah, absolutely. Minority Youth Violence Prevention was a way for us to do two things. One, pay for a community health advocate who can then do County Alameda Health System interviews, so use this Screening Tool for Awareness and Relief of Trauma with young people that we work with, and then it also helps pay for mental health services. For a long time, all of our services that we offered were peer-based, and all of our intervention specialists were community members that didn't have clinical training, and we would always refer to mental health services when needed.

What we found was that people didn't stick. But when a mental health therapist was introduced as a counselor, or someone you might want to talk to, and came along with them in the car, to someone's house, to someone's school, spent time with them in a more casual setting, that people were able to feel more comfortable with starting to engage in mental health services.

In any case, in the process of doing the County Alameda Health System interviews, some people are going to be flagged, because they present as needing an assessment for PTSD, right? Trauma can affect your life, and it can make your life unpleasant even without a full-blown PTSD diagnosis. We believe that people deserve help no matter where they are, but some people will actually have severe symptoms that require an assessment and it would be helpful to do, so that's also why we brought mental health services on through this grant.

POPE-SUSSMAN: What are your hopes for START?

MARKS: Our hopes for START is that it has a catalytic effect on how people in our community talk about trauma, and in the process of doing that, changes how the institutions that are incorporating START into their settings treat these young men. We have a culture that treats young men of color as if they are potential perpetrators when in fact, a young man of color is much more likely to be a victim.

POPE-SUSSMAN: What are the biggest challenges that you think Youth ALIVE! is facing right now?

MARKS: I guess I would say the biggest challenges that Youth ALIVE! faces are the same challenges that the people we serve face. Locally, that can mean the challenges of gentrification and equity. Largely, it means the challenges of the systems that interact with our young people that are also the systems we have to interact with. We pride ourselves on having worked a great deal with institutional partners that have not always best served the interests of our young people, from probation to police to health care systems, to the school district, but these are large systems, and helping these systems move along is always going to be a challenge.

POPE-SUSSMAN: Where do you see your relationship with law enforcement right now?

MARKS: Youth ALIVE! has an excellent relationship for example, with the police department. Our work with homicide victims we could not do without a strong partnership with the Oakland Police Department, who pass along next-of-kin notification to us, so we can reach out to these families. It works out really well because for them, having us work with the family actually de-escalates the tension that that family is dealing with, so that we're able to make them more calm and ready to deal with whatever the next steps are. They might have to deal with law enforcement, and it works out for us, obviously, because we get access to these families and can give them help. And it wasn't quick, but we're at a point now where the police never ask us for information about any of the incidents that led to the violence that we're dealing with, so that's been a great thing for us. I think for them it's been a really excellent relationship.

POPE-SUSSMAN: And the DA?

MARKS: Well we work a lot with the DA because we work with Victims of Crime. So we have a relationship with Victims of Crime that's such that they will let us know, for example, if a family of a homicide victim is coming in to the office, in case we haven't gotten the notification yet that the family has contacted them. We're able to actually meet them there in the office. They'll bring us in to actually meet with the family with them to help explain what the VOC process is. With that, we've had an excellent relationship with the DA.
Our board president for Youth ALIVE! is actually a deputy district attorney. I guess I would say this, I think one of the things that's unique about, for example, our board president, Mike Nieto, and our relationship with police and with the district attorney's office is that, given the work that we do, and given how the cycle of violence works, it is not helpful to draw a line between victim and perpetrator. That distinction makes a lot of sense in certain settings, like the criminal justice setting, but it makes no sense in the lives of the people that we work with.

Helping people think about breaking cycles of violence, helping people understand that someone may be in a system as a perpetrator but their actual history of trauma is much different than that is something that we've had some real traction in doing here, and I think that before the concept, the word of trauma-informed was out there, that was something that we've been working on here locally for some time--is helping really look at violent incidents and not as, who did what, but as, how do we respond to this eruption in way that helps all the parties not further hurt themselves or anyone else.

POPE-SUSSMAN: Wonderful. That's it.

MARKS: Thanks!

POPE-SUSSMAN: I am Raphael Pope-Sussman, of the Center for Court Innovation, and I've been speaking with Anne Marks, executive director of Youth ALIVE! For more information on the Center for Court Innovation, visit www.courtinnovation.org.

August 2015