RWJF Scholar examines neighborhood-based death rates from opiate-based painkiller overdoses, compared with heroin overdose deaths.
The Fighting Back® project in Vallejo, Calif., worked from 1990 to 2002 to prevent, intervene and treat alcohol and other drug abuse, focusing on local partnerships and strategic alliances to coordinate activities.
The project was part of the Robert Wood Johnson Foundation (RWJF) national program Fighting Back: Community Initiatives to Reduce Demand for Illegal Drugs and Alcohol.
RWJF provided five grants totaling $6,279,951 for this project from March 1990 through December 2002.
The City of Vallejo in Solano County, Calif., covers 28 square miles at the junction of San Pablo Bay and the Sacramento River east-northeast of San Francisco. In 1990, the population was 109,199, of whom 46 percent were white, 22 percent Asian-American (primarily Filipino), 21 percent African-American, and 10 percent Hispanic.
From 1980 to 1990, the population of Solano County grew 45 percent, and the population of Vallejo increased by 36 percent, due in part to its popularity as a relatively low-cost bedroom community near San Francisco and Oakland. According to the 1990 census, 22 percent of female-headed households in Vallejo were below poverty level, and nearly 11 percent of all families received Aid to Families with Dependent Children (AFDC).
During the 1990s, Vallejo lost one of its employment mainstays as the result of the downsizing and then closing of the Mare Island Naval Shipyard across the Napa River, which had employed 9,300 civilians, or about 25 percent of working Vallejo residents.
Before the Vallejo Fighting Back® Partnership began, the Vallejo Police Department and Solano County social service departments identified the city's downtown area, North Vallejo and South Vallejo as having a disproportionate share of crime, as well as drug, alcohol and poverty problems. Vallejo also had a large number of white, Filipino and black gangs and a reputation for being part of the Interstate 80 'drug route' between San Francisco and Sacramento.
The number of drug-related problems in Solano County rose sharply from 1981 to 1988. The number of drug-related arrests for adults increased more than tenfold, from 132 in 1981 to 1,577 in 1988; alcohol-related arrests increased at a smaller but still significant rate (91 percent) from 648 in 1981 to 1,239 in 1988; and nearly 40 percent of the deaths investigated by the Solano County Coroner in 1990 (i.e., homicides, suicides, automobile fatalities) involved alcohol or another drug.
In a 1991 survey of 11th graders (before the Vallejo Fighting Back Partnership began), 25 percent indicated that they had been drunk in the past 30 days, and 26 percent reported marijuana use in the past 30 days. Of the 11th-grade respondents, 27 percent were classified as at moderate risk and 8 percent as at high risk for alcohol abuse; 4 percent were classified as at high risk for marijuana use. Drug-related arrests for juveniles had increased by 240 percent from 1981 to 1988.
Promoting health and reducing the personal, social and economic harm caused by substance abuse is one of RWJF's goal areas. In May 1986, RWJF began a two-year analysis of the national problem of substance abuse. This led to the national program Fighting Back to assist communities of 100,000 to 250,000 people to implement a variety of anti-drug strategies to address their local problems.
Fighting Back implemented a communitywide approach that involved business, health care, the public school system, local government and its agencies, the police, community groups, local media and the clergy. Sites received funding starting in 1990.
The Fighting Back project in Vallejo began in 1990 under the auspices of the City of Vallejo. The overall objective of the project, called the Vallejo Fighting Back Partnership, was to develop and implement a comprehensive, communitywide system of prevention, intervention, treatment and aftercare to reduce the demand for alcohol and other drugs.
The Vallejo Fighting Back Partnership worked to create and strengthen local partnerships and strategic alliances to deal with substance abuse by bringing relevant parties together to coordinate their activities.
The City of Vallejo, with a council-manager system of government, received funding to plan its Fighting Back initiative in 1990 (ID# 016520). Three committees the Steering Committee, the Mayor's Roundtable and the Red Ribbon Committee planned the Vallejo Fighting Back Partnership, which then was implemented under the guidance of the City Manager's Office.
The Steering Committee included one voting representative from each involved sector, which included business, faith communities and drug and alcohol-related services. The Mayor's Roundtable small working groups focused on law enforcement, the courts, justice, health, mental health, education and social services provided overall guidance.
Vallejo's Red Ribbon Committee is a multidisciplinary citizen task force. Input from community surveys, key informant interviews, small town-hall meetings and existing quantitative data guided initial decision-making about planning the program. As the Vallejo Fighting Back Partnership developed, more participants were recruited from the business sector, the medical community, recovering residents and minority citizens.
During Phase 1 of Fighting Back, program sites were required to show that they could reduce the demand for illegal drugs and alcohol by combining their resources into a unified effort. Expected outcomes included: (1) a measurable and sustained reduction in the initiation of drug and alcohol abuse among children and adolescents; and (2) reductions in drug-and alcohol-related deaths, injuries, health problems, on-the-job problems and crime. RWJF realized that some of the anticipated outcomes could only materialize in the longer term.
Under the second and third grants (ID#s 019738 and 024533), the Vallejo Fighting Back Partnership began to implement its Fighting Back project, focusing on six objectives each with specific initiatives:
In 1994, the Vallejo Fighting Back Partnership established a nonprofit corporation called the Vallejo Community Consortium to administer the project, under a subcontract from the City of Vallejo. The Vallejo Community Consortium included a board of directors that oversaw the project and a community council that advised the board.
In 1996, RWJF concluded that tighter targeting and focusing of the program in some of the existing sites might facilitate an adequate test of the program's unified, community-based approach. In 1997, the National Program Fighting Back moved into Phase 2, in which program sites were required to concentrate on their most important substance abuse problems using a strategic plan that focused on obtaining measurable changes in local objectives.
In preparation for Phase 2, Vallejo's Fighting Back Partnership re-examined the usefulness of its broad, comprehensive plan. Working with Brandeis University, which was conducting a quantitative national evaluation of Fighting Back, the Vallejo Fighting Back Partnership designed a more focused plan to impact a significant number of people in fewer geographic and strategic areas.
The Vallejo Fighting Back Partnership identified the substance abuse-related problems that were most important to Vallejo using current research, an informal inventory of community problems and assets, local data on drug use indicators, GIS mapping of drug-related problems and an assessment of the need for and availability of publicly funded treatment. It also applied the following criteria:
This analysis suggested three problems as the focus of Phase 2: (1) deteriorating neighborhoods that lead to decreased public safety and increased crime and violence stimulated by alcohol and drug use; (2) inadequate substance abuse treatment for people without money or medical insurance; and (3) usage rates for tobacco, alcohol and marijuana among youth.
During the fourth and fifth grants (IDs# 031966 and 039481), the Vallejo Fighting Back Partnership developed "logic models" to guide the implementation of programs addressing these three objectives. These models contain detailed strategies, activities, benchmarks and measurements for each program area and are designed to focus the programs on measurable outcomes.
Over the course of the project, the project team collaborated with community groups; county, state and federal agencies; health care providers; and other organizations, including the Latino, African-American and Filipino community task forces; Kaiser Permanente; the Mare Island Naval Shipyard; many Solano County departments; the Vallejo City schools and police; and VISTA.
Through 2002, the Vallejo Fighting Back Partnership attracted more than $8.9 million in additional funding, including grants from:
Project staff reported these accomplishments under Phase 1 and Phase 2 of Fighting Back. The Vallejo Fighting Back Partnership:
The National Evaluation
The quantitative national evaluation (conducted by Leonard Saxe, Ph.D., first at the City University of New York and then at Brandeis University) looked at outcomes in four areas in each community: binge drinking rates, illegal drug use in the last 12 months, marijuana use in the last 12 months and knowledge about counseling opportunities. From 1994 to 1997, three measures moved in the right direction in Vallejo; however, none of these changes were statistically significant:
As is the case with other Fighting Back sites, Vallejo did not systematically measure existing conditions in their community before the Vallejo Fighting Back Partnership started and therefore could not measure other potential effects of their initiatives over time.
For example, the Vallejo Fighting Back Partnership identified several sets of data on drug-related indicators (alcohol-related traffic injuries and fatalities, drug- and alcohol-related hospitalization, drug- and alcohol-related arrests) in their mid-course assessment, but the Vallejo Fighting Back Partnership did not monitor changes in these indicators as the initiative moved forward.
One change that was monitored was Vallejo's substance abuse treatment capacity, which increased by more than 25 percent. The Vallejo Fighting Back Partnership was also cooperatively involved in a health care initiative spearheaded by Kaiser Permanente, which resulted in insurance coverage for substance abuse treatment for 64 percent of Vallejo residents, enabling them to take advantage of the increased opportunities for treatment.
According to a study by the National Institutes of Health (National Institutes of Health Documents, April 28, 2005), five Fighting Back communities (Kansas City, Mo., Milwaukee, Wis., San Antonio, Texas, Santa Barbara, Calif., and Vallejo, Calif.) undertook concentrated alcohol interventions and "experience significant declines in alcohol related fatal crashes during the 10 years of the program compared with 10 years before the program. " Ralph W. Hingston, Sc.D., professor at the Boston University School of Public Health and Center to Prevent Alcohol Problems Among Young People, conducted the study. He explains, "The efforts of [these] five communities were considered 'concentrated' because they implemented eight or more actions to restrict alcohol availability and expand treatment." Vallejo and the other concentration intervention communities:
Project staff created a Web site, and produced a video about the Vallejo Fighting Back Partnership. Staff also published community reports, a training manual and a book chapter, and made a presentation about the project at the annual meeting of the National Public Health Association. The White House mentioned the Vallejo Fighting Back Partnership in its 2002 National Drug Control Strategy. The Vallejo Times-Herald, VallejoNews.com and the Fairfield Daily Republic published articles about the project. (See the Bibliography for details.)
The City of Vallejo continues to administer the Vallejo Fighting Back Partnership, which sponsors programs to:
The project has expanded services, including opening a satellite office of the Greater Vallejo Family Resource Center in northern Vallejo and offering programs in more schools. Grants from local, state and federal government as well as from foundations fund the Vallejo Fighting Back Partnership.
The Vallejo Fighting Back(R) Partnership
City of Vallejo (Vallejo, CA)
Chris Dacumos's Story
"I wouldn't really be here right now if it wasn't for Fighting Back Partnership. I'd probably take the other route, be into gangs and drugs now. Both my sisters got into Youth Partnership and they got recognition and their voices were heard. So I wanted that for myself. I was in eighth grade and I wanted to get into gangs, at least a group where I felt support. So it was between entering a gang and Fighting Back Youth Partnership."
Chris chose the Fighting Back Youth Partnership:
"You always want to come back, no matter what, no matter if your point gets heard, because you always have next week to argue with them and get your point across. When my point does get heard, it's just that more special my confidence builds, so I do a lot more things, take up more responsibilities and try to be more active within the group.
Our Fighting Back Partnership is our backbone they provide us with a meeting place, give us food and snacks, helped us get permits for the 'silence the violence' rally, provide us with awesome moderators and advisers. They attend our meetings; and they're not like adults trying to tell us what to do. They're there to give us their input and help us make mature, intelligent decisions about how we want to approach things. They give us resources, so that we can contact those people ourselves. They're very supportive. They always attend our events. They're like parents you know, special.
"It's weird. I don't really see my life without the Fighting Back Youth Partnership, because everything I've done since 8th grade has been through their support. They've helped me get to know people who really shape my ideas towards life, helped me take the initiative and challenge myself to help unify the community and challenge other people also."
Tracy Lee's Story
Tracy Lee is currently a trainer for Solano County Health and Social Services, working with CalWorks recipients and applicants. She tells how she became involved with Fighting Back:
"In May of 1997, I thought I was hopelessly addicted to crank [methamphetamine] and probably alcohol. It was so bad. I was suicidal. I went to Kaiser and asked them for a pill. I thought I needed help for my depression. They sent me to treatment and I discovered recovery in a 14-day outpatient treatment program."
Bill, Tracy's son, describes his mom's transformation:
"My mom, when she was on drugs, would always get very nervous when my grandparents would come over for dinner. And so one time my mom asked me to vacuum the house while she took a shower. I [made a mess with] the vacuum powder stuff on the rug and that helps you clean. I was five years old then. And I remember just feeling tears and sadness coming out of me because I tried so hard to help her that I had just made a mistake, and I didn't understand why she had yelled at me. I just felt, well, I did something wrong, so I was wondering how I could do it better. But now when I vacuum, she doesn't complain at all. She just says, 'Well, how about if I do this spot because you didn't get it really good.'"
Shortly after she entered recovery, Tracy saw a flier for the Fighting Back Partnership, she recalls:
"They were looking for people interested in trying to educate people about recovery and that treatment works. And I thought, what a great way to help. My whole life was changing. I was discovering who I was for the first time, and leaving a place of such hopelessness, where all I did was lock myself in my room, smoke crank morning, noon and night. I really had no time to be a mother to my boy. And I went from that, to experiencing reconnections with my family, my mom and dad, my six brothers and sisters, my child. Oh, my God, what a joy. And learning how to really perform beautifully at work in ways I never knew."
Fighting Back's RAFT (Recovering Advocates For Treatment) program is made up of recovering addicts and community members interested in informal and formal policy advocacy and changing the public awareness around substance abuse. RAFT gave Tracy a place to take her recovery and tell people about it, without any shame:
"I love what AA and NA can do for people, but I needed more. I needed to really do something with my recovery and to believe that it would work. I wanted to go out and tell people that it works. Treatment works. We can recover. We don't have to die from our disease. And it's just given me so much. I learned to speak out at schools and in churches, wherever any one will listen. RAFT members go out and speak and spread the word. We talk with legislators. We try to educate anyone who is willing to listen to us that treatment works. Recovery works."
Tracy recalls the most triumphant moment of her turnaround talking about the power of treatment to turn a life around at the time the legislature was considering California Senate Bill 599, providing insurance coverage for treatment:
"My son and I, and others from RAFT, went up to the California Legislature, and we addressed the Senate commission that was hearing all the pros and cons about this bill. I was going to talk, as well as others from our organization. And my little boy, who was nine at the time, said, 'Mommy, I want to talk.'
"And I thought, 'Okay. What are you going to say, Bill?'
"And he said, 'Mom, let me talk. I know what I want to say.'
I was really nervous for him, but I thought, well, okay. Go ahead. So he's busily writing down his own little speech, and he didn't want me to edit it in any way. It was his. He went up there and I was so proud of him, because the gist of his message was, he remembered what it was like when I was using, how I would lock my door.
"What he told them was: 'I feel like my mom's an alien when she locks the door. I didn't even know who she was.' And he said, 'I remember her sleeping. I couldn't wake her up. I had to feed myself.' He was four or five at the time. And he said, 'Now, now, she takes me everywhere. We do things together. We go on little trips. Of course she needs me.' And he said, 'I believe that every kid, every boy and girl, deserves a mom who can get substance abuse treatment and be there for their children.'
"And that made a difference a big difference. And it was so powerful to me. I saw that one person really can make a difference, and we can affect policy in this nation, because what happened was, we swayed a commission that was not going to support that bill, and they did. Not unanimously, but very, very powerfully, they did support it after my son spoke. And that's something."
Since then, Tracy has been appointed to the Alcohol and Drug Advisory Board, the Community Action Council and the Substance Abuse Work Group. She continues to spread the message that people in recovery need to be at the table when substance abuse issues are discussed:
"We are the ones who know what works. We are the ones who understand this disease, which the normal rational person just can't get their arms around. We, perhaps better than anyone, know what to say to kids who are thinking about using. I've seen tremendous interest from our young audiences in high schools, because we don't tell people, 'Don't do this.' We just say, 'Here's the consequence. And it can happen to anyone.' People in recovery need to be at the table because we have the passion for spreading the news that treatment works. We're living proof that you can recover, re-enmesh in society and make a big difference."
Regarding her son, Tracy has this to say:
"I think he has been my umbilical cord to this earth. Even through deep depression, my love for my son was always there, but it wasn't until recovery that I got this child of mine. I had always loved him, but I didn't understand love. And I grew to know my child in a way I cannot describe to you. We have a relationship that is so incredibly fulfilling for me and for him. We know what each other needs. I can pick him up from school. He knows what I'm thinking. He can talk to me about anything, literally anything. He knows that I'll listen, no matter what. If he needs help on something, I'm going to help him. If he's interested in basketball, by God, I will get him there. I have many things I love to do, but Bill is what I love the most. He has blossomed in my recovery and our kids do, when we get help."
Barbara, a senior citizen who lives in one of the neighborhoods helped by Fighting Back, works at the Boys' and Girls' Club, one of Vallejo Fighting Back's partner organizations:
"When I moved here, it was like, 'Oh Country Club Crest.' It was a negative tone, and I think that has changed since we started taking our neighborhood back. It used to be you couldn't get credit if you lived in Country Club Crest, regardless of what your financial situation was like, but that has changed.
"I had gotten treatment I didn't appreciate from the police department. But when they came out to Country Club Crest to do revitalization, I had to change my mind. Being a part of their core team and part of the revitalization of my neighborhood has changed my perspective so I'm trying to change that attitude in my neighborhood as well. Working with them showed me that, hey, I live in this neighborhood, I need to clean it up I can't expect other people to do it. I'm learning, while I'm on this core team, that I can take care of myself. I don't have to have the police hitting me upside the head. And they're learning from me, as a neighborhood person, how I feel.
"I'm just thrilled to come here [to the Boys' and Girls' Club]. I love what I'm doing. I see us taking these young children and motivating them to want to do academics at their best. To excel so they can go to college, get a good job, not have to have a gun in their hand. We have a lot of young people who go to college all over the country and they're engineers and doctors and lawyers. So if that kid can do it, the rest of our kids can do it, and that's what I want. I've seen kids come in here who want to fight us, don't want to be here, who put holes in the walls or tear up books, and then all of a sudden it clicks, and it's like 'Oh, this is a good place for me to be.'"
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Sparks M and Wittman F. "Community Organizing." In Prevention Enhancement Protocols Systems (PEPS): Preventing Problems Related to Alcohol Availability: Environmental Approaches. Practitioners' Guide. Third in the PEPS Series. Grover PL (ed.). Washington: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Substance Abuse and Mental Health Services Administration, DHHS Publication No. (SMA)993298, 1999.
Moving Ahead Together: An Action Plan for Reducing Substance Abuse. Vallejo, CA: Vallejo Fighting Back Partnership, 1998.
Substance Abuse Report to the Community: Toward a Healthier Vallejo. Vallejo, CA: Vallejo Fighting Back Partnership, 1998.
Community Against Substance Abuse Civic Task Force. Vallejo City Unified School District City of Vallejo Fighting Back Partnership: Report and Recommendations. Vallejo, CA: Vallejo Fighting Back Partnership, 1999.
Community Report Card: Mid-Year 1999. Vallejo, CA: Vallejo Fighting Back Partnership, 1999.
We're Making Progress: Fighting Back Partnership City of Vallejo, Overview 2000. Vallejo, CA: Vallejo Fighting Back Partnership, 2000.
It's Never Too Late: Fighting Back Partnership City of Vallejo, Overview 2001. Vallejo, CA: Vallejo Fighting Back Partnership, 2001.
Alcohol Use and Misuse Among Frail Older Adults in Solano County. Calif.: Solano County Health and Social Services Department.
The CUP as a Prevention Tool. Vallejo, CA: Vallejo Fighting Back Partnership.
A 10-minute videotape about the Vallejo Fighting Back Partnership. Vallejo, CA: Vallejo Fighting Back Partnership.
www.fight-back.org. The Vallejo Fighting Back Partnership's Web site contains information about the project. Vallejo, CA: Vallejo Fighting Back Partnership.
"Best Practices Convention," Calif. Attended by 100 people representing a variety of community organizations. Co-sponsored with the Vallejo Unified School District.
Report prepared by: Antonia Sunderland
Report prepared by: Lori De Milto
Reviewed by: Richard Camer
Reviewed by: Molly McKaughan
Program Officer: Paul Jellinek
Program Officer: Floyd Morris
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