November 2008

Grant Results

National Program

Robert Wood Johnson Foundation Local Funding Partnerships

SUMMARY

From 2003 to 2007, the United Teen Equality Center hired two outreach workers who worked with members of seven of the most active Southeast Asian youth gangs in Lowell, Mass., to reduce violence and improve teens' access to health care. These outreach workers — who the center calls streetworkers — mediated conflicts between gangs, sponsored events and activities to promote peace and coordinated with the police and other partners to address gang violence. To increase the use of health services, streetworkers connected teenagers with community health organizations. The center also sponsored a health fair and health workshops.

The project was part of the Robert Wood Johnson Foundation Local Funding Partnerships — formerly Local Initiative Funding Partners — which provides matching grants for innovative community-based projects aimed at improving the health and health care of underserved and vulnerable populations. (For more information see Grant Results.)

Key Results

  • Streetworkers helped mediate more than 300 conflicts between gangs. More than 90 percent of the mediations resolved the conflict during the project period.
  • About 40 teenagers attended at least one of six peace summits, in which members of rival gangs signed a peace treaty. No major incidents of violence between members of the gangs who participated in these summits followed during the project period.
  • 118 teenagers received mental health counseling and 66 received primary care services.
  • 78 teenagers enrolled in health insurance.

Funding
RWJF provided $460,000 for this project. The United Teen Equality Center raised $903,000 in additional funds.

 See Grant Detail & Contact Information
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THE PROBLEM

The United Teen Equality Center in Lowell Mass., was established in 1999 from an organizing movement by young people to develop their own teen center in response to the gang violence among Latino and Southeast Asian youth.

At the time, there were more than 30 gangs in Lowell with more than 1,000 youth members, according to the center. Gang violence had risen dramatically before the RWJF grant began, with 16 shootings during five months in 2002.

Cambodians dominate the Southeast Asian population in Lowell, which is home to the second largest Cambodian population in the United States. According to the center, Cambodians have not only problems typical of low-income immigrant populations — low educational levels, poor health, cultural and linguistic isolation and very limited access to health care — but also the particular mental health problems associated with their parents' continued post-war stress and conflicts with their "Americanized" adolescents.

One result of such an array of difficulties is Cambodian youths' involvement in gangs.

Given the high levels of both health care need and gang involvement among Cambodian youth, United Teen Equality Center proposed this project to improve access to health care and reduce gang violence in Lowell with special outreach to Cambodian youth.

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RWJF STRATEGY

In 1987, the RWJF Board of Trustees authorized $8 million to fund a two-year trial of a matching grants program to be called Local Initiative Funding Partners.

Many matching grants programs set up by national foundations seek to replicate ideas formulated by the national foundation itself. Renamed the Robert Wood Johnson Foundation Local Funding Partnerships in 2007, the program was to be different. The local community would identify a pressing need, design the strategy for addressing it and put together a funding package that would provide at least one dollar of outside support for every dollar of RWJF grant money. Each project would have one lead local funder, but additional supporters would be welcomed.

To be eligible, a project would have to fall within the general scope of RWJF's interest in addressing the needs of vulnerable populations. But a proposal would not have to meet the kind of specific criteria common to other RWJF programs. Instead of top-down, Local Funding Partnerships would be bottom-up — with an emphasis on innovation. RWJF hoped this local "ownership" would ensure sufficient support to keep the project going after the RWJF grant ended. This hope was realized, with 86 percent of the Local Funding Partnership projects funded from 1987 to 2001 continuing at least one year after RWJF funding ended, according to a study by Mathematica Policy Research.

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THE PROJECT

Two streetworkers from the United Teen Equality Center worked to reduce gang violence and increase the use of primary care and mental health care services among Southeast Asian — primarily Cambodian — youth in Lowell, Mass. The streetworkers were paid, trained adults from the community who could help teenagers access community resources and advocate for and support them, including through home visits and phone calls.

Project Activities

Originally, the center planned to use a volleyball league as a way of engaging youth to promote healthier lifestyles and increase the use of health services. During the first year of the project, however, the streetworkers realized gang violence superseded all other problems for youth in the community and they needed first to work on reducing such violence before they could begin to promote healthier lifestyles and accomplish health-related goals.

Reducing Gang Violence
The center modified the project's goals to emphasize peacekeeping. The streetworkers worked with seven of the most active gangs and focused on building relationships with gang members and other teenagers in the community. They also:

  • Mediated conflicts between gangs.
  • Sponsored events and activities to promote peace in the community.
  • Collaborated with the police and other partners to address gang violence.

The center created a peace team, comprised of ex-gang members, to provide support and information when streetworkers were dealing with crisis situations on the street.

Increasing Use of Health Care Services
To determine what teenagers needed and wanted to help them have healthier lifestyles and gain access to health care, the streetworkers and some teenage volunteers surveyed 350 teenagers, primarily face-to-face on the streets. A few teenagers completed the survey at the United Teen Equality Center.

Using the survey results, the streetworkers decided to focus the health component of the project on access to health insurance, promoting HIV/AIDS prevention, parenting skills training and dating violence. They also offered a variety of activities — basketball and volleyball tournaments, break dancing competitions and a health game show — rather than just the volleyball league.

At these events, staff from community health organizations handed out information and talked to teenagers about services. These organizations included:

  • Lowell Community Health Center, a free clinic.
  • Metta Health Center, a division of the Lowell Community Health Center that integrates Western and Eastern medicine.
  • Mental Health Association of Greater Lowell.
  • Rape Crisis Center.

The center also:

  • Offered mental health services at the center 20 hours a week with staff from the Mental Health Association of Greater Lowell.
  • Helped teenagers enroll in health insurance.
  • Sponsored a health fair and HIV/AIDS workshops.
  • Provided tours of community health partners' facilities.

Other Funders

The United Teen Equality Center raised $903,000 in additional funds for the streetworker program. This included a Street Outreach grant from the U.S. Department of Health and Human Services ($300,000), a Shannon grant from the city of Lowell ($75,000) and two grants from the state of Massachusetts: Byrne grant ($95,000) and Prevention of Youth Violence grant ($56,000). See the Appendix for a list of funders.

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RESULTS

The project accomplished the following according to reports to RWJF.

Reducing Gang Violence

  • Streetworkers helped mediate some 300 conflicts between gangs (one-on-one and between groups of gang members). More than 90 percent of the mediations resolved the conflict during the project period.
  • About 40 teenagers attended at least one of six peace summits in which members of rival gangs signed a peace treaty. (The peace treaty covered only the gang members present). No major incidents of violence between gang members who participated in these summits followed during the project period.
  • About 300 teenagers attended at least one of 12 peace circles, where streetworkers brought together members of a single gang to continue to build relationships and lay the groundwork for peace.
  • About 950 teenagers participated in at least one of 38 peace trips — fishing, bowling, hiking, pool tournaments or basketball games — during which streetworkers took the teenagers outside the neighborhood to begin to build relationships with them.
  • About 600 teenagers participated in special events such as a Dance for Peace, Peace in Action (a community event to promote talking instead of killing, established in response to the killing of two teenagers by members of another gang) and Voices for Change (a peace vigil march).
  • About 60 teenagers attended beach day trips and midnight barbeques, designed to enable streetworkers to build relationships with them.
  • The United Teen Equality Center worked with the police, the juvenile court and other partners to address gang violence. For example, project staff:
    • Led the first gang summit in Lowell and participated in four city-run gang summits. During these summits, local youth, school officials, police officers, politicians, representatives of social service agencies and other community members came together to discuss how to reduce gang violence and improve community safety.
    • Coordinated a youth forum where 70 teenagers and 20 police officers discussed issues such as police harassment, racial profiling, gangs and loitering. The forum included break-out sessions that focused on creating possible solutions to these problems.
  • The United Teen Equality Center established a reputation as the "go to" agency for gang intervention and prevention within Lowell, according to JuanCarlos Rivera, director of the streetworker project. For example:
    • Streetworkers provided advice to staff from the city of Lowell about a campaign to address gang violence.
    • The RWJF project director — the center's executive director — served on the city of Lowell Gang Task Force.
    "The Streetworker Center has become part of the larger community in Lowell and is now seen as part of the solution to gang violence," wrote Rivera in a report to RWJF.

Increasing Use of Health Care Services

  • 118 teenagers received mental health counseling and 66 received primary care services. This includes 42 teenagers who saw the clinician based at the center 20 hours a week through a partnership with the Mental Health Association of Greater Lowell. Streetworkers also referred teenagers to other community organizations for mental health and primary care services.
  • 78 teenagers enrolled in health insurance. Project staff expected to help more young people enroll in health insurance, however, budget cuts in MassHealth, a public health insurance program for eligible low- and medium-income residents of Massachusetts, and new health insurance requirements, meant that most of the teenagers were no longer eligible.
  • More than 1,000 teenagers participated in various health education and awareness activities:
    • 150 teenagers participated in a health fair.
    • 550 teenagers participated in basketball and volleyball tournaments where community health partners handed out information and promoted their services.
    • 188 teenagers participated in 15 health workshops, and 80 of these teenagers participated in a health game show held during the workshops.
    • 203 teenagers participated in tours of health organizations such as the Lowell Community Health Center and the Rape Crisis Center.

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LESSONS LEARNED

  1. Build solid relationships with teenagers before trying to help them make changes. The streetworkers found this extremely important. A streetworker's ability to be transparent, to use "respectful curiosity" and to provide intensive follow-up were key factors in building strong relationships. (United Teen Equality Center Streetworker Project Director/Rivera)
  2. Maintain relationships with funders by being transparent and providing consistent follow-up. The United Teen Equality Center received funding from many sources during this project. Project staff increased administrative support to improve capacity to report on time and in a comprehensive manner. (United Teen Equality Center Streetworker Project Director/Rivera)
  3. Find good community partners and develop strong relationships with them. Project staff used consistent and open communication (such as monthly meetings with police command staff) to build strong relationships. (United Teen Equality Center Streetworker Project Director/Rivera)
  4. To develop political support, develop visibility in the political arena. The center did this in many ways including inviting political leaders to observe various activities, having them as guest speakers at events, providing follow-up thank you letters or letters of support for important political initiatives and making regular trips to the statehouse and city hall. (United Teen Equality Center Streetworker Project Director/Rivera)

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AFTER THE GRANT

The United Teen Equality Center hired two more streetworkers and was continuing its work to reduce gang violence and promote health. In 2007, the organization received another three-year Street Outreach grant from the U.S. Department of Health and Human Services and another Shannon grant from the city of Lowell, as well as a grant from the Department of Public Health. In 2008, the center received a grant from the Executive Office of Public Safety.

Under another RWJF grant, two researchers from the Johns Hopkins University Bloomberg School of Public Health were evaluating the streetworker program (Grant ID# 059598; March 2007 to January 2009). They planned to:

  • Document and describe characteristics and activities of streetworkers.
  • Assess the impact of the streetworker program on Lowell youth.
  • Develop a model illustrating how the streetworker program impacts youth violence.

The evaluation methods were:

  • A review of United Teen Equality Center records.
  • In-depth interviews with streetworkers, the executive director of the United Teen Equality Center and some community partners.
  • A survey of youth in the community.

As of July 2008, the evaluators had completed the records review and the interviews.

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GRANT DETAILS & CONTACT INFORMATION

Project

Increasing Access to Primary Health Care and Mental Health Services by Asian Youth

Grantee

United Teen Equality Center (Lowell,  MA)

  • Amount: $ 460,000
    Dates: July 2003 to June 2007
    ID#:  048872

Contact

JuanCarlos Rivera
(978) 441-9949
juan@utec-lowell.org

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Streetworker Center Funders

  • Department of Health and Human Services, $300,000
  • Byrne Grant, $95,000
  • City of Lowell, $75,000
  • Prevention of Youth Violence Grant, $56,000
  • Parker Foundation, $50,000
  • Roy Hunt Foundation, $50,000
  • United Way of Merrimack Valley, $30,000
  • Lowell Housing Authority, $28,000
  • Bank of America, $25,000
  • Yawkey Foundation, $25,000
  • Banknorth, $20,000
  • Jesse B. Cox Trust, $20,000
  • City of Lowell Enterprise Community, $19,000
  • Enterprise Community, $19,000
  • Filene Foundation, $15,000
  • Lowell Community Health Center, $15,000
  • Millipore Foundation, $15,000
  • Shaw Foundation, $15,000
  • Lenny Fund, $10,000
  • Greeley Foundation for Peace & Justice, $10,000
  • Aubert J. Fay Foundation, $6,000
  • Harvard Pilgrim Health Care Foundation, $5,000
  • TOTAL: $903,000

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Survey Instruments

"UTEC Health Survey," United Teen Equality Center, fielded September–October 2003.

Presentations and Testimony

Greg Croteau, to the Senate Judiciary Committee. Written request from Sen. Edward M. Kennedy, 2007.

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Report prepared by: Lori De Milto
Reviewed by: Janet Heroux
Reviewed by: Molly McKaughan
Program Officer: Jane Isaacs Lowe

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