Culture of Health Blog

During a recent webinar held by Stakeholder Health, a learning collaborative of health leaders aimed at improving population health, Margo DeMont, PhD, head of community health enhancement at Memorial Hospital of South Bend, Ind., shared about the hospital’s recent efforts to build a trauma-informed community through several innovative therapeutic programs.

For example, using eye motion desensitization and reprocessing (EMDR), a trained practitioner takes a person through their traumatic experience, and then follows with a series of hand movements, asking the patient to follow the movements with their eyes. After the sequence of movements, the patients are asked to review the intensity of their feelings about the trauma, with the goal of reducing the heightened emotions. The goal is to reprocess the information from the incident in their brain from the right hemisphere, where emotional experiences can be locked up, to the left hemisphere, which is the more cognitive area of the brain. While EMDR is still quite new and studies are still needed, some use of the technique has been suggested by both the U.S. Department of Defense and the American Psychiatric Association.

The goal of the behavioral interventions is to reach people who have suffered through adverse childhood experiences (ACE). Studies have shown that without help dealing with those childhood experiences, people are more likely to face long-term health problems such as substance abuse, cardiopulmonary disease, diabetes and obesity. Memorial Hospital assessed the impact of childhood trauma on adults in the community through a community health assessment.

NewPublicHealth recently spoke with DeMont about the initiatives.

NewPublicHealth: When was the community health assessment done that indicated that there was a great deal of trauma in the community related to adverse events in childhood?

Margo DeMont: That was done in 2012 as part of the community benefit requirement for non-profit hospitals under the Affordable Care Act. And we saw that in terms of health issues perceived by the community, violence was rated pretty high, it was one of the priorities, and it came out as both street violence and relationship violence. I was familiar with the work done by Kaiser Permanente on childhood trauma, and we included eight questions from the U.S. Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance Survey that dealt with adverse childhood experiences in random phone surveys completed by 599 adults

NewPublicHealth continues a new series to highlight some of the best public health education and outreach campaigns every month. Submit your ideas for Public Health Campaign of the Month to info@newpublichealth.org.

Two national multimedia campaigns are urging precautions and safe practices when it comes to firearms and children.

The National Crime Prevention Council (NCPC)—in partnership with the Ad Council and funded by the Bureau of Justice Assistance—has launched the Safe Firearms Storage campaign to encourage owners to make safe firearms storage a priority. According to a study by the RAND Corporation, about 1.4 million homes have firearms stored in a way that makes them accessible to children, at–risk youth, potential thieves and people who could harm themselves or others.

“We teach all drivers to buckle up in case of accidents and to lock their cars,” said Ann M. Harkins, President and CEO of the NCPC. “The same logic applies to this campaign; we want owners to lock up their firearms to prevent accidents and keep them out of the wrong hands. Safe storage ensures that owners are doing their part to increase public safety.”

In addition to a website, the NCPC campaign features television, radio, print, outdoor and online PSAs that call on firearms owners to use safety devices such as trigger locks, as well as to store ammunition in a separate locked container. A “Snapguide” illustrates options for properly storing a firearm in a household, and the website also offers resources to help firearm owners talk with their children about firearm safety.

The American Academy of Pediatrics (AAP), in partnership with the Brady Center to Prevent Gun Violence, is also making a beginning-of-summer push as part of its ongoing ASK campaign—“Asking Saves Kids”—to remind parents to ask whether there is an unlocked, loaded gun in a home before a child goes on a play date. A response of “yes” should be followed with questions about where the gun is and whether the children will be supervised. Concerned parents should then not be afraid to suggest the children play somewhere else, such as a playground or another home without a gun.

What do the needs of children in early childhood and improving community health have to do with each other? Everything, according to a group of panelists who addressed the Robert Wood Johnson Foundation (RWJF) Commission to Build a Healthier America at a public meeting in Washington, D.C. yesterday.   

Early childhood education and other interventions early in life, particularly for low-income children, can set kids on a path to better jobs, increased income and less toxic stressors such as violence and food insecurity, according to testimony at the today’s meeting. And that in turn creates more stable and healthier communities. Those two issues are the focus of the Commission, which plans to release actionable recommendations in September.

Yesterday’s event marks the first time the Commission is reconvening since it issued recommendations for improving health for all Americans in 2009. It will be co-chaired again by Mark McClellan, MD, PhD, director of the Engelberg Center for Health Care Reform at The Brookings Institution and former Administrator of the Centers for Medicare & Medicaid Services, and Alice M. Rivlin, PhD, senior economist at The Brookings Institution and former director of the Office of Management and Budget.

“Although we have seen progress since the Commission issued its recommendations in 2009, we still have a long way to go before America achieves its full health potential,” said RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA at the Commission’s  public meeting in Washington. “We know what works: giving children a healthy start with quality child care and early childhood development programs, and building healthy communities where everyone has an opportunity to make healthy choices. That is why RWJF is reconvening the Commission, to concentrate on these two critical areas.”

How can we put a stop to violence? Gary Slutkin, MD, believes the key is treating it as we would any contagious disease. The epidemiologist and Founder/Executive Director of Cure Violence recently spoke at TEDMED 2013 about utilizing public health and science-based strategies to prevent violence in communities.

“The greatest predictor of a case of violence is a preceding case of violence,” said Slutkin.

And as with an epidemic such as cholera, the way to stop violence is to find those “first cases” and interrupt the transmission. Cure Violence’s model involves violence interrupters who play a similar role as health workers during epidemics, going into communities to help re-frame issues and cool down situations that could lead to violence. At the same time, outreach workers help people change their behavior and—in time—change the social norms of a community.

>> Watch the full TEDMED presentation.

>>Read more about the public health approach to public safety from Cure Violence.

This commentary originally appeared on the RWJF New Public Health blog.

Crime and violence in U.S. inner cities has a profound impact on public health. The question is how best to combat it. According to recent studies, one answer could be as simple as assigning more police officers to foot patrols in crime hotspots.

With funding in part from the Robert Wood Johnson Foundation’s Public Health Law Research program, researchers from Temple University worked with the Philadelphia Police Department to conduct a study on the impact of police foot patrols on inner city crime. Findings published in Criminology in 2011 found foot patrols helped reduce violent crime — at least temporarily — by 23 percent in high-crime areas of the city. A recent follow-up study in Policing and Society revealed a qualitative look at how the participating officers developed extensive local knowledge and formed community relationships — both of which contributed to the cuts in crime.

These and other results demonstrate the need to involve officers on foot patrol in the development of violence prevention strategies, according to researchers.

>> Read more about the study.

This commentary originally appeared on the RWJF New Public Health blog.

Shortly after the shooting of 20 children and six adults in Newtown, Ct., a large group of Hollywood stars released a video asking viewers to “demand a plan” on action to be taken to prevent future mass shootings.  Since then several videos have popped up on YouTube that show almost all of the actors in the video wielding weapons in films and television shows.

Another video also demands a plan on gun violence, with a compelling set of spokespeople. This one stars and was developed with minority teens in California and produced by the California Endowment, a private health foundation. At last check, the teens’ video had gotten close to 750,000 hits on YouTube.

NewPublicHealth spoke with Barbara Raymond, director of youth opportunity at the California Endowment about how the video came to be and what the next steps are for taking action on gun violence.

NewPublicHealth: How did this video come to be?

Barbara Raymond: The Endowment looks at health very broadly, including things that happen in our schools and happen in our neighborhoods. We started work a couple of years ago in 14 communities across California, and through the process we’ve worked with  over 20,000 residents and they came back so strongly saying safety and my own health prevention are our number one issues. And they drilled down further to issues including school safety and school climate and the epidemic of suspensions and extreme school discipline policies.  

We have been able to engage a whole set of young people and they have really identified these issues as well. It’s especially the young people saying that working on these issues is urgent, including violence in the community and on the streets of our neighborhoods, fixing issues in our schools and what the kids call the school-to-prison pipeline. These issues have just come up so strongly so when the Newtown tragedy happened, young people wanted to say something and react to that.  

As staff, we talked about how the tragedy would open up a whole public conversation around mental health and school safety practices and staff members suggested we reach out to the kids with the video idea.  

NPH: How were the kids involved in the development of the video?

Last week at the American Public Health Association (APHA) annual meeting, a number of presenters took on an important, but often overlooked topic in the public health world: violence. Violence is often primarily considered a criminal justice or public safety issue, but there is a growing movement of public health practitioners that recognize that the health of vulnerable communities cannot be improved without first stopping shootings and killings.

When violence is present in a community, it impacts the physical, mental and emotional health of all residents. Violence also often prevents other positive changes from taking place. According to Greta Massetti from the Centers for Disease Control and Prevention, the current economic impact of youth violence is an estimated $14.1 billion in combined costs from medical care and work loss.

During the APHA meeting, speakers from organizations such as Cure Violence, UNITY and the Centers for Disease Control and Prevention discussed the latest research and strategies to prevent disease.

Treating violence as a disease

For many vulnerable communities, violence is the most pressing health issue. For children growing up in violent communities, the health impact is more than just the physical threat. As Benita Tsao from Urban Networks to Increase Thriving Youth (UNITY) pointed out, growing up in a community plagued by violence can often feel like being in a war zone.  That constant fear results in real health consequences, as evidenced by the increasing number of children who have grown up surrounded by violence and are now showing signs of chronic traumatic stress disorder. Experiencing ongoing trauma impacts young people’s physical, mental and emotional development, and has the ripple effect of making it harder to focus and succeed in school. 

>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.

Sheila Regan manages hospital partnerships for Cure Violence, formerly CeaseFire, an organization based in Chicago that has pioneered a public health approach to stopping shootings and killings. A grantee of the Robert Wood Johnson Foundation, Cure Violence has been successful at reducing violence in cities across America.

This week at APHA, Cure Violence shared how violence presents all the same characteristics of an infectious disease. Like tuberculosis or cholera, violence appears in clusters; it spreads and can be transmitted. By changing the frame on violence, Cure Violence is able to use proven public health strategies from other epidemics to stop shootings and killings. Hospital partnerships are a key part in stopping the spread and transmission of violence.

NewPublicHealth: Can you explain how Cure Violence’s hospital partnerships work?

Sheila Regan: We have a number of partnerships with level I trauma centers that are committed to the public health approach to violence prevention. We serve patients who are violently injured, typically shootings, stabbings or beatings and work to prevent further violence, retaliation or re-injury, which are seen as normal in our culture. There are the doctors, police, nurses, social workers, and everybody you’d expect to see in the hospital. What we’re trying to do is introduce a third party—our workers—who can impact behavior and mindset around violence at an opportune moment.

NPH: When someone has been injured, what is the goal of Cure Violence working with them in the hospital?

Much attention has been paid on NewPublicHealth and elsewhere to the connection between education, health, economic opportunity, and even life expectancy. Sadly, when we consider the health and life trajectories for our young men of color in this country, it’s clear that we have a lot of work to do. Boys and young men of color are more likely to grow up in poverty, live in unsafe neighborhoods and attend schools that lack the basic resources and supports that kids need in order to thrive. In addition, actions that might be treated as youthful indiscretions by other young men often are judged more severely and result in harsher punishments that have lasting consequences. Only about half of African American, Hispanic and Native American boys graduate from high school on time with their cohort. Down the road, pathways to stable, productive employment can be limited – they commonly lack access to career and positive mentorship connections. And disparities in their access to and quality of health care services persist.

RWJF Program Officer Maisha Simmons attests that the options for our young men of color have been too limited for too long. That’s why today the Robert Wood Johnson Foundation (RWJF), through its Vulnerable Populations portfolio, launched the Forward Promise initiative to strengthen education opportunities, pathways to employment and health outcomes for boys and young men of color. A new Call for Proposals released by the initiative today will focus on the following areas:

• alternative approaches to harsh school discipline that do not push students out of school;
• solutions that focus on dropout prevention and increasing school graduation rates;
• mental health interventions that tailor approaches to boys and young men who have experienced and/or been exposed to violence and trauma; and
• career training programs that blend workforce and education emphases to ensure that students are college- and career-ready.

NewPublicHealth caught up with Maisha about the challenges facing young men of color and the quest for collaborative solutions.

NewPublicHealth: Paint us a picture of the health and quality of life of young men of color. What are some of the causes of the disparities that persist?

Maisha Simmons: If you look at the statistics around men of color, specifically African American men, they usually die sicker and younger than any other population in this country. There are a lot of variables, but what we’ve begun to focus on is, what are some of the non-traditional, non-medical factors that go into that?

So for us, we began to really focus on education, workforce and mental health issues and how they coincide with opportunities for health. When you look at young men and boys of color, their school outcomes are often worse. There are large number of young men not finishing school  and they often don’t finish high school with their cohorts. We know the linkages between school and employment often have a collective impact on health outcomes.

NPH:  What are some other experiences that influence the health and quality of life of young men of color?

>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.

The Robert Wood Johnson Foundation and Cure Violence (formerly called CeaseFire), a program that takes a unique public health approach to stopping gun violence in communities, hosted a screening of the award-winning documentary, The Interrupters, in Los Angeles at the 2012 Annual Meeting of the National Association of County and City Health Officials. The screening featured a discussion panel including Ricardo “Cobe” Williams, one of the movie’s lead characters and Cure Violence violence interrupter and national trainer; Sheila Regan, director of hospital partnerships for Cure Violence; and Commissioner Oxiris Barbot of the Baltimore City Health Department, where the Cure Violence model was replicated and found to statistically lower either homicides or nonfatal shootings or both in all four of the historically violent neighborhoods in which it worked. Violence interrupters and outreach workers succeeded at cutting homicides by more than half in the Cherry Hill neighborhood.

Cure Violence pursues a singular, relentless focus on stopping shootings and killings. Maintaining that violence spreads fundamentally like a disease, and that it is possible to interrupt the transmission of violence much like a disease by changing the behaviors and norms that drive violent acts, Cure VIolence employs former gang members and ex-offenders who have the unique credibility with community members to effectively get people to rethink the impulse to resolve disputes using guns.

The program, begun in Chicago in 2000 by epidemiologist Dr. Gary Slutkin and funded in part by RWJF, has spread to other cities where violence is an acute health problem, including Baltimore, Md., Crown Heights, N.Y., Kansas City, Mo., and New Orleans, La. At the recent U.S. Conference of Mayors annual meeting, New Orleans Mayor Mitchell Landrieu stated, Violence is a deeply rooted problem that can only be dealt with as a public health epidemic. The Cure Violence model is built on an idea that is exactly right. It is one of many tools that we have to use to get to the problem.”

The Interrupters tells the story of three Cure Violence Chicago “violence interrupters” who work to protect communities from the violence in which they themselves once were involved.

NewPublicHealth caught up with Williams before the Los Angeles conference to ask about his experience as a violence interrupter for Cure Violence. “Before you do anything to intervene, you have to build relationships. That’s when community members open up to you,” says Williams, who at age 11 lost his own father to homicide. “We’re trying to stop people from retaliation, which is often the mindset they grew up with; it’s the mindset I grew up with,” Williams says.

Williams says it’s his job to “mediate the conflict, to put out the fire—to change their mindset and their thinking.” By establishing trust in the community, says Williams, “people will call me when they see a problem going on and I’m able to talk to people on both sides to work it out without shooting and killing. Once you build those relationships, it’s the fathers, the grandmothers, the brothers who start calling us to help work it out,” Williams says.

While Chicago has seen a dramatic increase in homicides this year over last year, Williams says many of those killings have not been in the communities where Cure Violence operates.

The message is simple, even if the work isn’t, says Williams: Violence is not acceptable, and to achieve new social norms that don’t accept violence as a commonplace, tolerable means of behavior, it’s important for everyone to get involved and build the community. “I grew up in a community where if I’m mad at you, all my friends are mad at you. That’s how I was raised. I lost a lot of friends to shootings. I wanted to be part of the solution.”

>>Bonus Link: Read a NewPublicHealth interview with Cure Violence founder Gary Slutkin.

This commentary originally appeared on the RWJF New Public Health blog.