Promote Equity Prevent Violence Karen Sheehan, MD, MPH Medical - - PowerPoint PPT Presentation

Promote Equity Prevent Violence

Karen Sheehan, MD, MPH Medical Director Lurie Children’s Healthy Communities

• I have nothing to disclose

Objectives

• Assess how the burden of violence in Chicago

disproportionately impacts youth of color

• Demonstrate the socioecological approach to youth violence

prevention

• Discuss how addressing health equity is a tool to prevent

violence

New York Times Chicago Sun-Times Chicago Tribune ABC News Chicago Tribune Chicago Tribune Chicago Tribune DNA Info

Chicago- Long History of Violence

Homicide Trend (1957-2017)

808

(2016)

682

(2017)

Homicide Trend (1957-2017)

808

(2016)

682

(2017)

More Information Than You Wanted To Know

Homicide Victims in Chicago, 2010-2017

Jens Ludwig Crime in Chicago: Beyond the Headlines University of Chicago 2018

As of October 9, 2018:

80 72 88 150 151 119 124 142 190 189 145 144 178 241 198 108 121 107 229 126 50 100 150 200 250

2013 2014 2015 2016 2017 Number of homicides Quarter 1 Quarter 2 Quarter 3 Quarter 4

Homicides in Chicago by quarter, 2013-2017

Illinois Violent Death Reporting System, Lurie Children’s IPRC, 2018

Illinois Violent Death Reporting System (IVDRS)

• Surveillance System funded by the CDC, IL joined in 2015
• Lurie Children’s is bona fide agent for State of Illinois
• Pools information about the “who, when, where, and how” of

violent deaths to provide a more complete picture and develop insight into “why” they occur

• Data sources: death certificates, coroner/medical examiner

reports, law enforcement

• IVDRS initial years 2005-2015 funded by philanthropy and

State of Illinois

• 10 year + dataset allows small area analysis

Homicides in Chicago, 2008-2017

529 475 459 468 534 450 457 514 810 681 100 200 300 400 500 600 700 800 900 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Year of Death

Illinois Violent Death Reporting System, Lurie Children’s IPRC, 2018

Homicide Rates, Chicago and Large Cities

Jens Ludwig Crime in Chicago: Beyond the Headlines University of Chicago 2018

Jens Ludwig Crime in Chicago: Beyond the Headlines University of Chicago 2018

Homicides by Weapon Type in Chicago Over Time

Illinois Violent Death Reporting System, Lurie Children’s IPRC, 2016

Homicide Victims by Race, 2015-2016

Gun Violence in Chicago, 2016 University of Chicago Crime Lab, 2017

Homicide Rates per 100,000 in Chicago over time, by race/ethnicity

Illinois Violent Death Reporting System, Lurie Children’s IPRC, 2016

Rate per 100,000 of homicides in Chicago which occur to black males aged 18 to 34, versus all others, 2008-2017

Illinois Violent Death Reporting System, Lurie Children’s IPRC, 2017

203.6 200.9 213.2 234.4 252.8 222.3 212.9 258.1 412.8 354.6 11.3 9.4 9.6 9.2 11.1 8.9 9.5 10.1 15.8 13.0 50 100 150 200 250 300 350 400 450

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Rate per 100,000 Black male, 18-34* All others

AGES OF HOMICIDE VICTIMS, 2015 VS. 2016 AGES OF HOMICIDE SUSPECTS, 2015 VS. 2016

Gun Violence in Chicago, 2016 University of Chicago Crime Lab, 2017

Locations of Gun Homicide and Shooting Incidents, 2015 vs. 2016

Gun Violence in Chicago, 2016 University of Chicago Crime Lab, 2017

Homicide Rates by Community Area

Illinois Violent Death Reporting System, Lurie Children’s IPRC, 2017

What Caused Chicago’s Homicide Increase?

• Fractured gang hierarchies
• High rates of neighborhood

poverty and segregation

• Influx of guns
• Demolition of public housing
• Insufficient penalties for illegal

gun-carrying

• Social media disputes
• Lack of resources to solve

serious crime

• CPD mis-management
• Changes in city and state

funding for social services

• Closing of mental health

services

• Weather
• Reduced police activity

Gun Violence in Chicago, 2016 University of Chicago Crime Lab, 2017

Data check in

• Between 2015 and 2016, Chicago saw a large increase

violence which

– Involved Guns – Involved African-American men – Involved mostly 20 to 30 year olds – Occurred in public – Focused on a handful of neighborhoods on Chicago’s South and West Sides – These neighborhoods have disproportionately affected by violence for at least a decade

• Between 2016 and 2017, Chicago saw a decrease in

violence

– Yea!-But why?

Public Health Approach to Violence Prevention

• Primary Prevention Orientation

– Efforts are focused on preventing violence before it occurs

• Data-driven

– Considers risk and resilience factors

• Collaborative

– Multi-sector approach

• Population-based

– Seeks community wide or “environmental” solutions

Factors Affecting the Frequency of Violent Events Incidence

• f Violence

Injury Outcomes Factors Affecting the Severity of Violent Incidents

KKC

Social-Ecologic Model: A Framework for Prevention

Individual and Family Community Public Policy

Individual and Family Public Policy Community

Individual and Family

Youth Development Programs

• Youth Violence is obviously a complicated

issue

• Many factors contribute to the incidence
• f youth violence
• Youth Development Programs are one

strategy of a multi-level intervention

Chicago Youth Programs

• Founded in 1984 by Northwestern

University Medical & Law Students

• Goal: to improve the health and life
• pportunities of at risk youth
• A once a year well child care visit was

not enough to improve the health of children

• To improve the health of children, it

was essential to get them out of

• poverty. For most, education was the

surest route

Cabrini Green

• ½ mile from NU’s Chicago

Campus

• Housing and Urban

Development

• 80 buildings
• ranging from 2-3 story row houses

to 19 story buildings

• Reputation for extreme poverty

& community violence

• CHA Plan for Transformation
• Last high rise torn down

2011

Improbable Beginnings

• Went to Cabrini Green;

invited kids to the NU campus

• For over ½ the kids, first

time to see Lake Michigan

• Any child was welcome
• No cost to participate
• No Conceptual Framework
• Right Thing to Do
• Trial and Error

The Early Years

• Saturday AM

– Tutoring – Computer Room – Basketball – Swimming

• 6-12 year olds
• 40 kids
• Medical & Law student

volunteers

• Modest Budget

By the late 1980’s

• Became clear that CGYP helped the volunteers more than

the kids – CGYP not suited for adolescents

• Pregnancy
• Gang Violence
• Asked the teens what should we do to keep them in?

– Teen specific activities – More responsibility/say in programming – Ability to make some money/learn skills

• Asked ourselves: who do we serve?

Exposure to Violence in a Cabrini Green Representative Sample of 7-13 yo Children

• 42% had seen someone shot
• 37% had seen someone stabbed
• 21% lived with a shooting victim
• 16% lived with a stabbing victim

Arch Ped Adol Med 1997

Chicago Tribune, 2016

Where Do CYP Children Feel Safe?

• Most children, but not all, felt

safe at home

• Most children did not feel safe

at school or in their communities

• The children felt the safest

when they were with caring adults

Arch Ped Adol Med, 2004

Early 1990’s: Teen Specific Programming

• Children Teaching Children
• Teens became positive role

models for younger children

• Provided teens ability to

make some money/learn skills

Partnership with Lurie Children’s-1993

• Clinic established
• 3 of the medical students from the

early years are on staff at Lurie Children’s and are on the CYP Board

• Partnership strengthened when 2

hospital leadership staff joined the CYP Board and chair key committees

• Identified as a key partner in the

hospital’s CHNA plan

CYP Clinic

• Medical student volunteers-
• in clinic and outside clinic
• Extensive Case

Management-Social Work, APN, Psychiatrist

• Triple P trained staff
• Second Generation children
• 2 populations served

Even the best doctor can’t improve the health of a child through a once year WCC visit alone—she needs to partner with

• thers outside the hospital walls.

CYP Model

• Evolved from a weekly mentoring

program

• Integrated, asset based,

comprehensive programs for youth, 0-21+ years

• Programs designed to address the

health, educational, recreational needs of youth

• Volunteer-led
• Students and corporate volunteers
• Donated space
• Free to participants
• Cabrini Green/Near North,

Washington Park, Uptown, North Lawndale

www.chicagoyouthprograms.org

Evaluation

• Individual Programs

– Children Teaching Children

• Process

– Retention

• Qualitative

– CYP “Graduates” – CYP “Drop-outs”

• Outcomes
• Minimizing Barriers
• Higher Education
• Long Term Follow Up Study

• Peer mentoring program
• Uses games, skits, and

music to teach health messages

• Used a case matched cohort

study to examine aggressive and violent behaviors

• Intervention group scores

maintained; control group worsened

Children Teaching Children

Pediatrics 1999

Program Participant Retention

10 20 30 40 50 60 70 80 90 100 1986 1991 1996 2001 2006 2011 2016

Attendance

Attendance

Qualitative Research

35 CYP “GRADUATES”

• Who, what, why, how did

you get to college?

• Family support critical (86%)

– 1/3 had a family member with some college education

• CYP helped them go on to

college (97%)

• Mentoring, tutoring, financial

support

25 CYP “DROP-OUTS”

• Why dropped-out? Any benefit?

Did CYP fail you?

• Even CYP participants who left the

program felt that they had benefited, particularly from help with school and opportunities for new experiences

• Half of the participants who dropped
• ut became involved in gangs or

selling drugs, primarily for financial reasons

• Identified need to have specific

programs for adolescent age-group with pay/ability to give back

• Many left for new opportunities

Kalish, Voigt, et al, HPP, 2010

Outcomes*

AVOIDING TEEN PREGNANCY AVOIDING DELINQUENCY

• 90% of CYP youth avoided

school dropout AND

• criminal conviction, gangs, and injury

while participating in drug/violent activities through 18 years of age

*Self-report

2 4 6 8 10 12 14 16 18 13-14 yo 15-17 yo 18-19 yo

% Giving Birth Per Year

1984-2015

n=1,011 CYP Females

Chicago AA Females CYP Females

Education Success

• High School Graduation Rate

3x/city rate

• Last 4 years, over 95% of HS

graduates have gone onto college and trade school

• Finishing college at higher

rates compared to national norms for under-represented minority students

“The CGYP gave us something to do that was positive. In Cabrini, often what people think is fun is a felony or is life-threatening to other people. But playing basketball, going out for pizza, going to a play—all that was a nice time and kept me off the streets as

• well. Those may seem like little things,

but, it’s had a major impact.”

H.V., 23yo, college student

Improved Health & Well-Being Poorer Health

Nurturing and Supportive Families Caring Adults Comprehensive, Asset Based Approach Long-Term Commitment

Long-term Impact of CGYP on Participant’s Health and Well-Being

Roehler D, Bhatti P, Yousuf S, Quinlan K, DiCara J, Sheehan K Data Collection in Progress

Improved Health & Well-Being Poorer Health

Nurturing and Supportive Families Caring Adults Comprehensive, Asset Based Approach Long-Term Commitment

Long-term Impact of CGYP on Participant’s Health and Well-Being

Roehler D, Bhatti P, Yousuf S, Quinlan K, DiCara J, Sheehan K Data Collection in Progress

Youth Development Programs are a Strategy to Prevent Violence

• Keeping kids in YDPs should be considered an outcome

measure, not just a process measure

• Need strategies to keep kids engaged
• Ability to make money and “give back” strongest

incentive

• Unclear if YDP can replace “good” parenting/family role

models

• Perhaps if can’t reach participants as kids, can reach

them as parents

• Need for long-term commitment from caring adults

Policy

Derrion Albert

Our CEO asked: “What is our role as a hospital in violence prevention?”

Created an Internal Committee

– Government Relations (lead) – Researchers – Social Work – Advocacy – Psychologist – Pediatricians – Pediatric Surgeons – Founders Board

Memorandum

DATE: February 1, 2010 TO: Patrick M. Magoon President and CEO FROM: Susan Hayes Gordon Chief Government and Community Relations Officers RE: Recommendations to Address School and Community Violence in Chicago “In response to your request to gather our best thinkers to discuss what we are doing now and what more we might do to address the problem violence affecting children and youth, this memo provides you with a summary of our efforts thus far.”

Community Listening Sessions

– Spring 2011 – Supported by Founders’ Board – Nonprofit, research, foundation, medical, policy sectors – Lots of good work, little coordination – Need to improve coordination and communication among

• rganizations

Strengthening Chicago’s Youth (SCY)

• A “collaborative”
• Convened by Lurie Children’s
• Build capacity among public

and private stakeholders to connect, collaborate and mobilize

• Focus on policy, systems and

environmental change, not service provision

• Catalyst for innovation

SCY Participants

• 130 individuals from 60
• rganizations at February

2012 kickoff meeting

• Current participation

– 4500+ individuals on mailing list – 1000+ individuals are “engaged” – Representing 300 “engaged” organizations – Community-based

• rganizations citywide (and

in suburbs)

Focus on Five

• Sustained investment in

children and youth

• Equitable access to high quality

mental health services

• Juvenile justice system that

reflects what we know about adolescent development

• Sustained investment in strong

communities

• Common sense approaches to

gun violence prevention

2018 Strategies

• Policy & Advocacy

– Advocate for SCY policy agenda – Support partners’ advocacy – Use data to inform policy

• Catalyst for Innovation

– Lead Juvenile Justice Collaborative – Incubate emerging ideas

• Sharing what works

– Hold trainings and quarterly meetings – Publish and amplify newsletter and social media – Support community-capacity building – Engage people outside of the most affected communities

• Community Connections to Data

– Disseminate Violence Research Agenda – Implement recommendations to support community engagement in violence research – Support community partners’ use of data

Policy and Advocacy

• Illinois Gun Violence Prevention Coalition

Catalyst for Innovation: Juvenile Justice Collaborative

SCY convenes youth service providers and government stakeholders in Cook County and

• versees the development and implementation of a

care coordination model for justice-involved youth

Central Intake: TASC Community Partners:

• Aunt Martha’s Youth Service Center
• BUILD, Inc.
• Heartland (Human Care Services)
• Lawrence Hall
• Maryville Academy
• New Life/Urban Life Skills
• SGA Youth & Family Services
• UCAN
• Youth Guidance
• Youth Outreach Services

In 2017, the JJC conducted 73 intakes and connected 58 youth to services through its provider network. As of June 2018, 51 youth from the original 2017 JJC cohort successfully completed their

• program. No youth connected to services was re-arrested during their

participation in the program.

Sharing What Works

• Monthly trainings
• August 14, 2018: CIRTification: Human Research Protections
• Quarterly meetings
• Sept 18, 2018: The Connection Between Housing and Violence

Prevention

• Biweekly newsletter, social media, website
• Participate in coalitions and attend events
• Support community organizations’ capacity building

Community Connections to Data

• NIH grant “Community-Academic Collaboration to Prevent

Violence in Chicago”

– Identify communities’ research priorities – Raise community awareness of violence-related data and prevention strategies – Develop a CBPR agenda for violence prevention in Chicago and establish a permanent infrastructure to facilitate CBPR projects

• Support community partners

– Facilitate connections with researchers – Training and TA

• Violence Data Landscape
• Partnership with Illinois Violent Death Reporting System

Community

“When it comes to health, your zip code

matters more than your genetic code”

Tony Iton, MD, JD

Child Opportunity Index

Educational lth and

68

COI is a composite measure of

• educational
• health and environmental
• social and economic factors

Social Determinants of Health

• Social, economic,

and environmental conditions into which people are born, live, work, and age

(World Health Organization)

SDOH

Health & Healthcare Social & Community Context Education Economic Stability

Source: Healthy People 2020

Neighborhood & Built Environment

Obesity Community Violence Child Maltreatment Substance Abuse

Obesity Community Violence Child Maltreatment Substance Abuse

Social Determinants of Health

Racism Segregation Education Opportunity Microaggression Employment Opportunity Built Environment Access

Moving Upstream

• Promote Health Equity through

Addressing the Social Determinants of Health

• Placed Based Interventions
• Hospitals as Anchor Institutions

– West Side United

• Build sustainability through

multi-sector collaborations

Lurie Children’s Healthy Communities

Lurie Children’s Healthy Communities

Public Health and Prevention Activities Policy and Advocacy Child Health Policy Initiative Capacity- Building Programs Clinical Programs and Partners (FQHCs, CIN) Community Relations Community Health Needs Assessment Smith Child Health Research, Outreach, & Advocacy Philanthropic Engagement

Lurie Children’s Healthy Communities

• Healthy Communities Goal:

– Increase health equity for children in Chicago

• Implement the CHNA Plan

– Social Determinants of Health – Access to Care – Asthma* – Child Maltreatment* – Complex Chronic Conditions* – Mental Health* – Obesity, Physical Activity and Nutrition – Violence Related Injury and Morbidity* *Decrease ED visits

Source: EPSi internal Lurie patient data; Qualified by: ED Level Charge Codes; Patient City: Chicago; Discharge Date: CY2016

Belmont Cragin Quality of Life Plan

• Created in 2015 by

community stakeholders through a collaborative process

• Priorities

– Affordable Housing – Business and Jobs – Education and Youth – Health and Older Adults

Source: Belmont Cragin Quality of Life Plan

Austin Quality of Life Plan

• Economic Development
• Public Safety
• Housing
• Education
• Youth
• Community Narrative
• Civic Engagement

Source: Austin Coming Together May 23, 2018 newsletter

Neighborhood Based Initiatives

• Parenting classes and integration of healthcare

practitioners with Metropolitan Family Services

• Center for Childhood Resilience

– Conducted training on building resilience in refugee/immigrant children and families at Portage-Cragin Branch of Chicago Public Libraries

• NWSHC Coordinated Parent University

– Topics include anti-bullying, trauma-informed practices, health literacy, and parenting support/child development

• Hired full-time Community Outreach Specialist
• ARCC Seed Grant for CBPR with NU faculty

member and NWSHC

• Cigna Fellow

– Starting in November to develop & pilot parenting support initiative in Belmont Cragin

• Exploring Healthcare Careers 2018 Internship

• Injury Prevention

– Playground build – Car seat classes and distribution with New Moms Program in Austin

• Early Childhood Symposium
• West Side United

– Belmont Cragin added as 10th community

• Various events with Community

Volunteer Corp

– Serv-a-thon with Chicago Cares at Steinmetz High School in Belmont Cragin – HopeFest in Belmont Cragin – Back-to-School Fair Picnic & Parade with

• Rep. Danny Davis in Austin

– Back-to-School & Gospel Fest with 37th Ward Ald. Emma Mitts in Austin – Back-to-School Celebration for Austin and Belmont Cragin communities at Michele Clark Academic Prep Magnet High School

Englewood

• Compared to the same

timeframe, shootings decreased from 441 in 2016 to 250 in 2017*

• Proposed reasons for decrease

– Whole Foods – Other community development – Engaged Community Members – Enhanced policing strategies

• Strategic Decision Support Centers
• Enhanced community policing

– State budget after 2 years *

Summary

• To decrease violence, we need

– Nurturing and Supportive Families – Caring Adults – Comprehensive, Asset Based Interventions – Long term Commitment – Enhancing collaboration between the clinic & community – Supportive Policies

• Access to Mental Health Services
• Common Sense Gun Safety Laws

– Going upstream to address the SDH – Work in partnership with communities – Equitable opportunity to reach one’s full potential