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Community Violence as a Population Health Issue: Proceedings of a Workshop (2017)

Chapter: 3 Changing Landscapes of Violence Through Social and Physical Interventions

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Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
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3

Changing Landscapes of Violence Through Social and Physical Interventions

The workshop’s first panel session began with moderator Therese S. Richmond, the Andrea B. Laporte Professor of Nursing and associate dean for research and innovation at the University of Pennsylvania School of Nursing, describing four take-home points from the research she and her team have conducted on the strategies young people and adults use to stay safe in their communities. Howard Pinderhughes, associate professor and chair of social and behavioral sciences at the University of California, San Francisco, School of Nursing, then presented a framework he has developed with colleagues at the Prevention Institute on community trauma and resilience, and Charles Branas, professor of epidemiology and director of the Penn Injury Science Center and the Urban Health Lab at the University of Pennsylvania, discussed an evidence-based solution to firearm violence. Richmond moderated an open discussion following the presentations. Highlights and main points made by individual speakers are in Box 3-1.

STAYING SAFE IN THE COMMUNITY1

To set the context for the two subsequent presentations, Therese Richmond presented four briefs she prepared from the research she and

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1 This section is the rapporteurs’ synopsis of the presentation made by Therese S. Richmond, the Andrea B. Laporte Professor of Nursing and associate dean for research and innovation at the University of Pennsylvania School of Nursing. The statements have

Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×

her colleagues have conducted on community violence. The first came from a study in West Philadelphia examining the impact of exposure to community violence on 10- to 16-year-old children (McDonald et al., 2011). Some 95 percent of the study participants had heard about violence in their community, 87 percent had directly witnessed violent events, and 54 percent had been victimized directly. Of the latter group, one-third had been victimized two or more times. “The impact of community violence on this group of youth, from impoverished and violent communities and communities of color, was substantial,” said Richmond.

The second snapshot illustrated the constant vigilance young people in violent communities maintain to cope with the stress of living in such communities (Teitelman et al., 2010). These youths, said Richmond,

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not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×

display a finely tuned and highly nuanced understanding of the risks they face in navigating their environments. While on the one hand such vigilance is not only warranted but a desirable behavior, this constant vigilance carriers a burden from an allostatic load associated with chronic stress, which Richmond explained is known to contribute significantly to increased morbidity and mortality. Indeed, she said, life expectancy for African American men and women in these communities is less than 70 years of age.

The third snapshot comes from work with long-time community partners to find out how children and parents in violent neighborhoods navigate their environments (Jacoby et al., 2016). She and her colleagues interviewed dyads of parents and children who had previously been homeless or had unstable housing and were now living in ACHIEVEability, a subsidized housing plus nonprofit in Philadelphia. This mapping exercise revealed that parents rarely permitted these 10- to 17-year-old children to leave their own homes, particularly in the summer when school was out of session, a finding Richmond called highly disturbing. Parents prioritized the safety of their children over the potential physical and mental ramifications of social isolation and inactivity (Jacoby et al., 2016). “They were not navigating their environments, so think about the health consequences of living in environments where violence is pervasive,” said Richmond.

The final snapshot Richmond shared, one she said was highly relevant to why it is important to change landscapes from a social and physical perspective, looked at the effect of microneighborhood conditions on adult educational attainment because education is considered a path out of poverty. This study, again conducted with colleagues at ACHIEVEability, looked at how adults living in 130 housing units spread across a 2.1-mile radius in West Philadelphia progressed toward finishing their general educational development degree, their associate degree, and finally a bachelor’s degree, all requirements for living in ACHIEVEability. These adults and their children were assigned to whatever housing unit was available at the time they entered the program (thus, quasi-random assignment), and those who lived on low-crime blocks accrued higher education credits more rapidly compared to those who lived on moderate- and high-crime blocks (Tach et al., 2016). What these results show, said Richmond, is that it is possible to change lives one block at a time.

Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
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A FRAMEWORK FOR COMMUNITY TRAUMA2

“I think everyone can agree that we have a number of traumatized communities across the country, particularly in our inner cities, but even in our rural neighborhoods,” said Howard Pinderhughes as an introduction to his presentation about community-level approaches to healing traumatized communities. His first experience with violence in his childhood neighborhood in Roxbury, Massachusetts, occurred at age 8, when his 6-year-old neighbor’s body was found in a green plastic bag sitting under the mailbox across the street from Pinderhughes’s house. He was reminded of his childhood exposure to violence by a more recent incident, a gang-related shooting in 2011 that claimed an infant in West Oakland, California. Working in the community at the time, Pinderhughes observed that people who did not even know this child were impacted tremendously and were in despair. “It hit home to me that community trauma goes beyond the individual person who is traumatized, beyond even the people in the family who are impacted, so we have to think about it in much wider terms,” said Pinderhughes.

Dealing with violence is not a new phenomenon for communities, said Pinderhughes. As a result, young people have been going to too many funerals and dealing for too long with the daily reality of the possibility and potential to be victims of violence. “What I have seen with the young people that I have been working with is that it has become so normalized we have a whole cottage industry that has grown up around dealing with loss,” said Pinderhughes. Within hours of a violence claiming a life, T-shirts come out and shrines go up, he noted, and communities begin trying to process their loss.

Today, he said, there is a growing understanding of the impact of what are called adverse childhood experiences (ACEs).3 The importance of ACEs was first elucidated by a joint Kaiser Permanente–Centers for Disease Control and Prevention (CDC) study of more than 17,000 Kaiser members in Southern California (Felitti et al., 1998). Conducted between 1995 and 1997, this study found that adults, largely white and middle class, who had four or more adverse childhood experiences from a list of nine were more likely to have chronic disease and suffer from a mental illness. With the young people he works with, the question Pinderhughes asks is what happens when children experience all nine of these adverse

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2 This section is the rapporteurs’ synopsis of the presentation made by Howard Pinderhughes, associate professor and chair of social and behavioral sciences at the University of California, San Francisco, School of Nursing. The statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

3 For more information, see https://www.cdc.gov/violenceprevention/acestudy (accessed September 15, 2016).

Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×

experiences on a daily basis, and this led him to develop the concept of synergistic trauma.

Synergistic trauma, he explained, is the combination of individual trauma from exposures to violence and the trauma from structural violence. Structural violence refers to the harm individuals, families, and communities experience from the economic and social structure, social institutions, and relations of power, privilege, and inequity that may harm people and communities by preventing them from getting their basic needs met. The concept of synergistic trauma also integrates the concept of complex posttraumatic stress disorder, which he said is a psychological injury resulting from protracted exposure to prolonged social and interpersonal trauma in the context of either captivity or entrapment.

Although people can experience police departments as a social institution that can potentially inflect harm, they are not the only community institution in the most impacted communities that induce trauma rather than serving as foundations and developers of resilience, said Pinderhughes. Other institutions, he added, such as schools, the foster care system, and the juvenile and criminal justice systems, may also perpetuate harm. “We have all of these systems that we move our young people through as they are traumatized and what do we do? We place them in contexts that further traumatize them,” said Pinderhughes. An economy and employment structure that often excludes members of the community represents another contributor to structural violence.

Pinderhughes said that the United States mass produces violence, and various root causes, environmental factors, and individual-level factors contribute to the production of violence. Most of the nation’s analysis, policies, and attention, he said, are focused on the individual level, and such attention is warranted. “Part of what we have come to understand over the past 15 years is the profound impact trauma has at the individual level in terms of people’s psychosocial state, their emotional state, and the motivations that they used for the behavior, particularly violent behaviors that they engage in,” said Pinderhughes. Trauma, he explained, alters, shapes, and impacts the ways in which these factors affect the individual, as does structural violence and community trauma. Community trauma, said Pinderhughes, is not merely the aggregate of individuals in a neighborhood who have experienced trauma from exposure to violence. Rather, there are symptoms of community trauma that come from cumulative and synergistic impacts of regular experiences of interpersonal violence, of historical and intergenerational violence, and of the continual exposure to structural violence.

The framework Pinderhughes developed in collaboration with the Prevention Institute was constructed using the Prevention Institute’s

Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×

Thrive tool,4 which looks at three domains of a healthy community: equitable economic and educational opportunity, the physical built environment, and the social and cultural environment (Pinderhughes et al., 2015). The symptoms of community trauma occur when the community no longer functions as the fabric and foundation of resilience for young people and families exposed to both interpersonal and structural violence. Instead, the community becomes a place that helps to produce violence rather than protecting its residents from the impacts of violence. Housing projects, which become deteriorated, unhealthy places with dangerous public spaces and crumbling built environments approximating prisons, are an example of a community with none of the domains of a healthy community. Intergenerational poverty, long-term unemployment, fleeing businesses, limited local employment opportunities, and government and private disinvestment also contribute to community trauma.

Dislocation and gentrification are more recent additional elements of structural violence. “The minute we are successful in helping to transform communities, folks are dislodged and moved out,” said Pinderhughes. As a result, people from these recovering communities relocate to new areas where they have the same set of problems, but with fewer services. In addition, gentrification and dislocation damage the social and cultural environments in which these individuals and families live, destroying their social networks and social support infrastructure. What follows, he said, is a low sense of collective political and social efficacy, and the elevation of destructive norms that promote violence and unhealthy behaviors instead of affirming community-oriented positive social norms. Examples include the thug and pimp cultures that develop among high schoolers in violent communities. Pinderhughes asked several questions, such as Where do the behavioral norms come from? How do we reverse them? “What happens when young people grow up in neighborhoods that are constructed as killing zones and they understand that that is their environment and that is their future?”

While research has shown that adversity can be a positive in someone’s life because it helps develop coping mechanisms and strength, adversity becomes a problem when it is overwhelming and there is no foundation of resilience to overcome it. “When we talk about my neighborhood killing me, we usually talk about environmental toxins, but we are also talking about economic, social, and cultural toxins that exist in communities as a result of structural violence imposed from the outside,” said Pinderhughes. One solution, then, is to build resilience into

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4 For more information on the Prevention Institute’s Thrive tool, see https://www.preventioninstitute.org/tools/thrive-tool-health-resilience-vulnerable-environments (accessed September 15, 2016).

Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×

a community by creating safer public spaces through improvements in built environments, addressing housing quality and transportation, and reclaiming public spaces. This is not difficult, said Pinderhughes, but it needs the political, social, and economic will to help communities to transform their built environments in a way that strengthens their communities and allows them to sustain themselves rather than be dislocated.

Pinderhughes then described several examples of programs he believes illustrate different ways of building safer communities. San Francisco’s BRIDGE affordable housing program has a trauma-informed community building component as part of its housing replacement initiative to help people stay in their rebuilt communities and thrive in healthy environments (Weinstein et al., 2014). The Taking Back Public Spaces program in New Orleans, Louisiana, and the Family Place Library in Chester, Pennsylvania, are two programs aiming to transform communities by rebuilding the social and educational structures that can support healthy family development. The Pine Ridge Reservation Stronghold Community is creating spaces such as skate parks and community gardens to serve as positive environments that meet the desires of the community and reflect Native American principles.

The people who provide these programs are attempting to establish foundations of equitable opportunity, restorative justice, healing circles, and economic empowerment to increase community wealth and resources that can resist the economic pressures that result from dislocation and gentrification, said Pinderhughes. Restorative justice, he explained, is an important model that helps change the way communities and individuals deal with conflict. In the best case scenario, restorative justice is intergenerational and reconnects people in a way that helps them understand the cost of crime and violence not just to an individual perspective, but to the whole community.

Another program he described is Roots of Success,5 a national prison-based environmental literacy and work readiness curriculum that connects felons with the employment structure and green jobs in their communities. The YouthBuild6 programs across the nation aim to rebuild communities by teaching construction skills to young people while rebuilding and revitalizing intergenerational social relationships.

As a final comment, Pinderhughes noted that social networks and infrastructures of social support, including culturally relevant mental health approaches, can strengthen and elevate social norms, promote healthy behaviors, and establish collaborations that promote healthy communities. Shifting and changing social norms, he said, means changing the

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5 For more information, see https://rootsofsuccess.org (accessed September 15, 2016).

6 For more information, see https://www.youthbuild.org (accessed September 15, 2016).

Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×

narrative in violent communities by incorporating young people in the process of policy making, an approach being taken by the Teens in Action program in Louisville, Kentucky. He recommended that everyone should attend a Spoken Word event, which he called an incredibly powerful experience that illustrates how young people need to be incorporated into the process of changing the narrative on social norms in the community.

CHANGING BLIGHTED URBAN ENVIRONMENTS TO STOP GUN VIOLENCE7

“It has been said that the federal government has all the money, the states have all the power, but our cities have been left with all the problems,” said Charles Branas as a preface to his remarks. The upside to that situation, as pointed out by Bruce Katz and Jennifer Bradley in their book The Metropolitan Revolution (2013), is that cities have been forced to innovate and develop new, homegrown ideas to deal with many problems, including firearm violence.

One such solution is to transform blighted and abandoned urban spaces as a strategy to provide opportunities for positive change and reduce violence. As an analogy, Branas drew on a model common in battling vector-borne infectious diseases. This model holds, for example, that if a brackish tidal pool is breeding mosquitos, filling in that pool is more likely to continue reducing the incidence of malaria long after funding ends than would expecting community members to continue regular applications of larvicide (Branas, 2010; Card, 2012). For urban firearm violence, the longer term solution would focus on remediating blighted urban environments, he explained, instead of focusing solely on victims, individuals responsible for gun violence, and weapons. Addressing blighted spaces as a solution to firearm violence is also supported by the public health impact pyramid framework offered by CDC Director Thomas Frieden (Frieden, 2010).8 According to this framework, changing places would be a default contextual intervention that would have a larger and longer term impact on gun violence than most other approaches and would also contribute to tackling socioeconomic factors that are the greatest opportunities for high-impact changes to health problems like gun violence. “If you can positively affect a place, the thing people see every day on their way to work, school, or play, you might do it in a way that

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7 This section is the rapporteurs’ synopsis of the presentation made by Charles Branas, professor of epidemiology and director of the Penn Injury Science Center and the Urban Health Lab at the University of Pennsylvania. The statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

8 To view a figure of the framework, see http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2009.185652 (accessed September 14, 2016).

Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×

helps people and makes things better without asking them to do anything,” said Branas. CDC is promoting this idea, he added, in its approach of making the healthy choice the easy choice, and it goes along with the concept that the less you ask of the people who would benefit from a program, the greater the probability of success of that program. For example, mandating that cars have airbags and changing roadways to make them safer has likely had a far more lasting and high-impact effect on reducing automobile mortality and morbidity than driver education programs.

Before discussing specific programs, Branas asked for practitioners in the field to think more about conducting randomized controlled trials and carefully designed quasi-experimental studies to learn what works. He noted that the Office of Management and Budget (OMB) issued a notice in 2013 encouraging agencies to support experimental and quasi-experimental approaches capable of distinguishing strong from weak evidence and measuring cost-effectiveness. In one example of such an approach, researchers in the Netherlands purposefully altered urban environments and observed how people in disordered neighborhoods behaved (Keizer et al., 2008). Not only did the presence of graffiti increase the amount of graffiti in the experimental neighborhoods, but it also increased the amount of littering and level of incivility in those neighborhoods.

A much larger study, called Moving to Opportunity, billed itself as a bold housing relocation experiment (Ludwig et al., 2011, 2012; Sciandra et al., 2013). This three-arm, five-city randomized trial of thousands of participants sponsored by the U.S. Department of Housing and Urban Development provided members of an experimental group with housing vouchers to move out of poverty. A comparison group of individuals were given housing vouchers to move anywhere, and a control group did not receive vouchers. “This was a landmark scientific work showing the impact of place,” said Branas. The study found that the experimental and comparison groups scored higher on measures of physical health, mental health, and subjective well-being. However, Branas questioned whether it was wise to formulate policy that moves people rather than fixes the places where they already live given the expense of doing so and ethical considerations along the lines of what Pinderhughes noted when he addressed the effects of dislocation and gentrification.

A more sustainable, scalable, and well-accepted approach in communities, said Branas, involves in situ, place-based interventions. These in situ changes to places are local and conducted on a block-by-block basis right where people live. They do not involve building parks or other large public places, but rather making basic structural changes that are inexpensive, can be infused near homes and residents in the neighborhoods that most need them, and thus can be scaled throughout a city. For more

Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×

than a decade, Philadelphia, for example, has been converting thousands of abandoned and blighted lots into green spaces at very low costs. These conversions take about a week to complete at about $1.25 per square foot, with maintenance costs of approximately $0.05 per square foot in each following year. Philadelphia has also been remediating abandoned buildings by simply cleaning graffiti and replacing their doors and windows at similarly low costs. Imagine, he said, how people living on these blocks feel when multiple green spaces for recreation suddenly appear, and boarded up houses disappear, on the block where they live. These changes affect how people interact with their local environments and, in essence, how they feel about themselves, said Branas.

Indeed, when Branas and his colleagues conducted a citywide study of 5,112 blighted properties—676 abandoned buildings and 4,436 vacant lots—that were fixed and compared to unfixed matched controls separated by at least one-quarter mile, they found an 8 percent drop in gun violence in the blocks with vacant lots that have been greened over the 3.5-year study (Branas et al., 2011). An economic analysis found that every dollar invested in the program returned $26 to taxpayers. Abandoned building remediation produced a larger 39 percent drop in gun violence with a return of $5 for every dollar invested (Kondo et al., 2015b). Based on these data, Branas believes these are promising approaches to reducing gun violence in cities. A study in Youngstown, Ohio, produced similar results (Kondo et al., 2015a).

Today, Branas and his colleagues are working with multiple cities to replicate both the vacant lot treatment and abandoned building remediation while at the same time conducting a multiple city–wide randomized controlled trial supported by the National Institutes of Health (NIH) to demonstrate the effectiveness of these approaches. In one study involving vacant lots, he and his collaborators fit people with heart rate monitors and GPS units and had them walk by newly greened lots and unremediated vacant lots. They found a biologically significant drop in heart rate when people walked by the newly greened lots, said Branas. Anecdotal evidence from interviews with community members also supports the efficacy of this approach, with multiple community members reporting that they avoid vacant lots and even take different routes to school or work to avoid interacting with abandoned spaces that they perceive as threatening. Blight remediation has also been shown to reduce self-reported levels of stress, although this is some of the first evidence that blight remediation may reduce biologic markers of stress (Branas et al., 2011; Garvin et al., 2012; South et al., 2015).

Blight remediation, said Branas, also can significantly reduce depression and serious mental illness, sedentary behavior, nuisance crimes, and perceptions of high crime and vandalism while significantly increasing

Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×

911 calls as community members strive to maintain the benefits of having a nicer looking neighborhood. Once you change an environment and improve it, people become invested, and that changes many of the informal policing structures that residents themselves suddenly participate in to maintain their neighborhood, explained Branas.

One interesting finding has been that firearm violence is reduced by blight remediation strategies, but other types of violence is less affected, perhaps because blighted spaces can serve as “storage lockers” for illegal guns. Early evidence from a randomized controlled trial of vacant lot greening, said Branas, showed that the magnitude of these reductions in firearm violence was most pronounced in neighborhoods below the poverty line. His team is now launching an abandoned building trial in Philadelphia, and is working with local academic partners in Flint, Michigan; Youngstown and Columbus, Ohio; Norfolk, Virginia; New Orleans, Louisiana; and both Camden and Newark, New Jersey. He also noted that the federal government has taken an interest in this approach via its Healthy People 2020 program and via support from CDC and NIH.

DISCUSSION

Richmond asked Pinderhughes and Branas for ideas on how to prevent gentrification and dislocation from happening after a community has undergone improvement. Pinderhughes responded that the places that are more successful at avoiding displacement do not make changes without community participation and without giving communities, particularly young people, real decision-making power about how these programs are implemented in their neighborhoods. Pinderhughes suggested this inclusive approach whether it involves having community members build parks and create public gardens or formulate changes in policing policies. As an example, he mentioned that Oakland, California, has instituted a police body camera policy, formulated after conversations between young people and police officers, that focuses on day-to-day interactions rather than on catching misbehavior by police officers. The goal set by these two groups was to better understand those interactions and improve them in a way that would build relationships at the community level so that police officers would be seen as members of the community. Branas stressed the importance of being ever vigilant about gentrification and forced out-migration (a key metric of gentrification) of residents from newly rehabilitated neighborhoods. One approach is to involve local, minority-owned businesses in projects that will create jobs for residents within those neighborhoods. That has been a valuable way to produce something of additional tangible value to residents and directly incorporate neighborhood voices, said Branas.

Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×

Pinderhughes added two words: anchor institutions. “Every institution represented here should take their role seriously as an anchor institution and be able to supply wealth in underserved communities,” he said. Branas then asked those at the workshop from universities to be aware that many of their institutions have historically done the opposite of this. He also said that local governments need to craft policies that can try to stem gentrification, and he encouraged the workshop attendees to watch the documentary film The Vanishing City,9 which explores the reasons why gentrification has happened to such a large extent in New York City and other cities like San Francisco. Philadelphia, on the other hand, has enacted policies that reduce property taxes for long-term, multigenerational residents and other mechanisms as a means of stemming gentrification (Williams, 2014). That type of action, along with rent controls, can be important tools for maintaining the diversity and economically mixed nature of many city neighborhoods, which is part of the reason people choose to live in cities in the first place, said Branas.

Terry Allan from the Cuyahoga County (Ohio) Health Department wondered if there is an opportunity to understand potential synergistic effects of multiple interventions within neighborhoods and use the resulting data to plan and fund projects that combine physical and community-based interventions. Pinderhughes responded that funding and programming are so siloed that it becomes very difficult to take a more comprehensive approach at a policy level. “I have worked with cities across the country, and it is difficult to get true collaboration across agencies that share data, information, and processes,” said Pinderhughes. An additional challenge, he added, is selling at a political level the need for a longitudinal, long-term strategy. In a follow-up comment, Allan wondered if there were opportunities for key stakeholders and influencers to have an impact on the siloed funding by talking to funders and stressing the importance of integration.

Branas said he and his colleagues have worked with community groups in Youngstown, Ohio, to combine their efforts with city involvement in rehabilitating derelict spaces in the city. This effort, which he said was done with little funding, appears to have enhanced the reduction in gun violence, but further study is needed to fully understand that effect. Pinderhughes then added that HOPE SF, a project to transform San Francisco’s most distressed public housing sites into thriving

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9 For more information, see http://www.thevanishingcity.com (accessed September 15, 2016).

Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×

mixed-income communities, would be a good example of a project worth examining.10

Jeffrey Levi of The George Washington University noted that the OMB’s Office of Community Solutions is looking for opportunities to blend funding streams to make it easier to do these kinds of projects at the local level. He then offered the opinion that randomized controlled trials are not always the best methodology for use in these communities given the history of how such trials were designed unethically in the past. More importantly, he said, “The lack of funding for this kind of work over time means that if OMB wants us to wait until we have those evidence-based interventions, we are not going to be intervening in those communities for a really long time and I do not think we can afford to wait for that.” Pinderhughes responded that community members in the cities he has worked with have been eager participants in designing and running experimental trials and they are greatly interested in the results of those trials. He also said that philanthropy, not government, will need to provide funding for these kinds of trials. Branas remarked that prior to producing evidence that rehabilitating empty lots and abandoned buildings actually worked, Philadelphia had smaller blight reduction programs that would come and go in a single neighborhood of the city. Only now has the city begun institutionalizing these programs on a citywide basis, informed to a generous extent by scientific studies that have emerged in recent years. Branas also noted that natural and quasi-experiments that can be done quickly and for less money can also be of great value to policy makers and help institutionalize more of these programs.

Levi then remarked that Pinderhughes and Branas addressed community trauma at the neighborhood level and noted that within neighborhoods are communities of identity, such as the LGBTQ community in Orlando, Florida. He asked what actions can be taken to address trauma at the level of communities of identity. Pinderhughes replied that as these programs spread across communities, he is seeing more interactions that perhaps can address communities of identity that do not necessarily live in the same physical community. He again reiterated the need to involve young people in whatever programs are developed and enacted.

Kahaari Kenyatta of the University of Pennsylvania asked the panelists how broadly they conceive community to be and the potential for national traumatization given the frequency of mass violence that has

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10 Anne Griffith of Enterprise Community Partners gave a presentation to the roundtable on HOPE SF. For more information, see NASEM (2016a). A video of Griffith’s presentation at the June 4, 2015, workshop may also be viewed at http://www.nationalacademies.org/hmd/Activities/PublicHealth/PopulationHealthImprovementRT/2015-JUN-04/Videos/Panel%20III/17-Griffith-Video.aspx (accessed September 15, 2016).

Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×

occurred recently in this country. Pinderhughes replied that the nation is clearly traumatized, so the question becomes how to heal at the community level and then move to the societal level. “There has got to be some way in which we conceptualize the issue of healing as something we need to move through in common and incorporate into our cultural practice,” said Pinderhughes. He suggested that this needs to happen in schools. A second component is getting the American public to understand how traumatized it has become and to recognize this as a problem the nation needs to address.

Samara Ford, an undergraduate at Harvard College, asked how the nature of education in the nation’s schools and the ways in which students are taught or not taught about the environments in which they live interact with the bigger structural issues the speakers discussed. Branas provided one final anecdote as a response. Teachers in the Philadelphia School District are taking schoolchildren on walks through their neighborhoods and teaching them about the history of their neighborhoods and the changes that have occurred since their parents and grandparents grew up in those same neighborhoods. This program is educating children about the physical and historic contexts within which they live and asking them to think about their neighborhoods in new ways, which perhaps will instill an urge to protect and improve the places they see every day.

Pinderhughes reported that he was shocked to learn at a recent White House conference on school expulsions and suspensions that there are 10 states in which preschool children are expelled, a phenomenon that he believes is a result of the trauma these children are experiencing. “Trauma-informed pedagogy has to become part of what happens in education in inner cities and across the nation,” said Pinderhughes. Some of this country’s best community-based youth organizations are conducting reeducation around the dynamics of their communities, he said. The RYSE Center11 in Richmond, California, for example, has young people think about how their community has become the way it is as a strategy to help them understand some of the dynamics of structural violence and develop the tools and foundation to become advocates and activists in their community. These types of educational programs will be needed, said Pinderhughes, to unleash the power of the nation’s young people to promote change.

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11 For more information, see http://rysecenter.org (accessed September 15, 2016).

Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
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Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×
Page 18
Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×
Page 19
Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×
Page 20
Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×
Page 21
Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×
Page 22
Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×
Page 23
Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×
Page 24
Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×
Page 25
Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×
Page 26
Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×
Page 27
Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×
Page 28
Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×
Page 29
Suggested Citation:"3 Changing Landscapes of Violence Through Social and Physical Interventions." National Academies of Sciences, Engineering, and Medicine. 2017. Community Violence as a Population Health Issue: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23661.
×
Page 30
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On June 16, 2016, the Roundtable on Population Health Improvement held a workshop at the Lutheran Church of the Good Shepherd in Brooklyn, New York, to explore the influence of trauma and violence on communities. The workshop highlighted examples of community-based organizations using trauma-informed approaches to treat violence and build safe and healthy communities. Presentations showcased examples that can serve as models in different sectors and communities and shared lessons learned. This publication summarizes the presentation and discussion of the event.

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