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

Chapter: 6 Public Health and Law Enforcement Collaborations

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Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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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6

Public Health and Law Enforcement Collaborations

The workshop’s final panel session featured three presentations focused on how police departments are tackling the problem of community violence by collaborating with public health professionals and incorporating public health models and practices into policing. Steve Marans, the Harris Professor and director of the National Center for Children Exposed to Violence/Childhood Violent Trauma Center at the Yale Child Study Center, and director of the trauma service and professor of psychiatry at Yale School of Medicine, spoke about efforts to translate clinical observations about childhood violent trauma into effective interventions. John Markovic, senior social science analyst in the Office of Community Oriented Policing Services (COPS) at the U.S. Justice Department (DOJ), presented an overview of programs supported by his office. Medina Henry, associate director of training and technical assistance at the Center for Court Innovation, then described a collaborative initiative between the U.S. Department of Health and Human Services’ Office of Minority Health and COPS aimed at preventing youth violence. An open discussion, moderated by Ted Corbin, associate professor in the department of emergency medicine at Drexel University School of Medicine, followed the three presentations. Highlights and main points made by individual speakers are in Box 6-1.

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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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TRANSLATING CLINICAL OBSERVATIONS INTO INTERVENTIONS FOR CHILDHOOD TRAUMA1

Steve Marans opened his presentation by saying that too often, human beings want quick fixes to disturbing problems. As a nation of creativity and innovations, there is often a desire to move quickly to scale interven-

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1 This section is the rapporteurs’ synopsis of the presentation made by Steve Marans, the Harris Professor and director of the National Center for Children Exposed to Violence/Childhood Violent Trauma Center at the Yale Child Study Center, and director of the trauma service and professor of psychiatry at the Yale School of Medicine, and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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.
×

tions without taking advantage of what has been learned along the way. An example, said Marans, is a failure to focus on trauma prevention.

The characteristics of trauma, he explained, are that it occurs when there is an overwhelming, unanticipated danger and feeling of helplessness that leaves an individual believing there is nothing to do to change, alter, or get away from the unanticipated event. In addition, there is an immobilization of the usual methods of defending oneself—the fight-or-flight response—and in fact, what usually happens in the acute moments of trauma is that an individual freezes. “We know that these experiences are undergirded and occur because of neurophysiologic dysregulation that compromises the way we are able to think, feel, and act,” said Marans. “It is an important consideration to remember that when we are talking about a traumatic experience, we are actually talking about the ways our brains are able to function. That has an enormous impact on how we feel and what we do in response.”

A clinical roadmap of trauma, said Marans, shows it occurs in phases: an acute phase lasting a few hours to a few days; the peritraumatic period lasting up to 3 months after the index event; and the chronic phase, characterized by the symptoms of PTSD and related disorders. Trauma can also have a delayed onset. The general symptoms of trauma are reexperiencing the index event, avoidance, and hyperarousal.

One lesson learned about trauma, said Marans, is that it is perhaps the most significant public health crisis the United States faces. This lesson, he said, is stressed in a report from the Attorney General’s Task Force for Children Exposed to Violence (Listenbee et al., 2012) and by many other organizations that have studied psychological trauma related to violence. In children in particular, trauma often goes unrecognized, and when left untreated, the aftereffects of trauma can lead to well-established adverse consequences. Marans emphasized this last statement because it ties back to his opening remarks about failing to follow through on lessons learned. “We fail too often to go far enough upstream,” said Marans. “We respond to the end-state result, which galvanizes and attracts our attention, but too often we are not going far enough upstream to think about prevention.” By prevention, he added, he was referring to treatments that can enable someone to recover from trauma and not suffer horrible outcomes that can include perpetuating violence.

The number of children who experience multiple types of potentially traumatic impacts and experiences is enormous, said Marans. The numbers are so large, he believes, that it leads the public to feel there is nothing that can be done to stop trauma from affecting children. The consequence of putting blinders on with regard to this problem is that it exacerbates one of the strongest risk factors for experiencing poor outcomes after trauma—the failure of caregivers or the broader community to recognize

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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.
×

the impact of trauma and provide social and familial support to the children who experience trauma.

The challenge to going upstream, as Marans put it, is to identify the children and families most impacted by potentially traumatic events. “How are non-mental health professionals, who actually respond to these situations, whether on the streets or in hospitals, schools, jails, or the criminal justice system, going to respond if they are not equipped [to identify trauma] and don’t have the right partners [to address trauma]?” asked Marans. He noted that research on trauma has led to the development of standardized tools for identifying the symptoms of trauma, training methods to teach non-mental health professionals how to use these tools correctly, and clinical strategies for getting the right treatments to those in need. The issue, said Marans, is how to take these to scale.

In 1991, Marans and his fellow clinicians at the Yale Child Study Center, who he said were steeped in the development of human behavior and the impact of trauma, realized that the majority of children and families affected by trauma were never going to come in for treatment. “We were never going to meet them, and often when we would, it would be so far down the road that the damage had been done,” said Marans. In response to this recognition, Marans and his colleagues reached out to the New Haven, Connecticut, police department, which he said was also frustrated with the 911-driven, post-incident response to violence that was not making a dent in the problem. The result was a collaboration that involved taking advantage of police authority and using it benignly to step in to help people, precisely at the time when they are not functioning optimally, and start them down the road to recovery.

Today, all police officers in New Haven and the other communities where this program has been implemented are trained on the intersection of child development, human functioning, trauma, and community policing, and participating clinicians are trained in the basics of policing. Similar to the police, clinicians are on call 24 hours per day and respond with police when notified there has been some potentially traumatic event. For the past 25 years, Marans and his clinical colleagues have been meeting weekly with the New Haven police to discuss the cases they have worked on together as a means of examining the wide range of intervention strategies needed to ensure optimal recovery.

In addition to the on-call service, the program has repeated follow-up visits with those potentially affected by trauma. “We identify different roles that different players—not just the police, but social services, medical providers, the schools, and others—can play in helping kids and families get back on their feet,” said Marans. Together, the police and clinicians also canvass neighborhoods after an event that has impacted an entire neighborhood to let the community know their problem is not

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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.
×

being ignored and to provide information about what the communities can do to help one another and their children and to connect them with available resources.

When Marans and his colleagues did a study of the impact of this type of intervention on women who had been victims of domestic violence in front of their children, they found that women who were part of the outreach group, as opposed to women who were getting the standard 911-driven police response, called police more often to address later incidents of violence. Moreover, these calls were not 911 calls, but regular calls to the neighborhood police whom they had come to know through regular contacts in the community. In addition, the number of children who were directed to trauma-related services was nearly two-thirds higher in the outreach group compared to the standard response group. A consumer satisfaction survey showed that the biggest reason for the dramatic increase in calls and use of services was that these women believed the police were ready and willing to support them. Marans noted that one lesson he and his colleagues have learned from their work in New Haven and in response to the September 11, 2001, terrorist attacks, Hurricane Katrina, and the Newtown school shootings, is that one group of professionals or one set of community members cannot tackle the enormous challenges that arise when individuals and entire communities are overwhelmed by trauma.

Marans and his colleagues have recently developed a toolkit and 2-day training in collaboration with the International Association of Chiefs of Police and DOJ. They are now hoping to get funding to make the toolkit and training available to law enforcement agencies nationwide. The goal, he said, is to train police officers who respond to these horrific and potentially traumatic situations with something to offer the affected individuals that can benefit their lives. Too often, police responding to tragedies believe there is nothing they can do to help the innocent victims of these highly traumatic events. “I think our experience as a country is not dissimilar,” said Marans. “We look away when we talk about trauma because we are not informed that we are not helpless to respond to what we do have control over.” The United States, he added, has the intellectual and financial resources to help children overcome the adverse effects of trauma and meet their full potential.

Marans and his colleagues have also developed an early intervention aimed at preventing the long-term disorders that can develop in children when trauma is left untreated (Marans, 2013; Marans et al., 2012). The intervention lasts from five to eight sessions and is based on a family-strengthening model. It is meant to be delivered to children from ages 3 to 8 during the peritraumatic period or after the recent disclosure of sexual or physical abuse. Marans said the intervention reduces posttraumatic

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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.
×

reactions, helps the children regain control of their emotions, increases communication between children and their caregivers, and leads to an effective decrease in the development of PTSD of 65 percent in comparison to standard of care. In addition, those receiving the intervention are 73 percent less likely to develop a broader range of posttraumatic reactions as compared to standard approaches.

OFFICE OF COMMUNITY ORIENTED POLICING SERVICES2

COPS was established in 1994 as part of the Crime Control and Law Enforcement Act of 1994 with a mission of advancing public safety through community policing, said John Markovic. Community policing, he explained, focuses on collaborative efforts to prevent and respond to crime, social disorder, and fear or crime, and it gets away from the idea of policing as strict law enforcement. The community policing era, he added, started around 1984 when a group of progressive police chiefs and academics came up with the idea that the police needed to reconnect with their communities. The preceding era, known as the legalistic era, was characterized by a strict adherence to rules, procedures, and regulations that developed as a reasonable response to police corruption scandals. Community policing, said Markovic, has always existed in some form, though its emphasis and priorities have changed over the years.

One of the mainstays of the COPS program is its hiring grant program for law enforcement agencies. Since 1994, COPS has provided some $14 billion in funding to enable more than 13,000 law enforcement agencies to put some 126,000 community policing officers on city streets, procure technology, and develop demonstration projects and tools, Markovic explained. Approximately 76 percent of the nation’s law enforcement agencies have received COPS grant funds. Except for 2009, when stimulus funds were allocated for hiring more police officers, COPS hiring grants per year have averaged between $200 million and $400 million. COPS also has a community policing development program and a grant program to promote demonstration projects, training, and research on advancing community policing. More recently, COPS has provided funding to state police agencies to support task forces to deal specifically with methamphetamine and heroin use. COPS also supports a DOJ-wide Tribal Technical Assistance Program to make it easier for tribal police departments to apply for and receive funding from DOJ.

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2 This section is the rapporteurs’ synopsis of the presentation made John Markovic, senior social science analyst in the Office of Community-Oriented Policing Services at the U.S. Department of Justice, and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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.
×

In December 2014, President Obama signed an Executive Order establishing the President’s Task Force on 21st Century Policing with the mission of promoting effective crime reduction while building public trust. Composed of a diverse group of experts, including activists, police chiefs, academics, civil rights organizations, and union officials, the task force developed a set of six pillars around which it organized its recommendations:

  1. Building Trust and Legitimacy
  2. Policy and Oversight
  3. Technology and Social Media
  4. Community Policing and Crime Reduction
  5. Training and Education
  6. Officer Safety and Wellness

The task force’s recommendations focused on strategies to reduce crime in a manner that did not alienate the community, and in fact, would enrich the community and minimize the collateral damage that sometimes results from strict law enforcement actions. The recommendations also emphasized making improvements in the training and education of police officers and focusing on officer safety and wellness given that policing is a stressful profession.

One recommendation, for example, called for law enforcement agencies to “collaborate with community members to develop policies and strategies in communities and neighborhoods disproportionately affected by crime for deploying resources that aim to reduce crime by improving relationships, greater community engagement, and cooperation” (President’s Task Force on 21st Century Policing, 2015). Other recommendations, said Markovic, also emphasized collaboration and community building, procedural justice, and the use of a guardianship model of policing rather than a warrior model. Markovic noted that since the early days of COPS, its hiring programs emphasized recruiting and hiring police officers motivated by a spirit of service rather than a call to “action.”

A public health approach to violence reduction can be integrated with policing practices, said Markovic. He noted that among the several existing frameworks that consider violence as a public health issue, a common thread is to focus on those who are most likely to be affected by violence and promote action as something that will benefit the common good, rather than as a strict law enforcement action. A strict law enforcement model, he said, “to put it very bluntly or crudely in the interest of time, it is finding out who the bad guys are, knowing who the good guys are, and putting the bad guys away.” Markovic went on to say that is not the model that reflects modern-day policing and it is not the model that

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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.
×

they promote. Both the World Health Organization and CDC stress the necessity of relying on data-driven approaches to address community violence that follow the public health model of identifying and prioritizing problems, identifying the risk and protective factors, developing and testing prevention strategies, and ensuring widespread adoption with continued evaluation of effectiveness. Markovic noted that an important aspect of community policing is that it does not just focus on the offender, but also on the environment in which violence occurs and the people who experience it.

Several of the tools used by police to identify risk are hot-spot policing and social network analysis. Markovic noted that maps of violence hot spots and comorbidities such as low education levels, a shortage of services, obesity, and cardiovascular disease usually overlap in distressed communities down to the block level. Social network analysis is used as an advanced analytics tool to enable a focused deterrence approach to addressing community violence.

Social network analysis relies on the observation that violence follows a disease contagion model, in which individuals who are associated with people who are the causes or victims of violence are much more likely to become victims of violence themselves or to be shooters, said Markovic. The focused deterrence approach means that the individuals identified as potentially most responsible for violence are approached by the police and warned of the legal consequences if they do not stop. Officers also contact other stakeholders—family members, clergy, prosecutors, and others—and bring them together to provide support.

Another strategy called the Cardiff Model for Violence Prevention, Markovic explained, relies on partnerships and public health to show that integrating emergency department and police data can help locate violence hot spots. Developed in Wales, originators of the Cardiff model identified hot spots of violence, which become focus areas in which to apply prevention strategies and produce significant reductions in violence (Florence et al., 2011). The Cardiff model identified neighborhoods surrounding drinking spots as the most common hot spots for violence. The solution was to have the drinking establishments replace their glassware with cups because incidents in Cardiff tend to involve stabbings rather than shootings. The police also went through the hot-spot neighborhoods and removed debris that could be used as weapons. An assessment of this approach showed that it did reduce violence compared to other areas in which standard policing was in effect.

Another approach is risk terrain modeling (Caplan and Kennedy, 2016), which is being offered free to analysts and police agencies, said Markovic. Public health officials have used risk terrain modeling to find areas with an elevated incidence of child abuse and neglect. This type of

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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.
×

predictive modeling identifies crime generators and crime inhibitors in the environment to forecast where crime is more likely to occur in the future.

The “Fit Zone” project in East Palo Alto, California, said Markovic, is another example of a public health approach that successfully reduced crime (Lawrence et al., 2012; Markovic, 2012). There, the police department identified areas where there were high volumes of gunshots by using traditional police data and shot-spotter data. The police helped organize community physical activities such as walking, biking, and even Zumba workouts to take back the neighborhood and create an environment that felt safe. An evaluation of the program found it reduced crime significantly in some neighborhoods.

MINORITY YOUTH VIOLENCE PREVENTION INITIATIVES3

In 2014, DOJ and the U.S. Department of Health and Human Services’ Office of Minority Health issued an innovative joint solicitation that is now funding nine demonstration sites that promote a public health and community policing approach to violence prevention with minority youths. Medina Henry, an associate director for training and technical assistance at the Center for Court Innovation, described the 3-year Minority Youth Violence Prevention Initiative.

Howard explained that the official goals of the project are to

  • reduce violent crimes against minority youth;
  • reduce community violence and crimes perpetrated by minority youth;
  • improve academic outcomes for participants;
  • reduce negative encounters with law enforcement;
  • increase access to public health and/or social services; and
  • improve coordination, collaboration, and linkages among agencies.

In their proposals, applicants for the grants were required to include public health and law enforcement partners. They also had to identify where violence was occurring in their communities, list the strategies that had been used in the past to address violence in those areas, and detail what interventions they were proposing to reduce violence among the young people in their communities. The nine grantees selected for

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3 This section is the rapporteurs’ synopsis of the presentation made by Medina Henry, associate director of training and technical assistance at the Center for Court Innovation, and the statements have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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.
×

the Minority Youth Prevention Initiative4 include two community-based organizations, two health-related organizations, a hospital, a health department, a police department, a district attorney’s office, and a city/county. The sites are in different areas of the country and include diverse populations. Two of the sites are where large populations of refugees have resettled, which Henry explained affects the type of violence that people in those communities have experienced and the interventions aimed at those particular communities.

Henry’s role in the project is to serve as a technical assistance provider to support the grantees. She helps them to identify staffing and training resources, advises them on the evidence-based practices being implemented, and how to identify risks within their programming. Henry said she spent a great deal of time encouraging the sites to be intentional about their work and the populations they are serving. She has also helped the sites identify proxies for various outcomes, such as negative encounters with police, and to work with the sites to improve coordination, collaboration, and linkages among agencies, which Henry said is challenging, but also likely to be the most sustainable element of the project.

The grantees and the populations they serve are diverse, said Henry, as are the approaches and types of violence the initiatives address. Some interventions target antisocial behaviors such as bullying, gang activities, violent crimes, homicides, and trauma. All sites focus on prosocial behavior, whether through police athletic league mentoring, healthy living, or other recreational activities. The intervention sites include hospital-based, school-based, and community-based programming. Some of the school-based projects focus on bullying, she noted, and several of the hospital-based programs collaborate with community policing efforts. At least one site deals with the trauma in families who have had a family member killed by violence. Henry noted that while dealing with trauma is not an explicit goal for these grants, it is impossible to talk about violence without addressing trauma, too. In some sites, she said, a trauma-informed approach to intervention, implementation, and development is an explicit component of the program (e.g., Children in Trauma Intervention, Cincinnati, Ohio; and Youth ALIVE!, Oakland, California), while others do not explicitly mention trauma but it is part of their work.5

In Minneapolis, where a sizable community resettled from Southeast Asia, Asian Media Access organized Shop-with-a-Cop, said Henry, as a

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4 For more information about the initiatives, see http://www.courtinnovation.org/minority-youth-violence-prevention-initiative (accessed August 22, 2016).

5 For more information on specific sites, as well as links to podcasts, see http://www.courtinnovation.org/minority-youth-violence-prevention-initiative (accessed November 2, 2016).

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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.
×

way to engage the community so that youth and police officers get to know each other on a more intimate level as police officers support these youth in getting education supplies. Through a parallel series of workshops, Asian Media Access provides training to law enforcement about cultural awareness and does community education to different immigrant groups around civic engagement and the role of law enforcement. Toward the end of the workshop series, Asian Media Access brings the police and the community together for an open dialogue at which community members can ask questions and law enforcement can explain policies and procedures. Henry noted that there is a general lack of understanding in these communities of what the police do and are required to do, so this is a way for both communities to learn more about each other.

At some of the sites, such as in Cincinnati, law enforcement officers serve as the facilitators, leading workshops and physical recreational activities and acting as formal or informal mentors. In Cincinnati, a youth organization provides police officers, who largely come from the youth services unit, with training on mentorship. Often, Henry explained, the role of law enforcement is not primarily to support young people, so the police learn how to engage with youth. “I think we take it for granted that people know how to talk to a young person and that just is not necessarily the case,” said Henry.

Programs may also focus on youth basketball leagues or community service. In the beginning, some programs that include developing supportive relationships between police officers and youth can be difficult, and sometimes a neutral third party facilitator needs to be involved to model appropriate interactions between the police officer and students. However, over the course of a semester, the officers and students get to know each other and build trust. Building on those relationships, there can be larger outreach and community engagement efforts through which youth bring their family and friends to engage with law enforcement differently and build trust and communication in the community.

With regard to the trauma-informed initiatives, the Cincinnati Police Children in Trauma Intervention program includes structured military drills for physical fitness (it is not a boot camp). There is a trauma specialist on site and all of the officers that participate get trauma training. Youth ALIVE! in Oakland, California, developed the Screening Tool for Awareness and Relief of Trauma.6 The screening tool was developed to address the needs of young men of color who disproportionately experience trauma, yet current approaches and responses to their particular needs are limited, said Henry. Youth ALIVE! has a trauma specialist on

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6 For more information, see http://www.youthalive.org/wp-content/uploads/2016/06/Trauma-Project-Clinical-Two-Pager-June-2015.pdf (accessed November 2, 2016).

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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.
×

site and also facilitates trainings for their staff, partners and others in the community. In Sacramento, California, the Health Education Council participates in a statewide initiative to inform all of their systems about trauma-informed care, education, the justice system, and other systems that impact the lives of youth.

Henry concluded her talk with common trends and promising practices she has identified over the first 18 months of this program. Multisector collaborations are nothing new, but many of the grantees have a convener, a designated person who brings collaborators to the table, organizes ways of thinking, and helps develop the shared vision, goals, and action plans. These are working groups, said Henry, and at most of the sites the collaborators have been working with one another for a long time, creating a certain level of trust and the ability to get key decision makers to the table quickly.

Opportunities for youth development and leadership are a key aspect of these interventions, said Henry. “You have to give a young person an opportunity to develop their own agency, and I think many of the sites do that very well,” she said. Another programmatic practice that she has seen at many sites is an intentional process for engaging the guardians or family members of the young people enrolled in these programs. “It is probably one of the hardest things and one of the challenges that many of the sites face in terms of consistently and actively engaging and getting a response from guardians and families,” said Henry. Often these adults are overwhelmed by the many responsibilities they have in their lives. These efforts to do outreach do lead to positive results, she added.

The final promising practice Henry has seen among the grantees is the development of strategic intervention based on shared data and information. Sharing data may be hard, she said, but the grantees are addressing that challenge and their interventions are the better for it. She also noted that just having conversations about sharing information has led to some ideas about other interventions to try. She noted in closing that the program’s website (http://www.courtinnovation.org/minority-youth-violence-prevention-initiative [accessed January 5, 2017]) has links to the nine grantees as well as podcasts that feature the different grantees and their partners and additional information about the tools and strategies the grantees are using in their communities.

DISCUSSION

Ted Corbin started the discussion by asking how such amazing examples of collaborations at the local level between health care and public safety and at the federal level between health and justice come to be. Marans replied, “Being in pain and having humility,” and Markovic said

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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.
×

it was partly by planning and partly by necessity to fill gaps. A big part of creating these collaborations, said Markovic, is people who are open to learning from different disciplines and understanding how approaches can be complementary instead of siloed.

Betty Lee Davis first commented that she sees this workshop’s focus on trauma as an important first step in stopping the transmission of violence. She then asked the panelists to comment on the role of racism in explaining why resources are not widely available to implement these interventions in communities of color given the long-standing attention given to youth violence as a public health problem. Marans replied that the unfolding history and legacy of discrimination in this country is one in which a disproportionately high level of certain kinds of illnesses and traumas are prevalent in communities of color.

Markovic replied by describing a study in which police officers were shown pictures of men holding guns or cellphones and asked if they would shoot or not. “As might be expected, the respondents are quicker to mistakenly identify cellphones as guns when the subjects are African American or other minorities.” This is a manifestation, he explained, of implicit bias, which also exists with regard to characteristics such as sexual orientation, political orientations, and obesity. The interesting thing about this study, however, was that the results held true across all groups, including among African American officers and students. He then noted there is evidence emerging to show that once an individual recognizes implicit bias, there are ways of changing behavior for the better.

Davis also asked the panelists if secondary trauma and the effects of law enforcement’s exposure to violence is contributing to the police-involved incidents that are now getting so much attention. Markovic responded that he believes that there is recognition that law enforcement officers are experiencing long-term effects of the stress. He and his colleagues have been working with law enforcement on what is known as procedural justice, the recognition that people obey the law because they find it procedurally just and generally fair, and not merely because they fear the consequences. There are two elements of procedural justice in this training. One is outward facing—that police officers and police administration should be fair to citizens in their interactions—and this concept is now being applied to new training procedures that are attempting to change the use of force and that stress the sanctity of life for all people, including the officers themselves. He also noted that in the early 2000s, the New York Police Department had a courtesy, professionalism, and respect training program. Customer satisfaction surveys showed that even when people received traffic tickets or citations for other violations, they reported feeling they had been treated fairly by the police. However, there were differences in how people felt by race and age, but they were

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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.
×

not as pronounced as the differences found when a random sampling of people is asked for their general opinions of the police.

The other element of training is internal procedural justice, which addresses how officers may find it hard to be fair with the public when they are constantly in a job where they believe they have been treated unfairly. Markovic said that officer safety and wellness was one of the pillars presented in the President’s Task Force on 21st Century Policing (2014) report. There is a need, he said, to be proactive and develop physical and mental health programs for officers to help them deal with the stress of being on the streets, particularly for those who patrol high-crime neighborhoods.

At the same time, Markovic added, programs are needed to help police officers recognize the symptoms of their own stress so they seek help. As an example, he described a Milwaukee Police Department program funded by COPS in which officers were trained to monitor their heart rates as an indicator of stress and use several techniques to reduce stress. There is evidence from the U.S. military, he said, showing that such methods not only reduce stress, but also reduce risk factors for cardiovascular disease and PTSD and improve sleep and general well-being.

Marans took a different perspective on this issue, though he agreed that more attention needs to be paid to self-care in all stressful professions and particularly those professions in which a person’s life is on the line. That said, he noted there are many high-stress professions with high rates of addiction and alcoholism, but it is unknown to what extent the failure to recover from trauma plays a role in that relationship. He also said that he has been to thousands of bloody murder scenes and as far as he is aware, he has never experienced the symptoms of PTSD and believes the reason is training and support. Police officers receive training and support to deal with murders, and this is completely different from the average citizen who is unprepared for a traumatic event, said Marans.

Another difference between police officers and the public that many in the civilian population do not appreciate is that the police do not go on service calls to celebrate the joys of life and the successes of love. Instead, they experience a steady diet, day in and day out, of confrontations and failures of life that can lead to the feeling that they are ineffective. “If we equip police officers to be able to be effective and feel effective, it is stunning the extent to which the blinders come off and the roles of being effective agents and supporting people getting back on their feet, and protecting lives is mobilized,” said Marans.

Pamela Russo commented that RWJF is beginning to invest heavily in what it calls trauma-informed care for children and for high-using patients who are homeless or have a substance abuse disorder or mental illness. She noted, too, that there are trauma-informed schools and even

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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 in Georgia that refers to itself as a trauma-informed community. Her question for Marans was whether he thinks that trauma-informed interventions will work at a later point in life, that is, long after the traumatic event or events occurred. She also asked, with regard to children, if the same treatment can be used again if a child experiences a subsequent traumatic event. Marans replied that the key to treating trauma is to remember that every individual is different in the way they experience and react to traumatic events. He noted there have been studies done with young boys who display violent behavior that have found that these boys are overstimulated by trauma. The analogy he used was of a football team of 12-year-olds playing as a National Football League team. “There is an imbalance, and over time, that imbalance results in compromised functioning and capacity that can lead to serious illness,” said Marans. What is important, he concluded, is to demonstrate equity and justice by treating each child and each adult as an individual and find out what specific treatments will fit that individual’s needs.

With regard to whether it is possible to treat the effects of trauma long after the traumatic event, Marans replied that there are well-established treatments for adults that can relieve and decrease PTSD even after it is well established. He noted that PTSD is not the only outcome of trauma—poor frustration tolerance and an inability to concentrate in school are two other conditions resulting from the lack of support and compensation for the damage done by trauma.

An unidentified workshop participant remarked that the programs Henry described seem to be working hard to build solidarity and break down the “us versus them” mentality between young people and police officers. She then asked Henry if the programs are also working to connect these young people to employment or training opportunities, and Henry replied that every one of the nine sites has a component that connects young people to educational support and internships. Some sites, she said, are developing their own in-house programs, and others are working with outside organizations. The West Palm Beach site’s Village Initiative, for example, works with the city, business development partners, and their vocational and educational partners to create job fairs. The message this program is sending is that they want local businesses to invest in the young people in the community and that they will work to train them so that they can become good employees. Consistent across all of the nine sites, said Henry, is consideration of the broader conditions these communities are facing with regard to access to quality food, good housing, employment, and education.

Suggested Citation:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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:"6 Public Health and Law Enforcement Collaborations." 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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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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