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In This Issue

Labors of Advocacy: Compassion Satisfaction and Wellness among Hospital-Based Intervention Program Caseworkers

By: Violence Intervention and Advocacy Program at Boston Medical Center

Compassion fatigue is prevalent in many health professions, and for Violence Intervention Programs, the importance of recognizing risk factors and implementing pro- active self-care plans for all staff is imperative. Other health care professionals, such as surgeons and nurses, have been heavily overrepresented in research projects and subsequent wellness programs to combat vicarious traumatization, while frontline violence interventionists have been overlooked. Compassion fatigue is the process of change that happens as a result of working with populations that have experienced traumatic events. Over time, this process can lead to vicarious traumatization and burnout, as well as negative changes in capacity for emotional energy and empathy, loss of compassion for clients, and hypervigilance.

Staff members of Violence Intervention programs come in contact with enormous amounts of trauma daily. Many staff members are committed to this type of work due to similar personal experiences with both violence and trauma. While recognizing this as an asset to relationship development and trust building with clients, it also makes staff extremely vulnerable and susceptible to vicarious trauma and burnout.

VIAP recently conducted a cross sectional study to better understand the scope of this phenomenon.  The instrument used was the 5th version of the Professional Quality of Life survey, which is a 30 item Likert Scale Survey which asks about various aspects of work. The survey measures compassion satisfaction, pleasure derived from work as well as the subscales of compassion fatigue, which are secondary traumatic stress and burnout. VIAP distributed this survey and an online link at the 2018 HJA conference in Denver, Colorado. In addition to questions on work, the survey asked about demographics: age, race and ethnicity, gender, whether the participant works in the community or in the hospital, whether they work in a direct care or supervisory role, and how long they’ve worked in this field. The final sample ended with 93 participants. Scores showed that there is a high prevalence of compassion satisfaction regardless of any demographic. This means that generally participants who are exposed to vicarious trauma are still able to derive high pleasure from their work despite the risk of compassion fatigue. Research also showed that burnout and secondary traumatic stress scores were the highest among the lowest and highest age groups. It shows a general pattern of burnout and secondary traumatic stress rates decreasing as age increases. An explanation for this is that people are entering this workforce early and are getting immediately overwhelmed by the type of work and leave early. The people who remain are not better at handling their trauma as they get older. We hypothesized that there may not be enough supports in the first 5 years of working and that those who could’ve received an intervention, instead chose a different job career and decided not to do this work long term, which is why data showed see a huge spike of secondary traumatic stress at 6-10 years of working and a lower rate for 10+ years. Overall this could suggest that instead of having resources available to them that could help with their compassion fatigue, participants left the field altogether.

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Program Spotlight: Kansas City Violence and Trauma Response Network, Kansas City, MO

Interview with: Nephateri Hill & Brandi May 

Briefly describe your program and the population that it serves.

The Kansas City Violence and Trauma Response Network (KCVTRN) is a multi-level intervention/prevention service designed to enhance identification and access to trauma support services for young men of color who are victims of crime. KCVTRN focuses on the increased use of evidence-based policies and practices in the community to better support youth survivors of violence. Case management services are provided to help identify and evaluate the needs of male survivors of violence to ensure that they are connected to appropriate community based services. 
 
The program enhances coordination of community responses and trauma support services to young men who reside in Beats 331 and 332 within the KC, MO East Patrol Division.

What have you found to be the biggest need for this population and how has your program addressed that need?

We’ve found that the biggest need for our population is for them to be willing to self-identify as a survivor of violence and understand violent behavior displayed in our community is from the effects of the trauma, we as a community have experienced.

To address the lack of knowledge, KCVTRN conducts one day events in different locations in our target area often, educating the community and young males on what a survivor of violence is, and the services offered to help began the healing process. We also provide individuals the opportunity to take the A.C.E’s survey to further show how some experiences that have been normalized is really adverse to our mental and emotional health.

What are you proudest of regarding your work through the SMSV grant?

KCVTRN is proud to be the first program Kansas City that intentionally works to identify and provide services to male survivors of violence. We are extremely proud to even be working in this space. It is gratifying to make survivors aware that there is an out. What you experienced as a child does not have to define who you are as an adult.

What new relationship or resource have you found to help move your work forward?

We have developed partnership with Healing Pathway Victim Services, who are dedicated to servicing youth ages 0-18, and their families who have lost a love one due to violence. This relationship has allowed us to ensure that youth are able to access mental health assessments and counseling, group therapy, and creative activities to interact with other youth and advocates to empower their healing process. Additionally, the merging of our Aim4Peace Violence Prevention Program with the Kansas City Health Department Division of Children, Family Health and Education has been very beneficial. The merger created more opportunities for our Network to have greater access to materials, information and resources for educating youth and their families on public health, violence prevention and living healthier lifestyles. 
 
What is something positive a client or partner said about your work related to the SMSV grant?

Mr. Ford, who is a teacher at an alternative school where we facilitate Life Skills classes; has this to say. “Mr. Walker is doing a fantastic job. He has developed relationships with many of the students in my class. He is able to interject real life events into the lessons I have planned. The students are definitely more invested in the community than they were before his arrival. I appreciate RaVae being part of my class and his positive attitude has inspired me on more than one occasion when things became difficult”.

What have you learned that you will carry with you as you continue this work?

The power of connectivity. To understand that not one entity can do it all. We have a much stronger impact when we work together for the common goal of helping our community become whole, healthy, thriving, and filled with hope and healing.  
 

Communications Corner

Preparing for a Media Interview (Pt.2)  

In our last communications corner, we talked about how to respond to media inquiries, and how to prepare answers to media questions in a way that supports the work that you do.
 
Now, we want to think about who good spokespersons can be for media interviews. The first thing to do is to check your organizational policies to find out who is allowed to speak with the media. If you’re clear, think of anyone who can speak from the heart about why supporting male victims of violence matters: community members, doctors, intervention specialists, etc. People in these roles can harness their voice to speak passionately about this work and why it is important. The second thing a good spokesperson must do is connect the dots between personal experience, and the structures and practices that are harming our communities, as well as how our programs are working to solve the problem. In other words, make sure that story includes the landscape. This is not easy, it takes practice! We recommend you and your team practice delivering messages about your work during meetings, or retreats, so when the media calls, you all are prepared.
 
Can the young people we work with be good spokespersons? It depends! Journalists often seek to ‘put a face’ to the issues they report on, so they may ask to speak to a participant. You and your organization would need to think about what support you can offer to the participant to help them connect their personal story to the larger landscape; to set boundaries about what they are comfortable talking about; to protect their privacy and safety; and even to process any potential negative comments that may appear in online publications. These are only a few ethical considerations when having young people speak to the media, we encourage you to have a team conversation to decide what’s your stance and align with your organizational policies around this, if you have them. Remember, it is ok to say no to reporters if you feel it could damage your cause, or your relationships with the community.
 
In our next communications corner, we’ll discuss some interviewing tips. In the meanwhile, if you need additional support in preparation for an interview, contact Shaddai at BMSG
In the News

Editorial: Crime fixes have eluded St. Louis politicians. Cure Violence is worth a try.
St. Louis Post-Dispatch

California's first surgeon general: Screen every student for childhood trauma
NBC News

Editorial: Milwaukee's violence prevention program needs the steady support that a new sales tax could offer
Journal Sentinel

A Q&A with Ray Winans, gang member turned violence prevention specialist
NBC News

School districts jointly win $5 million grant to launch intensive effort to prevent violence, engage communities and help students thrive
Fox19

California enacts nation's broadest rules for gun seizure
The Hill

Greensboro to consider $500,000 for violence prevention program
News & Record

Milwaukee teens announce youth 'violence interrupter' program, share impact of gun crime on lives
Journal Sentinel
 

Trauma-Informed Care Corner

 
By Ted Corbin, MD
Drexel University Center for Nonviolence and Social Justice


 In our communities, young people are dealing with reactions to sustained traumatic stress which is a normal healthy response to circumstances and experiences that shouldn’t be.  But it is imperative not to get used to feeling this way.  It is important to heal from traumatic stress.  Common causes are violence, poverty, racism, oppression and many things that hurt our peace of mind.  Many unknowingly experience sustained traumatic stress. The longer they go without understanding what’s happening to them, the more missed opportunities there are for healing, and a better life.

In addition to the sustained traumatic stress, the history of people of color is one that feeds the stress of racial trauma.  I would be remised if I did not acknowledge what happened four hundred years ago.  One of the first slave ships docked in Virginia in August 2019. The Africans on the ship were sold to the colonists which was the beginning of gruesome years of slavery.  Slavery begot the disparities and inequities to this day.  Though the United States has made stride in race relations, it continues to be light years behind of what it should be.  This horrific history undoubted contributes to what our communities of color experience today.

Please know the history of yesterday to make a difference today.  Hospital-based Violence Intervention Programs are ahead of the issues that people of color face.  It is imperative that we stand firm and keep the work moving.  For information the 1619 Project, please check out the New York Times 1619 Project.

Funding Opportunities

Center for Disease Control and Prevention: National Center for Injury Prevention and Control
Research Grants for Preventing Violence and Violence Related Reinjury
 
Forecast Amount: $350,000 (Award Ceiling)
Forecast Application Post: October 18, 2019
Forecast Application Deadline: January 20, 2020

The Centers for Disease Control and Prevention's National Center for Injury Prevention and Control (NCIPC) is soliciting investigator-initiated research that will help expand and advance our understanding about what works to prevent violence that impacts children and youth, collectively referred to as Adverse Childhood Experiences (ACEs), including child abuse and neglect, teen dating violence, sexual violence, youth violence, youth/parent suicidal behavior, and exposure to adult intimate partner violence. This initiative is intended to support the evaluation of primary prevention programs, practices or policies that target universal or selected high-risk populations (i.e., populations that have one or more risk factors that place them at heightened risk for violence). Funds are available to conduct such studies focused on preventing child abuse and neglect and at least one other form of violence affecting children and youth, including teen dating violence, sexual violence, youth violence, and exposure to adult intimate partner violence.
 
Open Society Foundations
Soros Justice Fellowships
 
Amount: up to $127,500
Deadline: November 20, 2019

The Soros Justice Fellowships fund outstanding individuals to undertake projects that advance reform, spur debate, and catalyze change on a range of issues facing the U.S. criminal justice system. The fellowships are part of a larger effort within the Open Society Foundations to reduce the destructive impact of current criminal justice policies on the lives of individuals, families, and communities in the United States by challenging the overreliance on incarceration and extreme punishment, and ensuring a fair and accountable system of justice. Fellows receive funding through the following three categories: Advocacy, Media or Youth Activist Fellowships.
 
Lizette Peterson-Homer Injury Prevention Grant
Injury Prevention Grant
 
Amount: $5,000
Deadline: October 1, 2019

The Lizette Peterson Homer Memorial Injury Research Grant supports research into psychological and behavioral aspects of the prevention of injuries in children and adolescents as reflected in the activities and interests within pediatric psychology of the late Lizette Peterson-Homer and her commitment to improving the status of children in the face of the most significant threats to their health and development. This grant is open to students and faculty to support research related to the prevention of injuries in children and adolescents. Funding is available up to $5,000 and is sponsored jointly by the American Psychological Foundation and APA Div. 54.

Bill and Melinda Gates Foundation
Grand Challenges Program
 
Amount: $100,000
Deadline: November 13, 2019
 
We're seeking creative, compelling ideas from individuals and organizations from all sectors in the U.S. to elevate diverse voices and broaden the national conversation about poverty and economic mobility. Anyone with a great concept is welcome to apply for a $100,000 grant to develop their idea.
 
Joyce Foundation
Gun Violence Prevention and Justice Reform
 
Amount: Project specific, $10,000-$500,000+
Deadline: LOL's-April, July

In urban areas, the impact of gun violence is experienced most acutely by young people of color and their families and communities. At the same time, lack of trust between police and community members, coupled with overreliance on incarceration, further weaken communities and compromise public safety. With the goal of reducing gun violence while improving the fairness of the justice system, the Joyce Foundation expands its Gun Violence Prevention Program in 2018-2020 to encompass three strategic priorities:
  • Reducing gun violence through state policy reform, research, education, and legal strategies
  • Supporting 21st Century policing to build greater police-community trust and legitimacy
  • Reducing incarceration of young people.
This program expansion is based on our assessment that in urban areas, gun violence and the justice system’s response are two sides of the same coin. Weak gun laws allow illegal guns to proliferate, causing shootings and homicides that devastate communities. But when the dominant response to gun violence is overly aggressive policing, prosecution, and sentencing, too often the tactics deployed result in additional harm to the communities already plagued by gun violence. For communities to be safe and just, we must renew our efforts to prevent gun violence before it occurs, with a holistic approach that includes stronger gun policies, fair policing, and a justice system that minimizes incarceration of young people. The Joyce Foundation makes grants in the Great Lakes region to strengthen evidence-based public policies to promote safe and just communities in the following three areas: gun violence prevention, 21st century policing, reducing mass incarceration.
 
 
 
 
 
 
 

Research Desk

Kalesan B1, Zuo Y, Vasan RS, Galea S.  Risk of 90-day readmission in patients after firearm injury hospitalization: a nationally representative retrospective cohort study. J Inj Violence Res. 2019 Jan;11(1):65-80.

Background: National conversation has justifiably been concerned with firearm-related deaths and much less attention has been paid to the consequences of surviving a firearm injury. We assessed the risk of hospital readmission, length of stay (LOS) during hospitalization, and costs within 90-days after surviving an index firearm injury and compared these data with pedestrians and occupants involved in motor vehicle crash (MVC).

Methods: Nationwide Readmission Database, a nationally representative readmission database from 2013 and 2014 was used to create a retrospective cohort study. The primary outcome was time-to-first all-cause readmission within 90-days after discharge from the index hospitalization. Secondary outcomes were LOS and hospitalization costs at index events and at 90-days.

Conclusions: The patients surviving a firearm injury have a substantial risk of subsequent hospitalizations, higher than pedestrian or occupant MVC injuries. Medicaid is disproportionately burdened by the costs of treatment of firearm injury.

Wood G, Papachristos, AV.  Reducing gunshot victimization in high-risk social networks through direct and spillover effects.  Nature Human Behavior, August 19, 2019

More than 60,000 people are victimized by gun violence each year in the United States. A large share of victims cluster in bounded and identifiable social networks. Despite a growing number of violence reduction programmes that leverage networks to broaden programmatic effects, there is little evidence that reductions in victimization are achieved through spillover effects on the peers of participants. This study estimates the direct and spillover effects of a gun violence field intervention in Chicago. Using a quasi-experimental design, we test whether a desistance-based programme reduced gunshot victimization among 2,349 participants. The study uses co-arrest network data to further test spillover effects on 6,132 non-participants. Direct effects were associated with a 3.2-percentage point reduction in victimization among seeds over two years, while potential spillover was associated with a 1.5-percentage point reduction among peers. Findings suggest that peer influence and the structure of networks might be leveraged to amplify gun violence reduction efforts.

Berman JD, Burkhardt J, Bayham J, Carter E, Wilson A.  Acute Air Pollution Exposure and the Risk of Violent Behavior in the United States. Epidemiology. 2019 Nov;30(6):799-806. 

Background: Violence is a leading cause of death and an important public health threat, particularly among adolescents and young adults. However, the environmental causes of violent behavior are not well understood. Emerging evidence suggests exposure to air pollution may be associated with aggressive or impulsive reactions in people.

Methods: We applied a two-stage hierarchical time-series model to estimate change in risk of violent and nonviolent criminal behavior associated with short-term air pollution in U.S. counties (2000-2013). We used daily monitoring data for ozone and fine particulate matter (PM2.5) from the Environmental Protection Agency and daily crime counts from the Federal Bureau of Investigation. We evaluated the exposure-response relation and assessed differences in risk by community characteristics of poverty, urbanicity, race, and age.

Conclusions: Our results suggest that short-term changes in ambient air pollution may be associated with a greater risk of violent behavior, regardless of community type.

Beal SJ,  Wingrove T, Mara CA, Lutz N, Noll JG, Greiner MV. Childhood Adversity and Associated Psychosocial Function in Adolescents with Complex Trauma. Child Youth Care Forum. 2019 Jun;48(3):305-322

Background: Childhood adversity is linked to a number of adult health and psychosocial outcomes; however, it is not clear how to best assess and model childhood adversity reported by adolescents with known maltreatment exposure.

Objectives: This study sought to identify an empirically-supported measurement model of childhood adversity for adolescents in child protective custody and associations among childhood adversity and adolescent outcomes.

Methods: Self-report survey data assessed childhood adversity and adolescent outcomes, including psychological well-being, quality of life, and substance use, in 151 adolescents ages 16 to 22 in protective custody with a documented maltreatment history.

Results: Findings suggest that, among youth with complex trauma histories, it is important to distinguish among risk related to unexpected tragedy (e.g., natural disaster, parental divorce), family instability (e.g., parental substance abuse or mental health concerns), and family violence (e.g., physical or sexual abuse). Family violence was associated with poorer psychological well-being and quality of life, while family instability was associated with cigarette and marijuana use.

Conclusions: Among adolescents with complex trauma histories, childhood adversity assessments reflect multiple domains of adversity, each of which are differentially related to adolescent risks. Properly assessing childhood adversity in adolescents with complex trauma histories may help target interventions for specific risks (e.g., substance use) based on which types of childhood adversity youth have been exposed to.

Cameron LD, Carroll P, Hamilton WK. Evaluation of an intervention promoting emotion regulation skills for adults with persisting distress due to adverse childhood experiences. Child Abuse Negl. 2018 May;79:423-433. 

This phase II trial evaluated psychosocial and health outcomes of an intervention designed to improve emotion regulation skills in adults suffering from Adverse Childhood Experiences (ACEs). The study utilized a pretest-post test design in which 92 adults enrolled in the community-based program completed pretest measures, attended either a faith-based or secular version of the 12-week ACE Overcomers program, and then completed post test measures. The theory-guided program involved group sessions providing education and skills training to improve emotion regulation, self-awareness, resilience, and social functioning. Pretest and post test surveys included measures of emotional regulation (suppression, rumination, cognitive reappraisal, and mindfulness), resilience (ego resilience and general self-efficacy), emotional experiences (perceived stress, moods, and depressive symptoms), quality of life (the SF-36 domains), and physical symptoms and illness (symptom load and sick days). Analyses revealed significant improvements from pretest to post test in all facets of emotion regulation (p < .01), psychological resilience (p < .001), mental well-being (p < .001) and physical symptoms and illness (p < .001), and in specific facets of quality of life (p < .001). The faith-based and secular versions of the program yielded comparable improvements in well-being. Improvements were comparable for older versus younger participants, except that younger participants reported greater improvements in perceived stress (p < .05). These preliminary findings support the application of an emotion regulation perspective to interventions for adults with high ACEs. The study, with its single-group design, represents a promising step in the translational research pathway and provides support for further studies utilizing comparison groups.

Annie Lewis-O’Connor, Abi Warren, Jeannie V Lee,, Nomi Levy-Carrick, Samara Grossman, Mardi Chadwick, Hanni Stoklosa, Eve Rittenberg.  The state of the science on trauma inquiry.  Women’s Health Volume 2019. 15: 1–17. 

Within the context of longitudinal medical care for adults, health care providers have a unique opportunity to inquire and respond to the traumatic life experiences affecting the health of their patients, as well as a responsibility to minimize retraumatizing these patients during medical encounters. While there is literature on screening women for intimate partner violence, and there is emerging data on pediatric screening for adverse life experiences, there is sparse literature on inquiry of broader trauma histories in adult medical settings. This lack of research on trauma inquiry results in an absence of guidelines for best practices, in turn making it challenging for policy makers, health care providers, and researchers to mitigate the adverse health outcomes caused by traumatic experiences and to provide equitable care to populations that experience a disproportionate burden of trauma. This state of the science summarizes current inquiry practices for patients who have experienced trauma, violence, and abuse. It places trauma inquiry within an anchoring framework of trauma-informed care principles, and emphasizes a focus on resilience. It then proposes best practices for trauma inquiry, which include tiered screening starting with broad trauma inquiry, proceeding to risk and safety assessment as indicated, and ending with connection to interventions.

Rowe M, Kimmel J Jr, Pavlo AJ, Antunes KD, Bellamy CD, O'Connell MJ, Ocasio L,, Desai M, Bal J, Flanagan EH.  A Pilot Study of Motive Control to Reduce Vengeance Cravings. J Am Acad Psychiatry Law. 2018 Dec;46(4):486-497. 

Violence is a serious public health problem in the United States, and a common risk factor for many forms of violence is the perpetrator's motivation to achieve personal justice for past wrongs and injustices. Using a fictional transgression scenario to stimulate revenge feelings, we studied the preliminary efficacy of an intervention designed to mitigate revenge desires among victims of perceived injustice. The intervention consisted of a guided role-play of key figures in the justice system (e.g., victim, prosecutor, defendant, judge, etc.) in an imaginary mock trial of the offender. Study participants' revenge desires toward the perpetrator decreased significantly immediately after the intervention and at a 2-week follow-up interview. Benevolence toward the offender increased immediately post-intervention and at a 2-week follow-up interview. These results suggest that the intervention has promise to decrease revenge desires in people who have been victimized, and it potentially opens the door to behavioral health motive control approaches to violence prevention. Findings on the roles of vengeance and the desire for retaliation in relation to violent acts, as well as neuroscience research that suggests a connection between retaliatory aggression and the neural circuitry of anticipated reward and cravings, are discussed. Limitations of this pilot study are also discussed, and recommendations for future research are provided.

Alison J. Culyba, Elizabeth Miller, Steven M. Albert, Kaleab Z. Abebe.  Co-occurrence of Violence-Related Risk and Protective Behaviors and Adult Support Among Male Youth in Urban Neighborhoods.  JAMA Netw Open. 2019;2(9):e1911375.

Importance: Male youth in lower-resource neighborhoods bear a disproportionate burden of violence involvement, but little is known about clusters of specific violence-related behaviors to inform cross-cutting interventions that address multiple forms of violence. 

Objectives: To examine associations between adult support and patterns of violence and risk or protective behavior co-occurrence among male youths in urban neighborhoods. 

Design: Cross-sectional analysis of baseline and end-of-program data from a recently completed cluster-randomized sexual violence prevention trial across 20 lowerresource neighborhoods. Participants were male youths, aged 13 to 19 years, enrolled at youthserving community agencies in Pittsburgh, Pennsylvania, from July 27, 2015, to June 5, 2017. Data were analyzed from July 1, 2018, to February 28, 2019. 

Conclusions: These findings suggest that co-occurrence of risk and protective behaviors differ significantly among youth with vs without adult support. Violence prevention interventions designed to leverage adult support should address broader co-occurrence patterns.

Matthay EC, Farkas K, Rudolph KE, Zimmerman S, Barragan M, Goin DE, Ahern J. Firearm and Nonfirearm Violence After Operation Peacemaker Fellowship in Richmond, California, 1996-2016. Am J Public Health. 2019 Sep 19:e1-e7. 

Objectives: To evaluate whether the Operation Peacemaker Fellowship, an innovative firearm violence-prevention program implemented in Richmond, California, was associated with reductions in firearm and non-firearm violence.Methods. We compiled city- and jurisdiction-level quarterly counts of violent firearm and non-firearm incidents from statewide records of deaths from and hospital visits for homicide and assault (2005-2016) and from nationwide crime records of homicides and aggravated assaults (1996-2015). We applied a generalization of the synthetic control method to compare observed patterns in firearm and non-firearm violence after implementation of the program (June 2010) to those predicted in the absence of the program, using a weighted combination of comparison cities or jurisdictions.Results. The program was associated with reductions in firearm violence (annually, 55% fewer deaths and hospital visits, 43% fewer crimes) but also unexpected increases in non-firearm violence (annually, 16% more deaths and hospital visits, 3% more crimes). These associations were unlikely to be attributable to chance for all outcomes except non-firearm homicides and assaults in crime data.Conclusions. The Operation Peacemaker Fellowship may have been effective in reducing firearm violence in Richmond but may have increased non-firearm violence. 

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This newsletter is funded in part through a grant from the Office for Victims of Crime, Project # 2015-VF-GX-K025, Office of Justice Programs, U.S. Department of Justice. Neither the U.S. Department of Justice nor any of its components operate, control, are responsible for, or necessarily endorse, this Web site (including, without limitation, its content, technical infrastructure, and policies, and any services or tools provided).

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