Community Health Approach to Violence

1. Philadelphia Collaborative Violence Prevention Center Community Health Approach to Violence Philadelphia Public Health Association Annual Fall Conference September 27, 2011 Joel A. Fein M.D., M.P.H. Division of Emergency Medicine The Children’s Hospital of Philadelphia Director, The Philadelphia Collaborative Violence Prevention Center

2. Inner City  Suburbs  Girls / women  Littlekids Violence in Our Backyard: Tears in the FabricProthrow-Stith, D.and Spivak H: Sugar and Spice and No Longer Nice; Jossey-Bass 2005.

3. Bruises Inside and Out:Effects of Violence Over Time FTT, attachment problems Anxiety, PTSD,Somatic symptoms Aggression, depression Risk taking Abusive relationships Perpetuates violence (male or female)

4. Impact of ViolenceNeurobiological Mediators Nutrition Hormones Triggers Experience Neurotransmitters Environment Structure

5. For G-d’s sake, Jim, I’m just a doctor! So What Do We Do About It?

8. National Network of Hospital-based Violence Prevention Programs http://nnhvip.org/

9. Moving upstream

10. Outside Our Walls:From Hospital to Community

11. Community Based Participatory Research (CBPR) • Equitably involves all partners in research process • Recognizes unique strengths that each brings • Combines knowledge with action • Achieves social change WK Kellogg Foundation-funded Community Health Scholars Program Key Features: • Partnership drives the project • Broad goals > specific research: Long Term • NOT a method, but rather an approach

12. The Payoff • Programs are: • Culturally sensitive • Developmentally appropriate • Sustainable • Communities: • Are properly respected for their strengths • Better understand the value of research • Researchers: • Understand the impact of research (and results) on the community and people’s lives • Respect the process of collaborative research

13. CDC Urban Partnership Academic Center of Excellence

14. Philadelphia Collaborative Violence Prevention Center CDC Urban Partnership Academic Center of Excellence • CHOP • Drexel (School of Public Health) • Temple (Department of Public Health) • Penn • Graduate School of Education • Firearm & Injury Center at Penn • Dept of Biostats and Epidemiology (Medicine) • School of Nursing • Philadelphia Area Research Community Coalition (PARCC): Community representatives as Co-directors of each of the Center’s Four Cores

15. Research Core Co-Directors Penn: Richmond, T Temple: Hausman, A Community: Guerra, T Living Healthy in Philadelphia Research Project(1) PI: Leff (CHOP) Co-PI: Thomas, D. Safety Nets Vacant Properties Center and CoreDirectors Executive Committee All Core Directors Center Coordinator: Ayana Bradshaw, MPH Communication & Dissemination Core Co-Directors: Drexel: Rich, J CHOP: Leff, S Community: Henry, T Administration and Infrastructure Core Co-Directors: CHOP: Fein, J Penn: Cheney, R Community: Hayden, T Information Core Co-Directors: Penn: Branas, C Penn: Ten Have, T Community: Walker, A Each core consists has 3 co-directors: 2 academic, 1 community

16. Centerpiece Research Intervention Targets Youth 10-14 years old Youth Intervention - Problem solving - Anger mgmt -Leadership Parent Intervention - Support - Discipline strategies - Resources / advocacy Community Workshops - Public Speaking** - Leadership Promotion** - School Advocacy/ Parent Rights - Healthy Relationships • Facilitators: • Research Therapist • Site Staff (older youth) • Facilitators: • Research Therapist • Site Staff (parents) • Facilitators: • Community Mobiliz. Team • Site staff (leadership)

17. Intervention Design: Focus on Sustainability

18. PARTNERS: Preliminary Results • Acceptability& Feasibility • Participant and Staff range 3.41-3.74 (1 = Strongly Unacceptable to 4= Strongly Acceptable) • Leadership & Involvement • Leadership Questionnaire, Efficacy Subscale • Effect Size: d = 0.79 • Youth Asset Scale, Community Involvement Subscale: • Effect Size: d = 0.91 • Knowledge of Anger Problem Solving • Effect Size: d = 0.62 • Behavior Problems • Eyberg Child Behavior InventoryParent Report • Effect Size: d = 0.48

19. Community Indicators of Violence PreventionFocus Groups: What Would Success Look Like? Environment: • Cleaner streets, healthier communities • No kids on corner smoking / junkies on my stoop • Fewer abandoned cars • Less severe and less frequent violent events Community Behavior: • Increased civility, helping others • Kids go to church • Kids go to and do well in school, plan for college • Physical space and resources Economic Stability: • More home owners, more professionals in community • More businesses, more trade opportunities

21. Journal of Public Health Management and Practice 2009;15(6):E22-E30

22. The health and safety effects of greening vacant urban space: a difference-in-differences analysis Charles C. Branas, PhD, et al Department of Biostatistics and Epidemiology Cartographic Modeling Laboratory, University of Pennsylvania

23. Dissemination Data FROM a community are data FOR a community

24. Community Issue Briefs

26. Circulation = 4000

27. Dissemination Animation Animated dialogue re-written by youth advisory board to reflect language that would impart realistic situations Safe Neighborhood Tips (N=55)

29. www.phillyviolenceprevention.org

31. Philadelphia Collaborative Violence Prevention Center