Program History

1
Program History

• Youth ALIVE!, a public health agency dedicated to
  preventing violence generating youth leadership
  in California communities established in 1991.
• Caught in the Crossfire formed in 1994 after an
  Emergency Room Doctor a Medical Social Worker
  call Youth ALIVE! requesting support services for
  youth repeatedly hospitalized for violent
  injuries.
• Between 1994 and 2002, Caught in the Crossfire
  expands to provide services to additional youth
  by entering into additional partnerships.

2
Partnership with ACPHD

• Since 2001
• Planning meetings with Jeff, Kimi Medical
  Directors
• Current partnership with Tiger Health Clinic/La
  Clinica
• Public Health Nurse provides services to clients

3
Demonstration of Need

• 113 homicides in Oakland in 2002!
• Of 113 homicide victims, 42 were age 25 or under
• Of known homicide suspects, 50 were age 25 or
  under
• Guns were the mechanism of injury in 85 of these
  homicides (99 for victims 25 and under)

4
Program Goals

• Prevent retaliatory violence.
• Reduce total number of youth injured killed by
  interpersonal violence.
• Reduce entry re-entry into the criminal justice
  system.
• Promote positive alternatives for youth.
• Provide positive peer role models.

5
Program Overview

• Employs local community residents who have
  experienced overcome violence in their own
  lives to serve as Intervention Specialists (IS)
• Intervention Specialists act as mentors provide
  case management, support wraparound services
  to clients and their families

6
Client Population

• Youth ages 12-20 injured by interpersonal
  violence
• Middle high school students ages 11-18
  identified as being at high risk for dropout,
  suspension or violence
• Program participants families and friends

7
What A Patient Can Expect After Hospital
Discharge For

• Heart Attack
• Diet plan
• Exercise plan
• Stress reduction plan

• Gunshot Wound
• Painkillers (1 week supply)
• Bandages

8
Risk Factors for Youth Survivors of Violence

• Youth are discharged from hospitals into the same
  violent environment in which they were originally
  injured.
• Family and friends may want to retaliate on
  youths behalf as a show of support.

9
Program Services

• Intensive initial bedside/home visit
• Case management/mentoring involving ongoing
  intensive personal telephone contact for up to
  one year
• Information and referrals
• Advocacy for youth and their families
• On call 24/7 crisis assistance and support

10
Services Referrals
Youth family
School
Hospital
Caught in the Crossfire
Health Care
Emergency Services
Job Training Placement
Counseling Services
School Enrollment
Court Advocacy
Transportation
Educational Programs
11
Fiscal Cost Comparisons

• Total program cost per year is approximately
  300,000 (averages to 3,000 per client per year)
• Costs of other programs/alternatives per person
• 27,000 for California Youth Authority per youth
  per year
• 40,000 for gun shot treatment per patient
  (Rizer et al. Hospitalization charges, costs, and
  income for firearm-related injuries at a
  univiersity trauma center. JAMA. June
  14,1995273(22)1768-1773.)

12
Case Study

• Name Maurice
• Age 15 years old
• Injury Gunshot wound to hand gunshot wound to
  face 3 weeks later

13
Program Evaluation

• A non-randomized retrospective case control study
  of the hospital component of the program was
  conducted from 1998-2001 by a multi-disciplinary
  evaluation team
• The California Wellness Foundation Violence
  Prevention Fellows
• Highland Hospital Trauma Services/ UC Davis
• Community Epidemiologist (Alameda County Public
  Health Department)
• Youth ALIVE!

14
Evaluation Design

• Total Sample Size112
• Treatment Group (N43)
• Youth ages 12 through 20 treated for
  violence-related injury at Highland Hospital
  1/1/99-5/31/00 who had 3 contacts with an IS
  within 6 months of hospital release (at least 1
  in-person contact)
• Comparison Group (N69)
• Youth ages 12 through 20 treated for
  violence-related injury surviving at Highland
  Hospital 1/1/98-12/31/98 who did not receive any
  program services
• Data collection period6 months following date
  of injury

15
Demographics (Treatment Control)
61
24
8
6

• 79 male 21 female
• Average Age 18 years

16
Key Outcomes Evaluated

• Rate of entry/re-entry into criminal justice
  system
• Rate of re-injury/ re-hospitalization
• Rate of violence-related death

17
Data Collection Methods

• Record review from the following data sources
• Highland Hospital, Eden Hospital, Childrens
  Hospital Oakland
• Alameda County Coroners Office
• Alameda County Probation Department
• Oakland Police Department
• Client case notes

18
Results

• Significantly lower arrest rates during 6 months
  post-injury among treatment vs. control
• One re-injury among treatment group during 6
  months post-injury one re-injury among control
  group
• No violence-related deaths among treatment or
  control group

19
Arrest Rates Prior to Injury
53.5
52.2
34.9
26.5
20
Arrest Rates During 6 Months Post-Injury
15.9
5.8
4.7
0
p
21
Reduction in Arrests

• Intervention youth were 70 less likely to be
  arrested for any offense (odds ratio0.257) and
  60 less likely to have any criminal involvement
  (odds ratio0.356) when compared to controls.
• Defined as placement on/violation of probation
  or arrest

22
Linkage Between Arrests Health

• Criminal involvement places an individual at
  increased risk for subsequent violent
  victimization.
• Dobrin, AL. The risk of offending on homicide
  victimization A case control study. Journal of
  Research in Crime and Delinquency
  200138(2)154-73.
• Dobrin, AL. The risk of offending on homicide
  victimization A public health concern. Am J
  Health Behav (forthcoming).

23
Study Limitations

• No long-term follow-up
• Results may have been confounded by historical
  effects
• Key indicators (school enrollment employment)
  not measured in relation to need data not
  available for control group

24
Program Outcomes

• Provide positive role modeling, mentoring, and
  advocacy for youth and their families
• Provide case management and wrap-around
  services to youth and their families
• Empower community members to improve their
  communities by hiring training them to serve as
  Intervention Specialists

25
Program Outcomes

• Provide trained peer bedside visitation and home
  support to youth and their families
• Provide youth with alternatives to violence
• Connect youth with community resources