Hospital-based Violence Intervention and a New Approach to Trauma

This podcast is part of a series highlighting innovative approaches to reducing violence and improving health outcomes among at-risk minority youth at the nine demonstration sites of the Minority Youth Violence Prevention Initiative. One of these demonstrations sites is the Youth ALIVE! anti-violence program in Oakland, Calif. Rafael Vasquez of Youth ALIVE!'s hospital-based violence intervention program, Caught in the Crossfire, joins the Center in this podcast to discuss Caught in the Crossfire and Youth ALIVE!'s novel approach to treating trauma.

The following is a transcript:

RAPHAEL POPE-SUSSMAN : Hi, this is Raphael Pope-Sussman for the Center for Court Innovation. This podcast is part of a series we are doing with people seeking to curb violence and improve access to public health for at-risk minority youth as part of the Minority Youth Violence Prevention initiative. The initiative is a partnership of the Office of Minority Health at the U.S. Department of Health and Human Services and the Office of Community Oriented Policing Services at the U.S. Department of Justice that encourages collaboration among public health organizations, law enforcement agencies, and community-based groups.

Our podcast series highlights innovative approaches at the nine demonstration sites that have received funding under the program. Youth ALIVE!, which is based in Oakland, is an anti-violence program that serves youth injured by violence or exposed to violence, youth who have a close relationship with murder victims, and formerly incarcerated youth. In August, I spoke with Rafael Vasquez, program coordinator at Youth ALIVE!'s "Caught in the Crossfire" hospital-based violence intervention program, about "Caught in the Crossfire" and Youth ALIVE!'s new trauma screening tool: The Screening Tool for Awareness and Relief of Trauma, also known as START. This interview was recorded at Youth ALIVE! headquarters.

POPE-SUSSMAN: Hi, I'm Raphael Pope-Sussman and today we're speaking with Rafael Vasquez, program coordinator at "Caught in the Crossfire" at the Youth ALIVE! program. Rafael, thank you for speaking with me.

RAFAEL VASQUEZ: You're welcome. Thank you.

POPE-SUSSMAN : So …  "Caught in the Crossfire."

VASQUEZ: "Caught in the Crossfire" is a hospital-based intervention program. It's been around for over 20 years. It was started at Highland Hospital. We service young men who have been victims of crime. We provide wraparound management services and we meet them at the hospital, which we believe, it's a crucial place to meet them at. We try to build the trust and a relationship with them, so that we can follow them out once they are discharged from the hospital.

POPE-SUSSMAN : Can you talk about how that happens logistically?

VASQUEZ: If someone comes into the hospital, we have an injury prevention coordinator at the hospital, she works for the hospital. She is the actually first interviewer of the client. She tells them a little bit about the program. She lets them know what sort of services we provide. She will then make a referral out to the program manager and then I actually go and meet with the client, in person, at the hospital. From there on, we match them up with an interventions specialist.

POPE-SUSSMAN : Can you tell me a little bit about the first visit?

VASQUEZ: The first visit can go in a lot of different ways. Generally, what should happen is you go in, make introductions, you introduce the program yourself, explain the program, you also let them know, depending on the severity of the injury, what sort of things they can expect from the doctors, what questions they may have. You can sometimes answer some of those questions for them, give them advice in terms of what they can do to feel better. Sometimes they're in a lot of pain and the interactions that they're having are not necessarily positive at that time. They're scared, so you try to gain as much information as you can. Do they have legal problems, or that kind of thing? Are they okay at home? Do they have children? Are the kids okay? Are there any safety issues where they're going?

Often times, we've had to move families out of where they're at just for their own safety. That's what tends to happen in the first visit. That's what you want to do. The idea is that you want to make sure they're not going to retaliate, go after somebody. Make sure that they're safe once they exit the hospital and someone isn't going to come after them or their family members.

POPE-SUSSMAN : You're coming in at an incredibly sensitive time.

VASQUEZ: Mm-hmm (affirmative).

POPE-SUSSMAN : How do you build trust?

VASQUEZ: It depends a lot on the individual. You have to be genuine and actually talk about things, so that they get a sense for you and they know that you understand. You don't want to necessarily self-divulge personal things, but the idea is that most of us have overcome violence in our own lives. We have experienced, whether it's a family loss, or a friend. You talk on that level with them. You also show them that their concern goes beyond, "Hey, you're going to be okay. We're going to ship you out and that'll be it. We're going to track you. We're going to be with you. We're going to be there to support you. Anything you may need, give us a call. We may not be able to do it, but we'll never lie to you. We'll tell you what we can and can't do." We try to meet them where they're at.

A lot of times, it may not be the first time you get there. By the time they have a feel for you ... By the time their visit is over, they have a feel for you that you're actually in their corner. That's what you want to try to establish with them.

POPE-SUSSMAN : What is the rule of law enforcement?

VASQUEZ: We let them know if ... for example, you're my client and you have a warrant. You're on probation, so we let them know, "We'll support you. Is there anyone we can contact? Do you have a PO? That kind of thing." We also let them know that any time that there's law enforcement contact, you're always going to know first. It's something that you're going to request for us to do. We're never going to go behind your back, do something, and talk to law enforcement without your knowledge. Everything is confidential in that, for the most part, any conversation that happens with law enforcement is on their behalf and for their benefit.

POPE-SUSSMAN : Is there apprehension sometimes when you are coming in about whether you're representing more of an institutional angle?

VASQUEZ: Always. That's the thing that we always try to address from the beginning. "We're actually here for you. We're in your corner and we're going to help you navigate through all these different systems." We like to make sure that they understand that even though we are at the hospital, we're not the hospital. Sometimes, unfortunately, they have negative interactions with hospital staff, so we want to separate that. "Hey, we're going to try to broker a better relationship between you and the nurse, between you and the doctors, whatever is going on, and we're working for you." The idea is that we're not going to place judgement on the client because we don't actually know what the full story is.

There are often times where you have medical staff who do place judgments, or they have their own ideas about why a certain person is in there, whether they way they speak, or the way they look, whatever the case may be. We try to advocate on their end that there could've been a number of historical things that led up to that shooting. That doesn't necessarily, or shouldn't necessarily make a difference on what kind of treatment they receive at the hospital.

POPE-SUSSMAN : Have you seen changes with your partners in terms of how they do treat the people who are coming in?

VASQUEZ: Yeah, there are some wonderful staff people at Highland. Over the years, I have seen they've grown more empathetic, I would say, towards young people and there's still a lot of hold-outs that are like, “Something's wrong with the parenting, these kids didn't get enough parenting, or their behavior,” or whatever the case may be that they will point the finger or the blame. I'm not saying that all youth are completely innocent from why they're there, but we're there to provide medical care for them. The word "care" needs to be in there. It's not about placing judgement, or making someone feel like, "You're in here because it's your fault. You need to shape up, pull yourself up by your bootstraps, and get over it."

POPE-SUSSMAN : Can you talk me through a case that you felt was a successful outcome?

VASQUEZ: Success can have many faces. Success can be simply not retaliating and not putting another body in the hospital or the morgue. It can also mean that the client, himself or herself, continues to move on and have a positive life, they have a family going, get jobs, go to college, or whatever their journey is. That's the ideal. Many times, depending on how severe the injury is, you can have a kid who ends up in a wheelchair. Getting him through not giving up on his own life, moving through, functioning somehow in society, and that sort of thing can also be a success. That's why we say, "We meet them where they're at," because you don't actually know where they're going to end up at, depending on how severe the injury is.

If they're already bringing a lot of historical factors that affect them, you want to see if you can get them the help, one--if you do get them around a whole stigma of getting mental health services, they actually sign up to mental health services, you move them past that, and they get something from the mental health, that's also a type of success. Success can vary, depending on what you're looking for.

POPE-SUSSMAN : If you can, tell me a recent story that sticks in your mind.

VASQUEZ: Let’s see. One of the recent stories is two sisters that were shot together, in front of their home, trying to stop a fight. They apparently got into a fight over the dogs with the neighbors. The neighbors called somebody up and said, "I have a problem with my neighbor. Come over here." Things escalated, they ended up shot. They have to go back into their neighborhood, into that same house. Luckily, we partnered with another agency that was able to get them safety relocation and got them out of the immediate area for a few days. Part of their other program is to come in and make peace between different people having different kinds of issues and we were able to calm things down through that.

Now, we're still working with both of the sisters. They're going to be moving out and being relocated. They have kids in their home, so we, for the most part, stopped the violence. We're ensuring that it doesn't keep going. The idea is that once they exit the immediate area where they're at, that danger will be gone for both sides. That's one that sticks out in my mind.

POPE-SUSSMAN : What is the follow-up there?

VASQUEZ: The follow-up would be making sure they're all right because they're still freshly out of the hospital. The danger is that they get re-injured, they're back in the hospital, now the injury is worse, or they can be killed, depending how serious it gets. The follow-up is that once you get them out of there, now you've focused them on getting the medical attention, then getting mental health, if the kids ... there's a total of four kids in the home, little kids. If they need assistance, getting them the assistance that they need, and then moving them past as a unit because there's two families that are being affected, then seeing where they end up in support. It could be getting them jobs wherever they're going to move to, making sure that they're okay, and they have some support group. Whether it's another agency, family members, churches, whatever it is that we need to hook them up with once they are wherever area they end up at.

That's the follow-up and then we just track them to see what kind of things come up as they go.

POPE-SUSSMAN : What is the role that this new trauma screening tool is playing?

VASQUEZ: The START program ... The cool thing about the START program for the kids, the really nice thing, is that they actually get techniques that really help them deal with the stress from day to day. The questions that are already there help them to open up, to talk about it, so they don't feel like when they're coming in, "Oh, somebody's going to lay me down on the couch and they're going to want me to talk about my feelings." Most of the young men we deal with don't react well to that. The major role that it's playing is that it's opening the kids up and prepping them for actually meeting one-on-one with their therapists. Knowing that the therapy is ... The way that we do it here is make sure that it's about your current injury and not about all your historic ... They can do that, too. Once they get a feel for the therapists and the trust is there, they tend to open up even more. That's the main impact that I've had.

POPE-SUSSMAN : Wonderful.

VASQUEZ: No, you got me before coffee. I hope I did all right.

POPE-SUSSMAN : Fantastic. This is Raphael Pope-Sussman, speaking with Raphael Vasquez, program coordinator at Youth ALIVE. For more information on the Center for Court Innovation, visit www.courtinnovation.org.