Promote Equity Prevent Violence Karen Sheehan, MD, MPH Medical Director Lurie Children’s Healthy Communities
• I have nothing to disclose
Objectives • Assess how the burden of violence in Chicago disproportionately impacts youth of color • Demonstrate the socioecological approach to youth violence prevention • Discuss how addressing health equity is a tool to prevent violence
New York Times Chicago Tribune DNA Info Chicago Sun-Times Chicago Tribune Chicago Tribune ABC News Chicago Tribune
Chicago- Long History of Violence
Homicide Trend (1957-2017) 808 (2016) 682 (2017)
Homicide Trend (1957-2017) 808 (2016) 682 (2017)
More Information Than You Wanted To Know
Homicide Victims in Chicago, 2010-2017 Jens Ludwig Crime in Chicago: Beyond the Headlines University of Chicago 2018
As of October 9, 2018 :
Homicides in Chicago by quarter, 2013-2017 241 250 229 Number of homicides 198 190 189 200 178 151 150 145 144 142 150 126 124 121 119 108 107 88 100 80 72 50 0 2013 2014 2015 2016 2017 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Illinois Violent Death Reporting System, Lurie Children’s IPRC, 2018
Illinois Violent Death Reporting System (IVDRS) • Surveillance System funded by the CDC, IL joined in 2015 • Lurie Children’s is bona fide agent for State of Illinois • Pools information about the “who, when, where, and how” of violent deaths to provide a more complete picture and develop insight into “why” they occur • Data sources: death certificates, coroner/medical examiner reports, law enforcement • IVDRS initial years 2005-2015 funded by philanthropy and State of Illinois • 10 year + dataset allows small area analysis
Homicides in Chicago, 2008-2017 900 810 800 681 700 600 534 514 529 475 468 500 459 457 450 400 300 200 100 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year of Death Illinois Violent Death Reporting System, Lurie Children’s IPRC, 2018
Homicide Rates, Chicago and Large Cities Jens Ludwig Crime in Chicago: Beyond the Headlines University of Chicago 2018
Jens Ludwig Crime in Chicago: Beyond the Headlines University of Chicago 2018
Homicides by Weapon Type in Chicago Over Time Illinois Violent Death Reporting System, Lurie Children’s IPRC, 2016
Homicide Victims by Race, 2015-2016 Gun Violence in Chicago, 2016 University of Chicago Crime Lab, 2017
Homicide Rates per 100,000 in Chicago over time, by race/ethnicity Illinois Violent Death Reporting System, Lurie Children’s IPRC, 2016
Rate per 100,000 of homicides in Chicago which occur to black males aged 18 to 34, versus all others, 2008-2017 450 Black male, 18-34* All others 412.8 400 354.6 350 300 258.1 Rate per 100,000 252.8 234.4 250 222.3 213.2 212.9 203.6 200.9 200 150 100 50 15.8 13.0 11.3 11.1 9.4 9.6 9.2 8.9 9.5 10.1 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Illinois Violent Death Reporting System, Lurie Children’s IPRC, 2017
AGES OF HOMICIDE VICTIMS, AGES OF HOMICIDE SUSPECTS, 2015 VS. 2016 2015 VS. 2016 Gun Violence in Chicago, 2016 University of Chicago Crime Lab, 2017
Locations of Gun Homicide and Shooting Incidents, 2015 vs. 2016 Gun Violence in Chicago, 2016 University of Chicago Crime Lab, 2017
Homicide Rates by Community Area Illinois Violent Death Reporting System, Lurie Children’s IPRC, 2017
What Caused Chicago’s Homicide Increase? • Lack of resources to solve • Fractured gang hierarchies serious crime • High rates of neighborhood poverty and segregation • CPD mis-management • Influx of guns • Changes in city and state funding for social services • Demolition of public housing • Closing of mental health • Insufficient penalties for illegal services gun-carrying • Weather • Social media disputes • Reduced police activity Gun Violence in Chicago, 2016 University of Chicago Crime Lab, 2017
Data check in • Between 2015 and 2016, Chicago saw a large increase violence which – Involved Guns – Involved African-American men – Involved mostly 20 to 30 year olds – Occurred in public – Focused on a handful of neighborhoods on Chicago’s South and West Sides – These neighborhoods have disproportionately affected by violence for at least a decade • Between 2016 and 2017, Chicago saw a decrease in violence – Yea!-But why?
Public Health Approach to Violence Prevention • Primary Prevention Orientation – Efforts are focused on preventing violence before it occurs • Data-driven – Considers risk and resilience factors • Collaborative – Multi-sector approach • Population-based – Seeks community wide or “environmental” solutions
Factors Affecting the Injury Incidence Frequency of Violent Outcomes of Violence Events Factors Affecting the Severity of Violent Incidents KKC
Social-Ecologic Model: A Framework for Prevention Individual and Family Public Policy Community
Public Policy Individual and Family Community
Individual and Family
Youth Development Programs • Youth Violence is obviously a complicated issue • Many factors contribute to the incidence of youth violence • Youth Development Programs are one strategy of a multi-level intervention
Chicago Youth Programs • Founded in 1984 by Northwestern University Medical & Law Students • Goal: to improve the health and life opportunities of at risk youth • A once a year well child care visit was not enough to improve the health of children • To improve the health of children, it was essential to get them out of poverty. For most, education was the surest route
Cabrini Green • ½ mile from NU’s Chicago Campus • Housing and Urban Development • 80 buildings • ranging from 2-3 story row houses to 19 story buildings • Reputation for extreme poverty & community violence • CHA Plan for Transformation • Last high rise torn down 2011
Improbable Beginnings • Went to Cabrini Green; invited kids to the NU campus • For over ½ the kids, first time to see Lake Michigan • Any child was welcome • No cost to participate • No Conceptual Framework • Right Thing to Do • Trial and Error
The Early Years • Saturday AM – Tutoring – Computer Room – Basketball – Swimming • 6-12 year olds • 40 kids • Medical & Law student volunteers • Modest Budget
By the late 1980’s • Became clear that CGYP helped the volunteers more than the kids – CGYP not suited for adolescents • Pregnancy • Gang Violence • Asked the teens what should we do to keep them in? – Teen specific activities – More responsibility/say in programming – Ability to make some money/learn skills • Asked ourselves: who do we serve?
Exposure to Violence in a Cabrini Green Representative Sample of 7-13 yo Children • 42% had seen someone shot • 37% had seen someone stabbed • 21% lived with a shooting victim • 16% lived with a stabbing victim Chicago Tribune, 2016 Arch Ped Adol Med 1997
Where Do CYP Children Feel Safe? • Most children, but not all, felt safe at home • Most children did not feel safe at school or in their communities • The children felt the safest when they were with caring adults Arch Ped Adol Med, 2004
Early 1990’s: Teen Specific Programming • Children Teaching Children • Teens became positive role models for younger children • Provided teens ability to make some money/learn skills
Partnership with Lurie Children’s -1993 • Clinic established • 3 of the medical students from the early years are on staff at Lurie Children’s and are on the CYP Board • Partnership strengthened when 2 hospital leadership staff joined the CYP Board and chair key committees • Identified as a key partner in the hospital’s CHNA plan
CYP Clinic • Medical student volunteers- -in clinic and outside clinic • Extensive Case Management-Social Work, APN, Psychiatrist • Triple P trained staff • Second Generation children • 2 populations served Even the best doctor can’t improve the health of a child through a once year WCC visit alone — she needs to partner with others outside the hospital walls.
CYP Model • Evolved from a weekly mentoring program • Integrated, asset based, comprehensive programs for youth, 0-21+ years • Programs designed to address the health, educational, recreational needs of youth • Volunteer-led • Students and corporate volunteers • Donated space • Free to participants • Cabrini Green/Near North, Washington Park, Uptown, North Lawndale www.chicagoyouthprograms.org
Evaluation • Individual Programs – Children Teaching Children • Process – Retention • Qualitative – CYP “Graduates” – CYP “Drop - outs” • Outcomes • Minimizing Barriers • Higher Education • Long Term Follow Up Study
Children Teaching Children • Peer mentoring program • Uses games, skits, and music to teach health messages • Used a case matched cohort study to examine aggressive and violent behaviors • Intervention group scores maintained; control group worsened Pediatrics 1999
Recommend
More recommend
