Practice Title: The Trauma Prevention Initiative (TPI): Putting the Public Back in Public Safety
Department: Los Angeles County Department of Public Health
Size: Large (Population of 500,000+ people)
State: California
Summary of Practice:
The Los Angeles County Department of Public Health (LAC DPH) is a local health department (LHD) that serves over 10 million residents. As the most populous county in the nation, Los Angeles is home to a racially and ethnically diverse population. It is also geographically large, encompassing over 4,000 square miles that range from dense urban areas to rural areas in the deserts and mountains. Due to its large size, the County of Los Angeles is divided into eight geographic regions used by the LHD to assist in the planning and delivery of services. Further, there are over 40 public health programs in the LAC DPH that work to plan, develop, and implement public health services. The Office of Violence Prevention (OVP), housed within DPH, seeks to strengthen coordination, capacity, and partnerships to address the root causes of violence, and to advance policies and practices that are grounded in race equity, to prevent all forms of violence and to promote healing across all communities in LA County. The Trauma Prevention Initiative is an early implementation priority of OVP.
In LA County, there are over 50,000 serious violent crimes reported each year, including over 500 homicides. Between 2013 and 2018, over 23,000 people were treated in trauma centers for injuries sustained in assaults. Community violence has increased alongside the devastating impacts of the COVID-19 pandemic, both of which disproportionately impact communities of color and highlight deep inequities. According to the LA County Sheriff’s Department, homicides increased 37% in 2020 compared to 2019, and tripled in January and February 2021 compared to the same period in 2020. LA County has estimated the cost of violence from medical care and loss of work was over $870 million in 2019.
Violence is a public health issue and a social determinant of health that has lasting impacts on individuals, families, and communities, long after the violence has stopped. Communities with high rates of violence are often also disproportionately impacted by economic hardship, increased risk of chronic disease, alcohol and drug use, and other negative factors, these inequities are rooted in historical oppression and systemic racism. Violence exposes communities to complex trauma and toxic stress, and the risk of re-victimization.
The Trauma Prevention Initiative (TPI) is a comprehensive, place-based approach with a goal of reducing community violence and violent crime. TPI invests in community safety solutions that center survivors, employ peer specialists, and engage community members in decision-making about violence prevention and healing. TPI began in 2015 to reduce the disproportionate impact of violence and trauma among Black and Latinx communities of South Los Angeles. Recognizing the need to invest in prevention and reduce the burden on LA County’s trauma hospital system, the Board of Supervisors and the Department of Health Services’ Emergency Medical Services Agency allocated ongoing local Measure B funding to DPH to implement TPI. TPI invests in three key objectives to prevent violence: 1) intervention, using a peer approach in hospital and community settings to reduce and break the cycle of violence and violent crime; 2) investment in community engagement and community identified strategies to increase collaboration and multi-sector coordination; and 3) capacity growth for small grassroots violence prevention organizations by providing technical assistance and multidisciplinary training opportunities. Specific activities include:
-Hospital Violence Intervention (HVI) employs credible messengers to establish rapport and trust with victims of violence in the trauma hospital setting, conducts an assessment regarding status and needs, provides links to community resources and ongoing case management services.
-Street Outreach and Community Violence Intervention (SOCVI) agencies employ credible messengers to respond to violent incidents, conduct rumor control and maintain peace across neighborhoods, conduct safe passages to and from schools and parks, and link gang-impacted and affiliated community members to resources and services. OVP has contracted for SOCVI services in 4 South LA communities since July 2018.
-Community Action for Peace (CAP) networks support local leadership for shared decision making and promote positive community identity and collaboration. Westmont West Athens CAP has convened since 2017 and Willowbrook CAP since 2018. TPI CAPs held 5 community summits and facilitated mini grants to promote peace and well-being. To increase inclusivity and health equity for our diverse communities, bilingual translation is provided for meetings, events, and materials through staff and contracted services. TPI has also implemented community-identified healing-informed strategies via county partnerships including healing arts programs with the Department of Arts and Culture, mental health training and Park Therapy with the Department of Mental Health, a job center and aligned employment with Workforce Development, Aging and Community Services (WDACS), and aligned hate violence prevention with the Commission on Human Relations.
-Capacity Building Training and Technical Assistance supports grassroots violence prevention and intervention agencies, with a focus on organizational development, funding/resources, marketing, and evaluation.
Public Health Impacts and Benefits (2020 Data): Between 2016 and 2020, violent crimes in two communities declined, while violent crimes in unincorporated Compton increased and in Florence Firestone rates remained steady, showing promising early results. Westmont West Athens and Willowbrook, which have ongoing community engagement infrastructure, saw the greatest declines.
The most effective approaches to preventing violence include: (1) A collaborative approach that works across sectors to address risk and protective factors; (2) A comprehensive approach that includes strategies that address primary prevention (general population), secondary prevention (at-risk populations), and tertiary prevention (Impacted populations), across a socio-ecological model (individual, family, community, policy and systems); and (3) Engaging those most impacted, as survivors or as perpetrators, in developing and implementing the solutions to violence in their communities.
TPI is built on this collaborative and comprehensive approach that centers those most impacted in the design and delivery of services, which is fundamental to TPI progress and achievement. TPI community engagement is based on the principles of equitable engagement including collective decision making, shared power and mutual respect.
TPI further advances equity by investing in grassroots community organizations, providing career pathways for individuals who have been previously incarcerated, and building trusting relationships between community, government, and law enforcement.
Website: Los Angeles County Trauma Prevention Initiative (lacounty.gov)
The Trauma Prevention Initiative (TPI): Putting the Public Back in Public Safety
Category
Injury and Violence Prevention
Description