Howard Pinderhughes and the Hope Dealers

Howard Pinderhughes’ latest book begins with the funeral of a young man he knew.

“It’s one of the many I’ve been to, and it looked like prom – coats and tails and limos,” says Pinderhughes, a sociologist at UC San Francisco School of Nursing. “When you scratch the surface, you understand it’s a rite of passage that replaces some that normally exist in the development of a young person…almost a celebration of survival.”

Such rites, he says, emerge from a relentless exposure to violence, which deeply affects the mental, physical and emotional health of young people in these communities. One of the things Pinderhughes does in his book – titled Dealing with Danger: How Inner City Youth Cope with the Violence That Surrounds Them and due out in 2016 – is document those impacts and the ways these young people try to adapt.

Yet as he conducted his research over the last 15 years – and as awareness grew and multiple organizations and programs emerged to mitigate the effect of violence on individuals – Pinderhughes began to see a bigger picture.

He says the young people he works with experience an exaggerated version of PTSD – not post- but persistent-traumatic stress disorder – which is caused by the steady assault of peer or family or community violence, as well as a social structure of schools, police, government and local businesses that too often is unresponsive or, worse, compounds the violence.

So while the groups working to heal individuals’ emotional and physical wounds do extraordinarily important work, in nearly every case the affected individuals go right back into communities where violence is rampant. Thus Pinderhughes feels his book’s most important contribution to the discussion of violence as a public health issue is his analysis of “community trauma.”

“The effects go beyond the aggregate of individuals – to social relations, the community social network and social norms,” he says. “In highly impacted neighborhoods, we see each of those things disrupted, altered or destroyed.”

One result is that young people who grow up with violence – regardless of culture or race – understandably prioritize knowing how and when to use it as opposed to prioritizing what are considered socially useful tools in other communities, such as education or workplace skills. The costs to the individuals, their communities, population health and the larger society ripple out in myriad ways.

Believing in Solutions

Yet in his work with these young people and their communities, Pinderhughes sees hope.

“I talk with thousands of young people, many of whom have done some pretty horrendous stuff,” he says. “I can think of maybe two where I’d say this guy is too damaged to allow him to be among us. All the rest – the message they give to me is, ‘If you can end the madness around me, I’ll put my piece down and try.’”

In response, a new generation of violence prevention/resilience promotion programs is working in innovative ways to end or at least mitigate the violence and its effects on young people. The programs, says Pinderhughes, almost always grow from people within these communities, and they have garnered some encouraging initial results in places long believed hopeless. Pinderhughes has played a role in many of these programs around the country, in part by working with UNITY, a national initiative that partners with cities on comprehensive violence prevention.

Pinderhughes says that by drawing on concepts such as restorative justice – based on reconciliation, atonement and taking responsibility for one’s actions – and the healing circles found in Native American and African tribal traditions, these organizations are forging new and more successful models for change.

“These are not earthshaking things,” he says. “It’s often a matter of resources, and we need to find a will and a way.”

First Things First: Stop the Shooting

From left: Sam Vaughn, Rohnell Robinson (an ONS success story), and DeVone Boggan Among the programs that have received attention for their results and somewhat controversial approach is the Office of Neighborhood Safety (ONS) in Richmond, Calif.

Long one of America’s most violent cities, Richmond has the entire litany of urban ills, from poverty and crime to a school system with high dropout rates and poor test scores.

The ONS was established in 2007 and charged with building partnerships and strategies that produce sustained reductions in firearm assaults and related retaliations and deaths. In 2014, Richmond experienced 11 criminal homicides, the lowest number in 44 years.

Though there may be a few different reasons for the reduction, the ONS has received a lot of press as a primary factor. The centerpiece of its efforts is what its founding director, DeVone Boggan, calls its “fellowship” program, which began in 2010.

“The fellowships were created as a result of finding out that of 45 firearm-related homicides and more than 200 assaults in 2009, maybe 17 people were the most responsible,” he says. “[In the fellowship program], each year we identify the players and work on the idea that if we embrace these young men, we can make our community healthier.”

In this work, it’s important to look beyond the clichés about hardened killers, says Sam Vaughn, an ONS outreach counselor, who grew up and lives in Richmond and spent 10 years in prison. “It’s a rare few who get to a place where life doesn’t mean anything,” he says. “For most, [their use of violence] is about keeping their community safe – they’re in a war and they have honor; they have loyalties.”

The fellowships try to take that sense of honor and give it a different place to take root by offering fellows up to 18 months of individualized life skills development, mentoring and what Boggan calls “social re-engineering support,” handled internally by the ONS because of the difficulty outside agencies have in connecting with these men and their life circumstances. Fellows can receive anywhere from $300 to $1,000 per month, depending on their progress following a life map that the ONS works with them to create.

But the program goes far beyond creating life maps. Program counselors call each fellow multiple times every day. The ONS brings in “elders” – Pinderhughes has been one – to speak with the young men about an array of life challenges.

The ONS also takes fellows on field trips, out of state and out of country, with one requirement: the fellows must travel with their enemies. “We expose them to the cats they’ve been trying to kill,” says Boggan, calling the encounters on these trips a form of restorative justice.

The trips vary from Disneyland to a meeting with the mayor of another city or a college president. “It communicates something when someone values what they’re thinking.… So they come home different, with some tools and wisdom to begin to negotiate that life map,” says Boggan.

Getting to that point, however, is rarely easy. “We have to build trust, and it helps that all of [the counselors] are from Richmond – all of us were involved in negative behavior. Folks know us; they know our uncles and dads. When we offer them choices, they understand that we understand,” says Vaughn.

It also helps that the counselors in ONS don’t share information with the police and appear to be in this work for the long haul. Vaughn, who has been with the program since it began, explains, “My family lives in this community. My daughter goes to school here. Selfishly, I want my family to be safe, but [to keep doing what I’m doing] I have to love that person’s daughter in the other neighborhood as much as I love my own.”

That love, he continues, is what he and others at ONS convey to the fellows. “It’s making them realize you really do care about them,” he says. “We don’t accept bad behavior; we challenge it – and they don’t always like us, but they know we care. These young men can never again say, ‘No one told me differently.’ There’s someone who sees them for what we believe they can be.”

Boggan talks as well about the need to understand the pressures and hurdles these young men face when they try to change their lives. Most still wrestle with poverty, suspicious police, inadequate education and expectations from friends that they will live by the old rules and “rep the hood.”

“I’ve sat down with young men crying under that pressure, so you need to understand what it communicates to get all of that massive love,” says Boggan. “If we can instill a passion for life, a stronger desire to live, he’ll make better decisions; he can be in the mud and still be clean.… We’re hope dealers. We believe we’ll be successful and that gun violence will go to absolute zero.”

Faith and Advocacy

Pastor Mike McBride Pastor Michael McBride, known as “Pastor Mike,” leads a church in West Berkeley, Calif., named The Way Christian Center and serves as the national campaign director for PICO National Network’s Lifelines to Healing Campaign, which “aims to address the root causes of violence in cities,” according to its website.

Having grown up in San Francisco’s Bayview-Hunters Point neighborhood and having lived and worked his whole life in communities traumatized by violence, McBride believes Pinderhughes’ focus on community trauma is essential. “This is a public health issue, and we have to take these toxic environments seriously,” he says.

McBride does this by engaging the people most affected by violence and bringing their voices to community leaders. “The people living these challenges every day deserve the dignity of solutions beginning with them first: their voices, resilience, brilliance – their agency,” he says. “They should have the power to hold folks accountable who are supposed to be stewarding them.”

Those folks include not just government and the police, but also churches and schools, he argues, because all are part of systems that even when well-meaning have failed to prevent community trauma.

McBride says much of his work begins with identifying leaders from inside communities and developing and coaching their ability to shape solutions. He points to Andrea Marta, now a campaign manager for Lifelines to Healing, who at 14 was deeply disturbed by a drive-by shooting that occurred in front of her San Francisco church. Rather than call for more police presence, Marta helped organize a group of young people and senior citizens against the violence and successfully lobbied the administration of then Mayor Willie Brown to get a $7.5 million youth center built in the neighborhood.

That’s not to say everyone can or should be Andrea Marta, says McBride. “The challenge we face as organizers and advocates is creating enough of a framework or scaffolding to maximize appropriate engagement for everyone’s power, capacity, skill set,” he says.

Building that scaffolding begins with building trust. “As a pastor, I cannot expect young people to just show up at my church,” says McBride. “I have to go find them – and they aren’t hiding. The question is, Do we have the time, the heart, the passion, the love to displace our own privilege, show up on their home turf and not always force them to play an away game? Jesus gave up his privilege.… And we have to understand that when God is there, anything is possible.”

For McBride, his faith is central to his ability to connect. “In [marginalized] communities, we have traditionally been people of deep faith, and one of the great tragedies of this postmodern moment is that there is no role for faith,” he says. “I believe faith is critical and crucial as the air we breathe; [otherwise] it’s impossible to have hope in the face of such pain and dehumanization, such death dealing. I don’t apologize for my faith or the faith of others.”

Besides, he says, faith works. “It’s readable to these young people because they have moms or grandmoms who have a connection to some kind of faith, and when you blow on some embers, it comes alive.”

Part of McBride’s faith is that his ministry can create a safe zone where young people can, in a sense, cleanse themselves of the impacts of community trauma. “I grew up around a lot of immoral, illegal behavior, but within that, there were a lot of legal and moral contracts,” he says. “So it becomes a question of persuasion: Can my moral way of life be so persuasive that people will forgo theirs and model mine? That takes time, and one of the greatest challenges in our communities is that we give up on each other a little too early.”

Families Protecting Their Children

Left to right: Joyce O’Connor, Carol Dawson-Rose, Paula Fleisher (of the UCSF CTSI), Dina Hilliard and Kate Robinson “With an estimated 4,000 children living in only a half square mile, the Tenderloin neighborhood is home to the densest concentration of children and families in San Francisco. However, when these children leave their homes they face a neighborhood with the highest concentration of sex offenders in California, open drug dealing, and the constant threat of violence.”

This is the description on the home page of Tenderloin Safe Passage, reminding the world that constant exposure to trauma and violence can have a lasting effect on the psyche of young children. In response, over the past three years – with the help of a large 2014 grant from the Saint Francis Foundation – the program has grown into a thriving coalition of neighborhood groups, parents, youth-serving agencies and schools dedicated to making the Tenderloin neighborhood a safer place.

The program has also forged partnerships with UCSF School of Nursing, UCSF School of Medicine’s PRIME-US program and the UCSF Clinical and Translational Science Institute (CTSI) to evaluate the program’s impact and develop new strategies (see accompanying article).

Executive Director Dina Hilliard – who has lived in the Tenderloin for the past 16 years and has a 2-year-old daughter – has been involved in Safe Passage since a group of mothers from a community organization called La Voz Latina del Tenderloin brought their concerns to a neighborhood nonprofit where Hilliard was working at the time.

“They weren’t asking for more police or more money; they wanted a way for the neighborhood itself to look after itself,” says Hilliard.

The program began in 2012 with a sidewalk mural – a path of painted yellow footprints through 11 key Tenderloin blocks – and its growth since then is reflected in an array of programs and events. These include holding meetings that bring together youth groups, community organizations, schools and police to discuss common concerns and coordinate efforts to promote the needs of Tenderloin children, as well as offering street safety classes for the Tenderloin community and residents.

But the primary focus at the moment is the Corner Captain Program, which places trained volunteers at high-risk corners along the route the children walk after school to home or child care. The volunteers – some of whom receive a small stipend – serve as a safety presence for the youth.

Initially, the corner captains were an informal group of chaperones, but now they each must undergo training with the Kidpower organization. Every day, from 2:45 to 3:30 p.m., they stand on the designated corners wearing recognizable vests. As part of the process, Hilliard and Program Director Kate Robinson are creating a fully coordinated response system among the corner captains, using color-coded safety indicators. Each corner captain has a walkie-talkie, and if there’s a dangerous or emergency situation, he or she calls out the appropriate color code, and everyone knows to reroute the children.

“The other day we had to call a Code Yellow, when this drunk man got very close to the kids – very aggressive and negative about us being out there,” says Robinson. Code Yellow means a dangerous street element and notifies the team that the next group of kids should be rerouted. “But what was interesting was that as this was happening, a group came out of a neighborhood liquor store that is notorious for its illegal activity, and they protected us.”

One of the men, a known drug dealer, began reminiscing about his own childhood, and Robinson says they have seen similar responses from others in the neighborhood. In fact, some of the local drug traffickers have agreed to move elsewhere while the kids are walking home from school.

As with the ONS and Pastor Mike, much depends on building trust with all denizens of the community. “We try to remain a consistent, positive presence: smiling, waving, handing out postcards,” says Robinson.

“It’s about little things,” says Hilliard. “In our workshops we’ll talk to moms about how to walk through the neighborhood with a stroller, how to change your position to protect your child. I had to learn that; it’s not intuitive. And these little things change the culture.”

To that end, Safe Passage has recruited some of the city’s young tech workers to volunteer as corner captains. “I’ve had many of them come back several times and tell us they really feel like they’re making a difference when they do this,” says Hilliard. “They can’t just look away – when they stand there for an hour, they start to see the good and get more insight into what this neighborhood is about. That creates community.”

To continue to expand the program – extend the hours and participating schools, pay a stipend to all volunteers, create safe passage for the neighborhood’s seniors and make the mural a more permanent piece of public art – Safe Passage needs resources. And this means convincing those in power that the program has both short- and long-term effects that benefit the entire city, which is where UCSF can help.

“It’s too early to tell about significant positive impact, but the researchers from UCSF are helping us determine the primary corners we need to watch and develop an assessment tool,” says Hilliard. “They’re also out there counting the kids and observing the neighborhood and doing baseline surveys about perceptions of safety.”

“This is at the cutting edge of public health,” says Joyce O’Connor, a student in the School’s Advanced Public Health Nursing (APHN) program who is working on the project. “It’s about primary prevention and the social determinants of health. It’s also about empowering everyone [in the Tenderloin] to be working together toward feeling safer within their own community.”

“Our students going into public health can learn how to engage with the community – to listen to their needs and form a bigger vision of health,” says Carol Dawson-Rose, who was mentored by Pinderhughes while in her doctoral program. She has worked in the Tenderloin for years and is leading the School’s participation in the project.

Pursuing the Public Health Model

Youth ALIVE! Executive Director Anne Marks (far left) and the Youth ALIVE! staff and board members That bigger vision of health appears to be what drove public health activist Deane Calhoun to create Oakland’s Youth ALIVE! program in 1991. Concerned that gun violence had become the leading killer of California’s young people in the 1980s, Calhoun wanted to implement a public health model of prevention and intervention. In the ensuing two and a half decades, Youth ALIVE! has been widely recognized as one of the nation’s most successful models.

The organization’s three programs work with young people who “are most at risk for committing or becoming victims of violence to build their resilience in the face of traumatic events and to develop their skills and resources to help themselves and their communities.”

Teens on Target was Calhoun’s original program. Youth ALIVE! staff train young people as leaders and peer educators to teach violence prevention workshops and advocate for policies that reduce violence in their communities.

The second project – Caught in the Crossfire – intervenes with young people at the hospital immediately after they’ve been shot or stabbed, as well as with youth returning from juvenile hall. The idea is to help them transition and to prevent retaliation and reinjury. The program began when one of the group’s staff members, Sherman Spears – who was already at a crossroads – realized how much his life had changed almost immediately after he was shot.

“He had decided he didn’t want to retaliate, and it just felt right to him that we should intervene right away after a shooting; he didn’t know at the time how effective it is as a prevention strategy,” says Youth ALIVE!’s executive director, Anne Marks.

It’s effective, she says, because it addresses a well-documented cycle of retaliation. Multiple studies have shown that as many as 44 percent of young people who are victims of violence will have a second injury due to assault within 5 years, and as many as 20 percent end up dying from violence.

“They’re scared, they’ve got PTSD, and you get all the collateral effects like using drugs to self-medicate for nightmares, poor school performance, attendance – all correlated with lots of bad outcomes. This program began to prevent that [cycle],” she says.

The third program – the Khadafy Washington Project – takes a similar approach by providing crisis response and support for families and friends, to promote healing and calm tensions in the immediate aftermath of a homicide. It was initiated by a woman whose son, Khadafy, had been murdered and who believed strongly that no one should have to go through what she went through. In this project, trained peer counselors try to respond to every young person who’s injured in violence – and every single homicide.

Youth ALIVE!’s intervention programs are based on three simple principles, says Marks: Respond as soon as possible. Bring someone in from the community who can relate because they’ve had an experience of violence. And don’t just respond once, but create an ongoing relationship. Small caseloads help create those relationships, allowing intervention specialists to do things like have lunch with clients and drive them to doctor and therapist appointments.

Marks notes that longevity and sustainability are important success factors. To keep counselors in the program, the group spends a lot of time debriefing, discussing self-care and undergoing training in how to cope with the difficult situations they witness every day. In addition, Youth ALIVE! has helped pass a California law that authorizes reimbursing peer counselors through a victim-of-crime fund, so organizations like Youth ALIVE! can stay on firm financial footing.

Sustaining and Growing the Movement

Howard Pinderhughes Sustainability also matters to Pinderhughes, who says it demands vigilance and the type of passion that characterize the individuals driving these various organizations.

Such passion is also a characteristic of Pinderhughes’ academic work. Though research is generally associated with being dispassionate, he says his life experiences and the work itself do not really allow for such an approach. The depth and scope of community trauma – its impact on population health – require that in considering new approaches for preventing violence and promoting resilience, people peer through different lenses than they have in the past.

“I have a specific set of lenses, and I’m trying to use my experience and research to understand the dynamics that produce violence, as well as the approaches we have to reduce and eliminate it,” says Pinderhughes. “My goal is not to be objective; it is to be honest.”

Having worked with policymakers in cities across the country and at the federal level, Pinderhughes believes perhaps the biggest challenge is convincing people that violence is preventable. “We’ve gotten to accept a certain level of violence in this country,” he says. “And there are certain communities where we accept it more than others.”

Thus he is constantly challenging those in power to not give up too early and to find different approaches. He recently gave a talk, for example, that urged UCSF to think beyond addressing health disparities in medical situations and think more broadly about the social determinants of health, including violence.

“We’re the second-largest employer in San Francisco, and if we committed to having an impact on the social determinants of health – to creating pipelines for thousands of jobs – we could shift the levels of health and violence and well-being in a lot of communities. It would take a radical restructuring.… But I believe it’s possible, because I’ve seen it,” he says. “Young people I grew up with I thought were going to die and didn’t. Programs turn people and communities around on a shoestring. To [do it on a large scale] is really a question of social, political and economic will. We know what works. When you start to build trust and a foundation for positive social norms and ways of relating with each other, change can happen.”