Monthly Archives: October 2015

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
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

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.

VASQUEZ: You’re welcome. Thank you.

: So …  “Caught in the Crossfire.”

“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.

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

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).

: 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

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.

: Is there apprehension sometimes when you are coming in about whether you’re representing more of an institutional

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?

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

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.

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

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.

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.

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.

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

: 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


Coming Home to Harlem: Understanding the Impact of a Reentry Court

Lama Hassoun Ayoub, researcher and co-author of Coming Home to Harlem, discusses the impact of the Harlem
Parole Reentry Court
on the lives of parolees returning to Harlem after incarceration. 


following is a transcript

Hi. I’m Avni Majithia-Sejpal, Senior Writer at the Center for Court Innovation. In today’s New Thinking
podcast we’re talking about reentry courts, specifically, the Harlem Parole Reentry Court in New York City operated
by the Harlem Community Justice Center. Researchers from the  Center for Court Innovation recently completed
a comprehensive study that explores the reentry court’s impact on the lives of its participants, comparing their
experiences and outcomes to those of individuals on traditional parole. Their report, titled “Coming Home to
Harlem,” has yielded some interesting results and can be accessed at Here with me today
is one of the report’s authors, Lama Hassoun Ayoub, Senior Research Associate with the Center. Welcome, Lama.

LAMA HASSOUN AYOUB: It’s great to be here.

MAJITHIA-SEJPAL: My first question is what is a reentry court and what does it

HASSOUN AYOUB: Reentry courts are specialized
courts that work to reduce the recidivism of ex-offenders and improve public safety. They work with people coming
home, usually from prison, to help them reintegrate into society. They’re considered to be a problem-solving
court and they’re really built off the drug court model that we know is successful.

MAJITHIA-SEJPAL: For the record, what recidivism entail?

HASSOUN AYOUB: Recidivism is the rate at which people who have returned
home from prison after incarceration re-offend. We measure recidivism by looking at a variety of different factors.
We look at rearrest, reconviction, and what we call revocations. Revocations are returns to prisons, usually related
to violating parole. Of the people who are released nationally, we know that about two-thirds of them will be rearrested
within five years of their release. Over half of them will be returned to prison on a new conviction or a violation
within five years of their release.

I see. When people return home from prison, what kinds of challenges do they face as they attempt to transition back
into their communities?

a lot of challenges associated with reentry. One of the biggest ones is employment. It’s very hard to find a
job after you come home from prison, especially with a record, a criminal record. Another challenges is housing.
People have trouble finding stable housing, and research shows that housing is actually really important to be successful
in your reentry. There are also many other challenges such as substance use, getting appropriate services and treatment,
and reintegrating with families and children.

Can you talk a little bit about the Harlem Parole Reentry Court. How does it work?

AYOUB: The Harlem Parole Reentry Court works specifically with parolees. Those are people who are coming home from
prison to be supervised in the community by parole officers. For a typical parolee, they interact with the staff
from the reentry court even before their release. They receive pre-release services that often involve risk and needs
assessment and some planning. Sometimes that risk and needs assessment occurs once they’re released. The first thing
that really happens with them is that they report to the reentry court, they see their parole officer, they see a
dedicated case manager, and they also meet the reentry court judge for the first time.

That’s the real center of the reentry court that makes it very different
from parole, the fact that they have to report regularly to a judge and have judicial oversight during the time that
they’re there. The reentry court team works closely together; the judge, the parole officer, the case manager,
and other staff to coordinate support services for the client. They also use a schedule of rewards or sanctions,
so that means that people get sanctioned based on their behavior, and they also get rewards based on positive behavior.
Those are really the elements that are central to the operations of the reentry court.

MAJITHIA-SEJPAL: Who are the participants that go through this court and what
kinds of offenses are we talking about here?

AYOUB: The reentry court works with clients who have felony offenses, for the most part. About half of them were
in prison for violent offense and another half were in prison for drug offenses. There are also small percentages
of property offenses. Most of the reentry court participants have been in prison for quite some time. They were in
state prison, which means they’ve served at least one year. For many of them, it been many, many years since
they were home in Harlem. The reentry court does exclude a few people. They exclude sex offenders, arsonists, and
people with diagnosed Axis I mental health issues. Just so you know, this population is predominantly male, it’s
only about two or three percent female, and it’s mostly black or Hispanic. Around 97 percent of the population
identifies as either black or Hispanic, or both.

Let’s turn our attention to the study that you recently completed: “Coming Home to Harlem.”How do
you go about your research?

had four major components. The first component was what we call a randomized control trial. That basically involves
randomly assigning parolees to either Harlem Reentry Court or traditional parole. The second component was looking
at the official records of those randomly assigned parolees. The third component was in-depth interviews with a subset
of the parolees that were randomly assigned. The fourth component was interviews with the reentry court judges. We
were actually able to interview six reentry court judges who served on the court over the last ten years.

MAJITHIA-SEJPAL: Based on your research, what kind of impact does the Harlem
Parole Reentry Court have on recidivism rates? Can you break down the numbers for us.

HASSOUN AYOUB: Sure. When we looked at recidivism we looked at rearrest, reconviction,
and revocation. By revocation, I mean, returns to prison that are associated with violations of parole, specifically,
not necessarily new arrest. With rearrest we really didn’t see a big difference. About half of the population
of the reentry court and half of the parolees are regular parole were rearrested within 18 months of their release.
We believe that we didn’t see a big difference because this population has a high exposure to arrest. They live
in Harlem and they’re a minority community.

when we looked at reconviction and revocation we did see significant differences. Reentry court parolees were significantly
less likely than the control group to be reconvicted within 18 months and we saw a 22 percent reduction in reconviction.
When we looked specifically at felony reconviction, we saw a 60 percent reduction in felonies. We also looked at
revocations. It’s important to know that the Department of Corrections and Community Supervision has been working
to reduce revocations, generally, so even the parolees on regular parole had lower revocations than they would’ve
had historically. But then we also saw a statistically significant difference, in fact, there was a 45 percent reduction
in revocations when we compared the reentry court group to the traditional parole group.

MAJITHIA-SEJPAL: What about the impact on other aspects of the parolees lives?

HASSOUN AYOUB: By doing the in-depth interviews we were able to explore
the other aspects of their lives because it’s hard to get official data on things like education or family relationships.
Our interviews really provided us with information we wouldn’t have gotten elsewhere. We saw significant differences
when we looked at employment. The reentry court parolees were more likely to report being in school or having a job
at one year after their release. In fact, 75 percent of them said they were in school or had a job compared to only
45 percent of the parolees on regular parole. They also had higher quality jobs. By that, I mean, jobs that give
you paid days off or provide you with health insurance. They also worked more hours per week than the parolees on
regular parole and they also worked more months in the past year. Because they worked more hours they also had a
slightly higher income than the parolees on regular parole.

Were there any other differences that you found between the experiences of participants of the reentry program and
those that had a more traditional experience of parole?

AYOUB: We saw some big differences when it came to their supervision experiences. We asked people in interviews about
how many times they saw their parole officer, but we also asked them about their perceptions of the criminal justice
system, an area that we call procedural justice. In that, we saw statistically significant differences. The reentry
court parolees had much more positive perceptions of the criminal justice system. They also had more positive attitudes
about the judge that they last interacted with. They also even had better attitudes toward their parole officer.
Those were statistically significant differences that we think may also be connected recidivism. I also want to add
that the reentry court parolees were also more likely to receive a reward during their parole and less likely to
receive a sanction, so only 30 percent of them said they had received any kind of sanction or consequence to their
bad behavior compared to nearly 70 percent of the regular parolees.

By reward, you mean?

HASSOUN AYOUB: Reward could
be something as simple as praise from your parole officer, like getting a pat on the back, but could also mean things
like gift cards or actual gifts.

To conclude, what are some of the challenges that the court faces today, and what are the next steps for the Harlem
Parole Reentry Court?

HASSOUN AYOUB: The evaluation
showed that reentry court model, as implemented in Harlem, is successful. They were successfully able to reduce recidivism
and have an impact of the lives of parolees. Many of their challenges today are associated with things like sustainability
and expanding the court, making sure that the lessons we’ve learned from this evaluation and from the work they’ve
done can be used in other areas, and that they can continue to sustain this work and help parolees coming home to

MAJITHIA-SEJPAL: Lama, thanks for sitting
down with me today.

HASSOUN AYOUB: Thank you, I appreciate
it. It’s really important for us to share the findings of this evaluation.

I’m Avni Majithia-Sejpal, and I’ve been talking to Lama Hassoun Ayoub about the Center for Court Innovation’s
report “Coming Home to Harlem,” which examines the impact of the Harlem Parole Reentry Court on the lives
of participants who are returning home from prison. To read and download the report, go to research
on Thanks for joining us today.