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.

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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. 

The
following is a transcript

AVNI MAJITHIA-SEJPAL:
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 courtinnovation.org. 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
do?

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.

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

HASSOUN AYOUB: There are
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.

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

HASSOUN
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?

HASSOUN
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.

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

HASSOUN AYOUB: The study
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.

However,
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.

MAJITHIA-SEJPAL:
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?

HASSOUN
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.

MAJITHIA-SEJPAL:
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.

MAJITHIA-SEJPAL:
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
Harlem.

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.

MAJITHIA-SEJPAL:
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 courtinnovation.org. Thanks for joining us today.

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John Chisholm, district attorney of Milwaukee County, Wisconsin, joins the New Thinking podcast
to discuss community prosecution, diversion, and his
work to reduce mass incarceration and racial inequities in the justice system.

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In this podcast, Anne Marks, executive director of the Youth
ALIVE! hospital-based anti-violence program in Oakland, discusses the history and mission of Youth ALIVE!,
its partnerships with local public health and law enforcement agencies, and how funding under the Minority Youth
Violence Prevention Initiative is increasing the organization’s capacity to serve high-risk minority youth.

The
following is a transcript

RAPHAEL POPE-SUSSMAN:
Hi, this is Raphael Pope-Sussman with the Center for Court Innovation. Today we’re speaking with Anne Marks,
executive director of Youth ALIVE!, and training director for the National Network of Hospital-based Violence Intervention
Programs. Anne, thank you for speaking with us today, and welcome.

ANNE MARKS:
Thanks.

POPE-SUSSMAN: Tell me a bit about Youth Alive.

MARKS: Youth ALIVE! is an almost 25-year-old violence prevention intervention
and youth leadership organization. We are a home-grown organization. We began with a group of students 25 years ago
in East Oakland who were dealing with violence in and around their school, and in their community who wanted to do
something about it, and they developed a series of workshops, which they peer lead to this day, to talk to young
people about gang, gun, family, and dating violence and what people can do to make themselves safer and to make choices
that are healthier.

Starting with those young people is how we began. We incorporated it to support
their vision and their work. They also do a number of community engagement and organizing and advocacy activities,
and from there, we actually had a staff person working in that program, who founded our Caught in the Crossfire program.

Sherman Spears was, as a young man, a victim of violence. He was a gunshot victim and found that that moment
was pivotal in his life, and he wanted to make sure that he was there for people who dealt with that in the future.
Whereas his options at the time were to retaliate or to just die, he wanted to find another way out, and so he found
a way to start working in violence prevention, so he started the Caught in the Crossfire program to help respond
immediately after a young person has experienced trauma, gunshot, stabbing, assault, to help them get on a different
path with a peer who can relate to them to support them.

That program then later incorporated
not just people who had been recently assaulted, but also people who had recently experienced the trauma of incarceration,
so we’ve been working with youth and young adults for some time through that program. That program has actually
been replicated in dozens of communities, and we support those programs through our National Network of Hospital-based
Violence Intervention Programs.

The last thing that we do at Youth ALIVE! is, we work not just
with young people who have been injured, but we work with the families and friends left behind when someone has been
killed by violence. We respond to every single homicide in the city of Oakland to provide the family and friends
with support. We do that work in the memory of Khadafy Washington, who was the murdered son of the founder of that
project, the Khadafy Washington project.

POPE-SUSSMAN: A lot of your
work really focuses on trauma and responding to trauma.

MARKS: Absolutely.

POPE-SUSSMAN: Can you tell me a bit about the Screening Tool for Awareness
and Relief of Trauma, and what the origin of that is?

MARKS: So START,
we call it the Screening Tool for Awareness and Relief of Trauma. It’s really just that. It’s a start for
addressing trauma. The metaphor that we think to look at this is that, trauma is something that hurts, and START
is not a cure. START is aspirin that helps relieve the pain of trauma. It doesn’t make it go away. It’s
not the same thing as engaging in long-term therapy or other support, but it’s something that can help people
feel better and get some relief. How it works is we do a brief screening with someone around different symptoms of
trauma, how it may actually be affecting their life. What their actual experiences of trauma are are actually irrelevant
to how we do this, so we don’t need to know the details of what happened to them to be able to say, “are
these things affecting your life?”

For example, issues with focusing, issues with sleep,
things that can really impact how you live. Then, based on how the respondent answers these questions, we give them
a series of one to three different tools that are brief. We can usually get through this interview in 10-25 minutes,
and give them tools they can walk away with, things they can take home. Maybe it’s a plan on how to sleep better,
maybe it’s a relaxation exercise they didn’t have before, so when they leave, they’ll have something
that will make their lives better.

The goal with START is two things. One, give people some relief,
but the other is that when they have this relief, either they will go home, and because they have some relief, they’ll
be able to kick in their own resilience and their own coping skills and strategies, and turn their life into a better
direction. And, the second thing is, maybe the experience of something actually being beneficial to them, that positive
experience will actually make them want to continue to get care and believe that change and improvement is possible
in their lives.

There have been a lot of tools out there that address trauma, and trauma is something
that, historically there have been three groups that have been treated for trauma: veterans of wars, refugees, and
survivors of domestic violence. What is in fact true right here, in America, and particularly here in Oakland, is
that the vast majority of people who are affected by violence are actually young men of color who are affected by
street violence. They are overwhelmingly the victims of street violence, community violence, and yet none of these
tools have ever been developed with their needs in mind, and none of them had ever been developed understanding that,
given the poor treatment they had had at the hands of a lot of institutions that are set up to “care for them,”
that the likelihood of someone attaching to long-term services was not necessarily something you could count on. So, how to give someone something when you, maybe this might be the only
time you interact with them that can actually help them, was really important to us.

POPE-SUSSMAN:
What’s the strategy for evaluating the efficacy of this tool?

MARKS:
This tool we use internally, and then we have a couple community partners that use it as well. Because there’s
a screen that is part of the tool, what we’re able to do is, 30-45 days after we’ve given them the tool,
we can do follow-up phone calls where we ask them again, questions about their symptoms that they’re having
and then also ask them questions about qualitatively, have they used any of the tools since then and has it helped
them in any way.

POPE-SUSSMAN: Are there plans to study that on a
larger level?

MARKS: Yes, we’re working right now with a couple
of clinics. One operated by Kaiser Permanente Vallejo and another operated by the county Alameda Health System in
East Oakland, as sites to do a randomized control trial to compare and show the efficacy of this, not just sort of
in people’s symptoms but potentially how it affects their other health concerns. We think that will be important
for the science for how this goes down. So we can really show the effectiveness of it. I will say, internally it’s
been very surprisingly dramatic just the responses that we’ve gotten from individuals who have received this.
We developed this over two years through a series of focus groups with young men who were gunshot victims, and then
a series of 69 structured interviews with young men who we didn’t know, who came in just from all parts of Oakland
to do an interview, and it was profound, the impact it had.

We feel very hopeful that this is
going to be something that we can publish and show the efficacy of so that other people can use it, but we have lots
of partners who are involved in the development of it who are going to use it right now.

POPE-SUSSMAN:
So, Minority Youth Violence Prevention Initiative. Can you talk about how that is allowing you to expand the work
that you do?

MARKS: Yeah, absolutely. Minority Youth Violence Prevention
was a way for us to do two things. One, pay for a community health advocate who can then do County Alameda Health
System interviews, so use this Screening Tool for Awareness and Relief of Trauma with young people that we work with,
and then it also helps pay for mental health services. For a long time, all of our services that we offered were
peer-based, and all of our intervention specialists were community members that didn’t have clinical training,
and we would always refer to mental health services when needed.

What we found was that people
didn’t stick. But when a mental health therapist was introduced as a counselor, or someone you might want to
talk to, and came along with them in the car, to someone’s house, to someone’s school, spent time with
them in a more casual setting, that people were able to feel more comfortable with starting to engage in mental health
services.

In any case, in the process of doing the County Alameda Health System interviews, some
people are going to be flagged, because they present as needing an assessment for PTSD, right? Trauma can affect
your life, and it can make your life unpleasant even without a full-blown PTSD diagnosis. We believe that people
deserve help no matter where they are, but some people will actually have severe symptoms that require an assessment
and it would be helpful to do, so that’s also why we brought mental health services on through this grant.

POPE-SUSSMAN: What are your hopes for START?

MARKS:
Our hopes for START is that it has a catalytic effect on how people in our community talk about trauma, and in the
process of doing that, changes how the institutions that are incorporating START into their settings treat these
young men. We have a culture that treats young men of color as if they are potential perpetrators when in fact, a
young man of color is much more likely to be a victim.

POPE-SUSSMAN:
What are the biggest challenges that you think Youth ALIVE! is facing right now?

MARKS:
I guess I would say the biggest challenges that Youth ALIVE! faces are the same challenges that the people we serve
face. Locally, that can mean the challenges of gentrification and equity. Largely, it means the challenges of the
systems that interact with our young people that are also the systems we have to interact with. We pride ourselves
on having worked a great deal with institutional partners that have not always best served the interests of our young
people, from probation to police to health care systems, to the school district, but these are large systems, and
helping these systems move along is always going to be a challenge.

POPE-SUSSMAN:
Where do you see your relationship with law enforcement right now?

MARKS:
Youth ALIVE! has an excellent relationship for example, with the police department. Our work with homicide victims
we could not do without a strong partnership with the Oakland Police Department, who pass along next-of-kin notification
to us, so we can reach out to these families. It works out really well because for them, having us work with the
family actually de-escalates the tension that that family is dealing with, so that we’re able to make them more
calm and ready to deal with whatever the next steps are. They might have to deal with law enforcement, and it works
out for us, obviously, because we get access to these families and can give them help. And it wasn’t quick,
but we’re at a point now where the police never ask us for information about any of the incidents that led to
the violence that we’re dealing with, so that’s been a great thing for us. I think for them it’s been
a really excellent relationship.

POPE-SUSSMAN: And the DA?

MARKS: Well we work a lot with the DA because we work with Victims of Crime.
So we have a relationship with Victims of Crime that’s such that they will let us know, for example, if a family
of a homicide victim is coming in to the office, in case we haven’t gotten the notification yet that the family
has contacted them. We’re able to actually meet them there in the office. They’ll bring us in to actually
meet with the family with them to help explain what the VOC process is. With that, we’ve had an excellent relationship
with the DA.
Our board president for Youth ALIVE! is actually a deputy district attorney. I guess I would
say this, I think one of the things that’s unique about, for example, our board president, Mike Nieto, and our
relationship with police and with the district attorney’s office is that, given the work that we do, and given
how the cycle of violence works, it is not helpful to draw a line between victim and perpetrator. That distinction
makes a lot of sense in certain settings, like the criminal justice setting, but it makes no sense in the lives of
the people that we work with.

Helping people think about breaking cycles of violence, helping
people understand that someone may be in a system as a perpetrator but their actual history of trauma is much different
than that is something that we’ve had some real traction in doing here, and I think that before the concept,
the word of trauma-informed was out there, that was something that we’ve been working on here locally for some
time–is helping really look at violent incidents and not as, who did what, but as, how do we respond to this eruption
in way that helps all the parties not further hurt themselves or anyone else.

POPE-SUSSMAN:
Wonderful. That’s it.

MARKS: Thanks!

POPE-SUSSMAN:
I am Raphael Pope-Sussman, of the Center for Court Innovation, and I’ve been speaking with Anne Marks, executive
director of Youth ALIVE! For more information on the Center for Court Innovation, visit www.courtinnovation.org.

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In this podcast, Kari Kerr and Kristi Hall-Jiran talk about Safer Tomorrows, Grand
Forks, North Dakota’s Defending Childhood Initiative. Safer Tomorrows implemented universal violence prevention programming in public, private, and rural schools across
Grand Forks County, beginning with pre-kindergarten and extending to high school. The initative is part
of the Department of Justice’s Defending Childhood Demonstration Program, which funded eight sites
across the country to  respond to the problem of children’s exposure to violence. The Center
for Court Innovation has produced a report on Safer Tomorrows, a series of reports on five other sites, and a report that condenses lessons learned across the sites.

Resources
mentioned in this podcast:

Safer
Tomorrows

The Community Violence
Intervention Center

Al’s
Pals

Friendships at Work

Lessons
from Literature

Digital
Citizenship

Coaching
Boys into Men

Lutheran Social Services Restorative Justice

Healthy Families

The
Fourth R

The following is a transcript

AVNI MAJITHIA-SEJPAL: Hi. I’m Avni Majithia-Sejpal, senior writer at the
Center for Court Innovation. Welcome to another episode of our New Thinking Podcast. Today, we’re here to talk
about Safer Tomorrows. Safer Tomorrows was established in Grand Forks County, North Dakota, as part of the Department
of Justice-funded Defending Childhood Demonstration Project, which was designed to address children’s exposure
to violence through eight demonstration sites across the country.

We,
at the Center for Court Innovation, have just released individual process evaluation reports on six of these eight
sites, as well as a multi-site report that condenses the lessons learned through our research. Today, from Safer
Tomorrows, we are talking to: Kari Kerr, director of community innovations at the Community Violence Intervention
Center and leadership team member of the Safer Tomorrows project, amongst others; and Kristi Hall-Jiran, executive
director of the Community Violence Intervention Center. Kari and Kristi, welcome to our podcast.

KARI KERR: Thank you for having us.

KRISTI
HALL-JIRAN: Thanks. We’re glad to be here.

MAJITHIA-SEJPAL:
Let’s begin by talking a little bit about the project itself. Safer Tomorrows aimed to implement universal prevention
programming in Grand Forks County. My question is, what made you decide to focus on school-based prevention programming?

KERR: I think there are a couple of factors that went into our decision.
The main one was, our state had just actually passed anti-bullying laws requiring schools to develop some type of
a policy or a response, and so the timing was really good in terms of approaching the school system.

Then, we also know that, obviously, for our school system, we can have a
wide reach of youth that are attending school. Certainly, from kindergarten all the way up to 12th grade, and we
went beyond that and looked at some of the pre-schools in our community as well.

HALL-JIRAN:
I think just to add to that, too. We also had really spent some time developing a good, strong working relationship
with the schools in several years before the project. We really felt like we already had the leadership of the school
system on board, the superintendent served on our agency’s board of directors, and so really felt that the timing
was right. We already have the collaborative relationship and so the natural outcome was to focus on that way.

MAJITHIA-SEJPAL: When we talk about violence, what are some of the forms
of violence, specifically pertaining to children and teenagers, that need to be addressed urgently in your county?

KERR: When we first developed our Safer Tomorrows project, we, of course,
wanted to be very inclusive of all types of violence and really make sure that we were addressing anything that could
affect the child, and we also wanted to look at how to prevent violence and not just to intervene. We did want to
also look at the things that were most impacting our children. What we did before we even started developing our
programming was really to do a needs assessment as to what the most prevalent forms of violence were.

As we looked at existing statistics and then gathered additional data, what
we found was that the kinds of violence that we saw the most in our county was pertaining mostly to bullying in the
school system, or just anywhere, and then also children exposed to domestic violence at home. Though we had pure
statistics on dating violence, we heard from a lot of our stakeholders that they felt that that was a pretty primary
issue as well.

Though we tried to address all of
the issues, those are the areas that we’re really focusing on.

MAJITHIA-SEJPAL:
Can you talk to us a little bit about the different features or highlights of the project?

HALL-JIRAN: We’ve looked at it in three different areas. We designed
the program around intervention effort, so any child age 0 to 17 that is being impacted in some way by violence,
we wanted to make sure we were finding a way to intervene. Then, we also looked at prevention. How could we start
building the kind of programming in our community that would prevent this type of violence from happening so that
two generations from now we don’t even have to have these conversations anymore?

Then, the third piece, we really tried to build a very strong data and evaluation
component because we really wanted to base our decisions on available data and then ongoing evaluation so that we
could treat what we implemented as we found out if that was working or not, or as different types of violence change
and, hopefully, if we were seeing good results we could start making some of those adjustments.

As far as specific things that are under each of those areas, maybe I’ll
have Kari talk about that a little bit.

KERR: Sure.
We were able to implement a variety of different prevention programs, many of which are evidence-based. Some of those
included Al’s Pals, which is for our youngest population, that’s bullying prevention program. We also implemented
“The Fourth R” for health classes, Friendships at Work, which is a positive friendship curriculum.

A couple of different programs looking at some of the online issues that
can happen with students, that would be Digital Citizenship. Then, we also have one of our schools implement Lessons
from Literature. Then we did Coaching Boys into Men.

We
really had a variety of prevention programming starting from, again the early years all the way up to 12th grade.
As Kristi mentioned, we had a lot of intervention services offered as far as specialized therapy services and the
Lutheran Social Services of North Dakota has provided restorative justice programming and Healthy Families. We’ve
also been able to work with some of our families …

MAJITHIA-SEJPAL:
Given that you’re targeting children and teenagers in such a wide age
range, from 0 through 17, how did you adapt your methods to different ages and specifically to the youngest children?

HALL-JIRAN: You’re right. That’s a very wide age range for, not
just prevention, but also for area of intervention as well. As Kari mentioned, for the youngest kid, we implemented
Al’s Pals. It’s a puppet program. It’s basically working with kids as they’re playing, so we
really try to adapt to what would be age-appropriate.

As
we got more into elementary school, the curriculum focuses more on respect and being kind to each other and all those
kinds of things. Then as we moved in the middle school age, we looked a little bit more at anti-bullying and respectful
friendship, and what would healthy friendship look like, how do we treat each other, those kinds of things. Then,
of course, as we got to the high school level, we looked more at dating violence and healthy relationships.

Really just trying to adapt the programming that we picked to really sit
with these age groups and what would be most primary for that group.

MAJITHIA-SEJPAL:
How did you adapt evidence-based and promising practices and tools, especially given that your target audience spans
such a wide age range?

KERR: I think one of the ones
that we ended up having to adapt a little bit the most was our Friendships at Work curriculum, which is more of a
promising practice. It was initially designed for seventh grade classes. As we were implementing, we were receiving
feedback from some of the teachers, for a variety of reasons that they felt it would be better suited for fifth grade.

Again, the author of that curriculum went back in to adjust some of the
language that we used as we’re teaching it, some of the videos that she used, some of the examples that she
would give just to adjust that down to fifth grade level because, again, you’re going down three levels from
what it was initially designed for. We’re finding that it’s working really well in the fifth grade right
now.

HALL-JIRAN: One of the other adjustments that
we made was Lessons from Literature. That was something that we were originally going to do in our high school English
classes, but the curriculum was just designed in Canada and the literature that they used in Canada was not going
to work for our high schools here in Grand Forks. We basically did some research and decided to implement “The Fourth
R” in our health classes rather than Lessons from Literature.

It
was just some of the speed bumps along the way, just look at what else you can do instead and just always try to
adapt to your population.

MAJITHIA-SEJPAL: That’s
really interesting. What were some of the challenges you encountered as you went about implementing your various
programs?

KERR: I think anytime you are involved
in a whole county of people, which involves seven different school districts and thousands of kids, it’s really
hard to just make sure that it’s all being well-taught uniformly. We know that all the curriculum that we implemented
is only as good as it actually is at the level of the teacher implementing it or the staff person implementing it.
I think it’s always a challenge just to make sure that everybody is doing it and doing it in a consistent way.

HALL-JIRAN: I would just add to that, as Kari mentioned, just when you’ve
got seven different initiatives that are all trying to implement on a whole spectrum of ages 0 to 17, all the way
from intervention through prevention, you have got a lot of moving parts and I think you absolutely cannot over-communicate
at that point. Just trying to make sure everybody knew what each other was doing and that we were all keeping that
common vision in front of us was really a constant challenge.

MAJITHIA-SEJPAL:
What are some of the lessons learned that you can pass on to other counties that might be interested in implementing
prevention programming that is similar to yours.

HALL-JIRAN:
I think one of the biggest lessons that we learned is to just plan for more time than you think you’re going
to need. I think, especially if it is involving federal funds, it’s really important to have adequate time to
have the review process that you need in place for different publications and things like that. That was one of the
things that sometimes the schools have found a little bit.

KERR:
I think in addition to that, just having good communication that’s ongoing with your collaborative partners
is important. We had lots of committees that we’ve set up to make sure that everyone stayed on top of what was
happening in our project. We did that through actual face-to-face meetings, as well as email and phone conversations,
and then being flexible as the project continues to make adaptations as they’re needed.

MAJITHIA-SEJPAL: What are some of the results that you have been witnessing.

HALL-JIRAN: We will be continuing to monitor this on an ongoing basis. Some
of the most exciting results that we’ve seen thus far is that, at the elementary level, we’ve seen 42 percent
fewer fourth and fifth grade students who are reporting being bullied. We’ve also had 46 percent fewer high
school students who have reported that during the past six months someone has forced them to do something sexual
that they did not want to do. We’ve had 28 percent fewer fourth through 12th grade students reporting that they
witnessed violence in their home.

We’re very
excited about the preliminary results and really are interested to see where this will go in the future.

MAJITHIA-SEJPAL: Wonderful! Thanks so much for speaking to me. That was
really interesting.

KERR: Thank you so much. We really
appreciate it.

MAJITHIA-SEJPAL: I’m Avni Majithia-Sejpal
from the Center of Court Innovation and I’ve been speaking to Kari Kerr and Kristi Hall-Jiran about the Grand
Forks, North Dakota Defending Childhood Initiative, Safer Tomorrows. Visit our website at www.courtinnovation.org
to download other podcasts and reports on Defending Childhood Demonstration project. Thanks so much for listening.

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Jill Smialek and Dr. Jeff Kretschmar discuss the Cuyahoga
County Defending Childhood Initative, which  seeks to address violence against children in one
of the country’s most violent areas – Cuyahoga County, Ohio. Their
unique approach includes the creation of an integrated, county-wide screening, assessment, and service system for children ages
0-18 who have experienced violence and trauma. The initative is part of the Department of Justice’s Defending Childhood Demonstration
Program, which funded eight sites across the country to  respond to the
problem of children’s exposure to violence. The Center for Court Innovation has produced a report on the Cuyahoga County Defending Childhood Initative,
a series of reports on five other sites, and a report that condenses
lessons learned across the sites. 

The
following is a transcript

AVNI MAJITHIA-SEJPAL: Hi,
I’m Avni Majithia-SejpaL, senior writer at the Center for Court Innovation. Welcome to another episode of our
New Thinking Podcast. Today, we’re here to talk about the Cuyahoga County Defending Childhood Initiative. Cuyahoga
County, in Ohio, which includes the Cleveland Metropolitan Area, was one of eight sites across the country to be
funded by the Department of Justice to address and raise awareness about children’s exposure to violence. We,
at the Center for Court Innovation, have just released our process evaluation on six of those sites, which includes
individual reports on each site and a report that condenses lessons learned across them. Today, from Cuyahoga County,
we’re talking to Jill Smialek, manager of the Family Justice Center and of the Witness Victim’s Service
Center, and to Dr. Jeff Kretschmar, research assistant professor at the Mandel School of Applied Social Sciences
at Case Western Reserve University, and senior research developer at the Gun Center for Violence Prevention, Research,
and Education. Jill and Jeff, welcome to our podcast.

DR. JEFF KRETSCHMAR:
Thanks, Avni.

JILL SMIALEK: Thank you.

MAJITHIA-SEJPAL:
I want to start by talking about violence. I understand that the county, and Cleveland in particular, has one of
the highest violent crime rates in the country. What kinds of violence are kids exposed to?

KRETSCHMAR:
You’re right that the kids in Cuyahoga County witness and experience pretty high rates of violence. The kinds
of violence they’re experiencing or witnessing are similar to other kids in other communities. We have a lot
of kids saying that they are hit and attacked. They witness a lot of shootings. There’s lots of verbal abuse,
physical abuse. Our kids report high rates of bullying. I will say that of the kids who have been in our Defending
Childhood system and who have been assessed for violence exposure, 96% of those kids report at least one past year
victimization and 87% report as least two past year victimizations. Those numbers are really, really high.

SMIALEK: We also know that a lot of children who are coming through the Defending
Childhood system have witnessed domestic violence in their homes. From our most recent report, it looks like about
50% of our cases are kids who are dealing with domestic violence in the home.

MAJITHIA-SEJPAL:
The Defending Childhood initiative created a streamlined county-wide screening assessment and service system up to
the age of eighteen who have exhibited symptoms of exposure to violence or trauma. Can you walk us through that process?

SMIALEK: When we were first starting the Defending Childhood initiative, we
wanted to make sure that we were implementing something that was not a new program, not a standalone program, but
rather something that was embedded within the very robust social service menu, or environment that we have here in
Cuyahoga County. We made the determination that we would work with our agencies and organizations that were already
serving a large proportion of kids who were exposed to violence but at the same time, not necessarily focusing on
that as the number one issue. We determined that we would work with our Children and Family Services, Juvenile Court,
and a number of our community based mental health service providers. We worked with Jeff and others to develop a
screening tool. We used that screening tool in those existing agencies. They screen very quickly for trauma symptoms
and trauma behaviors. Then, once they reach a specific threshold, they move on to a central intake and assessment
agency where they receive a full blown, roughly four-hour mental health assessment.

From there,
the mental health professional makes the determination as to any diagnoses that may apply and also makes a decision
as to an appropriate therapeutic intervention. From there, the child is referred into services.

MAJITHIA-SEJPAL:
Jeff, do you want to talk about the tool that you developed?

KRETSCHMAR:
Sure. Very early on in the process, when we were first awarded the grant, one of the things that we quickly discovered
that while there was some screening going on for violence exposure and trauma in our child-serving systems, it wasn’t
consistent, it wasn’t uniform, and a lot of times, when kids were screened, nothing happened as a result of
those scores or that information. They knew that kids were exposed but they didn’t really have much unique services
to put these kids into. What we thought was it would be really beneficial if our entire system used the same screening
tool and had some training on how to use it. Then, that tool, the results of the information from that tool, could
then be used to refer children to fuller assessments and then if necessary, into trauma-focused CBT or other trauma
informed services designed specifically for cases like this.

We first thought to use an existing
tool that would look at trauma and violence exposure but confine any that were really short and free and that would
span kids from zero to eighteen. We created our own. We came up with two screeners. One’s for the younger kids,
zero to seven. One is for the older kids, eight and older. We ask them or their caregiver about what kind of violence
they’ve seen and what trauma symptoms are also co-occurring at that time. If kids score a certain level in that
screener, they are referred in for a fuller assessment, to really get a handle on what they’re experiencing
and if that’s had some mental health consequences for them.

The worker who’s administering
the screening, regardless of the score on the screener, can also decide to refer that child for additional assessment
if they feel like they need it.

MAJITHIA-SEJPAL: I understand that
research was integral to the initiative from the very beginning of the planning process. How did you and your colleagues
go about this research? What were some of your insights?

KRETSCHMAR:
The most important thing we learned in the beginning was that there was just a lack of uniform screening for childhood
exposure to violence and trauma. We put a lot of effort into the development of the screener. We took information
from existing screeners, took data that we had collected previously on thousands and thousands of kids who have been
exposed to violence and trauma, and identified the questions that we could ask that best predicted how kids would
answer a much longer assessment. We were able to create these very short screeners. There are about fifteen questions,
they take on average four, five minutes, and essentially what we’re finding out is that these screeners are
really good at predicting who really has seen a lot of violence, who is experiencing trauma associated with that
violence. I think we’re probably close, at this point, to twenty thousand kids who have been screened since
July of 2012.

A lot of our research effort has focused on understanding what the kids in our community
were seeing and experiencing, figuring out how best to measure that in a consistent and uniform way, and then understanding
after the screening what needs to happen. What does a full assessment need to look like? What are the best treatments
for these kids? These kids, as you said, we’re talking about zero to eighteen. What might work in terms of a
therapy for an eight year old might not be appropriate for a seventeen year old.

MAJITHIA-SEJPAL:
That leads me to another question. Given that you address the needs of children and teenagers in such a wide age
range, zero through eighteen, how did you adapt your methods to different age groups, and specifically to the youngest
children?

SMIALEK: I think in addition to the screening methods that
we use, we made sure when we were selecting the various evidence-based treatment modalities, that we were encompassing
some or selecting some that were appropriate for younger children. One of those that we selected was PCIT, the Parent-Child
Interactive Therapy, which we know is especially effective for younger children, and we also are able to use trauma-focused
cognitive behavioral therapy for younger children.

We also recognize that this is a really tough
area. It’s hard to find an appropriate way to intervene with children who are so young, because of the age that
they’re in in development. Here in Cuyahoga County, in addition to Defending Childhood, we have a number of
social service agencies and initiatives at the large scale level that deal with child well-being. One of those is
an initiative that’s dedicated to early childhood mental health. We do have the ability to refer into one of
the early childhood mental health services, which are separate and apart from Defending Childhood but again, I think
it kind of illustrates how we have fit Defending Childhood into the existing system and the existing infrastructure
that we have in Cuyahoga County so that if we come across a child who we can’t fit into PCIT or TFCBT, we know
that we have this additional referral source that we can tap into.

MAJITHIA-SEJPAL:
How did you adapt and make use of evidence-based and promising practice into–

SMIALEK:
we worked a lot with a number of community based partners who have far more expertise than I do and that anybody
in my office has. When we were planning for the Defending Childhood initiative, there was a sub-committee that was
put together to specifically look at various services or various trauma modalities that would be appropriate for
Defending Childhood. We tapped into their brain power, their experience, their expertise, in order to come up with
some options that really made sense. We reviewed a number of different programs. We looked at not just therapies,
but also some community based group interventions, like the Families and Schools Together program, to make sure that
we were making smart decisions that would lead to good outcomes for us.

KRETSCHMAR:
In terms of the tools, we did a lot of work in establishing the screeners. Then, in the assessment process, we’re
using validated assessments, using validated and previously used questionnaires like the Child Behavior Checklist,
the Trauma Symptom Checklist for Children, to make sure we’re really measuring what we need to measure to best
be able to then refer kids into the appropriate services for them.

MAJITHIA-SEJPAL:
In addition to providing direct services, you also focused on creating an infrastructure that would span the entire
county. Can you talk a little bit about that?

SMIALEK: What we wanted
to do was ensure that whatever we started was first of all, taken to scale, because as you said earlier, we have
a lot of crime in Cuyahoga County, and particularly in the city of Cleveland. I think that we are very well aware
of the number of kids who are exposed to violence. We want to be able to make a difference for as many of those children
as possible. If we’re going to take it to scale given the resources that we have, we knew that we had to work
with what’s already in place. It just made sense, as we were thinking through how to make the biggest impact
with the amount of resources that we had, how exactly would we do that. The answer to that was to build on top of
what we already have so that we can sustain it long term and make the biggest difference possible.

MAJITHIA-SEJPAL:
What are some of the lessons for other counties that want to make changes on the level of infrastructure?

SMIALEK: I think there are several that kind Cuyahoga County can bring to the
table. The first is just to make sure that you take your time and do a thoughtful and thorough planning process.
I think that starts with doing a full environmental scan of the groups that are already in the neighborhood or in
the county or in the community, both groups who are interested in this issue, and who have the desire to be at the
table, and bringing them in and making sure that they have a relevant and meaningful role to play while they’re
engaged with the process.

I also think probably one of the most important lessons that we learned
here locally is that planning takes time and over time, things change. You have to make a promise to one another
that you will be flexible because the plan you write today, you may need to implement it a little differently tomorrow
when you’re finally ready to implement.

KRETSCHMAR: Something
else that we knew but was confirmed is that while you can have service providers and county employees and research
folks at the table, we’re talking about a program for and about kids. You need to have the involvement of the
kids. You need to understand what they’re experiencing, what their comfort level is with what we’re planning.
If you don’t have it, we can have a really, really great plan but if it’s not something that kids and families
are comfortable with, then it’s not going to work. Having that level of consumer involvement in the planning
process is really important. Also important is from day one, planning for sustainability of whatever it is you want
to implement, so thinking out a year or two years or three years ahead and say, “How are we going to make this
sustainable?” Which goes back to an earlier question around why we also focused on system issues in our project
is because if we can change the system, that’s a sustainable change. It doesn’t necessarily cost anything
to change the system like we’ve started to change it, but it can be really lasting.

MAJITHIA-SEJPAL:
That’s really interesting. Thanks so much for taking the time to talk to me.

KRETSCHMAR:
Sure.

MAJITHIA-SEJPAL: I’m Avni Majithia-Sejpal, from the Center
for Court Innovation and I’ve been speaking to Jill Smialek and Dr. Jeff Kretschmar about The Cuyahoga County
Defending Childhood Initiative. To read our report on the initiative, as well as our multi-site report, you can visit
our website at www.courtinnovation.org. Thanks very much for listening.

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In this podcast, Center for Court Innovation researchers Rachel
Swaner, Lama Ayoub, and Elise Jensen discuss their National Institute of Justice funded report on the United
States Department of Justice’s Defending Childhood Demonstration Program. The
program, which began in 2010, funded eight pilot sites across the country to address children’s exposure to
violence. The Center produced a series of reports on six of the eight sites, as well as a report that
condenses lessons learned across the sites. 

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Katheryn Lotsos and Stephen Forrester from the New York Society
for the Prevention of Cruelty to Children discuss their organization’s approach to supervised
visitation. Supervised visitation is frequently required by courts in child welfare or domestic violence cases and
allows children to meet with non-custodial parents in a secure and controlled environment. The Society’s therapeutic
model includes safety planning, parent education classes, special training for the professionals supervising the
visits, and close collaboration with the courts.

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Center for Court Innovation researcher Sarah Picard-Fritsche discusses the risk-need-responsivity model for
working with offenders and the Center’s efforts to develop a screening tool for misdemeanor offenders.

The following is a transcript

Raphael:
Hi. I’m Raphael Pope-Sussman at the Center for Court Innovation and in today’s podcast, we’re looking
at risk-need assessment tools for offenders. Our guest is Sarah Fritsche, associate director of research here at
the Center. Sarah, thank you for speaking with me today and welcome.

SARAH
FRITSCHE: Thanks. Happy to be here.

RAPHAEL POPE-SUSSMAN: Wonderful. What
is risk-need?

FRITSCHE:  Well, risk-need-responsivity theory is essentially
a theory of crime prevention which has three core components. The risk principle, which suggests that courts and
treatment programs that are interested in reducing the risk of offenders should focus on those individuals coming
through the system who are at the highest risk for re-offense–as opposed to what we sometimes see happening, which
is lower risk offenders, we focus our resources on them based on an idea that they deserve a second chance or that
the higher risk offender is a lost cause.

All of those ideas are quite intuitive
but actually research evidence shows us that when we focus our resources on treating and intervening with and supervising
the higher risk group, that is when we achieve risk reductions and when we are able to get people out of the revolving
door where they keep coming through the jails over and over again.

When
we focus our resources on lower risk offenders, ironically enough or perhaps it’s not really an irony, I don’t
know, but unfortunately when we do that, what happens is that we sometimes increase risk because we put folks who
have pro-social networks and not very serious drug problems who just were in the wrong place at the wrong time. We
put them into intensive treatment and that exposes them to anti-social networks, that takes them away from their
job, that takes them away from their family, and this increases their risk for future offense and future involvement
in the justice system.

POPE-SUSSMAN: What’s the origin of
this theory?

FRITSCHE:  The theory originates with two Canadian psychologists
in the late ’80s, early ’90s, James Bonta and his partner’s name was Andrews. They were actually developing
an assessment tool which is now one of the longest-used assessment tools in the field, called the “Level of Services
Inventory.” Their theories of criminal conduct are essentially psychological. Individual theories of criminal conduct
were what undergirded the assessment tool that they created. They came up with a theory– the main and most tested
principle in the theory is the risk principle, but there’s also two other components. One is the need principle,
which tells us that we should try to understand the specific needs of each individual person coming through the justice
system in order to give them the correct targeted treatment. It’s that part that is intuitive.

But without the correct assessment tools, we can’t figure out what that is. The third
component is responsivity, which means that we should develop treatment programs or therapeutic intervention programs
that respond to people’s learning styles and some clinical needs that might interfere with their ability to
recover, such as mental illness or trauma.

POPE-SUSSMAN: Can you talk a little
bit about what you’re working on in the Center and what is the Center’s focus right now in terms of risk-need
assessment?

FRITSCHE: Sure. I started working in this area about five years
ago and my interest in it grew out of one of the first studies that I did here at the Center, which was a study of
Brooklyn’s program, which they call the Universal Screening for Drug Court, for people in the criminal court
who might have the need for drug treatment. They were trying to find as many people as they could and send them into
drug court as an alternative to maybe a short-term jail sentence that they might get. They had a screening system
that was effectively just based on present charge. I guess my response to the system was that it was well intentioned
but that based on the research that I did that they probably needed a little more information to identify the individuals
that were most appropriate for drug court programming. A little more clinical information, maybe a little more criminal
history information.

I started looking around to see if anybody else had had
that idea and that’s where I ran into risk-need-responsivity theory. One of our first projects here that’s
really about this theory is testing the LSI-R, which I just described to you as one of the earliest tools in …

POPE-SUSSMAN: Just for listeners who aren’t so savvy, what does LSI-R stand for?

FRITSCHE: Oh, it stands for the Level of Services Inventory and it’s just a 54-item
assessment tool that they developed to assess individual offenders along the areas that we know may be related to
re-offense. We wrote a proposal to the National Institute of Justice to do a randomized controlled trial where we
looked at whether … we’re looking, we’re actually now analyzing and writing up the data, at whether the
treatment plans and outcomes of a drug court participant that was assessed using the LSI-R would be any different
than those where they didn’t get a standardized or RNR-based assessment. That was our first project that began
in 2010 and is ongoing and will be reported on soon.

Then shortly following
that project, the world of evidence-based assessment, evidence-based practice just however coincidentally really
exploded and a lot of the federal government agencies that we worked with and other non-profit organizations that
work in the justice system became very interested in some of these concepts– whether we could use evidence-based
validated assessments to learn more about what keeps offenders caught in this revolving door of being incarcerated
and re-offending very quickly. And whether we could then use that information or evidence to develop better programs
that are therapeutic interventions. The Center has a long history of trying to create therapeutic or problem-solving
interventions for offenders. This foray into this field was very natural for us.

Since
the evidence-based assessment research in the drug court started, we have picked up several new projects that are
in this area. At the moment, we are looking at a different assessment tool that’s similar to the LSI-R called
the COMPAS. Don’t ask me what that stands for because nobody really knows, but it’s a similar tool and
we’re looking at that specifically in a sub-population of mentally ill offenders because there’s a lot
of questions in the field as to whether these validated assessments that have been historically used to predict outcomes
for general felony populations will work in some of the sub-populations that are important in the justice system,
mentally ill offenders being one of them.

Then the other project that’s
very important in this field that we’re doing right now began specifically from misdemeanor offenders, which
is another important and understudied subgroup. We have, nationally in our justice system, about 10 million individuals
per year that come through our criminal courts on misdemeanor charges. We have a very underdeveloped understanding
or comprehension of what the clinical and social service needs and criminal risk of these individuals is. That gap
in the research is what brought us to develop and seek funding for the Misdemeanor Assessment Project, which is a
two-part project. First, to develop an assessment tool that can accurately give us a profile of the risk and needs
of misdemeanor offenders rooted in risk-need-responsivity theory, and secondly to develop an intervention that we
hope will effectively reduce risk for re-arrest in this population. Because the misdemeanor population is also quite
tricky in terms of therapeutic intervention because they may have very high needs. They may have very serious drug
problems. They may have mental illness. They may be traumatized. They may have long rap sheets. Their current charge
will not allow you to put them in a two-year drug treatment program such as a drug court no matter how badly they
may need it. We have to maintain legal proportionality.

The second part of
the Misdemeanor Assessment Project is specifically to develop short-term interventions including evidence-based cognitive
behavioral treatments for this population that we hope will at least advance the ball for them somewhat in terms
of reducing the clinical and social structural factors that cause them to come back into the system so quickly.

POPE-SUSSMAN: Are there specific projects that we’re rolling out?

FRITSCHE:Yes.
The Misdemeanor Assessment Project is a specific project. We’re at a stage now where we have developed a short
screening tool that we feel is feasible for people in criminal courts here in New York City and nationally to try
to get an idea of what the profile of their low-level offender population is in terms of risk and needs. This short
screening tool is currently being used in Cook County, which is essentially Chicago, with a pilot test of a program
they have for misdemeanor offenders who have been diverted from jail from traditional processing, court processing,
and are given some level of treatment. Based on our screening tool, they’re going to make an assessment of whether
to give them a high level of treatment because they’re high risk, or something a little less if they’re
a moderate risk, or basically just refer them to services if they’re low risk. In Cook County, we’re using
this tool as a test of the risk principle, basically.

The same short assessment
tool is being rolled out in New York City, in Brooklyn and Manhattan criminal courts as a part of a larger research
study to re-validate whether the items and domains that we think are predicting re-arrest in this population in New
York City … we’re going to test them again. We tested them once last year and we’re going to test them
again. That’s one product that we have that we’re refining but we’re also giving to the field to use
and test and then at the same time, we’re developing a short-term intervention for misdemeanor offenders that
we’re going to pilot test in the community courts in Manhattan, the Bronx, and Brooklyn over the next six months.

POPE-SUSSMAN: Great. Longer term on the horizon, are there any further plans?

FRITSCHE: Yes. I think it’s sometimes a little hard to see past the next six months
especially for those of us who do research because we’re oftentimes quite reticent to make claims. I think that
there’s definitely a demand on the ground for concrete tools, curriculums, assessment instruments that can help
people move the needle from their default response to a lot of criminal behavior and overloaded criminal dockets–which
is to put people into short-term stays and detention–to having more evidence-based responses to this kind of crime
that have the potential to reduce risk.

I think that it’s a very timely
field not just for practitioners but politically and especially socially here in the United States, that there’s
currently a public debate about whether incarceration is an effective response to crime, especially low-level crime.
I think that our focus on these issues is really going to become … I hope it will become a part of practical solutions
and a part of the national conversation on alternatives to incarceration.

POPE-SUSSMAN:
That’s very exciting. Well, thank you so much for talking to me today. I’m Raphael Pope-Sussman. I’ve
been speaking with Sarah Fritsche, associate director of research at the Center for Court Innovation about risk/need
assessment tools. To learn more about the Center for Court Innovation, please visit www.courtinnovation.org. Thank
you for listening.

FRITSCHE: Thanks.

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Dr. Susan Chinitz, a psychologist with specialties in the areas of infant mental health and developmental disabilities
in infancy and early childhood, and a Professor of Clinical Pediatrics at the Albert Einstein College of Medicine,
discusses the new Strong Starts Court Initiative, which will enhance the capacity of Family Court to bring positive
changes to court-involved babies and their families. (April 2015)

The
following is a transcript

SARAH SCHWEIG:
Hi, I’m Sarah Schweig of the Center for Court Innovation and today I’m speaking with Dr. Susan Chinitz,
a psychologist with specialties in the areas of infant mental health and developmental disabilities in infancy and
early childhood. Professor of clinical pediatrics at the Albert Einstein College of

Medicine
here in New York, she has extensive experience in child and infant mental health and recently she teamed up with
the Center for Court Innovation to craft what’s called the Bronx Infant Court, which aims to enhance the capacity
of Family Court to bring positive changes to court-involved babies and their families. Thanks for speaking with me
today and welcome.

SUSAN CHINITZ: Thank
you, Sarah. Thank you.

SCHWEIG: First off, you’re
a psychologist and an expert in infancy studies. What made you start thinking about the justice system and infants?
Can you talk a bit about what drove you to look at how court cases handle infants–cases involving infants or families
with infants.

CHINITZ: I direct a center up at
Einstein, as you said. It’s a therapy program for children under five years of age and many of the children
that we work with, a very large proportion of them are child welfare system involved. Children come to attention
at such a young age when something pretty significant or dramatic has happened to them and, certainly, that’s
the story of young children in the child welfare system. Our clinical population at Einstein has always had a very
robust number of children who have had allegations of neglect or abuse, who are in foster care, or otherwise under
court supervision. I’ve just had lots and lots of day-to-day experience with these children and their birth
parents and their foster parents.

Though the children struggle in their home
environments, which I guess by definition is true when they’re child welfare system involved, it also seemed
that the courts and the foster care agencies could be more protective of these children if they knew more about babies.
Sometimes in the absence of that knowledge, and totally inadvertently of course, the courts or the child welfare
system can inflict more harm on the children. So it seemed very important while we were working with the children
clinically, to also bring expertise to the systems that are making decisions about them every day.

SCHWEIG: Of course Family Court sees children of all ages. Could
you talk a little bit about what makes cases involving infants particularly different or difficult for courts to
handle?

CHINITZ: A lot of things–hard to know
even where to start but I’ll start with the fact that brain development is happening very, very rapidly during
these early stages of development, and we’ve learned through recent developmental neuroscience that children’s
brains’ development is very influenced by the environment and the context in which they live. In fact, in the field
we say that the brain recruits experience into its developing architecture. Children who have been removed from their
parents lose the biggest protection that children have; that bond with a committed and available caregiver. And we
know that that loss of a primary caregiver brings with it all kinds of risks to brain development.

It’s really out of nurture and security and engagement of a committed caregiver that
we see the brain develops. These children are struggling with attachment disruptions. Sometimes they’re struggling
with attachment disorders. If the interaction has been problematic, then they’re subject to exposure to violence
very often, instability in their care-giving as they move from caregiver to caregiver. There are just many, many
things that go on in the life of a young child during the stage of development of critical capacities; mediated by
brain development. It’s also a very important time for the consolidation of a secure attachment, so the whole
process of removing babies and moving them around in care is very detrimental to their development.

SCHWEIG: Maybe you can describe the traditional options available
for the court and dealing with cases involving infants and then how this new project is aiming to fill the gaps.

CHINITZ: Very interestingly, despite the fact that most
children become known to the courts because of abuse or neglect, or exposure to violence, there’s often very
little recommendation for relational parent-infant repair work. The typical interventions available through the courts
have been parenting classes, which means the parents attend a series of lectures about child development. But we’re
not identifying what went wrong in this particular dyad. Was it maternal depression? Was the child just so difficult
to manage that a parent just didn’t have enough support?

We have to really
understand what was the cause of the need to intervene with child welfare system intervention and then try to remediate
that, or even if we can’t remediate all of it, help the parent develop more safe and nurturing parenting skills
and help them learn to be with each other in ways that are healing to the child. We remove children but we don’t
do the critical work to repair what exactly went wrong. We’re trying to do that. We’re trying to evaluate
babies and parents and their relationship through this new project, so that the interventions that are court-mandated
will address the particular problems.

Not every family becomes child welfare
involved for the same reason, yet we’ve had one intervention of parenting classes. We want to tailor the interventions
to much better meet the needs of the babies and the parents. We have to help monitor these babies; there’s a
very high level of developmental delay and disability in children known to the foster care system and the courts
haven’t always known how to perform developmental surveillance, watching children’s development. What systems
are available to remediate that. You have to bring all kinds of expertise to the court in order for the court to
be a therapeutic agent that we think it can be through its authority and its involvement with the kids and families.

SCHWEIG: Wonderful. I hear you saying that we’re moving
towards looking at the individual relationships between the infant and the parent, instead of just a catch-all approach.

CHINITZ: Right, exactly. Even babies have their own parenting
load. There are some easy babies and there are some very, very hard babies. We have to help identify what the baby
brings into the interaction in addition to what the parent does.

SCHWEIG:
Right. Maybe you could talk a little bit about the mechanism that’s being introduced here to Family Court and
how that’s going to work.

CHINITZ: The referrals
are going to, at least at the beginning until we are really up and running and see how this all works, the referrals
are going to come just through the particular judge who’s been selected through her usual intake process. As
she picks up new cases, we will look for the babies under three. In this project we’re going to target children
under three. We’ve been asked by our various stakeholders to work with babies who are in foster care but also
babies who have not been removed from their parents but are under court supervision due to concerns. We will be looking
for children under three whether or not they’re still home with their parents.

Then,
we’re going to have an Infant Court team coordinator. A full-time infant practitioner who’s going to work
in the Family Court in partnership with the judge. So there will then be already in-house expertise full-time on
infant development. This clinician or practitioner will help with the assessments of the babies and the parents,
and I should use this opportunity to say that we have very two generational focus in this project. We’re looking
to help the life trajectory and life outcomes of the parents as well as the children because children will only do
as well as their parents are able to do.

The infant practitioner will help
with the evaluation of the parent and the child and will assist the other people planning on the case; the foster
agency case worker, and others who do some planning in recommending particular interventions that the court and child
welfare system may not be as cognizant of as infant practitioners are. As examples, we have early Head Sart programs
that are very, very rich in child development resources. We have home visiting programs, which we know improve the
life trajectory of vulnerable children, yet we don’t see courts or foster agencies getting children involved
in a early Head Start or involved in home visiting, but an infant practitioner will have a broader array of the knowledge
of what’s out there for babies.

The infant coordinator will help with
assessment. She will help with referrals. Then we hope to have very frequent team conferences about these children
and families that will include the lawyers but will also include the community providers that were working with the
families. We’re hoping to get everybody together on a monthly basis to help monitor progress; particularly,
to help solve problems so that families are really getting what they need to get. There are no barriers to their
getting what they get. That we can keep a close eye on the case and hopefully move a little bit more quickly than
usual towards permanency because we’re really front-loading services and we’re giving a lot of attention
to the cases early on.

We’re hoping, also, to develop a more collaborative
approach and to try to leave some of the adversarial approach behind as everybody puts their heads together to think
about how to better serve babies and their families.

SCHWEIG:
As a last takeaway, what would you hope to see a few years down the line with this project? Would you like to see
it replicated, would you like to see it expanded outside of the Bronx? What’s your vision?

CHINITZ:
Babies are such a large presence in the child welfare system and in the courts. In 2013, which is the last year that
we’ve got numbers for, there was 711 just in the Bronx alone; babies under two, just in the Bronx alone. That’s
a lot of children who are living in very vulnerable situations. Young children remain the largest cohort of kids
who become court-involved every year. Yeah, we’d like to see infant expertise in all of the Family Courts. It’s
a system that does intervene every day in the life of these children and they should be imbued with expertise.

It should be a place where judges have access to the best information they can have
about babies. Yeah, my dream is that we’re in every borough of the city bringing infant expertise to judges
and helping evaluate babies so that they get the right service. Like we said, keeping a close eye on cases, moving
children to permanency as quickly as possible. That’s really important. A child has to have security with at
least one ongoing primary caregiver. We see enormous pain and suffering when children are in limbo. Year after year
if they start to have behavior problems, they can’t catch up with their learning problems, we need to bring
permanency and security.

Those things; bringing expertise, so decisions are
good decisions. Bringing resources to these families as soon as the case becomes identified, so the court can be
an agent in positive change and resolving the permanency as early as possible.

SCHWEIG:
Wonderful. Well, thanks so much for speaking with me today.

CHINITZ:
Thank you.

SCHWEIG: I’m Sarah Schweig of the Center for Court
Innovation, and I’ve been speaking with Dr. Susan Chinitz about the complexities of infancy and infants who
become involved in family court cases. To learn more about the Bronx Infant Court or the Center for Court Innovation,
visit www.courtinnovation.org. Thanks for listening.

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