 Good afternoon, everybody. My name is Stacy Lindow. I'm a professor in the departments of OBGYN and Medicine Geriatrics and a longtime faculty member with the McLean Center for Clinical Medical Ethics. And so on behalf of the McLean Center and the University of Chicago Trauma Center, I'm standing in for Dr. Siegler and Dr. Rogers today, and I'm very fortunate to do so. I want to welcome all of you to the second lecture in the 2017-18 lecture series on ethical issues in violence, trauma, and trauma surgery. A few years ago, at a meeting here on campus, somebody referred to me as an activist professor. And I'm entirely sure it wasn't intended as a compliment. But I took it as one, and I would say in my observations of you, Dr. Merida, you are also an activist pediatrician, as many pediatricians are. Raise your hand if you're a pediatrician here today. Yeah, OK. And also a person who's made just a very tremendous commitment to the health of the public as a public servant. And many of us feel we've come to medicine for the purpose of public service. In early 2015, Dr. Merida was appointed by the mayor as commissioner of the Chicago Department of Public Health. And under her leadership, the Department of Public Health has developed and launched Healthy Chicago 2.0, a four-year plan that aims to achieve health equity in our city by addressing social determinants of health set of issues that many of us spend most of our time working on. Under her leadership, the Department of Public Health has led efforts to pass legislation to make it more difficult to access tobacco, helping to raise the tobacco purchase age to 21 years. And also with Dr. Merida's guidance, the Chicago Department of Public Health will continue to embrace, as you'll see today, a holistic view of public health, address the social determinants of health, and in so doing, advance health equity. And one of the main themes that I've heard her speak about recently, including at a seminar hosted by Dr. Rogers and the University of Chicago Medicine, is how the Department of Public Health is thinking about violence and trauma as health issues, topics that have long been in the domain of public safety. So I think it's important to add a little bit about Dr. Merida's background before her appointment to this role. She served as Chief Medical Officer at CDPH. She is a member of the Epidemic Intelligence Service, an officer of the Epidemic Intelligence Service, and has made tremendous impact in areas of infectious disease, including working on pandemic flu, getting more than a million people vaccinated in Chicago and working on the Ebola crisis. She has served at the Institute of Medicine. She's had a recent publication for the National Academy of Sciences on communities and action pathways to health equity. And without further ado, you came to hear her. Dr. Merida, please, we're excited to hear from you on your Violence Prevention Initiative. Thank you. It's really a pleasure to be here. I think Dr. Rogers asked me to talk about six months ago, a long time ago, and it was an interesting process of coming together, pulling all the presentation together, because again, what I'll talk about today is not just solely the work of the Chicago Department of Public Health, it's actually the work of the Department of Public Health, other city agencies, as well as many of our partners throughout the city of Chicago. What I would like to do is just point out to everybody, just remind folks about the 77 communities in the city of Chicago. As a native of Chicago, I often think about the city of Chicago as the skyline. That is how I think of the city of Chicago. But when I came back to the city to work in public health, my focus shifted from the skyline to the 77 community areas. And this map was actually created here at University of Chicago decades ago, so in the 1920s, and has been used over decades by city planners as well as public health to guide the work that we all do. And so this is the way that we, I think about the city of Chicago and the rest of the department does as well and many of our partners. And so as we go through the presentation, I showed this to you all to begin with. So what I wanted to do is, Dr. Rogers asked me to talk about violence prevention initiatives and the Department of Public Health is responsible for. But before I talk about that, what I wanted to do is just point out that the mayor announced in early 2016 his public safety strategy. And that strategy itself is a multi-component strategy that affects numerous agencies within the city and also outside of the city. But the first arm of that strategy is really focusing on strengthening long enforcement and really building trust between police and law enforcement in the communities. And so a lot of work has been done to enhance the size of the police department but also to focus on their training as they engage the community. And so those kinds of efforts are key elements of the public safety strategy. On top of that, there's some efforts that are going on related to gun violence legislation throughout the state to try to enhance the laws that are in place to prevent gun violence from occurring. So there are those kinds of issues that are going on. The third leg of this stool is actually focusing on ensuring economic opportunity for all Chicagoans. So some of you may have heard of the Neighborhood Opportunity Fund. It is a fund that was created so when large developments are occurring in the central business district, if there's zoning changes that occur because of the development that's occurring there, those individuals and developers that are creating these buildings actually have to contribute to a certain amount of funding to the Neighborhood Opportunity Fund. And those funds actually are directed to our high-risk, high-hardship communities so that more development can occur in those communities while development is also simultaneously occurring in the business district. But those are all things that are all managed outside of the Department of Public Health. What I wanted to spend the rest of this time today talking about is really just the investments in prevention, violence prevention. And of those, Department of Public Health is playing a more major role and has been working on those issues over the past couple of years. So I'll use that. So in order for me to talk about our violence prevention initiatives, I want to frame this in terms of our Healthy Chicago 2.0 plan because our violence prevention initiatives are not the sole focus of the Department of Public Health. Healthy Chicago 2.0 is a public health plan that we launched in early 2016. This plan took 18 months to develop. It's something that all public health departments have to do. We have to develop a community health improvement plan. And so this plan was one of many that we've created over the years. What was unique about this plan is we actually spent a long time engaging our partners, making sure that we had a lot of stakeholders involved. We actually reviewed existing data that we had access to on an ongoing basis and then also new data that we had just received access to. And so over the course of these 18 months we had engaged over 100 different organizations as well as hundreds of partners reviewed millions of records to come up with a Healthy Chicago 2.0 plan. So when we started on this plan, we started off by reviewing the data that we had access to. And our overall assessment was that Chicago is healthier than it had been in the past. And we knew that because when we looked at the data that we had access to, we saw things like this where our teen birth rates have gone down dramatically. And so we're really pleased with this kind of progress. We also know that the number of new HIV diagnoses in Chicago have gone down as well. See Emily Landon nodding her head as an infectious disease doctor. This is something that we're really celebrating. In fact, we just announced recently that we have a plan to getting to zero. So by 2026, we actually hope to be able to get to functional zero with new HIV infections. So great progress has been made. Also because of some of the policies that my predecessors have done and also that we were a part of most recently, our percent of teen smokings has gone down dramatically too. So where one in five, one in four teens where we're actually smoking previously is now less than one in 10. In addition to this, I think, Emily, like this one, this slide as well, is our teen girls HPV vaccine coverage levels. So over the past few years, we've intensified our healthcare provider education, community education to increase acceptance and administration of the HPV vaccine. And so our coverage levels are rising and they are actually higher than the national average. So we've seen great signs of improving health. However, when we dug down deeper in the data and reviewed the data more extensively, what we found is that despite the overall improvements in health, what we found were there are significant disparities that persist. And so when you look at this hodgepodge or this collage of information, we know that LGBTQ youth are three times more likely to attempt suicide. We know that in high poverty communities, the smoking rate is still 45% higher than the city average. So overall city progress has been made, but in some populations, health is not getting better. It may actually be getting worse. So this is a great example, kind of encapsulates the problems that we see in terms of in Chicago and health. When we look at this map, it actually reflects the train lines, the CTA elevated lines. And you can see that in the loop, life expectancy is 85 years of age. And then you take the red line south a little bit to Washington Park, not very far from here. And the life expectancy is 69 years of age. So just small distances, and yet we have significant health disparities in terms of life expectancy. And that's a problem. So with those kind of information in mind, this is actually a guiding force in terms of how we approached our health improvement plan, Healthy Chicago 2.0. What we did is we also wanted to look at those data, identify those existing health has improved overall, disparities still persist. But we also know that in order to address these health disparities, we really have to make that connect, things we have to do to address these health disparities that haven't necessarily been addressed by public health in the past. So social determinants of health are huge factors and influencers in terms of overall health. And they affect infectious diseases, chronic diseases, behavioral health, violence in communities. And so what we did is we found an index called the Child Opportunity Index of Brandeis University had created and took this index, which takes into consideration math and reading proficiency rates, access to green space, unemployment rates, economic poverty levels within communities. And then categorizes different communities in terms of whether they have very high opportunity for children or through very low opportunity for children. And then we compared them to health outcomes and health behaviors. And what we saw not surprisingly is that in these red communities where there's very low child opportunity, what we found is there's higher rates of teen births, increased levels of mental illness, increased rates of substance use disorder. So we could see there's a direct correlation to these social factors and also health behaviors and health outcomes. So our assessment, which is not novel and not something that I came up with or anybody in the department came up with, but that when it comes to our health in the city of Chicago and nationally, our zip codes actually make more of a difference than our genetic codes because geographic differences make a big difference. And so with those things in mind, we created Healthy Chicago 2.0. So the key tenants of Healthy Chicago 2.0 are focusing on partnership because public health, healthcare systems have not necessarily thought about social determinants of health that seriously or engaged in work to address these issues. And so in order for us to do this kind of work, we really have to engage non-traditional partners. So partnerships will be critical for us to being successful and achieving health equity. On top of that, we have to leverage our data. We know that we have limited resources. So in this current time, when we're concerned about federal funding, state funding and local funding, we really have to make sure that we're directing our resources in those places, into those communities, or to those subpopulations that have the greatest need. And the only way for us to do that is really to have access to quality data and to also have timely data. So the Department of Public Health in the past few years has launched the Healthy Chicago Survey. It's a telephone survey that we've implemented that provides us with annual estimates of health behaviors and health outcomes in addition to that we aggregate the data on an every three year basis to get smaller geographic area estimates for health behaviors and health outcomes as well. So we can actually pinpoint which communities are most affected, which communities need the most help so we can direct the limited resources that we have to those communities. And then lastly, focusing and calling out the fact that we need to address housing, education, transportation, access to healthcare. Those are kinds of things that we need to call out and say we need to address this with our partners in strategic ways in order for us to really move the needle on health. And so with that in mind, that is how the plan has been outlined. The plan is huge. There's 80, sorry, there's 30 goals, 80 objectives and 230 strategies within the plan itself. So it's a very big plan. And so I'm not gonna review all those things with you today. What I will focus on is reducing violence. So in addition to outlining the key tenants of what we need to do to address health equity, we also highlighted key health conditions that need to be addressed. And behavioral health was the number one priority. And that's not surprising. So that arose, but it wasn't something that public health has often or really aggressively addressed in the past. Strengthening child and adolescent health is something that we have done a lot of work in and will continue to do that work. Preventing and controlling chronic diseases as well as something that has been highlighted as a public health area of concern because of the huge burden of disease that it causes. And then reducing the burden of infectious diseases. Nobody ever says we need to do this. And yet we know in public health that if we don't do this work, we will be able to do nothing else. Unless we have the disease surveillance systems and interventions systems, our immunization programs in place, we will not be able to focus on the social determinants of health or any other chronic diseases. Because all we will be doing is dealing with infectious disease outbreaks. And so we have to, public health always pushes that back into the priorities. And then lastly, reducing violence arose. I can't talk in any community or in any setting without someone asking me the question about what is the city of Chicago doing for violence prevention or violence. It's amazing and I deliberately don't bring it up as a topic in most settings just because I know it's gonna be asked, the question will be asked about it. So I'll have plenty of opportunity to talk about it. But it is clearly an area of concern among everyone throughout the nation and also in the city of Chicago. So what I thought I would do is just go through some examples of the work that we're doing in the city of Chicago as it relates to reducing violence. And again, this is not comprehensive and it's also not a reflection of just the work of CDPH. It's a work of CDPH, our partners, both internal and external. So of the 30 goals, Healthy Chicago 2.0 has a goal of making Chicago a trauma-informed city. And so it's funny, I was just meeting with the Illinois chapter of the American Academy of Pediatrics earlier today about opportunities for giving the residents in the academic training programs opportunities in community health and advocacy. And we started talking about trauma-informed type of work. And then they said, well, we're doing all this and we're doing all these other partners are doing all this other work. So there's a lot of work that's happening out there. So what I'll just summarize to you is give you an example of some of the work that we're doing within the Department of Public Health. And part of our goal actually is to harness all the energy that's being invested in these activities and bring it all together so we all know what everybody's doing, so we're not stepping all over each other. And so through the Healthy Chicago 2.0 plan, we have an action team that's focused on violence prevention. We have a specific subgroup that's working on making Chicago a trauma-informed city so we can assess the landscape and understand what everybody is doing. So part of becoming a trauma-informed city means that relates to our work with our police department. So as part of our efforts, we recognize that it was critical for us to make sure that our first responders in the city of Chicago were equipped to deal with individuals who have mental illness and also have substance use disorders. Because when law enforcement is engaging with folks that have these kind of diagnoses, they aren't always necessarily appropriately trained and don't necessarily know how to deescalate or to get the people the appropriate care and we don't want these individuals ending up in the criminal justice system. And so what has happened over the past two years is there's been an intensive effort on increasing the crisis intervention team training in the police department. So more police officers have been trained so that they are equipped to deescalate with individuals who have mental illness and substance use disorders. On top of that, it's not enough just to have police officers who are trained to deal with individuals that have these diagnoses, but it's also really important that when individuals call 911 to ask for help, that the 911 operators know how to triage those calls to the appropriate police officers to ask for a CIT trained individual. And so we have trained 100% of the 911 call takers and dispatchers so they know how to triage those calls and then dispatch the appropriate personnel. In addition to that, we've spent some time focusing on educating the public because if the public doesn't know that you can ask for a CIT trained police officer and they have a family member, a loved one who has substance use disorder and mental illness, they might call up and just say I need police to come help me right away and they might send someone who's not appropriately trained. So we've done intensive education on the west side with the Kennedy Forum and NAMI to educate the public working with community organizations, faith organizations so that people are aware. Number one of destigmatizing that work to destigmatize mental illness and substance use disorder, but also to raise awareness about the CIT trained police officers so individuals call up and ask for the right thing. So the goal is actually to have a seamless process so that individuals get the appropriate care that they need. The other thing that we focused on in the Department of Public Health is really increasing linkages between the police and the mental health services because so what if a police officer knows how to engage with an individual but doesn't have a place to take someone who has a mental illness or substance use disorder? And so we've partnered with St. Bernard Hospital and Jackson Park Hospital and HRDI which is a community mental health provider to locate staff within the emergency rooms so that when a crisis intervention trained police officer interacts with someone who needs mental health support or substance use disorder treatment, they take them to those emergency rooms and get connected to care at that point and then also ongoing care as they're discharged from the hospital because one of the things we heard early on in the discussions was that the police were tired of taking individuals to the emergencies room and then just seeing them walk out the back door as the police were going the other way and we don't want that to happen. And so this kind of a program is something we've done to establish the kind of linkage. On top of that, Cook County Health and Hospital System has expanded their presence in Roseland and so in our former neighborhood health center, they now have a 24 hour a day, seven day a week community triage center where they take individuals that walk in off the street but also take individuals that are dropped off by crisis intervention trained police department staff so the individuals are getting appropriate interactions with law enforcement and also connection to appropriate care. One of the other elements that I didn't mention about becoming a trauma informed city because we had laid the groundwork for that goal and also had systems in place, we were actually successful in getting some federal funding from SAMHSA to do a recast which is a resilience in traumatized communities effort and so we received $5 million last year and we'll have five years to implement the initiatives to build resilience within these targeted or high risk communities. So when you think about the map that I showed you with the high low child opportunity with the red community areas, the communities that we're focusing on those same communities that have a lot of economic hardship, low opportunity for children, a lot of violence in them and so we're focusing our efforts in building resilience within those communities and equipping individuals in the community, whether in community organizations or faith organizations with mental health first aid, psychological first aid, trauma one-on-one, one-on-one so they know how to interact with individuals who have had trauma in their lives. This is another goal that we have in Healthy Chicago 2.0 that addresses violence prevention is decreasing the incidence of victimization, exposure to violence and strengthening community protective factors. So the next examples that I'll talk to are actually relevant to this overall goal. So we know that youth development is a critical important piece to preventing violence and so the mayor has been a strong advocate and proponent of One Summer Chicago which is a youth employment youth development program. Stacey's work with Napao and NAPS Core has taken advantage of, not taken advantage of it, has partnered very well with One Summer Chicago to give students an opportunity to have STEM experiences mapping out community resources within the 50 of the 77 community areas which is fantastic. But over the course of the past few years recognizing the importance of youth development and giving them job opportunities, the number has increased from just over 20,000 to 31,000 participants this last year. On top of that there's a subset of this program which is called One Summer Chicago Plus where these high individuals who are high risks for interaction with law enforcement are actually identified, pulled out and they actually get summer training for workforce opportunities and work experience but they also get some support therapy and get them into a different place in terms of mental health. It's not really, they don't have mental health, a mental illness necessarily but what they need is support in dealing with the trauma in their lives and those kinds of support services are given to these kids. And there has been work to show that those kids that are involved in the One Summer Chicago Plus who are at high risk for interaction with law enforcement are much less likely to be engaged with law enforcement in the future and so that program is ongoing and it is something that has been committed to. Another initiative that we have at the Department of Public Health is we have had a Play Streets program which started off as a physical activity program so we recognize that in certain communities there was not a lot of green space and kids were not outside playing and so to help with some of our obesity problems in Chicago, we identified these communities, made funding available to community organizations to create play spaces, block off streets, have events just on the street themselves so they don't have green spaces to play and so creating spaces for them to play but what we found is in these same communities there was also a lot of violence but these Play Street activities became positive presences in communities that are really impacted by violence and the positive presence actually prevents violence and so what we've been doing is more and more of these activities what we love about this activity is that we have over 75 events every summer that are, sorry, it's 150 events that are paid for by the Department of Public Health but the community organizations actually get the funding and because they buy equipment and learn the skills and how to organize these kinds of events we found that they actually do a lot more than what they're paid to do and they reach out and find additional support from grocery stores in the community, philanthropy or other organizations who are really to sponsor these kinds of events and so there's much greater impact in those communities and just what we're funding ourselves. This next program is a little bit different in that it's actually, it's a program that was initiated about three years ago by the Department of Justice it was a crisis recovery response program where Chicago survivors which is made up of individuals who have lost loved ones to homicide and they created this program to actually help interact with individuals who lose loved ones to homicide and provide mental health services, healthcare services or get folks connected to mental health services, primary care services, help them deal with the trauma of losing a loved one and also social services and help them fund funerals if necessary those kinds of things that are really acute need to be addressed but they also provide ongoing support to these individuals recognizing that the trauma doesn't go away just in the next few weeks you really have to work with them on an ongoing basis and so this Chicago recovery and response program was funded by DOJ for a couple of years and the funding went away but this program has been so meaningful and has made a difference in some of these communities so we actually continue to fund it with the Chicago Department of Public Health funding. What I have now is a video that I'd like to show that just gives you a sense of the individuals that are involved with the program itself and then also the individuals who are impacted by the program. Chicago Survivors is an organization that responds to every homicide throughout Chicago to provide immediate crisis intervention, to provide six months of proactive case management with comprehensive referral services and then a community of survivors, a place where peer to peer healing can take place over time. Chicago Survivors began as an idea in 2009 when Joy McCormack, our founder, lost her son to violence here in Chicago. When Frankie was murdered and my family was thrown into this chaos of dealing with police and hospitals and all of these things that we never expected to have to deal with, it was terrible and systems didn't know how to deal with the experience either. I decided to change that by starting Chicago Survivors. I met Joy and I heard about her vision for Chicago Survivors and we found funding through the Chicago Department of Public Health. We started back in 2010 and it was really started organically by people like me who were willing to come together and care. What's very important in violence prevention is how we respond when violence does happen. So my role as a crisis responder is anytime anybody gets shot here in the city of Chicago, the police department will call us out to help the families through what happens next. I was shot six times and my son was shot five. We were sitting on the porch. He died on top of me. That's not my first child that got murdered through violence. I had two more children murdered and Chicago Survivors reached out to me. I can always call them, talk to them, they're always there. Their foundation's been essentially collapsed and here we are coming saying we're gonna hold you up, keep you together, work with you. My nephew was killed last year. I think about him daily. I can hear him calling my name at night for help when no one helped him. I would never want anyone to sit in the same seat that I sit in. You can't expect for people to lose somebody in a violent way and just go back to their normal way of living. Now they have a new normal life that they don't know how to navigate so they need help with that. Your love is a prison with decorations on the wall. I can't tell you where I would be if I didn't have them to be able to call and just talk to them. Three kids for murder, that's a lot. But I'm still here and I'm still pushing with they help. I'd be okay. Violence is a public health issue because violence gets perpetuated from generation to generation. Violence is affecting every community and that it really doesn't matter where you live because bullets don't have boundaries. If there was one thing I would want somebody to know, I would want them to know about Chicago Survivors and how they helped me. Our program is lifting people up again after violence in the face of the community as a way of saying this is not how we're gonna live and that means everyone has to be part of the solution. Chicago Survivors is where it's at. Even if it's just a listen to you, they there. You took my heart but my soul Chicago Survivors is an organization that responds to every homicide throughout Chicago to provide immediate crisis intervention, to provide six months of proactive case management with comprehensive referral services and then a community of survivors a place where peer to peer healing can take place over time. Chicago Survivors began as an idea in 2009 when Joy McCormick, our founder, lost her son to violence here in Chicago. When Frankie was murdered and my family was thrown into this chaos of dealing with police and hospitals and all of these things that we never expected to have to deal with, it was terrible and systems didn't know how to deal with the experience either. I decided to change that by starting Chicago Survivors. I met Joy and I heard about her vision for Chicago Survivors and we found funding through the Chicago Department of Public Health. We started back in 2010 and it was really started organically by people like me who were willing to come together and care. What's very important in violence prevention is how we respond when violence does happen. So my role as a crisis responder is anytime anybody gets shot here in the city of Chicago the police department call us out to help the families do what happens next. I was shot six times and my son was shot five. We were sitting on the porch. He died on top of me. That's not my first child that got murdered through violence. I had two more children murdered and the Chicago Survivors reached out to me. I can always call them, talk to them. They're always there. Their foundation's been essentially collapsed and here we are coming saying we're gonna hold you up, keep you together, work with you. My nephew was killed last year. I think about him daily. I can hear him calling my name at night for help when no one helped him. I would never want anyone to sit in the same seat that I sit in. You can't expect for people to lose somebody in a violent way and just go back to their normal way of living. Now they have a new normal life that they don't know how to navigate. So they need help with that. I can't tell you where I would be. If I didn't have them to be able to call and just talk to three kids for murder, that's a lot. But I'm still here and I'm still pushing with their help. I'd be okay. Violence is a public health issue because violence gets perpetuated from generation to generation. Violence is affecting every community and that it really doesn't matter where you live because bullets don't have boundaries. If there was one thing I would want somebody to know, I would want them to know about Chicago's survival and how they help you. Our program is lifting people up again after violence in the face of the community as a way of saying this is not how we're going to live. And that means everyone has to be part of the solution. Chicago's survivors, where is that? Even if it's just a listen to you, they there. So, yeah, so that gives you a sense of what that program is, that particular program is and we do plan to continue to support this effort. We've worked with them as well. In addition to securing the funding from the city, we also partner with them to engage in philanthropy and other sources of funding so that we can help them to build capacity as well. I think over in the past, up into the first six months of this year, they'd actually worked with 300 families of individuals who'd been lost to homicide. So in addition to that type of work, another program that was launched just last year was a youth mentoring program. So along the lines of this youth development type of programming is the Department of Family and Support Services, which is a city, another city agency has kicked off a mentoring program that was based on BAM becoming a MAM mentoring program. And so the, with significant investment from the private sector as well as from this city, 7,200 boys and young men in eighth, ninth and 10th grades in high-risk communities, again those reddish communities that I pointed out earlier are will be engaged in this program. And then also 1,300 girls will be in a mentoring program called WOW, which is a similar to BAM program. And again, the focus in these kids is in the geographic area of 20 communities. And the goals for these kids are to have this positive presence and positive mentoring so they have positive school outcomes, lower their justice involvement and also link these kids to appropriate employment opportunities. So again, investing in youth to prevent violence down the line. So this is an example of, this is not the same map that I pointed out to you. This is not the low child opportunity communities, it's the mentoring communities, but you can see there's a lot of overlap with the communities that have low opportunity and the communities that are focused on from a mentoring perspective because these are the communities that are experiencing a lot of violence. The last program that I wanted to just describe to you is not a program that's run by the Department of Public Health of the City of Chicago. We are highly supportive of this though. There's a partnership for safe and peaceful communities that arose over the past couple of years and it's made up of 30 different funders, some philanthropies, some business sector partners who are committed to creating a safe and peaceful communities. And what they did is they raised enough funds to create this multi-component approach within nine communities in the city of Chicago. Again, it's a subset of those red communities that were identified for the mentoring program. But what they've done is they've created enough funding to actually for three years, or their goal is three years, they have secured for two years right now and are working toward the third year of a community-driven outreach and engagement program. And so Metropolitan Family Services is the lead organization. What they're doing is contracting with eight different community organizations that do community outreach. And when I say outreach, how many of you have heard about ceasefire or cure violence? So it's that model of interrupting violence when it occurs, but then also relationship building with those individuals and then doing case management and referring those individuals to appropriate services so that they can break the cycle of violence with them. And so there are eight different community organizations that do this kind of work in the city of Chicago and they've all been contracted to work together to standardize their approaches. And then they're linked up to the police department as well so they can actually work hand in hand. And so there's a delicate balance that has to be struck because in order for some of these folks in the community to really gain the trust of the individuals in the community, they can't be too closely affiliated with their line with law enforcement. And yet in order for them to be able to address these issues we need to have close relationships. And so these eight community organizations are committed to working with law enforcement, law enforcement is committed to working with them to make sure that this effort is successful. So they're standardizing the approach. They're in these nine communities to really disrupt and interrupt the violence that's occurring. On top of that, there's some positive presence activities. This is the weekly night light and night activities are much like our play street activities, but they're happening in these communities in the evening to be a positive. So there's more positive presence and less likely to be violence in the communities. Another arm of this approach is a rapid employment and development initiative called Ready. And Heartland Alliance is the lead organization for rapid employment of high risk individuals. So these are individuals that we know that have either probably already been engaged with the criminal justice system and are likely to re-engage. And so they're engaged with immediately gotten connected to intensive relationship based therapy as well as given workforce development opportunities. So not just the job but also ongoing training so they can then be successful in their current employment opportunity but then also have future opportunities as well. And so this one is actually being, there's a randomized controlled trial that will be happening in this particular subset of individuals to look at the impact that this has on their future employment and also their likelihood of returning to violent activities. So this is again not a partnership that is being run by the city of Chicago but definitely aligned with our priorities and also partnering with city agencies to make this to be successful. But it's something that we're really hopeful about and are looking, what this group is wanting to do these foundations in the business sector isn't planning to do this forever. And so what they want to do this is demonstrate this is successful for the first three years and then look at models for sustainability. And so I know Brenda Badle and we talked about this initiative last week and she's already engaged with Metropolitan Family Services to look at ways for process mapping this out to see what other initiatives are going on so that we can make sure that activities are all aligned. But that is what's so essential. There's a lot of work that is happening in the city of Chicago by a variety of stakeholders whether it's health centers, academic institutions, public health, law enforcement, community organizations. We all need to be working together to make sure that we are coordinating our work and also not stepping on each other's toes and that we're also spreading ourselves appropriately because we can't have all these resources in just a few communities and have nothing in some of the other communities. And so really being intentional about that has been a critical piece. And our focus on using data and also mapping things out and focusing on the highest risk communities is really an effort to bring that all together. So again, I can't really take credit for all the work that's being done. And again, those are just some examples of the work that's being done. But I really do want to call it the partnerships that we have throughout this city that have allowed us to initiate and plan Healthy Chicago 2.0, who are helping us implement all of Healthy Chicago 2.0 and our violence prevention initiatives. And I think our goal really is we recognize that when it's better for everyone, it's truly better for everyone. And that those of us in better places really can afford to reach down and help others who need help and that we really have to be intentional and focused. So thank you for your presence here today. Thank you for your interest in this topic. And I look forward to answering your questions. Yeah, so I mean, I think that's a good point. I wish that we had unlimited resources and we could do all levels of intervention. And the challenge is that it's not solely, it's almost, it's easier when we have an infectious disease epidemic because nobody else wants to deal with it. And so it all, it falls on our lap and people look to us to deal with this. Emily and I were just, Emily and I had talked, I don't know, a hundred times on the telephone, just met for the first time person to person because of Ebola. So when there's an infectious disease outbreak, resources come to us, dollars, lots and lots of dollars come to us and we're able to respond in the way that we feel is most appropriate. But this is a situation where we're not looked at as the sole solution and we aren't the sole solution. And so the resources have not followed, to be honest with you. So it's really a matter of resources and really making sure that we're directing the resources and those things that we feel like we are best suited to do and that we have capacity to do. So I would love to have a lot more resources but we really do not. So that's why we are so reliant on our partners. This is not the only situation though. I'd have to point out the opioid epidemic. I mean that is a similar thing where the resources really, I mean, this is a, that is a public health issue but there are law enforcement challenges and so we are working very closely with law enforcement and other first responders to address this issue. But unfortunately the resources really have not made it to this city. A lot of the federal funding that was made available went to states. And the states aren't used to sharing with large urban areas because we often have gotten funding directly. We just haven't had it in this situation. So we're advocating loudly and strongly. That's the activist in me. It's reaching out to federal agencies to say you can't forget the large urban areas because our epidemic is actually very different than rural and suburban communities. Our epidemic is heroin and fentanyl. It's not prescription drugs. So I mean, I think it's not, this is not unique to violence. It's, but I think infectious diseases, it's been easy because we're well established in having a primary responsibility. Hi, thank you so much for your great talk. My question relates to something that came up after last week's talk when Dr. Salman Rogers spoke. And in the Q and A there were comments about how we don't have enough behavioral healthcare professionals to provide the support after people have been, you know, shot or families affected by violence. And I wonder does the Department of Public Health kind of track those kind of staffing requirements? And do you have any ideas for how to increase the number of such professionals? So, oh, my name's Laura Botwinek and I'm with the graduate program in health administration and policy. Yeah, thanks for that question. Behavioral, so as you saw among the top priority health conditions that were identified in healthy Chicago 2.0 behavioral health was among the top because we recognize that there's inadequate resources available to address the needs of the community. There's a huge psychiatrist shortage in the nation and we feel the impact, particularly with children in the city of Chicago. And so there just are not enough behavioral health providers in the city of Chicago. But I've seen progress being made though because I think HRSA has invested in encouraging federally qualified health centers to expand their capacity to do both medication assisted treatment for substance use disorders, but also incorporating and integrating mental health services with their primary care services. And so the partnership between HRDI and Friend Family is a great example of the integration that's occurring between mental health services and primary care providers. And many of the federally qualified health centers within the city of Chicago are trying to figure out how best to make that happen and make it work. There's actually huge advantages in working with FQHCs and community mental health service providers working together because the reimbursement rates for federally qualified health centers for psychiatry visits is higher than it is in a community mental health service provider and then the mental health service providers actually get a higher rate for case management. So when they partner together, they're actually more self-sustaining than they are when they try to do things separately. And so this partnerships are really, really critical. We convened a group of federally qualified health centers and community mental health providers about a year ago and there are several different pilot projects that are going on and they're trying to just get through, the hardest thing is for them to get started because they need startup funds. But once they get started, they're actually able to sustain themselves. And so we're looking at ways we can identify seed money to actually allow these type of programs to grow and to actually expand access. But that doesn't really address the non-federally qualified health center problem. And I was talking with the Illinois AP again this morning about behavioral health and how that's a huge problem for the primary care doctor in their office. And I think what we need to do, this is just, I think we need to establish some models within the primary care setting of the kinds of services that could be made available. If you don't have a psychiatrist in your office, Ken and people will get LCSWs or other mental health personnel who can do some kind of triage, help do some therapy, low-level therapy so that lower level diagnoses can be addressed in the primary care setting and then elevate that mental health providers for the higher level or higher acuity issues. We're talking about Dan Johnson's program, the ECHO program, which is this consultation model using web based, it was meant for, it was developed for providers in rural communities so they could access experts, specialists that they don't have access to in their communities and they then access these individuals and get TA and consultation services but they also build capacity among themselves and then are able to tap into these experts on an ongoing basis. Well, it seems like that kind of model is probably what's necessary for behavioral mental health services. Even in urban areas like Chicago where we have lots of healthcare providers but where we're missing is really behavioral health services. That's a great question and it probably wasn't clear about our recast program which is this resilience and traumatized communities. What that is is really focusing on building that kind of capacity, training capacity to end support for those frontline workers. So we've actually done a lot of, we actually trained I think over 800 individuals that are frontline workers within city agencies to Chicago Public Libraries, Chicago Park District, Department of Family Support Services and CDPH, that was a subset of them and then we've also gone out into the communities themselves to do some training with those community organizations and faith communities. Is training or is it training their trauma? It's training to recognize trauma in themselves but also in others that they're working with because it's both, it goes both ways because these folks are living in traumatized and traumatic environments constantly and so they have to recognize it in themselves to be able to be supportive of others who are experiencing trauma as well. So the goal is that they raise awareness about their own situation and their own feelings as well as ability to help others. And then the goal really is to help them get access to resources because those individuals aren't trained to deal with the trauma in people's lives. What they are is to identify that people need help and then help them to get to the support that they actually need and then we have to build capacity to provide those, that support. Oh, the ACE, yeah, the ACE is, Marlita White is our Violence Prevention Director and she's done fantastic work and is very keenly involved with this, an ACE collaborative within the city of Chicago. Oh, adverse childhood experiences. So we know that there's, I think it is 10 different adverse experiences that we know if individuals have four or more of these exposures that they're much more likely to have chronic disease, mental illness, substance use disorders and so the ACEs, we're very aware of the literature and the work that's been done and we are cognizant of that as we develop our programs. We are also very active with the ACE collaborative which is in the city of Chicago and it's Lurie, has Lurie involved with the Health and Medicine Policy Research Group. There's a number of different agencies. Stroger Hospital has Marjorie Fujara who's also doing a lot of work in this area. So there's a, again, there's so much work that's happening. Healthcare systems are wanting to do more ACEs and more trauma informed kind of care and so it's really a matter of kind of really assessing creating a directory of what's happening out there to understand where is it not happening and where can we focus our resources to make sure that those needs are actually being met. Pretty much the multifaceted areas you're working in and I'm a big fan of programs like BAM and other youth development and jobs program but my question is about something else. It was about the crisis intervention training for police and I don't know what the extent of that is or the cost of that is but it seems like some version of that should be embedded into regular police training because it seems to me like any police officers at risk for being in a crisis and the more that training is infused it would also develop a culture, a shared culture about that. Yes, so the crisis intervention team training actually is a voluntary program within the police department and it's a 40 hour program so it's a pretty intensive program for these individuals to go through. Every police officer is given the opportunity to participate it but not everyone volunteers and there's actually some stigma associated with it because from a police perspective and you can understand how they might not, they might feel like that by being trained they're gonna be called into much higher risk situations and more likely to have an adverse outcome and so what they've done in the past probably nine months is they hired, not hired but they designated a lieutenant who is solely responsible for promoting this program and encouraging the uptake of the program and what they've done, they have found what they have is they've got some ambassadors crisis intervention trained police officers who will go about talking about how it's a positive that it's not a negative to get the police to actually understand that it's a positive experience and it gives them expertise and skills to diffuse situations and helps them overall but there was some stigma associated with it originally and then all of renew recruits and all existing police officers get some training it's just not the 40 hour training that the CIT trained officers actually get so they get some training it's just not that comprehensive program. So thanks Julie, we appreciate you giving us this overview of what's happening at the city level. In many large metropolitan cities the health department or a city entity actually serves as a convener for all of the activity that's happening in a city around these issues of violence prevention and trauma, those sort of issues and as you know, we've had this conversation here we're standing up the first trauma center in the 21st century in this country and we're all working to convene the groups that are all actively working on these efforts often in silos and now obviously the University of Chicago's goal is to become a convener at least for the south side for all of these entities that are working on these issues. Has there been any thought that the city at some point through maybe CDPH or somewhere else becomes a convener for this work, for the city to try to break down some of the silos and really bring all of us together that are working on these issues and I know it's happening in New York, in Boston and some of the other major cities. So there is, there was, I can't even remember the name of the group, there was a mayoral office program where it brought together all city partners all city agencies but also our external partners and brought them together to focus on violence prevention and that with the transition leadership at the mayor's, at the city hall mayor's office Walter Katz has now replaced Janie Roundtree. I believe that there's something that's in the works to actually happen out of the mayor's office and I think it's probably most appropriate for it to come out of the mayor's office as opposed to the Department of Public Health because it really isn't just a public health issue it really does require law enforcement, you know 911 call takers, support services, us to be at the table and there's no better agency to do that than the mayor's office with Walter Katz leading it so I'm hopeful, I have a, I don't know for certain but I believe that that kind of convening is a, will be happening and there's, because there is a strong desire and we recognize that because you can just hear all the different activities that are happening and bringing it all together is really essential. Hi, I'm Ann Jackson. I'm one of the McLean Fellows this year and I have a question relating to, so the initiative, so we know violence spills out into the suburbs and so I know that the task that you've undertaken is lofty but how and if there's any energy, our time spent in collaboration with the collar suburbs that this violence spills out into can you share with us any thoughts on how that's currently done, how that can be done and where you see opportunities for partnering there? So what I didn't mention is, maybe I didn't mention with Healthy Chicago 2.0 we do have a subgroup that's an action team that is focused on violence prevention and we don't, we focus on Chicago because that is the jurisdiction that we are responsible for but we don't exclude folks that are from other jurisdictions or outside areas and so we have a hospital collaborative that Brenda represents, University of Chicago at and it's Cook County. It's inclusive of a wall of Cook County hospitals and so it's over 20 hospitals that are participating in this collaborative and it's an opportunity for us to share knowledge, experiences, programmatic lessons learned so that we do cross jurisdictions and the action teams themselves include hospitals and healthcare providers that are outside of the city of Chicago. So it's like any epidemic we don't, we work hand in hand with our partner agencies either healthcare providers or public health agencies because we recognize the disease don't know boundaries and so we just have to work together so that we have strong working relationships with Cook County Health Department with other County Health Departments as well as with the state of Illinois. Sorry, were you gonna say something before I move on? Hi, no, go right ahead. All right, can you introduce yourself? Hi, I'm Kavi, I'm a medical student here at UChicago. So I was wondering, especially recently it's kind of re-come up the almost block on funding for gun violence research from like the CDC and stuff and like federal funding. I'm wondering if you can just like speak to that and if like that would make a difference for the public health department if on the federal level, the CDC had more funding for gun violence research and like what that looks like. So I would be, as I'm speaking as an individual not necessarily the city of Chicago but I would be a strong advocate for there being funding available to do research on gun violence. We can't really make informed decisions about effective policies and we were kind of guessing in some ways on some of these issues. So it'd be great to have more resources. Would those resources trickle down to us? Probably not and I wouldn't want them to come to us. We don't do research. We need academic institutions and partners to do that kind of research and so I would want that funding to be available for our partners to do the appropriate research that's necessary. So you mentioned that wherever you go even if this topic isn't the focus, the question about violence, what we're doing to prevent it and manage it is asked. And I think that they're probably in this room and probably everywhere you go there's a lot of pent up energy from citizens of the city who would like to be part of the solution but there's some paralysis. People just don't even really know what they can do. So thinking about from your talk today there were a few things we heard. We've heard about drugs and so one piece of advice to people would be don't buy drugs. What's that? What's that? Well, if we buy marijuana for our recreation on the street we're fueling some part of the economy that may be related to violence. No, I am just posing a question. No, I'm not offering other suggestions but it's a reasonable question and so you could add in. We could create jobs so those of us who have the opportunity through our work or our enterprises to create jobs for people especially in communities where people have limited opportunity. We have some mentorship programs. We could volunteer as mentors. We often times do mentor people here in our labs. Maybe some of us could learn some of these behavioral health frontline treatments or get trained in crisis intervention but what can we do? What can individuals do to be of help given your limited resources on this problem? I think a lot of people wanna help but don't know how to plug in. I guess I'll start maybe at the institutional level because I think that the health, so one of the things that's happening I think is that healthcare systems have this responsibility for doing community health needs assessments in order to maintain their taxes and status. And so they do these community health needs assessments and they also then are expected to use those needs assessments to inform their investments using community benefit dollars that are available. And so there's a great, that's a relatively new requirement and hospitals are trying to figure out healthcare systems are trying to figure out how they leverage your community health needs assessments and then use and then invest their dollars based on that. But so there are some institutions in the nation and also locally that are contemplating their role in terms of workforce investing in their communities for workforce development within the communities because they know that the communities that they provide care to are also the communities that they hire from and so that they can give workforce development opportunities to those communities or support businesses within those communities that those communities will then thrive. Cause I think one of the things that I've, a lot of what we do right now for violence prevention really focuses on specific interventions but it's not really addressing, not talking about the root cause issues that we're trying to address. And so economic development in these communities, if we could do something from an economic development perspective in these hard hit communities and academic health centers, non-profit hospitals can do that, they can invest in these communities either through hiring or providing employment opportunities to individuals living in the community, training them, providing educational opportunities within the communities, supporting those communities themselves. It actually helps the health and wellbeing of those communities overall and prevents violence downstream, prevents chronic disease downstream, prevents infectious diseases downstream. And so those are the kinds of investments that I'd like to see happen from a institutional perspective. At an individual level, I think this concept of being trauma informed is really important, understanding what that means, understanding the impact of trauma on individuals' lives and then identifying ways to refer those individuals to the resources that they need to have. We are actually about, one of the initiatives that we're trying to do, right, this, we just started this year, is 311 is a system that deals with city resources. When you call 311, you're just referred to streets and sanitation or to potholes, have potholes done. It's not a great system when we recognize that. So they're modernizing it. We're in the process of modernizing it to use a Salesforce platform, which is used in other jurisdictions like San Diego and it's a beautiful system. So people can access information online as well as have more up-to-date information by telephone. And it's mobile, so you can actually access it from your phones as well. So this system, but it doesn't have health and human service information. It just has city services. And so we've been working closely with partners throughout the city, United Way, Department of Family Support Services, which is in charge of innovation and technology to actually look at the cost of enhancing our 311 system to include health and human services resources so that with a phone call or within a quick search, people can identify the appropriate resources so people can get referred to the services they actually need, whether it's social support or whether it's behavioral health support or whether it's primary care, but actually help individuals get those kinds of resources. Because time and time again, when we were out in the community talking about how the Chicago 2.0, people said, we don't know where to go. We just don't know where to go. And then you talk to healthcare providers and they're like, we aren't that busy. So some places aren't that busy, have capacity, but don't have the patients, but patients don't know where to go. And so we're trying to push this concept forward and there's been great receptivity. The mayor himself is thrilled with this idea. He wants everything to be easily accessible, web-based, whatever we can do. It's a matter of getting the resources to follow through with this and also making this happen. But first, 311 itself has to be modernized. The next phase is the 311 Plus, which we're hoping to implement. But if healthcare providers understand how to recognize people who have been traumatized that are then able to identify they need help and then identify resources and help those individuals get connected to those services, that's how we're gonna make a difference whether it's infectious disease, chronic disease, mental health, or violence. Yeah, so Chicago Public Schools have about 400,000 children enrolled in them. It's a huge proportion of the population. A lot of these kids, these are the highest risk kids, not all of them, but many of them are high risk. And so there's a number of, in addition to the RECAST funding that we got, CPS also got some SAMHSA, I'm sorry, Education, Department of Education funding to do restorative practices within schools. And so they already had a number of social-emotional learning programs and restorative practices programs within the schools. And on top of that, they got some additional funding to expand into 10 additional schools, more comprehensive type of approaches. So the restorative practices are really focused on getting kids to how to deal with conflict non-violently and to learn how to de-escalate situations. And so this type of programming is happening throughout CPS system at various levels of intensity based on the funding that's available. We also support some of that work. So we invest in eight different schools every year that actually enhance their social-emotional learning and restorative practice programming within the schools so these kids are better equipped to deal with violence or conflict and learn how to, and the faculty in the schools are also able, better equipped to do that as well. So yes, there is work that's happening with CPS. Would we like to have more resources? Absolutely. Could we do more? Definitely. But there is work that's happening there. So if we want to be, so at a very basic level, healthy eating, active living, and no, not smoking, would be the areas that we would focus. And so, but again, I should have said this actually to begin with too maybe to give people perspective on what Department of Public Health is funded and able to do. We have about $150, $160 million budget and 80% of that is grant funding and most of that is federal funding. And so it comes to us to do immunizations, to do lead prevention, to do HIV work. And so it doesn't really allow, and we have never received any funding from the federal government to do any chronic disease prevention work. So what we've pieced together has been on our own dime and our own dollar. What we just did this past year is hired a program director and we have the process of hiring a medical director that we're very excited about who will then allow us to do more systematic policy and some programming work. We don't have a budget for programs so it will have to be a lot of policy type of work. So we will not necessarily add to our list of policy options the sugar sweetened beverage tax right now but those are the kinds of things that we could do that could actually make a difference in terms of chronic disease prevention in the long run. So we'll be exploring other policy options that we could implement within the city that would help us to be healthier overall and prevent chronic disease. So all the tobacco work that we did was really done just with our partners and also with our efforts to really drive the city policies forward to prevent menthol from being sold around schools to tobacco 21, to increasing the taxes so that tobacco products are less accessible to young people. And so those are efforts that we've been successful with. We now want to work on more active living, healthy eating type of initiatives over the coming years. Yeah, so our budget is about between $150 and $160 million every year and then 80% of that is grant funding and most of that is federal funding and so we're very dependent on the federal government for support and most of the funding fortunately comes directly to the city of Chicago. Most urban areas get funding from the state or from feds by way of the state. Fortunately the city of Chicago, Los Angeles, New York City have gotten directly funded in the past but it hasn't played out for opioids and for chronic diseases and so that's where we've been hurting the most. Oh, the population is 2.7 million. It's cure violence or ceasefire. Gary Sluckin's group at University of Illinois actually has a, it's an interrupter program where they interact with gangs and when there's violence they try to de-escalate. So we had in the past funded ceasefire. Currently for the past couple of years we've actually are funding an Institute for Nonviolence Chicago which is housed and focused primarily on the west side in Austin and so we are funding them to do that work and they've just gotten off the ground and they've interacted with about almost 200 individuals at this point this past year. But they are part of that group of eight community organizations that are doing this community outreach and interruption work in the nine communities. So it's a much more comprehensive approach thanks to the partnership for safe and peaceful communities. So it's a combination of our city investment and that one organization but there's seven others that are doing that kind of work. Is your question related to individuals that are incarcerated and are we doing any work with them? So there are a number of programs that are in place that interact with individuals that are being released from the Cook County Jail. So they get connected to mental health or behavioral health services upon release and so we're supporting a small program that deals with thresholds as a community mental health provider. So they provide services and linkage to individuals who are coming out of the jail that have these diagnoses. So they can connect it immediately to the services so they don't end up bouncing right back into jail. And so we have a small program like that but ours is one of many different programs that are involved with the criminal justice system or people that are incarcerated and or about to.