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.