MCH Student:

Sara Horton

Date of Defense:

October 5, 2018

Abstract:

Introduction

Ramsey is Minnesota’s most densely populated, and diverse county. With a population of 540,646, [1] and a wide array of coalitions and agencies serving various communities, Ramsey County is as unique in its assets, as it is in its needs. Violence in this community, as in many communities, disproportionately impacts youth, people of color, and vulnerable populations such as the LGBTQ community, or youth experiencing homelessness. [2] Residents of Ramsey County are over two times likelier than non-Ramsey County residents to sustain battering/maltreatment injuries that require Emergency Department, or hospital treatment, with the highest number of instances occurring in the 15-19 year age group. [2][3] However, the impacts of violence do not stop at the victim. Negative health outcomes are associated with perpetrator, victim, and witnesses alike. Not only do these instances have negative consequences on the involved individuals’ mental health, school attendance, and future health outcomes, but public instances of violence have the potential of endangering bystanders as well. [2] While risk-factors for youth perpetration of violence are numerous including violent adverse childhood experiences, chronic stress due to low economic status and instability, existing protective factors include engagement with pro-social peer groups, having a meaningful connection with an adult, and having a place that feels safe.[4] One theory behind these protective factors suggests that by reducing adolescent’s exposure to environmental stress, the occasions where that young person may be influenced to react violently are also reduced.[5] Ramsey County Public Health violence-prevention initiatives: Making Authentic Connections and the Wakahenza Project both draw from this theory, partnering with local organizations and groups to create less stressful environments while giving adults the social tools to enrich their relationships with youth. These initiatives are led by Grit Youngquist and Darleen Simmons and significantly influenced my work with the Violence Prevention Action Team.

Organization

Saint Paul Ramsey County Public Health, (SPRCPH) is a Government based local health department with the mission to “Protect and improve the health of people and the environment in Ramsey County”. Ramsey County houses over 3,600 employees with 243 employees housed in the Public Health Division. While I was employed through SPRCPH, my main connection for the experience was the Violence Prevention Action Team. The Violence Prevention Action Team (VPAT) is one of five action teams led by SPRCPH staff to address goals outlined in Ramsey County’s Community Health Improvement Plan (CHIP). VPAT focuses on developing strategic plans towards the prevention of violence and intentional injuries, and their consequences on all people in Ramsey County. Action teams are comprised of residents and community leaders whose missions align with CHIP goals. VPAT meets quarterly, with intermittent learning sessions, and formative conversations held between meetings. Attendance to these meetings typically includes 12-20 members from various organizations including: Tubman Family Crisis and Support Services, Saint Paul, and Ramsey County Public Libraries, Achievement Plus School, Voyager Outward Bound School, the County Attorney’s Office, YMCA, and other community organizations and invested residents. By gathering knowledge on how youth identify and connect with safe places in order to reduce youth-involved instances of violence and share this information with the VPAT members, the experience worked in-line with VPAT’s mission and furthered their work.

Experience

In order to better understand youth and young adults perspective on safer spaces, focus groups were conducted in the East Saint Paul area. Convenience sampling was used to recruit youth from Harriet Tubman Center East: Safe Journeys and Domestic Violence Shelter Services, Maplewood Mall North Star Youth Outreach Drop-In Center, and the Maplewood Library to participate in focus group discussion and crafts that prompted conversations about perceived safety and space. Through collaboration with VPAT members discussion questions and a survey was created and tested. A pilot test was conducted with Youth from SunRay Library Young Mentors program. Two of the three focus groups were facilitated by a member from the organization of interest (someone who knew the youth), while notes were taken by me. Discourse analysis was used to identify repeating themes among the discussions, [6] and a factsheet was developed in order to ease dissemination. Finally, the project findings were presented to the VPAT, and plans were made to disseminate the factsheet to groups that participated and onward.

Results

Throughout conversations with these you people, several themes emerged. In terms of what youth are looking for in a safe space and what prohibits them from connecting with this space. Youth Identified the following as appealing factor to a safe and comfortable space:1.  Potential “I like seeing how other people live differently”. Community space offers the opportunity for youth to experience lives that are different from their own, spaces that welcome a variety of people with different life experiences and interest, with resources on how to become involved with such interests/aspirations, create the greatest opportunity for youth to thrive. 2. Social engagement without fear of being reprimanded for volume, or behavior. 3. Opportunities to be active, especially during winter months. 4. Quiet, while social engagement and activities are important, so too is having a place that can be quiet and personal. In most focus groups youth expressed statements such as “I want a space for only me”, or “I like to have some peace and quiet sometimes”. All of these aspects came up repeatedly throughout various focus groups, while the following were perceived barriers to accessing these spaces: Sibling responsibilities/child care, school work, house chores, and employment.

Lessons Learned

While working with Violence Prevention Action Team members, I learned how important having a variety of perspectives can be. Whether through testing the questions, giving updates about recent focus groups, or identifying themes, I was always amazed at the variety of input I received and how much other’s input enriched my own perspective and the project value. As a public health professional, my respect for community-engage practice was deepened as I realized how much I enjoyed connecting with people in research. Working with youth and public health professionals, I found a balance between engaging in population level health, while still being able to interact with the population I was serving. Moving forward in my career I would like to maintain this balance, even if the population of interest varies. One challenge for me was not being able to establish longer relationships with the youth I worked with. Working on a project that was trying to enable pro-social relationship building, it was difficult to meet with these groups once, knowing I would not be able to follow-up again with them and form stronger partnerships. Ideally, I would have liked to be able to meet with all of the focus groups at least once more and discuss findings and takeaways from the project.

Recommendations

Moving forward, I would recommend the following to the VPAT team and Health Communities staff at SPRCPH:

1. Further disseminate the fact sheet developed from this work to business owners and youth engaged organizations, in an effort to promote safer spaces for youth.
2. Continue focus groups with youth to better understand current youth perspective on issues of safety in their communities.
3. Incorporate this knowledge into Wakahenza and Making Authentic Connections workshops when appropriate.
4. Boost youth involvement in the VPAT quarterly meetings.

Conclusion

My involvement with SPRCPH and the VPAT team was a fantastic ice breaker into the public health world. I am incredibly appreciative to my preceptors and mentors guiding me throughout this process and allowing me to hone skills learned in the classroom.

References

1. Community Profile [Internet]. Ramsey County; 2018. Available from: https://www.ramseycounty.us/your-government/about-ramsey-county/community-profile
2. Saint Paul – Ramsey County Public Health (April 2013). Ramsey County Community Health Assessment, 2013. Saint Paul, Minnesota.
3. MN Department of Health. MIDAS Hospital Treated Violence. [Internet] 2017. Available from: https://midas.web.health.state.mn.us/violence/index.cfm
4. Resnick, Michael D., et al. “Youth Violence Perpetration: What Protects? What Predicts? Findings from the National Longitudinal Study of Adolescent Health” Journal of Adolescent Health, vol. 35, no. 5, 2004, doi:10.1016/j.jadohealth.2004.01.011.
5. Fraser, Mark “Aggressive Behavior in Childhood and Early Adolescence: An Ecological-Developmental Perspective on Youth Violence” Social Work, vol 41, no. 4, 1996, doi: 0037-8046/96
6. Casey, Mary Anne., Krueger, Richard. “Focus Groups: A Practical Guide for Applied Research, Fifth Edition”. SAGE Publication, 2014.