TOWARD A LIFETIME COMMITMENT TO VIOLENCE PREVENTION IN ALAMEDA COUNTY: BACKGROUND AND PRELIMINARY RECOMMENDATIONS

The Value of a Strategic, Coordinated Approach to Violence Prevention

We know that violence -- in its many forms, and across our county -- is literally shattering lives. It is time to take action in preventing it.
-Nate Miley
Alameda County Board of Supervisors

Alameda County can be a wonderful place to live. It is an energetic, diverse, creative community. However, like many other counties in the state and nation, especially those with large urban, low-income populations, Alameda County faces serious violence problems. Violence is complex, and as such, requires a comprehensive solution. Comprehensive approaches have proven successful in reducing the negative impacts of numerous other community concerns such as alcohol abuse, tobacco, and traffic injuries and have been successful in reducing and preventing violence in other cities.

Within Alameda County, there are numerous valuable initiatives in place that address violence. There are heroic leaders within the county that are speaking out against violence, and working towards violence prevention. For example, young children and their families benefit from the First Five programs developed using Proposition 10 funding. There are effective school-based efforts that focus on violence prevention, such as Safe Passages. Shelters such as Shelter Against Violent Environments (S.A.V.E.) in Fremont protect women who have been battered and programs such as MOMS helps people- and the community at large- by providing the support for ex-offenders that reduces their likelihood of recidivism. However, while there are many violence prevention efforts in Alameda County, there is no coherent strategy by which to organize these efforts systematically.

There are people within the County and City governments who are committed to the issue of violence prevention; however, there is no distinct place within government where the responsibility for violence prevention lies and no venue where violence prevention planning consistently takes place. Without a comprehensive violence prevention framework, stand-alone programs can be inconsistent in their approaches, can appear confusing to the community, and can even be competitive and duplicative. They usually do not involve all of the necessary constituencies, and, alone, do not have the clout to affect underlying risk factors and change norms. Further, funds can't be as well spent and it's hard to determine if initiatives are working.

As a step towards preventing violence throughout Alameda County, this report was commissioned by Alameda County, through Supervisor Nate Miley's office. Its objective was to take a broad initial look at the efforts in the county and, in the light of relevant best practices throughout the United States, to recommend an overall direction and approach. In so doing, meetings were held and interviews* were conducted with approximately fifty key local government officials, state officials, and community members, and local data and documents were reviewed as well as relevant materials from research throughout the nation. Its span is county wide and its focus is on all types of violence. It is envisioned that this report is the first part of a continuing process and, as such, highlights the vital importance of an overall Alameda countywide strategy to reduce violence. This report is intended as a working document that will be shaped and revised by the violence prevention advisory board.

Strategy

The complexity of violence underlies the need for a strategic approach. Strategy is the key to determining priorities, maximizing discrete efforts and ensuring that they build on each other to promote broader system and policy level changes. By the term strategy is meant an analysis of the issue, delineating a final goal, defining what steps need to be taken and by who, and finally, executing the plan. The key components of a strategy framework for violence prevention include:

• Establishing a clear vision or goal
• Identifying the risk and resilience factors, needs and assets, of a community
• Establishing decision making processes
• Identifying the organization and the people responsible and accountable for effective decision-making
• Clarifying the role of different parts of government and of other constituencies in achieving a solution
• Engaging and gaining the support of key stakeholders
• Evaluating program effectiveness and ensuring that resources are being appropriately used
• Fostering sustainability of improvements

Strategy development leads to better outcomes by promoting approaches that are well coordinated, responsive to local needs and concerns, and build on best practices and existing strengths. Further, the process of strategy development builds a shared understanding and commitment, and enables participants to work out the relationships needed to enhance the likelihood of success. Strategy development won't solve violence problems but it will put Alameda County onto a roadmap for doing so.

Findings

Interviews repeatedly confirmed the lack of a comprehensive approach to violence prevention in Alameda County and described the elements that were deficient. These include: absence of leadership, lack of accountability, no mechanism for coordination and communication, limited understanding about violence prevention.

First, there has been an absence of leadership on the issue of violence prevention. There is no identifiable person or department that has overall responsibility for developing strategy, gathering data and measuring the effectiveness of violence prevention efforts in Alameda County.

Second, there is a lack of accountability for violence prevention outcomes. There is a notion that "everyone" is responsible for violence prevention in Alameda County, which contributes to a lack of initiative, coordination, accountability and effectiveness. County departments are working on problems that contribute to violence prevention, but not systematically and not necessarily together. Without a clear expectation of violence prevention outcomes from all stakeholders, as well as rewards for achieving them and consequences for not achieving them, there is no guarantee that violence prevention efforts will be prioritized or as effective as possible.

Third, there is little coordination and no regular venue where such coordination might appropriately take place. This results in poor linkage of services, little sharing of data and information, and little opportunity for maximizing the effectiveness of collaboration across County departments and services, nor between county and city governments. There is no mechanism for systematically connecting departments engaged in work that could reduce or prevent violence with community members and organizations that are doing work on violence prevention. One result of the lack of coordination is more of a reliance on intervention and suppression and less support for attempts to build on existing resiliency and protective factors. Without a forum for sharing ideas, perspectives and data that are useful in fully understanding the scope and nature of the problem of violence in Alameda County, the basis of a coordinated plan for its solution cannot develop. A consistent issue among community groups was the difficulty in obtaining data and information. Multiple interviewees noted that obtaining data is often contingent on personal relationships.

Fourth, while there was a significant understanding of the underlying factors that relate to violence, there appears to be inadequate understanding among many elected officials and county workers of what effective violence prevention entails. One result is that there is virtually no dialogue across departments about how the work of each department might contribute to reducing levels of violence in Alameda County. There is a clear understanding of the role and the responsibility of the police and probation departments play in intervening against criminal violence. There was some understanding of the role of social services in intervening in situations where domestic violence or child abuse may be identified. But there was little awareness or understanding of how to prevent violence other than a strategy of suppression and deterrence, in spite of understanding key underlying factors related to violence such as poverty, racism, poor educational outcomes, lack of appropriate role models, and insufficient activities and opportunities for young people. There is no shared definition of violence prevention and even the term violence has different meanings and implications to different people. Some characterized violence primarily as assault and homicide, some included violence against women and young children, and sometimes elder abuse. Few saw suicide as part of the problem or institutionalized violence -- e.g. police brutality, but for some people these forms of violence are paramount. There was little described in terms of analysis of risk or resiliency factors that would be the basis for a comprehensive and effective violence prevention strategy. As a result, there remains no articulated vision, strategy or plan for how the County of Alameda should or could reduce violence.

It's not surprising, then, that informants were not optimistic about violence being reduced. Many respondents described the violence problems in the county fatalistically. If they were hopeful about anything it was one particular piece -- one program that seemed to be working, or one person who was taking action in one community. "If I can just save one life..." is a comment that indicates a feeling that overall efforts are lacking. There was not the sense of a building movement, nor a roadmap, nor of pieces coming together.

An effective strategic approach to violence prevention in Alameda County would address each of the major findings in a comprehensive manner that would provide: 1) a common knowledge base about what violence prevention entails and why it is the only long term sustainable solution to the problem of violence in Alameda County; 2) a structure of accountability, leadership and collaboration; 3) a connection between county departments working on violence prevention and community based organizations engaged in related activities; and 4) a consistent and vigilant focus on the problem of violence and the potential for prevention approaches to be effective.

An important component in creating an effective violence prevention framework for the county is incorporating what different elements of the community can offer to the process. For example, the business community has an important role to play regarding economic growth and provision of sustainable jobs, and community libraries can promote literacy. Virtually each sector has a role to play. And while violence prevention requires a distinct set of efforts, it equally fits with broader approaches to the overall health and well being of a community. How buildings are designed -- and for who -- are related to violence prevention. Whether there are accessible parks, and art and sports programs in schools. Whether local stores sell alcohol or emphasize fresh fruits and vegetables all relates to preventing violence and while there seemed to be an intuitive understanding of the importance of overall community effort and investment in violence prevention, there was little sense of a plan underway.

Making Alameda County Safer

This report is intended to address all forms of violence existing within Alameda County, spanning across all ages and communities. The report emphasizes risk and resiliency factors of violence as a key element for a violence prevention framework that can be utilized across disciplines. The preliminary recommendations delineated in this document are not about "fixing the system"; rather, they are about laying the initial groundwork to creates a unified violence prevention system that will work for agencies and departments, and more importantly, for the people who call Alameda County home. These recommendations form the foundation of an overdue approach that will build accountability by clarifying where each stakeholder fits. Success depends on long-term commitment and leadership, but strategy is also a critical ingredient.

The need for such an approach is underscored by the National Crime Prevention Council's study entitled Six Safer Cities. The description of city efforts with crime prevention fits well with the broader goals of countywide prevention of violence.

Several cities in the United States have distinguished themselves in the fight to reduce crime over the past decade. These cities have surpassed national decreases and dramatically reduced crime through collaborative partnerships and the use of targeted policy and program strategies to address priority crime and quality of life concerns. At the heart of successful implementation of community-wide approaches is a deliberate process of bringing together formal and informal leaders to establish priorities for action. The process these cities engage in includes diagnosing local crime problems, assessing community assets and resources, forming coalition and partnership-based networks, and integrating crime control and prevention strategies into a balanced approach. At a fundamental level, such activities reinforce bonds among partners, holding each accountable for helping co-produce more comprehensive policies, innovative resource development tactics, and specific programs that recognize the fundamental role of prevention-oriented strategies.¹

One barrier to developing violence prevention strategy is often a lack of resources. Indeed, a much more significant share of resources is directed to addressing and ameliorating violence after the fact. This includes funding for incarceration, protection such as in shelters and out-of-home placements, and medical treatment. But waiting until after the onset of violence not only has financial costs, it also has costs in terms of loss of quality of life and loss of life. Violence is in fact preventable, but its prevention requires an investment of resources, people, leadership, and commitment. And it is most effective when it is done strategically. Further, resources are currently being committed to violence prevention in numerous ways. These resources need to be well spent and should fit within the overall framework and goals that are most likely to achieve success. Another value of having a good plan is that is can help attract resources. The City of Salinas, for example engaged in a violence prevention strategic planning process, which resulted in Cultivating Peace in Salinas², and since has succeeded in attracting funding for two major implementation efforts for just under ten million dollars in the first four years after the plan was developed.

Overview of Violence in Alameda County

According to the Alameda County Public Health Department, Alameda County ranks 6th in death due to homicide among all California counties.³ Suicide rates remain above national goals. In addition, there are multiple forms of violence that take place daily in people's homes, schools, and communities that do not result in death. Concerned at the increase, one person said, "I have never seen violence at the level that it is now."

Homicide: "Homicide... is any intentionally inflicted fatal injury to another person."⁴ Homicide is the most publicized form of violence in Alameda County. In 2001, there were 108 homicides in Alameda County.⁵ Approximately 78% of the homicides in Alameda County in 2001 occurred in the city of Oakland, despite the fact that Oakland only comprises slightly over 27% of Alameda County's total population. The homicide rate in Oakland increased dramatically in 2002 to 113, up from 87 in 2001.⁶

Child abuse: "Child abuse is a physical injury which is inflicted by other than accidental means on a child by another person."⁷ In the year 2000, 17,273 allegations of child abuse were reported to the Child Abuse Hotline in Alameda County; of these reported allegations, 38% lived in the City of Oakland.⁸ Studies show that maltreatment during childhood increases the likelihood of juvenile arrest by 53%, and arrest as an adult by 38%.⁹ Research has also shown that an overwhelming majority (85%) of convicted felons were abused as children.¹⁰ In addition, although East Oakland comprises only 5% of the population in Alameda County, it accounts for 21% of the county's foster care placement. One interviewee noted, "there should be something in the school curriculum early on so children know they shouldn't have to be abused."

Elder abuse: "Elder abuse is a term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult."¹¹ Broadly defined, abuse may be physical, emotional, or sexual abuse, exploitation, neglect, or abandonment. Elder abuse affects people of all ethnic backgrounds and social status and affects both men and women. In California, more than 225,000 cases of elder abuse occur annually.¹²

Intimate partner and dating violence: Intimate partner violence is often referred to as domestic violence. "It includes violence between spouses, individuals in dating relationships and former partners or spouses, and can occur inside or outside the home. Domestic violence often involves a pattern of behavior that includes physical, sexual, verbal, emotional and psychological abuse. The California Penal Code defines abuse as 'intentionally or recklessly causing or attempting to cause bodily injury, or placing another person in reasonable apprehension of imminent, serious bodily injury to himself, herself or another.'"¹³ In 2001, there were 5,700 domestic violence related calls made to police in Alameda County.¹⁴ In Alameda County in 1996, approximately 47% of the 8,880 domestic violence calls to police were from the city of Oakland.¹⁵ Nationally, each year, it is estimated that over 3 million children are at risk of witnessing parental violence.¹⁶ Research has shown that children who witness domestic violence are at a higher risk for becoming either a perpetrator or victim of violence in the future.¹⁷

Sexual assault and rape: Sexual assault is an act of sexual aggression and violence expressed through force, anger and/or intimidation in which a person is made to engage in sexual activity without consent.¹⁸ According to the Criminal Justice Statistics Center, in Alameda County in 2001, there were 495 reported forcible rapes.¹⁹ Of these, 295 were reported in the City of Oakland. However, the Federal Bureau of Investigations reports that only one in nine women who are sexually assaulted report the crime.²⁰ National statistics show that a woman is raped every 46 seconds.²¹

Youth violence: Youth violence encompasses a range of types of violence in which young people engage, including homicide and manslaughter, robbery, aggravated assault, and forcible rape.²² Youth violence also encompasses school violence and gang violence. "Gangs often form along ethnic and racial lines, although there is a current trend of youth joining gangs for economic motives, or for the glamour, excitement or 'high' achieved by committing acts of violence and participating in crimes. Gangs generally identify themselves by a name derived from a street, neighborhood, or housing project where they are based; a rock band they like; a cult they follow, or their ethnicity."²³ Research shows that youth are at a much greater risk of being the victims than the perpetrators of violent crime.²⁴

Suicide: "Suicide is defined as any purposely self-inflicted injury that is fatal..."²⁵ Suicides accounted for over 19% of the fatal injuries in Alameda County in 2001.²⁶ Between 1999-2001 Alameda County had the lowest suicide rate (7.7 per 100,000) compared to the statewide average (9.5 per 100,000) and neighboring counties of San Francisco (11.0 per 100,000), Contra Costa (8.8 per 100,000), and Santa Clara (7.1 per 100,000).²⁷ In 2000, Alameda County had a total of 108 fatal suicide attempts.²⁸

Hate violence: Hate violence is defined as, "any act of intimidation, harassment, physical force or threat of physical force directed against any person, or family, or their property or their advocate, motivated either in whole or in part by hostility to their real or perceived race, ethnic background, national origin, religious belief, sex, age, disability, or sexual orientation, with the intention of causing fear or intimidation, or to deter the free exercise or enjoyment of any rights or privileges secured by the Constitution of the laws of the Untied States or the State of California whether or not performed under color of law."²⁹ While Alameda County's total numbers of hate crime incidents dropped from 63 in 2001 to 56 in 2002, Berkeley's hate crime occurrences rose from 11 to 29. Hate crime events based on race, ethnicity or national origin account for the majority (more than 62 percent) of hate crime events.³⁰ Following the terrorist attacks in New York and Washington on September 11, 2001, many Muslims, people of Middle Eastern descent, and those perceived to be Muslim and/or of Middle Eastern descent have experienced increased hate violence.

Sanctioned violence (police brutality): Police Brutality is defined as "the use of excessive force. It is often physical force greatly exceeding the threat encountered, and sometimes used when there is no threat."³¹ In some communities there is widespread fear of the police, which has been reinforced by the case of the Riders. According to some interviewees, "The police are threatening, and we are powerless." Others noted that, particularly in Oakland, "The police don't live in the community, so how can they care about it?" Some people recommended developing a board to monitor the police department. Unfortunately, data is rarely kept on police brutality, which places no accountability around the actions of police departments.

Advancing Comprehensive Approaches to Violence Prevention

Recognizing that law enforcement alone cannot solve the problem of violence, those concerned about violence have increasingly turned toward a broader, more comprehensive approach, incorporating public health, law enforcement, social service, and education perspectives. A successful violence prevention strategy requires looking beyond the individual level. Individual behavior is the product not only of individual development and personality traits, but also a reflection of the social context of which people live. Henrik Blum notes "getting people to behave... encompasses only a small fraction of the routes to risk reduction and does not stand alone without significant support from major societal mechanisms."³² Therefore, a successful violence prevention strategy requires an environmental approach, such as efforts to address the complex and multiple underlying factors associated with violence including, but not limited to, poverty, unemployment, and discrimination. A socio-ecological framework provides the lens by which to view individual behavior in a larger context of families, communities, and society.

The Institute of Medicine's study that culminated in Promoting Health: Intervention Strategies From Social and Behavioral Research³³ affirms this. This study focused on the relationship between environmental approaches, behavior and medical care. It called for increased attention to environmental approaches to achieve better health and safety outcomes. The report asserts that, "One-to-one interventions do little to alter the distribution of disease and injury in populations because new people continue to be afflicted even as sick and injured people are cured. It therefore may be more cost-effective to prevent many diseases and injuries at the community and environmental levels than to address them at the individual level."³⁴ While behavior choices are directly associated with a significant share of health outcomes, including violence, education focusing on behavior change alone ignores larger environmental factors that can work against the educational message. Efforts that have been most effective are those that have recognized the value of comprehensive approaches involving a range of partners.

Further, to reduce violence, it is important to address underlying risk and resilience factors. A growing body of research demonstrates the interrelationship between risk and resiliency,³⁵ the ability of resiliency to mitigate the effect of some risks^{36, 37} and the importance of focusing on both factors.³⁸ Therefore, strategies that simultaneously reduce risk factors and increase resiliency factors have a greater chance of success. Interviewees identified a range of risk and resilience factors in Alameda County.

Risk Factors

Risk factors are characteristics or circumstances that increase the likelihood of an individual, family, or community being affected by or perpetrating violence. The effects of risk violence are complex, interactive, and cumulative. Not everyone exposed to these risk factors will become involved in violence, but those who are exposed to multiple risk factors have a higher prevalence of antisocial behaviors and a greater likelihood of decreased intelligence and social competence.^{39, 40, 41} The combination, frequency, and severity of risks influence whether or not problems develop.⁴² According to Dr. James Garbarino, "No one risk or asset counts for much by itself. It is only the overwhelming accumulation of risk without a compensatory accumulation of assets that puts kids in jeopardy."⁴³ Interviewees identified a number or risk and resilience factors.

1. Poverty and economic disparity
Many interviewees identified poverty as a significant risk factor in Alameda County. Lack of employment opportunities creates a sense of hopelessness and is a stressor. Some who cannot earn an adequate or living wage as part of the mainstream economy may turn towards drug dealing or other illegal activities to make a living. Several interviewees suggested that this is the case in Alameda County. For example, according to one person, "People are selling dope; they are getting involved in the drug markets because they need food". Furthermore, if the local economy is in decline, there tend to be less support services available to residents and deterioration of the local infrastructure. One interviewee said that gangs, which are developing as a response to disenfranchisement, represent a major risk factor for violence within the county. Declining quality among schools and housing contribute to the feeling among youth that society does not care about them; violence is often the mechanism by which youth express their frustrations and anger about the disparities that exist within their worlds.

2. Discrimination and oppression
Oppression, which includes sexism, racism, and discrimination on the basis of age, ethnicity, class, sexual orientation or culture results in inequality and feelings of powerlessness, which underlie many types of violence. Many people interviewed identified discrimination and prejudice as a significant contributor to violence in Alameda County. According to one person, "At the root, it's all the 'isms. Racism, sexism, age-ism -- you name it, all the 'isms." Youth may experience oppression based on their age, or the perception that they cannot actively contribute to society in meaningful ways. Several people mentioned young people of color as specifically experiencing discrimination in the county. According to one person, "The system is less responsive, such as police and healthcare. I deal with 'expendable' kids. They're not seen as worth investing in. " Another identified racial tension as a major contributor to school violence. Racial tension and conflict was also identified as a contributor to community violence as well as a barrier to positive relations within neighborhoods. Promoting safety in low-income communities can be ineffective because racism, bias, and discrimination can foster conflicts that leave the residents feeling powerless, divided, and alienated.⁴⁴

3. Incarceration/Re-entry
Re-entry is increasingly being identified as a contributor to violence in the county. Residents are returning following years of incarceration without adequate services, job training, or economic opportunities. Because state law requires the return of parolees upon their release to the county of their most recent residence, Oakland has been dubbed the "ex-con capital of California". According to Oakland's Department of Human Services, the California Department of Corrections (CDC) paroled 2,989 adult ex-offenders into Oakland during the 2000 fiscal year.⁴⁵ A recent article in the Los Angeles Times estimated that one out of every 14 adult males in the City of Oakland is on parole or probation.⁴⁶ The article also estimated that approximately 11,400 parolees and probationers currently reside within the city limits. Similarly, the National Organization of Black Law Enforcement Executives (NOBLE) found that on a daily basis, "approximately 700 parolees in Oakland are wanted for some type of [parole] violation and that over 50% of reported crime in Oakland is committed by persons on probation or parole."⁴⁷ One interviewee said that the number of homicides in an area correlates with the number of people on probation. For younger parolees, there are concerns about what opportunities exist for them. For example, school districts may not want parolees back in school due to safety concerns.

The United States has the highest incarceration rate per capita in the Western world.⁴⁸ The huge expenditures for prison building are a major determinant of available resources for schools, health, and other government necessities. California's rate of incarceration and expenditure make it one of the highest in the U.S. both for adults and for youth. Men and women are socialized within a violent subculture in prison and this is often spread to communities upon release.⁴⁹ Some interviewees noted the trend to high incarceration rates. As one interviewee expressed, "young adults no longer have the luxury to make mistakes."

4. Illiteracy and poor academic achievement
According to the 2000 U.S. Census, 17.6 percent of adults in Alameda County over the age of 25 have not completed high school. Although this figure is only slightly lower than the statewide rate of 18.8 percent, the high school drop out rates for the Berkeley, Oakland and Newark Unified School Districts are significantly higher than the statewide average. According to the Alameda County Public Health Department, the Oakland Unified School District alone has a high school drop out rate of 19.7 percent, which is almost double the state's average rate of 10 percent. The countywide drop-out rate for minority students, however, is significantly higher. According to the Alameda County Health Care Foundation, Latino/a youth have the highest drop-out rate of any ethnic group within the county (24.3%), followed by African-American students, whose current drop-out rate is 21.9 percent. This in turn impacts future opportunities. As one interviewee put it, "There is no true employment for uneducated people and people without work experience."

Many interviewees identified the educational system, academic failure, and truancy as a major risk factor for violence in the county. Many young people have unmarketable skills and a lack of opportunity as a result. Further, youth in the juvenile justice system with a learning disability and in need of special services don't get those needs necessarily met by the schools.

There is a strong correlation between school failure and aggressive or violent behavior.^{50, 51} Further, research shows that chronic exposure to violence harms a child's ability to learn.⁵² When children's energies are redirected because they are defending themselves against outside dangers or warding off their own fears, they have difficulty learning in school.⁵³ The relationship between violence and learning is particularly significant because cognitive skills form the foundation of academic success, self-esteem, coping, and overall resilience.

5. Firearms
Even if a reduction in the number of hostilities could not be accomplished, a mere reduction in the availability of guns and ammunition would decrease the lethality and injury associated with violence. Firearms significantly contribute to the lethality of violence in Alameda County. For example, in Oakland in 2002, nearly 85% of the 113 of homicides were committed with a firearm.⁵⁴ Firearms play a major role in domestic violence and can make domestic disputes more lethal. In 2001, there were many domestic violence related calls and of those calls, weapons were often involved. In Oakland, 200 of the 2,043 domestic violence related calls involved a weapon.⁵⁵ Other cities in the Alameda County recording the following: San Leandro (264 of 268), Alameda (203 of 203), Albany (14 of 14), Berkeley (234 of 342), Emeryville (15 of 16), Fremont (556 of 560), Hayward (415 of 425), Livermore (98 of 222), Newark (129 of 137), Piedmont (3 of 17), Pleasanton (93 of 123), and Union City (12 of 242).⁵⁶ In addition, in the courts, security is threatened by firearm usage as well, particularly related to domestic violence cases. Some interviewees called for reductions in access to guns.

6. Experiencing and witnessing violence
Many people identified violence as a now "normal" or common occurrence in many homes, schools, and neighborhoods. According to one person, "It feels like a fact of life in Oakland. The kids we work with are used to gunshots." Youth in Alameda County are saying, "Why should I worry about tomorrow when I don't think I'll live past today?"

Witnessing and/or experiencing violence is a traumatizing incident that can leave one feeling scared and helpless. It can also model violent behaviors and create and build upon norms of violence as an acceptable form of behavior and place people at greater risk for perpetrating or being victimized by further violence. Repeated (chronic) exposure to violence -- such as that associated with living in a violent home or neighborhood -- often result in negative effects that persist and accumulate over the long term.^{57, 58} Studies have found symptoms of post-traumatic stress and disorders among infants and toddlers exposed to community violence.⁵⁹ History of child maltreatment is a strong predictor of future behavior problems, some of which are violent, aggressive, or delinquent. While not all children who experience abuse or neglect become involved in violence, many do become either victims or perpetrators as adults. A study conducted for the U.S. Department of Justice found that childhood experience of maltreatment increases the likelihood of an arrest as a juvenile by 59%, as an adult by 28%, and of arrest for a violent crime by 30%.⁶⁰

7. Alcohol and other drugs
Interviewees identified substance abuse and the presence of drug markets as major contributors to the problem of violence in the county. Substance use and abuse contribute to violence in the home and the community. For example, it was associated with intimate partner violence as well as with shootings that happen at parties and cultural celebrations. Finally, many interviewees postulated that drug markets and struggles over them contribute to violence and in particular to homicides.

Nationwide, alcohol is the drug most closely associated with violent incidents; some researchers estimate that it is implicated in 50 to 66 percent of all homicides,⁶¹ 20 to 36 percent of suicides,⁶² and more than half of all cases of domestic violence.⁶³ The scientific literature strongly suggests that alcohol, like other drugs, acts as a "multiplier" of crime. The use of alcohol and drugs results in higher levels of aggression and crime. And in neighborhoods where there is a concentration of liquor stores, that neighborhood often suffers from alcohol-related social problems.

8. Negative family dynamics
Many people underscored the contribution of family and home life as contributing to violence. People said that families have a responsibility to model and teach responsible and non-violent behavior. Family dynamics refers to family relationships, interactions, structure, parenting skills, family communication, and methods of discipline. An unsupportive home life including psychological or physical abuse can begin or maintain a cycle of violence-in and outside the home. A lack of nurturing interactions between parents and their children harms child development and increases the risk of involvement in violence. Parental practices such as failure to set clear expectations for children's behavior, poor monitoring and supervision, lack of involvement, and severe and inconsistent discipline, have been shown to consistently predict later delinquency.^{64, 65}

9. Community deterioration
Community deterioration includes both a breakdown of supportive networks among community members and a lack of resources such as community recreation areas or health and educational facilities. According to one interviewee, " People are living in negative environments and need to get people out so they can get their heads together." Families living in such communities may be socially isolated, without the personal resources to make up for the lack of goods and services or to escape to a more affluent community. Many interviewees noted the deterioration of some neighborhoods and one person said, "We've lost all connection to our community." The combination of neighborhood poverty and family poverty poses a double risk for young children. Research suggests that moving to a more affluent community enhances the physical and psychological health of children as well as their academic performance, and reduces violent crimes committed by adolescents.^{66, 67} In addition, the absence of networks and organizations that help reinforce positive values contributes to high rates of violence.⁶⁸ For example, lack of validation of violence-free lifestyles in the community may undermine parents' efforts to teach their young children positive behaviors.⁶⁹

10. Mental illness
The California Youth Authority reported that in 2000, 45 percent of male inmates and 65 percent of female inmates had mental health problems. Indications also exist that point to a high rate of behavioral problems among Alameda County's preschool-aged children. In the Child Care Planning Council's February 2002 report, Preventative Mental Health Services for Young Children in Alameda County, the top concerns of childcare center directors included the "aggressive and violent behavior of children." Significantly, in a study conducted by the City of Denver, these same behaviors were observed among approximately half of all serious violent offenders and they are, according to the U.S. Surgeon General, "linked directly to violent behavior."⁷⁰

A 2001 report by the U.S. Surgeon General on youth violence argued that the prevalence of mental illness among violent youth is significantly higher than the prevalence of mental illness among non-violent youth. According to this report, surveys conducted by the State of New York and the City of Denver both demonstrated that serious violent offenders were at least twice as likely to suffer from mental health problems as either non-violent offenders or non-offenders. Among violent youth offenders, the rate of mental illness was 28 percent, however, non-violent, youth offenders were plagued by mental health problems at a rate of only 13 to 14 percent. Similar studies in the U.S. and New Zealand have demonstrated that for both young and middle-aged adult populations, the greatest risk factor for violence stems from a combination of mental illness and substance abuse.

11. Gender socialization
Boys and men are disproportionately represented among both perpetrators and victims of violence, including physical and sexual assaults. Most boys learn in a variety of ways that "rough and tumble" play, fighting, risk-taking, and lack of emotional expression are typical and natural male characteristics.⁷² This kind of socialization can cause boys and men to be less empathetic than girls and women and more prone to engaging in bullying and other violent behaviors. A growing body of research has documented a strong link between socialization into this stereotypical code of masculinity and an increased risk for violence.^{73, 74, 75}

12. Media violence
Media portrayals of violence enforce the message that violence is a common and appropriate way to solve problems. In addition to the barrage of violent images that children are exposed to on a daily basis through magazines, newspapers, films and computers, it is estimated that children in the United States view 8,000 murders and 100,000 acts of violence on television before completing elementary school.⁷⁶ Such exposure models violent behavior, increases fearfulness which can impel one to become involved in violence as a means of protection, leads to desensitization to violent images and acceptance of violence as normal, and increases desire for involvement in violent activities.⁷⁷ Numerous studies have shown that excessive exposure to media violence increases aggressive behaviors in children and is associated with long-term negative effects.^{78, 79, 80} In addition to television and movies, it has also been shown that violent video games produce a lower sensitivity to violence as well as contribute to violent behavior in youth.^{81, 82} Children under age five who witness television violence are especially vulnerable.⁸³ Without appropriate guidance, children can internalize the message that violence is a common and appropriate way to solve problems. This results in an increased likelihood for children to behave violently towards others and a decreased sense of empathy when they observe violence being perpetrated against others.⁸⁴ Additional research shows that the more violence a child watches at age five, the lower their grades later on in school.⁸⁵

Resilience Factors

The capacity to develop positively despite harmful environments and experiences is called resilience. Fostering individual resiliency has been shown to improve academic, emotional, social, and cognitive outcomes^{86, 87} and to reduce violence later in life. Further, building community resilience factors or assets can counteract the negative effects of risk factors. Research shows that, like risk, the effects of resiliency factors accumulate, with those with more assets being less likely to engage in violence and other high-risk behaviors. According to Search Institute data, only 6% of children with more than 30 assets were violent, compared to 61% of the children with less than 10 assets.⁸⁸ Having more assets also increases the chances that young people will have positive attitudes and behaviors such as good health, success in school, self-control, and value for diversity.⁸⁹ Resiliency factors function at a number of different levels to produce healthy and positive outcomes. Social and economic opportunities, strong and vibrant communities with cohesive social networks, supportive and nurturing families, and individuals who are mentally, emotionally, physically and spiritually healthy are all important goals of a comprehensive violence prevention approach.

1. Meaningful opportunities for participation
Interviewees overwhelmingly noted a lack of opportunities for youth and young adult in the county. While there was consensus that, "Kids need to have a sense of responsibility -- a sense of contributing to something bigger," many pointed out the lack of such opportunities. One noted that, "We offer few opportunities for them (youth) to belong." Other commented, "There is nothing positive for kids to do." Several people mentioned a decrease in activities and opportunities with budget and funding cuts. The impact on youth is profound. In addition to filling unstructured time with meaningless or risky behavior, young people feel uncared for and unimportant. For example, one said, "I'm not worth anything, so it doesn't matter what I do." One interviewee said, "I'm seeing kids take more risks because they don't think it makes a difference. They think, 'at least in jail I get food and a bed.'" The end result is that the county's young people feel, "no one wants to be interested in me, and I'm expendable." Some programs are fostering meaningful opportunities for participation and have witnessed reductions in violence on some school campuses.

Research has consistently supported the positive role of meaningful opportunities and participation. In their report, Community Programs to Promote Youth Development, the National Research Council and the Institute of Medicine outlined characteristics of positive youth development settings. These opportunities are vital for an adolescent's social development. Bonnie Benard, a leading trainer on youth resilience highlights meaningful participation as a significant protective factor. According to Benard, environments that promote positive youth development must provide youth with real choices and with ample opportunities for decision-making authority. Efforts that promote meaningful inclusion can successfully counter anti-social behavior among youth.⁹⁰

2. Positive attachments and relationships
Many interviewees talked about the importance of relationships. Whether they are between service providers, the police and community members, neighbors, or children and youth and adults, they are protective. Interviewees noted the value of mentoring programs. Others noted an absence of quality relationships. For example, one person stated, "We've lost all compassion for our young people. When you lose compassion for the young people, that's a major issue." Others noted the lack of positive role models, particularly men of color.

Children show significantly better cognitive and language skills, as well as positive social and emotional development, when they are cared for by adults who are attentive to their needs and who interact with them in encouraging and affectionate ways.^{91, 92} Research shows that when children have secure attachments early in life, they tend to develop better as they grow older, do better in social situations, and enjoy better academic achievement.⁹³ Attachment to parents, parental supervision, and consistency of discipline have been found to be the most important family protective factors in preventing delinquency in high-risk youth.^{94, 95}

3. Emotional and cognitive competence
People who understand and can regulate their emotions, exercise self-discipline, and develop impulse-control, judgment, and coping mechanisms can better deal with aggressive or violent experiences without negative effects. To learn this, children need to experience healthy and appropriate behaviors, such as open and positive communication, consistent discipline, and problem-solving modeled by the adults around them.⁹⁶

Cognitive competence includes oral, written, reasoning, and problem-solving skills, as well as creative expression and ability to learn. Cognitive skills lay the foundation for educational success and academic achievement^{97, 98} -- factors which are highly protective against involvement in violence.^{99, 100}

4. Good physical and mental health
Good health and mental health is associated with fewer behavioral and social problems as well as higher cognitive functioning and learning ability,^{101, 102} factors that can significantly reduce involvement in violence. Interviewees noted the relationship between violence prevention and health, highlighting the need for all people to have effective services and care.

One interviewee stated that all county schools should offer adequate health and mental health services to their students.

5. Economic Capital
Economic capital, including adequate living wage employment opportunities, job training, local ownership of businesses, homeownership, access to loans and investment capital can be encouraged and promoted at a local level. According to the most recent data compiled by the U.S. Census Bureau, 33 percent of businesses in Alameda County are owned by minorities and 31.8 percent are owned by women. Both of these figures demonstrate rates of minority-owned and women-owned firms that exceed statewide averages. The county also has the Economic Development Advisory Council, which is engaged with hundreds of private and public partners in economic development, including workforce development.

There is a strong correlation between economic factors and health and safety outcomes. These activities promote local access to resources, the opportunity to increase local capital that can be reinvested into the community, and stability among residents. Increases in local business are associated with reduced crime, and achieving living wages may be correlated with reduced stress levels and better housing.

6. Services and institutions
The range and quality of services within a community represent an opportunity to overcome barriers to safety and to foster strengths. One interviewee noted that, "Violence must be dealt with at every level from childhood on and before. The pattern that leads to violence starts early." Therefore, a broad range of services and institutions must be engaged in a solution. However, interviewees noted a disparity in services in some communities and some neighborhoods. "Partnerships aren't as strong as they should be."

Public and private services and institutions includes: local government, public health and health, social services, education, public safety, community groups and coalitions, community-based organizations, faith institutions, businesses, and arts institutions. These services must be available, accessible, high quality, culturally competent, and appropriately coordinated. Further, it is critical that community services be connected to broader systems and policy bodies, including those at the city, state, and federal levels in order to ensure that decisions that are made will have a positive impact on the community.

Community services and institutions may serve as the focal point from which community change can be planned and implemented. These places may have resources, including mandates and funding, staffing, facilities, connections beyond the community, and community support and credibility, to foster and engage the necessary momentum and participation. The capacity of such organizations to lead or catalyze such change is an important element in the community.

7. Social capital
Social capital is the "connections among individuals-social networks and the norms of reciprocity and trustworthiness that arise from them."¹⁰³ In 1999, the Fragile Families and Child Wellbeing Study found that the majority of single parents in Oakland, one of the most economically disadvantaged populations in Alameda County, have extended family, upon whom they can rely for social and economic assistance. According to the study, "nearly all unmarried parents [interviewed] in Oakland said there was someone in their family to whom they could turn for help with financial problems, housing or childcare." More specifically, the study reported that 44 percent of unwed mothers in Oakland received help from a family member with housing and that 33 percent received assistance from a family member with childcare.

Strong social networks and connections correspond with significant increases in mental health, academic achievement, and local economic development, as well as lower rates of homicide, suicide, and alcohol and drug abuse.^{104, 105} Participation in cooperative networks fosters mutual trust and increases community members' willingness to intervene in the supervision of children, participate in community-building activities, and maintain public order. Participation also increases supportive relationships, such as sharing, reciprocity, and recognition that the needs of others are needs of all.^{106, 107} Such networks also produce and enforce social sanctions and controls to diminish negative behavior and reduce the incidence of crime, juvenile delinquency, and access to firearms within communities.^{108, 109} A group willingness to intervene on behalf of the common good¹¹⁰ has been shown to be a "robust predictor of lower rates of violence."¹¹¹ For example, a neighborhood in South Central Los Angeles came together to put a stop to drive-by shootings. Residents worked together on a number of activities including outreach to local gangs to significantly reduce instances of gang-related gun violence in their streets.¹¹²

The behavioral and social norms within a community or social network "may structure and influence behaviors and one's motivation and ability to change those behaviors."¹¹³ Current social norms and behavior contribute to many preventable social problems such as substance abuse and levels of violence. Successes have been made through social support networks that enable positive social norms to be developed and strengthened within the organization or community, such as those provided to African Americans through church activities.¹¹⁴ Fostering positive gender norms within communities can promote respect and safer behaviors. Traditional beliefs about manhood are associated with a variety of poor health behaviors, including drinking, drug use, and high-risk sexual activity.¹¹⁵ The behaviors that men engage in often affect the health and well-being of women, children, other men, and the community. For example, an estimated one in three adult women experiences at least one physical assault by her male partner during adulthood. Men are also more often reported for the sexual abuse of children. Focusing on gender norms will therefore not only lead to improved safety conditions for men and boys, but will also contribute to building healthier families and communities.

8. Built environment
The term "built environment" encompasses man-made physical components such as buildings and streets,¹¹⁶ and includes land use, public transportation, and the style and permitted uses of businesses and residences. Land use, built environment, and zoning can have a positive impact on violence prevention. For example, "Land-use patterns that encourage neighborhood interaction and a sense of community have been shown not only to reduce crime, but also create a sense of community safety and security."¹¹⁷ Further, good community design can contribute to a general increase in community networks and trust by creating a "neighborhood feel" through which people are encouraged to interact with each other in a safe environment. Residents of buildings with green space had a stronger sense of community and reported less violence in dealing with domestic disputes.¹¹⁸

There are a number of built environment elements that promote violence prevention, including housing, transportation, product availability, and aesthetic/ambiance. Poor and inadequate housing is associated with increased risk for violence¹¹⁹ and psychological stress.¹²⁰ Alternatively, the availability of safe and affordable housing can reduce stresses associated with living in unsafe, noisy, or overcrowded conditions or not being able to secure housing. Decisions about housing and its design can promote social interaction, community stability, and build a solid tax base to fund needed services, including violence prevention. Reliable and affordable transportation can ensure that people have access to jobs and services. Zoning can also influence the availability of beneficial products such as books and school supplies, sports equipment, arts and crafts supplies, and other recreational items as well as limit availability or lack, of potentially harmful products such as tobacco, firearms, alcohol, and other drugs can also have an impact on violence within a community. Low-income communities and communities of color have greater access to alcohol and tobacco products due to the high prevalence of local liquor stores. Specifically, low socioeconomic status (SES) census tracts and predominately black census tracts have significantly more liquor stores per capita than more affluent communities and predominately white communities.¹²¹ Firearm availability is also disproportionately high in communities of color and low-income areas, leading to higher risk of violence in those neighborhoods. Youth in low-income communities and communities of color often recount stories of how easy it is to obtain a weapon, often a gun. As one youth resident of a low-income area of Oakland observed, "I can walk down to the corner and buy a gun, but I have to get on a bus to get school supplies."¹²²

The aesthetic/ambiance of an environment can also impact violence levels. Appearance can impact both perceptions of safety and reductions in crime. The New York Times reported on one Chicago housing project that had been transformed through an award-winning architectural makeover. Prior to the renovation, tenants did not feel safe enough to sit outside their front door, where chain-linked fences enclosed corridors and created a prison-like environment. As the president of the Tenants' Association explains, "Nobody thought the idea of putting glass over the sides of the buildings would really work, but it changed everything. You couldn't help but see a rosier day." In addition to anecdotal praise, the head of the local Chamber of Commerce has found that reports of small theft and violence from the building have stopped.¹²³

9. Artistic and creative opportunities
The visual and creative arts enable people at all developmental stages to appropriately express their emotions and to experience risk taking in a safe environment. For those who have witnessed violence, art can serve as a healing mechanism. More broadly, art can mobilize a community while reflecting and validating its cultural values and beliefs, including those about violence. Artistic and cultural institutions has been linked with lower delinquency and truancy rates in several urban communities.¹²⁴ For example, a study by Brice Heath, et.al., showed that, compared to a national sample, at-risk youth working in the arts during their out of school hours were four times more likely to have won school-wide attention for their academic achievement, three times more likely to be elected to class office within their schools, four times more likely to participate in a math and science fair, three times more likely to win an award for school attendance, and over four times more likely to win an award for writing an essay or poem.¹²⁵ Positive gains were found in another study conducted in partnership by Americans for the Arts, the National Endowment for the Arts, and the U.S. Department of Justice Office of Juvenile Justice and Delinquency Prevention, and three community arts groups. It was found that youth who participated in selected arts programs expressed anger appropriately, communicated effectively, increased their ability to work on tasks, engaged less in delinquent behavior, had fewer court referrals, and showed improved attitudes, improved self-esteem, greater self-efficacy, and greater resistance to peer pressure.¹²⁶

Finally, promoting arts and cultural opportunities may have other advantages. For instance, city planners have recommended the placement of theatres and other artistic institutions within the center of downtown blocks. Such placement increases foot traffic in these areas, which can contribute to retail sales, decreased crime, and increased perceptions of safety.

10. Media/Marketing
Marketing and media can play a positive role that supporting safe behaviors and environments through positive messages and role models. Local initiatives that engage the media as a partner in community safety are critical and effective. "In view of research findings on ways of changing attitudes or behavior, violence prevention efforts seem more sure of success if they combine strategies to limit access to guns with comprehensive programs that use the proven power of television, videotapes, and films to change attitudes towards guns and violence."¹²⁷ Use of the media in preventing problems such as violence should focus on the social issues at hand, rather than behavior change. "[M]edia approaches should focus on increasing the reservoir of social capital by engaging people and increasing their involvement and participation in community life... mass media strategies should also provide citizens with the skills to better participate in the policy process to create these conditions [for people to be healthy]."¹²⁸ Local media outlets can also play a role in supporting community safety through their advertising policies. For example, the Boston Globe set an internal policy to not accept advertising for firearms and gun shows.

11. Ethnic, Racial, and Intergroup Relations
Positive relations between people of different races and ethnic backgrounds can promote violence prevention goals. Several interviewees noted programs or individuals that are forging interracial interaction, dialog, and relations. They associated these efforts with reduced conflict and reduced risk of violence. With a sense of community based on place rather than race or ethnicity, neighborhood efforts to address safety related goals could be unified. House and Williams summarize the wide impact of racial/ethnic relations: "...racial/ethnic status shape[s] and operate[s] through a very broad range of pathways or mechanisms, including almost all known major psychosocial and behavioral risk factors for health."¹²⁹ While racial discrimination certainly can be traced beyond community boundaries, it is critical that communities foster positive intergroup relations. To the extent that there are positive relations, people within diverse communities can work together to achieve change that will impact the overall well being of the community.

Violence Prevention Requires an Integrated Strategy for Action

Few individuals and even fewer families experience violence as a single issue or as a discrete phenomenon. Often, different forms of violence-domestic violence, child abuse, sexual violence, gang violence, suicidal behavior-coexist within the same home or community. Each experience of these types of violence is a risk factor for other forms of violence. For example, a history of child maltreatment is a strong predictor of future behavior problems, some of which are violent, aggressive, or delinquent. While not all children who experience abuse or neglect become involved in violence, many do become either victims or perpetrators as adults. A study conducted for the U.S. Department of Justice found that childhood experience of maltreatment increases the likelihood of an arrest as a juvenile by 59%, as an adult by 28%, and of arrest for a violent crime by 30%.¹³⁰ Similarly, witnessing violence when young can create a norm of violence as an acceptable form of behavior, and increase children's risk for perpetrating or being victimized by violence later in life.¹³¹ Young children who witness violence often mimic those behaviors and find it harder to control their own aggressive impulses, and get along with parents, teachers, and other children. They also tend to exhibit behavior problems such as aggression, poor impulse control and problem-solving skills, lower levels of empathy, social competence and self-esteem, depression, inability to concentrate, and low academic performance.^{132, 133, 134} The result can be long lasting. For example, boys who witness violence against their mothers when young have an increased likelihood of using violence against their domestic partners when adults.¹³⁵

Given the complexity of issues, policies, and systems that promote or prevent violence in Alameda County, success beckons for an action plan that coordinates, supports, and strengthens a range of efforts. As one interviewee put it, "There needs to be a shared vision of goals and objectives on the role of county government in preventing violence." Since many valuable efforts are all already underway in Alameda County, a strategic approach examines how these efforts can strengthen and add value to each other and what modifications and other efforts may be necessary. By strengthening community assets and reducing the community risk factors for violence, an Alameda County unified approach can help protect all community members from experiencing the many forms of violence that exist, which in turn helps prevent violence. Because the cost of delay is too high in terms of risk, pain, suffering, and premature death. The focus of any approach must be on addressing problems before violence occurs, primary prevention. This approach emphasizes community-wide or "environmental" outcomes given the systemic roots of the problem.

Preliminary Recommendations

The initial recommendations that follow are intentionally broad. They are designed to be further shaped and defined by an advisory board that understands the needs of Alameda County. In particular, members of the advisory board will be charged with specifying the particular structure and elements of each recommendation and in delineating the contributions of different sectors in the county.

1. Institute a structure for violence prevention in the county that establishes leadership and accountability.
The county must have accountability for public safety outcomes and requires designated leadership to move things forward. While the preliminary scan indicated some individual departments and programs are doing good work, there is no overarching structure to oversee and advance violence prevention efforts -- a place to go with good ideas and a place where "the buck stops." As one interviewee stated, "The County needs strong leadership and a clear agenda regarding violence prevention."

2. Develop a strategic blueprint for the county that delineates an overall approach for the county, key stakeholders and their roles and responsibilities, and opportunities to leverage and raise resources that will promote public safety outcomes.
The County needs a plan that has broad buy-in and explicit objectives, with activities and specific roles and responsibilities delineated. The blueprint should build on existing efforts, which are successful and support other plans, such as that adopted by the City of Oakland in July 2003, and be grounded in prevention. Interviewees noted that many current efforts are after the fact and not focused on broader issues or primary prevention. They further noted that such efforts are resource intensive and called for attention to prevention in order to reduce the burden on the system. One interviewee said, "Bring the powers that be together and let them see the picture." Advisory board members are committed to involving young people in the planning process in the earliest stages.

3. Create a methodology and venue for coordination and communication within the county.
While many violence prevention efforts exist within Alameda County, there needs to be a forum for coordination and communication. Currently departments are making individual decisions about who they are working with and who they aren't. There are heroic leaders however, leaders working alone have a harder time refining their approaches and deepening their insights. This minimizes opportunities for synergy and increases the chances of duplication and critical activities falling through the cracks. The leadership of key departments must prioritize consistent outcome-oriented meetings with one another that are focused on violence prevention. This group must also establish a methodology for staff in their departments to engage in collaboration around violence prevention and related programs. Interviewees suggested that the county needs an organizing and rallying point that engages the diversity of the community.

4. Increase public awareness about the underlying contributors to violence.
Many interviewees asserted that everyone in the community has some responsibility for preventing violence but went on to acknowledge that people might not know how or are not empowered to do so. Some noted that people don't understand the reasons for violence and therefore don't believe it is preventable or don't know what to do or who to hold accountable. Increasing public awareness could foster and understanding and empower broader involvement in the solution.

5. Provide interdisciplinary staff training that builds a county-wide understanding about the underlying factors contributing to violence and how to effectively prevent it.
There must be a common and thorough understanding of the complexity of violence and effective prevention. In order to forge an effective approach, training should promote comprehensive strategy including both programmatic and policy options. Training should be provided for a wide-range of providers and practitioners across many disciplines and sectors, including for elected officials or their staff.

6. Identify additional methods of support as well as potential barriers that the State imposes on the county's violence prevention efforts and request assistance.
In its study on violence prevention, the Little Hoover Commission confirmed what many locales have been asserting for years -- the State's role must emphasize supporting local efforts. Further, many times the complexity of State bureaucracy puts barriers in the way of local success.¹³⁶ Despite resource shortages, there are significant state resources that come to Alameda County. The county should identify particular areas of concern and of potential, and areas where waivers might allow for more effective local work. Elected State officials, such as Don Perata, can play a key role in ensuring better State support and for obtaining necessary waivers and modifications.

7. Establish a system to measure effectiveness and an integrated data system that provides a complete picture of the problem as well as progress on prevention.
With the current lack of accountability, there is a risk that efforts are not as effective as they could be and that some resources are not maximized. There is a need for a system that accounts for effectiveness and holds people accountable for it. Further, and to support this goal, there is a need for improved data systems that improve access, facilitate sharing across departments, and answer questions that will promote the most effective violence prevention efforts.

8. Shift the norms to where violence is intolerable and all members of the community are engaged in the solution.
Violence is an issue that affects every resident of the county. Whether it is directly or indirectly, the county and all of its residents are paying a terrible cost for this problem. Further, people feel disempowered to prevent it or are not sure it can be prevented. The norms of a community influence people's behaviors and motivations and their ability to change their behavior. Shifting the norm that violence is inevitable and acceptable can promote social sanctioning and behavior change. Shifting norms about involvement in the solution can foster increased community participation.

9. Ensure that prevention efforts not only reduce risk but also promote and build hope.
Many interviewees reported that youth feel hopeless, are desensitized to the violence, and think they will die young. They, and the many others afflicted by violence need hope. One interviewee noted, "It's important to talk about promoting positive growth and development rather than talking about 'preventing violence.'" The promotion of positive growth and development not only will have an impact on decreasing violence, but will also impact education and literacy levels, and could also impact physical activity and nutrition. Involving youth in the planning process will ensure that these issues are considered by youth and with youth input. One step in building hope is to make visible to county's long-term commitment to preventing violence, particularly in the most highly impacted communities.

10. Establish a set of shared violence prevention principles by which all relevant sectors of the county support violence prevention efforts in their everyday work.
Shared principles are standards to guide prevention efforts. They can provide common objectives and language, which can promote effective internal planning and cross-disciplinary collaboration. At the same time, the common objectives provide a basis for which multiple sectors can be appropriately held accountable. Principles should promote an agreed upon framework for effectiveness including attention to programming, addressing risk and resilience factors, evaluation, collaboration, funding, and timeframes.

Conclusion: Toward a Lifetime and County-Wide Commitment

Violence prevention is not only the responsibility of those departments and agencies mandated to address violence and related issues. Violence is a problem that, in varying degrees, affects everyone in Alameda County. Productivity is diminished in the workplace not only by workplace violence, but also by violence that workers experience outside the workplace such as battering. Further, the county's representation as having a lot of violence -- particularly in Oakland -- affects business prosperity and property values and deters would-be residents, employees, and businesses from locating in the county. Abused children have more difficulties learning and may miss more school. Therefore, in addition to directly affecting thousands of lives, the indirect affects are nearly immeasurable and affect everyone in the county. A strategic and unified plan helps identify the range of roles and partnerships in which all of these stakeholders can engage.

* Quotes from these interviews appear throughout this document; however, they are not attributed to specific interviewees as agreed upon at with the interviewees.

Appendices

i. Definitions

Violence: the threatened or actual use of physical force or power against another person, against oneself, or against a group or community that results in or has a high likelihood of resulting in injury, death, or deprivation.¹³⁷

Violence prevention: a comprehensive and multifaceted effort to address the complex and multiple root factors associated with violence including, but not limited to, poverty, unemployment, discrimination, substance abuse, educational failure, fragmented families, domestic abuse, internalized shame, and felt powerlessness. Efforts build on resiliency in individuals, families, and communities. Violence prevention is distinct from violence containment or suppression. Violence prevention efforts contribute to empowerment, educational and economic progress, and improved life management skills while fostering healthy communities in which people can grow in dignity and safety. Finally, efforts realign institutions to be more inclusive and receptive in responding to community needs. Violence prevention efforts targeted toward young children work to prevent experiencing or witnessing violence when young as well as to reduce the risk of future perpetration or victimization of violence.¹³⁸

ii. Interviewees and Meeting Participants

Kimberley Aceves Executive Director Youth Together	Sara Bedford Policy and Planning Manager Human Services City of Oakland
Diane A. Bellas Public Defender County of Alameda	Jeffery S. Brown, MPH, MSW Director Community Health Services Alameda County Public Health Department
Amanda Brown-Stevens Policy Analyst to Councilmember Nancy J. Nadel City of Oakland	Deane Calhoun Executive Director Youth ALIVE!
Michael E. Cholerton Division Director, Juvenile Services County of Alameda Probation Department	Julie Conger Judge Superior Court of California Alameda County
Diana Cunningham Management Support Services Administrator Alameda County Behavioral Health Care Services	Lucas Daumont, MS Community School Connections Coordinator Alameda County Office of Education
Amy Dean Legislative Aide California State Senator Dede Alpert	Leonard Duhl, M.D. Professor of Public Health and Urban Planning University of California, Berkeley Professor of Psychiatry University of California, San Francisco
Sheila Foster Program Manager Juvenile Services Alameda County Probation Department	Mark Freidman Chief Excutive Officer Every Child Counts
Russ Giuntini Assistant District Attorney Alameda County District Attorney's Office	Gail Greenberg Program Specialist Alameda County Behavioral Health Care Services
Jon Gresely Executive Director Oakland Housing Authority	Joe Haraburda President and Chief Executive Officer Oakland Metropolitan Chamber of Commerce
Michelle D. Herrera, M.A. Youth Services Director Native American Health Center	Jackie Hollis-Myers The Wailing Women Foundation
Sheila Jordan Superintendent Alameda County Office of Education	Jackie Keeles Director Adult Services Alameda County Probation Department
Alex Kelter, M.D. Chief Epidemiology for Prevention and Injury Control Branch California Department of Health Services	Bruce Kern Executive Director Economic Development Alliance for Business (EDAB)
Alice Lai-Bitker Supervisor District 3 Alameda County Board of Supervisors	Rachel Aberbach Metz Fiscal and Policy Director Safe Passages
Nancy Lyons Deputy Director Little Hoover Commission	Nancy Matson Deputy Director Crime and Violence Prevention Center California Department of Justice
Mona Mena, MPH, MSW Program Specialist Injury Prevention Program Emergency Medical Services Alameda County Public Health Department	Sheila Mitchell Assistant Chief Probation Officer Alameda County Probation Department
Nancy J. Nadel Councilmember, District 3 City of Oakland	Carolyn Novosel Director Children's Services for Alameda County
Cheryl A. Pascual Supervisor Alice Lai-Bitker's Assistant Alameda County Board of Supervisors	Alice Park Alameda County Social Services Agency
Joshua Perez Violence Prevention Coordinator Native American Health Center	Charles C. Plummer Sheriff Alameda County
Nina Ramsey Public Information Officer County of Alameda Probation Department	Vincent Reyes Special Assistant to the Director Alameda County Social Services Agency
Barbara C. Staggers, M.D. Director Adolescent Medicine and Multi-Cultural Affairs Children's Hospital in Oakland	Olis Simmons Alameda County Health Care Services Agency
Gayle Steele Supervisor District 2 Alameda County Board of Supervisors	Marye L. Thomas, M.D. Director Alameda County Behavioral Health Care Services
Page Tomblin Planner Human Services City of Oakland	Wayne Tucker Assistant Sheriff Alameda County
Bonita Vinson Program Manager County of Alameda Probation Department	Marilyn Washington Executive Director Khadafy Foundation
Robert Wilkins President Chief Executive Officer YMCA of the East Bay	Sandra Witt, Dr. PH Director Community Assessment, Planning and Education Alameda County Public Health Department
Andrea Youngdahl Director Human Services City of Oakland

iii. About Prevention Institute

Based in Alameda County, Prevention Institute is a nonprofit, national center dedicated to improving community health and well-being by building momentum for effective primary prevention. Primary prevention means taking action to build resilience and to prevent problems before they occur. The Institute's work is characterized by a strong commitment to community participation and promotion of equitable health outcomes among all social and economic groups. Since its founding in 1997, the organization has focused on injury and violence prevention, traffic safety, health disparities, nutrition and physical activity, and youth development.

References

¹ National Crime Prevention Council. Six Safer Cities On the Crest of the Crime Prevention Wave. March 1999.

² Prevention Institute. Cultivating Peace in Salinas: A Framework for Violence Prevention. June 2001.

³ Alameda County Department of Public Health. Alameda County Health Status Report 2003. Available at: http://www.co.alameda.ca.us/publichealth. Accessed on September 3, 2003.

⁴ Alameda County Department of Public Health. Alameda County Health Status Report 2003. Available at: http://www.co.alameda.ca.us/publichealth. Accessed on September 3, 2003.

⁵ Office of the Attorney General, State of California Department of Justice. Criminal Statiscs Center. Available at: http://caag.state.ca.us/cjsc/. Accessed on September 3, 2003.

⁶ Harris, Scott. Listening to Oakland. Los Angeles Times. Available at http://www.latimes.com/la-tm-oakland27jul06,0,767640.story. Accessed July 7, 2003.

⁷ Safe State, Preventing Crime and Violence in California. Child Abuse. Available at: http://www.safestate.org/index.cfm?navID=9. Accessed September 3, 2003.

⁸ Alameda County Child Abuse Prevention Council. Child Abuse and Neglect Statistics. Available at: http://www.accapc.com/stats.cfm. Accessed on September 3, 2003.

⁹ Alameda County Child Abuse Prevention Council. Child Abuse and Neglect Statistics. Available at: http://www.accapc.com/stats.cfm. Accessed on September 3, 2003.

¹⁰ Alameda County Child Abuse Prevention Council. Child Abuse and Neglect Statistics. Available at: http://www.accapc.com/stats.cfm. Accessed on September 3, 2003.

¹¹ National Center on Elder Abuse. Available at: http://www.elderabusecenter.org/default.cfm?p=faqs.cfm. Accessed on September 3, 2003.

¹² Safe State, Preventing Crime and Violence in California. Elder Abuse. Available at: http://www.safestate.org/index.cfm?navID=11. Accessed on September 3, 2003.

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¹⁴ A Profile of Family Violence in Alameda County. Alameda County Domestic Violence Collaborative Report 2003.

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¹⁸ Sexual Assault Services George Mason University. What is Sexual Assault? Available at: http://www.gmu.edu/facstaff/sexual/whatis.html. Accessed on September 2, 2003.

¹⁹ Office of the Attorney General, State of California Department of Justice. Criminal Statistics Center. Available at: http://caag.state.ca.us/cjsc/. Accessed on September 3, 2003.

²⁰ California Coalition Against Sexual Assault. Available at: http://www.calcasa.org/. Accessed September 9, 2003.

²¹ California Coalition Against Sexual Assault. Available at: http://www.calcasa.org/. Accessed September 9, 2003.

²² U.S. Department of Health and Human Services (2001). Youth Violence: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; and National Institute of Mental Health.

²³ Safe State, Preventing Crime and Violence in California. Gangs and Youth Violence. Available at: http://www.safestate.org/index.cfm?navID=9. Accessed on July 8, 2003.

²⁴ Children's Defense Fund. Available at: http://www.cdfactioncouncil.org/americayvc.htm. Accessed on September 10, 2003.

²⁵ Alameda County Department of Public Health. Alameda County Health Status Report 2003. Available at: http://www.co.alameda.ca.us/publichealth. Accessed on September 3, 2003.

²⁶ California Department of Health Services, Epidemiology and Prevention for Injury Control (EPIC) Branch. EPIC California Injury Data Online. Available at: http://www.applications.dhs.ca.gov/epicdata/content/ST_suicide.htm. Accessed September 9, 2003.

²⁷ Alameda County Public Health Department, CAPE Unit, Community Info. Books 2001.

²⁸ California Department of Health Services, EPIC Branch. 2000.

²⁹ California Attorney General's Civil Rights Commission on Hate Crimes Final Report. Available at: http://caag.state.ca.us/publications/civilrights/reportingHC.pdf. Accessed on September 3, 2003.

³⁰ Richman, Josh. Berkeley sees rise in hate crimes; Alameda County has slight decline in incidents during 2001-2002. Oakland Tribune, July 16, 2003.

³¹ Amnesty International. What is Police Brutality? Available at: http://www.amnestyusa.org/country/usa/police_brutality/about.html. Accessed on September 3, 2003.

³² Blum, Henrik L. "Social Perspective on Risk Reduction." Family and Community Health. 3:1, May 1981, pg. 44.

³³ Smedley BD, Syme SL, eds. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington D.C.: National Academy Press; 2000:337-365.

³⁴ A social environmental approach to health and health interventions. In: Smedley BD, Syme SL, eds. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC. National Academy of Sciences; 2000:3.

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³⁸ Ibid.

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⁴⁰ Newcomb MD. Identifying high-risk youth: prevalence and patterns of adolescent drug abuse. In: Radhert E, Czechowicx D, Amsel L, eds. Adolescent Drug Abuse: Clinical Assessment and Therapeutic Intervention. Rockville, Md: National Institute on Drug Abuse; 1995:7-38.

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⁴³ Garbarino J. Personal communication, March 2002.

⁴⁴ Baker, Elizabeth. Personal communication, Feb. 13, 2003.

⁴⁵ Harris, Scott. Listening to Oakland. Los Angeles Times. Available at http://www.latimes.com/la-tm-oakland27jul06,0,767640.story. Accessed July 7, 2003.

⁴⁶ Harris, Scott. Listening to Oakland. Los Angeles Times. Available at http://www.latimes.com/la-tm-oakland27jul06,0,767640.story. Accessed July 7, 2003.

⁴⁷ National Organization of Black Law Enforcement (NOBLE). Racial Profiling: What Does the Data Mean? Available at: http://www.noblenatl.org/pdf/2-12%20Data%20Collection.PDF. Accessed on September 2, 2003.

⁴⁸ Shane, Scott. US Prison Population Largest in the World. Baltimore Sun. Available at: http://www.charleston.net/stories/060103/wor_01jailbirds.shtml. Accessed on September 9, 2003.

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⁵⁴ Carter S. Oakland Homicide Victims, 2002. The Oakland Tribune. February 19, 2003.

⁵⁵ California Department of Health Services. Domestic Violence-Related Calls for Assistance, 2001.

⁵⁶ California Department of Health Services. Domestic Violence-Related Calls for Assistance, 2001.

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⁶⁰ Office for Victims of Crime. Breaking the Cycle of Violence: Recommendations to Improve the Criminal Justice Response to Child Victims and Witnesses. Washington, DC: Office of Justice Programs, US Dept of Justice; June 1991. Publication NCJ #176983.

⁶¹ Murdoch D, Phil RO, Ross D. Alcohol and crimes of violence. International Journal of the Addictions. 1990:25:1065-1081.

⁶² Ibid.

⁶³ Collins JJ, Messerschmidt PM. Epidemiology of alcohol-related violence. Alcohol Health and Research World. 1993;17:93-99.

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⁶⁹ Tolan PH, Guerra NG. What Works in Reducing Adolescent Violence: An Empirical Review of the Field. Boulder, Colo: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado; 1994.

⁷⁰ U.S. Department of Health and Human Services (2001). Youth Violence: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; and National Institute of Mental Health.

⁷¹ U.S. Department of Health and Human Services (2001). Youth Violence: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; and National Institute of Mental Health.

⁷² Miedzian M. Boys Will Be Boys: Breaking the Link Between Masculinity and Violence. New York, NY: Doubleday; 1991.

⁷³ Marshall D. Violence and the male gender role. Journal of College Student Psychotherapy. 1993;8:203-218.

⁷⁴ Pollack W. Real Boys: Rescuing Our Sons from the Myths of Boyhood. New York, NY: Henry Holt and Company; 1998.

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⁷⁸ American Academy of Pediatrics Committee on Public Education. Media violence. Pediatrics. 2001;108;1222-1226.

⁷⁹ Liebert RM, Sprafkin J. The Early Window: Effects of Television on Children and Youth. 3rd ed. New York, NY: Pergamon Press; 1988.

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⁸¹ Zuckerman DM. Media violence, gun control, and public policy. Am J of Orthopsychiatry. 1996:66(3):378-89.

⁸² Brown JD, Witherspoon EM. The Mass Media and American Adolescents' Health. [UNC Chapel Hill website]. November 1998. Available at: http://www.unc.edu/courses/jomc145/witherspoon.html. Accessed December 13, 2002.

⁸³ National Association for the Education of Young Children. Media violence and young children: early years are learning years [National Parent Information Network Web site]. Available at: http://npin.org/library/pre1998/n00154/n00154.html. Accessed March 18, 2002.

⁸⁴ Slaby RG. Television violence: effects and remedies. Testimony presented to: U.S. House of Representatives Judiciary, Committee's Subcommittee on Crime and Criminal Justice; December 15, 1992; Washington, DC.

⁸⁵ Anderson D. Society for Research in Child Development Monograph. March, 2001

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¹³⁰ Office for Victims of Crime. Breaking the Cycle of Violence: Recommendations to Improve the Criminal Justice Response to Child Victims and Witnesses. Washington, DC: Office of Justice Programs, US Dept of Justice; June 1