LOCAL WISDOM IS THE KEY: FINDINGS FROM SAFEUSA FOCUS FORUMS

Local and Regional Input into a National Unified Strategy for Injury and Violence Prevention

Prepared by Prevention Institute for the SafeUSA National Conference
December 2001

Local Wisdom Is the Key: Findings from SafeUSA Focus Forums was prepared by Prevention Institute. Primary authors are Larry Cohen, Rachel Davis, and Emily Gordon.

Prevention Institute is a national nonprofit organization established to reduce illness and injury and improve the health and well being of communities through primary prevention. Through training, consultation, and tool development, the Institute translates national models into effective interdisciplinary local practice and, conversely, synthesizes the learnings of local initiatives to help shape national strategy. For additional information about the Focus Forums, please contact Prevention Institute.

SafeUSA is an alliance of organizations dedicated to eliminating unintentional and violent injury and death in America. SafeUSA seeks to make the nation's homes, schools, worksites, transportation areas, and communities safer by working through partnerships to enhance public awareness and support injury prevention efforts at all levels. Its purpose is to combine scientific research, programmatic efforts, sound public policy, and community involvement to achieve targeted safety objectives that will result in a better quality of life for all Americans. For more information about SafeUSA, visit safeusa.org.

Support for the Focus Forums

The Forums were made possible through support from the National Fire Protection Association (NFPA)/First Alert, National Highway Traffic Safety Administration (NHTSA), and Children's Safety Network, which is funded by the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services.

Thank you to the Focus Forum Workgroup of the SafeUSA Program Planning Committee: Ken Allen, Meri-K Appy, Lovell Brigham, Stephanie Bryn, Ashley Burt, Dennis Compton, Michael Meit, Lloyd Potter, Trevia Pereira, Barbara Shaw, Barbara Sauers, and Jana Telfer.

Finally, the success of the Forums would not have been possible without the ongoing commitment and hard work of the local hosts. A special thank you goes out to our hosts:

• Billie Weiss, Los Angeles Violence Prevention Coalition, Los Angeles, California
• Tony Borbon, Los Angeles Violence Prevention Coalition, Los Angeles, California
• Tony Gomez, RS, Manager, Violence and Injury Prevention, Public Health-Seattle and King County Prevention Division, Seattle, Washington
• Debbie Ruggles, MBA, Violence Prevention Specialist, Injury Prevention Program, Washington Department of Health, Seattle, Washington
• Laura May, Fire and Life Safety Education Administrator, Mesa Fire Department, Mesa, Arizona
• Bob Deleon, Mesa Fire Department, Mesa, Arizona
• Linda Stuckey, Mississippi Association of Public Fire Safety Educators, Madison, Mississippi
• Nathan Jordan, Madison Fire Department, Madison, Mississippi
• Chief Tom Lariviere, Madison Fire Department, Madison, Mississippi
• Carolyn Fowler, Ph.D., MPH, Director, Injury Prevention Program, Baltimore County, Department of Health and Assistant Public Health Professor, Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
• Barbara Shaw, Illinois Violence Prevention Authority, Chicago, Illinois
• Mark Hilliard, Illinois Department of Public Health, Chicago, Illinois
• Chris Hanna, National Children's Center for Rural and Agricultural Health and Safety, Marshfield, Wisconsin

INTRODUCTION

A lot of people are just ignorant to the facts that are around them, and they think that nothing's going to happen to them, and they just keep going on with their daily lives.
-Jayme Fisher, Youth Participant at the National Youth Diversity Summit on Traffic Safety, Los Angeles, CA

This report summarizes the process and key recommendations that emerged from a series of Focus Forums¹ held in seven states across the U.S. between June and August 2001. The purpose of the Forums was to garner community input into SafeUSA's development of a national unified strategy for injury and violence prevention. Specifically, the Forums sought to ascertain how SafeUSA could ensure that the prevention of injury and violence is viewed as a national priority and to delineate the national strategies that will mobilize action.

SafeUSA is an alliance dedicated to eliminating injury and violence. Working in partnership, SafeUSA members support efforts to make the nation's homes, schools, work sites, transportation areas, and communities safer. SafeUSA is currently developing a unified national strategy for intentional and unintentional injury prevention. Recognizing the value of local efforts, SafeUSA asked Prevention Institute to gather local perspectives to inform the development of their strategy through a series of Focus Forums. The Forums confirmed that local practitioners are committed and successful in effecting change in their communities. However, the Forums also confirmed that injury and violence are still occurring at high rates, and that attention to their prevention is critical. Drawing upon local successes, the efforts of local practitioners working in injury and violence prevention can be furthered by more coherent and integrated injury and violence prevention approaches at the national level.

The Need for a National Prevention Strategy and the Role of Local Input

Growing up on a farm, being injured on a farm, having a brother killed in a motor vehicle crash, having a brother that died in a drowning... I finally said it was preventable.
-Bobbi Martens, Greater Marshfield Area Safe Kids/Community Health Access, Marshfield Clinic, Marshfield, WI

Every year, 150,000 Americans die from injury and violence. In fact, injury and violence are the leading causes of death and disability among children and young adults. Additionally, hundreds of thousands of children and adults are hurt and disabled every year.

Injuries are not accidents. They are predictable and preventable. And there is evidence to show that prevention works. For example, the use of safety belts and child safety seats has saved nearly one hundred thousand lives, deaths caused by flammable children's sleepwear have been virtually eliminated, and the last decade has seen a significant drop in violent crime rates across the country.

Despite the many local prevention efforts underway and the successes that have been achieved, more needs to be done. The prevention of injury and violence must be an even higher national priority. Too often efforts at the national level are fragmented, and the prevention of injury and violence is not given the attention and resources warranted by the damage and suffering that these problems cause. A national strategy to better support local efforts is needed.

Successful strategy requires a comprehensive, multifaceted approach. This involves a range of activities, including strengthening individual knowledge and skills, promoting community education, training providers, fostering coalitions and networks, changing organizational practices, and influencing policy and legislation.² These activities together have the power to change behaviors and norms, improve the design of products and communities, and ultimately prevent hundreds of thousands of unnecessary injuries and deaths.

METHODOLOGY

A planning committee consisting of SafeUSA Partnership Council members and Prevention Institute staff guided the planning of the Focus Forums. The committee decided to hold Forums in seven states, which were selected to represent the geographical diversity of the U.S. The intention of each Forum was to include participants from a range of backgrounds and disciplines that would represent urban, rural, and suburban perspectives where appropriate. The ultimate goal of the Forums was to imbue local wisdom in the proceedings of the SafeUSA Leadership Conference in Atlanta in December 2001.

Specifically, the Focus Forums sought to:

• Elicit community and regional perspectives, which would then serve as the foundation of the SafeUSA national injury and violence prevention strategy/action agenda
• Encourage participation of diverse stakeholders in the strategy/action agenda development process
• Delineate the major national strategies that would mobilize action and ensure that intentional and unintentional injury prevention were seen as priorities
• Provide SafeUSA Leadership Conference attendees and the broader interested public with a community perspective for building a more effective movement for injury and violence prevention

Members of the planning committee felt it was important for each Forum to be planned with attention to local needs so that the structure and format of each hearing addressed community concerns. As such, the planning committee partnered with local hosts wherever possible to sponsor and hold SafeUSA Focus Forums. Forums were held in:

• Mississippi: Madison Justice Complex
• Maryland: Baltimore County Government facilities
• Illinois: Fourth Presbyterian Church, Chicago
• Wisconsin: Marshfield High School
• Arizona: Mesa Public Safety Training Facility
• Washington: Renton Technical College, Renton/Seattle
• California: Annual conference of the Violence Prevention Coalition of Greater Los Angeles. In addition, the Headlands Institute (Sausalito, CA) and the National Youth Diversity Summit on Traffic Safety (Los Angeles, CA) were sites added to ensure the broad participation of youth.

Members of the planning committee worked closely with local hosts to identify participants and outline a format and agenda for each Forum. Generally speaking, each Forum included time-limited testimony, panel presentations, and facilitated roundtable discussions. The goal of each activity was to answer the following questions:

1. What are the successes that have advanced injury and violence prevention outcomes? Why were these efforts and approaches successful? Who was involved in these efforts? What should be done by a national initiative to assist local efforts and help them succeed?
2. What are the barriers to advancing an injury and violence prevention agenda and outcomes at local, state, and national levels? What should be done by a national initiative to help overcome them?
3. What can SafeUSA and its partner members do to ensure that people feel safe in their communities?
4. What could be done nationally by SafeUSA and its partners to ensure that the prevention of injury and violence is viewed as a priority issue?
5. What are the major national strategies that will mobilize action and ensure that the prevention of injury and violence prevention is a priority?

Approximately 375 people participated in the Focus Forums. They represented a variety of disciplines, backgrounds, and perspectives. The range of participants included elected officials, prosecutors, judges, law enforcement officers, physicians, nurses, emergency medical responders, fire fighters, social service providers, educators, public health practitioners, academicians, advocates, survivors, grassroots organizers, staff from community-based organizations, violence and injury prevention specialists, state and local government staff, epidemiologists, counselors, clergy, parents, community members, media, insurance providers, liquor control board members, transportation and traffic safety specialists, farmers, and youth.

All of the oral testimony from the Forums was recorded and transcribed. The Forum transcriptions and written testimony were compiled, clustered, and analyzed by Prevention Institute staff. Findings were reviewed by the SafeUSA Program Planning Committee. This report is not intended to be a verbatim account but rather a synthesis of major themes and recommendations that emerged in this process. Final responsibility for this report rests with Prevention Institute.

FINDINGS

A popular health slogan is: "The life you save may be your own." But I think we need to promote a focus on group action for the common good. Perhaps a better motto would be: "The lives we save together might include your own." As we look for a national strategy, we should try to infuse it with that spirit of collective and true partnership.
-Xan Young, Children's Safety Network, Education Development Center, Washington, D.C.

Overall, local participants were eager to share their experiences in injury and violence prevention and interested in building a national strategy. Responses clustered into six major areas:

1. Build the Capacity of and Support Local Efforts
2. Increase Public Understanding
3. Address the Complexity of Injury and Violence through Comprehensive Prevention Efforts
4. Intensively Address the Needs of the Populations Most at Risk
5. Ensure Leadership
6. Support Policies

1. Build the Capacity of and Support Local Efforts

Participants stressed the need for national support and assistance with local efforts that are already underway, and often very successful. Participants stressed that communities utilize a broad range of strategies and resources, already have a lot of knowledge about injury and violence prevention, and are achieving important injury and violence prevention outcomes. While communities and local practitioners are best able to address local needs, they need more support for their efforts and more opportunities to build their own capacity to prevent injury and violence.

One of the things that I think could help at a national level is looking at what the best practices are. What do we know that works? It is not just education, and not just environmental, and not just enactment. It is a combination of all those. Whether it is an environmental issue, whether it is education, whether it's a behavior change, what tools can we give?
-Lucy Ranus, R.N., Prevention Programs, St. Joseph's Hospital, Phoenix, AZ

So at the national level, I see three basic needs: a need for intentional leadership that values community; a need for national and local data to inform local policy every bit as much as it informs national; and finally, you're going to hear it, national funding that enables local control, so that we can make the most effective use of the resources at a local level.
-Gary Goldbaum, Public Health Department, Seattle and Kings County Seattle, WA

Major recommendations:

A. Develop tools and technical assistance for effective injury and violence prevention planning, implementation, and evaluation.

B. Enhance national injury and violence prevention clearinghouse resources to include national and local data, key data links, information about best and promising practices, and a forum for local practitioners to share resources, practices, and information.

C. Ensure access to tools and resources to initiate and/or maintain effective coalition efforts.

D. Strengthen collaboration and coordination among government agencies in such activities as planning, program design, and Request for Proposal (RFP) development.

E. Simplify and streamline government requirements placed on localities receiving funding.

F. Establish funding opportunities that support local efforts including sustained and non-categorical funding.

G. Foster and support research efforts that will establish effective practice and build a case for prevention.

H. Ensure adequate and high-quality training for practitioners and in professional training settings such as medical, nursing, and public health schools.

I. Develop national speakers' bureau that can be accessed by community organizations on a sliding scale for conferences and events.

J. Develop and implement a comprehensive, integrated, multidisciplinary safety curriculum for schools.

2. Increase Public Understanding

Participants asserted that there is a lack of support for prevention among the general public and policy makers. They stated that people do not necessarily understand the need for or efficacy of prevention. They emphasized ways to build support.

I think that education is really the key. And not just education at the school level -- like at the elementary level and high school level -- but at the community level, in the newspapers on the front page, where people are actually going to read it. And it's not a blood and guts story; it's a story about people doing positive things, making other people want to do positive things.
-Lilly Falconer, youth participant from the Headlands Institute, Sausalito, CA

I think I'd like one of the roles for SafeUSA to be something like the March of Dimes. There is no comparable injury prevention organization. If it was in our faces and it was something that people could participate in, it may raise the level of injury prevention.
-Susan DeFrancesco, Ph.D., Center for Injury Research and Policy, Johns Hopkins School of Public Health, Baltimore, MD

Major recommendations:

A. Establish a national campaign that underscores that injury and violence is preventable and that it is everyone's issue, i.e., it can happen to anyone and everyone must take responsibility for preventing it, including taking responsibility with one's own family and on a community level.

B. Develop a coherent set of prevention messages that support local efforts.

C. Develop an infrastructure to provide ongoing prevention information to the media.

D. Reward and acknowledge successful efforts through initiatives such as "SafeUSA Communities."

E. Model SafeUSA activities on a March of Dimes approach, holding events to raise financial support and building awareness and understanding of the issue.

F. Develop materials that local and state practitioners can use with public officials and lawmakers to support prevention policy development.

G. Create avenues to federal policy makers to increase their understanding of the urgency and value of injury and violence prevention efforts.

H. Spread the word about SafeUSA as a valuable resource for people and its role in advancing a message about safety.

3. Address the Complexity of Injury and Violence through Comprehensive Prevention Efforts

Focus Forum participants affirmed the value of comprehensive strategy development, underscored the value of diverse partnerships to achieve prevention goals, and called for attention to underlying factors related to both injury and violence prevention.

[Children] in this country need to have a good meal, they need to have access to medical care, they need to have role models, they need to have pressure on them and incentive to complete [their] education, they need to have peers around them that enhance their self-worth. And if you ask yourself in terms of our programs here, if you're a child that grows up in a family that doesn't have all of those positive things, are you more likely to drink and drive? Are you more likely to use drugs? Are you more likely to commit suicide? To be involved in a traffic accident? To drop out of school? To be a victim of violence, or to be a perpetrator of violence? I think the answer is yes.
-Captain Brent Wingstrand, Captain of Violent Crimes, Seattle Police Seattle, WA

The first element of an injury prevention system is the built environment that protects the safety of people within it. I think that part of our challenge is to make an injury prevention infrastructure in a community.
-Chief Dennis Compton, Mesa Fire Department Mesa, AZ

Major recommendations:

A. Provide resources to enable comprehensive strategy development to take place in states and localities, including bringing together key players from intentional and unintentional injury prevention at state and local levels.

B. Expand SafeUSA membership to include diverse partners, including business and industry, media, and organizations that promote resiliency and sustainability within communities.

C. Establish government efforts that cross disciplines and bureaucracies.

D. Address root factors of injury and violence, including mental health, alcohol and drug abuse, illiteracy, and socioeconomic disparities.

E. Build on strengths and assets within individuals and communities, including advancing the notion that youth are assets and are part of the solution.

F. Ensure that efforts go beyond individual and community education to address design, organizational practices, and policies.

G. Encourage a community-wide prevention infrastructure and community design that engenders safety. Ensure that injury and violence prevention efforts are built into more broad-scale environmental change strategies, such as Safe Routes to Schools, or partnerships between physical activity, injury, planning/design, and transportation groups and the creation of walkable/bikeable communities.

4. Intensively Address the Needs of the Populations Most at Risk

There are certain populations that are at higher risk for injury and violence. They include communities of color, people living in poverty, immigrants, children, males 21-35, people with disabilities, people who do not identify with a heterosexual sexual orientation, people working in certain professions, and the elderly. The special needs of these populations must be taken into account to eliminate health disparities.

It is my opinion that to effectively build safe communities, communities as a whole need to acknowledge the need for a comprehensive, collaborative, and strategic approach. This approach should include representatives from all aspects of the community. These representatives should not just be the ones already in power, but those who do not typically have a voice.
-Nicole Edminston, Youth Advisory Board, The Illinois Violence Prevention Authority Springfield, IL

I work with all 11 tribes in the state. When we, who may not be part of that diverse community, try to say, "Change your lifestyle," it won't work. We have got to have people within those communities who are making those suggestions, and give them the support. So the national strategy for that needs to be to give the support to those people in the communities and make sure the state resources are all there to support them as well.
-JoAnne Pruitt Thunder, Pedestrian/Bicycle Safety, Wisconsin Department of Transportation Madison, WI

Major recommendations:

A. Ensure that information is available in languages other than English.

B. Support outreach efforts to involve higher risk populations in strategy development, planning, and programming.

C. Support policies and develop plans that address the needs of higher risk populations.

D. Support research and data collection efforts that will improve prevention efforts for higher risk populations.

E. Synthesize and disseminate what is known about effective practices with higher risk populations.

F. Ensure that adequate resources go to communities and populations most at risk for injury and violence.

5. Ensure Leadership

Because prevention requires long-term outcomes and is often under-prioritized, and because injury and violence take a terrible toll in the U.S., strong leadership is needed to advance the prevention movement. Leadership takes place at a range of levels and includes the ability to mobilize action and communicate clearly about prevention efficacy. Ensuring leadership means fostering new leaders and building leadership skills.

Nationally people have to be coming out, as well as within our state. We have to find leaders who are willing to take on the initiatives and move them forward, whether at the community level, at the state level, or federally.
-Linda Hale, Chief of Injury Prevention Section, Department of Health and Family Services, Madison, WI

We need to educate key legislators and key policy makers. And some of those may not be the mayor. They may not be the city council members. They may be the key leaders within that community, the key corporate leaders, the key civic leaders. Those are the people that we need to go out and reach to, and educate them on what injury and violence is doing in the communities across the United States.
-Rosemary Nye, National Highway Traffic Safety Administration, Region X, Seattle, WA

Major recommendations:

A. Secure champions who can speak out about and build support for injury and violence prevention.

B. Strengthen leadership skills among injury and violence prevention practitioners, including newly emerging spokespersons.

C. Foster leadership and/or build on the natural leadership skills of advocates, survivors, and youth.

D. Expand partnerships with less traditional players and support their adoption of leadership roles in their own arenas, including business, academic centers, unions, faith-based institutions, etc.

E. Provide leaders with the skills to shape strategy that addresses the complexity of injury and violence prevention.

6. Support Policies

A key aspect of achieving prevention outcomes is the development of effective policy. Strong policies are critical. Local participants acknowledged the leverage of a national alliance in advancing policies. They spoke generally about the need for advocacy for resources to support prevention. Further, they requested that attention be directed towards specific injury issues that were high priority local concerns. In some cases, they asserted that national policies are the most efficient way to achieve significant prevention outcomes.

If we look at the amount of money that is put aside for injury prevention, it's very little when we look at [the funds that go to] the chronic diseases that are out there. I think it would be great to have some type of lobbyist to get together and go before Congress, and let them know the importance of injury prevention?e need more money filtering in to programs to prevent injury in our states. And until we get that, it's going to be hard for us to wipe it out or get out there and do the education. And, you know, if we had two or three hundred million dollars set aside for injury prevention in the country, then all states could enjoy that privilege.
-Mary Reed, Branch Director of Injury and Violence Prevention, Mississippi Department of Health, Jackson, MS

There is a greater need for services such as additional social workers, psychologists, school nurses, counselors... Right now, those services are more geared towards those students that are in special education, but those services are needed for prevention and counseling in general education, too. I gave an example about a kid who experienced some type of violence over the weekend; when they come back to school, they're not prepared to learn, so in addition to reading and writing, we also need those other services.
-Eric Dockery, Chicago Schools Superintendents Office, Chicago Public Schools, Chicago, IL

Major recommendations:

A. Advocate for long-term and increased prevention funding.

B. Work with national groups (like the PTA) to make sure injury prevention is on their national agenda.

C. Support initiatives that foster safe and healthy early childhood and youth development.

D. Explore policy solutions to address specific topics such as firearm injury, pool fencing, and traffic safety.

E. Establish national standards for home, school, work, transportation, and community safety.

F. Explore national policy initiatives that address the findings of the Focus Forums:

1. Build the capacity of and support local efforts
2. Increase public understanding
3. Address the complexity of injury and violence through comprehensive prevention efforts
4. Intensively address the needs of the populations most at risk
5. Ensure leadership

CONCLUSION

In conclusion, I am here to remind you that you, too, were young once. And I challenge you, as adults in power, not just to ask the questions, but to listen to the voices, and take action on what you have heard. Words are not enough. I will be counted as part of the solution through my actions. What will you do?
-Nicole Edminston, Youth Advisory Board, The Illinois Violence Prevention Authority, Chicago, IL

America's best chance of preventing injury and violence requires engaging the efforts of local communities throughout the country. The hundreds of people who attended the SafeUSA Focus Forums exemplify the wisdom, compassion, and skills that can make a difference.

However, local communities and practitioners need national support. National regulations and strategies are the foundation on which local initiatives are grounded. Further, local efforts rely heavily on national groups and higher levels of government for information, assistance, guidelines, and financial support. Local groups look to national level organizations not only for concrete areas of support, such as funding and training, but for the vision and leadership that will encourage them to continually enhance their efforts.

The combined voice of people across the country has delineated what must be done. But more than just specific activities, they represent a call to action. What will you do? What will we do together?

Footnotes

¹ We have chosen to use the term "forums" rather than "fora," as one of the findings of our local hearings was that this term was easier to understand and more comfortable for local participants.

² Cohen, L., Swift, S. The spectrum of prevention: developing a comprehensive approach to injury prevention. Injury Prevention 1993; 5:203-207.

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