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Community Healing and Trauma Prevention Center

State: CA Type: Promising Practice Year: 2020

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Los Angeles County Department of Public Health
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Community Healing and Trauma Prevention Center

The Los Angeles County Department of Public Health (LAC DPH) is a local health department (LHD) that serves over 10 million residents. As the most populous county in the nation, Los Angeles is home to a racially and ethnically diverse population. It is also geographically large, encompassing over 4,000 square miles that range from dense urban areas to rural areas in the deserts and mountains. Due to its large size, the County of Los Angeles is divided into eight geographic regions used by the LHD to assist in the planning and delivery of services. Further, there are over 40 public health programs in the LAC DPH that work to plan, develop, and implement public health services.

The Community Healing and Trauma Prevention Center (Healing Center) is a place-based public health practice within Willowbrook, an unincorporated community within the South Los Angeles Region. The Healing Center was established in September 2018 in partnership with the community and its partners to serve as a strategic hub for healing and trauma prevention and intervention resources and activities in the community. By redesigning a small portion of an existing clinic space at the Martin Luther King Jr. Center for Public Health facility as the Healing Center, community residents have easy access to healing or trauma prevention resources or can participate in related activities. Additionally, community-based organizations and agencies can partner with and convene at the Healing Center to engage and implement community-based work.  

Building upon existing violence prevention and intervention efforts in South Los Angeles, the concept of the Healing Center emerged as a potential strategy that would be aligned with a larger, more comprehensive public health plan to address violence and trauma in the community. In South Los Angeles, which includes Willowbrook, residents experience the highest rates of assault-related trauma and homicide. While homicide has been the second leading cause of premature death every year for the past 10 years in Los Angeles county, homicide rates are nearly four times higher in South Los Angeles than the rest of the County. The complexity of trauma in this community includes physical, emotional, vicarious, and historical trauma as well as intergenerational transmission of trauma, institutionalized racism, food and housing insecurity, safe passages, and isolation, all of which have a tremendous impact on health outcomes and life course trajectories.

Prior to the planning and development of the Healing Center in Willowbrook, LAC DPH staff sought input and participation from the community, its leaders, and its partners through dialogue, surveys, and key informant interviews. A Healing Center Advisory Committee (Advisory Committee) was also established with the goal of working closely with community residents and partners to develop a space to promote healing and increase access to trauma prevention and intervention services. Additionally, the Advisory Committee agreed to focus on three priority areas: grief and loss, healing arts, and self-care and vicarious trauma. They also developed a set of objectives: increase the number of community members that access healing, trauma prevention and intervention services; increase (LAC DPH) staff understanding of resiliency and trauma-centered care; and as long-term objectives, increase community residents' skills in managing stress and trauma, increase social connectedness, and reduce rates of perpetuating emotional and/or physical violence.

In evaluating the Healing Center a year after its opening, many of the objectives set by the Advisory Committee were met or continue to be in progress. In its first year, the Healing Center welcomed over 5,400 visits, and trainings were also offered to LAC DPH staff to increase their understanding of resiliency and trauma-centered care. Efforts to achieve and measure the long-term objectives of the Healing Center are on-going.

Near the end of the Healing Center's first year of operation, LAC DPH staff also conducted a rapid assessment survey to have a better understanding why participants came to the Healing Center; their satisfaction with the workshops or events they attended; and any challenges, barriers, or opportunities for improvements that could be addressed. Many participants provided positive feedback, and the survey results indicated that many participants were satisfied with their Healing Center experience.

A key factor of the Healing Center's success is rooted in the level of community participation and support. From the beginning, community members helped identify the need for the Healing Center and its success has continued into the implementation phase as community partners and agencies have helped shape and provide the programming available at the Healing Center.

http://publichealth.lacounty.gov/chs/spa6/index.htm

The Community Healing and Trauma Prevention Center (Healing Center) officially opened in September 2018 by LAC DPH in partnership with community organizations, other County and city agencies, and community members. To help make this program a reality, LAC DPH redesigned a part of its MLK Jr. Center for Public Health clinic facility, in South Los Angeles, to serve as a resource center and strategic hub in the community. Open to the general community, residents can visit the Healing Center to access a wide range of healing and trauma prevention resources and programming. These services are free and focus primarily on three priority areas: support groups, healing arts, and self-care and vicarious trauma. Workshops and classes such as Aztec dancing, arts and crafts, mindful meditation breaks, and support groups for grief and loss are offered throughout the week, including evening and weekend hours. The programming and resources at the Healing Center are facilitated and conducted by a network of community agencies and partners in a safe, welcoming space. Additionally, the Healing Center functions as a strategic hub and physical space to support community dialogue, engagement, mobilization, and community-based work to address violence, prevent trauma, and promote healing. For example, in May 2019, when there was a fatal hit-and-run collision as a result of street-racing, community members requested that a townhall meeting be convened at the Healing Center to discuss the incident. County and city officials were also invited to attend the discussion and help identify potential future interventions; relevant support resources were also promoted at this time to those in the community.

The concept of the Healing Center emerged in response to the issues and needs of the community around violence and trauma. In South Los Angeles, residents experience the highest rates of assault-related trauma and homicide in Los Angeles County. Whereas homicide has been the second leading cause of premature death every year for the past 10 years in Los Angeles County, with rates highest among black and Latino men, homicide rates are nearly four times higher in South Los Angeles than the rest of the County. Willowbrook, a small unincorporated community nestled within South Los Angeles, has a population of approximately 36,000 residents. In this community, between 2013-2017, there was a total of 136 homicides, a rate four times higher than the County overall. The complexity of trauma in this community includes but is not limited to physical, emotional, vicarious, and historical trauma as well as intergenerational transmission of trauma, institutionalized racism, food and housing insecurity, safe passages, and isolation. Research shows that trauma and violence can have a tremendous impact on future re-victimization and/or perpetration as well as an impact on health outcomes and life course trajectories. Building upon the work of existing violence prevention-related initiatives in South Los Angeles, the concept of the Healing Center emerged as a strategy that was identified in partnership with the community, community-based organizations, and government agency partners to address trauma and violence in the community and respond to the community's input and needs.  

Prior to the opening of the Healing Center, several existing initiatives in Willowbrook were already underway. One such initiative was LAC DPH's Trauma Prevention Initiative (TPI), which was established in December 2015 to reduce trauma visits and deaths throughout Los Angeles County. TPI identified four target communities in Los Angeles County, one of which was Willowbrook, where a comprehensive approach to violence prevention and intervention could be implemented in coordination and partnership with other existing systems and programs between County, city, and community organizations as well as community members. Core strategies that were a part of this initiative include:

  • facilitating community engagement and strategic planning processes to build relationships and develop a comprehensive community-based violence prevention strategic plan;
  • providing hospital-based interventions where patients most at risk for continued violence and injury could be linked to intensive intervention and case management services through trained community intervention workers;
  • establishing street outreach and community violence interventions (e.g., conflict mediation, stopping retaliatory violence, ensuring safe passages to and from schools, libraries, and parks);
  • establishing a peer-to-peer violence prevention learning academy to provide peer workers with a trauma-informed foundation in implementing violence prevention and intervention strategies;
  • providing training and technical assistance opportunities to community organizations; and
  • supporting prevention strategies identified by stakeholders, residents, and youth in the community.

It was within this TPI work, with input from community leaders and a local coalition (Community Action for Peace) in Willowbrook, where the concept of the Healing Center emerged as a potential strategy to address the input and needs identified by community residents.

In addition to TPI, several other significant developments and initiatives were also underway in the community. The Department of Mental Health led a Health Neighborhoods initiative where an extensive network of County and city agencies, educational institutions, housing services, faith-based groups, vocational supports, advocacy and non-profit organizations, prevention programs and service providers convene to engage the community in discussions regarding behavioral health issues and needs and to coordinate the use of existing resources to develop and implement a blueprint of community-based strategies. In 2010, the Los Angeles County Department of Parks and Recreation implemented the County's Gang Violence Reduction Initiative as a primary prevention strategy, also known as Parks After Dark (PAD). PAD provides recreational activities (e.g., sports clinics, exercise classes, and walking clubs) as well as arts and educational programs, teen activities, and health and social service resource fairs in communities that experience higher rates of violence, economic hardship, and obesity. As with the other initiatives discussed, PAD was implemented in collaboration with multiple County agencies and community-based organizations to provide programming and access to resources.

Another additional community and improvement project that was underway in Willowbrook was the establishment and expansion of the Martin Luther King Jr. Health Campus, which includes the opening of the state-of-the-art Martin Luther King Jr. Community Hospital and Outpatient Center, Charles Drew University, Los Angeles Unified School District's King Drew Medical Magnet High School, and the MLK Jr. Center for Public Health. The goal of establishing the MLK Jr. Health Campus was to collectively promote community wellness and physical activities through connected facilities and spaces to increase access to and utilization of local services. Within the same vicinity, other existing and planned improvement projects include the Rosa Parks Station Improvement Project, a Willowbrook Bikeway and Streetscapes Project, and Project Willowbrook to cultivate a healthy community through arts and culture.

In general, the opening of the Healing Center was designed to function as a strategic hub by building upon and strengthening the coordination of existing systems, programs, and initiatives rather than introduce a new practice. However, in establishing the Healing Center at the MLK Jr. Center for Public Health, a new and creative combination of existing tools and practices were adopted and adapted to meet the needs of a specific population.

One existing practice the Healing Center applied in a novel context was the sharing of the LAC DPH's space with the community to increase access to healing and trauma prevention resources and activities. In the field of public health, advocates have promoted a shared use, or joint use, strategy to increase the availability of spaces for physical activity, particularly in communities where recreational spaces such as parks are not easily accessible to the community (source: www.changelabsolutions.org). By sharing spaces such as school playgrounds or other suitable facilities with the community or community partners during off hours, community members have more opportunities to access and engage in physical or recreational activities. In a similar way, a portion of the MLK Jr. Center for Public Health facility was redesigned and opened to serve as a strategic hub and resource center for community members to access resources and participate in healing and trauma prevention activities during regular business hours as well as during evening and weekend hours. Consistent with other communities that experience inequities or disparities in resources, Willowbrook residents expressed the need to have more spaces that are safe and gang neutral to participate in activities, meetings, and community events; the Healing Center offers such a space with a monthly calendar of activities and events offered by community-based organizations and partners. According to the County Health Rankings and Roadmap What Works for Health,” there is some evidence that shared use agreements increase opportunities for physical activity (NPAPVincent 2010Maddock 2008Lafleur 2013, Slater 2014, ALR-Shulaker 2015), and can be used as a strategy to increase physical activity. Additionally, some faith-based organizations are using shared use agreements to expand access to their recreational facilities (ChangeLab Solutions, Congregation to Community). To date, LAC DPH has not identified any other public health agency using this same practice in the context of trauma prevention and healing activities as an injury and violence prevention strategy.

Prior to establishing the Healing Center, LAC DPH program staff from the Injury and Violence Prevention Program, Policies for Livable, Active Communities and Environments (PLACE), and Community and Field Services Division staff engaged formal and informal community leaders to seek their participation and engagement in building the framework of the Healing Center to ensure that it would be culturally relevant, appealing, accessible, and sustainable in the community. Additionally, the Trauma Prevention Initiative (TPI), an existing initiative in Willowbrook, facilitated the development of a Community Action for Peace group to engage local residents and stakeholders, create collaborative networks, and develop community-driven safety solutions. Leveraging TPI's community engagement efforts, LAC DPH staff conducted formative research in May 2018 which included dialogue, surveys, key informant interviews, and guided tours.

In working with community leaders, LAC DPH staff sought to identify barriers to accessibility and reasons for underutilization of services in South Los Angeles. Community members suggested two likely causes: 1) that the community is not involved in the program planning and development of services and 2) there is a lack of knowledge around services that already exist. After conducting key informant interviews, several other major themes also emerged. Key informants shared that Willowbrook needed its own community identity. Because the community of Willowbrook was often associated with its neighboring communities of Watts or Compton, residents felt that resources were focused on other communities rather than Willowbrook itself. Key informant interviews also indicated that the primary intervention perceived as most needed and effective was more community-based youth development programs and services. Opportunities and activities for senior residents as well as intergenerational activities were also a need. Other needs that emerged from the key informant interviews include: more services that are culturally and linguistically appropriate for the community, improved community cohesion, funding to continue to provide and sustain services, and more trusted, safe, and neutral” spaces.

Results of formative research surveys around the Healing Center showed that the community requested traditional services. Workshops and classes on stress management, dealing with emotions, understanding trauma, and grief and loss support groups were favored over more non-traditional services like movement/dance, yoga/tai chi, or drumming circles and music. Results also indicated that respondents preferred family and individual counseling to couple counseling, and that the facility's services would be more accessible to the community if it was open during non-regular office hours (i.e., weekend and evening hours). Additionally, the community was adamant that youth programs must also be developed by youth, rather than youth allies.

A Healing Center Advisory Committee (Advisory Committee) was also convened to shape and inform the development and implementation of the Healing Center. Advisory Committee members include County agencies such as Public Health, Mental Health, Health Services, the District Attorney's Office, as well as community hospital and outpatient services, educational institutions, and Community Action for Peace members. To establish the Healing Center, the Advisory Committee drafted a common goal: to work closely with community and other partners to develop a hub space to promote healing and increase trauma prevention and intervention services. Additionally, three main objectives were developed for the Healing Center: increase community members accessing healing, trauma prevention and intervention services; increase staff understanding of resiliency and trauma-centered care; and increase residents' skills in managing stress and trauma, reduce rates of perpetuating emotional and/or physical violence, and increase social connectedness. A logic model along with key strategies and activities was also drafted. Finally, the Advisory Committee also agreed to focus on three priority areas in the Healing Center: grief & loss support groups, healing arts, and self-care and vicarious trauma.

An assessment and evaluation of the Healing Center after its first year of operation has revealed some successes and lessons learned. With a robust program schedule of activities facilitated by community organizations, over 5,400 visits to the Healing Center in its first year, and a growing collaborative network of partners, the most critical factor in the success of the Healing Center was due to the level of community participation and support throughout all the phases of developing and implementing the Healing Center. While the development of the Healing Center was based on the community's input and participation, many community partners also supported the Healing Center's implementation. Existing initiatives that were funded in Willowbrook, such as the Trauma Prevention Initiative, contributed in-kind support to establish the Healing Center while other community organizations and County agencies contributed by facilitating workshops and support groups at the Healing Center. LAC DPH contributed physical space and existing staff time to launch and operate the Healing Center. Additionally, a number of other community efforts including First 5 Best Start for Watts Willowbrook, Watts Gang Task Force, Clergy Council, Sheriff's Department Community Advisory Meeting, Safe Passages, and Neighborhood Watches, were also willing to promote and partner with the Healing Center through their existing efforts.

Since the beginning, the Healing Center has been well-received and supported by the community and its partners. As the Healing Center continues to more established, this support has been strengthened as trust continues to be built and the community recognizes the Healing Center's genuine intent to address its needs. When a beloved music artist and community advocate Nipsey Hussle was killed in South Los Angeles in April 2019, the community experienced a deep level of grief. To support the community at that time, the Healing Center offered grief and loss services for several weeks with assistance from many partners, including mental health providers, faith-based organizations, and street outreach and interventionists. The Healing Center's network of community-based organizations also helped distribute information about these services to community members. These services would not have been possible without support from its partners, and it is vital that the Healing Center continues to nurture the trust in the relationships that it has built in the community to continue to thrive.

As the Healing Center continues into its second year, additional funds from different programs will be also be added to expand its resources and services. For example, funding from LAC DPH's Substance Abuse and Prevention Control Program will contribute to provide on-site substance abuse counselors. The Healing Center Advisory Committee will continue to meet and participate in the Healing Center's evolution and growth, and existing initiatives will continue to be leveraged to ensure that the work of the Healing Center remains aligned with the priorities and needs of the community.

In collaboration with its partners and community members, the Healing Center Advisory Committee drafted a program goal and several objectives to identify the practice outcomes to be reached through the Healing Center project. The goal of the Healing Center is to work closely with community residents and partners to develop a space to promote healing and increase access to trauma prevention and intervention services, with a focus on three priority areas: grief and loss support groups, healing arts, and self-care and vicarious trauma. Additionally, the Advisory Group identified three objectives.

The first objective was to increase the number of community members accessing healing, trauma prevention and intervention services at the Healing Center. Without a reference or baseline of the number of community members visiting the Healing Center, LAC DPH staff began to track the number of visits to the Healing Center in its first year with the intention of using this number as a baseline. In its first year of operation (between September 2018 to August 2019), the Healing Center hosted over 600 events and activities and received 5,454 visits (note: some participants had visited the Healing Center on more than one occasion, and each visit was counted rather than each unique visitor). Many of these visits included participation in the healing arts activities (e.g., arts and crafts, drumming circles, Aztec dancing, mandala making) where there were 2,511 visits. Support groups (e.g., 12-step groups, trauma and substance abuse, empowerment programs) received 632 visits; self-care and vicarious trauma (e.g., mindful meditation breaks, yoga) activities had 429 visits; classes (e.g., stress reduction, healing gardens, mental health, trauma-informed trainings) received 708 visits; and a range of other community events (e.g., community meetings, youth programs, townhalls) received 1,174 events.

Another objective the Healing Center Advisory Committee identified was to increase staff understanding of resiliency and trauma-centered care. At the time of the opening of the Healing Center, there were approximately 60 LAC DPH staff that worked in the MLK Center for Public Health facility. An all-day trauma-informed practice training was offered to all DPH staff in the facility as well as other DPH staff and community partners. This training was conducted 4 times in May 2019 and June 2019, with 231 training participants, 152 of whom were LAC DPH staff that completed the training. Training evaluation feedback received from staff regarding this training indicated that staff felt this training was helpful and much needed, and additional trauma-centered care trainings will continue to be offered to staff.

The third objective set by the Healing Center Community Advisory included long-term objectives to increase skills in managing stress and trauma, reduce rates of perpetuating emotional and/or physical violence, and increase social connectedness among visitors of the Healing Center. While this objective has not yet been measured, an evaluation of this objective will be conducted at the end of 5 years, with a three-year intermediary assessment. 

Towards the end of the Healing Center's first year of operation, LAC DPH staff (Office of Health Assessment and Epidemiology) and partners also conducted a rapid assessment survey among visitors that participated in events or activities offered at the Healing Center. A 16-item survey was conducted during the month of August 2019 across 73 workshops, with a total of 226 respondents that agreed to answer the survey questions. 

When asked why the participants attended the workshop or activity, 34% of the participants indicated that they wanted to learn about the topic; 31% said they wanted to meet new people; 23% said they wanted to get emotional support/encouragement; 23% indicated that they wanted to learn a new skill; 23% said they attended to cope with stress; 20% said they wanted to improve how they feel; and 13% said they wanted to connect with professionals and staff for services.

Overall, survey participants provided positive feedback about the Healing Center and its workshops. When the participants were asked to indicate how satisfied they were in general the with workshop or activities at the Healing Center, 73% strongly agreed that they were satisfied; 19% agreed that they were satisfied; while 6% neither agreed nor disagreed; and 1% of the participants indicated they disagreed or strongly disagreed. Many participants also indicated that they felt better after participating in a workshop or activity (74% strongly agreed while 20% agreed); learned something useful related to mental health and well-being from the workshop or activity (62% strongly agreed while 28% agreed); and felt they could cope better with stress or other challenges because of what they learned from the workshop or activity (52% strongly agree and 29% agreed).

The rapid assessment survey also captured some of the participants' characteristics. Most of the participants were female (82%); 16% were male, <1% were transgender, and <1% were non-binary. Regarding race and ethnicity, more than half the participants were African American/Black (51%) while other participants identified as Hispanic/Latino (40%), White/ Non-Hispanic (4%), Asian/ Pacific Islander (4%), Native American/ Alaskan (2%), and other (5%).  Regarding age, the largest category of Healing Center workshop participants were between 40-49 years of age (24%), 30-39 years of age (22%), 50-59 years of age (22%), while the remaining participants were either 25-29 years of age (12%), 18-24 years (7%), 65 years or older (6%) or 60-64 years (6%). In evaluating the characteristics of the Healing Center participants, more work needs to be done to create workshops, resources, and opportunities that are of interest to a population that is more reflective of the Willowbrook community, including males and youth participants. 

The concept of the Healing Center was to establish a safe community space where community residents could more easily access healing and trauma prevention resources. Additionally, the Healing Center would serve as a strategic hub to support community dialogue and community-based work around healing and trauma prevention and intervention with local partners. By leveraging other existing initiatives and community convenings that were already underway, namely the Community Action for Peace coalition and the Trauma Prevention Initiative in Willowbrook, the concept of the Healing Center emerged from discussions and engagement with the community. Prior to its opening, LAC DPH staff invested a significant amount of time and effort to engage in dialogue with coalition members, community members, and local partners about what strategies could be implemented to address trauma and violence in South Los Angeles. During the planning and development phase and after a year of being in operation, there have been a number of lessons learned about the Healing Center as a public health practice as well as lessons learned in relation to partner collaboration.

As a public health practice, the Healing Center was successful in improving access to more healing and trauma prevention resources in the community. By sharing LAC DPH's space in the community, residents have benefited from the Healing Center space as new opportunities to participate in community events and activities were created and promoted throughout local networks. Additionally, community residents could visit the Healing Center during regular business hours as well as weekend and evening hours to talk with staff and be further connected to existing local community resources. By the end of the first year, the Healing Center had hosted over 600 events in partnership with other agencies and welcomed over 5,400 visits. Surveys to collect participant input provided positive feedback that the workshops were helpful and that visitors were satisfied with their experience at the Healing Center.

In addition to improving access to resources, the Healing Center also functions as a hub for community dialogue, strategic planning, and the mobilization of efforts around trauma prevention and intervention work. Agencies from different sectors (e.g., mental health, victims services, faith-based organizations, youth groups, health providers, substance use providers, and educational institutions) convened to strengthen their partnerships, exchange information, and share resources. As the practice of the Healing Center progressed, it was also apparent that there were many opportunities to incorporate a range of other public health issues and initiatives as a nexus to healing and trauma prevention; for example, to address the high rates of infant and maternal mortality in South Los Angeles, local providers and community-based organizations partnered with the Healing Center to offer prenatal classes, breastfeeding support groups, infant massage workshops, and parenting support groups for fathers. To address chronic disease issues, activities related to physical activity (e.g., Wazobia dancing and chair yoga), healing gardening classes, and events to distribute free produce and healthy foods (related to nutrition and food insecurity) were added to the Healing Center's schedule of events. Support groups for different topics including recovery, addiction, survivors of domestic violence and youth development programs, with agendas and curricula planned by youth, are also consistently a part of the Healing Center's calendar.

As a collaborative effort, the Healing Center has been well-received by the community. Community-based agencies have partnered with the Healing Center to create a robust program calendar and participation from the community has been strong. Upon reflection, one of the most significant factors leading to this outcome was having the support and participation of the community in developing, planning, and implementing the Healing Center. Early on, LAC DPH staff sought to build trust in their relationships and leveraged existing initiatives, such as the Trauma Prevention Initiative and the Community Action for Peace group in Willowbrook, to seek community input and participation in working through local issues and challenges. Information was also collected through surveys and key informant interviews with community members and leaders. By building the Healing Center practice around the community's ideas, the Healing Center was embraced and supported by the community.

The implementation of the Healing Center's programming was also supported by an extensive network of community-based organizations. Many agencies partnered with the Healing Center to offer workshops and activities at no cost to the participant. This model creates more opportunities for the community to access and participate in community activities and events and has also been a benefit to small community-based organizations and partners that have limited resources. In its first year, over 240 community agencies partnered with the Healing Center by linking residents to resources or facilitating workshops or support groups open to the community. In general, many agencies have contributed their time and resources according to their areas of expertise and skills. For example, the LA County Arts Commission and project partners LA Commons and local artist engaged with the community to identify and map the community's cultural assets and later helped create community artwork pieces that would be used to brand and market the Healing Center. In return, LAC DPH used its physical space as an asset by opening some of its space to the community. This model of contributing assets and resources to the Healing Center has been sustained for the past year and continues to evolve and expand as the number and variety of events continues to increase. To date, a cost/benefit analysis has not yet been completed, but as the Healing Center practice continues to be to be more established and refined, a cost/benefit may be needed to further capture its impact in the community.

NACCHO Publication (Connect, Exchange, Public Health Dispatch)