APPENDIX OR SUPPLEMENTAL DIGITAL CONTENT 2:
OXNARD ALLIANCE FOR COMMUNITY STRENGTH AND EMERGENCY ENTRY TO
EXIT
Oxnard Alliance for Community Strength
Oxnard Alliance for Community Strength is a community program dedicated to decrease
youth violence and create a safe environment for youths and families in Oxnard. The program
received funding from the State of California 2 years ago ($2 million). Members include a
multidisciplinary team of representatives from the Ventura County Board of Supervisors, Oxnard
City Mayor, Oxnard City Council, criminal justice and probation agencies, Oxnard Police
Department, behavioral health, Deputy Attorney, unified school district, Health Service Agency,
public health, Parents of Murdered Children, parent advocate for family members transitioning
from incarceration, and other community-based organizations and individuals working to prevent
violence.
A primary feature of this program is that it draws from and reflects voices from all
sectors of the community. The goal of this alliance is to provide data, build outreach and
awareness for partner programs, convene partners, provide technical assistance (facilitation and
support for community building and organizing), promote best and promising practices,
strengthen communication and referrals between partners, and encourage systems change. The
ultimate goal is to increase prevention and decrease youth violence in the City of Oxnard by
early intervention.
The “scared straight” technique of violence reduction does not improve outcomes of
violence reduction programs but perpetuates more violence. A different approach to this problem
is required. There was no structured funding for the hospital-based intervention. Therefore, we
applied for a grant from the State of California Victim Compensation and Grant Claims Board to
help formalize the initiative.
Emergency Entry to Exit
The proposed program Emergency Entry to Exit (EEE) was conceived by a meeting of
providers from Ventura County Medical Centers with judges, law enforcement agents, criminal
justice workers, behavioral health workers, and numerous community partners (number of
agency supporters, 27 people). The EEE program will augment the evidence-based Volunteers in
Police Service program endorsed by the United States Department of Justice by providing
outreach to victims who do not access typical care for their traumatic injury, and using
culturally- and ethnically-competent evidence-based models and staff training to address ethnic
and racial disparities in the system.12,13 Emergency Entry to Exit was approved by the
Institutional Review Board of the Ventura County Medical Center.
The purpose of the EEE program is to improve the care for victims of violent crime by
increasing medical and mental health services and to improve outcomes for victims of violent
crime, including transitional age youth (age, 15 to 24 y). The primary goals are (1) to strengthen
the community’s ability to foster programs and services to support the development and
rehabilitation of strong, healthy, and nonviolent crime victims; and (2) to improve functioning,
reduce hospital recidivism, and reduce criminal involvement by providing services that engage
victims and assist them through stabilization, recovery, rehabilitation, community reintegration,
and self-reliance (self-referral).
Victim identification
The EEE program will use the hospital intervention team (trauma team, social worker, and
motivational interviewer from the Street Smart Team) to identify and support the victim of
violence who is brought to the trauma center. Victims will be identified from 3 sources:
(1) Trauma center engagement: When treating patients who have injuries caused by violent
crime, a social worker from the EEE program and Ventura County Medical Center Social
Service Department will be notified to engage and evaluate patients for EEE program eligibility.
All victims of violent crime who present to the emergency room or trauma center will be
assessed for the need for services, regardless of age or gang involvement, with special attention
toward lifestyle changes for transition age youths (age, 15 to 24 y).
(2) Program partner referral: Extensive established community networks for health and social
services will provide needed services and program referrals. The program will serve vulnerable
families who live in neighborhoods that have high crime and poverty levels, and will use
community agencies that work with unserved and underserved populations. Referrals will come
from numerous referral partners including the Ventura County Superior Courts, Probation,
District Attorney’s Office, Public Defender, Ventura County Health Care Agency, and
Oxnard/Santa Paula/Ventura County Police Departments. After referral, the EEE team (social
workers, case managers, and Street Smart Team workers) will engage the victim in an initial
meeting to introduce the EEE program. The social worker and Street Smart Team worker will
meet with criminally involved youths or transition age youths and motivate them to change using
Motivational Interviewing techniques to develop trust. Motivational Interviewing is a goaldirected, individual-centered counseling style for eliciting behavioral change by helping
participants to explore and resolve ambivalence. Motivational Interviewing has been applied to
address problem behaviors related to alcohol and substance abuse, mental health issues, and
criminality.14,15 Depending on the source of identification of the participant, Motivational
Interviewing sessions will occur in the hospital before discharge; at the jail, juvenile hall, or
meeting with the Probation Officer; or in the community. During these sessions, victims will be
assessed for EEE program eligibility.
(3) Community outreach: Street Impact Teams will develop trust among victims by reaching
out to gang-dense communities (greater Oxnard and Santa Paula, Ventura County). They will
identify and intervene among victims of gang-related violence and their families, including those
who have barriers to services because of poverty, homelessness, and complex mental health
needs. Street Impact Teams will include bilingual, culturally-integrated community service
worker case managers and Street Team workers who will be recruited from the local
communities and have direct experience with street-gang culture. Street Team workers will be
contracted through 3 organizations that have experience in accessing gang-involved youth (City
Impact, Calles de Oro, and Clergy Council). Identification of victims will be documented in
medical records, police reports, court orders, probation referrals, program partner referral report
forms, and Street Team reports.
Victim assessment
After the trauma victims agree to participate, they will be assigned to an EEE team (social
worker, mental health clinician, and case manager). The social worker and mental health
clinician will conduct an initial assessment using evidence-based and trauma-informed tools,
with emphasis on involving the family. These tools will include trauma-focused cognitive
behavioral therapy, trauma resiliency model treatment, moral recognition therapy, restorative
justice healing circles, Ohio scales for youth, behavior and symptom identification scale
(BASIC), and University of California Los Angeles post-traumatic stress disorder reaction
index.16 A protocol will be used that is compliant with the Health Insurance Portability and
Accountability Act, includes consent to services and information release, and streamlines the
referral process for the case manager.
Administration and sustainability
The EEE program will have a central office with an administrator, outreach and training
coordinator, psychologist, public health nurse, social workers, community service workers,
psychiatrist, and medical office assistant. At the end of funding by the State of California Victim
Compensation and Grant Claims Board, sustainability of the EEE program will be supported by
(1) the reduction in the number of trauma patients treated at Ventura County Medical Center; (2)
community training with evidence-based practices to build the capacity of other community
agencies to serve victims; (3) identifying alternative funding sources for services; (4) fundraising
grant applications to state and national agencies; and (5) increased capacity of other community
agencies to identify trauma victims and meet the needs of youths.
REFERENCES FOR SUPPLEMENTAL DIGITAL CONTENT
1. Source: U.S. Census Bureau, 2012 data.
2. Source: Ventura County Human Services, 2009 data.
3. Source: Ventura County Probation Department, 2010 data.
4. Yoder KA, Whitback LB, Hoyt DR. Gang involvement and membership among homeless and
runaway youth. Youth & Society. 2003;34:441-467. doi:10.1177/0044118X03034004003.
5. Jenson JM. Aggression and violence in the United States: reflections on the Virginia Tech
shootings. Social Work Research. 2007;31:131. doi:10.1093/swr/31.3.131.
6. Source: Ventura County Behavioral Health, 2009 data.
7. Source: National Association of Realtors Housing Affordability Index, 2013 Data.
8. Source: Source: Santa Paula Police Department, 2012 data.
9. Source: Ventura County Medical Center, 2013 data.
10. Howell JC, Egley A Jr, Tita GE, Griffiths E. U.S. gang problem trends and seriousness,
1996-2009. National Gang Center Bulletin. 2011;6:1-23. Available at:
www.nationalgangcenter.gov/content/documents/bulletin-6.pdf dssccccA .November 29,
2013.
11. Soursc: California Healthy Kids Survey, 2013 data.
12. Huang LN, Pau T, Flatow R, DeVoursney D, Afayee S, Nugent A. Trauma-informed care
models compendium. 2012.
13. Jennings A. Models for developing trauma-informed behavioral health systems and traumaspecific services. Alexandria, VA: National Center for Trauma-Informed Care; 2008.
Available at: www.ct.gov/dmhas/lib/dmhas/trauma/TraumaModels.pdf dssccccA .November
29, 2013.
14. Kerig PK. Introduction to part II: trauma and juvenile delinquency: new directions in
interventions. J Child Adolescent Trauma. 2012:5:187-190. doi:
10.1080/19361521.2012.697023.
15. SAMHSA’s National Registry of Evidence-based Programs and Practices. Motivational
Interviewing. Available at: http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=130.
Accessed November 28, 2013.
16. Ogles BM, Melendez G, Davis DC, Lunnen KM. The Ohio scales: practical outcome
assessment. J Child Family Studies. 2001;10:199-212.
TABLES FOR SUPPLEMENTAL DIGITAL CONTENT
Table SDC 1. Population of Ventura County, California (Estimated) in September 2013*
Race†
White
Asian
≥ 2 races
African American
Native American
Pacific Islander
Other
Total
No.
566 625
55 526
36 995
15 185
8080
1645
140 457
824 513
(%)
(68.7)
(6.7)
(4.5)
(1.8)
(1.0)
(0.2)
(17.0)
(100)
*
Data from United States Census, 2013.1
The United States Census Bureau did not list Hispanic/Latino as a separate population category,
but the Ventura County Human Services Agency reported that 33.4% county population was
Hispanic/Latino.2
Table SDC 2. Gang Members in Ventura County, California*
Gang Members
Total documented gang members
Largest gang (Oxnard Colonia Chiques)
Second largest gang (Ventura Avenue Gangsters)
Hispanic/Latino
Male
Youngest documented member, age (y)
*
No.
2403
1000
450
2211
2235
13
(%)
(100)
(41.6)
(18.7)
(92)
(93)
Data from Ventura County Probation Department, 2012 data.3
Table SDC 3. Income and Crime in Ventura County, California in 2012*
Location
Ventura
Oxnard
Santa Paula
Countywide
*
Frequency of Crime
(per 1000 population)
Violent
Property
3.0
31.2
3.1
17.8
4.4
16.3
2.1
19.8
All
34.2
20.9
20.7
21.9
Median
Income
(2012)
(US dollars)
$40 413
$26 263
$29 203
$38 289
Data from National Association of Realtors Housing Affordability Index.7
Table SDC 4. Gang Involvement By Youths in Selected Ventura Area Schools*
Level
School
Elementary
Hueneme
Mesa Union Elementary
Oxnard Elementary
Pleasant Valley
Elementary
Rio Elementary
High
Oxnard Union High
Oxnard Union High
*
Grade
Year
2006†
2008‡
7
7
7
11%
6%
11%
10%
4%
11%
7
7
13%
0%
8%
10%
9
11
9%
10%
8%
8%
Data from California Healthy Kids Survey, 2012.1
†
Data for high school: year 2005.
‡
Data for high school: year 2007.
Table SDC 5. Admissions To Ventura County Medical Center For Violent Trauma*
Data
Trauma Type
Number of admissions
Assault
Gunshot wound
Stabbing
Total violent
trauma
Percent admissions
Assault
Gunshot wound
Stabbing
Total violent
trauma
*
2008
2009
Year
2010
2011
2012
41
21
36
36
18
46
74
15
52
65
31
89
146
66
136
98
100
141
185
348
7.7%
3.9%
6.7%
6.1%
3.0%
7.8%
8.5%
1.7%
5.9%
6.3%
3.0%
8.6%
7.3%
3.3%
6.8%
18.3%
16.9%
16.2%
17.8%
17.3%
Data reported as number or percent. Source: Ventura County Medical Center (unpublished
data).9
Table SDC 6. Admissions To Ventura County Medical Center For Violent Trauma in Patients
Aged 15 to 24 Years*
Characteristics
Race
White
Other
Black
Asian
Hispanic
Non-Hispanic
History
Penetrating injuries
Mental health history
Transported by law enforcement
Total patients
*
2010
Year
2011
2012
102
150
3
3
141
126
113
136
11
3
126
135
109
183
5
4
170
131
30
24
12
258
58
28
9
263
61
20
20
301
Data reported as number patients. Source: Ventura County Medical Center (unpublished data).9