| | Developing Partnerships to Advance Youth Violence Prevention in Puerto Rico: The Role of an Academic Center of ExcellenceAbstractThis article presents and discusses strategies implemented by the University of Puerto Rico Center for Hispanic Youth Violence Prevention (CHYVP) to facilitate community mobilization to reduce youth violence in a high-risk Latino community. Participatory communication strategies were used to enhance mobilization and to develop community partnerships. Short-term outcomes included overcoming resistance and distrust, active community dialogue and consensus building, the development of a school–community task force, the identification of priorities, the negotiation of conflicts, the implementation of a common action plan, and the commitment of government officials to adopt community recommendations. Challenges included gaining trust, inadequate coordination among partners, diversity within the community, dealing with prejudice, enhancing male participation, working at the community’s pace, party politics, and the effect of the loss of funding and its impact on the community. A participatory communication process can help to mobilize Latino communities to prevent and reduce youth violence. Introduction  Violence is defined as “the intentional use of force or power, threatened or actual, against another person, self, group, or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.”1 Youth violence occurs when the perpetrator and/or victim is 10–24 years old. Youth violence is a complex health problem that can be effectively addressed using the public health approach. This approach enables professionals to define the problem, its magnitude and trends; identify risk and protective factors; and develop, implement, disseminate, and evaluate preventive strategies. The public health approach needs to consider psychological, social, economic, and political factors associated with violence, as well as the consequences of violence.2, 3, 4 Bronfenbrenner’s ecologic systemic model addresses the impact of the interaction between the individual and the environment, and the sociopolitical context.2, 3 To understand an individual’s behavior, it is necessary to study the effect of his/her interaction with four system levels: microsystem (e.g., family, school, community); mesosystem (i.e., inter-relationships with each system); exosystem (i.e., decisions in scenarios where the individual does not have direct contact but that affect the microsystem); and macrosystem (i.e., values and beliefs of the social institutions, global influences).2 The definition of community includes members who reside in a specific geographic area and their interactions with the micro-, meso-, exo- and macro-systemic influences.2, 3 It refers to community members, resources and assets, and the government agencies and nongovernmental organizations (NGOs) that work together to advance the community’s goals. Youth violence prevention needs to address the interactions among a host of risk and protective factors. Risk factors may occur at different levels: individual, family, community.1, 5, 6, 7 They are interdependent and additive.6 An adolescent with impulsive behavior living in a dysfunctional family, who is repeatedly exposed to violence in his neighborhood is at risk of using violence in stressful/conflictive situations. Protective factors may also intervene at the individual, family, community levels to enhance prosocial behavior.1, 5 Community Mobilization Initiative The community mobilization initiative presented here was based on the Communication for Social Change (CFSC) model, where the target community actively participates in the identification of common problems and solutions.8 The model is based on the Convergent/Network model of communication (Figure 1) developed by Rogers and Kincaid.9 The process of participatory communication requires that information be exchanged among two or more individuals or groups rather than transmitted from one to the other (horizontal versus one-way communication). Cultural and ethnic values, social norms, and community history affect the perception and interpretation of the information by community members. Trusting the source and believing the message determines mutual understanding, which then leads to mutual agreement. The latter is basic to collective action and the resolution of a common problem (Figure 1). The CFSC model describes a cyclical process where community dialogue and collective action are linked to produce social change. According to the model, community dialogue is triggered by any of six potential catalysts: (1) an internal stimulus (e.g., noticeable increases in youth deaths); (2) an external change agent (e.g., visits from the university to discuss needs identified through previous community interventions); (3) an innovation (e.g., the availability of a new vaccine); (4) policies that prompt the community to act (e.g., new laws that require citizens to comply); (5) new technology (e.g., surveillance methods through cameras displayed in public spaces); and (6) mass media, including messages designed to promote individual behavior or collective action. These may stimulate members of a community to adopt the behavior or to emulate other communities that have achieved some common goal by working together.8 Community Dialogue Once initiated, community dialogue goes through a 10-step process that facilitates mutual understanding, mutual agreement, collective action, and problem resolution. These steps go from “recognition of a problem” to “action plan” (Figure 2). At some time, when a particular step is not properly worked out, the community may “loop back” to an earlier point in the process.8 Collective Action Collective action follows community dialogue. Responsibilities are assigned (to individuals, groups or community task forces); organizations are mobilized (e.g., schools, religious groups, community-based organizations [CBOs], health services); the action plan is implemented; and outcomes are evaluated (Figure 2). At this point, the model proposes seven outcome indicators of social change: (1) leadership, (2) degree and equity of participation, (3) information equity, (4), collective self-efficacy, (5) sense of ownership, (6) social cohesion, and (7) social norms. These outcome measures can be evaluated by community members, external change agents, and social scientists. The model explicitly emphasizes that self-evaluation by community members is an essential step, rather than leaving it entirely to external evaluators. Central to this model is the sense of ownership the community acquired over the entire mobilization process. This community mobilization effort focused on participatory communication and the development of partnerships. It proved to be effective in a community where distrust and resistance were prevalent, due to unilateral communication strategies employed in previous mobilization efforts, where an external agent imposed a solution without enabling active community participation. These prior efforts had created a sense of distrust toward any new initiatives from academia or outside entities. The Center for Hispanic Youth Violence Prevention (CHYVP) The University of Puerto Rico Center for Hispanic Youth Violence Prevention (CHYVP), one of ten Academic Centers of Excellence (ACEs) funded by the CDC in 2000, addressed community mobilization using the CFSC model to promote collective action, the development of partnerships, and social change within the community. Participatory Communication Strategies One of the goals of the Center was to develop a strategic plan for a coordinated school-based community response to violence prevention using a systemic approach. Partnerships were developed to identify community needs and resources, risk factors, protective factors, and develop a sound strategic plan. The first community meetings were held in one of the local elementary schools, with representatives from the schools, community, local police, housing administration, and religious sectors to discuss the problem of violence and obtain feedback on the Center’s focus-group findings. The CHYVP, an external agent, served as a catalyst stimulus in these first meetings, to openly discuss common problems related to youth violence in this community and prioritize its needs. A community advisory board was developed, and identified seven prevention priorities: 1.improve social skills training in third-grade students; 2.increase communication between the schools and the parents; 3.develop a school–community task force; 4.create a directory of individuals and organizations that work on the prevention of violence in the San Juan I School District; 5.enhance the educational environment (e.g., physical education, school theater); 6.identify at-risk students and bullies for appropriate and on-time interventions; and 7.improve parenting skills and child-rearing practices for young couples (parenting skills on issues of discipline, communication, and supervision of TV and homework). The community advisory board worked on these priorities, in collaboration with Center staff. The board met regularly, at least once a month, at different sites in the community. Board members planned two activities—to publish a community newspaper to highlight community accomplishments, and to host a family fair. The first edition of the community newspaper was written and submitted to the PR Education Department, which agreed to publish it. The family fair was planned but was suspended due to extraordinary circumstances at the PR Education Department. Community members were greatly concerned with student and teacher absenteeism and high dropout rates. They claimed that young people were often seen walking around during school hours, which could lead to problems such as illicit drug use and violence. They felt that it was imperative to get these young people back into school. A school–community task force was convened by a group of committed community stakeholders: staff from the local elementary, middle, and high schools; Center staff; parents; and students. A middle school social worker, who established clear guidelines to assure a dialogue and the participation of all community stakeholders, facilitated the meetings. The group invited the San Juan Mayor, and the Secretaries of the PR Education and Recreation Departments, who agreed to support the community’s demands to transform the middle and high schools into pre-vocational and sports-centered institutions, with the collaboration of school staff and the community. The Secretary of Education has continued to meet with them on a regular basis. Participatory communication has been effective in developing a sense of community ownership of common problems and solutions, the negotiation of conflicts, the development of a community vision of the future, the distribution of responsibilities, and reassessing accomplishments. It has promoted the accountability of participating government agencies in managing the problems and situations identified by community stakeholders. Other Strategies Additional strategies used to enhance community mobilization were the development and distribution of a directory of community agencies/organizations that deal with violence prevention. The Target Community The target community, the X Housing Project, is the largest in PR, with a population of over 25,000 residents. Located in urban San Juan, it is divided into three sections. In 2001, the project administrator performed a needs assessment survey of 1858 households (69%). Head of household was an unwed mother in 32.3% and a single parent in 31.4%. Forty-two percent of the resident population was aged under 18 years. Only 32.7% had finished 9th grade, and 31% were unemployed. The main source of income was government aid (77%). Seven percent reported that they had a family member who was a convict or ex-convict, or an illicit drug user/dependent (3.9%). These survey results illustrate the factors associated with violence in PR, which has the second highest murder rate in the nation, after Washington DC.10 In 2003, the homicide rate in the general population was three times the mainland rate (19.1 vs 6.1/100,000).11, 12 Over 770 homicides were reported islandwide that year, 87% of which were associated with firearms.11 It is estimated that 60% of homicides are related to drug trafficking.13 Homicides are the first cause of death for youths over 15 years (120/100,000 for males 20 to 24 in 2003).14 In 2003, there were 296 youth homicides, of which 34% occurred in San Juan. The majority of these victims (93.3%) were males; over two thirds (68%) were aged between 20 and 24 years.14 According to the PR Department of Education, 89% of students attending San Juan public schools live in poverty. Approximately 48.25% (11,717 families) live either in public housing or in low-income urban neighborhoods (barriadas). In 1997, the PR Foundation for the Humanities and the Sacred Heart University sponsored the Community and Dialogue Project in the target community to address problems related to unemployment. Participants defined unemployment as a social and economic problem that causes low self-esteem, depression, divorce, suicide, death, domestic violence, battering, and mental health problems. Solutions presented by community members included: (1) foster strategies to organize youth in the community, (2) address discrimination toward residents in barriadas, and (3) endorse joint efforts between community organizations and government agencies.15 Multiple interventions had historically taken place in this community, but had not been perceived as participatory in nature, leaving a sense of distrust and apathy. Experience with middle school students from this community, who had previously participated in school-based research initiatives, influenced the Center’s decision to target this community, in spite of the challenging conditions. Sociocultural Factors that Influence Community Mobilization Cultural values and social norms influence a community’s response to any intervention. Latinos are heterogeneous; ethnic groups may differ in some cultural aspects, while retaining similarities in others. The participatory communication process may be hindered or enhanced depending on existing knowledge of the cultural values, religious beliefs, and social norms prevalent in a particular community. Personalismo, where interpersonal relationships and personalized contact are essential,7 was evident in this community. Meeting with Center staff face to face, to openly discuss the problem of youth violence and define the Center’s and the community’s role in the community mobilization process, was an important step to community members. Initial distrust and resistance subsided, and open discussion of considerable historical events, community concerns, and priorities ensued. Colectivismo, a sense of mutual empathy, where personal desires are subordinated to the interests of the group, and common goals and interests provide a sense of belonging,7 was also prevalent. In this particular community there was a collective feeling of long-standing discrimination by the surrounding community and government agencies, allegedly due to their place of residence (public housing). The residents complained of being repeatedly rejected at job interviews and expressed a general feeling of hopelessness. After they openly expressed their frustrations, Center staff facilitated community discussion and identification of its strengths and assets. Colectivismo helped the community establish common priorities, distribute responsibilities, and develop and implement the community action plan. Respeto (respect) places great social worth and decision-making power on authority figures. There is deference to the decisions of elders, parents, teachers, physicians, and law enforcement officials.7 A highly respected middle school social worker, who had worked in the community for many years, became the coordinator and facilitator of the school–community task force meetings. Religious beliefs may influence a community’s response to preventive efforts. Determinismo (or fatalismo), is the belief that life events are determined by fate or God’s will. The general hopelessness perceived initially among community members was reminiscent of fatalismo. It was an early indication that community members would need to be highly motivated to continue to work toward achieving their goals and finding solutions to their problems. Another barrier to establishing trust and effective communication may be the perception of social hierarchies, clasismo. Community members need to perceive that their contribution is valid regardless of social, economic, or educational level. Otherwise, community members may refuse to participate or withdraw from planned activities. This was addressed from the beginning, where Center staff and community members met as partners, to discuss community concerns and share information. Misperceptions were clarified, and mutual understanding and respect evolved. The code of silence is a social norm prevalent in many public housing projects, including this community, where homicides, drug deals, child abuse, and domestic violence incidents are often not reported. The community members who participated in the mobilization process, however, openly discussed what they perceived as the roots of the youth violence problem in their community and were willing to work toward identifying solutions. Different sectors of the community need to participate throughout the process: they provide relevant background information; identify common problems, community assets and resources; and implement realistic solutions. They will become partners if effective dialogue is established, allowing understanding, trust, believing, and mutual agreement. The development of partnerships and alliances will enhance collective action. Challenges Challenges included gaining trust; inadequate coordination among agencies, CBOs, and the community; the diversity within the community; overcoming the media’s portrayal of poor, inner-city neighborhoods; prejudice; enhancing male participation; and working at the community’s pace. Party politics influenced a community leader’s decision (and that of the sector he represented) not to participate in the process. The strategies mentioned in the previous sections were helpful in overcoming many of these challenges. Outcomes To overcome long-standing barriers to community mobilization for violence prevention in this Latino community, and to enable the development of trusting partnerships, appropriate communication mechanisms were established. Mobilization was initiated by a catalyst stimulus (i.e., CHYVP initiated the meetings where open dialogue was established), partnerships were developed, and a driving force was created (i.e., a multisectoral group of committed community members). As a result, the community developed a sense of ownership. From the beginning, the community agreed that youth violence was strongly associated with the high dropout rates and the need for major curricular changes in the local schools; in particular, the middle and high schools. The short-term outcomes of community mobilization were (1) active participation of community members in identifying priorities, (2) planning community activities and establishing their own timeframe, (3) establishing a school–community task force, (4) open discussion of the community’s demands for major curricular changes, and (5) meeting regularly with high agency officials to address the community’s demands. After CHYVP left the community, two leadership summer camps (in 2006 and 2007) were held with students, parents, and teachers, and the Community Alliance in Support of Excellence in Education was formed to continue to work toward school autonomy and enhanced curricula, tailored to their needs. There has been a committed response by partners and government agencies to their demands. Limitations and Lessons Learned The Center’s participation in the community mobilization efforts was limited to 3 years, due to funding constraints. This period was too brief to measure the impact on youth violence in such a large, complex community. Two community priorities (i.e., parenting and school-based youth violence prevention activities), to be addressed during the following 5 years, were left unattended, due to loss of funding. Community members felt disconcerted and disappointed; they had expectations of a long-standing relationship with the ACE. Their farewell remarks—“we trusted you”—were reminiscent of the long process we had overcome to gain the community’s respect and trust. The community’s active participation in all stages of the mobilization process contributed to a sense of ownership. The participation of community leaders proved to be essential to assure adequate representation of most sectors of the community, particularly in such a large and diverse community. Not surprisingly, party politics also influenced the participation of community members in certain activities and events. Recommendations Collaboration among communities, CBOs, universities, and local agencies is essential to advance youth violence prevention in this population. Community mobilization requires effective participatory communication and respect for the cultural values, religious beliefs, and social norms of the target community. Community members need to develop a sense of ownership, mutual understanding, and agreement, which will result in collective action. Partnerships and participatory communication are strongly recommended to prevent youth violence in these communities. The authors would like to thank the CHYVP Staff, the members of the Community Advisory Board, and the School-Community Task Force, for their dedication and support. This publication was supported by Grant/Cooperative Agreement Number R49CCR024186-02 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. No financial disclosures were reported by the authors of this paper. References 1. 1Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R. World report on violence and health. Geneva, Switzerland: World Health Organization; 2002;. 2. 2Bronfenbrenner U. Ecology of the family as a context for human development: research perspectives. Dev Psychol. 1986;22:723–742.
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PII: S0749-3797(07)00761-1 doi:10.1016/j.amepre.2007.12.019 © 2008 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved. | |
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