Problem. Los Angeles County (LAC) has the largest juvenile justice system in the nation - more than 13,500 youth were arrested locally in 2015. Persons of color are disproportionately represented in the county’s justice system, for example, while Black youth represent only 7% of the youth population, they represented 24% of those arrested in 2015. Evidence and Theory. Research shows that contact with the juvenile justice system can lead to range of negative health and social outcomes, damaging family functioning, decreasing high school graduation and employment rates, increasing risk for involvement in violence, and worsening mental health outcomes. Additional work is needed to identify alternative activities and services that help young people avoid or minimize formal processing in the justice system and reduce risk for future crime. Policy Development and Implementation. The Youth Diversion Workgroup, a multidisciplinary group of governmental, academic, and community-based partners led by the LAC Department of Public Health, was formed in 2016 to advance a comprehensive approach to keeping youth out of the juvenile justice system. This presentation will present results from two key formative pieces of work: (1) an environmental scan of youth diversion programs, which highlighted the current scope and status of diversion work locally as well as the need for coordination and support of evidence-based practice; and (2) survey results gathered during a convening hosted by the Workgroup, which brought together diverse group of 75+ practitioners and researchers implementing or developing diversion programs. This formative work led to development and passage of a policy by the LAC Board of Supervisors in 2017, which created a framework and structure to coordinate youth diversion countywide. Recommendations for Practitioners. The presentation will describe strategies and lessons learned for convening community and governmental stakeholders, conducting data-driven assessment to inform policy change, and communicating results to decision-makers. The presentation will highlight the valuable role of public health in addressing juvenile justice as a key social determinant of health.

The Baltimore City Health Department (BCHD) has been a leader in recognizing the intersection between public health and violence prevention strategies with the creation of its Office of Youth Violence Prevention in 2003. The Office, while shifting in its programs and focus, continues to work on those issues that contribute to the spread of the contagion of violence. A significant and new focus through the Office and Health Department-wide has been addressing the issue of trauma in communities impacted by violence. Trauma-informed practices decrease the risk of future crime. After the civil unrest of 2015, BCHD embarked upon an aggressive plan of providing trauma-informed care training to all city agency employees and partner providers. Through the remainder of 2015 and continuing into 2016, over 1400 city employees were trained, with the support of SAMHSA, from over 15 different agencies. Continued training has engaged individual agencies to help them directly develop and implement TIC practices in their day-to-day work. The trainings of additional city employees will continue into 2017. Through our Office of Youth Violence Prevention's Safe Streets Program, we are currently planning a program that will support male survivors of violence through TIC and other mental health supports. Similar to trauma-informed training, addressing the impacts of violence head on can decrease the risk of future violent acts. Our Safe Streets (SS) program, a Cure Violence replication, is a violence interruption and violence prevention strategy that works with credible messengers who were formerly active participants in the violence in their communities but now work to mediate disputes and outreach to youth to prevent shootings and homicides in communities. With funding from the Department of Justice addressing victims of violence, we are bringing supports to those impacted by violence in the Safe Streets communities with the expectation that this support will result in significant reductions in retaliations and violence. Another program through our SS program is our Hospital Responder program. SS workers will respond directly to the hospital to talk with victims of violence to prevent retaliation. The work also supports victims to engage in more productive activity.

The City of Kansas City, Missouri is a diverse urban community on the Missouri-Kansas border. County Health Rankings place the county 95th of 112 in social and economic factors. Community violence, especially homicide has disproportionately impacted KCMO’s low-income and racial/ethnic minority communities. Research shows it is futile to fight violence without battling its root causes, behaviors and norms. Aim4Peace, engages communities to work with people at high risk of violence, provides on-the-spot guidance and works to change behavioral patterns. Aim4Peace reduces community violence by adapting core concepts from public health: looking at violence as an epidemic and “interrupting” the contagion. Aim4Peace is a public health approach that focuses on preventing exposure to violence, responding to violence exposure, and supporting survivors of violence. Aim4Peace works within three primary public health paradigms: 1) identify, detect and increase awareness of the perceived risk and costs of involvement in violence among the target population; 2) provide alternatives to violence when individuals in the community are making unhealthy behavior decisions; and 3) support healthy community norms and behaviors regarding violence. To implement this initiative, the Health Department created a new public health worker classification and trained Prevention Professionals. The Prevention Professionals are transformed returning citizens who formerly mirrored the violent acts (gun assault) within the affected communities. To do this the Health Department had to change institutional legal, human resources, risk management, and legislative norms. Aim4Peace has decreased gun violence in the target area by 56% in 2013 in the target zone, compared to 1% city-wide, and has facilitated more than 300 program, policy and practice changes in the community implemented through partnerships involving nine different sectors including law enforcement, business, and education. This presentation will describe the lessons learned and keys to success, with an emphasis on the participatory evaluation framework used by a local university and public health department to systematically build collaborative partnerships with law enforcement, schools, businesses, media, faith-based and community organizations. This partnership implemented the Aim4Peace intervention, evaluated it, and communicated the efforts to address the threat of violence.

All ways that the juvenile and criminal justice systems touch an individual’s life - arrest, court proceedings, incarceration, reentry, and the collateral consequences of having a criminal record - have grave impacts on individual, family, and community health. A 2013 study of the mortality effects of prison found that for every year a person spends incarcerated, their life expectancy declines by two years. Likewise, a 2016 study of youth found that for every step deeper into the juvenile justice system youth get, the higher their premature mortality rate climbs. Because of the long-standing disproportionate impact that the criminal justice system has on communities of color, it is a major driver of health inequities in the United States. The lifetime risk for imprisonment for black men is 1 of every 3 men, compared to 1 of every 17 for white men. In 2015, Human Impact Partners, a national nonprofit organization focusing on elevating the consideration of health and equity in public policy decisions, convened 50 national leaders who are working at the convergence of criminal and juvenile justice system reform and public health. This presentation will report on the results of ongoing work of the National Criminal Justice and Public Health Alliance, including the creation of a Vision for a justice system that operates according to public health principles, a new justice narrative based on those principles, elevation of health provider and community-based interventions that reduce involvement with the criminal justice system (#WeGotThis), and other efforts to promote health instead of punishment. This presentation will provide resources that practitioners and researchers can use to advocate that their local public health departments engage in criminal justice system change and will share tools to use in reducing the unhealthy and inequitable impact that criminalization has in communities.