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Even that can be intimidating, though, especially when the counselor starts asking personal questions. Getting too deep into someone's business is cause for alarm; it's what child protective services or the police department does. But sometimes the therapists reassure the skeptical by using the example of war veterans to explain what's happening to a client. Like with Javier Arango, these young men and women are quick to recognize the shared experiences of overreacting to the sound of a siren or a loud boom. In one case, a client had both perspectives: He served as a soldier in Afghanistan without incident, but returned to Oakland and was shot.
Of the mostly male African-American and Latino adolescents and young adults Youth ALIVE! encounters, 41 percent are referred to a counselor. Since the Caught in the Crossfire program launched two decades ago, more than 1,200 people have been treated, and preliminary research shows the model can be effective; a retrospective study at Highland Hospital saw significant reductions of those treated in involvement with the criminal justice system. As important is teaching these clients that healing from trauma is possible, that its burden doesn't have to be a life sentence.
John Rich, a professor of health management and policy at Drexel University in Philadelphia who won a MacArthur fellowship for his work on the health care needs of urban African-American men, said hospital-intervention programs and similar efforts challenge a powerful cultural message about responsibility. "A narrative is that you have control no matter what," he said. "Just because those bad things that happened to you, that's no excuse. We're not really asking for folks to provide excuses. We're looking for explanations, to understand what these forces are."
Javier Arango wanted to stop gangbanging after seeing his close friend's lifeless body on the street and watching his friend's mother weep over the seventeen-year-old's open casket. This path would only lay waste to whatever future a high-school dropout paraplegic from the 'hood could scratch out. Leaving the gang wouldn't be easy so he searched for help, settling on Catholic Charities of the East Bay because of its name. Despite whatever "shady shit" Arango had done on the streets, he remained faithful, and in search of redemption.
"God, you have a crazy world," he said he remembers thinking. "I could help you a little bit, but just keep me here." Before he could serve, though, Arango had to heal.
As it turned out, Catholic Charities of the East Bay is one of the key agencies working to treat trauma in Oakland. Its Crisis Response Support Network contacts the family and friends of homicide victims, a program made possible partly through Measure Y violence prevention funding. It is also a part of the city's restorative justice initiative, and it has a federal grant to educate school-based mental health providers about the effects of trauma.
And yet, Cindy Hill-Ford said, the several agencies that coordinate services can't meet demand: "It's a huge orchestra and it's all underfunded."
This is immersive work that requires a professional staff with roots in the community. When Catholic Charities of the East Bay's clinical case managers take on a client, they try to create a safe environment, and this can mean relocating someone from a neighborhood — like the agency did for Arango.
Before, Arango rarely left the forty-block span he called home in East Oakland. Once he emerged, he began to see an alternative universe in which people moved freely across neighborhoods without risking death. He spent time at the agency's office for therapy, but lingered before and after his appointments. The staff gave him small assignments and he felt something novel: pride. Conversations with his therapist also helped by giving Arango a confidant who wanted to see him succeed and could teach him how to relieve symptoms of post-traumatic stress.
Then the organization offered Arango a job as a youth specialist who would lead "trauma circles," which bring together high-risk adolescents to confidentially discuss how to cope with harrowing experiences. "That's something I never had," Arango said of the job. "I always used to know how to cut it, bag it, and get my money. I thought I'm going to be thugging all my life and selling drugs."
It's a dramatic turnaround, and even Arango can't quite believe it. He lives in a safer neighborhood and sleeps well. Just these two things alone are worthy of envy, and Arango knows he's lucky.
"I want the government to make more programs to help out more and to understand that we're all human beings," he said. "We just happen to live in a cold world, in a messed-up world, in a dirty world. But we deserve all the opportunities that anybody else deserves."
Some of this is already happening. The Department of Health and Human Services issued new guidance this summer on how government health-care administrators can use public funding like Medicaid to provide screening and treatment for traumatized children; last year the agency provided $1.3 billion to states to detect physical and mental health conditions in low-income children. In 2013, the Substance Abuse and Mental Health Services Administration awarded more than $40 million in grants to organizations, including Catholic Charities of the East Bay, to provide trauma-informed services in communities around the country. That funding, however, decreased by 5 percent last year as a result of federal budget cuts, according to the US Department of Health and Human Services.