Just Us Dialogues: Harnessing the Transformational Power of Discourse to Prevent Violence

Abstract

Anchor Institutions (AIs) provide tremendous value and benefit to the communities where they reside through initiatives, partnerships, and investments. As an academic medical center, Johns Hopkins devised to anchor its community by addressing the epidemic of violence and racial injustice through a series of webinars and a symposium entitled the “Just Us Dialogues.” An analysis of all comments and policy recommendations made by panelists and attendees was performed and a series of recommendations emerged regarding how an AI should approach addressing community violence and inequities to promote community wellness. The series consisted of 4 panels: “The 4th Amendment: Use, Misuse, and Case for Police Reform”; “Protecting Our Youth: Confronting Society's Role in the Harmonious Development of Adolescents”; “Immigration Matters: Building Humanity Within a Fractured Immigration Landscape”; and “Decriminalizing Mental Illness: Empathetic Approaches to Mental Health Supports.” These 4 panels, symposium discussions, and the keynote address yielded 18 recommendations. The recommendations from the panels and the symposium underscore the power and leverage that AIs possess to identify and implement approaches to address community violence.

Introduction

Anchor institutions (AIs) are established enterprises situated within a fixed community geography and are unlikely to relocate. ¹ Initiatives spearheaded by an AI should focus on sustaining the community, both within the institution and beyond, by providing access to educational programs and increasing the proportion of college-educated community members. ² Research has shown that the ongoing AI business operations, including hiring and employee recruitment/retention policies and practices, purchasing and service contracts, as well as engaging in real estate and neighborhood development in their geographic locations, are also key factors to improving a given community.^3-5 Academic institutions, as a form of AIs, also include community-engaged and participatory research, service learning and work-study, and volunteer projects. ⁶ Much of the existing work of academia, including of academic medical institutions, is on community engagement for community-based research that advances a health promotion topic or program and is often focused on individuals changing and does not usually target the contextual factors for health overall.^7,8 Academic institutions as large employers have the power to target these factors including increasing access to quality healthcare, providing access to higher education and advanced skill training, and addressing safety issues in their surrounding communities. ¹ In recent years, universities and colleges have begun to develop programs and goals for quality-of-life beyond their students and employees to include communities surrounding their campus walls. ⁹ Some of these university plans for improving community wellbeing include processes for shared decision making about real estate and community development, knowledge and data exchanges to address social and health challenges, and culturally and socially appropriate solutions to addressing social determinants of health (eg, food access, homelessness, violence). ⁹

Building health security for cities includes the investment of the government, police, industry and commerce, healthcare, and higher education. Outside of a pandemic, higher education may have the ability to provide a breadth of expertise, funding, or person-capital for advancing health security. ¹ As a service to the community, beyond employment benefits, academic institutions can provide resources to improve the conditions of the surrounding city and work with local leaders and legislators to create healthy and safe policies. Strong ties honed between academic institutions and their surrounding communities during times of stability provides some foundation for responses during natural disasters, states of emergency, and pandemics.

The COVID-19 pandemic and the epidemic of violence and racial injustice have widened the burden of health disparities in urban neighborhoods, including those surrounding AIs. ¹⁰ These dual emergencies require a stronger commitment to community improvement that is grounded in clear communication, community-engaged decision making, social justice planning, and the most innovative public health and community engaged practices available. ¹¹ This means that AI leaders and professionals need to engage in thoughtful dialogues that foster reflection on history, social context, community experience, collaborative planning, and communication strategies before embarking upon implementing strategies that might impact these crises and communities.

Violence impacts all communities; however, minority youth are disproportionately affected. Specifically, homicide is the leading cause of death for African American youth and the second leading cause of death for Hispanic youth in the 10 to 24 years age group. ¹² To that end, Johns Hopkins University and the Johns Hopkins Health System, located in Baltimore, Maryland, created efforts to address the epidemic of violence and racial injustice called the “Just Us Dialogues”—a series of 4 webinars leading to a half-day symposium with panel presentations and a keynote address were conducted. Webinar and symposium panelists were content experts with diverse perspectives. For each panel presentation, there was a legal expert, a clinical or researcher, a person with lived experience, and an advocate or service provider working with the population. All webinars and the symposium were hosted virtually and broadcasted via social media and Zoom.

The webinars and the symposium were advertised to engage an audience of citizens local to the AI, specific advertisements included the PR news wire, social media for the university, social media for organizations of panelists, social media for a local historically black university, and local professional organizations. Based on the advertisement, the audience included individuals who had personal experiences with the topic, advocates, medical practitioners, community leaders (both program and organizational leaders), policymakers, and lawyers. The 4 webinars focused on how academic AIs can address various aspects of violence prevention and systemic structures that can ameliorate the impact of racism and historic injustice for exacerbating health disparities. The first panel, “The 4th Amendment: Use, Misuse and Case for Police Reform,” was aimed at approaches to build more equitable community safety and monitoring of crime and violence. The second panel, “Protecting our Youth: Confronting Society's Role in the Harmonious Development of Adolescents,” discussed the unequal response to Black youth who have experienced violence either as a victim or a perpetrator and the need to make changes that are developmentally appropriate. The third panel, “Immigration Matters: Building Humanity within a Fractured Immigration Landscape,” focused on the experiences of individuals and families who are not US citizens. The fourth panel leading to the symposium, “Decriminalizing Mental Illness: Empathetic Approaches to Mental Health Supports,” discussed the need to provide a health response to persons experiencing a mental health crisis.

The Just Us biweekly dialogues led to a half-day symposium that integrated points from panelists with community leaders and other experts. Finally, the symposium culminated in discussions on health equity, restorative justice, protecting youth, and a keynote on investing in Black communities. This investigation aimed to determine suggestions identified during the Just Us Dialogues series that could inform actions of policies, practices, and programs for the AI to implement to reduce the disparity of violence in their surrounding urban communities. In our analysis, we provide suggestions for how universities located in urban settings can work with communities to reduce the burden of violence and address systemic inequalities as suggested through engagement among experts, service providers, community members, and AI staff and officials.

Methods

A transcript of each Just Us Dialogues series was created based on the discussions among the panelists and the questions asked by audience members. Coordinators of the series, including 3 AI leaders, 2 communication experts, and 1 researcher, reviewed the transcript. Two of the coordinators reviewed all suggestions and compiled them by each panel into themes that reflected policies, practices, or programs by webinar and the symposium. The research also coded the comments into the 3 themes. The coordinators and the researcher discussed any discrepancies until consensus was reached. For this analysis, the 3 themes are:

1. 1.

Policies are defined as the statements and identified overarching procedures for how the institution will conduct business. A policy provides the framework for how the AI operates.

2.

Practices are how polices are operationalized for the accomplishment of AI tasks.

3.

Programs are activities with a structure and a focus with a goal of accomplishing a specific outcome for the AI.

Results

From the 4 panels, the symposium discussions, and the keynote address, 18 suggestions were identified for approaches that university AIs can implement to reduce community violence.

Policies

The Just Us Dialogues series identified 2 overarching policies that AIs should consider in addressing the issue of violence in the communities where they reside.

1. 1.

   Security policies – Define expectations for university security officers including those who are provided by metropolitan area police (Panel 1)

2. 2.

   Anti-racist approaches for all – Develop and reinforce a welcoming environment from greeters to administrators university wide (Symposium discussion 1)

Practice

The Just Us Dialogues series provided 7 suggestions for practices that AIs should implement as steps to reducing violence in their geographic location.

1. 1.

   Hiring of leadership – Prioritize hiring individuals with expertise in community engagement in different areas of university operations, from researchers and administrators to supervisors and support staff (Panel 1)

2. 2.

   University reconciliation – Determine an approach for the AIs to identify mistakes they have made in violence prevention and to both acknowledge and make changes (Panel 1)

3. 3.

   Heal through the arts – Review the art and aesthetics that are created and presented on campus and the surrounding areas (Symposium discussion 2)

4. 4.

   Hire youth from the community – Provide year-round employment opportunities for youth from the surrounding community that includes developmentally appropriate support for conflict resolution and professional skill building (Panel 2)

5. 5.

   Acknowledge the importance of the community surrounding AIs – Recognize and find ways to acknowledge that without the surrounding community, many AIs will not be successful in achieving their organizational mission (Keynote address)

6. 6.

   Increase access to mental health services by diversifying the mental health workforce – Identify partnerships that can increase diversity of race, national origin, and sexual identity among mental health service providers working with the university (Panel 4)

7. 7.

   Support Black-owned institutions – Build partnerships for the institution and the employees to work with Black-owned business and financial institutions (keynote address)

Programs

Much of the discussion in the Just Us Dialogues symposium was focused on programs that AIs could implement—9 suggestions are listed below.

1. 1.

   System of accountability – Create a report card for policing and equity in cities that addresses community policing policies, transparency, arrests, response to community concerns, and community representation in law enforcement/policing (Panel 1)

2. 2.

   Family and caregiver engagement – Create programs as part of a developmental approach to youth engagement; consider including families and communities as a way to support youth growth (Panel 2)

3. 3.

   Hotlines – For university sponsored emergency services, provide hotlines that partner with community groups for culturally appropriate language and responses (Panel 3)

4. 4.

   Resources for non-law enforcement responses to mental health crises – Identify resources or convene pilot programs for surrounding neighborhoods to have non-law enforcement responses to mental health crises or concerns (Panel 4)

5. 5.

   Opportunities for residents – Provide law expungement clinics, application for employment clinics, and educational attainment clinics in partnership with community associations to increase opportunities for community residents (Symposium discussion 2)

6. 6.

   State of the community meetings – Create a platform/gathering for community to discuss power, resources, and information sharing for community leaders and the AI (Symposium discussion 2)

7. 7.

   Collaboration with other AIs (ie, universities and hospitals) – To address mental health and trauma responses to community violence, develop a city-wide partnership with other AIs for a coordinated response (Panel 4)

8. 8.

   Identification cards – Work with state and local officials to create an acceptable identification card that can be used by employees and people wishing to obtain services (Panel 3)

9. 9.

   Partnerships with community mediation centers – Partner with community mediation centers to resolve conflicts that arise at work and within the community surrounding the university; this includes contracting with mediation centers as part of the safety approach to university security and reconciliation (Panel 1)

Discussion

The suggestions from panelists and symposium participants underscore the power and leverage that AIs can use to address community violence. This paper identifies approaches to addressing violence in urban communities by first collapsing suggestions into classifications that align with policies, purchasing and services, procedures, and programs conducted at AIs. ⁴ The panelists identified programs as the most common suggestion for AIs to implement. But programs have limitations due to their usually limited parameters (eg, temporal, financial) and issues of sustainability. Programs often have a specific goal, are very limited in scope, and may require the collaborative efforts of others in the community. For example, one of the program suggestions was collaborating with other AI universities and hospitals. This requires shared resources in order to address the equity of contributions from participating institutions. Many partnerships like this can fail before they start because of the challenges of bringing similar organizations together for such collaborations.

Conclusion

The Just Us Dialogues series was developed to leverage the expertise of an AI and resources of research and industry experts for violence prevention in a large urban city. This series was in the traditional work of an academic medical university serving as an AI, specifically the sharing of knowledge from experts. ⁹ The innovation of the Just Us Dialogues series is that it engaged the community surrounding the AI to form suggestions for violence prevention that includes their willingness to engage in effecting change. In addition to the exchange of information, there was the elucidation of shared interest among all the AIs in a community to collaborate in improving health and safety. How an AI engages with their community should include a process for reflection of their own policies and practices, as well as consideration for the interests and needs of their neighbors.