7. Concluding Notes

This report provides the findings from a study of Acclivus, a community-based organization that provides violence prevention and interruption programs on Chicago’s south side and in areas with high rates of gun violence. Major findings, conclusions, and recommendations are presented here.

This study’s findings emphasize the importance of looking beyond a formal count of number of shootings and homicides to assess program effectiveness or even the prevalence or reduction of community violence. When homicide and shooting rates are up, i.e., showing steadily increasing numbers as in 2020 for Chicago and many other urban areas, one might easily conclude that programs are just not working. Similarly, a case might be made that factors other than a program or programs are the reason when homicides and shootings are down or declining.

The participants in this study looked at prevention and program effectiveness in terms of what they knew and understood based on their lived experiences, knowledge of their neighborhoods, and observations of events and activities rather than only on formal statistics. They talked about incidents that they knew could or would have gone bad, i.e., resulted in violence without Acclivus’ active intervention when discussing effectiveness. Even the use of numbers, e.g., shootings were down 75%, was more about what one could reasonably expect to happen on a certain street compared to what actually did happen. “It could have been worse than it was” captures this sentiment to some extent. Effectiveness was also viewed in terms of what does happen as well as what does not happen when Acclivus is present. Children being able to play outside without fear and stores in an area not being looted during summer protests were both attributed to having a highly visible Acclivus presence in those neighborhoods.

The Acclivus leadership team is viewed highly positively by staff, community leaders, community residents and community partners. There was no question on any interview guide that asked participants what they thought about the leader, leadership team, management system, etc. These assessments were usually conveyed when persons talked about their role and work, how they assessed effectiveness of their units or the organization and things they would change if in charge or would like to see enhanced. The leadership was praised for running a sound organization with integrity, for providing job opportunities, for being advocates for funding for communities beset by violence and for doing what they needed to do. “I really like my supervisor” and “They are there for us” provide pictures on a different level of perceptions of the leadership.

Though not addressed in the interviews, the ability of this organization to put in place the current organizational structure, funding streams, institutional and community partners and service programs in less than three years is commendable. This is notwithstanding the fact that the senior management team had been integrally involved in developing and leading major components of Cure Violence. A university-run program is substantially different, however, than a community-based one (especially a fairly new one) and has a solid infrastructure, brand, name recognition and policies and regulations that undergird, support and protect its operations. The Acclivus transition and development story has the content for a good case study for not-for-profit leadership and management courses. That type data gathering and analysis, however, was beyond the scope of this study.

In addition to the transition and development situations, Acclivus is distinct in other ways as demonstrated by the staff profiles. The organization is primarily Black and provides services in primarily Black communities. The CEO is a Black male, as is most of the 92-member staff. The majority of staff, including the CEO and members of the administrative team, have served time in prison. Many, including the CEO, have both street credibility as well higher education degrees. All of the four senior management team members have college degrees; two have Master’s degrees and a third is enrolled in a Master’s degree program. Being a credible messenger is a credential for being hired, enhancing that with formal in-service training is a requirement and with higher education is encouraged and supported. Close to one half of the staff participating in the study are enrolled in college programs.

While Acclivus staff clearly saw violence prevention and interruption as a fundamental aim or goal of the organization, they viewed their roles and responsibilities in a much broader social context. They were mindful of the need to prevent retaliation and assure safety, especially when someone was a victim of a shooting, stabbing, or beating. They were also cognizant of the value of changing norms about violence at both the individual and community level. What they often articulated when they described their work was the very concrete things they did or approaches they used to provide practical supports and basic resources for individual clients and communities. Among these were helping persons get back in school, get jobs and state identifications, relocate to a different area, make funeral arrangements and handle legal problems including accompanying persons to court. They also provided clothes appropriate for job interviews and distributed masks, sanitizers and groceries to families in need during the pandemic.

A theme that stood out when reading complete interviews one by one is how much staff cared about the communities in which they lived and worked, and the individuals that were their clients. This finding is not easily seen when reading and analyzing answers to specific questions. That caring came through in comments about loving the community, loving what they were doing, and wanting to give back and make things better. Some persons talked about doing things over and beyond what the job called for, and paying for things with their own funds because they cared. These included taking a client to brunch, making recreational things available for children, providing transportation for a family and even being available whenever clients called. Staff talked about showing respect and love for the clients and of the importance of building and gaining client and community trust. They were proud of how they were perceived in the community and when talking about clients sometimes voiced, “this could be me.” The caring, commitment, and community knowledge shown by Acclivus staff mirror the World Health Organization’s model of community health workers. The type caring reflected in the interviews is not a common feature, however, in health and human services organizations where boundaries between clients and professionals are kept distinct on purpose and individuals provide services, usually in a respectful way, because it is their job and not necessarily because they love the clients or see them as equals.

The study team was not able to review case records as one means of determining what staff do and how they go about doing it given time constraints and changes in recordkeeping. That review would have focused on determining the extent to which basic case management and trauma informed principles and practices were being used. Given the organization’s case manager staffing arrangements and partnerships with hospital trauma units, the standard features of these two service delivery approaches would be expected. The staff interviews, though not developed for that purpose, provided some evidence that both case management and trauma principles inform the way staff work. One person’s description of how she approached her work embodied all of the basic case management principles including problem identification and assessment through referral and follow up. What stood out was the description of the referral process and how the staff member worked to assure that referral was not just a hand off but involved assuring that the client received the service needed and that the intended outcome was reached. What also stood out in the interviews was how staff worked diligently to develop resources, to connect clients with resources, and to make agencies who had resources aware of Acclivus and Acclivus clients.

The use of different elements of trauma informed principles was reflected in the ways in which staff said they approached and talked with patients and families who were victims of violence so as not to blame or further traumatize them. The importance of having respect for individuals’ rights to make their own decisions, and building trust were also demonstrated. Unlike case management, however, the extent to which all the elements of trauma informed principles were used in any one case could not be assessed.

Most persons had little to say about changes they would make or ways Acclivus programs could be enhanced or teams could be even more effective. Comments usually focused on doing more of the same but expanding Acclivus programs to more and different neighborhoods. When resources were mentioned, it was usually in terms of obtaining monies to support the clients including being able to provide them with transportation for job hunting or obtaining or advocating for neighborhood recreational outlets for youth.

Information gleaned from these interviews indicate, however, that some staff, if not most are working “around the clock.” They spoke of being on call 24/7 or working all the time. This suggests a need for reviewing the work structure and expectations to determine if there are ways to alternate some on-call schedules in ways that allow for periodic designated times “away” from work while also assuring proper coverage. A client could be given, for example, both a primary number and back up number to call, rather than the number for only one person who would always be there no matter what. It appears also from a couple of statements that there may not be adequate coverage for high volume hospitals, though it was not clear what high volume entails or how that could be handled.

These are high stress positions and may be dangerous as well. Although one person stated they were not overwhelmed, the nature of the work and the demands that go along with it, including agency demands for training, education, meetings, on-call, etc., can become overwhelming. Staff face traumatic situations on the regular and may have been and continue to be exposed to trauma, violence, and stresses in their personal lives. Several staff recognize that clients who have faced dangerous situations and or fear for their lives need mental health services and that mental health resources are sorely lacking. They may not be fully aware, however, of how the situations they encounter on a daily basis have an impact on them. The interview data suggests that some persons find respite and solutions in team meetings. It is important to look at how Acclivus can provide supports to staff without being intrusive. Some organizations use automatic debriefing sessions led by trained personnel when especially difficult situations occur; others build in fun times or group activities for staff and their families; vacations and floating holidays serve that purpose for many. Larger organizations have complete counseling centers or units to deal with crises and ongoing situations. The latter may not be a viable option for Acclivus as some staff would have great difficulty relating to therapists who were also their colleagues and who might be perceived as providing personal and confidential information to the management staff.

Finally, Acclivus has grown very quickly by expanding violence prevention and interruption programs to different neighborhoods, generating funding from new and different sources and obtaining contracts for different services. As Acclivus continues to grow and expand it will be very important to determine not only how new programs advance the core mission, but also how different staffing patterns and staff with credentials to fill new positions mesh with the organization’s needs, infrastructure and way of doing things. Providing mental health services, for example, may involve hiring credentialed staff who are not accustomed to working in the ways and at the times that Acclivus deems most important. Continued growth will also bring new infrastructure requirements and decision-making structures and along with that new policies and procedures. Creative thinking, strategic planning and development and ongoing, rigorous evaluation will be crucial in sustaining the positive reputation, social impact, and program effectiveness reflected in
this report.