public health approach to the evaluation of violent...

Harvard T.H. Chan

School of Public Health

Public Health Approach to the Evaluation of Violent Extremism Prevention Programs in the Greater Boston Area

Leesa Lin, MSPH Senior Program Manager

Emergency Preparedness Research, Evaluation and Practice (EPREP) Center Division of Policy Translation and Leadership Development

Harvard T.H. Chan School of Public Health

September 8th, 2016 National Academies of Sciences, Engineering, and Medicine

Washington, DC

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• ELENA SAVOIA, MD MPH / Project Director

• LEESA LIN, MSPH / Senior Program Manager

• SOULEYMANE KONATE, PHD / Research Fellow

• NOAH KLEIN / Program Coordinator

• JESSICA STERN, PHD / Project Expert

• RICHARD SERINO / Project Expert

• MARCIA A. TESTA, PHD, MPH / Co-investigator

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http://www.hsph.harvard.edu/preparedness/

Our team DHS Project Title: Evaluation of the Greater Boston Countering Violent Extremism Pilot Program

http://www.hsph.harvard.edu/preparedness/

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This project was funded by the U.S. Department of Homeland Security (DHS), Science & Technology Directorate, Resilient Systems Division

(Cooperative Agreement Number: 2015-ST-108-FRG005 Evaluation of the Greater Boston Countering Violent Extremism Pilot Program).

The content of this presentation as well as the views and discussions expressed in this presentation are solely those of the authors and do not

necessarily represent the views of any partner organizations, the DHS nor does mention of trade names, commercial practices, or organizations imply

endorsement by the U.S. Government.

Acknowledgement

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What’s up in Boston?

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Aug, 2011- White House -

National Strategy

on Empowering Local

Partners to Prevent

Violent Extremism

Dec, 2011- White House -

Strategic Implementatio

n Plan (SIP)

March, 2014 – NSC - Boston

chosen to be a pilot region.

Feb, 2015 –

USAO-MA - A Framework for Prevention and Intervention

Strategies: Incorporating Violent Extremism into

Violence Prevention Efforts

&

The White House Summit

March, 2016 – MA EOHHS – Request for Information

(RFI)

Aug, 2016 – MA EOHHS – Request for

Proposal (RFP): “PEACE” Project

Oct, 2015 – DHS-Harvard

EPREP

May, 2016 – Boston

Stakeholders Meeting

Formative Evaluation

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Define the Problem

Identify Risk and Protective Factors

Develop and Test Prevention Strategies

Assure Widespread Adoption

Source: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control, Division of Violence Prevention

CDC’s 4 Key Steps in Implementing a Public Health Approach to Violence Prevention

reliable data: “who”, “what”, “when”, and “how”

Additional evaluation, training and/or technical

assistance

scientific research methods: what factors protect people

or put them at risk

evaluation

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Snow Ball

20 IN THE

FRAMEWORK

32

OUTSIDE THE FRAMEWORK

>24 HOURS

APPROX 2000 STATEMENTS

Who was interviewed?

Community-based

Organizations

40%

Government agencies

(including law

enforcement and schools)

24%

*Healthcare and

Mental/Behavior Health

16%

*Academia 20%

No. of Agencies Interviewed (n=45)

*Not mutually exclusive

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• Name and Scope: Controversial history associated with “CVE”; lack of support for violence prevention initiatives which are narrow in scope

• Definition of Outcome: Lack of clear definition for “VE” • Violent extremists defined as “individuals who support or commit

ideologically motivated violence to further political goals.”

- National Strategy on Empowering Local Partners to Prevent Violent Extremism, 2011

• Evidence: Limited evidence on the risk factors for VE

Review of Literature and Stakeholders’ Feedback: Challenges

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Industry of Violence

Primary

Prevention

Secondary

Prevention Tertiary

Prevention

No violent

behavior

Onset

of the precursors

of the violent

behavior

Act of Violence

Re-engagement in

Violent activities after

arrest

Primordial

Prevention

Quaternary

prevention

People potentially exposed to the risk and/or protective

factors: prevent personal exposure to risk factors and/or increase

protective factors

System: address broad

health determinants

Screening: detect and treat in early stages

Levels of Prevention in Public Health

Prevent progression and rehabilitation: reduce the risk of subsequent events, treat and rehabilitate persons as well as facilitate a return to (close to) normal

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“A screening program is only as good as the predictive ability

of the risk factors that the population screened is based upon.”

- Dr. Marcia Testa, Department of Biostatistics,

Harvard T.H. Chan School of Public Health

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False Positives

3,229,900

Image by Resnick B & Zarracina J via Vox

2016 US Population = 323m

10,000 VE in the U.S. and a powerful test

“How likely is it that this person is truly a Violent Extremist given that the test result is POSITIVE?”

= 0.003056 (0.3056%)!!

Screening Test

(person) (person)

VE

10,000 Non-VE

322,990,000

Positive Predictive Value (PPV)

= True Positives

True Positives + False Positives

True

Positives

9,900 False

Negatives

100

9,900

9,900 + 3,229,900

True Negatives

319,760,100

(Sensitivity: 99%) (Specificity: 99%)

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Theory of Change

Foster civic engagement and cultural awareness

Improve human conditions and reach

human potential

Build trust and earn

social support

• Listen and validate the opinions of stakeholders • Prevent profiling • Expand community policing

• Encourage civic conversation and open forums • Increase diversity in the “system”

and improve cultural sensitivity •Develop counter-narratives

• Invest in school systems and education initiatives • Expand youth programs and services •Address housing issues and nurture healthy and safe

neighborhoods

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• Goals: - To prevent Violence, and help to prevent people from joining organizations

that promote, plan or engage in “Violence”

- To promote resilience by strengthening protective factors

• MA EOHHS is listening and validating stakeholders’ feedback! - Focus on primary prevention

- Keep away the concerning concepts: CVE, radicalization, ideology, risk factors

- Define “Violence” and “Violence Extremism” as:

MA EOHHS Promoting Engagement, Acceptance and Community Empowerment (PEACE) Project

An act that violates state or federal law and causes physical harm to a person, or property

Motivated by Hate

Intention of Domestic Terrorism

and and/or

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Leesa Lin, MSPH o: 617.384.9872 Email: [email protected]

Thank you!

mailto:[email protected]

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