A Broader Vision of Public Health: UC San Francisco School of Nursing and Tenderloin Safe Passage

June 2015Andrew Schwartz

In 2014, Wiley Liu – program manager, Community Engagement & Health Policy at UC San Francisco’s Clinical and Translational Science Institute (CTSI) – approached Carol Dawson-Rose, who coordinates the Advanced Public Health Nursing (APHN) program at UCSF School of Nursing. Liu wanted to know if Dawson-Rose had any interest in becoming part of an interdisciplinary, community-based project for Tenderloin Safe Passage, a homegrown coalition of neighborhood groups, parents, youth-serving agencies and schools dedicated to improving safety in San Francisco’s Tenderloin neighborhood.

Dawson-Rose was interested. Safe Passage works on what many believe is a significant public health issue: reducing exposure to trauma and violence. Safe Passage’s primary focus is a Corner Captain Program, in which trained neighborhood volunteers stand on street corners from 2:45 to 3:30 p.m. each weekday, so children walking home or to child care can feel safe.

Having worked for years in the Tenderloin, Dawson-Rose saw an opportunity not just to help that community, but also to provide her students with an essential educational experience.

“An important part of training in public and community health is engaging with communities, listening to their needs,” says Dawson-Rose. “It gives students a bigger vision of what makes a healthy community and how community affects people’s health.”

In particular, at a time when the Affordable Care Act has intensified the focus on population health, a program like Safe Passage forces public health students to think beyond increasing immunization rates and conducting outreach focused on traditional public health concerns such as chronic disease or substance use.

“My clinical work and research focuses on caring for patients who are substance users, most of whom have a lifetime history of exposure to violence and trauma,” says Dawson-Rose.

She says such problems can become rampant and multigenerational in communities like the Tenderloin, where a lot of people – many of them recent immigrants, children and the elderly – are struggling economically while living in an area with one of the highest concentrations of alcohol retailers, open drug dealing and crime – including the threat of violence.

A Collaborative Effort

Within a few months, Dawson-Rose and a few of her students had started collaborating with Safe Passage, CTSI and students from the UCSF School of Medicine’s PRIME-US program in an effort to develop and implement tools that can help Safe Passage understand the impact of its work and refine it where necessary.

Specifically, the tools will (1) help Safe Passage evaluate whether the processes it has set up internally are the most effective and efficient for achieving its goal of improving neighborhood safety, and (2) measure whether the neighborhood is actually safer, as well as whether children and families feel safer.

The last – perception of safety – correlates more closely with mental health outcomes than actual safety, according to Joyce O’Connor, one of the School’s students, who has worked on the project throughout the 2014-2015 academic year.

Long interested in public health – including pursuits like program planning and evaluation – O’Connor is a nurse and a post-master’s student who has a master’s degree in nursing with a specialty in case management and a bachelor’s degree in psychology. She serves as a member of Safe Passage’s evaluation committee, which is devising and refining the measurement tools. The committee includes Dawson-Rose; Executive Director Dina Hilliard and Program Director Kate Robinson of Safe Passage; Pedro Vidal Torres, of the Tenderloin neighborhood-based National Council on Alcoholism and Other Drug Addictions – Bay Area; and Paula Fleisher of the CTSI.

Drawing on a growing body of neighborhood safety research, the tools aim to measure the complex factors that contribute to actual and perceived safety in a neighborhood. One tool, for example, tracks neighborhood assets, such as helping behaviors, beautification efforts and recreational activities. Another tool tracks things like the presence of litter, drug paraphernalia or loiterers. The nursing and medical students gather that information by doing a series of neighborhood observations at different times of the day, including before, during and after the periods when corner captains are present.

The committee is also developing and refining surveys for children and parents to gauge their perception of safety.

“It’s been challenging and fascinating to figure out how to do the assessments systematically, as well as what to do with the data once we have it and how to analyze it,” says O’Connor.

Applying the Learning

Wrestling with that challenge is precisely why both O’Connor and Dawson-Rose believe the work is enormously important for the students’ education.

“This is at the cutting edge of public health,” says O’Connor. “It’s about primary prevention and the social determinants of health. It’s also about empowering everyone [in the Tenderloin] to be working together toward feeling safer within their own community.”

Moreover, O’Connor believes she can take what she’s learning in the Tenderloin to her current part-time position as a behavioral health nurse in rural Lake County and to a future career in public health.

“In Lake County, for example, we sometimes have to evaluate things like, How many home visits should we do? Do they make a difference for patients as opposed to coming to the clinic?” she says. “I’m definitely learning a lot in terms of how one develops an instrument and tests it for validity and practicality, and I’m hoping to translate this into finding ways to affordably evaluate what does and doesn’t work wherever I wind up working [in the future].”