Supporting Frontline Gun Violence Workers with Judith Moskowitz, PhD

Erin Spain, MS [00:00:10] This is Breakthroughs, it's a podcast from Northwestern University Feinberg School of Medicine. I'm Erin Spain, host of the show. Gun violence continues to be a public health crisis in the United States. According to the CDC, more Americans died of gun-related injuries in 2020 than in any other year on record. Here at Northwestern Medicine efforts are underway to support community violence interventions. Judith Moskowitz, a social psychologist and professor of medical social sciences at Feinberg, is here to talk about how her NIH-funded research and intervention programs will be used to address stress and burnout in Chicago's frontline violence prevention workers. Welcome to the show, Dr. Moskowitz. 

Judith Moskowitz, PhD [00:00:56] Thank you for having me back. Erin, I'm happy to be here. 

Erin Spain, MS [00:00:59] Yeah, we had you on this podcast in April of 2020, when we were all sheltering in place at the start of the COVID-19 pandemic. And we talked about your research and how to increase positive emotion during that stressful time. Can you give our listeners a refresher about your research here at Northwestern and some of the intervention programs you do? You design, research and run? 

Judith Moskowitz, PhD [00:01:19] Our work is really in the space of stress and emotion and coping, and sadly, we keep having more and more things that we need to cope with. What we've studied is ways to help people have more positive emotion, which then helps them cope better, even in the midst of really extreme stress. So, our early work showed that people caring for a partner with AIDS, prior to their being effective treatments, were understandably distressed and had a lot of stress and anxiety and fear and sadness. But they also had moments of positive emotion, and they were doing things to increase those moments of positive emotion and that helped them cope better. Based on that, we developed a program of eight to 10 skills or tools, and these skills help people cope better with whatever stress they are coping with. And then we've tested it in various trials with people with serious illness, dementia caregivers, people with depression, high school students. We did a version of it in people just to cope with the stress of the pandemic. It's basically this program applies to any kind of stress that humans experience, which is all of it. 

Erin Spain, MS [00:02:32] And by the way, you know that podcast you did, you talked about these different skills. A lot of people listen to that show in April of 2020, so there's definitely a need out there. And now you're working with Chicago's frontline violence prevention workers. Tell me how this evolved and why you think this group is a good fit for your intervention programs. 

Judith Moskowitz, PhD [00:02:52] Toward the end of 2019, the American Psychological Association had its conference in Chicago, and one of the main stage events which had three thousand people attending was on gun violence. And we were at a point with our work where it really felt like we were getting a lot of traction, and we knew a lot about how these skills could help people coping with illness or mental illness, physical illness, caregiving. But I really wanted to have more of an impact, so many things going on in the world. There was a mass shooting right about that time, a couple of mass shootings about that time. So, they had this main stage event and they had a couple of scientists up there, you know, psychologists who study why people turn to violence, why people turn to guns to solve their problems. And then they had a couple of people who are working in the community and had a different perspective on gun violence. One was Nelba Marquez Greene, who is the mother of a child who was killed at Sandy Hook, which was just, she's an amazing human and it's a devastating story to hear. And then the other person up there was Eddie Bocanegra, who at the time was the senior director for programs at READI Chicago, one of the gun violence prevention programs in Chicago. And Eddie talked about the work that they do at READI. They reach out to people at highest risk of gun violence, either being highest risk of being perpetrators or victims of gun violence. They have outreach workers, go into the community, talk to these folks and bring them into the READI program, which involves 12 to 18 months of cognitive behavioral skills, job training they give them transitional jobs and they work with them. Working with them in this program for, like I said, 12 to 18 months to help them avoid gun violence in situations where they might be involved in gun violence. There's a program at the University of Chicago that is evaluating the effect of READI. When I heard Eddie speak, I just got really excited about the work that they were doing and wanted to help. I wasn't thinking about our research or what I'm like, but what can I do? I was like a fan. I'm like, I'm a psychologist, I'm in Chicago, how can I help you? And at first, he said, can you help with the cognitive behavioral skills like fidelity to the skills? And I said, 'Well, I'm not that kind of psychologist, but I know people, I bet I can connect you with someone who can help with that.' He said, 'Well, what do you do?' And I said, 'Well, I've got this positive emotion skills program that helps people cope with stress.' And he immediately said, 'Can you help our staff? Can you come in and help the people working on the frontlines? They're amazing. They do amazing work, but it's really high stress, it's really high burnout. And if your program can help them cope better with that stress. We want to work with you.' That started this process of talking to READI. We went and we presented our work at three of their sites where they where they do their work and recruited people who are interested in learning more. We tailor the program to each new group that we're working with, the basic skills stay the same. But we we tailor the delivery, the examples that we use. Sometimes we tailor which skills are included and sometimes will not include some skills. We went in, we presented just a very sort of bare bones couple examples and then looked for volunteers to come in and learn all the skills as we had them at that point. We recruited our positive emotion ambassadors through this, had about 15 folks in different roles at READI, some outreach workers, some of the coaches, for example. So, we had them come together and we taught them. And then this by this point, it was the fall of 2020, so everything was on Zoom. But we taught them the program, you know, weekly for six weeks where we would go through, you know, the content, and then we would have some extra time to talk about how did that work for you? What do you think about that? Each week, we would have them then practice the skills and then they would come in the next week and we'd find out what they did to incorporate the skills into their day to day. And then we talked about how might we bring these skills into READI, into the workplace? They're doing a lot of things there already where these skills could fit in. But this would just be making it more systematic. Around that time a call came out from the National Institute of Health. They were looking to fund programs in firearm mortality and morbidity prevention, which is not something that I normally would go for. It was such a great fit for what we wanted to do and what we were already starting to do. We put the grant in. We were awarded the first two years. So, you get the first two years, you get to do that work and then if you meet your milestones, they'll very likely fund the next three years. So, in our first two years, we are doing focus groups and in-depth interviews with the staff and the leadership at READI and also Heartland Alliance, because READI sets within Heartland, to find out how we can implement these skills. So, it's a very much sort of an implementation, pre-implementation work that we're doing, getting it sort of their understandings of stress and what is stressful about the job and sources of positive emotion for them, how they cope with the stress and then also talking about what are programs that have been rolled out within READI that have worked and been sustained. And how can we piggyback on that? And you know, what are the things we shouldn't do? So, we're we're sort of in that phase. We're also developing the plan for the second phase of the grant if we are awarded that, to actually implement the program. So, we will then whatever form of of delivery of our intervention we come up with, we will then in the next three years, implement it and evaluate it. 

Erin Spain, MS [00:08:43] Joe Biden recently referred to these types of programs like READI Chicago and his State of the Union address. There is national interests and what they are doing, and in turn what you're doing, do you see this type of training and intervention being expanded beyond Chicago in the future? 

Judith Moskowitz, PhD [00:08:59] Certainly, as READI expands and programs like READI expand, I would be delighted to partner with those organizations in rolling out our program as part of, of what they are doing, with this hesitation to sort of go out there and tell people, just be happy and it'll solve all the world's problems, which is not what this is. So, I really I think it's really important for our program to be couched within evidence-based programs that maybe are more directly targeted at whatever issue they're trying to address. And then our program can come in and helping the people who are delivering the programs deliver it consistently without a huge cost to their own psychological well-being. 

Erin Spain, MS [00:09:42] What sort of feedback have you gotten from the folks who went through that positive emotional ambassador training program? What have they said about these skills and how they've been able to use them in their job? 

Judith Moskowitz, PhD [00:09:52] They've been really supportive and really great and really positive in their feedback and have given us some really lovely sort of metaphors and insights. I'm looking at a quote that one of our positive emotion ambassadors gave me. So this is by Tristion McDowell. But he said, 'The use of positive emotions, it feels almost like going outside with a raincoat. If you go out with a sweater, you get rained on and your shirt gets heavy. You have to carry that burden. The raincoat allows that stuff to wash off you. Oftentimes at READI, we're standing in the rain all the time. I feel like we're often the people who need to remember why we're here and reminding us and giving us tools to not let these things weigh us down.' That's exactly what we're doing. I think it's such a great fit and such a great metaphor for what we're what we're trying to do is give people this resource, this source of resilience. When you're experiencing stress. 

Erin Spain, MS [00:10:49] Go through some of the top skills that you plan on working through and training these folks. And I think our listeners will really enjoy hearing those as well, maybe how they can implement them in their own lives. 

Judith Moskowitz, PhD [00:11:02] Skills like noticing positive events, which can be particularly hard when life is stressful. All you can see is all the bad things going on. And if you can just take a moment to notice the good things as well, even really small things. Like I'm always using the example of a good cup of coffee. If you enjoy coffee and you're having coffee this morning and it's really good, like take a moment and think, 'Wow, I really am really enjoying this coffee,' Right? And then related to that our second skill is savoring. When you're experiencing a positive event or a positive moment in your life, take a second to appreciate that and to savor it, and also savoring also covers like thinking back on something good that happened. It's, you know, posting it on social media. It's putting in your journal. It's even just thinking about it later and reflecting on it. As an example, as we're coming back into the office and starting to see our coworkers again, for those of us who've been able to work remotely, As we're coming back in, I hadn't anticipated how much, just seeing people that I had only seen on Zoom for two years, seeing them in person, what a positive event that is. So, I'm really savoring that each time that I'm in the office. That was really great to see this person that I maybe don't work directly with, but just to pass them in the hallway is such a joy, after the past two years, we've had. So that's noticing positive events. Savoring the third one is gratitude, which is related to the first two, but it can be more general. Just things you're grateful for in your life doesn't have to be an event or something that has happened. Then we do a bit of mindfulness. It's really the mindful awareness piece and sort of being mindful in your day to day activities. We do teach some mindful breathing, so a little bit of mindful meditation is in there. We find that this mindfulness component of our intervention really helps with the other skills as well. If you're more aware of what's happening in your life, you're going to see the positive things and remember that more if you go through life mindfully. The next skill is personal strengths and related to that sort of attainable goals. So personal strengths has to do with the facilitator has to tell the participant what they see as a strength because particularly when you're experiencing stress, it can be hard to see sort of the resources that you have in your life. You can just spiral down and be like, I am, I am so stressed. I'm so unhappy. I don't deserve to feel bad, you know, and it can really spiral down. Whereas if you can sort of cut that spiral short by saying, you know what, I am doing the best that I can in this situation. Related to that in this version of the intervention, we're doing self-compassion. In earlier versions, we did acts of kindness, which is still a very valid tool for increasing your positive emotion when you do something nice for someone else that also gives you a boost of well-being. But we were doing our intervention in a lot of sort of caregiving groups. So, like when we work with healthcare workers or we work with dementia caregivers, family caregivers, they are giving, giving, giving, giving all day long. So, for us to come in and say, why don't you try an act of kindness when it's their day-to-day, it's everything they do. It seems like maybe that wasn't as good a fit to their situation as self-compassion. And with self-compassion is really understanding that everyone is suffering on some level and it's sort of treating yourself and talking to yourself as you would talk to a good friend. So that piece about that I said about, you know, 'I don't deserve to feel bad. My life is good. I don't know why I'm feeling stressed by a global pandemic. You know, I'm healthy. My loved ones are healthy. I've been able to work from home. I don't deserve to be stressed.' But the self-compassion piece then comes in and says, 'This is really hard. This is hard for everyone and everyone deserves that compassion.' So, you should talk to yourself, as you would if a friend said that to you, you would say, 'Of course you deserve to be sad. This is hard, right?' So, that we're we're focusing on self-compassion instead of acts of kindness. So you're doing the kindness for yourself instead of others. The one that I've missed attainable goals. So this is about being able to set the SMART goals framework, things that are just enough of a stretch that you feel good when you've crossed them off your list, but not so hard that you're going to fail. We bring all of these eight skills together. Teach them, you don't have to do all of them. It's not like it's a magical package that they only work if they're all together. It's more about sort of a toolbox model where these are different things that can all help you have more positive emotion, find the one that you like and that you'll do consistently and then do that one. You don't have to do them all. 

Erin Spain, MS [00:15:40] I feel like this is such a great example of thinking outside of the box to tackle a big problem like gun violence. Tell me about the need for these sort of creative solutions, and you know how you feel about being a part of this program. 

Judith Moskowitz, PhD [00:15:54] Honored to be able to have even a small part in helping READI do the amazing work that they're doing, there's good evidence that these programs are helpful and are reducing gun violence. But the work comes at a cost to the frontline workers, and anything we can do to support them in doing this work then helps prevention in the future. When I met Eddie Bocanegra, I wasn't thinking of our program at all. He was the one who said, 'Can you help the frontline workers?' So, he saw the space where our program could fit in in terms of reducing burnout and boosting resilience. 

Erin Spain, MS [00:16:32] Does this change the way that you think about your own research or how it could be used in the future? 

Judith Moskowitz, PhD [00:16:38] It certainly changes my day-to-day and how I think about my research. It's really been such a great change for me to step out of my principal investigator role of writing the grant and analyzing the data and writing the paper and get really into what are we really doing and how can we teach these skills so they work for the people we want them to work for? When we were doing the early, the positive emotion ambassadors Zoom sessions in the fall of 2020, I was working with my colleagues, Liz Addington and Elaine Chung, in delivering that, and we talked a lot about how that was absolutely the highlight of our fall. Like all this work that we do with READI is always the highlight of my week, always. And it's it's just amazing. And I mean, it's not like we're talking about easy things and it's all, you know, happy, happy. And I mean, this stuff is intense. It's been such a privilege and continues to be a privilege to be able to work with them at this level to figure out ways that we might be able to have our program have a bigger impact. 

Erin Spain, MS [00:17:44] There seems to be a lot of momentum right now in this space to fund programs like yours, to talk about it, to try to tackle this problem. What would you say to fellow scientists, researchers who are listening if they're wondering how they can get involved? 

Judith Moskowitz, PhD [00:18:00] Have Dick Durbin as your senator (laughs). He has worked really hard to to increase funding for gun violence prevention and has been a real champion all along. When we received the grants, had a press conference and was super excited about it. You know, it's hard to stay aware of all these different levels, what's going on in the community, what's going on at the federal level, who's advocating for what? As an individual researcher the answer is to partner with lots of folks across disciplines, across expertise, across locations, inside and outside of academia, because otherwise we get too siloed and we can't get beyond, you know, was the p value less than 0.05 versus, you know, where can we have a broader impact that we might not see in our statistics but are seen in people's day-to-day even more? 

Erin Spain, MS [00:18:53] Thank you so much, Dr. Judith Moskowitz, for coming back on the show and telling us about this program. We're going to follow you through here and see what happens over the next few years. 

Judith Moskowitz, PhD [00:19:03] Great. Thank you so much, Erin. 

Erin Spain, MS [00:19:12] And thanks for listening. And be sure to subscribe to this show on Apple Podcasts or wherever you listen to podcasts and rate and reviews. Also, for medical professionals this episode of Breakthroughs is available for CME credit. Go to our website feinberg.northwestern.edu and search CME.