Life, Death, and PTSD in Oakland 

How violence and poverty are traumatizing the city's youth.

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Javier Arango can still feel the bullet lodged against his spine. It paralyzed him instantly and is a reminder of the war he's managed to survive. But this battle wasn't waged in Kandahar or Fallujah. Arango, 24, lived in East Oakland, right in the heart of the urban warfare practiced by gangbangers, drug dealers, pimps, and those who get caught in the middle.

Dressed in an oversize black T-shirt and jeans, with his black hair pulled back in a ponytail and a crucifix dangling around his neck, Arango tells the story of how the bullet ended up in his back. He was seventeen, only four years into a life in the United States. He had emigrated with his parents from Medellín, Colombia, where the cocaine trade was bloody and brutal. "I thought when I moved over here it was going to be better," he said. But it wasn't.

The night of the shooting, Arango sat in a parked car with friends on 92nd Avenue. He had danced at his high school prom hours before, gone to a club afterward with his friends, and was ending the evening when it happened. "We just got blasted," Arango recalled, describing how several men fired at him and his friends. To this day, he's not certain why. "At that time, I didn't feel like I needed to walk around with a gun," he said. "Shoot, I was just going to a prom."

The only bullet that struck Arango put him in a wheelchair. And that's really when he became a soldier in the war. He decided he wasn't going to let someone shoot at him again, so he bought guns for himself and his friends. His girlfriend knew a guy in the Army, and Arango got a hand-me-down bulletproof jacket that he wore everywhere.

"I didn't have the chance to move to the suburbs or live somewhere else," he said. "No, I had to live in a rough area in a wheelchair." He said he joined the Border Brothers gang for protection and became a leader. Arango always carried a weapon or wore the bulletproof vest and traveled with a coterie of young men hauling plenty of firepower.

The first time Arango heard the term post-traumatic stress disorder, or PTSD, it was on a television show a few years ago. He learned that it had something to do with soldiers and the wars they fought. These men came home, but their minds were still in the battle. Arango could relate to this.

He startled at the sound of sirens, or gunfire, or someone screaming for help. The daily shootings in his neighborhood were breath-holding moments. A pop-pop-pop followed by silence could be anything. But if a boom-boom-boom-boom broke the quiet, Arango knew someone was answering back, fighting for his life.

So he said he listened to a lot of music to block out the terror. And when it still followed him, he drank alcohol or snorted cocaine to blot out the present. The month of December was the worst because it marked, within the span of a week or so, the anniversary of his shooting and the shooting deaths of three close friends. At dusk Arango would roll out to the street in his wheelchair, with a pistol in his pocket and, to last longer in the cold, a baggie of cocaine. He sat for hours in the darkness.

Inside his house, he imagined how his enemies might kick in the door. He played out the firefight in his mind over and over again. Holding a gun soothed his nerves. They're never going to take me, he thought.

Eventually, at the age of 22, Arango decided to quit gangbanging and sought help doing so from Catholic Charities of the East Bay. He learned from a counselor there that he was more like the soldier on TV than he realized: He had PTSD. Except the counselor didn't call it that at first. Instead, being easily startled, emotionally numb, and always edgy were just signs of the trauma Arango endured. Over time, he understood that these signs were symptoms of a medical condition, just like a fever accompanied the flu. And eventually he would recover, but it would be a long road.

"There is basically a war going on in Oakland," he said. "It's not that you leave the war. You always live inside the war. You're not going back home."

In Oakland, youth like Arango haven't been told that the experiences they've come to consider normal — deaths of friends and family, abuse and neglect at the hands of caretakers, cupboards that are always bare, random acts of violence — are so traumatizing that they could lead to depression, anxiety, or even PTSD. These conditions can shackle a child, dragging him down as he tries to forge bonds with others, stay engaged in school, and dream of the future.

Unless a parent, teacher, counselor, or doctor is trained to spot symptoms of trauma and knows a psychologist or social worker who can intervene, few of these children will receive the treatment necessary to heal. But there is a growing awareness that PTSD is born and bred in our own neighborhoods, and there is a movement in Oakland, as well as nationally, to relieve the burden these children carry.

"We have to put a stop to the war here, and really take a look at how we are going to help our kids," said Cindy Hill-Ford, director of mental health services for Catholic Charities of the East Bay. "How are we going to help our veterans?"


Trauma is considered a physically or emotionally harmful event or set of circumstances that results in lasting mental, spiritual, or emotional anguish. Not all traumatic experiences lead to the condition known as PTSD. That can develop when a person is terrified, perhaps afraid for his or her life or that of a loved one. In adults, common symptoms include nightmares, flashbacks, emotional numbness, and avoidance of people or places that evoke the original trauma. Younger children affected by PTSD might wet the bed, forget how to talk, or act out the scary event during playtime.

No one in Oakland knows how widespread PTSD or related conditions have become. This is partly because psychologists are guardians of this information, and most of the local agencies that treat children don't track diagnoses. For a low-income child who lacks private insurance and qualifies for public assistance, Medi-Cal will cover the cost of therapy. In Alameda County, it did that for 1,100 children diagnosed with PTSD in fiscal year 2011-2012. At less than 1 percent of the population under age eighteen in the county, that's clearly not representative of the problem; the nationwide rate of adolescent PTSD is estimated at nearly 5 percent, according to a study published this summer in the Journal of the American Academy of Child and Adolescent Psychiatry.

There's another reason the Medi-Cal data might obscure what's happening locally: An additional 4,300 low-income children in the county received subsidized counseling for anxiety, depression, mood disorders, and attention deficit hyperactivity disorders, all of which are tied to symptoms that can be traced back to traumatic experiences. These figures also omit privately insured kids, those who can't get government coverage, and those who remain undiagnosed. (However, the expansion of Medi-Cal through Obamacare will make it easier for uninsured children to qualify for coverage.)

Psychologists working in Oakland say they are often frustrated by the current requirements of the PTSD diagnosis, which center on a single life-threatening incident. This definition can't capture the breadth of a child's trauma in Oakland, so therapists may instead give a fitting alternative diagnosis, like attention deficit disorder or depression. A broadened definition of PTSD will take effect next year and should allow therapists to more precisely diagnose traumatized children.

Some counselors, including Hill-Ford, don't even like the term PTSD. "In urban settings like Oakland, there's nothing 'post' about it," she said of the constant trauma children face. "So the diagnosis isn't correct." Another way to describe it is complex trauma, or relentless suffering that takes numerous forms over time, she said.

In 2008, the Department of Justice surveyed thousands of adolescents and teenagers about how often they'd been exposed to violence in their short lifetimes, and more than 60 percent reported at least one incident in the previous year. Forty percent of these children were victims of two or more violent acts, while 10 percent were victimized five or more times. The categories included sexual assault, domestic battery, child abuse, and community violence.

Children may be resilient, but these malevolent forces can wear them down. Those exposed to violence are more likely to fail or struggle in school, exhibit criminal behavior, and develop depression, anxiety, and PTSD, according to the Justice Department. The agency doesn't yet know how violence affects children across racial, ethnic, income, and geographic lines, but US Assistant Attorney General Karol V. Mason said in an interview that the problem knows no bounds.

African-Americans and Latinos comprise more than half of Oakland's population. Though the city's poverty rate is 20 percent, nearly a quarter of African Americans and a third of Latinos earn less than that. The city's robbery rate is the highest in the nation, and in 2012, about 2,000 violent crimes were committed per 100,000 people, according to data from the Federal Bureau of Investigation. By contrast, nationwide there were 387 violent crimes per 100,000 people.

Reverend Michael McBride, who is based in Oakland, directs the Lifelines to Healing Campaign, an anti-violence initiative run by the faith-based PICO National Network. The countrywide campaign, he said, encourages congregations and clergy to talk about violence and poverty in a way "that includes trauma as a very central part of how we humanize our communities in the national consciousness."

McBride served on the gun violence panel convened by Vice President Joe Biden following the Sandy Hook shooting last year, and he has been disheartened to see that routine shooting deaths in cities like Oakland, Chicago, and Detroit don't elicit the same outrage as the mass casualties in Newtown, Connecticut. "Part of what we have to do," he said, "is make sure that someone on the corner is considered as valuable and worthy of life as the precious kids in the Newtown classroom."

This requires a new way of thinking about impoverished neighborhoods. "There's a pervasive thought that if you just give someone a job, all of their problems will be solved," McBride said. But, he added, it goes beyond money to healing a wounded mind and heart.

Like veterans who are considered fully incapacitated by PTSD, and receive disability payments as a result, children and adults are also scarred by homegrown violence and trauma. In a community like Oakland, where violence is concentrated, so much misfortune can "break the human psychological threshold," McBride said.

Lisa Blair and Paul Organ, administrators at the E.C. Reems Academy of Technology and Arts in East Oakland, can catalog such violence with alarming ease. Blair, the school's chief executive officer and former principal who has worked there for thirteen years, remembers a time when children might encounter the dead body of a drug addict on the way to school. Now it's more likely, she said, that they know deceased victims of gun violence.

In October, according to the most recent data available, Oakland police sensors recorded 331 gunshots; the area in which E.C. Reems is located had the third highest rate of gunfire reports in the city for that month. By the end of November, there had been 84 homicides in the city since the start of 2013, a decrease from last year's rate, but many victims continue to die in East and West Oakland.

When students arrive at E.C. Reems, a kindergarten to eighth grade school with 250 children, many are sleep deprived, Blair said. They may have lain awake listening to the sound of gunfire and spent the night in the bathtub, their mother or grandmother trying to protect them from stray bullets. The lucky ones get breakfast in the morning, but children often come hungry. School days are commonly punctuated by the sound of sirens or gunfire; some years the grounds are locked down multiple times a month, with children sitting on the floor during class as police pursue a suspect on the street or raid a nearby house. Blair is grateful for quiet this year: The school has only locked down twice.

Organ, a psychiatrist by training who was the former head of the Howard University Middle School of Mathematics and Science in Washington, DC, started as principal at E.C. Reems in September. He watches the faces of his students closely; some days they're smiling and happy, but they often scowl or look vacant. The younger children tend to be more cheerful. "By fifth, sixth, seventh grade," Organ said, "you start getting a flat affect. You ask what's wrong, and the kids start crying. You just open the door a little bit and you get this incredible story about what's going on at home."

One young boy, according to Blair and Organ, knew several friends and family members who were shot to death over the summer. Another had to move in with a relative after a landlord tossed his family out of its apartment in the middle of the night. When he arrived at school, a classmate made a remark about his appearance, and the boy responded by striking him. Some students say that their mothers work as prostitutes, or that their parents are in jail or prison, or that whoever is supposed to care for them has otherwise disappeared.

Organ tries to be more principal than therapist, but he knows that most of his students are caught in the undertow of chronic trauma, which can interfere with normal brain development and derail how the body and mind typically handle stress. Some children become hypersensitive to harmless stimuli while others don't respond to threats that should scare them.

Organ recently watched this unfold when police sirens raced past the school. Some students jumped in their chairs, but some ran toward the window and began trading stories of the shootings they'd witnessed. Incredulous, Organ surveyed the students. "Come on, guys," he said. "Have you ever seen someone shot?" Three of the youngest in the group — second and third graders — raised their hands. It turned out one hadn't watched the shooting in question, but saw a body taken away in an ambulance and heard the details from the victim's sister, who had seen everything.

"It's just so matter of fact," Organ said. "That's part of the PTSD. They're just emotionally detached from what's happened."

Based on his experience as a psychiatrist, Organ said it's possible that more than half of the students at his school have symptoms of PTSD, the question is just severity. The school once had more resources for children diagnosed with post-traumatic stress disorder and other conditions. Several years ago, local clinics got government grants to place therapists at the school a few days a week. Withdrawn or disruptive students, who might stare out the window, regularly speak out in class, or fidget uncontrollably, saw the counselor for an evaluation. Sometimes signs of trauma overlapped with symptoms of attention deficit or hyperactivity disorder.

The school contacted a child's guardian if the therapist made a diagnosis. Most parents or caretakers gave permission for the child to receive therapy in the form of one-on-one sessions or learning techniques for relieving stress. The school used a case management system, pairing social workers and counselors with children and their families. This was key because the parents often needed treatment, or at least someone to confide in.

"Much of the time," said Organ, "the parents have been traumatized by street violence, drugs, prison, and unemployment, and they're not available for the children."

Once the grants ended, most of the intervention efforts stopped. Blair and Organ are fundraising to offer similar services again. In the meantime, Blair refers students to Oakland-based clinics, including one at Children's Hospital, but it can be very difficult to start therapy if there's no Medi-Cal or private insurance to cover the cost.

Blair and Organ know that this phenomenon isn't something an after-school program or better teachers can fix. The curse of poverty and violence must somehow lift, and until that happens these children need to learn what trauma is, how to recover from it, and when it inevitably strikes again, how to tame the symptoms that ruin their ability to focus, learn, and thrive.


If E.C. Reems were not a charter school, it could access mental health services through the Oakland Unified School District, which doesn't extend those same resources to local charters. Of the city's 49,000 students, more than a quarter attend a charter school.

Several years ago, the district adopted a more holistic approach to dealing with troubled students by staffing schools with a mental health counselor. This year, for the first time, every Oakland school offers mental health services. The district also runs a crisis-response team that identifies children who witness or experience moments of brutality, including the death of a friend or a shooting on school grounds.

The goal is to reach traumatized children within 48 hours of an incident to help them deal with feelings of fear and anxiety, which too often disrupt a student's education.

"Kids can fall through the cracks if they're not reached in time," said Barbara McClung, director of the district's behavioral health initiatives.

Using federal Medicaid money, Alameda County spends about $19 million annually to provide physical and mental health services in Oakland schools. That amount, according to Alameda County data, has increased significantly since 2000, but leveled off in recent years in part due to reduced state revenue. Each school-based therapist has a waiting list.

McClung described the district's intervention model as a "trauma-informed practice," an approach that views behavior and discipline through the lens of how the child might have suffered. This empathy doesn't lead to absolution, but instead values healing, relationships, and responsibility.

The district doesn't know how many of its students have PTSD, but survey data hints at how community violence burrows its way into the lives of children. The annual California Healthy Kids Survey asks students how many have lost a loved one due to violence. In some schools in Oakland, McClung said, more than 50 percent of respondents answer yes.

One therapist at the East Bay Agency for Children treated a client with PTSD who kept repeating a scene in which the main character always got attacked and chopped into pieces. Over time, the child imagined someone coming to the victim's aid, a new ending that helped him gain a sense of control and feel less alone.

The agency's therapists also use cognitive behavioral therapy, which is designed to give patients practical tools, like a safety plan, to defuse anxiety. So if there's gunfire at night or mom and dad start fighting, the child might hold her dog close and practice slow breathing to feel safer.

McClung knows that the lessons of a brief therapy session might help a child in school, but feel less immediate when the patient returns to the same violent block or fractured home. "We're teaching meditation," McClung said, "but that's not necessarily going to work in the neighborhood."

For its part, the district is trying to transform schools with a new set of common expectations. This means showing teachers what trauma looks like and convincing them that not every classroom outburst or minor aggression is a thoughtless affront to their authority. After all, said McClung, punishing a traumatized student is a dangerous form of exclusion; research shows that suspension and expulsion is associated with higher dropout rates and increased chances of a student being involved in crime.

"We have to do everything we can to hold onto them," she said. "They need second chances."

This reflects an emerging national ethos. Increasingly, said Karol V. Mason of the US Department of Justice, it's become clear that poor performance in school, disciplinary problems, and entering the juvenile justice system share a common denominator: "At the core of that, you can generally find some form of trauma."

That compassion guides the district's restorative justice program. Depending on the severity of the offense, it brings together a victim, perpetrator, family, and community members in a controlled setting to discuss what happened and find some form of healing.

"This is a highly traumatized population," said David Yusem, who runs the program. When, for example, a student is asked what led him to steal from a classmate, he might respond defensively. Some students in Oakand refer to slippin' — as in, if you left your computer out and someone took it, that's your fault, you were slippin'.

But eventually the thief might reveal a brother's incarceration or a father's murder, not as a defense but as context for his actions. These confessions, said Yusem, are a reminder of how acute trauma, layered over chronic experiences like poverty and incarceration, can lead to feelings of paranoia and desperation, making it difficult for a child to learn.

There is no therapy involved in restorative justice, but it helps a young person tell the truth about wronging someone else and be held accountable. This can have a profound lifelong effect as research shows that people exposed to violence are at higher risk for becoming criminals themselves. Yusem sums up that devastating cycle simply: "Harmed people harm people."


Hayden (not her real name) sits in an oversize living room chair in her mother's modest East Oakland apartment. The nineteen-year-old is one of countless children who fell through the cracks. After she expressed concerns about using her name publicly, the Express agreed to identify her with a pseudonym.

She cries softly, her large green eyes gazing downward, as she describes the last five years of her life. Things began to unravel in 2008. Her mother was randomly shot in the leg in July, and as the oldest child, Hayden was expected to care for two younger siblings. A week later, an uncle who lived with the family and helped Hayden around the house, was shot and killed — the third uncle she'd lost to gun violence since 2001.

"I was traumatized, I was hurt," she said. "I didn't know how to feel. It's someone you see everyday, and you don't get to see him any more." Then she recounts the recent deaths of five other friends. A stray bullet killed her "little sister," a sixteen-year-old girl who was like family to Hayden. She left behind a baby daughter. Gunfire also killed a fifteen-year-old friend as he walked through a nearby park. Another young man was shot multiple times as he went to the store.

These were random shootings to Hayden, and together they stoked within her constant terror. "Bullets don't have names," she said, and that's why she refuses to walk in her neighborhood. She would take the bus, but she worries about being kidnapped while walking; she knew someone who had been taken from the street by two men and sexually assaulted.

While the number of reported rapes in Oakland has decreased this year compared to last, anecdotally, the abduction and sexual assault of minors appear to be a not-insignificant threat. Kyndra Simmons, director of a trauma recovery program for the local nonprofit organization Youth ALIVE!, said the agency aided one girl who was shot fighting off her abductors. In such scenarios, Simmons said, the victims are often kidnapped and forced into prostitution.

"Young women are seen by men who are into pimping as property and possessions, so it's just like robbing," she said. "It's the same concept. They are stealing something for money. Unfortunately, it's been the young women."

But long before Hayden started worrying about walking through the park or being kidnapped, she had to deal with dropping out of high school. Stunned by her uncle's death, she felt incapable of sitting in a classroom. Instead, she frequently left class at Oakland High School and boarded the bus to visit her uncle's nearby gravesite. She just wanted to talk to him.

Hayden said none of her teachers asked about the disappearances. "It's probably my fault too, because I didn't walk into the counselor's office and tell them I need someone to talk to," she said. "I just kept it to myself, but nobody asked, so I didn't tell." When Hayden's mother found out about the graveyard trips, she enrolled her daughter in an independent study program, but that didn't work either. She still felt sad.

There is a culture of silence in Oakland, where asking too many questions about someone's death can invite trouble, and showing vulnerability can be viewed as weakness. And then these tragedies start to feel normal. "I don't think the violence affects people anymore," Hayden said. "And I think that's sad because nobody should get used to losing friends."

She has since found refuge at the East Oakland Youth Development Center, where she studied for and passed the GED test and now works as a tutor. She said this has given her a sense of purpose, as if a life less marked by heartbreak might be within reach. Hayden always wanted to join the police academy, and her experience at the youth center has brought her closer to that possibility. "I think I'll try to do something to change Oakland," she said. "Maybe I can be that one to start it."

Despite the best efforts of the school district, there is no way to find every at-risk young person in Oakland. When soldiers return from combat or prepare to leave the military, they are routinely screened for telltale signs of depression, anxiety, and PTSD. That system isn't perfect, either. Some deny their symptoms or have to fight bureaucracy to get benefits, but there still is a massive, well-funded infrastructure with a mission to treat veterans who volunteered for war. The children of Oakland, who just happened to be born into an urban warzone, have only a patchwork of services that they often don't know exists.

One way to reach people outside of school is to find them at the hospital, after they've survived an assault. Youth ALIVE!'s program, Caught in the Crossfire, was the first of its kind in the country to place young adults, who experienced and overcame trauma, in hospitals where they could engage youth in similar circumstances. It doesn't matter if the patient is a victim or perpetrator. In both cases, the premise of the program is that recovering from trauma may prevent future violence.

"We don't use the word 'PTSD,'" Simmons said. "We dance around those words." This is meant to simplify things, she said, but it's also to engender trust. Though empowering to some, diagnoses can scare some people or make them feel judged. Youth ALIVE! staff don't tell a client they need to see a psychologist, but instead say they might want to talk to someone about not sleeping or feeling edgy or using marijuana to numb physical and emotional pain. When therapists hand out a business card, the title reads counselor — that's familiar, that's someone who may have helped you choose classes in high school.

Even that can be intimidating, though, especially when the counselor starts asking personal questions. Getting too deep into someone's business is cause for alarm; it's what child protective services or the police department does. But sometimes the therapists reassure the skeptical by using the example of war veterans to explain what's happening to a client. Like with Javier Arango, these young men and women are quick to recognize the shared experiences of overreacting to the sound of a siren or a loud boom. In one case, a client had both perspectives: He served as a soldier in Afghanistan without incident, but returned to Oakland and was shot.

Of the mostly male African-American and Latino adolescents and young adults Youth ALIVE! encounters, 41 percent are referred to a counselor. Since the Caught in the Crossfire program launched two decades ago, more than 1,200 people have been treated, and preliminary research shows the model can be effective; a retrospective study at Highland Hospital saw significant reductions of those treated in involvement with the criminal justice system. As important is teaching these clients that healing from trauma is possible, that its burden doesn't have to be a life sentence.

John Rich, a professor of health management and policy at Drexel University in Philadelphia who won a MacArthur fellowship for his work on the health care needs of urban African-American men, said hospital-intervention programs and similar efforts challenge a powerful cultural message about responsibility. "A narrative is that you have control no matter what," he said. "Just because those bad things that happened to you, that's no excuse. We're not really asking for folks to provide excuses. We're looking for explanations, to understand what these forces are."


Javier Arango wanted to stop gangbanging after seeing his close friend's lifeless body on the street and watching his friend's mother weep over the seventeen-year-old's open casket. This path would only lay waste to whatever future a high-school dropout paraplegic from the 'hood could scratch out. Leaving the gang wouldn't be easy so he searched for help, settling on Catholic Charities of the East Bay because of its name. Despite whatever "shady shit" Arango had done on the streets, he remained faithful, and in search of redemption.

"God, you have a crazy world," he said he remembers thinking. "I could help you a little bit, but just keep me here." Before he could serve, though, Arango had to heal.

As it turned out, Catholic Charities of the East Bay is one of the key agencies working to treat trauma in Oakland. Its Crisis Response Support Network contacts the family and friends of homicide victims, a program made possible partly through Measure Y violence prevention funding. It is also a part of the city's restorative justice initiative, and it has a federal grant to educate school-based mental health providers about the effects of trauma.

And yet, Cindy Hill-Ford said, the several agencies that coordinate services can't meet demand: "It's a huge orchestra and it's all underfunded."

This is immersive work that requires a professional staff with roots in the community. When Catholic Charities of the East Bay's clinical case managers take on a client, they try to create a safe environment, and this can mean relocating someone from a neighborhood — like the agency did for Arango.

Before, Arango rarely left the forty-block span he called home in East Oakland. Once he emerged, he began to see an alternative universe in which people moved freely across neighborhoods without risking death. He spent time at the agency's office for therapy, but lingered before and after his appointments. The staff gave him small assignments and he felt something novel: pride. Conversations with his therapist also helped by giving Arango a confidant who wanted to see him succeed and could teach him how to relieve symptoms of post-traumatic stress.

Then the organization offered Arango a job as a youth specialist who would lead "trauma circles," which bring together high-risk adolescents to confidentially discuss how to cope with harrowing experiences. "That's something I never had," Arango said of the job. "I always used to know how to cut it, bag it, and get my money. I thought I'm going to be thugging all my life and selling drugs."

It's a dramatic turnaround, and even Arango can't quite believe it. He lives in a safer neighborhood and sleeps well. Just these two things alone are worthy of envy, and Arango knows he's lucky.

"I want the government to make more programs to help out more and to understand that we're all human beings," he said. "We just happen to live in a cold world, in a messed-up world, in a dirty world. But we deserve all the opportunities that anybody else deserves."

Some of this is already happening. The Department of Health and Human Services issued new guidance this summer on how government health-care administrators can use public funding like Medicaid to provide screening and treatment for traumatized children; last year the agency provided $1.3 billion to states to detect physical and mental health conditions in low-income children. In 2013, the Substance Abuse and Mental Health Services Administration awarded more than $40 million in grants to organizations, including Catholic Charities of the East Bay, to provide trauma-informed services in communities around the country. That funding, however, decreased by 5 percent last year as a result of federal budget cuts, according to the US Department of Health and Human Services.

Youth trauma is a major concern of the Department of Justice's Defending Childhood Initiative, founded in 2010. In the past year, the Office of Justice Programs awarded $10 million to projects around the country that are testing programs to prevent violence and help children locked in its grip — whether victim or perpetrator — recover from its effects. Oakland received grants from the initiative to fund its Ceasefire program as well as efforts to reduce juvenile recidivism, youth gang-related crime, and the sexual exploitation of children.

Currently, none of these programs focus on PTSD in youths, but the premise of Defending Childhood is to view young victims and offenders through the prism of public health, not criminal justice. "We're beginning to see a public conversation about the most extreme manifestations of trauma," said Rich, referring to war veterans and mass shootings. He would like to broaden that discussion to include the toxic stress children in Oakland, and other communities like it, come to see as a normal part of life.

"The goal of healing," he said, "is to get to a point where you're not really a danger to yourself or others. That's the personal responsibility in the context of your trauma."

Arango knows his place in this movement. "It's like I'm putting my brick into building a better community," he said, adding that when he was coming up, there were no "original gangsters," or wiser people, who had recovered from trauma and could guide him and his friends beyond the confines of a violent life and death in Oakland.

"We didn't have people like that," he said. "But there's me now. I could do it."

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