Houston Organizations Unite Against Hate Crimes

Hate crime data from the FBI is alarming. Since 2020, hate crimes have surged and continue their rancid ascent. As they continue to permeate the fabric of society, the University of Houston (UH) has been called upon by the Houston Coalition Against Hate (HCAH) to guide community-based organizations, which are on the front lines in leading communities through crisis, to come together to form a consolidated response to hate. HCAH is a network of community-based organizations, institutions, and leaders who have united to reduce hate and encourage belonging.

“What I would like to see in the city of Houston, and it can begin with community-based organizations, is a collective response that demonstrates our intolerance of hate is more powerful than the intimidation that a perpetrator of a hate crime would try to propagate against an entire community,” says Aabha Brown, LMSW, a clinical associate professor at the UH Graduate College of Social Work, whose academic review and recommendations are published in a specially commissioned HCAH report “Building Hate Crime Response Capacity in Community Based Organizations.” Her team of researchers included colleagues at the UH Graduate College of Social Work: Juan Barthelemy, PhD, LCSW-S, an assistant professor, and Donna Amtsberg, LCSW-S, a clinical assistant professor.

The coalition approached Brown and team to assess the response capacity of community-based organizations to hate crime. They had already published "Hate in Houston: A Study of Hate Crimes and Hate Incidents in the City of Houston,” and those findings emboldened them to continue.

“We found that gaps in hate crime reporting make it difficult to accurately track the instances of hate-based violence in Houston and around the country,” says Marjorie Joseph, executive director of the HCAH. “Submission of data to the FBI is voluntary, and many local law enforcement agencies elect not to participate.”

Taking aim at the heart of the reporting weakness came this: “Many cities in Harris County reported zero hate crimes over the 11-year period (2008–2018). This pattern of reporting does not align with findings from the National Crime Victimization Survey, which show that hate crimes are largely undercounted, thus suggesting that nonreporting of hate crimes does not automatically mean that hate crimes do not exist.”

Hate Crimes Exist, en Masse
In 2020, the FBI reported 7,759 hate crime incidents in the United States, a 6% increase from 7,314 in 2019 and the most since 2008, when 7,783 hate crime incidents were reported. Reported hate crimes targeting Black people rose to 2,755 from 1,930 the prior year, a 43% increase. The number of anti-Asian hate crimes rose from 158 to 274. Reported hate crimes targeting the Jewish community made up nearly 60% of all religion-based hate crimes.

Hate crimes are motivated, in whole or in part, by the offender’s bias against a race, gender, gender identity, religion, disability, sexual orientation, or ethnicity, and are committed against people, property, or society. Because motivation is subjective, it is sometimes difficult to know with certainty whether a crime resulted from the offender’s bias.

Brown and her research team found that the most powerful responses to hate crimes involve coordination and cooperation among community-based organizations.

“The nature of a hate crime is that one person may be targeted, but the idea behind a hate crime is to intimidate every single person who identifies with or cares for that particular group,” Brown says. “If organizations could work together as a collective and share the burden of responding, it would ease the burden on individual organizations, alleviating some of the concerns that organizations individually have with regard to impacts on funding or key stakeholder relationships.”

Brown’s report suggests the following steps necessary for community-based organizations to respond to hate-based incidents more effectively:

1. Define hate crime.
2. Establish a response protocol.
3. Train often and train everyone.
4. Provide vicarious trauma support.
5. Establish working relationships with law enforcement.
6. Assess response assets (physical spaces, skills, relationships, and resources specific to the community-based organization).
7. Create a response ecosystem.

With these protocols being built, creating mechanisms for how organizations can deal with hate crimes, Joseph is hopeful.

“Assessing the landscape was the first step. Now that we have the findings, we can be proactive in doing what we can to keep our city safe and ensure we foster communities where everyone belongs. It’s reassuring to know ultimately, we all want the same thing—safety and acceptance,” she says.

— Source: University of Houston

How Older Adults and Their Caregivers View Pain, Depression

Adults, especially older adults, may be in pain or depressed but not able to convey details of their symptoms and quality of life to their doctors for various reasons, including cognitive impairment. A new study from Regenstrief Institute and Indiana University (IU) School of Medicine researchers investigates whether adult patients and their proxies—typically spouses, children, or other family caregivers—agree on what they tell physicians about a patient’s symptoms and quality of life, information critical to clinical care.

The researchers found that patients and caregiver proxies agreed on severity of symptoms of pain, depression, and anxiety as well as functional status 50% to 60% of the time, with agreement on physical symptoms (pain and functionality) more likely than agreement on psychological symptoms (depression and anxiety).

Proxies tended to overestimate patient impairment at lower levels of symptom severity and underestimate at higher levels. Caregivers who were under a lot of stress were more likely to overreport their patient’s symptoms.

“Unlike blood pressure and blood sugar, symptoms like pain, depression or anxiety can’t be objectively measured,” says Regenstrief Institute and IU School of Medicine faculty member Kurt Kroenke, MD, who led the study. “Our group is very interested in symptoms—signs you can’t measure with an X-ray or a lab test. The only way to determine severity is with validated scales and if patients can’t report for themselves, then the proxy’s report is an important tool available to the clinician treating the patient.”

Even when a patient is able to self-report, complementary observations from a proxy providing a confirming or disagreeing perspective may inform treatment decisions, according to Kroenke, a primary care physician.

The study of 576 older adult and proxy participants (188 patient-caregiver pairs as well as 200 patients without identified caregivers) also found that when looking at group averages, patients’ self-reports and caregivers’ reports on patients were in line with each other because over and under reporting averaged out. Kroenke notes that this confirms the value of using proxy reports in research studies.

Paired patients and their caregivers who were white were 50% of study participants. An almost even percentage, 47% of the paired patients and 48% of their caregivers, respectively, were Black.

“Similar to what occurred during the pandemic, when we used rapid COVID tests rather than the more accurate PCR tests to make decisions about travel, attending events, or other issues, because rapid tests were the best we had on hand. When patients can’t complete a symptom scale, proxy reports, while not the best, are the best available and provide valuable information,” Kroenke says.

Kroenke, a pioneer in the field of symptomology, has developed multiple patient-reported outcome measures that have been translated into 80 languages, including the PHQ-9 depression scale, GAD-7 anxiety scale, PEG pain scale, and P4 suicidality screener. In this study, patient-caregiver agreement was evaluated using four commonly used scales, the PHQ-9, GAD-7, the PEG, and the SymTrak multidimensional symptom and functional impairment scale. SymTrak was also developed and tested by Regenstrief and IU School of Medicine researchers.

“Agreement Between Older Adult Patient and Caregiver Proxy Symptom Reports” is published in the Journal of Patient-Reported Outcomes. Authors, in addition to Kroenke, are Timothy Stump, MA, of the IU School of Medicine, and Patrick Monahan, PhD, of Regenstrief Institute and IU School of Medicine.

— Source: Regenstrief Institute