CASE STUDIES

Making Strides to Curb Violence Using a Public Health Approach

Problem

Violence, particularly among youth, is an epidemic in a number of American cities. Youth violence is the leading cause of injury and death for young people aged 10-24 years old, and in many of the country’s largest jurisdictions, homicides and violent crime rose significantly in the first half of 2016. Meanwhile, the Attorney General’s National Task Force on Children Exposed to Violence reports that 46 million of the nation’s 76 million children - roughly 60 percent - are exposed each year to violence, crime and abuse. The result: the nation pays a high price in lives, money and in lost potential.

Boston, MA

Boston, MA

Those who experience repeated exposure to violence can begin to process the experiences as something that is part of “normal” life. Consistent exposure to violence at home or in the community can become desensitizing. Violence makes it hard to feel safe, leading to anxiety, depression, less physical activity in communities, and social isolation.

For example, in Kansas City, homicides, along with aggravated assaults and firearm assaults, were “happening at an epidemic level,” says Tracie McClendon-Cole, Justice Program Manager at the City Health Department. From 2002 to 2011, in Minneapolis, homicide was the leading cause of death among residents ages 15 to 24, accounting for 39 percent of deaths in this age group. Nationally, homicide was the third leading cause of death for this age group during the same period.

 

Solutions

While many cities have looked primarily to law enforcement-driven policies to stem violence, in recent years, more and more cities have taken a public health approach to the problem. Boston, Kansas City and Minneapolis are among those showing that when violence and its root causes are addressed, significant progress can be made in reducing and preventing them.

BOSTON

In Boston, violence is the leading cause of death among black and Latino children and nearly 50 percent of high school students report knowing someone who has been shot or killed. To address this, the Boston Public Health Commission (BPHC) worked hand-in-hand with the police department and other city agencies to invest in strategies that prevent violence through skill development for children and youth, training and capacity building among providers, effective service delivery to individuals who have experienced violence, and resident leadership.

Boston Public Health Commission (BPHC)

·       Received a grant, in 2012, from the Department of Justice for the Defending Childhood Initiative to take a trauma-informed approach to violence prevention. The extra resources helped the city develop and test practical, sustainable strategies for implementing trauma-informed practice in six early care and education centers. Out of the grant, officials developed tools to make it easier to teach and learn about trauma, and developed a 3-day training institute that reaches thousands of health care providers, teachers, parents and others.

·       Developed programming that includes a network of eight community health centers with specially trained staff who lead activities in the neighborhoods with the highest rates of violence. Staff provide trauma response and recovery services to affected residents and lead prevention-oriented events through the health center. The focus: provide specialized support to residents and give them the skills and resources they need to recover from a violent incident.

·       Built out services for survivors of violence to ensure that they get needed services to recover from such an event.  This includes partnering with Boston Medical Center, the city’s primary level 1 trauma center, to implement a case management program for survivors of shootings and stabbings and their family members.

·       Works with the Boston Police Department to identify and provide services for the 300 young men identified as being at high risk of being a victim or perpetrator of gun violence. This initiative– Partners Advancing Communities Together (PACT) – is a multidisciplinary, comprehensive service delivery strategy targeted at high-risk youth, where partners work together to connect youth to long-term, meaningful relationships with trusted adults in education and employment services.

Boston Results:

·       A 2014 evaluation found that “a dollar invested in Boston’s PACT program could be expected to gain a savings of nearly $7.40 in crime-related cost savings.”

·       The trauma-informed practices, policies and environments were deemed a success by evaluators.

MINNEAPOLIS

In 2008, the City of Minneapolis implemented a multi-faceted, multi-sector plan, called “Blueprint for Action: Preventing Youth Violence.” The Blueprint takes a population-based, public health approach to violence. The public health approach promotes strategies that reduce the factors that put people at risk of experiencing violence and that increase the factors that protect or buffer people from risk.

“Overall, our big picture is that violence is a preventable outcome,” says Sasha Cohen, Youth Violence Prevention Coordinator at the Minneapolis Health Department. The Blueprint’s collaborative approach brings local government, schools, juvenile corrections, nonprofits and philanthropy organizations together to identify problems, design solutions, set goals and measure results. “That’s the strength of our program, we bring partners together. We can’t police ourselves out of a youth violence problem.”

Minneapolis’ Blueprint for Action:  Preventing Youth Violence

·       Every other Monday, a core group representing several of the Blueprint partners meets to gather intelligence and ensure that the city and involved partners are working toward common goals of reducing youth violence. Tweaks are made when needed.

·       The effort boasts an array of innovative efforts to tamp down violence, including the Juvenile Supervision Center (JSC), which:

o   Provides supervision and referral services to youths aged 10-17 picked up by police officers in Hennepin County for truancy, curfew and minor offenses that do not warrant admission to the Hennepin County Juvenile Detention Center.

o   Assesses and addresses juvenile delinquency risk factors around the clock while reconnecting kids with their families.

o   Provides a range of services—from assisting with parental involvement, providing enriching activities and information on rights and responsibilities to connect kids and families to resources, case management services and connections to needed social services, including housing and mental health counseling.

Minneapolis Results:

In Minneapolis, multiple efforts involving nearly 80 agencies and organizations have achieved impressive results. “We’ve seen great success with this program,” says Josh Peterson, Youth Intervention Coordinator at the health department, adding “80 percent of young people who show up don’t come back within the year.” Other results include:

·       In 2013 and 2014 combined, two children age 17 or younger were homicide victims in Minneapolis, whereas a total of nine died by homicide in 2006.

·       From 2006 to 2012, violent crime amongst youth (under 18) in the city fell 57 percent, incidents with guns among youth dropped 67 percent, youth homicides decreased 60 percent and youth gun-related assault injuries decreased 62 percent.

·       For youth, age 24 and under, homicides dropped almost by half, from 25 in 2006 to 13 in 2013.

·       In 2014, the JSC had visits from nearly 1,400 young people. Of those, nearly 500 participated in case management aftercare services. Among those receiving case management services, 83 percent decreased high-risk behavior, 88 percent did not re-enter the JSC within six months of case closure, and 86 percent increased school attendance by at least 5 percent

KANSAS CITY

In Kansas City, a decade ago, a commission made up of city officials also began addressing violence as a contagious disease. They recommended that violence be treated like a public health issue, not with a traditional policing approach, to reduce the city’s consistently high annual homicide rates.

Rather than believing violence is inevitable, Kansas City officials today see violence as an unacceptable learned behavior resulting from preventable and controllable factors, including family instability, poverty, domestic abuse, educational failure and substance abuse.

“Violence is definitely a public health issue,” says Tracie McClendon-Cole, Justice Program Manager. She found that adding the sections of the city with the highest violence rates were also those with some of the highest health disparities and inequities. “We began to see some patterns emerging,” she says. For example, retaliations and arguments were the main reasons for homicides, and these incidents were driven by firearms, particularly handguns.

Public health officials “know how to stop epidemics,” McClendon-Cole notes. Putting in place a public health-focused program that interrupted the transmission of violence, prevented it from spreading and changed group norms was essential. City officials looked at the evidence and considered 50 different anti-violence programs worldwide. One stood out: a Chicago-based effort that today is called Cure Violence, for both its potential to be replicable and its focus on cultivating interpersonal relationships.

Accordingly, officials have put in place a series of strategies to “cure” violence, especially retaliatory violence. Treating violence as an epidemic has gotten eye-catching results in the city.

Based on that model, Kansas City created Aim4Peace, which

·       Operates in the one-tenth of the city’s neighborhoods with the highest rates of killings and shootings.

·       Looks at violence as a learned behavior, and sets out to rewire some of those learned behaviors by those who are most prone to retaliate after a violent act. “We engage people in the community who are at the highest risk of the disease spreading,” says Rashid Junaid, the department’s violence prevention manager. “We try to interrupt that process.”     

·       Sends “credible messengers,” respected individuals from the community, who can help to calm individuals after violence erupts and broker peace within high-risk neighborhoods.

·       Uses a core group of 25 outreach workers and violence interrupters to be called upon to intervene. Aim4Peace workers also are embedded in the Truman Medical Center’s trauma team.

·       Is heavy on conflict resolution and mediation and does so via neighborhood outreach teams as well as the hospital prevention program.

Kansas City Results:

·       Violence prevention program has broad support, and is funded in part by a voter-approved “Health Levy.” A 2013 Office of Juvenile Justice and Delinquency Prevention (OJJDP) grant is enabling the city to expand the program beyond the target area.

·       In addition to reducing homicides by 75 percent in the target zone, the citywide homicide rate fell 28 percent between 2010 and 2014.

·       Kansas City’s Aim4Peace Violence Prevention Program saw a 70-percent reduction in the number of homicides between 2010 and 2014.

Summary

Based on the success from these three cities, policy makers and officials might consider:

·       City-wide recognition that youth violence is a treatable epidemic community problem

·       Rallying multi-faceted, multi-sector support across the city

·       Concentrating on breaking the cycle of youth violence – especially retaliatory violence

·       Focusing on youth and their families as well as victims and survivors in the highest impact areas

·       Replicating ‘best-practices’ from other urban communities

·       Investing in training of professionals who impact youth education, health, and crime

·       Documenting and publicizing results to inform continuous improvement