Lori Toscano, Executive Director of Innovation

Michael Davis, Training & Technical Assistance

Coordinator

University of Illinois - Chicago

School of Public Health

Health

“a complete state of physical, mental and

social well-being, and not merely the

absence of disease or infirmity.”

Preamble to the Constitution of the World Health Organization as adopted 19 June - 22 July 1946; signed by the representatives of 61 States, and entered into force on 7 April 1948.

obviously impossible while there is

violence!

Health

Preamble to the Constitution of the World Health Organization as adopted 19 June - 22 July 1946; signed by the representatives of 61 States, and entered into force on 7 April 1948.

“a complete state of physical, mental and

social well-being, and not merely the

absence of disease or infirmity.”

Violence Meets the Definition of Epidemic

1. Violence clusters - like a disease

Cholera Violence

2. Violence spreads - like a disease

Influenza

Violence

3. Violence is transmitted -

through exposure, modeling,

social learning, and norms.

Social Learning

Social Norms

Neurological Effects Modulating Factors

1

2

3 4

What Is Known About The Transmission of

Violence?

VIOLENCE EXPOSURE- Observing

- Witnessing

- Trauma

Methods of Transmission

Modulating factors: Age, prior immunity, type of exposure, dose, context, others

Behaviors are formed and maintained

• Formed through:

Modeling

Trial and Error

• Maintained

through:

Culture

Social Norms

Child Abuse Victims Becoming Abusers

30%

0

2

4

6

8

10

12

14

16

18

20

Community Violence Increases Post War

(WW1 & WW2)

Combat

Nations

Non-

Combat

Nations

# o

f

Nations

Increase Decrease No Change

0

5

10

15

20

25

30

35

1 2Chronic

Exposure

No/Low/Moderate

Exposure

Chronic Exposure to Community Violence

Associated with Perpetration

Exposure to Violence Perpetration of Violence

Pro

babili

ty o

f

Perp

etr

ating V

iole

nce

VictimizerVictimizerBeing a victim of violence as an adolescent makes an

individual 3.5 times more likely to perpetrate violence

as an adult.

City of

Chicago

62

Previously

shot

59,000

Englewood

(7th District)

230

Beat 735

(Englewood)

300

United

States

52

Increasing exposure, increasing rate of symptoms

In immediate

social network

740

Proximity/contact

Rates (Shooting)

Papachristos 2015; Carter 2015; FBI UCR; CPD

SDOH

Education

Economic

Conditions

Health Care

System

Built

Environment

Community

Resources

Violence

HOW violence

affects other SDOH

Diminished performance, lower

attendance, decreased grad. rates

Reduced business investment,

reduced commercial activity

Higher costs from violent injuries

and increased chronic conditions

Unsafe public spaces leading to

reduced usage

More resources to public safety;

high demand due to trauma

MORE VIOLENCE

Community

Cohesion

Reduced cohesion and sense of

collective efficacy

Violence

Violence is a Social Determinant of Health(and negatively affects the other determinants)

Negative effects

of violence on SDOH,

including itself

Plus violence causes even more violence

Violence

How we view something

determines what tools are

chosen to address it

Health PrinciplesViolence - an

untreated

HEALTH

problem

• Do no harm

• Neutral

• Scientific

• Guided by understanding - not blame

• Bias - care for most in need

• Grounding – person, family, community

• Community health workers, outreach

• Confidentiality, credibility, and trust

• Bottom line - Care

Viewing violence as a

health problem opens

up new ways of

treating it

Re-Understanding Violence

Moralism SCIENCE(not helpful)

Bad People

Bad Choice Adverse

Circumstances(contribute)

TRANSMISSION

(exposure )

Reduces current inequity and promotes understanding

Old View New View

Bad People Learned Behavior

Gang bangers Negative Norms

Isolated Incidents Contagious Process

Punishment Disease Control

Intractable Solvable

WE KNOW HOW TO STOP

EPIDEMICS

1. Interrupting transmission

2. Preventing future spread

3. Changing group norms

Prevent Retaliations

Mediate Conflicts

Keep Conflicts ‘Cool’

Assess Highest Risk

Change Behaviors

Provide Treatment

Respond to Shootings

Organize Community

Spread Positive Norms

INTERRUPT

TRANSMISSION

REDUCE

HIGHEST RISK

CHANGE

COMMUNITY

NORMS

THE MODEL

Credible

On your side

Validate

Get emotion down

Distract

New thoughts

Reframe

Ask (complex) questions

1. INTERRUPT

TRANSMISSION

Credible Messengers

2. CHANGE

BEHAVIORS

Resource at critical times

New role models

New rewards

Problem solving

New information

Skills, practice

Avoiding situations

Helping friends not do it

Getting/walking away

Multiple messengers

Response to shootings

Group effort

Tipping Point3. NORM

CHANGE

CHANGE

NORMS

Using Data Strategically24

The Right…• Community• Lead Agency & Implementing Organization(s)• Partners • Approach Workers with the Right skills & Right

credibility/suitability/support Data Analyses Participants Messages and Messengers

Critical Elements of the Model

The Right Staff with the Right Skills

MUST BE:• Able to relate to

highest risk• Credible• Suitable • Connected to target

community• Street-smart • Professional

The Right: Approach

Program ManagerOutreach Supervisor

Outreach Worker

Violence Interrupter

The Team

Credible

Supported

Suitable

Adaptations

School

Rapid reductionHospital

CANADA

MEXICO

TRINIDAD

COLOMBIA

SOUTH

AFRICA

KENYA

IRAQ

ENGLAND

JAMAICA

PUERTO RICO

WEST BANK

HONDURAS

SYRIAUNITED STATES

GUATEMALA

CURRENT PARTNER

EXPLORING PARTNERSHIP

PAST PARTNERSHIP

EL SALVADOR

Cure Violence International Adaptation PartnersAugust 2018

NIGERIA

ARGENTINA

MOROCCO

LEBANON

BELIZE

BAHAMAS

BRAZIL

It Works

“I just shook my head

in disbelief at what

they could do …. And

it works. It’s really

changed my view

about what’s possible.”

“I’ve seen this work;

I’m in the middle of

watching this work.

I firmly believe in

it.”

INDEPENDENT

EVALUATIONS

BALTIMORE

Up to 44% fewer shootings

Up to 56% fewer killings

>1 year with no shootings or killings in three communities

CHICAGO

41% - 73% fewer shootings and killings

100% reduction in retaliatory killings

48% fewer shootings during rapid reduction pilot program

LOIZA

(Puerto Rico)

50% decrease in killings in first year of implementation;

maintained for two years

NEW YORKUp to 63% fewer shootings

>1 year with no shootings or killings in multiple communities

EVIDENCE OF REDUCTIONS IN VIOLENCE

(U.S.)

arrows

41% - 73%

Chicago

Shootings

and

Killings

-56%

Baltimore

Killings

-63%

New York

City

Shootings

HONDURAS

(San Pedro Sula)73% - 85% decrease in shootings and killings

MEXICO

(Ciudad Juarez)

>50% reduction in killings in 2016

Reduction in perceived number of disputes and conflicts

SOUTH AFRICA

(Cape Town)

53% fewer shootings

31% fewer killings

TRINIDAD

(Port Of Spain)

67% reduction in woundings and attempted murders

33% reduction in calls to police reporting armed persons

UNITED KINGDOM

(Youth Prison Program)

95% reduction in group attacks

51% reduction in overall violence

EVIDENCE OF REDUCTIONS IN VIOLENCE

(International)

Effect Finding for clients

Employment

87% helped with job interviews

52% assisted were later employed

82% helped preparing resume

86% helped with finding jobs

Education45% assisted completing school/GED

Students less likely to fight

Children/

Family/

Parenting

87% reported home visits

53% reported assistance to family

18% of mediations had children present

Assistance to siblings and children of clients

Improved behavior towards children

26% Assisted resolving a family conflict

95% reported better parenting

97% Reported children less exposed to violence

Norms4X more likely to show little/no support for gun use

14% reduction in attitudes supporting use of violence

Additional Positive Effects

Sustainability

New York City & State

Juarez,

Mexico

What Questions Do You Have?

Violence is a

Health Issue

THANK YOU!www.cureviolence.org