November 2016 Charles Ransford, mmp Daniel Silverstone R. Brent Decker, msw, mph Cure Violence, London Metropolitan Gary Slutkin, md University of Illinois at University Cure Violence, Chicago University of Illinois at Chicago Cure Violence Model Adaptation for Reducing Prison Violence Abstract Prison violence is a signifi cant problem that results in serious health problems for incarcerated persons, including increased risk of behavioural problems, serious injury, and death. The disciplinary and management approaches that are typically employed for reducing violence in prisons have limitations; moreover, they do not change the norms or behaviors that drive violence. The Cure Violence model to stopping violence is an epidemic control model that reduces violence by changing norms and behaviors and has been proven eff ective in the community setting. In 2013, the Cookham Wood Youth Off ender Institute adapted the Cure Violence approach to the prison setting, implementing a program that included hiring incarcerated persons as workers and training them in methods of norm change and behavior change. The results from this pilot project showed sharp decreases in violence: CURE VIOLENCE 95% reduction in group attacks, more than 50% reduction in all other 1603 West Taylor Street | MC 923 Chicago, Illinois 60612 forms of violence, and large reductions in the use of force by prison staff . 312-996-8775 These results suggest that the Cure Violence approach can be a very cureviolence.org @CureViolence eff ective method for stopping violence in prisons, including violence facebook.com/CureViolence aff ecting incarcerated youth. thesmartcube.com Cure Violence Model Adaptation for Reducing Prison Violence n many countries, violence in prison was adapted from the Cure Violence is commonplace, and rates of assaults Health Model for the prevention of Iand deaths in these settings are much violence, which works by interrupting higher than in the general population. violent events, changing violent behav- Statistics on the magnitude of the prob- iours, and changing community norms. lem are not widely available because, The Cure Violence Health Model treats unlike violence that takes place outside violence as an epidemic process that prison, assaults in prisons are not tracked spreads through exposure and therefore as crimes. One study estimated that the adapts the methods used to stop other actual rate of violence may be as much as epidemics to stop violence.v vi The epidemic 11 times greater than what is reported.i control method detects and interrupts In the United States, it is estimated that violent events, identifies and treats prison assault rates were 18 times higher the highest risk, and changes norms to for males and 27 times higher for females discourage the use of violence. A central than in the general population, with about characteristic of the Cure Violence model 21% of incarcerated persons experiencing is the use of “credible messengers” as an assault over a six-month period and workers—individuals from the same about 40% of these assaults resulting in communities who are trusted and have injury.ii While data on international rates access to the people who are most at risk of prison violence is not widely available, of perpetrating violence. reports indicate significant problems in many countries throughout the Americas, The Cure Violence Health Model has been Asia, Africa, and Europe.iii externally evaluated several times, with each evaluation showing large, statistically Prison violence is typically handled using significant reductions in gun violence. disciplinary and management approaches, In the United States, the model has been sometimes involving the use of force, implemented in more than 50 communi- solitary confinement, restraints, or other ties and has had reductions of greater harsh forms of punishment, which can than 70% in shootings and killing. Cure be administered inhumanely and cause The program implemented Violence has also been adapted to address serious health problems in the individuals in 2013 in Cookham Wood violence in communities in Latin America, subjected to them.iv Even when they are the Middle East, and Africa. was adapted from the Cure practiced with care, disciplinary and Violence Health Model for the management approaches require substan- The Cookham Wood adaptation repre- prevention of violence, which tial resources in order to deal with multiple sents the first time that the Cure Violence works by interrupting violent factions and individuals involved in a Health Model has been used to address large, complex prison system. violence in prisons. This paper will events, changing violent describe the implementation of the CV HMYOI Cookham Wood is a Young behaviours, and changing prison program in Cookham Wood, report Offender Institute (Cookham Wood) in community norms. on the effectiveness of the program, and the county of Kent in southeast England suggest ways in which this model could that houses male prisoners under the age be implemented more widely to reduce of 18. In order to address a significant vio- violence in prisons. Our report on the lence problem, Cookham Wood decided to effectiveness of the Cookham Wood pro- Cubisms THESMARTCUBE.COM VOLUME 5 ISSUE 1 MARCH 2016 go beyond disciplinary and management gram will draw heavily on the independent approaches by piloting a health-based analysis performed by Daniel Silverstone model that used epidemic control tech- and Matt Scandrett (“Silverstone Report”) niques for stopping violence. The program of the London Metropolitan University.vii implemented in 2013 in Cookham Wood Cure Violence Model Adaptation for Reducing Prison Violence 2 Problem of Prison Violence Globally since admission due to a fight.xii In 2000, a total of 52,307 assaults by incarcerated In many places around the world, prisons persons were reported—a rate of 14.6 are extremely violent places. However, per 1,000. There were also 606 major data on violence in prisons is lacking incidents that involved more than five globally because, unlike violence that incarcerated persons and serious injury takes place outside prison, assaults in or damage (state facilities only).xiii prisons are considered disciplinary or management problems in correctional The rate of violence in prison is much facilities and therefore are not tracked as higher than violence outside prison and crimes.viii Yet the problem of violence in results in a very dangerous, inhumane prisons shows no sign of abating: “With environment. The seriousness becomes the decline of HIV and TB rates, injuries all the more important with the trend of are now the most common health problem mass incarceration around the world and in correctional facilities.” ix x particularly in the United States. Reports of people killed in prison are more An estimated 10.2 million people are held available. In the Americas in 2014, the in penal institutions globally, almost half homicide rate among prisoners (56.7 per of whom are held in the United States, 100,000 prisoners) is three times higher Russia or China.xiv The world prison popu- than the homicide rate for the general lation rate is about 144 per 100,000, with population in these countries.xi As a specific the United States having the highest pris- example, a total of 506 people were killed on population rate in the world at 716 per in Venezuelan prisons in 2013, and as many 100,000.xv In the United States at the end as 6,163 prisoners have been murdered and of 2014, there were an estimated 2,224,400 16,208 injured since 1999. persons incarcerated, with approximately 6,851,000 persons under supervision of Data on assaults is more difficult to obtain. the U.S. adult correctional system—about In the United States in 2004, a total of xvi one in 36 adults. http://www.mirror.co.uk/news/uk-news/rise- 15.9% of state prisoners and 8.3% of federal brutal-attacks-cookham-wood-6490392 prisoners reported having been injured Problem of Violence at Cookham Wood Cookham Wood Youth Offender Institute was built in 1978 in Kent, England, and is situated between two other Youth Offend- er Institutes—Rochester and Medway Secure Training Centre.xvii Cookham Wood was originally an adult female prison with a female juvenile unit. To reduce capacity pressures in London and the South East region, Cookham Wood was converted to a juvenile center for young men ages 15 to 18 in May 2008.xix Cubisms THESMARTCUBE.COM VOLUME 5 ISSUE 1 MARCH 2016 Cookham Wood had an operational capacity of 131 male juveniles through 2013. During the one-year implementation of the Cure Violence model in 2013, the number of incarcerated youth fluctuated Cure Violence Model Adaptation for Reducing Prison Violence 3 between a low of 84 and a maximum of 2012, led to the death of a 15-year-old 122. In January 2014, work was completed youth.xxiv Violent incidents at Cookham on new accommodation and education Wood were increasing and the nature of facilities that increased Cookham Wood’s the violence was escalating. xxv Violent capacity to 179.xx The establishment incidents doubled in the fi rst quarter of serves the courts from Kent, Sussex and 2012, and management staff became more London.xxi concerned about group assaults that could result in serious injuries or death.xxvi Cookham Wood has a signifi cant problem with violence. A year before the Cure Vio- While prison offi cials recognized the prob- lence model was implemented, violence lem and worked hard to address it, internal was described in a report on Cookham reports acknowledged the limitations of Wood as “our major concern.” xxii The the typical disciplinary and management reason for the concern was twofold: the approaches. Cookham Wood housed indi- harm done to incarcerated persons and viduals from an average of 30 recognized prison staff and the disruption of attempts gangs, with about one-third of the youth at rehabilitation.xxiii having gang affi liations.xxvii The number of incidents at Cookham The large numbers of gangs and high-risk Wood was signifi cantly higher than that in individuals creates extreme diffi culties.