Cure Violence October, 2018 Tools of Change Illustrated Partners Neighbourhood Coaches and Block Large municipalities such as Chicago, New Leaders York and Cape Town. Norm Appeals Small and mid-sized municipalities such as Vivid, Personalized, Credible, Kansas City, Baltimore, Durham, and Empowering Communication Yonkers. Word of Mouth Latin American municipalities in countries such as Honduras, El Salvador, and Initiated by Colombia Gary Slutkin, U. of Illinois at Chicago Middle East communities in countries such as Iraq, Syria, and Morocco Location Prisons Multiple locations across the United Schools States Latin America, Middle East, Africa, and the United Kingdom. Results Reductions in shootings and gun injuries of 25% to 73% Cure Violence was developed in 2000 by Gary Introduction Slutkin, M.D., an epidemiologist at the University of Illinois at Chicago School of Cure Violence shows it can be effective to treat Public Health. Launched in West Garfield, violence using a health approach i.e. to treat it as a contagion rather than as a problem of bad community, the approach reduced shootings by people. The intervention relies heavily on peer 67% in its first year and by 42% over three years. influencers and norm appeals. It has had In 2004, it expanded to 15 communities and multiple independent evaluations all showing homicides in Chicago dropped by 25%. The large statistically significant reductions in program name was changed to Cure Violence in violence. 2012, and by the end of 2015 it was being implemented in 23 cities in North and Central Background America. Note: To minimize site maintenance costs, all Getting Informed case studies on this site are written in the past tense, even if they are ongoing as is the case with this particular program. Returning to Chicago after working in Africa, epidemiologist Gary Slutkin was shocked by the Tools of Change Highlights Series | 1 2 similarities with the epidemics he had previously worked with the highest risk to change behaviors been working with: (1) they clustered in and norms. (Neighbourhood Coaches and Block particular times and places, (2) they self- Leaders, Norm Appeals, Word of Mouth) replicated - one incident led to another, and (3) they increased in waves. He wondered if similar Violence Interrupters and Outreach Workers mitigation approaches might work. That meant used their street credibility to change behaviors treating violence as a contagion that infected and interrupt conflicts. They also modeled and people, rather than a problem with bad people. taught community members better ways of communicating with each other and how to While working to stop the spread of TB in the resolve conflicts peacefully. US, and then the spread of AIDS and cholera in Africa, he learned that people were most 1. Detect and interrupt potentially violent receptive to advice delivered by peers. conflicts Trained violence interrupters and outreach workers prevented shootings by identifying and Prioritizing Audiences mediating potentially lethal conflicts in the The program focused on those currently community, and following up to ensure that the involved in violence or at very high risk for conflict did not reignite. involvement in violence. Preventing Retaliations Whenever a shooting happened, trained workers Delivering the Program immediately worked in the community and at the hospital to cool down emotions and Cure Violence used three main strategies to prevent retaliations working with the prevent violence: victims, friends and family of the victim, and 1. Detect and interrupt potentially violent anyone else connected with the event. conflicts 2. Identify, treat and foster positive behavior Mediating Ongoing Conflicts Workers change among high-risk individuals, and identified ongoing conflicts by talking to key 3. Mobilize the community to change norms. people in the community about ongoing disputes, recent arrests, recent prison Using a health approach to reduce the risk of releases, and other situations and used and recognizing the importance of mediation techniques to resolve them communicating through peer networks, the peacefully. program hired peers from each community to Workers followed change behaviors and norm and intervene in up with conflicts for as long as needed, disputes. Outreach Workers and sometimes for months, to ensure that the were employed and trained to conflict did not become violent. identify high-risk situations and persons by patrolling specific neighbourhoods and utilizing their existing networks. They then intervened before disagreements escalated into violence and Tools of Change Highlights Series | 2 3 2. Identify, treat and foster behavior change and diagnosis of violent behavior, appropriate among those at highest risk referrals for client issues, as well as a number of other areas and learn the methods that could be Trained, culturally-appropriate outreach used to encourage new positive behaviors such workers worked with the highest risk as conveying new information, teaching new community members to make them less likely to skills applicable to the new behaviors, practicing, commit violence, by meeting them where they developing opportunities for positive peer were, talking to them about the costs of using reactions, and avoiding negative peer reaction. violence, and helping them to obtain the social The program tried to maintain relationships services they needed such as job training and and violent cliques. drug treatment. 3. Mobilize the community to change norms. Accessing Those at Highest Risk Workers utilized their trust with high-risk individuals Workers engaged leaders in the community as to establish contact, develop relationships, well as community residents, local business and begin to work with the people most owners, faith leaders, service providers, and the likely to be involved in violence. high risk, conveying the message that the residents, groups, and the community did not Changing Behaviors Workers engaged with support the use of violence. (Norm Appeals) high-risk individuals to convince them to Responding to Every Shooting Whenever a reject the use of violence by discussing the shooting occurred, workers organized a cost and consequences of violence and response where dozens of community teaching alternative responses to situations. members voiced their objection to the For example, this involved talking about shooting what would happen to their girlfriend or children if they went to prison, or how their Organizing Community Workers mother would feel if something happened to coordinated with existing block clubs, tenant them. Workers also taught their clients new councils, and neighborhood associations to methods of behavior, such as how to assist; they also established new ones deescalate conflicts, save face in a Spreading Positive Norms The program confrontation, and stop a friend from being distributed materials and hosted events to violent. (Vivid, Personalized, Credible, convey the message that violence was not Empowering Communication) acceptable Providing Treatment Workers developed a By 2018, The Cure Violence Health model had caseload of clients who they worked with been implemented in large cities such as New intensively seeing them several times a York City, Chicago, Baltimore, San Antonio and week and assisting with their needs such as New Orleans, and also in smaller cities like drug treatment, employment, and leaving Kansas City, Syracuse and Albany, and all over gangs. the world from San Pedro Sula, Honduras to Cape Town, South Africa. These workers were trained in methods of persuasion, alternatives to violence, detection Tools of Change Highlights Series | 3 4 Measuring Achievements A 2009 NIJ/Northwestern University evaluation analyzed seven communities in Chicago over The program emphasized continual data three years. It found that the program reduced collection and monitoring. Program success was shootings and killings by 41% to 73%, with measured using the rates of reported crimes and retaliatory shootings eliminated in five of seven violent injuries. communities examined. In May 2008, Dr. Wesley G. Skogan, at During 2015 budget cuts eliminated program Northwestern University, completed a three- workers in 13 of 14 communities; homicides year, independent, Department of Justice- began increasing within a month and the funded report finding large reductions in following year w violence attributable to the program. There have two decades. In the one community where it been more than a dozen additional studies continued, violence continued to go down. In showing similar effects. Additionally, in 2017 funding was restored and murders dropped Chicago in 2015 and 2016, budget cuts and by 16%. subsequent budget reinstatement provided a reversal design opportunity to see the impacts on Baltimore A 2012 CDC/Johns Hopkins evaluation of 4 communities in Baltimore credited the program Financing the Program with reducing shootings and killings by up to 34- 56%. Community norms were influenced, even In 2018, Cure violence received $5.4 million with those who did not directly participate in the funding in Chicago (from state and city police program, and the reductions in violence spread budgets) and $17.2 in New York. Across the US, to surrounding communities as well. programs received about $40 million in funding. New York Results 37% to 50% The Cure for Violence Health Model has since reduction in gun injuries in two communities; a had multiple independent evaluations showing 63% reduction