Jul 12 2012

Preventing Violence: Discussion at NACCHO Annual

Oxiris Barbot Oxiris Barbot, Baltimore City Health Director

>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.

A group of impassioned attendees of the National Association of County and City Health Officials Annual Meeting attended a screening of The Interrupters, a documentary about the CeaseFire violence prevention program that began in Chicago and is now a prominent, effective program in other U.S. and international cities. CeaseFire takes a unique public health approach to stopping gun violence in communities. Findings from a study conducted by researchers at the Johns Hopkins Bloomberg School of Public Health show that shootings and killings in even America’s most violent communities can be reduced using the CeaseFire model—a model that employs disease control and behavior change strategies to reduce violence. CeaseFire employs ex-offenders who have unique credibility with community members and effectiveness in getting people to rethink the impulse to resolve disputes using guns.

Safe Streets Baltimore was launched by the Baltimore City Health Department in 2007 as a CeaseFire replication site. Speakers at last night’s screening included Ricardo “Cobe” Williams of CeaseFire Chicago and Oxiris Barbot, MD, the health director of the city of Baltimore in Maryland.

A health officer from Cambridge, Mass., asked the speakers about one thing they’d like to see changed in their communities. Dr. Barbot said: “We need a health in all policies approach with better housing, education [and other social changes] to improve the environment.” NewPublicHealth recently spoke with Dr. Barbot about the impact the program has made in the city.

NewPublicHealth: How does the Safe Streets program build on the CeaseFire model?

Dr. Barbot: We replicated what was done in Chicago, but our implementation differs in that the Baltimore health department houses the Safe Streets program–our name for the CeaseFire model—and we provide technical assistance for that community-based organization to actually carry out the model. We think that that works for us because it helps to create community ownership of the model, and it also allows us to focus on administering the program and making sure that the fidelity of the model is adhered to. We oversee the program and community groups implement it.

We’ve got staff on board that work intensively with the community-based organizations to make sure that they are tracking the number of mediations that occur, that they are tracking the number of face to face meetings, and if those numbers aren’t at a particular level, we do retraining so that the interrupters that are working in that particular neighborhood feel more comfortable in what they’re doing. Similar to any other chronic disease intervention model, the folks who are actually doing the work need to have ongoing professional development to make sure that their tools are as up to date as possible.

NPH: What has your success been since the program began?

Dr. Barbot: There have been a number of successes. Recently there was a study by researchers at Hopkins that demonstrated that in the neighborhoods where we had Safe Streets, there was a statistically significant decline in violent crimes compared to neighborhoods that didn’t have the program. The statistic I most want to point out is our Safe Streets Cherry Hill site has been without a homicide for 315 days, and our other site has been without a homicide for 292 days [as of July 9.] Previously in Cherry Hill, it wouldn’t be uncommon to have a homicide every other month.

>>Read more on the Johns Hopkins study on the successful replication of the CeaseFire model in Baltimore.

NPH: What are the key specifics in the program that are helping to achieve these successes?

Dr. Barbot: The biggest difference is the number of mediations. The model is based on the premise of credible messengers. These are individuals who have a history of living in a community, perpetrating violence in a community, and have now changed their lives around. These are individuals, who when they give examples of alternatives to violence, it’s because they’re living examples of what those alternatives can produce. It has a greater impact to have one of these individuals on the street rather than someone coming in from the outside not knowing the history and coming with an entirely different skill set.

NPH:  Have you been asked for help in training in other cities based on the CeaseFire model in Baltimore?

Dr. Barbot:  Absolutely. We’ve gotten requests from a number of cities in the U.S. and we actually also provide support to cities internationally. We recently had a delegation from Iraq come and visit us.

NPH: What else are you doing in Baltimore to combat homicides, to complement the Safe Streets program?

Dr. Barbot: We are looking at utilizing our zoning code to reduce areas that promote violence. So, for example, specifically we’re looking at reducing the density of carryout alcohol outlets. The literature has shown that package goods stores are strongly and consistently associated with violent crime. And so we’re currently in the process of proposing changes to the zoning code that would reduce the density of package goods stores in the city. And they also happen to be concentrated in the census tracts with some of the highest rates of poverty and some of the highest rates of violence.

NPH:  Have you consulted with CeaseFire and with the program founder, Gary Slutkin, on what’s worked and what might even improve the program at the national level?

Dr. Barbot:   Absolutely.  Our staff here works very closely with his staff and it’s a very collaborative working model because what we experience here and have been able to work through I think adds to the likelihood of new sites who are just getting started in other parts of the country having success early on.  This is an iterative process that we continue to learn from, and I think part of the process is adjusting to what comes our way.

NPH:  We spoke with Cobe Williams of CeaseFire Chicago recently and he talked about the modeling he had seen as a child—that if someone close to you is killed it’s your job to kill them or kill someone else connected with them. Do you feel that in addition to preventing individual attacks, that there is also modeling going on and that the younger generation is beginning to see a different  response so that a generation or two generations from now, the interrupters won’t be as needed as much or needed as all because the modeling will have been different?

Dr. Barbot: I think that is a very important point because this whole model is based on the premise that violence is a learned behavior. The more children that see a different behavior modeled by adult role models, the more they incorporate alternatives to violence, and actually, part of the evaluation that was done by the Hopkins folks shows just that very thing. That children who are growing up in these neighborhoods were less likely to see gun violence as a viable alternative to settling disputes.

Tags: Maryland (MD) SA, Public and Community Health, Violence and Trauma