The Interrupters: A NewPublicHealth Q&A With Gary Slutkin

Sep 29, 2011, 4:19 PM, Posted by

file Gary Slutkin, CeaseFire

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

The Interrupters,” a new documentary, tells the story of three CeaseFire workers who endeavor to stop the same violence they were once involved with in Chicago. CeaseFire is a unique public health approach to stopping violence in communities before it starts. CeaseFire was begun by epidemiologist Gary Slutkin, Ph.D, who uses an infectious disease model in his work. “Go after the most infected and stop the infection at its source.” NewPublicHealth spoke with Dr. Slutkin about the film and CeaseFire’s model of success.

Watch the trailer for "The Interrupters":

NPH: Tell us about the model for CeaseFire.

Gary Slutkin: CeaseFire is a disease control approach to reducing shootings and killings. We have reevaluated what is going on in the field of violence, scientifically, and used sciences of behavior and of epidemics. Re-dissecting violence you can see that it has the characteristics of any infectious epidemic. If you release yourself from preconceived ideas about good and bad people and just look at what is actually happening, empirically you see that it spreads like any other infectious disease. Therefore, you say well why don’t we actually take the approach that we use to interrupting infectious diseases. It means that we have to detect the potential for an event, in this case a shooting, in other cases it could be for measles or for flu or TB. We have to prevent one event from leading to another, which means that we have to have specialized workers who can have access to information about when a shooting might happen and be trained to be able to persuade that individual or group out of doing it. And so that prevents its spread.

Then we have to put in a second layer of work that prevents relapses. Of course, the third layer is fundamentally shifting the norms about violent behavior. We know how to do norm change. It’s a series of techniques that have to do with diffusing the innovation, using social pressure, using the right peers and involving the whole community.

NewPublicHealth: How did the idea come about to do the film?

Gary Slutkin: We’ve been approached by I would say over a dozen film and documentary-makers over the last four or five years alone to do documentaries on our work and Steve James, who directed The Interrupters is a very well-known and well respected documentary maker. So basically we just allowed them – they came to us. We didn’t commission this or seek this out at all really. This was not done as a promotional film. These guys kind of film what they see and so we were actually surprised to see how it came out ourselves – you know, what it is that they selected to view and so on, but it’s come out very well. They’re viewing this work very optimistically and they’ve got a chance to reveal a lot of the work on the street that people ordinarily don’t get to see.

You know, a lot of people know about CeaseFire, and a lot of people know that it is effective, that it does reduce shootings and killings, a lot of people know that we’re this combination of science and street, but they haven’t actually visualized it. And why? Because what we do is very hard to get cameras to because it’s in difficult neighborhoods dealing with people who are in very serious situations. So that’s really what the film has facilitated is a deeper view into what our work really is in terms of stopping shootings and interacting with people in very difficult situations.

NPH: How does the spread of violence mimic the spread of infectious diseases?

Gary Slutkin: Well, they’re similar in that you have to find where spread is occurring and interrupt it. And then you need to work with the highest risk people for getting it and prevent it from then emerging in them. So take TB. You have someone who’s coughing a lot and has TB and is spreading it to his friends and family. He needs to be put on anti-tuberculosis therapy to prevent that spread as well as for the cure of himself.

Now, take someone who is about to shoot somebody. This person has to be prevented from spreading more of this and so he needs to be persuaded from doing what he was thinking of because that will cause more and more events [of violence].

Then think about the TB patient. You’ve cooled his disease process down, but then if you don’t keep working with him over the course of the next few months it will reemerge. So you have to keep working with him for six months or a year with anti-tuberculosis therapy. These high-risk individuals, although they may have been persuaded out of one or two events, you now have to keep working with them to change their thinking so that they will not [engage in violence] the next time that they are motivated to or provoked or riled up.

NPH: What is it about the infrastructure of a community that encourages violence?

Gary Slutkin: The principal determinant of whether someone is going to use violence is whether they are living in a place among others where the social expectation is that they would use violence. There are a whole bunch of other things that are commonly found in that community just like there are in communities with AIDS or communities with other problems, but the principal risk factor is the norm of your peers. And so, there are a lot of people who focus on poverty and…lack of fathers and bad education, all these things, which could be a cause or effect of violence, but the main thing is, and we’ve shown this – that you can reduce violence by changing the peer pressure, the social expectations of your peers.

NPH: Has the CeaseFire model been studied?

Gary Slutkin: The whole CeaseFire model has been studied intensively by five different university researchers funded by the Department of Justice and by Johns Hopkins and by the CDC. It’s been solidly, statistically shown to reduce shootings and killings by several different statistical methods, by time series analysis, by hotspot mapping, by gang network analysis and by very intensive confidential interviewing of the high risk people. So this model has been shown to reduce shootings and killings and is shown that it can replicate in other spaces, in other places as well. There are a lot of people who continue to have the idea that you have to fix all social problems in order for violence to go away, but it actually may be the case that if we can reduce violence sufficiently that the other problems will sort themselves out, and we’ve seen that in several places. The most notable example is post-war. You know, when violence stops, that’s when reconstruction starts, that’s when businesses come back, that’s when investment comes back, that’s when the kids actually have opportunities for going to school, caring – thinking they’re going to be able to live a normal life.

NPH: What other cities have successfully implemented the CeaseFire model?

Gary Slutkin: New York City, Baltimore, Philadelphia, Kansas City, New Orleans, Oakland and several upstate New York communities. And we’re also working with Trinidad, Cape Town, London and Iraq. So the model is being accepted and actually promoted and in demand nationally and internationally. This model is now offering communities and cities and countries new ways to go at the problem. You know, it’s just like when people had speed limit signs for reducing traffic fatalities, but then people got wise to the fact that we need to do more than that. Let’s go at the problem from a different angle at the same time, and so came up with dividing the highways to prevent head-ons, making a car safer, putting a seatbelt in, and so that’s what we’ve done is we’ve added a new way, a different angle into the problem and it’s causing a strong reduction to add on to whatever else is being done by others.

NPH: What’s next for CeaseFire?

Gary Slutkin: Well the most immediate thing for us to do is to continue to do a good job in the places where we’re working now and to keep getting more and more scientific evidence, just building that so that there are more and more cities that have a good strong CeaseFire program. And then we’re additionally doing revisions to the model so it can be even more powerful. Just like Apple computers or car companies make newer models, we’re also designing an improved next phase model. [With the updated model], we’re exploring how to go deeper on the norm change and broader on the reach to high-risk people.

CeaseFire is a national model and a national movement. Our goals include not only replicating in more cities and helping communities become safer – but fundamentally changing the thinking about how the problem of violence is to be approached, as a health issue, in a modern and scientific society.

This commentary originally appeared on the RWJF New Public Health blog.