A Successful Model That Predicts and Prevents Violence
A surgeon in Cardiff, Wales, who regularly treated victims of violence, discovered that many cases went unreported. He devised a model for collecting data and collaborating with both law enforcement and community to predict and prevent violence. This approach is now taking root here in the United States.
Weekend after weekend, the wave of emergency department (ED) patients would arrive. Oral and maxillofacial surgeon Jonathan Shepard would treat shattered jaws, knife wounds and other facial injuries at the hospital in Cardiff, Wales. These injuries stemmed from brawls in bars and nightclubs where broken glasses and bottles were wielded as weapons. Strangely, Dr. Shepard found that only 23 percent of these assaults treated in the hospital were reported to law enforcement.
Harnessing the Power of Data for Violence Prevention
Determined to find a way to stem the violence, Dr. Shepard mobilized health care providers, law enforcement heads, city officials and other local leaders in working together to address what was happening within their community.
Local hospitals agreed to gather basic anonymized information from each assault victim admitted to the emergency department, including the specific location of the violent incident, time of day, and weapon involved. They removed patient identifiers and shared the anonymous data with local law enforcement officials, who combined those data with their own records.
With these data, police were able to map when and where violence might happen, and concentrate resources on hotspot locations such as specific streets, businesses, schools, or transit stations, and during particular times of the week, to help prevent incidents.
A Violence Prevention Board (Board) consisting of local stakeholders also used the data to develop a series of interventions. For example, patterns within the analyzed data revealed that many violent assaults occurred in the entertainment district. After investigating this area, the Board learned that fights erupted when alcohol-intoxicated people bumped into each other on sidewalks and grew frustrated as they waited for orders at fast food restaurants and for taxis. The Board worked with the city to create more pedestrian-friendly streets, move bus stops and taxi stands, and appoint marshals to help manage the taxi stands.
The Board also helped pass an ordinance that required pubs and clubs to use plastic or toughened glass barware so broken glass could no longer be used as a weapon. And these data are being used to ensure safety risks are taken into account when awarding alcohol licenses.
With this pioneering approach, called the Cardiff Model for Violence Prevention, the number of violent incidents in Cardiff dropped 42 percent, while they increased in similar cities in England and Wales. And they stayed down—hospital admissions due to violence in Cardiff halved between 2002–2013.
It also generated significant savings for the city: An analysis by the CDC found that, for every dollar spent, the Cardiff Model saved more than 19 dollars in criminal justice costs and nearly 15 dollars in health system costs for a total of $6.6 million annually.
How the Cardiff Model Is Taking Root in the United States
More than half of violent crimes in the United States go unreported according to the U.S. Department of Justice. The Atlanta metropolitan area is no exception.
In 2015, DeKalb County Police Department and Grady Memorial Hospital established the United States Injury Prevention Partnership (USIPP) to pilot the Cardiff Model in the Atlanta metropolitan area, through a CDC Foundation grant funded by the Robert Wood Johnson Foundation (RWJF).
ED nurses at Grady Memorial Hospital now routinely collect anonymous data from ED and trauma patients who have experienced violence in a public place. Nurses ask patients three questions during intake to understand how, when and where their injury occurred. It takes them approximately 20 seconds to screen each patient. The data are then mapped to help the partnership decide where to focus prevention strategies.
With more comprehensive information on when and where fights and assaults in public spaces occur—whether it’s a bus stop, a park, or a convenience store—the police and the community have been able to take steps to curtail violence.
For example, USIPP is partnering with local businesses in the targeted areas to identify ways to increase security, such as repairing property, improving lighting and securing vacant lots, to help reduce crime. In one case, a local hotel owner has started an after-school program for neighborhood youth to keep them off the streets and give them with a safe space to play and have fun.
The DeKalb County Police Department has utilized the pilot data and results in the effective deployment of personnel and resources in the area designated for interventions, to target hotspot activities. Research has shown that disrupting crime “hot spots” is an effective way to reduce crime—they do not get displaced to nearby neighborhoods. As more hospitals are recruited to the effort, USIPP expects to gather more data that will help further pinpoint these hotspots and develop more targeted, community-based interventions.
Joining Forces to Prevent Violence in Communities
It may seem like common sense for hospitals and police departments to work together.
DeKalb County and Grady’s experience shows how effective a partnership centered around using data can be to help communities better understand and take steps to stop the pervasive violence in our neighborhoods that threatens health, well-being and quality of life.
It’s time to expand community partnerships between hospitals, law enforcement agencies and others. By working together, there is great potential to develop strategies that keep people out of jail and out of harm’s way, creating safer, more productive communities for us all.
about the authors
Laura Leviton, PhD, who joined RWJF in 1999, has overseen evaluations in most of RWJF’s areas of focus. Leviton describes her senior adviser role as “striving to represent the quality and consistency of the Foundation’s research and evaluation and its impact on health and health care nationwide.”
George Hobor, who joined RWJF in 2017, is a program officer working to promote healthy, more equitable communities. He is committed to building the capacity of the nonprofit and public sectors to use data and research in their program and policy development, and to advancing a broader conception of health that extends beyond the health care system.