Violence interrupters using tested methods to save lives: Peace model replicated globally
=========================================================================================

* Mark Barna

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/50/10/1.3/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/50/10/1.3/F1)

Angelita McLaughlin, who lost her son to gun violence, joins violence interrupters and community activists in a gun violence march in New York City in July. Interrupters work to stop violence by conducting interventions with people who experience it.

Photo by Andrew Lichtenstein, courtesy Corbis/Getty Images

Violence continues to be a major problem in America. Gun violence is 10 times more likely in the U.S. than in other high-income democratic countries, and violence overall has increased during the COVID-19 pandemic.

But despite those grim facts, inroads have been made on the problem. In recent years, rather than taking a criminal justice approach to violence, more leaders have approached the problem from a public health perspective — as one that can prevent violence by reducing risk factors for exposure.

One of the longest running and most studied public health approaches to gun violence is the Cure Violence program, which uses principles of disease control to address the spread of violence.

“There is a lot of evidence for violence as an epidemic disease, and the science is all there,” Cure Violence founder and program director Gary Slutkin, MD, said during APHA’s 2020 Annual Meeting and Expo in October. “Treating violence in this way instead of through the existing paradigm (of law enforcement) works.”

Cure Violence is distinguished from other violence-reduction community programs by its commitment to framing violence as a contagion that spreads through exposure. In the same way that transmission of COVID-19 is reduced by mitigation behaviors, violence is decreased by changing learned behaviors that place people at risk, according to the program.

“Instead of seeing some people as bad and being moralistic about it, we say that there is a health problem and that people have acquired violence as a script and set of behaviors acquired in a contagious manner,” Slutkin, an APHA member, told *The Nation’s Health.*

Slutkin knows about infectious spread. He spent years as a field epidemiologist for the World Health Organization in Africa and other countries, fighting epidemics of Ebola, tuberculosis and cholera. He started the violence-reduction program, originally called CeaseFire, in Chicago in 1995.

WHO’s organizational structure influenced the program, which is also known as Cure Violence Global because it is used in over a dozen countries, as well as in 20 U.S. cities. While WHO guides, advises and trains health workers in its member countries, Cure Violence guides and trains health workers in cities and communities on violence reduction. Community members, not Cure Violence staff, run the programs.

Numerous studies by independent researchers have been published on the model. A study by the Johns Hopkins School of Public Health, published in 2016, revealed a 56% drop in violence in Baltimore neighborhoods following launch of the Safe Streets program.

![Figure2](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/50/10/1.3/F2.medium.gif)

[Figure2](http://www.thenationshealth.org/content/50/10/1.3/F2)

In March, violence interrupters from the Cure the Streets program in *Washington, D.C.*, head to a local market to talk with youth who were out of school during the pandemic.

Photo by Michael Williamson, courtesy The Washington Post/Getty Images

Be it COVID-19 or violence, stopping transmission depends on three factors, according to the program model: interrupting transmission, preventing spread and changing behavior.

The model adapts methods of epidemic control by detecting and interrupting conflicts, identifying and treating the highest-risk people, and changing behavioral and social norms through community programs and services. People ages 16 to 25 are targeted because statistically that age group commits most shootings.

Violence interruptors are the front-line workers of the program. They live in the same community they perform outreach in and typically have had a past history with violence. Outreach activities by interruptors include visiting victims of violence at hospitals and canvassing neighborhoods with gun violence.

Interruptors “have a skill set, a street knowledge, we really couldn’t teach someone without that background,” said Damian Cook, JD, who leads two Cure Violence pilot programs in Jacksonville, Florida.

Cook told a story of an interruptor from Bridges to the Cure, based in northwest Jacksonville, who was canvasing a neighborhood when he came upon an escalation between a young Black man and police. The man, known to be a weapons carrier, was yelling “Shoot me!” and running toward the officers. The interruptor grabbed the man in mid-run and de-escalated the situation. Aware of Bridges to the Cure, the police let the interruptor intervene with the man.

The man “brought our staff to tears as he told his story” of abuse, poverty and trauma, Cook told *The Nation’s Health.* “‘If you weren’t there that night, I would be dead,’ he said.”

Outreach workers serve as case managers for at-risk people. They connected the Jacksonville man with local programs designed to address trauma, teach vocational skills and address the psychological hold violence can have on young people in high-crime communities.

“In violent communities, violent behavior can become the accepted or even expected response to small disputes, perceived slights or insults,” Slutkin cowrote with a colleague in a 2017 working paper.

![Figure3](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/50/10/1.3/F3.medium.gif)

[Figure3](http://www.thenationshealth.org/content/50/10/1.3/F3)

In 2016, Safe Streets violence interrupter Lamont Medley, left, talks with community members in Baltimore. The program, which is in 10 neighborhoods, builds relationships with youth and young adults who are at high risk from violence.

Photo by Andre Chung, courtesy The Washington Post/Getty Images

Another program based on the the Cure Violence model is Philadelphia CeaseFire, overseen by Temple University’s Center for Bioethics, Urban Health and Policy at the Lewis Katz School of Medicine. CeaseFire has followed the model since 2013.

Temple University researchers examined the model’s effectiveness in a North Philadelphia district with high rates of gun violence, finding a 30% reduction in shootings.

Marla Davis Bellamy, JD, MGA, executive director of Philadelphia CeaseFire and part of the implementation of the Cure Violence model, said partnerships are key to successful violence-reduction programs. She works with about 50 organizations and faith groups dedicated to changing behaviors. Creating the partnerships has taken years, she said.

“It takes time to get people on board, it takes time to cultivate relationships, because you are introducing Cure Violence to people who don’t know anything about it,” Bellamy told *The Nation’s Health.*

The COVID-19 pandemic has created challenges for violence interruptors, as they cannot visit victims of violence at their hospital beds, a time when people are often open to behavioral change. Program leaders are doing workarounds by seeking referrals from community services. Virtual meetings, meanwhile, are hampered by lack of internet access. One-on-one meetings six feet apart in playgrounds or parks are alternatives.

The pandemic has also been associated with an uptick of violence in urban areas. During summer, homicides rose by around 50% in 20 large U.S. cities, according to data from the Council on Criminal Justice.

Economic hardship and an increase in gun purchases are among the reasons given for the rise in violence. A study published in October by the University of California-Davis estimated that from March to July, 110,000 people legally purchased new guns in the state, with buyers citing pandemic-related lawlessness as one of the reasons.

Meanwhile, crowds at protests against political and social injustices have sometimes become targets of violence, leading Cure Violence to roll out a peace team model with free online training for deescalating crowd fervor.

Based on what he has seen in past epidemics, Slutkin said he is not surprised by the increase in violence. Violence erupted in the Congo with the spread of Ebola, and in Uganda with the spread of AIDS. And now violence is rising in the U.S. as health workers battle an infectious disease in a politically divided country.

“Epidemics cause other epidemics,” he said.

For more information on Cure Violence, visit [www.cvg.org](http://www.cvg.org).

*   Copyright The Nation’s Health, American Public Health Association