According to the U.S. Department of Justice, over half of all violent crimes in the United States go unreported.1 This means that, often, the only way for law enforcement agencies to improve public safety is to develop insight on what’s happening in their communities. However, for this approach to be effective, agencies need data.
Community data can be drawn from a variety of sources, and, as the experience of the DeKalb County, Georgia, Police Department shows, partnering with local hospitals is a great way to understand what is happening in the community an agency serves.
In 2015, the DeKalb County Police Department and Grady Memorial Hospital joined forces to reduce crime in the county by using the Cardiff Violence Prevention Model. The Cardiff Model brings law enforcement, hospitals, and public health agencies together in a partnership to track when and where violence occurs so that it can be reduced and, ideally, prevented. Dr. Jonathan Shepherd, an emergency room surgeon and professor in Cardiff, Wales, developed the model in response to the violence-related injuries he saw every day, which were often the result of violence that had gone unreported to law enforcement.2
Shepherd began gathering basic information from each assault victim admitted to the emergency room, including the specific location of the violent incident, time of day, and weapon involved. He removed patient identifiers and shared the data with local law enforcement officials, who combined those data with their own records to identify pubs, nightclubs, and street corners that were “hot spots” for violent crime. These new insights informed planning for patrols and locating closed-circuit security cameras.
Over time this partnership grew and developed a greater emphasis on prevention. For example, hospital staff were particularly struck by the terrible injuries they treated from bar fights in which broken bottles and glasses were used as weapons, causing painful lacerations and lifelong scars in the victims. The partnership worked to pass an ordinance that required drinking establishments to change their barware to either plastic or toughened glass that couldn’t be used as weapons. As a result, the incidence of serious lacerations fell dramatically.
In fact, a research study found that implementing the Cardiff Model reduced police-recorded aggravated assaults by 32 percent and hospital admissions by 42 percent.3 Not only did the intervention cut down on violence, but it also helped keep people out of jail and out of hospitals.
When DeKalb County Police Sergeant David Fraser came across this research, he recognized its potential and brought it to his department’s attention. Department officials were eager for new data sources that could help them make better use of their limited resources, and they approached the U.S. Centers for Disease Control and Prevention (CDC), which works with Dr. Shepherd and his colleagues in Wales.
With a grant from the CDC Foundation, funded by the Robert Wood Johnson Foundation, the DeKalb County Police Department and Grady Memorial Hospital established the United States Injury Prevention Partnership (USIPP) to pilot the Cardiff Model in DeKalb County. Through the pilot, they are mapping violent incidents, including fights, assaults, and robberies.
With more complete information on when and where violent crime occurs—whether it’s a transit station, a park, or a shopping mall—the police department is allocating its resources more effectively, with directed patrols in areas where the data show higher rates of violence. As more hospitals are recruited to the effort, the department will better understand violence hot spots and devise more targeted special crime initiatives.
The USIPP collaboration has also served as a valuable springboard for working with stakeholders in the community to curtail violence. The model has provided an opportunity for community leaders to come together, review and reflect on new information, make decisions about prevention programs or policies, and hold each other accountable for following through with those changes.
For example, USIPP is partnering with the DeKalb County Police Department’s South Precinct and local businesses to develop public health and safety strategies, such as property improvements or increased security measures, that can help reduce crime. In one case, a local hotel owner, responding to the police department’s positive interest in his community, started a recreation program for neighborhood youth as a way to engage young people and provide them with a safe space to have fun and be active.
As in the rest of the United States (and in many areas worldwide), crimes in DeKalb County often go unreported. There are many reasons for this, including concerns about police legitimacy. For example, in many African American and Latino communities, trust may be low and immigration-related fears may be high, making residents reluctant to report crimes and draw police attention. With improved maps, law enforcement can get a better understanding of the true nature and extent of violence—even if it is unreported—in neighborhoods and develop more effective ways to address it.
Lessons Learned
The Dekalb County pilot has brought forth several important lessons for future replications in the United States.
The first lesson has to do with the partnership between law enforcement and health care. The DeKalb County Police Department was fortunate to already have a good relationship with Grady Memorial. Previous dealings between the two organizations, however, focused on how to transport arrestees back and forth to the hospital for health care when necessary. Mapping incidents of violence was something completely new and required a different level of understanding and collaboration. Of paramount concern to Grady Memorial was protecting patient privacy and confidentiality.
It helped that the partners shared a commitment to preventing violence in the community. Within that framework and with open communication, technical assistance from the CDC’s Division of Violence Prevention, and the diligence of Dr. Daniel Wu, an emergency room doctor at Grady Memorial, they established an effective screening process that ensured patient privacy and focused on violence occurring only in public places, without overburdening the nurses collecting the information. Hospital and police data were combined and mapped by public health professionals at the CDC, helping to show which areas and businesses were experiencing the most violence.
The second lesson learned has to do with community relations. Mapping violence via hot spots can raise sensitivities within the community. It is important to approach the community as a true partner in violence prevention and avoid the appearance of negativity. Fortunately, the DeKalb County Police Department had an excellent community liaison to help introduce the new initiative.
The department takes great care to explain the data to community leaders and to emphasize both what the data show—and what they don’t. For example, the county’s data did not indicate that incidence of violent crime was increasing; the data merely helped the department better understand where and when such crimes occurred. The department also holds community events on crime prevention where citizens can express their concerns, ask questions, and provide input.
Perhaps the most important lesson is that reducing violence requires many people working together. Law enforcement, hospitals, local elected officials, businesses, and others in the community all have roles to play. Good data are critical to inform the effort, but successful violence prevention requires a real commitment by all partners to change the community’s approach to violence.
The Cardiff Model is relatively intuitive and inexpensive to implement, while preventing costly crimes in terms of prosecution and incarceration and avoiding expensive injuries. An analysis by the CDC found that, for every dollar spent, the model saves more than $19 in criminal justice costs and nearly $15 in health system costs.4
Crime prevention is law enforcement’s highest goal. Public health is focused on protecting health. Preventing violence—which is both a crime and a health threat—is a priority for both fields. The Cardiff Model brings those silos together, arms them with better intelligence, and helps them engage the community as an ally in preventing and reducing violence. At its core, violence is a community problem that law enforcement agencies cannot effectively address on their own. Law enforcement needs partners, and the Cardiff Model offers a platform for building a successful community violence prevention partnership.
It also offers a great opportunity for local law enforcement agencies, many of which are under increasing budget pressures, to do more with less. Implementing the Cardiff Model can help agencies target their limited resources, be more focused with their interventions, and improve their relationships with their communities.♦
Notes:
1 U.S. Department of Justice, “Criminal Victimization,” 2016.
2 Roger Dobson, “Doctors May Report Violence to Police,” BMJ (January 1999).
3 Thomas R. Simon, “Passport to Health: The Cardiff Model Violence Prevention Replication” (PowerPoint presentation, on behalf of the CDC’s Division of Violence Prevention, Dec. 6, 2016).
4 Simon, “Passport to Health.”
Please cite as
Michael Yarbrough, “Partnerships to Prevent Violence: Policing with Hospital Data,” Police Chief online, June 20, 2018.
