Successful Public Health Approaches May 2014 Voiceover: Beat Intro 00:00 This is the Beat—a podcast series that keeps you in the know about the latest community policing topics facing our nation. TeNeane Bradford 00:08 Hello and welcome. My name is TeNeane Bradford and, on behalf of the COPS Office, I’d like to introduce you to Jonathan Shepard, Vice Dean, Cardiff University, Violence and Society Research Group. He’s here to talk to us today about successful public health approaches. Dean Shepard, thanks for joining us today. Jonathan Shepard 00:25 It’s a pleasure. TeNeane 00:27 In 1996, you, Jonathan Shepard, founded the Prototype Community Safety Partnership, otherwise known as CSP, and the approach that is now recognized as the Cardiff Model. Could you explain what Cardiff Model is as well as what the motivations and core elements of the program are? Jonathan 00:44 We brought together the Community Safety Partnership because the research was telling us that a lot of violence which puts people in hospital, into the emergency department, was not known to the police for various reasons. It’s because people, many people, don’t report offenses for various reasons. And so, because of that research discovery, we thought there was very good reason to combine information from emergency department patients who were injured in violence, with police intelligence, to get a fuller picture of the locations and times of weapons involved in violence. What’s become known as the Cardiff Model involves the use of information from emergency departments to target police resources and city government resources for things like alcohol licensing. TeNeane 01:45 Can you explain how the Cardiff Model is a partnership between medical practitioners and law enforcement and how this works in practice? And also, can you describe what practical benefits it brings compared to the old days when medical and police personal operated independently? Jonathan 02:01 Well, there are two ingredients, really, to making this effective and making this work. The first one is this unique intelligence that’s only obtainable from victims who go to the emergency department, using that for practical violence prevention purposes—police tasking being a prime example. Then the second ingredient, which is really important, is to get an emergency doctor or a trauma surgeon in the same room as a senior police officer, into a meeting, around the table, where violence prevention is discussed and tactical arrangements are decided. So for example, the emergency department information may show, may demonstrate, that a particular tavern, say, or particular street location, or a particular park location, is the site of a lot of violence. It’s using that unique intelligence for tackling violence and addressing the hot spots. It’s about the emergency doctor or the trauma surgeon looking across the table at his police counterpart, who is also an action orientated practitioner of course, and that dynamic—the joint work between those two action oriented professionals, one from the police and one from trauma or the emergency department—that really drives the violence prevention. Now, in terms of the practical benefits we’ve seen, and it surprised us to start with, I was a bit cynical. I didn’t think it would make too much difference. But it turned out to make a real significant difference. And we found that violence measured by the numbers of patients admitted to hospital, by serious woundings recorded by the police, went down 42 percent relative to similar cities where this approach has not been taken. And then we got the Center for Disease Control colleagues there to work with us to evaluate this completely independently, and they found exactly the same thing. When this prevention model, this Cardiff Model, was used, then you got far more violence prevention and fewer people in hospital and fewer people in court and fewer people sent to prison as a result, compared to cities where this approach has not been taken. TeNeane 04:42 Very interesting. So the medicine and public health professions have long advocated for practices that are evidence based. Government funders and local police agencies themselves are now calling for greater levels of accountability through evidence-based programs. In what ways have you been able to cite evidence that the Cardiff Model works and is cost effective? Jonathan 05:02 Yes. Well we published all the evaluations that were done of this Cardiff Model have been published in emergency medicine journals, in the British Medical Journal, in the journal Injury Prevention, and in a number of other places. This represents a body of work which is evidence that this approach is effective. And there have been two replications in the UK now, one in Cambridge and one in the Liverpool area, which both show the same thing and those, again, have been published. So that represents reliable evidence. We could always do with more evidence. But that constitutes sufficient evidence for others to be confident that this works. Now, with regards to cost benefit, again we worked with two health economists at the Center for Disease Control, Tom Simon and Curtis Florence. And did a very careful cost benefit analysis, a very careful economic analysis and found that the savings to the city far exceeded the cost of the program. In fact, there were almost seven million pounds were saved in the city, which is the capital city of Wales, of course, relative to the cities where this was not being implemented. The cost benefit analysis is hugely favorable, in favor of implementing the program. And the costs, in fact, are very, very limited. The costs of the program consists of the cost of people going to meetings, police officers, and the trauma surgeons we’ve mentioned. And then also, the cost of sharing the information. Generally, it’s an IT job. It’s electronic sharing arrangement, so that is not expensive at all. And even when we included the cost of all the violence prevention initiatives, like moving to plastic glassware instead of glass glasses and bottles in pubs and clubs, and pedestrianizing our main street, our main club land street, still very substantially cost effective. TeNeane 07:22 So finally, where was the model initiated? Is there a model like this in the United States? And if not, how could a model like this be implemented in the United States? Jonathan 07:32 Yes. The model was initiated here in the capital city of Wales. And as I said, it was initiated as a result of our discovery that a great deal of violence which puts people in the hospital is not known to the police. This is not something which has come from the United States or Australia or Canada or anywhere else. This is a UK-based initiative, developed in a city in the UK. I don’t think there’s any reason why this shouldn’t be implemented in the United States. In fact, there have been initiatives to do this in Milwaukee, for example. It does require buy-in by police and the city government though. And I think sometimes the police can be a bit disbelieving about whether or not violence that puts people in the hospital is detected by the police, is ascertained by the police, to use a public health term. But once everybody realizes that of course, for good reason, people don’t report many offenses, then you get over that barrier and then the work can start. TeNeane 08:46 So is there any other information you’d like the field to know as we’re closing the interview? Jonathan 08:53 I would say that the collaboration with local trauma centers for this kind of targeted police work is important. This is not about generating new cases for the police to investigate. This doesn’t increase caseloads. It provides intelligence on which preventive oriented policing could be based. And I think the other important thing is, because that often frightens police officers and senior police mangers, the fact that if they look under the surface of their emergency department, it’s going to increase their caseload. Far from it, that’s not what this is about. The only other thing I’d like to say is that this, of course, involves sharing anonymized information. This is not information about individual victims, their ages, their addresses, how to contact them, or anything about them personally at all. The information that’s important here, and which is shared, has all to do with location, and weapon, and time of violence. Therefore, there are no ethical issues or barriers to sharing this information because it has not to do with individual people. TeNeane 10:05 Ok. Well Dean Shepard, on behalf of the COPS office, thanks so much for providing us with this information and your expertise. Jonathan 10:12 It’s a great pleasure Voiceover: Beat Exit 10:14 The Beat was brought to you by the United States Department of Justice, COPS Office. The COPS Office helps to keep our nation’s communities safe by giving grants to law enforcement agencies, developing community policing publications, developing partnerships, and solving problems. Voiceover: Disclaimer 10:30 The opinions contained herein are those of the authors and do not necessarily represent the official position or polices of the U.S. Department of Justice. References to specific agencies, companies, products, or services should not be considered an endorsement by the authors or the U.S. Department of Justice. Rather, the references are illustrations to supplement discussion of the issues.