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Evaluation of Baltimore's Safe Streets Program: Effects on Attitudes, Participants' Experiences, and Gun Violence

Evaluation of Baltimore’s Safe Streets Program:
Effects on Attitudes, Participants’ Experiences, and Gun Violence
Daniel W. Webster, ScD, MPH
Jennifer Mendel Whitehill, PhD
Jon S. Vernick, JD, MPH
Elizabeth M. Parker, MHS
Johns Hopkins Center for the Prevention of Youth Violence
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD
January 11, 2012
In 1995, Dr. Gary Slutkin of the University of Illinois at Chicago developed the
CeaseFire program to reduce youth violence associated with firearms. CeaseFire is a
multifaceted intervention involving several different components. Most notably, street outreach
workers often former gang members develop relationships with high risk youth in high crime
urban areas. Outreach workers serve as positive role models for the young people, steering them
to resources such as job or educational training. Special outreach staff called violence
interrupters work to identify and resolve potentially dangerous conflicts before they escalate into
shootings. In addition, the program organizes community responses to shootings and attempts to
change social norms surrounding shootings, sending the message that using a gun to resolve
conflict is unacceptable. An independent evaluation by researchers at Northwestern University
found strong evidence that the program led to significant reductions in gun violence. A grant
from the U.S. Department of Justice enabled the Baltimore City Health Department (BCHD) to
attempt to replicate Chicago’s CeaseFire in Baltimore under the name Safe Streets.
The evaluation has four major components: 1) a review of implementation data for the
program; 2) an analysis of the effects of the program on homicides and nonfatal shootings; 3) a
community survey of attitudes toward gun violence; and 4) interviews with Safe Streets program
participants to ascertain their perceptions of the program’s effects on their lives.
Program Implementation
BCHD solicited proposals from community based organizations interested in
implementing the program in some of Baltimore’s most violent neighborhoods. Safe Streets was
initially launched in the McElderry Park neighborhood of East Baltimore in June 2007 and in the
Union Square neighborhood of Southwest Baltimore in August 2007. However, the Union
Square community group experienced substantial problems implementing the program, failing to
establish a stable group of outreach workers until March 2008. But program implementation
problems continued and Union Square’s contract was discontinued in July 2008. Additional
program sites were added latter. Elwood Park’s program was fully implemented as of March
2008, Madison-Eastend as of January 2009, and Cherry Hill as of January 2009.
Program staff were required to keep standard records of their activities including detailed
information about each incident mediated by outreach staff. Monthly totals and conflict
mediation forms were reported to BCHD and shared with the research team. After the initial
months of enrolling participants, program sites had 35 to 60 participants connected with outreach
workers at any given time and recorded 127 to 271 participant contacts per month.
A key approach to reducing violence was for program outreach workers to mediate
conflicts between individuals or groups in attempt at reaching a nonviolent resolution. From July
2007 through December 2010, Safe Streets outreach workers mediated 276 incidents. Nearly 9
out of 10 (88%) of these incidents involved individuals with a history of violence and 75%
involved gang members. Weapons were at the scene in nearly two thirds of the incidents. Based
on these conditions and other factors, outreach workers thought that 84% of the situations in
which they intervened would have either “very likely” (59.5%) or “likely” (24.6%) led to a
shooting. Outreach workers considered the situation to have been successfully resolved
(avoiding serious violence) in 69% of the incidents and at least temporarily resolved in an
additional 23% of the cases. The average number of incidents mediated per month ranged from
1.2 in Madison-Eastend to 4.0 in McElderry Park. Cherry Hill mediated an average of 3.2
incidents per month and Elwood Park mediated 1.4 incidents monthly.
Program Effects on Homicide and Nonfatal Shootings
We obtained data from the Baltimore Police Department for homicides and nonfatal
shootings from January 1, 2003 to December 31, 2010. We compared changes in the number of
homicide and nonfatal shooting incidents per month in the intervention neighborhoods with high-
crime comparison areas (police posts) without the intervention. To be a comparison area, the
police post must have been in the top 25% among all posts for the number of homicides and
nonfatal shootings from 2003 to 2006. Regression models were used to control for several
possible confounders including measures of police initiatives directed at reducing neighborhood
gun violence, arrests for weapon and drug violations, and baseline levels of homicide and
nonfatal shootings.
In Cherry Hill, Safe Streets was associated with statistically significant reductions of 56%
in homicide incidents and 34% in nonfatal shootings. Program effects in the three East
Baltimore sites varied. McElderry Park did not experience a homicide during the first 22 months
of program implementation (prior homicide levels in the area and citywide trends projected five
homicides in McElderry Park for that period without the intervention). However, homicides
increased during the period when program supervisors and staff also concerned themselves with
a new Safe Streets site in bordering Madison-Eastend where gang violence surged. During the
months McElderry Park’s program was running without the near-by Madison-Eastend program,
homicides were 53% lower than would have been expected without the intervention. However,
there were no program effects on homicides or nonfatal shootings in McElderry Park during the
months when Madison-Eastend’s program was operating. Both Elwood Park and Madison-
Eastend’s Safe Streets interventions were associated with statistically significant reductions in
nonfatal shootings (-34% and -44%, respectively). However, homicides were nearly three times
higher than would have been expected during the 18-month period the program was in operation
in Madison-Eastend. There was also evidence that positive programs extended into areas
bordering the neighborhoods that implemented Safe Streets.
Totaling statistically significant program effects across all the program sites and border
posts we estimate that the program was associated with 5.4 fewer homicide incidents and 34.6
fewer nonfatal shooting incidents during 112 cumulative months of intervention post
observations. There would have been more than 10 additional homicide incidents prevented had
there not been significant increases in Madison-Eastend and in the area bordering Elwood Park
that coincided with program implementation.
Youths’ Attitudes About Gun Violence
To assess the effects of Safe Streets on attitudes about the appropriateness of using a gun
to resolve conflicts, we conducted surveys in three Baltimore neighborhoods McElderry Park,
Union Square, and Oliver. A first wave of surveys was conducted in November/December 2007
after implementation had begun in McElderry Park but prior to a largely failed program
implementation in Union Square. Oliver, which had unsuccessfully applied for Safe Streets
funding, served as another nonintervention comparison neighborhood with baseline levels of gun
violence similar to that of McElderry Park. For the second wave of surveys, conducted in Spring
2009, we excluded Union Square due to implementation problems which led to discontinuance
of the program.
For each survey wave, young men ages 18 to 24 were recruited on the street and in public
places to complete a brief, anonymous, self-administered survey. The survey contained
hypothetical scenarios based on common sparks for shootings. One set of survey questions
asked whether the respondent thought it was okay to either “threaten” or “shoot” the antagonist.
Another set of questions asked respondents whether they thought their friends would think it was
okay to threaten or shoot the antagonist in the same situations.
For survey Waves 1 and 2, youth in McElderry Park were much less likely than youth in
the other neighborhoods to believe that it was okay to use a gun to resolve disputes in our
scenarios. In fact, youth in McElderry Park were 4 times more likely to have the lowest level of
support (“little or no”) for using violence than were youth in Union Square. Regression models
showed that Wave 1 respondents in McElderrry Park were less likely to support using guns to
settle disputes (p<.001) after controlling for confounders. In the models for Wave 2, McElderry
Park respondents were less likely to be in the “strong” support for gun violence category
(p<.001), but there was no longer a significant neighborhood difference for being in the
“moderate” support category.
Program Participants’ Experiences and Views of Program Impact
In May 2011, we conducted anonymous interviews with program participants in Cherry
Hill and McElderry Park to learn about their experiences with Safe Streets. Outreach staff
provided information about the survey to each adult (age 18+) program participant and directed
those who were interested to come to the program office at designated times when research
interview staff would be available to conduct interviews. A total of 32 program participants in
Cherry Hill and 33 in McElderry Park were interviewed.
As the Safe Streets program envisions, program participants are at high risk. Nearly half
of program participants (48%) had ever been shot at.
Program outreach workers appear to be important parts of the lives of these young
people. Two-thirds of participants saw their outreach worker 3 or more times per week; for
three-quarters of participants, these meetings lasted an average of more than 1 hour. Outreach
workers provided program participants with various types of assistance. Participants who sought
assistance reported that outreach workers helped with activities including: finding a job (88%);
job interviewing skills (75%); job training (63%); getting into a school or GED program (95%);
and resolving family conflicts (100%).
Outreach workers also helped the majority (52%) of program participants settle an
average of two disputes. Twenty-eight percent of these disputes involved guns and 91% avoided
violence. Overall, 80% of program participants reported that their lives were “better” since
becoming program participant of Safe Streets.
Safe Streets was implemented in four of Baltimore’s most violent neighborhoods,
engaging hundreds of high-risk youth, promoting nonviolence through community events, and
mediating over 200 disputes with the potential to lead to a shooting. The program was associated
with less acceptance for using guns to settle grievances in the one intervention neighborhood
where attitudes were studied. Program participants reported benefiting from their connections to
outreach workers in numerous ways that could be protective against future involvement in
Three of the four program sites experienced large, statistically significant, program-
related reductions in homicides or nonfatal shootings without having a counter-balancing
significant increase in one of these outcome measures. Both program sites where Safe Streets
was linked to large reductions in homicides mediated about three times as many disputes per
month than did the other two program sites. Future efforts should focus on understanding and
improving program implementation and discovering the conditions under which the program can
be most effective in reducing violence.
... It was also observed that homicides continued to go down throughout the study period, suggesting that the continuation of the program keeps contributing to the reduction of homicides in these areas. These reductions are much higher than the ones observed in other similar interventions developed in the United States ( (Skogan et al., 2009;Webster et al., 2012) and other countries such in Brazil (Abramovay, M. 2003;Waiselfisz, J.J. & Maciel, M. 2003.). ...
... These findings should be taken with caution, given that the descriptive approach used in this study cannot not rule out that external causes (e.g., the presence of local or national public policies) could explain the observed changes. Future studies using experimental/quasi-experimental approaches (Skogan et al., 2009;Webster et al., 2012), e.g., using control cities not exposed to similar interventions could provide additional evidence of the program effects on homicides. However, the fact that there were major reductions in street gang-related homicides in the intervened communes is an important finding indicating that youth lives are not being lost at the rate they were occurring in 2015. ...
... Previous studies (Skogan et al., 2009;Webster et al., 2012) show how similar approaches to reduce street gang-related violence have confronted multiple obstacles and opposition. For example, the cure violence model developed in different cities in the United States have faced difficulties in creating new programs due to lack of organization and community leaders, limited community buy-in, and inconsistent program funding (Butts et al., 2015). ...
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Cali is one of the cities in Colombia and Latin America with the highest rate of homicides, with around one third of homicides being attributed to street gang-related violence. In 2016, the Mayor's office from Santiago the Cali - Colombia, the Police Department and the Cisalva institute from Universidad del Valle worked together to develop an holistic intervention, "TIP -Youth without frontiers", to reduce street gang-related violence in Cali's communes. The intervention comprised six components focusing on developing personal/emotional skills, improving access to health and other public services, reducing substance use, connecting youth with employment and educational opportunities, promoting participation in sports and recreational activities, and improving the restitution of citizen rights to street gang members. This study aimed to describe the characteristics and implementation of this transformative street gang program and to describe changes in street gang-related homicides that could be associated with the implementation of this program. The program started contacting street gangs in January 2016, recruiting the first street gang members in August 2016. As of December 2018, 2.107 youth (from 84 Police identified street gangs) have participated in the program. A reduction in street gang-related homicides was observed in Cali's communes from 2015 to 2018. In intervened communes these homicides decreased on average by 80%, suggesting that the program could have contributed to the reduction of street gang-related violent behavior in these areas.
... 5 preventative interventions are often based out of inpatient units; however, the question of how often youth who have been injured due to violence are discharged from emergency departments (EDs However, hospital-and community-based interventions, such as the Safe Streets intervention in Baltimore, have been proven to decrease youths' risk of violence,. 6 For these public health interventions to be effectively and efficiently implemented, they must be appropriately targeted. This is particularly important in cities like Detroit that have relatively low population density (only eight census block groups have greater than 15 housing units per acre, the majority having less than five) spread over 139 square miles. ...
... 8 Geospatial mapping has previously been used to implement targeted interventions and to manage chronic disease by "hot-spotting" of acute care use. 6 Hot-spotting describes a "data driven process for the timely identification of extreme patterns in a defined region of the healthcare system." 9 Geospatial mapping has also been used to evaluate the geographic distribution of child abuse cases to deliver targeted interventions, as well as to identify communities with high burdens of opioid-related emergency department (ED) visits and hotspots of opioid overdose. 9 Examination of geospatial data relative to health system resources is a novel approach to inform not only areas of risk but also opportunities for health system-community partnerships. ...
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Introduction: Detroit, Michigan, is among the leading United States cities for per-capita homicide and violent crime. Hospital- and community-based intervention programs could decrease the rate of violent-crime related injury but require a detailed understanding of the locations of violence in the community to be most effective. Methods: We performed a retrospective geospatial analysis of all violent crimes reported within the city of Detroit from 2009-2015 comparing locations of crimes to locations of major hospitals. We calculated distances between violent crimes and trauma centers, and applied summary spatial statistics. Results: Approximately 1.1 million crimes occurred in Detroit during the study period, including approximately 200,000 violent crimes. The distance between the majority of violent crimes and hospitals was less than five kilometers (3.1 miles). Among violent crimes, the closest hospital was an outlying Level II trauma center 60% of the time. Conclusion: Violent crimes in Detroit occur throughout the city, often closest to a Level II trauma center. Understanding geospatial components of violence relative to trauma center resources is important for effective implementation of hospital- and community-based interventions and targeted allocation of resources.
... 85,86 We recommend the expansion of blight remediation programs that focus on neglected communities and eliminate sites used to store and sell illegal firearms. 87 Broad implementation of programs targeting individuals and communities could curtail firearm involvement among adolescents and reduce shootings, 88 Policy makers should also consider training pediatricians to educate parents on safe storage of firearms. One in 3 children live in a home where firearms are present. ...
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Importance: Preventing firearm violence requires understanding its antecedents. Yet no comprehensive longitudinal study has examined how involvement with firearms during adolescence-use, access, and victimization (defined as threatened with a weapon or gunshot injury)-is associated with the perpetration of firearm violence in adulthood. Objective: To examine the association between firearm involvement during adolescence and subsequent firearm perpetration and ownership in adulthood among youth involved in the juvenile justice system. Design, setting, and participants: This cohort study analyzed interview responses of 1829 randomly selected participants as part of the Northwestern Juvenile Project, a longitudinal study of health needs and outcomes of youth sampled from a temporary juvenile detention center in a large US city. Youth aged 10 to 18 years were interviewed in detention from November 1995 through June 1998. Participants were reinterviewed up to 13 times over 16 years through February 2015, for a total of 17 776 interviews. The sample was stratified by sex, race/ethnicity, age, and legal status (juvenile or adult court). Data were analyzed from April 2017, when data preparation began, through November 2020. Exposures: Firearm involvement during adolescence: use (ie, threaten, shoot), access (ownership, ease of access, firearm in household, membership in gang that carries firearms), and victimization (gunshot injury, threatened with a weapon). Main outcomes and measures: Firearm involvement during adulthood: perpetration of firearm violence (ie, threatening with or using a firearm) and firearm ownership. Results: Among the 1829 participants, 1388 had a 16-year follow-up interview: 860 males, 528 females; 809 were African American, 203 were non-Hispanic White; 374 were Hispanic; and 2 were other race/ethnicity; median (interquartile range) age of 32 (30-32) years. Eighty-five percent of males and 63.2% of females were involved with firearms as adolescents. Compared with females, males had significantly higher odds of every type of involvement except having a firearm in the home. In adulthood, 41.3% of males and 10.5% of females perpetrated firearm violence. Adolescents who had been threatened with a weapon or injured by firearms had 3.1 (95% CI, 2.0-4.9) and 2.4 (95% CI, 1.2-4.9) times the odds of perpetrating violence during adulthood. Similar associations were found for firearm ownership. Conclusions and relevance: Involvement with firearms during adolescence-including victimization-is a significant risk factor for firearm perpetration and ownership during adulthood.
... Outcome evaluations of Cure Violence have been mixed; a sixteen-year time series analysis found, after implementation of the program, shootings reduced in five of the seven neighborhoods assessed (Slutkin et al. 2015). However, in one Baltimore neighborhood, violence-related homicides increased by 2.7 times following the implementation of Cure Violence (Webster et al. 2012). The inconsistency in findings may be due to problems with program implementation across different neighborhoods (i.e., poor retainment of staff, lack of consistent funding, communication breakdowns, and limited data sharing; Fox et al. 2015). ...
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Tackling street gangs has recently been highlighted as a priority for public health. In this paper, the four components of a public health approach were reviewed: (1) surveillance, (2) identifying risk and protective factors, (3) developing and evaluating interventions at primary prevention, secondary prevention and tertiary intervention stages, and; (4) implementation of evidence-based programs. Findings regarding the effectiveness of prevention and intervention programs for street gang members were mixed, with unclear goals/objectives, limited theoretical foundation and a lack of consistency in program implementation impeding effectiveness at reducing street gang involvement. This paper proposes that the Good Lives Model (GLM), a strengths-based framework for offender rehabilitation, provides an innovative approach to street gang intervention. Utilizing approach-goals, the GLM assumes that improving an individual's internal skills and external opportunities will reduce the need to become involved in street gangs. Wrapping the GLM framework around current evidence-based interventions (e.g., Functional Family Therapy) increases client engagement and motivation to change, which is notably poor amongst those at-risk of, or involved in, street
... One of the key elements to interrupting transmission is hiring street credible persons as "violence interrupters." Their success in using this approach to reduce violence has been confirmed by multiple professional evaluations (Skogan, Hartnett, Bump, & Dubois, 2009;Webster, Whitehill, Vernick, & Parker, 2012). Cure Violence reported that in the Israeli/Palestinian context they will first create a network of activists/volunteers who are familiar with the health approach. ...
... Violent youth espouse retaliatory attitudes known as the "code of the street," which has been defined as a set of informal rules that involves demanding respect, self-protection, and the need to establish one's standing as someone who will react if provoked ( Jacques & Rennison, 2013 ). These normative beliefs form the basis for trauma center violence prevention programs that employ former patients injured by violence or gang members as violence interrupters to interact with patients and families at the hospital immediately following an incident to defuse further violence and promote conflict mediation ( Webster, Whitehill, Vernick, & Parker, 2012 ). Texting and social media have proven effective in connecting interrupters to assault victims (Institute of Medicine, 2012a). ...
The drivers of trauma disparities are multiple and complex; yet, understanding the causes will direct needed interventions. The aims of this article are to (1) explore how the injured patient, his or her social environment, and the health care system interact to contribute to trauma disparities and examine the evidence in support of interventions and (2) develop a conceptual framework that captures the socioecological context of trauma disparities. Using a scoping review methodology, articles were identified through PubMed and CINAHL between 2000 and 2015. Data were extracted on the patient population, social determinants of health, and interventions targeting trauma disparities and violence. Based on the scoping review of 663 relevant articles, we inductively developed a conceptual model, The Social Determinants of Trauma: A Trauma Disparities Framework, based on the categorization of articles by: institutional power (n = 9), social context-place (n = 117), discrimination experiences (n = 59), behaviors and comorbidities (n = 57), disparities research (n = 18), and trauma outcomes (n = 85). Intervention groupings included social services investment (n = 54), patient factors (n = 88), hospital factors (n = 27), workforce factors (n = 31), and performance improvement (n = 118). This scoping review produced a needed taxonomy scheme of the drivers of trauma disparities and known interventions that in turn informed the development of The Social Determinants of Trauma: A Trauma Disparities Framework. This study adds to the trauma disparities literature by establishing social context as a key contributor to disparities in trauma outcomes and provides a road map for future trauma disparities research.
This chapter makes a case for applying a masculinities lens to understand multiple forms of violence in conflict and nonconflict settings. It discusses how violence is tied to inequalities, marginalization, patriarchal and other power structures, masculinities, and young men’s identities. It further examines how those dynamics shape the differential impact of conflict on females versus males and individuals of other gender identities. Further, it brings an intersectional understanding of how ethnicity, social class, and masculinities interact in conflict and high-violence settings, addressing the cases of Brazil and the eastern Democratic Republic of Congo.
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Objectives Gangs are thought to enhance participation in violence. It is expected then that gang-related violent crimes trigger additional crimes in a contagious manner, above and beyond what is typical for non-gang violent crime.Methods This paper uses a multivariate self-exciting point process model to estimate the extent of contagious spread of violent crime for both gang-related and non-gang aggravated assaults and homicides in recent data from Los Angeles. The degree of contagious cross-triggering between gang-related and non-gang violent crime is also estimated.ResultsGang-related violence triggers twice as many offspring events as non-gang violence and there is little or no cross-triggering. Gang-related offspring events are significantly more lethal than non-gang offspring events, but no more lethal than non-contagious background gang crimes.Conclusions Contagious spread of gang-related violent crime is different from contagion in non-gang violence. The results support crime prevention policies that target the disruption of gang retaliations.
Objectives. To evaluate whether the Operation Peacemaker Fellowship, an innovative firearm violence-prevention program implemented in Richmond, California, was associated with reductions in firearm and nonfirearm violence.Methods. We compiled city- and jurisdiction-level quarterly counts of violent firearm and nonfirearm incidents from statewide records of deaths from and hospital visits for homicide and assault (2005-2016) and from nationwide crime records of homicides and aggravated assaults (1996-2015). We applied a generalization of the synthetic control method to compare observed patterns in firearm and nonfirearm violence after implementation of the program (June 2010) to those predicted in the absence of the program, using a weighted combination of comparison cities or jurisdictions.Results. The program was associated with reductions in firearm violence (annually, 55% fewer deaths and hospital visits, 43% fewer crimes) but also unexpected increases in nonfirearm violence (annually, 16% more deaths and hospital visits, 3% more crimes). These associations were unlikely to be attributable to chance for all outcomes except nonfirearm homicides and assaults in crime data.Conclusions. The Operation Peacemaker Fellowship may have been effective in reducing firearm violence in Richmond but may have increased nonfirearm violence. (Am J Public Health. Published online ahead of print September 19, 2019: e1-e7. doi:10.2105/AJPH.2019.305288).
Objectives Communities throughout the world are investigating various approaches to reduce violence, especially gun violence. The objective of this study is to determine the cost-effectiveness of the Peace Management Initiative as an intervention to reduce the homicide rate in volatile community in Kingston, Jamaica. Methods A preliminary longitudinal study tracked the homicide rate in a selected volatile community in Kingston, Jamaica, over the 5-year period of PMI intervention in this community. The changes in the incidence of homicides were costed according to direct medical costs and productivity losses assuming that, without intervention, the number of homicides per year would have remained at the 2005 level. This was used to estimate the cost-effectiveness of the intervention. Results The Peace Management Initiative approach reduced homicides by 96.9% over the 5-year intervention period. The cost/benefit ratio for the intervention has been estimated to be JMD $12.38 saved per dollar spent on intervention. Conclusions The Peace Management Initiative approach was seen to significantly reduce the murder rate over the 5-year intervention period and provides a promising cost-effective approach for violence prevention.
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