Gary Slutkin, MD is an epidemiologist who spent his early career working to eradicate AIDS, cholera, and TB in Africa through the World Health Organization (WHO). After a decade of grueling work, he decided he needed a break, and returned to his hometown of Chicago and a position at the University of Illinois at Chicago (UIC). His break never really materialized, as he found himself mesmerized by the local headlines of murder and violence on the streets of Chicago. He began looking at maps of where the shootings were taking place. What he found looked remarkably similar to the maps pinpointing the outbreak and spread of any infectious disease. Slutkin wondered if it might be possible to treat violence as an infectious disease and “cure” it using the same protocols that have proven effective time and again since John Snow first introduced the model to stop the spread of cholera in the mid-19th century.

Using the rigor that the WHO had trained in him, Slutkin spent five years (from 1995 to 2000), conducting research and developing his disease control model. He was convinced that violence could be halted with a three-pronged approach taken directly from the public health model: first, interrupt the transmission; second, identify and change the thinking of the highest potential transmitters; and third, change social norms.

He named his disruptive innovation CeaseFire Chicago. In 2000, having conducted an epidemiological analysis of violence clusters and transmission dynamics in Chicago, he put his theory to the test in the West Garfield section of Chicago, the most violent neighborhood in that city. That first year, there was a 67% reduction in shootings in that neighborhood. Since then, CeaseFire—now called Cure Violence—has a visible presence in many of the most violent communities of a notoriously dangerous city. Their results have continued to be statistically significant, with a 41-73% decrease in shootings and killings[ii] (the success rate varies by neighborhood). In five of eight communities studied by the Department of Justice, retaliatory shootings were stopped entirely (100% reduction).

The remarkable decrease in retaliatory attacks, in particular, points to the efficacy of the first of the three tenets of the program: interrupt the transmission, which is best done in the heat of the moment. Veterans of the streets are recruited and trained to become “violence interrupters.” Their rap sheets from the lives they now renounce serve as the entrée into a world where law enforcement and well-intentioned social workers are largely shunned. Interrupters roam the streets at night, keeping tabs on those most likely to shoot or be shot. With their ears close to the ground and their bona fides, they are able to step in in the heat of conflict and temper emotionally charged situations.

Interrupters are carefully recruited—like those they now help, they have grown up knowing only a life of crime. But maturity, or too many long days in jail, or some seminal moment have awakened in them the conviction to renounce violence and crime as a way of life. Interrupter Cobe Williams explains that his son was three years old when he first went to prison for attempted murder. At one point, during a court hearing, he was able to embrace his son for the short time his handcuffs were off. When they were put back on and he was being led back to his cell, his long walk back was accompanied by his son’s cries of “I want my daddy. I want my daddy.” “I realized then and there, I wanted to be a father to my son,” he said. Williams’ son was 11 when he was released from jail for the last time. That same son in currently in college. “He’s so proud of me,” Williams marvels. Williams’ son has not been in trouble with the law—the violence did not spread from father to son.

The question that begs to be asked is why anyone would actively choose to work as a violence interrupter. In fact, the interrupters are considered local heroes, according to Daniel Webster, director of the Johns Hopkins Center for Gun Policy and Research. Many covet the job and actively pursue it when they’re released from jail (prison outreach is a big component of the interrupters’ job). The job comes with a living wage and benefits. The recognition that the problem lies not with bad people but with bad behaviors diffuses any blame and mobilizes the people doing the shooting to be the primary resource in combatting the problem. Williams commented, “I got to do what I got to do.” Or as Joshua Gryniewicz, formerly the communication director for Cure Violence, said, “It’s not a job for them. It’s a calling. The recurring story is that they’ve taken so much; they just want to give back.”

All interrupters are vigilantly screened. No small part of their selection can be attributed to what kind of reach they have on the streets. They must be trusted by the community in order to be effective. According to Williams, the vetting is good enough that, over the past 10 years and about 300 ex-offenders, only about six have relapsed. Once accepted into the program, they undergo a 40-hour training in public health principles as well as things like conflict mediation, crisis work, and motivational techniques. That is followed up with booster training after several weeks on the street. They meet weekly, either in person or via Skype conference calls. The 2009 Department of Justice report indicates that the vast majority of interrupters feel sufficiently trained and supported in their work. Cure Violence is one of the highest profile employers of ex-felons. Slutkin is pushing for elevating their status further by having them designated as health care paraprofessionals—a logical next step, since funding for the program often comes from state health departments.

An equally dedicated and trained cadre of outreach workers complements the work of the interrupters, helping to flesh out the three core principles of the program. While the interrupters work in the heat of the moment, the outreach workers provide a type of back-up support, helping those in crisis with the very things that will help bring them stability: finding jobs, dealing with substance abuse, getting their GEDs and/or vocational or college training, severing their ties to gangs, etc. Like the interrupters, they come to Cure Violence with street credibility and a belief in a different future. They, too, work to change the community norm away from one where violence is an accepted avenue of behavior. By working to decrease community tolerance for gun violence, Cure Violence is creating a change in social norms, which they have identified as being critical to the success of the program.

The Chicago model has generated substantial interest from cities around the country and, indeed, around the world. These cities are desperate to cure the violence that is not only killing their young people, but directly impacting the economic viability of their neighborhoods. Replication is site-specific, dependent on funding factors, local host organizations, and local politics, among other things. Each city finds its own way in the implementation. What is immutable, however, is the theory of change: the belief that violence can be better addressed as part of a medical model than when viewed from a moralistic perspective. All of the training and technical support is provided on a contractual basis by the Cure Violence national team, headquartered in Chicago.

In 2007, Baltimore instituted the Cure Violence model and called it Safe Streets. Like the Chicago program before it, the efficacy of the Baltimore program, operating in four neighborhoods, was evaluated by outside sources—this time by the CDC. It, too, found that the program was associated with a reduction of homicides and nonfatal shootings. Brooklyn, New York, was the third American city to implement the program. The outside analysis of the local program once again showed statistically significant reduction in gun violence in the community where Cure Violence was at work.[iii] Notably, all three of the studies remarked that the program does not have a displacement effect—violence isn’t increased elsewhere when the model is introduced. In fact, there’s some evidence that shows that violence actually decreases in neighboring communities.

The national staff of 30 people in Chicago oversee the program at 50 sites in 16 cities across the country, with a budget of just under $10 million (funding, which is largely governmental, is funneled through the University of Illinois at Chicago’s foundation and varies depending on renewal of city contracts). About 200 violence interrupters and outreach workers make up the “boots on the ground” around the country. The national partners meet weekly by phone; the international partners are in equally close contact. Cure Violence programs currently operate in Honduras, South Africa, England, Kenya, Iraq, Syria, and Columbia. Brazil and Trinidad are in various stages of starting programs. In 2013, Global Journal placed Cure Violence the 9th on its list of the 100 top NGOs.

According to Karen Volker, director of Cure Violence’s Washington, DC office, the organization stands apart because “We’re the ‘only’ anti-violence program that actually interrupts the violence. That gives space for the other programs that start on the periphery to flourish.”

“[Gary]’s like a Buddhist monk. He never gets emotional, he never gets angry. He doesn’t get involved in the petty stuff, and that sets the tone for us…There is no judgment…It’s aspirational for me,” reflects the organization’s international director Brent Decker. “He’s an empowering person, a visionary who pushes us.” Others outside the organization are equally inspired by Slutkin’s vision. In 2011, PBS’ Frontline aired The Interrupters, a full-length film that explored the work of three interrupters.

“They see violence as their disease. They expect to die of this,” says Slutkin in The Interrupters. Cure Violence is working to change that expectation. Over the past 13 years, there have been reductions in shootings and killings of 16% to 34% that are directly attributable to the strategy. It’s clear that the epidemic of violence is, indeed, being interrupted.

Nonprofit Nutshell: Gun violence takes the lives of nearly as many Americans as do motor vehicle crashes. The US homicide rate is seven times greater than other high-income countries.[i] The Chicago-based organization Cure Violence has been steadily reducing gun violence throughout the country and around the world for 14 years. The program takes a radically different look at violence by likening it to a disease and viewing it through the lens of epidemiology. Epidemiologist Gary Slutkin’s expertise in combating infectious disease informs his approach to stemming the tide of violence in American cities. In 2000, he formed Chicago-based Cure Violence (then called CeaseFire), convinced that violence could be halted with an approach taken directly from the public health model: first, interrupt the transmission; second, identify and change the thinking of the highest potential transmitters; and third, change social norms. At the core of the program are the violence interrupters and outreach workers—veterans of the street who are carefully recruited and trained to stem the flow of violence. Cure Violence has effectively reduced shootings and killings by 41-73% in urban neighborhoods around the country. Dr. Slutkin is a 2013 recipient of an Elfenworks In Harmony with Hope award.
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[i] Center for Disease Control and Prevention, 2010. [ii] Evaluation of CeaseFire-Chicago by Wesley G. Skogan, Susan M. Hartnett, Natalie Bump and Jill Dubois with the assistance of Ryan Hollon and Danielle Morris, National Institute of Jusitce, US Department of Justice, Washington, DC, March 17, 2009. [iii] Testing a Public Health Approach to Gun Violence, An Evaluation of Crown Heights Save Our Streets, a Replication of the Cure Violence Model by Sarah Picard-Fritsche and Lenore Cerniglia, Center for Court Innovation, New York, NY, January 2010.

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