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How the ‘Cardiff Model’ is tackling US violence

2 March 2020

A recent mass shooting in Milwaukee has left six people dead. Professor Jonathan Shepherd knows the US city well: one of its suburbs, West Allis, has already adopted the ‘Cardiff Model’ for tackling violence. Professor Shepherd hopes the horrific event may prompt the city’s Mayor Barrett to accelerate violence prevention programs and implement the Cardiff Model across the city, putting a Violence Prevention Board at its heart. The Model has been adopted nationally – but the founder of Cardiff University’s Violence Research Group argues city mayors need to implement it now. Here, he reflects on the Model’s journey from his own PhD studies to the streets of some of America’s most violent cities.

“Little did I imagine that sending our published evaluation of a new violence prevention strategy to a couple of hundred criminologists around the world would be a crucial step to formal adoption in the United States.

This novel strategy, initiated and developed in Cardiff by a partnership I chaired for 20 years from July 1997, is based on the discovery in my PhD studies and subsequently, that most violence which results in emergency hospital treatment is not known to the police. The Cardiff Model comprises collection, anonymisation, sharing and use for violence prevention of information collected in emergency departments. This information includes precise violence locations, times, weapons and characteristics of assailants.

One of the recipients of this evaluation, Robert Boruch, professor at the Wharton School at the University of Pennsylvania and a champion of evidence based policy, pricked up his ears and sent the paper to one of his former graduate students, Laura Leviton, then at the Robert Wood Johnson Foundation (RWJF), the United States’ largest philanthropic organisation focused solely on health. After consultation, including with Tom Simon and Curtis Florence, my co-authors at the US federal public health agency, the Centres for Disease Control and Prevention (CDC), Dr Leviton visited Cardiff to discover more about the Model. A substantial grant followed, which funded replication and a process evaluation of the Model in Atlanta and Philadelphia. Along the way, the CDC’s injury research centre in Milwaukee, Wisconsin, was funded by the US Bureau of Justice Assistance to replicate the Model there.

Professor Shepherd visiting Philadelphia

Many lectures and workshops in these cities followed. I’d already presented at the CDC, piggy backing visits onto American Society of Criminology meetings where I present my team’s research.

Our cost benefit analysis was published during this period; it was clear that the implementation and maintenance costs of the Model are far outweighed by the cost savings by health, the justice system and local authorities associated with the violence prevented. Most importantly of course, for citizens and their families the pain, suffering and loss avoided are enormous.

Replication of the Model identified issues specific to the U.S. which can influence implementation. For example, whereas Cardiff, a city with approximately half a million people, is served by just one emergency department (ED), in the United States a city of similar size has several EDs. Helpfully though, implementation of the Model in London involves data collection in 29 emergency departments and the Greater London Authority SafeStats team had developed a way of combining and analysing data from multiple sites. Here was a solution almost tailor made for the United States.

A further issue was prevailing guidance on sharing information collected in hospitals, even depersonalised information such as that which is key to the Cardiff Model, with the police and municipal governments. In the UK, this had been considered and approved by UK Information Commissioners and Cardiff Model data has subsequently been codified by NHS Digital. Similar guidance and reassurance were needed in the United States.

These were forthcoming in the publication in the autumn of 2017 of CDC’s Cardiff Model toolkit. This includes guidance for U.S. cities on setting up the Model, and guidance for hospitals and law enforcement, legal technical and financial considerations, building partnerships, external communications and media relations and a “readiness checklist” for cities and relevant agencies. In his introduction, CDC Director James Mercy writes “We encourage you to use these materials to create a broad partnership to prevent violence in your community”.

Further grants have been awarded in the United States to support implementation of the Cardiff Model, including to apply it to mapping drug overdoses many of which are not known to agencies other than health. In late 2019 CDC funded a further study of facilitating and impeding influences on implementation.

The need for and relevance of the model has been boosted in the United States by a recent study showing that almost 90% of violence resulting in emergency hospital treatment in the state of Georgia is not known to police there, a much higher proportion than in Wales and England according to successive Crime Surveys.

As in the UK, the stories of violence prevention achieved through the Model are as compelling as the data. In West Allis, a suburb of Milwaukee, Cardiff Model data identified a school where violent injury of children is concentrated – a school not identifiable from any other information source. In Atlanta, Cardiff Model data revealed a shopping mall, gas station and budget hostel where serious violence is concentrated, enabling agencies there to recruit managers from these locations to the Cardiff Model partnership.

As in the UK too, lessons from Cardiff Model implementation are being learnt about the mechanisms of prevention. In the multi-agency boards at the heart of the Model, the boards which implement practical prevention based on the data, mutual accountability for prevention is generated – accountability not generated if agencies work in their traditional silos.

Nowhere is such silo working and the need for accountability more evident than in United States policing where 18,000 police departments, some with just a few officers, many not trusted or seen as legitimate, are responsible for violence prevention.

A 2015 Report initiated by President Obama recommended that “Law enforcement agencies should engage in multidisciplinary, community team approaches for planning, implementing, and responding.” As I and Steve Sumner at CDC have written, the Cardiff Model provides a blueprint for such teamwork.

Writing this at my Crime and Security Research Institute desk an image keeps coming to mind of the sign on the door of an Atlanta restaurant, “Cardiff Dinner”, signposting police, health and local government executives to their supper after a day of workshops. For me though, it signalled that the Cardiff Model really had become a Welsh export.”

Professor Jonathan Shepherd, Violence Research Group, Cardiff University

A recent Cardiff Model interview with Professor Shepherd by reporter Talis Shelbourne has been published in the Milwaukee Journal Sentinel