(suspenseful atmospheric music) (lively music) Welcome to "At Issue."

I'm H. Wayne Wilson.

Thank you so much for joining us for the conversation.

This time, we'll be discussing violence, violent crime in Peoria, specifically, and we're trying to address violent crime in a number of ways, but the most recent way is to use the health model.

Can health determine the violent crime level in the city of Peoria?

To have that conversation, I've invited Dr. Fredrick Echols here.

He is the CEO of what's called Cure Violence Global, or CVG.

- Yes.

- [H. Wayne] Thank you for being with us.

- My pleasure, thanks for having me.

- [H. Wayne] Monica Hendrickson is here, a repeat, many, many times on the program.

Monica is the administrator at the Peoria city/county health department.

Thank you, as always, for joining us.

- Thank you for having me.

- And I wanna start by a little bit of background.

Some of you may be familiar with the fact that the city of Peoria, the city council, voted not to pursue this particular program, not because they didn't think it was a good program, but because it was given to them at the last minute, and they didn't exactly know what they were voting on, but some of you may recall that, and I wanted to get that out on the table.

So, the city/county health department said, "Well, we'll put down some initial money, and we're going to invite CVG to come to Peoria."

Why?

- So, first and foremost, this is something that the health department has been pursuing or researching for a while, especially looking at evidence-based models and Cure Violence, over time and time again, demonstrated their ability to make drastic changes around violence reduction, but the reason why the health department really stepped in, and the board of health, is because this is a health issue.

If I were to tell you, H., that there was something that was killing individuals 50 years earlier than their expected life, you know, lifespan, and it was targeting a certain area, you would be asking me, "Monica, what's the surveillance looking like?

What is it, is it a chemical spill?

Is it something that they're eating," or, you know, something of that nature.

Is it a new virus?

Is it a type of cancer?

And we'd be doing a lot of research and try to understand what is going on to really combat it, but in the case, it holds true, but it's not a virus, it's not cancer, it's violence, and so with that, the health department sees this as a health issue that is decreasing the quality of life and the length of life of individuals, and so it's something that we can't ignore.

- And we say the length of life.

I understand from the statistics that the number one cause of death for young people is now guns.

It's no longer automobile accidents.

- Yeah, sadly, that's true, and it really targets the individuals under the age of 24, and so, really, it's our youngest individuals, really in the prime of their lives, as well as their potential lives as well, that are really, you know, in a specific zip code, it's the racial demographic area, and so, really, something that we need to focus on.

- I wanna point out to the audience that your background is not as just CEO of the Cure Violence Global, but you actually have a long history in health departments, specifically, St. Louis, and then prior to that, the state of Illinois.

- Correct, so I was the chief of communicable disease for the state of Illinois, where I helped lead the state's response to several public health emergencies, including the Zika virus pandemic, as well as the Ebola pandemic, and other public health emergencies, and in the city of St. Louis, served as the director of communicable disease control services, veterinary programs, and emergency response for St. Louis county in Missouri, and I was the director of health and the health commissioner for the city of St. Louis.

- So, Monica made reference to, and I did, that health can be, at least, in part, a solution, healthcare can be a solution.

We're not talking about healthcare, you know, getting your vaccinations, et cetera, but can you explain why the Cure Violence Global approach, the plan, mirrors what health departments do?

- Yeah, so public health has been known for establishing evidence-based best practice, and so one of the best practices that had been established over time is how we respond to epidemics and specialized outbreaks, and so, for such a long time, violence has been treated as a criminal, legal issue, and so there's been a lot of missed opportunities to really address the root cause of violence in our communities.

So we know how the criminal justice system works, so once you get funneled in, you get, you know, you pay your debt to society, and then you're released, but then when you're released, you still have those same issues, especially if you're placed in the environment where you had those initial exposures to violence as a younger individual, and so by using a health approach, we're able to not only stop the spread of violence using evidence-based approaches, but we're also able to change the trajectory of health for communities, particularly our most vulnerable communities, who we oftentimes report on through public health data, you know, whether it's chronic disease, such as heart disease, obesity, diabetes, and a slew of other conditions.

Violence should be a part of that as well, and so when we look at, when we think about the social determinants of health, violence should be treated as such as well.

So this gives us an opportunity to implement an approach that not only addresses the root causes, but really, again, changes social norms and creates more resilient and more healthy communities.

- Monica, the agreement with Cure Violence Global, has it reached the final stage at this point?

- So, our agreement is really to do this assessment and readiness phase, and so, just over this past weekend was one of the last steps, which was to go into our areas of interest or these catchment areas, and so, again, one thing to know about this is this is a very targeted approach to a very specific population base, and so these catchment areas are not the entire city of Peoria, but really, you know, one-mile blocks, so to speak, so you could cross the entire area in 20 minutes, you know, walking, but, this weekend, we actually went out into the community and walked those neighborhoods to get an understanding of what was in play, and Dr. Echols mentioned, the approach we're doing is not novel.

It's using a well and true tested public health approach in a way to address violence as a health issue.

So, great example, or qua, is that the model uses violence interrupters.

These are individuals that trade on the trust, they live in the community, they're engaged in the community, everyone knows who they are, and they are credible, and so they use that trust capital to start conversations, and from those conversations, start pulling people towards better options, and I say this is a true and tested, the reason why we have eradicated smallpox or where we have communities where there's no polio anymore is not because physicians and nurses showed up in villages in Pakistan and Afghanistan with their white coats and their vaccines, but rather, they trained and taught village, especially elder village women, about what polio was, what prevention was, what vaccines did, and those were the women who used their trust capital to then teach young families about the value of vaccinations, and that's how they got individuals vaccinated, so it's the same idea.

- I wanna talk more with Dr. Echols about the influencers, but just for the audience's benefit, catchment area is just a geographical area?

- It is just a geographical area, and these ones match up with the data that the police department helped provide, and it's really the hot zones, so where we see the darkest concentration or the highest concentration and rates of violence.

- So think, just to add a little bit to what Monica said, so it's really important for people to understand that the planning that goes into identifying the areas where the program will be implemented, so it's not just pulling us information from a random source.

There's a lot of detailed planning, so working with law enforcement to determine where those areas that have the highest incidence of gun violence, but also, not just, but taking it a step further as well, looking at the specific neighborhoods, even down to the street level, to determine where the program should be implemented because this is also using a health equity and health justice approach, meaning that we're providing the greatest need to those individuals and those communities that need it the most.

- Is it fair to assume that, even though there's going to be three catchment areas, Monica?

- Right now we're looking at three options- - Okay.

- Two for sure, we'd like to see.

- Two, at least two, maybe three, but this program, if implemented and carried forth a number of years, will affect the entire community.

- Yes, so what we typically see is although we have a designated catchment area or geographical area where the program is being implemented, the influence, or the impact, that the program has goes far beyond those boundaries, and I saw that really in St. Louis, so we had three catchment areas in the city of St. Louis, so three distinct neighborhoods, but what we saw was there was an overall positive influence or impact of the program across the entire city, and that's why, during the first full year of program implementation, we were able to see, receive a 25% reduction in homicides across the city of St. Louis.

- And the influencers that we've been talking about, they'll be hired, right?

- Right, correct.

- But who will they be, and I don't mean names or positions, but where are they coming from?

- So the individuals that we hire come from those communities.

So, for example, in Peoria, the individuals that will be hired are from Peoria, and that's really important because we need to make sure that people who are brought on to do this work, we wanna make sure that they have relationships within the communities where the work is being done.

We also wanna know that they are respected by the people living in those communities.

If you hire people who aren't credible and people who are not respected, as I tell my staff, "You don't have staff, you have targets," because the individuals, the groups that they need to engage with are those who are considered to be the most vulnerable, which are those who are typically most likely to be involved in acts of firearm violence, but also other types of violence in community.

- If we're talking about hiring influencers, that requires money.

- Mm-hmm.

- How will this program be funded?

- So, there's gonna be mixed model funding, looking at large grants, as well as foundation dollars and return on investment dollars.

You know, for every homicide or even ICU visit that's prevented, there is a return on investment in terms of community.

You know, when someone is preventing someone from shooting a gun, then that prevents them from going into the criminal justice system, and so the cost savings there as well can be reintroduced into the community to help sustain, but we've already received $250,000 from the city of Peoria's gun violence or violence reduction grants.

It was the first round that they released, and so we're hoping to seek out other funding, but what's also really important, because this is evidence-based, we will be collecting data that allows us to share information back out to not only funders, but the community as a large, to understand the impacts of it, so we can get more buy-in, more investment, and continue the program.

- The health department initiated, made the initial contact, with Dr. Echols and his team, but you're not working in a silo.

Who else are you reaching out to to make sure this is a coordinated effort?

- So, first and foremost, the city of Peoria.

So working with the city manager's office, the mayor's office, the police department, likewise, we have the NAACP involved, school districts, board of health, and part of this narrative is just, you know, really to kind of focus and look at things from the different lenses that we see the issue on, but it also includes healthcare because they are, you know, our trauma centers are directly impacted by gun violence, not only within their ERs, but even the parking lots, where, oftentimes, the next target, sadly, can be identified because of the reaction happening in there, so we wanted make sure we recognize that this is not just for criminal justice or just for health department.

This is gonna be a community-wide response, and so we wanted to have all those voices at the table.

- So with that, go ahead, Dr. Echols.

- Another group that was involved was the religious organizations, so the faith-based community also plays a critical role 'cause in most of our most vulnerable communities, those faith-based institutions are really safe havens for individuals, and so they've been real heavily involved in the process as well, and again, I think the one thing that we really appreciate about the city of Peoria is how the entire system, so a lot of these organizations that work across the local public health system are really coming together to lift this work as a unit.

- While the police department is part of the solution, is there a question that might exist in the public's mind that, oh, you're gonna be asking for informants?

- So we get that question quite often, and so one of the things that we have to make sure the community is clear on is that this is not a police informant program.

So the individuals who are hired as violence interrupters, outreach workers, even site supervisors, do not communicate directly with law enforcement.

We do hire, on an administrative level, work with law enforcement 'cause we have to understand how violence is changing in the community over time, so we utilize data, we talk about data, analyze data, with the police department so that we can understand, again, what changes are happening, and then if we need to modify how we implement our program to make sure that we're not causing harm to the community, we can do so using a data-driven process.

- I'll just also add, while this is very much not a police informant program, it's also not meant to replace police response.

So, after an action happens in the community that triggers a police response, that is the appropriate response.

The Cure Violence violence interrupters, outreach workers, they do not try to ever step into that boundary.

What their job is to prevent it from reaching the point where police involvement needs to happen.

- Is this, with these interrupters or the influencers, are they, this isn't a moral thing, where, you know, you go into someone who made a mistake and say, "You shouldn't have done that."

You're trying to change attitude?

- Right, so we have to understand the types of exposures that individuals are happening, what type of exposure individuals have had, and so by understanding that their action is based on their exposure, we have to engage them in a way that allows us to meet them where they are, and so when we do that, so as part of our process, as well as conducting a standardized intake for individuals who are enrolled in our case management program, so by doing the standardized intake, we're able to identify the true needs of the individuals who we deem to be most vulnerable for committing acts of violence.

Then after we identify their true needs, we say, "Okay, these are the needs that we identified during this process.

What do you want us to help you with?"

And that gives the participant of those individuals who are most vulnerable an opportunity to have control over their destiny, and so, and then, not only that will we follow them, we follow them over time because as they engage with our team, as they engage with the local public health system for resources, their mindset change, their behavior patterns change around not only conflict management, about just their overall health.

So one of the challenges that we see oftentimes in a lot of our communities is the lack of willingness to take advantage of things such as food, food assistance, mortgage and utility assistance, even behavioral health support, and a lot of that is due to the damage that has been done by the systems over time, and so by working with credible messengers and those individuals who are most vulnerable, we're able to get them connected to a system that truly supports them, that changes the entire narrative, not just for that one individual, but to their entire network, and so as we're working with that network, then we start working with the entire community, so you start to see spillover across the entire, not only catchment area, but cities.

- So that's why it's so important to involve other organizations, a whole spread of organizations, because you need to understand the environment that these people grew up in and what services could be available to help break that cycle.

- Exactly.

You know, the biggest thing to recognize is that violence doesn't happen in a vacuum, so solutions also cannot happen in a vacuum, but that this is generations of exposure where violence becomes a normalized behavior, and so by, again, treating this as a health issue, you want to decrease your exposure, not to bring COVID in it, but think about all the things we did to decrease our exposures for COVID, right?

So that we can decrease transmission, and so by then doing those preventative services or those referral points, people are less likely to then re-expose individuals, and so the transmission points start getting cut off, and so, once you have less and less transmission, as well as a change in behaviors and narrative that this is no longer acceptable, all of that really exponentially helps that community to move out of this feeling of, that violence is just a way of life and normalized.

- Assuming that this agreement with Cure Violence Global comes to fruition, is there a start date?

- Well, I think we wanna say as soon as possible or 10 years ago or what have you.

- [H. Wayne] 10 years ago, huh?

- But I think we don't have a, we have a start date, but to actually have it start implementing is two different things, and that's because it comes back to you have to have the right individuals in those neighborhoods, those trusted, credible individuals.

You know, you are a very trusted, incredible individual, but you're not from that neighborhood.

- No.

- And that neighborhood will sense that about you, and while you might have all the best intentions, if that neighborhood does not feel that you are the right fit for them, they will make it well-known, and then the program fails before even starting.

So a lot is pushed in the front end to find and identify the community-based organizations that will hire these individuals, as well as who these individuals are, and then train them.

- And Dr. Echols, you know that people are anxious to reduce violent crime, whether that be murders, shootings, invasions of homes.

How long, with the experience that Cure Violence Global has had, how long does it take before you start to see some sort of reduction in crime?

- So it varies some city to city.

In some cities, you can see almost 50% reduction over the period of a month, based on previous data, but our primary focus is making sure that the teams are properly trained, so that they can implement the model based on the fidelity, because what we've seen in other jurisdictions is because it, violence prevention has become such a politicized topic, everyone has different expectations, so in St. Louis, for example, individuals would say, "Okay, we expect to have a 60% reduction over six months," and it just kinda got out of control, but, really, the focus has to be making sure the staff are properly trained, and when the staff are properly trained and they have the proper support, the results will come.

- So, if you have a particular reduction in crime over a period of two years, three years, you want that to be sustained into the future.

Does this program have a long-term effort that will keep that reduction in crime in place in these communities?

- And so, one of the challenges that we've experienced in public health for decades now is, you know, that the federal government or the local government will establish projects, and so then you have this project period where work is being done and work is funded, and then after the project period, those resources, that funding, goes away.

We really need this to be a long-term initiative for the city of Peoria and all the other cities where we work, and so, to make sure that that's something that is at top of mind for the elected officials, as well as community-based organizations and other key stakeholders, we start having those discussions during the onboarding process.

- So, that's a long-term commitment, not just by the health department, but by all the partners that are involved.

Is everybody prepared for that?

- I think so.

I mean, I think at the point of time, again, this is a health issue.

People are dying, and people are dying too soon, and so, from that public health and public safety standpoint, I think we're all committed to finding solutions.

- This is something that has been addressed time and again in Peoria and many other communities.

How confident are you that this program's going to work in Peoria?

- That's a great question, and so, based on my experience with the health department, so Monica and her team, the elected officials, you know, the city manager's office, the mayor, other key stakeholders who we've been able to engage during our information sessions, people are really, the entire system here is supportive of this effort, and one thing that we aim to do is to be the best partner that we can, and by doing that, we have a couple of things that we'll be doing for the city of Peoria as we implement the work.

So one is training all the staff on our database, how to utilize our database so that we can capture information on the activities that they conduct in the catchment areas and even outside of their catchment areas that are related to violence prevention, and then each month, we'll issue a stakeholder report to the oversight agency, in this case, the local health department, and that information can be shared with other partners to make sure everyone has the same understanding around the impact that the program is having and how the data is also being utilized to inform quality improvement, performance management efforts to make sure that the program is being implemented as efficiently and as effectively as possible, but the other part of that is also making sure that the community, so laypersons in the community, are aware of what's happening in their neighborhoods.

One of the disconnects that oftentimes happen with these special projects with public health is the community is left out.

We're at a point where we have to shift power from government to community.

These are people who have the solutions, but oftentimes, because of our prescriptive nature, we go over and say, "This is what you need based on data," but no, we've been hearing them, and so as we hear them, we're able to tailor our model to make sure that we're meeting their needs, but then utilizing the data to make sure we're doing them as efficiently and as effectively as possible.

- Monica, you can have these interrupters or influencers come in and talk with the neighborhood, but social media has influenced so many of them, and it continues to.

They see disinformation, television stations talk about the latest murder or the latest shooting.

How do you address the social media aspect of this when you're trying to help these targeted areas?

- So I think there's, social media plays multiple roles in this type of work.

One, it can be used as a tool to counteract some of this conversation, but what we're finding now is, as Dr. Echols mentioned, that the trends in violence even, have followed along with social media.

You know, before, it's, you know, decades ago, it was related to specific gangs or, you know, the arms of gangs that have come down into Peoria.

Now, these are not even gangs, these are loosely based cliques that are connected via social media, and so sadly, oftentimes, you know who the next individual is or who the next possible target is because of something that's posted, so it can be a good thing in terms of helping counter some of the information, but the same time, the program utilizes it as a means to recognize kind of the next approach.

- And with that, our conversation has to conclude because we've run out of time, but Cure Violence Global will continue in Peoria.

If Monica Hendrickson has anything to say about it, I assume, so, and Dr. Echols as well.

Dr. Echols, Dr. Fredrick Echols, who is the CEO of Cure Violence Global, thank you for fitting us into your schedule.

I know you've been all over the country.

- It's always a pleasure to visit Peoria, so I'm glad, happy to be here.

- [H. Wayne] And Monica Hendrickson, who's the administrator at the Peoria city/county health department, thank you for your input.

- Thank you.

- We'll be back next time with another edition of "At Issue."

We'll be talking about the expansion of Uptown South in Normal, and that long-awaited Riverfront Park in Peoria.

Join us for the next "At Issue."

(lively music) (lively music continues) (lively music continues) (lively music fades out)