November 4, 2019
By Talis Shelbourne
Welsh law enforcement officials were concerned. For years, crime had been increasing in their country. Between 1981 and 1995, the number of violent crimes in the United Kingdom as a whole nearly doubled, leaving officials unsure of what to do.
But it was around that time that Jonathan Shepherd revisited a discovery he’d made years earlier as a doctoral student at Bristol University — a discovery that led to a new approach that is credited with reducing violence.
The evidence is compelling: In the Welsh capital of Cardiff, hospital admissions for violence-related injuries dropped almost by half and the government saved millions of pounds after Shepherd’s model was implemented in 2001.
Now, a version of Shepherd’s work is being tested in West Allis, where police, hospitals and researchers believe a coordinated effort to better identify violent acts could help law enforcement and others decide where to deploy resources.
What Shepherd found
The story begins years earlier when Shepherd began comparing the city of Bristol’s police and emergency services data and discovered that law enforcement was missing 75% of violent injuries.
He published a study about that discovery in 1989, and as he continued his research, Shepherd realized the more complete data might be able to reduce violent crime in Cardiff and beyond.
Shepherd pulled together a team of government officials, police and hospital executives and combined their data to map areas of violence and injuries. The maps made it easier to identify which resources were needed where.
And the number of violent incidents began dropping dramatically.
Shepherd called his approach the Cardiff Model, and soon his coalition of partners became known as the Cardiff Violence Prevention Board. It now has met more than 140 times to identify and deploy the resources needed to prevent violence.
Shepherd’s work has since been adopted across the United Kingdom and in some U.S. cities, such as Philadelphia and Atlanta.
Two years ago, West Allis decided to see if it could work here.
How does the Cardiff Model work?
The federal Centers for Disease Control and Prevention describes the Cardiff Model as a three-part, interagency approach that:
- Documents violent crime and injury trends using police, health, geographic and other data;
- Compiles the data to map areas of crime and violence;
- Deploys resources to those areas to address incidents of crime and prevent future crimes.
The model records as many details as possible about crime, such as the weapon used, number and relationship to perpetrators, time and location of violence and type of injury; then it is depersonalized to protect patient privacy.
Shepherd and other researchers conducted a study in 2011 comparing the levels of violence in Cardiff to 14 similar cities. According to their findings, the model’s use resulted in a 32% reduction in police-recorded injuries and a 42% reduction in hospital-recorded violence-related injuries.
Moreover, for every $1 spent on the Cardiff Model, the criminal justice system saved $19 and the health system saved nearly $15 — a total savings of $6.6 million, the study found.
Shepherd, now a surgeon, professor and criminologist at Cardiff University’s Crime and Security Research Institute, said the success spurred him to see if the model could work in other countries.
In Australia, emergency department doctors began asking intoxicated minors with injuries where they had been drinking; the results were used to identify bars serving alcohol to minors.
In Kingston, Jamaica, St. Williams Park was identified as a hot-spot for crime and injuries.
And in Britain, it was found that domestic violence is predominant in rural areas while cities tend to produce alcohol- and tavern-related violence.
Testing the idea in West Allis
Members of the Medical College of Wisconsin’s Comprehensive Injury Center had been interested in the Cardiff Model for a while, but they didn’t know if it could work in the U.S.
Where Britain has universal health care, the U.S. has a private insurance model, which could make collecting health data more difficult. In addition, the U.S. has a much higher rate of firearm deaths than Britain, where handguns are illegal in most areas; tamping down gun violence might require gun legislation — a highly contentious prospect politically.
To see if the model could be translated to Wisconsin, two Medical College researchers — Assistant Professor of Research Jennifer Hernandez-Meier and the department Chair of Emergency Medicine Stephen Hargarten — used U.S. Department of Justice funds from a nearly $500,000 National Institute of Justice grant.
That was the first of four grants they’ve tapped since 2015 totaling $1.7 million to implement Cardiff here. The grants were used, in part, to survey hospital employees, evaluate how to integrate the program without disrupting hospital activity, add violence queries to multiple hospitals’ data entry systems and retrieve that data every month for analysis.
Sally Nusslock, the previous health commissioner of the West Allis Health Department, is credited with bringing the Cardiff Model to West Allis. Both the Health Department and the Medical College of Wisconsin worked together to form the Violence Free West Allis Collaborative, a collection of government, social service providers and other agencies.
Nusslock could not be reached for an interview, but current West Allis Health Department Commissioner Bob Leischow said he is excited about continuing the efforts she began.
How is the model being implemented in West Allis?
Every month, Sarah Kohlbeck, assistant director at the Comprehensive Injury Center, analyzes data from West Allis police, emergency medical services and Children’s Wisconsin (formerly, Children’s Hospital), as well as Froedtert Hospital’s Emergency Department, Aurora West Allis Medical Center and St. Luke’s Medical Center.
Kohlbeck maps the data for bi-monthly community meetings, an effort that has been ongoing for almost two years, she said. Then, the West Allis Health Department brings groups together — such as representatives from the Medical College, community groups, and police and fire departments — to share and explain the data.
The process allows the groups to see patterns and develop strategies to address violence. In August, representatives met to discuss resource deployment strategies.
Michael Levas, a pediatric emergency medicine physician, helped implement the Cardiff Model at Children’s Wisconsin.
“The Cardiff Model bridges data for better mapping,” he said. “The more powerful part of the model brings together community members, stakeholders and public health officials for whatever is being found in those maps.”
Levas said the model also addresses patterns of escalating violence.
“The whole idea with Cardiff is that we know minor injuries and violence leads to more serious violence,” he explained.
In an article written in 2017, Levas listed some of the model’s findings in West Allis:
“For example, in the past year, we saw 10 injuries within a 500-foot area. We examined that location and found it contained four bars and a liquor store. It’s no secret that drugs and alcohol are common contributing factors to acts of violence. We also learned that 40 percent of all of the assaults happened in or around schools ….”
West Allis Deputy Police Chief Christopher Botsch said he is excited about the model’s potential for targeting opioid use.
“Right now, the health department in the city of West Allis is looking at an opioid review committee so they can use a similar model to the Cardiff Model to analyze overdose deaths,” he said.
The West Allis Health Department received nearly $1 million grant from the Bureau of Justice Assistance to help support this opioid-focused initiative.
Milwaukee officials studying Cardiff Model
The Cardiff Model has never been used in the city of Milwaukee, but data analysis has informed law enforcement in the city for years, said Milwaukee County District Attorney John Chisolm.
“Basically, you are looking to identify red flags and link them all together so you can precisely focus in on areas,” he said. “It’s totally consistent with what the Milwaukee Police Department has been doing: Let’s identify the individuals who are at the highest risk, and let’s introduce some type of intervention for those individuals.”
To implement a version of the Cardiff Model in Milwaukee, officials are using a small donation from the Avielle Foundation, which focuses on violence reduction, to target high-violence areas and take actions to prevent violence — cutting down trees that hide illegal activity in a park as one example.
In Milwaukee, Reggie Moore, director of the city’s Office of Violence Prevention, has taken the lead. He said addressing violence before it escalates can reduce fatalities.
“Where you have high concentrations of aggravated assaults, it is typically an overlay of where you will see nonfatal shootings and homicides,” he said.
Moore met with community groups to discuss the idea in August. More than 30 representatives were invited including Milwaukee’s police and fire departments, United Garden Homes, Safe and Sound, Amani United, the Dominican Center, Urban Underground, and Sherman Park Community Association along with representatives from Froedtert and Children’s Wisconsin.
Transparency, Moore said, is essential for building the community partnerships needed to address violence.
“The data around violence has to come from more than just the police,” he explained. “The more we can try to understand the scale of the problem in Milwaukee, the more we can try to get ahead of it.”