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Addressing Community Violence in St. Louis County

Existing Strategies, Gaps, and Funding Opportunities to Support a Countywide Approach to Violence Intervention

Introduction

Community violence in the St. Louis region is a pressing public health crisis. While much of the attention falls on the City of St. Louis, where homicide rates are 16 times higher than the national average,1 the reality is that the County of St. Louis is facing a parallel epidemic of violence, with shootings that are crippling the lives of residents, especially residents of color —and particularly young Black men. This is an issue that is reducing the quality of life for residents and depressing economic growth for the entire region.

But there are steps that can be taken to turn the tide of violence in St. Louis.  

In early 2022, Missouri Foundation for Health contracted with the Giffords Center for Violence Intervention to synthesize the information currently known about the scope and nature of the community violence epidemic in the County of St. Louis and identify strategies that need to either be implemented or scaled up to address this growing crisis. In recognition of the fact that this work requires a significant infusion of resources, Giffords staff and partners have also mapped out county, state, and federal funding opportunities to support the recommendations made here. 

This report is a follow up to a similar project Giffords Center for Violence Intervention completed earlier in 2022, which looked specifically at community violence in the City of St. Louis—one of the few cities in the nation to see a significant reduction in homicides and shootings between 2020 and 2021. Taken together, these reports represent a roadmap of regional actions that can and should be taken to make the St. Louis region a safer, more equitable place to live.

At the time of our city-level report, St. Louis did not have a clear violence prevention infrastructure to support the variety of efforts taking place on the ground. In July 2022, Mayor Tishuara O. Jones signed Board Bill 65 that codified the establishment of an Office of Violence Prevention (OVP) within the Department of Public Safety. Additionally, the mayor committed nearly $13.6 million in American Rescue Plan dollars to funding community violence prevention and youth programs through 2026, although the OVP plans to explore funding opportunities to extend programs in a more sustainable manner beyond that timeline. “Bringing together law enforcement, social service providers, and community groups under this innovative new office, we can make strides to prevent violence crime in St. Louis,” said the inaugural director of the Office of Violence Prevention, Wilford Pinkey Jr.2  

“Community violence” is defined by the United States Centers for Disease Control, is violence that occurs “between unrelated individuals, who may or may not know each other, generally outside the home. Examples include assaults or fights among groups and shootings in public places, such as schools and on the streets. Research indicates that youth and young adults (ages 10-34), particularly those in communities of color, are disproportionately impacted.”3 Community violence includes shootings, homicides, stabbings, physical assaults, and the unnecessary use of force by law enforcement. 

This violence is the result of many complex systems and inequities, from segregation and disinvestment in communities of color to grave disparities in the criminal legal system, among others. But until the immediate bloodshed is dramatically reduced, progress on any larger social issue in St. Louis will be more difficult, as violence is both a symptom and a cause of inequity.

Community violence creates tremendous human suffering and also generates economic losses for the entire region. The National Institute of Criminal Justice Reform estimates that a single homicide in St. Louis costs taxpayers in the city, county, and state $1 million, and the public cost of a single nonfatal shooting is $534,000.4 Based on these estimates, homicide in the County of St. Louis in 2020 alone cost more than $192 million in healthcare, law enforcement, lost wages, and other related expenses.

To better understand the lived experiences of those committed to facilitating meaningful reductions of violence in St. Louis County, members of our team traveled to the county to have in-person conversations with community stakeholders representing government agencies, nonprofit organizations, and residents directly impacted by violence. This took the form of multiple stakeholder focus groups, which were generously hosted by North County, Inc., a regional development association,5 and one-on-one interviews with dozens of individuals in the St. Louis area about what they believe the gaps are as it relates to a county-level response to community violence. Giffords would like to deeply thank Rebecca Zoll and Evan Maxwell of North County, Inc., for their assistance in identifying stakeholders and setting up these meetings.

The team hosted virtual follow-up conversations and interviews with leaders from social service offices, county political leaders, community-based organizations, and law enforcement officials to get a firm grasp on the landscape of community violence and the evidence-informed efforts being supported. Additionally, a broad range of documents were reviewed to improve our comprehension of the type of data organizations collect and their overall impact on reducing community violence, including annual reports, intake assessments, geography-based service utilization heat maps, and relevant policy and budget documents. Over 100 different stakeholders were interviewed over the course of this project, and an invaluable amount of insight was shared. The Giffords team is tremendously grateful to the St. Louis community for their trust and candor during this process. 

Community violence is a daunting challenge, but we know that progress is possible. This report is intended to assist St. Louis County leaders and community stakeholders in prioritizing—and funding—the most effective solutions for reducing community violence as quickly as possible.

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Understanding the Region

Before exploring the landscape of community violence in St. Louis County, it’s important to provide some context about the region and the county’s relationship with the neighboring City of St. Louis. 

The County and City of St. Louis voted to separate in 1876 during what many refer to as the “Great Divorce.”6 This separation has withstood over a dozen attempts at reunification and continues to have a major impact on the entire region. To this day, the two entities remain entirely distinct, with separate county and municipal governments and public agencies. Over the years, the schism has presented challenges for both the city and county alike.

Fragmented Governments and Services 

The St. Louis region is among the most institutionally fragmented metropolitan statistical areas (MSAs) in the nation.7 It ranks third among all other MSAs in the US for the largest number of local governments and school districts per capita, according to a 2015 analysis by the East-West Gateway Council of Governments.8 Furthermore, research shows that this type of fragmentation, particularly as it pertains to school districts and municipal governments, is more likely to lead to racial and economic segregation.9 As of 2017, school districts in the St. Louis region are the sixth-most segregated of all major metro areas in the country.10 

St. Louis County alone is made up of over 90 cities, towns, and census-designated places,11 the majority of which have their own municipal governments and are served by a patchwork of around 55 police departments.12 Not long ago, the number of police departments serving the county was closer to 80, but after numerous reports identified these disjointed police forces as a major source of confusion and distrust among residents,13 some jurisdictions worked to consolidate their resources to better serve the community. For example, the North County Police Cooperative, which was established in 2015, consolidated several police departments serving eight St. Louis County communities.14 While this marks significant progress, fragmentation remains an ongoing and serious challenge for the county. 

Due to the incredibly fragmented nature of St. Louis County, comprehensive, municipal-level crime data for the county is not readily available. The Missouri State Highway Patrol (MSHP) aggregates and reports countywide homicide statistics, but still only captures a snapshot of violence in the county.

Though variations between law enforcement and CDC data are common due to differences in how data is collected and how homicides are classified, a comparison of MSHP and CDC data reveals that a large and significant number of homicides—sometimes as much as half of all homicides in a given year—are not captured by MSHP statistics.

Systemic Racism and the Delmar Divide

The Great Divorce also had a significant impact on the size of St. Louis City and County and their ability to grow. At the time the two entities diverged, the City of St. Louis was experiencing a period of rapid expansion and benefited from industry and a large, affluent tax base. The county, on the other hand, had a much more rural population, limited resources, and substantial debt.15  

Today, fortunes in the city and county have reversed. 

Borders drawn at the time of the separation nearly tripled the size of the city, but also restricted its growth. By 1950, the population of the City of St. Louis was at nearly one million residents and expected to rival major metropolitan areas like New York and Chicago.16 As of 2020, the city is home to about 300,000 residents.17

After 1950, the city experienced a period of rapid population decline. This occurred, in large part, as a result of “white flight,” a term that refers to the migration of white Americans from the cities to the suburbs that occurred in many American cities throughout much of the first half of the 20th century.18 While the number of people living in the suburbs grew quickly during this period, by 1970, just 4.5% of the country’s suburban population was Black.19 For the City of St. Louis, this exodus left behind an older, lower-income, and predominantly Black population, and whittled away at the city’s once robust taxbase. 

Meanwhile, discriminatory policies like redlining worked to uphold and reinforce the segregation of Black residents by preventing them from owning or purchasing homes in some neighborhoods and labeling others as “hazardous” or “declining” due largely to the presence of Black homeowners.20   

As a result of this discrimination, 98% of federally insured home mortgages nationwide between 1934 and 1962 went to white borrowers.21 This left most homeowners of color cash-strapped and unable to make the repairs necessary to maintain their homes, pass them on to future generations, and build generational wealth. 

By the time the Fair Housing Act of 1965 passed, much of the damage was done, and deep structural divides were created. The Delmar Divide, as it’s often called, refers to an almost 10 mile-long road that spans across the City of St. Louis and part of the county, and divides the city into a northern and southern half, which have dramatically different demographics and huge disparities in wealth, income, and even life expectancy.22  

During the Jim Crow era, the street separated white neighborhoods from Black neighborhoods, and today in the City of St. Louis, neighborhoods directly north of Delmar Boulevard are 98% Black with a median income of $18,000, while neighborhoods south of Delmar are 73% white, with a median income of $50,000.23 Out of the 50 largest metropolitan areas in the US, St. Louis is ranked as the seventh most segregated.24  

Source: “A Picture is Worth 930 Words: The Delmar Divide,” Wiley Online Library, https://onlinelibrary.wiley.com/doi/10.1111/foge.12065.

In both the city and the county, vacant and dilapidated homes line the north side of the Delmar Divide, while homes worth hundreds of thousands cover the south side. It is a clear and troubling glimpse of how discriminatory policies continue to impact residents long after the laws have been changed. 

From the City to the Suburbs 

Still, from the 1970s on, a rapidly growing number of people of color began to settle in the suburbs, and by 1990, 37% of Black people residing in metropolitan areas in the US lived in the suburbs.25  

As race and class are closely linked in this country, the number of low-income people moving to these more rural areas also increased significantly. Between 2000 and 2010, in the country’s largest metropolitan areas, the number of people living in poverty in American suburbs increased 53%. By 2010, 55% of people experiencing poverty and residing in a metropolitan area called the suburbs home.26 According to Professor Todd Swanstrom from the University of Missouri, St. Louis, the region was on the “leading edge” of these trends. 

“Compared to other metropolitan areas,” writes Swanstrom, “more poor and minority households live outside the central city in the St. Louis metropolitan area. According to the 2010 census, only 30 percent of those in the metro area who identify as ‘black only’ live in the city of St. Louis.” Today, 27% of Black people living in the St. Louis metro area live in the City of St. Louis.   

Many Black and low-income people moving to suburban areas of St. Louis encountered a very unfamiliar, complex, and in many ways less efficient system of governance in the county. As Swanstrom explains, “Instead of one city government and school district, they face a fragmented institutional landscape of smaller (and often weaker) municipalities and school districts.” Furthermore, many new residents moved to unincorporated areas that fall under the jurisdiction of a distant county government.27 The unincorporated areas of St. Louis County presently contain nearly one-third of the county’s total population and one-third of its geographic area.28 

According to Swanstrom, the pattern of suburbanization of Black and low-income households in St. Louis follows Homer Hoyt’s sectoral model of neighborhood change, meaning that neighborhoods grow and expand as economic groups migrate outward along key transportation routes. As Black households in St. Louis have historically migrated north and west of the urban center,29 this theory helps explain how the divisions created by the Delmar Divide have extended from the city into the county. As Swanstrom explains, “Black suburbs are basically an extension of the segregated black communities in North St. Louis City.”30 As a result, people living in the northern part of the county experience many of the same hardships including a low per capita income, high poverty rate, and high rates of violence.

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St. Louis County

According to 2021 estimates from the US Census Bureau, St. Louis County—the largest county in Missouri—is home to nearly a million residents. Over two-thirds of people residing in the county are white (64.7%) and one-quarter (25.1%) are Black. The next largest racial or ethnic groups in the county are the Asian and Hispanic or Latino communities, who make up five percent and three percent of the population, respectively.31   

The county is comprised of seven council districts and has 686,293 registered voters. St. Louis County is led by an elected county executive, Dr. Sam Page, and a seven-member county council elected from the seven council districts.32 While there are services that are provided county-wide, however, the 88 municipalities have primary responsibility for their own public safety, planning, street maintenance, and other local services. The unincorporated area of the county, which contains nearly one-third of the county’s population and one-third of its geographic area, comes under the jurisdiction of the county government.33  

The median household income in St. Louis County is $68,661, exceeding both the state ($57,290) and national ($64,994) median income.34 Overall, poverty is relatively low in St. Louis County, and as of 2020, nine percent of county residents live in poverty.35 

However, as St. Louis’s complex history demonstrates, these figures fail to accurately describe many parts of the county, in particular the experience of many Black residents. Approximately 83% of Black people living in St. Louis County reside in what is often referred to as “North County.”36 As described above, this area more closely resembles the highly segregated and underserved communities in the northern part of the city than it does the rest of the county. 

Source: Explore MO Health, https://cares.page.link/Bvvj.

Unlike the rest of St. Louis County, North County is majority Black. Nearly two-thirds of residents living in North County are Black while less than a third are white.37 The average per capita income in North County is about 40% lower than the rest of the county, and people are more likely to live in poverty, with 16.5% of the population living at or below the federal poverty level.38  

Educational attainment in North County also lags behind the County as a whole. Almost three-quarters of North County fourth graders scored “Not proficient or worse” on state standardized tests measuring reading proficiency, compared to 55% of 4th graders countywide.39 North County residents are also more likely not to have a high school diploma (10%) than residents of the county more broadly (6%).40 

Research shows that community level factors such as poverty, poor economic conditions, and a lack of access to quality education, among others, can lead to high rates of gun violence.41 As described above, North County struggles in many of these areas as a result of a history of discrimination and divestment from the North St. Louis region, where most of the county’s Black population resides. This is in line with research from Northeastern University, which suggests that many community-level factors are the result of deep structural inequities rooted in racism.42

Community Violence in St. Louis County

Though conversations concerning violence in the St. Louis region tend to focus on the city, the county also struggles with a serious violence problem and high rates of shootings and homicides.43 Between 2016 and 2020, St. Louis County averaged nearly 160 homicides per year, almost 90% of which were committed with a firearm. During the same period, the county saw an average homicide rate of 17.5 per 100,000 residents.44  

Though this is significantly lower than the homicide rate in the neighboring City of St. Louis (48.5 per 100,000), the county experiences 34% more homicides per capita than the rest of Missouri (11.5 per 100,000) and more than 2.5 times the national homicide rate (6.4 per 100,000).45 

The number of homicides in St. Louis County has increased by more than 78% between 2016 and 2020, and in 2020, the most recent year for which the CDC provides data, the county suffered 192 homicides, 94% of which were committed with a gun.46 However, according to the Missouri State Highway Patrol, which as explained above does not capture the full picture of violence in the county, the number of homicides committed in St. Louis decreased by 15% in 2021.47  

While many stakeholders in the St. Louis region are focused on preventing youth violence, very few people under the age of 18 are the victims of homicide in the county or the city. According to our analysis of CDC data, the average age of a gun homicide victim in the county is about 31.5 years old, nearly identical to the average age of a gun homicide victim in the city.48 In the county, 61% of homicide victims are between the age of 18 and 35, while only seven percent of homicide victims are 17 or younger.49  

Homicides in the county take a disproportionate toll on the Black community, who make up roughly a quarter of the population but account for almost 90% of gun homicide victims countywide.

This violence overwhelmingly takes place in North County, where the vast majority of Black residents reside, and systemic barriers have created pockets of concentrated disadvantage. Murder and homicide data compiled by the St. Louis County Police Department (SLCPD), media reports aggregated by the Gun Violence Archive, and hospital utilization data all reveal that a disproportionate share of violence occurs in North County.

According to SLCPD, 67% of homicides within the department’s jurisdiction—which includes just under 50% of the county—occur in the North County and Jennings Precincts.50 Media reports aggregated by the Gun Violence Archive reveal that 72% of homicides occur in North County municipalities.51 Hospital inpatient, emergency department, and outpatient injury-related data from Washington University further shows a concentration of assaults, injury deaths, and high mortality rates in North County, as evidenced by the heat maps below.52

Source: Explore MO Health, https://cares.page.link/Bvvj.

For this reason, this report focuses on efforts and solutions in the North County area, but it’s important to understand that violence impacts every single resident of St. Louis County. Even for residents of relatively safe neighborhoods, the economic impact of community violence is staggering.

Given this, reductions of homicides and shootings in North County will not only save lives, but also bring economic and health benefits to the entire region and is an investment that is unquestionably worth making. From employment to tourism, there are a multitude of reasons to take a regional approach to reducing violence and adjusting the mindset that harm only touches a fraction of the St. Louis community—everyone is affected.

Risk Factors for Community Violence

In addition to these general trends, research has also established several individual and community-level risk factors that, when present, make it more likely that a person will commit or be the victim of community violence. The presence of risk factors helps indicate where interventions and services need to be focused, while protective factors indicate what kinds of interventions and services are most likely to make a difference. 

Individual Risk Factors

As the St. Louis Youth Violence Prevention Partnership’s 2018–2023 Strategic Plan describes, individual risk factors for young people include:

  • Impulsiveness
  • Youth substance use
  • Antisocial or aggressive beliefs and attitudes
  • Low levels of school achievement
  • Weak connection to school
  • Experiencing child abuse and neglect
  • Exposure to violence in the home or community
  • Involvement with delinquent peers or gangs
  • Lack of appropriate supervision
  • Parental substance abuse
  • Parental or caregiver use of harsh or inconsistent discipline

“Depression, anxiety, chronic stress and trauma, and peer conflict and rejection are also associated with youth violence perpetration and victimization. Youth who are arrested, particularly before age 13, have a heightened risk for future violence and crime, school dropout, and substance abuse.”53 

The relationship between prior acts of violence and exposure to violence are particularly strong. One study found that exposure to gun violence—being shot, being shot at, or witnessing a shooting—doubled the probability that a young person would commit a violent act within two years.54 Research shows that in areas where rates of violence are high, an individual who is admitted to the hospital with a violent injury has an up to 40% chance of being reinjured again within five years.55 Moreover, if an individual is exposed to social networks that engage in community violence, it increases the likelihood that he or she may become either a victim or a perpetrator of community violence.56  

This is why interrupting cycles of violence by tailoring resources and interventions to those at high risk is so important: stopping one violent act now can prevent dozens of future acts of violence.

Community Risk Factors

Community-level risk factors for violence in the St. Louis region include:57 

  • Residential instability
  • Crowded housing
  • Density of alcohol-related businesses
  • Poor economic growth or stability
  • Unemployment
  • Concentrated poverty
  • Neighborhood violence and crime
  • Lack of positive relationships among residents

Several of these key risk factors, which increase the probability that a person will suffer and/or inflict harm, are explored in more detail below.

Protective Factors for Community Violence

Protective factors may reduce the occurrence of violence or make the outcome less impactful. At a general level, addressing any of the risk factors listed above, at both the individual and community level, will help to reduce violence, including “household financial security, safe and stable housing, economic opportunities, increasing access to services and social support, residents’ willingness to assist each other, and collective views that violence is not acceptable.”58 A St. Louis-specific analysis by the Youth Violence Prevention Partnership identified the following protective factors:59 

  • Healthy social, problem-solving, and emotional regulation skills 
  • School readiness and academic achievement
  • Positive and warm parent-youth relationships
  • Positive peer and adult mentoring relationships 
  • Supportive social networks
  • Access to mental and behavioral health services
  • Steady employment

A US Department of Justice diagnostic project from 2017 showed how violence can be addressed even while certain risk factors remain present. Researchers compared four St. Louis neighborhoods, all with high levels of poverty, but only two with high rates of violence, and found key protective factors included fewer vacant houses, good public lighting, and less presence of trash. This is in line with other findings that “physical environments of schools, parks, and business and residential areas that are regularly repaired and maintained and designed to increase visibility, control access, and promote positive interactions and appropriate use of public spaces are also buffers to violence.”60  

Access to social services that can address the risk factors of violence and provide additional protective factors is critical as well. One study found that “having services that are within a two-mile radius of a person can serve as a protective factor to reduce recidivism,”61 which is why increasing access to services for those at high risk of engaging in violence is a crucial aspect of any locality’s violence reduction strategy. A 2017 focus group of adults living in high-violence areas in St. Louis echoed this finding as well, reporting that in order to reduce violence, “additional resources and services are needed to meet the needs of residents.”62 

This report examines violence reduction strategies in the County of St. Louis through the lens of the risk and protective factors discussed above, and recommends the expansion and implementation of specific initiatives based on those factors. This is in line with the consensus finding that “reducing violence requires multi-prong approaches that target the community, businesses, schools, criminal justice, social services, and the individual,” with successful initiatives marked by their consideration of the factors that most influence violent behavior.63 

With that context established, the next section of this report examines the current responses to community violence that the Giffords team was able to identify in our research and interviews. No community is starting from scratch in the fight against violence, and it’s important to identify and understand the area’s existing assets.

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Existing Strategies

At the city level, St. Louis is already implementing a number of evidence-based strategies to address community violence, yet most of these strategies are at the scale of pilot programs rather than robust, institutionalized solutions. At the county level, there remains much to be desired in terms of a meaningful fiscal and strategic commitment to community violence intervention efforts. Many of the existing strategies, as detailed below, serve a significant number of county residents yet receive little to no direct support from the county itself. Moreover, there is a need to bolster efforts centered around designing a strategic plan for violence reduction across the county that appropriately leverages some of the programs that are already in operation.

The existing programs and efforts fall into five major categories: coordination, data collection and analysis, services for survivors of violence, services to address the root causes of violence, and law enforcement. At this point, most of these are being implemented as individual programs, on a relatively small scale, and in siloes.

Coordination

It is now widely recognized that because community violence is a multi-dimensional issue with a number of root causes from poverty to trauma, it can only be effectively addressed with a coordinated response from a range of public and private stakeholders.64 In the greater St. Louis area, one of the only entities dedicated to coordinating and improving a regional response to community violence is the St. Louis Area Violence Prevention Commission, making it an important resource for addressing violence in St. Louis County.65  

St. Louis Area Violence Prevention Commission

The St. Louis Area Violence Prevention Commission (VPC) originated as a partnership between stakeholders at Washington University in St. Louis and United Way of Greater St. Louis, which saw the need for better coordination among the many individuals and groups working on the epidemic of violence in the region. It was later bolstered by the Saint Louis Mental Health Board, which dedicated executive-level staff time to move the group from planning to implementation.66 

Today, the VPC is a regional, cross-sector initiative working to reduce violence and promote collaboration between community residents, community-based organizations, and local government agencies.67 With the understanding that residents of color have uniquely tense relationships with law enforcement entities that impact perceptions of legitimacy, the VPC has made an explicit effort to address the systemic issues that undermine these relationships. 

In 2019, the commission issued a survey to police and community stakeholders to understand how police legitimacy could be improved through a racial equity lens. These efforts culminated in a “Statement on Policing & Violence Prevention in St. Louis County,”68 which lays out several concrete policy reforms the organization supports, as well as the county entities responsible for the implementation of each. Although all of the recommendations are of critical importance, there are three in particular that would have direct, immediate impact on the efficacy of community violence intervention in the county, all of which are echoed in this report:

Recommendation #5: Create a Civilian Public Safety Response Network for 911 Calls Unrelated to Crime
Not every situation calls for a police response, nor is a police response always the most appropriate response to a crisis. For example, mental health emergencies and nonviolent neighborhood disputes could be resolved with non-police entities equally committed to ensuring public safety that specialize in these specific issue areas. The VPC has recommended a shift towards leveraging the training of these social service providers through a civilian public safety response network for 911 callers who need assistance unrelated to crime. 
Recommendation #6: Invest in a Nonfatal Shooting Response System Supporting Victims of Gun Violence and Child Deaths
While the pain and trauma associated with a homicide is undeniable, there is also a very real need to pay better attention to those who suffer from the consequences of nonfatal shootings. VPC data shows that for every homicide, there are 20 aggravated assaults—a number that applies to both the city and the county. Given this gap, the VPC has worked to convene a group of social service providers and victim advocates to support a nonfatal shooting response system. However, a gap that has yet to be met relates to property repairs: a less obvious, but incredibly disruptive consequence to community violence (e.g. boarding up windows, replacing locks, fixing doors). Initiatives such as these merit greater investment as survivors work to find peace and safety after violence.
Recommendation #9: Invest in Community Capacity Building
The ramifications of community violence are not solely felt by a select number of loved ones, but rather an entire community that becomes destabilized by trauma and distress in the aftermath of violence. Seeing as the majority of nonfatal shootings and homicides happen in public spaces, it is important to build a sense of cohesion within communities that encourage them to find solutions that work. To the VPC, this means building the capacity of residents to lead violence prevention efforts in areas of the region that are most impacted in a sustainable way through trainings, mobilization, and community building. 

The VPC now has more than 150 organizational members representing education, health care, law enforcement, local government, neighborhood groups, and social services in both the City and County of St. Louis. There are a number of working committees that allow individuals to contribute to the collective effort, including in the areas of community engagement, policy and systems change, service delivery, evaluation, and communications. The VPC as a whole meets quarterly, and subcommittees meet monthly to provide regular opportunities for networking and information sharing. The group’s priority areas for 2022, which apply equally to both the City and County of St. Louis, are to advance an agenda around:69 

  1. Police legitimacy
  2. Trauma-informed care and safe spaces for young people
  3. Responses to nonfatal shootings
  4. Supporting evidence-based program implementation
  5. Community engagement and leadership development
  6. Engaging municipal governments in VPC’s action plan

Although it is a regional entity, at this point in its development the VPC has more participants and contacts from the city than the county. This is at least in part due to the fact that unlike the city, which has increasingly embraced VPC as a thought partner in strategic planning and gathering input from community members and other stakeholders,70 St. Louis County has not yet fully leveraged the potential of partnership with VPC and its network of committed residents, organizations, and advocates to help coordinate county-specific violence reduction efforts. This is a strategic miss for the county.

Reflecting the city’s greater engagement with VPC, the group has a “Municipal Engagement Taskforce,” and VPC leadership sees a strong need for a similar committee to also oversee engagement efforts with the county, particularly if the county is to carry out any of the recommendations contained in this report. Doing so in coordination and with the support of the VPC will be an important way to gather community input, create external accountability, and disperse news and opportunities to a broad array of stakeholders. 

Services for Survivors of Violence

Exposure to violence is one of the strongest risk factors for future violence: in certain areas, the violent reinjury rate is as high as 40%.71 This means that providing effective support services and interventions to survivors of violence is a powerful violence reduction strategy, reducing individuals’ risk of being victimized again and of seeking retaliation. There are a number of programs offering these kinds of services to survivors of community violence, and the St. Louis region has one of the only networks of hospital-based violence intervention programs in the country. However, these efforts remain underfunded, and as will be discussed below, despite the fact that at least half of their service population are county residents, they currently receive no financial support from the county itself. This needs to change, since support services for survivors of community violence (and for the families of homicide victims) are such a fundamental part of an effective regional violence reduction ecosystem.

Life Outside of Violence

Life Outside of Violence (LOV), formally referred to as the St. Louis Area Hospital-Based Violence Intervention Program (STL-HVIP), is an evidence-based strategy to improve outcomes for victims of violence and prevent future violence, based on the insight that exposure to violence is one of the strongest risk factors for future violence72 As the LOV concept paper explains, “Provision of quality screening, intervention, discharge planning, and follow up for this population is necessary to reduce the likelihood of subsequent violent injury and death. Hospitals are the primary location where patients who have suffered a violent injury seek medical care and thus are uniquely positioned to interrupt the cycle of violence for these high-risk individuals.”73  

$4m
in taxpayer cost-savings from a single HVIP
Hospital-based violence intervention programs (HVIPs) can save up to $4 million over five years in costs from the justice system, reinjury, healthcare, and losses to productivity.

Source

Purtle, J., et al. (2015). Cost-benefit analysis simulation of a hospital-based violence intervention program. American journal of preventive medicine, 48(2), 162–169. https://doi.org/10.1016/j.amepre.2014.08.030

To interrupt this cycle, HVIPs deploy culturally competent case managers to meet with violently injured patients in the hospital. Those that meet the criteria and voluntarily choose to join the program receive up to a year of intensive case management and other forms of assistance, depending on their individual needs and circumstances. Multiple studies, including several randomized clinical trials, have shown that HVIPs reduce reinjury rates for participants and improve other outcomes—saving lives and creating significant cost savings for health care systems. 

In St. Louis, LOV was launched in 2018 by the Institute for Public Health at Washington University and is a partnership with four different hospitals (St. Louis Children’s Hospital, Barnes-Jewish Hospital, SSM Health St. Louis University Hospital, and SSM Health Cardinal Glennon Children’s Hospital) and three research universities (Washington University, Saint Louis University, and University of Missouri-St. Louis). LOV represents one of the first regional HVIP networks in the nation. 

St. Louis City and St. Louis County residents ages eight to 30 who are injured by gunshot, stabbing, or blunt trauma, and who have been seen at a participating hospital, are eligible to enroll in the LOV program. For the purposes of this report, it’s important to note that approximately 50% of LOV’s clients are county residents. 

Each site employs licensed clinical case managers and outreach workers to build relationships with victims of violence and connect them with services and provide immediate counseling. Each case manager has a maximum caseload of 20 participants. Following medical treatment, a trained case manager works with each participant and his or her family for up to one year to develop and maintain a plan to stay safe, connect to community resources, and to receive treatment, support, and guidance.74 

Keyria Jeffries is a case manager with LOV and is based at St. Louis Children’s Hospital, where she screens young people admitted with violent injuries and flags eligible cases for initial contact and follow-up with her community outreach worker partner. If a patient agrees to participate in the program, Keyria provides ongoing therapeutic case management. For her young client population, this often means working with school systems, the child’s family or caregiver, church, or whatever other systems and activities constitute the young person’s support system. Keyria helps identify her clients’ needs and then work within their support system to help address those needs. One recent client, an 11-year-old, was admitted to the hospital after becoming the victim of seriously violent bullying. The dispute that led to the violence continued over social media, and Keyria is currently working with both the girl’s mother and the school system to create a safety plan. 

Many of the families Keyria is serving are dealing with multiple stressors based around the inability to meet basic needs, especially food and housing. “A lot of the violence with young people is really just being in the wrong place at the wrong time,” Keyria reported.75 “People can’t work on higher level things—whether it’s school or trying to figure out a career, or anything else, really—when their basic needs aren’t being met. 99% of our job is working on those basic needs and stabilizing people.”

A success with one client illustrates how LOV’s work prevents future violence by looking at root causes and helping to put people on a different path. Keyria once had a nine-year-old client who was admitted to the hospital after being attacked at school by an adult security guard. “This was a kid from a really supportive family, but they saw him struggling with his grades, starting to lose interest in school. And when you’re in third grade, you still have a whole lot of school left.” Keyria was able to identify that this child was disengaged because he felt unsafe at school because of this incident. “Once we figured that out and were able to get him into a different school, he just thrived,” Keyria said.76 “He’s become an honor roll student. It’s not that he didn’t like school, but when you don’t feel safe that can come out in a lot of harmful ways unless it gets addressed.”

As of January 2022, LOV had enrolled more than 196 survivors of violence, and LOV graduates have had a collective reinjury rate of seven percent, with no instances of homicides or acts of retaliation known to LOV staff.77 That’s a three times lower reinjury rate compared to 21% among a matched control group from the four LOV hospitals that did not participate in the program.78 While this is important progress, additional resources are needed—both to ensure that LOV is able to reach as many victims as possible, and to ensure that fewer and fewer people are needing those services in the first place.

LOV partners with a number of hospitals in St. Louis City including: Barnes-Jewish Hospital, SSM Health St. Louis University Hospital, St. Louis Children’s Hospital, and SSM Health Cardinal Glennon Children’s Hospital. All LOV-affiliated hospitals are situated in St. Louis City, however over 50% of clients come from the county. Despite the large utilization of LOV services by county residents, LOV receives no direct support from the county. Instead, funding for the program comes mainly from an HVIP grant through the Department of Justice and a fiscal commitment from the hospitals themselves. Additional funding would allow for more staff to increase coverage and also for the expansion of a physical space for receiving and working with clients. 

Victim of Violence Program – St. Louis Children’s Hospital

In any given year, the emergency department at St. Louis Children’s Hospital treats an average of 250 young people for violence-related injuries, with approximately 55–60% coming from the county.79 In 2020 alone, over 100 children seen by St. Louis Children’s Hospital were shot with a firearm—more than any full year in the hospital’s history.80 The Victim of Violence Program (VOV) was established to prevent the recurrence of violence and to interrupt the development of trauma, particularly in the lives of children between the ages of eight and 19 years old who have been shot, stabbed or assaulted, or involved in domestic violence.81 

VOV begins outreach within the hospital setting. A social worker connects with the child and his or her family members and lets them know about the basics of the program and that a VOV mentor will make contact in the next 24 hours. VOV mentors then meet with the child and their family to build a relationship and assess needs. If the family agrees to participate, the VOV mentor will work with them to “develop goals and treatment plans and to process the reasons that led up to the treatment in the emergency department.”82 Mentors can and will communicate with a range of individuals within a child’s life, including school personnel, deputy juvenile officers, court personnel, police officers, and community agency staff. They are uniquely accessible to participating children through hospital-furnished cell phones and are available 24/7 via phone for emergencies. 

Once a VOV mentor has conducted a needs assessment for the participating child, the two work collaboratively to identify the appropriate time frame of services and meeting intervals. Although there are no requirements for meeting frequency, participants are required to meet with their mentor for at least six sessions to maintain enrollment. A participant is discharged from the program after mutual agreement with their VOV mentor but is always welcome to reinitiate contact should they feel the need to do so. In cases where there is sporadic participation in the program, the mentor will ultimately close the case after multiple prolonged periods of no contact after one final attempt to reach out to the child’s family to see if they are still interested in participating.

“We have a 96% success rate with our kids,” says Warren Hayden, a retired youth program manager for St. Louis County’s Department of Human Services who is now a consultant for VOV.83 “One of the main challenges right now is that we need to improve our acceptance rate. We need more resources to be out in the community proactively so that people know what this program is and are more likely to take advantage of the services we offer.” The program’s partners include law enforcement agencies, families courts, and school districts in both the city and county. VOV receives funding from donors to St. Louis Children’s Hospital, but does not receive direct financial support from the County of St. Louis.

The BRIC and The T

HVIPs help provide services to victims of community violence who are treated in a hospital setting, but a large number of gunshot victims are also discharged without extensive treatment and simply given instructions on how to provide for their own self-care. Dr. LJ Punch, a trauma surgeon, noticed that many gunshot patients were simply not receiving a high quality of care, which was extremely harmful not just to the health of the individual, but to overall public safety. This need was also brought to his attention by Kateri Kramer-Chapman, the director of LOV, who was hearing that clients were not having their needs met in terms of pain management and that this was preventing the physical and mental healing needed to break cycles of violence.84  

“We were seeing that today’s poorly treated bullet injuries were like the gunpowder driving tomorrow’s shootings,” he said in an interview.85 Patients, mostly young Black men, struggling with untreated chronic pain and trauma were not getting the healing they needed from the health care system—a staggering 30% of patients seen after the BRIC was first opened needed to have bullets removed from their bodies. 

That’s worth repeating, because the implications are profound. Gunshot victims in the St. Louis region, mostly young Black men, are literally being discharged from emergency rooms with bullets still in their bodies. This population, says Dr. Punch, largely suffers in silence. “Despite the severe nature of gunshot wounds, they get an average of 4.2 hours of care and then they are left alone to care for themselves,” he said. ”If this were another public health issue, like TB, that’s simply not what we do.”86    

To address this glaring gap, in November 2020, Dr. Punch founded the Bullet Related Injury Clinic (BRIC) to provide responsive, trauma-informed, accessible, and culturally competent care to individuals who have been discharged in the aftermath of a violent injury.87 Annually in St. Louis, more than 2,000 people experience bullet injuries, and about 50% are discharged from the emergency department without ever being admitted, leaving many survivors to care for their wounds without support—especially the 55% who are uninsured.88  

“This is creating a gap in services provided by HVIPs like LOV. The BRIC has to be a part of the way that HVIP services get introduced in the ambulatory setting,” says Dr. LJ Punch.89 Without a referral to LOV from the BRIC, there is no way that this large population of gunshot survivors would even know about the services and supports available to them.

As described by the Wellbeing Blueprint, a national plan for reforming major public systems to achieve racial equity, “Too often, traditional service delivery models create false divides between community-strengthening activities and the services provided. The BRIC is radically different. Whereas hospitals deliver technical care primarily focused on physical healing, the BRIC combines medical care with a community-based approach to create long-term resiliency for patients, their families and the community.”90 

Potential patients can self-refer themselves to the BRIC or may be referred by one of the four major trauma centers in the region. The BRIC also created a physical box that is distributed at the trauma centers that provides patients what they need for wound care and pain relief, which introduces people to the BRIC and its free services. “They can’t just go to CVS for wound care, it’s expensive and confusing,” said Dr. Punch. “The wound care box is imperative because it’s a gesture that helps build trust. The BRIC is giving you something, and this is who we are.” For individuals that provide their contact information, staff from the BRIC generally follow up within 1–3 days. 

The BRIC received more than 600 visits in its first year of operation (the original goal was 200, but demand was three times that) and accomplished high participant retention rates with over 77% of patients returning for additional care after their first visit (compared to a rate of closer to 20% in traditional settings),91 and 80% of returning patients completing as many as six visits.92 Preliminary findings show that less than 20% of participants associated with the BRIC reported subsequent unplanned emergency department encounters—less than the regional average.93  

The gunshot survivors treated for free at the BRIC have a number of needs, from pain management to therapy to bullet removal. One young patient who was shot back in 2014 recently had a bullet removed from him by clinicians at the BRIC—eight years after his original injury. To address the physical aspects of bullet wound care, the BRIC offers physical therapy, occupational therapy, chiropractic care, and pain management services. For mental health and trauma-related needs, the BRIC offers a therapist who conducts group meetings, a chaplain for spiritual care, and referrals to a wide array of partner organizations, including LOV, Alive & Well Communities, and the Crime Victim Center.94 Clients of the BRIC can also access a host of services offered by its umbrella organization and physical headquarters: The T.

The T

The disproportionate impact of violence on communities of color raises concerns regarding structural racism, particularly as it pertains to health equity and access to quality care. To address this gap, The T was created to serve the St. Louis region as a health education and resource center, assisting those returning to their community after discharge as they prepare to heal physically and emotionally from their injuries.95 “The T promotes holistic healing from trauma related to bullet injuries and overdose in St. Louis,” the organization’s mission statement declares. “We transform healthcare delivery through education and anti-racist, community-based medicine.”96 

The T, a nonprofit organization, was born out of an initiative to expand certifications for Stop the Bleed training,97 a national campaign developed in 2012 to assist individuals in recognizing life-threatening bleeding and swift intervention, and to put community health into community hands. Led by Dr. Punch and the philosophy to provide “profound access,” The T now exists to ensure resources are accessible to those who are recovering from the impact of trauma, including bullet wounds, opiates, COVID-19, and homelessness. 

At its physical location on Delmar Boulevard in the City of St. Louis, The T provides free clinical services, Stop the Bleed training, harm reduction services including overdose prevention training, mental and behavioral health services, and a host of referral options through partner organizations. “It’s important that The T is based in community and people getting served by survivors and those with lived experience,” noted Dr. Punch.98 

Unfortunately, neither The T nor the BRIC have received funding from St. Louis County, despite the fact that 50% of their clients are county residents. They predominantly receive funding through a combination of city, state, federal, and philanthropic support.

Crime Victim Center

The Crime Victim Center (CVC) is a resource for victims of violent crime, witnesses to violence, and families of homicide victims in the St. Louis area, with approximately 60% of its clients being residents of St. Louis County.99 The CVC provides trauma-informed counseling and therapeutic services, support groups, advocacy services, resource mapping, legal assistance, and help with victim compensation to cover the cost of medical bills and other expenses related to violent victimization.100 As described in more detail below in the “Law Enforcement” section, CVC and St. Louis County Police Department (SLCPD) partnered in 2022 to have a full-time CVC-employed homicide advocate to serve the families of homicide victims within SLCPD’s jurisdiction.

The CVC is a nonprofit agency that provides services to over 7,000 victims of crime in St. Louis annually. Services provided by the CVC are free of charge and applicable to a range of crimes including burglary, robbery, identity theft, assault, homicide, hate crimes, domestic violence, intimate partner violence, sexual assault, among others.101 For victims of shootings, CVC receives referrals for services from partner organizations like the BRIC, LOV, and SLCPD. 

CVC partners with over 30 agencies across the St. Louis region in an effort to provide an expansive range of social service referrals to those in need. In 2020, 683 clients received assistance in filing Order of Protection in the context of domestic violence situations, 576 clients were supported in obtaining victims’ compensation, and over 2,100 cumulative hours of therapy was provided to participants.102 The organization manages this with a staff of approximately 20 people and an annual budget of around $1 million—but it currently lacks the capacity to meet the huge demand for its services. 

With the exception of a grant subcontract from St. Louis County’s Domestic Violence Court to support CVC’s Order of Protection advocate position for individuals facing domestic violence, the county provides no financial support for any other aspects of CVC’s work as of September 2022, despite the fact that a majority of CVC clients are county residents.

In sum, while there are a number of excellent organizations serving victims of violent crime in St. Louis County both in the hospital and the community setting, there is a lack of adequate resources for this important work. This is a strategic miss for the county when it comes to reducing community violence and should be a priority area of improvement, as we discuss in the recommendations section below.

Services to Address the Root Causes of Violence

In addition to prior violent victimization, there are a number of other primary root causes of violence that need to be directly addressed in order to improve public safety in St. Louis County. This includes risk factors such as repeated exposure to the criminal legal system; barriers to educational and employment opportunities; lack of awareness of trauma and resources to heal from trauma; substance abuse; and deficiencies in the neighborhood infrastructure, including the presence of vacant lots and building, the absence of light and safe communal spaces like parks, and the presence of food deserts.

Alive & Well Communities

Part of Alive & Well Communities’s mission is to activate communities to heal. It works with communities by naming racism and systemic oppression as trauma that impacts the well-being of all; responding to the impact of historical trauma to foster healing for current and future generations; elevating community wisdom by centering those who are most impacted; and leading innovative solutions based on the science of trauma, toxic stress, and resiliency. This approach helps those impacted understand trauma, which can be a strategy to disrupt community violence.

Alive & Well Communities is the product of two separate trauma-informed initiatives, Trauma Matters KC and Alive & Well STL, which came together in 2017 to help a wider range of residents address the trauma they have experienced at the hands of cultures and systems.103 It serves communities across the State of Missouri, and partners with school districts and health systems across the region to offer tailored evidence-informed workshops, workplace assessments, and trainings.

Since its inception, Alive & Well Communities has trained over 27,000 individuals and its work has been associated with reductions in school suspensions, increased student attendance rates, and lower rates of burnout among staff.104 As it directly relates to community violence, Alive & Well Communities has partnered with organizations like the BRIC to provide trauma training customized to the needs of the trauma experienced by gunshot victims.105  

“Gun violence and trauma go hand in hand, and it often starts with kids in Missouri witnessing violence at a very early age,” said Christin Simpson, Alive & Well’s director of Healthcare Activation.106 “People can be walking around with trauma that can cause them to go from zero to 100 in an instant, and not even know it. If we teach people about their emotional triggers, maybe they will pull triggers less often.”

Given the important connection between community violence and trauma, there is a need for St. Louis County to expand access to the kinds of trauma-informed training, workshops, and other resources that Alive & Well Communities is providing. Hospital systems in the St. Louis region are particularly in need of this training, Simpson said. “If places where gun violence victims were going were more trauma-responsive by applying their knowledge surrounding the science of emotional trauma, you wouldn’t need the BRIC to bridge that gap. In many cases, people need help to process the trauma from how they were treated in our hospitals following such a serious injury.”107

Pathways to Progress

Pathways to Progress is an initiative created by Catholic Charities of St. Louis and St. Francis Community Services that seeks to empower community members through long-term case management.108 “Our goal is to help whole families, not just one person,” says Maryn Olson, program director for Pathways to Progress, “We work with families for two to four years, helping them navigate the system to figure out how life could be different and better.”109 Pathways has a staff of nine, which includes seven case managers—known as “Member Advisors”—who provide clients (“Members”) with intensive and long-term case management services. All of Pathways’s Member Advisors are seasoned professionals who are trained in trauma-informed care.

This is important because nearly all of Pathways’s Members and their families have experienced various forms of trauma, and according to Olson, every Pathways family has likely suffered some form of violence—often gun violence. “Many members have been the victims of domestic violence, lost family members to gun violence, experienced shootings, had their cars shot at, so violence is a regular challenge for our members,” Olson said in an interview.110 “We’ve had a member whose son was shot and killed while sleeping at home in his bed, and another whose kids were playing with a gun and the gun accidentally went off—killing one of the children.” Without the kinds of support services offered by a program like Pathways, these episodes of traumatic violence can often be the start of a hard-to-break cycle of further violence.

The program started as a pilot in 2016 serving eight zip codes in North St. Louis County with the highest levels of intergenerational poverty in the county, eventually expanded to cover the entire North County area in 2019, and also grew into North St. Louis City in 2020. Most referrals come from word of mouth. Potential Members are eligible for participating in Pathways if they live in a service area, have a family income at or below 130% of poverty level, have a minimum level of housing security, and demonstrate that they want to join the program and participate regularly.111  

The Pathways intake process is extensive, and staff will look at a potential member’s life goals and needs, from safety to food access to mental and behavioral health. The intake process is used to develop a customized service plan that is reviewed with the member every 90 days to track progress and adjust as needed. For mental health needs that are beyond what Member Advisors can provide, Pathways has access to mental health professionals through partnerships with organizations like St. Louis Counseling. 

With an annual budget of approximately $1 million, Pathways to Progress is engaged with 74 families, including 200 children in the St. Louis region as of September 2022, and is funded almost completely through grants and private donations. While Pathways’s core focus is economic mobility and empowerment for its Members, the organization also measures outcomes related to quality of life, school engagement, school performance, successful referrals, and housing. 

Olson sees violence in the St. Louis region as being fueled by a feeling of hopelessness. “When you have no hope or sense of the future, it doesn’t matter what happens to you—you could go to jail and that doesn’t matter to you,” she said. “There’s really an epidemic of hopelessness, which makes people feel helpless and they lash out to try to find some sense of power.”112 Pathways is working to create hope and possibility in situations where none seems to exist.

One member’s story illustrates just how tragically common violence can be within the population Pathways serves. Before joining Pathways, Ebony Davis lost her son’s father to gun violence in a case of mistaken identity. This happened right in front of the car where Ebony was sitting with her two children, who were just two and eight months old when this senseless killing occurred. Thirteen years later, after joining the Pathways program to help her turn her life around, the unimaginable happened: shots rang out in the middle of the night, and a number of bullets came screaming through her Glasgow Village home. Ebony, terrified, ran to check on her 15-year-old son, Antione, who was asleep in bed. When she couldn’t wake him up, she realized what had happened: Antione had been struck in the head with a stray bullet and was already gone.

Antione was a warm, outgoing person who loved going to school. “He was a clown—was always making people laugh,” Ebony recalled. “He was going to school every day. He would have graduated from high school this year if he had lived.”113 The shooting happened at 5 a.m. and it took two hours for law enforcement to arrive on the scene. No arrest was ever made and the case was never solved. During this period of crisis, it was Ebony’s Pathways Member Advisor, Sarah, who was there for her. Pathways arranged for Antione’s funeral costs to be covered by their partner, the St. Louis Society of St. Vincent de Paul, connected Ebony with counseling, and advocated to the Housing Authority to help keep a roof over Ebony’s head during this traumatic time in her life.

Three years after the killing of her son, Ebony is still on her feet, though it’s still incredibly hard to keep going. “I still have trouble sleeping, but I’m working everyday,” Ebony said during an interview, wearing a t-shirt with a photo of Antione. But there are also the things that keep her going: her daughter, Ronetta, graduated high school last year, and Ebony is helping raise her new grandchild. Where there were no other sources of support after Antione’s killing, Pathways was there in a way that made all the difference. “I didn’t get help from the county or the city during this. There might have been a detective that showed up at Antione’s funeral, but that was it. Pathways though, they were there for me. They helped me get through all this.”

Ebony’s experience with gun violence in St. Louis County, tragic as it is, is not an isolated case. The teenage son of a friend of hers, another Pathways member, was also shot and killed on July 4, 2020. Olson also recounted the experience of another member with teenage children, whose home was shot up multiple times. Instead of assistance or support, she was told to stop reporting the incidents or her residence would be written up as a “nuisance property,” and there was pressure placed on her landlord to have her evicted. 

These cases illustrate the gap in services and supports that exist for victims of violence in St. Louis County. “In too many cases, law enforcement and government agencies are acting as if the victim is at fault, rather than what they are: a victim,” said Olson.114 “When police show up to these scenes of violent crime, they need to immediately assign a social worker or a case manager, so that people can learn about the available resources.” 

The current response, she said, is totally inadequate. “This is somebody’s child, and until you fix this, it sends the message that Black lives don’t matter.”

Re-Entry Community Linkages

Every year over 700,000 individuals are released from America’s jails and prisons.115 Many returning citizens are released to their families and communities yet face the challenge of learning how to reintegrate into society and connect with quality comprehensive services to support their fresh start. Prior acts of violence and repeated exposure to the criminal legal system are both risk factors for future violence. Yet, too often, formerly incarcerated individuals return to society without adequate support systems to reduce their risk. This helps explain the more than 40% crime recidivism rate in Missouri, and this is why reentry services are an integral component of an effective violence reduction ecosystem.116 

Re-Entry Community Linkages (RE-LINK) is a program within the Integrated Health Network (IHN), a health care intermediary that convenes care entities and bridges the gap between the public health system and community support system for young adults returning home from regional jails. RE-LINK leverages community health workers (CHWs) and over 20 partners in the Health and Social Services Network (HSSN) to provide essential wraparound support to clients that mitigate health inequities and reduce the likelihood of recidivism.117 

RE-LINK services initially launched in the City of St. Louis in 2016 with the help of a grant from the federal Office of Minority Health. That grant, however, expired in 2021, and RE-LINK became funded through a contract with the St. Louis County Department of Public Health. The program now operates exclusively at the county level and largely supports individuals between the ages of 18 to 45 years returning from St. Louis County jail, nearly all of whom have been impacted by community violence as either a victim, a perpetrator or—as is often the case—both.118  

CHWs identify potential clients pre-release and begin to provide services upon enrollment. These services include “release readiness classes” that cover topics like trauma, goal-setting, employment readiness, substance abuse, and an overview of community resources.119 CHWs also provide trauma-informed emotional support and help clients navigate a legal system that is archaic and difficult to understand. Prior to release, CHWs host classes and workshops with incarcerated clients to identify clients’ needs and identity supports that will be needed for a successful reentry into society, including identifying community-based partners that provide services in the areas of mental health, job training, substance abuse prevention, and housing. 

While RE-LINK has not been serving St. Louis County long enough to have impact data available, its record from several years of operation in the City of St. Louis suggests a significant positive effect on participants, with 97% of clients not returning to jail, more than 63% improving employment outcomes, and close to half of clients enrolling in insurance and reporting improved health outcomes.120 

STL Reentry Collective

In 2020, STL Reentry Collective, an organization started by formerly incarcerated individuals, sought to assess the types of services available within the City and County of St. Louis that support returning citizens.121 The group realized that while there are limited reentry services available, the most pressing need for returning citizens is financial support. Through community donations, the organization was able to raise funds and provide mutual aid financial assistance to those trying to reestablish themselves within the community. The organization also created a comprehensive reentry resource guide and is currently working on the creation of a documentary that will highlight the stories, needs, and experiences of those who are formerly incarcerated.122 

STL Reentry Collective plans to provide trauma focused workshops that will accompany the viewing of their documentary series. According to Harvey Galler, co-founder of the STL Reentry Collective, “the workshops will aim to provide information on how unaddressed trauma impacts incarcerated individuals, including contributing to higher rates of recidivism. Participants will be connected to mental health organizations that specialize in trauma treatment within the area.”123 Through a unique partnership with the St. Louis County libraries, these workshops will be held at various county locations and will be open to the public.

STL Reentry Collective views the trauma-focused workshops as an essential component of violence prevention initiatives within the city and county. Harvey argues that while “meeting basic needs are critical upon release from incarceration, it is also necessary to identify and treat unresolved trauma because it often perpetuates the revolving door of recidivism.”124 Formerly incarcerated individuals who have higher rates of recidivism are further locked out of resources and are less likely to receive adequate services due to institutional record and the stigma attached to repeat offenders. 

“Providers and the public in general often do not want to deal with those who have higher rates of recidivism. However, it is those individuals who are more likely to have the higher rates of unaddressed trauma and are at greater risk for perpetrating violent crime,” said Harvey.125 

Department of Public Health Initiatives

Within the St. Louis County Department of Health there have been two federally funded, multi-year projects to address trauma, inequity, and community violence in the north part of St. Louis County: ReCAST and Project RESTORE.However, it should be noted that the funding for both programs expires in 2022 and the need for sustainable violence reduction efforts remains. In addition to these programs, the county Department of Health also participates in a collective effort to analyze data and identify community health priorities, known as Think Health St. Louis. 

ReCAST

The Resiliency in Communities After Stress and Trauma (“ReCAST”) program was created as a response to the 2014 murder of Michael Brown in Ferguson, Missouri, to leverage the voices of regional leaders in shaping how systems work to promote well-bring, resiliency, and community healing in the St. Louis Promise Zone.126 The Promise Zone encompasses parts of both St. Louis City and St. Louis County, including: Bellerive Acres, Bel-Nor, Bel-Ridge, Berkeley, Beverly Hills, Cool Valley, Country Club Hills, Dellwood, Ferguson, Flordell Hills, Glen Echo Park, Greendale, Hazelwood, Hillsdale, Jennings, Kinloch, Moline Acres, Normandy, Northwoods, Pagedale, Pine Lawn, Riverview, University City, Uplands Park, Velda City, Velda Village Hills, and Wellston.127 Areas within the St. Louis Promise Zone are those that need more resources related to economic mobility, violence prevention and intervention, education, and overall community health.

In 2016, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) awarded $4.7 million to the St. Louis County Department of Health, the City of St. Louis Department of Health, and the St. Louis Mental Health Board to launch ReCAST, which supported community projects in the form of micro-grants in five key issue areas: 

  1. Violence prevention
  2. Youth engagement
  3. Peer support 
  4. Mental health
  5. Trauma-informed care

ReCAST has supported a few projects that have either directly or tangentially bolstered violence reduction initiatives happening in the region. For example, Community Health in Partnerships (CHIPs) was funded through ReCAST to expand its apprenticeship program where high-school aged youth that reside in the Promise Zone were trained to become peer health educators. Through this effort, nearly 1,200 youth were taught how to de-escalate and resolve conflict, as well as healthy coping skills.128 Another project, called the Metro Theater Company (MTC), similarly focused on conflict resolution through art. MTC connected educators and over 2,200 students to artists who would perform interactive shows on nonviolent resolution of conflict to model prosocial de-escalation skills for youth.129

As a method to mitigate inequality, each project underwent a participatory budgeting process, meaning that community members of the St. Louis Promise Zone themselves were directly involved in deciding which projects would receive grant funding. Nearly 1,000 residents across St. Louis County and City took part in the process, and approximately $2 million in grant funding was allocated to community projects—equating to 31 organizations being funded and 5,006 youth receiving services through ReCAST-funded projects.130 ReCAST funding expired in July 2022, but the county Department of Public Health has brought key ReCAST leaders onto its staff to continue the work as part of a broader plan to address violence within St. Louis County.  

The overall impact of ReCAST on county residents has been generally positive with many feeling like the projects undertaken were accurate interpretations of community need. Over 900 residents participated in community voting to determine the top proposals within each funding cycle. However, some community members indicated that they would have liked to see a few more priority areas included in the micro-grant solicitations, namely those centered on disability services and sexual health education. Residents also lifted up the need to include more youth voices and expand service delivery to areas outside the Promise Zone.

“[It] gives individuals a sense that they have a voice in decisions that are made, it’s a learning process in that you learn what is going on in the community and how some problems are solved.”131 

Researchers at St. Louis University also found that 52% of community members felt an improved sense of resiliency as a product of ReCAST contracted projects. Moreover, the participatory budget process was positively received, with some residents expressing feelings of empowerment by having their voices incorporated into the decision-making process for projects happening in their community.132 

Project RESTORE

Project RESTORE (Reconciliation and Empowerment to Support Tolerance and Race Equity) was a first-of-its-kind project in the St. Louis region, which started as a four-year collaborative in 2017 to address youth violence, to help schools become trauma-informed, and to provide teachers with professional development training on the impact of trauma on their students.133 The project leverages restorative justice research and community partnerships, and adapts community policing to implement targeted programming in order to meet three main goals: “(1) reduce problem behaviors (including violent conduct, bullying, and school dropout), (2) promote resiliency, school performance, and healthy decision-making, and (3) improve cultural competency among school personnel and police.”134 

The federal Department of Health and Human Services’s Office of Minority Health awarded $1.7 million to the St. Louis County Department of Public Health, which was then distributed to project participants, including the St. Louis County Police Department; three school districts in north St. Louis County: Normandy, Hazelwood, and University City;135 the Police Athletic League (PAL); and researchers at the University of Missouri – St. Louis (UMSL) and Southern Illinois University – Carbondale (SIU), to fund implementation and evaluation of the program.

Project RESTORE staff enrolled a cohort of students from 7th to 10th grades at each of the three target school districts, which were chosen based on epidemiological analysis showing that the majority of violence in St. Louis County was taking place in the north part of the county.136 Services for this cohort included training for students to become “Teenage Health Consultants,” who then engaged in peer-to-peer education on issues like violence, mental health, and substance use, as well as tutoring, after-school and summer programs through PAL—including several out-of-town, multi-day field trips, and training for school personnel.137 One PAL officer even adopted a student who was facing housing insecurity and numerous personal challenges.

At University High School, RESTORE staff helped create “wellness spaces” for students to feel safe and implemented a class on restorative justice and leadership principles. RESTORE staff also facilitated “Breakfast Clubs” with students, which featured restorative conversations with police departments, school board members, and community leaders. Through RESTORE, students were exposed to nationally recognized motivational speakers and hosted a week-long session on restorative justice for adults, which was taught by the students themselves. At Hazelwood High School, students received career counseling, access to PPE during COVID-19, and several restorative intervention classes for students of the class of 2023 and their families. To date, over 550 predominately Black students have received services through Project RESTORE.138  

“The county saw improvements in school attendance and police-community relationships as a product of Project RESTORE,” said Damon Major, the project’s director.139 In 2020, Project RESTORE was named a Model Practice Award by the National Association of County and City Health Departments.140 Federal funding for the project officially expired on June 30 of this year, but county DPH leadership brought key RESTORE leaders onto its staff to continue the work, including Major, who is now the Violence Prevention Coordinator at DPH and is incorporating Project RESTORE and related efforts into a county-wide plan for addressing violence at the county level.

St. Louis Partnership for a Healthy Community

The St. Louis Partnership for a Healthy Community, also known as Think Health St. Louis, includes over three dozen community partners committed to using principles of equity, community engagement, and data-driven results to create a comprehensive plan to improve the health of St. Louis residents. In 2014, the group of public health stakeholders came together to create the Community Health Improvement Plan (CHIP), a data-driven process designed to identify priority areas and coordinate methods to deliver targeted resources that center the most pressing needs of the community. 

To ensure that this process was guided by the concerns of community members, the Partnership convened a small group called the Community Health Advisory Team (CHAT) to guide the rollout of the Community Health Assessment (CHA). The CHAT is composed of St. Louis City and County health departments, as well as community partners and residents alike. Additionally, the Regional Planning and Leadership Group serves as a steering committee for the Partnership made up of leadership from the City of St. Louis and St. Louis County health departments, hospital systems, regional health organizers, and neutral facilitators.141 

Findings from the CHA illuminated concerns surrounding rates of violence in both the City and County of St. Louis, both of which significantly outpace statewide numbers annually. Specifically, the homicide rate in the city and county were seven times and two times greater than the state, respectively. High rates of violent crime and gun violence have been identified as sources of distress and unsafety by community members, and key findings from the CHA indicated that violent crime was a common concern for residents, especially gun violence in communities of color. Residents noted that violence is not only a threat to safety but also access to “opportunity and investment.”142  

By using a Mobilizing for Action through Planning and Partnerships (MAPP) model, community voices were represented in the assessment and results from the CHA were then utilized to inform the focus of the 2019–2024 Community Health Improvement Plan (CHIP). The following three priorities were identified to underscore the region’s commitment and intentional approach to improving public health outcomes: 

  1. Address the social determinants of health as root causes of community health
  2. Eliminate the disparities in health and promote health and racial equity
  3. Improve the local public health system to be able to collectively address the needs of the region

Within the Partnership, there are five action teams dedicated to addressing the strategic issue areas being tackled by the CHIP, including: (1) Improving Access to Community Health, (2) Chronic Disease Prevention and Management, (3) Maternal, Child, and Family Health, (4) Sexual Health, and (5) Violence Prevention. Each action team is supported by a different entity that serves as their backbone with the St. Louis Area Violence Prevention Commission fulfilling that role for the Violence Prevention Action Team. 

The goal of the Violence Prevention Action Team is to reduce gun-related homicides and nonfatal shooting incidents in the St. Louis region by 25% by 2024.143 To do so, the team has outlined three main objectives: 

Objective 1: Improve community-level response to nonfatal shootings
Objective 2: Advance trauma-informed and evidence-based violence prevention practices in community, systems and service delivery 
Objective 3: Activate communities to strengthen police legitimacy

Throughout 2022, Think Health St. Louis partners have been engaged in a process to update the CHAs that informed the 2019–2024 CHIP, since the last iteration of this process was completed in 2017. This process has involved four different components: (1) an assessment of the systems impacting health outcomes for St. Louis communities; (2) an assessment of the efficacy of local health systems; (3) a two-day event for sharing data related to health outcomes, including violence; and (4) a community health status assessment, looking at the factors that influence health outcomes for residents of St. Louis.144 The results are still being processed and have yet to be released, but multiple stakeholders indicated that community members and data have regularly identified violence as a pressing health priority in the region.

Law Enforcement 

While Giffords strongly believes that community-based responses to violence are essential and under-invested in, we also recognize that there is a critical role for law enforcement to play in reducing violence. Any law enforcement strategy however, must be grounded in principles of legitimacy, fairness, and equity, with a deep understanding and recognition of the historical and ongoing trauma created by both over-policing and violence at the hands of police, particularly in communities of color. 

The communities that have had the most success addressing violence in recent years have prioritized building back trust between the police and the communities most impacted by violent crime, which has included efforts to improve accountability; to reduce the use of stop-and-frisk and other forms of untargeted, sweeping enforcement; to reduce police use of force by prioritizing de-escalation; and to embrace the notion that the police are not the best first responders in every emergency situation.

A policing response to violence must also be strategic, data-driven, and focused. As the Council on Criminal Justice’s Taskforce on Violent Crime recommends, “police agencies must remain committed to solving the problem of community gun violence, rather than overcommitting to particular tactics such as low-level arrests.”

There are two categories of law enforcement activities that have been shown to have a particularly strong connection to levels of violence in a given jurisdiction: the rate at which law enforcement agencies solve homicides, shootings, and other forms of serious aggravated assaults,145 and the level of trust between law enforcement and the community it serves.146 

Consolidation

In the County of St. Louis, one of the major obstacles to effective policing is the fractured nature of municipal government: there are dozens of independent municipalities and almost as many law enforcement agencies, with a total of 60 different police agencies in the county. St. Louis County Police Department, the largest law enforcement agency in the county, still only has jurisdiction over about half of the county. The fractured nature of local government has a racial element to it as well. As the Forward Through Ferguson Report described, the result of decades of “white flight” in the late 20th and early 21st centuries left behind a large number of small towns that “are largely Black, and many of them have problems with budgets because of their small sizes.”147 The impact of this on policing is that there is a large number of small, independent departments, often with limited budgets, and a huge variation in policies, practices, and leadership.  

“This fragmentation of…police departments is not only costly and a grossly inefficient use of taxpayer resources,” concluded the authors of the 2015 Forward Through Ferguson report, “but more importantly presents as an impediment to justice for many of our region’s citizens.”148 This undermines the capacity of law enforcement agencies in the County of St. Louis to address violent crime. As stated by former St. Louis County Police Chief John Belmar, “It is not realistic for my agency to have close relationships with five dozen different departments. Inter-agency coordination and cooperation—from everyday policing to major investigations and events—would be much easier if there were a more manageable number of municipal departments.”149 

Given this challenge, the consolidation of law enforcement services is a solution that has been recommended in many other analyses, including the Forward Through Ferguson Report and the Teneo Report,150 and is one that is echoed here as well. When fractured city governments pool their resources, it becomes easier to provide residents with the kind of policing they deserve: a professionalized, effective, well-trained police force that puts community relationships first and that has the resources to hold itself accountable to a high standard. 

North County Police Cooperative

One successful example, and a potential model for the consolidation of law enforcement services for other areas of the county suffering from high rates of community violence, is the North County Police Cooperative (NCPC), which was formally launched on June 1, 2015, as agreement between the cities of Wellson and Vinita Park to share law enforcement resources. In effect, NCPC started as an agreement between Mayor James McGee of Vinita Park to provide policing services for its larger neighbor, Wellston. According to a report, the motivations for this arraignment were “efficiency, cost effectiveness, and a desire to do better for the community.”151   

From the start, two of the central pillars of NCPC were to build trust with community members and to pursue rigorous professional standards by successfully applying for accreditation through the Commission on Accreditation for Law Enforcement Agencies (CALEA). This led to the implementation of a number of important practices, from overhauling use-of-force training to building community policing principles into hiring practices, including a mechanism for community residents to sit in on interviews and ask questions of all potential NCPC hires.

In the months and years following its inception, NCPC rapidly added municipalities to its jurisdiction, and as of September 2022, NCPC services eight communities (Vinita Park, Wellston, Pine Lawn, Dellwood, Beverly Hills, Velda Village Hills, Hanley Hills, and Uplands Park) and maintains a staff of 60 sworn officers. It’s noteworthy that even with this consolidation, NCPC still serves a total population of only 17,000 county residents, but with 14 homicides in 2020, the concentration of serious violent crime in that five-square-mile jurisdiction is exceptionally dense.152 

The impact of working to improve both the quality of policing and the relationship of trust between the community and NCPC is apparent: homicides in its jurisdiction dropped from 14 in 2020 to just five in 2021, a more than 60% reduction in a year in which the national homicide rate continued to trend upwards.153 At the same time, the homicide clearance rate, one of the most important indicators of a police department’s ability to reduce violence, was higher than 90%,154 compared to a national average of 62%. For comparison, data showed a homicide clearance rate for the St. Louis Metropolitan Police Department as low as 25% in recent years. 

According to interviews conducted by the Forward Through Ferguson Commission, community members have also experienced a difference: “I have 50 years [in this community],” said Pine Lawn Alderman Elwyn Walls. “In the last 5 years there has been more improvement than in the last 45 years. Nothing is perfect, but they are trying.”155 In interviews in 2022 with leadership from the participating municipalities, similar support was expressed for the work of NCPC.

Over the years, NCPC has implemented a number of policies to help reduce incidents of unnecessary use of force by its officers, including de-escalation training (for new recruits and ongoing training for officers), the use of body cameras, implicit bias training, and creating an early warning system to flag signs of erratic or otherwise worrisome conduct.156 NCPC leadership also recognized the role of officer wellness in helping to reduce harmful interactions with community members, and instituted a Wellness Unit with peer support groups and in-house mental health professionals.

NCPC pairs these efforts to reduce unnecessary police-involved violence with several efforts to proactively build relationships and trust with community members. One of the first changes when NCPC was first created was a requirement for officers to conduct at least three on-foot patrols in their assigned neighborhoods each day, and another was that officers were required to attend and participate in Neighborhood Watch meetings, with instructions to report community feedback back to leadership.157 NCPC has also maintained a Police Athletic League, which is engaging with youth in the community and providing opportunities for after-hours activities and a chance for residents to interact with officers in more casual settings.

A 2019 follow up to the Forward Through Ferguson report gave NCPC one of the highest scores of any county law enforcement agency with respect to its efforts to consolidate police services and its “[p]olicy-focused implementation activity that seems to be leading to culture/systems change.”158 While recognizing that more work and reforms were still needed, the report nevertheless recognized the central role of NCPC in the ongoing conversation around consolidation of law enforcement services in St. Louis County, especially given the overall positive feedback from community members.“With time, it seems as though many in the communities that NCPC serves have opened up to them,” the report authors found.159 “This is thanks in part to several structural, policy-based steps the Cooperative has taken to improve relationships between its officers and civilians.” 

St. Louis County Police Department

In a county with incredibly fractured municipal government and law enforcement entities, St. Louis County Police Department (SLCPD) stands out as the county’s largest provider of law enforcement services—providing coverage for all unincorporated areas of the county, as well as approximately 17 municipalities on a contract basis.160 The population and geographic footprint of SLCPD’s jurisdiction represents about half of the county, with services being provided to approximately 550,000 of the county’s one million residents. There are eight precincts and 960 authorized officers, and according to department leadership they are currently about 75 sworn officers short of full capacity.

SLCPD is an asset to the county’s efforts to reduce violence, and while there is still room for reform and improvement, in many ways the department is implementing several best-practices in its efforts to keep county residents safe. “High clearance rates and generally strong morale indicate the department is doing well in many areas and is well resourced. The department, its Communications Center, and its Police Academy are all accredited by the Commission on Accreditation of Law Enforcement Agencies (CALEA), a rare and outstanding triple accomplishment that shows a true commitment to national best practices in policing,”  concluded a report from the Teneo Group, a police consulting agency.161 SLCPD “is sound in the fundamentals of policing. Its command staff is talented, engaged, well-informed, and service oriented. Its officers are motivated to serve, proud of the agency, and rightfully proud of the work they do.”

Strategies for Addressing Violent Crime and Homicide Clearance Rates

In 2021, SLCPD investigated 66 homicides and 309 non-fatal shootings.162 To address these violent crimes, SLCPD’s Bureau of Crimes Against Persons has a Homicide/Robbery/Sexual Assault Unit consisting of two sergeants and 18 detectives. SLCPD officers have several strategies and tools to try to investigate, solve, and prevent community violence.

Data-Driven Policing and ShotSpotter
First, the Violent Crime Initiative is an effort to bring a data-driven approach to SLCPD’s policing, using data to determine hotspots and then directing patrols to those areas. There are weekly precinct meetings in which officers discuss target “hot spots” and suspects based on data from that week, including laying information over an updated map of known gang territory and updating gang-related intelligence. Resources are then redeployed on a weekly basis, based on that information. This effort is supported by the SLCPD Crime Lab and by a full-time crime analyst that is embedded with the Special Investigations Unit. 

This work is also supported by the department’s use of two different ShotSpotter systems, a technology that detects gunfire and immediately alerts dispatchers. Through a federal grant, SLCPD is able to operate ShotSpotter in two areas of its North County Precinct: Glasgow and Spanish Lake. “That’s helping because not everyone calls in shootings,” said Lt. Colonel Steve Sack, the commanding officer of the Division of Criminal Investigation at SLCPD.163 “ShotSpotter helps us get accurate intelligence and get officers to the scene faster. In one case, a homicide occurred in a wooded area, and officers could quickly find the victim and pursue the suspect because of ShotSpotter.”

Services for Families of Homicide Victims
For the past 20 years SLCPD has worked with the Crime Victim Center (CVC) to embed full-time victim advocates who contact every victim of domestic violence in the department’s jurisdiction and provide victims and their families with support and services. This arrangement has been so successful for so long that SLCPD and the Crime Victim Center, seeing a gap in services for victims of homicide and other forms of community violence outside of the domestic violence context, applied for and received a state grant in 2022 to provide services to the families of homicide survivors.

The homicide advocate, Anna Chickey, is a CVC staffer who receives notifications from SLCPD when a homicide occurs and then makes contact with the families of victims in order to identify their needs and provide direct support.164 She will work with clients as much as is needed, including with things like applying for victim compensation to cover certain expenses and providing referrals for counseling, relocation, and home repair. Clients also have access to a variety of other in-house services from the Crime Victim Center, described in more detail above, including a homicide grief support group, mental health professionals, and free youth counseling. If charges are brought by the County Prosecuting Attorney’s Office, then clients are transferred to victim advocates working in that office’s Victim Services Division. 

This creates an obvious benefit to the families of victims, who receive the support of a trained professional and access to a wide array of referral services during a time of crisis, and leadership at SLCPD sees additional value in terms of reducing the likelihood of retaliation in certain situations and increasing the level of trust between families and law enforcement, which improves the chances of a successful homicide investigation.

Issue 

Community Violence

Every person should be able to live, work, and play in their community free from the threat of gun violence.  

The homicide advocate program at SLCPD is similar to a City of St. Louis initiative housed at St. Louis Metropolitan Police Department (SLMPD), which is described in Giffords’s earlier report for the city. According to Sgt. Joseph Bell, the supervisor of the Gun Crime Intelligence Center at SLMPD, it’s “instrumental” to have victim advocates as part of the default law enforcement response to community violence. “A lot of victims and witnesses are hesitant to support an investigation, but when a trained civilian helps them out first, that helps to build trust and bring a sense of ownership to the case. By the time a warm hand-off is made to a detective, they are more ready to see it through to prosecution.”165 

With these tools and strategies at its disposal, SLCPD boasts an impressive clearance rate for homicide investigations. With the caveat that this data was provided by the department, the average homicide clearance rate for unincorporated areas and contract municipalities within SLCPD’s jurisdiction was 87% for the first half of 2022 and 75% for all of 2021. According to interviews with SLCPD leadership, the department has been closer to 90% clearance rates over the past five years, which is well above the national average of just over 60%.166

Major Case Squad of Greater St. Louis

The Major Case Squad of Greater St. Louis exists to support local police departments with the investigation of serious crimes, including homicide.167 The Major Case Squad, first established in the 1960s, is another way of overcoming the fractured nature of policing in the region. It allows for the pooling of resources, including the most effective investigators in the area, in order to provide the kind of “high-saturation” investigative effort that often cannot be supported by small local departments.

When a serious crime occurs, municipalities in St. Louis County can activate the Major Case Squad, which draws from a bench of over 500 investigators, pulled from 15 different departments, who must meet strict criteria to join the squad. The initial activation period is usually a period of three to five days, in which somewhere between 15–20 investigators are deployed to the locality to conduct the most rigorous possible investigation. If the case isn’t cleared within the activation period, it is then returned to the requesting agency for further investigation. 

The Major Case Squad boasts a very high rate of success, with an overall clearance rate of 80%, according to its own data.168 As an example of broad regional collaboration, the Major Case Squad Operates in both Missouri and Illinois, and is an important tool for helping local jurisdictions to solve homicides.

While there are many areas of improvement when it comes to the county’s law enforcement response to community violence, which are discussed below in much more detail, there are also an encouraging number of assets, progress, and best practices to draw upon from recent years, especially in the consolidated and collaborative approaches represented by the NCPC, SLCPD, and the Major Case Squad of Greater St. Louis.

St. Louis County Prosecuting Attorney – Victim Services Division and Diversion Programs

In 2018, St. Louis County voters elected former public defender, prosecutor, professor, judge, and Ferguson City Councilmember Wesley Bell to the position of Prosecuting Attorney, the first Black person to hold the county’s chief prosecutor role.169 As a criminal justice reform-minded leader, County Prosecuting Attorney Bell has put in place a number of policies to reduce the impact of mass incarceration on marginalized communities, while simultaneously improving public safety.170 These efforts include a variety of diversion programs that are meant to keep lower-risk defendants out of the criminal legal system while improving public safety outcomes. In addition, County Prosecuting Attorney Bell has strengthened and expanded the capacity of the office’s Victim Services Unit, which is an important resource for victims of violence in St. Louis County.

Victim Services Division

The County Prosecuting Attorney’s Office maintains an entire division of staff members dedicated to the support of victims of crime.171 The division has six full-time staff members that support victims of various types of crimes, with an emphasis on violent crimes. Victim advocates in the division have many years of experience and handle various types of cases, with special attention to victims of child abuse, adult sex crimes, homicide, vehicular manslaughters, domestic violence, robbery, and assaults. Victim advocates build a relationship with their clients, accompany them to court hearings, and generally steer them through what can often be a difficult process for victims.172  

In addition, victim advocates identify the needs of their clients and take steps to ensure that victims have access to victim compensation funding that can cover things like health care costs not covered under a victim’s insurance and funeral expenses. According to Program Manager Lisa Jones, there is often a need for finding affordable therapy, grief counseling services, or support groups. Victim Service Division partners with agencies like the Crime Victim Center, among others, to provide referrals for counseling. They work closely with domestic violence and sexual assault centers to provide that type of specific counseling or support group referral.   

“Victims are often reluctant to seek therapy, aren’t addressing the trauma, and the criminal justice system is a slow moving process. All of that combines to make the healing process more complicated for victims of violent crimes,” according to Jones.173 Through its network of service provider partners, the Victim Services Division is able to help victims address many of their needs. For those living in high crime areas, however, relocation is frequently mentioned by victims but is often not possible because of moving expenses or the lack of affordable housing, a gap that is not currently addressed by any of the division’s partner organizations. 

Unlike many of the other programs identified in this report, the Victim Services Division is fully funded by the county as the program does not rely on grant funding, which brings stability and a consistent source of support for victims of violent crime in the county.174 While the Victim Services Division primarily works with victims on cases being prosecuted, there is still a section of the population that will not be directly reached—if the victim chose not to make a police report, for example. Division staff routinely take phone calls from such individuals and make the appropriate referrals to community partners to address their needs, making them an important part of the county-wide service network for victims of violence in St. Louis County.

Diversion Programs

Since incarceration and repeated contacts with the criminal legal system are both risk factors for violence, it’s important that law enforcement agencies create alternatives to incarceration in appropriate cases. Since his election in 2018, County Prosecuting Attorney Bell has expanded the number and scope of diversion programs available to low-level and first-time defendants, with very promising results. “So many of the people who are arrested and then cross the prosecutor’s doorstep struggle with the illness of addiction and quite often have experienced some recent trauma,” said Bell.175 “As prosecutors, it’s our duty to decide what charges to bring against people who are arrested or to not press any charges at all. Our choice is the biggest factor in whether that person heads to outpatient treatment and group therapy or is locked behind prison bars, still suffering from an untreated medical condition.”

According to Director of Diversion and Special Projects Danielle Smith, prosecutors and staff social workers will screen cases for qualifying defendants and invite them to participate in diversion services. This may take place before or after charges being filed, and is not conditioned on a guilty plea from defendants. The basic agreement is that in lieu of traditional prosecution, diversion candidates are required to complement a certain amount of programming and services. A social worker makes referrals to community-based partner organizations where they provide case management, substance use counseling, mental health services, and/or other relevant services, which are generally provided by community-based organizations. If defendants successfully complete their engagement with services and do not pick up any subsequent criminal charges, then they will have their cases dismissed.

Since 2019, approximately 1,700 defendants have participated in this form of diversion, and only 11% have picked up new charges, which is significant given the fact that 83% of people released from incarceration will be arrested again.176  

In addition to prosecutor-led diversion, the County Prosecuting Attorney’s Office uses federal grant funding to implement a pilot diversion program known as “law enforcement assisted diversion” or LEAD, which is implemented through the discretion of individuals police officers.177 In 2019, the County Prosecuting Attorney’s Office received a $1.2 million federal grant, passed through from the County Department of Public Health, in order to expand diversion programming for qualifying defendants. The LEAD pilot was launched in 2021 with the St. Louis County Police Department (in Jennings and Affton), the St. Ann Police Department, Hillsdale Police Department, the North County Police Cooperative (Wellston). 

The idea behind the program is for officers to identify individuals known to them that may be in need of substance use resources or intervention services, and to divert those individuals to LEAD-affiliated social workers instead of making an arrest.178 LEAD is a harm reduction model that is meant to help police departments move away from the “War on Drugs” paradigm that fueled the mass incarceration crisis in the US.179 After promising initial results in the five pilot areas—with approximately 100 cases diverted from potential arrest and into rehabilitative service—and positive feedback from both community members and police, the County Prosecuting Office plans to scale up LEAD to become a county-wide initiative.

These are efforts that will help reduce risk factors for violence and that should be brought to scale in St. Louis County. However, the Prosecuting Attorney’s Office does not currently implement diversion programming that is tailored to individuals charged with nonviolent gun offenses. As Giffords has argued in other reports,180 this is a population that is important to intervene with, when possible, and gun diversion programs have shown early promise in reducing recidivism rates for gun offenders—improving public safety while also significantly reducing public costs and the unnecessary use of incarceration. 

As will be discussed below, Giffords applauds the efforts of the County Prosecuting Attorney’s Office and also urges the office to review its internal data and, if indicated, consider a pilot diversion program specifically for individuals facing nonviolent gun charges. 

CONVERSATIONS WITH EXPERTS

Giffords Center for Violence Intervention partnered with the Northwestern Neighborhood and Network Initiative for a webinar series that explores community violence through conversations with experts. 

WATCH NOW

Models of County-Level Efforts

When it comes to directly supporting local community violence intervention and prevention ecosystems, more and more cities and states across the county have begun to take meaningful action. For example, there are now dozens of city-level Offices of Violence Prevention (OVP), which have the explicit goal of supporting and expanding effective violence reduction strategies. This growing list includes the City of St. Louis, which created an Office of Violence Prevention in the summer of 2022.181  

At the state level, when Giffords issued our 2017 Investing in Intervention report, only five states invested any funds to support community-based, public health approaches to reducing violence, with a total investment of just $60 million. As of 2022, that figure is now 15 states, with an overall investment just shy of $700 million, as more and more states create statewide Offices of Violence Prevention and implement robust grant programs such as the California Violence Intervention and Prevention Program (CalVIP).182 Dramatic change is also occurring at the federal level, where 2022 saw a historic level of investment in community-based violence intervention and prevention programs. 

However, despite this progress at the city, state, and federal levels, most counties are still not actively supporting or otherwise investing in public health and community-based strategies to reduce homicides and shootings. This must change.

County governments are a critical stakeholder in the fight against community violence for several key reasons. First, because of their size and position above municipal government, county governments are well-positioned to incentivize and enhance the coordination between violence reduction efforts across multiple cities, and to facilitate a regional approach to addressing violence, which often spills across artificial and invisible political boundaries. Moreover, service systems that are critical partners for violence reduction efforts, such as public health, mental health, workforce development, healthcare, child and family services, and criminal justice, often sit within county jurisdiction.

County governments are also uniquely positioned to give assistance to geographic areas that are disproportionately impacted by homicide and shootings. Indeed, in unincorporated areas, county government may actually be the only public entity in a position to implement violence reduction services. Finally, county governments often have the resources to leverage funding opportunities—such as federal grants—that might be too resource-intensive for local entities.

County governments “have a specific responsibility in preventing violence and addressing trauma,” concludes a foundational document for the Los Angeles County Office of Violence Prevention, which was created in 2019.183 “Government can also realign existing resources and work to generate new resources to support violence prevention efforts whether it is through the pooling of departmental resources to support programming in priority areas, responding to violence prevention funding opportunities from a variety of federal, state, and local sources, or supporting legislation that helps advance the field.” 

Several trailblazing counties—including Harris County, Los Angeles County, and Allegheny County—are building out robust Offices of Violence Prevention and other, related programs and strategies to directly address community violence that provide a model for how this can be done at the county level. Though each of the counties below has a unique political, geographic, social service, and community violence landscape, they have all made tremendous strides toward developing a comprehensive county-wide response to violence.  The following is a summary of the programs and practices of each county, with a final section that identifies best practices from each.

Harris County, Texas

Harris County is located in Southeast Texas along the upper gulf coast and includes the Houston metropolitan area.184 With 4.7 million residents, it is the third most populous county in the nation,185 and the largest in the state.186 The county encompasses more than 270 towns, places, and municipalities, and over a thousand local governments.187 Though Harris County is impacted by fragmentation, compared to St. Louis there are 53% fewer local governments per capita and one-fifth the number of municipalities per capita.188  

State 

Texas

In recent years, Texas has suffered some of the deadliest mass shooting incidents in modern U.S. history, yet Texas lawmakers have responded by continuing to weaken the state’s most basic gun safety laws.

Gun Law Scorecard Grade: F

There are 60 law enforcement agencies, including the Harris County Sheriff’s Office, Houston Police Department (HPD), eight Harris County Constable Offices, 29 local police departments in small cities, and specialized forces such as metro and university police.189  

According to the Harris County Institute of Forensic Science, violence in the county is on the rise. In 2021, 720 homicides occurred in Harris County, the vast majority of which (84%) were committed with a firearm.190

Community violence in Harris County is concentrated primarily in Houston, where over 70% of all homicides in the county take place.191 This violence disproportionately affects Black and Latino communities, who make up a combined 64% of the total population but account for 86% of homicide victims countywide.192 As in St. Louis, very few victims of homicide are under the age of 18. Nearly two-thirds of homicide victims in the county are between the ages of 18 and 39, while just eight percent are 17 or younger.193   

Harris County seeks to address this public health crisis by launching two new initiatives with a focus on reducing shootings and homicides. The Community Violence Interruption Program (CVIP) is led by Harris County Public Health’s (HCPH) Division of Community Health and Violence Prevention Services (CHVPS) and seeks to provide outreach and hospital-based intervention services.

Harris County Public Health – Division of Community Health and Violence Prevention Services

Violence in Harris County has intensified substantially over the last decade. Between 2011 and 2021, the number of homicides committed in the county has more than doubled.194 Much of this increase occurred at the height of the COVID-19 pandemic, as most major metropolitan areas in the US experienced a rapid increase in shootings and gun deaths.195 Between 2019 and 2021 alone, homicides in Harris County rose 47%.196  

In response to this increasingly urgent crisis, on June 9, 2020, the Harris County Commissioner’s Court directed departments to explore developing a violence prevention program and alternative responder model.197 To aid in this process and assess the feasibility of implementing such programs, the county’s independent research agency, the Justice Administration Department (JAD), partnered with technical experts at the Health Alliance for Violence Intervention (the HAVI) and Dr. Chico Tillmon, a consultant and leading expert in the community violence intervention field. 

TA providers worked collaboratively to review 10 years of violent crime data and assess the trauma registries of the county’s two Level 1 trauma centers, Ben Taub Hospital, and Memorial Hermann-Texas Medical Center Campus. The HAVI, Tillmon, and JAD also conducted numerous interviews with subject matter experts, community leaders, medical providers, and organizations providing services to the most impacted by residents.198 

Guided by this research, technical experts recommended implementing a gun violence intervention program that provides outreach to disproportionately impacted neighborhoods and at least one hospital-based violence intervention program (HVIP) housed in a local trauma center.199

On August 10, 2021, county commissioners acted on these findings and recommendations and voted to establish a Community Violence Interruption Program (CVIP) and Division of Community Health and Violence Prevention Services (CHVPS) within Harris County Public Health (HCPH).200 The Commisioner’s Court also allocated $2.9 million to HCPH to create the CHVPS division and $6 million in one-time funding to launch violence interruption programs housed within the new division.201  

The CHVPS is tasked with providing direction and aiding in the implementation of public health strategies to improve community health and safety in partnership with local agencies and community-based organizations. The division is also responsible for administering and implementing CVIP, described in detail below, and the Holistic Assistance Responder Team (HART), which dispatches behavioral health workers, social workers, and emergency service personnel to respond to non-emergency 911 calls. CHVPS is also expected to house other public health approaches to improve community safety going forward.202

Community Violence Interruption Program

When the proposal to establish CHVPS and the Community Violence Interruption Program (CVIP) was approved in August 2021, Harris County was bracing for yet another year of record-setting homicide cases. With this crisis looming, the Commissioner’s Court set out to establish CHVPS and CVIP with urgency. The Department of Public Health was tasked with launching the new CHVPS division, CVIP, and HART programs by as early as December and no later than mid-2022.203 

For the violence intervention program alone, this would involve onboarding and training staff, conducting outreach in impacted communities, developing an administrative infrastructure, and identifying locations for teams and programs to be housed.204 To accomplish these goals the Department again leaned on the expertise of Tillmon and the HAVI, who helped design the pilot program, select target neighborhoods, and aided in planning, training, and implementation.205 

By late March, Harris County Public Health was ready to launch the violence interruption program. CVIP is comprised of four primary components: (1) identifying gun violence hot spots, (2) conducting community- and hospital-based outreach with credible messengers, (3) addressing root causes of violence and coordinating care, and (4) engaging with the community. Each of the key elements is explored below.206

Identifying Gun Violence Hot Spots
To have an immediate and lasting impact on violence, communities must seek to serve those at highest risk of violent victimization or participation in violent activity. Research in numerous cities demonstrates that individuals responsible for the vast majority of violence usually make up far less than one percent of the population.207 As such, it’s important that efforts to reduce shootings and homicides focus narrowly on the small fraction of the population with the greatest need for intervention and support. This requires stakeholders to maintain and regularly review accurate and up-to-date shooting and homicide data to ensure programs are serving individuals and communities most impacted by violence.   

In Harris County, CVIP was piloted in the Sunnyside, South Park, Greater OST/South Union areas of Houston, and Cypress Station neighborhood in northwest unincorporated Harris County. After an extensive review of violent crime data and assessing the trauma registries of the two Level 1 trauma centers in the county, these communities were identified as having high rates of violence.208 According to HCPC and the CHVPS, these areas further experience “the highest rates of community health indicators such as generational poverty, having insufficient or no health insurance, lacking healthy food access, pervasive unemployment, and economic insecurity.”209   

Those implementing the strategy also used data from the sources above to identify which hospital provides the most medical care to victims of violent crime. Based on this analysis, Ben Taub hospital was selected to pilot the HVIP component of the county’s violence interruption program.210 In the summer of 2022, Harris County Public Health was approached by HCA Northwest in the Cypress Station area to bring HVIP services to their hospital.

Implementing Community Outreach and Hospital-Based Violence Intervention Programs 
Community violence intervention strategies rely on credible messengers, native to the most impacted communities, who share similar lived experiences with the individuals they serve. At Harris County Public Health, credible messengers are referred to as Outreach Specialists. These individuals work tirelessly to diffuse potentially deadly conflicts and connect people with services and support.211 Credible messengers are also at the core of Harris County’s violence intervention program.

CVIP was designed to reach people at highest risk for committing an act of violence or suffering a violent injury by engaging them in the hospital setting and through community outreach. Both components of this strategy center credible messengers. 

The community outreach component of CVIP leverages credible messengers trained in conflict resolution and mediation to identify and intervene in situations that may lead to violence. CVIP community outreach workers must understand the area and impact of violence on the community, build rapport with high-risk individuals, and work to establish trust. Harris County Outreach Specialists are on call 24/7 to mitigate conflicts in real-time.212  

The county’s newly developed HVIP program is housed in the emergency rooms at Ben Taub and HCA Northwest hospitals, where credible messengers are deployed to engage with people recovering from a violent injury in the hospital.213 Research demonstrates that people victimized by violence are at very high risk for reinjury and future involvement in violence, with the chances of injury recidivism as high as 45% within the first five years.214 When credible messengers are present in emergency rooms and trauma centers, they are able to meet with victims, their families, and social networks, and can intervene to prevent retaliatory violence. As an evaluation of a HVIP program in Baltimore revealed, violently injured people who did not receive HVIP services were 7 times more likely to be reinjured and require rehospitalization.215  

In both the community outreach and hospital programs, credible messengers draw on their lived experiences to connect and build relationships with those most impacted by violence. In doing so, they are able to connect individuals with case management teams that can provide individualized support and resources to meet the unique needs of program participants.

Addressing Root Causes of Violence with a Coordinated Supported Services
Areas most impacted by violence often experience concentrated disadvantage and lack access to quality food, education, employment, and health care, among other necessities. As such, programs seeking to have an immediate and lasting impact on gun violence must seek to assess and address the unique needs of individual participants and provide them with appropriate services to reduce their risk of engaging with violence or future victimization. 

After the highest-risk individuals in Harris County are engaged and develop a rapport with HVIP and community outreach teams, these credible messengers assess participants and connect them with violence intervention and support services.216 Those with multiple or compounding needs are directed to Accessing Coordinated Care and Empowering Self-Sufficiency (ACCESS) Care Coordination teams. 

The ACCESS Harris initiative was launched in 2021 with the goal of improving coordination and service delivery to county residents. The initiative is described as a “no-wrong door approach” that aims to break down silos and coordinate care across social service agencies and community-based service providers in the county. Violence prevention is a focus area for ACCESS, which will collaborate with CHVPS community outreach specialists to provide wraparound services to individuals in need of support. 

To help integrate services with ACCESS and expand the CVIP program, Harris County applied for the Community Violence Intervention and Prevention Initiative (CVIPI), a newly established federal grant program administered by the Office of Justice Programs (OJP) within the Department of Justice (DOJ). On September 9, 2022, the DOJ announced that it would provide $100 million in awards to community-based organizations and local governments to implement and expand violence intervention efforts, including almost $2 million for Harris County.217  

With this additional funding, ACCESS Harris Care Coordination teams will work community outreach specialists in the county’s violence interruption programs to develop coordinated care plans for participants. Through ACCESS Harris, participants will be able to more easily connect with housing, reentry, behavioral health, employment, medical, educational, economic, and food assistance.

Engaging the Community
To be successful, violence intervention and prevention programs must have support and buy-in from the communities they serve. Those nearest to the pain of gun violence hold the knowledge and expertise needed to heal their communities. Therefore, in addition to regular engagement between credible messengers and the highest risk population, it is important to engage residents of impacted neighborhoods, victims and their families, community and faith leaders, and trusted community-based organizations. 

Harris County’s Public Health Department (HCPH) began community outreach and engagement efforts in January 2022 with the goal of sharing information, answering questions, and soliciting feedback about the newly formed Division of Community Health and Violence Prevention Services (CHVPS), including the Community Violence Interruption Program (CVIP).218 The HCPH conducted numerous meetings in CVIP focus areas and included a wide variety of stakeholders, such as elected officials; public health, safety, and other county agency staff; community leaders; community-based service providers; residents and business owners; medical and mental health providers; and subject matter experts.   

In Southeast Houston, these meetings have evolved into hybrid community engagement meetings that help stakeholders stay connected and informed. However, the Cypress Station neighborhood has proved more challenging to engage. Cypress Station lacks defined neighborhood leadership, a centralized community center, and adequate public transportation for low-income people to access community-based services.219 While these findings present challenges, this information is critical to ensure that resources are directed to address the community’s most pressing needs while building trust and capacity. 

In addition to these community stakeholder meetings, the county plans to spearhead more public education campaigns, provide information about post-shooting vigils, and proactively communicate clear messages about alternatives to gun use. HCPH has launched a county-wide violence prevention campaign that involves billboards, public service announcements, and television ads in English and Spanish. The campaign will run through January 2023.

Summary

Though Harris County’s violence interruption programs are relatively new, since implementation, the county has taken a number of promising steps in line with national best practices. From the start, the county solicited technical assistance from Dr. Chico Tillmon and the Health Alliance for Violence Intervention (HAVI), renowned experts in the field of community violence, and partnered with them to develop and implement a countywide violence interruption program. Harris County Public Health and CHVPS also partnered with other public agencies and officials, technical assistance providers, and community organizations delivering on-the-ground services, among other key stakeholders.

Harris County violence intervention programs rely on credible messengers with lived experience and credibility in the communities they serve to engage people at the highest risk of being shot or engaging in violent behavior. These professionals are key to any successful community violence reduction strategy and are essential to building relationships and trust with the highest-risk members of the community. 

To ensure that the approach is focused on those at greatest risk, regular data collection and analysis are essential. Harris County worked with technical experts and public agencies to review crime and hospital data that would guide the implementation of the violence interruption programs. They also helped build data systems to ensure ongoing data collection and support future evaluation.

Harris County worked to break down silos between system and community-based service providers by launching ACCESS Harris, an initiative to connect people with various behavioral health needs to individualized support services via community care teams. The county is also engaged in a community engagement campaign to ensure the community can provide input and feedback as the program continues to expand and develop. 

Continuing to engage the community, maintaining adequate funding for programs, and ongoing data collection, analysis, and evaluation will be key to ensuring Harris County’s progress, but the county is off to a promising start. The county has accomplished an incredible amount in a relatively short period of time and should serve as an example to other counties seeking to develop violence intervention and prevention programming.

Los Angeles County, California – Department of Public Health – Office of Violence Prevention

Los Angeles County is the nation’s most populous, with more than 10 million residents. Although it is nearly 10 times larger than St. Louis County, when it comes to patterns of community violence, the two are actually similar. When staff at the Los Angeles County Department of Public Health took a look at countywide data in the mid 2010’s, it became clear that violence was disproportionately impacting a relatively small number of geographic areas within the county and that “people of color and people in communities that have borne the brunt of poverty, divestment, and racism are disproportionately impacted by violence.”220  

State 

California

Overall, California has the strongest gun safety laws in the nation and has been a trailblazer for gun safety reform for the past 30 years.

Gun Law Scorecard Grade: A

According to provisional 2020 data, the homicide rate in one particular region of Los Angeles County was 2.4 times higher than the overall county rate, similar to the disparities seen when comparing North St. Louis County to the rest of the county. Additionally, the homicide rate for Black residents in Los Angeles County was 25.7 per 100,000, compared to just 2.8 per 100,000 for white residents. Moreover, the data show us that young Black and Latino men die by homicide and experience assaults at rates higher than the County overall. When we look specifically at Black men and boys, disparities become even more obvious: the homicide rate among young Black men is 17 times higher than the rate for the County overall.221 As discussed above, this acute racial disparity is also a feature of community violence in St. Louis County. 

In 2015 Los Angeles County leadership launched the Trauma Prevention Initiative (TPI) in order to provide violence intervention and prevention services to four unincorporated areas of Los Angeles County with very high rates of community violence and other health and social inequities: Westmont West Athens, Willowbrook, Florence Firestone, and unincorporated Compton.222 It’s important to understand TPI because it served as the foundation for what would become the county’s Office of Violence Prevention (OVP), and TPI continues to be a cornerstone of the OVP’s strategic plan to reduce violence in the county.

Trauma Prevention Initiative Overview

In 2015, the Los Angeles County Board of Supervisors, recognizing the need to fund a public health-based and trauma-informed approach to violence reduction, voted to allocate $2 million annually to fund the Trauma Prevention Initiative (TPI) within the County Department of Public Health.223 This funding came from Measure B, a county parcel tax that supports trauma centers and emergency medical services, among other purposes, and the investment in TPI was made in recognition of “the need to invest in prevention and reduce the burden on the county’s trauma hospital system.”224 

TPI was rolled out in 2016, with a focus on four unincorporated areas in South Los Angeles with disproportionately high rates of community violence, according to a criteria-based assessment. The program has three core elements: intervention, prevention, and capacity building for communities and community-based organizations, each of which is discussed in more detail in the following sections.

Intervention

The first prong of the TPI strategy is to intervene with the small number of individuals at high risk of engaging in violent behavior.225 TPI does this in part through a contract with Southern California Crossroads, a community-based organization that provides hospital-based violence intervention program (HVIP) services to survivors of shootings and stabbings. The hospital-based violence intervention strategy, which is discussed in more detail in other parts of this report and other Giffords reports,226 is based on the premise that prior exposure to violence is closely associated with future acts of violence. When survivors receive long-term trauma-informed case management and wraparound support after discharge from the hospital after being injured, the reinjury rate drops significantly.227  

Through its contract with Southern California Crossroads,228 TPI was able to provide case management for more than 300 victims of violence at county trauma centers St. Francis Medical Center and Harbor UCLA Medical Center from 2017 to 2019.229 During the first two years of HVIP implementation, TPI communities saw a “35% reduction in assault-related trauma hospital visit rates, compared to a 18% reduction in LA County overall.”230 Moreover, there was a reduction in the number of overall Los Angeles County trauma patients coming from the four TPI communities.

As part of its intervention portfolio, TPI also funds community-based organizations Inner City Visions, Soledad Enrichment Action, and Southern California Crossroads to provide street outreach and violence interruptions services in TPI communities. This work leverages credible messengers, individuals with lived experiences that give them unique access to high-risk populations, in order to provide services ranging from safe passages to and from schools and parks to direct conflict mediation. Between 2019 and 2021, county-supported street outreach workers responded to more than 360 incidents of violence in the four TPI communities, including 176 shootings and dozens of homicides.231  

To support this work, TPI staff coordinated with other county agencies, including the Sheriff’s Department and the Parks and Recreation Department, to establish protocols for collaborating with street outreach workers. TPI also contracted with an evaluator to develop tools to help street outreach organizations to measure and understand their impact on public safety and community wellness, including the creation of mobile software for tracking client interactions and other work in the field.

Prevention

One of the core principles of TPI is helping to build community capacity to identify priority issues and then fund solutions that come directly from residents of impacted communities. To achieve this, TPI staff helped create local Community Action for Peace (CAP) coalitions in each of the target TPI neighborhoods. These CAP coalitions serve as a central hub to bring together residents, including through events designed to “celebrate positive community identity, foster collaboration, and identify priorities to prevent violence and promote peace and healing.” To strengthen the capacity of community leaders, TPI paid for a series of multi-disciplinary trainings  on topics like group facilitation and decision making, building community resilience, mental health first aid, conflict mediation, positive youth development, and awareness of violence intervention programs. TPI’s Street Outreach workers, and other community partners play a leadership role in these networks.

Through community input, TPI staff developed a priority list of prevention-oriented programming to address the root causes of violence and complement violence intervention efforts. For example, community members identified park safety as a pressing aspect of violence prevention and, in response, TPI worked with other county entities to support and fund various programs designed to improve safety and create access to park spaces. TPI staff worked with the Los Angeles County Department of Parks and Recreation to bring its Parks After Dark program to more than 10 parks within TPI communities, where staff provide free family programming and services from the hours of 6 p.m. to 10 p.m., including fitness, wellness, educational workshops, and access to fresh and healthy food.232 

Additionally, working at the intersection of access to public spaces and access to mental health, TPI partnered with community stakeholders to design and develop a community Healing Center at a local public health clinic to provide a safe and welcoming space for dialogue, peer support, and healing services. TPI also developed the Park Therapy pilot program in partnership with the county’s Department of Mental Health, in order to provide residents with alternative options for accessing mental and behavioral health services. Between 2016 and 2019, this facilitated services for more than 750 children, youth and families in TPI communities.233 In recent years, TPI has funded mini-grants to support community priorities, including distribution of personal protective equipment during COVID-19, implementation of a healthy manhood program, as well as trainings in mindful leadership and trauma-informed practice.

Capacity Building

The TPI Advisory Committee was created to foster regional community empowerment and alignment across county initiatives to support TPI communities. Since 2017, TPI has brought together nearly 200 individuals and dozens of organizations representing a cross-sector group  of county partners and TPI community providers. This group has collectively advocated for systems change, including increased collaboration between county departments in addressing the root causes of violence such as safe public spaces, increased resources for workforce development, healing arts and youth development programming, and a renewed focus on establishing parks as safe hubs of positive community activity and development.

Training and Technical Assistance
TPI staff also recognized early on that there was a “need to invest in local grassroots organizations that have strong ties to the community, in order to effectively address violence and trauma.”234 To address this, they launched a Training and Technical Assistance (TTA) Pilot Project in the fall of 2017, which involved contracting with four consultants with expertise in areas including nonprofit management and board development, data collection, grant writing, program evaluation, as well as branding, marketing, communications, and website building. The consultants provided 45 capacity building workshops and nearly 1,600 hours of one-on-one training and technical assistance to 260 individual participants representing approximately 30 grassroots organizations within the four TPI areas. According to a Department of Public Health report, about 50% of these organizations “advanced to the next stage of organizational development, and 90% of agencies agreed that the TTA helped them function more efficiently.”235 

As an example of how county agencies are in a position to create synergy and cooperation among other agencies to address community violence, this capacity-building success led the Probation Department to invest nearly $1 million for TPI to provide capacity-building workshops to grassroots organizations countywide.

TPI Budget

TPI has provided the services described above with a budget of approximately $2 million annually, which covers the salaries for several DPH staff members ($550,000), contracts with HVIP and street outreach organizations ($850,000), capacity-building and TTA ($385,000), a program evaluation ($100,000), and general operating expenses ($100,000).236 

TPI Results

Between 2016, when TPI first launched, and 2019, gang-involved Part I violent crimes in all four of the TPI communities declined by more than 34%, and overall levels of violent crime (both gang-related and non-gang related) declined by 12%, “showing promising early results for implementation of these strategies.”237 Of particular note, the two TPI communities with the most significant violence reductions were those with the longest-running Community Action for Peace coalitions, underscoring the importance of building community capacity and resilience when addressing gun and gang violence. Moreover, between 2016 and 2020, the overall number of assault-related hospital visits declined by 33% in TPI communities, compared to only an eight percent reduction for Los Angeles County as a whole.238 Based on this reduction in violence, TPI saved the county $1.9 million per year between 2016 and 2019 in terms of reduced criminal justice costs alone. These savings are likely much greater when considering health care system savings and benefits to individuals.239 The encouraging early experience with TPI became a springboard from which the Los Angeles County Department of Public Health was able to build its larger and more comprehensive Office of Violence Prevention.

The Los Angeles County Office of Violence Prevention

As is often the case in the US, a tragic mass shooting in Southern California spurred leaders in Los Angeles County to reassess their response to gun violence. On December 2, 2015, attackers armed with semi-automatic handguns and rifles entered the Inland Regional Center and opened fire on staff members from the San Bernardino County Department of Public Health, who were having an annual retreat. In the end, 14 people were killed and 22 more seriously injured, in a shooting that at the time was the deadliest since the 2012 massacre at Sandy Hook Elementary School in Newtown, Connecticut.

In response to this tragedy, the Los Angeles County Board of Supervisors requested the creation of a report with recommendations as to how the county could better address gun violence. The resulting report, which was finalized in June 2017, included a number of recommendations on gun safety policies that could be pursued at the local, state, and federal levels. Critically, the report also noted that “although several County departments are engaged in a variety of violence prevention efforts, these initiatives are not organized or coordinated in a holistic manner.”240 The report concluded that the county was missing a vital opportunity to leverage both its own work and the work being done by community-based organizations in impacted neighborhoods.

Another tragedy of unthinkable proportion, the shooting at Stoneman Douglas High School in Parkland, Florida—one of the deadliest school shootings in US history, which left 17 dead and 17 wounded—created another catalyzing moment for action in early 2018. In response to the shooting, the Los Angeles County Board of Supervisors took up the call to action of the 2017 gun violence report and passed a motion requesting the County Department of Public Health and the Chief Executive Office to “work together to create an Office of Violence Prevention within the Department of Public Health that will initially be tasked with coordinating the County’s various violence prevention efforts, and lead the County in a violence prevention strategic planning process.”241  

Establishing a single office to coordinate the county’s response to violence, the motion explained, would help the county identify gaps in its violence reduction strategies and would also “be a first step towards the County’s adoption of a more strategic approach to preventing gun violence.”242 The motion instructed the County Department of Public Health (DPH) to work with various other county agencies and stakeholders to create a report to the board that would include an outline of the basic functions and staffing needs of an Office of Violence Prevention, as well as detailing a process and the resources needed to create a countywide strategic plan to prevent violence.

This culminated in a report DPH presented to the County Board of Supervisors in June 2018, which included a landscape analysis of 25 different localities with offices of violence prevention and similar local programming.243 This analysis identified eight of the most common functions served by local offices of violence prevention:

  1. Standardizing data collection across city and county departments, programs, and community-based organizations
  2. Coordinating multi-sector implementation of violence prevention initiatives
  3. Creating centralized touch points of engagement for community members
  4. Integrating community resiliency strategies within an overall framework
  5. Building networks for community outreach
  6. Supporting street outreach teams as an important tool for interrupting community violence
  7. Engaging community members as peer mentors and advocates
  8. Building trust between police and affected communities
  9. Improving outcomes for young people at the highest risk of violence

The report also found that many of the same communities disproportionately impacted by violence are additionally affected by other issues. “Communities with high levels of violent crime also have high levels of pollutants in their environments and elevated rates of chronic disease, such as  diabetes,” the report authors concluded. “These factors, along with others, such as high levels of poverty and unemployment, low graduation rates, and lack of access to health care are inter-related, highlighting the importance of collaborative work across sectors. Violence prevention efforts will have the greatest impact when integrated with efforts to reduce inequity, to provide healthy environments, and to reduce the burden of chronic disease.”244 The report identified opportunities to coordinate across county initiatives to improve equity, safety, and wellbeing.

In order to facilitate a coordinated, multi-agency response to community violence in Los Angeles County, the report recommended the creation of an Office of Violence Prevention with a $2 million annual budget, seven staff members, and core functions including coordination of countywide violence prevention programs (including alignment of funding sources), data collection and surveillance, support for community-based violence prevention and intervention organizations, and responsibility for overseeing the creation of a five-year countywide strategic plan to address violence. 

On February 19, 2019, the Board of Supervisors unanimously approved a motion to establish the Office of Violence Prevention (OVP) within DPH, and allocated $6 million of funding from Measure B to support the first two years of OVP operations.245 The creation of OVP, the motion stated, would “fill the much-needed role of a local lead agency to coordinate, provide technical assistance, and expand known best practices county-wide for preventing and addressing violence in our communities.”246  

Per the Board of Supervisors motion, one of the first tasks of OVP was to convene a County Leadership Committee, which consists of department heads and staff from 30 different county departments, and a Community Partnership Council,247 which includes 25 individuals representing diverse geographic areas, demographics, and experience/expertise with different forms of violence, including survivors.248 These advisory bodies continue to meet every other month to help guide the implementation of the strategic plan, hold OVP accountable for meeting its objectives, and help coordinate violence prevention efforts by serving as liaisons to various community networks and initiatives.

To create the five-year strategic plan, OVP gathered input from the County Leadership Committee and the Community Advisory Council, and also contracted with the Prevention Institute to gather community and stakeholder input by conducting 14 listening sessions in each of the county’s eight Service Planning Areas, as well as individual interviews with 15 subject matter experts.249 With funding support from First5LA, OVP also contracted with a consultant to facilitate the strategic planning process and development of the plan. This process lasted several months and culminated in the 2020 release of the OVP’s Early Implementation Strategic Plan, 2020–2024.250 

The strategic plan lays out the overarching mission of OVP “to strengthen coordination, capacity and partnerships to address the root causes of violence, and to advance policies and practices that are grounded in race equity, to prevent all forms of violence and to promote healing across all communities in LA County.”251  

Of particular note is the strategic plan’s clear-eyed assessment of the nature of violence in Los Angeles County. “People of color and people who live in communities that have borne the brunt of racism, are disproportionately impacted by violence,” the report states.252 “Locally, the data show us that young Black and Latinx men die by homicide and experience assaults at rates higher than the County overall.  When we look specifically at Black men and boys, disparities become even more obvious: the homicide rate among young Black men is 18 times higher than the rate for the County overall.”

This had two very concrete policy implications that are woven throughout the strategic plan. First, addressing racism and systemic violence as central to addressing violence in Los Angeles County, and second, the notion that prevention and intervention strategies should be tailored to specific populations within disproportionately impacted communities.

The strategic plan lays out five priority areas: (1) Supporting Children, Youth, and Families; (2) Creating Safe and Thriving Neighborhoods; (3) Fostering a Culture of Peace; (4) Implementing Healing-Informed and Equitable Systems and Policies; and (5) Community Relevant Shared Data and Evaluation Support. Each of these priority areas has multiple concrete objectives for OVP and its partners to implement. For the goal of Creating Safe and Thriving Neighborhoods, for example, the strategic plan includes the following three objectives:

  1. Objective 2.1 – Establish Regional Violence Prevention Coalitions (RVPC) in each of the eight of the county’s Service Planning Areas (SPAs).
  2. Objective 2.2 – Work with RVPC’s to address built environment priorities in each area: e.g. Parks After Dark program.
  3. Objective 2.3 – Identify at least two strategies that address socioeconomic inequality that OVP can support and promote as violence prevention strategies.

The strategic plan also included an accountability system to measure progress, consisting of a series of two-year milestones and performance measures. For example, one of the milestones is establishing regional coalitions within each of the county’s eight Service Planning Areas, and the performance measures for this milestone include: (1) the number of regional violence prevention coalitions established; (2) the number and type of stakeholders, including community and faith based organizations, businesses, county departments, and others, that are engaged and support violence prevention and healing priorities; and (3) the number of youth and parents actively engaged and participating in regional coalitions.

Finally, to assess the impact of its work, the OVP strategic plan calls for the office to collect and assess basic quantitative data, including homicide rates, emergency visits for assaults, suicide rates, and other violence-related data points, as well as population impact indicators such as reductions in violence, increased perceptions of safety, reductions in disparities, process indicators including the number of stakeholders engaged and action plans developed, and coordination indicators like increased alignment of funding streams to address violence and implementation of joint department policies or protocols.

OVP Implementation

As of September 2022, OVP is approximately halfway through its five-year strategic plan and has been making progress on implementing the goals and objectives identified in the plan, although the work was delayed due to the onset of the COVID-19 pandemic. The implementation of OVP’s five-year strategic plan falls into several major categories.

TPI Expansion
As described above, TPI was an existing violence reduction strategy at DPH at the time that OVP was launched, based on a three-part approach of prevention, intervention, and capacity building. On July 13, 2021, the Board of Supervisors approved a motion to invest $5 million for the expansion of TPI services in the four existing target communities and to also expand TPI to five new communities, which were identified based on an analysis of crime data, homicide data, poverty rates, and recent increases in violence.253 This also allowed TPI to invest in enhanced evaluation and a peer workforce housed at OVP including a Community Violence Intervention Expert. 

OVP has continued to build infrastructure to support and adapt TPI work, including coordination with city public safety departments and hospitals in new communities, strategic alignments with diversion and youth development programs, and contracting with Urban Peace Institute to develop recommendations to support expansion. On April 6, 2022, to highlight the expansion of TPI into several new communities, DPH hosted a community event that included county supervisors, agency leads, OVP staff, and residents of both the new and existing TPI communities. To expand reach, the event was recorded and live-streamed, DPH issued a press release, and also featured the event in episode seven of its Public Health Podcast series, “Reducing Violence in LA County.”

Source: County of Los Angeles Public Health, http://www.publichealth.lacounty.gov/ovp/TPI_Expansion.htm.

Establishing Regional Violence Prevention Coalitions

Given the massive size of Los Angeles County, with more than 10 million residents, it was important for OVP to establish local coalitions in each of the county’s eight Service Planning Areas to support local priorities and violence prevention efforts. In line with the 5-year strategic plan, OVP has issued competitive contracts to lead agencies in each Service Planning Area in order to convene local stakeholders to create a local Community Action Plan for each area.254 These contracts, each approximately $150,000, also covered stipends to parents and youth to be able to participate in the planning process. OVP provided training to each regional coalition around topics like goal setting and community organizing, the public health approach to violence prevention, and trauma-informed care. Community Action Plans were submitted in March 2022 and revised versions incorporating OVP feedback were finalized in July 2022. OVP has also created a learning collaborative as a space for the regional coalitions to come together to share challenges, best practices, and learn from each other.

Implementing a Crisis Response Pilot Program

As part of its strategic priority to address the inequities and root causes of violence, OVP is launching a Crisis Response Pilot Program to provide immediate peer support to individuals and families most directly affected by violence, as well as supporting collective healing across the impacted community, including activities like vigils and healing circles, messaging about the unacceptability of violence, and linking survivors to long-term services to address mental health and well-being. This crisis response model, which will use a peer approach and respond to a broad range of violent incidents, will complement other local initiatives, such as Alternative Crisis Response, which diverts behavioral health and substance use calls from law enforcement to community providers.

Some of these services will be provided by in-house mental health professionals at OVP. A full-time crisis response coordinator was recently hired at OVP to manage this work, which is starting as a three-year $1.3 million pilot program in South Los Angeles communities with high rates of violence. OVP plans to contract with community-based organizations to carry out this scope of work to support homicide victims, survivors of violence, and their families. This will include a response for victims of violence at the hands of law enforcement, as well.

Open Data Portal with Culturally Relevant Information

At present, OVP uses a variety of data sources to understand the dynamics and impact of violence in the County, including crime data, hospitalization/emergency department visit data, and coroner/death certificate data. OVP also coordinates the Los Angeles County Violent Death Reporting System, a CDC-funded national surveillance system, to monitor local violence trends and dynamics.255 This system provides rich and important data about the circumstances of violent deaths and connects multiple deaths that occurred in a single incident. These and other data collected by county partners are critical to inform policymakers, but are not readily available to the public in an easy-to-use format. OVP staff is working to create an “Open Data Portal,” drawing from LAC-VDRS, but also other data sources, that would make violence-related data available to the public in a way that is easy to access, understand, and act upon. “This will include quantitative data about violent crime numbers, trends, demographic and geographic patterns, and risk factors, as well as qualitative data that will measure community member’s perceptions of safety, community priorities when it comes to addressing violence, and an assessment of community assets.”256 The open data portal will also include metrics to show the impact of TPI and other OVP programs.

Advancing Trauma-Informed Systems Change

Through the Trauma Informed Care Initiative, OVP staff are working with fellow county agencies to train them on the nature and impact of trauma and on the importance of working with a trauma-informed lens, particularly when providing services or otherwise interacting with families and youth. The OVP definition of trauma is “a person’s response to something (an experience, a sensation, an event) that is distressing, disturbing, or life-threatening.”257 A growing body of research and evidence shows that trauma, when not addressed and healed, can have a major negative impact on behaviors and outcomes for individuals. Moreover, when government systems interact with individuals without an understanding of trauma, it is all too easy to trigger a trauma response and exacerbate existing trauma without knowing it.

To help address this, OVP staff are conducting trainings for county agencies and for community-based organizations on trauma-informed and healing-centered care. There are three levels of training available based on how far along an agency already is with its understanding of trauma, from an introductory, four-hour course, to a 6–12 month program called “Full Trauma Informed and Resiliency-Focused Transformation.”258 In addition to these trainings and host of available trauma-related educational resources and materials,259 OVP also engages in systems change work by helping organizations develop policies, engage in sustainability planning, and conduct assessments of their capacity to deliver fully trauma-informed services.

As of September 2022, OVP staff have conducted trauma-related trainings for a variety of county agencies, including the Department of Parks and Recreation and the County District Attorney’s Office.260 OVP’s vision around this aspect of their work is “to build a Trauma Informed and Healing Centered Los Angeles County, where people approach each other from a place that is rooted in an understanding of trauma, oppression, and healing; where we ask first ‘Where is this person coming from? What happened to them that might make them act like this?’ instead of ‘What is wrong with this person?’”261

Changing the Narrative: Violence as a Public Health Issue

Finally, OVP staff are working on shifting the narrative around violence, both in terms of centering the lived experiences of survivors and also reframing violence as a public health issue—not just a law enforcement issue—requiring a comprehensive response. To help center survivors, OVP launched the Violence, Hope and Healing Storytelling Project, in partnership with the Department of Arts and Culture, which is an effort to document the experiences of Los Angeles County residents who have experienced violence.262 Team members have interviewed nearly 100 individuals and have compiled powerful personal stories into a book that was published in the fall of 2022 to increase awareness of both the impact and the scope of violence.263 “By highlighting individual stories, we hope to influence the way we understand and respond to violence so that we can advance policy, practice, and system change,” states the OVP website.264 

OVP has also hired a communications strategist to develop a plan to educate policymakers, partner agencies, and the public at large about the importance of addressing violence as a public health issue, and promote and provide transparency around the work of the office.265

Staffing and Budget

OVP staff currently includes an executive director, a deputy director, communications strategist, graphic designer, two TPI co-lead positions, four TPI regional coordinator positions, two community engagement coordinators, a community capacity building specialist, a community health educator, a health education assistant, a crisis response program coordinator, a trauma-informed care specialist, several epidemiologist and research analyst positions, four community health workers, a community violence intervention expert, and several administrative support positions.266    

According to interviews with OVP leadership, securing institutionalized ongoing funding has been one of the single largest challenges facing the office. As of October 2022, LA County has identified ongoing funding to support the office and several key initiatives, demonstrating the commitment of local leadership to community-driven public safety and a public health approach to violence.267 

In total, the OVP currently has an annual budget of approximately $14.6 million, funded through Measure B, AB109 Public Safety Realignment, net county cost, and other sources. Most of this is now ongoing funding and includes about $1.7 million in one-time funding that supports planning, capacity building, and evaluation projects. OVP has also received a one-time, $20 million allocation of American Rescue Plan Act (ARPA) funds over an 18-month period to support expansion of OVP strategies such as street outreach and HVIP in more communities, a peer to peer training academy, crisis response and community healing programs, and youth services and programs.

Summary

There is an important role for counties to play when it comes to addressing community violence, and Los Angeles County’s TPI initiative and its Office of Violence Prevention provide an example of what this can and should look like. Gathering data to identify priority communities within the county, centering survivor voices, allocating resources to implement intervention and prevention programs, helping to build capacity of impacted communities and of community-based organizations in the field, and coordinating a multi-sector response are all important features of this work.

This year, the National Association of County and City Health Officials (NACCHO), recognized TPI with a national “model practice” award, noting that “TPI is built on [a] collaborative and comprehensive approach that centers those most impacted in the design and delivery of services, which is fundamental to TPI progress and achievement. TPI community engagement is based on the principles of equitable engagement including collective decision making, shared power and mutual respect.”268   

Counties around the nation, including St. Louis County, should seek to understand and replicate the core elements of Los Angeles County’s Office of Violence Prevention.

Allegheny County, Pennsylvania 

Allegheny County, Pennsylvania, where the City of Pittsburgh is located, has many similarities with St. Louis County. Its total population is 1.2 million, and it has comparable levels of political fragmentation as St. Louis County, with approximately 130 municipalities and 110 law enforcement agencies—which makes coordination and collaboration more difficult. 

Overall community violence dynamics in Allegheny County are also extremely similar to the dynamics in St. Louis County. A detailed report on violence trends by the County Department of Human Services (DHS) showed that violence is heavily concentrated in just a small number of higher-need communities—on average, homicides occur in just 0.3% of census blocks, with 79% of these blocks located in census tracts with moderate to extreme levels of need. 

State 

Pennsylvania

Pennsylvania has made modest improvements to its gun safety laws in recent years, but can do much more to protect residents from gun violence.

Gun Law Scorecard Grade: B-

This violence also disproportionately impacts the lives of young Black men, with homicide victims in the county being 86% male. “Despite Black men making up only 6% of the County’s population, they are victims in 66% of annual homicides on average. Most of these victims are between 18 and 34 years old.”269 As is the case in St. Louis County, the vast majority of homicides in Allegheny County (86%) are committed with a gun.

“A very small percentage of at-risk young men in our higher-need communities are the most vulnerable to involvement with or victimization from gun violence, with social network analyses showing that most of these young men are acquainted with each other,” the DHS report found.270 “Most violence erupts as the result of ‘beefs’ between at-risk young men (arguments that are increasingly likely to start online) or is retaliatory in response to other instances of violence in the community, with at-risk young men of the belief that they are defending their life, the life of a loved one or their own reputation.” This is nearly identical to the violence dynamics found in St. Louis County.

Over the last several years, Allegheny County has suffered approximately 107 homicides annually, giving it a homicide rate that is very much on par with St. Louis County. About half of those homicides occur in Pittsburgh. As with St. Louis County, Allegheny County saw a large increase in homicides and shootings starting with the onset of the COVID-19 pandemic, with double digit increases between 2019 and 2021, creating increased pressure for local action to address community violence.

The county-level response has come primarily from DHS, which launched a Community Violence Prevention Initiative in 2021, and the Allegheny County Health Department’s (ACHD) Office of Violence Prevention, which has been supporting the implementation of the Cure Violence model of street outreach and violence interruption in communities outside of Pittsburgh for several years. These two county agencies are working closely together on a unified, countywide response to community violence. Allegheny County’s approach to community violence is important for St. Louis County leaders to know about and understand, and is discussed in more detail in this section.

Allegheny County Department of Human Services – Violence Prevention Initiative

DHS staff wanted to better understand what the department—the county’s largest and a provider of services to more than 200,000 county residents—could do to more directly support local violence reduction efforts. As a starting point, recognizing that “efforts to reduce gun violence must be informed by data,” staff conducted an extensive analysis of homicide data from the Allegheny County Office of the Medical Examiner (ACOME), supplemented with non-fatal shooting data from the Pittsburgh Bureau of Police.271  

This analysis of data from 2016 to 2021 revealed several important facts about the nature and dynamics of community violence in Allegheny County: the majority of homicides are committed with a gun, there are five non-fatal assaults for every homicide, serious violence is concentrated in a small number of geographic areas, much violence is driven by interpersonal conflicts and cycles of retaliation, and young Black men in high-need areas are disproportionately both victims and perpetrators of community violence. 

“It is important to note,” the DHS report concluded, “that our Black communities tend to have higher levels of need because of historical and contemporary racism in housing, lending and land use policy; the negative impacts of outmigration, white flight and urban renewal; disproportionate impacts resulting from deindustrialization and economic structuring; and the harmful ways in which government and other institutions have historically responded to public health challenges in Black communities (via punitive criminal justice policies and lack of investment).”272 

The assessment was intended to help inform policy for county and municipal decision makers and, to its credit, DHS also used the findings to inform its own response, the Community Violence Prevention Initiative, with the overarching goal of “sustainably funding public health approaches to community violence reduction that are rooted in evidence and well-coordinated.”273 This initiative has two primary elements. The first is to provide coordination and convening between the areas of the county most impacted by community violence, and the second is to directly support violence reduction efforts within those specific communities. This work is being funded at approximately $50 million total over the next five years, an annual investment of $10 million which comes from a combination of state and federal sources.

Direct Support for Impacted Communities

With its homicide and non-fatal shooting analysis, DHS found that violence in Allegheny County is highly concentrated in a small number of City of Pittsburgh neighborhoods, in several municipalities directly to the west and east of Pittsburgh, and throughout the Monongahela River Valley. Recognizing that Pittsburgh already had a well-developed violence reduction strategy and infrastructure, coordinated by the Pittsburgh Bureau of Police and Office of Community Services and Violence Prevention,274 DHS leadership decided to focus support on the disproportionately impacted areas outside of Pittsburgh, except for some municipalities that naturally overlap with highly impacted city neighborhoods. The data analysis helped identify areas of emphasis for this work, as did extensive conversations with stakeholders in the region, including frontline violence intervention and prevention practitioners, residents, law enforcement agencies, and others. These conversations began in early 2021 and continued throughout the year. As time passed, several key themes and challenges emerged:

  • The implementation of an evidence-based approach has been limited, particularly outside the City of Pittsburgh.
  • Grants to pay for community-led programs are often short-term and not sustained.
  • There is a lack of coordination that brings partners together and shares information.
  • There is a lack of focus on those at highest risk, particularly when it comes to wraparound services, trauma-informed care, and credible messengers.
  • There is a lack of capacity when it comes to building support and technical assistance for organizations doing the work on the ground.

With those principles in mind, DHS staff started to create a request for proposals to expand and coordinate violence reduction strategies in targeted communities. DHS staff knew they were asking a lot of local communities and that some of the work would be unfamiliar to certain stakeholders, so they took the extra step of going out to target communities to spread the word about the upcoming funding opportunity and give people time to prepare for it, ask questions, and distribute news of the opportunity within their own networks.275   

The solicitation was formally released on January 5, 2022, under the name “Community Violence Reduction Plans from High-Priority Areas.”276 The solicitation identified 12 eligible communities determined to be the most disproportionately impacted by community violence outside of Pittsburgh. These 12 communities, the solicitation stated, “have not had the resources and infrastructure to create and invest in a coordinated strategy.” The solicitation is grounded in the notion that, while no single strategy or organization can single-handedly stop community violence, “coordinated efforts rooted in evidence-based practices, sustainable funding, and solid infrastructure…have the potential to change a community.”277  

As a result, the solicitation requested applications from “Community Quarterbacks,” entities or organizations that could serve as a lead organizing body to work with an array of local stakeholders to create and implement Community Violence Reduction Plans. “Coordination is key in all of this,” said DHS’s Nicholas Cotter, “so we built it in by saying that applicants needed to elect a community quarterback—an agency to oversee the implementation of the Community Violence Reduction Plan and be the fiscal agent for the whole project.”278 

Based on a review of literature from the field, DHS required that applicants to incorporate at least one of three evidence-based violence reduction models into its Community Violence Reduction Plan:

  1. Cure Violence: Cure Violence’s theory of change utilizes carefully selected and trained workers—trusted members of the community—to stop the violence contagion using a four-pronged approach: (1) detect and intervene before violence erupts, (2) identify and change the behavior of those at highest risk for involvement with or victimization from violence, (3) change social norms to discourage the use of violence, and (4) respond to every shooting to prevent retaliation and treat trauma.
  2. Becoming a Man (BAM): An innovative program integrating clinical theory and practice, rites of passage work, and a dynamic approach to youth engagement and development. BAM places full-time, highly skilled counselors in schools to guide young men as they learn, practice, and internalize social emotional skills, make responsible decisions for their future, and become positive members of their school and community.
  3. Rapid Employment and Development Initiative (READI): An intensive 12-month initiative that connects people most highly impacted by violence with evidence-based interventions intended to decrease violence involvement, arrests and recidivism among adult men facing high rates of arrests and victimizations. READI works with participants to stay safe, free from incarceration and able to sustainably support themselves and their families. Core components include outreach, cognitive behavioral therapy, paid transitional employment, and life skills training and support services.

The solicitation included a detailed overview of each of these models and the evidence behind them, as well as links to additional information. DHS also arranged for the developers of these models to present to potential applicants in a recorded webinar, to help familiarize potential applicants with the core principles and elements of each model.279 

In addition to these three named evidence-based strategies, funding was also available to support existing violence prevention initiatives “that show results or promise,” as well as efforts to bring together to building safer and stronger communities, such as “Organizing music; performances and festivals; Organizing street fairs and barbecues; Building playgrounds; and Mentoring children.”280 

Finally, in recognizing the politically fractured nature of county municipalities outside of Pittsburgh, DHS highly encouraged applicants to submit proposals that would cover multiple Eligible Communities, “especially if a joint Proposal would amplify their ability to reduce violence,” and particularly in contiguous Eligible Communities that share the same school district fall.281 The solicitation also required applicants to demonstrate proof of multi-sector collaboration, including through memorandums of understanding with stakeholders such as “highest-level stakeholders in local government (e.g., Mayor),” and other stakeholders, as relevant, including school districts, law enforcement, neighborhood groups, and individual residents, among others.

To allow communities and potential applicants sufficient time to prepare, DHS left the solicitation open for four months, much longer than the usual window for a grant application. In addition, to ensure that proposals would not have overlap and to maximize coordination, DHS required applicants to submit letters of intent two months into the application period, and then worked directly with applicants with overlapping proposals and encouraged them to submit a joint proposal. DHS also gave applicants access to planners who were paid for by DHS, for any proposal that requested additional support.282 

In the end, there were six applications submitted, with no overlapping areas of coverage. Applications were evaluated by a panel of approximately one dozen individuals, a combination of DHS staff and staff from partnering agencies, community members with lived experience, and staff from the pre-selected model implementation organizations Cure Violence, BAM, and READI.

Awards are still being determined as of late August 2022, but once funding rolls out, DHS has a robust plan to support its grantees, including through training and technical assistance with each of the organizations that implement the Cure Violence, BAM, and READI models. Finally, all local grantees will be required to work with the Countywide Convenor, an entity that will oversee the coordination of all community violence reduction efforts across the county. The Countywide Convenor agency was selected through a parallel countywide solicitation process, which is described in the following section.

While the program is still being rolled out, the local aspect of DHS’s Violence Prevention Initiative provides a clear model of how county governments can directly build the capacity of localities to address community violence in a coordinated fashion—especially in areas, such as the County of St. Louis, where resources for this work are lacking and where incentives may be needed to encourage politically fragmented municipalities to coordinate their efforts.

Countywide Support for Violence Prevention

DHS staff and leadership recognized the need to not just directly fund local violence prevention and intervention strategies, but also to support and coordinate efforts at the countywide level, with an emphasis on the county’s unique role as convenor of local programs. On January 5, 2022, the same day that it released the “Community Violence Reduction Plans from High-Priority Areas” solicitation, the county also opened a related solicitation titled “Countywide Support for Violence Prevention.”283 This grant funds four specific strategies, each of which is discussed in more detail below.

Countywide Violence Prevention Convenor
The solicitation asked for applicants to serve as the Countywide Violence Prevention Convenor, with qualifications including knowledge of the field of violence intervention and prevention; relationships with national, state, and local subject matter experts; a history of successful collaboration with entities ranging from law enforcement to community-based organizations; and the ability to work effectively with the evidence-based models of violence reduction.284 

One of the main roles of the Countywide Convenor is to support the successful implementation of the local Community Violence Reduction Plans, through activities including the coordination of information-sharing among stakeholders, disseminating information about best practices in the field of community violence intervention and prevention, and providing technical assistance to localities in implementing their Community Violence Reduction Plans. In addition, the County Convenor is responsible for developing a “comprehensive approach to Crime Prevention Through Environmental Design (CPTED) in the county.” Finally, the County Convenor is expected to identify needed policy changes at the county level and for “doing the community organizing needed to make progress toward those changes.”285 

Shooting Reviews
The solicitation also sought applications from entities to work in partnership with the National Network for Safe Communities to implement shooting reviews for highly impacted jurisdictions across the county.286 A shooting review is a joint effort between law enforcement, social services and health service agencies to examine what drives gun violence hyper-locally and collect intelligence that frontline violence prevention staff may act upon to prevent future violence. Shooting review panels use problem analyses to better understand fatal and non fatal shootings and develop effective responses, which can include “changes in systems, communications and strategies.”287

The entity carrying out the shooting reviews would be responsible for establishing information feeds, including from social media and law enforcement sources; creating protocols for the collection and storage of relevant information; facilitating deliberation and problem solving with community-based organizations in the “High-Priority Communities” (the same communities identified as eligible to apply for the local “Community Violence Reduction Plans” grant from DHS, in addition to highly impacted neighborhoods in the City of Pittsburgh); and tracking and publishing results.

The shooting review model is inspired by the Milwaukee Homicide Review Commission, which was created to bring together a diverse group of informed individuals to share knowledge about the nature of homicides, and then analyze the resulting data in order to gain important insights regarding both individual and systemic responses.288  

According to a rigorous evaluation of MHRC by Harvard researchers, this effort succeeded not only in vastly improving the quality of data available for homicide and nonfatal shootings, but also facilitated cross-agency information sharing and problem solving that had a significant impact on levels of violence. Specifically, evaluators found that MHRC interventions were associated with a 52% reduction in monthly homicides.289 Control districts saw a 9.2% reduction during the evaluation period. These results were particularly significant because unlike most violence reduction strategies, Milwaukee was able to implement the MHRC model in a randomized fashion so that only some districts participated, while others continued on with business as usual.

Hospital-based Violence Intervention Programs
The third category requested by the solicitation was for at least one applicant to implement a hospital-based violence intervention program (HVIP) at a trauma center in the county. The HVIP model is based on providing comprehensive wraparound services to victims of violence, using credible messengers to connect with victims during their recovery in the hospital, and working closely with them after discharge for a period of months in order to address underlying risk factors for violence, including retaliation, housing insecurity, and lack of economic opportunities. This model emerged as a response to the fact that the reinjury rate is incredibly high for those injured in a shooting or other form of serious community violence. As the solicitation states, studies show that HVIP participants are “significantly less likely to have a subsequent injury or criminal recidivism and are more likely to see success with employment, school completion and social service access.”290 The hospital-based violence intervention awardee is responsible for providing relocation services for individuals at risk of becoming victims of violence.

The solicitation was open to new or existing programs and required applicant HVIPs to provide immediate services to victims of community violence, coordinate with other HVIPs in the county, and employ frontline workers with shared lived experience as the population impacted by community violence.

Parent and Survivor Support
The fourth and final category of the solicitation called for one applicant to “convene and provide resources” to groups of parents and survivors of community violence, including helping communities to create new support groups for survivors, providing direct support to survivors of violence in “communities without support,” and bringing together groups in order to organize projects and advocate for improvements.

Awards were made for each category in the middle of 2022, and contracts were being finalized as of the end of August 2022. The grant amounts are limited to $200,000 per category, per year, for a total grant amount of $800,000. These amounts may change during negotiation.

With a budget of at least $50 million over the next five years, and through a combination of direct support for localities outside of Pittsburgh, countywide convening, implementation of countywide strategies such as HVIPs, support for survivors and their families, and a formal shooting review process, DHS is engaged in an innovative and robust initiative to address community violence, with a number of elements that deserve to be examined and incorporated by counties around the nation including St. Louis County. This work is also being carried out in partnership with the Allegheny County Health Department’s Office of Violence Prevention, which has supported the implementation of Cure Violence in several sites around the county in recent years, and also merits closer examination.

Allegheny County Health Department’s Office of Violence Prevention

In 2013, in response to a 25% uptick in homicides over a period of 10 years in Allegheny County, then state representative Ed Gainey (the current mayor of Pittsburgh), requested Allegheny County Executive Rich Fitzgerald form a commission to make formal recommendations as to how the county could better address violence. As a result, on May 9, 2013, Fitzgerald held a press conference and announced the formation of a 23-member Commission on Preventing Violence and Promoting Community Mental Health.291 “Community violence is a public health problem. In order for us to have any impact at all on this issue, we need to start approaching it from a public health perspective,” Fitzgerald declared in a statement.292  

The Commission, which consisted of stakeholders including elected officials, health workers, advocates, representatives from private foundations, and members of law enforcement, was given one year to meet, research solutions, speak with community members, and ultimately identify effective means to prevent violence. 

The Commission’s findings and recommendations were released at the end of 2014. One of the core recommendations was the creation of a “Public Health Collaborative,” to help coordinate siloed efforts to reduce violence and to assist with the “implementation of evidenced-based interventions in targeted areas.”293 Other recommendations included expanding mental health first aid and support services to families in communities suffering from high levels of violence, developing a countywide “trauma-informed approach” for the work of all departments that provide services to vulnerable communities, implementing evidence-based programs to deter at-risk individuals’ involvement in the criminal justice system, offering training and support to community organizations and leaders working to reduce violence, and redesigning policing strategies in order to focus on the “small number of serious, violent offenders and raise their risk of apprehension” in order to reduce the likelihood of further violence.”294 

In 2016, in recognition of the fact that it would require dedicated resources and staff to implement the Commission’s recommendations, the Heinz Endowments, a major private foundation in the region,295 announced it was awarding a $500,000 grant to the Allegheny County Health Department (ACHD).296 “Gun violence has devastating consequences for individuals, families and entire communities,” said Heinz Endowments President Grant Oliphant in a statement announcing the grant. “Law enforcement alone is not enough. We need a holistic effort…Over time we believe this all-hands-on-deck approach has the potential to curb a dynamic that disproportionately affects African American communities.”

The funds from the Heinz Endowments were used to create the Office of Violence Prevention (OVP) with ACHD in the fall of 2016, with a mandate to implement the recommendations and actions items identified in the Commission’s 2014 report.297 One of the first tasks for OVP staff was to create a Community Advisory board, with diverse membership representing communities most impacted by community violence. The Community Advisory Board is responsible for:

  • Providing guidance during the planning and creation of the trauma response and street outreach teams
  • Reviewing and offering input on applications for violence prevention mini-grants
  • Monitoring gun violence data regularly to determine progress and identify emerging trends
  • Networking and finding potential opportunities collaborate with fellow violence prevention stakeholders

For its first few years of existence, OVP worked on implementing an ambitious and broad set of recommendations within the confines of a limited budget and staff. When Ross Watson arrived to lead the office in 2019, he found that the most amount of progress had been made around providing reentry support for formerly incarcerated individuals, but that there was still no specific programming to work directly with individuals at the highest risk of engaging in violence. After conversations with technical assistance providers at Cure Violence Global, Watson found a violence intervention strategy that he believed would make an impact: Cure Violence.298  

“Friends and family get involved and [violence] expands just like a disease,” Watson said in an interview. “The goal is to stop it at the head before it can fester and evolve out into more violence. So, if there was a fight on Sunday night, they’re going to be in the schools Monday to make sure that those fights don’t lead to shootings or homicides.”299 

With the goal of funding the implementation of the Cure Violence model in the areas of the county most impacted by homicides and shootings, OVP applied for and received a significant grant from the Pennsylvania Commission on Crime and Delinquency. Since 2019, OVP has contracted with Cure Violence Global to facilitate the implementation of six Cure Violence sites in five priority regions outside of the City Pittsburgh,300 with 14 overall localities receiving services. These sites have been operational since July 2020. 

Having started as a department with a single contract employee, as of September 2022, OVP now has a budget for eight staff members, is actively hiring, and is expanding its violence reduction programming beyond Cure Violence and the initial five priority regions. The majority of OVP’s more than $1.3 million in funding comes from state and federal grants, with additional support from the county budget and the Heinz Endowments.301 

With increasing resources, OVP is also working on building out partnerships with other county agencies, including its strategic partnership with the County’s Department of Human Services. The partnership between OVP and DHS has existed since the inception of OVP, with DHS staff providing support around data analysis and identifying community violence trends.302 However, with its $50 million investment in the Community Violence Prevention Initiative over the next five years, DHS is becoming much more of a substantive partner in the work, and is helping to build out local and countywide programs to complement the work OVP.

“Now, with DHS getting more involved, we can give more of the day-to-day implementation of Cure Violence back to community-based organizations at each side, and focus on coordination, convening, and technical assistance,” Watson said in an interview.303 The priority areas for expansion, which have been identified in collaboration with the Community Advisory Board, will include the creation of a homicide review process to examine the intersection of domestic violence, bullying, and community violence, the creation of an annual event to celebrate the achievements of individuals and organizations work to reduce violence in Allegheny County, and the launch of a Youth Advisory Committee to ensure the active participation of young people who account for nearly 50% of the county’s homicide victims in recent years.304  

Summary

While much of the countywide violence reduction work in Allegheny County is being rolled out as of September 2022, there are many elements of the work that merit close examination by stakeholders in the County of St. Louis and counties around the nation that are impacted by community violence. These include: (1) review of homicide and shooting data to establish violence trends and dynamics, (2) emphasis on the geographic regions most impacted by homicides and shootings, (3) inter-departmental partnership, (4) county-level coordination and convening, (5) direct support for evidence-informed violence reduction strategies, (6) support to build local capacity to address violence through training and technical assistance, and (7) community input at all stages of the solicitation design and rollout process.  

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Gaps and Recommendations

Community violence in the County of St. Louis has trended dramatically upwards in recent years,305 underscoring the need to address the gaps in its response. At the most fundamental level, the county lacks a strategic plan to guide its violence reduction work, nor does it have a countywide Office of Violence Prevention to gather and analyze data, coordinate strategies, and provide direct support to organizations engaged in reducing violence by addressing root causes. 

Equally critical is the lack of a county-backed effort to proactively identify and intervene with individuals who are at the highest risk of engaging in violence behavior, which has proven to be one of the most effective strategies for reducing homicides and shootings in the short-term. Moreover, some of the most effective systems for gathering and analyzing community violence data in order to inform impactful responses—such as problem analyses and shooting reviews—are not being conducted.

Finally, there is a lack of investment in strategies other than law enforcement that are designed to address the risk factors most closely linked to community violence. This includes reentry services for individuals returning from incarceration, trauma-informed mental and behavioral health services, housing security, relocation services, and employment training for those at high risk of engaging in or becoming the victims of violence. It also includes remediating vacant lots and buildings that currently act as a magnet for violent crime. In some instances, organizations based in the City of St. Louis are providing some of these services, but at present are receiving little to no investment or other forms of support from the county.

The following section details the gaps in St. Louis County’s response to homicides, shootings, and other forms of community violence and includes concrete recommendations for how to fill those gaps. The final section of this report includes detailed analysis of public funding streams that could be leveraged to implement these recommendations. Taking these steps will help to turn the rising tide of violence in St. Louis County, which will most importantly save lives, but will also generate significant cost savings and spur economic growth for the whole region.

Recommendation #1: Create a St. Louis County Office of Violence Prevention

The two most glaring gaps in St. Louis County’s response to community violence are the lack of a countywide strategic plan to reduce violence,306 and the absence of infrastructure to develop and implement such a plan. Without an overarching strategic plan to guide and coordinate violence reduction work, existing efforts are being carried out in silos, and any county involvement is ad hoc and piecemeal, at best. Especially in a county as politically subdivided as St. Louis County, there is great need for a county entity to see the big picture, work across agencies to create a multi-sector response, and coordinate across smaller municipalities. As the examples discussed above from Los Angeles, Harris, and Allegheny Counties illustrate, more and more jurisdictions are creating an Office of Violence Prevention to carry out those very functions.

The County of St. Louis should do the same, and incorporate best practices from each of the counties that have taken this step. In addition, a number of successful municipal models from which to pull best practices exist around the country, including the Office of Neighborhood Safety in Richmond, California,307 the City of Los Angeles Mayor’s Office of Gang Reduction and Youth Development,308 and the City of San Jose’s Mayor’s Gang Prevention Task Force.309 The National Institute for Criminal Justice Reform runs the National OVP Network, which brings together more than 30 such offices from around the country and is a valuable technical assistance provider in this space.310 

In order to centralize responsibility and accountability for crafting and implementing a coordinated, multi-sector response to community violence in the County of St. Louis, Giffords recommends that the county invest at least $5 million to launch an Office of Violence Prevention (OVP). Since a number of violence prevention initiatives already exist within the county’s Department of Public Health (DPH), especially around data collection and analysis, DPH is a leading candidate to house this office. 

As Los Angeles County Supervisors did in 2019, the St. Louis County Council should provide funding to staff the Office of Violence Prevention with an initial mandate to create a five-year countywide strategic plan to reduce community violence.311 As in Los Angeles, this process should be guided by a multi-agency, multi-sector advisory committee that includes residents who have been directly impacted by community violence and practitioners doing the work on the ground.

In addition to creating a five-year strategic plan, the St. Louis County OVP should be tasked with coordinating data collection and analysis relating to community violence, with an emphasis on improving the availability of data related to non-fatal shootings; convening stakeholders from around the county in order to break down silos and share best practices; and helping build capacity for community-based organizations working on the frontlines, including support for evaluations and the provision of training and technical assistance. The OVP should also take responsibility for identifying and applying for state and federal grant applications to assist with expanding the counties capacity to address community violence. Many of these funding opportunities are identified in the final section of this report, below.   

One of the core functions of the OVP, similar to what the Allegheny County Department of Human Services is doing in Pennsylvania, should be to directly fund the expansion of evidence-informed intervention strategies and to incentivize local coordination of community violence reduction work. That can best be done through the following recommendation, which could be implemented separately or in conjunction with the launch of a countywide OVP.

Recommendation #2: Directly Support Localities in Implementing Coordinated, Evidence-Informed Violence Intervention Strategies

One of the largest gaps in St. Louis County’s response to community violence is the lack of community-based organizations intervening with individuals at the highest risk of engaging in violent activity. While there is a law enforcement response to shootings and services for victims of gun violence, such as LOV and The T, these are all forms of a reactive response—meaning they are activated after a shooting occurs. In order to effectively reduce community violence, reactive responses must be paired with a robust array of proactive responses that are designed to prevent shootings before they happen. 

As Giffords has documented extensively, there are a number of such proactive strategies that have been shown to dramatically increase public safety by identifying those at highest risk of engaging in violence and then using credible messengers to build relationships and address risk factors through a long-term, high-contact engagement.312 Cities that have successfully reduced violence in recent years, including Los Angeles, Boston, and New York City, as well as smaller jurisdictions such as Richmond, California, and New Haven, Connecticut, have committed significant resources to support community-based organizations in delivering effective, trauma-informed, and culturally relevant services to this high-risk population.

In the City of St. Louis, which saw a 25% reduction in homicides in 2021313—a year in which the rest of the country saw continued increases314—and is on track for further reductions in 2022,315 this work is happening through efforts like Cure Violence, Serving Our Streets, and Better Family Life.316 Furthermore, many of these already-existing efforts received additional support directly from the city in the form of a $5.5 million investment of American Rescue Plan Act (ARPA) funds administered through the City’s Department of Public Health in the first half of 2022.317 The City of St. Louis continues to double down on these investments, with Mayor Jones signing a bill on July 22, 2022, that will invest an additional $13.6 million to fund “community violence prevention and youth programs” with ARPA dollars.318  

The County of St. Louis, in contrast, is not making any direct investments in community violence intervention services, and after dozens of stakeholder interviews, not a single county-based organization was identified as providing evidence-informed intervention services for individuals at very high risk of engaging in and/or becoming the victim of community violence. This is a major strategic miss for the county that must be addressed as soon as possible.

In order to fill this gap in services and to encourage the coordination of work across multiple municipalities within the county, Giffords recommends that the County of St. Louis invest a minimum of $10 million annually, structured along the same lines as the investment made by the Allegheny County Department of Human Services, described in detail above.319 This investment should be administered by a non-law enforcement agency, and include the following key elements:

  1. It should identify a limited number of eligible county municipalities, based on homicide, non-fatal shooting, and aggravated assault data.
  2. Before releasing a solicitation, the administering agency should contact stakeholders in eligible municipalities to raise awareness of the opportunity.
  3. The solicitation itself should allow applicants to implement one or more community violence intervention strategies, from a limited menu of eligible options. The Allegheny County solicitation, for example, limited applications to Cure Violence, the READI Chicago model, Becoming a Man, and/or the extension of any existing evidence-informed strategies.
  4. The solicitation should encourage and prioritize coordination across organizations and municipalities.
  5. The application window for the solicitation should be at least three months, to allow time for word to get out as well as for the administering agency to provide webinars to answer applicant questions and to have access to technical assistance providers. Letters of intent should be required in order to give the administering agency the opportunity to identify and resolve any potential overlap in applications.320     

Finally, there is increasing recognition that an effective violence reduction ecosystem requires an investment in direct support for frontline workers and for smaller, grassroots violence reduction efforts that lack the capacity to leverage traditional public grants. In a national survey of more than 200 violence intervention workers around the country, Giffords found that frontline staff in this field suffer from unequal pay and inadequate fringe benefits; untreated vicarious and direct trauma and a lack of uniform training, professional standards, and professional development opportunities.321 

As examples of efforts to address these issues, in Los Angeles, the city-funded Urban Peace Academy implements minimum qualifications and training standards, offers a tiered professional development track, and enforces standards of conduct and practice through a Professional Standards Committee.322 

“The Academy has not only helped to train and professionalize gang intervention and street outreach nationally, but is a career pathway for formerly incarcerated and gang-involved people to contribute to and come back to their communities,” said Fernando Rejon, executive director of the Urban Peace Institute, which runs the Urban Peace Academy.323 “The Academy has served as an organizing platform, which has allowed intervention workers to build strong networks, to leverage resources, [and] to define the work.”

In Massachusetts, the state-funded community violence workforce development program is providing a 36-hour, culturally relevant skills and professional development course for frontline violence intervention workers in Boston and other cities.324 At a cost of approximately $150,000, this training is provided in partnership with both local practitioners and the University of Massachusetts. 

Giffords recognizes the need for the County of St. Louis to develop its capacity to support the field of community violence intervention professionals, including the wellness and development opportunities of frontline workers. Given the scope of community violence in the county, Giffords recommends an annual investment of at least $300,000 in this effort. 

Recommendation # 3: Conduct a Formal Problem Analysis and Implement a Shooting Review Process

A universal best practice for areas grappling with high levels of community violence is to undertake a rigorous problem analysis in order to deeply understand local violence dynamics, and to institutionalize a shooting review process in which a range of stakeholders regularly meet to share the most recent information about serious violence and proactively solve problems.325 St. Louis County has a gap around collecting data pertaining to community violence, as described above, and this gap is particularly glaring when it comes to data about non-fatal shootings.

Problem Analysis

A problem analysis is a formal process that involves reviewing years of homicide and nonfatal shooting data, combined with interviews of homicide detectives and community members with knowledge of local violence dynamics, in order to create a detailed understanding of an area’s violence dynamics at a specific point in time. This process can help to both dispel myths and focus resources strategically. “For complex problems such as homicide, a deep understanding of the nature of the problem is crucial in framing appropriate responses,” wrote noted criminologists Anothony Braga and Deborah Azrael.326

In Oakland, California, for example, outside technical assistance experts from the California Partnership for Safe Communities (CPSC) conducted a comprehensive, year-long review of data and their findings revealed that the city, police, and community groups had fundamentally misunderstood the dynamics of gun violence in Oakland for years. As in many cities, the false narrative being perpetuated in Oakland was that large groups of young people involved in drug-related disputes were driving the majority of gun violence. 

CPSC’s problem analysis revealed that there were 50 violent groups or gangs in Oakland with an active membership of between 1,000 and 1,200 people, representing just 0.3% of the population.327 These individuals were responsible for up to 85% of the city’s homicides and were also the vast majority of homicide victims. Moreover, only a small subset of those groups, about 400 individuals—just 0.1% of Oakland’s total population—were at high risk for engaging in serious violence at any given time. Despite commonly held beliefs that juveniles were driving violent crime, CPSC’s problem analysis showed that fewer than 10% of homicides in Oakland involved anyone under 18. In reality, the average age of a homicide suspect in Oakland was 28, and the average age of a victim was 30. 

All of this information was used to reform the city’s strategy for addressing violence, which researchers found contributed to a close to 50% reduction in nonfatal shootings and homicides between 2012 and 2019.328  

Interviews with multiple stakeholders in St. Louis County confirmed that the county has not conducted a full-scale problem analysis with respect to community violence. This is a glaring gap that should be addressed as quickly as possible.

As the problem analysis is an important aspect of understanding and strategically directing resources to effectively address homicides and shootings, Giffords recommends that the County of St. Louis contract with a third party technical assistance provider, such as the National Network for Safe Communities or the National Institute for Criminal Justice Reform,329 in order to undertake a problem analysis that will capture the most recent violence trends, identify risk factors for those at the highest risk of engaging in violence, and inform resource allocation. Such an analysis could be used to inform the strategic plan of the Office of Violence Prevention, as recommended above, for example. 

A problem analysis on its own generally costs approximately $50,000, however, a longer-term technical assistance engagement is likely to yield better results. As such, Giffords recommends that the County of St. Louis invest at least $350,000 for a two-year engagement with a reputable technical assistance provider to conduct an initial problem analysis and ongoing assistance with the implementation of indicated strategies.

Shooting Review

A problem analysis, as useful as it is, provides a snapshot of violence dynamics at a very specific time, and so must be updated regularly, as these dynamics are often very fluid. A best practice is to implement a shooting review process in which a diverse array of stakeholders meet on a regular basis to analyze recent shootings, share information, and collectively problem-solve issues in a proactive manner.

As researchers evaluating the impact of Milwaukee’s Homicide Review Commission noted, “Homicide problems evolve over time and cities must be positioned to identify and understand new trends, implement appropriate strategies, and adjust strategies as necessary. Dynamic and adaptable processes, rather than tactics and specific programs, are needed to manage and control urban violence.”330 

As an example of a shooting review, in response to rising violence, the City of Milwaukee funded and launched the Milwaukee Homicide Review Commission (MHRC) in 2005,331 with the goal of reducing homicides by improving data collection, data sharing, and multi-agency problem solving around homicides and non-fatal shootings. Milwaukee (population 595,000) presents a useful case study for both the City and County of St. Louis because its violence dynamics are similar to those of the St. Louis region. Eighty percent of homicides in Milwaukee are committed with a firearm (90% in St. Louis), violence is highly concentrated geographically in areas affected by poverty and segregation, and the large majority of victims and suspects are Black males.332 As in the case in St. Louis, Milwaukee homicides are “often the outcome of an ongoing dispute between individuals and/or groups…and involved respect, status, and retribution as motives.”

The idea in Milwaukee was to bring together a diverse group of informed individuals to share knowledge about the nature of homicides, and then analyze the resulting data in order to gain important insights regarding both individual and systemic responses. The initial MHRC shooting review process, based in part on the Child Death Review model and implemented with the help of technical assistance providers,333 took place in four different phases meant to engage different sets of stakeholders at different times. 

The Criminal Justice Review, for example, took place once a month and consisted largely of law enforcement partners, although other partners, such as the Milwaukee Public Schools and Milwaukee Housing Authority, were present as well. These stakeholders came together to share information about homicides, with MHRC staff transcribing as much information as possible into a digital, searchable format.334 Another level of review, the Community Service Provider Review, focused on analyzing homicides through the lens of social service providers and public agencies, such as the health department, the Mayor’s office, and representatives from faith-based organizations. 

This process also involved real-time analysis of homicides and shootings conducted by police investigators and crisis response provided by community-based organizations, who were alerted to violent incidents through a shared notification system. Finally, community-wide reviews created transparency for residents and allowed them to give their input into the MHRC process.

Among other insights, the MHRC process revealed that many Milwaukee homicides (18%) and nonfatal shootings (15%) were concentrated in and around taverns, and 70% of these incidents occurred between 11 p.m. and 3 a.m. on Friday and Saturday nights. This led the MHRC review teams to recommend specific action items to address this issue, including the passage of a local ordinance to improve security protocols at taverns (e.g., the installation of security cameras), increased police presence at hot-spot taverns, and increased enforcement of various nuisance and alcohol regulations—leading three three targeted taverns to voluntarily surrender their liquor licenses, while four others were closed down. During the evaluation period, “treatment districts experienced no tavern-related homicides…[while] there were three tavern-related homicides in control districts.”335 

Another trend that emerged was the connection between certain “nuisance” properties and violent crime. The MHRC process revealed that 29% of homicides occurred at rental properties that had previously been identified by district officers as “nuisance” properties, meaning a property that received three substantiated complaints for criminal or disorderly activity within a 30-day period. This led to increased coordination between the police department and the City Attorney’s Office, which began to initiate civil actions against the landlords of nuisance properties, who also received a letter from the police department requiring them to meet personally with the District Captain to provide an abatement plan.

According to a rigorous evaluation of MHRC by Harvard researchers, this effort succeeded not only in vastly improving the quality of data available for homicide and nonfatal shootings, but also facilitated cross-agency information sharing and problem solving that had a significant impact on levels of violence. Specifically, evaluators found that MHRC interventions were associated with a 52% reduction in monthly homicides.336 Control districts saw a 9.2% reduction during the evaluation period. These results were particularly significant because unlike most violence reduction strategies, Milwaukee was able to implement the MHRC model in a randomized fashion so that only some districts participated, while others continued on with business as usual. 

In the years since the evaluation was conducted, homicide levels have bounced back in Milwaukee—but critically, this coincided with reductions in both participation in and funding for MHRC,337 with budget cuts that reduced staff size by 75% and a complete withdrawal of the police department in the process. There is renewed appetite to revitalize MHRC in the face of increasing violence, with one community-based organization lamenting that “we don’t stick with what works [in Milwaukee] when it comes to reducing crime and preventing violence.”338 

A shooting review process in Omaha, Nebraska, also helped drive the city’s 76% reduction in overall gun violence, 56% reduction in homicides, and 90% reduction in officer-involved shootings in the years leading up to the COVID-19 pandemic.339 As Willie Barney, founder and president of the African American Empowerment Network, which spearheaded the Omaha 360 effort, explained in an interview, “We meet every single week for at least an hour [to] engage in open dialogue about what happened during the past week, what’s coming up the next week, and…who needs to address what. For example, we discussed if the intervention team should be at a football game. We knew the police department would be there, but could we get some pastors and community leaders to go as well? We’re always asking what we can do together to create a safe environment.”340 

Despite the evidence in favor of implementing a shooting review process,341 interviews with multiple stakeholders indicate that the County of St. Louis is not engaged in such a process, at least not outside of the context of law enforcement, which needs to change. The operating cost of the MHRC has historically been around $275,000 per year, which has included some amount of in-kind support from the City of Milwaukee. Given this, Giffords recommends that the County of St. Louis invest at least $300,000 per year in staff, technology support, and a technical assistance provider to implement and institutionalize a rigorous shooting review process.

Recommendation #4: Create a Truly Regional, Multi-Sector Response to Community Violence

A consistent theme raised in interviews with stakeholders was the need for a regional response to homicides and shootings in the greater St. Louis region. As Sal Martinez, executive director of Employment Connections, pointed out, “The drivers of violence are the exact same whether someone lives in the city or the county. We need to see more regional coordination and cooperation on this issue. If a person can shoot from the city to the county—literally—how can we not be working together cohesively to address this?”342 In addition to the City and County of St. Louis, many stakeholders also pointed out the proximity of the City of East St. Louis and the fact that violence easily spills between all three areas—which are minutes away from each other—by car, although East St. Louis is part of the State of Illinois.

This is another reason for the County of St. Louis to launch an Office of Violence Prevention, with responsibility for coordinating efforts with other entities in the region, including the city’s recently created Office of Violence Prevention.343 It is a timely opportunity to leverage the infrastructure that is already in place and developing in the city to double down on initiatives to open up lines of communication across the region and create strong community networks.

50%
decrease in gun deaths & injuries
The number of gun deaths and injuries for participants in CRED, a Chicago-based street outreach program, fell nearly 50% in the first 18 months of participation.

Source

Northwestern Neighborhood & Network Initiative (N3). 2021 (August 25). Reaching and Connecting: Preliminary Results from Chicago CRED’s Impact on Gun Violence Involvement. Institute for Policy Research Rapid Research Report. https://www.ipr.northwestern.edu/documents/reports/ipr-n3-rapid-research-reports-cred-impact-aug-25-2021.pdf

On the law enforcement side, the Teneo Group released a report in 2020 finding that SLCPD’s “collaboration with the St. Louis Metropolitan Police Department (SLMPD) in terms of intelligence and resource sharing to combat crime is nowhere near as advanced and as cooperative as it should be.”344 

One concrete step the county can take to facilitate a regional approach to addressing community violence is to create incentives for local law enforcement agencies to regularly participate in the “Violent Crime/Armed Offender Meeting” hosted by St. Louis Metropolitan Police Department.345 At this weekly meeting, a variety of law enforcement agencies gather to talk specifically about violent crimes that occured within the last week, sharing intel from crime gun analysis, potential leads, and anything else that might be relevant to solving a violent crime.

Given the flow of violent crime across the artificial political lines of the city and county, the information discussed at these meetings are relevant to county law enforcement agencies. SLMPD’s Gun Crime Intelligence Center, which consists of six detectives and a sergeant that work directly with the federal Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) to run analysis on recovered guns to try to link them to specific crimes, is a resource that can and should be leveraged by county law enforcement agencies. Crime guns that are used in the city are being found and identified in St. Louis County and vice versa. This analysis is used to generate a Gun Intelligence Report that shows information about guns that are being linked to multiple crime scenes, including a “Most Wanted Gun” section, that helps provide leads on solving gun-related crimes.346  

Despite this, at a focus group of law enforcement agencies in the county, the majority of participants indicated that their departments were not aware of and not actively participating in the Violent Crime/Armed Offender Meeting.347 This should change.

Areas that are succeeding in reducing violence, such as Los Angeles, use resources to bolster a regional approach. The Los Angeles County Office of Violence Prevention’s Early Implementation Strategic Plan, for example, calls for identifying and funding a lead agency in each of the County’s eight Service Planning Areas to establish Regional Violence Prevention Coalitions, including a requirement of paid participation of at least two youth representatives in each.348 These regional coalitions are meant to include not just government agencies, but also community and faith-based organizations, businesses, and others engaged in addressing community violence.   

Giffords recommends that the City of St. Louis and the County of St. Louis create a working partnership to coordinate violence reduction efforts, funded either jointly and/or through a shared state or federal grant. Given the importance of this collaboration, Giffords recommends an investment of at least $500,000 annually in this coordination, including the cost of full-time staff support and ongoing technical assistance.

Moreover, in order to bring more diverse resources to bear on the issue of community violence, County Executive Sam Page and the St. Louis County Council should direct county agencies to examine their existing competitive solicitations in areas like employment and education, and look for ways to incorporate community violence. As an example of this at the federal level, in 2021 President Biden directed federal agencies to incorporate community violence intervention into their competitive grant programs.349 As a result, dozens of federal grants now prioritize applications from communities disproportionately impacted by homicides and shootings, and resources from agencies like the Department of Labor are being used to provide employment training and services to those at high risk of engaging in violence.350 

With a relatively simple directive, and ideally with support from an Office of Violence Prevention tasked with spearheading a multi-agency response to community violence (with an Advisory Committee made up of relevant agency leaders), the County of St. Louis can enlist a broader universe of systems to more intentionally address the root causes of violence. As an example of this in action, Los Angeles County’s Office of Violence Prevention’s Strategic Plan includes action items for partner agencies including the County Department of Mental Health, Department of Human Resources, Sheriff’s Department, Department of Arts and Culture, and the Department of Parks and Recreation.351 

Finally, both government and non-government entities are critical for reducing community violence, and the county should look for ways to partner with and expand the work of the St. Louis Area Violence Prevention Commission as a regional organizing body for a host of stakeholders working to reduce community violence. “This isn’t just a St. Louis City issue; it’s an issue that faces the entire region, because it affects the entire region,” said Pat Kelly, executive director of the Municipal League of Metro St. Louis, in an interview with local media.352 

Recommendation #5: Expand Services for Survivors of Violence

As discussed in detail in the Existing Strategies section above, several organizations in the St. Louis region are providing critical services to survivors of violence and their families. This includes Life Outside of Violence, Victims of Violence, the Crime Victim Center, the BRIC, and the County Prosecutor’s Division of Victim Services. Providing effective services to victims of violence is an important strategy for reducing community violence because exposure to violence is such a strong risk factor and predictor of future violence. However, with limited exceptions, most of these efforts are being carried out without direct support from St. Louis County, despite the fact that a large number of victims being served by these programs are county residents.

Cities having success in reducing community violence are investing in crisis response systems, including in programs that respond to the needs of victims of violence and their families.353 St. Louis County should follow this example and the model of counties like Allegheny and Los Angeles, which have both made multi-million investments to scale up hospital-based violence intervention programs and other services for victims of violence. 

Giffords recommends that the County of St. Louis invest a minimum of $3 million annually to directly support this work in three ways: (1) to issue a competitive solicitation to specifically expand the services available to victims of community violence, with an emphasis on county-based trauma centers that lack such services; (2) to issue a competitive solicitation to fund advocates for victims of homicide and shootings housed with local law enforcement agencies, as SLCPD is doing through its Homicide Advocate program in partnership with the Crime Victim Center; and (3) to incentivize collaboration and coordination among victim service providers in this space by funding a county agency or a community-based organization partner to facilitate convening and information sharing between relevant entities. 

Finally, in order to move towards closer coordination with the City of St. Louis, county leaders should explore the option of making this investment in partnership with the city, especially since many existing programs are serving a blend of city and county residents.

Recommendation #6: Expand Services for Community-Based Organizations Serving High-Risk Individuals, with an Emphasis on Employment, Housing, Mental and Behavioral Health, and Reentry Services

One of the keys to reducing violence is to provide intensive services to the relatively small population of individuals at high risk of engaging in violence. In order to be effective, these services must touch on the risk factors most associated with violence. In St. Louis County, as discussed in detail above, these risk factors include multiple contacts with the criminal justice system, poverty (including both job and housing insecurity), and lack of positive, adult relationships. In each of these areas, St. Louis County has existing networks of community-based and grassroots organizations, but interviews with stakeholders revealed the need to intentionally expand these efforts—especially in the areas of housing and relocation services354—and to incentivize organizations to work specifically with individuals at the highest risk of engaging in violence.

It’s also important to recognize that certain individuals and entities may lack the organizational capacity to leverage grant funding, despite having access and credibility in certain communities that others may not have. To maximize the reach of violence intervention efforts, it’s important for the County of St. Louis to support grassroots efforts.

46%
decline in gun homicides & assaults
The Advance Peace intervention program in Sacramento correlated with a reduction in gun homicides and assaults of up to 46% in areas where the program was implemented.

Source

Jason Corburn and Amanda Fukutome-Lopez, “Outcome Evaluation of Advance Peace, Sacramento, 2018–2019,” UC Berkeley Institute of Urban and Regional Development, March 2020, https://www.advancepeace.org/wp-content/uploads/2020/04/Corburn-and-F-Lopez-Advance-Peace-Sacramento-2-Year-Evaluation-03-2020.pdf.

One way of addressing this is to earmark a percentage of investment recommended here for smaller organizations, as the State of Pennsylvania did with its 2021 violence reduction grant program designed specifically for the City of Philadelphia. The program carved out categories of applicants based on organization and award size, and reserved funding for applicants “with under $100,000 in annual operating expenditures relying primarily on volunteers to operate and may have no full-time employees. These applicants are seeking funding to support small-scale, neighborhood level activities.”355 

Another is to partner with one or more intermediary organizations whose role is not just pass through resources, but also to develop the capacity of grassroots violence intervention and prevention organizations to serve their neighborhoods.356 An ideal intermediary would have a strong track record of focusing on issues of race and equity in their efforts to analyze problems, fashion solutions, and define outcomes, and a reliance on soliciting input from directly impacted individuals in shaping their work. 

In Colorado, the Department of Corrections successfully partnered with an intermediary, the Latino Coalition, which helped develop the capacity of several grassroots organizations providing reentry services in communities of color. As an Urban Institute study of this arrangement noted, the intermediary role was “important to the launch of the program because the CDOC was not in a position to provide this support,” which included administrative oversight as well as leadership, resources, and capacity-building skills.357 

The County of St. Louis would benefit from further investment in intermediaries to support local, grassroots organizations working specifically with individuals at high risk of engaging in violence at the individual neighborhood level, particularly in the areas of employment development, housing stability, mental and behavioral health, and reentry services. In Colorado, a state investment of just under $10 million supports the Latino Coalition in partnership with seven community-based, grassroots reentry service providers around the state. 

Given the scope of community violence in the County of St. Louis, Giffords recommends an investment of at least $5 million to support established community-based organizations, intermediaries, and smaller grassroots organizations in working with those at high risk of engaging in violence, with an emphasis on trauma-informed services in the areas of employment development, housing security and relocation services, mental and behavioral health, and reentry.

Recommendation #7: Expand On-Campus Mental and Behavioral Health Services and Safe Passage Programs In Districts Disproportionately Impacted by Community Violence

Interviews with educators from several school districts in north St. Louis County showed that community violence is a growing and ongoing area of concern for students and parents. Several interviewees pointed to record numbers of guns being carried on school campuses, the increasingly young ages of those involved with guns, and the dynamic of fights within school that then escalate out in the community.358 The role of social media in fueling violence was also echoed by several interviewees who noted that social media emboldens students to say things online that they wouldn’t necessarily say in person, adding fuel to the fire of conflicts and having serious, sometimes tragic, repercussions in the real world. 

Trauma was universally identified as a root cause of the violence seen both on and off of campuses in north St. Louis County. “We have entire communities that are living in trauma, some of it is generational,” said an educator. “People are in survival mode—both the kids and the parents. When we can identify and address the trauma, we can make a difference, but we just don’t have the resources to do that right now.”359 One of the barriers is resources, and interviewees pointed to the difficulty in hiring and maintaining high-quality mental and behavioral health professionals. 

Another barrier to addressing trauma is the stigma around accessing it in the first place. “We can make referrals, but a community living in trauma doesn’t realize it—people don’t want help,” said one educator.360 “We need policies to encourage our students and parents to identify and heal from their trauma.” Many educators saw the potential for schools as a hub of mental and behavioral health services for at-risk young people and their families, since people are more likely to access such services if they are readily available in a convenient location. The Jennings School District, for example, has seen success with a program that hires clinical therapists who are members of the staff and available to see students, their families, and staff members on campus. “It’s really important that they be staff members—then our students and families are more likely to get the help that they need.”361  

Some campuses have experimented with on-campus clinics that help students treat and prevent physical illnesses, but mental health has not traditionally been part of the services offered at such clinics. A new influx of resources from the recently enacted Bipartisan Safer Communities Act (BCSA) will provide St. Louis County with a once-in-a-generation opportunity to bolster trauma-informed services that are available to students and their families in high-violence districts. Given the importance of safe transportation to and from school, Giffords also recommends that St. Louis County school districts look to leverage BSCA funds in order to implement and/or expand Safe Passage programs, which employ community members and partner with local businesses to help ensure that students are able to safety get to and from school.362

Recommendation #8: Create Pilot Programs for 911 Diversion, Co-Responder Emergency Response, and Civilian-Only Emergency Response

The logic behind alternative emergency response programs is twofold. First, police departments are overly strained by a huge volume of calls, resulting in longer response times and unnecessary use of law enforcement resources that could be directed to more serious situations. Second, many emergency situations involve people with mental and behavioral health issues who need access to care rather than facing arrest at the hands of an armed officer and incarceration.363 Both of these elements are present in the County of St. Louis, where researchers from Forward Through Ferguson found long wait times for 911 callers and, crucially, only about five percent of overall calls to 911 in St. Louis County are for violent crime.364 The vast majority of calls are for non-criminal incidents that don’t require an armed police response.

Similar patterns in the City of St. Louis led to the launch of a pilot program several years ago that became a citywide effort in early 2021 to experiment with alternative, non-police emergency responses. The first aspect of this effort is the 911 Diversion program, in which emergency operators are trained to identify calls that would be better handled by behavioral health professionals trained in crisis intervention rather than dispatching police or EMS. Those calls are then transferred to Behavioral Health Response (BHR), a nonprofit agency that provides 24-hour access to mental health services and counseling in cities around the country. A BHR-trained operator will then ask the caller questions to determine if a response from a non-law enforcement clinician is the most appropriate response. 

Giffords Law Center to Prevent Gun Violence: Implementation

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“We know that police officers and the justice system have become the pseudo mental health treatment plan,” said Tiffany Lacy Clark, who heads up Behavioral Health Response, the agency the city is contracting with to run the program.365 “This gives us an opportunity to move treatment back to [trained service providers] and let the criminal justice system focus on what they are trying to do.”

In a powerful example of a private-public partnership, data analysis provided by MasterCard  showed that, in its first year of citywide operation, more than 700 calls were handled through the 911 Diversion program, with four out of five cases “resolved on the line without requiring police or EMS, saving nearly 500 ambulance dispatches and an estimated $400,000 over its eight months of operations.” Moreover, “88% of client’s receiving follow up were diverted from additional contact with EMS/police, and 78% were diverted from inpatient care.”366 

“It has always been a concern of police that [officers] come in contact with individuals who call 911 and clearly need something other than a police response,” said Wil Pinkney, director of the City of St. Louis’ Office of Violence Prevention.367 “Call diversion is all about transferring them to a crisis line where they can talk with someone who’s trained to engage with people going through a personal crisis. The hope is that this will decrease calls that require an emergency response or arrest in those situations.”

The second component of the city’s program is a co-responder model, known as Cops and Clinicians, which involved a Crisis Response Unit (CRU) consisting of eight dedicated officers and eight behavioral health clinicians who “work together in responding to calls involving a behavioral health crisis, substance use and trauma to provide resources and connection to care at the time of the incident.”368 If an emergency call is made for a response and officers deem the scene to be safe—but understand that a behavioral health issue is involved—then CRU clinicians are able to provide an on-site response to the individual in crisis.

The goal is to reduce the number of cases that end with a person being unnecessarily jailed or hospitalized. Data analysis provided by Mastercard showed that in its first year, the Cops and Clinicians teams “responded to nearly 5,000 cases. Ninety-five percent of individuals in crisis have been diverted from arrest and connected to services, with 87% diverted from hospitalization.” Mastercard also estimated that over eight months since the program started in 2021, “it saved the police department and EMS more than 2,000 work hours to help them respond to other priorities, saving the city an estimated $2.2 million in 2021.” Taken together, the savings from the 911 Diversion and Cops and Clinicians programs are far greater than the city’s initial $1.6 million investment.369

Given these promising results and similar challenges faced in high-crime areas of the county, Giffords recommends that the St. Louis County Council invest at least $1.5 million to launch a pilot program to test both 911 diversion and a co-responder model like Cops and Clinicians. This is in alignment with a recommendation from the VPC, which in 2021 recommended that “St. Louis County develop a civilian public safety response network that allows 911 callers to access mental health workers, community health workers, and social workers to respond to calls that are not about crime.”370 The county should also examine the impact and needs of the newly launched national 988 program, in which individuals experiencing an acute issue can call 988 to be connected with a trained mental health professional.371 

In addition, the county should fund a pilot to test the viability of a civilian-only emergency response, as has been implemented in cities like Denver, with its STAR program. Forward Through Ferguson’s transforming 911 project specifically calls on county leaders for a $3 million investment in order to plan, implement, and evaluate a civilian-only response model in a specific catchment area(s).372 With the initial results from various cities across the country showing cost savings, improved emergency responses, and movement away from arrest and incarceration, Giffords echoes that call here.

Recommendation #9: Create a Pilot Diversion Program for Gun-Related Offenses at the County Prosecutor’s Office

A growing body of evidence suggests that incarceration for non-violent gun offenders—individuals charged with illegal possession of a firearm, for example—actually increases the risk of an individual engaging in crime in the future. Since incarceration itself is a risk factor for violence, it stands to reason that programs to avoid incarceration, when possible, are an effective way to both improve public safety and reduce overall costs for the criminal legal system.373 An increasing number of prosecutors around the nation are implementing diversion programs that are specifically tailored to nonviolent gun offenders.374

Interviews with the County Prosecutor’s Office confirmed that, at present, there is no diversion programming for individuals facing non-violent gun charges in the county.375 As Giffords discussed in our 2021 report, A Second Chance: The Case for Gun Diversion Programs, there is tremendous promise in the idea of creating customized programming for offenders as an alternative to incarceration.376 In Minneapolis, Minnesota, for example, as the home to one of the nation’s first gun diversion programs, implementation data evaluators are seeing significant reductions in recidivism rates for diversion program participants after several years, compared to the status quo, with related cost savings.377 

The St. Louis County Prosecutor’s Office has used federal funding and other resources to increase its diversion programming in a variety of areas, and Giffords recommends that the office analyze its data and, if indicated, implement a gun diversion program in partnership with a local community based-organization. Based on program costs from around the country, this will require an investment of at least $250,000, and should be implemented in partnership with a community-based organization and in line with other emerging national best practices.378

Recommendation #10: Implement Group Violence Intervention in Localities Most Impacted by Community Violence 

One of the most consistently effective strategies to reduce community violence is known as Group Violence Intervention (GVI), and is also commonly referred to as “focused deterrence.” This strategy relies on a partnership between law enforcement, service providers, and community members. These stakeholders work together to identify the small number of individuals at the very highest risk of engaging in violence and then physically bring those individuals together for an in-person meeting known as a call-in.

The purpose of call-ins is to put individuals on notice of the risk they are in, to have them hear a genuine plea for change from members of the community directly affected by violence, and to connect with service providers who can help steer them in a different direction. In many cities, call-ins are also supplemented with individualized versions of a call-in known as “custom notifications,” where small teams of community members, service providers, and law enforcement meet with high-risk individuals one-on-one.

When implemented to the fullest extent possible, GVI represents not just a strategy for reaching and intervening with high-risk individuals, but also a paradigm shift for the way law enforcement approaches both serious violence and policing in general. In Oakland, for example, the implementation of GVI led to restructuring the police department to focus on boosting capacity to investigate and solve serious violent crime, improving relationships between police and community, reducing the use of unfocused enforcement actions and arrests for low-level offenses, and creating a regular system for multiple stakeholders to share information and problem solve around violence crime.379 Several of these elements are significant enough to be separate recommendations in other parts of this report.   

In cities that have implemented GVI effectively, the results have been dramatic,380 with multiple evaluations showing double-digit reductions in homicides and shootings over a one to two year period.381 In Oakland, researchers conducted a formal evaluation and found Oakland’s version of GVI to be associated “with an estimated 31.5% reduction in Oakland gun homicides controlling for seasonal variations and other trends,” including a 43.2% drop in group-involved shootings, which helped drive a near 50% reduction in homicides and shootings in the city between 2012 and 2019.382 Unfortunately, Oakland still suffered an increase in homicides in the wake of the COVID-19 pandemic, as did almost every other major American city.

To cover the costs of a technical assistance contract and the hiring of a full-time project coordinator and support staff, Giffords recommends that the County of St. Louis invest at least $500,000 to support the expansion of GVI in SLCPD precincts with high levels of homicides and shootings.

Recommendation #11: Remediate Vacant Lots and Buildings in High-Violence Areas

A number of studies from around the country establish the strong connection between vacant properties and violent crime.383 “In large cities, a small number of streets account for an outsize number of violent crimes. Those streets are usually in segregated Black neighborhoods that, because of structural racism, have suffered from decades of disinvestment and physical and economic decline,” explained Eugenia C. South, a researcher at the University of Pennsylvania.384 “Without changing these physical spaces in which crime occurs, violence-prevention efforts are incomplete. A focused and sustained investment in high-risk places should be a cornerstone in the effort to create safer and healthier communities.”

The connection between vacant property and violent crime has been specifically studied locally in the City of St. Louis using a technique known as “risk terrain modeling,” with researchers finding that “vacancy presents a strong, consistent risk for both homicide and aggravated assault,” a pattern that “emerges most clearly in the northern part of the city which is majority African American and has suffered chronic disinvestment.”385 This is reflected by the fact that 65% of the Black population in the City of St. Louis lives in high-vacancy census tracts, compared to 19% of the white population.386 

St. Louis County also has areas with high rates of property vacancy: a 2020 study by ATTOM Data Solutions looked at vacancy rates for counties with at least 50,000 residential properties and found that St. Louis had the second-highest vacancy rate, at 7.42%.387 Numerous stakeholders interviewed for this report identified vacant lots and buildings as a priority issue and root cause of violence—particularly in the areas of north St. Louis County that share a border with the City of St. Louis, including Jennings, Pine Lawn, Wellston, and Bellefontaine Neighbors. In an 2021 interview with local media, a Wellston resident described the situation in his community: “Wellston is plagued with vacant and derelict residential units and homes. It’s also plagued with vacant and derelict commercial and industrial sites as well and that speaks to the overall comprehensive strategy and comprehensive plan that needs to be in place.”388 

Alderwoman Dione Jones of Pine Lawn expressed similar concerns, noting that vacant properties in her district “attract drug addicts and become drug houses and we have rats and rodents. It’s just a magnet for all things horrible…The citizens of Pine Lawn, we deserve better.”389 

Studies from programs in a number of other cities help illustrate a way forward for St. Louis County. In Philadelphia, for example, a randomized control trial of the city’s LandCare program390 showed that various forms of vacant property interventions helped to reduce crime, but the strongest effects—up to 29% reductions in crime levels—occurred “in the several blocks surrounding vacant lots in neighborhoods whose residents live below the poverty line.”391 A similar study, in which vacant homes were randomized to receive either full remediation, trash clean-up services, or no intervention at all, demonstrated “a clear reduction in weapons violations, gun assaults and shootings as a result of the full remediation.”392    

The costs of the project studied in Philadelphia for remediation of vacant buildings was $2,550 per building, with $180 per year in upkeep. For vacant lots the cost was $1,600 per lot, with $180 per year in upkeep. Based on associated crime reduction, researchers found the average cost savings of these programs to local taxpayers to be more than $15 per dollar invested, creating benefits to both public safety and public finances. As an added benefit, in cities like Philadelphia, such programs employ local companies and work specifically with formerly incarcerated individuals to create opportunities for people at elevated risk of exposure to violence.393 

However, using vacancy remediation as a crime reduction strategy does not require a locality to address every single vacant building and lot. Instead, as a panel of experts recommended to the City of Dallas in 2019,394 county and local leaders should begin by prioritizing lots and buildings that present the highest risk of attracting violent crime.

Based on the above, Giffords recommends that the County of St. Louis allocate at least $2.5 million to: (1) conduct a risk assessment similar to the study that was conducted for the City of St. Louis and (2) implement and rigorously evaluate, using a randomized control trial, a pilot program to remediate vacant lots and vacant buildings identified as being at high risk for attracting violent crime, with an emphasis on localities and unincorporated areas most impacted by homicides and shootings.

Recommendation #12: Creation of Statewide Missouri Community Violence Coalition 

An emerging best practice in the community violence field is the formation of statewide coalitions focused on raising awareness and increasing state-level investment. While the issue of gun regulation as a solution to gun violence is extremely political and polarizing, especially in Missouri,395 the types of solutions promoted by such coalitions and discussed in this report are generally more amenable to bipartisan support. Statewide community violence coalitions—ideally consisting of a mix of on-the-ground practitioners, advocates, survivors of violence, city leaders, faith-based organizations, and researchers—in places such as Illinois, Wisconsin,396 and Virginia397 have won a number of impressive victories in recent years that should help inspire Missouri stakeholders to create a similar effort.

In 2021, for example, an alliance of organizations in Illinois successfully advocated for the governor to declare a state of emergency regarding gun violence and to commit an additional $250 million of state and federal dollars to address the violence epidemic.398 A similar coalition in California secured a more than $200 million increase in funding for the state’s Violence Intervention and Prevention grant program (CalVIP).399 Likewise, a group of community violence advocates successfully encouraged Governor Evers of Wisconsin—a state with a fraction of the homicide totals seen in Missouri—to allocate more than $45 million of federal American Relief Plan Act dollars to address community violence.400    

Even in the absence of a statewide community violence coalition, the Missouri legislature and governor agreed to earmark some new funding for violence reduction efforts in the City of St. Louis in 2021, appropriating $500,000 for “local violent crime prevention programs,” and another $500,000 for “services to residents in areas with high crime and deteriorating infrastructure.”401 This suggests that more support could be won with the concerted effort of an organized community violence coalition. However, as will be discussed in detail below, this was the state’s only direct investment in addressing community violence, and it was implemented in such a way that it was very difficult to access in general and almost impossible for community groups—leaving much room for advocacy to increase state-level support for evidence-informed solutions to this public health crisis.

Given the disproportionate impact of community violence in the City and County of St. Louis and Kansas City—which combined accounted for 65% of all homicides in Missouri in 2019—an effort to raise awareness of the problem and encourage investment in effective solutions should begin with meetings between stakeholders from each area. It will also be important to identify and conduct outreach to the high-violence areas that are contributing to the other one-third of the state’s homicides. Despite the politics, the State of Missouri has a powerful economic incentive to support its localities in their violence reduction efforts, as gun violence is costing Missouri taxpayers nearly $2 billion annually in costs ranging from health care to law enforcement.402 The timing of such an effort is also optimal, with the state enjoying record revenues and historic spending proposals from the Governor Parson.403

Based on experience, the cost to start a statewide community violence coalition is quite low, and generally covered by in-kind services provided by member organizations and volunteers. Giffords recommends that a private foundation in Missouri invest $100,000 for dedicated staff and administrative expenses to launch such a coalition in 2022.

Summary

The above 12 recommendations represent a total annual investment of more than $31 million to significantly reduce homicides and shootings in the County of St. Louis in the coming years. Given the extremely high human and economic cost imposed by community violence, this is an investment that will pay for itself many times over. The next section of this report outlines local, state, and federal funding opportunities that can help pay for the implementation of these recommendations.

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Funding Opportunities Analysis

The above recommendations require resources to implement, and the following section outlines local, state, and federal funding opportunities that could be leveraged for these purposes. Each section is also accompanied by a chart that contains detailed information, including the grant program name, purpose, eligible applicants, relevant funding priorities, application timing, and links to the most recent solicitation.

The largest opportunity comes from the federal government, with a number of historic funding opportunities available for addressing community violence. This year, Congress invested a record-setting $100 million in the Department of Justice’s new Community Violence Intervention and Prevention Initiative (CVIPI), which is the largest federal grant specifically focused on community violence. In addition, there are a host of competitive grant programs across various federal departments that newly prioritize strategies to address community violence, such as the Department of Labor’s Growth Opportunities Grant and the Department of Housing Urban Development’s Choice Neighborhoods Program. 

In addition, the Biden administration has encouraged governments to use American Rescue Plan Act (ARPA) funds—which have been allocated directly to the County of St. Louis and to the State of Missouri, separately—to address community violence, and several of the above recommendations could be initially funded with ARPA dollars. In addition, this year Congress passed and President Biden signed into law the Bipartisan Safer Communities Act, the first major federal legislation on gun violence in several decades. This historic legislation includes billions of dollars in new investments in areas directly related to addressing gun and community violence, including funds for expanding access to mental and behavioral health services, crisis intervention teams to enhance school safety, and programs to identify and address trauma.

Missouri Foundation for Health offers a unique resource through its MoCAP program, which provides grant writing support for community-based and government entities in its service area—which includes the City of St. Louis—that are applying for federal grant opportunities to address health issues, including community violence. MoCAP is discussed in more detail in the final portion of this section. 

At the state level, there are some relevant opportunities, but also a clear need for organized, state-level advocacy to encourage Missouri leaders to make the kinds of robust and targeted investments in local community violence efforts that have been implemented in recent years in states such as Pennsylvania, Illinois, New Jersey, and many others.

By leveraging the diverse range of local, state, and federal funding sources discussed below, leaders in the County of St. Louis can muster significant resources to develop and implement a countywide comprehensive plan for reducing community violence in coordination with regional partners, including the City of St. Louis.

County of St. Louis Funding Opportunities

Our local funding opportunities chart lays out the below information in a spreadsheet.

The total FY22 St. Louis County Budget is $889,986,658.404 The FY22 Operating Budget is $665,424,052, with Public Safety comprising 38% of those funds. The county’s fiscal year begins on January 1 and ends December 31. Budget development is a year-long process, and key milestones include: the county executive recommended budget presentation to the County Council on October 1, budget hearings from October through November, and the budget approval by the County Council by December 31.405 The budget process is a collaboration between the County Executive, the County Council, and the Division of Performance Management and Budget.

The three strategic objectives of the budget are: (1) health and safety for everyone, (2) opportunity for everyone, and (3) good government for everyone. While the first objective includes goals such as reducing health disparities within the community and reforming policing and the criminal justice system, funding for community-based violence reduction initiatives was not clearly identified. Similarly, the second objective includes the goal of promoting inclusive community development; yet again, the rise in gun violence in St. Louis County was not addressed.

The county budget contains just a few areas either directly or tangentially related to community violence reduction initiatives and/or opportunities for community partnerships for anti-gun violence activities, which are laid out in the following sections. 

Department of Public Health

The Department of Public Health (DPH) has a broad range of responsibilities. In addition to performing studies and preparing educational resources for community health, it also promotes “community partnerships and cooperative relationships with neighboring jurisdictions, state and federal agencies, and local and national organizations for the promotion and protections of the public health of the population.” The DPH budget for FY22 is $71,642,460.406 

As discussed above, federal funding supported ReCAST and Project RESTORE, two strategies that include reducing community violence as goals. However, federal funding for both programs recently expired, and although both programs are listed in the FY22 St. Louis County Budget, zero county dollars are allocated to the programs. So, it appears that the St. Louis County government did not pick up these programs with local funding, although interviews with DPH leadership indicated an interest in building these programs into a county-wide plan to address community violence going forward.407  

Violence Prevention Coordinator

The FY22 DPH budget does cover a full-time “Violence Prevention Coordinator” position, which is currently held by Damon Major, who was previously the director of Project RESTORE.408 As part of his role as violence prevention coordinator, Mr. Major has worked with multiple stakeholders to create a working Violence Prevention Action Plan, which lists a number of community partners committed to violence prevention, including the St. Louis County Departments of Human Services and Public Health. Notably, the Plan uses a public health approach to community violence, with support from these two county departments, rather than taking a law enforcement approach to address gun violence.  

Currently, Mr. Major’s position is the only resource funded by St. Louis County specifically for violence prevention.

Department of Human Services

The Department of Human Services (DHS), with a FY22 budget of $4,596,844, provides resources to the 88 municipalities and unincorporated areas that comprise St. Louis County to help residents live safely, productively, and independently.409 Programs include the Women and Children Services, County Youth Programs, and Workforce Development.  There is no direct funding for community violence reduction programming in the DHS budget, however there are tangential services being offered that do address some of the key risk factors for violence.  

County Youth Programs

No community violence reduction programming is specifically funded in the county Youth Programs budget. However, the FY22 budget of $1,194,879 provides services for children and youth through county programs and partnerships with local organizations, including several programs aimed at children and youth in the county that can address systemic factors contributing to community violence.410 For example, the Center for Youth on the Rise provides youth development training and skills for ages 12–19 and 17–23.411 The Outstanding Student Leadership Program provides leadership and citizenship training to high school students in the county.

St. Louis County Children’s Service Fund
County Youth Programs is funded through DHS as well as the St. Louis County Children’s Service Fund, a voter-approved, quarter-cent sales tax passed in 2008 to support mental and behavioral health services for young people.412 The Fund, which generates an average of $45 million in revenue annually, has granted $1,125,000 of its 2020–2022 Core Award to County Youth Programs.413

The Fund provides core funding to organizations in the county that provide services for children and youth grounded in equity. It recognizes that “[l]ong-standing systemic disparities have disproportionately impacted African-American, immigrant, and other minority communities, and the COVID-19 pandemic has underscored and further exacerbated these inequities. In addition to the pandemic, racial tensions in the region and across the nation have led to additional stress on children and families.”414 In addition to County Youth Programs, organizations supported by the Fund include those providing services for children affected by domestic violence, adult education, mental health services, homelessness, and education services.

The 2023–2026 Core Funding Opportunity from the St. Louis County Children’s Service Fund is open until November 18, 2022.415  

Office of Community Development

No anti-violence programming is directly funded in the Office of Community Development. However, its mission addresses housing and community development-related activities in St. Louis County, including “to carry out programs and activities which benefit low and moderate income households, eliminate slums and blighted conditions.”416 The office does not receive any funding through the county budget, but it does receive federal funding—approximately $4.5 million in Community Development Block Grant (CDGB) funds and $2.8 million in Home Investment Partnership program funds from the US Department of Housing and Urban Development.417 The top 10 Housing Policy priorities include rehabilitation of existing structures and walking neighborhoods and communities. Examples of programs the Office of Community Development implements are eliminating slums and blighted conditions, creating solutions to abandoned and substandard housing, and assisting the development of low and moderate income households.

Community Development Block Grants
As the recipient of federal CDBG funds, the Office of Community Development disburses much of its annual allocation to municipalities and nonprofit organizations through a competitive solicitation process, to “undertake community development activities in the county that meet one of three National Objectives:

  1. Benefit low and moderate income persons
  2. Prevent or eliminate slums or blight
  3. Address community development needs having a particular urgency because existing conditions pose a serious and immediate threat to the health or welfare of the community for which other funding is not available.”418 

For 2022, the CDBG solicitation—totaling $4 million in awards—was issued on July 1 and applications were due July 27.419 According to the solicitation, community-identified priority issues for the program in 2022 included vacancy reduction and crime prevention in the St. Louis County Promise Zone, which includes many areas of North County, where community violence is disproportionately concentrated.

Public Safety Department

With a FY22 budget of $255,558,500, St. Louis County places the following departments under the category of Public Safety: County Police, Prosecuting Attorney, Municipal Court, Emergency Communications Commission, Judicial Administration, and Justice Services.420   

The Department of Public Safety doesn’t fund an community-based violence reduction programming, but there may exist current community partnerships and/or the possibility for community partnerships with anti-gun violence organizations. The St. Louis County Police Department (SLCPD) has a $163,086,850 budget for FY22, which includes the SLCPD’s violent crime investigation efforts and new homicide advocate position, as described above. The budget also funds the County Prosecuting Office’s diversion programs and its Victim Services Division, also described above.  

American Rescue Plan Act

St. Louis County received $193 million in American Rescue Plan Act (ARPA) funds, to be distributed over a three-year period. The county received its first allotment of $96.5 million on August 13, 2021. The adopted FY22 budget includes the transfer of $80 million from the ARPA award to the General Revenue and Health funds as revenue replacement under the State and Local Fiscal Recovery Funds (SLFRF) program, which must be used for the provision of government services under US Treasury requirements.421 Therefore, the ARPA funding is being used to support the continuation of existing programs and services. Of the original $193 million in ARPA funds, approximately $109.8 million has already been allocated and $83.3 million remains.422  

The Biden administration and various federal departments have openly encouraged localities to use ARPA funds to address community violence and issued formal guidance clarifying that ARPA funds may be used for that very purpose. State and local governments started receiving ARPA funds in May 2021 and can spend these funds for eligible purposes through the end of 2024, so this is a current and time-sensitive opportunity for St. Louis County.423 

ARPA uses even broader language than prior pandemic-relief bills and authorizes state and local governments to use relief funds to “respond to the public health emergency” of COVID-19 and its broader economic harms. The law explicitly authorizes use of these funds to backfill cuts made to government services during the pandemic, provide aid to nonprofits, and support essential workers and entities that employ essential workers (such as street outreach workers, and community safety, public health, and behavioral health professionals).424 The Biden administration has clearly signaled that investing in community violence intervention is a critical national priority for responding to 2020’s unprecedented spike in homicide, the continued rise in violence in 2021, and longstanding inequities in health and safety that were exacerbated by the COVID-19 pandemic.425 

The US Department of the Treasury has issued guidance specifically permitting the use of ARPA funds to “facilitate access to resources that improve health outcomes,” including “evidence-based community violence intervention programs to prevent violence and mitigate the increase in violence during the pandemic.”426 The Department of Education also released guidance clarifying that ARPA’s $122 billion in resources for state educational agencies (SEAs) and local educational agencies (LEAs), through the ARPA’s Elementary and Secondary School Emergency Relief (ESSER) Fund, can be used for strategies to reduce community violence.427 ESSER and related ARPA funds “may be used to implement CVI strategies, which address students’ social, emotional, mental health, and academic development and are especially important in the context of the disproportionate impact of the COVID-19 pandemic on historically underserved groups of students.”428 

The Department of Labor also released a public notice in January 2022 emphasizing that ARPA funds may be used by states and localities to address the relationship between job insecurity and community violence. “The Department of the Treasury has designated community violence intervention strategies as a permissible and encouraged use for ARPA state and local funding,” states the notice.429 “These funds can be used for many employment-related services, including to scale up wraparound services for crime victims, youth, formerly incarcerated persons, and individuals and households facing economic insecurity due to the pandemic.” This underscores the fact that ARPA funds can be used to address many of the various systems that touch on the complex issue of community violence, from employment to education to health care.

A similar analysis was released by the Department of Housing and Urban Development (HUD), examining the intersection of community violence and housing instability, substance abuse, and economic instability, among other issues, and highlighting examples of HUD funding being used to address violence around the country.430 The HUD guide “identifies evidence-based strategies to mitigate and reduce community violence and provides suggestions on how such activities could be funded with Community Development Block Grant (CDBG) or Community Development Block Grant CARES Act (CDBG-CV) resources.”431 

ARPA dollars are separately allocated to cities, counties, and states, and jurisdictions across the country at all of levels government have invested relief funds to directly address community violence, including Baltimore ($50 million);432 Washington DC ($59 million);433 Multnomah County, where Portland, Oregon, is located ($4 million);434 and states such as Wisconsin ($45 million),435 Illinois ($250 million),436 and Pennsylvania ($15 million).437  

This list includes the City of St. Louis, which used its initial allocation of ARPA funds to address community violence. The city’s initial appropriation of $112 million of ARPA funds included a $5.5 million investment in “community-based solutions to violence such as Cure Violence,” as well as $5 million for the expansion of a community responder response model “designed to divert calls for clinical help away from the police department, thereby freeing up officer time to combat violent crime,” and a $4.7 million investment in youth jobs and programming.438 This was followed up in 2022 with an additional investment of $13.6 million of ARPA funds to support “community violence prevention and youth programs.”439 

Given the tremendous need to address the community violence that has increased in St. Louis County in the wake of the COVID-19 pandemic, clear direction from the federal government that ARPA funds can and should be used for this purpose, and both the magnitude and flexibility of the opportunity, Giffords recommends that county leaders consider earmarking ARPA funds for the express purpose of supporting community violence reduction strategies, including the recommendations presented in this report.

St. Louis Regional Racial Healing + Justice Fund

The St. Louis Regional Racial Healing + Justice Fund (“the Fund”) is a collaboration between Forward Through Ferguson, the Deaconess Foundation, Missouri Foundation for Health, and the InPower Institute that aims to “invest in healing community trauma and changing the conditions that reinforce systemic racism.”440 The Fund operates through a community-led grantmaking process that allocated more than $500,000 to Black and Brown-led organizations in its first two grant cycles. A third round of funding was closed on October 5, 2022. Nearly $800,000 will be distributed when that process is complete.

The priority areas of focus for the Fund are: (1) heal individual and community trauma, (2) engage a broader range of residents in systems change work, (3) prepare leaders of color to organize for healing justice, (4) build local capacity to nurture, support, and cultivate healing assets, and (5) align resources for long-term sustainability.441  

Given the overlap between these areas and the cycles of violence that impact Black and Brown communities in the County of St. Louis, Giffords encourages community-based organizations to learn more about the Fund and stay informed about additional opportunities for funding. Giffords also encourages the Fund’s Community Governance Board to encourage and prioritize future applications from community-based organizations that operate at the intersection of violence, trauma, and social justice. Finally, we encourage other philanthropic entities in the St. Louis region to look at the Fund’s “radical exercise in anti-racist philanthropy where the community has complete decision-making power over the allocation of funds,”442 as a model for informing giving processes and priorities. 

State of Missouri Funding Opportunities

Our state funding opportunities chart lays out the below information in a spreadsheet.

New Investments for State Fiscal Year 2023

The State Fiscal Year 2023 budget includes several new investments that may be relevant to agencies and organizations working to reduce community violence in the County of St. Louis. 

Community Revitalization Grant Program

This includes a $100 million line-item for the “Community Revitalization Grant Program,” which is being administered by the Missouri Department of Economic Development and funded via the State of Missouri’s share of the federal American Rescue Plan Act.443 The Department has allocated $20 million specifically for the St. Louis region, and eligible applicants include counties, cities, and nonprofit organizations. 

Among the eligible activities that can be funded through this new program are several activities that overlap significantly with community violence prevention, including:

  • Renovation, rehabilitation, maintenance, or costs to secure vacant and abandoned properties
  • Converting vacant or abandoned properties into affordable housing
  • Neighborhood cleanup programs
  • Development of parks and green spaces
  • Development of recreational facilities
  • Creation of sidewalks, crosswalks, streetlights444  

Also relevant are activities to address food insecurity, emergency housing assistance, and financial literacy programs for individuals in low-income communities. Applications for this opportunity are due by November 30, 2022.445 In addition, the Department is releasing a $7.5 million grant for “nonprofits facing economic hardships from COVID or nonprofits providing assistance identified as an eligible ARPA expense,” although the release date and specifics are to be determined.446 

988 Suicide and Crisis Lifeline

Also relevant was a $30.5 million investment to help implement the new national 988 Suicide and Crisis Lifeline, which offers a number for individuals who are experiencing mental health, substance use, and suicide crises in order to recive immediate help and support.447 As the state with the nation’s 14th highest suicide rate in 2020, “Missouri expects to receive nearly 258,033 contacts at an estimated cost of $16.7 million” in its first year of operation, according to the Department of Mental Health.448  

Other New Investments for FY23

Other new investments in the FY23 budget that may be relevant to community violence reduction efforts, although have yet to be implemented as of the publication of this report, include $104.7 million for a new public safety crime lab that will assist local law enforcement agencies, $148.7 million for community provider capital improvements and to expand services to underserved populations, and $12.8 million for substance use response grants for local governments.449 

Ongoing State Programs and Investments

Despite a historic, $48.3 billion budget for FY23,450 the State of Missouri is still not investing directly in community-based violence intervention and prevention initiatives, which is a major missed opportunity. The very few state-funded programs that are specific to community violence reduction have not been funded or implemented in a manner that will maximize their impact. 

Local Violent Crime Reduction Program

The Local Violent Crime Reduction Program was created in 2021, but it has a number of severe limitations, including its small overall funding amount ($500,000 for the entire state for FY22), low maximum award caps ($25,000), and, despite language suggesting the grant would support “community crime prevention/crime reduction strategies, gang-related activity prevention, [and] gun violence prevention,” the only allowable expenses ultimately approved by the Department of Public Safety were “technology and equipment” for law enforcement agencies.451 Moreover, the grant performance period is only seven months—not an adequate time frame to implement an effective violence reduction strategy—and community-based organizations were not eligible to apply.

Also passed in 2021 was a piece of legislation, Senate Bill 57, that created and funded two public safety programs: one to fund a stress-management program for law enforcement officers, and the other to support community organizations in high-crime areas.452 The Economic Distress Zone Fund Grant (EDZ) supports 501(c)(3) nonprofit organizations that provide “services” to residents in “areas of high incidents of crime and deteriorating infrastructure for the purpose of deterring criminal behavior.”453 

As with the Local Violent Crime Reduction Program, however, the EDZ suffers from a number of severe limitations, including its small size ($500,000 in total funding), short performance period of 10 months, and narrow window of time in which nonprofit organizations could apply for funding—just over three weeks (the opportunity opened on August 1, 2022, and applications were due August 26, 2022).454 Although the grant is narrowed geographically to seven cities and villages including the City of St. Louis, it is not strategically focused on violence or supporting any particular form of “services,” but rather on any program that could “deter criminal behavior.” This is not likely to support effective programming. There is also not any funding for vital complementary functions such as evaluations to measure impact, the provision of technical assistance, and capacity-building for grant recipients. 

State Services to Victims Fund

One of the more relevant state-funded programs identified by the Giffords team is the Department of Public Safety’s (DPS) State Services to Victims Fund (SSVF), which for FY22 (applications were due October 20, 2021) provided $1.8 million in funding to public and not-for-profit private agencies that provide services free of charge to eligible victims of crime.455 In the last round of funding, which was completed in 2021, eligible victims were Missouri residents who were the victim of a crime involving “the threat or the use of force,” and who were not the “perpetrator or a principal or accessory involved in the commission of the crime.”456  

Of note, the program is strategically limited to supporting victims of violence, the performance period is a full year, and the application window was a month. Additionally, allowable costs include direct services, emergency services, crisis intervention counseling services, and advocacy for victims of crime, as well as training for staff and volunteers in the field of victim services. Given the strong connection between violent victimization and future violence, discussed in detail above, this is an important investment. However, the potential impact of this otherwise well-designed program is limited by the relatively small total funding amount. Moreover, instead of a new solicitation for FY23, current awardees have had their grants extended through June 30, 2023, so any new organizations seeking to leverage SSVF funding will not be able to do so until later in 2022 or 2023.

Neighborhood Assistance Program and Youth Opportunities Program

Two other state-funded opportunities that may help support community violence prevention and intervention organizations are run out of the Missouri Department of Economic Development (DED). While not focused on services to reduce violence, the Neighborhood Assistance Program (NAP) and the Youth Opportunities Program (YOP) both provide extra tax write-offs for individuals who make charitable donations to organizations—generally, although not exclusively nonprofits—that are engaged in community support work. 

For the FY23 NAP grant, which was open until October 6, 2022, the solicitation notes that one of five qualifying services that an applicant must provide is “crime prevention,” including “services to ex-offenders; civilian services to help prevent crime and/or aid victims of crime; mediation services aimed at resolving conflict; or services to juveniles who have had contact with the court or police,” all of which fit within many of the recommendations made in this report.457 According to the department website, the NAP grant for FY23 is currently open, with applications due on October 7, 2022.458 

The 2022 YOP solicitation gave priority to applicants proposing to “decrease the number of at-risk youth committing crimes and violent acts” and applicants doing work in areas with a “higher incidence of crime, violence, and poverty.”459 In FY22, $12.6 million in state tax credits was awarded to organizations, with a maximum credit allocation of $350,000, and a total of $5.8 million in tax credits of YOP. The YOP solicitation for calendar year 2023 is expected to open in December, 2022.460 The DED conducts free and publicly available application workshops periodically during the year to assist organizations in preparing an application.

State-Administered Federal Grant Programs

The remaining opportunities discussed here are federal programs that are administered by state agencies. So while increasing funding is a matter of federal advocacy, the manner in which these funds are spent can be influenced by advocacy at the local and state level, including through relationship-building with relevant agencies.

Missouri Department of Social Services

Victims of Crime Act State Assistance Grants
The Missouri Department of Social Services (DSS) is the state administering agency for the federal Victims of Crime Act (VOCA) State Assistance Grants.461 It awarded approximately $34 million in grants for the most recent contract period covering October 2021 to September 2022 to eligible public and non-profit agencies providing services to victims of crime.462 Eligible entities must meet a list of criteria, including: (1) demonstrating a record of providing effective services to crime victims, (2) matching 25% of their award from non-federal and non-state sources, (3) using volunteers in the provision of services, (4) assisting victims in seeking crime victim compensation benefits, and (5) providing free services to crime victims.463 At least 10% of a state’s total VOCA assistance grants must be awarded to serving victims of crime in “underserved communities,” and DSS includes “victims of violent crime (including victims in high-crime areas, survivors of homicide, and victims of physical assault)” in its definition of “underserved.”464  The Missouri Department of Social Services (DSS) is the state administering agency for the federal Victims of Crime Act (VOCA) State Assistance Grants.465 It awarded approximately $34 million in grants for the most recent contract period covering October 2021 to September 2022 to eligible public and non-profit agencies providing services to victims of crime.466 Eligible entities must meet a list of criteria, including: (1) demonstrating a record of providing effective services to crime victims, (2) matching 25% of their award from non-federal and non-state sources, (3) using volunteers in the provision of services, (4) assisting victims in seeking crime victim compensation benefits, and (5) providing free services to crime victims.467 At least 10% of a state’s total VOCA assistance grants must be awarded to serving victims of crime in “underserved communities,” and DSS includes “victims of violent crime (including victims in high-crime areas, survivors of homicide, and victims of physical assault)” in its definition of “underserved.”468  

The State of Missouri’s FY23 budget includes $24 million to provide relief “to non-profit organizations that provide services and supports to victims of crime by supplementing recent federal changes to VOCA funding.”469 

For organizations addressing community violence by providing services to survivors of violence, VOCA assistance grants present an important funding opportunity, but one that has onerous requirements for both applying for and maintaining funding. There are a variety of helpful resources available to provide guidance to groups seeking this funding, including a VOCA application toolkit and checklist by Equal Justice USA and a VOCA advocacy guide by the Alliance for Safety and Justice, among others.

In addition to supporting individual grantees, as documented in Giffords’s 2020 report, America at a Crossroads: Reimagining Federal Funding to End Community Violence, a number of states are leveraging VOCA to specifically fund statewide networks of hospital-based violence intervention programs (HVIPs), including Virginia, which allocated $2.45 million in funding for this purpose,470 and New Jersey, which launched a network of 8 HVIPs with a $20 million investment in 2019.471 The Missouri Department of Social Services should consider implementing a similar program to support HVIPs around the state.

Community Services Block Grant
DSS also administers the Community Services Block Grant (CSBG), which is a formula grant from the federal Department of Health and Human Services. In Missouri, these funds support a network of 19 Community Action Agencies that help “create, coordinate, and deliver programs and services to low-income Missourians across the state.”472 The types of services supported include addressing housing insecurity, employment, and health for individuals whose income are below 125% of the federal poverty level. 

The designated Community Action Agency for the County of St. Louis is the Community Action Agency of St. Louis (CAASTLC), which provides a range of services from case management to employment training.473 According to the CSBG State Plan, CAASTLC is slated to receive approximately $2.0 million per year in federal FY22 and FY23.474 The CSBG State Plan is created by DSS with public input, which may provide community violence stakeholders an advocacy opportunity to improve how responsive the program is to those at high risk of engaging in violence.

Missouri Department of Public Safety

The Missouri Department of Public Safety (DPS) also administers a number of federal grants that touch on community violence, or could if the department chose to move in that direction.

Byrne JAG
As an example, DPS is the state administering agency for the Byrne Memorial Justice Assistance Grant Program (Byrne JAG), which is a federal formula grant that gives states funding to improve public safety each year based on their population and crime rates. Missouri received $4.5 million in Byrne JAG funding in federal FY22,475 which DSP administered through a competitive solicitation with eligible applications limited to “multi-jurisdictional drug task forces.”476

As Giffords pointed out in its America at a Crossroads report, this is a relatively common use of Byrne JAG funds, although not a strategy that is supported by convincing evidence. Nothing prevents DPS from restructuring its Byrne solicitations to encourage more effective strategies that are specifically focused on addressing serious violence. “The statutory language of Byrne JAG explicitly allows funds to support purpose areas including ‘crime prevention and education,’ ‘drug treatment,’ ‘mental health,’ and ‘crime victim’ programs,” concludes the Crossroads report. “While nonprofit agencies cannot directly apply for Byrne JAG, state and local government applicants may partner with community-based organizations and pass funds through to them as subrecipients.”477 As with DSS and VOCA, this kind of policy change is a matter of advocacy and raising awareness with DPS leadership and staff.

Title II Federal Formula Grant
A DPS program that does not require policy change to be leveraged by organizations working on community violence is the Title II Federal Formula Grant, which is designed to help “serve juveniles who are at-risk or involved in the justice system, the professionals and lay persons who work with those juveniles.”478 Missouri’s current Comprehensive Three-Year Strategic Plan, approved by DOJ, requires all applicants to work in one or more of the following program areas: community-based alternatives to incarceration and institutionalization including “for youth who need specialized intensive and comprehensive services that address the unique issues encountered by youth when they become involved with gangs.”479 Moreover, “Community-based, youth serving agencies and organizations with strong collaborative relationships with their local juvenile justice systems are encouraged to apply.”480 In federal FY21, $700,000 in total funding was available statewide through this program, and projects are for a one-year period but eligible for up to two one-year extensions, for a total of three years. No new solicitation has yet been issued for federal FY22.

Residential Substance Abuse Treatment for State Prisoners Program
Also worth mentioning is the DPS-administered Residential Substance Abuse Treatment (RSAT) for State Prisoners Program,481 which distributed $762,875 in the most recent grant cycle with the objectives to:482 “1) Enhance the capabilities of states and units of local and tribal governments to provide residential substance abuse treatment for incarcerated inmates. 2) Prepare individuals for reintegration into communities. 3) Assist individuals and communities through the reentry process by delivering community-based treatment and other broad-based aftercare services.”483 This is a grant that the County of St. Louis would need to apply for, and could be used to bolster reentry services for individuals at high risk of engaging in violence upon their release, as discussed above.

Missouri Community Service Commission

Finally, the Department of Economic Development (DED) administers the Missouri Community Service Commission (MCSC), which provides federal funding for applicants to “recruit, train, place, and supervise AmeriCorps Members who will serve anywhere from 100 to 1,700 hours in a community with the goal of alleviating or eliminating a defined community need.”484 There was $9 million in total awards available in 2021 through this program, with individual awards ranging from $50,000 to over $1,000,000 for an up to three-year performance period. Applications for the 2022 funding cycle are due by November 14, 2022.485 Eligible applicants include community-based and faith-based organizations, and the solicitation indicated priority for areas including “Geographic areas of the state that are currently underserved…Racial justice programming…[and] Returning citizens/incarcerated individuals programming,”486 all of which have significant overlaps with several of the recommendations made in this report.

While there are some existing state-level funding opportunities, the State of Missouri presents more of an opportunity for intentional organizing and advocacy in order to expand investments in community violence reduction strategies and to better leverage federal funding for those purposes. This would be the ideal role for a statewide community violence coalition, discussed at Recommendation 12.

Federal Funding Opportunities

Our federal funding opportunities chart lays out the below information in a spreadsheet.

Federal funding for community violence intervention and prevention strategies has been insufficient, unfocused, and sometimes harmful, with an overemphasis on enforcing non-violent gun possession crimes contributing to the mass incarceration that has hollowed out communities of color while failing to significantly decrease homicides.487 However, with the Fiscal Year 2022 appropriations and the passage of the Bipartisan Safer Communities Act (BSCA), federal funding to address community violence reached a high-water mark in 2022, with $100 million appropriated to the Community Based Violence Intervention and Prevention Initiative, and an additional $45 million in Congressionally Directed Spending, known as “earmarks,” to support local community violence reduction projects. The Biden administration has also instructed federal agencies to incorporate and prioritize community violence across dozens of competitive grant programs.

In addition, the BSCA includes billions of dollars in funding that will go to states, localities, school districts, and community based organizations in order to address issues ranging from access to mental and behavioral health to school safety. Finally, the American Rescue Act (ARPA) funding is still available at the county and state level and can be used to directly address community violence. Each of these major federal funding opportunities is discussed in more detail in this section.

Annual Appropriations and Federal Grant Programs

The Consolidated Appropriations Act of 2022,488 which provides the federal government budget for Fiscal Year 2022, marked the largest dedicated federal investment for funding to specifically support community violence intervention programs. 

Community Based Violence Intervention and Prevention Initiative

Within this bill, Congress appropriated $50 million for the establishment of the Community Based Violence Intervention and Prevention Initiative (CVIPI), which is administered by the Department of Justice’s Office of Justice Programs. CVIPI is a new grant program intended to support communities in developing comprehensive, evidence-based violence intervention and prevention programs, including efforts to address gang and gun violence, based on partnerships between community residents, law enforcement, local government agencies, and other community stakeholders.489 

Furthermore, the Consolidated Appropriations Act of 2022 advised the Department of Justice to prioritize awarding grants to communities with the highest number of homicides and the highest number of homicides per capita, enabling this federal funding to go to communities in most dire need of CVI programming.490 

The creation of CVIPI builds upon the work of previous federal grant programs within the Department of Justice like the Byne Criminal Justice Innovation program, Community Based Violence Prevention program, and the Innovations in Community-Based Crime Reduction program in two distinct ways. 

  • CVIPI received a substantially higher level of funding for Fiscal Year 2022 than any of the above noted programs received, and includes funding specifically for technical assistance and training, project evaluation, and for intermediary organizations to support the development of grassroots CVI organizations. 
  • CVIPI also includes a directive from Congress for the Department of Justice to prioritize funding community-based violence intervention programs to the fullest extent possible. The above noted grant programs sought to address community violence with an emphasis on restoring community trust with law enforcement, which limited the number of community violence organizations that could apply if their programmatic work did not include a partnership with a law enforcement agency. 

St. Louis County was not a recipient of CVIPI funding in 2022, but this opportunity will very likely present itself again in 2023, and county stakeholders should make plans to leverage it to the fullest extent possible to help build out local, community-based violence reduction strategies.

Congressionally Directed Spending

For the first time in many years, congressional leaders brought back a funding mechanism called “Congressionally Directed Spending,” also known more colloquially as “earmarks.” The Consolidated Appropriations Act of 2022 also included more than $45 million of earmarks in discrete funding for at least 67 community projects that support community violence intervention efforts. This funding provided a critical mechanism for Congress to provide funding for one year to support local or state-level efforts to address violence in their communities.

For Fiscal Year 2022, this process involved members of the House and Senate submitting requests for community projects from a series of federal accounts,491 several of which overlap with issues of relevance to community violence. Giffords tracked the inclusion of more than $46 million of earmark requests in the House and Senate FY22 appropriations bills for community-violence related projects, including a $601,700 request by Representative Cori Bush to expand the capacity of the St. Louis Area Violence Prevention Commission, as well as additional access to behavioral health professionals for those at-risk of exposure to violence and individuals referred through the Gun Violence Response Network.492 

All earmark requests for FY2023 are still pending the finalization of the congressional appropriations process as of the publication of this report in the fall of 2022. However, these funding opportunities will likely continue to be available in future years, and stakeholders in St. Louis County should plan to seek earmarks to specifically address community violence through outreach to federal representatives in both the House and Senate.

The advantage of this funding is that it is flexible and the application process is far less rigorous compared to other federal funding opportunities. However, because this funding is at the mercy of an unpredictable federal appropriations schedule and each award will be one-time and for one year in duration only, this should not be viewed as a sustainable funding source.

Bipartisan Safer Communities Act

In 2022, Congress passed and President Biden signed the Bipartisan Safer Communities Act (BSCA),493 which, among other things, invests $250 million in a community based violence intervention and prevention initiative and funds other programs across the Department of Justice (DOJ), the Department of Health and Human Services (HHS), and the Department of Education (ED) that may help support communities most impacted by gun violence.

The BSCA appropriated $1.6 billion for the DOJ.494 In particular, the BSCA appropriated:

  • $250 million (over five fiscal years) for the new Community Based Violence Intervention and Prevention Initiative, which includes a $50 million increase in available grant funds for FY22.
  • $200 million (over five fiscal years) for the Bureau of Justice Assistance grants authorized by the STOP School Violence Act of 2018 to implement crisis intervention teams and hire school support personnel such as school-based violence interrupters.
  • $100 million (over five fiscal years) for the Community Oriented Policing Services Office competitive grants authorized by the STOP School Violence Act of 2018 to improve school security by providing students and teachers with the tools they need to recognize, respond quickly to, and prevent acts of violence.

The BSCA appropriated $990 million to HHS, including $800 million for HHS’s Substance Abuse and Mental Health Services Administration,495 and $190 million for HHS’s Office of the Secretary’s Public Health and Social Services Emergency Fund.496 In particular, the BSCA appropriated:

  • $40 million (over four fiscal years) for the National Child Traumatic Stress Network (NCTSN)497 to improve treatment and services for children, adolescents, and families who have experienced traumatic events.
  • $240 million (over four fiscal years) for activities and services under Project AWARE,498 with $28 million to be used for grants to support trauma care in schools.
  • $120 million (over four fiscal years) for Mental Health Awareness Training to prepare and train community members and first responders on how to adequately recognize and respond to individuals with mental disorders.
  • $60 million (over five fiscal years) for primary care training and enhancement to provide mental and behavioral health care training as a part of pediatric training and other clinicians who provide care for pediatric populations and other vulnerable populations, including individuals with mental health or substance use disorder.
  • $80 million (over four fiscal years) for pediatric mental health care access.

Finally, the BSCA appropriated $2.050 billion to ED.499 In particular, the BSCA appropriated:

  • $50 million (to remain available until September 30, 2023) to improve and expand 21st Century Community Learning Center programs, which provide academic enrichment and youth development opportunities during non-school hours for low-income households.
  • $1 billion (to remain available until September 30, 2025) to increase funding for Student Support and Academic Enrichment Grants for Safe and Healthy Student Programs that provide mental health resources, drug and violence prevention programs, mentoring and school counseling, and positive behavioral interventions and supports.
  • $500 million (over five fiscal years) for School Based Mental Health Services Grants to increase the number of and reduce the turnover of qualified mental health service providers who provide school-based mental health services to students in school districts with demonstrated need.
  • $500 million (over five fiscal years) for Mental Health Services Professional Demonstration Grants to support innovative partnerships between institutions of higher education and school districts to prepare school-based mental health service providers for employment in high-need schools.

Many of these funding streams will run through state and local agencies that will have large discretion to determine how they are used. St. Louis County stakeholders should leverage these funds and otherwise advocate for them to be used to address trauma and provide resources to areas most impacted by community violence.

American Rescue Plan Act Funds

An important federal funding opportunity for addressing community violence in the County of St. Louis comes from the American Rescue Plan Act (ARPA). ARPA is a $1.9 trillion pandemic relief bill signed into law by President Biden in March 2021. The bill makes multiple investments in state and local infrastructure, schools, and public health efforts. Part of ARPA directs hundreds of billions of dollars in more flexible federal aid and relief directly to states, cities, and counties. State and local governments started receiving ARPA funds in May 2021 and can spend these funds for eligible purposes through the end of 2024, so this is a current and time-sensitive opportunity for stakeholders in the County of St. Louis.500 

Given the tremendous need to address the community violence that has spiked in St. Louis in the wake of the COVID-19 pandemic, clear direction from the federal government that ARPA funds can and should be used for this purpose, and both the magnitude and flexibility of the opportunity, Giffords recommends that city and state leaders consider earmarking ARPA funds for the express purpose of supporting community violence reduction strategies, including the recommendations presented in this report. Much more about ARPA funding is included above in the local funding section.

Medicaid

In April 2021, the Department of Health and Human Services organized a webinar and toolkit to educate states on how they can use Medicaid to reimburse certain community violence intervention programs, like hospital-based violence interventions.501 That same year, Connecticut and Illinois became the first two states to direct their Medicaid systems to directly reimburse violence prevention professionals for their services.502 In 2022, California and Maryland have passed similar legislation, creating even more momentum for this policy.503  

As an example, the Connecticut bill, HB 5677, instructed the state’s medicaid agency to “amend the Medicaid state plan to make community violence prevention services available, to the extent permitted by federal law, to any Medicaid beneficiary who has: (A) Received medical treatment for an injury sustained as a result of an act of community violence, and (B) been referred by a certified or licensed health care provider or social services provider to receive community violence prevention services from a certified violence prevention professional, after such provider determines such beneficiary to be at elevated risk of a violent injury or retaliation resulting from another act of community violence.”504 This legislation is still being implemented in the states where it has been enacted, but it is likely to create a significant new funding stream for violence prevention professionals in the community violence space.

As a Medicaid expansion state,505 Missouri has the option to similarly increase funding for the field of community violence prevention workers (with a large portion of costs covered by the federal government), which could be done via legislation or through agency action. Giffords and national partner organizations like the Health Alliance for Violence Intervention are available to provide more information on this policy to relevant stakeholders.506 Although there are opportunities to offer reimbursement for a whole range of services, the most likely beneficiary of Medicaid coverage are violence prevention professionals working in a hospital setting, such as those employed by Life Outside of Violence in the St. Louis region.

Missouri Foundation for Health MoCAP Program

For nonprofit organizations and government agencies that are seeking grant funds to support “health and prevention services,”507 Missouri Foundation for Health (MFH) offers its MoCAP Program, free of charge. MoCAP provides both educational resources,508 including a useful list of federal funding opportunities,509 and, in qualifying circumstances, direct technical assistance with the application process for federal and national funding opportunities.510 The types of entities that can qualify for services include community health centers, local public health agencies, local nonprofits, and state agencies within the MFH service area, which includes the County of St. Louis.511 

Since 2010, MoCAP has supported more than 780 proposals and over $356 million in funding has been secured for Missouri organizations. Interested organizations may apply for assistance online at the MFH website and do not need to be current grantees of MFH in order to use MoCAP services. This is an excellent resource for community-based nonprofit organizations and government agencies in the County of St. Louis that are looking to leverage some of the competitive federal grant programs identified in this report.

IN THE COURTS

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Funding Opportunities Charts

Conclusion

St. Louis County faces tremendous challenges when it comes to addressing increasing levels of homicides and shootings, but it also has historic opportunities. There is much left to be done at the county level to improve conditions so that meaningful reductions in community violence can be achieved and sustained—and there is reason to be hopeful that this change will come. Now is the time for leaders in the St. Louis region to come together to respond to the needs of residents most impacted by daily violence.

For any St. Louis County stakeholders that have questions or need additional information about any of the information discussed in this report, we encourage you to contact our team at Giffords Center for Violence Intervention. We are committed to assisting the people of St. Louis achieve meaningful reductions in violence and cultivate a safer community for all.

This report is dedicated to the memory of Antione Brown Jr., and all those who have been taken from us too soon because of gun violence.

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SPOTLIGHT

COMMUNITY INTERVENTION

Community violence intervention focuses on reducing the daily homicides and shootings that contribute to our country’s gun violence epidemic. We created Giffords Center for Violence Intervention to champion community-based efforts to save lives and improve public safety. 

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  1. “Fatal Injury Reports, National, Regional and State, 1981 – 2019,” Web-based Injury Statistics Query and Reporting System (WISQARS), Centers for Disease Control and Prevention, last updated February 20, 2020, https://wisqars.cdc.gov/fatal-reports.[]
  2. St. Louis, Missouri, Mayor’s Office, “Mayor Tishaura O. Jones To Sign Bill to Improve Public Safety, Creating Office of Violence Prevention and Dedicating Nearly $14 Million to Community, Youth Programming,” news release, July 28, 2022, https://www.stlouis-mo.gov/government/departments/mayor/news/mayor-jones-to-sign-bill-to-improve-public-safety.cfm.[]
  3. “Community Violence Prevention,” Centers for Disease Control and Prevention, last accessed October 20, 2022, https://www.cdc.gov/violenceprevention/communityviolence/index.html.[]
  4. “The Cost Per Shooting: St. Louis, Missouri,” The National Institute for Criminal Justice Reform, last accessed January 20, 2022, https://nicjr.org/wp-content/themes/nicjr-child/assets/StLouis.pdf.[]
  5. North County Incorporated, last accessed September 26, 2022, https://northstlouiscounty.com.[]
  6. Jeannette Cooperman, “St. Louis’ Great Divorce: A complete history of the city and county separation and attempts to get back together,” St. Louis Magazine, March 8, 2019, https://www.stlmag.com/news/politics/st-louis-great-divorce-history-city-county-split-attempt-to-get-back-together/; “The 1876 St. Louis City / County split and its effect on research,” St. Louis County Library, last accessed September 28, 2022, https://www.slcl.org/content/1876-st-louis-city-county-split-and-its-effect-research.[]
  7. MSA are federally designated geographical areas that groups counties in the United States together based on population and commuting patterns. Areas included in this analysis of the St. Louis MSA include the City of St. Louis and Franklin, Jefferson, St. Charles and St. Louis Counties. East-West Gateway, “Where We Stand: The Strategic Assessment of the St. Louis Region,” July 29, 2015, https://www.ewgateway.org/wp-content/uploads/2017/07/wws2015.pdf.[]
  8. Id. See also Todd Swanstrom, “Equity Planning in a Fragmented Suburban Setting: The Case of St. Louis,” Advancing Planning Equity Now (2018): 101–124, Ithaca: Cornell University Press.[]
  9. Gregory Weiher, “The Fractured Metropolis: Political Fragmentation and Metropoli-tan Segregation,” Albany, NY: SUNY Press, 1991; Eric J. Heikkil, “Are Municipalities Tieboutian Clubs?” Regional Science and Urban Economics 26 (1996): 203–26; Kendra Bischoff, “School District Fragmentation and Racial Residential Segregation: How Do Boundaries Matter?” Urban Affairs Review 44, no. 2 (2008): 182–217; Jonathan T. Rothwell and Douglas S. Massey, “Density Zoning and Class Segregation in U.S. Metropolitan Areas,” Social Science Quarterly, 91 (2010): 1123–43. See also Todd Swanstrom, “Equity Planning in a Fragmented Suburban Setting: The Case of St. Louis,” Advancing Planning Equity Now (2018): 101-124, Ithaca: Cornell University Press.[]
  10. East-West Gateway, “Where We Stand: The Strategic Assessment of the St. Louis Region,” July 29, 2015, https://www.ewgateway.org/wp-content/uploads/2017/07/wws2015.pdf.[]
  11. “St. Louis County Missouri Cities,” About St. Louis, last accessed September 26, 2022, https://aboutstlouis.com/local/st-louis-county-missouri-cities; “St. Louis County Police Precincts and Municipalities,” Open Government St. Louis County, Missouri, last updated November 15, 2019, https://data.stlouisco.com/documents/stlcogis::st-louis-county-police-precincts-and-municipalities/explore.[]
  12. Police departments estimate based on agencies reporting to the Missouri State Highway Patrol’s (MSHP) Summary Reporting System (SRS); See also “Division of Patrol,” St. Louis County Police, last accessed September 26, 2022, https://www.stlouiscountypolice.com/precincts/.[]
  13. Police Executive Research Forum, “Overcoming the Challenges and Creating a Regional Approach to Policing in St. Louis City and County,” April 30, 2015, https://bloximages.newyork1.vip.townnews.com/stltoday.com/content/tncms/assets/v3/editorial/4/72/47259e41-6c82-5c9f-b922-4585a5fe2a17/5548cf7cdd470.pdf.pdf; The Ferguson Commission, “Forward Through Ferguson: A Path Toward Racial Equity,” October 14, 2015, https://forwardthroughferguson.org/report/executive-summary/clarifying-our-terms/.[]
  14. Areas presently under the jurisdiction of the NCPC include Dellwood, Pinelawn, Wellston, Vinita Park, Hanley Hills, Velda Village Hills, Beverly Hills, and Upland Park.[]
  15. Jeannette Cooperman, “St. Louis’ Great Divorce: A complete history of the city and county separation and attempts to get back together,” St. Louis Magazine, March 8, 2019, https://www.stlmag.com/news/politics/st-louis-great-divorce-history-city-county-split-attempt-to-get-back-together/.[]
  16. Id.[]
  17. QuickFacts: St. Louis city (County), Missouri; St. Louis County, Missouri, 2021, United States Census Bureau, https://www.census.gov/quickfacts/fact/table/stlouiscitycountymissouri,stlouiscountymissouri/RHI225221.[]
  18. Emily Badger, “‘White flight’ began a lot earlier than we think,” Washington Post, March 17, 2016, https://www.washingtonpost.com/news/wonk/wp/2016/03/17/white-flight-began-a-lot-earlier-than-we-think/; See also The National Advisory Commission on Civil Disorders, “Report of The National Advisory Commission on Civil Disorders,” 1968, https://belonging.berkeley.edu/sites/default/files/kerner_commission_full_report.pdf?file=1&force=1.[]
  19. Todd Swanstrom, “Equity Planning in a Fragmented Suburban Setting: The Case of St. Louis,” in Advancing Planning Equity Now (2018): 101–124, Ithaca: Cornell University Press.[]
  20. Diego Mendez-Carbajo, “Neighborhood Redlining, Racial Segregation, and Homeownership,” Federal Reserve Bank of St. Louis, September 2021, https://files.stlouisfed.org/files/htdocs/publications/page1-econ/2021/09/01/neighborhood-redlining-racial-segregation-and-homeownership_SE.pdf.[]
  21. Oscar Perry Abello, “Breaking Through and Breaking Down the Delmar Divide in St. Louis,” Next City, August 19, 2019, https://nextcity.org/features/breaking-through-and-breaking-down-the-delmar-divide-in-st.-louis.[]
  22. Chico Harlan, “In St. Louis, Delmar Boulevard is the line that divides a city by race and perspective,” Washington Post, August 22, 2014, https://www.washingtonpost.com/national/in-st-louis-delmar-boulevard-is-the-line-that-divides-a-city-by-race-and-perspective/2014/08/22/de692962-a2ba-4f53-8bc3-54f88f848fdb_story.html.[]
  23. “Crossing a St Louis street that divides communities,” BBC, March 14, 2012, https://www.bbc.com/news/av/magazine-17361995.[]
  24. Youth Violence Prevention Partnership, “Safe and Thriving St. Louis: 2018-2023 Strategic Plan,” last accessed September 26, 2022, https://www.stlareavpc.org/_files/ugd/afc6b1_66598e82765b4d4e8b821497e011be5d.pdf.[]
  25. Todd Swanstrom, “Equity Planning in a Fragmented Suburban Setting: The Case of St. Louis,” in Advancing Planning Equity Now (2018): 101–124, Ithaca: Cornell University Press.[]
  26. Id.[]
  27. Id.; Enumerated in 2.180 of the County Charter.[]
  28. St. Louis County Government, “St. Louis County Fiscal Year 2020 Consolidated Annual Performance and Evaluation Report,” 2021, https://stlouiscountymo.gov/st-louis-county-departments/human-services/community-development/consolidated-plancaper/caper-2020/.[]
  29. Todd Swanstrom, “Equity Planning in a Fragmented Suburban Setting: The Case of St. Louis,” in Advancing Planning Equity Now (2018): 101–124, Ithaca: Cornell University Press.[]
  30. Id.[]
  31. “QuickFacts: St. Louis County, Missouri,” United States Census Bureau, last accessed September 26, 2022, https://www.census.gov/quickfacts/fact/table/stlouiscountymissouri/INC110220.[]
  32. St. Louis County Missouri, last accessed September 28, 2022, https://stlouiscountymo.gov.[]
  33. St. Louis County Missouri, “STLCO FY2022 Adopted Business Plan,” October 1, 2021, https://stlouiscountymo.gov/st-louis-county-departments/administration/performance-management-and-budget/2022-adopted-budget1/business-plan.[]
  34. “QuickFacts: St. Louis County, Missouri,” United States Census Bureau, last accessed September 26, 2022, https://www.census.gov/quickfacts/fact/table/stlouiscountymissouri/INC110220.[]
  35. Id.[]
  36. North County is defined here as any municipality or zip code above Delmar Boulevard and Page Avenue. Municipalities included in this analysis are Bellefontaine Neighbors, Berkeley, Black Jack, Bridgeton, Calverton Park, Cool Valley, Country Club Hills, Delwood, Edmundson, Ferguson, Flordell Hills, Florissant, Hazelwood, Jennings, Kinloch, Moline Acres, Riverview, Spanish Lake, and Woodson Terrace, as well as the following zip codes: 63031, 63033, 63034, 63042, 63044, 63114, 63120, 63121, 63134, 63135, 63136, 63138, 63140, and 63137.[]
  37. This figure is based on an analysis of US Census data from 2016 to 2020 for St. Louis County and zip codes in North County, as previously defined, and accessed through the Missouri Health Atlas. “QuickFacts: St. Louis County, Missouri,” United States Census Bureau, last accessed September 26, 2022, https://www.census.gov/quickfacts/fact/table/stlouiscountymissouri/INC110220; “Missouri Health Atlas,” Explore MO Health, last accessed September 28, 2022, https://cares.page.link/Bvvj.[]
  38. This figure is based on an analysis of US Census data from 2016 to 2020 for St. Louis County and zip codes in North County, as previously defined, and accessed through the Missouri Health Atlas. “Missouri Health Atlas,” Explore MO Health, last accessed September 28, 2022, https://cares.page.link/pYiB; “Missouri Health Atlas,” Explore MO Health, last accessed September 28, 2022, https://cares.page.link/Bvvj.[]
  39. This figure is based on an analysis of US data provided by the US Department of Education and the Center for Applied Research and Engagement Systems (CARES) at the University of Missouri from 2018 to 2019 for St. Louis County and zip codes in North County, as previously defined, and accessed through the Missouri Health Atlas. Id.[]
  40. Id.[]
  41. Daniel Kim, “Social determinants of health in relation to firearm-related homicides in the United States: A nationwide multilevel cross-sectional study,” PLoS Medicine 16, no. 12 (December 2019), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6917210/; See also “Crime and Violence,” US Department of Health and Human Services, last accessed September 26, 2022, https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/crime-and-violence.[]
  42. Michael Poulson et al., “Historic redlining, structural racism, and firearm violence: A structural equation modeling approach,” The Lancet Regional Health-Americas 3 (2021): 100052, https://www.sciencedirect.com/science/article/pii/S2667193X21000442.[]
  43. Jack Grone, “When We Talk About Crime In St. Louis, We Need To Talk About St. Louis County,” McPherson Publishing, June 28, 2021, https://www.mcphersonpublishing.com/stl-county-crime.[]
  44. Centers for Disease Control and Prevention, Wide-ranging Online Data for Epidemiologic Research (WONDER), last accessed September 26, 2022, https://wonder.cdc.gov.[]
  45. Id.[]
  46. Id.[]
  47. Jack Grone, “Violent Crime In St. Louis County Fell In 2021, But Remains Elevated Overall,” McPherson Publishing, July 29, 2022, https://www.mcphersonpublishing.com/crime-stlcounty-2021/; St. Louis County Police, “St. Louis County Police Report Declines in Violent Crime,” news release, July 6, 2022, https://stlouiscountymo.gov/st-louis-county-government/county-executive/county-executive-news/st-louis-county-police-report-declines-in-violent-crime/.[]
  48. Calculated with data from CDC WONDER based on a five year average from 2016 to 2020. Centers for Disease Control and Prevention, Wide-ranging Online Data for Epidemiologic Research (WONDER), last accessed September 26, 2022, https://wonder.cdc.gov/.[]
  49. Calculated with data from CDC WONDER based on a five year average from 2016 to 2020. Centers for Disease Control and Prevention, Wide-ranging Online Data for Epidemiologic Research (WONDER), last accessed September 26, 2022, https://wonder.cdc.gov/.[]
  50. Calculated with incident-level NIBRS and SRS data from 2017 to 2021 accessed through St. Louis County’s Open Data Portal, last accessed September 21, 2022, https://data.stlouisco.com/.[]
  51. Calculated using aggregregated media reports for municipalities in St. Louis County from 2017 to 2021 provided by the National Gun Violence Archive. For a complete list of municipalities included in this analysis please contact Giffords Center for Violence Intervention, last accessed September 21, 2022.[]
  52. “Missouri Health Atlas: ZIP Health Rankings Report,” Explore MO Health, last accessed October 20, 2022, https://cares.page.link/Bvvj.[]
  53. Youth Violence Prevention Partnership, “Safe and Thriving St. Louis: 2018-2023 Strategic Plan,” last accessed October 20, 2022, https://www.stlareavpc.org/_files/ugd/afc6b1_66598e82765b4d4e8b821497e011be5d.pdf.[]
  54. Jeffrey B. Bingenheimer, Robert T. Brennan, and Felton J. Earls, “Firearm Violence Exposure and Serious Violent Behavior,” Science 308, no. 5726 (May 2005): 1323-1326, DOI: 10.1126/science.1110096.[]
  55. National Network of Hospital-based Violence Intervention Programs, “Hospital-based Violence Intervention: Practices and Policies to End the Cycle of Violence,” last accessed January 20, 2022, https://static1.squarespace.com/static/5d6f61730a2b610001135b79/t/5d83c0d9056f4d4cbdb9acd9/1568915699707/NNHVIP+White+Paper.pdf.[]
  56. Andrew V. Papachristos, Anthony A. Braga, and David M. Hureau, “Social Networks and the Risk of Gunshot Injury,” Journal of Urban Health 89, (2012), 992–1003, https://doi.org/10.1007/s11524-012-9703-9; Deborah Gorman-Smith, David B. Henry, and Patrick H. Tolan, “Exposure to Community Violence and Violence Perpetration: The Protective Effects of Family Functioning,” Journal of Clinical Child & Adolescent Psychology 33, no. 3 (2004): 439-449, https://doi.org/10.1207/s15374424jccp3303_2.[]
  57. Youth Violence Prevention Partnership, “Safe and Thriving St. Louis: 2018-2023 Strategic Plan,” last accessed October 30, 2022, https://www.stlareavpc.org/_files/ugd/afc6b1_66598e82765b4d4e8b821497e011be5d.pdf.[]
  58. Id.[]
  59. Id.[]
  60. OJP Diagnostic Center, “Diagnostic Analysis for the City of St. Louis, Missouri: Executive Summary,” March 2017, https://www.yumpu.com/en/document/read/58105221/executive-summary-diagnostic-analysis-for-the-city-of-st-louis-missouri.[]
  61. John R. Hipp, Joan Petersilia, and Susan Turner, “Parolee Recidivism In California: The Effect of Neighborhood Context and Social Service Agency Characteristics,” Criminology 48, no. 4 (November 2010): 947, 966, https://doi.org/10.1111/j.1745-9125.2010.00209.x.[]
  62. OJP Diagnostic Center, “Diagnostic Analysis for the City of St. Louis, Missouri: Executive Summary,” March 2017, https://www.stlouis-mo.gov/archives/mayor-slay/public-safety/upload/Diagnostic-Analysis-Presentation-for-the-City-of-St-Louis-Missouri-Document.pdf.[]
  63. Faye S. Taxman, “Violence Reduction Using The Principles Of Risk-Need-Responsivity,” Marquette Law Review 103, no. 3 (2020), https://scholarship.law.marquette.edu/cgi/viewcontent.cgi?article=5453&context=mulr.[]
  64. “Saving Lives: Ten Essential Actions Cities Can Take to Reduce Violence Now,” Council on Criminal Justice, January 12, 2022, https://counciloncj.org/10-essential-actions.[]
  65. Saint Louis Area Violence Prevention Commission, last accessed January 20, 2022, https://www.stlareavpc.org.[]
  66. Interview with Serena Muhammad (Deputy Director, St. Louis Mental Health Board), January 12, 2022.[]
  67. St. Louis Area Violence Prevention Commission, “Statement On Policing & Violence Prevention,” July 24, 2020, https://www.stlareavpc.org/_files/ugd/afc6b1_f42e48fc3d75401cbeadd19e71fc9ee4.pdf.[]
  68. Id.[]
  69. “Our 2022 Priorities,” St. Louis Area Violence Prevention Commission, last accessed September 26, 2022, https://www.stlareavpc.org/2021-priorities.[]
  70. See Brittany Nieto, Mike McLively, and Tiffany Garner, “Addressing Community Violence in the City of St. Louis: Existing Strategies, Gaps, and Funding Opportunities,” Giffords Law Center to Prevent Gun Violence, February 17, 2022, https://giffords.org/lawcenter/articles/addressing-community-violence-in-the-city-of-st-louis-existing-strategies-gaps-and-funding-opportunities.[]
  71. National Network of Hospital-based Violence Intervention Programs, “Hospital-based Violence Intervention: Practices and Policies to End the Cycle of Violence,” last accessed January 20, 2022, https://static1.squarespace.com/static/5d6f61730a2b610001135b79/t/5d83c0d9056f4d4cbdb9acd9/1568915699707/NNHVIP+White+Paper.pdf.[]
  72. Id.[]
  73. On file with Giffords Law Center to Prevent Gun Violence.[]
  74. Interview with Keyria Jeffries (Clinical Case Manager, St. Louis Children’s Hospital), January 14, 2022.[]
  75. Id.[]
  76. Id.[]
  77. Interview with Kateri Chapman-Kramer (Project Coordinator, Life Outside of Violence), January 14, 2022.[]
  78. Interview with Victoria Anwuri (Associate Director, Institute for Public Health, Washington University in St. Louis), February 1, 2022.[]
  79. Interview with Warren Hayden (MSW, LCSW, Victims of Violence Program, Saint Louis Children’s Hospital,) June 3, 2022.[]
  80. Jasmine Payoute, “’I’m 8 and I know I’m invincible’ | Children’s hospitals see record breaking number of gunshot victims,” KSDK, September 24, 2020, https://www.ksdk.com/article/news/special-reports/cut-short/hospitals-record-children-gunshot-victims-st-louis/63-516b0594-3c4c-4d14-aa78-5cd00405c60e.[]
  81. “Victim of Violence Program,” St. Louis Children’s Hospital, last accessed September 26, 2022, https://www.stlouischildrens.org/conditions-treatments/social-work-and-chaplaincy/victim-violence-program.[]
  82. Id.[]
  83. Interview with Warren Hayden (MSW, LCSW, Victims of Violence Program, Saint Louis Children’s Hospital), June 3, 2022.[]
  84. Interview with Dr. LJ Punch (Founder, The T), July 14, 2022.[]
  85. Id.[]
  86. Id.[]
  87. The BRIC, last accessed September 26, 2022, https://www.thebric.org.[]
  88. Wellbeing Blueprint, “Case Study: Bullet Related Injury Clinic,” last accessed September 28, 2022, https://wellbeingblueprint.org/case_studies/bric.[]
  89. Interview with Dr. LJ Punch (Founder, The T), July 14, 2022; See also Jane M. Hayes, Indigo Hann, and LJ Punch, “The Bullet Related Injury Clinic—Healing the Deep Wounds of Gun Violence,” JAMA Surgery 157, no. 2 (December 22, 2021): 167–168, https://jamanetwork.com/journals/jamasurgery/article-abstract/2787396.[]
  90. Wellbeing Blueprint, “Case Study: Bullet Related Injury Clinic,” last accessed September 28, 2022, https://wellbeingblueprint.org/case_studies/bric.[]
  91. Interview with Dr. LJ Punch (Founder, The T), July 14, 2022.[]
  92. Id.[]
  93. “Bullet Related Injury Clinic (BRIC),” St. Louis Regional Health Commission, July 16, 2021, https://www.stlrhc.org/blog/bullet-related-injury-clinic-bric/.[]
  94. Id.[]
  95. The T, last accessed September 26, 2022, https://www.thetstl.com.[]
  96. Id.[]
  97. Stop The Bleed, last accessed September 28, 2022, https://www.stopthebleed.org.[]
  98. Interview with Dr. LJ Punch (Founder, The T), July 14, 2022.[]
  99. Crime Victim Center, last accessed September 26, 2022, https://www.supportvictims.org.[]
  100. Interview with Hope Hopwood (Director of Advocacy Programs, Crime Victim Center), July 28, 2022.[]
  101. Crime Victim Center, last accessed September 26, 2022, https://www.supportvictims.org.[]
  102. Crime Victim Center, “Annual Report 2020,” last accessed September 28, 2022, https://www.supportvictims.org/_files/ugd/5e53a2_45deeb3d909b4c08b9cc60dbedacf333.pdf.[]
  103. Alive & Well Communities, last accessed September 26, 2022, https://www.awcommunities.org.[]
  104. “Outcomes,” University of California San Francisco HEARTS program, last accessed October 20, 2022, https://hearts.ucsf.edu/outcomes.[]
  105. Interview with Christin Simpson (MSN, FNP-C, Director of Healthcare Activation) and Ted Simpson (Manager of Stakeholder Engagement & Activation, Alive & Well Communities), August 18, 2022.[]
  106. Id.[]
  107. Id.[]
  108. “Pathways to Progress,” St. Francis Community Services, last accessed September 28, 2022, https://sfcsstl.org/services/case-management.[]
  109. Interview with Maryn Olson (Program Director, St. Francis Community Services), August 10, 2022.[]
  110. Id.[]
  111. Id.[]
  112. Interview with Maryn Olson (Program Director, St. Francis Community Services), August 10, 2022.[]
  113. Id.[]
  114. Id.[]
  115. “Returning Citizens & Reentry,” United States Attorney’s Office: Northern District of West Virginia, last accessed February 3, 2022, https://www.justice.gov/usao-ndwv/returning-citizens-reentry.[]
  116. Missouri Department of Corrections, “Missouri Reentry Process: Report to the Governor 2016,” February 2017, https://doc.mo.gov/sites/doc/files/2018-01/GovReport.pdf.[]
  117. “Re-Entry Community Linkages (RE-LINK),” St. Louis Integrated Health Network, last accessed September 28, 2022, https://stlouisihn.org/re-link/#:~:text=What%20It%20Is,are%20returning%20to%20the%20community.[]
  118. Interview with Chase Shiflet (MSW, Justice Initiative Program Manager, St. Louis Integrated Health Network), April 20, 2022.[]
  119. St. Louis Integrated Health Network, “Coming Home For Good,” July 2019, https://stlouisihn.org/wp-content/uploads/2019/07/Coming-Home-for-Good-IHN-RELINK-Report.pdf.[]
  120. Id.[]
  121. STL Reentry Collective, last accessed September 26, 2022, https://www.stlreentryresources.org.[]
  122. “STL Reentry Resource Guide,” STL Reentry Collective, last accessed February 9, 2022, https://www.stlreentryresources.org/resources.[]
  123. Interview with Harvey Galler (Co-Founder of STL Reentry Collective), February 4, 2022.[]
  124. Id.[]
  125. Id.[]
  126. St. Louis County Missouri, “St. Louis ReCAST Projects For Community Well-Being Celebrating 5 Years of Participatory Budgeting 2017 – 2021,” last accessed September 26, 2022, https://stlouiscountymo.gov/st-louis-county-departments/public-health/recast/project-reports/culminating-report.[]
  127. HUD Exchange, “St. Louis & St. Louis County Promise Zone,” April 2015, https://www.hudexchange.info/sites/onecpd/assets/File/Promise-Zone-Designee-St-Louis.pdf.[]
  128. CHIPS Health and Wellness Center, last accessed September 15, 2022, http://www.chipsstl.org.[]
  129. Metro Theater Company, last accessed September 26, 2022, https://www.metroplays.org.[]
  130. St. Louis County Missouri, “St. Louis ReCAST Projects For Community Well-Being Celebrating 5 Years of Participatory Budgeting 2017 – 2021,” last accessed September 26, 2022, https://stlouiscountymo.gov/st-louis-county-departments/public-health/recast/project-reports/culminating-report/.[]
  131. Id.[]
  132. Id.[]
  133. Interview with Damon Major (Violence Prevention Coordinator, St. Louis County Department of Public Health), April 19, 2022.[]
  134. “Project R.E.S.T.O.R.E.,” University of Missouri St. Louis, last accessed September 22, https://www.umsl.edu/ccj/research/restore.html.[]
  135. “Project RESTORE Funds Used to Support Socio-emotional Programs,” The School District of University City, last accessed September 22, 2022, https://www.ucityschools.org/site/default.aspx?PageType=3&DomainID=4&ModuleInstanceID=33&ViewID=6446EE88-D30C-497E-9316-3F8874B3E108&RenderLoc=0&FlexDataID=4273&PageID=1.[]
  136. Interview with Nhial T. Tutlam (PhD, MPH, Postdoctoral Research Scholar, International Center for Child Health and Development, Adjunct Instructor, Public Health – Social Work, Brown School at Washington University in St. Louis), June 1, 2022.[]
  137. “Project R.E.S.T.O.R.E.,” University of Missouri St. Louis, last accessed September 22, https://www.umsl.edu/ccj/research/restore.html.[]
  138. Interview with Damon Major (Violence Prevention Coordinator, St. Louis County Department of Public Health), April 19, 2022.[]
  139. Id.[]
  140. National Association of County and City Health Officials, “NACCHO Announces 2020 Model Practice Award Winners,” news release, July 6, 2020, https://www.naccho.org/blog/articles/naccho-announces-2020-model-practice-award-winners.[]
  141. St. Louis Partnership for a Healthy Community, “St. Louis Region Community Health Assessment and Community Health Improvement Plan,” August 2018, https://www.thinkhealthstl.org/content/sites/stlouisco/CHA_Reports/St_Louis_2017_CHA_2018_CHIP_Summary_Report_FINAL_2.pdf.[]
  142. Id.[]
  143. “Action Team: Violence Prevention,” Think Health St. Louis, last accessed September 22, 2022, https://www.thinkhealthstl.org/tiles/index/display?alias=Violence_Prevention.[]
  144. Interview with Kate Donaldson (Deputy Director, St. Louis County Department of Public Health); Damon Broadus (Director, Health Promotion and Public Health Research, St. Louis County Department of Public Health), and Damon Major (Violence Prevention Coordinator, St. Louis County Department of Public Health), July 26, 2022.[]
  145. Greg Newburn, “Police should solve murders. Congress can help,” Niskanen Center, October 29, 2021, https://www.niskanencenter.org/police-should-solve-murders-congress-can-help.[]
  146. Giffords Law Center to Prevent Gun Violence, “In Pursuit of Peace: Building Police-Community Trust to Break the Cycle of Violence,” last updated September 9, 2021, https://giffords.org/lawcenter/report/in-pursuit-of-peace-building-police-community-trust-to-break-the-cycle-of-violence.[]
  147. The Ferguson Commission, “Forward Through Ferguson: A Path Toward Racial Equity,” October 14, 2015, https://3680or2khmk3bzkp33juiea1-wpengine.netdna-ssl.com/wp-content/uploads/2015/09/101415_FergusonCommissionReport.pdf.[]
  148. The Ferguson Commission, “Forward Through Ferguson: A Path Toward Racial Equity,” October 14, 2015, https://3680or2khmk3bzkp33juiea1-wpengine.netdna-ssl.com/wp-content/uploads/2015/09/101415_FergusonCommissionReport.pdf.[]
  149. Id.[]
  150. Teneo Strategy LLC, “St. Louis County Police Department Administrative Review Findings & Recommendations,” last accessed September 16, 2022, https://bloximages.newyork1.vip.townnews.com/stltoday.com/content/tncms/assets/v3/editorial/1/b8/1b8faec4-75fa-5333-9026-be17009f123c/5fe0f03c36617.pdf.pdf.[]
  151. Forward Through Ferguson, “The State of Police Reform,” September 2019, https://www.dropbox.com/s/jl3r47pkk5q30y3/FTF_SOPR_FINAL_web.pdf?dl=0.[]
  152. Jack Grone, “When We Talk About Crime In St. Louis, We Need To Talk About St. Louis County,” McPherson Publishing, June 28, 2021, https://www.mcphersonpublishing.com/stl-county-crime.[]
  153. Focus Group with North St. Louis County Law Enforcement Agencies, June 28, 2022; Jennifer Mascia, “Gun Deaths Hit an All-Time High (Again) in 2021,” The Trace, September 8, 2022, https://www.thetrace.org/2022/09/gun-deaths-cdc-2021-record.[]
  154. With 38 of 41 homicides cleared between 2018 and 2021. Focus Group with North St. Louis County Law Enforcement Agencies, June 28, 2022.[]
  155. Forward Through Ferguson, “The State of Police Reform,” September 2019, https://www.dropbox.com/s/jl3r47pkk5q30y3/FTF_SOPR_FINAL_web.pdf?dl=0.[]
  156. Focus Group with North St. Louis County Law Enforcement Agencies, June 28, 2022.[]
  157. Id.[]
  158. Forward Through Ferguson, “The State of Police Reform,” September 2019, https://www.dropbox.com/s/jl3r47pkk5q30y3/FTF_SOPR_FINAL_web.pdf?dl=0.[]
  159. Id.[]
  160. Interview with Lieutenant Colonel Steve Sack (Commanding Officer, Division of Criminal Investigation, St. Louis County Police Department), Lieutenant Craig Longworth (Division of Criminal Investigation Bureau of Crimes Against Persons, St. Louis County Police Department), and Ali Noble (Police Analyst, Bureau of Research and Analysis, St. Louis County Police Department), July 27, 2022.[]
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  162. Data provided by SLCPD via public record request.[]
  163. Id.[]
  164. Id.[]
  165. Interview with Lieutenant Colonel Steve Sack (Commanding Officer, Division of Criminal Investigation, St. Louis County Police Department), Lieutenant Craig Longworth (Division of Criminal Investigation Bureau of Crimes Against Persons, St. Louis County Police Department), and Ali Noble (Police Analyst, Bureau of Research and Analysis, St. Louis County Police Department), July 27, 2022; See also Brittany Nieto, Mike McLively, and Tiffany Garner, “Addressing Community Violence in the City of St. Louis: Existing Strategies, Gaps, and Funding Opportunities,” Giffords Law Center to Prevent Gun Violence, February 17, 2022, https://giffords.org/lawcenter/articles/addressing-community-violence-in-the-city-of-st-louis-existing-strategies-gaps-and-funding-opportunities.[]
  166. Interview with Lieutenant Colonel Steve Sack (Commanding Officer, Division of Criminal Investigation, St. Louis County Police Department), Lieutenant Craig Longworth (Division of Criminal Investigation Bureau of Crimes Against Persons, St. Louis County Police Department), Ali Noble (Police Analyst, Bureau of Research and Analysis, St. Louis County Police Department), July 27, 2022.[]
  167. Major Case Squad of Greater St. Louis, last accessed September 26, 2022, https://majorcasesquadstl.org.[]
  168. “About Major Case Squad,” Major Case Squad of Greater St. Louis, last accessed September 26, 2022, https://majorcasesquadstl.org/about-mcs.[]
  169. “Wesley Bell,” St. Louis County Prosecuting Attorney, last accessed September 22, 2022, https://www.stlouiscountyprosecutingattorney.com/wesleybell.[]
  170. St. Louis County Prosecuting Attorney, last accessed September 22, 2022, https://www.stlouiscountyprosecutingattorney.com/welcome.[]
  171. “Victim Services Division,” St. Louis County Prosecuting Attorney, last accessed September 22, 2022, https://www.stlouiscountyprosecutingattorney.com/services-for-victims.[]
  172. Interview with Danielle Smith (Director of Diversion & Special Programs, St. Louis County Prosecutor’s Office), Lisa Jones (Program Manager, Victim Service Division, St. Louis County Prosecutor’s Office), and Samantha Stangl (Director of Data and Strategic Partnerships, St. Louis County Prosecutor’s Office), September 21, 2022.[]
  173. Id.[]
  174. Id.[]
  175. St. Louis County Prosecuting Attorney, last accessed September 22, 2022, https://www.stlouiscountyprosecutingattorney.com/welcome.[]
  176. “Recidivism,” National Institute of Justice, last accessed September 26, 2022, https://nij.ojp.gov/topics/corrections/recidivism.[]
  177. “Saint Louis County Law Enforcement Assisted Diversion,” Bureau of Justice Assistance, US Department of Justice, last accessed September 22, 2022, https://bja.ojp.gov/funding/awards/2019-ar-bx-k004.[]
  178. Interview with Danielle Smith (Director of Diversion & Special Programs, St. Louis County Prosecutor’s Office), Lisa Jones (Program Manager, Victim Service Division, St. Louis County Prosecutor’s Office), and Samantha Stangl (Director of Data and Strategic Partnerships, St. Louis County Prosecutor’s Office), September 21, 2022.[]
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  240. Los Angeles County Department of Public Health Motion by Supervisors Sheila Kuehl and Mark Ridley-Thomas, “Addressing the Epidemic of Gun Violence in Our Communities,” March 13, 2018, http://publichealth.lacounty.gov/ivpp/docs/OVP%20documents/Text%20of%20board%20motion%203_13_18.pdf.[]
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  428. Id. at 3.[]
  429. Employment and Training Administration, US Department of Labor, “Adult and Youth Workforce Development Programs’ Role in Supporting Community Violence Interventions,” January 4, 2022, https://wdr.doleta.gov/directives/attach/TEN/TEN_18-21.pdf.[]
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  431. Id.[]
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  444. Id.[]
  445. Id.[]
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  454. Id.[]
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  456. Id.[]
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  486. Id.[]
  487. Brittany Nieto and Mike McLively, “America at a Crossroads: Reimagining Federal Funding to End Community Violence,” Giffords Law Center to Prevent Gun Violence December 17, 2020, https://giffords.org/lawcenter/report/america-at-a-crossroads-reimagining-federal-funding-to-end-community-violence.[]
  488. Pub. L. No 117-103, 136 Stat. 49.[]
  489. United States. Congress. Conference Committees 2022. Joint Explanatory Statement of the Committee of Conference on HR 2471: Committee on Appropriations, House of Representatives, 117th Congress, Second Session. Washington: U.S. Govt. Print. Off., 2022.[]
  490. Id.[]
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  493. Pub. L. No. 117-159, 136 Stat. 1313.[]
  494. Id. at 1338–1339.[]
  495. Id. at 1340.[]
  496. Id. at 1341.[]
  497. NCTSN is a national network of grantees who develop and promote effective community practices for children and adolescents exposed to a wide array of traumatic events.[]
  498. Project AWARE is designed to identify and provide services to children and youth in need of mental health services in their school.[]
  499. Id. at 1341-1342.[]
  500. Giffords Law Center to Prevent Gun Violence, “Funding Community Safety with American Rescue Plan Relief Funds,” memorandum, April 15, 2021, https://giffords.org/lawcenter/memo/funding-community-safety-with-american-rescue-plan-relief-funds.[]
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  503. California Legislature, Assembly, “Medi-Cal benefits: violence prevention services,” AB 1929, Approved by the Governor August 22, 2022,  https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220AB1929; Maryland General Assembly, Senate, “Maryland Medical Assistance Program – Community Violence Prevention Services,” SB 0350, Enacted May 29, 2022, https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/sb0350?ys=2022RS.[]
  504. Connecticut General Assembly, House, “An Act Concerning the Availability of Community Violence Prevention Services Under Medicaid,” HB 5677, 2021, https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&which_year=2021&bill_num=5677.[]
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  507. To define “health and prevention services,” Missouri Foundation for Health uses the World Health Organization definition: “Health is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.” “MoCAP Frequently Asked Questions,” Missouri Foundation for Health, last accessed February 3, 2022, https://mffh.org/the-foundation/funding-opportunities/mocap/mocap-faq.[]
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  510. Id.[]
  511. “Where We Work,” Missouri Foundation for Health, last accessed February 3, 2022, https://mffh.org/the-foundation/where-we-work.[]