Responding to Violence in Coronet City: Contrasting and Complementary Approaches of Criminal Justice and Public Health Practitioners Jeffrey Roth and Mark H. Moore August, 1993 I. Introduction Over the decade of the 1980's, violent crime in the nation's cities increased significantly  reaching levels not seen since the days of Prohibition. (Violence Report, p.81) Today, more than 2 million Americans, fully 1% of the national population, suffers a violent attack each year. (Violence Report, p.56) Nor are the consequences of the violence limited to the suffering of the victims. The fear spawned by the attacks has sped the middle class flight from America's cities, leaving an increasingly impoverished population to fend for itself. Tragically, in the resulting vacuum, violence has become the leading cause of death among young, black men. (Violence Report, p. 65) A. Violence and Criminal Justice Traditionally, society has viewed urban violence as a "crime problem", and has looked to the criminal justice system for its solution. To a degree, this responds to the natural moral indignation that citizens feel when one citizen attacks another. To the extent that the violence seemed deliberate or premeditated  the result of the malevolent intentions of criminal offenders  both victims and citizens reasonably demand that the offender be called to account. Nothing less is consistent with the demands of justice. And justice is at least part of what the criminal justice system is supposed to deliver. Yet, society has relied on the criminal justice system because it also believed that the criminal justice responses could produce a practical effect. At least in theory, the mechanisms of general and specific deterrence, incapacitation, and rehabilitation, triggered by arrests, prosecutions, and sentencing, could reduce crime in general, and violent crime in particular. Both to satisfy the demand for justice and to produce the practical effect of reducing violence in the future, then, society has relied primarily on the criminal justice system to deal with violence. B. Violence and "Root Causes" Of course, there has always been a different idea about the causes of violence and how the society might best deal with these. In this alternative view, the causes of crime lie not in the evil intentions of offenders, but in the social conditions that spawn angry, despairing and alienated citizens. The right response for society to make, then, is not to arrest, prosecute, and jail individual offenders, but to alter the "root causes" of crime  to reduce unemployment, lessen racial discrimination, improve the quality of education, and help poor families raise their children to responsible citizenship. The implication is that the best policies for controlling crime and violence do not lie within the narrow grasp of the criminal justice system, but in the wider embrace of society's overall social policies. Hopes for the success of this approach in dealing with violent crime have been battered somewhat by the nation's experience with the Great Society programs of the sixties. Yet, the ideal of attacking "root causes" retains an enormous appeal. One of the reason it has this appeal is that it seems to promise an opportunity to prevent rather than merely control violence. Faced with the choice between preventing violence or reacting to it once it occurs, it seems obvious that prevention would be preferred. Thus, the goal of preventing crime has animated a long search for effective means of doing so even when it has seemed impossible to eliminate "root causes". C. Reclaiming Criminal Offenders One enduring preventive idea has focused on those who commit violence. The hope has been that such people could be remade or reclaimed for the society. It has always seemed an enormous waste (as well as a potential injustice) to do nothing more than condemn and abandon those who committed crimes. After all, without some kind of effective intervention, criminal offenders remained a continuing liability to the society. Out of jail, they harassed society with continued crimes. In jail, they remained expensive wards of the state. Given this reality, the alternative of intervening in their lives to make them less of a burden to the society over the long run always seemed eminently sensible, as well as humane. This idea seemed particularly compelling for young offenders. Because young people were relatively easily influenced, there was simultaneously less reason to hold them morally accountable for the offenses they committed and more reason to hope that small investments made now would be repaid later in lessened prospects of future offending. This goal of redemption has animated and sustained many important innovations within the criminal justice system over the years. It has sustained efforts to use prisons for the rehabilitation of criminal offenders. And it has provided some of the justification for developing a complex juvenile justice system whose special procedures and dispositions were designed (at least in part) to steer youth away from lives of crime. In these respects, then, the criminal justice system has long sought to join other social institutions in reclaiming those who would otherwise commit violence. Yet, historical experience has not been particularly kind to these ideas, either. The empirical evidence on the effectiveness of prison rehabilitation programs has been discouraging. And both the justice and practical effectiveness of the nation's juvenile justice system have been attacked. D. New Ideas About Violence Prevention A more recent development is the notion that violence might be prevented by interventions that go beyond the traditional ones that focus on "eliminating root causes" or "reclaiming of criminal offenders" (though neither of these would be ruled out if they held some promise of success). In these newer conceptions, the opportunities for prevention lie in crafting solutions to particular problems that seem to occasion local incidents of violence; for example, negotiating a pact between feuding gangs, or reducing weapons carrying in bars where violent fights tend to break out. Or, they focus on reducing "risk factors" for violence that exist generally in the society; for example, high levels of alcohol and drug abuse in the society, or lack of knowledge about how to resolve disputes peaceably. These new ideas emerge from professions that, for somewhat different reasons, feel responsible for acting against the violence that afflicts society, and are frustrated with the limitations of current approaches for dealing with it. 1. Community and ProblemSolving Policing Over the last decade, police executives and their agencies have begun experimenting with new strategies of policing variously called "community policing" or "problemsolving policing". While these concepts remain somewhat inchoate, some simple ideas form their core. Significantly, these ideas place a great deal of emphasis on preventing rather than controlling violence. These ideas include the following: 1) Behind the "incidents" reported to police lie "problems" waiting to be solved. The best police response to the incidents lies in understanding and responding to the underlying problem rather than to the incident. If small existing problems can be solved, future crimes and instances of violence might be prevented. 2) Arrest is only one of the tools available to the police in responding to incidents or problems. They can also take advantage of their office to offer mediation, or to use civil litigation, or to refer people to services, or to mobilize other agencies of city government to make responses that can ameliorate local problems. 3) The local community is a potentially valuable partner in responding to instances of violence and disorder. Indeed, in many ways, the relationships within the community constitutes the first line of defense against violence. It is these relationships that bind people to one another, that define the paths that individuals may take to success, and that help to limit opportunities for victimization. At best, the police "backstop" the informal social control that already exists in the community. 4) In the interests of establishing effective working partnerships with local communities, the police should take their cues about what problems are important to solve from the community itself. They should learn about the problems through face to face contacts with individual citizens, and through community meetings as well as through calls that come in over the 911 system. 2. Public Health Approaches to Violence A second new approach to prevention comes from the field of public health. Their interest in violence has been engaged for two reasons. First, the public health community noticed that unintentional injury (rather than disease) was a major threat to the nation's overall health status. Indeed, because injury tended to affect relatively young, injury loomed large in accounting for the overall volume of the quality of life years lost to health threats in the country. Moreover, the public health community had learned that it could have an impact on injuries through preventive efforts such as passing laws mandating seat belts in automobiles, insisting that consumer products be made safely, and that individuals be educated in the proper use of many dangerous commodities. If injury was an important health problem that could be prevented by public health means, it seemed just a short step to imagine that intentional injuries might yield to the same kinds of measures. Second, somewhat surprisingly, it turned out that when the public health community looked closely at the problem of intentional injuries, they learned that deaths and injuries associated with violence occurred frequently enough to register in national statistics on leading causes of death and injury. Moreover, they noticed an important piece of the intentional injury problem that did not seem to be handled very well by the criminal justice system: the kind of violence that occurred in the context of ongoing relations, and was often not reported to the police. This included domestic assault, child abuse and neglect, and an emerging problem of elder abuse. Finally, it seemed to them that their commitment to epidemiological methods for identifying problems and fruitful avenues of interventions, and their commitment to preventing problems rather than reacting to them, would be an important complement to existing criminal justice approaches to the problem. As in the case of "community policing", the "public health approach" to controlling violence remains somewhat unclear. Even leaders in the public health community find it difficult to define this particular approach to reducing deaths from disease and injury. Yet, the writings of public health practitioners focused on reducing violence are frequently distinguished by the following basic themes: 1) Violence is a threat to a community's health as well as to its social order. 2) Important aspects of the violence that occurs in a community goes unreported to criminal justice agencies; yet public health and medical personnel are often in good positions to see this particular kind of violence. 3) Victims, witnesses, and perpetrators of violence may all need some important response from the society if the damaging effects of violence are to be reduced, and if instances of violence are to be prevented; the social response cannot be just against the offender. 4) Violence may be composed of many different kinds of violence, each with its own causes and aetiology, and each with its own opportunities for intervention. Epidemiological methods can be very important in identifying both overall levels and different types of violence that can be reduced through different means. 5) In seeking to reduce violence and its many, adverse consequences, the emphasis should be placed on prevention rather than amelioration. Primary prevention  measures that eliminate large pieces of the problem entirely, and do so across a large portion of the population  should be the primary focus. Secondary prevention  measures that keep emerging problems from escalating  should be the secondary focus. And tertiary prevention  measures that reduce the damage associated with violence that has already occurred  should only be the last resort. 6) There are many opportunities to control violence that do not depend on controlling or redeeming the perpetrators of violence. Just as traffic deaths can be reduced by making cars and roads safer, or by discouraging the practice of drunk driving as well as by arresting careless or drunk drivers, so violence may be reduced by making bars or city streets less dangerous, and by teaching alternative methods of dispute resolution as well as by arresting violent offenders. 7) In seeking to prevent violence, it will often be important to engage the community that is afflicted by the violence. Such engagement is important to gain both the legitimacy and the capacity to act. Often, the community is the only source of information about where the problems are, and what the points of intervention might be. They are also often the only ones who can generate the political will to pass legislation needed to achieve preventive measures, or to bring the informal pressures to bear on themselves and one another to take actions that reduce the violence. E. Finding Overlaps, Contrasts and Complementarities in the New Preventive Approaches It is obvious that these new approaches to preventing violence have much in common, and are quite distinct from the older criminal justice traditions. At a minimum, the new approaches are both focused on preventing rather than reacting to violence. They also tend to put a great deal of emphasis on community involvement in the identification and solution of the violence problems. And it may also be true that each approach admits the possibility that the general problem of violence might be divided up into many smaller problems, and that some of the interventions one can imagine making would have an effect on relatively large parts of the problem, while others would work on relatively small bits of the overall problem. Yet, it is also clear that there are some points of tension between these approaches. For example, the criminal justice models  both traditional and new  retain a focus on criminal offenders, and a commitment to the idea that they might justly be held accountable for their actions and punished as well as redeemed. Although the public health approach recognizes the distinction between unintentional and intentional injuries in their taxonomic approach to health problems, they seem somewhat reluctant to emphasize the moral culpability that might be associated with intentionally injuring someone. To some degree, the tensions among the traditional criminal justice view, the community policing view, and the public health view of violence make it difficult for the different communities to work together. They start from such different premises, and make such different assumptions about the nature of the problem and the most effective responses that useful conversations are inhibited. Yet, that would be a pity, for it seems clear that each perspective usefully complements the others as well as contrasts sharply with it. Indeed, a paper written for the National Academy of Science's Violence Panel by individuals representing these various approaches found precisely this: there were important tensions, but once worked through, the tensions became important complementarities. Their preliminary effort to synthesize the different approaches included the following points: 1) Violent crime is a threat to the nation's health and safety as well as to public security. It must be seen and responded to as both a health problem and a crime problem. 2) In reckoning the social consequences of criminal attacks resulting in injury, it is important to consider not only the magnitude of the physical injury done, but also the psychological damage and fear that are stimulated by criminal violence. 3) It is important to see that violence that occurs in the context of ongoing relationships (such as within families) are particularly damaging, and particularly hard for the criminal justice program to identify and manage. Consequently, it is in these areas that the public health and medical communities have particularly important roles to play. 4) Acts of violence that will be properly labelled by the society as criminal attacks emerge from a complex causal system that includes, but is not limited to the intentions of the offender. Other factors influencing individual incidents and aggregate levels of violence include such things as: a) the availability and use of criminogenic commodities (such as guns, drugs and alcohol); b) the density of criminogenic situations (such as ongoing unresolved conflicts), and c) a variety of cultural factors that help to justify and encourage violence. 5) It follows as a corollary, then, that there are important opportunities to prevent criminal violence beyond those ordinarily relied on by the criminal justice system. While it is both just and effective to hold offenders accountable for violent attacks, it may also be possible to prevent such attacks or reduce their seriousness by altering the "risk factors" that lead to criminal violence. 6) In all likelihood, society's main line of attack on criminal violence will continue to come from the nation's criminal justice agencies. They are the ones who have the troops, and the most familiar paradigm for defining and attacking the problem. Their efforts can usefully aided by a partnership with those in public health, however. 7) The public health community can enhance the significance of the criminal justice community's efforts by emphasizing that health is at stake as well as security. They can widen the perspective of the criminal justice community about the possible causes of violence, and the possible lines of attack. And, they can mobilize support for antiviolence programs from constituencies that have not previously been involved in dealing with these issues. F. The Purpose and Method of this Monograph The purpose of this monograph is to report the findings of some further efforts to explore the overlaps, contrasts, and complementarities of these different approaches to violence control and prevention. More specifically, we report the results of a simulated problemsolving exercise in which representatives of the three different approaches to violence control and prevention (traditional criminal justice approaches, community policing approaches, and public health approaches) were challenged to diagnose and make recommendations for solving the problem of violence in a hypothetical city. The basic idea was that by observing and recording the interactions of the individuals who represented these different schools of thought, we might learn more about the differences in these approaches, the issues that provoked tensions among the different professional communities, and how the differences they might be reconciled or exploited as useful complements to one another. It was also possible that some new ideas about how best to deal with the problem of violence plaguing the cities would emerge from this conversation. To conduct this exercise, the following steps were taken. First, a case study, Violence in Coronet City, was developed. The case described the problem of violence in both anecdotal and statistical terms  much as it would be experienced by a community trying to deal with the problem. It also described the responses that the city was making to the violence, including action at both the governmental and community levels. Because the case was heavily based on the actual experience of a particular city, a high degree of verisimilitude was maintained. Second, the case was presented to three distinguished practitioners chosen to represent the three different approaches to controlling and preventing violence. 1) James K. Stewart, former Chief of Detectives for the City of Oakland, and now a police consultant for Booz, Allen, Hamilton was selected to represent the potential that first rate professional police work, aided by modern technology, held for the effective control of violence. 2) Sylvester Daugherty, currently Chief of Police in Greensboro, North Carolina and First Vice President of the IAACP, was selected to represent the potential that "community policing" and "problemsolving policing" held for reducing violence. 3) Beverly Coleman Miller, a physician from Washington, D.C. who has worked for the last ten years as the Emergency Ambulance Bureau Medical Officer, was chosen to represent the potential that public health approaches hold for diagnosing and preventing violence. Third, each of these individuals was asked to prepare a short memorandum giving their diagnosis of the problem of violence in Coronet City, and offering some initial ideas about solutions. These memos were prepared in isolation from one another, but were made available to the participants before the meeting to discuss the problem. Fourth, the individuals were convened for a day long meeting facilitated by Mark H. Moore, Guggenheim Professor of Criminal Justice Policy and Management at the Kennedy School of Government. The agenda for that meeting included: 1) defining the problem; 2) evaluating the Mayor's response to the problem so far; and 3) recommending particular solutions  substantive and organizational  for solving the problem of violence. The meeting was videotaped and transcribed. Fifth, the record of that meeting was analyzed to see if there were distinct approaches taken by the different practitioners to the subject, where tensions arose, and what useful new ideas were contributed. This monograph is a record of those findings. G. Preview of the Findings It is fair to say that we were surprised by the outcome of the problemsolving exercise. At the risk of some dramatic tension, we review our principal findings here by comparing what we expected to find with what we did find. We expected that the different proponents would have well worked out views about how violence might be effectively addressed that were both relatively comprehensive and also distinct from one another. We also expected that the solutions they recommended would naturally rely on the distinctive competencies of the organizations they represented: a technologically supported professional law enforcement organization, a community oriented police department, and the public health/medical community. We also expected that they would have quite different views about whether the community was an asset in dealing with the problem, or part of the problem that needed to be managed. And we anticipated some important conflicts among the representatives of the different views. What we found was something quite different. Of course, the findings are undoubtedly importantly influenceable by the particular representatives of the different perspectives we chose, and by the somewhat artificial nature of the problemsolving exercise. Still, what occurred may offer some indication of the strengths and weaknesses of society's combined ability to diagnose and respond to the problem of violence. Here is what seemed significant to us. First, there was as much concern about the perceptions of the community  the subjective experiences of fear and despair  as there was about the concrete victimization associated with the violence in Cornet City. The community's perception of the problem seemed important for two different reasons. On one hand, the community's agitation and concern was part of what defined the problem of violence (if the community weren't so agitated, the violence problem would be different than it was when everyone was so frightened and upset). On the other hand, it was the community's agitation that might be used to solve the problem (because the community was upset, resources that would not otherwise be available for dealing with the problem became available). Second, none of the representatives was prepared to put forward particular, concrete, programmatic solutions to the problem of violence as it was described in the case. It seemed that each had some general ideas about where the solution might lie, but it was very hard to translate those general ideas into specific programmatic actions. This may suggest that society lacks specific, good, specific, operational ideas about how to deal with the violence that now besets us. Third, as the participants "groped" towards possible solutions, a quick consensus arose that there should be a strong emphasis on violence prevention. Everyone could quickly agree that merely reacting to the violence as it occurs was an inadequate community and governmental response. Fourth, there was widespread agreement that the community itself as well as government agencies had to be involved in both defining the problems and in implementing the solution, but also some recognition that some elements of some communities could be an obstacle to successful action. Indeed, finding ways to strengthen the elements of the community that wanted to act effectively on the violence problem was considered both problematic and key to dealing effectively with the issue. Fifth, because there was no specific agreement about what the problem was or how it might best be handled, and because it was important to involve the community in the solution, it was important to develop a process that would allow citizens to learn about the problem, and experiment with solutions. This meant that there would be lots of pressure on methods for capturing, analyzing and disseminating information about the nature and extent of violence; and that organizational boundaries would have to be transcended. Sixth, the assumption was that the solution to the violence problem would not lie in some "wholesale" or "general" solution, but would instead lie in the cumulative effects of many smaller interventions designed to deal with particular components of the problem. This was true partly because "violence" itself was a heterogeneous rather than homogeneous problem, but also because the means available for solving the problem would be different across the city, and everyone who had a potential solution should be welcomed to give it a try. Of course, if a general solution showed itself, that opportunity would be seized. Seventh, there were some important valuebased, ideological disagreements among the participants that did sometimes interfere with the conversation. These concerned such familiar issues as: 1) how culpability for violent acts of young offenders should be parcelled out between the individual who committed the crime, the caretaking institutions that were wrapped around the child, and the broader society; 2) the extent to which an individual's character was preset and unchangeable rather than importantly influenceable by environmental factors affecting the individual's development; and 3) the extent to which informal social control exerted in idiosyncratic ways by particular communities should be tolerated and valued by the broader community in its efforts to deal effectively with violence. Although such issues occasionally diverted the conversation, they could eventually be handled by returning to the operational questions of what should Coronet City do to deal with its problem. In the face of these practical issues, the ideological questions turned out to have little power for good or ill. In effect, the group agreed that the best approach to dealing with the urgent problem of violence was to organize a process of social learning that was guided by the goal of preventing violence, that used epidemiological information about the risk factors associated with violence quite intensively to identify possible points of intervention, and that used the combined energy of concerned communities and governmental agencies, united by a common crisis, to deal with the urgent problem facing the community. The hopes for success did not lie in finding and implementing one general policy response to the problem, but in searching for smaller scale interventions that could accumulate to a substantial and perceivable difference in the problem of violence. The reasons to go for the small scale interventions were essentially three: 1) the general problem of violence was most likely made up of a great many different problems that would need different solutions; 2) because we knew so little about how to deal with violence, almost any kind of experiment seemed appropriate to try; and 3) to establish the legitimacy of the effort and to make resources available it was important to include as many people as possible in the violence control efforts. This, to us, represents an important approach to dealing with urban violence that differs both from "locking 'em up and throwing away the key" and from "eliminating root causes". 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