Health Director

State: MO Type: Model Practice Year: 2016

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The Kansas City Missouri Health Department (KCMOHD), Aim4Peace Violence Prevention Program (Aim4Peace) works in the most dangerous neighborhoods of Kansas City, Missouri (KCMO) to stop the spread of violence. Aim4Peace’s model adapted and successfully implemented the internationally acclaimed, evidence-based Cure Violence model, which utilizes a public health approach to preventing, disrupting and limiting the violence disease, especially retaliatory violence. 

The U.S. Department of Justice, Centers for Disease Control, and Johns Hopkins University have evaluated the Cure Violence archetype and found it to be the most effective violence prevention model to positively influence and change violent behavior.

Using this model, Aim4Peace identifies individuals at high risk of becoming involved in violence and calls on a team of trained, public health workers to act as first responders who:

1) provide one-on-one case management and conflict resolution;

2) intervene in violent situations to broker peace and

3) appear at hospitals after penetrating injuries occur to prevent retaliatory violence.

The program also offers educational opportunities that teach conflict resolution skills, alternatives to violence, life and parenting skills, and hosts community meetings, activities and events that have shown to help change violent behaviors within the community.

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Kansas City Health Department
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Health Director
Description: KCMO is a diverse urban community nestled on the Missouri-Kansas border in the heart of the Midwest, ranked as the 37th most populated city.  The KCMOHD is an accredited health department serving a population of 459,787 people, across four counties (315 square miles). Current County Health Rankings place Jackson County (a good proxy for KCMO) 95th out of 112 in Social and Economic Factors.  Aim4Peace treats persons aged 16 – 40 who are at a high-risk of perpetrating retaliatory, gang-related violence and their families in the East Patrol Division (EPD) area; home to 90,541 citizens.  There are roughly 25 known active gangs in the Aim4Peace zone who make up roughly one percent of the target zone population.  Gang members range as young as 12 years old and as old as 49 years old. Approximately 95% of the gang members in the area are male.   Issue: Community violence, especially homicide has been an ongoing issue disproportionately impacting KCMO’s minority community. In 2000, homicide was the third leading cause of death for African Americans and the fourth leading cause for Hispanic Americans.  The African American and Hispanic American homicide rates were 9.5 times and 4 times higher than the White homicide rate, respectively. In 2001 the Mayor and City Council accepted the recommendations for minority racial/ethnic health improvements passing a resolution to establish the Kansas City Health Commission (KCHC). KCHC launched a collaborative, community based decision-making process to provide structure and oversight for the CHIP. Further community-based policy change occurred with the 2006 Commission on Violent Crime Report, which strongly urged the city to develop a strategic community-based strategy to address the violence epidemic.  In response to the inequities between minority and non-minority populations, KCMOHD’s Aim4Peace, uses a public health model treating community violence as a “contagious” disease, taking action to prevent, disrupt and limit its ability to spread.  Goals and Objectives: Recognizing the potential of the internationally acclaimed Cure Violence model, KCMOHD adapted and successfully implemented Aim4Peace. Aim4Peace incorporates three primary public health paradigms:  1) identify, detect and increase awareness of the perceived risk and costs of involvement in violence among the target population; 2) provide alternatives to violence when individuals in the community are making unhealthy behavior decisions; and 3) support healthy community norms and behaviors regarding violence. How implemented/activities: To implement this initiative, KCMOHD created a new public health worker classification, an innovation only made possible by changing the norms within the governmental system, working through legal, human resources, risk management, and legislative oversight, to be the first department to hire transformed ex-offenders who formerly mirrored the violent acts (e.g. homicide, gun assault, etc.) transmitted in the dosage (target) area. These public health workers are highly skilled, trained to provide one-on-one case management and conflict resolution, intervene in violent situations to broker peace, and appear at hospitals after intentional injuries occur to prevent family and friends from retaliating against the assumed perpetrator. The program also offers educational opportunities teaching conflict resolution skills, alternatives to violence and parenting skills mobilizing the community to reduce tolerance towards violence.  Results/Outcomes: Aim4Peace is based upon concepts and strategies adapted from the public health field’s effort to limit the spread of infectious diseases.   Objectives Met: Aim4Peace is managed by outcomes with an independent evaluation team, University of Kansas, who assembles systematic measures of program staffing and activity. Along with other violence prevention and treatment efforts, Aim4Peace has contributed to an overall reduction in citywide homicides by 28%, and a decrease of 70% within the intervention zones (2014).  To prevent the spread of violence, Aim4Peace brokered sustained peace in 156 conflict resolutions, responded to 68  intentional injuries incidents (a positive reduction from 115 in 2013), provided 448 unduplicated alternatives to violence (conflict resolution skill building and effective parent education training) directly to community residents, patients and their families. Specific Success Factors: In 2011, Aim4Peace received a NACCHO Promising Practice award. Realizing that the designation was primarily due to being spread too thin in the initial dosage area, Aim4Peace adapted and concentrated its dosage to the proper target area size, focusing on obtaining at least two calendars years demonstrating success. The strategy worked. From 2010 to 2014, Aim4Peace contributed to a -70% reduction in the number of homicides in its target area (e.g. 20 to 5).  Public Health Impact: The Institute of Medicine 2012 reported, Contagion of Violence, there is an accepted shift in the violence prevention field from assuming that violence is inevitable to recognizing violence is preventable. By working as credible public health messengers (e.g. outreach workers/interrupters), Aim4Peace treats the epidemic of violence and shifts social norms so that shooting and killing is no longer normal.  Program Website: http://kcmo.gov/health/aim4peace/    
Problem Statement: The City of Kansas City, Missouri Health Department (KCMOHD) is accredited by the Public Health Accreditation Board (PHAB).  Recognized for its enduring commitment to traditional and innovative approaches to health for all residents, KCMOHD was awarded the 2015 Robert Wood Johnson Foundation’s Culture of Health Award. KCMOHD champions policy changes coupled with unique public health approaches, including successfully challenging city human resource practices to create new public health classifications, allowing KCMOHD to hire ex-offenders. KCMOHD’s documented successes in addressing community violence, economic equity, social justice, and expansion of health care systems beyond clinical care are critical in its efforts to align local resources, thereby creating lasting change. Throughout its rich 149 year history KCMO encountered many challenges related to its eerie past of segregation, creating a physical and cultural gap between communities. KCMO has a sizable concentration of racial and ethnic minority populations, but has historically, been racially and socio-economically divided. Most Blacks remain highly concentrated in the urban center or core. The poverty rate of Blacks in KCMO is 22.5% and centralized, while the White poverty rate is 5.8% and spread geographically throughout the city. Nearly 29% of Blacks and Hispanics live below the poverty level compared to less than 18% of all residents. In 2000 with the release of the KCMOHD’s report, Is it Good for the Children? – Minority Health Indicators 2000, troubling statistics regarding outlooks of life expectancy for minorities became a catalyst for change. Community violence, especially homicide has been an ongoing issue that disproportionately impacts the KCMO minority community. In 2000, homicide was the third leading cause of death for African Americans and the fourth leading cause of death for Hispanic Americans.  The African American and Hispanic American homicide rates were 9.5 times and 4 times higher than the White homicide rates, respectively. The threat and use of violence significantly impacts the ways that members of a community socially interact. Terrorized and living in fear, residents and businesses of specific KCMO neighborhoods faced physical, mental and emotional attacks daily. The community proactively responded to transform the culture surrounding violence and expand funding sources for violence prevention initiatives in recognition of its universal impact on achieving economic well-being and maintaining health. In order to retain residents and business or to prevent further urban flight, community violence must be solved. In 2001 the Mayor and City Council accepted the recommendations for minority racial/ethnic health improvements and passed a resolution to establish the Kansas City Health Commission (KCHC). Formed to provide structure and oversight for the development of a CHIP, the KCHC immediately began discussions for launching a collaborative and community based process. With participation from community members, each CHIP is a community-owned and community-driven document serving as a blueprint to improve the health of residents of KCMO. Further community-based policy change occurred, when the 29 community member of the Commission on Violent Crime submitted its 2006 report, strongly urging the city to develop a strategic community-based, public health strategy to reduce community violence, shootings and killings.  In response to these inequities between minority and non-minority populations, KCMOHD’s Aim4Peace Violence Prevention Program (Aim4Peace), uses a public health model treating community violence as a “contagious” disease and taking action to prevent, disrupt and limit its ability to spread.  Affected Target Population: Aim4Peace treats persons aged 16 – 40 who are at a high-risk of perpetrating retaliatory, gang-related violence and their families in the East Patrol Division (EPD) area; home to 90,541 citizens. There are roughly 25 known active gangs in the Aim4Peace zone who make up roughly one percent of the target zone population. Gang members range as young as 12 years old and as old as 49 years old. Approximately 95% of the gang members in the area are male. Since 2008, Aim4Peace served 242 male participants; 96 percent were males of color and 45 percent resided within Sector 330. Aim4Peace primarily focuses operations to the most violent area of Kansas City, the police department’s East Patrol District (EPD) Sector 330. The area is approximately 25 city blocks or 3.4 square miles with a population of 13,910 (87.3 percent Black, 5.3 percent White, 2.3 percent Hispanic), 30.7 percent living below the poverty level, 18.2 percent have no high school diploma and over half the population has no college experience, 20.5 percent are unemployed, and the median household income is $27,318. In December 2014, Aim4Peace violence prevention programming and conflict mediation services expanded the dosage to Sectors 320 (Population: 15,850 (48.8% Black, 26.9%, White, 29.5% Hispanic, 24.3% Other; Median household income: $22.559; 38.6% below poverty level) and 340 (Population: 34,532, 36.4% Black, 52.1%, White, 12.9% Hispanic, 21.2% Other; ; Median household income: $35,31; 20% below poverty level) as a result of a three year grant from the U.S. Department of Justice – Office of Juvenile Justice and Delinquency Prevention (OJJDP-CBVP). Past Problem Solving: In the past misunderstandings existed about the great infectious, communicable diseases such as tuberculosis, cholera, plague and others before public health understood the root causes, both apparent and invisible.  Prior to public health’s intervention those suffering from these communicable maladies were blamed for the problem or characterized as “bad” or “immoral” people. Failures of past or traditional public health cures were unsuccessful when we embraced flawed paradigms. The traditional narrative regarding community violence centers on “punishment” or try to solve with the “everything” theory.  These old paradigms lack a scientific base to cure violence. If punishment were effective, violence rates would not continue to climb in affected communities. It is extremely hard, to address every social, academic, ecological, psychological issue, if violence is still present, because it inhibits the ability to adequately solve these underlying factors. The disease of violence is resistant to these traditional prescriptions because both center on “bad” or “immoral” people or try to solve community-level issues before the primary infection is addressed.  Science is evolving. To cure violence, this disease must first be interrupted. Current is Better:  According to the Institute of Medicine 2012 report, Contagion of Violence, there is an accepted shift in the violence prevention field from assuming that violence is inevitable to recognizing violence is preventable. It is futile to fight violence without battling its root causes, behaviors and norms.   KCMOHD’s new public health practice, Aim4Peace, engages communities to work with people at high risk of being involved in violence, provides on-the-spot guidance and works to change behavioral patterns.  Aim4Peace is built upon a coherent theory of behavior that specified the “inputs” to be assembled and set in motion and how they caused the “outcome,” reductions in community violence.  Aim4Peace works to interrupt the cycle of violence and to change norms about violent behavior.  The program aims to change operative norms regarding violence, both in the wider community and its patients. Aim4Peace provides on-the-spot alternatives to violence when gangs and individuals on the street were making behavior decisions, treating them as rational actors, capable of making choices. The strategy promotes their consideration of a broader array of responses to situations that too frequently elicited shooting as a problem solving tactic. Finally, the program treats the perceived risks and costs of involvement in violence among high-risk youth. In addition, staff members emphasize the "social risks" of involvement, including the impact of violence on the families of clients and the immediate community. This new program practice is built upon a coherent theory of behavior that specified the “inputs” to be assembled and set in motion and how they caused the “outcome,” reductions in shootings and killings. Some of the core concepts and strategies are adapted from the public health field, which have shown considerable success in addressing issues such as smoking, seat belt use, condom use, and immunization.   This new program practice was built upon a coherent theory of behavior that specified the “inputs” to be assembled and set in motion and how they caused the “outcome,” reductions in shootings and killings. Some of the core concepts and strategies were adapted from the public health field, which have shown considerable success in addressing issues such as smoking, seat belt use, condom use, and immunization.   Innovative Practice: Violence is an unacceptable learned behavior resulting from preventable and controllable factors. The resulting cultural shift and perceptions around violence within highly violent populations is remarkable. Since inception Aim4Peace met and meets its goals and is proving to be a more effective response contributing to the reduction in community violence.   KCMOHD’s new public health practice, Aim4Peace, engages communities to work with people at high risk of being involved in violence, provides on-the-spot guidance and works to change behavioral patterns.  Aim4Peace is built upon a coherent theory of behavior that specified the “inputs” to be assembled and set in motion and how they caused the “outcome,” reductions in community violence.  Aim4Peace works to interrupt the cycle of violence and to change norms about violent behavior.    The new public health practice needed a new public health worker, an innovation that was only made possible by KCMOHD changing the norms within the governmental system, working through legal, human resources, risk management, and legislative oversight, to be the first department to hire transformed ex-offenders who formerly mirrored the violent acts (e.g. homicide, aggravated gun assault, etc.) transmitted in the target or dosage area. These new public health workers are highly skilled, qualified individuals who are compassionate about seeing violence end in the community.  Through Aim4Peace, KCMOHD, calls on these new public health workers who are trained to provide one-on-one case management and conflict resolution, intervene in violent situations to broker peace, and appear at hospitals after gunshots or stabbings occur to prevent family and friends from retaliating against the assumed perpetrator. The program also offers educational opportunities that teach conflict resolution skills, alternatives to violence and life skills mobilizing the community to reduce tolerance towards violence. Critical to the program’s success are its community partnerships.  Critical community partnership include: K.C. police department, (program design, training, data and fund support); independent evaluators, University of Kansas; Kansas City Public Schools (memorandum of understanding whereby Aim4Peace provides mediation services and violence prevention programming); community centers and youth serving agencies (Aim4Peace provides mediation services and violence prevention programming); Truman Medical Center (memorandum of understanding whereby the Aim4Peace Hospital Prevention Program is administered and an integral part of the Trauma Response Team); and neighborhood residents, associations and businesses (partnership on community events and annual campaigns to cure violence).  Evidenced-based Practice: Aim4Peace is managed by outcomes with an independent evaluation team, University of Kansas, who assembles systematic measures of program staffing and activity. Along with other violence prevention and treatment efforts, Aim4Peace has contributed to an overall reduction in citywide homicides by 28%, and a decrease of 70% within the intervention zones (2014).  To prevent the spread of violence, Aim4Peace brokered sustained peace in 156 conflict resolutions, responded to 68  intentional injuries incidents (a positive reduction from 115 in 2013), provided 448 unduplicated alternatives to violence (conflict resolution skill building and effective parent education training) directly to community residents, patients and their families. Aim4Peace is grounded in both the social-ecological model, adopted by the Centers for Disease Control as a violence prevention model, and the framework for public health action in communities, adopted by the Institute of Medicine. Aim4Peace coordinates prevention strategies at the individual, relationship, community, and societal levels. As a Cure Violence partner, Aim4Peace shares in the Robert Wood Johnson Foundation comprehensive research and program evaluation. Through multi-sector partnerships and participation in coalitions and trainings locally, regionally, and nationally, Aim4Peace reviews and utilizes unpublished methodologies, evaluation data, and research that may be beneficial. Links: http://cureviolence.org/wp-content/uploads/2014/01/iom.pdf http://cureviolence.org/results/scientific-evaluations/  
Heathcare-associated Infections
Goals and Objectives: Aim4Peace project implementation follows the goals and objectives that strategically flow across a continuum from response to violence exposure, to intervention for violence survivors, to prevention of violence exposure. Activities are designed to decrease risk factors and improve resiliency factors associated with the use of violence while improving access to care and quality of services for those who are survivors of violence; thus, reducing the likelihood of violence and exposing others to violence in the future. This strategy is designed to break the cyclical pattern of violence and create long-term change for individuals, families, and neighborhoods and communities. Aim4Peace affects community change on three levels; evaluation data, public education campaigns, and community mobilization. Key components of Aim4Peace include: 1.       Identification and detection: Aim4Peace is a data driven model. Through a combination of statistical information and street knowledge, the health department identifies where to concentrate efforts, focus resources, and intervene in violence. Data guides to the targeted communities that are most impacted, and provides a picture of those individuals at the highest-risk for violence and how to intervene. Highlighted Method:  Community Mobilization. Rapid response to each shooting, informing all involved that shootings are not acceptable. Assessing the community’s available resources, Aim4Peace staff collaborates with residents, schools, businesses, health care and social service agencies to fill the gaps in service affecting the target population. 2.       Interruption, intervention and risk reduction using credible messengers: Aim4Peace intervenes in crises, mediates disputes between individuals and intercedes in group disputes to prevent violent events. Staff are seasoned, well-trained professionals from the communities they represent with a background on the streets: they know who has influence, who to talk to, and how to de-escalate a situation before it results in bloodshed. Aim4Peace works directly with high-risk youth to connect them with services and opportunities when they are often considered beyond the reach of traditional social support systems. These youth have dropped out of school, exhausted social services or aged out, and many have never held a legitimate job. Usually, their next encounter with the system is either prison or the emergency room. Staff helps where others can’t, meets the participant where they are, works to change behavior and connects them to resources otherwise out of reach. Highlighted Method:  Faith-based and Community-based (C/FBO) Partnership. Aim4Peace works with faith and community leaders, who use their relationships in the community to stop violence, distribute public education materials, urge people to respond to shootings, and spread the message: “No Shooting.” 3.        Changing behaviors and norms: Aim4Peace works to change the thinking on violence at the community-level and for society at large. For disproportionately impacted communities, violence has become accepted as an appropriate—even expected—way to solve conflict. At the street level Aim4Peace provides tools to resolve conflict peacefully. Aim4Peace seeks to shift the cultural norms toward the view of violence as a disease and placing emphasis on finding solutions to end this epidemic. Highlighted Methods: Criminal Justice Collaboration. Staff encourages police, probation officers, prosecutors, and other criminal justice partners to focus their efforts specifically on prevention of youth violence in the target zone and to share the message that shootings are serious matters that will not be tolerated. Aim4Peace works directly with the Kansas City Police Department (KCPD) in the selection and screening of potential applicants, data reporting and hot spot analysis. Public Education. Utilize multiple forms of mass media communication, including posters, fliers, FaceBook, rap concert with Peace as the main focus, radio advertisements and bumper stickers, to raise awareness of Aim4Peace, change social norms and promote nonviolence.   Steps Taken: Since inception, Aim4Peace uses diverse strategies and unique collaborations to accomplish remarkable change. The first key to change is partnerships with key sectors:  law enforcement, education, social services, government, public health, businesses, media, faith-based and the community.  Through these essential partnerships we have learned that building relationships with other cultures or departments is time intensive.  It takes time to work within the governmental system to work through legal, human resources, risk management, and legislative oversight, as well as non-governmental entities. Any entity deciding to embark on the journey to cure violence must be in it for the long haul. A second key to change is keeping the end goal in mind. It is essential that the initiative not spread itself too thin (geographically). The source of success of the model is proper intervention dosage or effect in a concentrated area. However, if the dose is too diluted then the cure loses effectiveness. When we reduced the dosage area to a manageable size, Aim4Peace contributed to significant homicide reductions in the target community (-70% in 2014). Another key to change is recognition that reducing violence is a leverage point. Reducing violence helps to increase and sustain overall community health and life expectancy.  Aim4Peace promotes life; preserves the community by providing the necessary services to help change negative behaviors and social norms; and protects the health of each resident in the community. Summary of Key Steps to the Achieving Goal: Align current prevention efforts with partnering agencies who have demonstrated proven success in creating social change Plan and implement violence prevention programming models that integrate both evidence-based methodology and successful social change efforts Constant and clear communication between partnering agencies Engage community organizations providing violence survivor services in education and training regarding trauma-informed, culturally competent services. Assess baseline measures and evaluate interventions across each interaction level (individual, family and community/neighborhood) to determine early progress or if changes must be made   Selection Criteria: Prior to implementation, KCMOHD conducted a needs assessment to develop a strategic plan that incorporates a public health strategy with conflict resolution techniques, using a multi-disciplinary approach to attack the underlying factors contributing to violent crime.    Analyzing the origins and causes of violent acts in the city, KCMOHD sought to understand the nature and effect of this disease upon the community.  We received data and research assistance from multiple partners, including:  The Kansas City Police Department;  Jackson County Prosecutor’s Office; Bureau of Alcohol, Tobacco and Firearms (ATF); Midwest High-Intensity Drug Trafficking Areas (HIDTA); the Penn Valley Community College Department of Criminal Justice;  Department of Sociology/Criminal Justice & Criminology, University of Missouri - Kansas City; Drug Enforcement Administration (DEA); and the Office of the Jackson County Medical Examiner. We solicited suggestions from interested youth and adults about the potential causes and solutions to aid in the prevention or reduction of retaliatory crimes in the community.  We narrowed respective topical foci by assessing a gaps analysis of evaluated, evidence-based methodologies that causally appeared to significantly deter violent acts, including housing, education, youth employment, criminal justice, and public policy approaches.  We selected the Aim4Peace model because it is fills a gap by directly connecting with high-risk youth and adults (e.g. shooters and killers). Grounded in both the social-ecological model, adopted by the Centers for Disease Control as a violence prevention model, and the framework for public health action in communities, adopted by the Institute of Medicine, Aim4Peace coordinates prevention strategies at the (1) individual, (2) relationship, (3) community, and (4) societal levels [i] Krug, Dahlberg, Mercy, Zwi, & Lozano (2002).   Timeframe for the Practice: Success will be realized when there are no longer any statistically significant gaps in life expectancy in Kansas City’s or any U.S. Urban population regardless of zip code, or racial or ethnic background, especially due to community violence. KCMOHD envisions a community, locally and nationally, that makes healthy choices, has equitable access to resources and thrives across all communities, cultures and spans of life.   Community Stakeholders:  Aim4Peace works with community partners to identify high risk individuals, interrupt the spread of violence, especially retaliatory violence, and change behaviors of victims, offenders and those around them. The Aim4Peace community stakeholders are important because they can reach an array of populations, from students in a school to families in crisis.  Aim4Peace forms partnerships with community-based organizations to develop comprehensive strategic plans for reducing violence. A Management Team, comprising criminal justice, health, religious, and civic leaders, provide on-going support for strategy development and leverage city and county resources for the project and its partners. The role of the stakeholders/partners in the planning and carrying out the violence prevention program is to: Develop goals and objectives.  Foster collaboration and decision making.  Conduct needs assessment and analysis.  Assist with fund development.  Evaluate the program.  Through collaboration, Aim4Peace also contracts with local community-based organizations, Neighborhood Action Teams (NATs), to build and energize a base of support for Aim4Peace that involves a variety of efforts to both stop shootings and killings in the near term and to change the underlying conditions that give rise to shootings and killings in the long-term.  Aim4Peace has also strengthened collaborations by building an extensive, informal network of public and private service providers.  The roles of these agencies is to offer commitment and support in the community for Aim4Peace, as well as be a direct resource for participants to partake of their services (e.g. substance abuse counseling, food, rental, vehicle assistance, etc.).  A few of the partner service summaries are below: Cure Violence, formerly Chicago Cease Fire: Violence Prevention Project - national partner since 2007 provides bi-weekly and as needed technical assistance Kansas City Police Department – statistical and logistical support University of Kansas, KU Work Group - independent evaluator Kansas City Public Schools – MOU – mediation services to the schools in need and violence prevention classes Truman Medical Center – MOU – Aim4Peace Hospital Prevention Program is administered through this partnership Youth Build – participants accepted into their program and Aim4Peace taught one of their career sessions Vineyard Neighborhood Assoc., Seven Oaks Neighborhood Assoc., Gentlemen of the Roundtable – bi-weekly canvassing in the Aim4Peace neighborhoods to document blight or neighbor concerns, attend Aim4Peace events, and submit documentation for review by the KU Work Group Brush Creek Community Center – several community classroom course locations, activities, including Job Fairs Communities Creating Opportunity– formed partnership with community group to collaborate on complementary projects and initiatives. The KCMO HD fosters collaboration through multiple pathways.  Community mobilization is a common public health strategy for addressing maladies ranging from obesity to immunization. Aim4Peace’s community mobilization efforts include residents, local business operators, other community groups, and elected officials. Aim4Peace’s public education campaign is aimed at both norm change and increasing awareness of the costs of violence to individuals, families and the community. Recognition of Aim4Peace and its logos, and perhaps support for the program, might also be a fallout of the public education campaign. Public education activities include distributing printed material: flyers, posters and bumper stickers.  Outreach workers drop off materials when they do door to door canvassing, often in the context of mobilizing community members to attend a shooting response. Participants at rallies carry signs, and stores in the program areas sport window posters. Clergy are asked to speak about the program on Sunday mornings.  The message is always short:  “Stop the Killing” or “No More Shooting.”    Costs / Budget Breakdown:  Violence has a price tag. When shootings and killings are common in a neighborhood, it stands in the way of advancing progress on jobs, housing and schools. The economic condition is visible in abandoned buildings and shuttered store fronts. Communities suffering from high rates of violence struggle economically and offer limited job opportunities for residents. Businesses are afraid to invest in the neighborhoods with limited buying potential, physical security, and high insurance rates. The estimated annual budget for the Aim4Peace Program is $296,417 Health Levy and $723,773 Grant funds. There are 28.5 positions, 20 full-time and 8.5 part-time. Stakeholders Investing Resources are:  Law enforcement, juvenile/criminal justice, youth/faith/community/non-profit institutions, foundations and philanthropy, advocacy organizations, local business and government, housing, parks and recreation, urban development, universities. This evidence-based approach has been heavily supported by local funders including the Health Care Foundation of Greater Kansas City (HCF) and the voter approved Health Levy tax dollars. Funding has expanded and diversified through several other local, regional and national dollars including a $1.3 million award from the Office of Juvenile Justice and Delinquency Prevention to assist in expanding the program, of which Aim4Peace was one of six awardees out of 47 applicants and the only local health department.  Similarly, Aim4Peace is the first city program to receive funding from the Jackson County legislature, Community Backed Anti-Drug Tax (COMBAT). The focus on resources to violence prevention programming in KCMO demonstrates a shift from previous thinking that violence in an isolated neighborhood or minority problem. KCMO has achieved a greater understanding that violence is a community problem, one that affects the overall social and economic wellbeing of the city, and that must be addressed for the health of all residents. Aim4Peace, the city supported violence prevention program, estimates that for every dollar spent on programming, $15.77 may be saved by the community for costs associated with violent behavior, including medical and criminal justice costs. (Cure Violence).  
Goals/Objectives Restatement: The three main components of the Aim4Peace program is to detect, interrupt, and improve conditions and outcomes through efforts supported at the individual and community levels to prevent and reduce violence. Data were analyzed at both the individual participant and community levels to examine the impact of the program. Between 2013 and 2014, the program engaged residents as program participants in the street outreach component of the program, through conflict mediations, and in community activities that supported violence prevention efforts. The activities supported by Aim4Peace are contributing to improvements to prevent and reduce shootings and killings in the Aim4Peace priority area, which is also having a broader impact in addressing violence in the community.   Extent Outcomes Achieved: Along with other violence prevention and treatment efforts, Aim4Peace has contributed to an overall reduction in citywide homicides by 28%, and a decrease of 70% within the intervention zones (2014).  To prevent the spread of violence, Aim4Peace brokered sustained peace in 156 conflict resolutions, responded to 68  intentional injuries incidents (a positive reduction from 115 in 2013), provided 448 unduplicated alternatives to violence (conflict resolution skill building and effective parent education training) directly to community residents, patients and their families. Based on the findings presented in the KU 2014 evaluation report, the following was achieved.   Individual-Level Activities with Participants with Risk for Violence Since 2008, 357 individuals have participated in the outreach component of the program, with 90 new participants enrolled in 2014. In 2014, 93% of the new participants enrolled in the program were considered high-risk. Approximately, 39% of the participants were youth or young adults ages 15-24. • In 2014, Aim4Peace provided direct mentoring supports to 310 individuals, including 133 participants and 177 prospective participants through 7,077 contacts over nearly 4,564 hours. • Goal areas most commonly addressed through individual participant contacts were employment needs (25%), followed by education (17%) and substance abuse (17%) related issues. Through the program Aim4Peace workers assist participants in addressing determinants of health or underlying factors such as employment, as broader conditions that often influence and may increase or decrease the likelihood that an individual may engage in violence. In June 2015, participant surveys were conducted with 21 participants involved in the street outreach component of the program over the past year. • Based on survey responses, the most pervasive needs of participants when starting the program for which they sought program support were in the areas of employment (52% of respondents) and housing (38%). • Aim4Peace also supported high levels of goal attainment in assisting participants in resolving family conflict, meeting emotional needs, assisting individuals in leaving street organizations for the surveyed participants who self-identified a need for assistance in these areas, 100% of them indicated their goals and needs for support had been met through the program. On average  67% of study participants’ indicated that their needs identified through the program overall were met through program-facilitated services (range=25% to 100%). • In addition to individual case management activities, 43% of the survey participants, indicated having participated in Aim4Peace activities supporting violence prevention and community mobilization activities several times in the past year. Nearly, 88% of survey participants (n=17) involved in the Aim4Peace program indicated not being involved in any other community-based programs. • The majority of the survey participants (85%) reported having received conflict mediation training from Aim4Peace, of which 71% of the respondents reported being either somewhat or very satisfied with their ability to mediate a conflict without resorting to violence. • All of survey participants indicated that they felt the program had positively impacted their lives. All the program participants agreed that Aim4Peace can change people’s minds about shooting, with nearly 76% of the respondents strongly agreeing.   Community-Level Violence Prevention Efforts Supported by Aim4Peace • Since 2008, Aim4Peace and partnering Neighborhood Action Teams have implemented 347 community-level activities, of which 65% were delivered in the Aim4Peace priority area. • Since the program began in 2008, Aim4Peace has contributed to facilitating 223 documented community changes—new program, policy, and practice changes- including 26 community/system changes implemented by the program in 2014 through partnerships involving nine different community sectors (e.g., law enforcement, business, health agencies). • In 2014, there were a total of 82 shooting response activities supported by Aim4Peace street intervention workers either in the neighborhood (i.e., on the street) or in the hospital setting, which resulted in interactions with 813 individuals in hospital and/or neighborhood settings. • Since 2008, Aim4Peace has mediated 402 conflicts that may have potentially led to violence, with 166 mediations documented in 2014. Nearly, 77% of the conflicts were identified by street intervention workers to have likely led to a shooting if a mediation had not occurred.   Improvements in Targeted Outcomes—Homicides and Aggravated Assaults Based on the findings presented in the KU 2014 evaluation report, Aim4Peace has contributed to preventing and reducing homicides and aggravated assaults in the priority area in 2014. Although it is recognized that there are other violence prevention and reduction activities occurring in the community that may also be contributing to improvements in outcomes. In 2014, there less shootings (i.e., firearm aggravated assaults) and killings (homicides) in the Aim4Peace priority area as compared to the previous year. • Between 2013 and 2014, there was an aggregate decrease of 16 combined homicides and aggravated assaults overall for the beats encompassing the Aim4Peace priority area, which was nearly an 8 percent change decrease in total violent incidences. From 2008 to 2014, there has been a 16 percent change decrease with 37 less violent incidences reported as measured by police reported data of homicides and firearm aggravated assaults. • Between 2013 and 2014, there was a decrease of eight homicides in the Aim4Peace priority area, which was a 42.1 percent change decrease. Since 2012, there has been a steady decline in homicides occurring in the Aim4Peace priority area. For the beats in the Aim4Peace priority area, the average change in homicide rates from 2013 to 2014 was a decrease of 3.03. The average change in homicide rate for the comparison beats was a decrease by 2.86 (SD= 4.70), but there was not a significant difference. • From 2013 to 2014, there was a reduction by eight firearm aggravated assaults in the Aim4Peace priority area, which was a 4% change decrease in incidences over time. The decrease in the average change in the firearm aggravated assault rates in the Aim4Peace priority beats (-2.71) was significantly different than for the comparison beats, which experienced an average increase (4.27) in the firearm aggravated assault rate during this period   Primary Data Sources:  Aim4Peace is managed by outcomes with an independent evaluation team, University of Kansas’ Work Group for Community Health and Development (KU Work Group), funded by an external foundation, who assembles systematic measures of program staffing and activity. Data included in the report are based on information recorded daily by program staff in the KU Work Group’s Community Check Box system, a data recording tool that supports the systematic collection and analysis of program data. KU Work Group staff systematically review and analyze the data. The KU Work Group also conducted participant interviews with a random sample of participants served by the program to obtain participant feedback.   Secondary Data Sources: Data sources also include KC Police Department and KCMO Health Department (e.g. provides access to additional data resources including the Behavior Risk Factor Surveillance System (BRFSS) data, etc.).   Performance Indicators: Neighborhood Mobilization (supports decrease in tolerance towards violence) Quarterly: Number and type of community changes (new or modified program, policy, practice change), including new or expanded collaborations and partnerships Monthly: Number and type of activities, events, and services (e.g. BBQ, rally, etc.) supported by Aim4Peace and collaborative partners Monthly: Number and type (if available) of participants involved in activities and events Quarterly: Number and type of observations and referrals made in the community related to problems/concerns (e.g. housing, education, employment, health, substance abuse, etc.)   Outreach Activities Monthly: # of new, current, and closed-out participants, including participants successfully completing the program Monthly: # of total contacts and cumulative time spent with participants Monthly: # and type of referrals Quarterly: Aggregated risk level of participants  Quarterly : # and type of conflict mediations Quarterly: # of Risk Reduction Plan goals set and attained by participants   Crime Data: Monthly: # of homicides East Patrol and target sector Monthly: # of aggravated assaults in East Patrol and ground zero     How the results were analyzed:  The purpose of the annual evaluation is to enhance understanding of the implementation and effectiveness of Aim4Peace to further guide improvement and adjustments by the program and collaborative stakeholders. Specifically, The premises undergirding this evaluation are anchored in the community change theory and contribution analysis. KU Work Group uses a time-series design. •      The community change theory asserts that to collectively change behavior at the community-level  there must first be targeted changes in the environment related to the goal area(s). •      Contribution analysis focuses on understanding the contribution, “how”, the program is making a difference in association with observed results, based on a theory of change. •      Contribution analysis shifts the focus from ‘measuring and proving to understanding and ‘improving’.  A focus on contribution, rather than solely attribution of cause and effect, recognizes that there are community efforts collectively supporting improvements in community outcomes.  The evaluation focuses on:   Neighborhood Mobilization, Street Outreach and Homicide/Firearm/Aggravated Assault results.   Modifications Made: In 2011, Aim4Peace received a NACCHO Promising Practice award. Realizing that the success of the program data was deemed promising, primarily due to the initial target or dosage area of the program being spread too thin, Aim4Peace adapted and concentrated its dosage to the proper target area size and focused on obtaining at least two calendars years demonstrating success. The strategy worked. From 2010 to 2014, Aim4Peace contributed to a -70% reduction in the number of homicides in its target area (e.g. 20 to 5). By working as credible public health messengers (e.g. outreach workers and interrupters), Aim4Peace treats the epidemic of violence and shifts social norms so that shooting and killing is no longer normal.
Practice Lessons Learned: During this journey, KCMOHD and Aim4Peace have learned many practice lessons but there are a few that standout as essential: Funding Support. Since the City of Kansas City is beginning to show a decline in the number of homicides each year, additional funding to further expand the program throughout the entire Metropolitan area of Kansas City can be subjected to its challenges. Aim4Peace must continue to take a stand in interrupting the violence before it exists. Aim4Peace has sought out additional funding support from different local and federal agencies, but a national effort to support the violence prevention should be created to support this public health practice, similar to the Ryan White Title Grant. Public Perception and Education. The pubic approach to violence can be difficult for some to understand its significance to changing behavior norms and preventing violence which is quite different than the traditional “lock-em up” approach that has helped to increase the prison population one generation after another, which ultimately has little to no effect on crime rates.  We need to do a better job, in public health, educating and communicating the regarding the services and supports offered by this practice. It is critical that we raise awareness of the problem of community violence and establish social norms that make violence unacceptable. Develop a network of leaders within the community. Connect community members to services and informal supports when they need help. Make services and institutions accountable to community health needs. Change the social and community conditions that contribute to violence. Partner Lessons Learned: The Aim4Peace Program had the opportunity to host the 2014 My Brother’s Keeper Listening event in response to President Obama’s initiative to expand the opportunities for every young man of color from cradle to career. This event allowed different local and state agencies to come together and to forge pathways  to address the comprehensive needs that are prevalent in this region for young men of color. As a result of this convening and in response to high youth violence exposure and its impact on living and learning, the Kansas City Missouri Health Department (KCMOHD) drafted a recommendation, which was unanimously adopted by the City Council, to create and sustain a Youth and Family Violence Prevention Plan. The project began in February 2014 with the creation of the Violence Free KC Committee (VFKCC).  KCPD, an active member of the VFKCC, is joined in this multi-sectorial collaboration of public and private entities by KCMOHD, Communities Creating Opportunity (CCO), KC Metropolitan Crime Commission, MORE², Jackson County COMBAT, Aim4Peace, KC No Violence Alliance (KC NoVa), Jackson County Prosecutor's Office, Ad Hoc Against Crime, Jackson County Juvenile Justice Center/Family Court, and other community agencies. As program activities surrounding the creation of a comprehensive Youth and Family Violence Prevention Plan continue into 2015, the VFKCC has recognized the need for assistance and guidance from proven community violence prevention planning professionals. Kansas City has struggled for too long at curbing crime and violence rates; documented evidence-based and collaborative solutions are needed to affect change.    Cost/benefit Analysis:  Violence has a price tag and Kansas City is highly conscious of the cost saving measures of effective health programming. Aim4Peace, the city supported violence prevention program, estimates that for every dollar spent on programming, $15.77 may be saved by the community for costs associated with violent behavior, including medical and criminal justice costs. (http://cureviolence.org/post/resource/the-cost-of-firearm-violence/)   Stakeholder Commitment:  Aim4Peace is preventing violence in the Kansas City area. Since the City of Kansas City is beginning to show a decline in the number of homicides, additional funding to further expand the program throughout the entire Metropolitan area of Kansas City can be subjected to challenges. Aim4Peace must continue to take a stand in interrupting the violence before it exists. The Health Care Foundation of Greater KC (HCF) funding support helps to employ the credible public health messengers necessary to approach violence as a disease and prevent this epidemic from spreading. The commitment that HCF has shown since 2009 indicates that the work being done by the program continues to produce positive results each year. In the words of the Kansas City Police Department Chief of Police, “Aim4Peace continues to reach a segment of the community that has demonstrated the propensity for committing violent acts. Law enforcement has not been successful in building trusting relationships with many of those who have shown the propensity for violence.” Through the VFKCC, Aim4Peace and related partner project activities are designed to create city-wide policy change and implement activities that will impact all Kansas City youth and families that will be codified in the 5-year business plan.   Sustainability Plans: Aim4Peace already seeks creative partnership to fund the project. By leveraging funding provided each fiscal year by the city and HCF, Aim4Peace’s existing program positions are supported. Aim4Peace secured the commitment of Mid-America Regional Council to support Aim4Peace fundraising efforts by partnering with KCMO to raise private resources and to use its 501(c)3 subsidiary to support sustainable fund development. A4P is seeking to raise/leverage funding through: (1) Promotional Activities; (2) Personal Contact; and (3) Public Relations (e.g. develop a press kit, press releases to get the story and successes known quarterly, and build media relationships with approximately two contacts per month). Through multi-sector partnerships and participation in coalitions and trainings locally, regionally, and nationally, Aim4Peace reviews and utilizes unpublished methodologies, evaluation data, and research which is essential to sustainability and relevancy. Plans include policy and fiscal advocacy at local, state and federal governmental levels and philanthropic levels. Success will be realized when there are no longer any statistically significant gaps in life expectancy in Kansas City’s or any U.S. Urban population regardless of zip code, or racial or ethnic background. 
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