San Antonio is using a public health approach to address violence

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San Antonio will become the latest Texas city to use a public health framework in an effort to prevent violence. The approach uses evidence and research to better understand the causes and circumstances of violence—and to develop ideas for better preventing it.

Authorities in the state’s second-largest city are focusing on four areas: youth crime, gun incidents, sexual assault and domestic violence. Residents identified these four areas as priorities.

“The public health approach to any community problem starts with understanding the nature of the problem: using data, talking to residents and using that to advise us on what to do,” said Erica Haller-Stevenson, city public health administrator . “Ultimately, when you look at violence as a public health issue, you’re looking at it beyond public safety.” You look at how violence affects people deeply and throughout their lives.

With the so-called non-policing approach, San Antonio joins Houston and Austin, which have similar programs already underway and growing, as well as municipalities across the country.

“In the last 10 to 15 years, public health has really started to see violence prevention as something that is directly theirs and has taken a more active leadership role in conversations about addressing violence,” said Jeff Coots, a professor at John Jay College of Criminal Justice justice in New York.

In San Antonio, officials who have been working on the plan expect to brief City Council members on it this month, before the official launch. The first year could consist of a lot of research and connecting dots and people, according to a November draft shared by a city health spokesperson.

The draft plan outlines 50 prospective stages for each of the four pillars. For example, by December 2025, the initiative calls for increasing the number of voluntarily surrendered firearms under programs to help tackle gun violence and creating a map of services that support victims of sexual violence.

By December 2028, the plan aims to reduce the number of repeat sexual assaults and abuse of children by people who have previously been investigated or convicted of such crimes, and reduce school truancy to help reduce violence among the youth.

“We want to lay the groundwork for the work,” Haller-Stevenson said. “Our community is doing a lot of work on some of these topics, but people are often doing different things and we’re missing the opportunity to join forces.” If we pool our efforts and our resources, we could have a really big impact instead of just scratching the surface.”

Ensuring that violence prevention organizations do not operate in silos is a key factor in the success of such programs that use a public health framework, according to criminologists.

In recent years, there have been several changes in the way government officials — and ordinary Americans — view law enforcement’s actions regarding crimes and the reasons behind those crimes.

Police have come under increased scrutiny after several high-profile killings — including the 2020 death of Houston native George Floyd, who was killed by a Minneapolis police officer.

At the same time, America’s homicide rate increased in 2020 as the onset of the coronavirus pandemic upended society. And while overall crime has recently declined, the vast majority of Americans perceive it to be on the rise.

As crime in the US fell last year from the year before, Texas has seen a steady increase in gun violence affecting young people over the past decade, a sharp rise in gun suicides over the past two decades, and total gun deaths last year reached a level not seen in almost three decades.

Meanwhile, there is also more federal money available to research gun violence in particular. In 2018, Congress specifically said the federal government could research gun violence as long as the research didn’t promote gun control.

Criminologists say community involvement will be vital to programs like San Antonio’s and can be achieved by working with leaders in neighborhoods that bear the brunt of violence. Adequate funding that ensures people stay connected to important services — such as nutritional supplements or therapy — will also be important, criminologists say. .

San Antonio officials do not yet have specific funding earmarked for the plan, but they have increased funding for the city’s health force’s anti-violence unit, which has 134 doctors, Deputy City Manager Maria Villagomez said. That increase comes from the city’s general fund and through grants from the federal government, she said.

“These programs need to be well staffed and adequately resourced, so sometimes they come with a price tag that is impressive,” said Dr. Alexander Testa, an assistant professor at the UTHealth Houston School of Public Health in San Antonio. .

Testa is the principal investigator of a program being set up at Memorial Hermann in Houston to intervene in potential acts of retaliatory violence by talking to gunshot victims at the hospital bedside.

“The goal of this is to use the hospital setting as a way to identify people who are at risk of violence and offer them an opportunity for resources to get them out of that violent lifestyle,” Testa said.

There are other programs in Harris County.

An alternative 911 response sends teams of two—consisting of a certified emergency physician and a crisis intervention specialist—to nonviolent calls for service.

Once launched in March 2022, the program aimed to respond to 751 calls in one particular sheriff’s district, said Lupe Washington, director of the county’s health and violence prevention services. Initial crews responded to more than 2,000 calls. The program has now been expanded to the Sheriff’s Office’s second district.

The county also runs a violence intervention program in four ZIP codes that have the highest rates of gun violence in the county. People from these communities, often referred to as “trusted messengers,” establish relationships with residents and attempt to intervene in potential acts of violence. They do this by helping those in need find resources such as rental assistance, navigate bureaucratic systems, and sometimes apply for jobs.

In addition, the county has inpatient intervention programs at two hospitals, including Ben Taub, which, like Memorial Hermann, is a Level 1 trauma center. This means they are equipped to offer the highest level of care to trauma patients, such as those with gunshot and stab wounds.

“We’re really trying to be proactive,” Washington said.