‘Prevention is the Best Cure’: Community Violence Intervention Research in Boston

Community violence is a deeply entrenched problem that arises from numerous, complex factors. Any comprehensive solution to preventing or intervening in community violence must address the issue from multiple vantage points.

In 2022, the U.S. Department of Justice, Office of Justice Programs launched the Community Based Violence Intervention and Prevention Initiative, which supports local leaders as they implement strategies and interventions designed to reduce community violence. In September 2023, the Office of Justice Programs awarded an additional $90 million toward these efforts, supporting interventions and research in the greater Boston region. 

The National Institute of Justice has funded AIR, in partnership with WestEd, to develop a violence intervention and prevention intercept model that pinpoints where, how, and why people interact with Boston's hospital and community-based service array. This project also aims to engage other cities to ultimately produce a tool that they can use to evaluate and improve their own urban violence prevention ecosystem. 

In this Q&A, Principal Researcher Patricia Campie, Ph.D., explains how Boston became a leader in this field, how hospital-based interventions work, and why she thinks the root causes of community violence are universal.    

Q: This newest grant funds efforts in Boston. What implications, if any, are there for the rest of the country?

Campie: Massachusetts has long been a leader in the field of community violence prevention. With the launch of the Safe and Successful Youth Initiative (SSYI) in 2012, it became the first state to have its own statewide violence prevention strategy and dedicated office for programmatic, technical assistance, and evaluation support. The Massachusetts model showed other states how they could similarly develop state-level strategies to prevent violence at the community level. For example, California’s statewide gun violence initiative was inspired in part by a study of Massachusetts’ work. Because Massachusetts has this mature body of research and policy structure around this work, it’s an ideal setting to test new ideas that can then be translated or reapplied elsewhere.    

Q: This grant emphasizes hospital-based interventions. How do those work?

Campie: For decades, cities and states have typically focused their attention on community-based interventions. By contrast, hospital-based interventions are relatively new, mostly springing up in the last five years.

The origins of hospital-based interventions are interesting: In the early 1990s, public health professionals in Boston and Oakland independently realized that they were treating the same patients in their hospitals and health agencies for gunshot wounds over and over. Some of these patients expressed interest in stopping the cycle of violence—they didn’t want retribution, they wanted to change their lives. The doctors and public health professionals understood that these patients needed treatment beyond just their physical wounds, to address emotional trauma, as well as support and resources for the long-term. Those early conversations with victims and patients prompted the first Hospital Violence Intervention Program.

Now nearly 100 such programs exist around the U.S. Essentially, in a hospital-based intervention, a staff member flags when a patient is the victim of violence. That’s a wide umbrella, encompassing everything from community violence to domestic violence to even violent accidents. Then a victim advocate will interview the patient—trying to determine what happened, the degree to which they are at risk for future violence, and what resources would help them. Ideally, this is followed by case management, to support the patient over time.      

Q: How does that differ from community-based interventions?

Hospital-based Interventions:

  • Newer approach
  • Take place in or with hospitals
  • Focus on individuals affected by gun, domestic, and other types of violence
  • Provide a variety of resources and follow-up based on individuals’ needs  

Community-based Interventions: 

  • Established approach
  • Occur in a variety of settings
  • Can target a wider range of individuals affected by violence
  • Resources can include cognitive behavioral therapy, housing, and employment assistance

Campie: Community-based interventions can occur anywhere, and there are many different types based on risk of violence. In communities where violence is prevalent, experts might work directly with schools to teach young people principles of conflict resolution before things escalate. Or they might reach out to teenagers who have demonstrated risk factors—like fighting at school or delinquency—and recruit them for targeted programming. 

Community-based interventions can also take place further along in the cycle of violence. In any city, there’s a very small number of people responsible for shootings—less than 1% of the population—and generally, the police and community members and non-profits know who they are. Experts, including those with lived experience, can reach out to these individuals personally to build relationships and act like mentors. They also can offer them resources, including cognitive-behavioral therapy, which can help them change the way they think about decisions that may lead to violence; provide access to safe, stable housing; and prepare them for gainful employment, so that they can make a living without resorting to income-generating alternatives often tied to violence, such as the drug trade.    

Q: What kinds of partnerships are needed for effective community-wide violence intervention and prevention?

Campie: That’s one question we’re hoping to answer with this study—we want to create a framework for cities to understand how hospital and community-based programs and systems can best work together. Where are the duplication points, and where are the best possible points for collaboration? Once we develop the intercept model with feedback from cities across the United States, we’ll test the model by examining up to 2,500 victims of violence in Boston, retrospectively over several years. We will collect information to understand how an individual’s experience with the ecosystem impacts long-term outcomes, based on who you are and where you enter—and re-enter, in some cases—the violence prevention ecosystem.    

Q: You’ve conducted violence prevention work both domestically and internationally. How do they differ?

We should be investing in the general health and vibrancy of communities. Violence isn’t prevalent in thriving, well-resourced communities. Prevention efforts that focus on root causes will always be the best cure.

Campie: In my experience and through research I’ve conducted, the root causes of violence are identical here and abroad. At the family level, it often stems from poverty. If parents are working three jobs, they aren’t necessarily able to provide their children with supervision and guidance. Those kids may not be in school, and then they are vulnerable to bad actors, criminal groups, and so on. At the community level, in addition to economic and structural disadvantage, a critical risk factor is frequent and sustained exposure to violence, which can be anything from gang activity to armed conflict. This exposure can desensitize people to violence, and young people are especially vulnerable to traumatic experiences that impact normal brain development and interfere with decision-making. 

While the problems driving violence are largely the same across countries, the solutions may look different in practice. Successful solutions will address core issues but be context-specific: they’ll be culturally relevant, fit the physical structure of the community, and rely on specific local institutions and other assets for support.    

Q: What is the greatest misconception around community violence prevention?

Campie: A lot of community violence prevention efforts are centered around that 1% of the population I mentioned earlier—the ones who commit the most violent crimes. But throwing money at programs and police to “fix” the 1% causing violence today won’t prevent violence tomorrow. If a community is impoverished from decades of disinvestment, both economically and from positive support from local institutions like schools and police, families and children will continue to be vulnerable to violence as victims and perpetrators. We should be investing in the general health and vibrancy of communities. Violence isn’t prevalent in thriving, well-resourced communities. Prevention efforts that focus on root causes will always be the best cure.