Shifting to a Public Health Frame

Prevent, detect, treat. Responding to crime after the fact is akin to an ER-only response to disease. The public health field has much to offer when thinking differently about addressing epidemics, such as replacing crime response methodologies with prevention, detection and treatment. Threats to safety worsen when root causes are left unaddressed or critical symptoms are misdiagnosed. Advancing safety through this lens recognizes that a lack of safety is a public health issue, and assesses risk factors to prevent and treat conditions like trauma and drug addiction. It’s time we replace the emergency room approach with a Shared Safety approach.

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1. safety

Adopt safety as a public health issue

Applying a public health approach means addressing the what, when, where and how that causes a lack of safety so that we can tackle the real underlying problems, not the symptoms.

Why do we need it?

Unaddressed exposure to community violence causes short- and long-term physical and behavioral health consequences and yet we continue to treat public safety as a criminal justice issue–not a public health problem.

How does it help?

Instead of waiting until after crime occurs, a public health approach offers the tools essential to detect, prevent and treat unsafe conditions while building community strength and resiliency.

Questions To Ask

  • How is our leadership committed to building safety through investments in community well-being and prevention?
  • How does our Shared Safety approach prioritize crime prevention? How much focus is on triaging only after harm has happened?
  • Do our strategies effectively protect those who are most at risk of harm?
16.7% of Californians have experienced 4 or more adverse childhood experiences, which can shorten lifespans by as much as 20 years.

What does it take to implement?

  • Engage public health, social services and a cross-section of the community in public safety policy-making.
  • Conduct a culturally relevant, community-wide risk assessment – just as you would for any disease.
  • Identify the most salient risk factors of the communities most harmed.
  • Develop a triage and long-term plan to reduce those risk factors.

Outcome Measures

  • Increased ability to measure risk of harm by race/ethnicity, gender/sexual identity, disability, age, legal status and geography (e.g., zip code).
  • Increased use of short- and long-term cost analyses of safety strategies.
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2. safety

Align Heath & Safety Delivery Systems

When delivery systems are integrated, coordinated and deliberate, people are far less likely to fall through the cracks, and problems can be identified and resolved before they become more serious and costly.

Why do we need it?

Health and safety work hand in hand. So should the systems that serve them. Operating in silos creates redundancies and inefficiencies, which drive up costs and often fail to address critical needs.

How does it help?

Recognizing safety as an “ours” issue, not a “yours” issue, allows local governments to prioritize investments in prevention and community health that have historically struggled to meet capacity. It also leads to integrated delivery systems: shared planning, shared data, coordinated strategies and, in some cases, shared funding.

Questions To Ask

  • How can we better integrate physical and behavioral health screening, assessments and care?
  • What tensions or barriers might strain or block integration, and what are the mechanisms to resolve them?
Nearly one in six Californians has a mental health need. Of those who seek help, 43% do not receive treatment.

What does it take to implement?

  • Integrate regular communication, data collection and activities among police, probation, sheriff’s department, health, behavioral health, social services and local treatment providers.
  • Integrate preventive and ongoing physical and behavioral care across departments, including care to address possible drivers of crime.
  • Make sure providers are conducting bidirectional screening and referral protocols.
  • Consider system navigators and ensure that case managers communicate, and possibly function, across department silos.
  • Identify the “super-utilizers,” the small percentage of individuals involved in multiple systems who are responsible for a large share of the costs.

Outcome Measures

  • Increased number of cases in which systems are coordinating care.
  • Reduced costs of care for super-utilizers.
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3. safety

Prioritize Preventive Health

Imagine what our communities would be like if we made preventive health a priority.  The potential in terms of social and financial savings could be a game-changer.

Why do we need it?

Waiting until after a crime has occurred to make investments in treatment and other social programs costs a lot more and ruptures community well-being. It also puts an unreasonable burden on law enforcement, asking them to solve problems that are beyond their control.

How does it help?

Investing in early interventions such as preventive healthcare, mental health services, drug treatment, housing, jobs and trauma recovery makes communities healthier and safer.

Questions To Ask

  • What is the percentage of uninsured, by neighborhood, and why do they lack insurance?
  • What barriers exist to connecting people to the right interventions based on their needs?
  • Are our providers’ locations and operating hours accessible to everyone in need?
  • Does immigration status prevent individuals from accessing treatment?
The state prison system treats more than five times the number of people with mental illness as state psychiatric hospitals.

What does it take to implement?

  • Make investments in prevention a local budgetary priority.
  • Take advantage of every opportunity to improve, integrate and reward preventive healthcare.
  • Aim for 100% healthcare coverage enrollment.
  • Partner with youth-serving organizations, e.g., schools and churches, to evaluate children for trauma and ensure timely and effective treatment.
  • Locate services within vulnerable communities and tailor outreach to hard-to-reach populations including homeless individuals and immigrants. Help residents navigate service providers and systems.

Outcome Measures

  • Greater percentage of local budget spent on preventive measures.
  • Reduction in the percentage of uninsured individuals.
  • Increased number of providers and clinics in high-needs communities.
  • Increased number of children screened for Adverse Childhood Experiences (ACEs).
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4. safety

Generate Shared Health & Safety Data Systems

Sharing responsibility for community safety means finding ways to share data and knowledge so that we can holistically assess whether we are adequately preventing, detecting and treating health and safety issues.

Why do we need it?

When public agencies are unable to share information and data, they continue to operate in silos, missing critical opportunities to maximize resources, track progress and coordinate problem-solving.

How does it help?

Even if agencies lack the resources to create an integrated data system, developing data-sharing strategies stimulates a number of important processes to occur, including agreement on common definitions, clarification of roles and responsibilities, and facilitation of integrated operations.

Questions To Ask

  • Do we have agreed-upon definitions and data sources?
  • Do we have short- and long-term plans to address the technological challenges of cross-system data sharing?
  • Are all the necessary entities, including legal counsel, actively engaged in this effort?
  • Where could we achieve savings if we had better data-sharing capacity?

San Diego reduced spending on emergency rooms, hospitals, jails and ambulances by 67% in 3 years, by housing the 28 most frequent users.

What does it take to implement?

  • Assign a department or individual the role of coordinating your shared-data effort. Develop short- and long-term strategies that are commensurate with potential available resources.
  • Develop agreed-upon definitions and data sources, considering quantitative and qualitative information, including community knowledge. Commit to jointly addressing and resolving technical challenges.
  • Enter into data-sharing agreements (e.g., memoranda of understanding [MOUs]) and use consent forms where necessary.
  • Support grassroots efforts to access and produce data.
  • Consider starting with an analysis of high-utilizers in multiple systems; this may reveal a lot about your systems.
  • Don’t reinvent the wheel. Learn how other communities are resolving data-sharing challenges.

Outcome Measures

At least four to five measures representing joint accountability, such as an increased percentage of justice-involved people with mental illness who access community-based treatment.
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5. safety

Harness Media to Promote a Public Health Frame

The media, a critical battleground for shaping public opinion, can help build mainstream support for the public health frame. Without this, Shared Safety cannot succeed.

Why do we need it?

“If it bleeds, it leads.” Media coverage of crime tends to focus on the sensationalism of the crime rather than the factors that put communities at risk. Over time, this distorts public perception, drives policymakers to advance laws based on fear and increases the divide between communities and law enforcement.

How does it help?

In a democratic society, broad public support is necessary for government to succeed in shifting priorities around health and safety. Proactively framing crime prevention as a public health issue through media campaigns, public commentary and storytelling helps the public understand the importance of new and more effective safety priorities.

Questions To Ask

  • Does local media coverage reflect the public health frame when reporting on public safety?
  • Who do we most need to reach with our message, and which media outlets will most help?
  • Who are the reporters with whom we can work?
  • Who are our best experts, and which data are most compelling to put forward?
Articles about murder appeared in California media nearly 10 times more frequently than articles about community safety, between 2013–2015.

What does it take to implement?

  • Make the case for public health approaches in op-eds, interviews and social media.
  • Publicize research on crime prevention, detection and treatment for trauma, and highlight success stories.
  • Refer reporters to public health officials when asked to comment on crime and criminal justice issues.
  • Cultivate reporters, including in non-English media sources, who cover issues like health and homelessness.
  • When you see an unbalanced crime story, contact the reporter and/or comment on online stories with a public health perspective.

Outcome Measures

  • An increase in stories portraying crime as a public health issue.
  • Greater inclusion in crime stories of predictors/contributing factors.
  • Increased presence of public health experts in crime stories.
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Blueprint Overview