Public health is the collective effort of a society to create the conditions in which people can be healthy; relative to violence, the public health approach has never been fully implemented.
— Dr. David Satcher, 2015 Kelly Report

Violence is a health crisis in the United States, and it is time for it to be recognized and treated as one. The Movement towards Violence as a Health Issue has prepared a framework for confronting violence, in all of its forms, as a public health issue in impacted communities across the United States. This framework will guide local government and organizational leaders to improve and systematize their efforts in violence prevention - making our country safer, healthier, and more equitable for all.

Listed below are the system elements detailed in the framework. An overview of the Framework can be viewed here and the full Framework with citations can be viewed here.

+ Public Health Departments

Local Public Health Departments will be the main entity responsible for the development and implementation of integrated, comprehensive community-based violence prevention in their communities. These departments will use and disseminate funding to incentivize health sector leadership to address social determinants related to violence and to coordinate the use of health and other data with other sectors to improve their communities’ abilities to address social determinants of health. Public health departments must improve coordination and infrastructure to confront violence as a health issue— and address the pervasive racial and gender inequities stemming from violence— as an interconnected, multi-sector force. They will help address these inequities through hiring, training and supporting violence prevention professionals and coordinators. Furthermore, public health departments will use funding to research and monitor past and current violence trends to disseminate resources to increase resilience in those communities experiencing the highest rates of violence. Local Health Departments will be connected and supported through leadership in their respective State Health Department. The State Health Department will be responsible for disseminating best practices, ensuring accountability and securing resources through funding and policies to sustain the system.

+ Community Organizations and Community Residents

The community—local residents, businesses, and organizations—is of vital importance to a health system focused on violence prevention. Community members have unique insight into the local context and the credibility to successfully do the work of violence prevention. Several models of prevention and healthcare delivery have defined their success through the employment of these “credible messengers,” such as Community Health Workers (CHWs) and the Cure Violence program’s “violence interrupters.” How a community conducts this work will vary, but generally there are four types of work to be done in communities affected by violence.

Preventing violence in all of its forms (e.g., community-based, domestic, sexual, child abuse, self-harm, etc.) is of primary importance. Specialized local workers are best prepared and suited to detect and interrupt potentially violent incidences. This approach has been modeled after other public health efforts to address a variety of health issues around the world, wherein community-specific knowledge and credibility have been critical for connecting residents to available solutions and changing community norms.

Second, community members must identify and support those individuals at highest risk for violent behavior. In much the same way disease control specialists, caseworkers, and other health outreach workers detect those suspected of having infectious diseases, special community members will use a health approach to detect individuals most likely to be involved in violent situations. Of course, the proper treatment for these individuals depends on each case; for some, a positive role model and mentor may be effective for prevention, while others may need a treatment program such as cognitive behavior therapy, substance use treatment, or functional family therapy. According to surveys in Baltimore City, people living in communities with the health approach to violence prevention were significantly less likely to find it acceptable to use a gun to settle a conflict, compared with peers in areas without the intervention. It cannot be stressed enough that communities must be equipped to address prevention by having multiple strategies in place and ready for deployment.

Third, communities need to address environmental factors both to reduce communities' susceptibility to the “contagion of violence” and to bolster their resistance. Communities everywhere will work to replace negative norms that encourage the use of violence with positive norms that hinder its spread. Community organizing can be used to address environmental factors such as employment, education, housing, safe spaces, equity, and social cohesion, which influence a community’s susceptibility and resistance to violence. Community initiatives will improve the general quality of life in communities through the provision of accessible, high quality health care, school facilities, libraries, parks, and other public amenities. Grassroots mobilization is essential for holding systems accountable and working to change the social norms, to stop accepting violence and start preventing it. Moreover, as the movement’s goal is to lead the transformation to social equity through the reduction in violence—which disproportionately affects people of color —it is essential that voices from impacted communities are included in all aspects of development, implementation, and evaluation of all components of this collaborative health system.

Fourth, communities must address risk factors—including social determinants of health, which the World Health organization defines as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems”—that affect an individual's susceptibility or resistance to violence. Individuals themselves also must be encouraged to employ strategies to fortify resistance to violence, including cognitive and behavioral interventions, constructing and maintaining social support networks, and the development of skills like meditation and mindfulness.

+ Social Service Providers

Perhaps the most important method of implementing the community health-based approach to violence prevention involves addressing the needs of local residents and delivering appropriate services with a focus on those most impacted by violence. Social service providers and Community Health Workers (CHWs), who are attuned to issues in the community and have credibility because of their personal relationship to the people they serve, are uniquely positioned to identify people most in need of services. Additionally, these social service providers increase retention rates in available services, reduce costs, and increase adherence to care plans. This access and community-specific knowledge makes frontline workers, such as CHWs, an essential part of the broader health-based system to prevent violence.

In the process of identifying individuals at highest risk for involvement in violence, social service providers are able to identify individual, family, community, environmental, and structural risk factors. These factors can be related to social determinants of health and other conditions that may limit an individual’s access to necessary resources and positive social norms. Specialized training for social service providers, focused on trauma and the impacts of exposure to violence, can increase the capacity of these workers to effectively detect individuals at risk. This capacity makes it imperative for social service providers to create and sustain community-specific care programs to assist with the delivery of benefits and assistance to address the diverse needs of those exposed.

The Patient Centered Medical Home Model delivers improved care and unrestricted access to prevention services within communities typically deemed Medically Underserved Service Areas. Early childhood home visitation programs and Nurse-Family Partnerships, through which health professionals visit uninsured or underinsured homes during the mother’s pregnancy or the child’s infancy, have been shown to prevent child abuse and promote positive parenting and school readiness. CHWs, nurses, patient navigators, and promotoras are often aware of potentially violent circumstances within the home and community long before it manifests in a hospitalization or police or child protective services report. Linkage to mediation services, child protective services or crisis management allows providers to address the critical need for safety for their clients. Federally Qualified Health Centers serve communities with life-saving efforts within the community’s backyard. These centers will be equipped to deliver trauma-informed services, which recognize that patients may bring with them a history of traumatic experiences and need for emotional support, while identifying those at-risk for violence in order to intervene effectively.

Many federal and state agencies that support people traumatized by violence— child and family services, alcohol and substance abuse services, veteran and military services, mental health providers— play an important role in detecting ongoing violence and identifying those exposed or at risk. These ongoing efforts will be further enhanced by incorporating a health understanding of violence in their work, through training and collaboration with health-based violence prevention programs.

+ Primary Care

Primary care providers are at the front lines of health care. They have the ability to guide people toward healthier lifestyles and to intervene before illness or injuries arise. These very skills will be applied to address and prevent violence and trauma, and thus reduce the resultant racial inequity. For example, many hospitals and clinicians routinely assess for risk of intimate partner violence, cases of self-harm, elder abuse, and child abuse; primary care providers can and should expand their use of these strategies. These are intimate problems, with serious concerns of privacy and confidentiality. Clinicians are uniquely positioned to deal with delicate situations involving violence. Models of primary care will be developed to assess the risk for interpersonal violence (including bullying, intimate partner violence, sexual assault and exploitation, child abuse), while providing clinicians with skills, resources for referral, and health departments that promote problem solving and avoid injury. As an example, specialists have developed brief, easy to administer suicide screening tools and intervention techniques for use in primary care, and are currently devoting research toward enhancing these tools and establishing linkage to evidence-based mental health and behavioral health treatments.

Public and private primary care providers will develop and implement efforts that address violence and trauma among their patients and in their local community, always with an eye to social equity. These efforts will work in coordination with existing local violence prevention programs. Medical societies like the American Medical Association and the American Academy of Pediatrics have recommended that clinicians include topics of gun safety, bullying, relationship violence, and peer-to-peer violence in their anticipatory guidance with patients. In order to create comprehensive, accessible, integrated health systems, funding will support the facilitation of connections between primary and behavioral health services. The healthcare sector will join forces with community organizations that specialize in intimate partner violence, sexual assault, self-harm, human trafficking, and child abuse (among other forms of violence) in order to develop safe, effective protocols and procedures. One example of a program with a broader, more integrated understanding of health care is the Prevention Institute’s Community-Centered Health Homes (CCHH) model, which provides high-quality medical care while actively advocating for community environment and policy changes through multi-sector partnerships aimed at positively improving communities’ health and well-being, particularly communities beset by violence.

+ Emergency Departments and Acute Care Facilities

As another first line of contact, emergency departments and trauma units are best positioned to address symptoms as early as possible and provide risk assessment, trauma-informed services (starting with first responders), and post-discharge case management. These steps address the physical, emotional, and psychological consequences of all forms of violence and play a critical role in breaking the cycle of violence. Dozens of hospital-based programs are dedicated to providing and refining these services, aligned through the National Network of Hospital-Based Violence Intervention Programs. These local programs integrate violence into emergency-preparedness plans and health needs assessments, and track patients and outcomes via standardized data collection. Evaluation of youth intervention programs have found that they result in decreased involvement with the justice system and generate substantial cost savings for health care and criminal justice sectors.

An analysis of medical, criminal justice and job opportunity costs for a Philadelphia-based HVIP showed a potential range of savings for that specific program of up to $4 million over five years, depending on the eventual outcomes of the involved clients. Similarly, a randomized control trial of high risk, justice-involved youth presenting to a Baltimore trauma center found that a hospital-based violence intervention program (HVIP) lowered re-injury rates from 36% to 5% and subsequent violent crime convictions from 55% to 13%, while increasing employment rates from 20% to 82%.

Historically, health care venues have had the ability to accurately identify persons experiencing intimate partner violence. Although benefits vary by population, a judicious and studied approach to intimate partner violence in the healthcare setting poses little risk to victims. Beyond intimate partner violence, emergency providers are trained to recognize signs, symptoms and “red flags” for suicidality, depression, sexual assault and exploitation, child abuse, and elder abuse, and human trafficking. In order to advance toward comprehensive care, mechanisms will be established to effectively and efficiently screen for these conditions in order to accomplish early identification and referral.

+ Hospitals as Anchor Institutions

Hospitals will contribute to their communities both through support of local organizations that promote positive youth development and community connectedness and by reorganizing their hiring, business, advocacy, and investment strategies to benefit the communities they serve and in which they are located. These hospitals, which can and should be “anchored” to their communities, are uniquely positioned to create and sustain economic growth that will improve the long-term health of their communities. Healthcare institutions have a wide range of resources that, when used in collaboration with local business and community leaders, can advance the goals of improving the physical, mental, and social health and reducing the racial inequities of their communities. Furthermore, hospitals will employ the public health approach to violence and draw on local organizational structures to develop and implement violence prevention strategies.

Private and public hospitals with new or existing violence prevention efforts will expand and/or implement additional programs with new funding, including matching funds from local, collaborative hospital systems. These hospitals will implement their violence intervention programs in coordination with existing prevention initiatives, and with consideration of patients’ current and past traumatic experiences. In addition, the presence of trauma-informed employees within the hospital system will reduce the potential for unintended re-traumatization of community members and will increase the system’s sensitivity to the impact that violence has on community members. These systems will encourage the inclusion of violence and other determinants of health in health assessments and community needs assessments in coordination with local health departments. It is also of vital importance that hospitals be funded to develop and contribute to metropolitan area health systems.

+ Health Care System Economics, Violence Prevention and Policy

The American health care system is undergoing rapid transformation, and policymakers have made a concerted effort to encourage providers and systems to rein in costs. Health care institutions are increasingly held accountable for managing the health of entire populations, rather than many individuals. Changes in the way that health care systems are reimbursed increasingly make violence prevention an imperative from both the community health perspective and the financial perspective. For example, hospitals participating in Accountable Care Organizations, global budgeting, and assuming global risk in partnership with Managed Care Organizations or private insurers stand to benefit as levels of violence decline. Targeting funds to match the investment of health systems in violence prevention and evaluating the financial results is a strategy to develop sustainable approaches to funding.

Beyond reimbursement reforms, the relationship between health systems and the broader community is changing. Criteria to maintain not-for-profit status has evolved to focus more on “community benefit,” promoting health and charity health initiatives in the local community, rather than on charity care alone. This expectation requires the active participation of health systems outside the walls of their facilities, expanding their reach to the streets of their communities. Non-profit hospital systems are required to create community health needs assessments (CHNA), with accompanying action plans, every three years. For those located in geographic areas with a high prevalence of violence, where violence is identified as a need through the CHNA, any action or inaction to prevent violence will not only be publicly reported, but will be attached to tax exempt status.

+ Mental Health

The mental health community must be at the forefront in advocating for community-based, collaborative violence prevention models. One example of a mental health organization successfully aligning with the violence prevention movement is the American Psychological Association's Violence Prevention Office, which disseminates research and assists mental health professionals and community organizations with implementing violence prevention efforts. The National Child Traumatic Stress Network is a multidisciplinary collaborative of frontline providers, researchers, and families who work to improve the standard of care and access to it for traumatized children and their families by combining knowledge of child development, expertise in the full range of child traumatic experiences, dedication to evidence-based practices, and dissemination of information on violence prevention. Though the large majority of people who have mental illnesses are not dangerous, many people at risk for violence are at risk due to mental health issues, suicidal thoughts, or feelings of desperation. As people with mental illnesses are many times more likely to be victims of violent crime than the general population, new strategies and interventions will be developed and implemented to assist this at-risk population. New mental health approaches that build resilience will greatly benefit this portion of the population. Policies and programs that address mental illness will be made national priorities. Stronger community collaboration between mental health services and community programs will provide easier access to and engagement in these services that are needed by so many. Access to mental health care is insufficient in America and future solutions will depend upon increased funding and resources.

+ Behavioral Health Care

Behavioral health providers have the power and opportunity to address and reduce incidents of violence in all of its forms, as well as the resultant trauma. They must develop and implement trauma-informed protocols and practices, and training and programming for non-clinical peer counselors. These programs are needed to address feelings of shame and guilt frequently experienced by victims of violence, while also connecting them to the appropriate crisis response. Providers will implement behavioral health training across various community sectors— from police to schools. They will also support community level approaches for violence and trauma intervention such as community healing programs that promote individual and communal resilience against violence. As already discussed, behavioral health and primary health care will be connected at location and provider levels, providing access to, and increasing engagement in, high quality behavioral health care.

+ Academic Medical Centers

Health care institutions must not only eliminate the threat of violence and treat its effects, but also lead the research that underlies all future prevention and treatment efforts. Academic medical centers will facilitate the development of curriculum and research on community-based violence prevention and on violence as a health issue generally. These institutions are uniquely positioned to train future generations of health care professionals and carry out research that will save lives from violence. As leaders in this movement, academic medical centers must prepare future health care providers with the framework for their role in violence prevention through training in the delivery of trauma-informed care and holding health care providers accountable for implementing efforts to prevent violence.

+ Schools

Unfortunately, many schools are located in communities suffering from violence, and this violence and the accompanying trauma often spill over into the schools and their students' lives. With a particular focus in primary and secondary school districts, violence prevention and intervention will be addressed by developing and implementing programs that promote the health understanding of violence, training educators in non-violent conflict resolution, and encouraging pro-social, equity-based norms and positive school climate through updated curricula and trauma-informed policies and practices. Students' out of school time will be minimized, including through the development of safe after-school alternatives, and counterproductive zero tolerance policies will be eliminated. School districts must also develop and integrate comprehensive school based mental health services. Those schools in areas with the highest rates of violence will be prioritized in fund allocation. Schools must play a central role in connecting students at risk for becoming violent with the services they need; this will result in both healthier schools and in school personnel having a deeper understanding of their students and an enhanced capacity to address issues appropriately. Schools are places where universal prevention strategies can be implemented, like trauma-informed services and initiatives such as mindfulness promotion and Second Step, a social-emotional learning and problem-solving intervention which has seen improvements in social-emotional competence and behavior resulting in 42% reduction in reported aggressive incidents for 6th graders in Chicago and Wichita over a 1 year study period.

+ Early Childhood Development Centers and the Child Welfare System

Exposure to violence has lasting detrimental effects on children of all ages. Evidence from brain and developmental science, the Adverse Childhood Experiences study, and the growing work related to trauma is clear that systems working with vulnerable children must both identify and respond to the impacts of violence. While more work is needed, education and child welfare systems are moving towards becoming trauma responsive. These systems are uniquely positioned to identify trauma from exposure to violence, and to respond with healing interventions. Kansas City’s Head Start Trauma Smart program has seen considerable success in mitigating the effects of the high incidence of complex trauma through appropriate responses and therapeutic intervention when needed. Increasing trauma assessment and mitigation resources in education and child welfare is a key strategy in reducing, and ultimately eliminating violence in our communities. The federal Commission to Eliminate Child Abuse and Neglect Fatalities recommends that all home visiting agencies, as well as Medicaid providers, ensure their services are working to reduce child abuse and neglect.

Initiatives designed to reduce/eliminate violence, locally or nationally, should consider intentional inclusion of education and child welfare leaders as partners in strategy and resource development. One study indicated 85% of children involved in the child welfare system reported being exposed to violence. With up to 80% of children in foster care having significant mental health issues and 40% with behavioral issues, safety and permanency are essential and linked to improved emotional and behavioral outcomes later in life. Preventing violence, healing trauma, and helping our children become well is a collective responsibility. Education and child welfare systems have an opportunity to assess and intervene, have skilled and devoted staff that can support healing and healthy development, and can add both credibility and resources to any initiative designed to reduce/eliminate violence.

+ Schools of Public Health

As we understand violence as a health issue, schools of public health will be at the forefront of the movement. Universities at large, but specifically schools of public health, must lead the way in research documenting the impact violence has on communities and applying public health methods in violence prevention. These schools will fund faculty, research, and trials that are engaged with violence as a health issue. Furthermore, this funding will be used for research and evaluation of health-informed violence interventions, the development of a coordinated network of higher education institutions that support local and regional violence prevention efforts, and the development of certification for violence prevention coordinators with the aim of establishing centers for violence prevention research that are regionally based. Most importantly, these schools will develop curricula to promote the health understanding of violence, and provide funding for further research on the subject. Education that identifies violence as a health issue, as a socially-determined behavior, is critical to inspiring future leaders in this field.

+ Community Information Systems

Funding will be provided for the further development of a health-based surveillance system that collects data from multiple sectors on incidences of violence and their treatment. The Centers for Disease Control and Prevention’s National Violent Death Reporting System (NVDRS) is utilized to gather and report data in 40 states, and this system will be expanded and built upon— states and communities will have increased resources and access to this data. The CDC currently funds Injury Control Research Centers (ICRCs) and National Centers of Excellence in Youth Violence Prevention, both of which conduct research and gather data that is useful in addressing violence nationwide. These funded programs will be used as a foundation and model for an expanded, more comprehensive and collaborative system of research and training that will play an integral role in the violence as a health issue movement.

Across sectors, further methods for reporting, collecting, sharing and using data on all forms of violence will be established. This information will be used to generate cost-benefit data and predictive analytics that will be used to prevent and reduce violence across communities. Institutions with health-based data reporting systems already in place will adapt those systems to include data on violence. The health sector and health representatives will publicly present their data and findings. This surveillance system will not only make data on violence more accessible to the public, but also guide the violence prevention effort moving forward.

+ Law Enforcement and the Justice System

Current policies and practices reflect the clear, but unrealistic assumption that fixing the problem of violence is the responsibility of the criminal justice system. We cannot arrest our way to a less violent world. The health understanding of violence must inform criminal justice sector policies and practices. In fact, many health practitioners, in particular public health departments have convened community conversations and/or provided health-informed recommendations to help inform the justice sector. These conversations have led to an array of strategies including addressing trauma in new and existing law enforcement officers to prepare and respond to past, present and future stress. The approach will be used on an individual level— training police, corrections, and probation officers, parole boards, judges, prosecutors, defense attorneys, and attorneys general— and, more generally, to increase the use of effective and innovative programs like pre-booking diversion and restorative justice approaches such as drug courts and youth courts. Further, law enforcement departments will help provide real time information and referrals to health and related professionals to be used to detect conflicts, prevent violence, and treat trauma. This support must also be made available to the recently incarcerated populations to prevent recidivism, promote health and maintain safety. Preventing violence is critical in reforming our criminal justice system as 50% of people in prison are serving time for violent crimes and many others involved in the system have been impacted by exposure to violence.

Funding will be provided to support innovative health-criminal justice efforts to work together to reduce violence. These funds, which will include matching funds from the local justice system, will support the development and implementation of officer training focused on trauma and the history of racial disparities, the incentivization of de-escalation strategies rather than force, the hiring of intervention specialists and case workers who address violence as a health issue, and the implementation of strategies that employ trauma-informed health alternatives to arrest. Current criminal justice responses to violence, which typically utilize suppression and punitive practices, are proving to increase adverse conditions and risk factors in marginalized communities. This funding for health approaches will have the intended effect of treating and eliminating patterns of behavior that promote violence as well as reducing ineffective and inappropriate imprisonment for preventable crimes of violence. Prioritizing an explicit focus on addressing the inequities produced within our current systems and incorporating the health-centered approaches to violence into law enforcement and the criminal justice system is critical in reducing racial inequities and creating opportunities for healing.

+ Faith-Based Institutions

Churches and other faith-based institutions often lie at the heart of communities, and thus are positioned to assume a central role in violence prevention and treatment efforts. These institutions are often trusted and respected by community members and deeply engaged in community efforts. As such, they have a unique ability to connect people, both to each other and to services and resources. Many FBOs have the ability to define and promulgate what is or is not acceptable. This is particularly true in the case of acceptability or norms around intimate partner violence as well as the role and treatment of women. They also provide a physical space where issues of violence will be discussed and mediated, and where education of the public on the causes and effects of violence will occur. Many churches provide an established structure for community mobilization that will be drawn upon and incorporated into the movement to end violence. Public health departments will work with local faith-based institutions and provide them with resources and training for violence prevention.

One example of a successful faith-based health system is the Catholic Health Initiatives (CHI), which unites its facilities and communities across the country in efforts to bring about healthier communities through the prevention of violence. CHI has a foundational commitment to building a culture of nonviolence and peace, rooted in its Catholic heritage. Over 45 CHI sites across the US are currently implementing community-based violence prevention programs, using a collaborative, multi-sector approach.

+ Media

The Institute of Medicine states, “It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural and physical environment conspire against such change." This statement is relevant to every sector discussed in this framework, but has particular relevance to news media, which often shapes perception and norms. Violence is mostly discussed in the news as a random, episodic phenomenon that takes place at the individual level. The challenge with this framing is that random problems—like natural disasters—are not preventable. According to a Berkeley Media Studies Group study, violent crime is covered more frequently than prevention - with stories of murder being 6 times more frequent than stories of community violence or community safety.

As referenced previously, the current rhetoric regarding violence is moralistic - bad people in bad places committing bad behaviors with the answer being punitive actions. To make real progress, it is critical that this narrative shift to one in which violence is framed as a preventable and treatable behavior. Under this framework, coverage will include reporting on how violence spreads and causes trauma with an emphasis on systems/structures that contribute to conditions that prevent or perpetuate violence in order to hold them accountable. Secondarily, though still important, media will highlight examples of individuals and communities who have changed their behavior or shifted norms and situations in which violence has been averted. Partnerships between public health and the media have shown success in changing behavior through social campaigns to reduce tobacco use, prevent HIV, and prevent various types of accidents. A recent example of the media sector working with the health sector to prevent violence is Futures Without Violence’s Changing Minds Campaign, which raises awareness regarding the effects of violence exposure on the brain and the need to intervene to promote healing.

Advocates can use the media as a tool to change policy (media advocacy). The media will play a critical role in promulgating the health understanding of violence. The media has the power to assist community effort to achieve policy and environmental changes that ensure sustainability and hold decision makers accountable. The media (specifically news media) has a history of voluntarily establishing codes of conduct for itself that have been helpful in preventing the spread of violence. Just as it has tempered its coverage of suicides to prevent copycat suicides, it is recommended that a similar protocol be established for reporting on other forms of violence. This protocol will be based on the scientific understanding of how violence spreads and how exposure – including media exposure– facilitates this spread.

Additionally, producers of movies, television, music, interactive video games, pornography (physical and verbal violence are the hallmark of mainstream online pornography) and all other forms of media that provide entertainment will be held to a higher standard with regard to acceptable portrayals and levels of violence in their programming. They will be encouraged to counter the culture of violence and to become part of the solution, looking for ways to promote equity and build resilience to violence in our society while framing violence as unacceptable. As the narrative begins to shift so will social norms.

+ Cross-Sector Collaboration

There is a great need for different sectors to connect and collaborate to provide holistic assistance to those at risk of violence, to make resources from multiple sectors available, and to institutionalize a true change in our nation’s understanding and approach to violence and its prevention. This cooperation will happen at all levels and be facilitated through regular cross-sector meetings to exchange information and develop coordinated responses. Cross-sector collaboration will also focus on particular sectors that have natural linkages in their work as it relates to violence prevention with leadership coming from health leaders such as the local health department, universities, or nonprofit organizations with expertise in this area. One example of a successful cross-sector cooperation is the Street Violence Response Team in San Francisco, which convenes weekly meetings with senior representatives from the mayor’s office, police department, community-based workers, public health department, child and family services, housing, education, probation and district attorney’s office. Another collaborative approach that has worked in multiple communities is the hospital-based violence prevention model, which connects victims of violence to appropriate community-based organizations for ongoing services and support. Connecting the hospital to the community allows for a full retaliation-prevention and trauma treatment response by deploying workers to all locations where people are affected. This integrated health system, with hospitals that are connected to their communities and healthcare that is linked across other sectors, will lead to healthier, more equitable communities.

The health sector will also be responsible for connecting with schools, law enforcement, and social services to ensure that responses to violence within each context are health-centered. Connecting schools affected by violence to health systems will ensure that they receive the help that they need to prevent the development of violent behavior and its associated health issues. Connecting police to health systems will provide additional resources for police to use when responding to violent situations; the health system will also provide treatment when police are traumatized by their experiences. Finally, connecting social services to the health sector will ensure that those who are seeking help for issues that may expose them to violence– such as substance abuse, poverty, and unemployment – are connected to trauma treatment services.