1. Introduction

The high and continuing levels of community violence in cities across the United States have garnered the attention of diverse publics including law enforcement, academic researchers, community residents, elected officials, social workers and public health professionals. Gun violence is of particular concern as homicide rates are high and firearms are the most used murder weapon.

Chicago, one of the nation’s most popular cities and tourist attractions, is also one of the nation’s cities with the highest rates of gun violence and deaths. According to data reported by the Chicago Sun-Times, one of the City’s major newspapers, Chicago had more murders than any other US city in 2020 (Charles, 2020). The number of murders in Chicago in 2020 totaled 50% more than the 506 number in 2019 and almost twice the number for New York City and Los Angeles combined. Shootings also increased significantly from 2,120 in 2019 to 3,237 in 2020 (Charles, 2020).

The victims of community violence in Chicago are disproportionately young Black men and the majority of shootings and murders occur in neighborhoods on Chicago’s south and west sides (“Tracking Chicago homicide victims”, 2021). Poverty, low educational attainment, and poor health outcomes including shorter life expectancy are concentrated in these neighborhoods and resources to support community health and well-being are few, inadequate or nonexistent. These harmful and life-threatening conditions and events produce trauma and lasting effects on the functioning of the neighborhoods’ children as well as adults.

Addressing the problem of gun violence is a priority for many different groups. Thoughts about measures that should be given priority in dealing with the causes and outcomes of community violence differ considerably, however, and often depend on the group advocating change or the persons holding positions of power or authority. This is the case even when there is general consensus that community violence is, as the Centers for Disease Control and Prevention indicates, a serious public health problem. In Chicago, for example, different police commanders have called for long prison terms for persons caught with guns as the best solution for the problem. Groups more cognizant of trauma producing events and oriented to providing individual services demand funds for more mental health clinics and case management services as a reasonable approach. Still others advocate a broader population strategy that focuses on violence prevention and interruption, or one that combines a public health approach with social work services including individual help, trauma informed care, and community advocacy.

Acclivus, Inc. (Acclivus), the organization that is the focus of this report, is a not-for-profit community-based social services organization that operates primarily on Chicago’s south side. Acclivus focuses specifically on violence prevention and interruption through three major programs: hospital response, community violence prevention and prisoner reentry. The organization’s flagship program is a hospital response program that provides services to connect patients who are gunshot victims with resources that reduce the risk of violent reinjury and further involvement in community violence. The program was created in 2005 under the leadership of CeaseFire, later named Cure Violence, an internationally recognized public health, violence prevention model developed by research practitioners at the University of Illinois Chicago. When the University Cure Violence unit decided in 2018 to focus on policy and research and end the provision of direct services, Acclivus assumed leadership for the hospital response program operations. The team leading Acclivus had been program leaders and longtime staff for both the University unit’s hospital response program and its community violence prevention and interruption program and services. Acclivus’ leaders maintained the foundation funding stream previously awarded to the University for the hospital response program when assuming responsibility and within a few months also established and obtained funding for the community-based violence prevention program. Prisoner community reentry services were implemented
in FY20.

Acclivus’ community-based violence prevention program operates in six Chicago communities characterized by high rates of gun violence. The organization also manages contracts with agencies providing similar services in four additional communities. The community-based program employs teams of street outreach workers and case managers to create a sense of safety in these communities and to provide assistance and support to high-risk individuals and their families.

Outreach workers respond to incidents of community violence (non-fatal and fatal shootings, etc.), meet with the individuals involved and provide support to prevent retaliation and minimize trauma. Case managers help persons access victim compensation resources and legal assistance, coordinate community-based support, and connect program participants to services to facilitate a healthy lifestyle and prevent further incidents of violence.

Access to Justice, the newest program, provides transitional and reentry navigation services to individuals re-entering the community after serving a prison or jail term. Community navigators work with program participants to develop and implement individualized plans that support their transition back into the community.

The CURE Violence program model developed under the University auspices and now used by Acclivus uses public health disease control methods and strategies to stop the spread of violence. A central feature of the model is the active participation of persons from the community as program staff, a concept advocated by the World Health Organization (Lehmann, et. al., 2007). Similar to Acclivus, several organizations and cities have implemented violence intervention programs using the CURE Violence model or aspects thereof, and extensive research and evaluation studies have been conducted. As might reasonably be expected, studies focus on program outcomes, i.e. whether the program reduces gun violence and deaths. (See, for example, studies by Butts, et. al., 2015; Skogan, et. al., 2008; Webster, et. al., 2013, and Whitehill, et. al., 2014.)

Although Cure Violence program descriptions and studies typically note basic features of the program such as identifying high risk individuals and changing social norms and make references to having “credible messengers’’ as key staff members, detailed documentation, systematic analysis and reports of how programs actually operate are rare. The personal and professional experiences and views of program staff are similarly missing, as are examinations of the leadership and decision-making structures guiding program operations. Sometimes outcomes beyond reductions in gun violence are reported, though understandings of how those results were achieved are seldom provided. The absence of these type data and their importance in understanding outcomes are sometimes identified as a study limitation by researchers reporting positive findings for outcome studies.

Answers to questions about the work processes, infrastructure, people, and decision making that organizations use to obtain positive outcomes can greatly enhance community capacity for addressing not only gun violence but also overall community health and well-being. At the organizational level documentation and assessment of an organization’s program strategies, community support and operating principles, similar to information on program results and outcomes, are important for organizational growth, development and sustainability. The understandings generated from these type studies can, in addition, help inform program decisions and current discussions about ways to advance racial equity and social justice in communities most impacted by gun violence.

This report provides an assessment of Acclivus’ service programs. Given the many studies of the effectiveness, over an extended period of time and in many cities, of the Cure Violence program model that Acclivus uses, emphasis is placed on process, or what Acclivus does and how, rather than on typical outcomes. The results are intended to inform decision making within Acclivus as well as to better inform other community violence prevention processes. The report follows a traditional evaluation report with sections on study questions, methods, findings, conclusions and recommendations.