Loading...
VPCSC PACKET 08-16-16 dkCITY OF Federal Way Violence Prevention Coalition Steering Committee (VPCSC) August 16, 2016 Regular Meeting Council Chambers 2:00PM-3:30PM 1. CALL TO ORDER 2. CITIZEN COMMENT a. (Comment limit—3 minutes) 3. COMMITTEE COMMENTS 4. COMMITTEE BUSINESS Topic Action or Info Presenter A. Approval of August 9, 2016 Action Chair Baxter B. Set timeline and goals Discussion Chair Baxter C. Objective of VPCSC Discussion Vice Chair Garrett D. Survey Questions Discussion Chair Baxter 5. OTHER BUSINESS 6. NEXT MEETING Regular Meeting—August 24, 2016 @ 3:00PM 7. ADJOURN * ADDITIONAL INFORMATION: Handouts • PowerPoint presentation to Council on crime stats and strategies for reducing gun crimes, presented May 12, 2016- (7 pages) • Federal Way homicide statistics, 2005 - 2016 (10.7 years) - (1 page) • Seattle Youth Violence Prevention Report, December 2015 - (71 pages) • Gun Violence in King County, Public Health Seattle & King County February 2013 - (20 pages) • Firearm Homicides in King County: Key Findings from Homicide Investigations, Public Health Seattle & King County October 2014 - (21 pages) • The Impact of Firearms on King County's Children: 1999—2012, Public Health Seattle & King County November 2013—(10 pages) Deputy Chief Kyle Sumpter, Police Department, 253-835-6701 Jeri-Lynn Clark, Executive Assistant, 253-835-2401 Violence Prevention Coalition Steering Committee MEETING SUMMARY August 9, 2016 @ 7:00PM Hylebos Conference Room Committee Members Present: Chair Doug Baxter, Vice Chair Lawrence Garrett, Alonso Aguilar, Mark Hendricks, Erin Herringshaw, Andy Hwang, Kira Kuetgens, Kelli Lauritzen, Dion Schell, Dr. Andre' Sims, Dianne Zoro Absent: Dr.Tammy Campbell, Zenaida Cruz Staff Present: Kyle Sumpter, Deputy Chief, Ryan Call, Acting City Attorney,Jeff Watson, Community Services Manager (CSM),Jeri-Lynn Clark, Executive Assistant to Council Citizens Present: None. 1. CALL TO ORDER The meeting was called to order at 7:13PM. 2. WELCOME&INTRODUCTIONS—Brian Wilson, Chief of Staff Mr. Wilson welcomed the committee members and discussed the agenda. Staff support will be provided by Jeri-Lynn Clark, Executive Assistant to Council. Committee members introduced themselves and provided background on their experience and why they are a part of the committee. 3. VPCSC MISSION -Brian Wilson, Chief of Staff "Liaison with the community to formulate and submit recommendations to the Mayor and Council by November 1, 2016 regarding what is needed to reduce incidents of violence in the Federal Way community." 4. OPEN PUBLIC MEETINGS ACT(OPMA)—Ryan Call,Acting City Attorney Mr. Call reviewed the OPMA with the committee members and discussed the rules for quorums, emails, and meetings. 5. SELECTION OF CHAIR—VPCSC Mrs. Clark opened up nominations for Chair and Vice Chair. Nomination for Chair: Doug Baxter—nominated by Dianne Zoro & Lawrence Garrett Lawrence Garrett— nominated by Andy Hwang&Andre Sims Discussion occurred between nominated members; Mr. Baxter agreed to be Chair and Mr. Lawrence agreed to be Vice Chair. Mr. Sims motioned to approve Doug Baxter as Chair of the VPCSC, Mr. Garrett seconded, motion passed unanimously. Ms. Zoro motioned to approve Lawrence Garrett as Vice Chair of the VPCSC, Ms. Herringshaw seconded, motion passed unanimously. 1i 6. MEETING DATES—VPCSC Meetings will be held on the 2nd and 4th Wednesday of each month from 3:00PM-4:30PM., Meeting space to be determined and committee members will be notified when the locations are confirmed. Meetings dates: 8/16/16, 8/24/16, 9/14/16, 9/28/16, 10/12/16, & 10/26/16. Community meetings will be scheduled at an upcoming Committee meeting. 7. OPEN DISCUSSION—VPCSC Discussions occurred regarding how will the Committee reach out to the community that doesn't attend the meetings. What is the area of focus for the VPCSC? What questions will we ask when we are out asking residents about their concerns? Do we divide the city up in sections in order to reach certain groups? Is our focus on specific types of violence or as a whole? Is the focus on the youth and their families? What about business owners who are victims of crimes? Chief Hwang suggested that the Committee narrow down its scope: How does the Committee make our community healthy and stronger? What impact to our community will be the greatest? Gun violence is generally with the 15-24 year old population (nationwide statistic). The younger generation tends to be more reckless and engage in that type of activity. Committee members will come to the next meeting with ideas and share feedback from community members that the Committee has spoken with. 8. NEXT MEETING Regular meeting on Tuesday,August 16, 2016 at 2PM, Federal Way City Hall,City Council Chambers. 9. ADJOURN -The meeting was adjourned at 8:25PM Attest: Jeri-Lynn Clark Exec. Assistant to Council Approved by VPCSC Committee: 2 1 , , , ; 4 . .. , , Police Department Crime Statistics & Trends Strategies for Reducing Gun Crimes Andy Hwang, Police Chief May 12, 2016 `„y,OF,,,, e Y AI y 0 Recent Homicides In a short span of time,we have had three homicides,which is very unusual for our community. • On Monday(May 9th)at 1:01 AM,officers were dispatched to an apartment complex at 1300 SW Campus Dr.for someone who had been shot. A male victim,26 years old,succumbed to his gunshot wound. • On Monday(May 9th)at 11:27 PM,officers were dispatched to a man slumped over the wheel in a parked vehicle, located at 2200 block of S. 333rd St. A male victim,27 years old,was found deceased. He had been shot. • On Tuesday(May 10th)at 11:12 PM,officers were dispatched to a shots fired call. Officers arrived and found a male victim,30 years old, lying in the sidewalk with gunshot wounds. Officers and firefighters performed live saving measures, but he succumbed to his injuries. 1 c} May 2016 Homicides r 0 Safety Precautions We recommend residents take extra safety precautions. For instance: • Avoid going out on foot late at night,especially in secluded areas such as trails. • When you are out after dark, be in groups. • If you see someone or something suspicious,call 911 and report it so officers can check it out. • Although none of these recent incidents involve a home invasion,as always we encourage you to take standard safety precautions,such as keeping your doors locked even when you're home. 2 ".OFF a e Crime Statistics - NIBRS lotivo Federal Way Total NIBRS Crimes 12000 _ 10000 eaoo - 6000 z000 o ;_ 2012 2013 2014 2015 2016' Per Capita Rate:105.7(89,460 pop) 106.8(89,720 pop) 104.9(90,150 pop) 99.4(90,760 pop) 'First Quarter 2016 Population Source:Office of Financial Management http:-,w v--.ofin.wa.govrpop/aprilli Federal Way Homicide Rate Federal Way Homicides 7 6 5 4 3 • +t00% -33% o•/. 2 1 2012 2013 2014 2015 2016° '2016 Total Homicides YTD:1/1/16-5/11/16 3 Federal Way Homicide, Robbery, .0110 and Aggravated Assault Homicide, Robbery, and Aggravated Assault 1st Qtr 2015 v. 1st Qtr 2016 90 80 �.._—. 70 - 60 50 40 30 20 10 — 0 1st Qtr 1st Qtr 2015 2016 a 2013-2016 Crime Statistics y. FOfRiI.Ww Involving Firearms FEDERAL WAY POLICE DEPARTMENT Crime Statistics Involving Firearms 2013-2016 Drive-by Assault with Homicide with Illegal Year Shootings Firearm Firearm Discharge 2013 6 13 5 10 2014 4 21 3 7 2015 6 24 3 12 2016• 5 11 1 7 *First Quarter 201.6 • June 2015 officers required to document all confirmed shootings 4 Surrounding Jurisdictions Comparison 2015 NIBRS Data - Homicides Tacoma 12 Auburn 7 Kent 5 Renton 4 Federal Way 4 Surrounding Jurisdictions Comparison 2015 Drive-by Shootings Tacoma 114 Renton Data Not Available Kent Data Not Available Federal Way 6 Auburn Data Not Available 0 20 40 60 80 100 120 5 What We're Doing • Media notification with each incident in order to inform the public. • Prioritized all of our resources to capture these offenders. • Re-allocated personnel to increase staffing in detectives. • Re-tasked uniformed personnel to focus on reducing gun crimes. • Using crime analysis data to direct uniform patrols at specific locations. • Ongoing Juvenile Delinquency Prevention Programs: — School Resource Officers,Commons Mall Officers,Special Operations Unit,Traffic School&Safety Programs,Explorer Scout Post,Youth Policy Academy,and Positive Tickets Program. 1.32 Partnering With: • Federal and state L.E.agencies to identify ballistic connections between inter-jurisdictional gun crimes. • Local,state,federal L.E. agencies/detective units for investigatory help. • King County Prosecutor's Office — Specifically on the recent homicide investigations;and — To identify,vigorously prosecute gun violence offenders. • Suburban King County Coordinating Council on Gangs, — Multi-jurisdiction,coordinated response to youth violence in suburban communities (prevention,intervention,suppression,and re-entry). • Public Health,"Safe Storage Saves Lives"campaign.www.LOKITUP.org — Reduce crimes done with stolen guns; — Reduce opportunities for children to be injured or killed(accident or suicide)by unlocked firearms. • Multi-family housing organizations to help reduce crime on/near those properties. Sign up for Safe City at www.safecityfw.com 6 Reward Crime Stoppers of Puget Sound 1-800-222-TIPS (8477) www.crimestoppers.com LID O • • N .4 * 0 N • e-1 0 • N MEI M a-1 0 N i I N 0 N u V V N 0 O H .x. O N a , lG �r1 N N w1 _ -a Ln ,_ca CU'a 0 N o = • LL -- 01 0 O N CO 0 0 N n O O N O 0 N V1 O 0 N Q1 CO N l0 111 d' m N e-1 0 Seattle Youth Violence Prevention Needs Assessment City of Seattle • Human Services Department December 2015 Edward B. Murray Mayor Catherine Lester Department Director �.S N:ATTLE.GOV/HUMANSERVICES Table of Contents Executive Summary 3 Introduction 8 I. Nature and magnitude of youth violence in Seattle ...10 A. Overview .10 B. Important definitions &notable data limitations 10 C. 2012- 2014 youth violent crime trends: incident data ...14 D. 2012- 2014 youth violent crime trends: offender data 16 E. Youth homicide 17 F. Gang Crime .19 II. SYVPI budget & services 20 A. SYVPI Overview .20 B. SYVPI Budget .22 C. SYVPI Enrollment 24 III. Gaps in SYVPI programming 27 1. Alignment of SYVPI &crime data findings 27 B. Alignment of SYVPI with risk factors 28 C. SYVPI operational&program design issues.... 33 IV. Promising prevention strategies & evidenced-based programs 37 A. General strategies to address youth violence ..37 B. Evidenced-based interventions ..38 C. Other strategies ..40 V. Potential opportunities for action .41 A. Sample primary, secondary, tertiary prevention strategies ...42 B. Current City investments in primary, secondary, tertiary prevention ...43 C. Moving forward: potential areas of opportunity ... .46 VI. General observations & conclusions 54 A. Systems Coordination ..54 B. Partnerships 54 C. Program design,monitoring,and evaluation ...55 D. Contracting for services ..56 Appendix A: Additional Crime Data 58 Appendix B: Common theories about contributing factors related to youth violence ...66 2 Executive Summary Background The Seattle Youth Violence Prevention Initiative (SYVPI) constitutes the City's core programming in youth violence prevention with an annual budget of approximately$5.8 million per year. SYVPI is intended to be a coordinated violence prevention and intervention program providing wrap-around services for youth between 12- 17 years who are involved in or thought to be at risk of becoming involved in violence. However,while SYVPI has been operating since 2009,it has been unable to clearly articulate how its program works to reduce youth violence. In 2013,the City Council asked the City Auditor to conduct an"Evaluability Assessment" of SYVPI with the goal of developing a rigorous evaluation of the program. In October 2014,the City Auditor issued a report by MEF Associates that concluded SYVPI could not be evaluated due to several operational and program design issues. MEF identified several issues that would need to be addressed before SYVPI could be evaluated (while MEF was asked to focus on an evaluation design for SYVPI,the problems it identified have broader implications for SYVPI's efficacy). MEF also recommended the City conduct a youth violence needs assessment. This report is in response to this recommendation. Findings A. City's current approach to youth violence lacks an overarching strategic vision The City's current approach to youth violence prevention lacks an overarching strategic vision that recognizes the complexity and multi-faceted nature of youth violence. A substantial body of research recommends viewing youth violence through a public health lens,which posits youth violence can be prevented before it occurs. Adopting a public health approach means viewing the problem from a systems perspective and recognizing the environments in which youth grow and develop have the ability to influence norms and behaviors. A public health perspective also acknowledges that no stand-alone program or entity can effectively address youth violence.Thus,an effective strategy will seek to identify the relative strengths and respective roles and responsibilities of different institutions and systems that play a role in youth violence prevention. Ideally,this will lead to more effective partnerships, the identification of shared goals,and improved service alignment and coordination across systems. B. SYVPI's programming is limited in scope SYVPI is largely focused on the provision of pro-social activities for individual youth between 12- 17 years. As noted in a recent City Auditor report on SYVPI,"While these services are important for youth who might otherwise have barriers to these opportunities, this strategy does not address issues with the criminal justice system or schools."' In addition,research has identified several risk 1 Office of the City Auditor,Seattle Youth Violence Prevention Initiative:Two Key Conclusions,October 14,2015 3 factors associated with youth violence,many of which SYVPI programming does not address (and will require more than a single, stand-alone program to effectively tackle). Several of these risk factors indicate a strong attachment to family and school is key, thus interventions focused solely on individual youth will have limited impact. Risk factors found to have a strong or moderate association with violent behavior include the following: • substance abuse • bullying perpetration Individual • impulse control • school connectedness School • child maltreatment • school climate • harsh parenting • community efficacy Family Community • parental drug use • gun availability • parent mental health Other aspects of SYVPI, such as case management and street outreach, depend on the ability of providers to develop positive relationships with youth over an extended period of time,which can be difficult outside the context of close coordination with key leverage points, e.g. schools, caregivers. In addition,many SYVPI program components are not available"on demand"and youth may not be immediately connected to services as a result. Aside from these issues,the MEF report documented numerous operational and program design problems with SYVPI. The City will need to decide whether it wants to invest in fixing these problems and then evaluate SYVPI accordingly, or re-think its current programming in an effort to develop a more comprehensive youth violence prevention strategy to directly address the risk factors outlined above. C. Crime data indicates several areas warrant special attention 1. 18- 24 year olds:The crime data indicates the majority of youth violent crime involves young adult males 18-24 years old. This cohort is also much more likely to be involved in homicide events, either as victims or offenders. 2. Juvenile domestic violence: A large percent of youth under 18 years are involved in juvenile domestic violence offenses involving a family member. 3. African American/Black youth: African American/Black youth are disproportionately represented in the crime data relative to their share of Seattle's population. 4 Potential Opportunities for Action When selecting specific interventions, the City,in partnership with the community and other stakeholders, should consider the following questions: – What risk factors resonate most in the community? – Where along the prevention spectrum—primary, secondary, tertiary—is there a desire to act? Prevention Spectrum Secondary Primary Prevention Prevention Tertiary Prevention (stop problems from developing) (early detection& (rehabilitation&reintegration) response) T + + T Prevention Prevention Intervention Re-entry Enforcement – Who is the intended target population? – What are the respective roles and responsibilities of other stakeholders and government jurisdictions that operate along the spectrum of prevention, e.g., schools,law enforcement, criminal justice,public health and mental health agencies,and non-profit providers? – Are there evidenced-based programs or strategies available to address the identified problems and target populations? These questions alone,however, are insufficient for identifying appropriate interventions. It will be difficult to make headway on youth violence without acknowledging the ways in which structural racism in systems and institutions limits access and opportunity,leading to inequitable racial outcomes for youth of color and their families.The issues surrounding youth violence also have a great deal of overlap with those related to the recent community dialogue around disproportionality in youth detention. To this end, the City should use its Racial Equity Toolkit to evaluate any substantial programmatic changes in its current youth violence prevention activities and in the creation of new programming. One key aspect of the Racial Equity Toolkit involves engaging those in the community who are most impacted by the particular issue in question. In this case,youth and families who are disproportionately impacted by violence should be consulted. Thus, the table on the following page, which summarizes potential opportunities for action,represents only a possible starting point of potential ideas for community dialogue and subsequent program planning.The emphasis is on system change improvements over specific programs and services, though the latter are important too and will need to be identified as part of an overarching strategy. 5 Potential Opportunities for Action Primary Prevention Stop Problems from Developing 1.Ensure all youth,regardless of income,have access to quality out-of-school-time programming 2.Continue to strengthen safety net for low-income families 3.Ensure Nurse-Family Partnership is reaching all eligible low-income first time mothers 4.Inventory existing family and parent support services provided by the City and its partners that seek to promote and build healthy parent-child relationships.Consider investing in family focused evidenced-based programs if these are not already available 5.Review the City's Families and Education Levy investments to identify additional opportunities to support and encourage whole school transformation efforts at Seattle Public Schools with the goal of improving school climate,discipline practices and policies,and teacher-student relationships 6.Consider providing support for schools to consistently implement evidenced-based curricula to reduce bullying,improve resistance to negative peer behaviors,promote healthy teen dating relationships,and reduce alcohol/drug abuse consumption 7.Work with school based health clinic providers to identify stronger referral pathways for youth in need of cognitive behavioral therapy and substance abuse treatment while partnering more closely with school administrators,parents and caregivers 8.Consider expanding school-based health clinics to cover all elementary and middle schools,which could help ensure strong referral pathways to services for youth and families 9.Carefully track implementation of Seattle's Preschool Program 10.Explore partnership opportunities with Seattle Public Schools to see what career supports can be provided to students who will graduate from high school but are not college bound 11.Continue to work on reducing access to illegal firearm possession 12.Continue to improve relationships between SPD and the community 13.Review community-led place-based crime prevention strategies and implement where appropriate Secondary Prevention Early Detection & Response 14.Work with partners to review referral and access points for youth who could benefit from substance abuse and cognitive behavioral therapy(CBT)to understand if and how connections are being made and appropriate services are available 15.Strengthen the City's case management services to ensure more consistent implementation of best practices, service quality,and youth experience 16.Consider developing case management approaches that involve parents/families 17.Focus secondary prevention efforts on Interagency Academy students 18.Identify effective strategies for addressing juvenile domestic violence 19.Review referral and access points for parents who need substance abuse and mental health treatment 20.Ensure trauma based therapy interventions are available that address family dysfunction and/or improve parent-child bonding 21.Work with Seattle King County Public Health to review existing mental health supports for youth and family and strengthen where appropriate 22.Determine how the City can best partner to support the Road Map Project's efforts to re-engage youth who have dropped out/are pushed out of school 23.Request the Seattle Police Department monitor and disseminate youth crime data on at least an annual basis 24.Consider asking SPD to issue an annual report on the number and nature of youth homicides Tertiary Prevention Rehabilitation & Reintegration 25.Work with Washington State DOC on re-entry alignment pilot 26.Collaborate with King County Juvenile Court to identify potential gaps in services for youth on probation (i or who have been released after a stay in detention 27.Review the City's programming associated with GOTS,CURB,Co-Stars General Recommendations The City currently funds various programs and services intended to foster healthy youth and resilient communities.These include but are not limited to,youth employment,recreation,high quality pre- school, K-12 investments, and Career Bridge,which the City should continue to support. In addition, as part of creating a more cohesive and strategic vision for youth violence prevention, the City could make more general changes to the way it does business that should help improve service quality and client outcomes across the board.These include: — Conducting an environmental scan of other stakeholder activities before creating new programs and initiatives to avoid replicating programs and services already being provided. — Improving internal coordination and alignment between City departments to avoid service duplication and working at cross purposes. — Implementing evidenced-based strategies where possible while piloting new ideas and incorporating a monitoring and evaluation plan upfront. — Creating a one-stop repository where City staff can access data on basic socio-economic, criminal justice, and equity indicators (education, health,etc.) that are reliable,current,and Seattle-specific. — Setting higher performance standards in City contracts tied to meaningful outcome measures and then holding contractors accountable for meeting them. — Creating a small fund to support and encourage promising new ideas as they arise,increasing the ability to act more nimbly and flexibly. — Investing in strategic capacity building so more community-based organizations can be in a competitive position to bid on City contracts. — Making more focused investments,as opposed to spreading limited dollars broadly or in a piecemeal fashion. — Strengthening the City's partnership with Seattle Public Schools. Conclusions The City cannot effectively address youth violence acting solely on its own. In fact,many areas that have an impact on this issue do not fall within the City's direct sphere of influence. In these cases, the City may want to consider how it can best support and work with its partners, or it may decide to focus resources on those activities where the City has more direct control. In either case,there is value in considering the roles and responsibilities of various stakeholders as the City's ability to prevent youth violence is partly dependent on the actions of others. Thus, a longer-term goal should be to identify a variety of appropriate strategies along the spectrum of prevention in concert with a range of stakeholders while clearly delineating roles and responsibilities and holding each other accountable for results. 7 Introduction What is a needs assessment? A needs assessment is intended to identify gaps in a current state or condition compared to what is desired. A needs assessment can be used to understand barriers and constraints associated with effectively addressing the needs of a particular target population or it can be used to identify gaps in operational and organizational capacities. This youth violence needs assessment is a bit of a hybrid in that it identifies several operational and conceptual issues associated with the City's primary programming for youth violence while also examining more broadly the needs of Seattle youth who may be involved in violent behavior or who are at risk of violent behavior. It also contemplates what the City's competitive advantage might be vis-à-vis other stakeholders while considering the research base for effective strategies. This report is organized to address the following points: I. What is the nature and magnitude of youth violence in Seattle? II. What services are provided by the Seattle Youth Violence Prevention Initiative (SYVPI),the City's core youth violence prevention programming? III.How well does SYVPI programming align with the crime data findings and risk factors? IV.What are promising prevention strategies and evidenced-based programs to address youth violence? V. Given the above,what are opportunities for action by the City? VI. Concluding observations and general recommendations. Methodology The information in this report draws upon the following data: 1. 2012-2014 crime data collected by the Seattle Police Department. SPD provided this data to researchers from the Center for Evidence-Based Crime Policy,Department of Criminology,Law and Society at George Mason University (GMU). GMU cleaned,analyzed,and organized the data into various violent crime categories.The data provided by GMU was then used to develop the charts and graphs provided in this report. 2. Information from the SYVPI database. SYVPI's database manager provided raw data from SYVPI's database.This data was then organized and analyzed to obtain demographic and enrollment information on SYVPI youth. 3. SYVPI historical documents and budget information. A review of SYVPI related information was also conducted,including past budget documents, summit financial reports, Council Central Staff memos,related legislation,and Office of City Auditor memos and reports.This needs 8 assessment draws heavily upon findings within the MEF Associates report issued in October 2014,Supporting a Future Evaluation of the Seattle Youth violence Prevention Initiative'. A literature review was conducted with a focus on reports and research institutions that consolidate and synthesize research on youth violence. The literature review also included a review of strategy documents created by member cities of the National Forum for Youth Violence Prevention as well as a review of several databases that identify evidenced-based violence prevention strategies. Several unstructured and semi-structured interviews and discussions were conducted with SYVPI staff,providers, and partners,along with other relevant stakeholders. A deliberate effort was made not to replicate the research already completed by MEF Associates,though many discussions led to additional insights into SYVPI's program challenges. Interviews were conducted with the following: — King County Juvenile Court Staff(3) — School administrators from Chief Sealth High School (2) and the Interagency Academy (2) — Chief Sealth High School students enrolled in SYVPI (4) — SYVPI case management agency supervisor (1) — SYVPI network coordinators and intake and referral specialists (6); — SYVPI street outreach supervisor (1) — Seattle Department of Parks and Recreation staff(2) — Seattle Youth Employment Program staff(1) — HSD case management staff who oversee SYVPI case management contracts (2) — Members of SPD's gang unit,including a tide-along(4) — SPD homicide detective (1) — SPD civilian employee working in SPD's domestic violence advocate program (1) — SPD School Emphasis Officers (2) — Department of Education and Early Learning staff(2) — Public Health Seattle King County staff(4) — Head of the City Prosecuting Attorney's Criminal Division (1) — Washington State Department of Corrections staff(1) — UW researchers involved in developing SYVPI's risk assessment tool (1) In addition to interviews, at least ten SYVPI meetings were attended,including three Whole Team meetings involving all SYVPI providers, four network coordination meetings, a case manager supervisor meeting, and numerous internal City staff meetings. Perhaps most illuminating was participating in real-time discussions with SYVPI staff and providers regarding issues and challenges associated with the risk assessment tool, engaging youth in services,internal communications among network providers, operational protocols,and data collection. Finally,between January and June 2015, there were several informal and on-going discussions with SYVPI management and staff regarding SYVPI operations. 2 Glosser,A.,Obara,E.,Dyke,A.,Harris,A,Kim,E.,Seattle Youth Violence Prevention Initiative-Evaluability Assessment,October 7,2014 9 I. What is the nature & magnitude of youth violence in Seattle? A. Overview This section of the report draws upon three years of Seattle Police Department (SPD) crime data from 2012-2014. Several takeaways from the data include the following: • The majority of youth violent crime offenders,regardless of crime type,involved young adults between 18-24. • Black youth were disproportionately represented in the violent crime data relative to their proportion of the population in Seattle. • A large percent of youth violent crime offenders under 18 years were involved in a domestic violence related crime. • The vast majority of youth homicide victims and offenders were between 18-24 years and male. • African American/Black youth were disproportionately represented as homicide victims and offenders. • Approximately 500 unique offenders per year were under 18 years while 1,100 were between 18- 24 years.These numbers include youth who were arrested and youth who were suspected of a crime but not arrested. • Approximately 80%of offenders under 18 years and 67%of offenders between 18-24 years live in Seattle with the balance originating from outside Seattle3. B. Important definitions and notable data limitations Important definitions and notable caveats and limitations associated with the SPD crime data are outlined below. In general,given the various limitations, caution should be applied when using the data for program planning purposes. How is youth violence defined in this report? Various definitions of youth violence exist,both in terms of the nature and scope of what constitutes violence as well as the age range of who is considered a "youth".The City's current youth violence prevention program, the Seattle Youth Violence Prevention Initiative (SYVPI), targets youth 12- 17 years old. This needs assessment adopts the Center for Disease Control's (CDC) definition of youth violence,which is defined as such: When a young person between the ages of 10- 24 years old intentionally uses force or power to threaten or harm others; Based on home addresses recorded by SPD. David-Ferdon C.,Simon TR.,Preventing Youth Violence:Opportunities for Action,Atlanta GA:National Center for Injury Prevention and Control,Centers for Disease Control and Prevention,2014. 10 Brain science research suggests young people's brains are not fully developed at 18 years. Risk-taking and impulsive decision-making do not automatically subside when a youth becomes a legal adult. From this perspective, the CDC age bracket of who constitutes a youth makes sense. Thus, references to "youth"in this report mean young people between the ages of 10-24 years while an "adult"means a person 25 years and older. Youth between 10-24 years constitute approximately 17%of Seattle's overall population of 641,000. The table below breaks out Seattle's 10- 24 youth population into two age grou i � by race (note: the 18- 24 category includes a large subset of college students who move to Seattle each year). 2014 Seattle Population Estimates by Age& Race 10-17 18-24 race/ethnicity # % race/ethnicity # Pacific Islander 359 i 1% Pacific Islander 540 I 1% American Indian/Alaskan Native 475 I 1%American Indian/ Alaskan Native 794 I 1% Multiple race 4,143 • 11%Black 5,118 ® 7% Hispanic(any race) 4,175 • 11% Multiple race 5,523 ® 8% Black 5,244 It 14% Hispanic(any race) 6,645 I 9% Asian 5,955 16%Asian 14,932 20% White 20,620 White 46,536 It's important to keep in mind that youth involved in violent crime offending 18 years and older are treated differently in Washington State's criminal justice system than youth under 18 years.The consequences of violent offending can be more significant for young adults between 18- 24 years and the challenges with re-entry can be more difficult. In addition,youth under 18 years are generally still in school,while most youth 18 years and over are either on the cusp of graduating or no longer in high school.This is an important distinction that has implications for the strategies and interventions selected in terms of where and how to reach and engage youth and young adults. At the same tim e, effective outh violence strategies start early in a child's life.Thus, the target population for certain strategies may be much younger than either teens or young adults who are currently involved in violent crime offending. What constitutes a "violent" crime? For the purposes of this report, the following categories,which are all felonies with the exception of simple assault, are classified as violent crimes unless otherwise noted: • Robbery • Rape • Homicide • Aggravated Assault • Simple Assault 11 Many of the above crimes have different"degrees" or levels of severity associated with them but these are not distinguished in this report. Brief definitions of each are provided below. Robbery:The taking or attempted taking of anything of value from another person by force, threat of force and/or by putting the victim in fear. Rape: When a person engages in sexual intercourse with another person by forcible compulsion. Homicide: The killing of a human being by the act,procurement, or omission of another, death occurring at any time,and is either 1) murder,2) homicide by abuse,3) manslaughter,4) excusable homicide, or 5) justifiable homicide. Assault: An unlawful attack by one person on another for the purpose of inflicting bodily injury.The type of assault is classified by degrees. In general, there are two types of assault. • Simple Assault:Involves bodily force or threat of bodily force with little or no injury to the victim. • Aggravated Assault:If a weapon is used, or if there is serious injury,or the threat of serious injury to the victim(s). Both the extent of the injuries caused,as well as the degree to which a victim was threatened (based on a reasonable person standard defined by case law), can influence whether an offense is deemed a simple or aggravated assault. It should be noted that simple assault is a gross-misdemeanor and it is not counted as a violent crime for the purposes of calculating a person's criminal history. Simple assault can involve a wide range of behaviors,including unwanted touching or harassing behavior in which no physical contact is made. Offenders include both arrestees and suspects To obtain a more accurate understanding of the size of the offending population,both offenders and suspects are included in the offender data. Offenders are suspects who have been arrested,while suspects have not been arrested but are thought to be involved in a crime based on various criteria used by police. For simplicity, the term"offender"used in this report refers to either an offender who has been arrested or someone who is suspected of a violent crime but has not yet been arrested. It is important to note that not all offenders included in the data would have been ultimately convicted of a crime. SPD collects limited race/ethnicity information SPD's data system captures only four categories of race: White;Black/African American;Asian;and Native American. Moreover, this information is based on the officer's best guess. Information is not available for other races or Hispanics/Latinos.This is a significant data limitation. For example,it is 12 not possible to distinguish between African American youth and Black youth of East African descent. Nor is it possible to determine the number of Hispanic youth,who may be counted as "White" or another race. Repeat offenders are included in most counts For the most part, the data in this report includes repeat offenders.That is,where offenders are being referenced, these numbers do not represent the number of unique individuals who are offending. A section in the appendix of the report,however, does disaggregate unique offenders from repeat offenders. Thus, this section should be consulted for question regarding the number of unique youth involved in offending. Note: GMU identified repeat offenders by looking at the number of youth who had a repeat offense within 12 months of their initial offense. Using a 12-month window makes sense with only a 3-year data set,but it likely undercounts the true number of repeat offenders in the data.This is because research indicates recidivism is more likely to occur within an 18 month windows. Incidents and offenders are different units of analysis The number of incidents is not the same thing as the number of offenders and these two categories should not be confused. Incident data is counting events while offender data is counting people. Incident data includes all events that involve at least one victims and/or offender 24 years old and younger. Multiple people could be involved in one event. Violent crime incidents prioritized by most serious offense Violent crime incidents can involve multiple offenses.The GMU researchers selected the most serious offense to define the incident. Violent crimes (assaults,robbery,homicide,rape) were prioritized over property and other crimes. All incidents classified as violent by the researchers and all offenders involved in these violent incidents are included in this report. Age groupings for data analysis differ slightly from "youth" While this report uses the CDC age range of 10- 24 years old in terms of who constitutes a "youth", GMU researchers disaggregated SPD's crime data by the following age brackets: 13 years and under; 14-17, 18-24. On average,the researchers found only seven youth under 10 years old in the data provided by SPD. With so few offenders under 10 years, there was little impact in leaving these youth in the dataset. 5 180 Workshop Program Evaluation,October 2014,King County Office of Performance,Strategy,and Budget 13 C. 2012- 2014 youth violent crime trends: incident data The next section focuses on SPD incident data,which counts events,not individuals. Events can include both offenders and victims. 1. Youth violent crime incidents constitute 16% of all youth crime Between 2012- 2014, 16%of incidents involving a youth offender were violent in nature. # of youth violent crime incidents vs. all youth crime incidents, 2012- 2014 9420 8122 7378 1466 1320 1235 #all crime #violent crime #all crime #violent crime #all crime #violent crime incidents incidents incidents incidents incidents incidents 2012 2013 2014 2. Youth violent crime locations mirror adult crime locations The following hotspot maps are useful to the extent they compare relative concentrations of crime.That is,an area with a small number of violent crime incidents can look"hot" compared to an area with even fewer incidents.The maps show the location of violent crime incidents and also include threats,harassment,and weapons offenses,broken out by age groups. all violent crime violent crime committed violent crime committed by youth 18-24 by youth under II PP •411 . 4 i .. . - 10, All* Apo imoor, . ''''' . k; YU"' . '''' ' pritop , .., ii, .....41 lit .. ..,_ Iralit ..._. , . 101% illit 14 3. Youth violent crime incidents are largely diffuse In general, the locations of youth violent crime incidents are spread across the city. Only a handful of census tracts have relatively high concentrations of youth violent crime incidents (see appendix A). Between 2012- 2014,the top three census tracts (out of 132 tracts) with the highest concentrations of youth violent crime experienced between 3%-6% of incidents (tract 81 in downtown Seattle, tract 75 in Capitol hill and tract 118 in southeast Seattle).The percent of youth violence incidents in each of the remaining census tracts was under 3%. 4. Simple assault was the most common youth violence incident The majority of youth violent crime incidents (offenders and victims)involved simple assault,which is a misdemeanor. The other violent crime categories (rape,homicide,robbery,and aggravated assault) are felonies. Rape and homicide comprised a relatively small share of youth violent crime. % of youth violent crime incidents by crime type, offenders & victims, 2012- 2014 22% 19% .03% . 2% Homicide Aggravated Assault Simple Assault Robbery Rape 5. A substantial P ercent of incidents were DV-related If certain crimes involve a family or household member, SPD will tag these crimes as domestic violence (DV) related. Between 2012-2014, SPD classified 41% of all youth violent crime incidents as DV-related. More than half of simple assaults and a significant portion of aggravated assault incidents were DV-related. %youth violence incidents involving domestic violence, 2012- 2014 Robbery IIME 5% Simple Assault 53% Aggravated Assault 42% Homicide 11111 4% 15 III D.Youth violent crime trends: offender data This next section examines youth violent offender data,including offender demographics and crime types. 1. Most offenders were male, 18-24, & either Black or White Between 2012-2014,youth 24 years and under comprised 30% of violent crime offenders. While the youth violent offender profile varies by crime type and demographics,overall, the following observations can be made based on information recorded by SPD: — Nearly 2/3 were male — 84%were either African American/Black (45%) or White (39%)6 — 43%were involved in a DV-related offense, primarily simple assault — 18-24 year olds were the largest youth violent crime offender group,regardless of crime type %youth offenders by crime type and age, 2012- 2014 13&under 14-1- 18-24 simple assault 65% aggravated assault 69% homicide :; 91% robbery ir 58% rape 10% 4 'r1 2. The number of offenders has decreased Between 2012 and 2014,youth violent crime offenders declined by 20%. Annual # of youth involved in violent crime 2633 2277 2129 Y2012 Y2013 Y2014 6 As SPD race categories are limited,the extent to which White offenders include other races/ethnicities,is unknown. 16 3. The number of youth violent crime offenders was relatively small The number of unique (non-repeat) violent crime offenders between 2012- 2014 was relatively small. These numbers reflect both youth who were arrested and not arrested (suspects). Moreover,not all youth who were involved in a violent crime offense in Seattle live in Seattle.Approximately 20%of youth under 18 years and 33% of youth between 18-24 years had a home address outside of Seattle. • The average annual number of unique offenders under 18 years was approximately 521 youth,approximately 1.4%of Seattle youth population between 10- 17 years. • The average annual number of unique offenders between 18-24 years was 1,097 young adults, approximately 1.5% of Seattle's young adult population between 18- 24 years. While these numbers suggest a small share of Seattle's youth population is involved in violent offending, the repercussions from violent offending, for both victim and offender, can be severe. Thus,these numbers should not be used to minimize the problem but to bring greater focus on identifying those youth at risk. E.Youth homicide 1. Offenders While the vast majority of youth violent offenders were involved in robbery,aggravated assault, and simple assault,it is worthwhile to examine homicide more closely given the severity of the crime. Between 2012- 2014: • 44 youth offenders were involved in a homicide,constituting approximately 35% of all known homicide offenders of all ages. • The vast majority of youth offenders involved in homicide were between 18-24 years. • For the 41 homicide offenders where gender was recorded, 66%were male and 34% female. • Blacks were disproportionately represented in the homicide offender population, comprising 0 0 55/o of offenders while making up just 7/o of Seattle's 18-24 population. g Pl 1' p • The majority of youth homicide offender's victims were also youth,primarily 18-24 years. % and number youth homicide % and number of youth homicide offenders by age,2012-14 offenders by race,2012-14 91% 55% 34% 11% 9% 40 © 24 14-17 18-24 unknown Black White 17 Between 2012- 2014,SPD recorded a total of 78 homicides in Seattle. This number includes adults and youth. 74%of homicides involved a firearm. Between 2012- 2014: • The majority of homicide victims were adults 25 years and older (51/78). • 27 out of 78 homicide victims were youth under 25 years. • 26 out of 78 youth victims, or 33%,were killed by a youth offender • The vast majority of youth homicide victims were between 18-24 years old. • For the 25 youth homicide victims where gender was recorded, 80%were males and 20%were females. • For the 22 youth homicide victims where race was recorded, Black youth comprised the majority of homicide victims. youth homicide victims by age,2012- %of homicide victims by adults vs. 2014 youth status,2012-2014 18-24 89% adult 65% 14-17 ! 4% youth 35% 13& under 7% and number of youth homicide victims %homicide victims killed by a youth by race, 2012- 2014 offender,by victim age,2012-2014 48% 25+ 35% 26°o 19°o 7% 18-24 62% \sign Black White unknown under ti 4% 18 18 F. Gang crime For various reasons,SPD reports that it does not keep records of the number of gangs and suspected gang members in Seattle,and thus,it does not have reliable statistics on gang-related violent crime'.The following observations are based on interviews with SPD's gang unit and other readily available information. • A lieutenant from SPD's gang unit believes today's gangs are relatively fluid in nature,both in terms of membership and location. It is not unusual for young gang members to change affiliations or allegiances.This is a change from the type of gangs active in Seattle in the 1980's and 1990's,when several California gangs operated in Seattle. In addition, over the years,more gang activity has migrated south of Seattle's borders.The lieutenant further believes the majority of gang-involved youth under 18 years are not serious violent offenders but often engage in behavior that mimics older gang members. • SPD's homicide unit believes four of the nine youth homicides in 2014 were gang related.All four suspected gang-related homicides involved black male victims between 19- 24 years who were killed by a gun. • The Center for Children and Youth Justice (CCYJ) published a report in January 2014 that examined the number and type of gangs operating in South King County. Of the ten gangs profiled in the report, five appeared to have some cross-over membership in Seattle,with two located"primarily in the Rainier Valley".Ages of gang members with some presence in Seattle ranged from 17- 25 years. Of the five gangs with Seattle membership,two were thought to comprise predominantly African Americans, two Hispanic, and one Asian.The largest gang was estimated to have 400-450 members while the smallest between 50- 75 members. Since all five gangs with some presence in Seattle also had members in other cities,it is difficult to know how many of these estimated gang members actually live and actively operate in Seattle. • In the CCYJ report,the King County Prosecutors' Office estimated approximately 40% of"high impact juvenile offenders" were gang-involved,or 28 out of 71 youth.As these statistics were for all of King County, some number likely lived outside of Seattle. • According to the 2014 Healthy Youth Survey,which is a national survey administered every other year in schools across the country, 6%of Seattle Public School 8th graders (-206 students) self-identified as gang involved. • In June 2015, a vice-principal at Chief Sealth High School estimated between 20- 30 students were gang involved,which is 1.6%-2.4% of Chief Sealth's 2013- 14 student population of 1,259. It is problematic to draw conclusions about the scope and magnitude of Seattle's gang problem given the available data and conflicting statistics. Without on-going and reliable tracking of 7 There is no universally accepted operational definition of gangs or gang members.The National Institute of Justice notes many jurisdictions use definitions unique to their local circumstances.It is unclear if SPD has an official agreed upon operational definition. 19 suspected gang activity in Seattle,it will be difficult to effectively address problems and track progress if the issue itself is not well-defined or understood. In October 2015, the City Auditor issued a report with specific recommendations for improving SPD's data collection of suspected gang activity and identified how the City's investments in street outreach could be strengthened. II. SYVPI budget and programming The Seattle Youth Violence Prevention Initiative (SYVPI) constitutes the City's core programming in youth violence prevention. This section provides a general overview of SYVPI,including its annual budget,programming, and enrollment. A. SYVPI overview SYVPI is intended to be a coordinated violence prevention and intervention program providing wrap-around services for youth at-risk of violence. It was launched in 2009 and initially located in what was then called the Office of Policy and Management before it was transferred to the Department of Neighborhoods (DON) in 2010. Within DON,SYVPI fell under the oversight of the Office for Education,which in 2015,became the Department of Education and Early Learning (DEEL),where SYVPI is currently housed'. •r - SYVPI's programming is organized by three geographic SYVPI Network areas in Central, Southeast (SE),and Southwest (SW) Boundaries -- `' Seattle,which are referred to as the Central, SE,and SW "networks". The networks are intended to act as a "MM gateway and referral source for youth between 12- 17 years who are involved in or at risk of becoming • involved in violence. According to SYVPI,youth who ._ are eligible for SYVPI services should meet one of the f . following four criteria: I! ' 1. Convicted multiple times and released from supervision or under minimal supervision and at-risk to re-offend. 2. Arrested for crimes that do not meet juvenile detention intake criteria and released. 3. Middle school students at risk of chronic truancy (absent 9 or more days per semester) or have had "1".-77":-":":=7 ' ; multiple suspensions as a result of violent behavior. 4. Gang-involved youth. 8 SYVPI will be moved to the City's Human Services Department in 2016. 9 These criteria are not strictly adhered to in practice. 20 SYVPI's primary services are outlined below with the department responsible for program delivery or contract oversight indicated after each service category10: 2015 Contract Oversight and/or Program Delivery by Department • Case management HSD • Aggression Replacement Training HSD • Job training& employment HSD • Mentoring HSD • Street outreach DEEL • Community Matching Grants DEEL • Recreation DEEL • Network coordination DEEL Many of the above services are not available "on demand". For example,the majority of employment opportunities are offered during the summer,and Aggression Replacement Training (ART) is only offered 2- 3 times a year and serves approximately 38 youth in total,or 2.5% of SYVPI's enrolled youth. Thus,while a youth may be referred and enrolled in SYVPI, some period of time may pass before they are able to engage in any particular service or programming. SYVPI has also struggled to engage youth in SYVPI specific recreation activities. In addition to SYVPI's core programing,the Seattle Police Department funds four School Emphasis Officers (SEO)who work in Denny,Washington,South Shore K-8,and Aki Kurose middle schools. SEO's are often shown as part of SYVPI's programming,but the connection between the SEO's work and SYVPI is not always clear. The SEO's refer youth to SYVPI, but the SEO's do not typically attend SYVPI organizational meetings and there is no feedback loop between providers and SEO's regarding SEO referred youth. SEO officers report a cordial but distant relationship with most SYVPI providers. '°The Mayor's 2016 Budget proposes to transfer SYVPI into HSD,which would serve to consolidate contract oversight within HSD. 21 B. SYVPI budget SYVPI's 2015 budget is approximately$5.7 million. Between 2009 and year-end 2015, SYVPI has or will have expended approximately$26 million. The graph on the left shows SYVPI's budget over time,including actual expenditures through 2014 while the one on the right shows 2015 expenditures by major program category. SYVPI budget 2009- 2015 (in millions) 2015 SYVPI Budget actuals through 2014 case management 1,059,890 youth employment 1,037,043 network coordination 1,025,331 5.17 director's office NOM= 686,832 5. 4.3 recreation MM. 450,000 street outreach 438,851 3.3 3.4 3.2 matching grants 263,125 database/db consulting 256,531 mentoring — 224,493 unallocated • 85,787 planning/evaluation ■ 75,000 1.3 aggression replacement training I 63,923 risk assessment tool I 31,334 2009 2010 2011 2012 2013 2014 2015 community education I 20,890 Since 201011, SYVPI's budget has grown by 73%. Through the City's annual budget process, the McGinn administration requested an increase of approximately$1.9 million for 2013 and$2.3 million in 2014,bringing SYVPI's proposed budget to nearly$5.3 million in 2013 and$5.6 million in 2014. The rationale given for the request was that more youth were enrolled in SYVPI than anticipated and the additional budget authority would allow SYVPI to expand the number of youth served from 1,050 youth per year to 1,500 youth (500 per network)12. Conversations with SYVPI staff suggest the projected increase in the number of youth who could be served was largely budget-driven; that is, SYVPI arrived at 1,500 youth based on the amount of available budget and associated services and slots that could be funded vs. an estimate of the number of youth at risk for violence. SYVPI's actual expenditures in 2013 and 2014 were approximately$1 million less than the adopted budget amounts of$4,952,282 in 2013 and $5,629,288 in 2014. The following table provides a brief description of SYVPI's primary program areas along with the 2015 budget,associated FTEs, and the number of youth expected to be served. 11 SYVPI's initial 2009 budget was deliberately under-budgeted in recognition of the time needed to ramp up. 12 SYVPI staff have indicated the request for an increase to SYVPI's budget was not initiated or desired by SYVPI staff. 22 SYVPI Key Program Components & Associated Staffing/Budget Targets/goals:# FTE Program/ SYVPI youth served 2015 Service annually* City Non-City Budget Description Network 500 enrolled per included in 13.8 1,025,331 Network coordinators recruit youth,conduct Coordination network(1500 total) City admin. intake&referral using risk assessment tool,help connect youth with other SYVPI services,provide limited direct youth programming. Case Management 319 included in 14.5 958,483 Case managers help connect youth to services and City admin. have been described as"life coaches"and "mentors". Youth 248(80%completion 1.3 6.25 922,591 Job training and internships for youth.Most jobs Employment rate) are available in summer.The City's youth employment program provides 45%of the slots while various non-profits provide the remainder. Mentoring Group mentoring:36 included in 3.1 216,835 HSD contracts with three mentoring agencies to youth(70% City admin. provide 1:1 mentoring and group mentoring. completion rate); individual:100 youth, with at least 50%of matches lasting 1 year Aggression 38(70%completion included in 0.78 63,923 A 10-week evidenced-based program based on Replacement rate) City admin. cognitive behavioral therapy principles. Provides Training(ART) training in social skills,anger control and moral reasoning.It has been shown to reduce recidivism when implemented with fidelity. Street Outreach 90 youth served at any included in 7.3 438,851 Street Outreach targets youth involved in gangs, (YMCA) one time City admin. violence,and juvenile justice system.Street outreach workers work to engage and connect youth to needed services. Office of Arts& 38 youth(78% 0.25 n/a 114,452 90 hours of work readiness training Culture Youth completion rate) Employment Community —100 unduplicated induded in n a 263,125 Annual grant-making program.Funds various non- Matching Grants youth per year City admin. profits to provide programming specific to SYVPI youth,usually during the summer.Programs vary in length and hours.Average cost per youth is$2,630. Recreation at least 450 0.6 2.0 450,000 Up until 2015,the Department of Parks& unduplicated youth Recreation was SYPVI's primary recreation participate in one provider.SYPVI began contracting with the recreation program YMCA and the Boys and Girls club to also provide recreation in 2015.Programming varies. City n/a 4.8 n;'.i 612,452 Includes director,contract management,training, Administration administration. These are goals/targets vs.actuals 23 C. SYVPI enrollment This next section provides SYVPI demographic and programmatic information. This information is based on various extractions from the SYVPI database during June 2015 and thus represents only a snapshot in time. For the purposes of this report,programmatic and demographic information that refers to "currently enrolled"youth are youth who were enrolled in SYVPI as of June 23,2015. 1. Youth demographics As of June 23,2015, approximately 1,420 youth were enrolled in SYVPI. 55% of currently enrolled SYVPI youth are male and 45% are female. The average age is 16.5 years. The majority of SYVPI enrolled youth are African American/Black13. Approximately 17%of youth are Hispanic14. % currently enrolled SYVPI youth by race Asian/mixed I 0.5% White/mixed I 1% US Indian II 1% Native Hawaiin/Pacific Islander ■ 2% blank • 2% White IN 4% Asian MI 5% Black/mixed MIN 8% other 13% Black 62% 2. Overall enrollment and exit trends SYVPI has enrolled approximately 3,217 unique youth over the life of the initiative. Approximately 2,000 youth have been exited from SYVPI over the 6.5 years it has been in operation,including 400 youth who have been exited and re-enrolled in SYVPI,i.e., enrolled a second time's The following chart shows how many youth are currently enrolled in SYVPI and how many have been exited by the year in which they were initially enrolled. For example,in 2009,a total of 617 youth were enrolled and since that time, 573, or 93% of those youth, have since been exited while 42 youth remain enrolled. As shown, a greater number of enrollments occurred in the early years as SYVPI was ramping up and fewer in more recent years as youth who were previously enrolled continue to remain on SYVPI's docket. Approximately 55% of SYVPI's currently enrolled youth were enrolled prior to 2014. 13 SYVPI providers do not consistently ask youth to self-identify their race/ethnicity.Thus,it's unclear to what extent the demographic data is an accurate reflection of how youth self-identify. 14 Approximately 13%of Hispanic youth are reported to be Black or Black/mixed,9%White,and 76%"other". 15 2009-June 2015 24 SYVPI youth enrollment status by year enrolled 1 209 169 «■ 82 2009 2010 2011 2012 2013 2014 2015 •currently enrolled I exited 3. Program & service enrollments The total number of program and service enrollments average approximately two programs per youth. In reality, some youth are enrolled in more than two programs while others are enrolled in fewer than two. The percent of youth enrollments by program category is shown in the chart below. This includes all enrollments over multiple years depending on the length of time a youth has been in SYVPI. %of SYVPI enrollments by program category for all currently enrolled youth, spans multiple years case management 23% recreation 22% employment 17% mentoring 15% street outreach 10% community matching grant 9% ART 4% It should be stressed that enrollment in a particular program or service does not reflect actual youth program participation or completion. To illustrate this point,it is useful to examine enrollment and participation rates for SYVPI's recreation programming in 2014. Information in SYVPI's database indicates approximately 239 youth were enrolled in a recreation program in 2014. Yet,according to SYVPI staff,only 93 unduplicated youth participated in a SYVPI sponsored recreation program in 2014. Both the enrollment number (239) and the actual participation number (93) are much lower 25 than the goal set by SYVPI,which is to have at least 450 unique youth per year participate in recreation programming(budgeted at$450,000)16. Unfortunately,in most cases,because the City has not required providers to track youth participation and completion rates in the SYPVI database,it's not possible to readily compare youth enrollment numbers to actual participation and completion rates. For this same reason,it would be difficult and time consuming to try to reconstruct and verify this informationt7. 16 SYVPI in ge neral has struggled to engage Y outh in recreation-related activities; consequently,some network staff pay youth financial incentives to participate,a practice that should be reviewed if it is to continue. 17 In 2015,staff report that SYVPI began tracking recreation completion rates in the database,but this does not apply to other SYVPI P � g P PPY program components. 26 III. Gaps in SYVPI programming This next section examines the following: A. The extent to which SYVPI's target population and programming aligns with the crime data findings. B. The extent to which SYVPI services are responsive to various risk factors associated with youth violent offending. C. Operational&program design concerns related to SYVPI. A.Alignment of SYVPI and crime data findings The SPD crime data indicates at least two gaps in SYVPI programming: 1) domestic violence involving youth and family members,and 2) services for 18-24 year olds.This does not necessarily mean, however, that SYVPI is the appropriate mechanism by which to address these gaps. Moreover, some services already exist for youth domestic violence and"disconnected"young adults outside of SYVPI and these should be accounted for in the design of any new City funded programming. 1. Juvenile domestic violence Between 2012-2014,a significant portion of youth violence was DV-related. Earlier research conducted by the Seattle Office of the City Auditor indicated the majority of reported juvenile domestic violence for youth under 18 years involves a family member,as opposed to intimate dating partners'. Interventions to address juvenile domestic violence should involve family members as well as the offending youth.This type of intervention likely requires a licensed therapist who is in a position to mediate and address complex family dynamics, dysfunction and conflict.The referral points for engaging with youth and families experiencing this type of violence would likely involve training for police officers responding to calls for service as well as civilian staff with expertise in juvenile domestic violence who can help connect families to appropriate therapeutic services. 2. 18- 24 year olds As noted by the crime data,SYVPI currently enrolls youth 12- 17 years,though youth who enroll in SYVPI prior to their 18th birthday may continue to be served after they turn 18. In general, most of SYVPI's current programming is not appropriate for 18-24 year olds,who face different challenges and repercussions for violent crime offending than youth under 18 years. Moreover,it could be problematic, for a variety of reasons,to mix young adult populations who may no longer be in school and would be treated as an adult in the criminal justice system with youth under 18 years. 18 The nature of DV-related crime involving 18-24 year olds cannot be discerned from the data,thus,additional follow up research on appropriate interventions for this age cohort is needed. 27 Thus,if the City is interested in further exploring gaps in services for young adults 18- 24 year olds, it may want to consider an alternative delivery model apart from SYVPI. 28 3. Additional observations African American/Black youth • The findings from the SPD crime data indicate Black/African American youth are disproportionately represented in the violent crime offender data relative to their share of Seattle's population'. On this front, SYVPI has done a good job enrolling a large share of Black/African American youth into the initiative. Given that youth of color in Seattle experience a variety of disparities in health, education, and employment, continued focus on this population is appropriate. Areas for further research • The race data collected by SPD is extremely limited and therefore, the percent of youth SPD categorizes as "White"likely includes a certain percent of Hispanic youth'.Thus,while White youth under 18 years comprise the second largest offender group as reported by the SPD data, more precise demographic information is needed to understand this part of the offender population better. • Some SYVPI providers indicated there can be tension between East African and African American youth and consequently, some East African CBO's may be reluctant to refer their youth to SYVPI. Only one SYVPI case manager has an East African background and there are no SYVPI street outreach workers who speak an East African language.Thus,while there is anecdotal evidence suggesting some East African youth in Seattle (in itself a diverse group) are gang involved,it's unclear to what extent SYVPI is equipped to provide them with culturally appropriate services. In addition,while the SYVPI database allows for providers to distinguish between different Black and Asian populations, SYVPI providers do not reliably input this data so it is not possible to obtain an accurate understanding of these particular demographic groups and their enrollment in SYVPI based on information in the SYVPI database. B. Alignment of SYVPI with risk factors Research suggests youth violent crime offending is linked to a variety of"risk factors" that may increase a young person's propensity to engage in violent crime. Thus, many prevention and intervention strategies seek to reduce these risk factors. The risk factors linked to youth violence fall within several"domains",including Individual, Family,Schools,and Community.This view of youth violence is based on the belief that a youth's environment can influence norms and behaviors, either negatively or positively. It's important to keep in mind that risk factors are not predictive of 19 believe While this report does not attempt to explain the reasons for this disproportionately,some community members bee e Black youth are disproportionately targeted by police. 20 Currently,4-5%of youth enrolled in SYVPI are reported to be White and 17%are Hispanic. 29 violence but are thought to increase the likelihood of it. In addition, the risk of violence is greater for youth who experience multiple risk factors and few protective factors,which can have a cumulative and interactive effect'. 1. SYVPI investments related to individual domain risk factors The following risk factors associated with individual youth have been linked to violent offending by either the CDC or Child Trends, a non-profit,non-partisan research organization. • Substance abuse Per Child Trends (risk factors with moderate-high • Self-control association with violence) • Attention deficits,hyperactivity,learning disorders • History of early aggression • Deficits in social cognitive or information processing abilities • Substance abuse • Poor behavioral control CDC • Anti-social beliefs and attitudes • High emotional distress • Low IQ • History of violent victimization How well does SYVPI programming respond to individual risk factors? SYVPI's programming does not directly address many of the risk factors listed above. While SYVPI is almost exclusively focused on individual youth,much of its programming seeks to provide and engage youth in"pro-social activities"rather than address the specific risk factors outlined above. Perhaps SYVPI's most salient programming related to the individual risk factors noted above is the Aggression Replacement Training (ART) program. ART is a 10-week evidenced-based program that provides training in social skills,anger control and moral reasoning. It employs Cognitive Behavioral Therapy (CBI) principles and has been shown to reduce a youth's risk of recidivating when implemented with fidelity22. ART is only expected to serve approximately 38 SYVPI youth a year and receives the least amount of program funding. According to the MEF report,most SYVPI youth who participate in ART are referred by their school,which sometimes require students to enroll in a behavior modification course as part of disciplinary action. 21Moore,KA.,Stratford,B.,Caal,S.,Hickman,DT.,Schmitz,H.,Thompson,J.,Horton,S.,Shaw,A.,Preventing Violence, A review of Research,Evaluation,Gaps,and Opportunities,Child Trends,February 2015,p.i 22 Washington State Community Juvenile Accountability Act and Quality Assurance Committee,Evidence Based Programs Effective Practices,January 2011. 30 SYVPI also has three other program components that may indirectly address some of the above individual risk factors (though without further review, this is largely speculative).These three program components,Big Brothers Big Sisters mentoring, case management,and street outreach, are described briefly below. • Big Brothers Big Sisters: Big Brothers Big Sisters mentoring program supports positive youth development by providing youth with a caring adult role model. Although it is not directly focused on addressing problematic youth behaviors related to violence,the mentoring approach used by Big Brothers Big Sisters has been shown to have a positive impact on youth behaviors. • Case management: Case managers help connect youth to services and have been described as "life coaches" and"mentors". SYVPI funds 14.5 case managers through various community based organizations with a capacity to collectively serve 319 SYVPI youth at any point in time. This constitutes approximately 21% of the 1,500 SYVPI youth who can be enrolled in SYVPI. SYVPI does not have consistent criteria or written protocols in place to guide decisions about which youth are referred to case management.The MEF Report noted that SYVPI providers suggested youth are referred to case management if they have issues with school,are court- involved,or need"out of network services", such as mental health counseling and substance abuse treatment.Thus,SYVPI youth assigned to a case manager youth should,at least in theory, have an increased likelihood of being connected to needed services to address behavioral health or substance abuse issues. SYVPI,however, does not have a reliable tracking system in place to systematically monitor youth and ensure they receive and complete needed services • Street Outreach: SYVPI funds six street outreach workers through the YMCA's street outreach program. Street outreach workers attempt to develop relationships with harder to serve youth involved in gangs,violence,and the juvenile justice system. The goal is to develop a trusting relationship so outreach workers can eventually persuade youth to engage in needed services. Currently, street outreach workers generate the majority of their own referrals (as opposed to Y g 1 tY ( PP receiving referrals from SYVPI's Network Coordinators).The six outreach workers have a total caseload of 90 youth who can be served at any point in time. It is unclear to what extent these programs are connecting youth with needed therapeutic services. It can be a significant challenge to persuade teens to engage in these types of services, especially outside the context of family or school involvement. Moreover, since SYVPI's programming consists primarily of pro-social activities,behavior and mental health related services would typically Y P � Y be provided"out of network". SYVPI providers,however, do not consistently track out-of-network services in SYVPI's database, so it is not possible to obtain reliable information on the extent to which youth have been successfully connected to these services. Y Y 31 2. SYVPI investments related to family domain risk factors The following risk factors associated with a youth's family have been linked to youth violence. • child maltreatment • harsh parenting Child Trends (risk factors with moderate-high association • parental drug use with violence) • parent mental health • poor monitoring and supervision of children • low parental involvement • poor family functioning CDC • poor parent-child emotional attachment • parent criminality • low parental income and education How well does SYVPI programming respond to family risk factors? SYVPI does not fund any direct services for parents or families, though some of the non-profit agencies contracted to serve SYVPI youth also have therapeutic services available for the broader community. In theory, these agencies could offer"out-of-network" services (non-SYVPI contracted services) to families of SYVPI youth. Discussions with SYVPI staff,however, suggest family outreach is inconsistent and occurs infrequently, so it's unclear how families would be connected to out-of-network services offered by SYVPI providers. At least one case management agency contracted to serve SYVPI youth conducts home visits for youth assigned to their caseload,but most case management agencies have no policies or protocols in place for doing home visits and many indicated they prefer not to do them. That said, even if SYVPI created a more formal family engagement strategy, this would not address the family-related risk factors outlined above. Moreover,it's unclear if SYVPI's current delivery model could be effectively modified to be responsive to family related risk factors. Given the myriad and unique needs of families at different points in time,adopting a"systems perspective" may be more effective than a singular program. This would require the City and various providers and partners to strengthen and increase referral pathways and align and coordinate evidenced-based services and programs that are responsive to a variety of needs and situations, e.g. parenting classes,mental health and substance abuse treatment,education and employment services, etc. These services would not only address several of the risk factors noted above,but produce various benefits beyond violence prevention. 32 3. SYVPI investments related to school domain risk factors Youth under 18 years spend a great deal of time in school. School environments can have a significant impact on youth,both in terms of their feelings of attachment towards school,peer group formation,and academic performance. Risk factors associated with the school domain include: • bullying perpetration • school connectedness Child Trends (risk factors with moderate-high • school climate association with violence) • anti-social peers • low commitment to school • school failure • social rejection by peers CDC • lack of involvement in conventional activities • gang involvement • association with delinquent peers How well does SYVPI programming respond to school risk factors? While SYVPI recruits youth from central and south end schools, SYVPI providers have varied and inconsistent relationships with specific schools in their networks. Several SYVPI providers identified a close working relationship between one particular middle school and an SYVPI network,but this is not the norm. And while some case managers and SYVPI providers report helping youth with individual goals related to academic performance, SYVPI is inherently limited-- through no fault of its own--in what it can do to address the bulk of school domain risk factors. Successful strategies to address school climate and connectedness will require the consistent implementation of school-based curricula related to behavioral expectations and youth problem- solving skills. It will also involve whole-school transformation efforts designed to reduce suspensions and expulsions and minimize their adverse impacts on youth. Thus,individual external efforts to assist youth with school-related risk factors will have limited impact if larger school climate and discipline issues are not addressed at the school/district level. 33 C. SYVPI operational and program design issues The preceding sections identified gaps in SYVPI programming relative to the crime data findings and the various risk factors associated with youth offending. This next section outlines several operational and program design concerns raised about SYVPI over the years. Moving forward,the City will need to decide whether to invest additional resources to fix these issues, or whether to reconsider its current approach as part of a broader overhaul of the City's youth violence prevention investments. SYVPI's strengths include the following: — SYVPI has done a good job building strong relationships between the City and Federal agencies that work in youth violence prevention. As a result of these outreach efforts,the City has been invited to become part of the National Forum for Youth Violence Prevention. — SYVPI has been pro-active in pursuing additional grants and forming research partnerships, including work with University Washington researchers to create a risk assessment tool. — SYVPI has excelled in enrolling African American/Black youth into the initiative and working with a diverse mix of community based organizations who are passionate about their work. Over the years,however, the City Council's policy staff and the Office of the City Auditor have raised questions about SYVPI's ability to prevent youth violence.These questions were largely prompted by the following concerns: 1. Several components of SYVPI's programs and services have weak or no connection to evidenced-based violence prevention strategies and much of SYPVI's programming is focused on youth development opportunities, such as jobs,recreation,and mentoring(which should, theoretically,be available to all youth in the City). 2. SYVPI's average costs per enrolled youth are high,approximately$8,125 per youth'. (In contrast,a promising Cognitive Behavior Therapy intervention in Chicago costs $1,200 per youth.) 3. SYVPI has been unable to articulate a plausible and consistent theory of change that demonstrates a link between SYVPI's activities and programming and its selected outcome measures (reduction in juvenile court referrals and school suspension rates). That is,it's difficult to see how SYVPI's approach and activities directly exerts a positive influence on these selected outcomes.These outcome measures, moreover,are impacted by a variety of external actors, policies,and conditions,many of which have more direct influence over these outcomes than SYVPI. Yet various iterations of SYVPI's theory of change do not account for this or attempt to identify what SYVPI's unique contribution may be in reducing violence. 23 Based on 3,200 unduplicated youth served and$26 million spent or budgeted from 2009-2015 34 Consequently,in 2013,the City Council directed the City Auditor Office to hire an independent evaluator to assess the feasibility of conducting a rigorous evaluation of SYVPI. In October 2014, the City Auditor released a report authored by MEF Associates (referred to herein as the "MEF report") that identified a host of problems related to SYVPI's program design and implementation24. Many of the observations documented in the MEF report echoed the City Council's initial concerns and have implications that extend beyond the question of SYVPI's evaluability. Specifically,the MEF report found SYVPI: — Does not clearly explain how its program design and various components exert influence over the desired outcomes. — Is unsubstantiated with empirical evidence that clearly defines and measures the problem it seeks to address. — Lacks an infrastructure of policies,procedures and mechanisms to implement a systematic and holistic approach, one that includes a systematized referral,intake,and assessment process,matching of clients with appropriate services,and an exit procedure.25 While the MEF report focused on whether SYVPI had the necessary structure in place to be evaluated (it concluded it did not), the questions raised in the report have implications that extend beyond SYVPI's evaluability. One primary question raised in the MEF report is whether SYVPI as a whole is greater than the sum of its separate services and programs: "Our work suggests that, despite the intended function of the Networks—to coordinate services, components, and local resources— we observed a lack of communication across Networks and a lack of a unified infrastructure that is consistently applied to all Networks and providers.This limits SYVPI's ability to function as a singular initiative as opposed to serving as a provider of discrete services." 26 Here,MEF Associates is questioning the effectiveness of SYVPI's network approach,which is intended to coordinate youth services and track youth across providers. In practice,however,MEF Associates observed a lack of communication and consistency between networks,calling into question the coordination function of the networks. The MEF report also identified a host of additional SYVPI operational issues,including: — Vague and expansive entry criteria — Limited tracking of youth across providers — Varying and poorly defined approaches to client exits 24 Glosser,A.,Et Al. 25 Glosser,A,Et.Al..,p.18 26Glosser,A.,Et.Al.,p.Overview-2 35 — Misalignment between service mix and logic model — Lack of data systems to track outcomes and ensure adherence to initiative wide standards In addition, SYVPI requires youth to meet certain criteria and undergo a risk assessment to enroll in SYVPI.This might make sense if SYVPI's services were specifically tailored to the needs of individual youth and focused on addressing violence-related risk factors. However,because many SYVPI services (employment,recreation, mentoring,etc.) could benefit all types of youth,regardless of risk level for violent offending,it's unclear why a risk assessment is needed for youth to receive these services. Indeed,many services provided by SYVPI are available to Seattle youth through other means.That is,many Seattle youth have access to similar services, or even the same programming,without being enrolled in SYVPI,including the Seattle Youth Employment Program, mentoring,recreation,and case management27. Even in cases where services may be unique to SYVPI,it's not clear a network approach,where youth must first enroll in a network before accessing services,is the most efficient delivery model,especially if systematic coordination and tracking between program providers is absent. For example,street outreach workers generate almost all of their own referrals,yet youth must first enroll in SYVPI via the networks before they can access street outreach services.This represents an extra"hoop" for youth to jump through. Concluding Observations on SYVPI While it's often possible to fix operational problems if the leadership,will,and capacity to do so exists,the City will need to consider whether it should"double down"on SYVPI's current program model. SYVPI has been operating for nearly seven years and has yet to establish consistent operational protocols and metrics that would allow it to systematically track youth across providers, readily measure program participation and completion rates at an individual and programmatic level, establish consistent exit criteria, etc. Moreover, significant resources will be needed to address the operational issues that currently render SYVPI unevaluable. Of greatest concern,however,are conceptual flaws with SYVPI's underlying program design,which cannot be addressed solely through operational fixes.The MEF report found SYVPI's service mix lacked cohesion and consisted of services that were cobbled together primarily because they had already existed--as opposed to being the most appropriate mix of services for addressing youth violence.As stated in the MEF report: Our fieldwork raises concerns regarding the appropriateness of the various programmatic components included in SYVPI. While we heard from SYVPI management and staff that the goals... included a reduction of community-level youth violence, the services provided... center more on the personal development of individual youth. The service mix offered through SYVPI does not offer one cohesive model of programing that focuses on, for example, decreasing 27 Also provided by the City and/or other non-profits and youth serving organizations in Seattle. 36 suspensions and expulsions or decreasing community-level violence. As told to us by multiple staff and practitioners, the host of services included in SYVPI was pieced together because most had already existed in some form within the communities identified at the time of the development of SYVPI, or the programs already had city funding via other types of programs... thus many of the programs were included under the umbrella of SYVPI services due to convenience.' Aside from the findings in the MEF report,there are other reasons,perhaps even more compelling, for the City to re-consider its approach to youth violence prevention. Specifically, the City's current approach lacks an overall strategic vision that: 1. Effectively accounts for the complexity of the problem and the broader eco-system in which youth live and learn,i.e., families, schools, communities 2. Coordinates and aligns the City's own investments and actions across departments 3. Fully considers the roles and responsibilities of external partners That said, certain characteristics of SYVPI programming may be worth retaining in some form,e.g., Aggression Replacement Training and mentoring. In addition, SYVPI has done an outstanding job enrolling a large number of Black/African American youth. Given the disproportionate representation of African American/Black youth in the criminal justice system, coupled with documented disparities in education,income, and health,a continued focus on African American/Black youth (and other youth of color) will remain paramount. The City,however,may want to consider a different delivery model that would enable youth to directly connect to needed or desired services rather than being required to enroll via a network,which may in some cases pose more of a barrier to certain services rather than a facilitator. 28 Glosser,A,Et.Al..,p.23 37 IV. Promising prevention strategies & evidenced-based programs This next section outlines the elements of a successful youth violence prevention strategy. It also identifies several specific evidenced-based programs thought to be effective in preventing youth violence. A. General strategies to address youth violence While the knowledge base continues to evolve,an ample body of research on effective youth violence prevention strategies has accrued over the years. A public health approach to prevent youth violence has gained widespread credibility and traction among researchers and practitioners alike. A public health approach posits that youth violence can be prevented before it occurs. Adopting such an approach also underscores that no single government entity or stand-alone program can effectively address the myriad facets associated with youth violence. Thus, stakeholders (schools, courts,law enforcement,public health,local and regional governments, social services,and community based organizations) are encouraged to coordinate and align specific evidenced-based strategies along the "spectrum of prevention" continuum to increase information sharing,avoid costly and inefficient service duplication,and ensure gaps are covered29. Spectrum of Prevention Secondary Primary Prevention Prevention Tertiary Prevention (stop problems from developing) (early detection& (rehabilitation&reintegration) response) V Prevention Prevention Intervention Re-entry Enforcement The spectrum of prevention includes two general areas of action: — Strategies that stop youth violence before it occurs. — Strategies that respond to youth violence after it occurs. Within these two broad areas are gradations for action,often distinguished by primary, secondary, and tertiary prevention strategies. Research indicates certain personal characteristics,risk factors,and 29 The term"spectrum of prevention"is used in a variety of public health contexts and includes different models depending on the context.The"Spectrum of Prevention"graphic contained herein is modeled after one contained in the City of Minneapolis'youth violence prevention strategic plan and is used primarily for illustrative purposes. 38 trauma can all play a part in why a youth may become involved in violent offending and behavior (see Appendix B for more information).A large body of research also identifies programs and strategies thou g ht to be effective in responding to these challenges. Several online clearing houses consolidate and disseminate information on effective, evidenced-based interventions. In general, the CDC believes a successful youth violence prevention strategy will comprise the following: • Strategies and policies that promote safe and healthy institutions and settings in which young people grow and develop, e.g. schools, homes, communities. (In other words, not just focusing on individual youth). • Leadership from different stakeholders with varying skills,perspectives, and areas of expertise. • Evidence-based prevention approaches found to be effective through rigorous evaluation. In terms of the last point,in order for a program or strategy to be deemed"evidenced-based",it should undergo several rigorous evaluations in different settings with different participants.As noted by the CDC, several youth violence prevention programs have met this test: "A strong and growing research base demonstrates there are multiple approaches to preventing youth violence that are cost-effective, scientifically supported, and proven to work." The National Forum for Youth Violence Prevention (NFYVP),a consortium of communities and federal agencies committed to reducing youth violence, encourages similar strategies. The NFYVP states the following three principles are necessary to have an impact and make the most of limited resources. • Multidisciplinary partnerships are key to tackling this complex issue—police,educators, public health and other service providers, faith and community leaders,parents,and kids, must all be at the table. • Communities must balance and coordinate their prevention,intervention,enforcement and reentry strategies. • Data and evidence- driven strategies must inform efforts to reduce youth violence. B. Evidenced-based interventions Once an overarching strategy is developed, the next step will be to select specific evidenced-based programs and interventions to address the identified priorities.The Child Trends graphic below highlights several evidenced-based programs to address various risk factors associated with youth violence. 39 Proven Programs by Target Age Source:Child Trends'LINKS Database Birth 5 10 15 18 24 Pali (:c,mmutntlt: ~' thar('are LiftSkill;Training Pnsirivc \corm PR(h'Pl..R 1 PROmoting School-community-university • • Partnerships to Enhance Resilience G,i,,d lirhastrr(,amc&PAX(;,x Kl Brha+ior Gana — -- --.*--�—...— Multisysrcmic Therapy ♦--+ Il \ I.:u4 r hip I.I.x.m,.n Through 1rhknr Ih•,c6pnxvtr) P.\THS }--� I'rr.rrn,nry;\Irrrninvr Malang srrart-pcs -SRN ..• u.- GRENI Fri Nurse-1-arnih I(.ans Rtst<nnct 1,docannn and Trammtii Pattnrr'hip l Second Step steps d, Child Parent I 1(t•spcet Psychotherapy f PHIS.Pusnire Rehasi.,r l Intersentwris and Support) �-- PoSinte Parenting Pt ntcam;Triple 1') 1.--• • (mg-time Beh.0 turd Therapt :CBT■ • According to the CDC, the more effective youth violence prevention programs entail behavior modification interventions for youth (problem-solving,impulse control, and anger management skills) and relationship-building interventions between caregivers and children30. Universal school based prevention programs, such as Life Skills Training and Good Behavior Game, teach conflict resolution skills and change how youth think about violence. Evidenced-based programs that fall under this domain can result in a 15%reduction in violent behavior31 Evidenced-based programs focused on improving parenting practices include Strengthening Families, the Incredible Years, and Guiding Good Choices. In addition,nurse-family partnership, a home visitation program for low-income first time mothers that promotes parent-child bonding and healthy parenting practices,garners frequent mention in the literature as having secondary benefits on reducing youth violence. The Washington State Institute of Public Policy (WSIPP) has calculated the benefit-costs of several programs included in the Child Trends graphic and found a positive return on investment for many. For example,WSIPP estimated that for every dollar spent on Life Skills Training, $11.50 is saved on avoided downstream costs'. 30 CDC Grand Rounds:Preventing Youth Violence,February 27,2015,p2 31 David-Ferdon C,Simon TR,Preventing Youth Violence:Opportunities for Action,p12 32 David-Ferdon C,Simon TR,Preventing Youth Violence:Opportunities for Action,p27 40 Many effective interventions that tar g et individual youth behavior are based on cognitive behavioral • therapy (CBT) techniques,which have been shown to be effective in addressing impulse control issues, one of the primary risk factors in the Individual Domain. Two Chicago non-profits developed an in-school and after-school program called Becoming a Man (BAM) that is grounded in these principles. BAM specifically aims to address "social cognitive skills",including emotional regulation and interpersonal problem solving. A recent randomized control trial by the Chicago Crime lab indicates it is a promising strategy for reducing youth violence (and relatively inexpensive at$1,100 per participant). Other strategies Research on other types of programming and interventions is mixed;that is, some research found a positive link between violence reduction and certain types of programming while other research did not. Areas where this is the case include youth employment, street outreach and gang intervention programs. Employment To date,the bulk of research on the effectiveness of youth employment as a violence prevention strategy has been mixed. If done well,youth employment can have positive effects,but context and details matter.A recent Chicago study found that youth who participated in a summer employment program,where they worked 25 hours a week for eight weeks,experienced reductions in violent offending compared to youth who were not in the program33.The number of arrests for property crimes, drugs,and other nonviolent offenses did not differ between the two groups,however,and no differences were found in school performance.Yet,given the reduction in violent offending, the researcher involved in the study found the results "encouraging".The researcher also stressed the need for youth jobs to provide meaningful experiences, that is,youth jobs should come with high expectations and responsibility: "Youth are smart... They know when you're making work for them just for the sake of doing work. And you must imagine that that's a lot less rewarding...s34 Moreover,employment programs for youth should be designed to strengthen the youth's commitment to school, or at least not weaken it. For example,working long hours during the school year could have negative effects on academic performance and participation in after school activities. King County Juvenile Court staff also identified potential issues with employment for youth already involved in juvenile offending. Some youth may delay dealing with difficult issues,like substance abuse treatment,if they are distracted by a job. Or, a job may interfere with other important goals court-involved youth need to focus on, such as re-enrollment in school. In these cases,employment may be more appropriate as a reward for progress made towards other goals, as opposed to an intervention strategy in and of itself. 33 Heller,Sara B,Summer jobs reduce violence among disadvantaged youth,Science,December 5,2014 34 http://www.chicagomag.com/city-life/December-2014/How-a-Chicago-Summer Job-Program-Reduced-Violent- Crime 41 Gang Interventions According to the Bureau of Justice Assistance (BJA), some gang intervention strategies that focus on individual gang members and/or on the community have shown promise while others have been shown to be ineffective. Interventions that involve people working directly with gang members on the street to provide counseling and advocacy have been show to either be ineffective or increase gang crime (called a backfire effect)35. The BJA notes that the more effective gang intervention models will involve police, outreach workers,and probation officers who "team up" to work intensively with gang-involved youth36. In addition, the CDC underscores the necessity of preventing youth from joining gangs in the first place by adopting prevention strategies that address youth problem-solving skills, family functioning,academic performance, school safety,and violence in the home and community. Business Improvement Districts According to the CDC,Business Improvement Districts (BIDS) have shown some success in reducing crime. BID's work by addressing aspects of Crime Prevention through Environmental Design, (CPTED),which posits that changes in the physical environment, such as neighborhood order and maintenance, formal and informal social control, and community cohesion, can reduce violent crime. V. Potential opportunities for action This section outlines potential opportunities the City may want to consider when designing a more comprehensive youth violence prevention strategy. It also identifies,in general terms,related investments the City is already making. This section is organized as follows: A. Sample primary, secondary, and tertiary youth violence prevention strategies implemented by a variety of stakeholders in a community. B. Current City investments (in addition to SYVPI) that may have a direct or indirect impact on violence prevention. C. Potential areas of opportunity for the City. A. Sample primary, secondary, tertiary prevention strategies A brief list of"sample"youth violence prevention strategies follows. It should not be considered inclusive or exhaustive. Several sample strategies fall outside the City's direct sphere of influence. Thus, the City's ability to impact this issue in a comprehensive way is partly dependent on the actions of other stakeholders.The City may want to consider how it can best support and influence these stakeholders to adopt appropriate actions;alternatively, the City may decide to focus resources on those activities where it has more direct control. 3s https://www.bja.gov/evaluation/program-crime-prevention/gangs2.htm 36 In October 2015,the Office of the City Auditor released recommendations for improving SYVPI's Street Outreach programming and also included additional research on effective gang prevention and intervention strategies. 42 Sample Prevention Strategies (not City specific, assumes other partners) Domains Sample Primary Prevention Strategies Sto. Problems from Develo s in Individual a.Teach children problem solving,conflict resolution and socio-emotional skills at an early age b.Provide high quality pro-social out-of-school activities for all youth regardless of income,including recreation and skill-building activities,academic support,and job training that reinforces the importance of educational credentials Family c.Promote healthy parenting practices and strong parent-child bonding via Nurse-Family Partnership and other evidenced-based interventions d.Provide access to teen health services and birth control to reduce unintended teen pregnancies e.Increase access to socio-economic opportunities to support strong families and future parents f.Ensure parents and caregivers who may need extra help with parenting and supervision skills have access to relevant services,e.g.,Positive Parenting Program(Triple P) School g.Implement school-wide transformation efforts that pro-actively set consistent behavioral expectations resulting in a positive school climate and declines in school discipline h.Ensure all youth graduating from high school have a clear path forward for college or career i.Provide a set of consistent academic and mental health supports across all schools Community j.Improve relationships between law enforcement and teens k.Support improvements in community efficacy and socio-economic opportunities I.Reduce access to firearms Sample Secondary Prevention Strategies Early Detection&Response Individual a.Identify youth with substance abuse issues and connect them to treatment b.Provide cognitive behavioral therapy for youth who are exhibiting aggressive behavior,or who are having problems with impulse control,classroom disruption,and risky-decision-making c.Ensure appropriate counseling and trauma-based care is available for youth who have suffered from a traumatic event or situation Family d.Create strong referral pathways(schools,faith-based organizations,primary care providers)to identify parents who need substance abuse and/or mental health treatment e.Coordinate and align services and programming to address family dysfunction and poor parenting practices and identify ways in which families can be connected to services f.Provide Functional Family Therapy,Multi-systemic Therapy,and other evidenced-based intervention services for youth involved in the juvenile justice system* School g.Strengthen early warning systems to identify students needing more academic support or are at risk of 'dropping out h.Create a system of strategies and supports to re-engage students who have dropped out i.Implement tiered school-wide behavioral based prevention and intervention programming,such as Positive Behavioral Intervention Supports(PBIS),to identify and help students in need of more intensive behavioral interventions Community j.Implement a mix of placed-based community and law enforcement strategies in high-crime or hot spot locations 1 Sample Tertiary Prevention Strategies Rehabilitation &Reintegration Mobilize interdisciplinary,collaborative leadership teams convened by corrections agencies to guide reentry efforts Individual a.Offer services and job training to detainees prior to release b.Provide intensive post-release services for at least six months to those who need additional support, including job training,housing,mental health and substance abuse treatment c.Focus not just on job acquisition but retention as well Family d.Involve family members in transition efforts where possible School e.Connect individuals to vocational training and college __..__._._._........._.....___.......... Community f Work with the faith community to help with re-integration 43 g.Have a strong network of potential employers to call upon *King County Juvenile Court provides these services now.They are noted here to underscore these are evidenced-based programs. B. Current City investments The following section provides a brief description of related City's investments by domain. As services associated with SYVPI were discussed earlier, this section primarily focuses on other City investments. Similar to observations about SYVPI, some of these City investments do not directly address specific risk factors associated with youth violence but instead provide"pro-social" opportunities for youth. 1. Current City investments related to primary prevention The City has several investments in programming that could be considered primary prevention, though many of these are not specifically focused on youth violence prevention. Pro-social activities/Recreation: The City's Department of Parks and Recreation offers a wide variety of recreation and skill building programming and partners closely with many Seattle Public Schools to provide out-of-school time activities. The City's Families and Education levy (F&E) also provides some funding for sports activities at certain schools. HSD also funds several positive youth development programs specific to Seattle's South Park Neighborhood. Job training and employment: Several City departments offer job training,internships,and service learning opportunities for youth,primarily during the summer months. Nurse-Family Partnership (NFP): NFP is an evidenced-based intervention for first time low-income mothers. It entails frequent home visits between a nurse and a first time mother,beginning before birth and continuing for two years. NFP has been shown to be effective in promoting positive parenting practices and healthy parent-child bonding when fidelity to the program model is followed. Family Resource Centers (FRC): HSD oversees contracts for six FRC's in Seattle.The FRC's are intended to promote healthy families through parenting classes and support groups,parent-child play groups,resource and referral, family advocacy and community engagement events.While open to all, the FRC's primarily serve low-income families of color,including immigrant and refugee families. Four FRC's also provide services for pregnant and parenting teens. Seattle Preschool Program: Seattle's new preschool program is intended to provide high quality all day preschool with free tuition for families earning less than 300%of the federal poverty level.The preschool program is in the early demonstration phase,with 2,000 children expected to be served by 2018. Families and Education (F&E) Levy: The City's Department of Education and Early Learning manages the Families and Education levy,which provides supplemental funding to Seattle Public Schools with the goal of improving academic achievement and closing the achievement gap. The Families and Education Levy also helps support United Way's Parent Child Home Program which is a home visiting program for 2-3 year olds focused on early literacy. 44 Teen Health Clinics at Seattle Public Schools: The Families and Education Levy contributes approximately$5 million in annual funding for 26 school-based health clinics,which are managed by Public Health Seattle King County (PHSKC).The school-based health clinics are located in ten comprehensive high schools,seven middle schools (including a K-8), six elementary schools,Seattle World School,NOVA,and the Interagency Academy. The Middle and high schools are generally staffed with one full-time mental health provider (licensed clinical social worker), one full-time medical provider, and one full-time clinic care coordinator.The elementary schools do not have full- time staff. Business Improvement Areas (BIAS): There are currently ten BIA's in the city,which are supported by the Office of Economic Development. 2. Current City investments related to secondary prevention Once youth and families start to exhibit risk factors associated with violence,including family dysfunction,parent mental health problems, or youth involvement in violent offenses,other jurisdictions and stakeholders may become involved,including the Washington State Department of Social and Health Services, Child Protective Services, Seattle-King County Public Health (for alcohol/drug'and mental health treatment and services), King County Juvenile Court,and school administrators.That said,some of the City investments outlined below may be considered appropriate secondary interventions,though they are not specifically focused on youth violence. Most would appear to be related to or address individual-level risk factors. Youth/family mental health support: HSD provides funding for culturally appropriate mental health services for youth and their families who are not Medicaid eligible or do not have private insurance. HSD contracts with community-based agencies to "provide services at their offices,in community settings and in middle and high schools in Central, South and West Seattle. Mental health services are coordinated with case management,academic support,and other forms of assistance to youth and their families.s37 Case Management: Both DEEL (via the Families and Education Levy and SYVPI) and HSD contract with various non-profit agencies to provide case management services to youth who need help accessing services and navigating various systems. Mental health support for Seattle preschool students:The Seattle Preschool Program includes supplemental funding for students who may need additional mental health support. School-based health clinics:The school-based health centers,which receive 2/3 of their funding from Seattle's Families and Education levy,provide on-site mental health counselors. 37 2015 Youth and Family Empowerment Book of Business,Seattle Human Service Department 45 Restorative justice pilot project for young adults 18-24:The Seattle City Attorney's Office is currently sponsoring a restorative justice pilot program for young adult misdemeanor offenders between 18-24 years. Partnership with Harborview Medical Center: The City will be providing funds to Harborview's Injury Prevention&Research Center to pilot a hospital-based intervention for gun-shot wound victims. Earlier Harborview research indicated approximately 110 individuals are admitted to King County hospitals for gunshot wounds each year. Harborview found that gunshot wound victims are at increased risk of re-hospitalization for another firearm related or assault-related injury, future criminal offending,and being murdered within five years after their initial hospitalization. Intervening with this relatively small number of individuals has the potential to reduce their disproportionately high risk of recidivism,violence,and crime perpetration. 3. Current City investments related to tertiary prevention Between 2011-2014, the Washington State Department of Corrections (DOC) released approximately 400 adults annually in Seattle;many were involved in violent offenses. 91%were male. Only 44%of those released were supervised.Approximately 18% were homeless. HSD oversees two program areas that serve individuals over 18 years who have been involved in the criminal justice system (not necessarily violent crime offending).These include: GOTS. CURB,Co-STARS:These three programs serve adults 18 years and over who have a history of involvement with the criminal justice system including involvement with drugs, the sex industry or gang-related activities;are struggling with chemical dependency and mental health conditions;and are homeless. HSD contracts for services with three non-profit organizations that provide access to treatment,recovery services,housing, employment and training and case management support.The City's total annual investment is approximately$1 million. Collectively,these investments serve 175 adults per year. Career Bridge: Career Bridge was created to connect African-American men and other men of color who experience multiple barriers to employment,education and training with jobs,and other necessary support. Many Career Bridge participants have been involved in the criminal justice system. HSD contracts with the Seattle Urban League to implement the program. Career Bridge's annual budget is approximately$400,000. It serves 50 new adults per year plus 60-90 carry-over participants. 46 C. Moving forward: potential areas of opportunity for the City The following list identifies potential areas of opportunity for the City in primary, secondary and tertiary prevention. To the extent that some actions listed below are already being implemented,they are listed here if potential actions can be taken to improve current efforts. 1. Primary prevention opportunities Potential primary prevention partners include: — Seattle Public Schools — Seattle-King County Public Health — private and non-profit health care providers — non-profits and community-based organizations serving youth and/or families — faith based organizations — private foundations a. Ensure all youth.regardless of income, have access to out-of-school-time recreation opportunities: This could include the following activities: • Review the Seattle Department of Parks and Recreation (DPR) outreach efforts to low- income youth and families and make improvements as necessary. • Evaluate DPR's current strategies to obtain youth input into programming, ensuring feedback is collected regularly and systematically via diverse channels from families and youth of various ages with the goal of offering relevant and compelling out of school time programming. • Inventory DPR partnerships with Seattle Public Schools to ensure all interested students have access to recreational activities after school and during the summer. • Explore if there are ways to increase access for youth who qualify for free and reduced price lunch without filling out scholarship applications for individual programs. • Assess DPR policies to ensure they are not inadvertently preventing barriers to access. For example,DPR currently requires youth who attend late-night activities to have a photo-ID on hand. Some police officers reported this requirement reduces the number of youth participating in late night programming and is unnecessarily burdensome given officers are on-site. b. Continually work to strengthen the safety net for low-income families.This does not necessarily entail a new program per se,but better coordination and alignment of existing services and referral points for financial assistance,job training, crisis intervention,mental health treatment, housing services,etc.Adding new programs and services is sometimes the easier thing to do,but even when there is adequate funding,identifying, engaging,and successfully connecting families to existing services remains an on-going challenge. 47 c. Ensure Nurse-Family Partnership (NFP) is reaching all eligible low-income first time mothers. Seattle's NFP program has funding for 408 expectant mothers at any point in time. However, Public Health- Seattle King County (PHSKC),which administers the program on behalf of Seattle, has not been able to fully fill these slots.This is not due to a lack of demand. PHSKC estimates approximately 900 eligible low-come mothers in Seattle could benefit from NFP. But while PHSKC is currently reaching approximately 86%of eligible mother's 17 years and younger in Seattle (a superb take-up rate for this population),it has had trouble expanding beyond teen mothers. According to PHSKC staff, the primary challenge has been developing robust referral pathways,which PHSKC is working to address.The City should closely monitor PHSKC's progress to fully fill the current number of funded slots and once this has been achieved, assess any outstanding gaps. d. Inventory existing family and parent support services provided by the City and its partners that seek to promote and build healthy parent-child relationships. Consider investing in family focused evidenced-based programs, such as Triple P,if these are not already available.Triple P (Positive Parenting Program) is an evidenced-based program that provides parenting support and strategies for dealing with a range of behaviors for children from birth through their early teens. Some studies have found parents who use Triple P feel less depressed, stressed and use fewer harsh disciplinary techniques while other studies show Triple P slowed rates of child abuse and reduced foster care placements. e. Carefully track implementation of Seattle's Preschool Program (SPP). Scaling up a new, complex program is no easy task and there are sure to be bumps in the road and lessons to be learned. In general,the City should ensure it has systems in place to track its progress in growing the SPP so that course corrections and improvements are made in real-time. f. Ensure the Seattle Preschool Program has the necessary policies and training in place to support age-appropriate and fair and consistent discipline practices.The City is in a position to implement model policies across SPP providers to create welcoming,safe,and warm classroom environments in which positive behaviors are taught and modeled and discipline is age- appropriate and fairly and consistently applied. g. Review the City's Families and Education Levy investments to identify additional opportunities to support and encourage whole school transformation efforts at Seattle Public Schools with the goal of improving school climate,discipline practices and policies,and teacher-student relationships. School discipline is an on-going concern within the community and SPS is currently under investigation by the Department of Education for disproportionate discipline rates involving students of color. The longer students are away from school, the more difficult it is to catch up and stay engaged upon return. Even a relatively short-time away could have adverse impacts on school performance.The graphs below,based on data from the Office of Superintendent of 48 Public Instruction, shows that suspensions and expulsions have been declining overall, but a large number of suspensions continue to involve unspecified"other" offenses. Seattle Public Schools suspensions & expulsions by offense 1200 1000 800 600 400 200 'L!'0 _C C C C C C C C C C C C C O O O O O O O O O O O O O. . .o. o, a o. a. o. o. a. a. o. o. o. . o. o. a. N N N N N N N N Bullying tobacco alcohol drugs fighting violence violence Other w/o major w/o major w/major behavior injury injury injury •2010-11 •2011-12 •2012-13 •2013-2014 In 2014, 1,695 students (out of 51,744 students who were enrolled as of October 2014) had short-term suspensions and nearly 51% of these students were suspended more than once. The average length for a short-term suspension was four days. 447 students had a long-term suspension and 15% of these students were suspended more than once. The average length of a long term suspension was 42 days. Suspensions&Expulsions,Seattle Public Schools, #of unique students,2014 1685 447 14 short term suspensions long-term suspension expulsions Data Source:OSPI h. Consider providing support for schools to consistently implement evidenced-based curricula to reduce bullying.improve resistance to negative peer behaviors. promote healthy teen dating relationships. and reduce alcohol/drug abuse consumption. Some Seattle schools offer programs 49 to address these issues,but they are not consistently implemented across schools, nor does the District track which programs are implemented in what schools. i. Work with Public Health Seattle King County and school based health clinic providers to identify how health clinic staff can work with school administrators to create stronger referral pathways for youth in need of cognitive behavioral therapy and substance abuse treatment while partnering more closely with parents and caregivers. According to Child Trends,research indicates that"...School Based Health Centers are a preferred access point for care for teens from racial and ethnic minorities...,as well as for teens seeking mental health services.Teens reported they were 10- 21 times more likely to seek mental health services at a school based health center than a traditional HMO or a community based organizations...X38 j. Consider expanding school-based health clinics to cover all elementary and middle schools, which could help ensure strong referral pathways to services for youth and families. k. Strengthen high school transition support:According to a Road Map Project report, few college and career supports exist for students who graduate from high school but do not enroll directly in postsecondary education.39 Given that a large percentage of youth violent offending involves 18-24 year olds,many of whom are likely not in school and not working, high school transition planning for this population is key.The City may want to explore partnership opportunities with Seattle Public Schools to see what can be done to support graduating high school students who are not college bound. 1. Reduce access to illegal firearm possession: Between 2012-2014, 74%of youth homicides in the City involved a firearm. m. Continuing to improve relationships between SPD and the community,especially with teens and young adults. This may involve specific training focused on police interactions with teenagers and training in teenage brain development. n. Review community-led place-based crime prevention strategies, similar to the effort implemented in Rainier Beach as part of a Department of Justice Byrne Justice Innovation Grant, to determine whether these strategies may be worth replicating in other Seattle neighborhoods. 38 Moore,KA.,Stratford,B.,Caal,S.,Hickman,DT.,Schmitz,H.,Thompson,J.,Horton,S.,Shaw,A.,p.40 39 The Road Map Project,Building a Regional System to Reconnect Opportunity Youth,p.3 50 2. Secondary prevention opportunities When attachments to school and family start to fray, or when youth start to exhibit problematic behaviors,it is important to intervene early. Effective strategies will acknowledge and align with other institutions and relationships that impact youth. Many youth can be difficult to engage, thus, caregivers and schools should be involved whenever po ssible so that different leverage points can be used to exert positive influence. Potential secondary prevention partners include: — Interagency School (Seattle Public Schools) — Seattle-King County Public Health — State Department of Health and Human Services — King County Juvenile Court — King County and Seattle Prosecutor offices — private and non-profit health care providers — non-profits and community-based organizations serving youth and/or families — faith based organizations a. Work with partners to review referral and access points for youth who could benefit from substance abuse treatment to understand if and how connections are being made and appropriate services are available. One possible partner in this effort are school-based health centers. As part of the OJJDP's Pathways to Desistance study,researchers found substance abuse "stands out among the risk factors". Moreover, having a substance abuse problem exacerbated other risk factors linked to offending41.The study also found that treatment was more effective when family members were included and the process lasted more than three months. b. Identify possible partnership opportunities with Seattle Public Schools to provide on-site and cognitive behavioral therapy (CBT) interventions. CBT has been shown to be effective in addressing impulse control issues,one of the primary risk factors associated with youth violence. The City may want to explore with Seattle Public Schools whether and how to co-sponsor some type of school-based CBT classes or suite of CBT based services more consistently across schools to ensure all youth who could benefit from this service receive it. This work may involve reviewing promising practices elsewhere. One program worth highlighting is Chicago's Becoming a Man (BAM) program. BAM is an in- school dropout and violence prevention program for at-risk male students in grades 7- 12 in Chicago. According to the non-profit youth serving organization that developed the program, 40 Slowikowski,J.,OJJDP Juvenile Justice Fact Sheet,Highlights from Pathway to Desistance:A longitudinal Study of Serious Adolescent Offenders. 51 "BAM is grounded in research that shows a large share of homicides of Chicago youth stem from impulsive behavior—young people with access to guns "massively" over- reacting to some aspect of their social environment. This is consistent with a growing body of research showing that social-cognitive skills such as impulse control, future orientation, and conflict resolution are predictive of a wide range of key life outcomes such as school success and crime involvement." A randomized control trial by the University of Chicago found BAM reduced violent crime offending and increased school achievement.The Chicago Crime Lab website states that BAM costs approximately$1,100 per youth. c. Strengthen City-funded case management services to ensure more consistent implementation of best practices, service quality,and youth experience with the goal of developing individualized case management plans that address specific risk factors41. Clarification and expectations in the following areas is recommended: • Purpose and goals of case management,including a theory of change • Characteristics and presenting issues of youth who will benefit most from case management • Case worker's roles,responsibilities,qualifications and experience levels • A rubric of what successful case management looks like at various stages of youth engagement,including how and when to successfully transition youth from case management • Creating a quality assurance process to ensure all youth have a consistent and positive experience when working with a case manager d. Consider developing case management approaches that would involve parents/families. Initial engagement would likely begin with the caregiver in these cases instead of the youth. e. Identify effective strategies for addressing juvenile domestic violence.Work with the Seattle Police Department, the City's existing domestic violence experts, and King County (King County juvenile court and prosecutor's office) to identify effective intervention strategies for juvenile domestic violence and clarify roles and responsibilities. f. Review referral and access points for parents who need substance abuse and mental health treatment to ensure these connections are being made and services are being provided. g. Ensure trauma based therapy interventions are available that address family dysfunction and/or improve parent-child bonding. One example is Child-Parent Psychotherapy (CPP),an evidenced-based intervention for children from birth through age five who have experienced at least one traumatic event and as a result are experiencing behavior,attachment,and/or mental 41 Assuming this aspect of SYVPI is maintained 52 health problems. CPP is designed to restore the child's sense of safety and attachment and to improve the child's cognitive,behavioral, and social functioning by creating stronger parent- child bonds". h. Work with Public Health Seattle King County to review existing mental health supports for youth and family.The region's mental health system has a reputation for being fragmented and underfunded and consequently, difficult to navigate and access. i. Determine how the City can best partner to support the Road Map Project's efforts to re-engage youth who have dropped out/are pushed out of school. Youth are entitled to state funds to help them obtain their degree until they are 21 years. The Roadmap Project is helping to support the creation of a regional entry,referral, and navigation system for these youth to take advantage of this funding entitlement but there are challenges with re-engaging these youth and designing appropriate educational programming and supports. j. Focus secondary prevention efforts on Interagency Academy students. One population that is likely at elevated risk for violence,either as victims or offenders, are students at Seattle Public School's Interagency (IA) Schools. In the past year, three IA students have died by homicide and three by suicide. Many IA students have multiple and overlapping risk factors for violence and other negative life outcomes,including low attachment to school and family, substance abuse issues,homelessness,and involvement with the juvenile justice system.There are ten IA sites across the City,mostly in downtown or south Seattle with two sites serving incarcerated or detained Y outh. k. Request the Seattle Police Department (SPD) monitor and disseminate youth crime data on at least an annual basis so that baseline data can be tracked and stakeholders involved in prevention and intervention strategies will have access to reliable data.While SPD has made progress in using more data to help inform policing efforts,it does not appear to collect key metrics on youth crime on a regular and consistent basis. 1. Consider asking SPD to issue an annual report on the number and nature of youth homicides in the City. To the extent known,the report could address the circumstances surrounding each incident,such as location,relationship of victim and offender,victim and offender demographics, cause of death, etc. Given that some cases will be under active investigation still, the ability to publicize certain information associated with some cases may be limited. That said, an on-going accounting of even basic youth homicide data would be useful and the details of what this would consist of could be determined in collaboration with SPD. 42 Substance Abuse and Mental Health Services Administration(SAMHSA),National Registry of Evidenced-based Program and Practices,http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=194 53 3. Tertiary prevention opportunities Effective re-entry strategies should help youth and young adults successfully re-engage with their families, schools, and communities through education and job training/employment opportunities and a system of supports to address substance abuse,mental health,housing,and parenting assistance. Partners in tertiary prevention efforts include: — Washington State Department of Corrections (youth 18-24 years) — King County Juvenile Court (youth under 18 years) — non-profits and community-based organizations serving youth and/or families — faith based organizations a. Work with Washington State DOC on re-entry alignment pilot. The Washington State Department of Corrections is currently working on a pilot project in King County to align and coordinate the myriad re-entry programs available in King County. According to a DOC representative involved in this effort, the problem is not so much a lack of re-entry programs,but a problem of quality, coordination, and alignment. Seattle has been invited to participate in this effort. b. Collaborate with King County Juvenile Court to identify potential gaps in services for youth on probation or who have been released after a stay in detention. c. Review the programming associated with GOTS. CURB. Co-Stars,including the theory of change and the metrics used to track success. Consider conducting an implementation evaluation to gauge how well the programs are being implemented and obtain some sense of how well they are meeting identified outcomes. 54 VI. General observation & conclusions The following observations and conclusions speak more broadly to the City's policymaking, program implementation,and service delivery efforts,which impact the efficacy of a range of City programing and policies,including youth violence prevention. A. Consider role of systems coordination 1. Identifying and connecting youth and families with specific needs to appropriate services is an on-going challenge. This could be said about Seattle's social service sector in general. Thus, improved coordination and alignment across the City and service providers would itself constitute an effective strategy for preventing youth violence if, for example,more caregivers had access to evidenced-based parenting interventions and mental health counseling when needed,or more youth with impulse control problems and poor decision-making skills are connected to cognitive behavioral therapy programs. In other words, creating an overarching strategy based on a systems perspective is needed,with specific evidenced-based interventions made available through a variety of referral pathways and providers. B. Seek strategic partnerships 1. No single stand-alone program can prevent youth violence. Strategies and programs should recognize,and work in concert with, other institutions and stakeholders that play a role along the spectrum of prevention—schools, families,law enforcement,prosecutors,local and regional governments, community based organizations, non-profits,and youth. 2. Fostering and sustaining external partnerships is important,but equally important is the need for City departments to partner well with each other.Too often,departments don't acknowledge or recognize areas of overlap.This creates redundancies,which are inherently inefficient. 3. When considering new programs and initiatives, the City should conduct an environmental scan to determine the extent to which other jurisdictions and/or agencies are already delivering services to the target population. Too often, the City only assesses gaps in services based on its own investments,without considering what external partners are doing. For example, over the last several months, City staff have mentioned a desire to `do more re-entry'programming;yet Washington State DOC staff note the biggest challenge isn't a lack of programs--"if someone can't find a re-entry program in King County,they aren't looking hard enough"--but a lack of alignment and coordination and to some extent, efficacy. 4. The City may do well to invest its limited resources in fewer areas along the prevention spectrum,bringing a concentrated focus to its efforts, as opposed to spreading limited dollars broadly and/or in a piecemeal fashion. This will require creating strategic partnerships in which other stakeholders assume lead responsibility and are held accountable for progress in those arenas that represent their area of expertise and in some cases,legal obligations. 55 5. The City's comparative advantage will be in its ability to leverage dollars to fund primary prevention strategies, such as creating access to high quality preschool,supporting strong families through programs like nurse-family partnership and Triple P, and promoting healthy youth development opportunities more generally.That said,as the City is also responsible for public safety,law enforcement responses should figure into any overarching strategy. 6. School-based prevention strategies are critical as this is where youth spend a great deal of their time learning,growing,and socializing. School wide strategies involving whole school transformation approaches to student behavior and discipline,as well as the more consistent implementation of specific school-based curricula,could have a significant long-term impact. Thus,while the relationship between the City and school district has its challenges, the benefits for overcoming these challenges are significant. C. Build capacity for sound program design, monitoring, and evaluation practices within City and with City partners 1. The City lacks a central repository where staff can readily access current data on basic socio- economic,criminal justice,and equity indicators at a meaningful unit of analysis.This type of data is often needed to inform sound program planning. Yet City departments currently collect data in silos and usually for specific point-in-time purposes. It is often not widely shared and difficult to track down.This leads to constant re-invention of the wheel,which is time- consuming and duplicative.And while county-level data is often accessible from federal and state databases,there can be significant differences between Seattle and the county as a whole. Indeed, there can be significant differences between adjacent neighborhoods within Seattle.The City should consider creating a lean and dedicated staffing unit that can disseminate up-to-date, reliable data at a census block level (or some other meaningful unit of analysis) on a variety of indicators for use by all City departments. 2. The research recommends that organizations prioritize evidenced-based programs that have been shown to be effective in reducing youth violence.There may be,however,legitimate reasons for testing unproven ideas at times. When funding untested ideas, the City should pilot first and build-in a plan to monitor and evaluate upfront,which will help establish expectations regarding program performance. On-going monitoring and evaluation will also help policymakers make informed decisions about whether to continue funding. That said,it is often politically difficult for the City to roll back funding for programs once they are up and running,even if the program in question proves ineffective.The inability to reprogram existing funds represents a significant opportunity cost: of money that could be invested more effectively;of additional money that must now be found to seed new ideas;and finally,of clients who are not as well served as they could be,resulting in unmet needs and problems that continue unabated. 56 3. When creating new programs or strategies designed to solve difficult social problems, the City should exhibit more consistent discipline in applying sound program design principles. This starts with requiring such programs to be accompanied by a"theory of change". In general, a theory of change creates a collective understanding of the program goals,how they will be reached,and what metrics will be used to measure progress towards achieving identified goals. If done well, the exercise of developing a theory of change is itself valuable because it requires program staff to surface underlying assumptions about how the program will cause the desired changes to come about,in individuals, families,and/or communities. A theory of change should also address how many individuals need to be served,what type of services are needed and in what amount, and who should deliver them and in what setting. An inability to come up with a clear and convincing theory of change that is both plausible and realistic (in terms of an intervention being able to influence the outcomes) suggests the program will not be able to deliver on the desired outcomes. Thus, the act of thinking through the"logic"of a program may help the City avoid investing in programs that are fundamentally flawed at the outset. 4. The City needs to track program implementation more closely. Even if a program is well designed,bringing about change,in people or conditions,is difficult work. A lot can go wrong. Absent closer tracking of implementation,however,implementation issues can go unaddressed, sometimes for years. Closely linked to this is the need to foster a culture of reflection and transparency,rewarding inquisitiveness, critical thinking,and continuous improvement while discouraging defensiveness or the mistake of confusing good press for results. D.Reform contracting practices 1. The City may want to re-think its contracting and request for proposal processes. Too many organizations that receive funding for a certain purpose assume it will continue regardless of performance. The City should set higher performance standards tied to meaningful outcome measures that truly measure results and then hold organizations accountable. In addition, the City needs to cultivate partnerships with agencies that are open to critical assessment and evaluation.Too often, on-going service contracts create an entitlement mentality,making it difficult,if not impossible, for the City to pivot to more effective strategies or allow new populations to be served. Thus, change only comes about incrementally and often requires new, additional funds while existing funds continue to flow to ineffective programs and services. 2. The City should consider setting aside funds that can be used to support and encourage promising new ideas as they arise,increasing the ability to act more nimbly and flexibly. 3. The City should consider investing in strategic capacity building so that more community-based organizations can be in a competitive position to bid on City contracts. 57 Appendix A Youth violent offender profiles by age The section disaggregates the offender population by: 13 and under43, 14-17,and 18-24. It's important to keep in mind that SPD collects limited crime data by race. It does not record ethnicity. 1. 13 years & under violent offender profile Between 2012-2014: • The average annual number of total offenders was approximately 263 • The average annual number of unique offenders was approximately 208 • On average, at least 56 out of 263 youth, or 21%,were involved in repeat offending • Black youth were disproportionately represented relative to their share of Seattle's youth population The vast majority of violent offenders aged 13 years and under were involved in simple assaults,a misdemeanor that can involve a wide range of behaviors. Average annual#of violent offenders 13& under,2012-2014 13& under,%violent offenders by race & crime type,2012- 2014 avg.annual % by crime type #offenders crime type G9°o 55°0 simple assault 172 65% 48°io aggravated assault 69 26% 41% 38°o robbery 20 7% 22°0 rape 2 1% 10% homicide 0 0 300 50,0 2°% 1°% total 263 100% — —robbery simple aggravated Avg. annual#unique 208 offenders •Native American Asian •Black •White 43 George Mason University researchers,who cleaned and analyzed the SPD data,noted that only a handful of violent offenders in the 13 and under age bracket were under 10 year old;thus,while the focus of this report is on youth 10-24 years,given the small number of youth under 10 years found in the data,a determination was made to leave these in(hence,the age category 13&under is used vs. 10-13 years). 59 Under 13 years youth violent offender profile, continued 63% of violent offenders 13 years and under were involved in DV-related offenses and the vast majority of these were either simple or aggravated assault. Based on prior research conducted by the City Auditor Office in spring 2015,it is thought that majority of these DV-related offenses for youth under 18 years involve a family member as opposed to an intimate partner.The following chart breaks out the percentage of violent offenders 13 years old and under by assault type and DV status. Domestic violence status by assault type, 2012- 2014 aggravated 35% assault DV-related 65% simple 30% assault DV-related 70% The table below shows the estimated average annual number of offenders by race and crime type45. These estimates includes both one-time and repeat offenders. 13 & under, estimated average annual# of offenders by race & crime type, 2012- 2014 R ,bber� Simple Aggravated Total by race assault assault Native 1 3 1 4 American Asian 1 17 4 23 Black 14 82 38 134 White 4 70 26 100 Total by 21 i 172 69 261 crime 44 Intimate partner violence involving youth under 18 years is believed to be under-reported. 45 The numbers in the tables are estimates derived by calculating the percentage of recorded offenders by race involved in each particular crime and then multiplying it by the total number of offenders in each crime category.This was done because race was not recorded for a small number of offenders.As these are estimates,actual numbers could vary slightly.For example,the actual average annual number of Blacks and Whites involved in aggravated assaults between 2012-2014 where race was recorded was 36 and 24 youth respectively,while applying the percentages of race recorded to the total number of offenders yielded 38 Blacks and 26 Whites. 60 2. 14-17 youth violent offender profile Between 2012-2014: • The average annual number of total offenders was approximately 553 • The average annual number of unique offenders was approximately 313 • At least 240 out of 553 youth, or 47%,were involved in repeat offending • Black youth were disproportionately represented relative to their share of Seattle's youth population Simple assault was the most common crime type,though a large share of 14-17 year olds were also involved in robberies and aggravated assaults. A larger percentage of 14- 17 year olds were involved in robberies than younger or older youth. Average annual#of violent offenders 14-17,2012- 2014 14-17,%violent offenders by race & crime type,2012-2014 avg. annual# % by crime type offenders crime type 70°° simple assault 297 54% aggravated assault 101 18% 4700440. robbery 150 27% 31 ° 250;0 rape 3 1% homicide 1 0% 500 700 7% 1°b 2°o 30 total 553 100% _ robbery simple aggravated Avg. annual# 313 unique offenders •Native American Asian •Black •White 61 14-17 youth violent offender profile, continued 14- 17 year olds were involved in a lower percentage of DV-related offenses than youth 13 years and under,but DV-related offenses still comprised a large percent and the majority of simple assaults were DV-related. Domestic violence status by assault type, 2012- 2014 aggravated i 56% assault DV-related 44% simple 47% assault DV-related 53% The table below shows an estimated average annual number of offenders by race and crime type46. This table includes both one-time and repeat offenders. 14-17, estimated average annual# of offenders by race & crime type Robbery Simple Aggravated Total by assault assault race Native 1 6 3 10 American Asian 5 21 7 36 Black 115 141 59 304 White 37 130 32 198 Total by 150 297 101 549 crime 44 The numbers in the tables are estimates derived by calculating the percentage of recorded offenders by race involved in each particular crime and then multiplying it by the total number of offenders in each crime category.This was done because race was not recorded for a small number of offenders.As these are estimates,actual numbers could vary slightly.For example,the actual average annual number of Blacks and Whites involved in aggravated assaults between 2012-2014 where race was recorded was 36 and 24 youth respectively,while applying the percentages of race recorded to the total number of offenders yielded 38 Blacks and 26 Whites. 62 3. 18- 24 violent offender profile Between 2012- 2014: • The average annual number of total offenders was approximately 1533 • The average annual number of unique offenders was approximately 1097 • At least 436 out of 1533 youth, or 28%,were involved in repeat offending • Black youth were disproportionately represented relative to their share of Seattle's youth population Simple assault was the most common crime type for 18-24 year olds, followed by aggravated assaults and robberies. Average annual#of violent offenders 18-24,%offenders by race &crime type, 18-24,2012- 2014 2012-2014 avg. annual %by crime 62% crime type #offenders type 887 58% 49% simple assault 45%44% 41% aggravated assault 380 25% 32% robbery 237 15% rape 17 1% homicide 13 1% 8% 9% total 1533 100% o% 5% 2% 2% Avg. annual# 1097 robbery simple aggravated unique offenders •Native American Asian •Black a White 63 • 18-24 youth violent offender profile, continued A majority of simple assault offenders between 18-24 years were involved in DV-related offenses while a higher percent of aggravated assaults were non-DV related. It cannot be determined from the data the extent to which DV-related offenses for 18-24 year olds involve family members or intimate partners. Domestic violence status by assault type, 2012- 2014 aggravated 65% assault DV-related 35% simple 46% assault DV-related 54% The table below shows the estimated average annual number of offenders by race and crime type47. This table includes both one-time and repeat offenders. 18-24, estimated average annual# by race & crime type Robbery Simple Aggravated Total by assault assault race Native American 22 1 8 31 Asian 73 12 33 117 Black 361 148 170 679 White 431 76 168 675 Total by crime 887 237 380 1503 47 The numbers in the tables are estimates derived by calculating the percentage of recorded offenders by race involved in each particular crime and then multiplying it by the total number of offenders in each crime category.This was done because race was not recorded for a small number of offenders.As these are estimates,actual numbers could vary slightly.For example,the actual average annual number of Blacks and Whites involved in aggravated assaults between 2012-2014 where race was recorded was 36 and 24 youth respectively,while applying the percentages of race recorded to the total number of offenders yielded 38 Blacks and 26 Whites. 64 Washington State DOC Re-entry statistics Between 2011- 2014, the Department of Corrections (DOC) released approximately 400 adults annually in Seattle;many were involved in violent offenses. 91% were male. Only 44% of those released were supervised. Approximately 18% were homeless. Annual# Seattle DOC releases in °A) of Seattle DOC releases by crime Seattle,2011-2014 type,2011- 2014 drug 18% 399 397 398 property 31% ■384 assault 23% robbery MEM 9% sex offense 13% Y2011 Y2012 Y2013 Y2014 manslaughter I 1% murder ■ 1% Just 7%were between 18-24 years old (<25). Percent of Seattle DOC releases by age, 2011- 2014 65+ EMT 3% 55-64 mixat 11% 45-54 24% 35-44 25% 25-34 i '; 30% <25 7% Whites and Blacks comprised the majority of offenders released in Seattle between 2011- 2014. of Seattle DOC releasees by race,2011- 2012 46% 45% 3% 3% 4% White Black Asian/PI American Other Hispanic Indian/Alaskan Native 65 Violent Crime by Census Tract In general, the locations of youth violent crime incidents are spread across the city. Only a handful of census tracts have relatively high concentrations of youth violent crime incidents. Between 2012- 2014, the top three census tracts (out of 132 tracts) with the highest concentrations of youth violent crime experienced between 3%-6% of incidents (tract 81 in downtown Seattle, tract 75 in Capitol hill and tract 118 in southeast Seattle). The percent of youth violence incidents in each of the remaining census tracts was under 3%. % OF VIOLENT CRIME BY CENSUS TRACT Percent of youth crime by year& Percent of youth crime by year& Percent of youth crime by year& census tract census tract census tract tract 2012 2013 2014 tract 2012 2013 2014 tract 2012 2013 2014 80.01 G 1.47 1.44 El 1.43 1 [ 2.03 1.62 1.49 41 I 0.12 a 0.18 1 0.13 80.02 J 1.08 1.01 ! 1.16 2 0.69 0.86 0.63 42 1] 0.46[] 0.581] 0.66 81 s.56 5.9_ 6 i.- 3 I] 0.39 0.63 0.40 43.01 Q 0.39 ] 0.48 E 0.53 82 ® 0.39 0.30 Q 0.45 4.01 U 1.29 1.49 1.06 43.02 ® 0.48�J 0.43 0.55 83 84 4.02 j 0.53 0.71 1.03 1.45 ] 1.01 1.24 85 ®ID 1.50 1 0.97 1.17❑J 1.40 5 I 0.07 I 0.10 0.08 45 0.37[ 0.351 0.05 86 lij 1.20 1.29 U 1.50 6 43 1111111.32 1.40 46 1 0.141 0.201 0.42 87 ! ] 1.70 1.39 I1 1.21 7 ® 0.74 0.86 0.95 47 El 0.92 N 0.94® 0.79 88 El 1.38 0.91(1 1.00 8 I 0.091 0.15;; 0.13 48 I 1.06 I 0.56] 0.16 9 49 i1 0.44 I7 0.411 0.40 90 II 0.81 1.04❑ 0.90 9 1 0.091 0.151 0.05 91 ❑ 0.76 0.61❑ 0.90 + 10 U 0.39 0.43 El 0.61 50 I] 0.12 I] 0.411 0.37 92 1.06 1.70IfEj 1.82 51 0.12 0.181 0.26 93 2.58 1.70 III 1.93 11 ' 0.12 0.25 0.24 52 U 0.90 w 0.71® 0.69 94 ❑ 1.17 0.9611 0.98 12 L 1.40 1.93 1-9-4 53.01 j.16 ..46 2.h4 95 © 1.57 1.80[] 1.32 13 J 0.97 0.79 0.90 53.02 1 0.05 I 0.101 0.08 96 fI 0.51 0.53 1 0.24 14 IN 0.74 ] 0.58 0.45 54 I 0.231 0.281 0.21 97.01 0 0.28 0.33 0] 0.53 15 I 0.02 0.10 0.05 56 I 0.121 0.201 0.29 97.02 I 0.23 0.23 I 0.26 98 [I 0.60 0.5311 0.66 16 111E 0.60 0.43 0.69 57 I 0.321 0.201 0.18 99 ❑ 0.81 0.7911 0.92 17.01 [] 0.51 _1 0.66 0.42 58.01 I 0.14[ 0.381 0.32 100.01 In Loa 0.79 III 0.77 17.02 11 0.32 _ 0.63 0.58 58.02 1 0.301 0.151 0.37 100.02 [1 0.69 0.301 0.29 18 Er 0.67 __1 0.81 _j 0.77 59 0.211 0.331 0.24 101 1E:1 1.89 1.85 U 1.82 19 ® 0.44 0.41® 0.40 60 0.211 0.151 0.16 102 I1 0.39 0.43® 0.66 20 I 0.14 0.101 0.03 61 0.121 0.23 1 0.16 l03 ; 1.22 1.75 1.69 104.01 ! 0.78 0.96 0.82 21 © 0.41 0.48 1 0.21 62 0.12 I 0.151 0.08 104.02 11 0.67 0.53® 0.63 22 I 0.12 0.181 0.03 63 0.14 1 0.15 1 0.26 105 [ 0.83 0.94[I 0.74 24 I 0.05 t 0.0511 0.24 64 0.021 0.151 0.21 106 1] 0.60 0.56 8 0.45 65 0.211 0.081 0.26 107.01 [I 0.97 0.96❑ 1.00 25 I 0.14 0.08 I 0.16 107.02 1 1 1.38 1.11[I 0.63 26 11 0.21 0.20 1j 0.32 66 1 0.51E 0.511 0.18 108 1 0.99 0.81 0.63 27 N 0.44 0.43 11 0.24 67 I] 0.46 I 0.481 0.34 109 t 1 0.62 0.53 1.1 0.61 28 I 0.18 0.23 I 0.08 68 I 0.301 0.181 0.26 110.01 j , 1.54 1.19 U1 1.27 29 0.07 0.10 I 0.13 69 ® 0.74 0.301 0.48 110.02 4 I 0.78 0.73® 0.77 30 © 0.32 0.46 0.26 70 1] 0.46 0.461] 0.50 111.01 - 1 1.40 1.32 p 1.06 31 1 0.23 0.33 U 0.50 71 0.55 0.66 0.82 111 oz H 1.27 1.01 1] 1.27 32 ® 0.41 0.25 1 0.13 72 2.40 2.08 1.37 113 1.34 1.37(1 1.08 33 IN 0.51 0.41 11 0.37 73 1.68 1.37 1.61 114.01 7 1.52 1.37 tri 1.53 34 I 0.12 0.08 0.08 74.01 [j 0.48 0.41 I] 0.48 114.02 , 1.34 1.85 ] 1.79 35 a 0.18 0.05 0.26 74.02 ® 0.81 0.79 1.24 115 1 0.32 0.251 0.26 75 EU 2.16 3.70 11I1U,62 116 ] 0.37 0.35 II 0.42 36 ID 0.30 0.35 r 0.37 76 I 0.35 0.43 0.45 117 t-1 1.22 1.09 J 1.13 38 9 0.14 0.15 E] 0.26 77 ® 0.60 0.531 0.34 118 -_._._.13.48 13-88 13.77 119 I 1 1.20 1.22[j 1.21 39 0.12 0.08 I 0.08 78 I 0.18 0.281 0.37 120 ,1 0.28 0.13 0.05 40 0.39 0.25 El 0.34 79 IL 0.90 Li 0.761 0.63 121 0.07' 0.05 I 0.18 66 Appendix B Research on contributing factors related to youth violence Different theories exist as to why some youth become involved in crime. A few are outlined below. 1. A General Theory of Crime One oft cited theory,referred to as the "General Theory of Crime"8, states that a lack of self- control is at the heart of most offending: "Persons with high self-control consider the long-term consequences of their behavior; those with lower self-control do not. Such control is learned, usually early in life, and once learned, is highly resistant to change."49 In March 2015, the Office of Juvenile Justice and Delinquency Prevention (OJJDP) issued a research brief based on a study called Pathways to Desistence. This study examined why some serious juvenile male offenders between 14-25 years desisted from offending while others did not50. Some of the key findings in the OJJDP brief include the following • "Youth whose anti-social behavior persisted into early adulthood were found to have lower levels of psychosocial maturity in adolescence and deficits in their development of maturity compared with other anti-social youth. • The vast majority of juvenile offenders,even those who commit serious crimes,grow out of anti-social activity as they transition to adulthood. Most juvenile offending is,in fact,limited to adolescence. • ...the process of maturing out of crime is linked to the process of maturing more generally, includin g the development dl ment of impulse control and future orientation."51 These findings are consistent with the General Theory of Crime in that, for the same reasons a youth might become criminally involved (poor self-control),youth are also likely to desist once they reach psychosocial maturity.The OJJDP Brief also notes that youth who continued to offend into early adulthood were "significantly less psychosocially mature than youth who desisted..."52 Psychosocial maturity, as noted in the OJJDP brief,is marked by the following characteristics53: Temperance. Ability to control impulses,including aggressive impulses. 48 Gottfredson,M.R.,Hirschi,T.,A General Theory of Crime,Stanford University Press,1990 49 Gottfredson,M.R.,Et.Al..,Stanford University Press website. 50 The study involved interviews with 1,354 youth offenders seven years after their convictions. 51 Steinberg,L.,Cauffman,E.,Monahan,K.,P.cycborocialMatxrity and Desistance From Crime in a Sample of Serious Juvenile Offenders,March 2015,pl. 52 Steinberg,L.,Et.Al,K.,p3. 53 Steinberg,L.,Et.Al,p3. 67 III Perspective. Ability to consider other points of view,including those that take into account longer term consequences or that take the vantage point of others. Responsibility.The ability to take personal responsibility for one's behavior and resist the coercive influence of others. 2. Risk Factors The General Theory of Crime and related research focus primarily on the psychosocial maturity of the individual youth. Other research suggests youth violent crime offending is linked to a variety of "risk factors" that may increase a young person's propensity to engage in violent crime.Thus,many prevention and intervention strategies seek to reduce these risk factors. The risk factors linked to youth violence fall within several"domains",including Individual, Family, Schools/ Peers, and Community.These risk factors are grouped as such in recognition that a youth's behavior can be influenced and shaped by their environment. Some of the more commonly cited risk factors for each domain are listed in the following table,which is drawn from a CDC youth violence prevention publication54. Risk Factors associated with Youth Violence (source:CDC) rsrr {•idual Family School/Peer Community/Society History of violent Authoritarian child- Association with Diminished economic victimization rearing practices delinquent peers opportunities Attention deficits, Harsh,lax or Ifigh hyperactivity,learning inconsistent disciplinary Involvement in gangs concentrations of disorders policies poor residents History of early aggressive Low parental Social rejection by High level of behavior involvement peers transiency Invovementwithdrugs, Lowemotional Lack of involvement in fflgh level offamily attachment to parents or alcohol,tobbaco conventional activities disruption caregivers Low parental education Low commitment to Low levels of Low IQ school and school community and income failure participation Poor behavioral control Parental substance abuse Socially disorganized neighborhood Deficits in social congitive Community social or information processing Parental criminality norms support using abilities violence to solve problems Gender norms that link High emotional distress Poor family functioning maculinity with aggression History of treatment of Poor monitoring and emotional problems supervision of children Anti-social beliefs and attitudes Unsupervised access to firearms and weapons Exposure to violence& Family conflict Poor academic performance 54 David-Ferdon C,Simon TR,Striving to Reduce Youth Violence Everywhere(STRYVE):CDC's National Initiative to Prevent Youth Violence:The Centers for Disease Control and Prevention's national initiative to prevent youth violence foundational resource.Atlanta,GA:Centers for Disease Control and Prevention;2012. 68 The link between risk factors and youth violence is complex; therefore, the following caveats should be kept in mind: • Risk factors are not predictive of violence but are thought to increase the likelihood of it. • The risk of violence is greater for youth who experience multiple risk factors and few protective factors,which can have a cumulative and interactive effect55. • Some risk factors are more malleable than others and research recommends focusing on those that most likely can be changed. • Not all risk factors are equally significant and some may have a stronger link to violence than others. • Youth may respond differently to different risk factors depending on age,gender, and race. For example, attachment to parents is more influential when children are younger,but strong parental supervision becomes more important as children ages • The research is not as well established on the influence of"protective factors" and their relationship to youth violence,but these are thought to act as a buffer against youth violence. Protective factors include access to pro-social activities, the involvement of a caring adult, and religious affiliation. • The degree to which risk factors exist varies between and within neighborhoods, schools,and families. Concentrated extreme poverty,high unemployment, and low educational attainment can increase individuals and communities exposure and involvement in violence.57. The chart below shows differences in adolescent risk behaviors by family income,with low income youth more likely to be involved in crimes that target other people'. Adolescent Risk Behaviors by family Income Level Although youths from loin Income!aunties am as likely to use or sell drugs as are them lugher Income counterparts the former are ugulfic.uuly non likely to eupage in cnmuud.rcnrdie,that Iar_et ogler puopie W 35 .0 )` 25 5 15 g ,o 0 Useman,uusa Use other kg drugs Attack &camea Steal somemYng Carty drug, someonclget rne,nbcr of worth more agun Into.fight •gang than 550 •youths*an lowue.romafwaRes At roughs Iran mdd ,ncomefembes •rauths from higMuomet wMS l rn2aa tiAbtILTON Sow*M Y.en.]enM IM'+RY'9?'4e1<N:'�vJnnN'M/.ef'r•aiP i.»n%aM�L:+Mwe �edW20 'nf0a w)[.er..•leas *Y0Y^a b0fl wn[a tl mNLeen o U Ur rolto KIM%anW.be M.t 0050 eCMM.n w.0x01;x.lweMr V M me Vawv[d.e!.1era rvt,a».mcc,tnw.s Awa nc:Ms orwrow..ni m 4:o cwceni,. Ufe.. nm:e+:4re 111(4 It/f0\C:s 55Moore,KA.,Stratford,B.,Caal,S.,Hickman,DT.,Schmitz,H.,Thompson,J.,Horton,S.,Shaw,A.,Preventing Violence, A review of Research,Evaluation,Gaps,and Opportunities,February 2015,p.i 56 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3375078 57 Moore,KA.,Et.Al.,p.i 58 Kearney,M.S.,Harris,B.,Jacome,E.,Parker,L.,Ten Economic Facts about Crime and Incarceration in the United States,The Hamilton Project,Policy Memo,May 2014. 69 In February 2015,Child Trends,a non-profit non-partisan research center,identified several risk factors associated with youth violence by the strength of the evidence linking them to certain types of violence59.The following table summarizes this research for three types of youth violence. A "blank" means Child Trends found no research to support either a strong or weak link. A"weak" designation means Child Trends found some evidence indicating a weak association between a particular risk factor and violent behavior. Risk Factors Linked to Youth Violence (source:Child Trends) actors ( ) Delinquency/ Domain Risk Factor Crime Gang Violence General Aggression substance abuse strong moderate self-control moderate weak moderate Individual youth mental health weak weak weak hostile attribution weak weak moderate bias dysregulated sleep moderate child maltreatment strong strong harsh parenting strong strong Family parent mental health moderate parent drug use strong moderate Domestic violence moderate moderate bullying weak weak moderate perpetration anti-social peers moderate Sell, school moderate moderate moderate connectedness school performance weak school climate weak weak moderate collective efficacy moderate moderate Community gun availability moderate strong A note about mental illness as a risk factor Parental mental health is a risk factor for youth violence but child mental health is not.This is consistent with the research that finds a weak link between youth mental illness and violent crime offending. Youth substance abuse, however,is strong linked to youth offending (a finding consistent throughout the literature) and substance abuse and mental health disorders are often co- occurring conditions.Thus,it may be hard to disentangle their effects. Moreover, several mental health treatments,particularly Cognitive Behavioral Therapy (CBT) techniques,have been shown to reduce youth violence by helping youth learn to control impulses and regulate emotions. Other mental health treatments that help repair the negative effects of trauma,which can impact brain development and lead to behavioral issues, may also be appropriate. 59 Moore,KA.,Et.Al. 70 3. Trauma The premise underpinning the General Theory of Crime and the psychosocial school of thought suggests most youth outgrow their offending behavior once they mature.Yet,not all behavioral problems linked to crime are associated with maturity and can simply be outgrown. Some behavioral problems identified as risk factors in the Individual Domain may stem from early child abuse and trauma, the negative effects of which can last a lifetime if left untreated. A recent Seattle Times article noted that children growing up in homes with alcoholism, mental illness,domestic violence and other family dysfunction may experience trauma. Children impacted by trauma exist in a "simmering state of emergency", and exhibit problems with impulse control, edginess, and aggression60. The chart below summarizes the effects of trauma on brain development,which identifies several behaviors linked to violet offending61 Trauma's Impact on Brain Development Exposure to chronic,prolonged traumatic experiences has the potential to alter children's brains, which may cause longer-term effects in areas such as: 1. Attachment:Trouble with relationships,boundaries,empathy,and social isolation 2. Physical Health: Impaired sensorimotor development,coordination problems,increased medical problems,and somatic symptoms 3. Emotional Regulation:Difficulty identifying or labeling feelings and communicating needs 4. Dissociation:Altered states of consciousness,amnesia,impaired memory 5. Cognitive Ability:Problems with focus,learning,processing new information,language development,planning and orientation to time and space 6. Self-Concept:Lack of consistent sense of self,body image issues,low self-esteem,shame and guilt 7. Behavioral Control:Difficulty controlling impulses,oppositional behavior,aggression, disrupted sleep and eating patterns,trauma re-enactment Source:Cook,et al,2005 so http://www.seattletimes.com/education-lab/you-are-more-than-your-mistakes-teachers-get-at-roots-of-bad- behavior/ 61 Children's Services Practice Notes,Volume 17,No.2,May 2012,North Carolina Division of Social Services and the Family and Children's Resource Program 71 Public flea LAI Seattle & King Coun GUN VIOLENCE IN KING COUNTY February 5, 2013 ASSESSMENT, POLICY DEVELOPMENT AND EVALUATION 401 5`h Avenue,Suite 1300 Seattle,WA 98104 www.kingcounty.gov/health/data 2 Acknowledgements: This brief was prepared by Public Health —Seattle & King County's Assessment, Policy De- velopment and Evaluation unit in collaboration with the Prevention Division. We wish to thank the King County Medical Examiner's Office, the King County Prosecuting Attorney's Office, Dr. Fred Rivara, and Dr. Charlene Wong for their thoughtful input and review. 3 Introduction More than 31,000 people in the United States are killed by gun violence each year. In King County, the death toll is more than 125 people a year. More people in King County die from gun violence than motor vehicle crashes. Many more are injured, with enormous economic and emotional costs. Despite these deaths and injuries by gun violence, there are reasons to be optimistic that we can solve this public health threat. In the past 20 years, our nation has come together to dramatically decrease deaths from smoking and car crashes. We have created safer cars equipped with airbags and required child seats. We have changed social norms around tobacco use, especially among children, and support- ed educational campaigns about the health risks of smoking. We can take similar public health approach- es to reducing gun violence. We can also look to best practices in other countries and determine what might make sense here. Com- pared to the United States, deaths from gun homicide are on average 20 times lower in other developed countries. In countries like Australia or the United Kingdom, the rates are 30 times lower. The first step in developing strategies to decrease gun violence is to better understand current gun vio- lence data and policies. To that end, this paper provides information on: • Overall firearm deaths and injuries; • Economic costs of gun violence on our community; • Firearm homicides, suicides and unintentional injuries; • Firearm ownership and access in King County; and • Firearm policies in Washington state. Overall firearm deathsl and injuries • Between 2006 and 2010, the average numbers of firearm deaths per year were 131 in King Coun- ty, 583 in Washington state and 31,346 in the U.S. • During these 5 years, 50 King County children and youth age 19 and under were killed by fire- arms. • Since 2007 in King County, the number of firearm deaths has surpassed the number of motor ve- hicle traffic deaths. In 2010, there were 123 firearm deaths and 102 traffic deaths. • Among King County youth aged 15 to 24, firearms are involved in almost 1 in 5 (18%) of total deaths. For black youth, where homicide is the leading cause of death, firearms account for four in 10 (41%) deaths. • During the last decade, the rates of firearm deaths in King County have been relatively stable and substantially lower than the rates in the early 1990s. • Compared to national and Washington state rates, the King County firearm death rate is substan- tially lower. • The firearm death rate in the U.S. is 7.5 times higher compared to 23 other high-income coun- tries.2 • On average, between 2006 and 2010, there were over 72,000 nonfatal firearm injuries per year in the U.S., based on emergency department data. 4 • Based on national 2010 emergency department data, youth 15 to 19 years of age had nonfatal firearm injury rates nearly 3 times that of the general population.3 Most (79%) nonfatal firearm injuries among youth were due to assaults. • In King County, from 2006 to 2010, there were 583 hospitalizations for firearm injuries, of which 47 died during the hospitalization. Figure 1 Age-Adjusted Rate for Firearm Death King County,WA State,and the U.S. 16 Three-Year Rolling Averages, 1992-2010 14 • g Washington • 6 King County 4 2 0 _._ .. E •1 ry m in in n g s s a s s Types of firearm deaths and injuries • In King County, of all firearm deaths between 2006 and 2010, 29%were homicide and 68% were suicide. The remaining 3%were due to unintentional injuries, legal intervention, or death of un- determined intent. • Death from unintentional firearm injuries was relatively uncommon. Between 2006 and 2010, there were two cases among King County residents. • Of the 536 nonfatal firearm injuries between 2006 and 2010 that required hospitalizations, 15% were unintentional, 6% self-inflicted, 73% assault, and 6%other. Economic costs of firearm deaths and injuries • Nationally, direct medical costs and lost productivity due to firearm deaths and injuries was esti- mated at about $32 billion in 2005.4 Another study of U.S. firearm injuries from 1994 estimated a cost of$2.3 billion in lifetime medical costs alone, an average of$17,000 per injury.5 When costs associated with long-term disability, pain and suffering, diminished quality of life, and other indi- rect costs such as decreases in real estate values due to neighborhood safety issues are included, the price tag reaches $100 billion annually or, as estimated by another study, an average annual cost of$1,300 per person.6 • In King County, based upon data from 2007-2011, the average annual cost of firearm deaths and nonfatal hospitalizations was $177 million due to medical expenses and lost productivity. Direct medical costs were $2.2 million, and work lost accounted for$174 million annually.''$ • The average charge for a firearm hospitalization was $66,000. 5 • Seattle:A recent study of eight U.S. cities, including Seattle, examined the economic benefits of reducing crime (i.e., homicide, rape, assault, and robbery).9 The majority of all violent crimes in- volve weapons. Handguns are used in 67% of homicides, 41% of robberies, and 20% of aggravat- ed assaults.10 In 2010, violent crime cost Seattle $89 million, or $144 per resident. An often over- looked aspect of homicide is the cost to residential housing values. Researchers estimated that a 10% reduction in homicides would boost the total value of all residential housing by $2.9 billion in the Seattle metropolitan area. Moreover, a 10% reduction in violent crime in Seattle could save more than $2 million per year, reduce the direct costs to victims by more than $2 million per year, and avert nearly $22 million in annual, intangible costs to victims. Table 1: Estimated direct and indirect costs of violent crimes, Seattle 2010($ in millions) Direct costs (in millions) Intangible and total costs Victim Justice Productivity Total Direct Intangible Total Direct (medical System losses and costs) (criminals) Intangible Seattle $21 $56 $12 $89 $216 $305 Source: Shapiro and Hassett,2010. Direct costs per resident: $144 Total costs per resident: $492 Homicide In this section, we present the following data: • Local, state, and national homicide numbers and rates; • International comparisons and U.S. county comparisons of homicide rates; • King County homicide rates by demographic characteristics and geography; • Type of firearm used in homicide and relationship between perpetrator and victims; and • Firearm injury due to assault. Table 2: Firearm homicide, 2006-2010 Number Age-adjusted rate(per 100,000) KC WA US KC WA US Total 190 600 60,173 2.0 1.8 4.0 • Between 1999 and 2010, the number of firearm homicides in King County fluctuated between 25 (2009) and 50 (2007) per year. • The King County homicide rate and firearm homicide rate were significantly lower than the na- tional rates. Compared to the U.S. rates, after adjusting for age and race, the risk of homicide in King County was 30% lower and the risk of firearm homicide was 35% lower. • Of all homicides in King County between 2006 and 2010, 61% were firearm homicides, compared to 68% in the U.S. 6 Figure 2 Homicide and Firearm Homicide 2006-2010 i 1 6 -- •Homicide •Firearm-homicide 5.8 5 g 4 4.0 Ca. 3.2 3.1 I 3 a g 3 2.0 I v A w et 1 0 I KC WA US International comparisons and U.S. county comparisons of homicide rates Figure 3 Homicide and Firearm Homicide Rates Among Selected Countries 6 5.8 ' 5 Homicide •Firearm Homicide I 4.0 %, 4 1 n 3 g 0 2 16 :1 1.1 1.1 1.2 Z 0.9 0.8 0 -.0.0 0.2 ::-., 0 z 0.4 0.1 0.1 _ 0.3 iiii. .. 0.1 0.5 itimi c c .S i, to c Y a $ m v ° c °c fo e E 3 42 u m a to a' g`I - u Note:the homicide rates are for 2009 or 2010 and the flrearmhomiciderates are for ear ied years between 2004 and 2010. 2 The US rates are for 2006-2OlO combined. Source;Un■Is',adons Office on Drug and Gl me.Imp3/www.unodc.org/unodcien/data-and-enelvs s ern Iclde.html • Overall, homicide rates in the U.S. are 7 times higher than those of other high-income countries; firearm homicide rates are 20 times higher. • King County is the 14th largest county in the U.S. by population. Compared to the ten largest counties in the U.S., the King County homicide rate and firearm homicide rate were low, ranking 10th in homicide, and 9th in firearm homicide. 7 Table 3: Homicide and firearm homicide among the 10 largest U.S. counties and King County, 2006-2010 Homicide Firearm Homicide Age Adjusted Rate Age Adjusted Rate County (per 100,000) Number of Deaths (per 100,00) Number of Deaths Total White Black Total White Black Total White Black Total White Black Cook County, IL 11.1 4.5 31.7 2980 786 2176 8.6 3.2 25.5 2316 549 1762 Harris County,TX 10.0 8.6 17.4 2042 1263 723 7.3 6.1 13.4 1510 908 562 Miami-Dade County, FL 9.5 5.0 26.1 1172 479 691 7.4 3.4 21.9 912 323 588 Dallas County,TX 9.1 7.1 17.5 1106 602 486 6.6 5.1 12.9 816 437 366 Kings County, NY 8.6 4.1 17.0 1114 261 835 5.6 2.0 12.2 735 126 604 Los Angeles County,CA 8.1 6.9 26.6 4158 2608 1351 6.2 5.2 21.7 3210 1982 1108 Maricopa County,AZ 7.8 7.3 17.9 1480 1198 202 5.6 5.2 14.3 1058 851 162 Queens County, NY 4.2 2.7 11.1 473 160 272 2.3 1.0 7.9 261 58 197 San Diego County,CA 3.3 2.9 10.5 523 364 110 1.7 1.4 6.6 272 175 72 King County,WA 3.2 2.3 13.4 315 171 95 2.0 1.3 9.2 192 93 68 Orange County,CA 2.6 2.8 8.5 395 325 30 1.6 1.7 * 237 198 18 Notes: Age adjustment is to 2000 U.S.population. Race categories may not sum to total deaths due to other race groups not presented. Persons of Hispanic ethnicity can be of any race and are included in the racial categories. *Rate considered unreliable and not available when there are fewer than 20 deaths. Data source:Centers for Disease Control and Prevention,National Center for Health Statistics.Underlying Cause of Death 1999-2010 on CDC WONDER Online Database,released 2012.Accessed at http://wonder.cdc.gov/ucd-icdl0.html on 1/30/13 King County homicide rates by demographic characteristics and geography • In King County, the firearm homicide rate for males is five times higher than for females. • In the U.S., firearm homicide rates peak in 20-24 year olds, and generally decline with age. The King County rates follow a similar gender and age pattern. • Of the 190 firearm homicides between 2006 and 2010 in King County, 34 (18%) victims were age 19 and under. Figure 4 Firearm Homicide Rates by Age and Gender in the United States,2006-2010 Average 25 20 15 -4-Male -a-Female A 10 5 0 o m a m a m A m 3 m m a m g a a d � ti N N r1J M CyJ Q IA 10 I1O� n ti �N N M M Q O 11 t,r1 lD 0 n W 8 • The firearm homicide rate among blacks is substantially higher than the rates for other racial/ ethnic groups. In King County, the black rate is seven times higher than the white rate. • Compared to whites, a higher proportion of black homicide victims were killed by firearms. Of the 94 homicides among blacks between 2006 and 2010, 72%were firearm homicide, compared to 54% among whites. Figure 5 Age-Adjusted Rate of Firearm Homicide by Race/Ethnicity King County,2006-2010 Averages 1C 9.1 0 3 0 0 9 J 2 2.1 2.6 2 1.6 1.3 0 White African Am. AIAN Asian/PI Hispanic • Within King County, there are large geographic disparities in the firearm homicide rate. Averaged over ten years between 2001 and 2010, the firearm homicide rates in South and Central Seattle (including Beacon Hill/George Town/South Park, SE Seattle, Delridge, and Central Seattle) and part of South County (including SeaTac/Tukwila, Burien, and South Renton) were significantly higher than the county average. The combined average firearm homicide rates in these areas was more than 20 times higher than the combined average rate in Sammamish, Mercer Island/Point Cities, Bellevue, Kirkland, and Issaquah. Figure 6 KeennoreaFP Banea,WOedinnue Shrrelme Firearm Homicide Death Rates by Health Reporting Area NW Seattle Attend NPnh King County,Washington, Nahsean 10-year Average 2001-2010 a NE Seattle Bear Creek/Carnation/Duvall Fremont/ Reamed 3eeNeke CeP trdvkM/ ... ... ` E.lake �. Downtown Wett ::e: 00 d - Wog County border ww Seael ® Bellevue-Seuth tif�ter Snaeualme/N.Bend/Skykanls ,000 Renton, 0.5-0. Rev/Castle/Fair Nona Renton- Necestle/Fair Creeks East 1.0-1.7 Burin SeeTecaukwila 1.$-2.$ ROMOd-SPUN FaIn.000 2.9-5.2 . 5.3-$.2 . e Eefl Des moo Kent-West Connptm/Maple Valley Normandy Park 0 1 2 4 6 8 KertsE ®Miles Public Health oWg/ Seattle&King County Wary Rd _ a AuWm-South Ble"'Th"'n'Enum'ee'sE iwnry Data Saurce.Washinptm Slate Department or Health.Center he - - PealN Produced yPCS Heim St N/:Public Health Seattle 6 King County:Assessment. Policy Development 8 Evaluahat Unit.122/2013 9 Types of firearm and relationship between perpetrator and victim • Nationally, according to FBI data on homicides, most (67.8%) involved the use of firearms. Hand- guns comprised 72.5% of the firearms used in murder and non-negligent manslaughter incidents in 2011.11 • A 1986 study of King County deaths found that handguns were used in 71% of firearm homicide deaths.12 • Nationally, in 2011, in incidents of murder for which the relationships of murder victims and offenders were known, 54.3% were killed by someone they knew (acquaintance, neighbor, friend, boyfriend, etc.); 24.8% were slain by family members. • Firearm deaths that occurred in King County homes involved friends or acquaintances 12 times as often as strangers.13 • A 1993 study showed that firearms kept in the home were associated with an increased risk of homicide occurring in the home, especially by a family member or intimate acquaintance. Com- pared to households without a firearm kept in the home, the odds of homicide among house- holds that kept a firearm was 2.7 times higher.14 Firearm injury due to assault • Between 2006-2010, there were 414 firearm injury hospitalizations in King County due to as- saults. The King County rate of assault firearm injury hospitalization for this period (4.3 per 100,000) was 1.5 times higher than the rate for Washington state (2.8 per 100,000). Suicide In this section, we present the following data: • Local, state, and national suicide numbers and rates; • International comparisons and U.S. county comparisons of suicide rates; • King County suicide rates by demographic characteristics and geography; • Type of firearm used in suicide and where suicides occur; and • Self-inflicted firearm injury. Local, state, and national suicide numbers and rates Table 4: Firearm suicide, 2006-2010 Number Age-adjusted rate(per 100,000) KC WA US KC WA US • Total 443 2,168 90,585 4.5 6.5 5.8 • Between 1999 and 2010, the number of firearm suicides in King County fluctuated between 79 (2001) and 98 (1999) per year. • The King County suicide rate and firearm suicide rate are lower than the U.S. rates. • Of all suicides in King County between 2006 and 2010, 42% were firearm suicide, compared to 51% for the U.S. 10 Figure 7 Suicide and Firearm Suicide 2006-2010 1 14 13.2 Suicide •Firearm-suicide 12 11.6 10.8 10 1. 1 1 F. 8 e+ Q. 6.5 :: 6 5.8 z 4.5 ci in 4 3 'O I W bb Q 2 KC WA US International comparisons and U.S. county comparisons of suicide rates • The overall U.S. suicide rate is 30% lower than that of other high-income countries, but the U.S. firearm suicide rate is nearly six times higher.15 Figure 8 Suicide and Firearm Suicide Rates Among Selected Countries 25 •Suicide •Firearm Suicide 8 16.3 15 12.3 121 12.4 I 11.3 9.3 IC 7.6 82 5 0 C ft a Y_ A to 3 tS LL _ d yt . L u 'U O1 Z Note:the suicide rates are for varied years between 2004 and 2010. The rates of firearm suicide are estimated based on percent n the WHO mortality database forvaried combined years ■ in the late 1990s and early 20005 provided by Aidaac-Gross etal. Source:WHO.htp://www.who.irt/mental_health/preventiort/suidde/cour*ry_reparts/en/ • By age, the suicide rate in the U.S. among youth age 15 to 24 is 20% higher than the high-income countries, and the firearm suicide rate in this age group in the U.S. is almost 9 times higher. This suggests that access to firearms is leading to higher rates of suicide for this age group in the U.S.16 11 Figure 9 Firearm Suicide Rates by Age and Gender in the United States,2006-2010 Average 40 35 30 -Male :Female 25 20 I15 5 0 3 ti A A m v A S' pp S' 1p� N M R V�1 �D O UO • Compared to the ten largest counties in the U.S., the King County suicide rate and firearm suicide rate were high, ranking third in suicide, and fourth in firearm suicide. Table 5:Suicide and firearm suicide among the 10 largest U.S. counties and King County Suicide Firearm suicide County Rate Deaths Rate Deaths Maricopa County, AZ 14.7 2,706 8.0 1,477 San Diego County, CA 11.4 1,740 4.4 663 King County, WA 11.0 1,089 4.7 452 Harris County,TX 10.5 1,995 6.0 1,099 Dallas County, TX 10.1 1,121 5.7 617 Orange County, CA 9.2 1,380 3.0 442 Miami-Dade County, FL 8.9 1,153 4.0 519 Los Angeles County, CA 7.7 3,764 2.9 1,377 Cook County, IL 7.4 1,953 2.3 587 Queens County, NY 5.7 666 0.8 97 Kings County, NY 4.9 611 0.8 99 • In King County, firearm suicide rates for males are eight times higher than for females. • In the U.S., firearm suicide rates increase with age and are the highest among elderly men. The King County rate follows a similar gender and age distribution. • Of the 443 deaths from firearm suicides in King County between 2006 and 2010, 88% are males and 12% are females. Of the male deaths, 10% are age 15-24, 30% age 25-44, 36% age 45-64, and 24% age 65 and over. • Youth suicides are not uncommon. Of the 443 firearm suicides between 2006 and 2010 in King County, 13 (3%) were youth age 19 and under. • In King County, American Indian/Alaska Natives and whites had the highest suicide and firearm suicide rates. However, the rates for American Indian/Alaska Natives were not significantly differ- ent from the white rates due to small numbers. 12 Figure 10 Age-Adjusted Rate of Firearm Suicide by Race/Ethnicity King County,2006-2010 Averages 8 77 8 6 Y d 29 a 9 2a a - 11 u v 'Ite African Am. A AN Arlan/Pi Hispanic Figure 11 - 1 Firearm Suicide Death Rates ) „a:wan eAFP�I ell Mnodln e by Victim Residence - -- , by Health Reporting Area NWSeattleNdMSeattle "°"' King County, Washington, 10-yearAverage 2001-2010 Bi1lara Wrkland Bear creekcarnaagnDq an Redmmd 1Ike Bellevue-NE Dwyntown n BNlevue- el West Bellows- mho,Legend Ile " cena.l 1 _j King County border 4 ----- ,. Water Bellevue-Soo/h •.ri... e Issaquah Snoqualnua/N.Bend/Skylants RATE 1.7-2.9 all Hight,:' Renton- 3.0-4.1 Rath Renton- Newcastle/Four Creeks East 4.2-5.1 aTec/Tukarla 5.2-63 Renton-south ® 6.4-7.9 - 8.0-9.9 Des Kam-East Cwingtm/Maple Valley NClma 1.11 0 1 2 4 6 8 Kent-SE Miles N l' Public Health D.-% ! k'bern-Nath ed ay/ Seattle King Count \ MltlFery W Rd o I w Auburn-South Black DlamoncVEnumciow/SE County Data Source:Washington State Department or Health,Canter tar --- _- Health Statistics Produced by:Public Health-Seattle&King County,Assessment. ��� Policy Development&Evaluator Unit.1222013 t • Significant geographic differences also exist in firearm suicide rates. Averaged over ten years be- tween 2001 and 2010, the firearm suicide rate in West Kent was almost six times higher than the rate in Sammamish. People living in Sammamish, Queen Anne/Magnolia, and southeast Seattle had significantly lower firearm suicide death rates than the King County average. Types of firearms and where suicides occur • Men are more likely to use firearms, and women are more likely to use poisoning in suicide. Guns are much more lethal than drugs and thus a higher proportion of attempts are successful. 13 • Of the 307 firearm suicides investigated by the King County Medical Examiner's Office between 2009 and 2011, 39% used semi-automatic handguns, 39% used revolvers, 10% used shotguns, and 7% used rifles. The remaining 5% used other types of firearms or the firearm type was un- known. Figure 12 Firearm Type Among Suicides King County Medical Examiner's Office,2009-2011 Shotgun 10% Other 2% Unknown 3% Y Handgun-Revolver = 39% • Of the 307 firearm suicides investigated by the King County Medical Examiner's Office, suicides are more likely to occur at home. Of the 307, by place of event, 66% occurred at the victim's resi- dence, 7% were inside a vehicle, and the remaining 27% occurred in other places such as a hotel or motel, a park, or a parking lot. Self-inflicted firearm injuries • Patterns of self-inflicted injury hospitalization rates by age were similar between King County and Washington state. Figure 13 Self-inflicted Firearm Injury Hospitalization Rate by Age in King County and Washington State, 2006-2010 Average 2.5 2 +-WA State-GP-King County § 1.5 V- 1 a i 1 05 10-14 15-19 20-24 25-29 30-34 3S 39 40-44 45-49 33 54 55-59 60-64 65-69 70-74 75-79 80-84 S • Between 2006-2010, there were 48 self-inflicted firearm injury hospitalizations, accounting for 8% of all firearm injury hospitalizations in King County. The King County rate of self-inflicted fire- arm injury hospitalizations was 0.5 per 100,000, not statistically different from the Washington state rate of 0.7 per 100,000. 14 Unintentional firearm deaths • In the U.S. between 2006 and 2010, on average there were 600 unintentional firearm deaths each year. For this same period, there were a total of 35 unintentional firearm deaths in Washington state and 2 deaths in King County. • The unintentional firearm death rates for King County," Washington state and the U.S. are all less than 1 per 100,000. • Although there is insufficient local data to assess urban and rural differences, a study published in 2012 reported significantly higher rates of adult unintentional firearm death in rural than in urban counties18 in the U.S. from 1999-2006. Unintentional firearm injuries • Nationally, more than one-third of unintended firearm wounds require hospitalizations.19 • 80,400 Americans were treated in emergency departments for unintentional firearm nonfatal injuries between 2006 and 2010, accounting for 22% of all firearm nonfatal injuries treated in emergency departments. The 2006-2010 U.S. unintentional firearm nonfatal injury rate was 5.3 per 100,000. • Of the unintentional firearm injuries seen in U.S. emergency departments between 2006 and 2010, 30% (about 24,100 injuries)" resulted in hospitalization. • In Washington state from 2006 to 2010, there were 489 unintentional firearm injury hospitaliza- tions, accounting for 27% of all (1,790) firearm injury hospitalizations, for a rate of 1.5 per 100,000. • In King County, there were 84 hospitalizations for unintentional firearm injury, contributing to 14% of all firearm injury hospitalizations over the same 5-year period, 2006-2010. The corresponding rate was 0.9 per 100,000. Table 6: Unintentional firearm injuries, 2006-2010 Number Age-adjusted rate (per 100,000) KC WA US KC WA US Hospitalization 84 489 24,100 0.9 1.5 — Emergency Department — — 80,400 — — 5.3 Note: Washington state does not collect data from emergency departments • Nationwide, the rate of nonfatal firearm injuries treated in emergency departments was 7 times higher for males than females. Similar to the national pattern, King County and Washington state unintentional firearm injury hospitalizations were 8 times higher among males than females. 15 • Among children and adolescents (0-19 years), 34% of unintentional firearm nonfatal injuries (6,100 out of 17,800)17 seen in U.S. emergency departments from 2006 to 2010 resulted in hospi- talization. • Statewide, from 2006-2010,there were 94 unintentional firearm injury hospitalizations among children and adolescents 0-19 years, a rate of 1.1 per 100,000. In King County, there were 17 un- intentional firearm injury hospitalizations among youth (ages 0-19), a rate of 0.8 per 100,000.17 (Washington state does not collect injury data from emergency departments, so only those who were admitted are included in these figures.) Firearm ownership and access to firearms in King County • In 2009, firearms were reported in approximately 24% of King County households (183,300), the largest percentage in 13 years. • Among households with firearms, an estimated 23.2% (41,300 households) stored them loaded and 14% (26,500 households) stored them loaded and unlocked. • In 2009, an estimated 6,000 King County children lived in homes where firearms were stored loaded and unlocked. • Among King County high school students in 12th grade, 18%thought it was easy for them to get a handgun, 29%thought they would not be caught by a parent if they carried a handgun without permission, 10% had ever carried a handgun, and 8% reported one or more of his/her best friends carried a handgun in the past 12 months. Figure 14 Access to Handgun Among King County Students in Grade 8,10,and 12 Healthy Youth Survey, 2010 30% 29% 25% 24% •Grade 8 •Grade 10 20% 18% Grade 12 I 15% 11% 12% 10% 10% 8% 9% 8% 7% 7% 59'0 - 0% Easy or very easy to get a Would not be caught by Ever carried a handgun One or more best friends handgun parent if carried a handgun carried a handgun in the without permission past 12 months Data Source:Washington State Healthy Youth Survey,2010. 16 Firearm policy in Washington state Federal and state constitutions and statutes regulate firearm possession, where and how firearms can be carried, and design and safety of firearms and ammunition. Courts further interpret federal and state constitutions and statutes. Some regulation of firearms occurs at the local level, though limited in Wash- ington by express pre-emption, with narrow exceptions. The chart below summarizes Washington statutes, identifies several key gaps in Washington statutes, and compares the statutes to other states. Note that the U.S. Congress or Washington state legislature can legislate in many of these areas, but must not abridge the federal and state constitutional rights to bear arms. Funding for public health surveillance and research on the impact of firearms on health and the efficacy of firearm laws can be included in local, state and federal budgets for public health and public safety agencies. Funding for surveillance and research on firearms and effective interventions has been virtually eliminated at the federal and state levels since the late 1990s, due to changes in appropriations.20 Fund- ing for public education campaigns on safety, and risk factors for potential suicide, homicide and injury from firearms are also virtually non-existent. Status of Washington state law regarding firearms (as of January 12, 2013)* Law provision Washington Other states21 Universal background check for NO.Only for sales through licensed gun dealers.40%of *CA,RI,DC require universal background all sales guns sold nationally are estimated to occur through checks private sales.This gap is often called the"gun-show" *MD,CT,PA require some background checks loophole,but exempts all private sales from checks. beyond dealer sales *CO,CT,IL,NY,OR require background checks at gun shows *Local:Chicago,Columbus,NYC and Omaha regulate private sales Local legislation or regulation NO.State law pre-empts local government from en- *No local pre-emption:MA,IL,HI,OH,CT,LA, allowed acting legislation,except in very specific situations.This NJ,NY,NE,CA restriction has been tested in Washington courts and has been upheld as allowing very narrow exceptions for local jurisdictions. Restrict types of weapons/ NO.Washington permits assault weapons,.50 caliber *CA,CT,HI,MD,MA,NJ,NY—ban all or ammunition rifles,and large capacity magazines(those that can some types of assault weapons convert guns to high capacity weapons). *MD,MN,VA—regulate some types Washington also permits large capacity ammunition. Some states ban large capacity magazines designed for use with any firearm,others for use with handguns,others limit by number of rounds fired. Child Access Provisions(CAP) NO.Washington does not have specific child access *27 states have CAP laws. provisions,though law does not permit knowing trans- Criminal liability: HI,MD,MA,MN,NJ,TX fer to someone believed to be legally unable to possess a gun.CAP laws regulate by requiring safe storage, *Local locking provisions:Chicago,Cleveland, training/education,etc. LA,NYC.Chicago and Cleveland have CAP laws. NO criminal liability explicit in law for negligence/ reckless endangerment where poor storage allows child access. 17 Law provision Washington Other states Access to guns for youth under YES. *37 states impose stricter minimum age than 18 federal law for purchase and/or possession of Purchase by Under 18: firearms,and vary,including all firearm pur- Rifles/shotguns—Cannot purchase from licensed fire- chases,handgun possession,and long guns. arms dealers(federal minimum).No minimum age for private purchase of these long guns. *Local:Boston,Chicago,Cleveland,NYC Handguns—Cannot purchase from either licensed deal- er or private sale. Possession/Use by Under 18: Rifles/shotguns—Can possess/use in certain circum- stances.Even though state law default is that youth un- der 18 may not possess guns,the law gives 8 exceptions. These exceptions effectively allow possession in many circumstances. Handguns—Cannot possess under 18,with certain ex- ceptions(federal law). Access to guns for youth 18-21 YES. *37 states impose stricter minimum age than Purchase by 18-21: federal law for purchase and/or possession of firearms,and vary,including all firearm pur- Rifles/shotguns—Can purchase from licensed firearms chases,handgun possession,and long guns. dealers(federal minimum)and private sale. *Local:Boston,Chicago,Cleveland,NYC Handguns—Can purchase from private sale. Possession/Use by 18-21: Rifles/shotguns—Can possess/use(but subject to re- strictions on adult/youth possession,below). Handguns—Can possess/use at residence,business,or on his/her property(but subject to restrictions on adult/ youth possession,below). Ammunition:No age limit for purchase/use in private sale under Washington law.Where federal law specifies age limits for purchase of handguns and long guns,age limits for ammunition sales by dealers track these limits. Concealed weapon permits.Youth under 21 may not apply for a concealed weapon permit. *RCW 9.41.042 allows the following exceptions for youth possession.A youth under 18 may possess if s/he is: • In attendance at a hunter's safety course or firearms safety course; • Engaging in practice in use of a firearm or target shooting at an established range or any other area where discharge of a firearm is not prohibited; • Engaged in organized competition or performance; • Hunting or trapping with a valid license issued to the person; • In an area where discharge of a firearm is permitted,is at least 14,has been issued a hunter safety certificate and is using a firearm other than a pistol,or is under the supervision of a parent,guardian,or other adult approved by the parent or guardi- an; • Traveling to/from one of the above activities and the firearm is unloaded; • At residence and with permission of parent or legal guardian to possess a firearm for purposes of exercising right of use of force(self-defense)per 9A.16.020(3); • On property of parent,relative or legal guardian,and with permission to possess a firearm;or • Is a member of the armed forces,when on duty. 18 Law provision Washington Other states21 Restrictions on adult/youth pos- YES.Felon possession.Washington prohibits those con- *Federal laws provide basic minimums for session victed of felonies from possessing a firearm,unless that prohibitions,including prohibiting ownership right is restored by a court.For certain felonies,the pen- by convicted felons,unless the right is re- Federal law sets minimums— alty is more serious. stored,those"adjudicated as a mental defec- Washington law mirrors many five"and those"committed to a mental insti- provisions in federal law MIXED.Misdemeanants'possession.Those convicted of certain misdemeanor crimes cannot possess a firearm, tution." including specific crimes against family members,unless *23 states disqualify for some misdemeanor that right is restored by a court.Note that felonies can be offenses. pled to misdemeanors through plea bargain. *18 states prohibit alcohol/substance abus- NO.Alcohol/substance abusers.Washington's law does ers from owning firearms. not address limits on alcohol/substance abusers.Some limits exist for substance abusers under federal law. MIXED.Mentally ill.Washington's law prohibits those who have been found not guilty by reason of insanity for certain crimes or committed for mental health treatment from possessing a firearm,unless that right is restored by a court.Specific mental illnesses such as bipolar disorder, schizophrenia and major depression do not prohibit fire- arm possession. MIXED.Youth offenders.Washington law has a 10-day sentence for the first 4 convictions for illegal possession of a firearm,but there are numerous sentencing alterna- tives,such as deferred dispositions,and other ways around the 10-day provision.It takes 5 convictions before sentencing of 15 to 36 weeks to the Juvenile Rehabilita- tion Administration. Theft reporting required MIXED.Washington does not require gun theft to be *Require theft reporting:CT,MA,MI,NJ,NY, reported by private individuals(licensed dealers are re- OH,RI,DC quired to report loss/theft under federal law).Theft re- *Local requiring theft reporting:Chicago, porting can help deter gun trafficking. Cleveland,Columbus,Hartford,Los Angeles, NYC,San Francisco Registration system NO.Washington law does not require registration of *HI,IL,MA,NJ—require registration for all firearms and firearm owners. purchasers/owners *CA,CT,IA,MI,NY,NC,RI—license for all handgun owners/purchasers *HI,DC—require registration of all firearms Waiting period YES.5 days,but ONLY for licensed sales of handguns *There is no federal waiting period.Under without concealed pistol license(state law).For sales that the National Instant Criminal Background take place on the private market(approx.40%of all Check System(NICS),a dealer may transfer a sales),there is no waiting period. firearm to a prospective purchaser as soon as he or she passes a background check. *12 states/DC have wait periods,including 4 states with wait period for federally-licensed and private sales. Multiple purchases NO limit on number of purchases. *CA,MD,VA restrict number of purchases 19 Appendix: Years of available data In the Public Health—Seattle & King County fact sheet on Gun Violence in King County, we provided death counts for 2007-2011. However, at the time of writing this report, we do not have population esti- mates for 2011, and therefore, we cannot calculate rates for 2011 or 2007-2011 combined. As a result, we only provided data for 2006-2010 in the report. The table below shows the death counts related to firearms for different years or periods. _ King County WA state Year Intent Total Firearm Total Firearm 2010 Unintentional 574 0 2,590 10 2010 Suicide 226 86 947 462 2010 Homicide 48 30 178 113 2010 Other 5 5 16 15 2010 Undetermined 30 2 106 7 Total 883 123 3,837 607 2011 Unintentional 570 0 2,671 9 2011 Self-Inflicted 243 107 992 492 2011 Assault 40 19 180 92 2011 Other 5 5 19 18 2011 Undetermined 27 3 94 8 Total 885 134 3,956 619 2006-2010 Unintentional 3,063 2 13,226 35 2006-2010 Suicide 1,071 443 4,399 2,168 2006-2010 Homicide 312 190 1,013 600 2006-2010 Other 14 13 66 59 2006-2010 Undetermined 128 7 532 29 Total 4,588 655 19,236 2,891 2007-2011 Unintentional 2,971 1 13,251 35 2007-2011 Suicide 1,108 460 4,595 2,268 2007-2011 Homicide 274 164 974 571 2007-2011 Other 17 17 74 68 2007-2011 Undetermined 133 8 538 29 Total 4,503 650 19,432 2,971 Data sources National firearm death data were obtained from Centers for Disease Control and Prevention (CDC) Won- der online database. Data are from CDC National Center for Health Statistics Underlying Cause of Death 1999-2010. Washington state and King County firearm death data were obtained from VistaPHw. National firearm nonfatal injury data were obtained from CDC WISQARSTM (Web-based Injury Statistics Query and Reporting System). Data are from the National Electronic Injury Surveillance System—All Inju- ry Program (NEISS-AIP) operated by the U.S. Consumer Product Safety Commission in collaboration with CDC National Center for Injury Prevention and Control (NCIPC). State and local firearm nonfatal injury hospitalization data were obtained from Washington state Com- munity Health Assessment Tool (CHAT). Firearm deaths and non-fatal hospitalizations cost data comes from CDC WISQARSTM Cost of Injury Mod- ule. 20 References and notes The overall number of firearm deaths includes: homicides, suicides, unintentional deaths, undetermined deaths, and other. 2 Richardson EG, & Hemenway D. Homicide, suicide and unintentional firearm fatality: Comparing the United States with other high-income countries, 2003.Journal of Trauma. 2011;70(1):238-43. 3Council on Injury,Violence, and Poison Prevention Executive Committee,from the American Academy of Pediat- rics. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012;130(5):e1416-e1423. a Centers for Disease Control and Prevention, National Center for Injury Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARSTM) s Cook PJ, Lawrence BA, Ludwig J, & Miller TR.The medical costs of gunshot injuries in the United States.JAMA. 1999;282(5):447-54. 6 Shapiro RJ, & Hassett KA. (June 19, 2012)The economic benefits of reducing violent crime: A case study of 8 American cities. 2012. Retrieved from Center for American Progress website: http:// www.americanprogress.org/issues/economy/report/2012/06/19/11755/the-economic-benefits-of- reducing-violent-crime/ 'Numbers will not sum due to rounding. Data &statistics (WISQARSTM): Custom cost of injury reports. Retrieved from Centers for Disease Control and Prevention website: http://wisgars.cdc.gov:8080/costT/ 8 Cost estimates due to firearms were obtained from the Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System (WISQARSTM) Cost of Injury Module by applying King County case counts to national average costs. Medical costs will be underestimated as they do not include emer- gency department use or mental health costs. http://www.cdc.gov/injury/wisqars/index.html 9Shapiro RJ, & Hassett KA. Ibid. 10 Federal Bureau of Investigation. (Sept 2011). Uniform crime report: Crime in the United States, 2010. Retrieved from Federal Bureau of Investigation website: http://www.fbi.gov/about-us/cjis/ucr/crime-in-the- u.s/2010/crime-in-the-u.s.-2010/summary 11 Federal Bureau of Investigation. (Sept 2012). Uniform crime report: Crime in the United States: 2011. Retrieved Jan 18, 2013, from Federal Bureau of Investigation website: http://www.fbi.gov/about-us/cjis/ucr/crime- in-the-u.s/2011/crime-in-the-u.s.-2011/offenses-known-to-law-enforcement/expanded/expanded- homicide-data 12 Kellermann AL, & Reay DT. Protection or peril?An analysis of firearm-related deaths in the home. N Engl.1 Med. /986;314(240557-1560. 13 Ibid. 14 Kellermann AL, et al. Gun ownership as a risk factor for homicide in the home. N Engl J Med. 1998;329(13):1084- 1091. is Richardson EG, & Hemenway D. Ibid. 16 Ibid. 17 Estimate based on small numbers and is statistically unstable; should be used with caution. 18 Carr BG, et al. Unintentional firearm death across the urban-rural landscape in the United States.J Trauma Acute Care Surg. 2012;73(4):1006-10. 19 Hemenway D. (2004). Private guns, public health. Ann Arbor, MI:The University of Michigan Press. p.30. 20 Kellermann AL, & Rivara FR. (Dec 21, 2012).Silencing the science on gun research. JAMA.Available on JAMA website: http://jama.jamanetwork.com/mobile/article.aspx?articleid=1487470 21 Legal Community Against Violence. (Feb 2008). Regulating guns in America:An evaluation and comparative analysis of federal, state and selected local gun laws. Available from Law Center to Prevent Gun Violence website: http://smartgunlaws.org/regulating-guns-in-america-an-evaluation-and-comparative-analysis-of- federal-state-and-selected-local-gun-laws/ R ' ,T. o U o, ,:c 0 •0 U 0 •� •• •- } N O g; PIO ci C 0 - D U 4D O C) .c C V_ - c O � •- _ — 0 N I a, O E a ,v 4— (1) —0 E N N u o 73 0, U E c .. N 1_. •- •- _ N LL SC F- a N v 0 N o, N 0 C 0 (r) } N 0 2 a E w 0 05 4- 4E N 0 a) N O E c �_ O C C 0 1_ �> u a) V O N (1. p >s = '.-0 C _ } 0 V °� O O C C o O s *r•N V �V 4 0) E N O Q V c j L iri 0 N D a- 0) C O) vim► > _ N p la O .� C N C 73 0 t .71 a 0 4— m 0 0 0 C 0 0 (1) 04 ❑ ❑ 0 41U L4 .„,,,,t 14 rd a °' M - C O _T E 4- O .� = U D N 0 +C- > O _O = O 0 (1) (1) i > 0— • N U -0 I— _C ;4(.7 a _ .E 0 C ` — 'i V) 0 fi O = • N C LE m 4- , 3 Q; C tn > > O 0 W _ � ul- } T • O 0 a) 0 = = N 0 E 0 O 1... 0 C E 0 O O U U Q O o• = O O - N C I i O p .y' N E 0, Q N • �- %-F- L vNi H •N Q N S 'i O a O — Q N I O ID _ cI O (1.0) u oz O x v 1 v v v 0 CV CT CV 0 N 0 —0 N (1) I O .> O 0 t— CV I 3 06 c m -0 a o N 0) •O Q. a) N 0_ I N } f= c - s_ U 0 a a E— v 0 0 a (1) U (1) } (1) iii 0 ?., E N a Q &_. -, •L Q } V t Q D 0 D o Q D E > E a �> .M1 O .N U 0 0 0 N '� c > c 0 u° a NL 0 0 0 O z ox Q ❑ .,, t o,, P60 %' , z • O 0 s i i i %- 0 0 0 (1) v N 4- -0 o • > 0 E O O- .1-,:' _ O, N u 0 46 o 4 col E .> � O Q O O s III O C `. C t L- 0 N •- 4- 3 •O u 4-= N+- } i O c N E n N Q 7 u u a (N 0 v, O Q TD •T c-. u t c c = •- U) O CN s N 0 '� ,= O g I 4- 0 -0 0 0 = } a _0 0 •- O 0 0 � 0 0 a 0 0 E s > Ill o N%_ j 0 0 = N v, > E E •_ > O 0 u .O O O O a u F- `n - O s O` N +s- N ? N a. _ E 0 - E N a v) 0 0 T E. v N 0 E E '; a) 3 0 c CO O 0 a _ u 0 Al F E 0 F. 0 _ _ _ _ H _ N 0 c a a u_ 7 N 0 S Ou O N •> r .- O v' *' �a) 0 N 0 0 N - LL- = 0 0 _D O= E _ ° co - < 0 u 0 < O- < >- < 0 0 ^I 4� c4 Y ❑ ❑ ❑ ❑ ❑ ❑ ❑ .0 023 a) ,o i. N a c CD Jill) v o NJ ............ `- N 0) 4— `1' Co 0 CO M CO = O N L } Q > E 1 c CV o a) = o O 411. * D o OD NO O a) t3 LO o ,c W O a 01 0 (I) a a o 0 L.. E t/) N > v V) V • a, OD V V a) 0 05•_ N t/1 a) .— 'I- y-- 'a) E . _ �; O 0 0 N _ 4) 41 0- 0 i' _a ...a _a '_ tn O N � y �E > D > L ex ,� LL n Z Z Z ' .° Z LL .� 0 ISZ y AO cY) N Q a) ? Cl v r r \ CN = N tu) = ; N • s cc — L °' p CO N Nr 1) a) V '" o 1 > c tn p 4- 2 } c C O L a •v O 7.3 7V a = N V ._ w O N 0 cz -'.` ._ . N N N E V i 0 o• 0) C a E 1- O D a) O O 0 j N D I V 0 0 0 E �.' Z o O , p a, 0 0 I p ul v� N r v i N . O 44- LL * 0 O Q) V c N i •= H O u E .N Q) 0 0 (I) O N = Q � fix'., � s O } N Z �U) c 0 ._ N U 4— O QWfi O 0 N O O •� O O U) 0 0 0 0 - - -a 4) cz D O tom ) D -0 s c x V) N N — V D D * •,_,,V ,-.4 y V 4.4 0 T �N co 0 _ i O .— 0 0 N — Q = O j N D c N N O V = N 3 1.0 o �_ 0- N _ _ N H I CI ° , n u 3 0 O 00 5 r V N Q V ' N c ' N N �[ N f• N 0 o c 0 a N •— m•• Lc) o O F- L() rN-I c 4- 0 o 0 O •= N a) ch %—i a ' • O N - cV o o •i 0 a V N ir CO V F a � ■ . oa H E 11 D > 0 1 I I I I I 1 a) O N C 3 u •a 7:a u) -0 G) E 0 0 Ty 4- 0 V ti t ce � = o u E d4 E > \ ° O 0 . c N O X = 0 s o a 4- += 4- c C E ° a Q -a E _ v) 5 a� a 0 = d) i i Z O 0 .a a" 0 •. i •C O •— \ R - 5 } D a o ° � c � o •� 0 V E m a a.)x a ,--- v 4 a v 0, N N - M O N v o q. N> O N O C) 0 N 4- in .siV 0 u _ O . £,. , N +- 73 V C `■f mJ O 1/1 .- '. . . . N c L N 0 W 0 .4-:'c . M 0 N D 0 0 0 a o a E • ds CC) O 3 V M O N a) N E Q o 44- Lo •V O O 0 E a 0 0 c 1- NI Y 0 I E ° o a D N 1- _ m .! , °O Z ii N Q -a c = N a N M O s- co O a R } N -a N ch O . c� o V N o y a O I I I 1 I 1 1 ■ 1 Z . Z O � O � O VI O W) O in O E U l) ' ' co CO N N i- r- m •,_, 0 cu IegwunN � 0-I '%`)) 0 0 — 0 ap 4- v 0; C o (N •- V N • V °'- 0 0 W V 0) E 0 •_ 0 1 0 a •- C 0 LL 0 ,,. � �s .4=. C U- — 0 ii N a) w C h- a) CO VI d. a) ,. 0 0 o E o Tv •� C = H c > 0 a) N — >.TD _ > C •E c N .� v m O N •i °c° E S (/) C N v) a D N I 0 Q a O C.) _ T W •N > L } al....•— N E �..I 0 •�o C cdo u U O Q) E 04 o Q Z Z z CO E V D 0i • = 0 v O O CO CO — CO v 0 r. p. 0 N C D L 0) O 0 to 43 c d 0 t O N :0 > C — a ._ o w' 0 0 06 ^, Q W `0 M C M ,o -0 CV O O O O O ° in .o 0 - o O H 0) T 0) 0) 0) 0) 0) D S p H- }O O O 0 0 0o c V N >.... N N N ° U :O v CIO 0 a) + v + a) a) v - Y a. O E — c1) ~ � N 2 E2 -z w = cp = oc T = * v a, y._ -� ~ a) O C ; V a m m i N VI 4 — U) v O Q o j V > V) o (N 1.. c o a °' O 0 44= O c (N CD 4- 0 N L 0 4� >. N O ± N �_ I- O �_ _C v }, T O N N N +- (:0 >••• °, ° a •C:0 - a O� 0 '— 0 w , 0 N df M ,« 0 _ L w E Q Z T Q > c N c D O Tu L N v m O V Q stu a N 2 Y v N N W o 0)01 ........71. ^N W Q L Q T V H = O o V o W Q o •a E � • �''+-V O O o O O O N O co-:t I z O,c) xaG o o U a_ •r,E 0 a a s av) C cn O c •V a c — u it Q N ° s C O O 04 1— i o co O Z = / v c l.L r u T a O H O \ •� C a > c a N c::.0 E Y c S O 0.N a O Q O Nt C c `~ o a = g' Q a o N V V a Y w > c E O r, N c 4- Q ^, O \ O W• C V_ N O` • o a 0 o CO : ID V a O i V ID 00 = - 0 ✓ Q o o, , o c;1 } C� . o p E >. O V N O c Q a a) ▪ V N s w 0 E m � Y E O c O R O O V S m ,,,i E N N '^ ._ LC) O i E 3 0 • *—I 0 O N a Q _ d� o0 Q) j Cl) • o E MTI =_ LL L Q. D o _O O ►�"iy� O t/) a �' a o ii .. a 4 v v a) o IN a N N N o 0 � N 1.... 0 0 N N N 1- O V = `.' a) E 0 a T N Cl) p p O } C 01 0% 0% N c o ' a o t/1 = a _> w�x( .� _ ww, W 4— w W V 7 C •— �.t C o 0 E a) 1 -0 Q o zi= a > V O o D v w` o Q C s 0 E Q " C V N a) N i 3 -o Q •— U/ U) N N N 0 4-1- L L L L O V CT ' 0 + + s N p N p o T QO CO CO M 73. 4 0 0 Q N E CV 0 u Q U a a v' " U (1) prZ 47: 0 v >. a LW` \ a O - W, 0 — Lo V N > v Q ce Q ,/ O N T cy U U W o N C o _ O N >' a_ 0 N r ° V O O N v, y °0 N O e U O s I U \�_ o E c O Q N = O M) 0 I 0) € 0 0 ~ N a O c -0 D o O 0 .� 0 0 w v, 0 oS O ) 3 E C .� a) O 0 a) .�O' ° ° ,- c = E a) Cll- � V a) :} CD T o! w s O 3 7"' 0 CV ce i 4)›.' 4) .- vi O T D N N � � E QO Q } il .-1_ Q U y 3 0 (1)„. O N a)N •� 4- O r C > Q I \ t a } p emu° M 3 O to D. _ N N E Z s_ > V a4 0 u N D o •> (> Al U 0 > 0) •TO 0 (1) o a T p 0 > o a v N ..O E H .— E _ 4.- O V o -3 T •• 0 a- CO a) O — U N O N _ CO •a o > 0 C CV^ ._ CNI 2 v ° = �' `� 0 o o .— _ ,^ > ._� V — c N CO 0 a) a) a) o 0 N •... _ -0 N 0 O 0) o U)) �; o V °a' Q Q Q ~ ° 4) `o V O O O 0 I` . . E N 4- 4> O 0)0 N • ._i — ' D a E a) s- a) a) I- (...) > N ❑ ❑ ❑ ❑ ❑ ❑ D > 4 o a '}' 0 0 w CO • Q Go C C N QJ E 0) 3 a. . o ▪ > O .V a) ° o o E a) °� = E a) O us_ 0 s u O 3 in � � O\ � E o O . a E — ; C x Q cij „id/40w / ,... D row W1 Q 0 ' o CI C u .C- 0 >— N c' � „ Q D o a) o > O CO N c o N .__ '�-4 v 0 > glo c`,"1' E y °; N E w _ 4– i O -0 v ' — N ° i , o > 4- N O aa.. N Os C 0 O — — N �. a \ `i +- ° o +— '— o N Al O O H E D (N V = Cpl d) O O \o D o ° o 0 0 ° 0 — .Nt (NI N a i Q) i L� L o—_0 'a O N O O (1) N ° E a - - o U E > 4- C v O Q V Q Q 0 < z N `o V -.I= '- 4_ N n E CA O O Ce O E c a E 0 O ' 0 .� U O N 0 d >) N ° L N o� c Q) a O 0 .� ❑ ❑ ❑ _ a O p w SO 0 w ozs ▪ _ } > 0 C N > > E c N i _ V N 4) O Q. DI a) p 0 +- v 7 3 O .V w o \ = p N N \ '� 0 Tv r _ o Q v Y v o N J 1 o a C (D r 0 II L O p L • ›- = Q N O M ' O (0 o oc _ � x a + V } 0 o •+--i °so I— CO • •> P■4 co N � a >. <1 N co L CP O C N iNts,„ a N L (7.1 th L O W 0 _ ri' o a E Q }> 0 N N O co N .— >` N _ s_ I _ a r < U 0 >Mililialli LL_� c LU 06 O N C E Ti) N > N p L 41\ 01.3 o a / N 01 N (1) S CSI v 3 a V „ o 0 0- E D "q" " a) 0) (\I 0 N �' c cz LL s.. 1_ >. N p I o U a) = _ s a) X } \ .�--i X23 s o w } .o ^'' av } 0 r 0 V Q 7a v a • o. , N -0 v s a 3 0 U v CN +- N c s p o 73 i a) ,... O '' a) a) 4) N -c C O •a . {,., o N a) C O N T o 3 N — °O � - > a)V o a) 5 Op N N a E ' E. 1- "' 0 N O O U a) c) - u •5 O a) 4) o 0 C c O U N = ,15 N o C 73 • 2 N U ? N Q 0 O .� O i v } O T �O C o •a) • O �C E '�,• a) -0 � H i L `=' a C L H 0 s = U O u D 0 0- k3 s — •� vvi O 0 •17 Q - Q O • O O 0 0 N v > 4n a) %-m N \o _ -4S N N •_ 0 R O .- o a -0 -0 E C a)N —T E 4 V Q O Z 6 O o C.) J J ® o z to 04 0 x 0 ❑ ❑ Y mt ;' v O N • O a N L L L L O 0 0 a) v Tc N 0 O a E O . o CV 'i u a a) CV CN ) Ea) c p O a E •> • O Q p C a) C `I c s s- 0 `n •— 4- 3 L .6 •� ' a) c . a a) • E V v ,� (NJ O `n a) •= v LE - C = Q C •_ r NO s 0) `n a —_ ._ O o I 4- 73 0 O C } a H = _ } 0 2 L O 0 0 O 0 a) > O 0 w N } a) E O O +- a) dS V > L N �N E •> 0 u Q E `n 0 a� 0 •c • i T 0 c E Q a 0 O -0 v O L `n N E ' E E . 0 > C a) 1 •V a a E a L _C a) a V E Z Q i v N 0 a) •E O > a a) 0 a to H 4" L O -� O• - a) D a) 0 >E 0 E N a n O c_ a �` O E u a CO co E •> L L ) �n 0 a L V a Fi 0 CO N N `� `n �� } n� Q N V 7 0 0;7)- E cy) L a a) NO } V `in T s_ ”. a' LL c a O _0 0 E_ O M -0 tt3 3 ❑ ❑ ❑ ❑ ❑ ❑ •U •--` c., 4 - LX N v 0 (N o, 0 1'+-- a (7 _ o E O E CD '� L N.... '>a o a Q W E 0 a. d3 c_, v) a. a) > �) L co E _ 0 o .'^ v To a N L I— O > 0 U r T 0) L C N a N.1-- -'Q- a) 0 N a N p s O O N 0) I o N •0 U Vao o .s x 3 D U '� ...0 ai — a) 4 1p-4 '11 The Impact of Firearms on King County's Children : 1999 - 2012 November 25, 2013 Alet , , t, I t i lij- ii ..... . . .. itiv ,,, / wy tir N. , 400,..,,,,,:„..t., ..i„..;,,, Ilk. voiter iip, ., .. N_ .v • ..:, t...... .tt . . , _ . .... „. ,,, a i � i ..- } I M 401 Fifth Avenue,Suite 1300 Public Health 141 Seattle,WA 98104 Seattle & King County www.kingcounty.gov/health Public Health-Seattle&King County Acknowledgements This brief was prepared by Public Health—Seattle & King County as a collaboration between the Assessment, Policy Development and Evaluation Unit and the Prevention Division. We wish to thank the King County Medical Examiner's Office for their assistance in this report as well as for their leadership role in Child Death Review. 2 The Impact of Firearms on King County's Children: 1999-2012 Introduction Background Every day in the United States, five children The mass shooting of children at Newtown, CT age 18 and under are killed by gunsl. King struck a chord here in King County. Shortly County is not immune to this violence. after, King County Executive Dow Constantine Between 1999 and 2012, 68 King County issued an Executive Order directing Public children under the age of 18 died from gun Health - Seattle & King County to develop violence, and another 125 children were innovative, data-driven local strategies to injured and had to be hospitalized2. All of prevent gun violence in King County. these deaths and injuries were preventable. Executive Constantine called gun violence a This report describes what we know about public safety and public health crisis. these tragic deaths with the aim of informing what we can do to prevent other children from Just as it has been applied to reducing motor needlessly dying by gun violence. vehicle-related injuries or tobacco use, a public health approach may be our best chance for In reviewing data from the Medical Examiner's reducing gun deaths and injuries. A public Office and Child Death Review, three key health approach relies on data and rigorous findings emerge: 1) There is a paucity of evaluation to identify effective policies and data to inform policy and program decision strategies to prevent bad outcomes. In this making; 2) gun violence among children is case, the goal would be to prevent really two problems, one being homicide and unnecessary deaths and injuries by firearms. the other suicide, and each may require different approaches to prevent; and 3) the There is reason to believe that by using a risk of a completed suicide by firearm among public health approach, we can be successful. children is nine times greater in households A comparison of the gun-related deaths and where firearms are kept unlocked and are injuries among children in the U.S. to other easily accessible. Western countries reveals that American youth ages 15-19 have a 43 times higher firearm Based upon these findings, we have two assault mortality compared to youth in the major recommendations: same age group in Western Europe3. In fact, 1. King County has decided to take a public across 23 high income countries, 87% of the health approach to preventing gun firearm fatalities in children less than 14 years violence, but there are barriers. If we want of age occurred in the United States4. The to move forward, we need changes in our lower rates in other countries prove that it is systems to improve information gathering possible, with the right policies and programs, and sharing, to allow creation of a robust to prevent firearm deaths. data system - the basis for developing and implementing effective interventions. 2. Every effort should be made to encourage and incentivize gun owners to safely store their firearms, away from the reach of children. 3 Public Health-Seattle&King County Methods Findings Child firearm fatalities were identified through There are two distinct problems of gun a report generated from the Medical violence among children: homicide and Examiner's office (MEO) database for the years suicide 1999-2012. A similar report was generated From 1999-2012, 68 children younger than age from the Child Death Review (CDR) 18 were killed by firearms in King County. Of database. The MEO and CDR lists were these deaths, 62% were homicides and 37% compared to ensure there were no missing were suicides. The manner of death for one cases and to create a final list of all firearm firearm fatality was undetermined. The deaths of individuals less than 18 years of age. characteristics and factors associated with All incidents occurred in King County during the firearm-related homicide and suicide differ, as years 1999-2012. Each record was then described below. reviewed and information extracted to tabulate data. Law enforcement records and narratives Homicide that were already included in the CDR system were reviewed to help complete the data. Child firearm homicide victims From 1999 to 2012, there were 42 firearm King County age-specific rates of child (< 18 homicides of King County children under 18 years) firearm homicide and suicide for the 14- years old. That accounts for 42% of the year period, 1999-2012, were calculated using overall child homicides during this period. Washington State death certificate data (1999- Firearm homicide victims were more likely to 2011) and King County MEO database (2012 be male, Black, and between the ages of 15 deaths). Corresponding population estimates and 17. were obtained from Looking Glass Analytics • Males were three times more likely than and the Washington State Office of Financial females to be firearm homicide victims. Management (Feb 2012 release). The 2012 • Black children were six times more likely population estimates were assumed to be the than white children to be firearm homicide same as the population estimates for victims. (Fig. 1) 2011. Rates were calculated based on • Child homicide rates were higher in Seattle residence (decedent was resident of King (1.8 per 100,000) and South King County County), rather than occurrence (where the (1.0 per 100,000) compared to North (0.3 event occurred). per 100,000) and East King County (0.2 per 100,000). (Fig. 2) Data on high school student access to guns comes from the Washington State Healthy Youth Survey for 2012. 4 The Impact of Firearms on King County's Children: 1999-2012 Figure 1. Child (<18 years)Firearm Homicide by age,race/ethnicity and gender— King County,WA(1999-2012 average) Age<1 yrs' _ 0.3 Age 1-4 yrs' MI 0.2 Age 5-9 yrs* • 0.1 Age 10-14 yrs* -0.5 Age 15-17 yrs 3.5 AIAN No Events Asian/NHPI' 0.8 Black* 3.0 Hispanic' 0.8 White -0.5 Males 1.2 Females* - 0.4 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 Firearm Homicide Rate per 100,000 Youth(0-17 years) 'Rates based on fewer than 20 events are unstable and should be interpreted with caution. Notes:AIAN x American Indian/Alaska Native;NHPI x Native Hawaiian/Pacific Islander.Persons of Hispanic ethnicity can be of any race and are included in the racial categories. Data Source:Death Certificate Data,Washington State Department of Health,Center for Health Statistics,1999-2011;King County Medical Examiner data,2012. Prepared by:Public Health-Seattle&King County,Assessment,Policy Development&Evaluation,10/2013 Figure 2. North Region } r - 0.3 per 100.000 Child (<18 yrs) Firearm Puget j 1 Homicide Rate by Region- Sound King County,WA, 14-year Seattle Region - average.1999-2012 1.8 per 100.000 Rate per 100,000 0 1-o s East Region 0.2 per 100.000 04 Ob -07- 10 - 11-20 • 0 1 2 4 6 8 i R61es Public Health Seattle&King County Oats Swe. *Wrgbn Slab Dear Cereata. sod Kaq Crory better E.amew..data Produced by awwament PO*[y Op.ebpnenl i E■h.MUn Una IP' :0. NOTE Raw la P nq Cwxy Ear and Nam.epee Puget South Region Nye ap towel r . ro ar Sound 1.0 per 100.000 rompereaw wPeew or dald roan wear ea Pak awOaNMBTa4erne A derde edien[We WM*ti.er40See...._rY.Ww.ed.o. 5 Public Health-Seattle&King County Context and details of child firearm • What are the reasons for the shootings? Are homicide incidents they gang-related incidents? • Who are the shooters, and what are their • The type of firearm used is known in 76% of ' child homicides. Of the cases when the motives? firearm type is known, 94% involve • Where do the guns come from, and are they handguns. Two cases were committed with obtained legally? shotguns and hunting rifles. • Were there histories of violence or The relationship between the shooter and interactions with law enforcement prior to • the victim is known in 69% of the cases. Of these events? the cases where the relationship was • To what degree did violent media, such as determined, in 21% of incidents, the shooter video game or films, influence perpetrators was a family member; another 52% were to use firearms? friends or acquaintances. • 29% of child firearm homicides were Suicide multiple-death incidents. All firearm Child firearm suicide victims homicides of children less than ten years of Between 1999 and 2012, 25 King County age also involved fatalities of adult family children under 18 years old committed suicide members. using a firearm. That accounts for 39% of the • Drug and alcohol use appears common overall child suicides during this period. among victims of firearm homicides. Sixty- Firearm suicides were more common in the late two percent of all child homicide victims teen years (ages 15-17) and more likely among tested positive for illegal drugs and/or males and Whites. alcohol. The most common drug detected • Males were 3.5 times more likely than was marijuana (38% of all child firearm females to be a firearm suicide victim. homicides), followed by alcohol (14% of all White children were three times more likely •child firearm homicides) and cocaine (12% than black children to be a firearm suicide of all child firearm homicides). Data on the victim. There were no firearm suicide shooters is not available. victims during this period among Hispanic, Asian/NHPI, or Alaskan Native/American What we don't know Indian children. (Fig. 3) Critical information is missing about the nature • Child firearm suicide rates were higher in of these events. This report was limited to the East (0.7 per 100,000) and South (0.5 per data elements collected by the MEO or Child 100,000) King County than in North (0.3 per Death Review. Additional information may be 100,000) King County or the Seattle region available through other sources, such as law (0.3 per 100,000). (Fig. 4) enforcement or court records; however, it often cannot be shared due to legal restrictions. Other information is not systematically collected by any agency. Data that would help in understanding the nature of these incidents include answers to questions, such as: 6 The Impact of Firearms on King County's Children: 1999-2012 Figure 3. Child (<18 years)Firearm Suicide by age,race/ethnicity and gender— King County,WA(1999-2012 average) Age<1 yrs No Events Age 1-4 yrs No Events Age 5-9 yrs No Events Age 10-14 yrs* _0.3 Age 15-17 yrs 2.3 AIAN No Events Asian/NH PI No Events Black* _0.2 Hispanic No Events White 0.6 Males 0.7 Females' —0.2 0.0 0.5 1.0 1.5 2.0 2.5 3.0 Firearm Suicide Rate per 100,000 Youth(0-17 years) 'Rates based on fewer than 20 events are unstable and should be interpreted with caution. Notes:AIAN=American Indian/Alaska Native;NHPI r Native Hawaiian/Pacific Islander.Persons of Hispanic ethnicity can be of any race and are included in the racial categories. Data Source:Death Certificate Data,Washington State Department of Health,Center for Health Statistics,1999-2011;King County Medical Examiner data,2012. Prepared by:Public Health-Seattle&King County,Assessment,Policy Development&Evaluation,10/2013 Figure 4. North Region I �/7 0 3 per 100.000 Child(<18 yrs) Firearm Puget Suicide Rate by Region - Sound Seattle Region King County, WA, 14-year 0.3 per 100.000 average,1999-2012 Rate per 100,000 ®o t-0 3 East Region ... 04-06 07 per 100.000 -07- l0 e y - 1I-20 0 1 2 4 6 B //���� Miles !� j� .� Public Health Seattle&King County "- Oats sar,. Wa..q..n sear Owe Cantata*. ana Nna Cocnry rqr.E,.rwr ar. Dv. omaoma nr sw..w.n. oo.,T o...a.n..a E'"""`°"""t0'52011 Puget South Region NOTE.Nor,br Name ra bawd on r.r elan:a .vents .w .pwd w ....w0 .an coupon .SOL't -� 0.5 per 100.000 Ur pond cu.aonw r br amps's.,..woos.*it <'rd d,.,.,, n.w I i tsar swamMEQlaTNO•pA panom.owaranaauro4*.won<arqwrrja.wrrrlaRga. 7 Public Health-Seattle&King County Context and details of child firearm suicide receiving treatment? incidents • Are there opportunities to identify children Of the child firearm suicides, handguns were at risk of suicide and intervene? • used in 60% of the incidents while the remaining 40% involved a hunting rifle or Access to Firearms shotgun. National studies, as well as those from here in • In 80% of cases, gun ownership was King County, indicate that having a gun in the identified. Of the incidents where gun home increases the risk of injury or death6. ownership was known, 25% of suicides were Although details regarding the origin and committed with a gun owned by the child, ownership of firearms involved in these specific and 70% were committed with a gun owned child deaths are limited, additional information by a family member. about general accessibility of firearms in King • Only 16% of the guns used to commit County is known: suicides were stored in locked cabinets, and • In King County, nearly one-quarter of all those children either knew the combination households have at least one firearm. or where the key was kept. Among households with firearms, an • The risk of completed firearm suicides estimated 22% (40,800 households) stored among King County children (< 18 years) is them loaded, and 17% (31,200 households) 9.2 times greater when firearms in or stored them loaded and unlocked'. around the home are stored unlocked • In 2012, an estimated 2,500 King County compared to when firearms are stored high school students reported carrying a gun locked5. for purposes other than hunting in their • Drugs and/or alcohol were involved in 32% communities at least once during the past of child firearm suicides. The most common 30 days. drug detected was marijuana (20% of all • In 2012, an estimated 11,600 high school child firearm suicides), followed by alcohol students in King County (which represents (8% of all child firearm suicides) and 14% of the entire public high school methamphetamine (8% of all child firearm students population) reported that it would suicides). be very or sort of easy to get a handgun if they wanted to. What we don't know • During the 2011-2012 school year, 52 King As with child firearm homicides, many details County students were suspended or expelled regarding child firearm suicides are not for possessing a firearm on public school available. Much of the information that would grounds8. Over the past 10 years there was help in understanding the nature of these no significant change in the total number of incidents is not collected systematically, reported incidents of carrying guns in public including answers to questions, such as: schools statewide. • What causes children to use guns versus other methods to inflict self-harm? • What are the factors that put some children at higher risk of firearm suicide? • Do children who commit suicide by firearm have identified mental illness, and were they 8 The Impact of Firearms on King County's Children: 1999-2012 Conclusion law enforcement, juvenile justice, the courts, No region or community in King County is and social service agencies. immune to gun violence, and there are too many children who die from firearms to consider Specific next steps for consideration include: that these are unique and unavoidable • Participating in the National Violent Death incidents. There are some notable trends; the Reporting System or developing a similar data reveals that firearm homicide and suicide system which systematically links variables have different characteristics, both from different sources, such as the medical geographically and in terms of which examiner's office, law enforcement reports, communities are most impacted. Unfortunately, and crime labs, to identify trends related to the data does not provide sufficient information violent events. to guide prevention efforts. A public health • Supporting the full implementation of a approach (and/or a public safety approach) that youth shooting review based on leads to successful interventions to reduce gun Milwaukee's Homicide Review Commission violence deaths and injuries will require many with the aims of 1) using case review to more details as to how and why these events identify trends and gain a better occur. understanding of youth gun violence, 2) developing innovative and effective Based upon what we know and don't know, we responses and prevention strategies, and 3) have two recommendations: helping focus available prevention and 1. King County has decided to take a intervention resources. public health approach to preventing gun violence, but there are barriers. If Both of these options would require instituting we want to move forward, we need new efforts to gather standardized data beyond changes in our systems to improve what is currently collected, as well as sharing information gathering and sharing, to the information in a way that allows linkage of allow creation of a robust data system, case information across different sources. Only once we have more information can we In a rational world, we would base policies, scientifically identify trends and potential areas develop programs, and allocate resources based of intervention. upon data and evidence. But there is scattered and incomplete data on gun violence, especially 2. Even with incomplete data, the critical pertaining to children. If the goal is to make importance of storing firearms safely is evident. We should ensure that gun data-driven decisions, then all partners will need to put into place the components owners store their firearms safely and necessary to obtain the data for analysis. This out of the reach of children. includes developing procedures to collect Keeping firearms out of the reach of children is additional data, creating or adjusting policies to allow broader sharing of information, and an important step in preventing children from providing sufficient resources for these efforts. committing suicide and homicide. As noted Additionally, it will require commitment and earlier, there is a much greater risk of a collaboration by partners such as public health, completed suicide by firearm in homes where guns are kept unlocked. Some of the potential 9 Public Health-Seattle&King County steps that could be taken include: (CDR) for number of completed firearm suicides Assuring that gun owners have access to by firearm storage practice and (2) Behavioral • affordable safes and lockboxes and are Risk Factor Surveillance System (BRFSS) for educated on the critical importance of their percentage of children (< 18 years) in homes use. with locked and unlocked firearms. The number • Working with retailers to promote safe and of children in households with locked and responsible storage of firearms. unlocked firearms was estimated by multiplying the 3-year average prevalence from BRFSS with References and notes the King County, WA population <18 years. As a conservative approach, completed firearm suicides where storage was unknown (n=9, 1. Centers for Disease Control and Prevention. 36% of completed firearm suicides) were Injury prevention & control: Data & statistics (WISQARSTM). www.cdc.gov/ncioc/wisgars. assigned to locked storage. Characteristics of households in the CDR data were assumed to be 2. Firearm injury hospitalization data comes similar to characteristics of BRFSS respondents from the Washington Comprehensive Hospital from households with children. Abstract Reporting System (CHARS). CHARS 6. Kellermann AL, Reay DT. Protection or peril? contains coded hospital inpatient discharge an analysis of firearm-related deaths in the information (derived from billing systems) home. N Engl J Med. 1986;314(24):1557-1560. available since 1987 and is used to collect doi: 10.1056/NEJM198606123142406. information such as the age, sex, zip code and billed charges of patients, as well as the codes 7.Washington State Department of Health. for their diagnoses and procedures among other Behavioral risk factor surveillance system items. Analysis focused on the period 1999- (BRFSS). http://www.doh.wa.gov/ 2011 and excluded King County youth who died DataandStatisticalReoorts/HealthBehaviors/ while hospitalized. BehavioralRiskFactorSurveillanceSystemBRFSS. aspx. (Public Health — Seattle & King County is 3. Institute for Health Metrics and Evaluation. responsible for data analysis.) Global burden of disease (GBD) visualizations: GBD compare. http:// 8. State of Washington Office of Superintendent www.healthmetricsandevaluation.orgigbd/ of Public Instruction. Weapons and Schools visualizations/country. Reports. http://www.k12.wa.us/SafetyCenter/ Weapons/default.aspx. 4. Richardson EG, Hemenway D. Homicide, suicide, and unintentional firearm fatality: Comparing the United States with other high- income countries, 2003. J Trauma. 2011;70 (1):238-243. doi: 10.1097/ TA.0b013e3181dbaddf. 5. The relative risk was 9.2 with a 95% confidence interval of 4.2 to 20.1. Unadjusted relative risk of completed firearm suicide by firearm storage practice (locked vs. unlocked) in or around the home was estimated using data from two sources: (1) Child Death Review 10