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Program Profile: Cardiff (Wales) Violence Prevention Programme (CVPP)

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on November 30, 2015

Program Summary

This is a multiagency partnership designed to prevent violence and reduce violence-related, emergency room admissions. The program is rated Promising. Both hospital admissions related to violence and violence recorded by the police decreased as a result of the program, when compared with the comparison cities.

Program Description

Program Goals
The Cardiff (Wales) Violence Prevention Programme (CVPP) is a multiagency partnership designed to prevent all forms of violence and reduce violence-related, emergency room admissions, particularly late at night and on weekends, when services are overextended and alcohol-related disorders are common.  In 1997, the UK decided to adopt a multiagency approach to violence prevention and specifically include the health sector because of research that showed that a significant percentage of violent incidents, which required treatment in emergency departments, were not known to police. CVPP was developed to serve as a data-sharing strategy and became fully operational in 2003.

Through CVPP, city government representatives, police, city-licensing regulators, and an emergency-department consultant work together, and use data collected in emergency departments and through police intelligence to inform targeted-policing efforts and other strategies. It is believed that including emergency departments leads to increased violence prevention, as emergency departments have the unique ability to share anonymized electronic data about the precise location, weapon use, assailants, and the day/time of the violence that is not always known to the police (Florence et al. 2011; Shepherd 2007).

Program Activities
In CVPP, when a patient first reports to an emergency department for an injury caused by a violent incident, information about the precise location of the incident (i.e., name of bar, nightclub, school, park, street), the time of day, and the weapon used in the incident is captured electronically by emergency department reception staff. This information is stripped of all personal identifiers and shared by hospital IT staff with the partnership crime analyst on a monthly basis.

The crime analyst combines this data with police intelligence to generate updated maps of violence hotspots and summaries of weapon use and violence type (classified as stranger, acquaintance, or domestic to fit with the National Crime Survey categorization). The information can indicate if it was a knife or gun crime; if the person is a repeat victim, and if so, if he or she were injured by the same attacker; and if the violence has been occurring in similar locations (such as particular night clubs). This constantly updated information is then used to aid in violence prevention efforts, as police departments are better informed of where and how to target their efforts.

Using the combined emergency department and police data, the CVPP met about every 6 weeks to introduce or try to sustain a range of strategies that were designed to address the specific risks and patterns identified through the combined hospital and police data. Police strategies could include adjustments to patrol routes, employing more police in the city rather than the suburbs, targeting problematic areas, and informing the public of the use of closed circuit television.

Program Theory
CVPP is grounded in the idea that information-sharing-partnerships across police, emergency departments, and health professionals can aid in violence prevention. According to this approach, coupling police and relevant data from emergency departments, and including health professionals in the initiative–given that they treat the injured and can serve as advocates for prevention–can help prevent more violence than would be possible from police efforts alone (Florence et al. 2011). 

Evaluation Outcomes

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Study 1
Violence Recorded by the Police
Total Assaults
Florence and colleagues (2011) found that the average rate of total assaults decreased following the implementation of the Cardiff Violence Prevention Programme (CVPP). The average rate of total assaults was approximately 79 percent of the rate prior to implementation.
 
Wounding Assaults
Wounding assaults had a significant reduction after implementation, with a rate of 68 percent of the wounding assault rate prior to implementation. Furthermore, following program implementation, Cardiff’s rates began to decline and were consistently and significantly lower than the mean rate for the comparison cities over the remainder of the analysis.  

Common Assaults
There was a significant increase in the common assault rate following program implementation (38 percent). This increase was attributed to improved information sharing which was part of the intervention strategy.  Moreover, Cardiff was consistently below the mean of the comparison cities; however, Cardiff’s rate rarely fell within the confidence interval, and was therefore not significant.    

Hospital Admissions Related to Violence
Following program implementation, hospital admissions in Cardiff fell from 7 a month per 100,000 population, to 5 a month per 100,000 population. Comparatively, hospital admission rates in the comparison cities increased from 5 admissions a month per 100,000 population, to 8 a month per 100,000 population. 
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Evaluation Methodology

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Study 1
To investigate the impact of the Cardiff Violence Prevention Programme (CVPP) on violence, Florence and colleagues (2011) compared changes in violence in Cardiff (Wales) with changes in comparison sites. The comparison sites were 14 cities throughout the United Kingdom (UK) that were classified as “most similar” to Cardiff by the UK Home Office. The cities were chosen according to 20 sociodemographic and geographical variables, which were used to cluster together a list of the most similar cities to Cardiff. The variables included items such as percentage of young men, minority populations, single-adult households, unemployment, and population per square mile. The final list of cities included Birmingham, Bristol, Coventry, Derby, Leeds, Leicester, Lincoln, Newcastle upon Tyne, Northampton, Plymouth, Preston, Reading, Sheffield, and Stroke on Trent. The study controlled for police force and city unemployment rates, as they have been found to be linked to incidences and records of violence.

The outcomes of interest included violence recorded by police (both wounding and common assault) and hospital admissions related to violence. Wounding assault could include an injury resulting in permanent disability or permanent loss of sensory function; or, in less serious cases, it could include a temporary loss of a sensory function or the loss or breaking of a tooth. Common assault could include grazes, scratches, abrasions, minor bruising, swellings, or an assault that did not result in an injury. Police-recorded data for both Cardiff and the comparison cities was analyzed starting in April 2000 and continued to March 2007. The CVPP was implemented in January 2003, after 33 months of development, and data was shared over 51 months following implementation. The analysis of hospital admission data took place between January 2000 and December 2005, which included the 36 months before implementation and the 35 months after implementation.

To compare changes of violence over time as a result of CVPP, Cardiff’s rates of violence were compared with the mean rates of violence in the comparison cities, by month. Multivariate regression modeling was used to measure the overall impact of CVPP. It is important to note that between 1999 and 2002, the National Crime Recording Standard (NCRS) was introduced across England and Wales, which led to increases in recording rates. To control for the increase of recording as a result of the NCRS, a dummy variable was introduced to code the months before implementation as 0, and the months after implementation as 1. These dummy variables were introduced because they could control for changes in overall violence that might be common across all the cities in the sample.
 
It is important to note that only three of the 14 most similar cities had data on hospital admissions related to violence (Leeds, Reading, and Sheffield). Therefore, to determine the impact of CVPP on hospital admissions related to violence, analyses were conducted to compare these three cities to Cardiff. 
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Cost

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Florence and colleagues (2014) conducted a cost-benefit analysis of the Cardiff Violence Prevention Partnership (CVPP) over time. They found that for every 1 British pound spent on the program, there was a savings of 19 pounds in criminal justice costs. In U.S. dollars, this means that for approximately every $1.50 spent, there was a $29 reduction in criminal justice costs.
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Implementation Information

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Florence and colleagues (2011), who studied the effectiveness of the Cardiff Violence Prevention Programme (CVPP), noted that there may be barriers to successful community partnerships that need to be addressed so that other communities can see similar effects to those in Cardiff. These barriers could include a lack of analytical capacity, fears about breaches of confidentiality, lack of a science-based culture in the police service, and lack of a preventive focus in emergency services. The CVPP was dependent on the sustained and continuous capture, sharing, and use of data; however, with necessary recourse and support, the CVPP is a viable approach for communities wishing to adopt a similar violence prevention partnership.  

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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Florence, Curtis, Jonathan Shepherd, Iain Brennan, and Thomas Simon. 2011.”Effectiveness of Anonymised Information Sharing and Use in Health Service, Police, and Local Government Partnership for Preventing Violence Related Injury: Experimental Study and Time Series Analysis.” British Medical Journal 342: 1–9.

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Additional References

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These sources were used in the development of the program profile:

Droste, Nicholas, Peter Miller, and Tim Baker. 2014. “Emergency Department Data Sharing to Reduce Alcohol-Related Violence: A Systematic Review of the Feasibility and Effectiveness of Community-Level Interventions.” Emergency Medicine Australasia 26(4): 326-335.

Florence, Curtis, Jonathan Shepard, Iain Brennan, and Thomas R Simon. 2014. “An Economic Evaluation of Anonymised Information Sharing in a Partnership Between Health Services, Police and Local Government for Preventing Violence-Related Injury.” Injury Prevention 20: 108–14.

Shepherd, Jonathan. 2007. Effective NHS Contributions to Violence Prevention. Cardiff, Wales: Cardiff University.

Warburton, A. L., and J. P.  Shepherd. 2004. “Development, Utilisation, and Importance of Accident and Emergency Department Derived Assault Data in Violence Management.” Emergency Medicine 21(4): 473–77.
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Program Snapshot

Geography: Urban

Setting (Delivery): Other Community Setting, High Crime Neighborhoods/Hot Spots

Program Type: Community and Problem Oriented Policing, Community Awareness/Mobilization, Crisis Intervention/Response, Situational Crime Prevention, Violence Prevention, Hot Spots Policing

Current Program Status: Active

Program Developer:
Jonathan Shepherd
Professor
Cardiff University
School of Dentistry, Health Park
Cardiff CF14 4XY
Phone: 0044.0.2920744215
Email

Researcher:
Jonathan Shepherd
Director, Violence Research Group
Cardiff University
School of Dentistry, Health Park
Cardiff CF14 4XY
Phone: 0044.0.2920744215
Website
Email