SUBJECT
Title
GUN VIOLENCE COMMUNITY NEEDS ASSESSMENT FINAL REPORT AND RECOMMENDATIONS (DISTRICTS: ALL)
Body
OVERVIEW
On October 19, 2021 (1), the Board of Supervisors (Board) directed the Chief Administrative Officer to develop options for community-based gun violence reduction and disruption programs and to return to the Board within 180 days. On April 5, 2022 (16), staff returned to the Board with a recommendation to conduct a contractor-led, regional gun violence community needs assessment to better understand the scope, complexity, and impact of gun violence and to share key findings with the Board upon completion. The recommendation was approved by the full Board and the County issued a competitive solicitation and contracted with Health Assessment & Research for Communities, Inc. (HARC), a non-profit research and evaluation firm.
To complete the community needs assessment, HARC conducted extensive data analysis; issued and analyzed two community surveys; hosted a dozen listening sessions and community forums receiving broad stakeholder input; facilitated numerous meetings with a Gun Violence Reduction Advisory Group comprised of community stakeholders; and conducted a best practice review of local, state, and national programs and practices designed to reduce gun violence. HARC issued its analysis and findings in a Gun Violence Community Needs Assessment Final Report, which summarizes findings from secondary data analysis, community surveys and surveys of practitioners working in jobs that pertain to gun violence, and through virtual and in-person listening sessions. The final report includes recommendations to reduce gun violence in the county. Public Safety Group Executive Office staff have used those recommendations to prepare a Gun Violence Reduction Work Plan.
Today’s recommendations are to receive the HARC report, the Gun Violence Reduction Work Plan, and a presentation, and to authorize the submission of grant applications that will support violence prevention and intervention programs and services; and to direct staff to return in early 2024 with plans for how gun violence reduction work will be structured and organized within the County.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Receive Health Assessment & Research for Communities, Inc. Final Report and recommendations.
2. Receive the Gun Violence Reduction Work Plan and approve year one actions.
3. Receive a presentation on the gun violence community needs assessment project.
4. Waive Board Policy B-29 Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery, which requires prior approval of applications for, acceptance of, and full cost recovery for grants.
5. Pursuant to Board Policy B-29, authorize the Deputy Chief Administrative Officer for the Public Safety Group and the Health and Human Services Agency Director or his/her designee, to submit grant applications and accept grants that support violence prevention and intervention programs and services through June 30, 2028.
6. Direct the Chief Administrative Officer to return to the Board in early 2024 with plans for how gun violence reduction efforts will be organized and structured within the County that includes the engagement of the Public Safety Group and Health and Human Services Agency; a proposed evaluation framework for the Gun Violence Reduction Work Plan that includes the engagement of the Public Safety Group, Health and Human Services Agency, Office of Evaluation, Performance, and Analytics, and the Office of Equity and Racial Justice; and an initial update on Work Plan actions.
EQUITY IMPACT STATEMENT
According to the American Public Health Association, gun violence is a leading cause of premature death in the United States. In San Diego County, from 2017-2022, there were 1,310 deaths by firearm (70.9% were suicide and 28.9% were homicides). From 2016-2020, there were 699 firearm-related hospitalizations and 668 firearm-related emergency department visits.
While gun violence impacts people of all ages, genders, and racial/ethnic backgrounds, it does not impact people equally. In San Diego County, the firearm-related homicide rate for Black residents is 11 times greater than the rate for Asian residents, who have the lowest rate. Black residents between the ages of 15-44 have the highest rate of firearm-related hospitalizations and emergency department visits in the county. Regional suicide data shows that White men over the age of 65 have the highest rates of firearm-related suicide in the county.
By focusing programs, services, and practices on the places and people experiencing the greatest burden of violence and underlying conditions that contribute to risk, the strategies are to have both an immediate impact on preventing violence and to establish long-term solutions. With an emphasis on equity, the goals are to reduce disparities and disproportionality and enhance the health, safety, and well-being of residents through partnerships, innovation, and active community engagement, which is in alignment with the County of San Diego’s Equity Strategic Initiative.
SUSTAINABILITY IMPACT STATEMENT
Today’s proposed actions contribute to the County of San Diego’s Sustainability Goals by seeking to meaningfully engage the community, provide just and equitable access to programs and services, and protect the health and well-being of residents. Ongoing efforts to reduce gun violence will impact the communities and populations historically burdened by gun violence by providing better long-term outcomes through investment in community-centered approaches. Extensive community engagement through listening sessions, surveys, forums, and the integration of an Advisory Group of individuals who actively work on gun violence related issues, was a major component of the project. By partnering with community members to identify challenges and opportunities to reduce gun violence, we hope to see long-term improvements in the health and well-being of neighborhoods and residents.
FISCAL IMPACT
Funds for year one of the Work Plan are included in the Fiscal Year 2023-24 Operational Plan in the Public Safety Group. If approved, this request will result in estimated costs and revenue of $300,000 in Fiscal Year 2023-24 for suicide prevention activities and community engagement and outreach. The funding source is Public Safety Realignment. There will be no change in net General Fund cost and no additional staff years.
Fiscal impact related to future recommendations will either be included in future Operational Plans for the Public Safety Group or staff will return to the board for consideration and approval of other identified funding sources.
BUSINESS IMPACT STATEMENT
N/A
ADVISORY BOARD STATEMENT
Health Assessment & Research for Communities, Inc. (HARC) convened a Gun Violence Reduction Advisory Group to review and provide input into its analysis, findings, and recommendations. The Advisory Group included 16 community members and County representatives with diverse perspectives, experiences, and expertise related to violence prevention, intervention, and aftercare (recovery), including those who specialize in suicide prevention, domestic/intimate partner violence prevention, community violence prevention and intervention as well as research and advocacy. The County and HARC have incorporated Advisory Group feedback to the extent possible in HARC’s Final Report and in the Gun Violence Reduction Work Plan.
Details
BACKGROUND
On October 19, 2021 (1), the Board of Supervisors (Board) directed the Chief Administrative Officer to develop options for community-based gun violence reduction and disruption programs and to return to the Board within 180 days. On April 5, 2022 (16), staff returned to the Board with a recommendation to conduct a contractor-led, regional gun violence community needs assessment to better understand the scope, complexity, and impact of gun violence in our communities, and to share key findings with the Board upon completion. The recommendation was approved by the full Board and the County issued a competitive solicitation and contracted with Health Assessment & Research for Communities, Inc. (HARC), a non-profit research and evaluation firm.
HARC conducted extensive data analysis; issued and analyzed two community surveys; hosted a dozen listening sessions and community presentations to receive broad stakeholder input, including numerous meetings with a 16-member Gun Violence Reduction Advisory Group; and conducted a best practice review of local, state, and national programs and practices designed to reduce gun violence. HARC pulled from a variety of data sources to describe the extent of gun violence across San Diego County. Sources included County of San Diego Medical Examiner’s Office, Health and Human Services Agency, and Emergency Medical Services data related to firearm-related deaths and injuries as well as firearm-related crime data from the Automated Regional Justice Information System (ARJIS).
Community engagement was at the center of the needs assessment project. In addition to collaborating with the Gun Violence Reduction Advisory Group, HARC hosted nine listening sessions and three community forums to allow residents to share their thoughts, experiences, and perspectives about gun violence as well as to provide feedback regarding preliminary findings from the assessment. Sessions and forums were held in Chula Vista, Escondido, El Cajon, San Diego, San Marcos, and virtually with two youth-specific listening sessions hosted with Aaron Price Fellows and the Live Well San Diego Youth Sector.
HARC issued its analysis and findings in a Gun Violence Community Needs Assessment Final Report, which summarizes findings from secondary data analysis, surveys, and listening sessions and includes recommendations to enhance gun violence reduction efforts in the county.
HARC’s Findings
The Final Report provides an overview of gun violence in San Diego County and outlines possible solutions to prevent violence and mitigate impacts. The findings highlight that while gun violence impacts people of all ages, genders, and racial/ethnic backgrounds in all regions of the county, gun violence does not impact people equally. Results from the assessment indicate that everyone has a role to play in the prevention of gun violence; that addressing systemic and historic inequities is central to reducing gun violence; and that prevention and intervention strategies should be tailored to specific populations.
From 2017-2022, there have been 1,310 firearm-related deaths in San Diego County - 70.9% were suicide and 28.9% homicide. Local data shows that, during the five-year period from 2017-2021, the homicide rate in San Diego County increased 56.3%, while the suicide rate decreased 18.0%. The San Diego County firearm-related death rate of 6.6 per 100,000 residents remains below the State of California rate of 8.0. The San Diego County firearm-related homicide rate of 1.9 per 100,000 residents is half the State of California rate of 3.8. The San Diego County suicide rate of 4.7 per 100,000 residents is higher than the State of California rate of 4.0 per 100,000 residents.
Some populations are disproportionately impacted by firearm-related deaths.
• Males have a firearm-related death rate that is 15 times greater than that of females.
• The firearm-related homicide rate is highest among Black residents at 9.9 per 100,000 residents. This is 11.0 times greater than the rate for Asian residents (0.9 per 100,000 residents), which is the lowest rate.
• The firearm-related suicide rate is highest among White residents at 8.2 per 100,000 residents. This is 6.8 times greater than the rate for Asian residents (1.2 per 100,000 residents), which is the lowest rate.
• Firearm-related homicide rates are highest among people ages 25-44.
• Firearm-related suicide rates are highest among people ages 65 and older.
The most common manner of suicide death in San Diego County from 2017-2021 is by firearm, followed by asphyxia (hanging/suffocation), and drug - medication. Additionally, the most common manner of homicide in San Diego County from 2017-2021 is by firearm, followed by cutting/stabbing, and blunt force.
From 2016-2020, there have been 1,367 firearm-related hospitalizations or emergency department visits. About half of firearm-related injuries were treated by hospitalization and half by emergency department visits. Data showed that, over time, the hospitalization rate for firearm-related injuries has increased 19.0% and emergency department visits have increased 4.5%. Demographic trends are similar for firearm-related injuries, with young Black and Hispanic males having the highest rates of hospitalization and emergency department visits. The age for hospitalization and emergency department visits also trends younger with rates highest among those ages 15-24.
The assessment also looked at alleged crimes involving firearms. From 2017-2021, the rate of firearm-related arrests (often for alleged assaults or robbery) increased 64.0% in San Diego County. The majority of arrests were for felonies (94.8%). The average firearm-related crime rates for suspects are highest among Black and male residents. The average firearm-related crime rates for victims are highest among male residents who identify as “other” race, followed by Black.
Data from available sources helped describe gun violence across San Diego County, but it is important to acknowledge limitations of these data. Some injury cases (say for certain age groups) can be suppressed when there are fewer than 11 cases (in 2020). This suppression means that the precise number of cases for certain groups (e.g., age 65 and older) cannot always be determined. Crime data reflected reported incidents and arrests, rather than convictions, thus, demographic data is available on alleged suspects, not those convicted of a crime. Federal healthcare data was not available for this assessment, so if an active-duty military member, veteran, retiree, or family member went to a military or Veteran’s Administration hospital with a firearm injury, that data was not available. And, death data were limited to cases in which the firearm incident and the death occurred within San Diego County. Deaths were excluded from the analysis when the firearm incident occurred outside the county or when the place of death was unclear. Limitations are further described in the Final Report.
HARC’s Final Recommendations
The Final Report contains recommendations outlining actions the County can take to reduce gun violence. HARC’s recommendations include opportunities to enhance or expand upon existing efforts in San Diego County as well as explore new areas of focus or investment. The recommendations are organized into four key strategic areas: Awareness & Advocacy, Community Engagement & Collaboration, Community Healing & Trauma-Informed Practice, and Planning & Evaluation. A summary of the recommendations is below.
Awareness and Advocacy
Building public awareness of effective violence prevention strategies and efforts and connecting individuals to culturally tailored resources are key to reducing gun violence. Evidence shows that recognizing warning signs for risk factors related to violence, implementing strategies to keep individuals safe, and connecting people to support services can reduce violence. There are opportunities to offer universal prevention education as well as education and resources that are tailored towards high-risk populations and those who live, work, and interact with populations most at risk for violence. Recommendations in the report include:
1. Increase awareness of violence prevention strategies and resources for those at highest risk by developing and sharing educational content specific to suicide prevention and domestic/intimate partner violence and identifying opportunities to enhance street outreach programs designed to change community norms about gun violence through dialogue, education, and mediation.
2. Partner with agencies to promote gun lock distribution programs that offer gun locks at no cost to the public.
3. Provide gun safety awareness training for County staff who perform home visits and conduct community outreach to share information on safe storage laws, navigating through unsafe scenarios, and educating clients on gun safety practices and prevention strategies.
4. Support programs that allow individuals experiencing a mental health crisis to temporarily and voluntarily transfer their firearm.
5. Promote implementation of a standardized, evidence-based suicide screening tool for use by healthcare providers to screen patients for suicide risk regardless of whether the patient is seeking care for psychiatric symptoms.
Community Engagement and Collaboration
Community engagement, collaboration, and stakeholder coordination must be at the heart of an effective strategy to reduce gun violence. Research shows that to facilitate engagement and collaboration, a multi-sector approach is needed to identify, develop, evaluate, and monitor meaningful strategies to reduce gun violence across the spectrum, from prevention and intervention to long-term recovery. Multi-sector collaboration would also support outcomes that no one sector can achieve alone and presents an opportunity for adopting the most strategic and efficient approach to achieving goals. Partners may include representatives from public health, healthcare, law enforcement, education, behavioral health, community and public leadership, businesses, community- and faith-based organizations, and advocacy groups. Recommendations in the report include:
1. Coordinate and support an ongoing Gun Violence Reduction Community Advisory Group to engage residents in gun violence reduction efforts, including participation of youth leaders.
2. Facilitate collaboration across agencies, organizations, and sectors to promote connection, build capacity, and share resources to include the coordination of networking events/roundtables for community organizations and the development of an online communication and collaboration platform for those working to reduce gun violence in San Diego County.
Community Healing and Trauma-Informed Practice
The prevalence of trauma in communities experiencing high rates of gun violence as well as the impacts of untreated trauma and re-traumatization must be acknowledged, and trauma-informed practices should be employed to build community capacity for self-healing. Best available evidence shows that risk for violence for young people can be reduced through involvement in activities that help young people grow strong connections to caring adults. Youth mentoring and afterschool programs are two such ways to expose youth to positive adult role models and to help youth learn acceptable and appropriate behaviors that are protective against involvement in violence. Hospital-community partnerships are also a promising practice that help violence survivors and their families connect to needed services, including counseling, mentoring, and follow-up assistance, to overcome trauma and stop violence from reoccurring. Hospital-based programs can reduce revictimization and rates of entry or re-entry into the criminal justice system and thereby break interpersonal and intergenerational cycles of violence. Recommendations in the report include:
1. Explore opportunities to enhance and implement community-centered approaches to community gun violence prevention in neighborhoods facing high risk factors for gun violence, which includes coordinating with community stakeholders to enhance youth-focused programs and services.
2. Establish partnerships between trauma hospitals, law enforcement, and community-based organizations to connect firearm injury patients and their families to support services that may include mental health support, financial assistance, and other services to support their recovery.
Planning and Evaluation
Planning and evaluation are key components of any successful strategy to identify and demonstrate commitment to outcomes, show progress or need for course correction, and to ensure transparency. To facilitate planning and evaluation, many jurisdictions are centering gun violence reduction work in civilian-led Offices of Violence Prevention. Centralizing this work provides the infrastructure and resources to ensure interventions are sustainable and are elevated as integral elements of public safety practice. Another important factor in ensuring sustainability of efforts is long-term and adequate funding, especially for community-based organizations that are critical to providing and connecting people to services. Recommendations in the report include:
1. Plan for longevity, sustainability, and an enduring commitment to gun violence reduction by establishing and adequately resourcing a central office or unit within the County structure to lead and guide gun violence reduction efforts and work with local communities to develop strategic plans to address gun violence.
2. Identify and monitor meaningful metrics to ensure accountability which includes a monitoring and evaluation framework, sharing of local aggregate data with stakeholders, and the coordination of townhalls or listening sessions to receive feedback and evaluate residents’ perception of success.
3. Develop a long-term strategy to address the funding of violence prevention and intervention efforts in the region, to include identifying, promoting, and applying for grants in support of programs and services in communities most impacted by gun violence.
The recommendations provide a promising path forward for reducing gun violence. While these recommendations are not exhaustive of all possible actions, they underscore the critical importance of targeting efforts that support and invest in populations and communities at greatest risk of experiencing gun violence. These recommendations are also not inclusive of all ongoing actions County departments are engaged in related to suicide prevention, domestic/intimate partner violence prevention, and community violence prevention and intervention. Implementation of these recommendations will require a commitment to multi-sector collaboration as well as financial investment.
Ahead of the release of the Final Report in late June 2023, HARC conducted three community presentations to share key findings and recommendations with the public. Presentations were held on June 6, 10, and 13, 2023. Some attendees were supportive of HARC’s recommendations and the gun violence reduction project. Others noted concerns with the overall study and the focus on gun violence rather than a focus on all types of violence. Some community members shared their views that the recommendations should have included more strict criminal justice penalties for those involved in violent crimes. Many community members also called for analysis of areas outside the scope of this assessment, including conducting homicide case reviews to determine prevalence of the defensive use of firearms and studying the impacts of officer-involved shootings. Community members were encouraged to review and comment on the Final Report via the project’s website.
County Violence Reduction Work Plan
Using HARC’s recommendations, the County developed a Gun Violence Reduction Work Plan. These actions span the four key strategic areas, focus on the types of gun violence included in the assessment (suicide, domestic/intimate partner violence, and community violence), and cover the spectrum of prevention strategies, from actions designed to stop violence before it starts (primary) to services that address immediate (secondary) and long-term (tertiary) responses to violence.
The Work Plan is a living document that sets goals for gun violence reduction work that are in alignment with guiding principles that were established when the community needs assessment was initially recommended. The Work Plan outlines actions to be initiated over the next two fiscal years. Ten actions are proposed in Fiscal Year (FY) 23-24 and three actions for FY 24-25. Five other actions are proposed to start in FY 24-25 but will require significant collaboration and/or funding over the long-term to complete the action. There are currently no dedicated staff or permanent funding sources for gun violence reduction work at the County. The Public Safety Group has identified $300,000 from the Public Safety Realignment to support the implementation of Work Plan items in FY 23-24.
Work Plan Highlights
Below are Work Plan highlights by Fiscal Year (FY). Work Plan actions include opportunities to enhance or expand upon existing efforts and explore new areas of focus or investment.
FY 23-24
|
Action |
Prevention Strategy |
Violence Type |
|
Develop and share educational content related to suicide prevention, focusing on highest risk populations. |
Primary |
Suicide |
|
Partner with agencies to promote gun lock distribution programs, including offering gun locks at no cost. |
Primary |
All |
|
Monitor state and federal actions for opportunities to improve safe gun ownership and investment in communities most impacted by gun violence. Actions may include federal and state grant opportunities tailored towards gun violence reduction and other efforts that will contribute to safer communities. |
Primary |
All |
|
Coordinate and support a Gun Violence Reduction Advisory Group and include youth leadership. |
Primary |
All |
|
Create and host a platform to serve as a centralized communication and collaboration point for agencies and organizations working on gun violence prevention, intervention, and aftercare (recovery) in San Diego County. |
Primary |
All |
|
Plan for how gun violence reduction work will be structured and organized within the County. |
Primary |
All |
|
Establish a monitoring and evaluation framework for efforts implemented to reduce gun violence. |
Primary |
All |
|
Share local aggregate data on gun violence in the county with stakeholders and the general public. |
Primary |
All |
|
Coordinate town hall/listening session to evaluate residents’ perception of success. |
Primary |
All |
|
Identify and apply for grant funds to support prevention and intervention programs and services in San Diego County. |
Primary Secondary Tertiary |
All |
FY 24-25
|
Action |
Prevention Strategy |
Violence Type |
|
Develop and share educational content related to domestic/intimate partner violence prevention, focusing on highest risk populations. |
Primary |
Domestic/ Intimate Partner Violence |
|
Promote implementation of a standard healthcare suicide screening tool for use by healthcare providers. |
Primary |
Suicide |
|
Coordinate networking events/roundtables for community organizations working to reduce gun violence. |
Primary |
All |
Starts FY 24-25 - Requires Significant Collaboration and/or Funding to Complete
|
Action |
Prevention Strategy |
Violence Type |
|
Develop strategic plans to reduce gun violence in partnership with communities experiencing the highest incidence of violence. |
Primary |
Community Violence |
|
Identify organizations that operate violence intervention programs, including street outreach and violence interruption and disruption programs, in southeastern and northern San Diego County and coordinate with these stakeholders to identify new and existing opportunities to enhance community-based gun violence intervention programs. |
Primary Secondary |
Community Violence |
|
Identify County positions responsible for performing home visits and community outreach to offer gun safety awareness training and provide staff resources to educate clients on gun safety practices, safe gun storage, and violence prevention strategies. |
Primary |
All |
|
Identify organizations that provide youth-focused programs and services in northern and southeastern San Diego County and coordinate with these stakeholders to identify new and existing opportunities to enhance youth-focused programs and services in neighborhoods facing high risk factors for gun violence. |
Primary Secondary Tertiary |
Community Violence |
|
Establish partnerships between trauma hospitals and community-based organizations to strengthen/enhance support services for firearm injury patients and their families. |
Secondary Tertiary |
All |
The Public Safety Group will work with partners, such as the community Advisory Group, Health and Human Services Agency, the Office of Equity and Racial Justice, and Office of Evaluation, Performance, and Analytics, to monitor Work Plan actions and review and prioritize recommendations for future Board consideration while assessing whether these efforts can be incorporated into other relevant prevention initiatives. Additionally, the Public Safety Group will work with the Office of Evaluation, Performance, and Analytics, Health and Human Services Agency, and the Office of Equity and Racial Justice to establish a monitoring and evaluation framework to evaluate the impact of County efforts to reduce gun violence. To address funding challenges for gun violence prevention and invention efforts, today’s action also includes a recommendation that will authorize County staff to apply for and accept grants that support gun violence prevention and intervention efforts.
The Work Plan reflects an integrated approach that takes both individual and systemic issues into account to address the complex drivers of gun violence in our communities. Continuing engagement and collaboration among community stakeholders, non-governmental organizations, and public agencies is paramount to reducing gun violence in San Diego County.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed action supports the Community and Equity Strategic Initiatives in the County of San Diego’s 2023-2028 Strategic Plan by encouraging civic engagement and meaningful conversations to reduce disparities and enhance the health, safety, and well-being of residents.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Interim Chief Administrative Officer
ATTACHMENT(S)
Attachment A - Gun Violence Community Needs Assessment Final Report
Attachment B - Gun Violence Reduction Work Plan