In 2015, Durham Public Health Director Gail Harris (now retired) brought a model created by Chicago epidemiologist Dr. Gary Sulkin to her hometown. The Cure Violence model approaches gun violence through a public health lens, a method that has been shown to provide more sustainable outcomes than enforcement-based violence reduction methods.1 Bull City United, under the Department of Durham County Community Intervention and Support Services, became North Carolina’s first firearm violence interruption program, approaching Durham’s gun violence epidemic through a public health lens that includes identifying neighborhood conflicts and employing community members to interrupt transmission, prevent future violence, and change community norms.2

Bull City United’s team of violence interrupters come from the communities in which they work to predict and de-escalate violent conflicts across six census tracts in Durham that experience frequent firearm injuries and mortalities. According to Bull City United, 58% of participants are employed, 15% are in school, 22% are on probation, and 0% have been arrested or incarcerated (Krystal Harris, MSW, Director, Durham County Community Intervention and Support Services, email communication, March 21, 2023). Team members provide quarterly reports to the city and county; those data show that these efforts appear to be working.

“There hasn’t been one community in the six census tracts we have entered so far where violence hasn’t reduced significantly,” Bull City United Program Manager David Johnson told the North Carolina Medical Journal.

Johnson lived in one of the first two communities Bull City United entered; he was recruited as a violence interrupter in 2017 and has grown alongside the program. He spoke with this issue’s co-guest editor, state injury epidemiologist Scott Proescholdbell, about how the Cure Violence model works on the ground in Durham, how violence interrupters stay safe, and how health care systems and other institutions can partner with communities to decrease firearm violence.

Scott Proescholdbell: What does your work as a vio­lence interrupter look like on a typical day?

David Johnson: The role of a violence interrupter changes day to day, depending on the needs of the community. One day you might be a chauffeur, one day you might be a social worker, one day you might be a motivational speaker. But every day we are a boots-on-the-ground organization, every day we’re in the community, every day we’re stopping violence and trying to connect people to resources. We’re on the front lines of trying to stop this cycle of violence that’s been plaguing Durham since I can remember.

We recently had a young 12-year-old girl shot in one of our communities and we were trying to keep her father, uncles, [and] brothers from retaliating. It was hard and heartbreaking at the same time. We just had a prayer vigil for the little girl exactly where she got shot. Every day there is a conflict that we need to mediate. Most times we mediate before there’s even a gunshot or a violent incident, and we try to prevent the violence from taking place.

Proescholdbell: That is so hard for the family and com­munity. At what point did you hear about what happened, and how did you decide to get involved?

David Johnson: Well, the great and unique thing about Bull City United is all the workers come directly from the neighbor­hoods that we are focusing on. Our staff is made up of people who are credible messengers with lived experience from those communities. So, as soon as the situation happened, I actually got a phone call from the father telling me what happened and the things that he was going through mentally. He was trying to be a strong father, be a protector, when his child was an innocent bystander getting shot for no reason, so there was a lot of anger and emotions built up. I would say we have great relationships in the communities because we’re from those communities already.

Because of the relationship that I had with the individual, he just let me know, first and foremost as a friend, what happened. And then, as a member of this program, he called me to calm him down and to try to get a hold of the situation, to talk to his family, talk to his sons, his brothers, and to try to keep the conflict from spilling out and becoming worse than it already was.

Proescholdbell: I appreciate that approach, and I also know sometimes that creates a challenge when people have concerns about hiring those with “lived experience” (a criminal background, for example). How does Bull City United respond to these concerns?

David Johnson: My answer to that would be: who would you want dealing with these people more than those who have lived through those experiences and came through on the other side? Who would you want to help walk you through situations where you can better your life than the people who’ve already done that? They’ve been there and they look like you and talk like you. Everybody deserves a second, third chance at this thing we call life, and that’s one thing about Bull City United, it gives our individuals second and third chances to be a part of the solution. At one time, many of us were part of the problem, and that means we’ve got great inroads, and we have great relationships with the people still out there.

This is a part of the Cure Violence Global model that we follow. We still follow Durham County Government hiring processes, including background checks. There are some offenses that will prevent employment.

Proescholdbell: The work you’re doing can be really dangerous. How do you navigate that? What kind of safety protocols are there?

David Johnson: First and foremost, our number one goal is making it back for our families. But we have different protocols if different things happen. If there’s a situation that we can’t get control of, or that can potentially turn violent even when we are there, we back out of the situation. We do not have firearms, and we are not law enforcement, so we have to use our best judgment to make sure we stay safe. The same instincts we used when we were in those communities before the job are the ones we use while on the job. But at the same time, they don’t always work. There have been numerous situations when staff have been out there when shootings have happened. Some of the staff have had guns pulled on them. This is not a job that’s for the faint of heart. You have to have a real commitment to change. It’s not easy.

Proescholdbell: What do you think is important for hos­pital systems, providers, public health, and other partners to know for this work to be more successful?

David Johnson: This is a 24/7, 365 job. Even when you think you’ve got a person on the right road, life happens, and it might throw the individual all the way off and you might have to start all the way back over again.

Bull City United is open to all—we are always looking for people to come to our events. Come get to know us, see if you want to help with the program. We’re a great group of people committed to helping the community and trying to stop the violence, and we’re looking for all the help we can get. Violence is a problem for everybody, not just law enforcement and victims.

One more thing I would add: this program has not only saved the lives of the community, but it also has saved the lives of staff. I know this program has saved my life, because the path I was on was not a good one.