CARDIFF MODEL TOOLKIT

COMMUNITY GUIDANCE FOR VIOLENCE PREVENTION
CARDIFF MODEL TOOLKIT

DEVELOPED BY:

CDC CONTRIBUTORS

Laura M. Mercer Kollar, PhD

Molly Kurnit, MPH

Steven A. Sumner, MD, MSc

UNIVERSITY OF PENNSYLVANIA CONTRIBUTORS

Sara F. Jacoby, PhD, MPH, RN

Greg Ridgeway, PhD

2017

Division of Violence Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Atlanta, Georgia

Mercer Kollar, L.M., Jacoby, S.F., Ridgeway, G., Kurnit, M., Sumner, S.A. Cardiff Model Toolkit: Community Guidance for Violence Prevention. Atlanta, GA: 

Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2017.
THE CARDIFF MODEL FOR VIOLENCE PREVENTION TOOLKIT: AN INTRODUCTION

More than half of violent crime in the United States is not reported to law enforcement, 

according to the U.S. Department of Justice. That means cities and communities lack 

a complete understanding of where violence occurs, which limits the ability to develop 

successful solutions. 

The Cardiff Violence Prevention Model provides a way for communities to gain a clearer 

picture about where violence is occurring by combining and mapping both hospital and 

police data on violence. 

But more than just an approach to map and understand violence, the Cardiff Model 

provides a straightforward framework for hospitals, law enforcement agencies, public 

health agencies, community groups, and others interested in violence prevention to 

work together and develop collaborative violence prevention strategies.

The toolkit includes a printable poster, infographic, and these guidance materials:

• What Is the Cardiff Model?

• Hospital Guidance

• Law Enforcement Guidance

• Legal, Technical, and Financial Considerations

• Building Partnerships

• External Communications and Media Relations

• Readiness Checklist

All materials are available for download at www.cdc.gov/violenceprevention/

fundedprograms/cardiffmodel.

The Cardiff Model is a promising solution to prevent violence. We encourage you to use 

these materials to create a broad partnership to prevent violence in your community.

Sincerely,

James A. Mercy, PhD

Director

Division of Violence Prevention

National Center for Injury Prevention and Control
WHAT IS

THE CARDIFF MODEL?

WHAT IS THE CARDIFF VIOLENCE

PREVENTION MODEL? 

More than half of violent crime in the United States is 

not reported to law enforcement, according to the U.S. 

Department of Justice. That means cities and communities 

lack a complete understanding of where violence occurs, 

which limits the ability to develop successful solutions.

The Cardiff Violence Prevention Model provides a way for 

communities to gain a clearer picture about where violence 

is occurring by combining and mapping both hospital and 

police data on violence. But more than just an approach to 

map and understand violence, the Cardiff Model provides a 

straightforward framework for hospitals, law enforcement 

agencies, public health agencies, community groups, and 

others interested in violence prevention to work together and 

develop collaborative violence prevention strategies.

1
TOOLKIT: WHAT IS THE CARDIFF MODEL? 2

HOW DOES IT WORK?

The Cardiff Model is a multi-agency approach to violence prevention that relies on the strategic 

use of information from health and law enforcement organizations to improve policing and 

community violence prevention programs.1 The basis of the model is information sharing. In 

healthcare settings, anonymous violence-related injury data including location, time, date, 

and mechanism of injury are collected. These data are combined with information from law 

enforcement to help communities map where violence frequently occurs. These maps can 

identify the specific locations where violence occurs in public spaces such as bars, street 

corners, or subway stations. 

The Cardiff Model relies on sustained partnerships between healthcare, law enforcement, other 

government agencies, and community organizations. The partnership uses local data to create 

effective injury and violence prevention policy, educate community leaders about the need for 

changes in the places people work and live, and encourage business owners and residents to 

prevent violence by using evidence-based solutions.

HOW WAS THIS MODEL DEVELOPED?

The Cardiff Model was created by Dr. Jonathan Shepherd, a surgeon and 

professor at Cardiff University in Wales, United Kingdom. Dr. Shepherd 

frequently treated people who were injured through violence in his 

hospital’s emergency department. Through his research he discovered that 

only a fraction of these injuries treated in emergency departments were 

reported to law enforcement.2 

In 1996, Dr. Shepherd gathered healthcare providers, law enforcement 

leadership, and other community stakeholders to discuss the concept of 

data sharing and the development of violence prevention interventions. 

By 1998, the Cardiff Model became the primary approach for violence 

prevention across the United Kingdom. The model has helped to facilitate 

solutions to violence such as changes in the environment of violent places 

(increased street lighting and the creation of more pedestrian-friendly 

streets), policy change (switch from glass to plastic barware in taverns), 

and promotion of stronger community partnerships (increased programs 

partnering with clergy to assist violence prevention).
TOOLKIT: WHAT IS THE CARDIFF MODEL? 3

WHAT IS THE EVIDENCE THAT THE 

CARDIFF MODEL IS EFFECTIVE FOR 

VIOLENCE PREVENTION?

Since its development in 1996, the Cardiff 

Model has shown that sharing anonymous 

data describing the location of violence, 

weapon use, assailants, and time of 

violence can allow local police to improve 

their strategies to prevent street violence.3

CDC collaborated with Dr. Shepherd to 

conduct a multi-year evaluation that 

compared violence outcomes in Cardiff, 

Wales to the experience in 14 similar cities. 

The results indicated a 32% reduction in 

police-recorded injuries (comparable to 

aggravated assaults in the U.S.) and a 42% 

reduction in hospital admissions for

violence-related injuries. The model saved 

over $19 in criminal justice costs and nearly 

$15 in health system costs for every $1 spent.4

REDUCTION IN POLICERECORDED INJURIES

REDUCTION IN HOSPITAL 

ADMISSIONS FOR VIOLENCERELATED INJURIES

42%

32%

1.

2. Shepherd (2000). BMJ, 321(7275): 1481-1482. DOI: https://doi.org/10.1136/bmj.321.7275

3. Florence et al. (2011). British Medical Journal, 342, d3313. DOI: https://doi.org/10.1136/bmj.d3313

4. Florence et al. (2014). Injury Prevention, 20(2), 108-114. DOI: http://dx.doi.org/10.1136/injuryprev-2012-040622

Shepherd (2001). Annals of Emergency Medicine, 38(4), 430-437. DOI: http://dx.doi.org/10.1067/mem.2001.114317
HOSPITAL GUIDANCE

4

WHAT IS THE CARDIFF VIOLENCE

PREVENTION MODEL? 

More than half of violent crime in the United States is 

not reported to law enforcement, according to the U.S. 

Department of Justice. That means cities and communities 

lack a complete understanding of where violence occurs, 

which limits the ability to develop successful solutions.

The Cardiff Violence Prevention Model provides a way for 

communities to gain a clearer picture about where violence 

is occurring by combining and mapping both hospital and 

police data on violence. But more than just an approach to 

map and understand violence, the Cardiff Model provides a 

straightforward framework for hospitals, law enforcement 

agencies, public health agencies, community groups, and 

others interested in violence prevention to work together 

and develop collaborative violence prevention strategies.
TOOLKIT: HOSPITAL GUIDANCE 5

WHO COLLECTS THE INFORMATION? 

Nurses may be in the best position to collect violence-related injury information when asking 

general screening questions during intake or registration. If the registration process is completed 

by a non-nurse, this staff member could also be considered to be the primary point of contact for 

data collection.

WHAT SPECIFIC INFORMATION IS COLLECTED? 

Hospital and healthcare personnel collect violence-related injury information* that can be used 

to track local violence trends and develop prevention programs. This information includes:

• When the injury occurred (date and time)

• Where the injury took place (exact location: business name and/or street address)

• How the injury happened and/or weapon used (e.g. hit, stabbed with a knife)

Violence-related injury information may be collected at any point during the patient visit. For 

example, the U.K. Cardiff Model and U.S. pilot sites collected data during registration or initial 

triage to prevent any disruption in the workflow.

WHEN IS THE INFORMATION COLLECTED?

It is recommended that data be collected in the emergency department (ED), including the 

trauma bay if the hospital is a trauma center. If the hospital has a separate, on-site urgent care 

clinic and/or trauma unit, these intake points may also be used to collect injury information.

WHERE IN THE HOSPITAL IS THE INFORMATION COLLECTED?

HOW IS THE INFORMATION COLLECTED?

The violence-related injury information can be integrated into the existing electronic medical 

record (EMR) or collected via separate data forms and databases. Integration of violence-related 

injury information into the EMR permits the most efficient data collection and data extraction 

process.

Violence-related injury data from hospitals in combination with law enforcement records are used to map where violence occurs. The U.K. Cardiff 

Model collects intentional injuries only; in the U.S., unintentional and/or intentional (violent) injuries have been collected and shared with the 

*

community safety partnership. Each hospital and community can decide whether to focus on violence or injuries more broadly.
TOOLKIT: HOSPITAL GUIDANCE 6

HOW OFTEN DOES ANONYMOUS VIOLENCE INFORMATION GET SHARED?

Violence information can be shared on any mutually agreeable timeframe within the community 

safety partnership (CSP). Past partnerships have found monthly sharing to be useful, although 

more frequent sharing could occur.

CHALLENGES OF USING ELECTRONIC MEDICAL RECORDS (EMRS) TO COLLECT AND 

SHARE DATA

Protection of private patient information is a major consideration in the implementation of the 

Cardiff Model. The Cardiff Model shares anonymous information that captures an injury location, 

date and time, and the weapon used. The model uses real-time hospital and law enforcement 

data to help communities identify and map areas where violence frequently occurs such as in 

public spaces like street corners or bus stops and businesses. 

In some hospitals or healthcare facilities, using the EMR or other forms of a patient medical 

record to collect data that will be shared outside of the institution may raise privacy concerns. 

These concerns are addressed in the "Legal, Technical, and Financial Considerations" document.
TOOLKIT: HOSPITAL GUIDANCE 7

KEY STEPS TO ESTABLISHING THE CARDIFF MODEL IN YOUR HOSPITAL:

1. BUILDING RELATIONSHIPS

a. Establish a violence prevention partnership with local law enforcement 

and other applicable partners

b. Determine the most useful injury information for the local partnership 

to collect, with a focus on keeping information collection brief. It is 

important to weigh the advantages of including the information that 

stakeholders might like to have against the consequences of making 

the screening process too long. It is best to focus on the information 

that is most critical. 

c. Gain hospital leadership (e.g. management and nursing) and support

2. COLLECTING AND SHARING DATA

a. Identify the personnel or departments with the capacity to integrate 

Cardiff Model fields in the health record or EMR

b. Establish procedures for collecting injury information

c. Train nurses and other staff to collect injury information

d. Determine strategies to monitor and improve data quality 

e. Find out what laws and regulations must be considered in order to 

collect and share violence information outside of the hospital or 

healthcare system

f. Establish procedures for extracting and sharing injury information

g. Identify hospital information technology/data quality team to set up a 

data sharing process

h. If necessary, develop and sign a shared data use agreement to protect 

the information that is shared

3. BUILDING A COMMUNITY SAFETY PARTNERSHIP

a. Work with law enforcement partners to establish a broader community 

board to review the maps on violent injury

b. Help to develop a culture of decision-making based on real-time data

c. Assist in implementing multi-agency prevention programs and 

initiatives at locations identified in the mapping of the data
TOOLKIT: HOSPITAL GUIDANCE 8

TRAINING OPTIONS FOR HOSPITAL STAFF

Training can be delivered in many different formats. Below are some of the advantages and 

challenges with different training formats. The U.S. Cardiff Model pilot sites tested multiple 

methods of training; in-person training is most helpful for rapid scale-up and close adherence to 

the model when starting a new Cardiff Model program.

FORMAT DELIVERY 

METHOD ADVANTAGES CHALLENGES

Self-study E-mail, online, 

paper

Easy and does not require 

significant personnel time 

or effort, can be integrated 

into standard staff training 

and education platforms

Difficult to evaluate the 

extent and efficacy of 

training process

Staff In-service Large group 

instruction

Face-to-face, provides the 

opportunity to ask questions

Requires on-site trainer until 

all staff have completed 

training; in-services may 

be infrequent and slow the 

initiation of project activities; 

training may not reach new 

staff

Regular staff 

or shift change 

meeting

Small group 

instruction

Face-to-face, provides the 

opportunity to ask questions

Requires trainer or project 

champion on shift until 

everyone is trained and in 

continuation to educate new 

staff

One-on-one 

training

Individual Face-to-face, opportunity to 

ask questions, able to assess 

knowledge

Requires on-site trainer; 

resource intensive
LAW ENFORCEMENT GUIDANCE

9

WHAT IS THE CARDIFF VIOLENCE

PREVENTION MODEL? 

More than half of violent crime in the United States is 

not reported to law enforcement, according to the U.S. 

Department of Justice. That means cities and communities 

lack a complete understanding of where violence occurs, 

which limits the ability to develop successful solutions.

The Cardiff Violence Prevention Model provides a way for 

communities to gain a clearer picture about where violence 

is occurring by combining and mapping both hospital and 

police data on violence. But more than just an approach to 

map and understand violence, the Cardiff Model provides a 

straightforward framework for hospitals, law enforcement 

agencies, public health agencies, community groups, and 

others interested in violence prevention to work together 

and develop collaborative violence prevention strategies.
TOOLKIT: LAW ENFORCEMENT GUIDANCE 10

WHY IS HOSPITAL INJURY INFORMATION IMPORTANT FOR LAW ENFORCEMENT?

According to a 2016 U.S. Department of Justice report, many crimes go unreported to law 

enforcement, including:

• 53% of violent crime in 2015.

• 58% of simple assaults in 2015.

• 43% of violent crime involving an injury in 2015.

Hospitals treat individuals who are injured in violence incidents. If the time, date, and location 

of violent incidents are captured through the Cardiff Model, a community can develop a greater 

understanding of how and when violence is occurring. Mapping areas of where violence occurs 

from hospital and police information (known as hotspot mapping) is critical to understanding 

and developing violence prevention programs and strategies within the community.

HOW DOES LAW ENFORCEMENT PARTICIPATE IN THE CARDIFF MODEL?

Law enforcement and area hospitals form a local community safety partnership where data are 

shared. This information includes:

• When the injury occurred (date and time)

• Where the injury took place (business name and/or street address)

• How the injury happened and/or weapon used (e.g. hit, stabbed with a knife)

Through the community safety partnership (CSP), law enforcement works hand-in-hand with the 

hospital (at a minimum) to combine data sources to identify potentially new and existing violent 

injury hotspots. After identifying injury hotspots, the CSP develops innovative ways to address the 

specific hotspot needs.

The law enforcement agency plays a critical role in combining data with hospitals to identify 

existing or new violence hotspots. In addition, law enforcement has historical knowledge of what 

type of prevention programming and current efforts are being directed in these areas. These 

critical elements of providing hotspot evidence and historical knowledge will help guide CSP 

efforts and complement (not duplicate or interfere with) previous or ongoing work. The new maps 

may also be used to guide ongoing law enforcement violence prevention activities and patrol 

patterns.

WHAT IS LAW ENFORCEMENT’S ROLE IN THE COMMUNITY SAFETY PARTNERSHIP?
TOOLKIT: LAW ENFORCEMENT GUIDANCE 11

HOW OFTEN DOES ANONYMOUS VIOLENCE INFORMATION GET SHARED?

Violence information can be shared on any mutually agreeable timeframe within the CSP.

Past partnerships have found monthly sharing to be useful, although more frequent 

sharing could occur.

MY ORGANIZATION DOES NOT HAVE THE CAPACITY TO PRODUCE AND PROVIDE HOTSPOT 

MAPPING IN-HOUSE. CAN THE COMMUNITY SAFETY PARTNERSHIP STILL WORK?

Yes! While the basis of the CSP’s work and prevention activities should be guided by sharing 

current data on where violence is happening, there are many alternatives to producing the maps 

in-house. Public health departments, colleges, and universities may be interested in participating 

in the partnership and can add value by providing mapping services and statistical analysis of 

program effectiveness. There are also many private geospatial data service agencies that provide 

mapping of governmental data.

IN ACTION

THE CARDIFF MODEL For example, in Cardiff, Wales, United Kingdom, the Violence Prevention 

Board (local name of the CSP) identified many violent assaults occurring 

in particular streets in the city’s main entertainment district. After 

investigating this area, the Board realized that these assaults were largely 

due to alcohol-intoxicated individuals bumping into each other on the 

sidewalks after a night of drinking, resulting in fights breaking out. This 

risk was made worse by such people rapidly becoming frustrated while 

waiting to be served at fast food outlets and for taxis. The Board worked 

with the city to make the streets more pedestrian friendly, move taxi 

stands, and appoint taxi marshals (capable guardians), which helped 

decrease violent assaults in the area.
TOOLKIT: LAW ENFORCEMENT GUIDANCE 12

KEY STEPS TO STARTING THE CARDIFF MODEL IN MY LAW ENFORCEMENT AGENCY:

1. RELATIONSHIP BUILDING

a. Establish a violence prevention partnership with the local hospital

b. In collaboration with hospital partner, determine most useful injury information 

to collect and map

2. LAW ENFORCEMENT AGENCY BUY-IN AND SUPPORT

a. Obtain law enforcement leadership buy-in and support

b. Obtain permissions for receiving hospital injury information or sharing crime 

incident data with partners

c. Ensure hotspot maps can be created within the law enforcement organization or 

by another party involved in the community safety partnership

3. TRAINING AND TECHNICAL PROCESSES

a. Identify in-house or external expertise to combine hospital and law enforcement 

information to produce hotspot maps

b. Establish procedures for sharing data and maps

4. INJURY INFORMATION AND MAP SHARING

a. Establish procedures for sharing injury information and maps

b. If necessary, develop and sign a shared data use agreement with the hospital

5. COMMUNITY SAFETY PARTNERSHIP ACTIVITIES*

a. Work with hospital and other partners to establish a broader community board to 

review the maps on violent injury

b. Help to develop a culture of decision-making based on real-time data

c. Assist in implementing multi-agency prevention programs and initiatives at 

locations identified in the mapping of the data

*

Please see the "Building Partnerships" document for more information on how injury information is used within the 

partnership, relationships are expanded, and violence prevention programs are implemented.
LEGAL, TECHNICAL,

AND FINANCIAL CONSIDERATIONS

13

WHAT IS THE CARDIFF VIOLENCE

PREVENTION MODEL? 

More than half of violent crime in the United States is 

not reported to law enforcement, according to the U.S. 

Department of Justice. That means cities and communities 

lack a complete understanding of where violence occurs, 

which limits the ability to develop successful solutions.

The Cardiff Violence Prevention Model provides a way for 

communities to gain a clearer picture about where violence 

is occurring by combining and mapping both hospital and 

police data on violence. But more than just an approach to 

map and understand violence, the Cardiff Model provides a 

straightforward framework for hospitals, law enforcement 

agencies, public health agencies, community groups, and 

others interested in violence prevention to work together 

and develop collaborative violence prevention strategies.
TOOLKIT: LEGAL, TECHNICAL, AND FINANCIAL CONSIDERATIONS 14

LEGAL AND REGULATORY CONSIDERATIONS

Laws and regulations can impact how data can be shared among healthcare institutions, public 

health agencies, universities, and law enforcement agencies.

The Cardiff Model is a promising data-driven prevention model. The Cardiff Model can be 

implemented in a hospital and police department without undergoing an Institutional Review 

Board (IRB) review, just as any other public health program which directly benefits the local 

community. Data can also be collected and used in evaluating the Cardiff Model’s effectiveness 

and local program adaptations. However, data sharing strategies must respect patient privacy 

and adhere to any applicable laws.

The Cardiff Model emphasizes sharing only de-identified information on violence that happens 

in public spaces (e.g. bars, gas stations, parks, etc.). A data sharing agreement helps to ensure 

a high standard of security and a common understanding on use of the data (see attached 

sample agreement). If the intent of data collection or use is for research purposes rather than 

programmatic purposes, then appropriate IRB determination must be obtained.

Experience from U.S. pilot sites suggest that (1) focusing the Cardiff Model as a public health 

program (rather than a research project) and (2) implementing the Cardiff Model with close 

adherence to its original design is most likely to lead to more rapid uptake and sustained 

commitment from partners.

Partnerships may need to create unique data sharing models that adhere to the Health Insurance 

Portability and Accountability Act (HIPAA) Privacy Rule. For example, the HIPAA Privacy Rule 

permits disclosure of protected health information to public health authorities* who are legally 

authorized to receive such reports for the purpose of preventing or controlling disease, injury, or 

disability, such as state, city, or county health departments. 

Public health agencies are likely to be key partners for data sharing as cities consider regional 

implementation of the Cardiff Model where multiple hospitals are involved and a central 

repository for shared data is needed.

Other legal and regulatory requirements may include local and/or state statutes that are 

associated with the collection and reporting of violent incidents. States have different mandatory 

reporting requirements and other local laws that might shape an adaptation of the Cardiff Model, 

so be sure to check the requirements in your state and locality.

TECHNICAL CONSIDERATIONS

The Cardiff Model does not require any specific technologies for implementation. Efficient 

capturing, comparing, and mapping of violent incidents can be done with minimal technological 

inputs or advanced technological support. However, there are several components of the Cardiff 

Model that require consideration of current and future technological capacity.

A "public health authority" is an agency or authority of the United States government, a state, a territory, a political subdivision *

of a state or territory, or tribal nation that is responsible for public health matters as part of its official mandate.
TOOLKIT: LEGAL, TECHNICAL, AND FINANCIAL CONSIDERATIONS 15

INFORMATION COLLECTION

Collecting injury information can be 

accomplished through separate data 

forms or integrated into a hospital’s 

existing electronic medical record (EMR) 

system. Integration of injury information 

into the EMR is the most efficient process 

for collecting and extracting data. 

INFORMATION CLEANING

Once collected, injury information needs to 

be retrieved from the EMR and/or organized. 

Before it can be shared, this information 

needs to be reviewed and cleaned to ensure 

it does not contain patient identifiable 

information and that the information is 

entered in the correct data fields. This is a 

good time to consider how to benchmark 

the extent and quality of the information 

that is collected.

INFORMATION SHARING

The technical requirements for sharing 

information will depend on the data 

sharing agreement established by the local 

partnership. If information is shared beyond 

the healthcare system, the sharing process 

will depend on the capacity and regulations 

of the recipient agency (academic partner, 

law enforcement, public health). Important 

considerations include the data format (i.e. 

structure and file type), the security of data 

transfers, frequency of data transfers, and 

potential for computer-automated sharing.

MAPPING

Mapping areas of violence (known as 

"hotspots" by law enforcement) can 

be accomplished by using a range of 

technologies. Partnerships may have 

the capacity to use advanced mapping 

processes to create maps. There are also 

a range of mapping resources, including 

free and open source software, such 

as R or QGis, for producing maps and 

managing geospatial data. 

INFORMATION SECURITY

When information is collected or extracted, 

sharing it beyond the healthcare system will 

require protective mechanisms such as data 

encryption or other forms of web-based data 

transfer security. Collaborating institutions 

may also require explicit data use agreements 

that explain how data will be used, secured, 

and shared.

PROGRAM MONITORING AND 

EVALUATION

Regular monitoring and evaluation of the data 

collection system is important, especially 

during the early stages of implementation. 

Collaborating institutions should consider 

the technological inputs required to ensure 

that the injury information collected from the 

health system and law enforcement agencies 

is as accurate and complete as possible, and 

to monitor the changes that occur as the 

program progresses.

FINANCIAL CONSIDERATIONS 

Initiation and maintenance of the Cardiff Model may be based on volunteer effort or supported 

through municipal, foundation, or federal/state grants. Experience from multiple sites suggests 

the Cardiff Model can be feasibly implemented without external funding (e.g. grants) if there is 

institutional support for dedicating staff time to work on the initiative, as staff time is the major 

input. Small amounts of funding to support data collection, data collection system development, 
TOOLKIT: LEGAL, TECHNICAL, AND FINANCIAL CONSIDERATIONS 16

and incentives to support program activities are helpful. Cost-benefit analyses reveal that the 

model saves approximately $25 in criminal justice costs and $19 in health system costs for 

every $1 spent. Potential costs to bear in mind include:

PERSONNEL

What financial or other compensation

(if any) are required to:

• Develop and sustain the community

safety partnership 

• Refine the information collection system 

(e.g., hospital IT staff time if integrated 

into an electronic medical record)

• Collect information

• Conduct trainings and promote the 

program among staff and within the 

community 

• Clean, transfer, and map data 

• Attend partnership meetings and other 

program activities

• Develop and implement violence 

prevention interventions 

• Write and apply for grants

PARTNERSHIP FACILITATION

Who pays and what will be the costs for:

• Partnership meetings

• Partnership materials (i.e. program 

promotion, local branding)

• Public events

HARDWARE AND SOFTWARE

Will there be additional costs to:

• Collect, store, and manage violencerelated injury information data

• Program data collection fields into 

an electronic medical record or other 

parallel database

• Create and maintain a process for data 

to be secured and securely shared

» Manual

» Automated

• Procure mapping software

PROGRAM EVALUATION

What support is required for the 

monitoring and evaluation of:

• Program Effectiveness

How will the evaluation of process or 

outcome effectiveness of a local program 

be supported?

• Cost-benefits

How will the evaluation of cost savings 

associated with local prevention of violence 

and violent injuries relative to program 

inputs be supported?
BUILDING PARTNERSHIPS

17

WHAT IS THE CARDIFF VIOLENCE

PREVENTION MODEL? 

More than half of violent crime in the United States is 

not reported to law enforcement, according to the U.S. 

Department of Justice. That means cities and communities 

lack a complete understanding of where violence occurs, 

which limits the ability to develop successful solutions.

The Cardiff Violence Prevention Model provides a way for 

communities to gain a clearer picture about where violence 

is occurring by combining and mapping both hospital and 

police data on violence. But more than just an approach to 

map and understand violence, the Cardiff Model provides a 

straightforward framework for hospitals, law enforcement 

agencies, public health agencies, community groups, and 

others interested in violence prevention to work together 

and develop collaborative violence prevention strategies.
TOOLKIT: BUILDING PARTNERSHIPS 18

WHO NEEDS TO PARTICIPATE IN THE CARDIFF MODEL TO 

CREATE A COMMUNITY SAFETY PARTNERSHIP (CSP)?*

At a minimum, the Cardiff Model CSP is based on two groups 

working together: hospitals and law enforcement. Each 

organization collects anonymous information on the location, 

timing, and type of violence-related injuries that occur in public 

places. While data may be shared directly between hospitals 

and law enforcement agencies, the involvement of public health 

agencies is recommended as such agencies are ideal as central 

repositories for health system data (particularly in large cities with 

multiple hospitals) and can help guide evidence-based prevention 

efforts. Based on the resulting maps, the CSP may bring in other 

government agencies and community organizations to partner on 

violence prevention programs and activities.

It is important to have designated hospital and law enforcement 

representatives, and multiple individuals if possible from each 

agency, participating in the CSP. Key hospital members may 

include emergency department physicians, charge nurses, or 

senior trauma staff. Key law enforcement individuals may include 

senior officers who report directly to command staff, those 

within leadership positions, and those who produce or assist in 

producing maps of where violence occurs, (referred to as "hotspot" 

maps in the law enforcement community). 

WHY IS A MULTI-AGENCY CSP IMPORTANT FOR VIOLENCE PREVENTION?

Multi-agency CSPs provide an opportunity to (1) frame violence prevention as a law enforcement 

strategy to reduce crime and (2) address violence prevention using a public health approach. The 

public health approach† encourages violence prevention at a population level to provide data and 

interventions with the maximum benefit for the largest number of people.

Partnership members 

are best guided by which 

locations the hospital and 

law enforcement maps reveal 

as areas of the greatest 

violence and partnering with 

agencies or organizations 

that serve those areas. 

Cardiff Model Potential 

Partnership Members may 

include:

• Hospitals

• Law Enforcement 

Agencies

• Public Health 

Department

• City Planning/Zoning 

Officials

• Mayor’s Office

• Faith Based 

Organizations

• Business Associations

• Other Community 

Organizations

For example, in Cardiff, Wales, United Kingdom, the Violence Prevention Board (local name of the 

CSP) identified many violent assaults occurring in particular streets in the city’s main entertainment 

district. After investigating, the Board realized these assaults were largely due to alcohol-intoxicated 

individuals bumping into each other on the sidewalks after a night of drinking, resulting in fights. This 

risk was made worse by people becoming frustrated while waiting to be served at fast food outlets and 

for taxis. The Board worked with the city to make streets more pedestrian friendly, move taxi stands, 

and appoint taxi marshals (capable guardians), which helped decrease violent assaults in the area.

"Community Safety Partnership" is not intended to be prescriptive; local communities are encouraged to adopt a name, if they so choose, to represent 

their local collaboration.

For more information about the public health approach please visit https://www.cdc.gov/violenceprevention/overview/publichealthapproach.html

*

†
TOOLKIT: BUILDING PARTNERSHIPS 19

KEY STEPS TO STARTING THE CARDIFF MODEL CSP IN MY COMMUNITY:

1. RELATIONSHIP BUILDING

a. Establish a CSP between law enforcement and 

local hospitals

b. Determine the most useful injury information 

(time, date, and location are critical elements) 

for the CSP

c. Establish regular intervals (e.g. monthly) for the 

CSP to meet and discuss violence information, 

maps identifying areas of violence, and other 

relevant issues. In-person meetings focused 

on violence prevention are a great way to build 

relationships between individuals and the 

organizations they represent.

• Face-to-face meetings are important to develop 

relationships within the partnership, although 

phone meetings may sometimes be more 

convenient

• CSPs are also encouraged to have opportunities for 

informal meeting settings such as over breakfast/

lunch/coffee or having a meeting followed by some 

time for socializing

2. HOSPITAL BUY-IN AND SUPPORT (SEE "HOSPITAL 

GUIDANCE" FACT SHEET)

a. Obtain hospital (emergency department/

trauma) leadership buy-in and support

b. Obtain permissions for collecting and sharing 

injury information

c. Navigate HIPAA and privacy rules which may 

require the involvement of a government 

public health agency to facilitate the exchange 

of information (see "Legal, Technical, and 

Financial Considerations" fact sheet)

3. LAW ENFORCEMENT BUY-IN AND SUPPORT (SEE 

"LAW ENFORCEMENT GUIDANCE" FACT SHEET)

a. Obtain law enforcement leadership buy-in and 

support

b. Obtain permissions for receiving hospital 

violence information and sharing combined 

hospital and law enforcement maps

4. TRAINING AND TECHNICAL PROCESSES

a. Identify, establish procedures, and train 

hospital staff to collect violence information

b. Identify, establish procedures, and, if 

appropriate, train law enforcement officers to 

combine violence information with existing 

law enforcement data to produce maps (note: 

law enforcement officers may not be producing 

maps, see 4c).

c. Identify and establish procedures to share 

information and produce maps if a third party 

is producing the maps

5. VIOLENCE INFORMATION AND MAP SHARING

a. Identify hospital information technology/data 

quality team to set up data sharing

b. Establish procedures for sharing violence 

information and maps

c. If necessary, develop and sign a shared data 

use agreement

6. INJURY PREVENTION INTERVENTION 

IDENTIFICATION, PLANNING, AND EXECUTION

a. Review hospital violence and law enforcement 

information combined maps identifying areas 

of violence

b. Identify an area or areas that the CSP would 

like to examine more closely to plan violence 

prevention activities

c. Examine the types of violence occurring in 

the areas and consider all aspects of the area, 

such as: geographic area features (roads/

intersections, lighting, transportation options, 

etc.), businesses (bars, clubs, restaurants, 

lounges, gas stations, etc.), and other factors 

that may contribute to violence and injury

d. Recruit appropriate partners to the CSP 

based on the patterns of violence (e.g. other 

government agencies such as alcohol licensing 

or code enforcement; business associations; or 

community leaders)

e. Identify and review any existing evidence-based 

strategies that could be appropriate for this 

area (e.g. address risk and/or protective factors 

that are particularly relevant to the community 

or make use of unique opportunities in the 

community)

• Evidence-based strategies used in other 

communities, including the U.K. serve as important 

resources to help guide implementation of violence 

prevention interventions

• CDC’s Division of Violence Prevention has several 

technical packages on different topics (e.g. 

Child Abuse and Neglect, Sexual Violence, Youth 

Violence, Suicide) that may serve as a resource 

for identifying appropriate evidence-based 

interventions. Available here: https://www.cdc.gov/

violenceprevention/pub/technical-packages.html 

f. The partnership should determine next steps 

which may include: reviewing crime report 

narratives, visiting the area, examining the 

types of violence and injuries, talking with 

business/community leaders to see if they 

are willing to work with the CSP, and any other 

ideas that are driven by the maps.

g. Cardiff Model interventions have included 

strategies at multiple levels:

• Policy: Switching to toughened glass in bars and 

enforcing alcohol-related ordinances

• Community: Repairing the appearance of buildings 

and vacant lots to improve lighting and visibility, 

increasing police patrols in high-violence areas, 

and creating more pedestrian-friendly streets

• Individuals: Developing programs where "capable 

guardians," such as clergy, assist at-risk 

individuals
EXTERNAL COMMUNICATIONS

AND MEDIA RELATIONS

20

WHAT IS THE CARDIFF VIOLENCE

PREVENTION MODEL? 

More than half of violent crime in the United States is 

not reported to law enforcement, according to the U.S. 

Department of Justice. That means cities and communities 

lack a complete understanding of where violence occurs, 

which limits the ability to develop successful solutions.

The Cardiff Violence Prevention Model provides a way for 

communities to gain a clearer picture about where violence 

is occurring by combining and mapping both hospital and 

police data on violence. But more than just an approach to 

map and understand violence, the Cardiff Model provides a 

straightforward framework for hospitals, law enforcement 

agencies, public health agencies, community groups, and 

others interested in violence prevention to work together 

and develop collaborative violence prevention strategies.
TOOLKIT: EXTERNAL COMMUNICATIONS AND MEDIA RELATIONS 21

The greatest benefit to implementing a Cardiff Model 

communications plan is to ensure transparency and trust with 

local communities. The Cardiff Model is intended to benefit the 

community. The Community Safety Partnership (CSP) should 

designate a centralized point of contact to serve as the lead on all 

communications and media. This person should: 

• Take the lead on developing a communications and media 

strategy for the partnership, 

• Draft communications materials, 

• Provide expert guidance on strategic communications 

and develop decision-making processes for reviewing 

communications materials under consideration by CSP 

members, and 

• Coordinate with media relations staff who serve within the 

collaborating members’ individual organizations, as needed. 

Planning for communications and media should be done 

collectively and in tandem with all other project planning, and may 

include some or all of the following activities:

• Communications Strategy & Plan

• Goals and SMART Objectives 

• Audience Analysis 

• Risk Communication Plan

• Communication Channels

• Budget: Financial resources, human resources, and

in-kind resources

• Products and Activities: A work plan, including a time-line, 

is recommended to streamline needed inputs and desired 

outputs, roles and responsibilities, monitoring and evaluation

MEDIA ENGAGEMENT AND STRATEGY DEVELOPMENT

Information about the project should be prepared by the media lead regardless of whether 

the CSP intends to engage the media. The information should include the development of 

talking points about the project (frequently asked questions, history of the Cardiff Model, 

information about the local CSP collaboration), a general timeline for project implementation, 

a list of the organizations that are collaborating together and other relevant public information.

Collaborators will need to review and approve all documents prior to dissemination.

SMART

ARE:

OBJECTIVES

SPECIFIC

Concrete, detailed, and

well defined so that you 

know where you are 

going and what to expect 

when you arrive

MEASUREABLE

Numbers and quantities 

provide means of 

measurement and 

comparison

ACHIEVABLE

Feasible and easy to 

put into action

REALISTIC

Considers constraints 

such as resources, 

personnel, cost, and time 

frame

TIME-BOUND

A time frame helps to set 

boundaries around the 

objective
TOOLKIT: EXTERNAL COMMUNICATIONS AND MEDIA RELATIONS 22

SAMPLE: CARDIFF MODEL PRESS RELEASE

JANUARY 18, 2017 – Violence is a serious 

public health problem that affects people of all 

ages, but according to the U.S. Department of 

Justice, more than half of violent crime (53 

percent) in the United States is unreported to 

law enforcement. Therefore, communities lack 

a complete understanding of where violence 

occurs and how to develop tailored prevention 

programs. The Cardiff Violence Prevention Model 

(Cardiff Model), developed by surgeon and 

Professor Jonathan Shepherd, M.D., of Cardiff 

University in the United Kingdom, provides a 

way for communities to gain more complete 

information as to where violence occurs and 

how to prevent it by forming partnerships 

between hospitals and law enforcement and 

others interested in violence prevention. Grady 

Memorial Hospital and DeKalb County Police 

Department have created a local Cardiff Model 

partnership.

The partnership, known locally as the United 

States Injury Prevention Partnership or 

USIPP, has worked since June 2015 to collect 

anonymous information on the location 

and timing of violent events and use that 

information with existing law enforcement 

records to create local maps of where violence 

occurs. Local maps have identified that the 

southern region of DeKalb County has a higher 

number of assaults and crimes than other 

areas of DeKalb County. This information and 

predictive analysis enhances law enforcement 

efforts and helps guide environmental 

improvements that can reduce crime, such 

as building repairs, safety improvements, 

and other USIPP-led ideas. Currently, USIPP is 

partnering with DeKalb Police Department’s 

South Precinct and business group to develop 

public health strategies and environmental 

approaches to address violence and crime in 

the area.

The DeKalb County Police Department works 

with area businesses to improve public safety 

and seek new opportunities to prevent crime 

in DeKalb County. "We welcome community 

involvement and partnerships to enhance 

J.W. Conroy. "We are always looking for new 

and innovative ways to identify and reduce 

crime." USIPP’s support and community 

engagement have strengthened the interest of 

businesses to prevent crime by improving their 

properties using evidence-based environmental 

approaches such as property beautification and 

increased security measures.

Daniel Wu, M.D., associate professor of 

emergency medicine at Emory School of 

Medicine, says, "The opportunity to work with 

DeKalb County Police Department allows 

the hospital [Grady Memorial Hospital] to 

prevent violence before it enters our doors. 

We are committed to improving the health 

of our communities by making them safer 

through innovative programs like the Cardiff 

Model and partnerships like ours with DeKalb 

County Police Department." 

USIPP also has been working closely with the 

Centers for Disease Control and Prevention’s 

(CDC) Division of Violence Prevention, which has 

provided technical assistance and support for 

adapting the Cardiff Model to the United States 

and selecting public health approaches for 

violence prevention.

Preventing violence and making communities 

safer are key USIPP goals. DeKalb County Police 

Department and Grady Memorial Hospital 

hope to engage with more community groups, 

public health agencies, local governments, 

and others interested in violence prevention 

to scale up and sustain implementation of the 

Cardiff Model in the Atlanta metropolitan area. 

South DeKalb County businesses interested in 

learning more about how the local Cardiff model 

partnership could benefit their business and 

communities are welcome to attend the next 

business group meeting, scheduled for Feb. 22, 

2017, from 10:00–11:00a.m. ET at South DeKalb 

County Police Precinct, 2842 H F Shepard 

Drive, Decatur, GA 30024.

the quality of life for the residents of DeKalb 

County," said DeKalb County Police Chief 
TOOLKIT: READINESS CHECKLIST 23

READINESS CHECKLIST

WHAT IS THE CARDIFF VIOLENCE PREVENTION MODEL? 

More than half of violent crime in the United States is not reported to law enforcement, according to the 

U.S. Department of Justice. That means cities and communities lack a complete understanding of where 

violence occurs, which limits the ability to develop successful solutions.

The Cardiff Violence Prevention Model provides a way for communities to gain a clearer picture about 

where violence is occurring by combining and mapping both hospital and police data on violence. 

But more than just an approach to map and understand violence, the Cardiff Model provides a 

straightforward framework for hospitals, law enforcement agencies, public health agencies, community 

groups, and others interested in violence prevention to work together and develop collaborative violence 

prevention strategies.

Below are a list of key steps and a checklist to determine the community’s readiness to adopt the Cardiff Model. The organization 

leading the Community Safety Partnership (CSP) can vary (e.g. law enforcement, hospital, university, health department). It is 

critical to have an individual within the organization who can assume a leadership role in convening and organizing the group. 

For each topic below, a task is outlined along with identifying the readiness level. There is space to write in next steps and identify 

a target completion date. This Readiness Checklist is intended to identify high-level tasks and establish due dates. Please note that 

each task may have several sub-tasks that must be completed to achieve the task listed on this checklist, and note that this list is 

not exhaustive. For example, under "Establish a CSP," this task may include (1) reaching out to area partners (area hospitals, area 

law enforcement agencies), (2) convening a conference call or in-person meeting to discuss the Cardiff Model and forming a CSP, 

and (3) talking internally within each organization to ensure that each organization is interested in joining the CSP and engaging in 

local violence prevention activities.
24

TOPIC: COMMUNITY SAFETY PARTNERSHIP READINESS

TASK READINESS

LEVEL NEXT STEPS

TARGET 

COMPLETION 

DATE

Establish a Community Safety 

Partnership (CSP). Key partners must 

include law enforcement and hospital(s), 

and other key partners may include 

public health departments, other 

government agencies, universities, and 

other local community organizations

HAVE NOT 

STARTED

IN PROGRESS

COMPLETED

Establish where, when, and how often the 

CSP will meet

HAVE NOT 

STARTED

IN PROGRESS

COMPLETED

Determine most useful violence 

information to be collected. Critical 

information includes: time, date, 

weapon used, and location of injury; 

other information may also be useful to 

address specific needs

HAVE NOT 

STARTED

IN PROGRESS

COMPLETED
25

TOPIC: HOSPITAL READINESS

TASK READINESS

LEVEL NEXT STEPS

TARGET 

COMPLETION 

DATE

Work with hospital leadership to obtain buy-in and support, especially among 

these groups:

• Emergency Department – Physicians

• Emergency Department – Nurses

• Trauma Department (if applicable)

HAVE NOT STARTED

IN PROGRESS

COMPLETED

Determine who is able to regularly attend CSP meetings as a hospital 

representative (may be more than one individual)

HAVE NOT STARTED

IN PROGRESS

COMPLETED

Establish process with appropriate hospital staff to determine ability to 

integrate Cardiff Model injury information into the electronic medical record 

(EMR) or planned record-keeping system

HAVE NOT STARTED

IN PROGRESS

COMPLETED

Work with hospital departments to (1) integrate the injury information 

data collection fields into the EMR/record-keeping system, (2) identify 

and train appropriate hospital staff to collect violence information (e.g. 

nurses, registrars), and (3) extract violence information at regular intervals 

– established by the partnership – and share with law enforcement so they 

can combine data and create maps to share with the community safety 

partnership

HAVE NOT STARTED

IN PROGRESS

COMPLETED

Develop a communication plan for the hospital, which may include:

• identifying a communication lead

• developing internal communication materials

• developing external communication materials

HAVE NOT STARTED

IN PROGRESS

COMPLETED
26

TOPIC: LAW ENFORCEMENT READINESS

TASK READINESS

LEVEL NEXT STEPS

TARGET 

COMPLETION 

DATE

Work with law enforcement contacts to obtain buyin, especially from:

• Command Staff/Leadership

• Analysts

HAVE NOT 

STARTED

IN PROGRESS

COMPLETED

Determine who is able to regularly attend (CSP) 

meetings as a law enforcement representative 

(may be more than one individual)

HAVE NOT 

STARTED

IN PROGRESS

COMPLETED

Identify a process for information sharing and 

mapping, this may include:

• Receiving hospital violence information

• Combining violence information with law 

enforcement records*

• Creating maps with hospital violence 

information and law enforcement records

• Sharing maps with the CSP

HAVE NOT 

STARTED

IN PROGRESS

COMPLETED

If the law enforcement does not have internal capacity to combine and map data, examine external partners who may have that capacity. This may include academic *

institutions, state or local governments (e.g. Health Department), or hiring third party law enforcement geographic information systems specialists.
27

TOPIC: FINANCIAL, LEGAL, AND TECHNICAL READINESS

TASK READINESS

LEVEL NEXT STEPS

TARGET 

COMPLETION 

DATE

Identify legal and regulatory 

considerations including institutional 

review boards or institutional legal 

departments

HAVE NOT 

STARTED

IN PROGRESS

COMPLETED

Determine how data are shared and kept 

secure (see note)

HAVE NOT 

STARTED

IN PROGRESS

COMPLETED

Determine costs and whether these 

can be supported internally or identify 

funding mechanisms

HAVE NOT 

STARTED

IN PROGRESS

COMPLETED

NOTE: Sharing injury information from hospital records in accordance with the local legal and regulatory environment may require 

collaboration with the local or state public health department.

LEARN MORE about the Cardiff Model and how to start using it in your community’s violence 

prevention efforts at www.cdc.gov/violenceprevention/fundedprograms/cardiffmodel

This material was developed by the Centers for Disease Control and Prevention (CDC). The pilot of the Cardiff Violence Prevention Model was a collaboration 

between the CDC, DeKalb County Police Department, Grady Health System, the University of Pennsylvania, and the CDC Foundation. Support for this pilot was 

provided by the Robert Wood Johnson Foundation.