The Business of Social Issues
When a bullet is fired, the damage it creates ricochets through a community, impacting layers in ways not always immediately seen. Intervention programs, many of them grassroots and all grounded in the best intentions, put feet on the street in an effort to quell the violence. While there are brief respites, many Philadelphians live knowing the gun violence will return.
They wonder if things will ever change.
In the heart of some of the hardest-hit neighborhoods sits Temple University’s Center for Urban Bioethics, housed at the Lewis Katz School of Medicine. The Center uses evidence-based intervention programs to detect conflicts, treat high-risk individuals and change norms in Philadelphia to prevent gun violence.
One of those programs is CeaseFire-Cure Violence. The program has had notable success in Philadelphia and other cities, but its leaders are keenly aware that sustainable funding is needed to ensure the programs’ long-term success.
In this episode of Catalyst, TL Hill, managing director of Fox Management Consulting and the Translational Research Center, discusses how the Fox School of Business collaborated with the Center for Urban Bioethics to look at the crisis through the lens of a business model. The project looked at who has the need for the services and who is a source with the ability and willingness to pay for them?
At first glance, a business model approach to ensuring sustainable funding for gun violence intervention programs might not seem the obvious route. Does it really make sense to craft a value proposition and process to make the connection from the payor to the service provider? Can you even measure success in that situation? And, thinking in broader terms, can this approach be used as a model for other crises?
The Fox Management Consulting project team identified where you can find sustainable funding for intervention efforts like CeaseFire-Cure Violence. Here’s a hint: it’s the same entities that feel the economic pain for many of those downstream costs associated with gun violence.
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Host: Welcome to the second season of Catalyst, the podcast of Temple University’s Fox School of Business. I’m your host Tiffany Sumner and today we’ll explore the business of social issues. Specifically, [00:01:00] we’ll look at how an organization with a mission to cure gun violence can ensure its financial stability and continue to help our community.
I’m joined by Professor TL Hill, the managing director of Fox Management Consulting and the Translational Research Center. I spoke with TL about how the Fox School and Temple’s Lewis Katz School of Medicine collaborated to create a business model for Philadelphia’s CeaseFire-Cure Violence. In this episode, we discuss which entities have the need for CeaseFire’s services and which funding sources would most likely ensure the organization’s longevity. We also learn about the Chicago Cure Violence program, which treats gun violence as a health epidemic and is a model for the Philadelphia CeaseFire program. Here’s what TL had to say about paving a sustainable path to curing gun violence. [00:02:00]
TL, can you tell us how you collaborated with the medical school and what theories you used to create this business model?
TL Hill: Sure so, I guess the way we got into the collaboration is that one of our colleagues in the business school, Dan Issacs, who is an ethicist in our Legal Studies Department, was talking with one of the ethicists, bioethicists up the medical school about whatever ethicists talk about. And it became clear that the Center for Urban Bioethics wasn’t just teaching classes about bioethics but was actually running programs. And Dan is very aware of the Fox Management Consulting Program, which is the capstone program for our MBA students. It involves the students doing real-life projects for both for-profit and nonprofit organizations and he just thought we should talk.
We started to talk and the more I learned about the multiple programs that this Center for Urban Bioethics kind of funds [00:03:00] and does, all having to do with trying to think about health crises—you know, chronic health issues—as public health problems. So, problems that have roots and social issues like violence or obesity or drug use, poverty things like that. And so, their approach is that you have to get at the underlying issues if you want to reduce the health issues, right?
As a business school person, I’m interested in social ventures, social entrepreneurship and I’ve been interested in social impact for a while. And so, when I hear conversations like that, my mind immediately goes to, “Well, who pays for this? Which parts of society, which parts of the economy are feeling the pain? Which parts of society, which parts of the economy have the resources? Can we design a program such that the people or the organizations feel the pain and have the resources pay [00:04:00] for the prevention, pay for the reduction of violence?”
We have the Fox Management Consulting program, which is very much an evidence-based way of training MBA students. We were able to say, “Well, if you have a particular project that you’d like us to work on and think about the long-term sustainable business model, we can give you a group of students and advisors and executives to work on that problem.”
Kathy Reeves, who runs the Center for Urban Bioethics, said, “CeaseFire-Cure Violence is an amazing program. We’ve got a lot of evidence from criminal justice about how it works and all of what we do is evidence-based. We can see a 30% reduction in violence in the areas in which we operate”—which is unlike pretty much any other program in the city. There are maybe two others that have an evidence base to them and the rest are well meaning, coming out of the community but without an evidence base [00:05:00] to them. “Even with that, we struggle to find funding to sustain it year to year and we really struggle to find funding to expand it. We would like a business model that not just funds it in two precincts but allows to fund it across the entire city.” And so, we took that as a challenge.
Host: That’s really great. Can you tell us a little more about CeaseFire-Cure Violence and how the work being done is different from other crisis intervention programs?
TL: Yeah, so it’s different in two ways. One has to do with the philosophy—actually three ways: philosophy, who they involve and the sort of commitment to measurement into evidence.
So, the philosophy is, they’re looking at this as a public health problem. And if you think about how we stopped any kind of epidemic, there’s monitoring, there’s interruption and there’s prevention. In this case, the monitoring has to do with outreach and connection across the community from the streets to the religious organizations to the businesses. [00:06:00] Interruption has to do with actually going in right after an incident of violence, talking to everybody who are involved and trying to prevent the tit-for-tat escalation that almost always happens. And prevention has to do with working in the schools around education and with businesses and other organizations to create economic opportunity so that the community members, particularly the young people in the community, have a future and some hope. So that’s the basic kind of approach.
The people they involve it to say, you know, “You can’t do this on the outside.” Even the management of it, you know we talk about it (CeaseFire-Cure Violence) being under the Center for Urban Bioethics. It’s not exactly accurate—that’s where the money comes from, but there’s a nonprofit CeaseFire-Cure Violence, which is community-based and everybody who works in it is from the community. And everybody that they hire, particularly the outreach workers and the interrupters, tend to be young people who, essentially, are the people at risk.
Host: So, if we could look at the larger picture, for a minute—gun violence is often seen as primarily a social issue, not a business issue. [00:07:00] What steps should you take in the process of building a business model? And I’m also curious, how did you identify that what was necessary for the CeaseFire-Cure Violence was a business model?
TL: So, for a part that came out of the conversation with Kathy Reeves, a pediatrician who is kind of behind the Center for Urban Bioethics. She always works in partnership with community people, like Marla Davis from the CeaseFire-Cure Violence world. The conversation was, “Look, we got a model that we got research that shows that it works. We know that it works from anecdotal sort of stories. We also have actually done research with criminal justice professors, looking at the violence reduction in the 22nd Precinct in comparison to what was going on in the baseline, right. Statistically significant, not just because what’s happening in the larger secular changes. So we can actually see that this particular [00:08:00] program works.” That’s great. It’s not super expensive—but it costs $300,000 for two years for one precinct, so it’s not cheap.
If we want this to spread, we need a model of sustained funding. So the question is, “How do we sustain funding?” And when you think about sustained funding, if you’re a business person, you think, ah, a business model! There has to be a way in which we need to find and align the interests of people who have the resources, who are willing to pay, because otherwise their lives and their resource base would be affected. So, I think of one of the things that we can do in the business school is think really well about alignment of interest in the designing of business models that have the people most affected who also have resources paying for the problem.
So that was the way we reframe the conversation. We said, alright we’re up for the challenge. We have our MBA students, six MBA students and then we supervise [00:09:00] them very closely with not just the faculty member in the class, you know like me or whomever, but with a project executive who is a senior businessperson and a couple or three advisors are also businesspeople. So, for this group we have a really good group of students, which we always have. We had somebody who had built a number of medical and healthcare organizations and been a CEO so he has kind of thought about that and knows the issues well. Then we have people with community experience, hospital experience and insurance experience on the advising group. We kind of pull together the right people to think about it.
What we began to look for is who is affected and what are the circles? There are social circles of violence, you know. One person is shot, maybe killed. One person did the shooting. But then there’s the person who was shot and maybe killed; people watch that so there’s trauma there. That might affect their family in some way or another, right? They lost a [00:10:00] loved one, depending on their age and their gender, what they’re doing for business, whether it is legitimate or illegitimate. It may affect the cash flows for that family, right? So, you’ve got psychological pressures, social pressures, economic pressures on the family of the victim, if you will.
But the family of the perpetrator is also suffering, right? This person is that much more hardened, they’re running around with a gun, maybe they’re going to do this again, maybe they’re going to get caught and put into jail. It can have the same interruptions of the family dynamics if someone gets put away for 10, 20 years or life as if they’re shot, right? It’s hard to say that but it’s this affecting a social system.
I think we calculated that there are seven layers, seven ripples but we simplified it down to three: the primary cost, the secondary cost and then the social costs. And we built the model around what are those costs and who’s responsible, who feels the pain and who needs to pay for those costs.
Host: [00:11:00] How does the model lead the way for a sustainable path forward for funding?
TL: Right, so once you figure sort of the categories of costs involved then you can do research to figure out what those costs are. What we did is a mixture of primary research, figuring out actual cost so we can find the relatively easy, and then secondary research, which is basically looking through the literature to find other instances that were close enough for people who did the estimation. Someone maybe did unemployment study here or somebody in Chicago looked at the cost of food stamp changes and you kind of put that together. We ended up with a pile of costs organized by concentric circle.
Then the next question was, “Who pays for the stuff?” So, if you think about the direct medical costs, insurance pays for it. The way Pennsylvania is set up, the insurance companies administer the payments. But the payments very often come from the state for the social costs that’s done through a mixture of city programs [00:12:00] and state programs. But the funding again, is federal state and city taxes coming in all three of those areas and being assembled and then it’s run in whatever the programs are.
So, when you do that, you can do a return on investment or social return on investment (ROI) calculation. The investment in this case $350,000 or so for two years of operations. And then the return on investment would be well, if we see a 30% drop, which is what the criminal justice people tell us this program is creating, you turn that into a number of people killed, a number of people shot. And then you multiply that by whatever the various costs are. So, if you have two less people killed per month, 24 less people in a year, each person associated with a certain amount of money from healthcare, a certain amount of money from social impact, we can kind of calculate the savings. So, you take the savings divided by the costs and you get your return on investments. It’s really straight forward. [00:13:00] The basic idea is how much to save versus how much it costs that you return on investment.
Host: So, if you’re looking at the social ROI, the research found that statewide resources offered through the Department of Human Services (DHS) that could be saved through those prevention measures were significant. Can you tell me more about that?
TL: If you look at DHS more broadly, all of DHS at the state level, this is now the people who are paying for food stamps or paying for all the mental health or paying for foster care. They’re paying for all the social costs. Then the return investment is about 30 to 1. A dollar of prevention gets you $30 in savings. Now, we’re talking.
Host: Absolutely. And when did the students in Fox MC work to create this business model?
TL: Yeah, so this was last fall, so the fall of ’19, finishing up in December. [00:14:00] Several people in the city have asked to see the results and we’ve had meetings particularly with Rebecca Rhynhart, the controller. We’ve made sure that the Mayor’s Office has it, so we’re trying to get kind of the word out.
Host: Right, I’m curious—will you or can this approach be used in other types of intervention programs?
TL: Yeah, we’ve continued to work with the Center for Urban Bioethics, because as I said in the beginning, they do have a kind of wide remit where they’re really looking at all kinds of health issues as a public health problem. And they want to approach it in a variety of ways. So one program is the CeaseFire-Cure Violence. Another program is called Began the Turn which is the hardest part of the opioid epidemic is getting people to turn, to step back and to get out of… you know, when you’re in the life of the streets and you’re deep into your addiction [00:15:00] there’s really not much anybody can do. But there are moments in which you can begin that turn, begin to the step away, begin the step into rehab. And if you can be with people that moment and provide enough support, it’s the interruption idea, again in monitoring interruption.
So, this program is doing something similar. They’re monitoring, mostly in the Kensington area, what’s happening. They’ve got a mobile van which then shows up to interrupt when there’s been particular deliveries, maybe a lot of overdoses, they’re there. They’re ready to help people begin that turn. And then they work with a variety of different partners to make sure that there’s like a network around the person who’s wanting to try to make that step, to break out. So, we do the same study there, looking for ways to get long-term funding.
But anyway, so there’s a model out there now with a similar approach looking for that. And now we’re talking about two more programs with them. One of them has to do with some wealth creation in the African American and Latinx communities, [00:16:00] which we know have a very persistent wealth gap. And there’s very strong epidemiological evidence connecting lack of wealth with healthcare long-term, chronic health conditions. And so, the idea is basically, how can we use anchor institutions to generate more income and more wealth for African American- and Latinx-owned businesses? So that’s a pure economic problem, right? It’s a great business school problem but with this really interesting health and social overlay.
Host: That’s great. In closing is there anything that you want to talk about more personal anecdotes about just this work being sort of different and meaningful for you and for other faculty and staff and the students and alum at Fox?
TL: First of all, the whole approach—of being able to work alongside with community people and having community people asking the questions and leading the research questions—I think is probably in some normative sense, the right way of doing things. [00:17:00] We don’t know, we’re academic researchers who are coming in from the outside and we need to be guided by the people most affected. And then from the student perspective, adults learn by doing. You remember what you experience. And so in general, I think Fox Management Consulting is effective that way because we get the adult learners to do something and remember their doing and they’re going to remember because of the experience.
To the extent you add a social overlay to it, it usually makes the experience that much more intense. The students went out with interrupters, they began to turn and they were out in the van, you know working with people who are coming off of meth overdose. They’re not doing the interruption work, they’re not doing the medical work after the overdose, I mean they are not trained to do that. But that’s not something you normally do in business school and they’ve now got a vivid memory of that empathy, which I think makes all the numbers come alive. [00:18:00]
Host: Thank you, TL, for joining me and sharing your insights on funding a gun violence prevention program. The findings from this research show that sustainable funding for CeaseFire-Cure Violence and other intervention programs should come from city and state governments because they most often incur the cost related to gun violence and its downstream effects.
Many of us at Temple University are leveraging our expertise in order to identify solutions to real and eminent social problems, such as gun violence. Thanks to projects like this one, we should have a better idea of how we can do our part to help fund and ensure the sustainability of intervention programs that will help society at large.
Catalyst is a podcast from Temple University’s Fox School of Business. Visit us on the web at fox.temple.edu/catalyst. We are produced by Milkstreet Marketing, Megan Alt, Anna Batt, Stephen Orbanek and Karen Naylor. I hope you’ll join us next time. Until then, I’m Tiffany Sumner and this is Catalyst. [00:19:00]
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