Flint, MI– Every morning, seven days a week, Michael Bolton loads his stash of Narcan into his car, and drives into Flint neighborhoods, offering it to anyone who will take it.
Narcan is a common brand name for Naloxone, a medication used for the emergency treatment of a known or suspected opioid overdose.
With a quick spray into the victim’s nostril, it only takes a few minutes for the medicine to bind to the opioid receptors and push off any opiates, like heroin or fentanyl, currently on the receptors, reversing the effects of the overdose.
Since the beginning of 2021, Bolton suspects he’s delivered about 400 boxes, which makes for 800 doses to residents in the city so far. He’s had to personally administer it to people who have overdosed 15 times, and said he’s gotten about 40 people into treatment.
According to Michigan’s System for Overdose Surveillance, since Jan. 1, of this year, there have been 127 suspected fatal overdoses in Genesee County. There have been 572 EMS Naloxone administrations in the county so far this year.
A few years ago, Bolton started the Rise Up Initiative with a goal of reducing overdoses, as well as violence throughout the city using a three-point model: harm reduction, violence prevention, and health equity.
In addition to distributing Narcan, Bolton and his team partner with community organizations to educate and train people about overdoses, and how to administer Narcan.
Bolton hopes that Rise Up can get more funding to do even more outreach under a unique model that assesses the needs of specific neighborhoods and communities.
“One community might have more shootings and less overdoses or vice versa, and we can just go in there and help those folks, show them what we know and try to figure out what’s going on in the community,” Bolton said. “Is it more young people? Older people? Are the violent people just getting out of prison and coming back on the block and trying to take it back over? There’s so many variables, so each neighborhood is uniquely different.”
The strategy would involve a data coordinator collecting overdose and violent crime data; a community liaison; an implementation specialist who would train people on the model; community partners like employment or housing organizations that provide services people could be connected to; safe groups, community centers, and block clubs; and outreach specialists.
The outreach specialists would go door to door assessing the needs of residents, and connecting them with all kinds of services.
Do you need insurance? The outreach specialist would whip out their iPad and sign you up. Do you need to get vaccinated? The outreach specialist would help you make an appointment. Are you looking for work? The outreach specialist could make a call and get you connected with a skill center.
Bolton said it’s crucial that services be brought to people’s doorstep because many people need help navigating these various issues.
In addition to training on trauma-informed care and mental health, outreach specialists would also receive “violence interruption” training, which is a strategy that has been proven to work.
Rise Up’s model is based on a public health model that approaches violence as if it were an infectious disease.
“So think about COVID. You have a case of COVID, that person will infect however many people they infect or come in contact with,” said Dr. Debra Furr-Holden, an epidemiologist and public health professional. “The goal is to get somebody identified, get them in isolation, get them out of harm’s way from infecting others, get them treatment, get them whatever support they need, so that they can recover, and then they can be back out in community.
“This is what the violence interruption model is about,” she said. “It’s about identifying people who are at high risk for being a victim or a perpetrator. It’s about interrupting the spread and transmission of violence.”
Furr-Holden works for Michigan State University, and works with several organizations in Flint developing evidence, and implementing evidence-informed community violence prevention initiatives.
She said Rise Up could be an “influential and critical partner in a community-wide evidence-based gun violence prevention initiative.”
As of Aug. 15, homicides are up 46.3% in Flint compared to last year. In 2020, there were 55 murders total, and as of Aug. 15, 2021, Flint has already had 41. But that number is increasing nearly everyday– so much so, that Mayor Sheldon Neeley declared a State of Emergency due to gun violence last month.
“When we try to solve all of our community violence problems with pastors and police, we get what we get,” Furr-Holden said. “Pastors are great, and police are great, and we get the outcomes that we get with those models.”
The implementation of the public health model and “violence interruption” strategy has been shown to be effective in several cities around the country. In 2017, there was a 63% reduction in shootings in the South Bronx with the implementation of this model, according to a study from the John Jay Research and Evaluation Center. In 2012, a Johns Hopkins evaluation of the model’s effects in Baltimore reported a 56% reduction in killings and a 34% reduction in shootings in one community.
“There’s real science and evidence underneath community violence prevention,” Furr-Holden said. “And we want to invest in programs that have been tried and proven to reduce gun violence, and not make things up out of thin air that makes us feel good, but that don’t actually move the needle on gun violence.”
Furr-Holden said violence often starts over “petty beef that starts on social media.” The “beef” spreads from person to person, and spills out onto the streets, resulting in a shooting or a stabbing, and then there can be retaliation after that.
“Violence interruption is about interrupting. Getting the person who’s either at risk for being a perpetrator or victim, in isolation out of harm’s way, negotiating the terms of a peaceful agreement, almost like a settlement, where the violence doesn’t continue to spread,” Furr-Holden said. “And then ultimately, getting people back into and re engaged in the community in ways that are safe and healthy.”
The outreach specialists who can do the interrupting and the mediating, will need to be what Bolton and Furr-Holden call “credible messengers.”
“In order to be a credible violence interrupter, you’ve got to have credibility on the street,” Furr-Holden said. “And the only way you earn credibility on the street is through bad acts … so a lot of the people we want to engage have either been perpetrators or victims of violence in the past, but have made a change in their lives, and are now seeking to be a part of the solution and not a part of the problem.”
Some people might be scared to call the police for help if they think they’ve taken too many drugs, Bolton said. And Furr-Holden added that some families might be afraid their loved one may go to jail, but know they need help.
Bolton said it’s “common sense,” that people in those situations might feel safer calling someone they trust in the community who has a history and understands what they’re going through, as opposed to the police.
Bolton isn’t proud of his past, but it’s part of what makes him good at what he does.
He grew up on the streets of Detroit, around gangs, gun violence, and drug addiction. He lost friends, and family due to some of these things. He’s been a victim of gun violence himself.
“I was a product of that environment, but I got out,” Bolton said. “I’ve been through the recovery side.”
This month Bolton turned 50. He’s a nationally certified peer recovery coach, and he’s working to combat the same issues he grew up around and personally dealt with every day on the streets, and in his office at the Ferris Wheel in downtown Flint.
“There’s no degree for this, you know. This is a unique situation that requires lived experience,” he said.
But it also requires training.
“There’s real training that goes behind this,” Furr-Holden said. “That lived experience and that street credibility does uniquely qualify people, but they also have to be trained, they have to be accountable, and they have to be paid.”
Angalia Bianca is a perfect example of that kind of credible alternative with lived experience. She’s an anti-violence author and advocate, but also a former gang member. She has become a part of the core team for Rise Up as the Chief Program Officer, and has just established a Rise Up office in Chicago, her hometown.
She gave a talk at the Ferris Wheel last month about street outreach, and spoke about how she’s talked to “high risk” people, and pulled them away from potentially violent situations.
“If you don’t have lived experience, then young guys involved in high-risk activities, they’re not going to listen to you,” Bianca said at that talk on July 6.
She also said funding programs like Rise Up now will save the city money in the long run, because gun violence is expensive.
According to a state-by-state analysis published in 2019 by the U.S. Congress Joint Economic Committee, the annual cost of gun violence in Michigan is $6.9 billion. That number comes from employer, healthcare, and police and criminal justice costs, as well as lost income.
Bolton said a $5,000 grant from Phil Hagerman through the Community Foundation of Greater Flint allowed Rise Up to keep its doors open at the Ferris Wheel. For one pilot year of implementing the public health model, Bolton said Rise Up would need about $350,000 to $500,000.
“The world is changing, and services and systems are not. I tell people that I mentor every day, the world is changing and we gotta change with it,” Bolton said.
Furr-Holden said she believes Flint should be investing in and using the strategies that are known to work.
“We can adapt them for use in our community, but the fundamental aspects of the program that are tried and tested and proven. We should stand true to those things, and use those things because they work,” she said. “You know, the definition of insanity is doing the same thing expecting a different outcome. The things that we’ve done have gotten us to this point, but they haven’t moved the needle on violence.”