B15 - HD - before NVDRS

National
 Violent
 Death
 Reporting

System
 (NVDRS)

FY
 2014
 Background
 Document

NVDRS
 Data
 Saves
 Lives

Violence
 is
 not
 inevitable
 and
 can
 be
 prevented.
 The
 National
 Violent
 Death
 Reporting
 System
 (NVDRS)
 is
 a
 state-­‐
based
 surveillance
 system
 developed
 by
 the
 Centers
 for
 Disease
 Control
 and
 Prevention,
 National
 Center
 for

Injury
 Prevention
 and
 Control
 (CDC
 Injury
 Center).
 NVDRS
 collects
 facts
 from
 different
 sources
 about
 the
 same

violent
 death
 to
 provide
 a
 more
 complete
 picture
 of
 the
 circumstances
 of
 the
 event.
 State
 and
 local
 violence

prevention
 practitioners
 use
 these
 data
 to
 guide
 their
 prevention
 programs,
 policies,
 and
 practices
 including:

• Identifying
 common
 circumstances
 associated
 with
 violent
 deaths
 of
 a
 specific
 type
 (e.g.,
 gang

violence)
 or
 a
 specific
 area
 (e.g.,
 a
 cluster
 of
 suicides);

• Assisting
 groups
 in
 selecting
 and
 targeting
 violence
 prevention
 efforts;

• Supporting
 evaluations
 of
 violence
 prevention
 activities;
 and

• Improving
 the
 public’s
 access
 to
 in-­‐depth
 information
 on
 violent
 deaths.

Public
 Health
 Problem

Preventing
 violence
 is
 a
 critical
 public
 health
 goal
 because
 violence
 inflicts
 a
 substantial
 toll
 on
 individuals,

families,
 and
 communities
 throughout
 the
 United
 States.
 No
 one
 is
 immune
 to
 violence.
 It
 affects
 people
 across

the
 lifespan-­‐from
 infants
 to
 the
 elderly.
 CDC
 Injury
 Center
 data
 indicates:

• In
 2010,
 violence
 claimed
 more
 than
 55,000
 American
 lives,
 translating
 into
 more
 than
 six
 people

dying
 each
 hour
 from
 a
 homicide
 or
 suicide.

• In
 2010,
 38,364
 people
 died
 by
 suicide.

• In
 2010,
 homicide
 claimed
 more
 than
 16,000
 people
 in
 the
 United
 States.

• Violence-­‐related
 deaths,
 assaults,
 and
 acts
 of
 self-­‐harm
 cost
 the
 United
 States
 an
 estimated
 $84.3

billion
 in
 medical
 care
 and
 lost
 productivity
 every
 year.

Strategies
 that
 Work

NVDRS
 aids
 in
 violence
 prevention
 through
 the
 creation
 of
 a
 reliable
 violence
 surveillance
 system
 synthesizing

multiple
 data
 sources
 into
 one
 uniform
 system,
 which
 can
 be
 used
 to
 inform
 decision
 makers
 and
 program

planners
 about
 the
 magnitude,
 trends,
 and
 characteristics
 of
 violent
 deaths
 so
 appropriate
 prevention
 efforts
 can

be
 put
 into
 place.
 It
 also
 facilitates
 the
 evaluation
 of
 state-­‐based
 prevention
 programs
 and
 strategies.
 Capturing

data
 from
 various
 sources
 allows
 us
 to:
 link
 records
 on
 violent
 deaths
 occurring
 in
 the
 same
 incident
 to
 help

identify
 risk
 factors
 for
 multiple
 homicides
 or
 homicides-­‐suicides,
 provide
 timely
 preliminary
 information
 on

violent
 deaths
 (currently
 data
 is
 not
 available
 until
 2
 years
 after
 death),
 describe
 in
 detail
 the
 circumstances,

which
 may
 contribute
 to
 a
 violent
 death
 such
 as
 job
 loss,
 physical
 and
 mental
 health
 problems,
 family
 and
 other

stressors.

1

Unique
 Role
 of
 the
 CDC
 Injury
 Center’s
 NVDRS

In
 2002,
 CDC’s
 Injury
 Center
 received
 funding
 to
 create
 NVDRS.
 It
 is
 a
 state-­‐based
 surveillance
 system
 pooling

information
 from
 state
 and
 local
 agencies,
 medical
 examiners,
 coroners,
 police,
 crime
 labs,
 and
 death
 certificates

to
 form
 a
 more
 complete
 picture
 of
 the
 circumstances
 surrounding
 violent
 deaths.
 NVDRS
 uses
 state-­‐level
 data
 to

describe
 the
 “who,
 when,
 where
 and
 how”
 leading
 to
 better
 understanding
 of
 the
 “why”
 in
 violent
 deaths,

unintentional
 firearm
 injury
 deaths,
 and
 deaths
 of
 undetermined
 intent.
 NVDRS
 is
 unique
 in
 that
 no
 other
 data

system
 combines
 information
 from
 various
 data
 sources
 to
 provide
 a
 complete
 picture
 of
 violent
 deaths.

 NVDRS

is
 currently
 supported
 in
 18
 states.

Federal
 Partnerships

CDC’s
 Injury
 Center
 is
 collaborating
 with
 the
 Department
 of
 Defense
 (DOD)
 to
 link
 information
 from
 NVDRS
 with

information
 from
 DOD
 data
 systems.
 The
 integrated
 analysis
 found
 intimate
 partner
 problems
 and
 military-­‐
related
 stress,
 particularly
 job
 stress,
 was
 common
 among
 decedents.
 Many
 decedents
 were
 also
 identified
 as

having
 suicidal
 ideation,
 a
 sad
 or
 depressed
 mood,
 or
 a
 recent
 crisis
 before
 death.
 Focusing
 efforts
 to
 prevent

these
 forms
 of
 stress
 might
 reduce
 suicides
 among
 soldiers.
 Collaborations
 between
 the
 CDC
 Injury
 Center
 and

DOD
 are
 ongoing.

NVDRS
 in
 Action

Currently,
 18
 states
 participate
 in
 NVDRS:
 Alaska,

Colorado,
 Georgia,
 Kentucky,
 Maryland,

Massachusetts,
 Michigan,
 New
 Jersey,
 New

Mexico,
 North
 Carolina,
 Ohio,
 Oklahoma,
 Oregon,

Rhode
 Island,
 South
 Carolina,
 Utah,
 Virginia
 and

Wisconsin.
 Sixteen
 states
 have
 collected

information
 on
 violent
 deaths
 from
 at
 least
 2005
 to

2010,
 while
 2
 states,
 Michigan
 and
 Ohio,
 began

reporting
 information
 on
 violent
 deaths
 in
 2010

when
 additional
 resources
 were
 added
 to
 the

program.

The
 CDC
 Injury
 Center
 distributes
 information
 from
 NVDRS
 at
 the
 state
 and
 national
 level
 in
 summary
 reports,

public
 websites
 (see
 http://www.cdc.gov/injury/wisqars/nvdrs.html
 for
 national
 data),
 and
 topic
 specific
 reports

as
 well,
 as
 responding
 to
 data
 requests
 by
 the
 public.

A
 major
 current
 focus
 of
 NVDRS
 is
 transitioning
 data
 collection
 from
 state-­‐based
 databases
 to
 a
 web-­‐based

platform
 in
 FY2013.
 Currently,
 NVDRS
 collects
 information
 through
 18
 state-­‐maintained
 databases.
 In
 addition
 to

requiring
 states
 to
 maintain
 the
 system
 and
 upgrades,
 the
 current
 system
 restricts
 the
 use
 of
 the
 program
 to

computers
 with
 the
 NVDRS
 software
 and
 results
 in
 unique
 state
 technical
 and
 data
 problems,
 which
 need
 to
 be

addressed
 on
 a
 case-­‐by-­‐case
 basis.
 The
 goals
 of
 the
 new
 web-­‐based
 platform
 are
 to:

• Increase
 access
 to
 people
 entering
 data
 by
 allowing
 authorized
 users
 to
 access
 the
 system
 from

any
 computer
 with
 Internet
 access.
 This
 will
 allow
 current
 NVDRS
 states
 to
 enter
 data
 from

different
 locations
 and
 enable
 newly
 funded
 states
 to
 easily,
 quickly,
 and
 efficiently
 be
 added
 to

NVDRS;

• Increase
 reliability
 and
 security
 by
 centrally
 maintaining,
 monitoring,
 and
 updating
 the
 system.

This
 means
 all
 states
 will
 be
 using
 the
 same
 program
 at
 all
 times;

• Decrease
 overall
 maintenance
 costs
 by
 hosting
 and
 maintaining
 the
 system
 nationally
 instead
 of

in
 each
 state.

2

NVDRS
 Program
 Successes

NVDRS
 informs
 national
 and
 state
 violence
 prevention
 efforts.
 The
 18
 NVDRS
 states
 use
 the
 surveillance
 data
 to

respond
 to
 the
 unique
 circumstances
 and
 patterns
 of
 violent
 deaths
 in
 their
 states.
 For
 instance,
 NVDRS
 states
 are

able
 to
 investigate
 whether
 violent
 death
 circumstances
 vary
 across
 local
 communities
 by
 examining
 violent

deaths
 by
 county
 or
 zip
 code.
 This
 allows
 states
 to
 target
 prevention
 activities
 and
 tailor
 them
 to
 the
 unique
 needs

of
 their
 local
 community.
 At
 the
 national
 level,
 NVDRS
 data
 can
 be
 used
 to
 better
 understand
 general
 patterns
 in

violent
 deaths
 and
 emerging
 multi-­‐state
 trends.
 Highlighted
 below
 are
 recent
 specific
 examples
 of
 where
 NVDRS

data
 has
 supported
 efforts
 to
 prevent
 violence:

NVDRS
 Data
 Supporting
 State
 Suicide
 Prevention
 Efforts

South
 Carolina

South
 Carolina,
 in
 partnership
 with
 the
 South
 Carolina
 Mental
 Health
 Association,
 utilized
 state
 NVDRS

data
 to
 describe
 the
 problem
 of
 youth
 suicide,
 identify
 target
 communities,
 and
 successfully
 apply
 to

the
 Substance
 Abuse
 and
 Mental
 Health
 Services
 Administration
 (SAMHSA)
 for
 a
 suicide
 prevention

grant.
 The
 grant
 provided
 evidenced-­‐based
 gatekeeper
 training
 to
 schools,
 institutions
 of
 higher

education,
 local
 offices
 of
 public
 welfare
 and
 juvenile
 justice,
 pediatricians’
 offices,
 faith-­‐based
 and

community
 organizations,
 and
 to
 foster
 and
 adoptive
 parents.
 Currently,
 South
 Carolina’s
 NVDRS
 data

is
 being
 used
 to
 assess
 and
 update
 South
 Carolina’s
 suicide
 prevention
 plan.

Utah

In
 Utah,
 NVDRS
 data
 enabled
 the
 state-­‐wide
 task
 force
 to
 identify
 trends
 and
 risk
 factors
 for

prescription
 drug-­‐related
 suicides.
 As
 a
 result,
 a
 number
 of
 prevention
 strategies
 are
 currently

underway
 including
 training
 on
 prescribing
 practices
 and
 better
 access
 for
 medical
 providers
 to
 a

controlled
 substances
 database.

Oregon

NVDRS
 data
 helped
 Oregon
 to
 develop
 and
 target
 suicide
 prevention
 programs
 for
 older
 adults.
 Almost

50%
 of
 men
 and
 60%
 of
 women
 65
 years
 of
 age
 or
 older
 who
 died
 by
 suicide
 were
 reported
 to
 have
 a

depressed
 mood
 before
 death.
 However,
 only
 a
 small
 proportion
 were
 receiving
 treatment
 for
 their

depression
 when
 they
 died,
 suggesting
 screening
 and
 treatment
 for
 depression
 might
 have
 saved
 lives.

In
 response
 to
 these
 findings,
 Oregon
 recently
 developed
 a
 state
 Older
 Adult
 Suicide
 Prevention
 Plan

recommends
 primary
 care
 be
 better
 integrated
 with
 mental
 health
 services
 so
 suicidal
 behavior
 and

ideation
 is
 diagnosed
 and
 older
 adults
 receive
 appropriate
 treatment.
 The
 plan
 is
 currently
 being

implemented
 in
 Oregon.

Rhode
 Island

Rhode
 Island
 NVDRS
 data
 identified
 the
 importance
 of
 creating
 suicide
 prevention
 programs
 targeting

35
 to
 54
 year
 olds.
 Although
 a
 substantial
 percent
 of
 suicides
 in
 Rhode
 Island
 were
 found
 to
 be
 among

this
 age
 group,
 most
 suicide
 prevention
 efforts
 did
 not
 target
 them.
 This
 data,
 along
 with
 suicide

attempt
 data,
 were
 presented
 to
 the
 Rhode
 Island
 Injury
 Community
 Planning
 Group’s
 Suicide

Prevention
 Subcommittee.
 Responding
 to
 this
 information,
 the
 subcommittee
 recently
 launched
 new

prevention
 efforts
 targeting
 working-­‐age
 adults.

New
 Jersey

New
 Jersey
 NVDRS
 suicide
 data
 has
 been
 used
 to
 help
 task
 forces
 plan
 responses
 to
 youth
 and
 police

suicides.
 In
 addition,
 the
 data
 has
 recently
 supported
 suicide
 prevention
 efforts
 by
 the
 Governor’s

Council
 through
 raising
 awareness
 and
 reducing
 stigma
 about
 mental
 health
 problems.

3

New
 Mexico

New
 Mexico
 NVDRS
 suicide
 data
 is
 currently
 supporting
 the
 writing
 of
 a
 comprehensive
 state
 suicide

prevention
 plan.
 The
 suicide
 prevention
 plan
 will
 be
 a
 requirement
 for
 the
 combined
 New
 Mexico

Substance
 Abuse
 Prevention
 and
 Treatment
 and
 Community
 Mental
 Health
 Block
 Grant
 application
 to

SAMHSA.

NVDRS
 Data
 Increasing
 Understanding
 of
 Suicides
 among
 Current
 or
 Former
 Military

A
 number
 of
 NVDRS
 states
 are
 using
 data
 to
 investigate
 military
 suicide
 deaths.

• New
 Jersey
 is
 using
 data
 collected
 via
 NVDRS
 to
 create
 a
 description
 of
 suicides
 among
 current
 or

former
 military
 personnel
 in
 the
 state,
 which
 will
 be
 used
 to
 inform
 prevention
 efforts.

• Colorado
 is
 utilizing
 NVDRS
 data
 to
 work
 with
 the
 Denver
 Veteran’s
 Affairs
 Medical
 Center
 to

develop
 a
 clearer
 picture
 on
 suicides
 among
 current
 or
 former
 military
 personnel
 in
 the
 state.

• Kentucky’s
 NVDRS
 data
 was
 used
 in
 a
 recently
 funded
 National
 Institutes
 of
 Health
 (NIH)
 grant

entitled
 “Suicide
 Bereavement
 in
 Military
 and
 their
 Families”.

NVDRS
 Data
 Supporting
 Homicide
 Prevention

• From
 2004-­‐2007,
 intimate
 partner
 homicides
 accounted
 for
 approximately
 16%
 of
 all
 homicides
 in

Oklahoma.
 Efforts
 to
 reduce
 these
 homicides,
 however,
 could
 not
 be
 evaluated
 without
 homicide

data
 including
 victim-­‐suspect
 relationship.
 Collaborating
 with
 Arizona
 State
 University
 and
 Johns

Hopkins
 University,
 Oklahoma
 NVDRS
 intimate
 partner
 homicide
 data
 helped
 to
 secure
 a
 National

Institute
 of
 Justice
 (NIJ)
 grant.
 The
 grant
 is
 being
 used
 to
 implement
 and
 evaluate
 a
 new
 strategy

for
 responding
 to
 domestic
 violence
 calls.
 Specifically,
 police
 officers
 responding
 to
 these
 calls

conduct
 a
 brief
 11-­‐item
 lethality
 assessment
 to
 determine
 if
 the
 victim
 is
 at
 high
 risk
 for
 homicide.

If
 they
 determine
 the
 victim
 is
 at
 high
 risk,
 immediate
 coordination
 with
 the
 local
 domestic

violence
 service
 provider
 will
 occur.

• CDC’s
 Injury
 Center
 analyzed
 gang
 homicide
 data
 in
 five
 large
 cities
 from
 2003–2008
 using
 NVDRS

data.
 The
 proportion
 of
 gang
 homicides
 resulting
 from
 the
 drug
 trade
 or
 other
 crimes
 in
 progress

was
 consistently
 low,
 ranging
 from
 zero
 to
 25%
 across
 the
 five
 cities.
 Also,
 findings
 from
 this

report
 suggest
 many
 gang
 homicides
 are
 quick,
 retaliatory
 reactions
 to
 ongoing
 gang-­‐related

conflict.
 This
 highlights
 the
 need
 to
 prevent
 gang
 involvement
 and
 to
 increase
 youths'
 capacity
 to

resolve
 conflict
 nonviolently.

NVDRS
 Data
 Informing
 Local
 Communities
 about
 Violence

• Virginia
 and
 North
 Carolina
 NVDRS
 have
 recently
 published
 reports
 analyzing
 violence
 by
 each

county
 in
 their
 state.
 This
 information
 helps
 local
 communities
 better
 understand
 and
 respond
 to

the
 problems
 of
 violence
 they
 face.

• New
 Jersey
 currently
 geographically
 maps
 violent
 death
 to
 better
 understand
 trends
 and
 patterns

in
 violence.
 For
 instance,
 geographic
 analyses
 revealed
 suicide
 rates
 in
 New
 Jersey
 were
 highest
 in

rural
 areas.
 This
 information
 is
 being
 used
 to
 tailor
 targeted
 suicide
 prevention
 initiatives
 in
 New

Jersey.

Future
 Goals

To
 continue
 to
 strengthen
 and
 expand
 the
 NVDRS
 program,
 future
 goals
 include:

• Expanding
 the
 NVDRS
 system
 to
 all
 50
 states.

 Currently,
 NVDRS
 data
 cannot
 be
 generalized
 to

national
 trends
 because
 data
 from
 the
 current
 18
 states
 are
 not
 nationally
 representative.
 With

additional
 funding,
 the
 NVDRS
 system
 could
 be
 expanded
 to
 cover
 more
 states
 and
 provide
 more

data.
 Unfunded
 states
 will
 continue
 to
 lag
 behind
 in
 their
 violence
 prevention
 efforts.

• Ensuring
 NVDRS
 data
 supports
 and
 translates
 into
 violence
 prevention
 activities
 by

Ø Increasing
 dissemination
 and
 use
 of
 NVDRS
 data
 at
 the
 national
 level;
 and

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•

Ø Providing
 technical
 assistance
 to
 funded
 states
 to
 help
 them
 monitor
 and
 report
 their

state
 data.

Linking
 NVDRS
 data
 with
 other
 data
 sources,
 such
 as
 child
 fatality
 review
 reports
 and
 adult

protective
 services
 reports.

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