On a hot, sunny Monday in mid-July, Dr. Leana Wen stood on a sidewalk in West Baltimore flanked by city leaders: Mayor Stephanie Rawlings-Blake, interim police commissioner Kevin Davis, Rep. Elijah Cummings. Under a huge billboard with the web address dontdie.org, she proudly unveiled a 10-point plan for tackling the city's heroin epidemic.
Wen, the city's health commissioner, said she aims to create a 24/7 treatment center, an emergency room of sorts for substance abuse and mental health. She spoke of targeting those most in need, starting with those in jail.
What Wen did not know was that, across town in East Baltimore, police had hours earlier arrested two workers with Safe Streets, the health department's flagship anti-violence initiative.
The project, first launched by the health department in 2007, hires ex-offenders to go into the streets and mediate conflict before it erupts into violence. They're called violence interrupters. It's based on the Cure Violence model out of Chicago.
The workers have credibility in their communities because they are from those communities. Some have histories in the drug trade, and many of them have served time in prison.
What had happened was that in the wee hours of the morning, police responded to a call about an armed robbery. They chased the suspects to an address which turned out to be a Safe Streets neighborhood office. Inside, police found guns, drugs, and paraphernalia related to the manufacture and sale of drugs, including sifters, cutting agents and scales. Nine people were arrested, including Two Safe Streets employees who face gun and drug charges.
It wasn't the first time Safe Streets workers had gotten into trouble. And Wen says she knows there are risks in hiring ex-offenders.
"But everything has risks," she says "In my work as an ER doctor, there's no procedure that I can recommend, no medication I can recommend that doesn't come with a risk."
Research shows Safe Streets does deliver. Last year, the health department says the program mediated 880 conflicts in Baltimore. Until recently, a couple of the neighborhoods they operate in had gone a year without a fatal shooting.
At the time of the arrests, Wen and the health department were preparing to announce the opening of a fifth neighborhood site for Safe Streets. There was talk of it opening in Sandtown-Winchester, Freddie Gray's neighborhood.
Instead, Wen appeared at a press conference at police headquarters, this time flanked by the police commissioner and federal agents. She reported that the raided Safe Streets site had been suspended and that two employees had been fired. She strongly defended Safe Streets as a program, and spoke of standing united with the police and partners in reducing violence in Baltimore.
Her words had been chosen carefully. But there were problems.
She soon learned from her deputy Olivia Farrow that the Safe Streets staff was not happy.
Part of the problem was the image.
"People were upset to see me standing with the police in the first place," Wen told us. "Because the entire point of Safe Streets is that they're separate from the police, and in the mediation for conflicts, there has to be total trust. And we had potentially interfered with that relationship."
So she sets about trying to fix things. She calls a meeting with the Safe Streets site directors. She brings in Brent Decker from Chicago's Cure Violence, who trained many of the Baltimore staff, as well as violence expert Daniel Webster from Johns Hopkins University.
They talk about what could be done differently to keep staff from falling back into their old patterns and getting involved with drugs and crime. They discuss providing more counseling for the staff, who themselves have been perpetrators and victims of violence.
Wen then turns the conversation to a topic she'd heard about in one of her early visits to the program.
"Initially when I was meeting with Safe Streets, I said, 'What is the one type of support we can help you with?' And I thought they were going to say trauma debriefing, mental health support. And they said child support."
That puzzles her. She wonders why she would be helping with child support in the first place, and also just how that would be done.
Dante Barksdale, Safe Streets' outreach coordinator, explains that most of the guys coming to work for the program are over 30, which means they're likely to have children. Many owe upwards of $50,000 in child support. The Safe Streets jobs pay about $28,000 a year.
A couple months after they start working, the state starts deducting child support from their paychecks, leaving them with very little. Most of these men have never held jobs before and don't have the skills to find other work. All of these factors make for a very stressful transition to legal employment.
"We see that a lot," Barksdale says. "That translates through all the sites."
Dedra Layne, who oversees Safe Streets at the Health Department, proposes talking with the bureau of child support enforcement.
"If they don't know that we're faced with this issue, they can't do anything," Layne says. "We should at least be having the conversation about are there any options to consider. Are there any things that we can put in place that would support the staff as they move through their first employment opportunities and still have families to manage."
What started as a conversation about preventing violence has now wandered into the realm of child support law, further and further away from what many might think of as public health. But Dr. Wen pushes on.
"Have there been, around the country, efforts to do different types of salary arrangements to bypass the child support problem?" she asks. "An example might be instead of paying child support directly, have there been experiments to see what happens if we pay for housing?"
Heads nod around the table. They don't know if it will work, but the sense is it's worth looking into.
No one here would argue that child support isn't important. In a different story, we might be using the term "deadbeat dads" to describe this problem. But what do you do when your deadbeat dad is someone who voluntarily puts himself in dangerous situations for the good of the community, wedging himself between people who literally want to kill each other? What do you do when your deadbeat dad represents your hope for the city, if only he can stay on track?
These are the questions that Leana Wen is wrestling with. And like so many other questions in Baltimore — there are no easy answers.
NPR and All Things Considered will continue reporting from Baltimore in the coming months, checking in with Leana Wen and her team periodically. Stay tuned for future stories.
AUDIE CORNISH, HOST:
Baltimore grabbed the world's attention this spring when the death of Freddie Gray sparked an outpouring of emotion - anger at the police, outrage over the state of the city's neighborhoods and frustration that nothing ever changes. Out of all that has emerged a perhaps unexpected voice.
LEANA WEN: Good morning, everyone.
UNIDENTIFIED CROWD: Good morning.
WEN: Good morning.
CORNISH: Dr. Leana Wen is Baltimore's 32-year-old health commissioner. She's energized, confident and truly convinced that public health isn't just about inspecting restaurants or telling people to wash their hands to prevent the flu. Dr. Wen is among those who believe that public health can make a big difference in Baltimore, treating what most would consider problems for police - drugs and street violence. So in order to put that theory to the test, we're spending time with her - not just at press conferences and public meetings, but in the moments between.
WEN: Hi, Andrea, it's Lena. This is a little bit strange for me and...
CORNISH: Andrea Hsu is our producer, and this is Lena Wen's audio diary. We asked her to record her thoughts and to talk about how things are going. And one of her first shares was about the pace of the job, how quickly things unfold.
WEN: I'm used to fast-paced environments. I'm an ER doctor. I'm trained to work in environments that are high-intensity, high-stress. But nothing has quite prepared me exactly for this role because of just how unpredictable things are.
CORNISH: Our story today looks at what happens when one of the department's flagship initiatives - a violence prevention program called Safe Streets - runs into trouble.
WEN: I am recording this on the night of July 14, and it's been a long and challenging day.
CORNISH: It wasn't supposed to be that way. The day before, she'd unveiled with great fanfare a 10-point plan for fighting the city's heroin epidemic. That morning, Dr. Wen headed to a TV station to talk about it.
WEN: And while I was waiting for the interview to start, I received a call from a senior leader within the police department saying that there was something urgent.
CORNISH: What she would eventually learn was that two Safe Streets workers had been arrested. Inside one of their neighborhood offices, police found guns, drugs and materials used in the sale of drugs - cutting agents and scales. It was a serious setback, as she made clear in her audio diary.
WEN: This was disappointing and - and certainly not the news that we were hoping for.
CORNISH: Let's take a moment to explain Safe Streets. The program hires ex-offenders, often newly released from prison, to go out in the streets and stop violence. They're called violence interrupters. They talk drug dealers out of fights and convince gangbangers not to retaliate. They don't snitch to the police. They don't carry weapons. They are of that world, but not part of it. That's how it's supposed to work. Dr. Wen says, of course, there are risks.
WEN: But everything has risks. I mean, in my work as an ER doctor, there's no procedure that I can recommend, no medication that I can recommend, that doesn't come with a risk.
CORNISH: And research shows Safe Streets does deliver. Last year, the health department says the program mediated 880 conflicts in Baltimore. Until recently, a couple of the sites hadn't seen a fatal shooting in more than a year. And now this stumble.
(SOUNDBITE OF NEWSCAST)
UNIDENTIFIED REPORTER: Well, several Safe Street employees are now behind bars after a police raid turns up guns and drugs stashed in the East Baltimore facility.
CORNISH: News reports about the raid featured Dr. Wen at police headquarters speaking to the press. She's flanked by officers and federal agents. And instead of doing what she'd hoped to do this summer - announce the opening of a new Safe Streets site, perhaps in Freddie Gray's neighborhood - Dr. Wen announces she's shutting down the raided site temporarily while they figure out what went wrong.
(SOUNDBITE OF ARCHIVED RECORDING)
WEN: We stand united with the police department and our partners in reducing violence in the city and making Baltimore safe and healthy.
CORNISH: Now, her words had been carefully chosen. She had strongly defended the program, but there's a hitch. She soon learns from her deputy Olivia Farrow that the Safe Streets staff were not happy. Here's what she told us when we saw her later that week.
WEN: I actually felt really badly about it because what she said was that we - for lack of better words - messed up on the messaging.
CORNISH: Part of the problem was the image.
WEN: People were upset to see me standing with the police in the first place. And then to use the terminology of we're partnering with the police because the entire point of Safe Streets is that they are separate from the police and that in the mediation for conflicts, there has to be total trust. And we have potentially interfered with that relationship by standing with the police.
CORNISH: So Leana Wen sets about trying to fix things. She calls a meeting with the Safe Streets site directors. And she brings in a guy from the Chicago program that was the model for Safe Streets. Brent Decker trained the Baltimore staff and swaps hugs with them as they walk in.
BRENT DECKER: Well, I might as well just get my apartment back here in Baltimore.
UNIDENTIFIED WOMAN: Might as well.
CORNISH: They gather around the table, the Safe Streets workers in bright orange, their signature color, and talk about what went wrong and what they can do differently - more counseling, deeper background checks?
WEN: Would you do auditing on a regular basis, too? Or...
UNIDENTIFIED MAN #1: Yeah.
UNIDENTIFIED MAN #2: Yeah.
UNIDENTIFIED MAN #3: Yeah.
UNIDENTIFIED MAN #4: We do background checks.
UNIDENTIFIED MAN #5: Yeah.
UNIDENTIFIED MAN #6: We do background...
UNIDENTIFIED MAN #7: Yeah.
UNIDENTIFIED MAN #6: ...Checks every month.
CORNISH: Delaino Johnson says how about trying to get beat cops on board with what they're doing?
DELAINO JOHNSON: And I have heard officers say program ain't nothing but this; it ain't nothing but that. You're hard this, hard that. We've got to get to these officers at roll call. Dr. Wen, if you can come and - anybody, let's go and talk to them and let them know what's happening.
CORNISH: Dr. Wen is taking notes. But she's got something else on her mind, something she'd spoken to us about a few days earlier.
WEN: Initially, when I was meeting with Safe Streets, I said what is the one thing that you think we should be helping you to address? What is the one type of support we can help you with? And I thought they were going to say, you know, trauma, debriefing, mental health support. They said child support. And I thought child support? How am I supposed to - first of all, why am I helping you with child support, but how am I helping you? And I didn't quite follow up on it and didn't understand it.
CORNISH: Until now, at this meeting, when she asked the Safe Streets team to explain the problem.
WEN: I want to understand it so that we can...
DANTE BARKSDALE: See, it looks like this. Most of these guys, they never had jobs before. Most of them come do this work, they're over 30. Most of them have children.
CORNISH: This is Dante Barksdale. He explains when these guys get out of prison, they might owe upwards of $50,000 in child support. Now, some of them used to walk around with $20,000 or $30,000 in their pockets every day, drug money. But then they get the Safe Streets job and it pays $28,000 a year. Now, they're all right with that. It's a job after all. But in just a couple months, they go from being proud to discouraged.
BARKSDALE: Let's just take Tez in East, for instance.
CORNISH: That's one of the guys who was just arrested.
BARKSDALE: When he first got the job, his mother was living with her sister. He got the job; they found a house. Rent was about $900. He was paying the rent. It's about 60 days later. He comes to me, says man, child support done came and took all my money. His check went from probably $800 every two weeks to about $100 and something. His mother got put out of her house. He was homeless, and he was having all these kind of issues. And I was watching him. He was going crazy, but there was really nothing I could do for him because he doesn't possess the skills to really work anywhere else.
CORNISH: He has problems reading and writing, Barksdale says.
BARKSDALE: But he was really good at doing mediation, so we see that a lot. And that translates through, like, all the sites.
CORNISH: Dedra Layne, who oversees the program for the Health Department, proposes talking with the Bureau of Child Support Enforcement.
DEDRA LAYNE: If they don't know that we're faced with this issue, they can't do anything.
UNIDENTIFIED MAN #8: Put something back out there.
LAYNE: So we should at least be having the conversation about are there any options to consider? Are there any things that we can put in place that would support the staff as they move through their first employment opportunities and still have families to manage?
CORNISH: And yes, they are getting further and further away from what you might think of as public health. What started as a conversation about preventing violence has now wandered into the realm of child support law. But Dr. Wen pushes on.
WEN: Have there been around the country efforts to do different types of salary arrangements to bypass a child support problem? An example might be instead of paying child support directly - because I don't know how one exactly does that - but have there been experiments to see what happens if we pay for housing so that...
CORNISH: Heads nod around the table. They don't know if it'll work, but the sense is hey, it's worth looking into. Now, no one here would argue that child support isn't important. The guys we've been discussing - in a different story, we might be calling them deadbeat dads. But what do you do when you're deadbeat dad is someone who voluntarily puts himself in dangerous situations every day for the good of the neighborhood, wedging himself between people who literally want to kill each other? What you do when your deadbeat dad represents your hope for the city, if only he can stay on track? These are the questions that Leana Wen is wrestling with. And like so many other questions in Baltimore, there are no easy answers.
(SOUNDBITE OF MUSIC)
CORNISH: And we'll be following up with Dr. Wen and her team in the coming months. If you missed our first piece in the series, you can find it at our website npr.org. Transcript provided by NPR, Copyright NPR.