Beyond Immediate Responses: A Systems Map of Community Factors Underlying Persistent Gun Violence in New Haven.

Gun violence is a pervasive and multifaceted public health problem. This study describes a novel application of group model building-a process that centers stakeholder voices to describe a complex problem-to investigate drivers of gun violence and design community-led interventions for prevention in New Haven, Connecticut. We recruited community leaders to participate in 2 group model building sessions in New Haven. Discussions and diagrams created during the sessions were used to produce a causal loop diagram illustrating proposed relationships between gun violence and other variables. Our resulting "iceberg model" illustrates how short-term and visible responses to gun violence "above the surface," such as incarceration and policing, may only transiently decrease gun violence. Long-term, downstream effects of "above the surface" responses may ultimately increase gun violence and are summarized in 3 layers "under the surface," which examine the effects of incarceration and lack of re-entry support, vulnerability to stress and social stigmatization, and community-police relations and community safety, respectively. This study demonstrates the value of using group model building to design community-driven interventions for gun violence prevention, as well as reiterates the importance of targeting structural causes of gun violence. This work has informed TRUE HAVEN, a multi-level intervention that addresses community gun violence in New Haven.