A Medical Model for Community Policing.

In the past, doctors had closer relationships with their patients than they do now. They knew them all by name, and they even made house calls. Today, the practice of medicine has given way to health maintenance organizations, where doctors may see hundreds of patients and may never get to know them on a first-name basis. American policing has evolved in much the same manner. The desire to create an ethical and efficient police force moved officers from foot beats to patrol cars. The pendulum has swung back as police departments adopt community policing principles.

Although the small-town doctor may have become a relic, police departments would do well to take their cues from the medical profession. [1] Physicians know a great deal about disease and the nature of injuries; they treat patients based on the collective knowledge and experience in the treatment of illness. They observe the symptoms present in the patient, diagnose the disease, prescribe the treatment, then monitor the patient's progress. At the same time, they practice preventive medicine and educate the public. To treat the causes of illness in the community, the police must do the same. [2]

The Anatomy of a Healthy Community

The police first must understand what defines a healthy community in order to learn what threatens its health. Six types of neighborhoods exist that exhibit various levels of well-being. [3] With its well-manicured lawns and well-maintained structures, the integral neighborhood shows a high level of pride. Law-abiding citizens visibly interact, indicating a strong internal support system in the neighborhood. Residents also have a link to outside organizations, which helps them solve problems.

Residents in the parochial neighborhood have homogeneous values and cultures. They insulate themselves and try to "take care of their own" without involving the police. In the diffuse neighborhood, residents have a great deal in common but rarely interact. This may limit their ability to quickly perceive and react to problems.

As its name implies, the stepping-stone neighborhood serves as a stepping stone for many residents. Small single-family residences, townhouses, and apartment buildings characterize this neighborhood. Although residents tend to move out quickly, they get involved in community organizations and assume leadership positions. In transitory neighborhoods, residents either move frequently or have so little in common that the community lacks consensus and cohesion. As neighbors isolate themselves, it becomes more difficult to improve conditions, which have begun to deteriorate. Isolation and alienation characterize the anomic neighborhood, where residents have accepted criminal victimization as a way of life. Still, such communities remain susceptible to outside influences, both bad and good. A lack of defined leadership makes problem solving difficult, but not impossible.

As these neighborhoods illustrate, the existence of a strong support system and high levels of pride and self-esteem represent the core of a healthy community. In their ground-breaking article "Broken Windows," James Q. Wilson and George Kelling indicate that broken windows measure the amount of pride and self-esteem in a community. [4] In healthy neighborhoods, residents fix windows quickly; in deteriorated neighborhoods, it takes a little longer. In the worst neighborhoods, broken windows give way to boarded-up and abandoned buildings. Police agencies recognize that when broken windows remain unfixed, crime problems left untreated fester and develop into cancer. Its symptoms manifest in repeat calls for service.

Yet, just as doctors can detect cancer early and prevent it from spreading, police can work in communities to influence the variables that threaten community pride and self-esteem. Early treatment can keep the community from becoming ill. For example, in some communities, a patrol officer who sees or hears of graffiti pages a public works employee who immediately paints over the graffiti. This action sends a message that people care and that a support system exists to ensure community health.

The Patient's Medical History

Once they understand how disease attacks the patient's anatomy and support system to produce various symptoms, the police can systematically get to know the patient, just as the family physician collects a medical history. This involves a four-step process.

First, sociodemographic data--for example, level of income, education, and community resources--available from the U.S. Census Bureau provide important information on crime. [5] Generally, a decline in sociodemographics creates a rise in reported crime, reflecting the onset of disease in the patient. When sociodemographics improve, a healthier patient results.

In addition to a community analysis, a medical history also requires comparative crime analysis. Crime analysis requires collecting, categorizing, analyzing, and disseminating to line personnel timely and useful information that describes crime patterns, crime trends, and potential suspects. Community surveys and citizen interviews complete the four-step process. How do the patients themselves say they feel?

Based on the knowledge of the patient's medical history and the doctor's expertise in anatomy and disease symptomology, the doctor can diagnose illnesses in the patient. Other members of the police department--as well as other governmental, public, and private organizations--represent the specialists that patrol officers may need to call for particular expertise to treat the patient.

The Prescription

The medical team should consider every means available to treat patients, including traditional and nontraditional responses, as well as both reactive and proactive strategies. Just as doctors use seemingly threatening methods, such as defibrillation and chemotherapy, to save lives, the police must perform similar operations. Their methods involve search and seizure, arrest, use of lethal force, and the like. Oftentimes, however, these methods treat the symptoms of the disease rather than the illness itself. Thus, the police must apply a full range of treatments to solve the underlying problem and end repeat calls for service.

At the same time, the doctor must evaluate the patient to ensure that the prescribed treatment works. By conducting surveys and interviews, performing crime analyses, and using other evaluation tools, the police can assess the effectiveness of their approaches. A computer-aided dispatch system, for example, can flag repeat calls for service to the same location. If the police constantly scan for problems and look for symptomology reflected in repeat calls to particular locations, they may be better able to restore the patients to health before neighborhoods deteriorate so badly that they require intensive care.

Intensive Care

Intensive care involves the application of governmental, public, and private services in one location. Neighborhood Network Centers, sometimes called Community Centers, serve communities with a permanently assigned police officer and other agencies' representatives assigned part time. Police executives should make it clear that once the treatment resuscitates the neighborhood, the other agency representatives will return to their offices, where citizens may contact them on an as-needed basis. Otherwise, residents may become dependent on the care instead of strengthening their support systems so they can take care of themselves. Of course, the police remain in the neighborhood and can serve as liaisons between the other agencies and the residents.

Intensive care represents the extreme, a last resort to save a neighborhood from death. Before implementing this approach, the police should help residents practice preventive medicine.

Preventive Medicine

Doctors know that patients who take care of themselves will be less vulnerable to infection, and at the same time, patients who do get sick can recover more quickly and completely. So, primary-care physicians advocate that their patients eat right, exercise, get enough sleep, take vitamins, and give up harmful practices, such as smoking and excessive drinking.

Preventive medicine also constitutes an important part of the police treatment methodology. The police should advocate crime prevention practices, such as Neighborhood Watch, in the communities they serve. While such programs do not make neighborhoods impervious to crime, they can create an internal support system that makes the community stronger in the fight against disease. They also help educate the public.

Health Education

Community education represents a crucial component in helping patients share responsibility for their own health as well as defining the legal boundaries for their behavior. Community policing should create citizens who are vigilant, not vigilantes.

One of the best vehicles for educating the community, Neighborhood Watch should broaden to include problems other than crime and also may include social events and other activities that result in a sense of community. The police must not let anonymity creep between the doctor and the patient and among the patients themselves. Interaction among law-abiding citizens on a regular basis provides an important indicator of health. In the sickest neighborhoods, residents do not even know who lives next door.

The Citizen Police Academy has become another effective community education tool. This program allows the police to select community leaders to learn not only what the police do but, more important, why they do it. It provides two-way communication in a nonthreatening environment, raises the image of the police in the eyes of the community, and gives the police the opportunity to develop a relationship with citizens that parallels the doctor-patient relationship. Rather than blame the doctor when they become ill, patients share in the responsibility for their own health.

Either alone or in conjunction with Neighborhood Watch, Citizens on Patrol programs help community members share responsibility for a healthy neighborhood. Residents become the eyes and ears of the police in their neighborhoods and report suspicious or criminal activity to the police via radios or cellular phones.

Blending program concepts often involves unique community education issues. For instance, a few years ago, the National Sheriffs' Association blended the concepts of Neighborhood Watch and Victim Assistance. At Neighborhood Watch meetings, neighbors volunteer to provide such services as cooking, driving, and baby-sitting to neighbors who have been victimized. In doing so, residents require fewer outside services and also take responsibility for one another in times of crisis.

Bedside Manner 

Doctors have come to realize that convincing patients to follow their treatment or preventive medicine directives requires a relationship based on mutual respect. Likewise, police officers need the appropriate bedside manner to develop a proper relationship with citizens. In policing, appropriate bedside manner means treating everyone with courtesy and respect unless they prove that they do not deserve it; it means taking a few extra minutes to educate citizens; it means not treating people in a patronizing manner. And, according to the Coosbay, Oregon, Police Department's policy, bedside manner means taking the time at the end of a call to ask, "Is there anything else we can do to make you feel safer today?" Proper bedside manner often requires that police officers ask themselves if they would desire the same treatment. It requires "naively listening" [6] to patients, and if they make a plausible, cost-effective suggestion, implementing it.

In order to cultivate appropriate beside manner, police agencies may need to change the way they recruit, hire, and promote their officers. They may need to purposefully select officers who live with a golden-rule, or service-oriented, mindset. At the same time, training officers to perform in this manner and rewarding such performance can influence their behavior. Perhaps the most dramatic change may come to those who realize that their next pay raise depends on citizens' evaluation of their bedside manner.

Physician, Heal Thyself 

Police agencies need to be healthy before they can treat the community's illnesses and injuries. Signs of good health include pride, self-esteem, quality leadership, comprehensive training, and board certification. Officers also should receive continual training in state-of-the-art responses based on current research. Ongoing training remains one of the best ways to defend against liability lawsuits, the police officer's equivalent of malpractice.

Conclusion

Doctors who make house calls may no longer exist, but when citizens call the police, they expect an officer to show up at their door. Unfortunately, merely coming when called will not cure a community's ills. The police can follow the lead of the medical profession to treat and prevent disease in the communities they serve.

With a knowledge of the patient's anatomy and medical history and analysis of the disease's symptoms, the police can work with other specialists in the community to diagnose illnesses, prescribe medication, and evaluate the treatment plan. They also can educate. their patients and convince them to practice preventive medicine. In addition, they should remain wellversed on the latest diseases and treatment techniques. Finally, and perhaps most important of all, they always should demonstrate an appropriate bedside manner and always practice what they preach.

Endnotes

(1.) This article was adapted from J.A. Harpold, "A Community Doctoring: A Medical Analog to Community Policing," in Organizational Issues, ed. J.T. Reese and R.M. Solomon (Quantico, VA: U.S. Department of Justice, Federal Bureau of Investigation, 1996), 319-333.

(2.) For a comparison of policing to medicine, see, e.g., R. Trojanowicz and B. Rucqueroux, Community Policing: A Contemporary Perspective (Cincinnati, OH: Anderson, 1990), 35-38; and H. Goldstein, Problem-oriented Policing (New York: McGraw-Hill, 1990), 106.

(3.) Rachelle B. Warren and Donald I. Warren, The Neighborhood Organizer's Handbook (Notre Dame, IA: University of Notre Dame Press, 1977), 92-124.

(4.) James Q. Wilson and George L. Kelling, "Broken Windows," The Atlantic Monthly, March 1982, 29-38.

(5.) See R.L. Depue, "Community Analysis Worksheet," in A Manual for the Establishment and Operation of a Foot Patrol Program, ed. R. C. Trojanowicz and P.R. Smyth (E. Lansing, MI: The National Neighborhood Foot Patrol Center, Michigan State University, School of Criminal Justice, 1984), 37-47.

(6.) T. Peters and N. Austin, A Passion for Excellence: The Leadership Difference (New York: Random House, 1985), 13-17. In their book, the authors credit the chairman of Allergan with pioneering this business practice, which involves getting direct feedback from customers in their own words.