Breaking the Cycle of Violence


Could hospital-based trauma intervention offer a strategy for dealing with urban violence?

A program called Healing Hurt People (HHP) in the Philadelphia region employs trauma counselors at hospitals to engage victims of intentional violence, such as shootings, stabbings and assaults.

“(These interventions) are part of a much broader public health strategy that seeks to intervene in as many places as possible,” says Dr. Arthur Evans, Commissioner of the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS).

The program, first implemented at Philadelphia's Hahnemann University Hospital in 2007 by Dr. John Rich and Dr. Ted Corbin of Drexel University, is expected to be used in all level-one trauma centers in Philadelphia by the end of the year.

It's run by individual hospitals, but the overall funding comes from Philadelphia's DBHIDS.

“Those who choose to participate in the program are interviewed and evaluated to identify the complete set of issues that may be affecting the victim—not just issues related to the violent incident they experienced,” Evans says.

“So, in addition to addressing clinical needs such as physical injury, depression and anxiety, HHP counselors help with social needs such as stable housing, employment and health insurance.

“If unaddressed, support issues can exacerbate and contribute to health issues.”

About half of the victims who participate in the hospital-based violence intervention programs are also people who will perpetuate violence in the future, according to DBHIDS officials.

Most of them are young men who lack resources, employment and family stability. A lot of them were raised in a culture of violence that preys on the weak and revolves around street credibility.

“In the environments where these victims live, it's almost required for them to retaliate otherwise they are seen as weak and are further targeted,” Ava Ashley, Manager of the Trauma Unit in the Strategic Planning Division at DBHIDS, said.

“They don't want to retaliate, but that's what they feel they have to do to survive in these environments.”

DBHIDS officials believe that one of the keys to breaking the cycle of violence in urban communities is to challenge the belief that retaliation is the only option to survive.

“A lot of these young men are afraid,” Dr. Evans said. “They have that tough exterior because they need it to survive. But often they're fearful and they feel vulnerable.”

In the Philadelphia hospitals that now employ trauma counselors, Evans said, about 25 percent of the people treated in the emergency room for intentional violence are being admitted into the HHP program.

Officials cite anecdotal evidence suggesting the effectiveness of the program, and Temple University is currently researching the rate of recidivism to establish raw data.

“There's a greater awareness in our city about the impact of trauma,” Ashley said.

“Many of the hospitals in Philadelphia are eager for this program; they understand trauma and how it's related to violence and other adversities in our communities.”

…In Trenton, New Jersey's capital, a spike in violent crime during the spring of 2014 (a few months after the announcement of a multi-faceted crime fighting initiative) has sparked conversations about what more can be done to reduce violence in the city.

“…A small number of people in various neighborhoods are responsible for most of the gun violence, and certain individuals are repeat offenders,” said Trenton Police Sgt. Carmelo Rodriguez, who leads Mercer County's Shooting Response Team (SRT).

“We tend to find ourselves dealing with the same individuals, whether they're an offender or a victim.”

Penny Ray, a 2015 John Jay/Solutions Journalism Network Reporting Fellow, is working on a series of stories looking at successful anti-violence interventions. This is an abridged version of a story that appeared in The Trentonian on Oct 18, 2015. For the complete story, please click HERE. He can be reached on Twitter @Penny Ray. Readers' comments are welcome.

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