Each day in the United States, about 315 people are shot, including self-inflicted wounds and accidental shots.
According to a 2017 study in Pediatrics, that number includes nearly 1,300 children who die from gun injuries annually and another 5,790 who are treated for gunshot wounds.
The aftermath of incidents involving firearms—as well as those involving other acts of violence—often mean whole families experiencing immeasurable emotional and mental anguish, as well as lost productivity, rehabilitation costs, and disability. In addition, a study by Stanford University School of Medicine researchers found that the nationwide costs of gun-related hospitalizations averaged $735 million annually between 2006 and 2014.
Accordingly, some medical centers have launched education, research, and clinical initiatives targeting the problem of violence. In 2010, Boston Medical Center (BMC) responded when the community voiced concern that mental health resources were lacking for victims of violence and their families. BMC established the Community Violence Response Team (CVRT). The team provides immediate on-site and ongoing crisis intervention, trauma education, and therapeutic support to victims who enter the hospital and to their families and close friends.
“We wanted to start it in a way that would help reduce stigma and break down the barriers to mental health care for our most vulnerable patient populations and the people who are primarily exposed to community violence,” said Lisa Allee, MSW, LICSW, an instructor of surgery at Boston University School of Medicine and CVRT director.
Thomas Weiser, MD, coauthor of the Stanford study and a surgeon at Stanford University Medical Center, maintained that adding “to the body of knowledge around treating, preventing, and helping patients with injuries” falls within the mission of academic medical centers that have Level I Trauma Centers.
Establishing violence response teams
BMC’s CVRT is one piece of a larger hospital initiative to reduce violence and aid victims. Since 2006, the hospital has operated the Violence Intervention Advocacy Program (VIAP), a program that identifies victims of community violence and offers multiple tiers of services throughout a patient’s recovery. These services include hospital care navigation, housing assistance, family and child support, legal advocacy, education assistance, and job readiness training.
“The majority of our clients are from an urban population impacted by multiple, chronic stressors, including lack of access to resources, poverty, lack of access to education and employment, chronic trauma, and exposure to community violence,” said Elizabeth Dugan, MSW, LICSW, clinical director of VIAP.
“We have a lot of conversations, especially with our young folks, around retaliation,” she said. “I think collectively as a whole, the city is much more aware of violence prevention, and the numbers for us have shown a decline,” Dugan added.
The rate of return gunshot victims to BMC has decreased from 30% to 7% since the launch of VIAP and other city and statewide antiviolence initiatives, according to Dugan. However, she noted that there is no way to know whether the victims sought treatment at a different hospital with a different injury. Overall gunshot and stabbing patients coming to the hospital with injuries sustained from other acts of violence has also declined, and the number of firearm victims served by the program dropped from 200 in 2010 to 179 in 2017.
The role of research in prevention
The Harvard Injury Control Research Center (HICRC), a branch of the Harvard T.H. Chan School of Public Health, was established to prevent injuries through surveillance, data systems, research, dissemination, and training. In the last decade, the majority of HICRC studies have focused on firearm injuries and deaths. Researchers found that gun availability—in the home, in the community, in the car— raises the risk factor for homicide. In addition, a gun in the home increases the risk for suicide threefold.
Conducting research to expose the reasons behind gunfire is critical to understanding why the violence occurs and how to work toward prevention, said David Hemenway, PhD, a professor of health policy and HICRC director. “[Violence] is an enormous public health problem. It’s like saying, should medical and public health researchers do anything about cancer or opioid poisoning? Data and research are crucial for understanding the problem, proposing effective policies, and evaluating those policies.”
The CDC-funded Harvard Youth Violence Prevention Center, a component of HICRC, is working with Boston leaders to establish a model data system on youth violence for the city. HICRC was also instrumental in creating what is now the CDC’s National Violent Death Reporting System. In addition, HICRC assists other organizations to establish anti-suicide action plans.
Through its Means Matter campaign, HICRC is raising awareness about firearm suicides and reducing a suicidal person’s access to guns through counseling. Thanks to the campaign, most national and state suicide prevention plans now include a component about access to lethal weapons, said Hemenway. In addition, the campaign focuses on encouraging health providers, gun owners, and gun shop owners to educate patients and clients about the suicide risks of having a gun at home.
“The response has been excellent from gun advocates because we’re working with them and they are carrying the message to other gun owners,” said Hemenway. In some 20 states, gun shop owners now provide suicide prevention material to their customers. In addition, gun trainers in Massachusetts and Utah now include a suicide component in their classes.
In July 2017, the University of California (UC) launched a similar research center, The UC Firearm Violence Research Center, at UC Davis. The center will build on resources already in place at the Violence Prevention Research Program, which UC Davis Health established in 1989. The new center will conduct transformative violence-prevention research and inform the development of effective prevention policies and programs, said Garen J. Wintemute, MD, the center’s director.
Hospitals take a lead in trauma recovery
In January 2017, MetroHealth and University Hospitals, both in Cleveland, received a grant from Ohio’s attorney general to participate in the state’s new network of trauma recovery centers. The initiative will help identify violent crime victims in the hospital and provide them with on-site and follow-up services after discharge. The Ohio State University Wexner Medical Center, Cincinnati Children’s Hospital, and Springfield Regional Medical Center will also participate and individually partner with a victim services provider.
For its part, MetroHealth will serve as the first point of contact for victims of violence and their families. Staff will provide education to patients and assist in bedside support. “We launched programming services in April of 2017 and are working to reach as many victims as possible through our emergency rooms, outpatient clinics, and inpatient settings,” said Sarah Hendrickson, manager of MetroHealth Survivor Recovery Services.
Metrohealth patients are referred to the May Dugan Center, a community partner with the hospital that provides food and clothing, behavioral health counseling, community education, and preventative health care.
The hope is that the trauma recovery program will be at “the very heart of making a difference,” said Hendrickson. “The mission is to meet people where they are and recognize that hurt people, hurt people. If we can step in and make access to resources easier … and if we can make their health management easier and more transparent, then we are doing our community a world of justice.”