Breaking the cycle of gun violence with hospital-based intervention

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Cecilio “Pepe”, a 19 year old, was shot in his leg while he was playing cards on his deck. He was able to see the driver who attacked him in New Haven, 1989, but he kept his back from the scene.

On his way to the hospital, he claims a policeman pulled over an ambulance and began questioning him. Vega refused to say he knew, and the officer began swearing at Vega.

According to Vega he said, “I hope that you die” and slammed against the door. Vega spotted him again at the hospital whispering to his physician in the doorway. He fled the hospital and never came back.

Anthony Campbell, Yale’s newly appointed chief of police and former chief for the New Haven police force, said, “Unfortunately, this was a frequent incident back then.” “There was so much gun violence. Officers were so busy going call to call, and when a shooting victim came in, particularly one where it was unclear whether they were going to live, officers often—whether they meant to or not—were revictimizing them by the way they asked questions.”

Vega was the victim of another drive-by shooting in a pizzeria close to Yale’s campus a year later. His arm was injures by the gunshot that shattered his windows. He reflected on his past experience and decided not to seek help.

Yale pediatric emergency medicine experts and child psychoanalysts alike agree—gun violence is a public health crisis both in New Haven and across the country, for the death and physical injury it causes and for the mental anguish that victims such as Vega suffer. According to the Johns Hopkins Center for Gun Violence Solutions in 2020, guns were the leading cause for death among youth. Vega joined forces with Yale researchers, including James Dodington MD, assistant professor in pediatrics (emergency medicine), and medical director of Yale New Haven Hospital’s Injury and Violence Prevention Center, many decades later, to help end the cycle of violence within the New Haven community. Dodington’s Hospital based Violence Intervention Program, (HVIP), at Yale New Haven Hospital is the only one of its kind in Connecticut.

Dodington states that experiencing violence in the community can affect you in all possible ways. “We are working to create policies that will have an impact on victims and bring about sustained improvement.”

Connecticut’s gun violence can have serious health consequences

Connecticut has a shockingly high level of community violence. New Haven was a top four American city in terms of violence per capita. It had 34 homicides and 268 shootings in 2011. Although there have been efforts made to reduce the violence in New Haven, the impact of the gunfire is still very significant. Campbell says that New Haven has seen seven homicides in the past year. This violence is particularly harmful to people of color and those with lower socioeconomic and educational status.

He says that gun violence and gunfire in the city are a serious problem that must be addressed. “Not because of the victims. It traumatizes residents of the community, and most important, it traumatizes children by desensitizing them to the reality of gun violence in their neighborhoods—making them more prone to either engage in that activity or be victims in the future.”

The state has taken steps in improving firearm safety. This includes introducing child access prevention law such as Ethan’s Law that have been shown to reduce suicide risk and accidents. Also, red flag laws have been introduced to keep guns away for people who are considered to be a threat to others. There is still much to be done, especially since the emergence of COVID-19 has triggered an increase in gun violence. Dodington’s research has shown sobering statistics. His team discovered that the number of victims in the state due to gun-related injuries and stabbings increased by 66% in the first month of the pandemic. This was especially true for Blacks and Latinos.

He states, “Clearly there needs to be more efforts made to address community violent,”

The long-term health impact of experiencing a traumatic event such as a shooting on a young person depends on two factors, says Steven Marans, Ph.D., Harris Professor in the Yale Child Study Center—how the youth’s development was progressing in the first place, and the kind of support they receive following the trauma. The outcomes for children and adolescents with traumatic dysregulation may be significant if evidence-based interventions are not available, he said.

They might experience problems sleeping, anxiety, withdrawal, fearful responses even when there is no danger, withdrawal from family and friends, aggression, difficulty concentrating, nightmares more often, and avoidance or avoidance of certain activities and pleasures. These youth are more likely to develop post-traumatic stress disorder, other long-term anxiety disorders and personality disorders, substance abuse, personality disorders and suicidal behavior.

Marans says that the core of trauma is the child’s loss of control and helplessness. The most effective treatment interventions are designed to increase the child’s ability take control of what they have control over, which is the reduction in symptoms that follow the initial traumatic dysregulation.

Hospital-based intervention programs interrupt the cycle of violence

Youth who are exposed to violence are more likely than others to become involved in future violence. This is why it is crucial to have evidence-based programs to break the cycle for communities like New Haven that are affected by firearms.

Kirsten Bechtel MD, professor of pediatrics, says that children who are physically assaulted are more likely to be involved with a homicide or assault with a firearm within the next six months. “Hazard-based violence intervention programs can make a difference in the lives and health of children who have been harmed by firearm homicides.”

Dodington states that HVIPs provide a “golden opportunity” to interact directly with victims of gun violence when they arrive at the hospital. Yale’s HVIP allows staff to coordinate with a trauma team in order to ensure that both mental and physical health are properly addressed.

Many victims of violence require more than medical care. First, the program assesses the patient’s current needs and circumstances to determine if there are any opportunities for them. If they are eligible for coverage for mental health visits, staff may be able to work closely with patients in order to help them complete federal victims compensation applications. They then help patients to get back on their feet with regard to their education and career goals as well as their housing stability.

Dodington said, “We have been extremely lucky to have a partner right now with an organisation called 4CT which allows us cash assistance for the immediate needs of victims.” “We can improve outcomes, and really help get people in a better position if we are able to meet them needs, especially around housing.”

They help families get compensation for funeral expenses in the most difficult of circumstances. This is a significant burden for many.

“Having people who deal with treating the impact of gunfire on a regular basis—trauma surgeons, nurses, doctors—working hand-in-hand with members of the community who are on the ground level to address this level of violence and trauma is crucial,” says Campbell.

Dodington believes that Vega is the true founder of the program. Vega has dedicated his entire life to victims’ aid since he was injured by a gunshot in his back years ago. He is now in charge of patient outreach at Yale’s HVIP.

Dodington says, “Vega taught me everything I know about the work on the ground.” “We are so lucky to have him.”

Vega says that New Haven’s gun problem is very serious. “Most of my youth friends in the community have a gun or have a friend who has one. Or they know where it is.” They feel afraid and that they have to have a gun because everyone else has. If that’s not a crisis of public health, I don’t know what is.”

While gun violence is still a problem in New Haven and throughout the country, Vega, Dodington and others agree that HVIPS and community violence intervention are chronically underfunded. Dodington says that while critics may point out the inability to conduct randomized controlled trials to support these programs, Dodington believes this assessment is unfair.

He says that there have been very few investments made in this area. “There hasn’t been enough investment from the medical research industry to show a sustained outcome in large trials.” Part of that has been a longstanding federal prohibition—only recently lifted— against funding studies of guns’ public health effects.

Dodington is happy about two major wins, despite this huge obstacle. First, Connecticut was the first state to offer Medicaid reimbursement to community services for violence intervention outreach. New Haven, Hartford and Bridgeport have also established violence interruption organizations like Project Longevity to engage and disrupt the cycle of community violence through street outreach and group violence intervention.

Dodington says, “It’s exciting to be able advocate and see real changes happening in a state such as Connecticut.”

Yale researchers tackle gun violence

HVIPS is just one piece in the puzzle to reduce gun violence. Yale researchers are trying to improve our understanding of the problem and offer solutions. Marans, for instance, pioneered a relationship with New Haven’s police department and developed a model for mental healthcare law enforcement and collaborative response to communities that are vulnerable to violence. This partnership has been in existence for over 30 years.

Marans says that “our work has led us to a better understanding of effective ways to help children and families affected by violence and other catastrophic events achieve greater acute stabilization.”

Bechtel’s team recently spoke with Connecticut gun owners about weapon storage. Many of the participants indicated that they would be open for changes after having children. Participants who used to keep their guns in drawers started unloading their firearms after the arrival of their child.

Bechtel says, “The birth of a baby would be an excellent opportunity for health care providers talk to parents about locking down and unloading weapons in their home.” “We won’t be able stop people from owning firearms. But we can encourage them to store them in responsible ways so that they aren’t accessible to anyone who doesn’t need them.”

Campbell says that it is particularly important to consider risk factors that could put people at high risk. Campbell grew up in an environment that was heavily influenced by gun violence. He saw firsthand how education can change one’s life.

He said, “You can’t change someone’s race but you can help them with education.” You can help them improve their socioeconomic status and find better, more sustainable jobs. You can also help them move to areas where gun violence is less common. These are some of our key ways to help those who have been victims of gun violence in this country.

Although gun violence is a real threat, parents can communicate with their children about the current events.

Bechtel says, “One thing we can talk with children about is that adults are working really hard trying to figure out how to make this not happen anymore and keep the kids safe.”

Study shows that children in violent homes are often left behind by their parents and face long waits for help

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Yale University

Hospital-based intervention (2022, August 12,): Breaking the cycle gun violence
Retrieved 16 August 2022

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