Rochester Youth Violence Partnership
Program Description
Background:
An injured patient with a history of prior injuries is known as a recidivist. If the injuries involved were caused by a penetrating mechanism (gunshot or stab wound), the risk of repeat injury by this mechanism increases significantly, as does the lethality of each subsequent injury. For this reason, victims of penetrating trauma are felt to represent a patient population at real risk of additional serious injury or death. In our community, the problem of penetrating trauma has reached alarming levels in our adolescent population.
In an effort to address this problem, we have developed a hospital-based program that works to identify at-risk youth and targets them for individualized interventions. The primary goal of this effort is aimed at breaking the cycle of violence that so frequently results in escalation, retaliation and further senseless injury.
The period directly following violent injury is felt to represent an opportunity for intervention. An organized and consistent response following penetrating trauma can be individualized based on the needs of the victim, the caregiver, the situation, and the resources available within a given community. Careful and consistent screening of all injured youths following penetrating injury is required to help identify those at risk for further victimization or unsafe discharge from medical care, as well as those in need of advanced protective strategies.
It is no longer acceptable to simply treat the physical injuries sustained as a result of penetrating trauma in a child, while neglecting the continued risk for further injury. Whether they go on to become victims again, or perhaps go on to perpetrate a violent crime, it is clear that this population is at significant risk of further violence. Health care facilities have an opportunity, if not an obligation, to join with community and governmental partners in efforts to target violence reduction in this vulnerable population.
Goal:
To identify adolescents at risk of violent death in our region and offer specific and ongoing hospital/community based interventions designed to prevent further injury or death.
Strategy:
The conceptual framework of this program is based on several key assumptions:
a)A child should never be shot or stabbed. This mechanism of injury
should not be tolerated in this patient population.
b) Penetrating injury, when it occurs in a child, is frequently associated with high-risk behaviors or a failure of proper adult supervision.
c) Someone is always legally responsible for the well-being and safety of a
child. Failure to provide appropriate supervision constitutes neglect, and in some cases, abuse.
d) The hospital/medical profession has an obligation to report suspected
child neglect or abuse.
e) A structured, organized and coordinated response on the part of the
hospital, in partnership with specialized governmental and community
resources, must work to prevent repeat episodes of violent injury.
Approach:
1) At-risk group identified:
All children under the age of 18 who present to the StrongRegionalTraumaCenter having suffered a stab wound or gunshot wound, regardless of severity.
2) Standardize interventions:
a. Mandatory evaluation by hospital social worker using a standardized risk assessment tool to screen for risk and protective factors surrounding the individual, family and community in relationship to the injury.
b. Parents/guardians are encouraged to participate in the evaluation process. Liberal involvement of Child Protective Services (CPS), in cases where adult responsible for supervision of injured child refuses to participate or obstructs process.
c. Liberal use of hospital admission/observation for youths under age 18 who present with stab wounds or gunshot wounds and are felt to be at risk for additional injury, unsafe discharge, or to allow time to complete the required social work assessment. The decision to admit these patients is based on the psycho-social evaluation, as well as clinical injury severity.
d.Complete psychiatric evaluation is offered to all admitted patients.
e.Information gathered during social work and psychiatric evaluation is used to arrive at a safe discharge plan. Outpatient follow-up with specific organizations and services is individualized to meet the specific needs of the patient and his/her family and participation is monitored.
f. All patients view a video prior to discharge designed to help them and their families understand the risks for further injury. Both patient and parent/guardian sign a document of understanding signifying that they understand this material and that they understand what resources are available to help them.
3) Identify/recruit broad based community support for multidisciplinary approach to intervention once “at-risk” status is identified.
a. Adolescent violence is a community problem and requires a community solution. The hospital serves as the front-line by recognizing the problem, identifying at-risk patients and treating injuries. Once the patient is stabilized and the psycho-social issues leading to injury are identified, a coordinated series of interventions occur based on the specifics of each
individual case. Services/interventions may include:
- Hospital based: Continued medical treatment, continued psychiatric treatment.
- Outpatient: Drug treatment, psychiatric treatment, counseling.
- Safety assessment which may result in family relocation
- Coordination of post-discharge services as well as protective options.
- Structured follow-up and regular home visitation by street outreach team.
- Mobile mental health crisis services for silent/secondary victims.
- Coordinated reintegration of victims into school.
- Enrollment in educational/vocational programs.
- Supportive counseling to siblings.
- Ongoing tutoring and family support to victims and high risk youth.
- Structured mentorship program for victims and families (in development)