How Hospitals Can Cure Violence

Editor’s Note: Joel Fein is the co-chair of the National Network of Hospital-based Violence Intervention Programs (NNHVIP). Cure Violence is a founding member of NNHVIP.

“The guy that did this – I’m gonna cap him.”

This is a sentence that I happened to overhear while taking care of a 16-year-old boy who had been injured in a fight with a boy from another neighborhood.  We were in the Emergency Department at The Children’s Hospital of Philadelphia, and I truly felt helpless.  That feeling has taken me, and many others like me, down a long road trying to prevent what seems like the next inevitable patient in my resuscitation room.

The most urgent need for violence intervention arises directly after someone is injured in an assault, when escalation of the event can result in tragic consequences.  Breaking that retaliation cycle can save lives and prevent severe injuries – for the moment.  The work of “violence interrupters” are crucial in this regard.  But to truly prevent future violence in the lives of young men and women we need to discover and honor how their past impacts their future.  This is the basis of a “trauma-informed” approach to working with assault-injured youth.  This is also the foundation of Hospital-based violence intervention programs (HVIPs).

What is a Hospital-based Violence Intervention Program?

An HVIP works directly with people who are at high risk for repeat violence.  HVIPs operate either directly from a hospital or medical center or are a non-profit organization that links with hospitals, such as the Cure Violence program that started in Chicago and is now in more than 20 U.S. cities. Clients are recruited through emergency departments, trauma units and clinics, usually after an assault injury, and all receive some dosage of post-discharge case management and system navigation. HVIP personnel provide emotional support for post-traumatic stress and connect youth with employment or after-school, mentoring, and parenting programs.  The interventionists also help youth and their families with their medical, legal, educational, housing, and social service needs.

National Network of Hospital-based Violence Intervention Programs (NNHVIP)

In 2009 many of the HVIPs working around the country joined the National Network of Hospital-based Violence Intervention Programs (NNHVIP), which was founded by Youth Alive! in Oakland, CA.. Through working groups, e-bulletins, online communication forums and an annual conference, NNHVIP member programs develop and share best practices, collaborate in research and evaluation, explore opportunities for funding sustainability, and identify ways to collectively have an impact on policy.  Network members, from medical directors to on-the-ground interventionists, share their experiences, data and perspectives and create strategies for effective responses to violence. Studies emanating from NNHVIP member programs have demonstrated that these programs can reduce future criminal behavior and alleviate behavioral distress and aggression in these high risk youth.  A few studies have also demonstrated potential cost savings in terms of preventing future injuries and hospitalizations.

The group currently consists of 25 member programs and is growing quickly.  Headquarters for NNHVIP are located in Philadelphia, PA and are staffed  by The Children’s Hospital of Philadelphia and Drexel University Schools of Medicine and Public Health.  Collectively, network members have created a curriculum which details insights and recommended strategies for starting and maintaining an HVIP:  Violence Is Preventable: A Best Practices Guide for Launching and Sustaining a Hospital-based Program to Break the Cycle of Violence.

The book is available through the Office of Victims of Crime website >>

Belonging to this organization helps me and my colleagues realize that we are not alone in our efforts to put “a cap” on the violence-related injury and death rates experienced by our ED patients.  And the only “cap” I want my 16-year-old patient to experience will match his graduation gown.