Columbine, Sandy Hook Elementary, the Boston Marathon, and now just this morning, we're hearing word of another violent act unfolding at the U.S. Navy Yard in Washington. It seems as if every week another tragedy occurs that eats away at us a little inside and dulls us a little more to the next misfortune. I can't even imagine the grief that befalls the folks on the front lines at hospitals, who have to mend these broken bodies and help their families cope.
Hospitals are often the place where the victims of community violence end up, and it's critical that hospitals take a role in helping to curb violence. The American Hospital Association released a report earlier this month titled "Reducing Violence in Our Communities," which highlights strategies that hospitals and health systems have used to tackle this issue.
"I always say that all social and community failures eventually find their way to the hospital, and certainly the results of violence mean that people do wind up in hospitals in pretty critical condition," Rich Umbdenstock, president and CEO of the AHA, told me by phone last week. "It's critical for hospitals to do whatever they can to either get upstream in the community, working with others to reduce violence, or taking the opportunity when someone is within the hospital's reach to try to prevent somebody from finding themselves in the same situation and winding up a patient again, or harmed even worse than that."
I also attended a thought-provoking session last week at the Mayo Clinic's Transform 2013 symposium that suggests violence is a public health issue for hospitals and health departments. Gary Slutkin, M.D., the founder and executive director of Cure Violence, made a case for how violence is really a contagious disease, and should be treated in the same fashion as one. I spent a few minutes with Slutkin discussing the issue:
The AHA report offers 11 different examples of hospitals and health systems that have developed programs to intervene and help prevent violent situations. Engaging with patients and their families while they're recovering from a violent incident is a key time to direct them toward social resources, offer counseling, or link them with life-skills coaches, according to the report.
Here are a couple of examples:
- Facing a homicide rate for the young that's higher than state and national norms, Virginia Commonwealth University Medical Center has developed a program called "Bridging the Gap" to stop violence before it happens. While staying as inpatients, victims of violence receive an intervention that includes reviewing the incident, exploring possible conflict-resolution strategies, and discussing ways to better cope with the aftermath of an incident. The program has also helped victims fill other needs that might lead to violence, including housing, education and mental health services.
- Northwestern Memorial Hospital — which treats about 1,000 traumas annually, a third of which are violence-related — staffs its ED with violence interrupters to help break the cycle of retaliation. Interrupters, who have links to the neighborhood and its cultural issues, are dispatched to both the hospital and at the street level to help assess the situation and minimize any risk of retaliation.
- In Chelsea, Mass., Massachusetts General Hospital sends clinical social workers along with police responding to 911 calls where children are present. The social workers provide immediate counseling and intervention to kids who have witnessed or are victims of violence, to help reduce trauma.
Umbdenstock says the report stems from the gun control debate waged earlier this year following several violent incidents, and from calls for the AHA to take a stance on the issue. Guns and violence is a complicated topic that's different in every locality, and the organization wanted to find a way to provide guidance to hospitals while also avoiding getting involved in such a polarized discussion.
"Rather than try to jump into that gun debate, which is so highly political, it was more prudent for us to look at the manifestations, the outcomes of gun violence, and then we started to say, 'Well, we really ought to look at violence in general,' and that's where this set of case studies came from," he says. "It's a way in which we can play an appropriate role and not get bogged down in what are some seemingly never-ending debates across our vast American society."