Gun violence often occurs in a vicious cycle — similar to drug or alcohol addiction — with one incident begetting the next. With that in mind, a Seattle hospital is taking a page from substance abuse treatment methods to keep gunshot victims from returning to the emergency department.
Harborview Medical Center in east Seattle proposes a three-pronged approach to addressing gun violence, which includes intervening during the first visit and assigning a caseworker to each victim. A recent study found that people admitted to the hospital following gun violence in King County were much likelier than others to end up rehospitalized, arrested or murdered.
With the new emphasis on keeping patients healthy and out of the hospital, gone are the days when doctors can mend a bullet wound and move on, says Frederick Rivara, M.D., adjunct professor of epidemiology at the University of Washington and core faculty at the school’s Harborview Injury Prevention and Research Center. “Hospitals should have an interest in this because we know, if they just patch people up and send them out, they’re likely to come back,” he says. “We need to be more involved with prevention, in addition to just treating their immediate problems.”
Fashioned after Harborview’s approach to treating alcohol abuse, the program would start with a social worker to assess gunshot victims during their initial encounters, and refer them to therapy. Harborview would then hold a dozen or so follow-up one-on-one sessions with patients. The hospital also would convene with local community agencies a few times each month to determine any additional, nonmedical services needed to aid in the intervention.
The Seattle City Council had OK’d plans to cover $275,000 in costs to support the first two years of the program through a tax on firearm and ammunition sales. However, the National Rifle Association filed suit in August to halt adoption of the so-called “gun violence tax.” Rivara says Harborview and the city are exploring other sources, such as philanthropy, to finance the effort, and adds that the mayor has put money for the intervention into the next city budget.
Funding, along with looking more closely into patients’ personal needs, is often one of the largest challenges to sustaining such efforts, says Joel Fein, M.D., co-director of the National Network of Hospital-based Violence Intervention Programs. The state of California addressed that issue recently by allowing for the reimbursement of violence prevention specialists as part of the health care delivery team. Partnering with other community agencies, for both funding and to expand the hospital’s reach, has proved essential to Children’s Hospital of Philadelphia’s own Violence Prevention Initiative, of which Fein is co-director. He’s excited to see hospitals around the country leading the charge against gun violence.
“I’m really glad that centers like Harborview are taking this on because it’s such an important issue for our community members,” Fein says.” Their safety is the most important thing that we can provide, and this is a huge threat to a lot of our families, both where they live and sometimes where they work.”