Health

Hospitals that treat armed violence as a public health issue

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Dr. Megan Ranney, associate professor of emergency medicine at Warren Alpert Medical School at Brown University in Providence, RI, said she was once just one of a handful of doctors and researchers who openly called for violence. with the weapon a public health problem. “This discussion has become normalized in the last five or so years,” he said.

This includes increased attention in Washington, DC The American Medical Association in 2016 declared armed violence as a public health crisis and called on Congress to lift the study ban as such. And after the mass shooting in Boulder in April, the Biden administration issued a statement calling for gun violence. “public health epidemic. “

And while hospital-based violence intervention programs are taking off, they are still offered only by a subset of hospitals.

“If you go to most U.S. hospitals, it’s about treating the physical injury,” said Ranney, who serves as head of research for the American Foundation for the Reduction of Firearms Inferences in Medicine. , a non-profit organization that brings together health and public professionals. “That has changed, though.”

Hospitalization for a gunshot wound he status ligatu with the likelihood that a patient will experience another violent injury or be arrested for a violent crime.

It has led to a dozen hospitals in the United States raising programs to provide mental health services and connections to community groups that deal with social determinants such as food and housing insecurity, which they say can make the next accident is less likely.

One study in Chicago found 8% of patients who participated in a hospital-based violence intervention program reported a repeated injury in the next six months, compared with 20% of those who did not participate in a program. Another study in Baltimore reported that 5% of patients participating in a program were readmitted, compared with 36% of those who were not.

That said, hospital-based violence intervention programs are not easy to implement.

They require the hiring — and paying — of staff to regularly engage with patients and cultivate connections with the community for services that some might initially see as beyond traditional hospital care.

The cost of a hospital-based violence intervention program varies depending on how busy you are, what types of services patients need, and, in particular, how many staff members a hospital decides to hire. It costs about $ 350,000 annually to manage a hospital-based violence intervention program that serves 90 clients, according to a 2015 study published in the American Journal of Preventive Medicine.

Most of this cost goes to funding staff, i.e. staff who work with patients and connect them to relevant community services.

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Stephanie Harris has worked as a clinical case manager with the Life Outside of Violence program, a hospital-based violence intervention program in St.Louis, since 2018.

She says her favorite part of the program is getting to know new people and building a rapport after a patient is admitted to the hospital, so she can understand what organizations and services in St. Louis – the city where she grew up – are. can connect them with to help them build their future.

It’s “really not knowing what kind of situation a person has to come up with (with),” Harris said. “It’s part of the challenge, but it’s also part of the reward.”

The LOV program brings together four Tier 1 trauma centers in St. Louis. St. Louis-Barnes-Jewish Hospital, SSM Health St. St. Louis University Hospital, St. Louis Children’s Hospital and SSM Health Cardinal Glennon Children’s Hospital – and he is housed at the Institute for Public Health at the University of Washington in St. Louis.

The program is funded by a three-year, $ 1.6 million grant from the Missouri Foundation for Health.

He is also part of the St. Louis area Violence Prevention Commission, a group that brings together various groups for the prevention of armed violence in the city.

Harris is part of a team of case managers who reach out to patients arriving at a participating hospital with a violent injury to talk about the program, ideally within 24 or 36 hours of presentation to the hospital. Four of the home managers work outside of a hospital they are assigned to; another is a “floater” that covers all units.

She said it is important to talk to patients to understand their goals and what motivates them, what informs them what will drive potential changes in their lives.

If a patient is struggling because they don’t have a job, a case manager can help them build their communication skills and cope with anger management, and even talk about how not changing these behaviors can hinder their goals. employment. A case manager can also refer patients to services that help with job opportunities and curriculum creation.

It’s “really figuring out what types of services can be looked at,” and explaining how the LOV program can provide that, Harris said. It is usually more effective than just launching the program right away and trying to convince a patient to enroll, without first understanding what types of support or services they need.


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