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University of Maryland Medical Center's Approaches to Interrupting the Cycle of Violence

Rationale / Objectives

  • The Shock Trauma Center at the University of Maryland Medical Center treats over 8,000 trauma patients per year. The center has a high recidivism rate for repeated violent injury; 23 % of victims of violent injury were readmitted months later due to another, more severe violent injury. Individuals presenting to the trauma center due to a second violent injury were 10 times more likely to die as a result of their subsequent injury.
  • This recidivism was occurring because victims of violence were returning to the same communities and social situations in which they were injured. The objective of the Violence Intervention Program was to teach victims the skill sets needed to change their lives and prevent those at risk from becoming victims. The hope was to break the cycle of violence in their communities and reduce the number of repeat victims.

Project/Program Description & Major Achievements

  • Preventing violence is a complex public health issue involving social, economic and behavioral components, all of which must be addressed to improve population health. The Shock Trauma Center worked to modify social and environmental risk factors as well as caring for patients’ medical needs. The Shock Trauma Center operates three programs that address violence at multiple levels of prevention: Violence Intervention Program (VIP), Promoting Healthy Alternatives for Teens (PHAT) and My Future–My Career.
  • All three programs recognize that an individual’s behavior is a product of his or her environment. The programs helped victims, those at risk of becoming victims and broke the cycle of violence. Participants in the Violence Intervention Program were less likely to be re-hospitalized due to violent injury. The program saved lives and decreased health care costs.
  • Individuals who were randomized to the program had an 83% decrease in repeat hospitalization, exhibited a 67% decrease in violent crime and a 75% reduction in criminal activity.

Lessons Learned

  • Violence prevention is a component of population health improvement and should be treated as such. Hospitals have a unique opportunity to work with the victims of violence to modify risk factors and help prevent future injury and save lives. Hospitals should consider making violence prevention part of their community benefit strategy, especially if a hospital is located in a community with widespread violence. Hospitals should assess their community to identify the appropriate program to meet the community’s needs. Ultimately, hospitals and communities will benefit from violence prevention interventions.

People / Organizations Involved

Further Description

A comprehensive violence prevention approach addresses primary, secondary and tertiary prevention levels, which are aligned with components of the cycle of violence. Hospital based violence intervention programs start with secondary prevention which is an immediate response to violence through emergency and inpatient medical care, and extend through tertiary prevention which is a  long-term response to violence to address trauma and rehabilitate perpetrators. Providing victims with long-term wraparound case managers to coordinate behavioral health and social services addresses the conditions that put the patient at risk of repeated violence. The University of Maryland Medical Center’s Shock Trauma Center operates three programs that address violence at multiple levels of prevention:

Violence Intervention Program (VIP) the foundational program at University of Maryland Medical Center is an intensive hospital-based intervention to provide social assistance to victims of violent injury. Eligible individuals are identified through the electronic medical record and approached at bedside about joining the program. Patients receive assessment, counseling and social support while they are in the hospital. Outreach workers continue after discharge to create an individualized action plan designed to reduce risk factors of repeated violence. This program also runs a weekly support group.

Promoting Healthy Alternatives for Teens (PHAT) an after-school program incorporating a tour of the University of Maryland Medical Center’s Shock Trauma Center, testimonials of victims and perpetrators of violence, creative self-expression through spoken-word poetry theatre, and role-playing exercises. The PHAT program works with “The 5th L” creative poets, who perform spoken-word theatre to stimulate the youth’s awareness of risk-taking behaviour associated with violence. Medical staff members help the youth understand what happens when a person is shot, so that participants have a realistic view of the consequences of violence.

My Future–My Career addresses the socioeconomic correlates of violence. Created by the University of Maryland Medical Center, this program is working to reduce Baltimore’s 50% high school dropout rate. The medical center partners with schools to identify at-risk youth who would benefit from My Future–My Career. Participants take six weekly trips to visit the medical center, gain exposure to different career options and learn which skills are needed for a particular career.

All three programs recognize that an individual’s behaviour is a product of his or her environment. These programs help victims and prevent those at risk from becoming victims—thus breaking the cycle of violence in their communities.

Major Achievements

Participants in the Violence Intervention Program were less likely to be re-hospitalized due to violent injury. In a longitudinal study, individuals who were randomized to the program had an 83% decrease in repeat hospitalization, exhibited a 67% decrease in violent crime and a 75% reduction in criminal activity. In addition, the Baltimore judicial system recorded an overall decrease in violence. The estimates of VIP cost savings at the base effect estimate of 25% ranged from $82,765 (narrowest model) to $4,055,873 (broadest model). [2]

Metric Result Detail
In program participant Repeated hospitalization Decreased by 83% [2]
Violent crimes Decreased  by 67%  [2]
Criminal activity Decreased by 75%  [2]
Cost savings 25% ( ranged from $82,765 to $4,055,873)  [2]