Advocate Christ Medical Center/CeaseFire
Violence Prevention Outreach Program
A Synopsis of Twelve Test Cases
In January 2005, Advocate Christ Medical Center
began training and working with CeaseFire community outreach staff in a joint
effort to prevent violence in Chicago. The Advocate Christ Medical
Center/CeaseFire Violence Prevention Outreach Program has an overall goal of
reducing violent injury, particularly re-injury, in high-risk youth. The
intervention works to screen and connect victims of violence-related trauma
(e.g. gunshot wounds, stabbings and blunt trauma injuries) with community
resources, including youth outreach services, educational opportunities, job
skills training, and counseling. The team involved with this project identified
the following as potential goals for this intervention:
1. To provide outreach to the highest risk – Those that have already been violently injured
are at highest risk for getting injured again and for retaliating for the
wounds they or their loved ones have suffered.
2. To prevent retaliation or further shooting – Outreach workers are able to assess the
likelihood of violent reactions, and have the street connections necessary to
broker peaceful resolutions, thereby preventing retaliation.
3. To get the highest risk on a positive path – A difference can be made in their lives by
providing support and access to opportunities that put them on a more
productive path.
4. To introduce a positive plan into a negative
situation – People in crisis have
varied reactions. For those who have access to weapons, violence may be a
potential answer. Our goal is to prevent retaliation and further violence by
suggesting proactive responses.
The idea is to approach high-risk youth in
the hospital during a time of self-reflection, while they are susceptible to
changing the behaviors that got them there in the first place. By providing youth
with a support network to help address risk factors for violent injury, it is
hoped they will reduce involvement in high-risk behaviors, leading to a reduction
in chance of further injury. Navigation of the support network is facilitated
by a CeaseFire outreach worker -- street-savvy
individuals, many of whom come from similar backgrounds as the patients they
serve. The background of the outreach workers makes them credible interveners
who offer a way out during a critical time in the lives of wounded youth. The main
goal of the outreach workers is to prevent violence by coaxing those at highest
risk of shooting or getting shot onto a positive path by working with these
individuals to resume their education, seek legal employment, and resolve
conflicts nonviolently.
The Test Cases – Overview and
Process
To validate the team’s initial intervention
design, the CeaseFire outreach staff responded to twelve patients who were
treated in the Advocate Christ Medical Center Emergency Room for violent
injuries from March to June 2005. Eleven of the patients were males and one was
female. All patients were between the ages of 15 and 33, and were from the
Southside of Chicago. Of the test cases, nine patients were African American,
two were Latino, and one was Asian. Ten of the cases were gunshot wounds, one
suffered multiple stab wounds, and one was treated for blunt trauma injuries.
To ensure a consistent approach to each
test case, the hospital staff and CeaseFire workers developed a protocol that
could be initiated by either the trauma surgeon or the chaplain on duty via a
call to the CeaseFire hospital hotline. The trauma surgeon or chaplain provided
the CeaseFire worker with key background information, including the gender and
age of the victim, the severity of the wound, the state of the waiting room and
visitors related to the case, any information related to gang affiliation, any
information related to plans for retaliation, and the address of the incident
which led to hospitalization of the patient. Based on the preliminary
information provided, the CeaseFire worker dispatched the appropriate outreach
worker team (usually consisting of two CeaseFire outreach workers) to the
hospital as quickly as possible in an effort to reach out not only to the
patient, but also to the friends and family in the waiting room who may be
planning to retaliate for the injury their loved one suffered.
When appropriate, the CeaseFire worker also
sought assistance from a “violence interrupter,” a special outreach worker with
close ties to street gangs who can quickly establish the likely motive of the
attack and any potential plans for retaliation. The violence interrupter was
given the address of the incident, along with any information regarding potential
motive or gang affiliation. Violence interrupters work in the community at the
site of the crime to prevent retaliation, while the outreach team works in the
hospital with the patient and the patient’s family and friends.
Upon arrival in the emergency room,
outreach workers spoke to the chaplain, trauma team, and security to establish
an intervention plan. Often one outreach worker stayed in the waiting room with
family and friends to assess their need for support and potential plans for
retaliation. The other outreach worker would attempt to meet with the patient,
provide program literature, and ask if the patient would like to receive
ongoing assistance from CeaseFire. When possible, the outreach workers are from
the same community as the patient and have an understanding of the conditions
and available services in the community. Their role is to develop a trusting
relationship with the youth and guide them to services already available in the
community or surrounding areas in order to meet the individual needs of the
patient and to provide them with a potential path for positive life change. Outreach
workers followed up using personal contact information that was offered
voluntarily by the patient. Hospital staff also encouraged participation in the
CeaseFire program as a way to avoid further injury.
The Test Cases – Beyond the ER
Between March and June 2005, CeaseFire
outreach workers made contact with 10 patients and members of 12 families of
patients in the hospital. Outreach workers were unable to work directly with
two of the patients due to the death of one and the comatose state of another. Follow-up
activities, including home visits and/or phone calls, were conducted with nine
of the 12 patients or family members (in the case of the deceased) after
discharge.
As illustrated in the following examples, this
partnership has the potential to reach far beyond the walls of the ER in terms
of violence prevention The 12 test case patients were injured in 9 different
incidents. Two incidents involved multiple hospitalizations for injuries – one
incident produced two injured patients and the other produced three injured
patients. The other seven incidents resulted in a single hospitalization. Each
incident was reviewed for possible signs of retaliation. Outreach workers and
violence interrupters were able to establish that retaliations were seriously
discussed in five of the nine incidents. In one case a youth was spared further
injury by a mediation session held by a violence interrupter with the gang that
was targeting him. In another incident retaliation was prevented for both the
target and witnesses. In the case of the deceased patient, CeaseFire workers
responded to an outraged community by coordinating a community march and vigil
in memory of the youth. These activities were done in conjunction with family
members who turned to involvement with CeaseFire as a constructive alternative
to violence, following the loss of their family member.
Overall, it is likely that the partnership
between the trauma team and CeaseFire outreach staff led to actions that spared
at least four people from being violently injured or killed during this initial
phase of the program.
The Cost
Savings
Based on previous research conducted by
Miller and Cohen (1997), the average medical cost of a shooting in 2005
(adjusted for inflation) is $35,900.* Using the anecdotal information from the
test cases, we can assume that at least four retaliations were prevented, saving
$143,600 in medical costs. Considering that the high-risk youth reached by this
intervention are likely to be uninsured, the burden of these costs fall on the
hospital and taxpayers. Thus, in a very limited four month test of the intervention,
we may have already saved more than the annual cost of the salaries of a
dedicated hospital response team.
|
Potential Savings
from Test Cases |
|
|
Medical Costs/Shooting* |
$35,900 |
|
Potential Test Case Retaliations
Prevented from Mar-Jun 2005** |
4 |
|
TOTAL |
$143,600 |
** This is anecdotal information based on
the case summaries provided by the CeaseFire Outreach Workers and Violence
Interrupters
Summary
Our highest-risk youth are those who are in
the most need of services and at greatest risk for intentional injury and thus
re-injury. The most common needs of these youth are related to educational,
occupational and social environmental (e.g. gangs, neighborhood violence, etc.)
issues. However, these individuals are also the hardest to reach with primary
violence prevention interventions, because they are not usually in school and
do not usually have a primary care physician, meaning they do not receive
traditional violence prevention programs. Thus, engaging with these youth in an
alternative environment, such as the emergency room, is critical to our ability
to identify truly high-risk individuals and work with them to better their
lives. A continued partnership between