Healthcare’s Role in Firearm Violence Prevention

A teenage male is brought in by ambulance to the emergency department after being shot several times. He is resuscitated, his injuries are surgically repaired, and he is admitted to the trauma service. During admission, it becomes clear that he lives with issues of poverty, low education, mental illness, and substance use. Standard hospital consultations are made. Upon discharge, this young victim retaliates against the initial perpetrators.

Another teenage male is brought in by ambulance to the emergency department, and a cycle continues… The American epidemic of interpersonal violence involving firearms has worsened across the United States during recent years. According to the Centers for Disease Control, there was a 35% increase in the firearm homicide rate during the first year of the COVID pandemic with the rate in 2020 reaching 6.1 per 100,000, the highest level in over 25 years. The largest increases occurred among Black or African American males ages 10-44, American Indian or Alaska Native males ages 24-44, and in communities with higher rates of poverty. Meanwhile, the firearm suicide rate has remained persistently high, at around 8 per 100,000. Minnesota has not been immune from the increasing trend in firearm violence. In June of this year, the CEOs of Allina Health, CentraCare, Children’s Minnesota, Essentia Health, Fairview Health Services, Gillette Children’s, HealthPartners, Hennepin Healthcare, North Memorial Health, and Sanford Health released a joint statement declaring that gun violence has

By Bjorn Westgard, MD, Kentral Galloway and Danny Givens

Bjorn Westgard, MD Kentral Galloway Danny Givens

“reached epidemic levels and represents a significant threat to public health.” They also pledged to develop solutions and push for gun reform. Locally as well as nationally, there is, therefore, a need for proven strategies that address the economic, physical, and social conditions that contribute to the risks for violence. More than a few cities have established violence interruption programs, where workers from neighborhoods experiencing crime and violence identify and mediate disputes in their communities and follow up with all involved to ensure that conflicts do not escalate. Hospital-based violence intervention programs (HVIPs) offer one increasingly promising avenue for prevention where health care can play a critical role in interrupting the cycle of violence taking place in the communities we serve. Conceived in the 1990s, HVIPs are multidisciplinary programs that bring together trauma-informed medical care and community partners to provide support and services to the victims of violence who are at risk of becoming perpetrators. Those interventions can help patients as they reintegrate into their community, altering the patterns of behavior that led to these patients being hospitalized and preempting recidivism and retaliation by providing patients with a support network of outpatient care and services once they are discharged from the hospital. In the Twin Cities, LifeTeam, Next Steps in Hennepin County, and now Healing Streets in Ramsey County are striving to do this critical work in and outside of metro area hospitals, funded largely by county, local government, and philanthropy. HVIPs begin with intervention at the patient’s bedside in the hospital or the emergency department. Many victims of violence are young and distrustful of systems that have not historically treated them well. However, the time that victims spend recovering in the hospital provides a “teachable moment” when patients are particularly receptive to interventions to promote positive behavior change. Culturally-competent violence prevention specialists, coming from similar communities and experiences as the clients whom they serve, can break through patients’ distrust. Frontline HVIP workers can then work directly with victims and their families to develop short- and long-term goals to help with behavior change and the healing process. For victims of violence to begin to heal, they need support in developing coping strategies to help them understand what

has happened to them and to move forward with the changes that have become permanent in their lives due to the violent event they experienced. After violence prevention workers have connected with victims in the hospital, case managers can work to connect patients with community resources to provide whatever intensive services they may need in the months following violent incidents and injuries: mental health crisis resources, mentoring, home visits, and assistance with follow-up appointments. Both the road to recovery and the resilience necessary to break the cycle require holistic strategies in order to heal and foster the resilience of the predominantly young victims of violence. Young people may need job training and education development to complete their high school degree/ GED, attend higher learning institutions, or learn job skills to be able to work. Often, victims’ families may need short-term financial assistance to pay for rent/mortgages, food, and clothing while they try to support patients in their recovery. It is therefore critically important for HVIPs to have relationships with partners in the community, in the schools, in the legal system, and in outpatient health care who all can help youth that have been deemed at-risk change their behavior and begin to heal from the trauma they have experienced in their lives. While the hopes for violence interruption and intervention efforts are high, front-line workers experience high rates of burnout, particularly when faced with disparate funding and inconsistent backing. If these programs are to achieve their promise, there is a need for ongoing infrastructure and support, both social and financial, within communities, healthcare institutions, and government. Hospitals and communities are engaged, but broader support and standardization are needed. If we support them, hospital-based violence intervention programs have the potential to halt the revolving door of trauma while addressing the inequalities that lead to atrisk behaviors. HVIPs have the potential to heal the survivors of violence by building relationships and partnerships between hospitals and emergency departments and the communities they serve.

Bjorn Westgard, MD is an emergency physician, medical anthropologist, and community health researcher at Regions Hospital, the HealthPartners Institute, and Hennepin Healthcare. Through his clinical work and research, he searches for community solutions to the health and social issues that show up in the emergency department. Kentral Galloway has worked in child protection and youth shelter and treatment services, always seeking to serve those most in need, to fight for those without voice, and to work for change to address systemic, racial issues in society. He is the director of Hennepin County’s Next Steps program serving survivors of violent crimes. Danny Givens is a heartfelt and experienced activist, orator, pastor, and advocate for racial justice in Black, brown, and Indigenous communities in Minnesota who has worked with many congregations and communities and who now works to deliver Ramsey County’s Healing Streets program to those who need it most.

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