Healing Hurt People

Theodore Corbin, MD, MPP

Project Summary

“Our children are dying and we can stop it,” says Dr. Ted Corbin, an emergency department physician at the Drexel University College of Medicine where he is both a doctor and a violence prevention practitioner. Violence, he says, is a major public health problem nationally—and especially in Philadelphia and among young men of color. Trauma in childhood and young adulthood leads to depression, anxiety, obesity, other chronic diseases and the perpetuation of violence. Ted is at the forefront of a growing awareness that the emergency room provides a pivotal and potentially life-changing moment in the lives of young people who end up there with intentional, nonfatal injuries such as gunshot, stab or other assault wounds. Healing Hurt People (HHP), is Ted's response—one that addresses the psychological wound of the trauma, not just the physical wound. Using an interdisciplinary team consisting of an emergency room physician, internist, psychiatrist, social worker and psychologist, Healing Hurt People provides case-management and appropriate service referrals and community-based resources to reduce reinjury and retaliation among young people ages 8 to 30.

Scope of the Problem

According to the Centers for Disease Control and Prevention, homicide is the leading cause of death for young people ages 10 to 24. In Philadelphia, homicide is the leading cause of death among African Americans aged 15 to 24 years. In 2007, Philadelphia recorded 392 homicides—and 41 percent of the victims were under age 25. Yet, as disturbing as these figures are, that same year there were 3,152 nonfatal shootings. It is these nonfatal injuries that are the focus of Ted’s work and of his fellowship proposal.

National statistics define the scale of this crisis. In 2007, more than 668,000 young people ages 10 to 24 were treated in emergency departments for violent injuries. Additionally, according to the most recently available statistics (2001), 16 million adolescents in the United States have witnessed some type of violent assault in their lifetimes, including up to 95 percent of children in the inner city. In contrast to patients whose injuries require hospital admission and who get additional supports, victims who are released often receive nothing beyond the physical care needed to treat their injuries. Most young people who suffer intentional injury have witnessed violence prior to their injury and are likely to witness more violence after discharge. Witnessing community violence is a risk factor for substance abuse, aggression, anxiety, depression, and antisocial behavior in adolescence. Violent injury is also a recurrent problem. Up to 45 percent of victims who suffer a penetrating injury are reinjured during the 5 years following the first injury and 20 percent are dead within those 5 years. Exposure to violence and victimization are strongly associated with later acts of violence by victims. Intentional injuries are among the most costly health problems in the United States, accounting for $75 to $100 billion yearly in disability and lost productivity.

Violence is not inevitable. Like other public health threats, polio and influenza for instance, violence can be prevented. Research reveals a link between past trauma and future violence. Yet, in conducting background research on this proposal, we could not identify another emergency room intervention such as HHP. We did, however; find strong support for the model among non-Philadelphia hospitals that maintain other emergency room violence intervention responses, the Philadelphia Deputy Mayor of Health and Opportunities and Director of Behavioral Health.

Fellowship Project

Ted’s project is the cornerstone program of the Center for Nonviolence and Social Justice at the Drexel University College of Medicine. It is an innovative, community-focused, hospital-based program designed to address the needs—physical, emotional and social—that victims of violence face after being released from the emergency department. Ted leads a multi-disciplinary team with extensive expertise in violence prevention and trauma. HHP is operational at Hahnemann Hospital and St. Christopher’s Hospital for Children.

The core components of the program are as follows.

  1. Upon admission to the Emergency Room, a trauma-trained Master’s level social worker engages the patient in a dialogue to ensure that the patient is safe.
  2. An assessment is made to gauge the depth of trauma, using a standardized assessment tool.
  3. Before discharge the social worker verifies that the client has a safe place to go; offers referral services; and advises the patient and/or family about likely traumatic-stress symptoms.
  4. A trained outreach worker follows up with the client through phone and home visits to ensure that s/he has connected to the referral support or to help the patient navigate those supports.
  5. The outreach worker provides ongoing mentoring and case management for 6 months.
  6. Clients are encouraged, and usually accept the offer, to participate in S.E.L.F. psych groups. These groups are based on the nationally recognized Sanctuary Model and help clients create momentum toward change. These 10, weekly, one-hour sessions are run by a trained facilitator.
  7. An interdisciplinary team monitors the program and advises on challenging cases during weekly case reviews. Quarterly case reviews engage a broader community of stakeholders.

Since January 2008, staff of HHP has identified 704 violently injured people between the ages of 15 and 30. To date 190 clients at Hahnemann Hospital have been served by HHP. (This enrollment level reflects both victims’ willingness as well as staff capacity of the program.) In fall 2009, the program expanded to St. Christopher’s Hospital for Children to reach younger victims of violence ages 8-21. HHP has served 52 clients at St. Christopher’s Hospital.  More information about HHP can be viewed at www.healinghurtpeople.org.

Goals

Ted's fellowship will allow him to achieve three primary goals.

  1. Establish the evidence base for Healing Hurt People through a feasibility study involving 90 adult subjects: 45 in a control group and 45 in the treatment group cycling through the full HHP program. The purpose of the research is to demonstrate: (1) the utility of an emergency department, trauma-informed intervention at addressing the psychological stress brought on by violence; and, (2) the cost-effectiveness of the program. In doing so, Ted hopes to expand the model to other emergency departments in the region and across the country.
  2. Establish a coordinated effort to address youth violence among multiple systems by creating a Youth Injury Review Panel. These systems include law enforcement, justice, medical, behavioral health, human services, and education. The Youth Injury Review Panel would:
    • Review serious nonfatal injuries;
    • Identify system-level barriers faced by these victims;
    • Formulate strategies for removing barriers;
    • Inform collective efforts to provide appropriate services to clients; and
    • Formulate policy recommendations as needed.
  3. Advocate and provide leadership—locally and nationally—for policy and practice changes that reflect a public health approach to youth violence that is trauma-informed. Some of the reforms that Ted will promote include the collection of data at hospitals to include all violence related incidents, not just homicides and gunshot wounds as well as professional development and training in trauma-informed approaches for providers in the systems that serve injured youth.

Ted and his program are also members of the Network of Hospital-based Violence Intervention Programs (www.nnhvip.org) of which is now headquartered in Philadelphia.  This is a shared effort between the Center for Nonviolence and Social Justice (Drexel) and Philadelphia Collaborative of Violence Prevention Center (CHOP).

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