A memorial for victims who died in incidents of violence in Philadelphia. Photo: Tony Fischer, CC BY 2.0
As the epidemic of community violence swells in U.S. cities, one promising place for intervention and prevention of future violence is the emergency departments of hospitals. More than 25 hospitals nationwide have adopted a public health approach to helping victims of violence with programs that aim to prevent future violent injuries, not just treat them.
In Philadelphia, that public health approach is about to reach a much larger public: Healing Hurt People, a trauma-informed hospital-based violence intervention program developed at Drexel University, is expanding its reach at an unprecedented city-wide level. Efforts are underway to offer the program soon at Temple University Hospital in North Philadelphia, with further expansion planned for Einstein Medical Center Philadelphia and the Hospital of the University of Pennsylvania later in 2015-2016. The program currently operates in partnership with the emergency departments of Hahnemann University Hospital and St. Christopher’s Hospital for Children.
“No other city has expanded hospital-based violence intervention in this way,” said Ted Corbin, MD, an associate professor in Drexel’s College of Medicine and School of Public Health and director of Healing Hurt People. “What’s especially valuable about Healing Hurt People is that our approach to violence intervention is trauma-informed, meaning the program is built on principles recognizing how traumatic stress and past exposure to violence affect clients and their needs.”
Healing Hurt People, a program of Drexel’s Center for Nonviolence and Social Justice in the School of Public Health and College of Medicine, has previously been replicated at two hospitals in Chicago and one in Portland, Oregon, with a second Portland site under development.
“Research has shown that more than 60 percent of young people who are victims of violence show symptoms of PTSD at a diagnosable level after their injuries, and many more experience symptoms of hyperarousal,” said John A. Rich, MD, a professor in Drexel’s School of Public Health and co-director of the Center for Nonviolence and Social Justice. “We see that people who live with chronic traumatic stress in an unsafe environment are more likely to seek safety by resorting to carrying a weapon and in some cases retaliating, or to self-medicate with drugs—all behaviors that put them at continued risk and perpetuate the cycle of violence.”
Intervention programs like Healing Hurt People offer services to victims at a critical moment when their thoughts may turn to retaliation or to changing their lives. The programs’ case management services and behavioral health interventions offer clients a personalized path to safety from future violence, including access to health care and education.
The emphasis on trauma-informed care in Healing Hurt People has engendered its support from Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). The department provides funding for trauma specific behavioral health, case management and other components of Healing Hurt People at its existing Philadelphia sites; DBHIDS is now funding the expansion to other city hospitals. The department’s commissioner, Arthur Evans, PhD, has publicly stated a goal of making Philadelphia the most trauma-informed city in the nation.
“We think Healing Hurt People is a terrific model,” said Evans, “and represents a tremendous opportunity to engage people in care without those individuals having to reach out for the crucial services they need. We're very pleased that HHP is expanding its reach to help more young people in Philadelphia.”
In the program expansion process already underway, Drexel’s Healing Hurt People program staff are currently working with academic and health-care partners at Temple, including training and hiring staff and initiating enrollment in a rigorous research program to evaluate the program’s effectiveness. Hospital and affiliated academic leaders of the Healing Hurt People sites from Drexel, Temple, Einstein and Penn have already formed a “learning community” so they can share the process of planning and implementing Healing Hurt People across the city.
The research program to evaluate Healing Hurt People during its expansion across Philadelphia is funded by the Annie E. Casey Foundation and the Stoneleigh Foundation and aims to measure the effectiveness of the program’s trauma-informed services on clients’ mental health outcomes. Previous research studies on the effectiveness of hospital-based violence intervention programs, including a limited number of randomized controlled trials, have demonstrated their success in preventing violent reinjury and involvement with the criminal justice system, among other outcomes. A recent simulation study led by members of Drexel’s Center for Nonviolence and Social Justice also demonstrated that such programs are likely to save money, compared to nonintervention. However, the primary aim of these programs is typically not research, but service to clients to address critical community needs in violence prevention.
“Temple is no stranger to developing and maintaining programs that serve to reduce the incidence of gun fatalities in Philadelphia, and we are proud to be a part of this program,” said Marla Davis Bellamy, JD, co-principal investigator of the Healing Hurt People replication at Temple. “The expansion of Healing Hurt People to Temple University Hospital will provide our Emergency Department an opportunity to provide patients with behavioral health support to help them deal with traumatic stress given their overexposure to violence. The goal of this collaboration is to provide the residents of our surrounding neighborhoods with the tools necessary to prevent future violence as well as to improve the overall health of our community.” Kathleen Reeves, MD, is also a co-principal investigator of the Healing Hurt People replication at Temple.