About the Program

The program was created by an interdisciplinary team consisting of an emergency room physician, an internist, a psychiatrist, a social worker, and a psychologist with extensive expertise in violence prevention and trauma.

With this interdisciplinary approach, Healing Hurt People addresses the needs — physical, emotional, and social — that victims of violence face after being released from the emergency department. Rather than addressing the needs of young victims of violence as a criminal justice concern only, Healing Hurt People strives to shift the perspective to include public health concerns.

The HHP multi-disciplinary team consists of Licensed Clinicians (LSW, LCSW, LPC, or LMFT) in the role of Community Intervention Specialists (CIS) and Licensed Certified Peer Specialists in the roles of Engagement Specialists and Community Health Worker Peers (CHWP).

HHP Services consist of the following phases:

• Phase 1: Assertive Outreach, Screening, and Engagement
• Phase 2: Active Involvement Phase
• Phase 3: Discharge and Aftercare Planning

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Violence in Philadelphia

Philadelphia has been plagued by ongoing street violence. In 2020, there were 2,254 shooting victims, an increase of 54% from 2019. Fatal shootings increased 34% to 405 while nonfatal shootings increased 82% to 1,849 (https://controller.phila.gov/philadelphia-audits/mapping-gun-violence/#/2020); 83% of the non-fatal victims were African American, followed by Latinos at 10%. The number of children under the age of 18 shot in Philadelphia has also been increasing in recent years. In 2020, 199 children were shot in Philadelphia, an increase of 83% from 2019 and 154% higher than 2015. Physical assault is also highly prevalent among African American and Latino youth. Although suspected to be vastly underreported, the School District of Philadelphia reported 774 assaults in the school district and over 800 incidents of bullying, harassment, and threats during the 2018-2019 academic year (https://www.philasd.org/performance/).

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How It Works

Phase 1: Assertive Outreach, Screening, and Engagement

When possible, Healing Hurt People works with patients of intentional injury — shootings, stabbings, assaults, etc. — during the "golden hour" in the emergency department to offer services that will help turn their lives around. HHP is fully committed to conducting assertive outreach, screening, and engagement of potential participants. The main goals of this phase are to 1) introduce HHP program and services to the youth and their caregivers; 2) assess the child’s and family’s strengths and needs, including natural support systems, physical and emotional safety, and traumatic stress reactions; 3) provide brief trauma psychoeducation; 4) instill hope and enhance health-seeking behavior.

The time after traumatic injury is referred to as the "golden hour." While in the emergency department, those who have been violently injured report that their thoughts are to either change their way of life or to retaliate. Until now, most emergency departments treat the physical wounds of violence victims but neglect these three factors that could potentially lead to future emergency room visits:

• Someone probably still wants to do the injured person harm.
• The injured person might be planning to retaliate against the assailant.
• The psychological trauma of being the target of attempted murder might contribute to behaviors that increase risk of re-injury and retaliation.

During this "golden hour," victims of violence are at a crossroads. Without any guidance, after being discharged just hours later, they are likely to choose the more familiar road, one that leads back to the violent environment that sent them to the emergency room in the first place. Healing Hurt People strives to guide victims during this pivotal time toward a path of reform and healing.

While many patients can be contacted and accept HHP services during the “golden hour”, others resist services at that time due to their physical injuries, symptoms of trauma (fear, anger, agitation, confusion, etc.), legal obligations, or general resistance and stigma associated with mental health services.

CHWPs lead efforts to engage these young people in trauma-specific and culturally sensitive mental health services through bedside visits, follow-up calls, and home/community outreach after discharge. CHWPs, who share similar lived experiences related to violence, racism, and discrimination, are uniquely positioned to engage violently injured youth in trauma-specific services. Peers embody credible messengers who can challenge the distrust and stigma often associated with such services among racial and ethnic minorities of low socio-economic status.

When a patient accepts HHP services, an intake process will begin, and they will enter the 2nd phase of services.

Phase 2: Active Involvement Phase

During the Active Involvement phase, participants receive a comprehensive, strength-based, and trauma-focused intake assessment conducted by a CIS, with the support of a CHWP. A complete psycho-social history is completed, including mental health history, treatment and diagnosis, trauma history, and a Mental Status Exam. Additionally, the CIS conducts a thorough clinical assessment of the participant, via the utilization of a semi-structured interview that assess PTSD DSM-5 diagnosis and symptom severity (CPSS-5 for children and PCL-5 for adults); self-report measures that screen for depressive disorders (SMFQ for children, and PHQ9 for adults). At the completion of the assessment, a treatment plan is developed for the patient with specific clinical, case management and peer service goals.

Services Provided:

Throughout the Active Involvement Phase, HHP provides trauma-focused psychotherapy, peer services, and trauma-informed case management to the participants. HHP services are provided in a variety of settings, including home, community, hospital, office, and school-based services. Our ability to meet our participants in the setting they prefer allows us to serve vulnerable individuals who would not access office-based outpatient and other traditional mental health services settings. The Active Involvement Phase typically lasts from 9 to 12 months.

• Trauma-focused interventions
  Community Intervention Specialists offer trauma-focused clinical interventions to HHP participants and their families. These interventions include but are not limited to: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), for children ages 3 to 18 and Cognitive Processing Therapy (CPT), an evidence-based practice for adults ages 18+.
• Group therapeutic interventions
  Community of Young People Healing, Experiencing, Rebuilding (CYPHER)
  CYPHER is 10-session culturally relevant group intervention which grew out of S.E.L.F. trauma recovery groups. CYPHER’s goals are to create shared meanings of community, foster vulnerability, and connections as a way of promoting healing. CYPHER’s participants will gain an understanding of several main thematic areas that are impacted by trauma (safety, emotions, loss, future) as well as a sense of connection and community among young people with shared experience of violence. These concepts are interwoven with trauma education and coping skills related to the group member’s injury as well as lifetime adversity.
• Peer Services
  CHWPs and the Engagement Specialist (ES) provide peer services to HHP youth and young adults. Peer Services are provided by young professionals with similar lived experiences than violently injured youth and consists of the following components
  • Being the credible messenger who bridges the gap between the patient and the CIS
  • Supporting the patient to generalize coping skills learned in therapy sessions (i.e., deep breathing, managing negative feelings, conflict resolution skills)
  • Provide systems’ navigation and case management support around unmet basic need
  • Strengthen the child’s and family’s natural support systems
• Trauma-informed case management, and systems navigation
  Supportive case management generally focuses on educational support, housing, legal and court, doctors and medical, afterschool, substance use, employment/training, and other levels of mental health care, as needed and willing.

Phase 3: Discharge and Aftercare Planning

Once the participant has met the goals identified in their individualized treatment plan, the HHP team will work with them to develop a comprehensive discharge plan. Its core element is the Aftercare Plan, which includes a detailed description of coping skills and other tools learned while at HHP that the participant will be able to implement in the future as needed, potential trauma-reminders that could challenge their well-being, and plan for overcoming such challenges, which is heavily focused on reaching to family, friends, and community organizations that form the participant natural support systems.

 
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