Truman Medical Center Hospital Hill, in Kansas City, Missouri, includes so-called violence blockers on its trauma team, whose job is to urge retaliatory violence between the shooting, stabbing, and the social circle of survivors and victims. The golden time to take a bleeding or injured victim to a trauma unit is when these non-peaceable peacekeepers can have the greatest impact on reducing further activities of violence in the city.
“The first hour is when we want to be there,” says Rashid Junaid, Violence Prevention Manager with the Aim4Psy Violence Prevention Program, which oversees a team of trained violence blockers by trauma staff on the “Peace” line Is called immediately. Victims of intentional violence.
“We are working with patients and family and anyone else who wants to retaliate,” Junaid notes. “We buy time, talking to them and helping them understand the consequences of their actions.”
The goals of the hospital violence prevention program – a partnership between Truman and Aim4Peace – include reducing retaliation and re-injury, as well as promoting positive alternatives to violence. The base includes so-called “credible messengers”, individuals trained in conflict resolution and mediation and who come from the city’s harshest areas and have experienced violence as trauma victims to prevent more victims in the trauma unit As part of the response unit. .
By several measures, the program has been successful in recent years, including a citywide slaying of up to 28%.
Aim4Peace relies on mapping hot spots to help prevent violence in the Kansas City, Mo., area.Courtesy Aim4Peace
“We have seen a decline in reducing trauma,” said Teresa Leinhope, director of trauma services at Truman Medical Centers. Between 2012 and 2014, the percentage of trauma patients who stumbled, shot or who were present with intentional, penetrating wounds dropped from 31 percent to 25 percent. This is more than one per day versus one day, notes Truman trauma surgeon Dustin Neal.
“They have proven to the hospital that they are very valuable,” Neil Aim4Peace activists say. For example, many patients treated for such wounds either have no insurance or are covered by taxpayer-funded programs. As hospitals bear greater financial risks, the financial burden of costly treatment enhances the ability of safety-net hospitals such as Truman to fulfill their missions.
Health care reform is changing how hospitals and health systems view and address the health of a community. Through financial carrots and sticks, Affordable Care Act An attempt to introduce a system that has rewarded the provision of services for the treatment of disease where providers will prosper by keeping people well and preventing disease.
Addressing issues such as violence, starvation, housing, and education affects people’s health, rather than medical services hospitals. Studies show that behavior and environment account for about 70 percent of a person’s health outcomes, while medical care accounts for about 10 percent of a person’s health. Nevertheless, the lion’s share of the nation’s health spending goes to medical treatment rather than prevention. He is slowly changing.
The result: experimenting with care-delivery changes in hospitals, including collaborating closely with community doctors, creating accountable care organizations (ACOs) and paying people on a well-being basis, and not just treating the sick. Still, others such as Truman, Harlem Hospital Center and other New York City Health and Hospital Corporation (HHC) facilities, and Bon Secours Richmond (VA) health system are taking a big bite of the apple in conjunction with neighborhood activists, businesses. , Nonprofits and others, such as taking root causes of health such as violence, food, and poverty.
Treating Violence as an Infectious Disease
Trance’s violence prevention program began in 2008, when Kansas City leaders called for a solution to the body count, which perennials had crossed the 100 mark. A city-appointed commission recommends dealing with violence from a public health point of view, not through a strictly law-enforcement lens, like an infectious disease. Today, more than 45 organizations – counting city schools, police departments, faith-based organizations, nonprofits and civic associations – work to support the Aim4Peace effort.
While Aim4Peace has many elements, a partnership with Truman “anchors,” Tracie McClendon-Cole, director of Aim4Peace and community justice program manager at the City of Kansas City (Mo.) Department of Health. “They are probably our strongest champions. We would not have been as successful if we had not been our champions in the trauma unit.”
In addition to reducing the number of homicides in Kansas City by 28 percent between 2010 and 2014, the Truman program has played a role in the mortgage maintenance rate – a 70 percent reduction – in the city’s eastern patrol section, traditionally the city’s most violent One of the communities. . The area covers about one-tenth of the city and home blanketed by Aim4Peace’s conflict resolution, mediation and other violence prevention efforts.
“I think this is one of the best Truman programs we have here,” says Mickey Keeling, a Truman research nurse and Truman’s research nurse about Truman’s violence prevention program. After examining violent crime patterns in the city, public health officials retaliated and argued the homicides and some attacks. “We can’t do this program,” Keeling notes. Neil adds: “If you didn’t have Aim4Peace, the cycle of violence would never break.”
The program has expanded since 2008. Initially, Aim4Peace activists only observed gunshot victims, had to be screened through security and obtained patient’s consent, resulting in many victims not receiving timely seizures. Today, anyone with intentional, penetrating violence gets a visit from the violent disruption, which carries a hospital badge and is widely known around Truman. The implied consent makes it easier for workers to reach victims and loved ones at that golden hour. Aim4Peace hopes to soon expand the program to another area hospital.
Kansas City, Mo., to help community norms and expectations around violent behavior.
But early visits to violent disruption are often not enough to save people from retaliatory violence. “They constantly see patients through hospital stays,” Lienhop says. Aim4Psy Violence Violence observer, Jamal Shakur, says “violence blockers” try to build a credible relationship with the person. He often means being hospitalized, from attending funerals for victims to “going home to a family, bringing food, praying with them, maintaining relationships.”
“We want to make them a success story,” says Junaid of the surviving victims. This means that helping otherwise disadvantaged and disgruntled individuals “feels connected to the community.” Aim4Peace workers can help them obtain a driving license, connect them with job training, help stabilize their housing conditions, or connect them to mental health services.
Research shows individuals who are constantly exposed to violence in the home or community may begin to process experiences as normal and condensed individuals. Stress and internal conflict can lead to aggression – exacerbating violent problems – and other problematic behaviors, including substance abuse and disorderly eating habits. Violence makes it harder to feel safe, causing anxiety, depression, reduced physical activity in communities, and social isolation, all impacting on health.
“Trauma has a huge impact on inequalities and also on health disparities,” McClendon-Cole says. The partnership with Truman is trying to break it down and take other steps to stop the violence. To that end, Truman administrators have hired a trauma outreach coordinator who trains police, teachers, and others in efforts to better understand trauma and respond more favorably to those affected by the trauma .
“Hospital systems are providing health through a larger lens,” says Susan Kansagara, HCH’s assistant vice president of population health. At its three hospitals in New York City, the safety-net system connects pediatric patients and their families with resources including food, housing and child supplies, thanks to a partnership with Boston-based nonprofit Health Leads.
Pediatric clinic patients are screened at Harlem Hospital, Bellevue Hospital Center and Woodhull Medical and Mental Health Center for their intake. A provider can “prescribe” basic resources such as food and heat as they do medicine. Patients take those prescriptions to the Health Leads desk at the clinic’s waiting room, where trained college students in the program work with patients to use community resources and public benefits.
“One of the most frequently requested [resources] “Food helps,” says Kansagra. Health Leads staff can include eligible patients in the Women, Infants and Children program for meal tickets, set up families with emergency food supplies, or food aid programs. Or provide coupons at local farmers’ markets. ” In 2014 more than 1,800 patients / families were connected in three hospitals. Now, HHC is expanding the program, Kansagra says, “Our patients need a large volume.”
Health Leeds works with 11 hospitals and health systems, including Kaiser Permanente in California, Massachusetts General Hospital in Boston and Johns Hopkins Hospital in Baltimore, connecting 50,000 patients and dependents with the necessary resources last year. “This is exactly what is breaking the barriers,” says Health Hall principal Kelly Hall.
“Overall, health leads are contributing to the overall needs of patients,” says Kansagra. “What foods do you eat or have access to your housing affect health. Health is not just medical care. When patients are identifying needs and when we are helping them to meet those needs , We see it as a breakthrough. ”
Meanwhile, the five-hospital Bon Secours Richmond Health System leads a partnership with Virginia Local Initiatives Support Corp. to revive Richmond’s East End. The effort, which grants businesses to start or expand enterprises in the area, has attracted more than 20 businesses to date and is working to address residents’ needs, “more affordable housing and Desires Job Opportunities ”, says David Belde, Senior Vice President of Mission Services at Bon Secure.
Working with about 50 nonprofits, says Belde, is “co-building a healthy community,” with a focus on economic development. It includes stimulating and supporting local businesses, building parks and grocery stores And working to attract a fitness and wellness center to the area. Belde says, “People often and very young die of diseases that can be preventable. It is caused by poverty, lack of education and other non-care factors. “” In the future, health care is the need to take care of people who are ill and develop a strategy to keep people healthy. “