A hospital steps in to stop cycles of violence

HCMC adopts a tested approach to shifting lives away from guns and knives

Ann Eilbracht is leading HCMC’s hospital-based violence intervention program pilot. The hospital is attempting to replicate an approach to addressing youth violence that has worked for other big-city hospitals. Credit: Photo by Dylan Thomas

A brief, precious window into the lives of young victims of violence opens the moment they arrive in Hennepin County Medical Center’s emergency room.

HCMC aims to seize on that critical moment when it launches the nation’s newest hospital-based violence intervention program this year. Similar programs at other hospitals have shown promising results, including lower rates of re-injury and reduced costs for emergency departments.

The idea behind the intervention is simple: If they speak with the right person at the right time, young victims of violence might choose to pivot away from knives and guns and the risky decisions that got them hurt. They might be willing to accept some help.

Ann Eilbracht, senior director of support services at HCMC, said the program grew out of a realization that just patching up those patients and putting them back out on the streets is “not enough.”

“We help them recover, but then send them back out to that same dysfunctional lifestyle,” Eilbracht continued. “Chances are they may be back with another injury, and we’d rather help them find a better approach to life so that they don’t end up back in the emergency department with maybe a more serious wound.”

The National Network of Hospital-based Violence Intervention Programs counts more than 30 similar programs already up-and-running, including Oakland’s Caught in the Crossfire, a pioneering project that started in 1994. The programs are found mainly in big-city U.S. hospitals, but the model has been replicated in Canada, England and El Salvador.

Linnea Ashley of the National Network of Hospital-based Violence Intervention Programs said the approach hinges on “that golden moment” in the hospital when victims feel vulnerable and open to change. Trained intervention specialists try to reach the patients before they pass that critical stage and begin to think about retaliation.

“At that moment, people are pretty earnest and pretty raw about what’s going on and how someone might be able to help them,” Ashley, the network’s director, said.

HCMC’s program would focus on patients between 12 and 28 years old who arrive at the hospital with gunshot and stabbing wounds. The hospital sees about two to three of those patients in a typical week, Eilbracht estimated.

The intervention specialists will be trained to connect those patients with the services they need to shift their lifestyles.

“It could be safe housing, it could be a job, it could be finishing high school, it could be getting out of an abusive relationship, it could be help with legal matters,” Eilbracht said. “The services will be wrapped around the individual based on what they think they need.”

She said the program would launch with two or three part-time intervention specialists on call during peak hours, like early on weekend mornings.

“At some point, because we’ll have limited staff initially, we’ll probably do a warm handoff to either a government or a private social service agency that hopefully can help that individual continue to pursue that healthier and safer lifestyle,” Eilbracht said.

City of Minneapolis Youth Intervention Coordinator Josh Peterson said the program has about $75,000 to get up-and-running this year, including $25,000 included Mayor Betsy Hodges’ 2016 city budget and a $50,000 grant from the Minnesota Department of Public Safety. The grant through the department’s Office of Justice Programs was “intended as seed money to develop and pilot implementation,” Peterson said, adding that it’s not yet clear how much the HCMC program will cost.

Planning for a local hospital-based violence intervention program goes back at least to the city’s original Blueprint for Action to Prevent Youth Violence, an initiative launched in 2007 by former Mayor R.T. Rybak. The Blueprint was drafted in response to a significant rise in violent crime in the city, an increase that was largely driven by young people and gang activity. Between 2003 and 2006, homicide was the leading cause of death of Minneapolis residents aged 15–24.

The Blueprint proposed treating youth violence as a public health epidemic. The research underlying the approach showed violence begets violence; youth who were victims of violence were more likely to become perpetrators.

There’s evidence those victims also are more likely to end up in the hospital again with another violent injury. At that point, they face an increased risk of dying from their wounds, said Dr. Carnell Cooper of the University of Maryland Medical Center.

Home to one of the busiest trauma centers in the country, the Baltimore hospital introduced a violence intervention program in 1998. Since then, rates of recidivism, or return visits, for violent injuries have “decreased dramatically,” Cooper said.

Baltimore’s hospital-based violence intervention program operates on an annual budget of about $300,000. Although the hospital hasn’t analyzed the cost-effectiveness of its program, Cooper estimated three-quarters of those patients were uninsured in the pre-Obamacare era, “so we’re eating most of the costs.”

Cooper said the success of hospital-based violence intervention requires a change in attitude, not just in the minds of the patients who are victims of violence but in the hospital staff who treat them, too.

“There’s too often a laissez-faire attitude that says you can’t do anything. That’s not true,” he said. “… We can impact them. We can save their lives.”