Dr. Megan Ranney, associate professor of emergency medicine at Warren Alpert Medical School of Brown University in Providence, R.I., said she was once just one of a handful of physicians and researchers openly calling gun violence a public health problem. “That discussion has become normalized over the last five years or so,” she said.
That includes increased attention in Washington, D.C. The American Medical Association in 2016 declared gun violence a public health crisis and called on Congress to lift the ban on studying it as such. And following the mass shooting in Boulder this April, the Biden administration issued a statement calling gun violence a “public health epidemic.”
And while hospital-based violence intervention programs are picking up steam, they are still only offered by a subset of hospitals.
“If you go to most hospitals across the United States, it’s all about treating the physical wound,” said Ranney, who serves as chief research officer for the American Foundation for Firearm Injury Reduction in Medicine, a not-for-profit that brings together healthcare and public health professionals. “That is changing, though.”
Hospitalization for a firearm injury has been linked with the likelihood of a patient experiencing another violent injury or being arrested for a violent crime.
That’s led a few dozen hospitals across the U.S. to stand up programs to provide mental health services and connections to community groups that address social determinants like food and housing insecurity, which they say can make that next incident less likely.
One study in Chicago found 8% of patients who participated in a hospital-based violence intervention program reported a repeat injury in the following six months, compared with 20% of those who hadn’t participated in a program. Another study in Baltimore reported 5% of patients participating in a program were re-hospitalized, compared with 36% of those who weren’t.
That said, hospital-based violence intervention programs aren’t easy to set up.
They require hiring—and paying—staff to regularly engage with patients and cultivate connections with the community for services that some might initially view as beyond traditional hospital care.
The cost of a hospital-based violence intervention program varies depending how busy it is, what types of services patients need and, notably, how many staffers a hospital decides to hire. It costs roughly $350,000 annually to run a hospital-based violence intervention program that serves 90 clients, according to a 2015 study published in the American Journal of Preventive Medicine.
Most of that cost goes to funding personnel, namely the staffers who work with patients and connect them to relevant community services.
Stephanie Harris has worked as a clinical case manager with the Life Outside of Violence program, a hospital-based violence intervention program in St. Louis, since 2018.
She says her favorite part of the program is getting to know new people and building a rapport after a patient comes into the hospital, so she can figure out which organizations and services in St. Louis—the city she grew up in—she can connect them with to help them build their future.
It’s “really not knowing what type of situation that a person’s going to come in (with),” Harris said. “It’s part of the challenge, but it’s also a part of the reward.”
The LOV program brings together four Level 1 trauma centers in St. Louis—Barnes-Jewish Hospital, SSM Health St. Louis University Hospital, St. Louis Children’s Hospital and SSM Health Cardinal Glennon Children’s Hospital—and is housed at the Institute for Public Health at Washington University in St. Louis.
The program is funded through a three-year, $1.6 million grant from the Missouri Foundation for Health.
It’s also part of the St. Louis Area Violence Prevention Commission, a group that brings together various gun violence prevention groups in the city.
Harris is one of a team of case managers who reach out to patients who arrive at a participating hospital with a violent injury to tell them about the program, ideally within 24 or 36 hours of presenting at the hospital. Four of the case managers work out of a hospital that they’re assigned to; another is a “floater” who covers all of the units.
She said it’s important to talk with patients to understand their goals and what motivates them, which informs what will drive potential changes in their lives.
If a patient is struggling because they don’t have a job, a case manager can help them build their communication skills and address anger management, as well as talk through how not changing those behaviors may stand in the way of their employment goals. A case manager can also refer patients to services that help with job opportunities and creating resumes.
It’s “really finding out what types of services they might be looking at,” and explaining how the LOV program can provide that, Harris said. That’s usually more effective than just pitching the program right off the bat and trying to convince a patient to enroll, without first understanding what types of support or services they need.