Gun violence and community violence are among the most tragic injuries Scott Weiner, MD, MPH, says he witnesses on a regular basis as a physician in the Emergency Department.
“It’s just heartbreaking,” he said. “We’re so lucky to have a team with us at the Brigham that’s working on this, both for prevention and for response after violence occurs in a community.”
That team is the Violence Recovery Program (VRP), which was founded in 2011 as a collaboration between the Center for Community Health and Health Equity (CCHHE) and the Division of Trauma, Burn and Surgical Critical Care to advocate for survivors of community violence and patients with gunshot or stab wounds. An estimated 89 percent of patients in the VRP between 2018 and 2020 experienced trauma from a gunshot wound.
The group’s work was highlighted during Thorndike Quality and Safety Grand Rounds on April 9, which featured a panel discussion about addressing community violence with Mardi Chadwick Balcom, JD, senior director of the CCHHE, Katherine Palm, MSW, LCSW, an injury prevention and outreach coordinator for the Division of Trauma, Burn and Surgical Critical Care, and Rahsaan Peters, Violence Recovery program coordinator. Weiner served as the discussion’s moderator.
As a certified Level 1 trauma center, the Brigham can provide total care for every aspect of injury — from prevention through rehabilitation.
Palm opened the conversation by discussing the importance of injury prevention. When caring for a survivor of community violence, she aims to prevent, treat and reduce injury-related disability and death.
“As injury prevention professionals, what we do is very broad,” Palm said. “We influence policy and legislation, we mobilize neighborhoods and communities, we change internal practices and policies, and promote community education.”
To set the stage for what drives gun and community violence, Chadwick Balcom shared a quote from Paul Farmer, MD, PhD, chief of the Division of Global Health Equity: “Structural violence is visited upon all those whose social status denies them access to the fruits of scientific and social progress.”
Gun violence is on the rise in Boston. The number of aggravated assaults involving a firearm increased dramatically between 2019 and 2020 — from 94 to 632 per year, according to crime statistics collected by the Massachusetts Executive Office of Public Safety and Security.
When asked by an audience member about whether COVID-19 affected these statistics, Chadwick Balcom hypothesized that the stress of the pandemic, including stay-at-home orders and other restrictions, may have created additional tensions that led to violence.
VRP advocates work together with survivors of gun or community violence to begin the process of physical, emotional and spiritual healing from a traumatic experience. Their mission is to reduce the burden of someone’s exposure to violence when they leave the Brigham.
“Being a VRP advocate, you can meet a family on the worst day of their life,” Peters said. “Just being there and having compassion and empathy for that family and that patient is so important.”
Violence Recovery Program in Practice
By surveying patients who had received support from the VRP, the team learned that the most common patient needs after receiving hospital care at the Brigham are basic needs such as food and shelter, safety planning and trauma/mental health. Following a traumatic event, the VRP meets patient needs by providing services, including crisis intervention, legal advocacy, access to community resources and assistance in navigating education, employment and housing.
As the program coordinator and a VRP advocate, Peters collaborates with multidisciplinary colleagues to meet with patients as they enter the Emergency Department (ED), remain with them throughout their stay in the hospital and make frequent visits after they re-enter their community.
“There’s a lot that goes into it. I definitely feel inspired just being a part of the medical team, and they put a lot of trust in knowing that we’re going to follow up,” Peters said. “Part of my work wouldn’t be possible without a nurse doing their job or a social worker connecting us with a patient and their family. I want to thank the overall system of support that VRP has in the hospital.”
Chadwick Balcom emphasized the importance of the VRP providing continuity when caring for patients of gun violence who experience multiple transitions of care in the hospital.
“If you’re in the Emergency Department, you’re going to have one care team, and then, upon admission, you’re going to have a different team that’s taking care of you, then after discharge you’re going to go to your follow-up appointment — I think for any of us who have navigated our own system, it’s a real wakeup call,” she said. “Even for those of us who understand the system, it can be hard.”
Men, particularly men of color, are disproportionately affected by gun violence. Seventy-eight percent of VRP patients are male. Of that group, 54 percent identified as Black, 28 percent identified as Hispanic/Latinx and 16 percent identified as white.
“I think we have to be really thoughtful about the structural violence and the impact of structural racism, and how that plays out in who we’re seeing and how folks are impacted,” Chadwick Balcom said.
During the panel, Peters reviewed a case of a patient who passed away after experiencing multiple gunshot wounds. The VRP assisted the family in planning the patient’s funeral, provided emotional support and reconnected with the family three months later in group therapy at the Louis D. Brown Peace Institute, a local nonprofit that supports families of homicide victims.
In another case of a patient with a non-life-threatening gunshot wound, Peters shared how the VRP met him at bedside to introduce the program, coordinated and attended family meetings with social workers, and assisted him with employment opportunities after he was discharged.
“He got himself healed up and stayed in communication with VRP and was interested in putting some goals together and getting a career,” Peters said. He connected the patient with a trade union and set up a job interview. “Just being able to have that opportunity was a big resource moving forward for that young man.”
The VRP and Stepping Strong Injury Prevention Program have teamed up for the Mother’s Day Walk for Peace to support the Louis D. Brown Institute. Learn more.