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A Forerunner in Violence Prevention Shares Comprehensive Outreach Approach

In the mid-1990s, Alameda Health System’s (AHS’) Oakland-based Highland Hospital was no stranger to victims of violent crime, many of whom ended up in Highland’s trauma department. While at Highland, these patients healed physically and received the immediate crisis and emotional support they needed, but long-term, permanent change remained elusive. Determined to make a deeper connection that healed more than just the short-term effects of a gunshot or stab wound, Highland joined with Youth ALIVE! to develop Caught in the Crossfire, a youth violence intervention program that has changed the lives of countless Oakland youth and has become a model for violence intervention programs across the country.

“Having worked for 11 years as a medical social worker, I saw that once we saved, loved, and cleaned them up, that was it for these patients,” says Stefania Kaplanes, MSW, injury prevention specialist for AHS. “We were missing the hand-off.” To make a meaningful and lasting connection with patients during that hand-off, Highland Hospital and Youth ALIVE! developed Caught in the Crossfire in 1994. The program hires young adults who have overcome violence in their own lives to serve as intervention specialists. “These intervention specialists can do what we can’t,” Kaplanes says. Coming from the same communities as the victims themselves, the intervention specialists initially provide the emotional support at the bedside that these patients need. “They catch these patients when they are lying in a hospital bed, staring at the white walls – it’s a moment when they really have the opportunity to think about their lives,” she explains. Patients’ openness to change at this moment is made clear by the program’s 99 percent consent rate.

The initial conversations focus on the crisis at hand and preventing retaliation. And to be truly effective, these conversations involve more than just the victims themselves. “They talk to the victim’s brother in the waiting room or his friends in the parking lot,” Kaplanes says. The in-hospital moment is the point at which the victim, friends and family and can see the toll this violence takes on parents, siblings and the perpetrators themselves, and the intervention specialists use that momentum to stop retaliation and position these troubled youth on a divergent path.

Once patients are discharged, intervention specialists provide case management for the following 6 to 12 months. They help patients get situated in school or job training, link them to community programs and provide at-home mentoring. “The intervention specialists are also there for the details such as transporting patients to clinical appointments,” Kaplanes says, “and it’s amazing the amount of counseling they can accomplish in the waiting room before an appointment.”

The program quickly proved successful, and in 1999, former Attorney General Janet Reno selected it as a model to be replicated throughout the country. Kaplanes, however, was not satisfied with the program as it stood. “Initially the program only targeted youth ages 14 to 20, but we saw so many more victims of these crimes outside that age range,” she explains. She eventually persuaded Youth ALIVE! to increase the upper age limit to 24, and the group now reports that since 1994, more than 1,300 Oakland and Los Angeles youth and several thousand of their family members have been helped by Caught in the Crossfire. And, as of 2009, 95 percent of all active Caught in the Crossfire participants avoided re-injury and 90 percent were not arrested.

But Kaplanes still found too many victims that Caught in the Crossfire couldn’t reach. So, she contacted Oakland Unite, a city-administered program that works with residents, local agencies and community-based organizations to stop violent crime. With the help of Oakland Unite, Kaplanes was able to target older adults in particularly violent areas. “Oakland Unite does street outreach,” Kaplanes explains. “With our help, they can pinpoint people who have been victims before and remind them what it was like to be in the hospital and that they deserve a better life. My heart and soul is in this hospital, but Oakland Unite is my heart and soul in the streets.”

In addition to working with Oakland Unite, Kaplanes facilitated weekly meetings with different community resources to ensure the entire community is doing everything it can for each and every patient. “We provide information on hotspots in the community where shootings and homicides are taking place,” Kaplanes says. “We also follow up on referrals for mental health counseling and other services. We’re holding the community responsible for its members.”

Kaplanes also participates in the recently launched Operation Ceasefire, an evidence-based strategy designed to significantly reduce gang and group related homicides and nonfatal shootings. The program brings high-risk offenders involved in actively violent groups together with the mayor’s office, police department, parole and probation offices, clergy and other community groups. During these meetings, the groups try to show these violent offenders the range of outcomes that can result from their behavior – Kaplanes shares what gun violence can do. “I describe what it is like to be a quadriplegic, to lie in a hospital bed unable to move,” Kaplanes says. “And most of them say, ‘the hospital case got me the most.’ They’re not scared of the other options – jail, death – those things don’t scare them. But being paralyzed, that scares them.”

For younger community residents, who haven’t yet landed in the hospital or a jail cell, Kaplanes is working to ensure they find something greater to live for. During Highland’s Youth Leadership Tours, students visit the hospital emergency department and intensive care unit (ICU). They talk with clinicians about brain damage and respiratory therapy. “On the way to the hospital, the students are bragging about gangs. But on the way home, after getting a sense of what it is like to go through that kind of physical damage, they’re talking about hospital-based career options,” Kaplanes says. “Many of these kids don’t even expect to make it to 25. So for them to make such a mental turnaround, to get excited about life, is a major accomplishment.” Not only do these students change their perceptions of the future, but many follow through on their tours with internships and hospital-based projects.

Through these programs, Kaplanes and Highland Hospital have not only prevented community violence and hospital readmissions for violent trauma, but have brought meaning and success to countless struggling youths. In an effort to share these achievements – and learn how other hospitals are fighting these same battles – Highland’s Caught in the Crossfire program became a founding member of the National Network of Hospital-Based Violence Intervention Programs in 2009. This network brings together the best and most exciting programs in the country to share knowledge, develop best practices, collaborate on research and affect policy change. Kaplanes also presented her work at Highland during the 24th Institute for Healthcare Improvement annual forum in December 2012.

“When I worked in the ICU, I always wanted to have had the opportunity to talk to the patients before they got there,” Kaplanes says. “I miss being with those patients during their time of need. But it makes sense for me to be in the community, reaching them now before they reach the ICU.”

For more information about Highland Hospital’s violence prevention programs, please contact:

Stefania Kaplanes, MSW
Injury Prevention Specialist
Alameda Health System – Trauma Department
skaplanes@acmedctr.org
(510) 535-7648

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