The range of small communities that make up New York City all have different identities, complete with their own sounds, smells, tastes—and problems. To tackle the problem of youth violence in these communities, the New York City Health and Hospitals Corporation (HHC) and its philanthropic arm, The Fund for HHC, have developed a number of local-level programs that connect various resources such as hospitals, schools and nonprofit organizations to high-risk youth in a variety of settings—from the emergency department (ED) to the basketball court. These programs have produced a range of positive results, including developing successful, productive youth and increasing the communication and discussion around youth violence.

Kings Against Violence Initiative (KAVI)

KAVI is a three-pronged violence intervention, prevention, and empowerment program based at Kings County Hospital Center in Brooklyn. KAVI was founded in 2011 by Robert Gore, MD, executive director and attending physician and clinical assistant professor at Kings County Hospital Center. Gore grew up in Brooklyn across the street from the hospital, which made trauma a part of his daily life from a young age. “I started seeing the same things over and over again—violence, trauma—among people that looked like me, kids in my community,” he explains. “So I started thinking about what kept me and my friends out of trouble and away from these kinds of activities.”

Once Gore began his medical training, the true impact of this type of violence began to emerge. “Treating patients and talking to families about their kid who has been killed or brutally injured and seeing the people fall to the ground, hearing their screams, having nightmares and, eventually, even becoming numb to it, you start to realize that we have to do something different,” he says. “We need to find more effective solutions that give young people the resources they need.” KAVI is the result.

In the Hospital

KAVI’s hospital component is a collaborative effort among KAVI staff and KAVI’s community partners, including Save Our Streets and Man Up, Inc., both community-based efforts to end violence. Intervention teams formed from members of these groups visit kids in the ED who are victims of violence. They focus on ensuring retaliation doesn’t occur, the victims and their families are safe and they have access to follow-up behavioral health and social resources. Intervention teams have seen more than 50 kids in the ED, and their message is growing among staff as well. “We’re starting to see more clinical staff having the dialogue about safety, community resources, and the repercussions of their actions with the kids who are coming in,” Gore says.

In School

KAVI also works with high-risk youth from several local high schools to help prevent violent injury (or its reoccurrence) and re-set participants on a more successful path. Students are referred from school social workers, guidance counselors, principals and even other program participants for a variety of reasons, including a history of frequent fighting, poor school performance, gang activity, incarceration and selling drugs. “Many of these students end up in the ED as patients,” Gore says, “and all of these are risk factors for re-injury.”

Through both in-school and after school programs, KAVI provides academic tutoring, conflict resolution, mediation skills development, idea development, business and job skills training, martial arts and meditation, and arts such as photography and film. Through these avenues KAVI helps participants explore identity and perception, increase concentration, decrease anxiety and develop real skills they can apply in the world. “We make sure the kids in the program have regular mentorship and a certain level of camaraderie,” Gore notes. “All of our facilitators have been in similar [risky] situations and gotten out of them and transformed their lives.”

More than 30 students are currently enrolled in the program, and Gore notes that improvements include positive changes in attitude and demeanor, decreased substance abuse and better grades. Several participants have even gone from failing to being accepted into college. KAVI is currently working with students from three different high schools and is in the process of implementing the program in two additional schools.

In the Community

The third component is a community-based program also for high-risk youth that emphasizes behavioral health services. High-risk youth, who are referred by social workers, and even friends and family members who work at HHC, are evaluated to determine their pre-existing situation and conditions in the home environment. “Factors such as substance abuse and family trauma aren’t always identified in the schools and hospitals,” Gore says. While KAVI is working on creating workshops for participants similar to those offered in its school program, the community component currently emphasizes providing behavioral health resources, particularly counseling and therapy for participants and their families.

While each component has begun to see success and improved outcomes for participants, one important overall result of KAVI’s work is the ongoing dialogue that has emerged among the various groups involved in each effort. “It’s always been our goal to have partnerships with community-based organizations,” Gore says, “because that’s where victims go when they leave the hospital—we can’t be in all places at all times.” And he notes that by bringing all of the parties to the table, each group can share challenges and solutions and gain better access to needed resources.

The Fund for HHC

Among the participants in this dialogue is The Fund for HHC, which serves as a catalyst for innovative approaches to better care and safer communities. Using outreach and connections throughout the city, The Fund for HHC is able to suggest alternative avenues for resources to KAVI and its partners. “There is such an organic quality to the way KAVI is growing and becoming a set of links to other community organizations that are addressing pockets of social need,” explains Joe Schick, The Fund’s executive director. “In that way it’s becoming increasingly powerful.”

In addition to supporting KAVI, The Fund is working with other community partners and hospitals across HHC on related efforts. At Harlem Hospital Center, The Fund is supporting Erik Cliette, director of injury prevention, who leads the hospital’s anti-violence efforts. To offer alternatives to break what Harlem views as the Circle of Violence, Cliette has developed an arts therapy curriculum for young people and a mentoring program for new fathers called Six Winners, which pairs mature men with young men as they prepare for and experience fatherhood for the first time. Mentors teach life skills such as budgeting, physical parenting, meal preparation and home safety product installation and use. Group lectures and small group discussions augment the one-on-one interaction and offer credible adult models for program participants. “Using tangible life lessons, Six Winners is designed to engage and guide new fathers and encourage their active involvement in the lives of their children,” Schick says.

Another effort, this one at the grassroots level, is Guns Down, Life Up, a violence reduction communications campaign that uses nontraditional avenues such as short films, social media and apparel to connect with youth. “The number of people ages 18 to 24 getting shot in our communities is a community health issue of tragic magnitude,” Schick says, “Summer 2011 was extremely violent in New York.” In response, The Fund for HHC developed the phrase, “guns down, life up,” and began to spread it organically across the city via T-shirts and wristbands. “Initially we worked with HHC staff such as Dr. Gore and Mr. Cliette, who handed them out to their community partners, kids in the ED,” Schick explains, “But now we’re finding a following among different groups, such as the hip hop community, and we’re filling requests in Los Angles, Atlanta.”

Schick notes that so far The Fund has circulated roughly 4,000 T-shirts and wristbands, which are turning up across the city in outdoor basketball courts, marches and community protests. “Our message is a piece of clothing with a tag on it, but it’s become a rallying cry around violence reduction,” Schick says. “It’s an interesting approach because it gets everywhere, and it’s an effective complement to the structured, formal, hospital-based messaging.”

“If you want to subvert the circle of violence, you can’t wait until someone is a victim,” Schick says. You need to reach them when they are 10, 11 years old and change the lens they use for their lives so they can develop alternate pathways for growth.” HHC is committed to continuing down this path because as Gore notes, “They come back. Every ED doc out there can tell you stories of kids they’ve treated who come back. You don’t forget the faces or the sounds of what happens when you see that kid come back.”

For more information about KAVI, please contact:

Robert Gore, MD
Executive Director, KAVI
Attending Physician and Clinical Assistant Professor, Kings County Hospital Center
robert.gore@nychhc.org

For more information about The Fund for HHC, please contact:

Joe Schick
Executive Director
The Fund for HHC
joe.schick@nychhc.org
(212) 788-3330