Clinicians at Wishard Health Services provide level I, state-of-the-art trauma care on a daily basis. But because they release so many patients – specifically those with gun, stabbing or assault wounds – back into the same environments in which their injuries occurred, without intervention, those patients are likely to return with a similar injury. By implementing a number of violence prevention programs, including Prescription for Hope, Wishard has reduced recidivism (repeat behaviors), creating a safer, less violent community.
“In trauma care, we take care of victims of violence,” says Gerardo Gomez, MD, head of Wishard’s trauma center and Prescription for Hope medical director. “We fix them up and send them home in the best condition possible. But we wanted to change the factors that led to the injury in the first place.” To do so, Gomez and his staff first needed to understand the true nature of the problem. They studied readmissions for gun, stabbing and assault wound patients and found that in a 5-year period, almost 31 percent of those patients returned to Wishard with a similar injury at least once.
Gomez turned to Lisa Harris, MD, Wishard’s chief executive officer and medical director, who pointed him toward fellow safety net hospital (and NAPH member) San Francisco General Hospital. San Francisco General developed a Wraparound Project, which aims to address the root causes of violence to “stop the revolving door of violent injury.” “One of the key components of the program is to approach the patient in the hospital,” Gomez explains. “It is a teachable moment because the person, at that point, is susceptible to change.”
With a grant from the city of Indianapolis and the foundation of the Wraparound Project for support, Gomez and his team created Prescription for Hope in May 2009. They hired support specialists to interview patients – along with their family members – once they are admitted to find out which risk factors for injury the patients face. “We know that factors such as substance abuse and low socioeconomic status can influence behavior,” Gomez says. “Once we assess which risk factors are leading a patient to violence, we create an intervention program that works to change the environment and behavior.”
Wishard teams up with various county agencies to develop health, education and employment opportunities for program participants. Through these channels, Wishard helps patients develop effective life skills for responsible behavior; reduces repeated criminal activity, arrest and traumatic injury; and creates safer homes and neighborhoods. After 3 years, the hospital has seen results. Between May 2009 and May 2012, Wishard enrolled 174 patients and 83 family members in the program. During this same period, only 3.1 percent of patients have returned to Wishard with a similar traumatic injury, compared to the 31 percent return rate prior to the program.
The hospital has also developed a number of other prevention programs that run in conjunction with Prescription for Hope. For example, the Youth Violence Reduction Team (YVRT) is a pilot project focused on preventing violence among youth between the ages of 16 and 24. Wishard works with the Indianapolis Metropolitan Police Department, Peace Learning Center and Ten Point Coalition to identify and approach youth at risk for violent crime. With neighborhood-based partners such as schools, churches and community centers, YVRT works to engage these youth in positive behaviors and deter them from criminal activity. “YVRT captures the potential for violence before it happens,” Gomez says. Other Wishard-based violence prevention programs include the following:
- Soaring High – a men’s group that focuses on necessary life skills for healthy adult male development and effective communication
- Educating Kids about Gun-Violence (EKG) – a youth education program that teaches students about the legal, medical and emotional implications of youth gun possession and related gun violence
- Peace Is Power – a 1-day youth educational program put on by the Marion County Juvenile Detention Center during which trauma center surgeons and staff present concepts of the EKG program and Prescription for Hope staff and Soaring High participants present personal experiences with violence, strategies for peaceful conflict resolution and steps to getting their lives on track
- Project LIFE – an intensive program designed for youth ages 12 to 17 who have been referred from the Marion Superior Courts, Juvenile Division; participants and their families learn about the problems and consequences that arise from acts of violence through guest speakers and violent incident simulations, and they discuss their own family situations, factors that led them to violent crime and steps for change
- Gun safety posters and trigger lock distribution
While Wishard is committed to preventing violent traumatic injury before it occurs, Gomez admits that one of the biggest challenges he faces is funding. “It’s a nationwide problem,” he says. “The sources of grant support for this work are dwindling. We are showing results – these programs work – and still we are challenged to find funding.”
As the administration works to develop new policies for reducing gun violence across the country, programs such as these play an important role in creating real change in this area. And hospitals such as Wishard will continue to search for the resources to create safer communities.
For more information about Wishard’s violence prevention programs, please contact:
Gerardo Gomez, MD
Medical Director, Prescription Hope
Wishard Health Services