Helping victims break the cycle of gun violence
When Javier Arango was paralyzed in a drive-by shooting at age 17 in Oakland, he became part of a high-risk patient statistic: a young black or Latino male injured in gun violence who was likely to be shot again, and possibly killed.
Arango, now 26, recalled being approached by representatives from a violence intervention program connected with Oakland’s Highland Hospital, where he was treated. The purpose of the program was to connect gun victims like him with resources to break the cycle of violence. But Arango said he was so angry and bent on retaliation he wasn’t receptive to the help.
“I didn’t receive no counseling, no trauma support,” he said. “I just got put back in the hood.”
Arango joined a gang and in 2009 was grazed in a shooting, but it took the death of a young friend later that year to make him put down his gun.
Dr. Jahan Fahimi, a UCSF emergency room physician who saw patients like Arango at Highland during his training, believes that when gunshot victims come to emergency rooms, hospitals need to do a better job of lowering their risk of later injury or death from firearm violence.
“Everyone treats gun violence like a weird social phenomenon. Nobody really treats it like a medical health phenomenon,” he said. “These people are patients. This is a medical condition. They’ve been shot, and that carries with them injuries and personal risk when they go back to the community.”
He led a recently published study that showed gunshot victims were 5 to 6 times more likely to die in the first year after they had been treated than those injured during assaults that did not involve firearms, or in car accidents. The study, published in the medical journal Injury Prevention last month, was based on the records of more than 2,200 patients treated at Highland in 2007.
The team of UCSF and Highland researchers found that 1 in 20 of those who survived getting shot were likely to die within five years from street violence. The authors say the data show that better intervention is needed with first-time gunshot patients.
Gun violence is responsible for more than 33,000 deaths and 84,000 injuries a year in the United States, according to the U.S. Centers for Disease Control and Prevention. While many victims don’t make it to a hospital alive or die before getting discharged, others survive and go back into violent neighborhoods where they are reinjured or killed, often in retaliation or from continued criminal activity.
To break the cycle of violence, a growing number of urban trauma centers around the country, including Highland and San Francisco General Hospital, have created violence-intervention programs to reach out to patients and connect them with services to try to change the course of their lives.
Fahimi said more research needs to be done to determine how those programs are performing, but it starts with figuring out how many patients are dying after they leave the hospital or coming back with injuries.
In his study, 14 percent of gunshot patients who made it to the hospital died within five years of their injury. That includes 9 percent who died during that initial hospital visit. Of those who survived and were discharged from the hospital, 5 percent died within the following five years — with 80 percent of those the result of homicide. The vast majority were black and Latino males in their early 20s.
If there were a cancer killing that many young men, Fahimi said, “We would say that’s a huge public health problem.”
The hospital antiviolence programs that exist are still relatively new and sparse. The National Network of HospitalBased Violence Intervention Programs, which works to represent and promote such initiatives, lists just 26 established programs around the country, with an additional eight in the works. Most of the programs have started in the past five years.
Highland and San Francisco General were among the first trauma centers in the country to establish programs to connect gunshot victims with various resources.
Caught in the Crossfire, a youth violence intervention program of the Oakland nonprofit Youth Alive!, has been working with young people at Highland and other Bay Area hospitals since 1994.
The Wraparound Project at San Francisco General, which started in 2006, has a team of four case managers who rush to patients’ bedsides to link them to services that can help them with everything from post-traumatic stress or mental health issues to finding jobs and housing or continuing their education.
Dr. Rochelle Dicker, a trauma surgeon and UCSF professor who runs the Wraparound Project, said the San Francisco program is working. A 2012 analysis found that 85 percent of the patients the case managers approached agreed to participate in the project, and in less than seven years the percentage of gunshot victims that came back to the hospital dropped from 16 percent to just 4 percent.
“There are risks involved in violent injuries, just like someone who is susceptible to heart disease,” Dicker said. “But the risks are more socially determinant.”
Dicker commended Fahimi’s study for drawing attention to the problem, but she said more needs to be done, such as promoting policies that would require hospitals in violent urban areas to have specific programs to help gun-violence patients.
“Violence was always thought of exclusively as a criminal-justice issue,” Dicker said. “The thinking is still new that this is a public health issue.”
As for Arango, he is now a youth mentor and trauma expert with Catholic Charities of the East Bay. He said he visits the bedsides of young people injured in gun violence and reaches out to offer help while they’re recovering.
Arango said it might have made a difference if he had received more than one outreach attempt while he was rehabilitating.
“What the people, as soon as they get to the hospital, need first is to concentrate on healing and, at the same time, to get some trauma therapy into their life,” he said. “If not, you’re going to come back to the hospital, one way or another.”