1 of 20

Violence Recovery Program

INTERNAL USE ONLY

Franklin N. Cosey-Gay, PhD., MPH Urban Health Initiative

University of Chicago Medicine

2 of 20

Public Health Prevention

INTERNAL USE ONLY

19th Century Great Sanitary Awakening

  • John Snow’s Epidemiological Discovery of Cholera
  • Edwin Chadwick’s Sanitation Systems

​

Mid 20th Century (1950s-60s) –Please complete this sentence below:

“ don’t kill people, People Kill People!”

​

Public Health Goal: neither to determine fault nor to place blame but to focus

on prevention- eliminate the problem before something bad happens

(Hemenway, 2006 p. 6).

​

Public Health: When the social and environmental conditions cause disease, and the solutions lie within society, it is no longer and individual responsibility it is a collective responsibility.

2

3 of 20

Violence is Public Health Problem

INTERNAL USE ONLY

  • Victims are overwhelmingly male (86%)
  • Primarily killed by firearms (85%)
  • Mostly African-American (77%).

​

    • In 2022, African Americans comprised 81.2% of homicide victims and 79.4% of non-fatal shooting survivors across all community areas, despite the fact that African-American residents make up approximately one-third of the city's population (Chicago Violence Reduction Dashboard, 2022).

​

    • “In the U.S.A., for every 100,000 black men, there were 1,341 years of potential lives lost due to homicide” (Sharkey, 2018 p. 70).

​

•

3

4 of 20

Public Health Approach to Violence

INTERNAL USE ONLY

The public health approach emphasizes understanding risk and protective factors at the following levels:

  • Individual
  • Relational (family, peers, acquaintances)
  • Community (neighbors, community based organizations)
  • Societal

Public health is approach focuses on prevention and the strong conviction that violent behaviors and its consequences can be prevented (Dalhberg & Krug, 2006).

​

Efforts at preventing violence begin answering the following questions: What, Who, How, Where and Why?

4

5 of 20

Emerging Public Health Approach

INTERNAL USE ONLY

Emerging Public Health Practice is going beyond just looking at risk behaviors but looking upstream at conditions such as:

  1. Physical environment (land use, transportation, housing, residential

segregation, exposure to toxins),

  1. Social environment (experience of class, racism, gender, immigration)
  2. Economic environment (employment, income, retail business, occupational hazards)

Emerging Public Health Practice examining issues concerning social justice and equity by paying special attention to the root causes of violence; oppression, racism and structural violence

5

6 of 20

Chicago, A Tale of Two Cities: A Century of Structural Racism

INTERNAL USE ONLY

6

1919

1950’s

1970’s

1980’s

1990’s

1920’s

2000

  • Urban Renewal Acts
  • Slum Clearance Act
  • Federal Housing Authority (FHA) Mortgage insurance programs

National Highway System built

Deindustrialization and Restructuring of Economy towards globalization begins

Due to lack of jobs - Crack Cocaine Generation spawns from underground economic trade

Mass Segregated Housing Begins

  • War on Drugs
  • De-Centralized Gang leaders
  • CHAnge:

Transformation of Public Housing

  • RE-Segregation of the Poor

Birth of Carceral Age

  • Largest school closing in US history
  • 400% increase in mass supervision
  • 700% increase in incarceration rates

2010

Chicago Race Riots

Restrictive Covenants

7 of 20

Violence Recovery Program – Needs and Launch

INTERNAL USE ONLY

7

Image of 2016-20 violent crime rates per 100,000 in UCMs community service area, on Chicago’s South Side

Images of 2018 news article headlines discussing re-opening of Level 1 adult trauma center at UChicago

8 of 20

UHI: Core Public Health Functions at UCM

INTERNAL USE ONLY

https://www.cdc.gov/publichealthgateway/publichealthservices/originalessentialhealthservices.html

UHI’s scope covers all public health function areas and essential services (CDC, 2020)

UHI is not alone: many other programs, services, and researchers across UCMC fulfill aspects of essential public health services

UHI partners with many of these stakeholders to evaluate full-scope of UCMC impact on communities we serve.

Evaluation and Continuous Quality Improvement

Run access to care and service linkage programs

Public health workforce and leadership (CHWs, Epidemiologists, etc.)

Strategic planning: community health improvement planning (e.g. CHNA)

Partnerships with CBOs, civic groups, faith orgs, foundations

Regulatory reporting for UCMC non-profit status maintenance

Partnerships with CBOs, civic groups, faith orgs, foundations

Expand prevention and care coordination programs across UCMC and beyond (e.g. SSHCO)

Home and Community Screenings; Referrals to services; Case management follow-up

Conduct CHNA; Use primary and secondary data to inform program aims, assess for program impacts, community-level implications

9 of 20

Violence Recovery Program Model

INTERNAL USE ONLY

9

Reduce re-injury risk & promote comprehensive recovery

Objectives

Increase outreach & engagement with patients & families

Coordinate interventions & referrals via case management

External Partners

Violence Recovery Program Model

Initial Trauma and In-Patient Stay

Assessments, interventions, planning

Case Management and Follow up

Violence Recovery Specialists

Healing Hurt People

REACT

Child Life

Trauma Teams (Comer &

Spiritual Care

CCD)

​

Goal

10 of 20

The Work of a Violence Recovery Specialist (VRS)

INTERNAL USE ONLY

Crisis Intervention

Case Management

Crisis intervention aims is to reduce secondary traumatic stress for survivors and friends/family. The Violence Recovery Specialists utilize a trauma responsive psychological first aid framework to aid in reestablishing emotional/psychological safety. These tasks can include:

  • Assessing for immediate re-injury risk
  • De-escalation in collaboration with public

safety

  • Facilitating visitation and wayfinding
  • Facilitating clinical updates + death notification
  • Facilitating body viewing for the deceased with chaplaincy
  • Connections to bereavement support
  • Interfacing with law enforcement, strictly by patient/family request

Case management can last 1-day to 1-year varying on a case-by-case basis. Case management primarily serves the violence survivor but also extends to their loved ones when appropriate. These tasks include:

​

  • Safety assessments and planning
  • Referrals to community based behavioral health, social services, and street outreach/victim advocate service providers
  • Psycho-education on trauma responses and supportive counseling
  • Addressing barriers to service via advocacy
  • Crime victims’ compensation education and application support
  • Continuous reinjury risk and protective factors

assessment

11 of 20

UCM Patients Engaged by the Violence Recovery Program – General Overview

INTERNAL USE ONLY

12 of 20

UCM Patients Engaged by VRP to Date

INTERNAL USE ONLY

Month of Arrival Date

​

VRP Inclusion Criteria: VRS respond to all Level I trauma activations for patients presenting to ED with intentional and/or community violence-related injuries. VRS also respond to pages, consults, and requests from trauma teams for Level II and non-trauma activations, for cases such as graze wounds and/or assault disclosures. The ED is defined as both Comer (pediatric patients younger than 16 years) and CCD (adults and patients 16 years and older) locations of the UCMC.

​

Data Source: Patient information collected by VRS through patient interviews documented in REDCap and UCM medical records in Epic between May 1, 2018 and Dec 31, 2022.

Number of UCM Patients Engaged by VRP

7,486

13 of 20

UCM Patients Engaged by VRP in the Past Year

INTERNAL USE ONLY

Month of Arrival Date

VRP Inclusion Criteria: VRS respond to all Level I trauma activations for patients presenting to ED with intentional and/or community violence-related injuries. VRS also respond to pages, consults, and requests from trauma teams for Level II and non-trauma activations, for cases such as graze wounds and/or assault disclosures. The ED is defined as both Comer (pediatric patients younger than 16 years) and CCD (adults and patients 16 years and older) locations of the UCMC.

​

Data Source: Patient information collected by VRS through patient interviews documented in REDCap and UCM medical records in Epic Jan 1 and Dec 31, 2022.

1,909

2021

2,283

2020

1,814

2019

1,299

14 of 20

Geographic Distribution of UCM Patients Engaged by VRP:

Map of all Patient Home Zip Codes, to Date

INTERNAL USE ONLY

VRP Inclusion Criteria: VRS respond to all Level I trauma activations for patients presenting to ED with intentional and/or community violence-related injuries.

VRS also respond to pages, consults, and requests from trauma teams for Level II and non-trauma activations, for cases such as graze wounds and/or assault disclosures.

The ED is defined as both Comer (pediatric patients younger than 16 years) and CCD (adults and patients 16 years and older) locations of the UCMC.

Data Source: Patient self-reported home zip codes, of patients engaged by VRP from program’s inception to date (May 1, 2018 and Dec 31, 2022.).

​

Zip codes include: 60637; 60619; 60649;

60636; 60617; 60621; 60620; 60628;

60609; 60653; 60615; 60629; 60419;

60827; 60643; 60411; 60426; 60409;

60616; 46312; 60623; 46404; 60624;

46407; 60438; 60473; 46408; 60478;

60652; 46324; 60608; 60612; 60406;

60428; 60429; 60606; 60644; 60633;

60651; 46409; 60632; 46320; 46410;

60466; 60607; 46327

​

Missing zip code data from total VRP sample = 30% (of 7,486 total patients engaged by VRP).

15 of 20

Overall UCM Patients Engaged by VRP in Past Year, Descriptive Details

INTERNAL USE ONLY

VRP Inclusion Criteria: VRS respond to all Level I trauma activations for patients presenting to ED with intentional and/or

16 of 20

UCM Patients Engaged by VRP Presenting

with Gunshot Wound-Related Injury in Past Year

INTERNAL USE ONLY

Of 1,909 VRP –

engaged patients, 67.5% presented with gunshot-related injuries

VRP Inclusion Criteria: VRS respond to all Level I trauma activations for patients presenting to ED with intentional and/or community violence-related injuries. VRS also respond to pages, consults, and requests from trauma teams for Level II and non-trauma activations, for cases such as graze wounds and/or assault disclosures. The ED is defined as both Comer (pediatric patients younger than 16 years) and CCD (adults and patients 16 years and older) locations of the UCMC.

​

Total VRP-Engaged Patients (Jan 1 – Dec 31, 2022) = 1,909

17 of 20

Among VRP-Engaged Patients Engaged,

Percent of those who were Discharged from the ED

INTERNAL USE ONLY

2020

Jan-20

Feb-20

Mar-20

Apr-20

May-20

Jun-20

Jul-20

Aug-20

Sep-20

Oct-20

Nov-20

Dec-20

Average

​

20.2%

​

19.5%

​

29.4%

​

10.7%

​

16.0%

​

26.5%

​

29.0%

​

38.6%

​

36.0%

​

37.9%

​

44.6%

​

37.7%

​

28.8%

2021

Jan-21

Feb-21

Mar-21

Apr-21

May-21

Jun-21

Jul-21

Aug-21

Sep-21

Oct-21

Nov-21

Dec-21

Average

​

27.5%

​

31.8%

​

43.3%

​

38.2%

​

34.2%

​

45.1%

​

30.2%

​

39.8%

​

42.0%

​

43.1%

​

42.4%

​

58.9%

​

39.7%

2022

Jan-22

Feb-22

Mar-22

Apr-22

May-22

Jun-22

Jul-22

Aug-22

Sep-22

Oct-22

Nov-22

Dec-22

Average

​

50.5%

​

44.6%

​

44.4%

​

53.4%

​

56.4%

​

37.8%

​

46.1%

​

47.3%

​

42.2%

​

44.2%

​

46.3%

​

43.1%

​

46.4%

​

Total VRP-Engaged Patients, Jan 1 – Dec 31, 2020 = 1,721

Total VRP-Engaged Patients, Jan 1 – Dec 31, 2021 = 2,189

Total VRP-Engaged Patients, Jan 1 – Dec 31, 2022 = 1,909

18 of 20

Expansion of Service Flow

INTERNAL USE ONLY

18

​

​

​

​

**NEW**

Street Outreach Coordination in highest volume neighborhoods

​

​

​

​

**NEW**

Medical Legal Partnership

19 of 20

​

THANK YOU!

INTERNAL USE ONLY

20 of 20