"While I was visiting there on an educational trip I saw that they had this wonderful model that they use to address PTSD for the people because they are always under the constant threat of violence," Harris said.
Northwestern Medicine and the University of Chicago Medicine each invested $250,000 to launch the initiative. Trauma counselors from Israel were flown to Chicago on several occasions to provide their expertise on how best to modify the program to address the specific challenges found on the city's South and West sides.
Evidence has shown that constant exposure to violence during childhood makes an individual more likely to engage in unhealthy behaviors that often result in higher rates of chronic disease and shorter lifespans. But healthcare providers still face a number of challenges in connecting with underserved communities. Such problems have stemmed from a sordid past relationship between the medical establishment and underprivileged populations caused by multiple incidents of ethical violations against people of color for the purpose of medical research.
"Typically, black and brown people don't really go to counseling for a number of different reasons," Harris said. "They don't know the counselor, they don't trust the counselor, they don't think they can afford counseling, and the stigma—nobody wants to be labeled as being crazy."
TURN is the first violence intervention program in the U.S. to use trained community and faith leaders to provide trauma counseling. Harris said part of the program's appeal is that it leverages the relationships many of these stakeholders have developed through years of work in the community in order to serve as a bridge of trust between community residents and healthcare providers.
Last November, health insurer Cigna joined the partnership with a grant for $450,000 over the next three years to support a number of its outreach efforts.
"We had looked at the influence of violence as a co-morbidity to so many other things," said Michael Phillips, president and general manager of Cigna's Midwest market, a region comprising Illinois, Indiana, Michigan, Minnesota and Wisconsin. "We knew the best way for us to participate at the start was this idea that call center needed to be staffed and funded so that these faith leaders can do the work that Pastor Harris and the TURN Center had trained them to do."
One of the endeavors Cigna's grant has supported is operating TURN's Trauma Helpline, which launched last July to provide crisis intervention counseling for community members or referrals to healthcare professionals for more intensive mental health services. The call center is open three days a week and has received an average of about 130 calls a week so far during its first year.
There's no limit to the number of times a person can call the center for help, call center supervisor Elaine Smith said, though callers are usually encouraged to seek longer-term care from the healthcare professional.
"Most of the time we look at it as a possibility that anyone who calls us will need long-term care," Smith said. "We don't want them to become dependent on the help line."
Faith and community leaders also serve as TURN ambassadors, who go out into the neighborhoods to raise mental health awareness and educate residents about trauma.
For their part, the collaboration's healthcare partners view the project as a way for them reach out to communities where they have traditionally had more difficulty establishing inroads.
"We are obviously seeing patients who've been shot or affected by violence," said Posh Charles, vice president of community affairs at Northwestern Medicine, which receives a large proportion of shooting victims in its Level 1 trauma unit at Northwestern Memorial Hospital. "But we also want to think about what solutions we can engage in on the prevention side outside of our trauma center."
In addition to its funding, Northwestern provides the TURN Center with clinical support from its psychology department. The goal is to have the counselor hand off a patient in need of higher-level behavioral healthcare services to either their primary-care provider if they have one, or to Northwestern or the University of Chicago if they don't. "It's kind of a triage system," Charles said.
Over the past year, counselors have become more adept at care navigation by directing callers to social services and helping uninsured clients enroll in Medicaid.
A big question that Harris and his partners are just beginning to explore however is whether the TURN Center model can be replicated elsewhere. Bright Star and Tel Aviv-based NATAL, the not-for-profit that Harris visited in Israel, are in talks to develop similar programs in nine states.
Harris and Cigna's Phillips both hope their collaboration will inspire healthcare stakeholders to re-examine the way they engage with their own communities.
"This is not corporate sponsorship," Phillips said. "This is community involvement using the resources of a huge enterprise behind us to facilitate the community resources—this is community sponsorship."
