Beyond the Byline: Gun violence prompts preventative intervention

Modern Healthcare Hospital Operations Reporter Alex Kacik and Technology Reporter Jessica Kim Cohen talk about how some hospitals are viewing gun violence as a public health epidemic.

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• Modern Healthcare (@modrnhealthcr)
• Alex Kacik (@alex_kacik)
• Jessica Kim Cohen(@JessicaKimCohen)

Music Credit: Coffee by Cambo

Alex Kacik: Hello, and welcome to Modern Healthcare's Beyond the Byline, where we offer behind the scenes look into our reporting. I'm Alex Kacik, I write about hospital operations. And today I'm talking with technology reporter, Jessica Kim Cohen, to talk about how hospitals are trying to prevent gun violence. Thanks for joining me, Jess.

Jessica Kim Cohen: Yeah. Thanks Alex.

Alex Kacik: So, we get to preview a story coming up, a special report that's taken a look at how providers are responding to shootings, and that's going to publish on Monday. And we live in Chicago, which is home to some of the busiest trauma centers in the world. But across the country, there have already been around 23,000 gun-related deaths, as of early July, just pretty stark.

Alex Kacik: I'm curious, what did you learn when you talk to a clinical social worker at Cook County's Stroger Hospital who coordinates a violence intervention program?

Jessica Kim Cohen: I think one thing that came up that I thought was really interesting was, if you're familiar with trauma care, a concept that comes up a lot is this idea of the golden hour and this idea when someone is suffering from a severe injury, that you want to get them to medical treatment within an hour. And that that is going to basically increase the likelihood that they survive.

Jessica Kim Cohen: So something many of the people who are involved with hospital-based violence intervention work talked about, including Andy Wheeler at Stroger Hospital, was this idea of a similar type of golden opportunity in the aftermath of a violent injury, such as a gunshot wound, and this idea that after being injured through a gunshot wound or a stab wound or another form of violent injury, patients might be more amenable to making certain changes that might make it less likely that they're injured again in the future, which is where this idea of some of these violence intervention programs at hospitals come from; basically programs that provide wraparound services to patients recovering from a violent injury. So they might connect them to social service resources, related to social determinants of health, mental health resources, a lot of things that kind of fall under that category.

Alex Kacik: And I'm curious, since we live in Chicago where we have a lot of gun violence, and I'm imagining just in terms of the prevalence of these programs, when you talk to hospitals in the area, as well as across the country, what did you gauge about how common these are, and generally, that the clinical worker that you talked to portraying in a bit of a different light, mentioned it in the lens of a public health issue? Is that sentiment generally more accepted?

Jessica Kim Cohen: Yeah, that's a great question, because it does seem like most hospitals across the US tend to focus on just treating kind of the physical wound when someone comes into a trauma center, treating that physical injury. So these types of programs that provide wraparound services and try to reduce the likelihood that a patient experiences another violent injury, not particularly common. There's a few dozen of these programs throughout the US at various hospitals, but they are becoming more common as this concept of gun violence as a public health issue has become more mainstream.

Jessica Kim Cohen: I'd say about five years ago, maybe 10 years ago, it was potentially controversial or maybe a little different to be making that claim, but it's become a little more accepted now. I know recently President Joe Biden put out a statement where he referred to gun violence as a public health epidemic. So it is something that is talked about more widely now.

Alex Kacik: Yeah. And you mentioned typical practice of treating the physical wound. A lot of times, it's harder for hospitals to expand from and beyond that mindset. Looking at things like family issues and coordinating visits with peer support groups, maybe connecting folks with food and housing assistance and mental health resources, that's not their historical approach. And you have to look at the incentives that drives some of these programs.

Alex Kacik: You have hospitals being paid typically on a fee for service basis, which doesn't encapsulate these wraparound services oftentimes, but then some of these alternative payment models try to reward that more. But I imagine some of the barriers for these programs getting traction is how these services sometimes are not paid.

Jessica Kim Cohen: One of the major challenges to setting up these types of programs is definitely a funding challenge. It does take work and money to set these programs up. Particularly kind of a cornerstone of a hospital violence intervention program is hiring a social workers or case managers who work really closely with the patients who coordinate those wraparound services. And there has to be a way to pay those people for that work, and right now there's not a consistent way that those employees are reimbursed. A lot of the ways that they are paid today is through grant funding. And while it's great that there is grant funding, can definitely be a challenge.

Jessica Kim Cohen: If an organization is awarded, say, a three-year grant to stand up a program, when it comes to the end of that three year, they have to either apply for a new grant or figure out a new way to fund that program, so that's always a challenge. There have been some efforts to encourage health plan health plans, like Medicaid health plans to begin reimbursing for some these services, but that is not something that's widely caught on.

Alex Kacik: And I imagine, just having the resources and expertise of navigating a grant cycle, you have to have someone that's familiar with how some of these state and federal grants work and make sure you have the right approach when asking for these types of funds. And then, so I imagine that could put some hospitals at a disadvantage too, if they're not as familiar with how these grant cycles work. I know they're typically working with CMS for reimbursement issues, but yeah, it sounds like you have to have another layer of expertise when you're trying to work around some of these potential alternative payment forms.

Jessica Kim Cohen: Definitely. And I guess in terms of grants, there's also, every grant might have a different focus or different criteria. So that's something that hospitals have to balance if they're applying for multiple grants. Some grant funding comes through philanthropies, some comes through research grants. A major source of funding for these types of programs is from the Victims of Crime Act, which was federal law that was passed in the 80s. And money is distributed through the states and through local governments to fund programs that support victims of crime. So there's a bunch of different things we balance in when figuring out how to finance this type of program.

Alex Kacik: Sure. And there seems to be a link from a couple of studies that you referenced in your story between these intervention programs and a reduction in repeat injuries. There was a study in Chicago and another in Baltimore. What did they find?

Jessica Kim Cohen: Yeah, definitely. I'd say for hospitals, that is one of the main kind of healthcare ties. Folks might wonder what the since, like you mentioned, a lot of these wraparound services are not what one might traditionally view as hospital care, but the thing to keep in mind is that one of the benefits that proponents say these types of programs have is that they reduce the likelihood that a patient who appears with a violent injury or presents at the hospital with a violent injury, has a repeat injury.

Jessica Kim Cohen: So one study in Chicago found that 8% of patients who participated in a hospital-based violence intervention program, reported a repeat injury in the following few months, compared with 20% of those who hadn't participated in that program. And then there was another study in Baltimore that found 5% of patients who participated in a hospital-based violence intervention program were rehospitalized, compared to 36% who had not participated in such a program.

Alex Kacik: So I'm curious, just from your general sense of, I imagine you talked to hospitals that were a bit more progressive on this scale of trying to look at some of these wraparound services that would prevent some of these gun violence deaths, but is it catching on with some of the federal indications that they'll be looking at this issue and it should be treated more as a public health epidemic. What was your general feel for the appetite of, of investing more resources in these intervention programs, and if they're feasible and if they're the proper incentives?

Jessica Kim Cohen: It does seem like there's growing interest in this type of model. I'd say generally speaking, there's also been growing interest among hospitals to be tackling social determinants of health in general. So I think this kind of almost fits into a piece of that and I definitely think there's more interest.

Jessica Kim Cohen: And in terms of funding, the White House recently put out kind of a strategy about its approach to how it wants to tackle gun violence and it included a bunch of different facets; some are related to law enforcement, some are related to mental health. And then one of the things that did mention was providing more funding for community-based violence intervention programs, so programs that are doing this similar type of work that we're talking about hospitals doing.

Alex Kacik: Then you get into this thorny issue of systemic institutional racism that can be tied to some of these programs. I know it's harder to pinpoint in our reporting, but it definitely is worth a mention, where you have hospitals that have operated under a certain kind of approach and guys over the past decades and attacking these issues in these lower socioeconomic communities just hasn't been a priority. Partially that seems and how these organizations are set up. And it requires some new energy and momentum and interest.

Alex Kacik: But typically, these trauma centers, they serve a vital role in the community, but it goes to show that you have to look at some of these persistent issues and how these institutions, at least in their current form, may not be set up unless there's a mindset change or some change in staffing or resources.

Jessica Kim Cohen: Mm-hmm (affirmative). And something that also came up when I was speaking to social workers and case managers, the people who are actively working with these patients as part of these programs on a regular basis, is the importance of having those types of staff members be people who come from the community, are with the community, who can also help patients who, there might be some patients who might be a little cautious, might have a little mistrust of the medical systems. So folks who are able to really engage with patients, understand where they're coming from, make sure they understand what that patient needs, explain the ways that these programs can help them and keep them engaged. That's definitely a core part of these types of programs.

Alex Kacik: Jess, you talked with Jashawnda Dunigan, a 41 year old who has been seeing a therapist at OSF Healthcare in Peoria. Her stepson passed away in September, 2020; he was shot and killed shortly after his 21st birthday. Just from a reporting process, how did you connect with her and what was it like talking with her?

Jessica Kim Cohen: Yeah. It was really great to speak with Jashawnda, who unfortunately, her stepson died in September, 2020, like you mentioned, after being shot and killed in Peoria. She is very passionate about speaking out against gun violence. Unfortunately, multiple members of her family have been killed as a result of gun violence. And it is also very passionate about how thankful she is for the help she's received from the trauma recovery center program at OSF Healthcare, so she has been speaking about this publicly in general.

Jessica Kim Cohen: We were connected through OSF Healthcare. I reached out to them to learn more about their trauma recovery center program, which encompasses some aspects of these wraparound services we've been talking about, but also has a really big focus on mental health and helping people who have suffered from violent injuries, including kind of the family members of people like Jashawnda, deal with anxiety and depression and PTSD. So was able to be connected to her through her therapist actually at OSF.

Alex Kacik: So how did this reporting shape you, Jess, as a journalist and an individual?

Jessica Kim Cohen: Yeah, it was definitely a very heavy topic. And especially for you and I Alex, who are based in Chicago to be able to talk to some local organizations like Stroger Hospital and OSF Healthcare, isn't in Chicago, but it's in Peoria, Illinois. So to learn more about some of the programs that are going on here and also how they kind of built on and are based on other programs from throughout the country, was really interested to see this as an example of how best practices kind of permeate the Stroger Hospital-based violence intervention program, which is called Healing Hurt People Chicago was based off of a program at Drexel University in Philadelphia, and then the trauma recovery center program I mentioned at OSF, that was based off of a similar trauma recovery center at the University of California in San Francisco. So, it's been interesting to see how those best practices spread throughout the nation.

Alex Kacik: Well, Jessica, thank you so much for your reporting and sharing your experience with us.

Jessica Kim Cohen: Great. Thanks so much, Alex.

Alex Kacik: All right. Thank you all for listening and stay tuned for the story that we'll publish on July 19th. If you'd like to subscribe and support our work, there's a link in the show notes. You can subscribe to Beyond the Byline on Spotify or wherever you listen to your podcasts. You can stay connected with our work by following Jessica and I at Modern Healthcare on Twitter and LinkedIn. We appreciate your support.