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May 08, 2013 // By Greg Richter // Comments

Penn Medicine CAREs Grant Helps Prevent Youth Violence

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IMG_0909Most Penn Medicine CAREs grants expand existing programs or start new ones that support community health. In the case of the Children’s Hospital of Philadelphia (CHOP) Violence Intervention Program, a CAREs grant extends a program already making a difference that may not have received enough funding otherwise.

After a young boy was assaulted in school by a group of peers, he was promptly treated in the ED. After receiving the medical care, he agreed to enroll in CHOP’s Violence Intervention program.  During subsequent meetings with an assigned case manager, the patient and his family shared his history of trauma and a record of numerous fights in school.

Soon that child’s long history of trauma and neglect was overshadowed by strength, as he progressed through several meetings with the case manager as well as some group sessions. Now the young man consistently sticks up for others at his school who are bullied.

“We are addressing the violence issues faced by children in their lives by identifying kids who are assaulted or injured,” said Joel Fein, MD, MPH, professor of Pediatrics, Perelman School of Medicine, director of The Philadelphia Collaborative Violence Prevention Center and an attending physician in the Emergency Department at CHOP.  “We work with a fairly high risk group within a high risk community. The goals are both immediate needs, in terms of retaliation, safety, and traumatic stress and longer term needs that are identified by the patients, families and case managers.”

The group’s focus is strictly on youth (ages 8-19) non-partner violence, and non-child abuse cases.  Fein explained that goals are set for the patient within the first month after his/her injury to most effectively prevent future violence.   A CHOP research grant started the project, but the group notes that the Penn Medicine CAREs grant is integral to continuing the initiative’s effectiveness.

In the late 90s and early 2000s, Fein worked with a team doing similar research at HUP and CHOP and had more than 1400 kids enrolled.  Recognition that there were many other similar programs across the country led to the formation of the National Network of Hospital-based Violence Intervention Programs (www.nnhvip.org). 

 “We know from our colleagues around the country, as well as the work we did earlier, that this is important work and has the potential to save lives and dollars,” said Fein.

The VIP team currently handles five high intensity cases and three low-intensity cases at a time.  Sixty kids been contacted since the program started a year ago. VIP promotes  trauma-informed care, which involves understanding what people have gone through to see how that impacts how they register and process what is happening to them in the hospital and afterward.  Youth come in through the ED or trauma unit with injuries.

Most prospective participants are not enrolled in person when an event happens.  Rather, the social work staff in the ED or on the trauma unit gives the families a brochure and informs the team that they can contact the patient within a couple weeks if the patient is interested in joining the program.

“It’s a vulnerable moment for them, and it’s a golden opportunity to give them resources to help,” said Ayana Bradshaw, program manager. 

That opening up process often reveals different perspectives in a variety of cases. Nadja Peter, MD, a adolescent medicine specialist and consultant on the project, echoes Bradshaw’s sentiment. “A lot of people think that sick kids in the hospital don’t want to talk, but then we don’t give them the opportunity to talk,” said Peter. “They are feeling stressed and anxious. If you actually try, most of those kids are thrilled to have a chance to tell what happened.”

We have some kids who are considered bullies and we have some kids that were victims of bullies, but either way, we see a lot of kids talk about their feelings in a healthy and safe way,” said Laura Vega, MSW, the violence prevention specialist. “We have seen former bullies sticking up for other kids.”

Progress with the kids helps relieve stressors on their family as well. Beyond emotional support, the group assists with school transfers, victim assistance, medical or insurance issues, and mental health referrals. The team collaborates with the Department of Human Services, assists kids on probation, and explores available legal services if needed.  In addition, they collaborate with Drexel University’s Healing Hurt People program to provide trauma-informed group therapy.

“Families are dealing with so many of their own financial burdens and health issues, and the program helps provide relief knowing there’s someone else out there to support their child,” said Vega.

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