Carnell Cooper, MD,FACS Clinical Associate Professor Department of Surgery University of Maryland School of Medicine Senior VP, Chief Medical Officer

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1 Carnell Cooper, MD,FACS Clinical Associate Professor Department of Surgery University of Maryland School of Medicine Senior VP, Chief Medical Officer & DIO of Dimensions Health System VPMA, Prince Georges Hospital Center

2 On an average day in the U.S. 39 people are murdered 180 are shot and wounded 2,000 children are abused 27,000 people are hurt by a significant other 117 people commit suicide

3 In an average year in the U.S. 60,000 lives are lost due to violence 490,000 years of life are lost due to violence $450 billion is spent on violence related injuries Countless people are exposed to the enduring affects of trauma from violence

4 3. Violence is transmitted - through exposure, modeling, social learning, and norms.

5 TRANSMISSION OF VIOLENCE Exposure to Violence Violence Source: Mullins et al. 2004; Devries et al. 2011

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7 What Is Known About The Transmission of Violence? 1 Social Learning Modeling Mirror Neurons

8 What Is Known About The Transmission of Violence? (continued) 2 Social Norms Scripts

9 What Is Known About The Transmission of Violence? (continued) 3 Neurological Effects Desensitization Hyper-arousal Stress

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11 Impoverished Communities Chronic unemployment or underemployment Drugs and weapons easily available Gangs, Crime and violence become normalized Institutionalized prejudice/racism

12 Impoverished Schools Under-funded, under-staffed, underresourced Disorganized Limited enrichment courses Zero-tolerance policy

13 Violence Intervention Project (VIP) Archives of Surgery, Vol. 135, No. 7, July 2000 Repeat Victims of Violence: Report of a Large Concurrent Case-Control Study History of Abuse as a Child 25% 25% 20% 15% 15% Cases Controls 10% 11% 5% 6% 5% 2% 0% Emotional abuse Physical abuse Sexual abuse

14 Violence Intervention Project (VIP) Archives of Surgery, Vol. 135, No. 7, July 2000 Repeat Victims of Violence: Report of a Large Concurrent Case-Control Study 45% 40% 35% 40% Parent(s) / Immediate Family History 43% Cases Controls 30% 25% 20% 15% 10% 5% 23% 15% 5% 20% 10% 13% 0% History of alcohol abuse History of drug use Admitted for psychiatric care Family member imprisoned

15 Violence Intervention Program (VIP): Four Phases of Service Intervention (rev 04/09) An Intensive Hospital-Based / Community-Driven Set of Services to Reduce Interpersonal Violence & Violent Crime University of Maryland Medical Center R Adams Cowley Shock Trauma Center PHASE 1 PHASE 2 PHASE 3 PHASE 4 GOAL: Stabilization GOAL: Recovery & Rehabilitation GOAL: Community Reintegration GOAL: Self-Reliance Trauma & Hospitalization Time of medical, emotional, spiritual, psychological & social crisis Wonderful chance to conduct comprehensive assessments Golden opportunity for positive change From immediate trauma care to a commitment to long-term life changes Discharge & Healing Attribution of meaning to events and personal recovery Identification of supports and connection to resources Development of personal goals Recognition of risk taking & violent behaviors From physical healing and immediate crisis to positive adjustment and new outlook Life Skills & Environment Identifying, developing, & reinforcing positive resources Learning & practicing new skill sets Establishing new support systems & goals From ongoing crisis and drama to daily integration & application of constructive attitudes & behaviors Managing Change & Growth Reinforcing skill sets through practice Maintaining positive supports Staying future oriented & committed to goals Being solution focused Celebrating accomplishments From instability to a foundation of internal & external resources Outcomes Outcomes Outcomes Outcomes Rapport building/trust Focus on personal goals/strengths Non violence/safety /No retaliation Family involvement Positive social support networks Commitment to medical recovery Recognition of risk taking behavior Acknowledging negative behavior Commitment to change behavior Commitment to VIP services Develop & reinforce future orientation Learn non-violent means of self expression & conflict resolution Learn & practice healthy coping skills Referrals based on needs assess.: Parole/Probation Drug/Alcohol Mental Health Education/Employment Other. Growth in personal responsibility Improvements in setting & reaching goals Success with referrals and service plans Decrease in violence and criminality Increase in pro-social attributes Improvement in healthy coping skills Significant personal accomplishment Role model to peers, family & kids Promotions at work / new jobs Sobriety / long term recovery Long term renter /home owner Child custody /positive parenting Continuing education Continued health / health insurance Drivers license / insurance Other.

16 Pre-Post VIP Statistics Before Program After Program Intervention/ Non-intervention/ Intervention/ Non-intervention Case Group Control Group Case Group Control Group (n=56) (n=44) (n=56) (n=44) Hospitalizations 56 (100%) 44 (100%) 3 (5%) 16 (36%) Cost of $46,000 each $46,000 each $138,000 $736,000 hospitalization

17 First National Symposium of Hospital-based Violence Prevention Programs March 2009 Oakland, California

18 Mental Health in our Communities The role of behavior health in perpetrators or victims of violence. Diagnosis?? Treatment?? Management??