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
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
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
3. Violence is transmitted - through exposure, modeling, social learning, and norms.
TRANSMISSION OF VIOLENCE Exposure to Violence Violence Source: Mullins et al. 2004; Devries et al. 2011
What Is Known About The Transmission of Violence? 1 Social Learning Modeling Mirror Neurons
What Is Known About The Transmission of Violence? (continued) 2 Social Norms Scripts
What Is Known About The Transmission of Violence? (continued) 3 Neurological Effects Desensitization Hyper-arousal Stress
Impoverished Communities Chronic unemployment or underemployment Drugs and weapons easily available Gangs, Crime and violence become normalized Institutionalized prejudice/racism
Impoverished Schools Under-funded, under-staffed, underresourced Disorganized Limited enrichment courses Zero-tolerance policy
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
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
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.
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
First National Symposium of Hospital-based Violence Prevention Programs March 2009 Oakland, California
Mental Health in our Communities The role of behavior health in perpetrators or victims of violence. Diagnosis?? Treatment?? Management??