U.S. Department of Justice Office of Justice Programs Office for Victims of Crime

J ULY 2001

Working With Victims of Gun Violence About This Bulletin by Judith Bonderman Gun violence in America crosses the demographic lines of age, race, ethnicity, Identify promising or successful as- religion, gender, and class—very few Introduction sistance programs for victims of Americans have not been affected by gun violence. the scourge of gun violence. Gun violence corrodes the fabric of our n March 3, 2000, the Office for Develop recommendations for how communities, traumatizing victims, Victims of Crime (OVC) spon- federal and state crime victims’ witnesses, families, communities, and sored a roundtable discussion funds could be used to address even our Nation, as recent high- aboutO the effects of gun violence on indi- profile school shootings have shown. unmet needs. vidual victims, their families, and their To understand and respond effectively communities. This 1-day meeting in The 18-person group reflected a wide to violence in our society, we must , D.C., brought together a di- range of expertise—from a trauma sur- build on many disciplines, including the verse group of professionals who work geon who operates on gun victims to a victim assistance and criminal justice with victims of gun violence: physicians, counselor who accompanies families to fields, health care, social services, educa- tion, and the clergy.To guide our efforts social workers, mental health providers, the morgue to a judge who hears victim prosecutors, nurses, lawyers, teachers, in serving victims of gun violence, the impact statements. Although each partic- Office for Victims of Crime (OVC) school principals, victim compensation ipant’s contribution to the discussion was sponsored a multidisciplinary group of administrators, and judges. Several gun- shaped by his or her unique experience, national experts in March 2000 to iden- shot victims and survivors who lost the major concerns raised by all partici- tify key victim issues and needs, develop family members to gun violence also pants were remarkably consistent and recommendations for using federal participated. This interdisciplinary supported by the growing literature on funds to address victims’ needs, and discussion was designed to gun victimization. This bulletin high- identify promising practices to serve victims of gun violence. lights the issues raised and the recom- Identify key victim issues stemming mendations developed by the roundtable. Not surprisingly, this bulletin indicates from violence. While our focus was victims of gun that some demographic groups are dis- proportionately victimized by gun vio- crime, as mandated by the Victims of Increase understanding of the full lence and that many victims never Crime Act (VOCA) administered by range of gun victims’ needs and how receive needed services.And while we OVC, we recognize that victims of all they differ from the needs of other typically think of gun violence victims as crime victims. types of gun trauma—including uninten- victims of , we were reminded tional shootings and —have Continued on page 2 OVC Bulletin

geographic boundaries—from inner cities between the ages of 15 and 24 have the About This Bulletin to remote rural areas to upscale suburbs highest firearm homicide rate of any de- Continued from page 1 and in homes, public housing communi- mographic group. Their firearm homicide ties, schools, workplaces, recreational rate of 103.4 deaths per 100,000 is 10 that there are many more victims who areas, bars, and on the street. Gun vio- times higher than the rate for white males survive their injuries, often with long- lence victims are young and old, male in the same age group (10.5 deaths per term physical and psychological disabili- and female, African-American and white. 100,000). In 1997, 92 percent of homi- ties.Addressing the needs of secondary victims, including children and adults In some cases, the shooter and victim are cides of young African-American men who witness violence, is another chal- strangers, but in many others, they are occurred by , compared to 68 lenge for practitioners, and one that we intimately related. percent of by firearms in the are just beginning to address systemati- general population.5 Even though violent cally in the victim assistance and com- In spite of the pervasive nature of gun crime rates, including crimes committed pensation fields.This bulletin not only violence, some demographic groups are with guns, have declined each year since outlines the many challenges before us disproportionately represented in the gun 1993, according to Federal Bureau of but also describes some promising crime victim population. The 13,252 gun 6 practices in communities across our Investigation trend reports, guns remain homicide victims recorded in the mortali- Nation to serve victims and stop the the leading cause of death for young violence.We believe that the informa- ty statistics for 1997 included 5,110 who African-American males.7 tion provided in this bulletin will ad- were 15 to 24 years old. Firearm homi- vance the field’s understanding of how cide2 was the second leading cause of gun violence affects victims and their death for the 15- to 24-year-old group. In communities and will help OVC identify the 25- to 34-year-old group, there were If all Americans were killed with and support improved services for vic- 3,706 deaths from gun homicide; at firearms at the same rate as African- tims of gun violence. younger ages (5–14), there were 284 American males between the ages firearm homicides. In fact, firearm homi- of 15 and 24 (103.4 per 100,000), many of the same needs that can be met cide was within the top 10 causes of death there would be 276,843 firearm with help from victim service providers. for all age groups from 5 to 44 years. homicide victims annually in the Gun homicide victims are disproportion- United States. (Based on 1997 Who Are the Victims ately young and predominantly male. CDC numbers and a total population According to CDC, 84 percent were male of 267,636,061.) of Gun Violence? in 1997. At ages 15 to 19 years, the gun homicide rate for males was 8 times the The Death Toll rate for females in 1997.3 The Bureau of hen confronted with the ques- Justice Statistics (BJS) reports that males The Nonfatal Gun Crime tion, “Who are the victims of gun of all ages were 3.2 times more likely Victimization violence?” we usually think first than females to be murdered in 1998. For every firearm death, there are ap- Wabout the fatalities. According to death Moreover, the circumstances of firearm proximately three nonfatal firearm in- certificate data compiled by the National violence differ significantly for men and juries that show up in hospital emergency Center for Health Statistics, a part of the women. In contrast to men, women are rooms. With no mechanism, such as a na- Centers for Disease Control and Prevention far more likely to be killed by a spouse, tional registry, to collect uniform national (CDC), a total of 32,436 persons died intimate acquaintance, or family member data on nonfatal firearm injuries, this is, from firearm injuries in the United than by a stranger.4 at best, an estimate based on a sample of States in 1997. The majority of these hospitals.8 There may be many more non- deaths—54.2 percent—were suicides, Firearm homicide also disproportionately fatal firearm victims who do not go to 41.7 percent were homicides, and the affects African-Americans. Approximately hospital emergency rooms for treatment. remaining 4.1 percent were uninten- 52 percent of gun homicide victims are Others have estimated four to six non- tional shootings or deaths of an undeter- African-American, even though they rep- fatal injuries for each gun death.9 In mined nature.1 The effects of gun resent less than 13 percent of the total violence cross all socioeconomic and population. African-American males

2 WORKING WITH VICTIMS OF GUN VIOLENCE

addition, many crime victims may be beyond the lives lost and injuries inflict- traumatized by the presence of a gun dur- ed. According to a report from the U.S. Even those who have never ing a crime, whether or not the gun was Department of Housing and Urban “encountered a gun are aware fired. According to the National Crime Development, public housing residents Victimization Survey (NCVS) in 1998, are more than twice as likely as other of the widespread presence victimizations involving a firearm repre- members of the population to suffer from of guns in our communities, sented 23 percent of the 2.9 million vio- firearm victimization, one in five resi- lent crimes of rape and sexual , dents reports feeling unsafe in his or her witness news reports of gun- robbery, and aggravated assault. In 1998, neighborhood, and children show symp- related crime, domestic 670,500 crime victims reported facing an toms of posttraumatic stress disorder ,and high-profile assailant with a gun.10 (PTSD) similar to those seen in children exposed to war or major disasters.11 This shootings at schools, churches Secondary Victims is consistent with numerous studies find- and other public places. The The number of deaths and injuries is ing high rates of exposure to violence ever-present fear that some- just a crude index of the effects of gun particularly among youth in urban com- violence in the United States. There is munities. In one study, almost two-thirds one we love might be killed or an even greater number of secondary vic- of high school students had witnessed a injured is another form of gun shooting, and in another, 70 percent of tims, sometimes called covictims or sur- trauma. vivors of homicide. These are the parents, the youth ages 7 to 18 in a public housing ” children, siblings, spouses, and others project had witnessed a shooting and 43 12 who have lost a loved one or friend to percent had seen a . Recent data —From The Bell Campaign’s gun homicide. In the aftermath of a also indicate substantial exposure to World Wide Web site at homicide, covictims must deal with law gun violence among suburban school-age 13 www.bellcampaign.org enforcement, the medical examiner, the children. The Bell Campaign is now referred to press, and the court system, among oth- Multiple-Victim Shootings as The Million Mom March Foundation. ers. They may have to clean up a crime scene, pay the homicide victim’s medical While the number of crimes commit- bills, and arrange for a funeral and burial. ted with firearms has been falling to lev- the most secondary victims as whole els not seen since the mid-1980s,14 media classrooms of first graders, cafeterias full Secondary victims also include those who coverage and public awareness of gun of teenagers, and hundreds of fellow are touched by or witness gun violence in crime are increasing. In the past few workers witness a . The their homes, schools, or workplaces or on years, a rash of multiple-victim tragedies media coverage alone multiplies the num- the street. In the Nation’s largest public has erupted in schools, workplaces, ber of persons victimized by the crime. housing projects, the damage goes well churches, nursing homes, fast food restau- rants, shopping malls, and transportation. These are very public venues—places Needs of Gun Victims It is estimated that each that we frequent on a daily basis and “ where we should feel safe. When a gun he roundtable participants were asked homicide victim is survived massacre interrupts play in a daycare cen- to consider how gun victims may be by an average of three loved ter, prayer in a church, or commuters different from other crime victims Tand how the differences might affect the ones for whom the violent going home from work, it shatters our most basic sense of security. Consequently, services they need or receive. The main death produces a painful and even though the percentage of homicides themes that emerged were 1) the gun as traumatic grief. involving five or more victims was less the weapon of violence, 2) the young age ” than 0.05 percent in 1998,15 these are of the victims, 3) the high cost of gun —Deborah Spungen the ones that receive the overwhelming violence, and 4) the extraordinary media attention given to a small subset of gun Homicide: The Hidden Victims majority of the media’s attention. In Sage Publications, 1998 addition, the multiple-victim shootings crimes. in public places may be ones that create 3 OVC Bulletin

1. The Gun as the Weapon of Violence Much has been written on why gun Bystander Victims use increases the deadliness of attacks; for example, because guns inflict more Durham, North Carolina: April 7, 1998. While walking with his mother, a damage than other instruments, they 5-year-old boy was hit by a stray bullet from a gunfight. The bullet severed his can be fired multiple times with little ef- spine, and Taquan Mikell may never walk again. The bullet struck him more fort, firearms have a greater range, and than half a block away from the gunfight. assailants intending to kill choose the most efficient instrument.16 Whatever Nashville, : July 2, 1999. Nashville teenager Eric Harvey Hazelitt the impact of these different factors, it was fatally shot in the chest when gunfire erupted at the John Henry Hale pub- is clear that the fatality rate from gun lic housing complex in Nashville. Just 14 years old, he was caught in the cross- is much higher than that from fire of two groups shooting at each other. other weapons. This is true regardless of the relationship between the victim and Referenced from In the Crossfire: The Impact of Gun Violence on Public shooter, as the presence of a gun can turn Housing Communities, published by the U.S. Department of Housing and Urban a robbery, an argument, or an abusive Development, February 2000. relationship into a homicide.17 Washington, D.C.: June 21, 1999. Helen Foster-El, a 55-year-old grandmother, According to a 1996 BJS report, 29 per- was outside her home in the 100 block of 56th Place SE. watching neighbor- cent of firearm homicide victims were hood children play when gunfire erupted between two groups. On hearing the killed because of an argument; 21 percent gunfire, Ms. Foster-El began to shepherd the children into one of the neighbor- were killed during the commission of an- hood homes for their safety. As she was doing so, she was struck in the back by other crime, such as a robbery or drug a stray bullet and died instantly. crime; and 6 percent died as a result of a Harrisburg, Pennsylvania: June 10, 1999. Raphael Rivera, 14, was in the im- gang-related shooting.18 Offenders report mediate area of an altercation involving several individuals. When the alterca- firing a gun within 15 seconds of bran- tion escalated into gunfire, Raphael, who was not involved in the argument, dishing it, even when they had not in- sustained a fatal wound to the chest. tended to shoot the victim.19 Gun victims include those shot during traffic alterca- Referenced from The Death Toll Since Columbine, a report of the U.S. tions, gambling disputes, and verbal Conference of Mayors, Washington, D.C., January 2000. disagreements.

The lethality effect is not lost on the vic- tims. Participants repeatedly spoke of the victims putting their hands in front of gang members intent on retaliating shoot nature of the weapon used. “An impor- them and “holding up articles of all kinds at random victims when they can’t find tant difference is the gun itself. Guns are in their last moments in the magical be- the rivals they intended to kill.21 Other the only instrument developed to kill; lief that even a sheet of paper might participants talked about small children victims facing a gun suffer the trauma of save them.”20 sleeping in bathtubs to hide from stray death or the fear of death,” said family bullets penetrating bedroom walls at bereavement counselor Kevin O’Brien. Gun violence also is frequently more night. Meanwhile, participant DeLano Foster, random than other types of criminal vic- an OVC Program Specialist and survivor timization. One participant noted that The bystander victim represents the most of multiple homicides, offered that “the “bullets don’t always have a name on impersonal type of crime. But participants difference between an armed robbery and them. You can be shot from a great dis- commented that, even when the shooter a homicide could be the time it takes tance even with a bullet meant for some- targets a particular victim, the gun crime is the victim to hand over his wallet.” one else.” Young men can be “casualties somewhat impersonal. The gun, as an in- Eyewitness accounts frequently report of a war they did not partake in” when strument of both power and detachment,

4 WORKING WITH VICTIMS OF GUN VIOLENCE

allows the shooter to remain physically the lunchtime crowd, killing 23 specify the clothing in which they want and emotionally distanced from his or her people before shooting himself.22 to be buried. A psychological counselor victims. When the victims are shot in the for teenagers in Baltimore, Maryland, Dr. back, as many are, they never even see Moreover, gun victims face constant re- Rosetta Graham, spoke of the need to do the shooter’s face. This may increase the minders of their trauma from the ever- much more for this age group: “Around “Why me?” response of so many gun vic- present gun seen on television programs age 14 or 15 they become more private tims, similar to the feelings of victims of and commercials and in films and videos. and hold in their grief. They are caught drunk driving. Even American slang, for example, “one between adults who know how to make shot,” “take aim,” and “set your sights,” their needs known and young children The ability of mentally disturbed individ- takes its toll on some victims. Some whose caregivers speak for them.” Studies uals to kill at a distance, together with participants reported that any loud of urban youth show a high correlation the enormous firepower of semiautomatic noise, like balloons popping and cars between exposure to violence and depres- weapons, may have facilitated the gun backfiring, could “trigger” a response. The sion and PTSD.24 rampages that have taken so many lives exorbitant media attention paid to each in recent years. Participant Michelle new multiple-victim shooting also is re- The hopelessness of this population was a Scully Hobus was shot and her husband traumatizing for gun victims of similar recurring theme. The participants agreed killed when a crazed gunman armed with tragedies. Security changes, such as metal that one major shooting, or the daily loss two semiautomatic TEC–9 pistols roamed detectors in schools, hidden cameras, of friends and classmates, can have a pro- a San Francisco, California, law firm, dress codes, and guards in the halls, are found effect on young people just begin- shooting 15 people, killing 9 before tak- constant visual reminders of school ning to explore their independence and ing his own life. It was a long time before shootings. develop plans for their future. While she could shake the feeling of danger. some hold in their grief, others become “Even though I knew that the gun mas- Like other crime victims, gun victims suicidal or act out their feelings on the sacre at the law firm was an extremely seek redress against their shooters through street. Even in suburban settings where rare event, I kept having the feeling that the criminal justice and civil justice sys- violence is rare, a highly publicized it would happen again. I couldn’t sit with tems. Many victims, like participants school gun massacre can have a signifi- my back to the door; I thought someone Scully Hobus and Jaquie Algee, have cant impact. Counselors working with would come in and blow everyone away.” become activists. students at Columbine High School in Littleton, Colorado, worried about kids Just as Larry Gene Ashbrook did RECOMMENDATION: Clinical evidence sup- ports the therapeutic value of victims who were somewhat depressed and doing on September 15, 1999, when he working as change agents, in grassroots or drugs before the shooting. In the months shot 14 people (7 dead) in the church activities, informal support groups, since the shooting, they have seen an in- and anticrime organizations.23 Wedgwood Baptist Church in Fort crease in drunk driving, attempts, Worth, Texas. 2. The Young Age of the and fighting. Disaffected students—or those who feel alienated or rejected— Victims Just as Mark Barton did on July 29, don’t trust anyone, don’t feel safe, and 1999, when he shot 22 people (9 As previously noted, gun crime dispro- don’t do well in school. Similarly, after dead) at two brokerage firms in portionately affects young people. Their the 1998 shooting of 22 students at Atlanta, Georgia. injuries and grief must be understood in Thurston High School in Springfield, this context. The participants who work Oregon, there was a 600-percent increase Just as Kip Kinkel did on May 21, with adolescents spoke of the pessimism in referrals to the school nurse and a 400- 1998, when he shot 24 people (2 and despair, particularly in the inner percent increase in arguments and fights dead) at Thurston High School in cities, where communities are losing chil- reported to the principal. Many students, Springfield, Oregon. dren to gun violence daily. Youngsters even some who were not present at the whose relatives and friends have been Just as George Hennard did on school but who watched the news cover- shot automatically think that sooner or October 16, 1991, when he drove age, experienced a loss of control, a feel- later it will happen to them. They plan his truck into Luby’s Cafeteria in ing of being violated, and a sense of guilt their funerals, write their obituaries, and Killeen, Texas, and opened fire on that they survived.

5 OVC Bulletin

For many students, the fear of gun vio- Different problems arise and different to help them because of the high risk of lence is strong enough to interfere with types of interventions are needed to reinjury and subsequent acts of violence the quality of their lives and their per- address chronic gun violence. For the by the victim. formance in school; they also may suffer past 10 years at least, young African- from increased absentee, truancy, and American males have experienced vio- The myth that all adolescent victims dropout rates. Participants who work with lent crime at a rate significantly higher are “bad” kids is particularly harmful for children explained the importance of get- than the rate for other age groups.26 young African-American men growing up ting them to talk about their fears. They Sandra DeLeon, Director of the Rise in neighborhoods rife with drugs and gun are hungry for information and may dis- Above It violence prevention program violence. Generalizations about “predator tort facts and think they could have in West Orange, New Jersey, reported prevented the shooting. They need to that 60 percent of the students they serve understand that the school shootings on know someone who has been shot. In After my 19-year-old son the evening news are rare events and that their neighborhoods, gun violence is “was shot in Chicago, I went schools are safe places. more predictable than random. They to many support groups, com- come to school worrying about the gun- Although exposure to violence will affect shots they heard the night before. The munity organizations, and all adolescents to some extent, different students need to hear, preferably from church-affiliated meetings, but services are needed when the shooting is peer counselors, that there is a future to an isolated tragedy versus when there is a look forward to and they are not destined I really wasn’t getting what I daily threat of violence in the communi- to be either buried or behind bars in jail. needed. I needed to be more 25 ty. In the high-profile school and work- But the participants also agreed that this active in the movement to place shootings, crisis response teams is an uphill battle. The strong correlation “debrief” the victims and witnesses, often between poverty and violent crime means reduce gun trauma. I found in a group setting. The interventions for that those with the fewest resources are comfort in joining The Bell schools and communities that witness vi- the most vulnerable. In some cases, the olence are based on the assumption that parents of homicide victims are very Campaign, a grassroots the incidents they witnessed are one-time young. An enormous amount of preven- victim-based organization, horrific events. Participants who had the tive counseling is needed to keep them modeled after Mothers benefit of this type of crisis response serv- from exacting retribution while they ice felt a sense of security while the teams struggle to get daycare, buy food, and Against Drunk Driving. were there and a great void when they arrange for the burial of a loved one. ” left. In the absence of organized training, —Jaquie Algee, teachers, school administrators, and guid- The literature on children and adolescent Southeast Regional ance counselors are scrambling to get up victims reinforces the group’s findings to speed on crisis response. Many profes- about the vulnerabilities of young gun Director for The Bell sionals who helped care for the students victims. A Task Force on Adolescent Campaign who were shot or witnessed a massacre of Assault Victim Needs, convened by the their classmates also became depressed American Academy of Pediatrics, recom- youth” cause added grief for gun victims and suicidal. According to School mends addressing the psychosocial needs and stigmatize them and their families Superintendent Jamon Kent, the shoot- of young victims along with their physical unfairly. Future employers may refuse to ing at Thurston High took place May 21, injuries.27 To do this effectively, the task hire a young man with a bullet in his 1998, and the aftershocks still occupy force noted that health care providers arm, assuming that he was a gang mem- one-third of his time in the office. must acknowledge and address three ber or a bad person because he’d been myths: 1) that all adolescent victims are shot.28 On the other hand, the tendency RECOMMENDATION: Participants recom- “bad” kids who probably deserve what mended that communities victimized by to use violence is considered a serious po- gun massacres be offered long-term assis- they got, 2) that it is dangerous to care tential consequence of being a young vic- tance and training so they can more effec- for adolescent victims who may be mem- tim of gun violence. In fact, “a new study tively be involved in the healing process. bers of a gang, and 3) that it is hopeless

6 WORKING WITH VICTIMS OF GUN VIOLENCE

by the National Center on Crime and who have been raised in a subculture of and the frequent need for rehospitaliza- Delinquency finds that one of the best violence in the home may have addition- tion, the lifetime medical costs are very predictors of whether a teenager will al risk factors for long-term psychosocial high, around $35,500 per victim. For all commit a crime is whether he or she consequences.33 Effects also can be seen victims of firearm injuries (assaults) and has been a victim.”29 Siblings of gunshot in somatic disturbances. According to deaths (homicides) in 1994, the life- victims are frequently preoccupied with participant Marianne Z. Wamboldt, time medical costs totaled $1.7 billion. revenge fantasies and may be encouraged M.D., a child psychiatrist in Denver, Government programs, primarily Medi- and assisted by their peers in exacting Colorado, clinicians have noted a rela- caid, are the primary payers for 50 per- vigilante justice. Once having resorted to tionship between the general stress in cent of hospitalized gunshot injury cases violence, young men engage in more risk- the community after the shooting at due to violence.37 taking behavior. Thus, a cycle of violence Columbine High and an increase in asth- continues, and being shot once becomes ma cases and deaths among preschoolers. The growing cost of gun violence can af- the greatest predictor for being targeted fect the trauma care available for all com- 30 again. However, the risk factors for RECOMMENDATION: The roundtable consen- munity members. At King/Drew Medical sus was that much more research is need- this group are often overcome by the Center in Los Angeles, California, hospi- resourcefulness and determination of ed to develop services that take into account the full range of effects that gun tal expenses, not including professional families surviving in the inner city. violence has on children. OVC should work fees, were more than $270.7 million for with other offices in the Office of Justice the 34,893 patients hospitalized for gun- RECOMMENDATION: Participants agreed that Programs (OJP), such as the National assistance for gun victims, particularly Institute of Justice, the Office of Juvenile shot injuries from 1978 to 1992.38 Some young African-American men, must include Justice and Delinquency Prevention (OJJDP), 96 percent of these costs were paid with programs designed to teach victims to re- the Violence Against Women Office (VAWO), public funds.39 Between 1983 and 1990, gain their self-respect and status in the and BJS, to develop a research agenda con- community without resorting to more vio- cerning the needs of gun violence victims. the financial strain of treating uninsured lence. Quick outreach and support to newly The evaluation of promising direct service patients contributed to the closure of 10 bereaved families can help redirect their programs for child victims of gun violence out of 23 trauma centers in Los Angeles grief toward positive efforts to honor the should be encouraged and funded by OJP. memory of their loved ones. County.40 3. The High Cost of Gun In addition to direct health care and re- Although much of the roundtable discus- Violence sion centered on teenage youth, elemen- lated expenditures, gun violence exacts a tary school-age children also are frequent Gunshot injury and death place a substantial economic toll on its victims witnesses to gun violence and often burden on the health care system in the and society in general in terms of lost display symptoms of PTSD and other United States that far exceeds the toll productivity, use of the criminal justice trauma-related disorders.31 Some children of other types of criminal victimization. system, pain and suffering, and dimin- are afraid of school, and many become Because of the traumatic nature and ex- ished quality of life. Economists and pub- fatalistic. Some engage in aggressive play tent of their injuries, gunshot victims are lic health statisticians estimate an annual and perform poorly in school,32 while oth- more likely than other crime victims to bill of more than $100 billion for all of ers become desensitized to violence and require overnight hospitalization and these gun violence costs. An examination lose the ability to recognize and avoid followup care. BJS reports that gunshot of more than 1,000 jury awards in cases dangerous situations. The few research victims represented only 5 percent of the involving shooting victims yields an aver- studies that were available to participants estimated 1.4 million hospital emergency age loss of more than $3 million for a sin- suggested that witnessing gun violence department patients treated in 1994 for gle family of a homicide victim.41 affects children in many different ways, violence-related nonfatal injuries. But depending on the type of wound, the while the majority of crime victims are The economic loss is even more stagger- proximity to the shooter, the relationship treated and released, gunshot victims ing for victims who sustain spinal cord of the shooter and victim, and whether represent a third of those requiring hospi- injuries (SCIs) from gunshot wounds. the shooting took place in a context gen- talization.34 The average cost of acute These relatively rare catastrophic cases erally considered safe, among other care treatment ranges from $14,85035 to account for the lion’s share of the medical things. Different reactions can be expect- $32,00036 per hospital admission. Because costs for gun injuries. Each year, approxi- ed from boys and girls. Child witnesses of the young average age of the victims mately 10,000 persons suffer an SCI and

7 OVC Bulletin

require hospitalization. Nearly a quarter surviving months with tubes in their bod- School shootings in particular are trau- of these injuries are caused by acts of ies face a daunting challenge in school. matizing for children because they all violence, primarily gunshot wounds. Paralyzed for life, they never will be the go to school.45 After Columbine, pre- Violence-related SCIs have increased same active teenagers again. The practi- schoolers in Colorado began talking dramatically since the early 1970s, over- cal and social problems like calling ahead about where they would be going to taking falls as the second leading cause of and waiting hours for transportation, school as the place where they would die. SCIs (after motor vehicle accidents) in wheelchair access to classrooms, and School systems around the country saw the past 4 years.42 The average first- dealing with colostomy bags are difficult the phenomenon of school-phobic kids, year expenses have been estimated at enough without the added fears of testify- as both the news media and talk shows $217,868 (in 1995 dollars) for violence- ing in court and being targeted again by exaggerated a child’s risk of being shot at related SCIs, although the amount varies the shooter. Those with violence-related school. Although participants thought considerably depending on the extent of SCIs are more likely than other SCI pa- that such news coverage should carry a neurological damage. With recurring an- tients to have intractable pain and com- warning caption for parents about the nual charges for violence-related SCIs mit suicide. For others, the cost of acute possible adverse effects on young chil- calculated at $17,275, the lifetime care and rehabilitation, among other dren, they also felt that older children are charges are estimated to be more than things, can lead to the dim prospect of hungry to know what has happened and $600,000 for each victim. This includes constant dependence on the Government have a great need for information. In all charges incurred as a direct result of the or family.44 cases, parents and teachers need to help injury, such as emergency medical children process the information they see services, hospitalizations, attendant care, 4. The Extraordinary Media on television, so they can realistically equipment, supplies, medications, Attention to a Small Subset assess their own safety in school. environmental modifications, physician of Gun Crimes Unfortunately, the misconceptions about and outpatient services, nursing homes, On April 20, 1999, the world watched the risk of school shootings are pervasive household assistance, vocational rehabili- as two high school students, armed with in all age groups. A recent analysis of tation, and similar miscellaneous items. It automatic weapons and shotguns, killed opinion polls taken after the shootings in does not include indirect costs, such as 12 students and a teacher and wounded Jonesboro, Arkansas, and Littleton found lost wages, fringe benefits, productivity, 23 others before turning the guns on a 49-percent increase in parents’ anxiety pain and suffering, and diminished quality themselves. The tragedy at Columbine about children’s safety in the classroom, of life, which could be twice as much as High School is considered a defining 43 even though statistical studies by the U.S. the direct costs. moment in the public’s consciousness Department of Justice (DOJ) and the about gun violence. The nonstop real- A handful of gunshot SCI victims have National School Safety Center showed a time media coverage of this horrendous fared better than most. For example, the 40-percent decrease in school-associated massacre, both on the air and in print, SCI students from the Columbine shoot- violent deaths in 1998–1999, the school was traumatizing to the victims’ families ings have had the benefit of a community- year including the Columbine shooting. and friends, the community, the state wide effort to raise funds for remodeling These tragic events are truly rare—with of Colorado, the United States, and the living areas, paying for medical and living 52 million students enrolled in public world. The roundtable participants dis- expenses, specially equipped vans, and school, the chance that a school-aged cussed this media coverage, focusing on even college scholarships. But these are child would die in school in 1998–1999 its impact on children and its message atypical cases. The majority of people was 1 in 2 million.46 for those haunted by the unpublicized with violence-related SCIs are young loss of a loved one to gun violence. African-Americans with low socioeco- The gap between public fear and reality nomic status. Many in this group have RECOMMENDATION: Participants agreed is not surprising, as media coverage been targets of gun violence and have that the media should be more sensitive is focused on less than 1 percent of to how their coverage of gun violence homicides—those with multiple victims. sustained most of their injuries because of affects victims and children. OVC should drug- or gang-related activity. Those who develop training materials and guidelines Even within a group of multiple-victim return to their communities after for media coverage of gun massacres.

8 WORKING WITH VICTIMS OF GUN VIOLENCE gun homicides, the rarest events get the Services for Gun segment of the population and most media attention. For example, Victims perpetuate racial stereotyping. December 4, 1999: Sacramento, California. A 31-year-old Asian man he roundtable participants were Crime Victim shot and killed his daughter and four asked to consider how VOCA- sons, reportedly after having an ar- funded programs, both compensa- Compensation gument with his wife. A shotgun Ttion and direct services, are useful for and a high-powered rifle were found gun violence victims. Two points made rime victim compensation pro- in the apartment. throughout the day were reiterated in this grams—operating in all 50 states, discussion: the District of Columbia, the CCommonwealth of Puerto Rico, the U.S. December 5, 1999: Baltimore, Maryland. Five women were found Communities most at risk for gun Virgin Islands, the Commonwealth of shot to death in their Northeast violence need ongoing prevention Northern Mariana Islands, American Baltimore row house. Police said the work. Even though the Federal Samoa, and Guam—provide financial as- women, who were not involved in VOCA Victim Assistance Final Pro- sistance to victims for crime-related out- drug activity, were shot to send a gram Guidelines preclude the use of of-pocket expenses, such as medical care, message to a relative who was in- Crime Victims Fund moneys for “ac- mental health counseling, lost wages, volved in the drug trade. tivities exclusively related to crime and, in cases of homicide, funerals, loss of prevention,” direct services and support, and counseling for secondary vic- December 6, 1999: Fort Gibson, compensation for gun victims could tims. Many programs also pay for crime Oklahoma. Five students were in- have a secondary preventive effect scene cleanup, durable medical equip- jured when a 13-year-old opened fire by minimizing the risk of retaliation ment like wheelchairs and hospital beds, at a middle school with a 9 mm and repeat victimization. Compre- transportation to medical providers, reha- handgun he took from his home. hensive programs that provide direct bilitation, physical therapy, and ramps or services and help break the cycle of modifications to homes for paralyzed vic- The family homicide, an all-too-common violence in the community typically tims. All state victim compensation pro- occurrence, was reported only by the have more than one funding source. grams are “payors of last resort,” covering California press. The Baltimore shooting For example, a program could re- losses not recouped from other sources was prime-time news for a day and then ceive VOCA funding to support such as public or private insurance, em- was eclipsed by the middle school shoot- direct victim services and funding ployee benefits, offender restitution, or ing in a rural community in Oklahoma. from another federal agency, such as civil judgments. The state programs set DOJ’s OJJDP or the U.S. Depart- their own administrative rules and reim- Even among victims of the same shoot- ment of Health and Human Serv- bursement maximums, which average ing, the media may focus on one or two ices, to support prevention $25,000 and range from a low of $10,000 to represent the face on the story. Perhaps initiatives. to no limit for medical expenses (as in because of their pronounced activism on New York). A few states set higher limits the gun issue or because of some other Gun violence disproportionately af- for catastrophic or permanent injuries special attribute, these chosen victims fects young African-American men. that could be used for special home and become the story of . In The health care, criminal justice, health aids. In view of the large medical, Homicide: The Hidden Victims, A Guide for and media response to these victims rehabilitative, and counseling expenses Professionals, Deborah Spungen describes may be less sympathetic than re- faced by gun victims, participants agreed how individual victims of multiple-victim sponses to other crime victims. that VOCA- and state-funded compensa- shootings “tend to get lost in the scale of Whatever the reason for the tion programs provide much-needed the horror,” while “covictims who have disparate treatment of these victims, financial assistance. Although there is had a loved one selected for the [poster we must not ignore them. Assump- no available estimate of the number of victim] may experience feelings of reluc- tions about the blameworthiness of gun victims who benefit from these pro- tance, exploitation, loss of control, and young African-Americans and grams,48 Program Director of the D.C. 47 anger.” Hispanics shortchange a large Superior Court’s Crime Victims

9 OVC Bulletin

Compensation Program Laura Banks housing modifications, and occupa- program staff should be trained to under- Reed stated that 30 percent of claims paid tional therapy. For the most severely stand and be sensitive to the fears of these victims. by her program are to gun victims. injured victims, durable medical equipment such as a powered Most compensation programs have We are in a new era of crime victim wheelchair can cost anywhere from time limits for filing compensation compensation: program funding is more $20,000 to $25,000, in addition to applications. Although many states secure than ever before, and state admin- other equipment that may be need- have specific exceptions or will istrators are more responsive to the needs ed. Many have living arrangements waive filing limits for minors, the of crime victims and flexible in adminis- that can’t be modified to meet their time limits may still disqualify some tering their programs. Participants identi- needs—their third- or fourth-floor teen and young adult gun victims fied special needs of gun violence victims walk-up apartments are not wheel- who need mental health counseling and made the following recommendations chair accessible, and they cannot but are embarrassed to come forward for state crime victim compensation afford to move. In many cases, the at first and admit they need help. programs. parents or family members don’t have the resources or services to stay RECOMMENDATION: Compensation programs Survivors of serious gunshot injuries home and care for the injured per- should waive time limits for filing applica- tions to avoid penalizing young victims. may require long-term mental health son; there are a large number of 21- counseling. Currently, the states im- year-olds on ventilators in nursing pose many different limits on mental homes being covered by Medicaid. health claims, for example, limits Direct Victim Services on the total dollar amount and the RECOMMENDATION: Limits on medical ex- number of sessions. As a result, the penses should be raised for catastrophic in- VC makes annual VOCA crime juries, and programs should be flexible in victim assistance formula grants to percentage of compensation dollars defining eligible expenses as the needs of spent by the states on mental health gun victims become clear to them. For ex- all 50 states to support the provi- ample, New Jersey pays for childcare and sionO of direct services to victims of crime. claims varies enormously. Nearly all daycare services along with domestic help The state VOCA administrators, in turn, states pay for grief counseling for at a rate of $50 a day. This type of innova- survivors of homicide, and some pay tive benefit allows family members to con- subgrant the funds to victim service for mental health counseling for tinue working rather than having to stay providers. Ten percent of each VOCA family members who witness the home to care for a minor victim or an state grant must be allocated to victims of adult. crime. violent crime who have been previously underserved in that state. Underserved Although eligibility requirements RECOMMENDATION: Where necessary, state victims include, but are not limited to, compensation caps and limits should be vary somewhat from state to state, victims of federal crimes, survivors of raised for mental health counseling to they all require victim (or claimant) homicide victims, and victims of assault, permit long-term counseling. States should cooperation with police and prose- consider extending benefits to more sec- robbery, gang violence, hate and bias cutors. These requirements may be ondary victims, such as students or co- crimes, intoxicated drivers, and elder workers who witness a shooting, even if difficult for gun violence victims in abuse. States also may define underserved they are not family members and were some cases and may discourage them not threatened by the shooter. victims according to their status as sen- from applying for compensation ior citizens, persons with disabilities, benefits. In addition to medical and mental racial or ethnic minorities, and residents health expenses, victims whose RECOMMENDATION: Encouraging victim co- of rural areas or inner cities. Eligible di- brains have been damaged or spinal operation with law enforcement is a valid rect services include programs that 1) re- cords have been injured as a result of goal of state compensation programs. However, the Federal VOCA Victim Com- spond to the emotional and physical gun violence may require long-term pensation Final Program Guidelines en- needs of crime victims, 2) assist primary care, special transportation services, courage program administrators to be and secondary victims of crime to stabilize flexible about cooperation requirements their lives after a victimization, 3) assist in cases where they may present special barriers for the victim. Law enforcement victims to understand and participate personnel, prosecutors, and compensation in the criminal justice system, and

10 WORKING WITH VICTIMS OF GUN VIOLENCE

4) provide victims of crime with a meas- The Recover program in Washington, victims. Program staff are available to as- ure of safety and security, such as board- D.C., has a professional grief counselor in sist families of all emergency patients at ing up broken windows and replacing or the Office of the Chief Medical Examiner the hospital. If the patient dies, the pro- repairing locks. to offer emotional support before, during, gram advocates help the decedent’s family and after the process of identification of a navigate the next steps—decisions about Many of the current VOCA subgrantees loved one. Recover staff do an early assess- organ transplant, hospital procedures, may provide services that are used by vic- ment of needs, including inquiring about meeting with police officers, answering tims of gun violence, such as homicide children who may be affected, and set media inquiries, and referrals to counsel- support groups and victim advocates in up case management services. Staff or ing or pastoral services. This program is prosecutors’ offices. Because there are trained volunteers are available for practi- staffed primarily with retired D.C. homi- no data on how many existing programs cal and emotional support, including cide detectives. serve gun victims and no service directory planning a funeral, explaining the griev- of gun victim programs, the roundtable ing process, talking to children about RECOMMENDATION: OVC should support the development of promising multiservice pro- participants identified a few promising death, driving the family to the store, grams that reach families of gun victims practices and discussed the types of pro- helping with paperwork, or simply listen- within 24 hours after the shooting and re- grams they would like to see funded ing. Recover also makes referrals to mental main available to assist with longer term under VOCA to benefit gun victims. needs. State VOCA administrators should be health counseling and other services but encouraged to fund programs like Recover, Clearly, many innovative programs are recognizes that these may be premature the Family Bereavement Center, and the not known outside their limited geo- and/or insufficient for victims having Family Advocacy Program. Evaluation stud- graphical area. ies for these and similar programs should trouble getting out of the house, getting be encouraged and funded by OJP. food on the table, and dealing with funer- RECOMMENDATION: Participants recom- mended that a database of providers serv- al homes and police investigators. 2. Support Groups for Nonfatal ing gun victims be established and that Gunshot Victims OVC increase efforts to publicize promising The Family Bereavement Center in Balti- programs and encourage states to fund more, Maryland, is funded by a VOCA Victims who had been shot and sur- them. subgrant and administered by the state’s vived their wounds spoke of the need RECOMMENDATION: If gun violence victims attorney’s office. The center reaches out to tell their stories many times. They have been underserved, states should be to every homicide victim’s family by stressed the importance of peer support encouraged to fund programs that serve sending a letter encouraging them to call groups. But unlike for rape victims, gun victims as part of their required 10- victims of domestic abuse, victims with percent minimum allocation of VOCA sub- for services. Center staff provide liaison grants for underserved victim populations. services with the police department, the severe SCIs, and parents/friends of mur- medical examiner, and the state’s attor- dered children, there are few, if any, spe- ney’s office. They offer crime scene cialized services or organized support 1. Holistic Care for Families of groups for “plain, old-fashioned assault.” Homicide Victims cleanup services, court support and escort services, notification of case status and These victims, who are shot, one by one, Participants who counsel surviving victims’ rights, assistance in applying for day in and day out, have bullets removed family members spoke of the need to as- victim compensation, and individual and in emergency rooms and then are released sist with day-to-day problems to reduce group grief counseling sessions. They also to carry on with their lives. the immediate, ongoing, and long-term sponsor educational and support activities Participants recommended developing effects of traumatic loss. Programs that such as memorial services, weekend gun violence assistance centers modeled operate at the community level and pro- camps for adolescents and younger chil- on the Thurston High Assistance Center vide a range of free services and referrals dren who have lost family and friends to in Springfield. This center was estab- are preferred. They might be administered violence, and a quarterly newsletter. by the law enforcement or prosecutor’s of- lished in the aftermath of the Thurston fice, a hospital, a church, or an independ- The Family Advocacy Program at the Wash- High shootings and functions as a clear- ent private agency. Three multiservice ington Hospital Center in Washington, inghouse for services, activities, and re- programs were discussed in detail at the D.C., also provides coordinated services sources related to healing individuals and roundtable. for family members of gun homicide the community. The proposed centers

11 OVC Bulletin

could be located within a YMCA or recurrent nature of assaultive trauma, Review the violent incident. recreation center already functioning in with hospital readmission rates as high as the community and should be available 44 percent in some areas and subsequent Explore alternative strategies for to secondary victims like friends, neigh- homicide rates as high as 20 percent. conflict resolution. bors, and family. They would be safe- Medical personnel working with social haven drop-in sites where victims could workers and counselors could turn the Provide information on risk factors meet with each other and with a multi- crisis of injury into an opportunity to for violence. disciplinary support team. Ideally, the intervene and interrupt this pattern of Explore coping skills and safety plans. centers would coordinate all services for violence. According to participant Dr. gun victims in the community, such as Caesar Ursic, Director of Trauma Services Arrange for followup contacts. medical and mental health evaluations, for the Alameda County Medical Center counseling services, family assistance, in Oakland, California, there are anec- The recovery period in a hospital and help with schoolwork or job applications, dotal evidence and some data suggesting rehabilitation center offers victims an referrals to other programs, applications that such programs diminish the psycho- opportunity to be exposed to supportive for victim compensation, emergency logical impact of the injury, prevent retal- services. After victims have been dis- housing, and victim/witness protection. iatory violence, minimize violent injury charged, followup visits are scheduled for The centers also could be integrated with recidivism, decrease future involvement a minimum of 12 months. The CC pro- prevention efforts, such as community with guns, and increase the likelihood of gram uses trained peer counselors, many policing and afterschool programs. success in school. in wheelchairs because they too were victims of gun violence. Participants who worked with young gun The Caught in the Crossfire (CC) program violence victims felt that the support of in Oakland has been hailed as a model RECOMMENDATION: OVC should continue to other victims would help reduce the stig- program. It maintains a hotline for the recommend that VOCA subgrants be award- ed to hospital-based gun victim programs.49 ma associated with talking to the police Alameda County Medical Center to call The elements critical to a model program and testifying against an accused shooter. when a youth between the ages of 12 and should be identified for replication. Where The centers could encourage cooperation 19 is admitted to the emergency room funding is not available for comprehensive programs, emergency rooms should imple- with the criminal justice system and non- with a . CC crisis inter- ment protocols to assess the risk of recur- violent ways of solving disputes. vention specialists visit the patient at rent injury and provide counseling services bedside and— for young gunshot victims and their RECOMMENDATION: OVC should fund the de- families. velopment of model gun violence assistance centers that could be replicated in commu- nities across the country.

3. Multidisciplinary Hospital- Based Programs for Adolescent Recover, a program of the William Wendt Center for Loss and Healing Gun Victims 4880–A MacArthur Boulevard NW., Washington, DC 20007–1557 202–333–4880, www.lossandhealing.org Although virtually all U.S. trauma centers have some sort of counseling and Family Bereavement Center, a program of the referral services for victims of violence State’s Attorney’s Office for Baltimore City and violence prevention clubs exist in a 10 South Street, Suite 502, Baltimore, MD 21202 majority of SCI units, there are fewer 410–396–7351 than a dozen hospital centers nationwide that offer comprehensive counseling, inter- Family Advocacy Program vention, and inpatient treatment pro- Office of Decedent Affairs, Washington Hospital Center grams to victims of gun violence. 110 Irving Street NW., Washington, DC 20010 Participants agreed that this should be a 202–877–8351 high priority for DOJ funding. Urban trauma centers have reported the

12 WORKING WITH VICTIMS OF GUN VIOLENCE

4. School-Based Peer Counseling part of more comprehensive victim serv- from those of other crime victims. By for Violence Prevention ice initiatives, including crisis interven- sponsoring this roundtable, OVC has tion, age-specific courses on victim opened the door for a full and frank dis- The power of peer counseling, evident trauma, and stress reaction training.50 As cussion of these issues. Participants ex- in the hospital-based programs, also is an Dr. Enid Margolies with the New York pressed the hope that there would be important component of school-based City public school system observed, vio- other opportunities to continue this violence prevention programs. The Rise lence prevention and victim response discourse. For example, Above It program was launched in 1995 issues must be folded into a school’s core in direct response to an increasing num- curriculum, as funding for separate pro- Once a national-scope search of ber of severe SCIs and gunshot wounds in grams is difficult. providers and programs serving young people in the Newark, New Jersey, the needs of gun trauma victims is area. Program presenters, like Hashim RECOMMENDATION: OVC should recommend concluded, OVC should reconvene Garrett, the Violence Prevention that VOCA subgrants be awarded to qualify- ing school-based victim services programs. this or a similar group to identify Coordinator for Rise Above It, are indi- School boards should be encouraged to in- unmet needs and make additional viduals who were paralyzed as a result of clude victim services and violence preven- recommendations for funding new violent acts. They are teamed with tion as part of a school’s core curriculum. programs. able-bodied peer educators to let the students see the long-lasting effects of Smaller focus groups of gun victims gunshot wounds and to teach them skills should be held regionally to identify to deal with anger and prevent fights. their needs and learn about the The classes are part of the public school Caught in the Crossfire services they used to meet those health sciences curriculum and have Youth Alive needs. reached more than 10,000 students. The 3300 Elm Street program has been posttested—meaning Focus groups should be held on Oakland, CA 94609 that the program surveyed students before particular topics that were not fully 510–594–2588 and after they participated in the pro- covered in the roundtable. For gram, asking questions about their Rise Above It example, we know that guns and do- behavior and their beliefs about the con- Kessler Anti-Violence Program mestic violence terrorize, injure, and sequences of fighting—and shows positive Kessler Institute for Rehabilitation kill women every day. On average, results as both students and teachers re- 1199 Pleasant Valley Way in 1997, more than one woman a port a decrease in arguments and violent West Orange, NJ 07052 day (393 women total) was shot and incidents. 973–731–3600, ext. 2253 killed by her husband or intimate acquaintance during an argument.51 School-based peer counseling programs The use of guns in like Rise Above It are designed as violence situations and its impact on victims prevention initiatives. But roundtable should be explored further by both participants found it difficult to draw a OVC and VAWO. Some key issues line between the victim services provided Next Steps were raised during OVC’s September and the prevention aspects of the pro- 2000 Intimate Partner Homicide grams. The victim presenters are empow- his roundtable was the first time Forum. These issues and recommen- ered by their ability to speak in front of that OVC focused exclusively on dations on how to identify trends an audience and become whole again by the needs of victims of gun violence. and factors associated with intimate TParticipants found the process extremely sharing their stories and acting as change partner homicide will be addressed agents for a violent school-age communi- useful and were satisfied that many key in a future OVC bulletin. ty. And many in the classroom are also victim issues stemming from firearm vio- victims, suffering physical or emotional lence were identified. As indicated in this OVC should develop training materi- harm from the violence they experience bulletin, gun violence victims have some als and sponsor training and technical daily. These types of programs could be unique concerns and needs that differ

13 OVC Bulletin

assistance programs for state VOCA Nonfatal Firearm-Related Injuries: 267:3043–3047. (When a gun is involved administrators and compensation Beyond the Tip of the Iceberg,” The in a domestic dispute, it is at least 12 programs to help them identify the Journal of the American Medical times more likely that the dispute will diverse needs of victims of gun vio- Association, 1995; 273:1749–1754. end in death.) lence and how to respond to them. 10. Available online at 18. Zawitz, Marianne, Firearm Injury From www.ojp.usdoj.gov/bjs/guns.htm. Crime, U.S. Department of Justice, Notes Bureau of Justice Statistics, 1996. 11. In the Crossfire: The Impact of 1. Hoyert, D.L., K.D. Kochanek, and S.L. Gun Violence on Public Housing 19. “Firearm-Associated Homicides Murphy, “Deaths: Final Data for 1997,” Communities, U.S. Department of Among Family Members, Relatives, or National Vital Statistics Reports, 1999; 47 Housing and Urban Development, Friends—Ohio,” Epidemiologic Notes (19). February 2000. and Reports, Morbidity and Mortality Weekly Report, 1989; 38 (15):253–256. 2. The terms “gun homicide” and “firearm 12. Bell, C.C., and E.J. Jenkins, homicide” have the same definition and “Exposure and Response to Community 20. Larson, Eric, Lethal Passage, Vintage are used interchangeably throughout the Violence Among Children and Books, 1995, p. 86. (Describing student bulletin. Adolescents,” in Children in a Violent holding up French textbook to ward off Society, Osofsky, ed., The Guilford bullets from a Cobray M 11/9 semiauto- 3. Available online at the National Press, 1997. matic pistol shot by a fellow student.) Center for Injury Prevention and Control’s database at 13. Campbell, C., and Donald F. 21. Slevin, Peter, “District Teen Gets 127 www.cdc.gov/ncipc/wisqars. Schwarz, “Prevalence and Impact of Years in Random Shooting of Four,” The Exposure to Interpersonal Violence Washington Post, Jan. 6, 2000, p. B2. 4. Kellermann, A.L., and J.A. Mercy, Among Suburban and Urban Middle “Men, Women, and Murder: Gender- School Students,” Pediatrics, 1996; 22. A list of multiple-victim shootings in Specific Differences in Rates of Fatal 98:396–402. the United States is available online at Violence and Victimization,” The Journal www.millionmommarch.com. of Trauma, 1992; 33:1–5. 14. Available online at www.ojp.usdoj.gov/bjs/guns.htm. 23. Temple, Scott, “Treating Inner-City 5. Hoyert, D.L., K.D. Kochanek, and S.L. Families of Homicide Victims: A Murphy, “Deaths: Final Data for 1997,” 15. Available online at Contextually Oriented Approach,” National Vital Statistics Reports, 1999; 47 www.ojp.usdoj.gov/bjs/homicide/ Family Process, 1997; 36 (2):133–149. (19). multiple.htm. 24. Schwab-Stone, Mary E., Tim S. 6. Available online at www.ojp.usdoj.gov/ 16. See, e.g, Reiss, A.J., and J.A. Roth, Ayers, Wesley Kasprow, Charlene Voyce, bjs/glance/guncrime.htm. Understanding and Preventing Violence, Charles Barone, Timothy Shriver, and National Academy Press, 1993, pp. Roger P. Weissberg, “No Safe Haven: A 7. Available online at 260–261; Zimring, F.E., and G. Hawkins, Study of Violence Exposure in an Urban www.cdc.gov/ncipc/wisqars. Crime Is Not the Problem: Lethal Violence Community,” Journal of the American in America, Oxford University Press, Academy of Child and Adolescent 8. “Nonfatal and Fatal Firearm-Related 1997, pp. 106–123. Psychiatry, 1995; 34 (10):1343–1352. Injuries—United States, 1993–1997,” Centers for Disease Control and 17. Saltzman, L.E., J.A. Mercy, P.W. 25. Duncan, David, “Growing Up Under Prevention, Morbidity and Mortality O’Carroll, M.L. Rosenberg, and P.H. the Gun: Children and Adolescents Weekly Report, 1999; 48:1029–1034. Rhodes, “Weapon Involvement and Coping With Violent Neighborhoods,” Injury Outcomes in Family and Journal of Primary Prevention, 1996; 9. Annest, J.L., J.A. Mercy, D.R. Gibson, Intimate Assaults,” The Journal of the 16:343–356. and G.W. Ryan, “National Estimates of American Medical Association, 1992;

14 WORKING WITH VICTIMS OF GUN VIOLENCE

26. Bastian, Lisa, and B. Taylor, Young The Journal of the American Medical 45. The National Education Association Black Male Victims, U.S. Department of Association, 1999; 282:447–454. has issued Advice for Journalists covering Justice, Bureau of Justice Statistics, 1994. school shootings. See www.nea.org/ 36. Kizer, K.W., M.J. Vassar, R.L. Harry, issues/safescho. 27. “Adolescent Assault Victim Needs: A and K.D. Layton, “Hospitalization Review of Issues and a Model Protocol,” Charges, Costs, and Income for Firearm 46. Brooks, K., V. Schiraldi, and J. Pediatrics, 1996; 98:991–999. Related Injuries at a University Trauma Zeidenberg, School House Hype: Two Years Center,” The Journal of the American Later, Justice Policy Institute/Children’s 28. Slevin, Peter, “District Teen Gets 127 Medical Association, 1995; 273:1768– Law Center, 2000. Available online at Years in Random Shooting of Four,” The 1773. www.cjcj.org/schoolhousehype/shh2.html. Washington Post, Jan. 6, 2000, p. B2. 37. Cook, P.J., B.A. Lawrence, J. Ludwig, 47. Spungen, Deborah, Homicide: The 29. Jackman, Tom, “Group Urges More and T.R. Miller, “The Medical Costs of Hidden Victims, A Guide for Professionals, Help for Victims of Crimes,” The Gunshot Injuries in the United States,” Sage Publications, 1998, pp. 110–111. Washington Post, Dec. 15, 2000, p. B5. The Journal of the American Medical Association, 1999; 282:447–454. 48. While a recent survey conducted for 30. Christoffel, K.K., “Youth Violence OVC indicates that 23 percent of the Prevention: The Physician’s Role,” 38. Ordog, G.J., J. Wasserberger, and G. programs enter information into their medical student Journal of the American Ackroyd, “Hospital Costs of Firearm databases about whether the crime was Medical Association (msJAMA). Injuries,” The Journal of Trauma, 1995; gun related, OVC does not require states 38:291–298. to report the number of claimants who 31. Nader, Kathi, Robert Pynoos, Lynn were victims of gun violence, although Fairbanks, and Calvin Frederick, “Child- 39. Ibid. states do report categories of “assault” ren’s PTSD Reactions One Year After a (34 percent of claims) and “survivors of Sniper Attack at Their School,” The 40. Klein, S.R., I.J. Kanno, D.A. Gil- homicide” (11 percent of claims). American Journal of Psychiatry, 1990; more, and S.E. Wilson, “The Socio- 147:1526–1530. economic Impact of Assault Injuries 49. In October 1996, OVC recommend- on an Urban Trauma Center,” The ed that hospital-based counseling and 32. Bell, C.C., and E.J. Jenkins, “Expo- American Surgeon, 1991; 57:793–797. prevention programs be established in sure and Response to Community medical facilities that provide services to Violence Among Children and 41. Goldman, H., “Gun Violence in the adolescent gunshot victims and victims Adolescents,” in Children in a Violent U.S. Costs More Than $100 Billion a of gang violence. In May 1998, OVC Society, Osofsky, ed., The Guilford Press, Year,” Bloomberg News, available online made the same recommendation in New 1997. through Deseret News Archives at Directions From the Field: Victims’ Rights deseretnews.com. and Services for the 21st Century. 33. Richters, John E., and Pedro Martinez, “The NIMH Community 42. Available online at 50. Gregorie, Trudy, — Violence Project: I. Children as Victims www.spinalcord.org/resource/ Are You Prepared To Respond? National of and Witnesses to Violence,” Psychiatry, Factsheets/factsheet2.html. Center for Victims of Crime, 1999. 1993; 56:7–21. Available online at www.ncvc.org/newsltr/ 43. DeVito, M.J., “Causes and Costs of schvio.htm. 34. Rand, M.R., Violence Related Spinal Cord Injury in the United States,” Injuries Treated in Hospital Emergency Spinal Cord, 1997; 35:809–813. 51. Brock, K., When Men Murder Women: Departments, U.S. Department of Justice, An Analysis of 1997 Homicide Data: 44. Holicky, R., “Violently Acquired Bureau of Justice Statistics, 1997. Females Murdered by Males in Single SCI: A Recipe for Inequity.” Available Victim/Single Offender Incidents, Violence 35. Cook, P.J., B.A. Lawrence, J. Ludwig, online at www.spinlife.com (reprinted Policy Center, 1999. and T.R. Miller, “The Medical Costs of from New Mobility, March 2000). Gunshot Injuries in the United States,”

15 OVC Bulletin

This document was prepared under the direction of the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice.The opinions, findings, conclusions, and recommen- Judith Bonderman, J.D., M.P.H., dations expressed in this document are those of the author and do not necessarily represent the teaches a course on gun violence pre- official position or policies of the U.S. Department of Justice. vention at the George Washington The Office for Victims of Crime is a component of the Office of Justice Programs, which also in- University School of cludes the Bureau of Justice Assistance, the Bureau of Justice Statistics, the National Institute of and Health Services. She thanks the Justice, and the Office of Juvenile Justice and Delinquency Prevention. roundtable participants for sharing their experiences and for their can- NCJ 186155 did and full discussion of the issues.

U.S. Department of Justice PRESORTED STANDARD Office of Justice Programs POSTAGE & FEES PAID Office for Victims of Crime DOJ/OVC PERMIT NO. GÐ91

Washington, DC 20531

Official Business Penalty for Private Use $300