The New Violence Intervention Advocacy Program (VIAP)

Welcome to the new Violence Intervention Advocacy Program (VIAP) at 6 Massachusetts ED sites In response to the increase in gunshots Locations (VIA) with strong community knowl- and stab wounds in cities across Massa- edge. Advocates attended a two week chusetts, (1,621 GSW/SW in Massachu- A VIAP demonstration project began training at BU SPH and BMC ED, setts from January through September at Boston Medical Center in 2006, covering substance abuse screening, 2007) the BNI ART Institute received a funded by the Boston Public Health brief negotiated intervention and supplemental grant to add a violence Commission $100,000 Shannon Grant referral to treatment and exposure to component to the MA ED SBIRT award and is now being disseminated strategies for violence prevention and program funded in 2006 by the Dept. at the request of the governor, to intervention , including case manage- of Public Health’s Bureau of Substance serve victims of violence cross the ment skills and review of available Abuse Services. state, at Brockton Hospital in Brock- community resources and services. ton, UMASS Memorial in Worcester, The curriculum was adapted from a Massachusetts General Hospital (MGH) Robert Wood Johnson funded in Boston, BMC in Boston, Lawrence program in Oakland, California called Mission General Hospital and Baystate Medical “Caught in the Crossfire.” The VIA are Center in Springfield. The BNI-ART now beginning to work with patients The mission of VIAP is to “assist Institute worked closely with Dr. Thea and their families to provide crisis victims of violence to recover from James and Dr. Benjamin Shelton from intervention and low impact case man- physical and emotional trauma and Boston University’s Department of agement; to intervene in the cycle of empower them with skills, services and Emergency Medicine and violence violence to prevent retaliation; to opportunities so they can return to intervention advocates Anthony Chris- reduce morbidity and mortality, and their communities, make positive tian and Leroy Muhammad to adapt prevent re-injury and entry into the changes in their lives, strengthen this program for conditions in Massa- criminal justice system; to facilitate others who have been affected by chusetts. access to continuing health care and violence, and contribute to building local community resources, including safer and healthier communities.” At each of these sites, VIAP is collabo- housing, jobs and education; and to rating with public and private agencies promote positive role models and to offer a broad spectrum of concrete positive alternatives to violence. services to patients recovering from Contact Info: violent injury. Each site has hired a We would like to welcome the Violence Brenda Rodriguez peer Violence Intervention Advocate Intervention Advocates to our Massachusetts Email:[email protected] ED SBIRT team:

BNI-ART Institute - Jason Casey, Brockton Hospital, Youth Alcohol Prevention Center Winifred Atwell, Boston University Medical Campus Baystate Medical Center, 715 Albany Street, 580 3RD floor Rosemary Hall, Boston, Massachusetts 02118-2526 Lawrence General Hospital, Nixon Corney, MGH, Website: Anthony Christian, BMC and Leroy Muhammad, BMC. http://www.ed.bmc.org/sbirt

1 Sucess Stories Violence Intervention The violence intervention advocates Other site advocates also serve as a During these meetings he kept having have been welcomed into their emer- bridge to help their clients obtain episodes and flashbacks. Rosemary was gency departments and already have mental health services when needed. able to link this young man to mental great success stories. We asked them For example, Rosemary at Lawrence health services and continue following to share a few de-identified cases for General Hospital helped a young man him in the program. She also shared the newsletter to give readers an idea who saw his mother stabbed 17 times the story of one client, a 19 year old of what their daily work is like, and as a result was experiencing Post Trau- girl who was assaulted by her neigh- how they go about fulfilling their com- matic Stress Disorder (PTSD). He told bors, who lived alone and was afraid to mitment to provide comprehensive Rosemary that he still blames himself return home because of the assault. services to victims of violence. for what happened to his mother Rosemary was able to find her a because he was unable to help her. shelter bed and connect her with At BMC the advocates are paged as After that initial intake meeting, the mental health and substance abuse soon as trauma victims arrive at the client went missing for 5 days. Once he services, and begin to address her ER. Anthony Christian walked into the was found, he continued his meetings marijuana, cocaine and heroin use. This trauma room to see a familiar young with Rosemary. client is now clean for more than 10 face, someone he had known since he days, and is in a residential program was 11 years old. This is the second that provides drug abuse counseling. assault this young man suffered. He had moved out of his neighborhood after being stabbed. This time this young man is determined to end any ties that How a cup of coffee goes a long way can connect him to violence and Jason Casey, at Brockton Hospital tells it…until after the coffee. This case decided to enter the Violence Inter- us that he has learned that a cup of shows how it may take a person some vention Advocacy Program (VIAP). He coffee can go a long way… The first time to build trust and be able to admit is worried about his safety and wants person Jason saw was a 54 year old their use to you. He asks us to remem- to recover his life and stay away from male heroin user. He introduced ber that these patients will come back, the streets. Anthony is proud to himself and was able to establish a and that you are planting seeds, and report that his client checks in with relationship with this patient, but when maybe the next time the person will him on a daily basis. Anthony helped they got to the drug and alcohol ques- remember who gave him a cup of this young man with his application for tions, the patient quickly denied any coffee and be ready to talk about more SSDI and with obtaining a driver’s use. Jason said “ok”, and once the openly about his heroin use. license, took him to the DTA interview was over Jason said, “Would (Department of Transitional Assis- you like me to do anything else for tance) to obtain food stamps, and has you?” The patient said, “Can I have a being able to advocate for his client in cup of coffee?” which Jason got for court, where he was able to state that him. Jason was aware that this patient the client was fully involved in the VIAP had a problem with heroin, but the program. The client was released and patient was not ready to talk about not sent to jail. He also motivated him to seek mental health services at Pyra- mid Builders and attended several sessions to ease the transition. Clearly, Anthony’s perseverance has allowed this client to stay out of trouble and jail.

2 Overcoming the barriers Hospital Services Network of resources Advocates are doing everything possible Other hospitals have come forward Advocates have also started to estab- to help their clients stay on the right and provided in-kind services to facili- lish a network of providers and track and gain their lives back, but tate contact with resources. For resources for their clients. Lawrence, there are real barriers that they have example, UMASS Memorial is provid- for example, has looked into a mentor- to address in order to be effective. ing taxi vouchers so that victims of ing program called the “Big Sisters and Safety for themselves and their clients, violence and the advocate can more Big Brother Program.” Other sites are resistance to change, desire for and easily get to their appointments. They planning to have community partners fear of retaliation and confidentiality are also working with their IT depart- host an open house to inform agencies are big issues. Steps taken to overcome ment to set up a mandatory field in in their communities that the program some of these barriers include select- their electronic triage record in which is in operation and to expect referrals. ing safe public destinations such as a triage nurses will flag patient in need of Winifred Atwell at Baystate has begun hair salon or a Dunkin Donuts. To help violence and substance abuse interven- to partner with a 16 week program in their clients opt out of thinking about tion services. They also plan to the Springfield community that prepares retaliation, advocates work with the in-service all 60 triage nurses to screen clients to get a GED and be able to victims and their family members to and enter this field. The VIA has access interview well for jobs. come up with plans that will keep their to the tracking system and the triage client safe and away from becoming a field will help her identify those in need In two short months, the advocates perpetrator as a reaction to being a of her services. Universal screening at and the VIAP program are demonstrat- victim of violence. Sometimes it is triage will offer the hospital the oppor- ing that they can be a vital piece in a necessary to find safety outside the tunity to assess needs and develop comprehensive public health community, and advocates have also improvement strategies to ensure that strategy, and interfaces with the work arranged for patients to move to more and better services are provided of community based organizations. another city or state for their safety by the hospital’s UMASS VIAP team. while maintaining close contact.

Dedication The Violence Intervention Advocacy Many of us remember the "truce pact" Program developed a training manual between two rival gangs that he nego- dedicated to the memory of Don tiated right in the emergency depart- Mounds, a colleague of many years ment. He taught violence prevention who lost a protracted battle with to first year BU medical students in illness in July of 2007. He was Boston their Social and Behavioral Sciences City Hospital/Boston Medical Center course, and authored a chapter on Emergency Department's first Youth Violence in the textbook, "Case violence prevention advocate in1991. Studies in Emergency Medicine and He had a big heart for teenagers and the Health of the Public." We have communicated effectively with them in included this chapter in the curriculum; the street or at the hospital bedside. it is still one of the best pieces of He was an active member of Boston's writing about the roots of youth Don Mounds, Vietnam Vets Against Violence, and violence. His presence is sorely missed. First violence prevention mediated many gang conflicts. advocate at BMG in 1991

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