Atrium Health Doctor Believes That Stopping Violence Starts In The Emergency Room
In 2020 there were 122 homicides in Charlotte and violent crimes were up by 16% compared to the previous year, according to Charlotte police statistics. Numerous studies show that 25% of people who are victims of violent crimes will be a perpetrator or victim of another crime in the future.
To tackle this specific aspect of the crime Charlotte faces, Atrium Health and city officials are working together on a new violence intervention program. Atrium's Dr. David Jacobs says they see about 750 people annually for gunshot wounds in their trauma unit, alone.
Jacobs, who is overseeing the new program, says they plan to work with emergency room victims and take a more comprehensive approach to preventing people from becoming a repeat victim or repeatedly engaging in violent criminal activities.
Dr. David Jacobs: Violence is not random, it happens for a reason. If you think about violence as a disease, which is what the public health approach now to violence is, to think about it as a disease that's passed across communities, it's passed across generations. It's almost like an infection. There are risk factors that lead to violence.
And so the person that is a victim of violence serious enough to land you in the hospital, they have these accumulations of risk factors that make it very likely that unless you address those risk factors, they're going to be back in the same position again.
So the whole purpose of the violence programs, therefore, is to identify those individuals, identify those risk factors, and then work with whatever they need — community agencies to try to minimize those risk factors and make sure they don't come back to the hospital again.
Gwendolyn Glenn: And who will you have on staff — and how many — to work with people who come in who are victims of violence?
Jacobs: We're going to be hiring two people in the next, I would say, couple of months. Two violence prevention coordinators on the way to more. We believe that we need to have people on site and available 24 hours a day, seven days a week.
We need to keep in mind that many of these patients will be discharged from the emergency department. And so they're only going to be in our care for an hour, maybe an hour and a half or two hours. And so it's going to be incumbent upon us to be sure that we have the resources to get somebody to that patient's bedside immediately so that we can begin to assess them.
Are there other individuals at risk in the community? Is there talk of retaliation or is this individual going to go out and try to retaliate or become a victim again? And so this is not a situation that can wait until the next day or wait until the weekend is over. You really have to address it in real time. So the two people that we at least have in mind right now will probably not be sufficient to carry the program forward.
Glenn: As you said, a lot of these people will be coming into the emergency room and you will only have them for a short time. What can you do in that short time? Because most of that time is going to be taken up with them getting treatment. How can you give them the resources or talk to them to find out what they need in that short time?
Jacobs: I think the first step in this will be for our intervention workers to establish a trusting relationship, make sure that they know that the information is confidential between the two of them. And we're not going to be able to solve the problems right there at the emergency department. But if we can at least establish a trusting relationship.
And we will have a standard assessment. We know what a lot of those risk factors are: drug abuse, involvement in gangs, their specific neighborhoods where violence is more likely to happen. There are specific community risk factors, individual risk factors. And just like you do a history of physical examination in the emergency department, you can go down that checklist pretty quickly and determine what risk factors are present, what resources are available in the hospital, in the community that we can immediately call in order to try and bolster that patient's resilience.
But this is going to be a long-term relationship. Maybe they need to go to court together. Maybe that person needs a GED. Maybe that person needs tattoo removal. Those things will require follow-up.
Glenn: And what kind of training will these specialists have? Will they be specialists in mental health care and social work?
Jacobs: We are partnering with an organization called The Health Care Alliance for Violence Intervention, HAVI. This is what they do for their work. They will be handling job descriptions and giving us a sort of infrastructure from where we can start.
Having said that, I think the most important job qualification is knowledge and awareness, I guess you would say, and understanding of the community in which they're going to work. They have to be credible. Somebody who comes from the neighborhood, somebody who understands those risk factors, somebody who understands the circumstances that lead to violence is the most important job characteristic.
Glenn: And you said other programs around the country have had success. What kind of success? Do you have statistics on how they have seen changes or numbers go down?
Jacobs: Well, I think that's an important point, and I'm glad you raised it. So I think it's important to set reasonable expectations for what's going to happen here in Charlotte. Keep in mind that these are only patients who are presenting themselves to Atrium Health's Level One trauma center. I sincerely believe we will have success in reducing violent recidivism in the patients that we see.
The problem is big, and you have to sort of eat at it from the corners, if you will, but you have to stick with it. If you are not seeing results in the first 30 days or 60 days or six months or a year, you can't get frustrated and say, "Well, the model's not working." You really do need to exhibit some patience and some support because, again, the experience of hospitals from around the country suggests that this does work if you give it time.
Dr. David Jacobs is an Atrium surgeon who heads the new intervention program at the hospital in partnership with the city of Charlotte.