How one hospital is applying public health interventions in effort to curb gun violence

AHA News

Discovering that people treated for gunshot wounds in your hospital are 21 times more likely to get shot again and wind up back in the hospital is a disturbing statistic. It disturbed Seattle’s Harborview Medical Center and the city of Seattle enough to launch a pilot gun violence-intervention program at the hospital.

A 2014 study of patients admitted to Washington state hospitals for gunshot wounds led the city of Seattle to allot $275,000 in 2016 budget money for a project that tests whether a successful alcohol-intervention initiative can have similar results for victims of gun violence. 

Harborview’s gun violence-intervention program comes as the AHA and a growing number of hospitals and health systems view violence as one of the nation’s major public health and safety issues. The AHA has developed new web-based resources to help hospitals address violence and the toll it takes on their communities. 

Harborview enrolled its first gunshot victim in the project on March 21, and now has 50 participants. After medical staff treat patients’ gunshot wounds, social workers interview them and brainstorm reasons to avoid high-risk behaviors. Social workers then hold face-to-face meetings with victims and their families, and analyze the role of guns in victims’ lives over 12 sessions, developing strategies for anger management and resolving conflict.

Case managers follow gun victims’ progress over six months. They meet with local community agencies a few times each month to determine what nonmedical services are needed to aid in the intervention, like, for example, substance abuse counselling, mental health treatment or employment, education and housing services.    

“We need to be more involved with prevention, in addition to just treating their immediate problem,” says Ali Rowhani-Rahbar, M.D., the lead researcher on the project. “When they are in the hospital, we are at a critical point in their lives where we can intervene and hopefully begin to make a difference.” He believes the project marks the first time a hospital has applied a model of public health intervention to victims of gunshot wounds.

The blueprint for the initiative is a screening and counseling program for alcohol abuse developed by the hospital in the mid-1990s. When patients arrived at the hospital due to a traumatic injury, they were screened for alcohol use.

If alcohol proved to be part of the problem, they met with a psychologist for 30 minutes before discharge. Together, they discussed alcohol-consumption norms, the negative social and physical consequences of alcohol, and a “menu of strategies” to help the patient avoid further harm. The patients’ personal responsibility for their drinking was emphasized.  

The hospital found that this screening and counseling program help reduce repeat visits to its trauma center by nearly 50%. Today, trauma centers around the country must conduct alcohol screening on trauma patients and follow up with intervention whenever appropriate.

Rowhani-Rahbar believes what worked with alcohol can work with firearms.

While it’s too early to gauge the project’s impact, Rowhani-Rahbar is encouraged by what he’s seen so far.

Patients are “grateful and excited,” he says. “It has been remarkable for all of us to see how cooperative they have been and how hungry they are to join the program because they know they need help.”

He says the hospital and health system field has a “moral obligation” to address gun violence in the communities it serves.

“If we think about gun violence as a public health epidemic, then there is an obligation for all of us to get involved in the community,” he says. “Hospitals are uniquely positioned to employ that teachable moment.” 

Topics: Advocacy and Public Policy, Community Health
Tags: population health, Community health, Community Connections

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