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Throughout his career as a Boston street worker, David Crump has worked to support victims of violence, often gang-related, in the city.
“Some victims of violence are simply in the wrong place at the wrong time,” said Crump. “Some are not, but our place is not to judge, it’s to help them heal and break the cycle of violence.”
Now, Crump is working on behalf of BWH as part of a violence intervention program that launched this fall.
“We want to support patients who are affected by violence and figure out how we can prevent them from winding up in the hospital again,” said Crump, a BWH community advocate who meets with victims of violence as they are treated, opening up a dialogue about their situations and connecting them with psychological support and resources in the community.
The program is a collaboration between the Division of Trauma, Burn and Critical Care Surgery and the Center for Community Health and Health Equity, which strives to address inequity in the neighborhoods of Boston, including violence—the leading cause of death for young black and Latino men between the ages of 15 and 35.
“We need to focus on violence if we’re going to have an impact on mortality,” said Wanda McClain, executive director of the Center for
Community Health and Health Equity.
The Violence Intervention and Prevention Program is two-pronged. Crump works with patients in the hospital, providing them with an outlet to talk about the events that led them to be impacted by violence and to connect them with supports that address the social factors that brought them to this situation, such as unemployment. Samantha Wright Calero, violence intervention specialist, is developing programs to educate youth in the community about healthy relationships and domestic violence and connecting them with the BWH Passageway program.
“My position bridges domestic violence and community violence,” she said. “People who are impacted by or who perpetrate community violence are at a higher risk for perpetrating or being impacted by domestic violence.”
For Selwyn Rogers, MD, MPH, chief of the Division of Trauma, Burn and Surgical Critical Care, this program is imperative in changing the way the hospital treats victims of violence. He explains that violence should be addressed as a disease. “For diabetes, you take insulin and glucose every day, not just when you don’t feel well,” he said. “We find ways to manage other diseases and prevent them – we need to work with victims of violence in the same way.”
For Rogers, one July Fourth weekend working at another hospital was a turning point. A 17-year-old who had been shot in the neck returned to the hospital days later with a bullet in his stomach, a clear indicator that the approach to treatment was incomplete. “That’s when I knew there was something wrong with the system,” said Rogers. “We’re not using the near misses as opportunities to address the problem before we send these patients back to the community.”
Enter Crump, who meets with these patients within 72 hours of their admission to BWH, or what was coined by Carnell Cooper, MD, a Maryland trauma physician, as the “second golden hour” for trauma patients.
“The first golden hour is responding to these patients medically within an hour to save their life,” said Mardi Chadwick, JD, director of Violence Intervention and Prevention Programs in the Center for Community Health and Health Equity. “The second golden hour refers to the fact that people are more likely to be open to changing the factors in their lifestyle that made them susceptible to this injury. If we can reach them within three days, we have a greater opportunity to help them.”
Crump has worked with more than 20 patients in his first few months on the job. “BWH should be applauded for looking outside the hospital to help these people,” he said. “For me, it’s an honor to be working with surgeons, nurses and the care team in their environment.”
Rogers has noticed a change in the way clinicians discuss these patients. “A few weeks ago on rounds, we had a group of care providers talking about how we could get a patient to a situation where he would be safe,” said Rogers. “David wasn’t even there – these were direct care providers thinking about the care of this patient in a transformative way. This program has already changed our dialogue about these patients.”
BWH’s Department of Surgery recently co-hosted grand rounds with the Center for Community Health and Health Equity, featuring Carnell Cooper, MD, division chief of Traumatology and medical director of Trauma Services at Prince George’s Hospital Center in Maryland. He spoke about hospital-based violence intervention programs and the “second golden hour.”