Violence is the leading cause of death for young adults in Baltimore and is a widely recognized public health concern.
Dr. Carnell Cooper started the Violence Intervention Program (VIP) in 1998 after seeing victims of traumatic violent injury being treated, released, and readmitted months later due to another, often more serious, violent injury.
Dr. Cooper recognized that this "revolving door phenomenon" occurred repeatedly, with patients being discharged without any form of counseling or intervention to the same streets where they had sustained their injuries. Seeing this caused Dr. Cooper to ask a simple scientific question: "How can we reduce the number of repeat victims of intentional violent injury coming through the doors of Shock Trauma every day?"
To answer this question, Dr. Cooper, Dr. Paul Stolley, and other colleagues completed a comprehensive case-control study (Archives of Surgery, Vol. 135, No. 7, July 2000) that identified the risk factors for repeat victims of violence. The study identified the following risk factors:
Additionally, eighty-six percent (86%) of the victims felt that disrespect was involved with their injury, and a majority of the victims had a history of involvement with the criminal justice system. This comprehensive data analysis provided the basis for the evidence-based Violence Intervention Program (VIP) model.
The VIP is an intensive hospital-based intervention program that assists victims of intentional violent injury, including gunshots, stabbings, and beatings. Victims receive assessment, counseling, and social support from a multi-disciplinary team to help make critical changes in their lives.
However, the program also recognizes that victims of violence may also be perpetrators of violence. This dynamic plays an important role in the program, but does not interfere with the overlying belief that reaching victims of violence in the hospital setting immediately following a life-threatening or life-changing event is an opportune moment to engage them for intervention. Individuals are not only experiencing a medical crisis at this time, but also social, emotional, psychological, and spiritual crises. This approach also hinges on the reality that health care professionals are frequently the first, and sometimes the only, professionals who have the opportunity to intervene.
The VIP Model
The VIP model begins in the hospital and thrives in the community. Once victims of violent traumatic injury volunteer to participate in the program, they are paired with a case manager or outreach worker to assist them with individualized action plans formulated to reduce risk factors correlated to violent recidivism. Strong partnerships with community providers are maintained to ensure successful referrals.
In addition, multi-disciplinary relationships are also put in place to address mandated goals, such as parole/probation or court ordered requirements (i.e., for perpetrators of violent crimes who are also victims of violence). VIP participants have peer support groups to practice new skill sets and to celebrate personal accomplishments.
Priorities of the VIP model include:
Given that participant success is gradual, setbacks may occur, and outcomes are measured over time, services are not time limited. The degree to which VIP staff remains involved with participants is dependent upon the level of engagement, the complexity of presenting problems, and the involvement of supportive systems.
The four basic phases of change and growth for VIP participants include:
VIP staff review the CERNER daily admissions roster for the Shock Trauma Center to identify patients who meet VIP eligibility requirements. VIP staff members talk to eligible patients and their families at the bedside to discuss voluntary enrollment into the program. Those who give informed consent for participation complete an intake questionnaire and begin the assessment process for service planning. The VIP team is multidisciplinary. There are representatives from medicine, social work, epidemiology, parole/probation, social services, as well as consultants from other fields as needed to best meet program needs.
The VIP Impact
The VIP is a highly effective service model. Its design addresses a myriad of psychosocial variables, the complexity of multisystem collaboration, and the challenging task of working with victims of violence who may also be perpetrators of violence as well. The model is outcome focused and formatted for ongoing research evaluation. It is also a blueprint of best practice standards for healthcare providers addressing violence as a matter of public health.
In 2000, Dr. Cooper and his colleagues conducted a three year study that randomly assigned victims of violent trauma to either receive the VIP services or not. Those patients who participated in the program were less likely to be re-hospitalized due to violent injury. The VIP is recognized in the professional literature as a service model that effectively reduces trauma recidivism (Journal of Trauma, Vol. 61, No. 3, Sept. 2006). This study also confirmed a correlation between violent injury and the criminal justice system:
|VIP Participants repeat hospitalization rate due to violent injury||83 % decrease (36% savings as compared to those not getting the intervention )|
|VIP Participants violent crime||66.7 % decrease|
|VIP Participants violent criminal activity||75 % reduction|
|VIP Participants employment at the time of follow-up||82 % rate (as compared to 20 % not getting the intervention)|
In 2008, Dr. Cooper proposed expanding the umbrella of VIP services citywide. This plan would have partner hospitals identify eligible patients, obtain VIP consent, and refer recruits for VIP participation. Each hospital may allow personnel the time needed for in-service training, administrative tasks, and record keeping responsibilities as in-kind benefits. To date, written commitments have been obtained from Bon Secours, Harbor Hospital, Johns Hopkins Bayview, Sinai, Union Memorial, Maryland General, and St. Agnes. This proposal is also supported by the Baltimore City Police Commissioner, DPSC Secretary Maynard, the Baltimore City Health Department, and the HSCRC.