R Adams Cowley Shock Trauma Center

Violence Prevention Program (VPP)

Violence is the leading cause of death for young adults in Baltimore and is a widely recognized public health concern.

The VIP mission is to prevent violent personal injury among Baltimore City’s most at risk populations through research into the root causes of violence and the development of evidence-based interventions that target said risk factors and bolster correlated protective factors.

VIP Background: Dr. Carnell Cooper started the Violence Intervention Program (VIP) in 1999 after seeing victims of traumatic violent injury being treated, released, and readmitted months later due to another, often more serious, violent injury. He recognized that this ‘revolving door phenomenon’ occurred repeatedly with the patients being discharged without any form of counseling or intervention to the same streets where they had sustained their injuries. Dr. Cooper asked a simple scientific question: “How can we reduce the number of repeat victims of intentional violent injury from coming through the doors of Shock Trauma every day?”

To answer that question, Dr. Cooper, Dr. Paul Stolley, and other colleagues completed a comprehensive case-control study (Archives of Surgery, Vol. 135, No. 7, July 2000) identifying the risk factors for repeat victims of violence. The study identified the following risk factors:

African-American male
Median age 31
Unemployed
No health insurance
Income less than $10,000 yearly
Current drug user
Past or present drug dealer
Positive test for psychoactive substances upon admission

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.

VIP Approach: The VIP is an intensive hospital-based intervention to assist victims of intentional violent injury, including gunshots, stabbings, and beatings. Victims receive assessment, counseling, and social support from a multi-disciplinary team to make critical changes in their lives. Victims of violence may also be perpetrators of violence. This dynamic is an important distinction however it does not interfere with the overlying belief that reaching victims of violence in the hospital immediately following a life-threatening and 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 to have the opportunity to intervene.

VIP Structure: 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.

VIP Clients: VIP participants include males and females ages 14 and older residing in Baltimore city or contiguous counties. Participants are victims of violent injury who are treated at the University of Maryland Shock Trauma Center (STC) who are capable of making informed consent/assent.

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 to reduce risk factors correlated to violent recidivism. Strong partnerships with community providers are maintained to ensure successful referrals. Multi-disciplinary relationships are in place to address mandated goals, such as parole/probation or court ordered requirements (ie: 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 for the VIP model are: safety, responsibility, progress, and self-sustainability. 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

Priorities for the VIP Intervention:

Personal and Public Safety Issues (ie: retaliation, domestic violence, risk taking behavior, etc…)
Attribution of Meaning to Events and Recovery (ie: medical, mental, social adjustment, etc…)
Reinforcement and Development of Positive Skills and Supports (ie: healthy coping skills, etc…)
Connection to Community-Based Services (ie: needed referrals for personal growth, etc…)

Four basic phases of change / growth for VIP participants:

Stabilization (ie: “handling daily crises”)
Recovery & Rehabilitation (ie: substance abuse, criminal justice, etc…)
Community Reintegration (ie: education, employment, housing, medical, etc…)
Self-Reliance & Self-Referral (ie: personal goals)

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. 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 (table).

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)

Future Goals: 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, Mayor Sheila Dixon, DPSC Secretary Maynard, the Baltimore City Health Department, and the HSCRC.

This page was last updated on: October 13, 2009.

For all patient information, please call 410-328-9284.