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Case Study: Advocate Christ Medical Center, Chicago

CeaseFire Partnership: Hospital-Based Violence Reduction Program

Advocate Health Care provides a quarter of trauma care for Illinois, mostly unreimbursed. At Advocate Christ Medical Center, a Level 1 Trauma Center, physicians and staff began to recognize patients who were being admitted multiple times and partnered with Chicago-based CeaseFire (visit Cure Violence). CeaseFire has been effective in reducing community violence rates. The partnership offers services to trauma patients, their families, and communities, within an hour of a violent incident. Conversations happen when patients are willing and able to reflect on the import of retaliation and the cycle of violence they are caught up in.

In Chicago, violence is a leading causes of death for people between 15-34 years. The majority are male, low income, young and minorities. This deadly violence is concentrated in communities with high unemployment rates, few business opportunities and limited social service resources. Repeat violent injury patterns are common. According to one study, after being victimized once, a person’s risk of being violently re-injured is 1.5 to 2.4 times greater than an individual who has never been victimized. In communities where violence is an accepted method of resolving conflict, victims and their families are also highly susceptible to retaliation.

Violence Interrupters

stakeholder health case study ceasefireIn 2005, Advocate partnered with CeaseFire to develop the region’s first hospital-based gun violence prevention project. CeaseFire, which works in five ‘hotspot’ communities that overlap with Christ Medical Center’s service area, employs trained “violence interrupters” and “community-based outreach workers.” The violence interrupters—individuals who may previously have been in street gangs—use cognitive-behavioral methods to mediate conflict between gangs, and intervene to stop the cycle of retaliatory violence that threatens after a shooting. Professionally trained and credible, they are able to work effectively with highest-risk individuals to change thinking around violent behavior. The community-based outreach workers provide counseling and services to high risk individuals in communities with high violence rates.

The program builds on the strong role of chaplains already working in the Emergency Department as part of the trauma care team. When a gunshot victim is admitted, an Advocate chaplain alerts the hospital response coordinator, who is available 24/7, to their pending arrival. Hospital responders immediately work one-on-one with the victim, and family and friends, to diffuse tension and reduce the risk of retaliation. Responders are street-savvy individuals (many are ex-offenders) with strong community ties to the high-risk population. They leverage their network of contacts with CeaseFire ‘violence interrupters’ to mediate conflicts and squash retaliations.

Dante, previously in a gang, forged a strong bond with the hospital case manager, whose own ‘street history’ allowed Dante to confide about serious family and social issues he faces in his transition away from the street activity. In the course of these conversations, the hospital case manager supported Dante, encouraging him to seek clinical care from a licensed therapist. Due to the stigma associated with mental health issues and treatment within his community, it would have been very difficult for another intervener to successfully connect Dante with the services needed.

The Numbers

In 2011, the Christ CeaseFire Violence Prevention Project responded to a total of 580 incidents of violent injury and connected 298 patients to community-based violence interrupters. While unable yet to assess actual impact on costs, Advocate Christ Medical Center invested $120,000 in 2013 to support the case manager role. The program’s success has led to its replication at two other Chicago trauma centers.

See related New York Times article: Blocking the Transmission of Violence.

Video: The International Association of Chiefs of Police. Photo: Cure Violence.