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How Hospitals Can Help Stop the Cycle of Youth Violence

...and save money at the same time.
(Photo: Greet Ilegems/Shutterstock)

(Photo: Greet Ilegems/Shutterstock)

When Joel Fein was working in the emergency room of the Children’s Hospital of Philadelphia, treating a 16-year-old boy for injuries he had suffered in a fight, he felt truly helpless when he heard the boy say: “The guy that did this—I’m gonna cap him.” It would mean another fight, another victim of violence, and another patient in the ER. How could Fein do anything to stop the continuation—and escalation—of violence?

This helpless feeling, and this question, both eventually led Fein to his role as co-chair at a national network of “hospital-based violence intervention programs” (HVIPs) that teach health care workers how to help kids and teenagers who have undergone a trauma, and to divert their energies away from dangerous retaliation. And (not that this should be the primary goal, but) according to a new study out by Drexel University, it might save communities a lot of money, too.

The idea behind an intervention program in the hospital setting is that, while victims of violence might have other opportunities to connect with social workers or other resources at other times in their lives, the time right when they are recovering from their injuries may be the most crucial. So the people who are surrounding them at that time should be trained to help them make the right choices. The national network’s handbook for starting up a new hospital-based program reads:

The philosophy of these programs is that violence is preventable and that trauma centers and emergency rooms offer a unique opportunity at the hospital bedside—the teachable moment—to most effectively engage a victim of violence and stop the cycle of violence.

How programs actualize that philosophy will vary, but, for instance, San Francisco’s Wraparound Project assigns case managers to patients who can organize ongoing home visits or cognitive behavioral therapy, and can help patients get better access to government services. They can also point young people to vocational training and new after-school programs to occupy their time, and even to free or discounted tattoo removal—presumably so the kids can take steps to dissociate themselves from gangs.

According to the National Network of HVIPs, the network grew out of the work of a public health agency in Oakland, California, called Youth ALIVE! in the mid-1990s. A symposium on youth violence and what health care providers could do to prevent it soon brought kindred programs from Chicago, Philadelphia, Massachusetts, Milwaukee, Baltimore, and San Francisco into the fold. Today, the network includes programs across the country that have all sprung up with its guidance. One such founding member, Healing Hurt People in Philadelphia, has recently gained the attention of This American Life and ProPublica for its work in identifying and treating the PTSD that psychologists now know can result from experiencing or witnessing inner-city violence.

These programs can actually save not just hospitals, but the criminal justice system as well, millions of dollars.

These programs don’t have to be expensive, either. A 2006 study that calculated the savings from a hospital violence-intervention program in Baltimore found that the program had saved $598,000 in hospital recidivism costs, because only five percent of the people who participated in the program came back with another injury, whereas 36 percent of the people in a control group did. And another study that looked at the results of a similar system in San Francisco found that if the program prevented just three or four re-injuries, then that would neutralize the cost of the entire thing.

Any program that can make a demonstrated difference in young people’s lives, and that also happens to pay for itself, is hard to ignore. But a new study in a forthcoming issue of American Journal of Preventive Medicine makes an even stronger economic case, showing that these programs can actually save not just hospitals, but the criminal justice system as well, millions of dollars.

Public health researcher Jonathan Purtle and his colleagues at Drexel University made a cost-benefit analysis simulation of 180 violence victims over five years—half who would receive HVIP intervention at the time of hospitalization, and half would not. They looked at both the health care-related costs of re-injury (return visits to the hospital after later incidents of violence), the costs to the criminal justice system (if they committed violent crimes after they left the hospital), and the “lost productivity” costs that would result from more hospitalization or incarceration.

When the researchers combined all of those costs, took into consideration the costs of the programs themselves, and extrapolated from the programs’ previous rates of success, the researchers found that the HVIPs came out on top. They concluded that these programs can save up to $4 million over a period of five years.

As the authors wrote in their conclusion, these results “should be considered within the context of evidence about society’s desire to prevent violence for reasons beyond health care and criminal justice costs.” In other words, that $4 million total is significant, but not as significant as improving an incalculable number of utterly unmonetizable lives in the process.

True Crime is Lauren Kirchner's weekly column about crime and criminal justice issues.