Case Studies

Hahnemann University Hospital - Healing Hurt People

Philadelphia, PA

Overview
Healing Hurt People (HHP), the cornerstone program of the Center for Nonviolence and Social Justice, recognizes that victims of violence often have physical and mental health consequences that go untreated. HHP offers a hospital-based trauma-informed intervention to address both the psychological and physical wounds of trauma among clients who are seen in the emergency department (ED) for intentional injuries (gunshot, stab, or assault wounds). Highly trained program staff provide clients with intensive case management, innovative behavioral health strategies and structured peer support to promote healing while ultimately preventing re-injury and retaliation. The program is headquartered in the EDs at Hahnemann University Hospital and St. Christopher’s Hospital for Children, both affiliated with the Drexel University College of Medicine. HHP also serves victims ages 8 to 30 in three additional EDs across the city: Einstein Medical Center, Penn-Presbyterian Medical Center, and Temple University Hospital.

Recognizing the need to intervene during this crucial time in victims’ lives, the program was conceived by an interdisciplinary team consisting of an emergency physician, an internist, a psychiatrist, a social worker and a psychologist with extensive expertise in violence prevention/intervention, health policy, program planning and trauma. HHP was specifically designed to address the needs – physical, emotional, and social – that victims of violence face after being released from the ED. HHP uses a trauma-informed approach to capitalize on this potentially life-changing moment and address the needs of these youth by providing connection to resources such as medical follow-up; emotional support for post-traumatic stress; mentoring; working with schools to help students affected by school violence; housing; substance-abuse treatment; recreation; legal services; after-school program referral; job training and placement; and parenting education and support.

The ultimate goal of HHP is to interrupt the cycle of violence that can trap these youth, particularly young men of color. To meet these goals, HHP’s model includes three main program components:

  • Assessment in the Emergency Department. Before discharge, a master’s-level social worker verifies that the client has a safe place to go, offers referral services, and advises the client about likely traumatic-stress symptoms.
  • Intensive Case Management in the Community. A trained social worker follows up through phone calls and home visits, and provides ongoing case management services to facilitate clients’ access to medical care, housing, education, employment, and legal help.
  • Structured Peer Support. Clients participate in evidence-based, psychoeducational peer support groups to discuss the trauma they have experienced and generate momentum toward change.


In addition, HHP staff engage with clients’ family and friends, who are often vicariously traumatized, to help prevent retaliatory violence. On average, clients and their families are engaged in the program for six months to one year.

The staff at HHP also educate medical and ED staff about a trauma-informed approach to working with victims of violence. Ongoing in-services are conducted with hospital department personnel (such as social work staff, inpatient trauma team and psychiatric unit), and quarterly presentations are led for residents in which clients may convey their traumatic experiences and the services that have helped them. This educational initiative is anticipated to expand to ongoing trauma-informed professional development curricula for hospital and social service providers.

Impact
A clear and demonstrable impact of HHP is to connect injured victims to needed resources – such as victim compensation, insurance coverage, health care navigation and trauma treatments – that help to address their physical and behavioral health needs. Currently, rigorous research is underway to assess HHP’s long-term impact on re-injury, retaliation, trauma symptoms, and involvement with the criminal justice system. This research will also reveal the program’s effect on participants’ connections to physical and mental health services, employment, and education. Early study findings have shown promising reductions in trauma symptoms among program participants.

HHP has gained significant national attention and is a leader in the movement to end violence using a public health approach. The HHP model has already been replicated in hospitals in Portland, Ore., and Chicago. In addition, HHP advances system-level solutions to prevent violence in Philadelphia – in part through an innovative citywide case review model that engages leaders from law enforcement, medicine, behavioral health, human services, and education.

Lessons Learned
Hospital personnel are keenly aware of the need for intervention among victims of violence, but given the clinical demands of their jobs, they need the support of HHP to serve these victims. Physicians and nurses are the greatest champions for HHP once it is put into place. There is evidence that the HHP is cost effective and that hospitals can benefit both their bottom line as well as their relationships with community partners by implementing HHP. Victims of violence, many of whom are young males of color, are extremely receptive to engaging with the behavioral health services when these services are paired with case management to meet the concrete needs in their lives.

Future Goals
There are plans to incorporate a follow-up health clinic for clients in the program to ensure that their post-emergency medical issues are addressed. A follow-up clinic will enable continuity of medical care while also presenting opportunities for clients to connect with and support each other. Through the Healing Hurt People program, a prototype for other level 1 trauma centers in urban settings may emerge so that victims of violence may heal in a comprehensive and compassionate manner. In this way, a “Best Practice” model may be developed that outlines the approach and steps to creating similar programs across the country. Finally, HHP is working with behavioral health leaders in Philadelphia to develop a sustainable model of reimbursement for HHP services.

Contact: Ted Corbin, M.D.
Associate Professor, Department of Emergency Medicine
Drexel University College of Medicine
Medical Director, Healing Hurt People
Telephone: 215-762-3431
Email: tcorbin@drexelmed.edu


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