Transcription:

Roxanna Gapstur PhD, RN (Host):    On this episode of Inspiring Health, we're putting a spotlight on gun violence and our work to reduce it by addressing its root causes through community partnerships. York City's gun violence rate is higher per capita than most similar sized cities. What makes York unique in this way? And what is a health system's role in reducing community gun violence?

Today, we'll talk about the research and collaboration that is powering York's efforts to disrupt high recidivism rates among gun violence perpetrators. We'll talk about the leadership role WellSpan is playing to build a comprehensive community effort to prevent gun violence and the best practice pilot project currently underway and our next steps. Joining me today is Dr. Michael Bohrn. Dr. Bohrn is WellSpan's Vice President and Chief Academic Officer. In addition, he serves as an Emergency Department Physician at WellSpan York Hospital, and he's the Associate Dean of the WellSpan York Hospital Regional Medical Campus, Drexel University College of Medicine and a past President of the Pennsylvania College of Emergency Physicians. Dr. Bohrn, welcome. And thank you for being here today.

Michael Bohrn, MD, FACEP, FAAEM (Guest): Thanks, Roxanne. It's great to be here.

Host: Dr. Bohrn, help us understand what the gun violence situation looks like in York City and how it's impacting our hospital.

Dr. Bohrn: Well, as you know, Roxanna, York City and especially our region and the Philadelphia area, as well as the nation are seeing increased rates of gun violence over the last several months. York City has faced several recent shootings and several of these involve retaliation from previous gun violence episodes. As the rate of gun violence over the last few years has gone on, it has represented about 1.84 violent crimes per thousand population. That's about 80 shootings per year. The average age for gun violence victims in our area is 24 and 89% of these victims are male.

Sadly, 20% of these victims are under the age of 18 and WellSpan York Hospital has cared for patients as young as four, five and 10 years old in the recent past. One positive note, is that the number of homicides or deaths by gun violence has decreased recently from 17 to 12 deaths during the last full year of reporting.

Host: That's a really stark picture. Mike. I can't imagine how that feels to be working in the emergency center or in the trauma ICU, when these patients come in, it must be incredibly difficult. Mike, do we know what sets York apart from other similar sized cities when it comes to this higher rate of gun violence?

Dr. Bohrn: Well, Roxanna, some of this seems to be related to York's location between New York, Philadelphia, Baltimore, and Washington, DC. There are several related shootings to drugs in York each year. And at a recent press conference, Commissioner Muldrow, the York City police department noted the influx of guns from many areas outside of York. Every community that has significant gun violence has a recidivism rate or the rate of repeat gun violence among those involved previously. We also see retaliatory shootings and these are always a concern as well. Nationally, some young men in cities like York face homicide rates, 100 times the national average.

And we're seeing the impact of COVID-19 on many of these episodes of gun violence as well. Across our region in the country, there are sharp increases in gun violence currently. And unfortunately York seems to be seeing a lot of the same stresses. There are social, financial, medical, and behavioral health factors that are involved including drugs and alcohol use. All of these are involved in shootings, and there are many other reasons that shootings occur in York. We'll be looking at a few of these a little later on today's podcast.

Host: Mike if I didn't know any better I'd say solving this problem, isn't in the scope of a healthcare system, but let's talk about why it matters to us here at WellSpan.

Dr. Bohrn: So, Roxanna, we've learned a lot and we've learned through the Group Violence Intervention, or GVI program of the York City police department, as well as through other community groups focused on this issue, that if we can disrupt the cycle of retaliation, we can prevent further gun violence. The York City Gun Violence Program is based on research from the National Network for Safe Communities at John Jay college. They found that traditional approaches to reducing gun violence have largely centered on over-policing communities of color, while failing to protect them from violence and increasing mistrust. The truth is, these traditional approaches just haven't worked. Instead they advocate a Group Violence Intervention approach, which brings together three key elements.

One, community members with moral authority over group members who deliver a credible moral message against violence. Two, law enforcement puts groups on prior notice about the consequences of further group involved violence for the group as a whole, and three, support and outreach providers make a genuine offer of help for those who want it.

In this model, healthcare systems like ours can serve in that third role, providing support and outreach for those who want an honorable exit and need a supportive path to change. When we think about it, we're uniquely positioned because we're likely to see the gun violence perpetrators and their victims in our emergency department and hospital, we have the access and the direct touch to be able to prevent further violence.

Host: Mike it's so true. We do have direct access to these community members and taking a strong role in reducing gun violence is another way to demonstrate our vision of being a trusted partner to our communities. It's similar to efforts at health partners in Minnesota, my former health system and successful programs at the University of Maryland in their shock trauma department and the Jackson Memorial Hospital program in Miami Dade County. What's fascinating is that these health systems have built programs by addressing two root causes of gun violence, including social determinants of health and treating drug addictions like medical conditions.

Dr. Bohrn: Exactly Roxanna. And I don't need to tell you that we're already doing so much great work in these areas. Just last month we opened the Start Program and the WellSpan Certified Community Behavioral Health Clinic, or CCBHC in downtown York to aid with acute behavioral health needs and connecting patients to the right resources.

And we're doing really good work in the space of social determinants of health. It makes sense to expand our thinking, to reduce gun violence in the same way. And this is exactly what led to the pilot project that we started at WellSpan York Hospital. Our ED Trauma Service has developed a screening process for gun violence victims at WellSpan York hospital, focusing on social determinants of health and behavioral health issues.

There's then a connection process established for interventions and referrals to WellSpan providers and the community, and this results in a network of WellSpan providers, community service providers, behavioral health teams, and others to provide longitudinal support after discharge from the hospital. It's important to note that there's a key impact point involved, a vulnerable period that happens directly after gun violence injury. And this is where we have the greatest chance of helping someone make a change. So, integrating community members with interventions and services in a timely way, is a really important step.

Host: Mike, have we seen any early indications that we're moving in the right direction?

Dr. Bohrn: Yes, Roxanna. We're definitely on the right track with this and we're expanding our efforts to help address the longstanding and recently increased gun violence we're seeing here in York, we've already begun pursuing the next step, which is a Credible Messenger Program. This is a program that's designed to integrate a community-based team member with street credibility to help intervene and guide gun violence patients, to connect to needed resources, to medical and behavioral health care and to other services.

As we just noted, there was a critical period of vulnerability for gun violence victims directly after the episode occurs. Having the Credible Messenger be able to interact with patients, both in the hospital and then to follow along with them after they leave hospital is a huge support and will reduce our local recidivism rate. We're partnering with friends and neighbors at Pennsylvania, a York-based organization, which will be hosting the Credible Messenger staff. This type of partnership is the cornerstone for WellSpan to work hand in hand with our community toward long-term solutions to the gun violence problem. And Roxanna, as you know, WellSpan has just stepped forward to help support the Credible Messenger Program by approving a startup community partnership grant, which will allow this role to be supported for the entire first year.

Host: Absolutely Mike, I know the Credible Messenger Program is one of the four components in our work that leads to the formation of integrated community coalitions to decrease gun violence. And we're also pushing forward to create a sustainable collaborative community centered effort to draw on the strengths of our city government, residents and local community-based organizations who make up the fabric of York, and were planning a media campaign aimed at gun violence prevention. And we continue to seek out appropriate partners, invested in drug treatment and community intervention.

Dr. Bohrn: Thank you for sharing that comprehensive strategy. At the center of our work is collaboration and we can collaborate more efficiently and effectively when we build trust between organizations and between people. So, I'm really glad we're at the table and we're working to build trust between our healthcare community, our residents, and our organizational partners. Thank you for sponsoring this work and using your influence to push it forward, Roxanna.

Host: Mike, this is too important of an issue not to support it. And your own leadership and influence have been incredibly important to the process, as well. As you've shared with us today, we can make a meaningful impact at the most critical time after a gun violence injury. And I'm really eager to see what our pilot program reveals and to get the Credible Messenger Program off the ground. This is exactly how we build trust. I can't think of a better way actually. Thank you for being with me today, Mike, I appreciate your dedication and leadership in all the areas you touch and especially this one.

Dr. Bohrn: Roxanna.

Host: That's all the time we have for today. We hope you'll join us for the next episode of Inspiring Health.