Violence prevention starts at Pittsburgh hospital with gunshot victims

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A program that tries to curb violence by introducing at-risk gunshot victims to counselors in the hospital room has been quietly working on a startup basis in Pittsburgh for the past six months as it seeks foundation funding to get fully up and running.

The effort is patterned after Caught in the Crossfire, which began in Oakland, Calif., in 1994.

"We've got everything in place," Steven M. Albert, a professor at the University of Pittsburgh's Graduate School of Public Health, said Tuesday. "We're doing it right now. We're waiting on some funding."

Mr. Albert is working with Richard Garland, a visiting instructor at the school, to reduce violence in Pittsburgh.

They were among five co-authors of a study released Tuesday that classified nearly a third of the city's 42 homicides last year as involving or possibly involving "peer conflict" -- a type, the study argues, that could have been prevented by such methods as hospital intervention.

Mr. Garland formerly ran Allegheny County's defunct violence prevention program, One Vision One Life. That program tried hospital-based interventions on a small scale. But the effort was hampered by a lack of data, services and follow-up, Mr. Garland said.

"It was a little unstructured," recalled Alan Murdock, an Air Force colonel working as a trauma surgeon at UPMC Presbyterian. Dr. Murdock trained in Pittsburgh. He knew Mr. Garland through One Vision One Life and became taken with the idea of hospital-based intervention.

"We're really trying to grab the family in the process," Dr. Murdock said.

Under the Pittsburgh program, a hospital worker asks if a gunshot victim is willing to speak with a counselor. The immediate goal is to keep the peace. The long-term goal is to improve the lot of the victim, the family and the community.

"We talk to him. We talk to his associates. We talk to his family, whoever, and see what we can come up with. This isn't going to be a one-shot deal that we're going to have one conversation and that'll fix the problem. This will be a laborious process," Mr. Garland said.

The program might be most successful with people shot as a result of "peer conflict" -- disputes over drugs, money, power and respect -- rather than gang conflict.

Mr. Albert and Mr. Garland believe there is a general perception that most Pittsburgh homicides stem from gang violence. That's not so, they say. In fact, just three deaths involved gangs, they found. And understanding the difference between gang violence and "peer conflict" violence could lead to different preventive solutions.

"If it's gang stuff, it's harder to get in front of that," Mr. Garland said. When it comes to arguments over such points of friction as money, drugs and women, though, "cooler heads can come in between that. We can come up with different interventions."

"Perhaps a gang member may be less accepting or more resistant to this," Mr. Albert said.

A startup hospital program has been at work in Pittsburgh at UPMC Presby, UPMC Mercy, Children's Hospital of Pittsburgh of UPMC and Allegheny General Hospital for the past six months.

At AGH, for instance, trauma director Allan Philp contacts Mr. Garland if a victim arrives who might respond to outreach. He's done that roughly a half-dozen times.

"The crux of this, and one of the things that we really liked, is you've identified an at-risk population by the very fact that they're in your emergency room and operating room and they've had one of these injuries," Dr. Philp said. "And if you look at the people around them, there's another population that's potentially at risk."

Mr. Garland, a onetime gang member in Philadelphia in his youth, and his partners have the kind of street credibility that a trauma surgeon does not, Dr. Philp said. They offer counseling to try to calm the victim and those in the victim's circle.

"The question I'm going to ask is: 'Who's most likely to retaliate because of you getting shot?' " Mr. Garland said. The next step would be to have the victim call that person in an effort to stave off retaliatory violence.

Ultimately the hope is to try to change the victim's life circumstances through education and jobs. That, however, is the most expensive component and the most challenging.

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Jonathan D. Silver:, 412-263-1962 or on Twitter @jsilverpg. First Published October 15, 2013 8:00 PM


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