Temple University Hospital's trauma outreach coordinator Scott Charles wants to do everything for young gunshot victims. Keeping them from returning to the emergency room is a good start.
"We know what the problem is," Charles says. "We don't need any more public awareness. We have to do something."
There's the obvious: provide quality education and meaningful jobs. But as Charles says, even if you put jobs out there, how do you undo a lifetime of damage?
"You can't air-drop hope into a neighborhood," he says. "You can't do drive-by inspiring. You got to plant seeds, and make sure they take root. We're so far past kids needing a pep talk. We've got to have a presence in those neighborhoods, and we don't. So until we can figure it out, my job is basically doing triage."
Many of the gunshot victims Charles sees needed a trauma team long before they got shot. Referring to one young patient, Charles says: "It wasn't like his life wasn't messed up before he got shot. I'd have a full-time job just helping him with that."
In 2005 Gov. Rendell established a commission to address gun violence. The result was a pilot program called the Pennsylvania Injury Reporting and Intervention System (PIRIS), a hospital-referral program that connects gunshot victims ages 15 to 24 to social service and intervention providers to identify effective violence-reduction strategies.
Philadelphia was chosen for the program because it has the greatest number of firearm-related hospital discharges (38.3 percent) in the state for people age 15 to 24.
The program, which launched in April of last year, works with the city's three trauma centers: Temple, Einstein and the Hospital of the University of Pennsylvania. It's funded through the state health department, managed by the Philadelphia Health Management Corporation (PHMC), and aided by the Philadelphia Anti-Drug/Anti-Violence Network (PAAN).
Through PHMC, each of the program's gunshot victims is assigned a case manager to support the physical, emotional and social needs of the victim and their family.
"It's really a holistic approach," says Doris Spears, PHMC's case management supervisor. "Let's look at what was going on before the traumatic event. You never know where it's gonna take you. It's much more than, 'Some young person got shot at 23rd and Diamond.'"
If the victim was an innocent bystander, Spears says, PHMC assists them in returning to their previous life--back to school, back to work. If the victim engaged in behavior that contributed to their being shot, "then we need to talk about lifestyle changes," she says.
PHMC provides intensive, long-term case management, which means supplying a web of services: public assistance, medical assistance, witness protection, GED training, job training, resume writing, drug treatment, truancy issues and parenting issues. They even provide smoke detectors. They help victims get back to school, prepare for upcoming court cases, make doctor's appointments and deal with posttraumatic stress.
But the question becomes, where do you start?
It's an experiment still in its infancy. But the individual stories provide bittersweet hope. Like the paraplegic who's getting married in May, or the once-truant student and father of two who's graduating from high school in June.
But Spears cautions, "This is a process. Sometimes it's as basic as helping people get their birth certificate before tackling lofty goals."
Once the bullets are removed, Spears says, there's an expectation that victims should be able to carry on with their lives, and most of the time that's not the case. "Victims and families need help--not just with day-to-day problems but with the ongoing effects of their shooting. Some of them are desensitized, the walking wounded."
|Infinite patients: Inside Temple's trauma unit.|
While PHMC works with the gunshot victim, PAAN focuses on the community.
"The gunshot filled the young person," says PAAN coordinator Elisha Morris, "but it affected the entire community. The community is more afraid, more angry and more and more apathetic as it feels more and more unsafe."
PAAN goes into the neighborhood where the young person was shot to ease tensions and foster healing. They host events, sometimes on the very corner where the shooting took place. They invite police, elected officials, clergy, neighbors, the victim and their family with the hope that someone will want to keep it going.
"The reality is most of these people can't move, and don't want to," says Spears. "They're invested in their community. But there's not the support structure to make that community vital."