The National Network of Hospital-based Violence Intervention Programs (NNHVIP) highlighted the Massachusetts Violence Intervention Advocacy Program (MA VIAP), which serves as a resource for established and emerging hospital-based violence intervention programs.
The Network is a partnership of programs across the country providing intervention services to individuals being treated for violent injuries. The philosophy of these programs is that violence is preventable and that trauma centers and emergency departments have a golden moment of opportunity at the hospital bedside to engage with a victim of violence and to stop the cycle of violence.
Background: The Violence Intervention Advocacy Program (VIAP) serves communities through three hospital emergency departments in the state of Massachusetts: Boston Medical Center (BMC) and Massachusetts General Hospital (MGH), both in Boston, and Baystate Medical Center in Springfield. The program acts in accordance with its mission to assist victims of violence to recover from physical and emotional trauma and empower them with skills, services, and opportunities so they can return to their communities, make positive changes in their lives, strengthen others who have been affected by violence, and contribute to building safer and healthier communities. Funding and support for the program comes from the Massachusetts Department of Public Health Bureau of Substance Abuse Services, the Boston Public Health Commission Division of Violence Prevention through a Robert Wood Johnson grant, the Boston Foundation and contributions from the three hospitals emergency departments.
Structure: VIAP is unique in that it is both one unified state program and also three separate programs at three hospitals across the state. VIAP aims to reduce factors that put young men and women at-risk for future injury, other related health and social issues, or even death. All the while, VIAP promotes positive alternatives that foster growth and transformation in life. Violence Intervention Advocates (VIAs) contact violently injured patients as they arrive to the ED and are admitted to inpatient floors or reach out to them post-discharge. The program provides various levels of service and referrals depending upon patient need and risk as assessed by the VIA and program staff. These services may range from a dialogue about safety and peaceful alternatives upon discharge, to short-term in-hospital or outreach services, to long-term case management relationships. Not to be overlooked as a marquee service of VIAP is the active role VIAs perform in motivating patients to make changes and in modeling consistent and constructive behavior for their clients.
Services: Operationally, VIAP’s services are thought of in tiers that reflect the levels of recovery and development. Each tier is associated with types of services VIAs can educate about, advocate for, and refer to directly. These tiers often interact and blend into one another in practice. Progress is dynamic and non-linear. By moving clients through these tiers, clients receiving case management can successfully complete the program. The services covered under each tier are:
- Injury and recovery – Hospital care navigation, primary care and surgical appointments, medical equipment needs, physical therapy, mental health, alcohol or substance abuse, state victim’s compensation awards.
- Basic needs – Housing/relocation, transitional assistance/food, family and child support, legal advocacy and support.
- Personal development and growth – Education assistance (GED, college application), job readiness training, employment assistance, counseling (individual and family).
- Maintenance – Check-in and reflection, maintaining jobs and school, personal development.
Accomplishments and Challenges
The Boston Medical Center VIAP’s upcoming focus is on workforce development and self care for staff. They are in the process of developing and implementing an in-depth case management training for VIAs, which will focus on relational, professional, and technical development. Recognizing the need for clients to also enhance their quality of life and experience joy, a new commitment to providing activities and new experiences for clients in underway. Most recently, one VIA planned a fishing trip with a client!
The Baystate Medical Center VIAP employs one VIA, Winifred Atwell. Winnie has found great success in providing case management services for her clients, linking them with essential transitional assistance services, counseling, housing and job training, and moving them through the different tiers of services to complete the program.
The Massachusetts General Hospital (MGH) VIAP also employs one VIA, Amanda Breen. Amanda has worked to build key collaborations in the hospital with staff, specifically the social services and in-patient teams, and build networks outside the hospital. Amanda found early success with the state victim’s compensation fund by making contacts there and consistently following-up after applications were submitted.
Some of the challenges VIAP faces are:
- Funding is still the biggest issue. There is the need to prove to hospitals that the intervention fiscally provides a long-term solution to the reduction of recidivism of violent injury.
- On-going need for workforce development and staff support for continued improvement.
- Capturing the outcomes of an intervention program such as VIAP is needed to show its efficacy.