Public Health Crisis: Hospital-Based Violence Intervention Programs

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Abstract

Gun violence prevention is one of the critical public health issues in the US since the current policies cannot address this epidemic. The horrific acts of violence are committed every day, leading to human suffering and enormous medical costs. Although it is recognized that no single solution can be applied to this problem, the government tries to combat gun violence by issuing the related policies. It is essential to extensively research and fund gun violence prevention to establish successful initiatives for public health improvement. While New Jersey enacted several bills that facilitate the introduction of the Hospital-Based Violence Intervention Programs (HVIPS), there is a need to understand the techniques that should be used to adopt them in practice. The efforts of social services, law enforcement, and community providers should be coordinated and focused.

Keywords: gun violence, reinjury, public health, Hospital-Based Violence Intervention Programs (HVIPS)

The events of mass shooting and gun violence tend to remain critical in the US, leading to numerous preventable deaths. The increase in the frequency of gun violence is an alarming issue that requires a multifaceted solution to be supported by the government. In particular, approximately 80 persons die daily from shooting since they committed a suicide or another person they knew killed them (Affinati et al., 2016). Therefore, it is essential to explore the reasons for gun violence and research potential intervention as only evidence-based solutions can help in addressing this public health problem. Among possible solutions, one can list more background checks and restrictions on owning guns to protect people. The key idea is to decrease the exposure to firearm violence, focusing on strategies to enforce and improve policies.

Despite the efforts initiated by the US government to protect its citizens from gun violence, the national injury and crime rates remain high. Violent injury and reinjury are often faced by the most vulnerable communities once a patient was hospitalized. The emergency departments present an access point, through which 50 percent of those who were intentionally injured and discharged from the hospital receive another trauma (Affinati et al., 2016). It is important to emphasize that not only physical but also psychological complications occur, including acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). The recent research shows that the “annual societal cost of firearm injury in the USA is estimated to be US$174.1 billion” (Affinati et al., 2016, p. 1). The major part of violent injury cases involves people who have no or limited insurance.

Reasons for Implementing the Hospital-Based Violence Intervention Programs (HVIPS)

In 2018, the state of New Jersey enacted the Hospital-Based Violence Intervention Programs (HVIPS) bill to protect its citizens from repeated injury and address associated costs. The purpose of this law is to interact with the survivors of gun violence in care settings, making this intervention an integral part of the healthcare system. Lieutenant Governor Sheila Oliver signed the bill that requires partnerships between trauma centers and the Victims of Crime Compensation Office. Although the law was enacted, there is insufficient funding to ensure its implementation across New Jersey. The situation is complicated by the fact that such programs are not adopted in terms of a coordinated effort to combat firearm violence. To better understand possible ways to resolve the identified health issue, it is critical to examine the reasons for promoting the HVIPS, such as high mortality rates, psychological issues, and the need to identify vulnerable populations (Governor Phil Murphy, 2020). Although HVIPS were enacted in New Jersey to prevent reinjury in the victims of gun violence, a lack of specific actions to implement them makes it essential to research this field and suggest possible strategies.

Once a patient received the necessary services in a hospital, he or she is to be discharged into the same community, where the person faced firearm violence. Lowe (2019) states that in New Jersey, such cities as Newark, Camden, and Trenton are characterized by the highest rates of deaths from gun violence. As for Atlantic City, its death rate from firearm wounds is lower than in the mentioned cities, yet it still four times greater compared to the state levels (Lowe, 2019). The medical organizations and law enforcement agencies identify such a situation as a public health crisis, calling for an urgent action.

In spite of the introduction of concealed carry permitting and background checks, 3000 people deceased between 2010 and 2016 as a result of gun violence in New Jersey. There is a link between firearm violence and ethnicity / race: while African-Americans compose only 16 percent of the state’s population, they make up almost 50 percent of victims (Giffords Law Center, 2018). At the same time, there is a correlation between gun homicide and high unemployment rates. In the disadvantaged areas, people are more likely to use firearms against others, which places the victims of such violence in a vulnerable position. In particular, small urban areas can be mentioned as the destinations that present more threats. Within these communities, the injustices tend to be systematic and challenging to address.

In addition to the tremendous number of gun violence victims, there is a need to prevent health problems in people who observe gunshots and related injuries. For example, children, pregnant women, and older adults are the most vulnerable populations that can be involved in reinjury while walking around (Purtle, Rich, Fein, James, & Corbin, 2015). Among the consequences of such incidents, one may note PTSD, ASD, and other metal illnesses, which are likely to occur from violence they were exposed to (Giffords Law Center, 2018). In this connection, it is critical to work on revealing the vulnerable populations and ensuring their safety. Another reason lies in the threat of engaging in criminal activity of younger adults under the impact of gun violence environment. By targeting youth, police departments can reduce felony convictions and further violence.

Strategies to Promote the HVIPS in New Jersey

Street outreach work is one of the most effective strategies to establish a supportive environment and connect with the individuals who are at risk. Specially-trained and culturally-competent workers should build the relationships with these people and direct them to the relevant social services. Such an approach can address the underlying reasons for gun violence and reduce the number of potential victims. For example, since a lack of economic opportunities often acts as the cause of violence, they can be guided to social support services. To increase their awareness, the workers can also clarify the options for educational opportunities. The street outreach programs that exist in other cities, such as New York City, show their implementation helps in decreasing the number of shootings in neighborhoods (Purtle et al., 2015). In New Jersey, there is a need to employ street outreach programs to contact at-risk individuals to protect them. The teams of professional workers should be given full-time job offers, thus making sure that the communities are monitored continuously.

The strategy of the Group Violence Intervention (GVI) is a focused deterrence intervention that is implemented in a variety of cities across the US. The key idea of this strategy is to create the partnerships between law enforcement agencies, community members, and social service providers with the purpose of identifying the most vulnerable individuals (Giffords Law Center, 2018). After that, these people are invited to participate in face-to-face meetings with the mentioned stakeholders. The meetings are expected to encourage a powerful interaction to explain the reasons for gun violence as well as the need to stop it. The participants should also receive information on the fact that further shootings will meet the response from law enforcement. In recent years, some New Jersey cities, including Paterson, adopted the GVI efforts, yet other places should be encouraged to act similarly (Giffords Law Center, 2018). It is also essential that the mentioned strategy is to be applied in a robust manner, with the close cooperation of the involved parties.

While discussing the strategies to promote the HVIPS, one should also pay attention to the available funding resources. The Safe Neighborhoods Services Fund was established in New Jersey to support the Safe and Secure Neighborhoods Program (Governor Phil Murphy, 2020). The Department of Law and Public Safety provided the grants for the above program, which can be “up to $200,000 per two-year project and grantees may apply every year” (Giffords Law Center, 2018, p. 31). The eligible municipalities can receive a grant for the introduction of innovative community policies that were designed for reducing crime levels in a certain neighborhood. The Attorney General’s Office of Community Justice (OCJ) provides another funding option via the Neighborhood Crime Prevention and Intervention. To stop gang involvement of youth, the Outreach to At-Risk Youth (OTARY) program was launched by the Department of Children and Families. Nevertheless, the presence of these programs does not seem to be robust.

Combating gun violence is also possible in the context of emergency departments to identify the patients who are at a high risk of being injured repeatedly. In particular, the involvement of nurses, physicians, and social workers in the process of collecting more data about the victims of violence is useful (Dicker, 2016). The coordination of services also needs to be performed to provide the best care and support possible. The efforts of medical staff can be regarded as the first step in intervening with the target patients after their discharge from the hospital. The information collected in emergency departments should be transferred to social workers and other professionals implementing the mentioned programs (Dicker, 2016). In this connection, medical staff plays a key role as the mediators between the victims of gun violence and the future coordinators. More to the point, nurses, physicians, and other involved parties should provide rehabilitation services by providing crisis interventions and follow-up assistance.

Although the evidence shows that certain efforts were implemented by New Jersey organizations to decrease gun violence with regards to its victims, there is a lack of studies that confirm the effectiveness of the HPIVS. Therefore, one may suggest that further research is critical to evaluate the current strategies and challenges that are faced by the professionals who introduce them. The recommended areas of research include examining the link between the community input and program results along with any alternative solutions to the problem of firearm violence and reinjury.

Advantages and Disadvantages of the HVIPS

The critical review of the HVIPS initiatives reveals their strong and weak points that should be examined to understand their potential in gun violence prevention in an in-death manner. The first advantage of this policy is associated with their focus on building the links across the communities. Based on the coordinated efforts of social services and law enforcement, they strive to target at-risk people, which facilitate a community-level input. The long-term orientation of the policy is another advantage that refers to eradicating the core of the problem instead of addressing only its consequences. The fact that the HVIPS programs are employed by various states allows for learning on their successes and failures in the course of experience sharing.

The funding of firearm violence prevention programs is the key disadvantage and challenge that should be addressed by the local and state organizations. The legislators of New Jersey should adopt more policies to enforce the HVIPS. The current funding provided by federal and state agencies is insufficient to ensure the use of evidence-based strategies. The example of other states that significantly reduce gun violence levels can be considered to make the new policies more effective. For instance, Massachusetts enacted the Safe and Successful Youth Initiative to identify at-risk citizens and refer them to the social services, which allowed declining gun homicide cases among African-Americans by 47 percent between 2010 and 2015 (Giffords Law Center, 2018). This reduction was accompanied by the 17 percent increase in gun violence among the identified population at a national level.

Implications to Public Health

The initial contact with the victims of gun violence in the hospital settings allows revealing many diseases that are likely to remain unidentified. Since the majority of them live in low-income and disadvantaged communities, such conditions as obesity, hepatitis, diabetes, substance abuse, and so on (Bell et al., 2018). The exposure to violence and a lack of assistance lead to depression and other psychological issues. The synthesis of hospital-based interventions and community services reduces the risk of recidivism and enhances patient outcomes. The implementation of the HVIPS promotes the prevention of complications and timely treatment, which is important not only to patients but also healthcare in general. According to Bell et al., (2018), public health area can benefit as a result of a decrease in care costs, resource utilization, and recreational programs. The reduced number of suicides, overdoses, and other traumas that are characteristic of gun violence victims also contribute to public health improvement.

Conclusion

In conclusion, it should be stressed that the Hospital-Based Violence Intervention Programs (HVIPS) were enacted in the state of New Jersey, they lack practical implementation strategies. This paper examined the reasons for introducing such techniques as street outreach programs, focused deterrence, and funding options. It was suggested that the coordinated efforts of medical staff, law enforcement, and social support services compose the most relevant solution to the problem of repeated gun violence with regard to its victims. The potential implications of the HVIPS to public health include timely disease diagnosis and treatment as well as reduced costs and resource use.

References

Affinati, S., Patton, D., Hansen, L., Ranney, M., Christmas, A. B., Violano, P.,.. Crandall, M. (2016). Hospital-based violence intervention programs targeting adult populations: An Eastern Association for the Surgery of Trauma evidence-based review. Trauma Surgery & Acute Care Open, 1(1), 1-7.

Bell, T. M., Gilyan, D., Moore, B. A., Martin, J., Ogbemudia, B., McLaughlin, B. E.,… Zarzaur, B. L. (2018). Long-term evaluation of a hospital-based violence intervention program using a regional health information exchange. The Journal of Trauma and Acute Care Surgery, 84(1), 175-182.

Dicker, R. A. (2016). Hospital-based violence intervention: An emerging practice based on public health principles. Trauma Surgery & Acute Care Open, 1(1), 1-2.

Giffords Law Center. (2018). New Jersey gun violence impact analysis and policy audit. Web.

Governor Phil Murphy. (2020). Governor Murphy, Attorney General Gurbir Grewal, and former congresswoman Gabby Giffords announce winners of grants for nine hospital-based violence intervention programs across New Jersey. Web.

Lowe, C. (2019). Gun violence is one of Atlantic City’s biggest health threats. The Press of Atlantic City. Web.

Purtle, J., Rich, J. A., Fein, J. A., James, T., & Corbin, T. J. (2015). Hospital-based violence prevention: Progress and opportunities. Annals of Internal Medicine, 163(9), 715-717.

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