Violence Intervention Program
The Violence Intervention Program (VIP) at CHOP was established in 2012 by Joel Fein, MD, MPH, an Emergency Department (ED) Physician who had treated far too many assault injured youth. For most, the ED was able to heal their physical wounds, but for some, the patients were discharged back into the community only to be re-admitted with similar violent injuries. Dr. Fein realized that violence prevention required a public health approach, and trauma-informed care needed to be at the core of providing services to families.
CHOP VIP provides a direct and sustainable connection between the hospital and the community. Today, as part of CHOP’s comprehensive Center for Violence Prevention, this program promotes healing, and seeks to reduce re-injury and retaliation through a community- and family-focused model that works directly with patients between 8 and 18 years old who are treated at CHOP for an injury due to interpersonal violence.
- How VIP Works
A youth injured by assault is identified in the ED or Trauma Unit and referred to CHOP VIP. A Violence Prevention Specialist then connects with the patient and patient’s family, at the bedside when possible but often after discharge, to perform a comprehensive intake assessment and provide psycho-education regarding trauma symptoms, safety planning, and provides resources to support families through the post-injury period.
After discharge from the hospital, we provide trauma-informed case management, mental health services, and navigation to needed resources.
The VIP Team helps the youth and his or her family navigate complex systems of care to meet their needs within the communities in which they live. The patient and family work together with VIP team members to establish goals with the aim of reducing the negative consequences of violent injuries.
The VIP serves as a bridge to long-term support for families and increases the likelihood that families successfully engage in services. In order to satisfy our patient's goals, the team builds relationships and partnerships with service providers and community agencies in the Philadelphia area. These relationships facilitate access to the services and programs that our patients require to achieve recovery and safety.
Through VIP directly, our youth and staff can participate in psycho-educational groups that help build their resilience. Read more about Building Resilience After A Violent Experience (BRAVE) and the Stress-Less Initiative.
The multidisciplinary VIP team includes Licensed Social Workers, a Family Liaison, an Emergency Department Physician, an Adolescent Medicine Physician, a Psychiatrist, a Clinical Psychologist, a Research Scientist, Research Coordinators, Peer Mentors, and Administrative staff.
- The Community We Serve
We serve youth who reside in Philadelphia County and have sought care for assault-related injuries in the ED or the Trauma Unit at CHOP. Here are a few facts about the community of youth that we serve.
- The majority of program participants (70%) reside in neighborhoods within West and Southwest Philadelphia.
- The average age at injury for our patients is 14 years, 82% are African-American, and we serve an equal numbers of male and female youth.
- Overall, Philadelphia has a young population, with 25% younger than 20 years of age.
- Approximately 70% of our patients’ assaults occur in school or directly after school. Thus, we provide advocacy on the individual school and district level to ensure the safety needs of patients are being addressed.
- While there has been an overall decrease in homicides in Philadelphia, homicide remains the leading cause of death for our teens and young adults. For Philadelphia youth ages 10 to 24 years, the homicide rate is 4.7 times greater than the national average.
- One in eight high school students reported carrying a weapon in the past 30 days
- More than 30% of elementary and middle school youth are involved in daily bullying and victimization.
- In high school, 45% of youth report being in a physical fight in school.
- At CHOP, we have seen an increase in violently injured youth presenting for emergency care. Approximately 500 patients with assault-related injuries are treated each year in our ED and Trauma Unit.
- VIP Impact
VIP not only serves the assault-injured patient, but wraps services around the entire family, including caregivers and siblings, understanding that violence and trauma impact the entire family.
Most patients receive VIP services for 3 to 6 months but that time period could be longer as needs require. During that time we advocate to reduce barriers to successful goal resolution and coach youth and family members in how to successfully navigate complex service systems. CHOP VIP measures its impact by rigorous tracking of each patient’s needs, goals, and outcomes.
Through the support of the Hospital and donations/grants from funders including Kohl's Cares®, our intensive community-focused model is on pace to provide services to more than 100 youth and their families annually.
Participating youth self-identify recovery goals in 15 domains of needs, ranging from post-injury medical needs to basic needs, including housing and food insecurity. Additionally, many youth identify significant post-assault safety needs. Through continued tracking, more than 800 discreet patient goals within these need domains have been identified. Patients who have completed our program have had an average of 5 self-identified goals, and almost 80% of these are resolved through referrals, resources, education, and advocacy provided by VIP.
To date, our youth are most in need of support in these critical areas:
- Mental health (86% of youth): Providing and/or referring youth/siblings/caregivers for therapy to; suicide safety planning; referring family to the Office of Intellectual Disabilities; care coordination with clinical professionals; and providing support to family in seeking emergency mental health care.
- Education (64% of youth): Care coordination and advocacy; re-enrollment or school transfer (due to safety issues); assistance in 504 Accommodations; requests for an Individual Education Plan (IEP); assistance with homebound services requests; college preparation assistance; and referrals to the Education Law Center.
- Legal (57% of youth): Accompanying patients and families to court hearings; assisting families in navigating the legal system; obtaining police reports; and care coordination and advocacy within legal system.
The emphasis on these needs was also observed in a study of male VIP clients from 2012-2016, as published in the Journal of Adolescent Health. Young men in the program self-identified mental health (89%), legal (60%), and education (58%) as their primary areas where additional support was needed. Learn more about the study.
Another VIP-led research study, published in the Journal of Interpersonal Violence, re-emphasized a priority on outcomes related to psychosocial health. In the study, 79 front-line staff members from 22 hospital-based violence intervention programs (HVIPs) were asked to identify and prioritize individual-level outcomes they believe are achieved among their clients by participating in such a program. The authors found that mental health and coping, social support, and well-being were important indicators of HVIP success. Learn more about the study.
Being able to assess our case management goals has been extremely beneficial in guiding both our research efforts and our clinical services. In addition to these successes, we see our clinical work (therapy and psycho-educational peer groups) as critical to improving outcomes in patients' self-esteem; sense of safety; ability to trust; sense of belonging; emotion regulation; coping and communication skills; and family relationships. We are currently designing outcome measures for these domains.
- Towards a Replicable Model
The VIP is one of more than 30 member programs in The Health Alliance for Violence Intervention (The HAVI) and we are increasingly recognized as a model in pediatric hospital-based violence prevention. Most recently, in early 2020, the VIP program was chosen by the Centers for Disease Control and Prevention’s (CDC) Division of Violence Prevention as one of nine programs to participate in the Evaluability Assessments of Promising Hospital-Based Violence Prevention Program. Philadelphia is fortunate to have a number of these hospital-based programs and we are grateful for the assistance of and collaboration with the Healing Hurt People program at Drexel University. Through The HAVI, CHOP’s VIP collaborates on clinical best practices, while we undertake research opportunities to rigorously evaluate and inform enhancements to our program. The HAVI hosts an annual conference that brings more than 200 participants from member programs.
- CHOP Publications on Treating Assault Injured Youth
- W Monopoli J, Myers RK, Paskewich B, Bevans KB, Fein JA. Generating a Core Set of Outcomes for Hospital-Based Violence Intervention Programs. Journal of Interpersonal Violence. 2018:886260518792988
- Myers RK, Vega L, Culyba AJ, Fein JA. The Psychosocial Needs of Adolescent Males Following Interpersonal Assault. Journal of Adolescent Health. 2017.
- Fein JA, Mollen CJ, Greene MB. The Assault-Injured Youth and the Emergency Medical System: What Can We Do? Clinical Pediatric Emergency Medicine. 2013;14(1):47-55.
- Fein JA. The Assault-injured Youth: What We Know, How We Use It. J Adolesc Health. 2012;50(3):213-4.
- Wiebe DJ, Blackstone MM, Mollen CJ, Culyba AJ, Fein JA. Self-reported Violence-related Outcomes for Adolescents Within Eight Weeks of Emergency Department Treatment for Assault Injury. J Adolesc Health. 2011;49(4):440-2.
- Cunningham R, Knox L, Fein JA, et al. Before and After the Trauma Bay: The Prevention of Violent Injury Among Youth. Ann Emerg Med. 2009;53(4):490-500.
- Blackstone MM, Wiebe DJ, Mollen CJ, Kalra A, Fein JA. Feasibility of an Interactive Voice Response Tool for Adolescent Assault Victims. Acad Emerg Med. 2009;16(10):956-62.
- Hausman AJ, Hohl B, Hanlon AL, et al. Translating Community-specified Indicators of Program Success into Measurable Outcomes. J Public Health Manag Pract. 2009;15(6):E22-30.
- Cohn JM, Ginsburg KR, Kassam-Adams N, Fein JA. Adolescent Decisional Autonomy Regarding Participation in an Emergency Department Youth Violence Interview. Am J Bioeth. 2005;5(5):70-4; discussion W14.
- Fein JA, Kassam-Adams N, Gavin M, Huang R, Blanchard D, Datner EM. Persistence of Posttraumatic Stress in Violently Injured Youth Seen in the Emergency Department. Arch Pediatr Adolesc Med. 2002;156(8):836-40.
- Fein JA, Kassam-Adams N, Vu T, Datner EM. Emergency Department Evaluation of Acute Stress Disorder Symptoms in Violently Injured Youths. Ann Emerg Med. 2001;38(4):391-6.
- Fein JA, Ginsburg KR, McGrath ME, Shofer FS, Flamma JC, Datner EM. "Violence Prevention in the Emergency Department: Clinician Attitudes and Limitations." Arch Pediatr Adolesc Med. 2000;154(5):495-8.
- Relevant Publications
- Aboutanos MB, Jordan A, Cohen R, Foster RL, Goodman K, Halfond RW, Ivatury RR. Brief Violence Interventions With Community Case Management Services Are Effective for High-Risk Trauma Patients. Journal of Trauma and Acute Care Surgery. 2011;71(1), 228-237 210.
- Becker MG, Hall JS, Ursic CM, Jain S, & Calhoun D. Caught in the Crossfire: The Effects of a Peer-based Intervention Program for Violently Injured Youth. Journal of Adolescent Health. 2004;34(3): 177-183.
- Cheng TL, Wright JL, Markakis D, Copeland-Linder N, & Menvielle E. Randomized Trial of a Case Management Program for Assault-injured Youth: Impact on Service Utilization and Risk for Reinjury. Pediatric Emergency Care. 2008;24(3): 130-136.
- Cheng TL, D Haynie, et al. Effectiveness of a Mentor-Implemented, Violence Prevention Intervention for Assault-Injured Youths Presenting to the Emergency Department: Results of a Randomized Trial. Pediatrics. 2008;122(5): 938-946.
- Cooper C, Eslinger DM, & Stolley PD. Hospital-based Violence Intervention Programs Work. Journal of Trauma-Injury Infection & Critical Care. 2006;61(3): 534-537.
- Corbin TJ, Purtle J, Rich LJ, Rich JA, Adams EJ, Yee G, Bloom SL. The Prevalence of Trauma and Childhood Adversity in an Urban, Hospital-Based Violence Intervention Program. Journal of Health Care for the Poor and Underserved. 2013;24(3): 1021-1030.
- Corbin TJ, Rich JA, Bloom SL, Delgado D, Rich LJ, Wilson AS. Developing a Trauma-Informed, Emergency Department-Based Intervention for Victims of Urban Violence. Journal of Trauma and Dissociation. 2011;12(5): 510-525.
- Karakker N, Cunningham RM, Becker MG, Fein JA, Knox LM. A Best Practices Guide for Launching & Sustaining a Hospital-based Program to Break the Cycle of Violence. Online PDF courtesy of the National Network of Hospital-based Violence Intervention Programs and Youth ALIVE! 2011.
- Purtle J, Dicker R, Cooper C, Corbin T, Greene MB, Marks A, Creaser D, Topp D, Moreland D. Hospital-based Violence Intervention Programs Save Time and Money. Journal of Trauma and Acute Care Surgery. 2013;75(2): 331-333.
- Shibru DE, Zahnd E, Becker M, Bekaert N, Calhoun D, & Victorino GP. Benefits of a Hospital-based Peer Intervention Program for Violently Injured Youth. Journal Of The American College Of Surgeons. 2007;205(5): 684-689.
- Zun LS, Downey L & Rosen J. The Effectiveness of an ED-based Violence Prevention Program. American Journal of Emergency Medicine. 2006;24(1): 8-13.
- Violence Intervention Program Blog Posts
- The Impact of COVID-19 on CHOP Violence Intervention Program’s Clinical Services -- July 14, 2020
- Finding New Ways to Conduct Behavioral Research During the COVID-19 Pandemic -- June 25, 2020
- Focusing on Emotional Health in Uncertain Times -- March 25, 2020
- We Are All Part of the Solution to Prevent Violence in Philadelphia -- August 22, 2019