vpp-vip focus 4.2011

R ADAMS COWLEY SHOCK TRAUMA CENTER

VIOLENCE PREVENTION PROGRAM (VPP)UNIVERSITY OF MARYLAND MEDICAL CENTER

Who We Are and What We DoA Focus on the Violence Intervention Program

(VIP)April 2011

Melissa Cole, LCSW-C

VIOLENCE PREVENTION PROGRAM (VPP)

Carnell Cooper, MD, FACS Founder & Team Leader 1998-present

VPP Component Services Violence Intervention Program (VIP)

Promoting Healthy Alternative for Teens (PHAT)

My Future My Career (MFMC)

VIP-City Wide (VIP-CW)

Component 1Violence Intervention Program

(VIP)

Victims in the Hospital

Talk to victims of violent injury at the bedside in STC

Assess immediate needs

Develop individualized service plans / “plans of action”

Deliver intensive clinical case- management services in the community post-discharge

Priorities / Outcomes

Interrupt the cycle of violenceTeach non-violent coping strategiesConnect clients to community providersReduce risk taking behavior & re-injuryReduce criminal behaviorPrevent violence and criminal activity

Component 2Promoting Health Alternatives

for Teens (PHAT)

Youth in the Community

Talk to youth about the “power of choice” & decisions

Have youth & professionals talk about career paths in

Introduce youth to former victims/perpetrators of violence to talk about positive life lessons

Deliver messages through spoken word artistry

Priorities / Outcomes

Interrupt the cycle of violencePlant “seeds” for pro-social behavior, problem solving & future orientation Increase discussions about “taboo topics” & important life decisions Decrease risk factors for violence

Component 3My Future My Career

(MF-MC)

Group of at Risk Youth

Expose a group of at risk youth to specific career paths over 8 weeks of sessions at UMB through VPP

Youth talk with professionals, express themselves through spoken word exercises & are connected with resources in the community

Re-engage youth with school

Priorities / Outcomes

Interrupt the cycle of violence Plant “seeds” for pro-social behavior, problem solving & future orientation Increase discussions about “taboo topics” & important life decisions Decrease risk factors for violence

Coordinated Hospital Effort

Extend VIP service model to area Emergency Departments

Collaborate with healthcare providers to maximize quality care for victims of violent injury

Reached MOUs with eight Emergency Departments in 2009 – no funding available

Efforts to expand city-wide continue

Priorities / Outcomes

Extend the VIP service model to reach eligible victims of violence across the city Reduce violent crime & re-injury Contribute to best practice standards Implement a cost-effective, evidence- based & pro-active approach to interpersonal violence

Component 4Violence Intervention Program-

City Wide (VIP-CW)

COMPONENT SERVICES of the UMMC Violence Prevention Program (VPP) (rev 05/10)

KEY DEMOGRAPHICS Urban Victims of Violence

African American MaleAges 15-27High School drop outUnemployed-no stable incomePositive toxicology screen for drugs / alcoholHistory of involvement with criminal justice Repeat victims of intentional violent injuryNo health insuranceNo stable housing – no rental historyNo credit or banking history

IMPACT ISSUES Risk Factors

Poverty Limited education Under-employment Untreated mental

health problems Untreated medical

conditions History of victimization Recent victimization Inadequate social

supports No insurance

Protective Factors Healthy social supports Preventive medicine &

timely health care Timely mental health

assessment & services Sufficient financial

resources Adequate education Gainful employment No history of victimization

– help for traumatic experiences

Insurance coverage

Rev. 4.2011 Melissa Cole, LCSW-C

Snapshot of the VIPThe foundation for the core set of services under the VPP umbrella

Serving victims of intentional violent injury ages 14 and older

Reaching residents of Baltimore city & contiguous counties

Evidence-based outcomes: 1) reduction in repeat hospitalization due to violence

gunshot stabphysical assault

2) reduction in criminal behavior arrestsconvictionsactivities

3) increase in pro-social activity employment parenting

housinglife skillsmentoring

VIP SERVICES Recruitment at the hospital bedside IRB consent Comprehensive questionnaire /

assessment Service planning Role modeling / mentoring Referrals to the best community

resources Advocacy Crisis intervention Life skill development Counseling / peer support group

Phase 1 Crisis Intervention &

Enrollment

Assessment Relationships

Public and Private Safety

Involvement of social networks

Identification of & connection to services

Goal identification

Willingness to change

Other?

Phase 2 Goal Development

Rapport BuildingGoal solidification

Commitment to change

Develop & reinforce future orientation

Learn non-violent means of self-expression & communication

Learn & practice healthy coping & social skills

Stay community connected

Other…

Phase 3 Goal Solidification

Values Clarification Growth in personal responsibility

Improvements in setting & reaching personal goals

Success with referrals & service plans

Decrease in violence & other risk factors

Increase in pro-social attributes & other protective factors

Other…

Personal GrowthSignificant & substantial personal accomplishments

Sustained relationships with community providers

Positive social networks

Protective factors outweigh risk factors

Other…

Phase 4Reinforcement

VIP Phases of Intervention: Objectives & Outcomes

Rev 4.2011 Melissa Cole, LCSW-C

Phase 1 Crisis Intervention &

Enrollment

Assessment Eligible for the program? Active parole/probation? Repeat victim of violence? Immediate safety issues? Mental health needs? Medical concerns? Educational history? Employment status? Illicit substances / alcohol? Housing situation? Gang affiliation? Children? Other?

Phase 2 Goal Development

Rapport Building Meeting with VIP staff Following special conditions Identifying risk taking behavior Attributing meaning to events Practicing new skill sets Increasing positive supports Completing identified tasks Engaging in nonviolence Meeting new service providers Getting documents in order Recognizing stressors Other…

Phase 3 Goal Solidification

Values Clarification Setting priorities for goals Identifying emotional triggers Reducing risk taking behavior Increasing protective factors Managing external stressors Incorporating new skill sets Planning for the future Maintaining positive supports Keeping new service providers Completing service plans Building nonviolent skills Other…

Personal Growth Utilizing adaptive skills Maintaining positive supports Self-referring for services Making own service plans Completing personal tasks Role modeling for others Volunteering in the community Minimizing risk taking behavior Maximizing protective factors Attributing meaning to events Applying nonviolent tenets Reconnecting with VIP staff Other…

Phase 4Reinforcement

VIP Phases of Intervention: FOCAL POINTS

Rev 4.2011 Melissa Cole, LCSW-C

Key Elements of the VIP Intervention Rapport between worker & client Strategic community referrals Teachable moments / defining moments “No topic is taboo” / Values clarification Trigger identification for risk taking behaviors Positive social support & resource development Skill set practice in safe environments Getting documents in order Ongoing assessment & service plan review Conscious use of self Respect, Respect, Respect

Rev. 4.2011 Melissa Cole, LCSW-C

ASSESSMENT Safety (assessments for personal & public lethality need to be ongoing)

Revenge, retaliation, gang affiliation (past & present)

Self-injury, impaired impulse control (past & present)

Impaired functioning (addiction, mental status) (past & present)

Perpetrator behavior (past & present)

Benefits (they need identification to apply for benefits & a stable mailing address)

Social services, disability, food stamps, mobility Victim of crime compensation Health insurance

Criminal Justice Warrants (ie: may need to contact probation officer of hospitalization to avoid FTA & warrant)

Special conditions (ie: ex-parte, urination, reporting requirements)

Active cases (ie: pending charges, pending sentence, multiple jurisdictions)Rev. 4.2011 Melissa Cole LCSW-C

ASSESSMENT Substance Abuse / Addiction

In patient consultation Possible detox / community referrals

Mental Health / Spiritual Needs In patient consultation

In hospital crisis intervention Community referrals

Physical / Medical Needs Community referrals & advocacy for ongoing issues

Housing Community referrals for shelters, recovery homes, etc.. Assessments of living conditions

Rev. 4.2011 Melissa Cole, LCSW-C

SERVICE PLANNING

KEY VARIABLES:*Motivation

*Capacity*Support *Opportunity

* Tasks *Time Frames

*Obstacles

*Protective Factors

* *Primary & Secondary Gain

*Risk Factors

Rev. 4.2011 Melissa Cole, LCSW-C

THE VPP TEAM Carnell Cooper, MD, FACS, team leader: ccooper@umm.eduHolly Miller, LCSW-C, clinical supervisor: hmiller@umm.eduSharon Moore, case manager: smoore3@umm.eduHoward McCray, case manager: hmccray@umm.eduDavid Ross, PHAT coordinator:nativeson@5thl.comFemi Lawal, PHAT coordinator: thedrifish@5thl.comMelissa Cole, LCSW-C, clinical trainer: mcole2@umm.eduLillian Carter, parole agent: lcarter@dpscs.state.md.usTara Carlson, business development mgr: tcarlson@umm.edu

110 South Paca Street, 3rd Floor, Baltimore, MD 21201Office: 410-328-7436fax: 410-328-0864

http://www.umm.edu/shocktrauma/vip_mission.html