While working as an orthopedic surgeon in Hawaii, Dr. Diane Payne had treated one person with a gunshot wound in three years. But when she moved to Atlanta in 2013, Payne said it was like treating gunshot victims was suddenly all she was doing.
鈥淚 was shocked by the number of gun-related injuries that we鈥檙e seeing and taking care of here,鈥� said Payne, who works at Atlanta鈥檚 busy downtown trauma center, Grady Memorial Hospital.
In 2013, Grady treated more than 600 gunshot victims.
鈥淎nd I started asking 鈥榃hat is going on?鈥� And the answer I was getting routinely from my colleagues was 鈥榃elcome to Grady. That鈥檚 just how it is here,'鈥� Payne recalled.
She said it was like everyone had just gone numb.
So she did some research, and found a model that鈥檚 well established in other parts of the country, called hospital-based violence intervention. Payne successfully applied for a grant through the federal Bureau of Justice Assistance.
The approach is designed to offer a menu of resources and support to gunshot victims, like educational support, job training and mental health services. It鈥檚 all in the hopes that they won鈥檛 end up back in the Emergency Room 鈥� or worse.
Atlanta鈥檚 Approach
Grady鈥檚 hospital intervention program is called PIVOT, and it鈥檚 about six months old.
Aric Johnson is a licensed social worker at Grady, and he鈥檚 the guy implementing PIVOT on the ground.
鈥淪o I got somebody that I鈥檓 working with. He got into a situation with a guy and the guy shot him,鈥� Johnson said. 鈥淐ome to find out, he鈥檚 a kid. He鈥檚 not even 20. And he doesn鈥檛 have a high school diploma or GED, no job. Only thing he knows is the hustle.鈥�
Grady Memorial Hospital social worker Aric Johnson outside where he meets most of his patients. Johnson is the man behind Grady鈥檚 hospital-based violence intervention program, PIVOT.
Lisa Hagen / WABE
His task is to get that 19-year-old his GED, find him job training and maybe mental health care. Basically, to keep him alive.
That鈥檚 because injury researchers have found that if you survive a gunshot wound, your likelihood of dying within the next few years increases significantly. That鈥檚 what hospital violence intervention tries to fight.
For now, the PIVOT outreach is reserved for people shot in a select set of zip-codes, based on data from the Atlanta Police Department. They are all predominantly black neighborhoods with median incomes significantly lower than average for metro Atlanta. PIVOT is looking to follow a well-trodden path.
A Product of the 鈥�90s
Hospital intervention programs have been around for almost 25 years. So why is the approach just catching on in Atlanta?
鈥淚n 1995, as a children鈥檚 hospital, we had an alarming number of firearm injured children,鈥� said Dr. Marlene Melzer-Lange, a pediatric emergency doctor in Milwaukee, Wisconsin. The violence intervention program she helped start at Children鈥檚 Hospital of Wisconsin was one of the first in the country.
鈥淚n looking at some of the records of the children that came [to the emergency room with gunshot injuries], we noticed something startling,鈥� said Melzer-Lange. 鈥淚t wasn鈥檛 the first time they had come for an injury that was provoked through violence.鈥�
Children were returning to the emergency room after having shown up the before because of fights or stabbings.
The Milwaukee program, called , adopted an approach used to help abused children and applied it to victims of violence.
鈥淲hen you identify an abused child, there are a lot of services that come around,鈥� said Melzer-Lange.鈥漇ocial services, child protective services, parenting programs in the community are all surrounding that child and family to help them out.鈥�
On the other side of the country in Oakland, California, doctors formed a parallel model in 1994 at Highland Hospital. Over the years, similar hospital-based programs took root across the country. And in 2009, a handful formed the National Network of Hospital Based Violence Intervention Programs (NNHVIP).
The network is working with the on issuing an official recommendation for trauma centers that treat a high rate of violent injury to create violence intervention programs.
Word of mouth is the main way the model has spread according to Melzer-Lange.
鈥淚 think people train in one place where there鈥檚 been such a program, and then they move to another place for their next job and they either start it up, or encourage other people in the new hospital to start up a program,鈥� she said, adding that the number of applications to join NNHVIP is growing.
Wide Open Spaces
If you look at a map of where these programs are, there are clusters: California, the Northeast and the Great Lakes region. In other areas, they鈥檙e spread thin. The South is one. The Mountain West is another.
In Denver, Colorado, the AIM (At-Risk Intervention and Mentoring) program began 10 years ago, and remains the lone violence intervention program in the Mountain West region.
鈥淭here was somebody from the city who came and wanted to do an assessment on youth who came to our facility with injuries, and their idea was to put out a survey in the waiting room for youth to answer if they were gang involved,鈥� said Katie Bakes, an emergency physician at Denver Health and AIM鈥檚 director.
Bakes wasn鈥檛 a fan of that original plan.
鈥淚 suspected that that was not a really good approach,鈥� Bakes said. 鈥淭hat maybe youth who were involved in something they thought could bias providers were not going to be honest about their involvement.鈥�
But it got her looking for an alternative, which led her to the hospital-based violence intervention model.
Last year, AIM did more than 200 bedside interventions. In the early days, Bakes said it was a balancing act.
鈥淥ne of the problems that programs like ours face is that funding is always an issue and so you end up working to get the funding as opposed to working on the program,鈥� Bakes said.
She thinks funding challenges may be what slows down geographic expansion as well.
The AIM program is city-funded now, but she had no doubts there鈥檚 a need in nearby communities outside Denver.
鈥淢y hope is that we鈥檒l be part of what will create a snowball effect in our region,鈥� said Bakes, 鈥渂ut it鈥檚 hard to promote what you鈥檙e doing when you鈥檙e trying to raise funds and you鈥檙e trying to function in the program.鈥�
Culture also plays a role in why these programs have yet to sprout in some parts of the country, said Bakes.
鈥淭here鈥檚 a lot on the East and the West Coast,鈥� she said. 鈥淚n Denver, at least, we鈥檙e a pocket in the [Mountain West] that tends to be more socially minded and maybe more action-oriented in terms of reaching out to our communities.鈥�
Who鈥檚 In The Room?
Like the AIM program in Denver, the in Brooklyn, New York, has also been around for 10 years.
Dr. Rob Gore, who runs the program out of Kings County Hospital, says his dedication to violence intervention is personal. Earlier in his career, he worked in Chicago鈥檚 Cook County.
鈥淚 looked around the [emergency] room and the only two people of color in that entire room was me and the clerk,鈥� said Gore, who鈥檚 black.
In Chicago, he found himself treating members of his own family, which was different from what his colleagues in the ER were experiencing.
He thinks the growing national attention on mass shootings may have something to do with a the increasing interest in really understanding where violence comes from.
That interest is positive, said Gore, but 鈥渋t does make me upset, because we鈥檝e been dealing with issues of violence and conflict in the black and Latino and even in poor white communities in the United States for a long period of time.鈥�
In New York, Gore has been able to be vocal about the disproportionate impact of gun violence on young black and brown men.
But depending on where you are in the country, hospital-based violence intervention programs may have to steer very clear of any message that can sound like political activism.
How To Survive in Atlanta
In Atlanta, Diane Payne says PIVOT is about tackling a public health issue, full stop.
鈥淭his is not about gun control,鈥� said Payne. 鈥淚 think a lot of people, when they hear about or listen to stories about gun violence, it鈥檚 such a politically charged topic that it tends to be very divisive.鈥�
Dr. Diane Payne has been working to bring violence intervention to Atlanta鈥檚 Grady Memorial Hospital.
Lisa Hagen / WABE
Social worker Aric Johnson said the work has been slow going, so far. Out of 80 patients who have qualified, just a handful have agreed to work with him. For Johnson, that鈥檚 understandable.
鈥淧overty is trauma,鈥� said Johnson. 鈥淓ven understanding that and helping break that down to some of these families is really astonishing. They鈥檙e looking at me like a deer in the headlights like, 鈥業 thought that was normal. My cousin got shot. My uncle got shot, with six of us in the house.'鈥�
The normalization of violence is just one of the many challenges Johnson鈥檚 up against. A lack of health insurance and a learned distrust of institutions are also major hurdles.
鈥淚鈥檓 a black guy. I鈥檓 cool, whatever,鈥� said Johnson. 鈥淏ut I鈥檓 just another guy representing another system who said they were gonna do something.鈥�
He鈥檚 hopeful more support will come with time. Ideally, that will look like enough sustained funding to hire another social worker and allow the program to reach people in their neighborhoods. That has been a crucial part of making violence intervention work in other cities.
The program is still in its infancy in Atlanta, which makes it vulnerable. Payne鈥檚 goal now for the program is a lot like what she wants for her patients: for it to survive and grow.
Correction: This report has been updated to correct the spelling of Aric Johnson鈥檚 name.
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