Funded Projects

Reducing Community Violence Through Community Building

Project Year

2022

City & State

Providence, Rhode Island

Program Name

CATCH Resident

Topic

Injury & Violence (LHI)

Program Description

Problem: Youth violence has a tremendous impact on children’s health. Not only is youth violence the third leading cause of death in adolescents, being exposed to community violence places youth at risk of psychological conditions such as anxiety, depression, and PTSD [1], [2]. Pediatricians have learned how to effectively intervene for other forms of injury prevention, but we are less experienced with conversations as they pertain to youth violence [3]. In 2016, in the United States, firearm-related homicides claimed 1,865 lives of youths aged 12-19 years old, higher than all forms of malignancies in that age group [4] and currently the third leading cause of death for 15-24 year olds. These issues disproportionately impact Black and Latinx children who—compared to white youth—are five times and twice as likely (respectively) to die by homicide [4]. Despite being one of the smallest states, Rhode Island has seen at least 145 emergency department visits for gun related injuries in youth from 2015-2019 [5]. Further, in 2019, over 2,000 Rhode Island youth were involved in some form of youth violence—be it physical assault or use of a weapon [5]. These issues historically have been a greater focus for community members such as local activists, schools, social workers, and law enforcement agents. However, given the disruptive impact violence has on youth’s lives, pediatricians must continue to engage in these discussions early. Primary Setting: Hasbro Children’s Hospital, Rhode Island’s only children's hospital and tertiary care center, is located in south Providence, the epicenter of most of Rhode Island’s violence. Previous work, done at our institution—including through prior CATCH grants from our clinical mentor, Dr. Alison Riese—has shown that a high proportion of our patients engage in violence [6] and that youth appreciate when their physicians, particularly their pediatricians who know them, elicit their violence exposure history [7]. Still, pediatricians have less experience with screening for youth violence and when youth make disclosures, we have yet to identify appropriate interventions for them [3], [8]. Project Goal: We will collaborate with a community-based organization, the Nonviolence Institute and youth in our clinic to create a nonviolence provider training, community violence screening and referral program for youth at a pediatric primary care clinic in order to reduce rates of youth community violence. This project will draw on the experience and knowledge of youth in the community and the Nonviolence Institute as true experts in reducing in community violence. Proposed Intervention: We will engage youth in our community and facilitators from a community-based organization, the Nonviolence Institute, to serve as topic experts with whom we can build sustainable relationships. First, we will host a set of collaborative meetings between the Nonviolence Institute and Youth Ambassadors from our clinic, to adapt existing adult-focused training to create a community-based, youth-driven, pediatric-focused Nonviolence Training to serve as an intervention. These stakeholders will also collaborate to update training tools for pediatric providers on screening for violence based on existing standardized questionnaires. For families who do endorse firearms at home, we will distribute gun locks within the clinical setting. For youth with a positive screen, providers will refer them to the previously mentioned community-based, youth- driven Nonviolence Training. Anticipated Outcomes: We anticipate that we will increase collaboration with youth in the community and the Nonviolence Institute, increase provider comfort with screening for community violence, increase referrals for youth who screen positive for exposure to community violence, and increase safe storage of guns for those who screen positive for guns in the home, with long-term goal of reducing rates of community violence among youth.

Project Goal

Create a new intervention with community stakeholders for youth exposed to community violence. Screen youth for exposure to community violence in a pediatric primary care clinic and refer youth with exposure to the newly created intervention. Follow-up to ensure appropriate referrals placed and youth attend and benefit from the intervention.

Project Objective 1

Host 4 stakeholder meetings to develop a relevant, youth-centered intervention for the purpose of community violence reduction that builds on existing trainings as taught through the Nonviolence Institute by October 2022

Project Objective 2

Screen at least 50 youth, aged 12 and up, who present to Hasbro Children’s Hospital for routine well child check with a validated community violence screening tool by March 2023

Project Objective 3

Review all positive screens weekly to ensure that at least 50% of positives have been referred to and participated in the aforementioned intervention developed with the Nonviolence Institute

AAP District

District I

Institutional Name

Hasbro Children's Hospital/Alpert Medical School at Brown University

Contact 1

Yvorn Aswad

Contact 2

Christine Paula Lewis-de los Angeles