In 2020, more than 400,000 children and adolescents suffered an injury due to violence, and 9,472 were buried by their parents. Historically, violence has been treated primarily through a criminal justice and punitive lens, with a significant increase in incarceration rates in the United States from 1970 to 2010. But the epidemic of violence is a symptom of broken foundations and torn safety nets, with Black and Hispanic communities being disproportionately affected. These persistent disparities are driven by structural racism that is manifested in concentrated poverty, persistent neighborhood disadvantage, lack of social and economic mobility and harmful living conditions. Given these root causes and drivers of violence, we must be more earnest and urgent in applying a public health approach. Only then can we effectively address the structural causes that perpetuate the cycle of violence and disorder.
Our children and families not only suffer at the time of a violent injury but also face a greater risk of reinjury, mental health comorbidities and chronic health conditions. Children and families who are victims of violence have a significantly higher number of adverse childhood experiences (ACEs). Among participants in a violence intervention program in Philadelphia, more than half of young adults had more than four ACEs.
Children’s hospitals have an opportunity to provide exceptional clinical care, research the root causes of violence and develop effective programming to help children and families recover and become stronger in the broken places. Here’s how.
Develop community partnerships
Hospitals must develop a thorough understanding of the effect of violence on their local communities and coordinate efforts with community members, organizations, local governments and partnering civic institutions—especially those who have been doing the unsung work of violence prevention for decades without institutional support or resources.
For example, in 1991 it was a young adult victim, Sherman Spears, who created and designed one of the earliest violence intervention programs in the country in Oakland, California. In Brooklyn, mothers such as Natasha Christopher and Sandra Rougier coordinate support groups and help others navigate grief and recovery after losing loved ones to violence.
Many members of our community have been helping their own children and neighbors in navigating recovery after a violent injury without formal resources. We must listen to their lived experiences and develop programming together.
Ensure equitable care
Many of our children who are victims of violence are victims of health inequities that start at birth. For example, a study in Cleveland demonstrated that more than 40% of pediatric trauma victims had lead poisoning and significant rates of abuse and neglect in their development period prior to their violent injury.
Make research investments
Institutions need to develop and apply their research infrastructure in studying and developing the most effective solutions to violence prevention and intervention. In Philadelphia, Eugenia South, M.D., and her team applied a citywide cluster randomized trial that showed that remediating abandoned houses helped reduce gun violence.
Create intervention programs
There is growing recognition of the positive impact of hospital-based violence intervention programs (HVIP). Studies of programs in California, Maryland, Indiana and Illinois have demonstrated that participation in an HVIP can reduce reinjury, improve access to services, and empower victims on their road to recovery.
While most HVIPs serve adult victims, there is a growing number of pediatric HVIPs. These include Project Ujima at Children’s Wisconsin, Violence Intervention Program at Children’s Hospital of Philadelphia, and our own Antifragility Initiative at UH Rainbow Babies and Children’s Hospital in Cleveland, Ohio. Program staff at pediatric HVIPs meet with victims of violence and their families at the time of injury and help them navigate their recovery. We recommend hospitals collaborate with Health Alliance for Violence Intervention (HAVI), a national collaborative network of violence prevention programs, their local community and existing HVIPs in developing effective programs that are specific to the needs of their local neighborhoods.
Our collective goal should be to meet children and families where they are and to be purveyors of hope. We need to work with our families and neighborhoods to identify their strengths, provide the necessary resources and fill the gaps to ensure that our children are back and stronger.
