crossfire-staffThe Oakland, Calif.-based “Caught in the Crossfire” program doesn’t view at-risk youth as the cause of the violence that plagues their distressed urban communities, says program director Kyndra Simmons. Rather, she says they are the solution.

That idea spawned Caught in the Crossfire, started in 1994 as the nation’s first hospital-based violence intervention program.

Caught in the Crossfire, a program of Oakland’s nonprofit Youth Alive, teamed up with Alameda Health System’s Highland Hospital to reduce gun-related injuries and retaliatory violence among the city’s at-risk youth. Along the way, it has inspired similar hospital-based violence-prevention initiatives around the country.

“When the patients are in the hospital recovering from their gunshot wounds, we talk to them about moving forward,” Simmons says. “We look at what their life will be like after the injury and how we can keep them from getting into this situation again.”

In the early 1990s, Highland Hospital’s trauma center looked for ways to keep former victims of gun violence out of the line of fire and out of its emergency department. Like other hospitals, treatment of gunshot victims stopped after doctors removed the bullet and stitched the wound. “We were missing the handoff,” recalls Stefania Kaplanes, an injury prevention specialist for Alameda Health System.

In the Caught in the Crossfire program, the patient handoff is to violence intervention specialists – young adults who have overcome violence in their own lives. They visit gunshot victims at their bedside in the hospital and provide follow-up assistance.

Caught in the Crossfire today has four intervention specialists serving gunshot victims between the ages of 14 and 24 at Children’s Hospital of Oakland and Eden Medical Center, in addition to Highland Hospital. The specialists provide support and mentoring to victims while they are in the hospital and after they are released, juggling 12 to 14 cases at a time.

They counsel the victim, their friends and family not to retaliate, and develop a plan for staying safe. Following the patient’s discharge, they will continue to provide case management and mentoring for anywhere from six to 12 months.

“It’s about building relationships with these young people and realize that it takes time to do that,” Simmons says.      

The program draws support from city agencies like Oakland Unite’s Violence Prevention Network. The network is part of a broader effort to interrupt the city’s cycle of violence by connecting gunshot victims to services such as job training, adult education and substance abuse treatment that could change their lives.

The collaboration among Youth Alive, Oakland Unite and area health care providers has produced positive results. Caught in the Crossfire says less than 2% of its clients return to the hospital with a violent injury.

But perhaps one of its biggest accomplishments was helping to make violence prevention among youth a national conversation. In 2009, Caught in the Crossfire helped create the National Network of Hospital-based Violence Intervention Programs to promote such initiatives. “The more agencies or hospitals that have violence prevention on the agenda, the more we can make a difference,” Simmons says.

She believes it is a public health imperative for hospitals and health systems to work with others in their communities to address the larger issues that lead to violence and to treat it as a disease.

“Violence is a community health issue,” she says. “Hospitals are a valuable resource for truly healing, restoring and reconnecting victims of violence with their community.”

The AHA’s “Hospitals Against Violence” campaign raises awareness about how hospitals and health systems are working to reduce violence in their communities and in their facilities. The campaign’s web page offers examples of innovative examples to tackle the problem, as well as tools and resources that can help hospitals and health systems support their role in reducing violence. Read more AHA News stories on how hospitals are addressing violence in their communities:

Hospital engages community to help heal young victims of violence

Regional One Health's positive alternatives to youth violence

'Wraparound' support stops revolving door of violent injuries

'Cradle to Grave' helps at-risk youth understand gritty reality of gun violence

How one hospital is applying public health interventions in effort to curb gun violence

Keeping teens from being repeat victims of gunshot, knife wounds


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