Friday, April 7, 2017

Michel Aboutanos, M.D., recalls a young patient who came to Virginia Commonwealth University Medical Center’s Emergency Department with a gunshot wound to his leg.

“We thought he was going to lose his leg and we worked hard to save it so he could walk,” said the medical director of the VCU Trauma Center.

A few months later the patient returned, this time with a gunshot wound to his stomach.

“We thought he was going to die,” Aboutanos said. “He had an open abdomen, but he stayed with us for a couple months and we got him through it.”

Four months after that, the teenager returned to the emergency department with a gunshot wound to his head.

“I watched this 16-year-old kid die,” Aboutanos said. “Something more must be done.”

Aboutanos, a trauma and acute-care surgeon, leads the medical team that provides life-saving care for victims of violent crime in Richmond. More than 200 people survived being shot in the city in 2016. At a news conference in January, Richmond Police Chief Alfred Durham said if it wasn’t for VCU Health, the city’s homicide count would be much higher. But despite the lifesaving work done at VCU Medical Center, 2016 was Richmond’s bloodiest year in a decade with 61 homicide-related deaths. Violent crime in Richmond rose 17 percent in 2016, after being at a 40-year low in 2015, according to the Richmond Police Department.

“These young kids come to us injured and we fix them,” Aboutanos said. “We spend so much effort putting them back together only for them to go back to the same environment without any resources and sure enough, they get shot again and come back to us.”

Earlier this year Aboutanos joined VCU Health colleagues, the Richmond Police Department and the Richmond City Health District on a new initiative that aims to stop the cycle of violence. The initiative, RVA Alternative Pathways, was launched with a Robins Foundation Community Innovation Grant. It connects violence prevention programs at VCU Health, the Richmond Police Department and community partners that share the goal of helping young people steer their lives from a path of violence to success.

“RVA Alternative Pathways’ aim is to establish a coordinated system across the region to prevent Richmond youth from engaging in violent or criminal activities,” said Sheryl Garland, vice president of health policy and community relations at VCU Health System. “It is a prevention program with a primary goal of keeping participants from utilizing the services of our trauma center or being incarcerated.” 

Connecting the dots“Just like we were frustrated about the number of kids who we were treating for violence-related injuries in the emergency room, the Richmond police were equally frustrated about the number of young kids who they were arresting and sending to jail only for them to get out and be re-arrested,” said VCU Trauma Center Medical Director Michel Aboutanos, M.D. Interactions between physicians and police are typically limited to brief conversations in the emergency room lobby.

“Our paths will cross occasionally, but there is no follow-up,” said Steve Drew, deputy chief of the Richmond Police Department.

RVA Alternative Pathways changes the dynamic among community programs that share the objective of   reaching at-risk youth before they enter the juvenile justice system or need trauma care at VCU Medical Center. The model specifically connects VCU Health to the Richmond Police Department and Richmond Public School’s LIFE program, which started at Armstrong High School in January 2016.

LIFE (Law Enforcement Intervention Focused on Education) is a nine-week program led by police officers that offers an alternative to the juvenile justice system for students who commit minor legal offenses. It originated from a 2015 report released by the Center for Public Integrity that found more public school students are referred to the police and court systems in Virginia than in any other state. While researching the issue locally, Durham found that of the 149 students Richmond police arrested in 2015, 59 were for behaviors such as not sitting down in class or using profanity toward a teacher.

“Just like we were frustrated about the number of kids who we were treating for violence-related injuries in the emergency room, the Richmond police were equally frustrated about the number of young kids who they were arresting and sending to jail only for them to get out and be re-arrested,” Aboutanos said.

Through 90-minute classes that cover topics including conflict resolution, drug and alcohol awareness and gangs, LIFE aims to reduce the school-to-prison pipeline, avoid criminal arrests for minor misbehavior and increase opportunities for student success.

The program just had one problem: “Even though they had a great program, after nine weeks the kids had nowhere else to go and were at risk of going back to their old habits,” Aboutanos said.

Meanwhile, VCU Health’s Injury and Violence Prevention Program has led a community initiative called Emerging Leaders since July 2015. The program shares LIFE’s goals, with a mission to reduce the number of Richmond youth engaged in violence and provide opportunities for young people.

Emerging Leaders recruits participants through the pediatric emergency room and adolescent clinic at VCU Medical Center, as well as through word-of-mouth referrals. It provides continuing case management services, hosts bi-weekly group meetings and provides mentoring and internships at VCU Medical Center. Meeting topics include coping skills and financial literacy. The internships, coordinated through the Mayor’s Youth Academy, provide a small stipend for participants. About 40 young people have been involved with Emerging Leaders so far, and the program follows participants through completion of high school.

“A lot of kids in Emerging Leaders are the same as those in LIFE,” Aboutanos said.

The Robins Foundation’s Community Innovation Grant has attracted more than 100 applications from nonprofit organizations throughout greater Richmond since its inception in 2014. The foundation selected RVA Alternative Pathways as one of the five proposals to receive funding in the 2016 competition based on the model’s innovative solution to a community issue.

“The Richmond Police Department and VCU have been running injury and violence prevention programs that are focused on at-risk youth,” Garland said. “We are leveraging the Robins Foundation grant to build a coordinated system that includes the ability to share information across organizations to enhance the level of support available to youth and their families.”

Open communication

The key to RVA Alternative Pathways’ success is that it will enable information sharing about program participants among the Richmond Police Department, VCU Health and community partners.

“We are going to do something we have never done before, which is to share data,” Aboutanos said. “If we are all together as an alternative pathway system, we can have participants sign something that allows everybody who is in the system to share data as long as it is protected within the pathway. Now we will know exactly what is happening to the child as they move through the system.”

“When they are done with the LIFE program, we will be able to say to the child, ‘We can continue to help you. We already know what you have been exposed to. You have these ongoing challenges and this is how we are going to address them.’ Before, we couldn’t talk like that. We had no idea what was happening,” Aboutanos said.

The Richmond Police Department agrees that RVA Alternative Pathways will solve a lot of issues the two organizations had been facing.

“There are a lot of organizations in Richmond that do great jobs, but we don’t share information,” Drew said. “With RVA Alternative Pathways, we are going to open communication so that everyone can take part in the intervention of these young people and hopefully put them on a new direction in life.”

An optimistic opportunity

Homicide is the leading cause of death among Richmond youth. Ninety-five percent of assault-related injury visits were for youth younger than 25, according to VCU Health’s 2015 trauma registry, and the five-year re-injury rate for victims of intentional injury ranges from 10 to 50 percent.

“There are far too many young people who are using the trauma center’s services who could and should have different life experiences,” Garland said. “As an academic medical center and home to Central Virginia’s only Level 1 trauma center, VCU Health has chosen to engage in helping at-risk youth find alternative pathways in an effort to reduce the number of young people who end up at our hospital.”

This summer RVA Alternative Pathways participants will work 40 hours a week for eight weeks at VCU Medical Center. During the internships, they will shadow physicians and police officers at various departments throughout the hospital and learn about professions in the health care field.

“A lot of these kids live right across the bridge, but they have never been to the university and if they come to the hospital it is only because they are ill,” said Likisha Frazier, violence prevention coordinator with the VCU Injury and Violence Prevention Program. “The RVA Alternative Pathways model will help with exposing them to many positive things that go on inside the hospital, with the hope that they will go to college at VCU, and maybe will end up working at VCU Medical Center.”

“When you put the child and the family in the middle and make them the focus, then you will start seeing the programs work,” he said. “We want to change the way VCU and VCU Health approaches the community. Rather than being perceived as the end result when someone is injured from violence, we want to be involved in preventing injuries from the beginning.”Aboutanos is optimistic the program will lead to him seeing fewer young violent crime victims at the emergency department.