American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Step 1: Define the Problem

Globally and within Your Community. Who Is Your Target Population (Individuals, Families, Both)?

Assess the Burden

Assess the burden of disease—the fundamentals.

  • Homicide is the number one killer of young African Americans and the number two killer amongst young Latinos.
  • Use local city/county data and national data to understand your target population.
    • Local data resources include: trauma registry, vital statistics, police data, and child death review. Important information includes: demographic information, such as age, race, location (zip code or census tract).
    • National resources include: CDC’s WISQARS and the National Violent Death Reporting System (NVDRS)

Determine Efforts

Determine existing efforts that are present in your hospital and community. Partnering with these organizations gives your program legitimacy and helps in understanding existing risk reduction resources.

  • Emergency medicine
  • Cure Violence programs in your local community
  • Juvenile/criminal justice system: police, schools, attorney general’s office
  • City/county health departments
  • Office for Victims of Violent Crime
  • Mayor’s office of community engagement or equivalent
  • Neighborhood efforts of city supervisors
  • Community-based organization case management programs
  • Community-based organizations offering risk reduction resources
  • University programs (for example, Schools of Public Health, Nursing, and Social Work)

Principles in Practice

Overcoming challenges in new/developing programs:

  • When conducting initial surveillance, recognize that this is an opportunity to highlight the burden of violent injury and garner interest in the cause from hospital leadership and city officials.
  • Attending community based organization meetings is a critical step in building social capital among underrepresented populations. It builds alliances and demonstrates your commitment to serving the population at risk. This is also an opportunity to engage the community in creating the hospital-based program by obtaining valuable input on building the case management team.
  • Impress upon the hospital leadership and community based organizations that the status quo is unacceptable, and that violence should never be “normalized” in any community.

Overcoming challenges in established programs:

  • Understand the local target population and that the efforts both inside and outside the hospital is a dynamic process. It is critical to continuously assess that the program remains focused to serving the most current population at risk. Organizations and cities change over time in regards to priorities, funding, and capacity. As such, reevaluating other entities to keep track of the provider landscape assists in building networks and strengthening a region-wide or city-wide violence prevention plan.

Potential Pitfalls

  • When conducting surveillance to understand the target population, reference multiple sources of information that will provide a comprehensive picture. This may require data from not only trauma registries, but police data.
  • Understanding the current violence prevention landscape of your community helps to avoid replicating services. Violence prevention “takes a village” and working in isolation is not nearly as effective as using the team approach. In addition, interacting with the communities at risk is an essential component to developing trust and buy-in from the very people you plan to serve and the people already providing some form of services.