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

Step 3: Developing the Essential Resources

Case Management

Culturally sensitive and competent case management is a key component of a successful program.

  • The long-term case management model (beyond the initial hospitalization) with participant follow-up and tracking of utilization of resources
    • Case managers who have experience working in violent neighborhoods have the ability to accurately screen for high risk individuals, conduct needs assessments with the client, develop almost instant rapport, and shepherd clients through risk reduction resources for upwards of three months post-injury.
  • Referrals to mental health system
    • Mental health services do not necessarily need to be a part of the program, but there need to be strong links between case managers and mental health providers. There is evidence to support the notion that peer counselors aid in diffusing the stigma of mental health often felt by people of color (particularly young men). A tight partnership between case management services of a hospital-based program and mental health providers can be essential in enrolling and sustaining participation of clients in mental health services.
  • Referrals for housing, employment, school, and other services, depending upon the needs of your community and individual clients
    • There is evidence to support the prioritization of mental health, education, and jobs as core resources for clients of these programs. Mental health is the priority, given that clients cannot move onto jobs or school without at least engagement in mental health care (if applicable). The Trauma Informed Care Approach, acknowledgement of long-standing traumatization, as well as Moral Reconation Therapy describe this need well.
    • It is important to recognize the struggles of this population; as such, the case managers may successfully place clients in jobs or school/GED programs, but the client may not stick with their initial placement. It is important to recognize that retention is part of a longer term commitment and goal.
  • Multidisciplinary integrated approach, includes medical campus as well as other University programs
    • Involvement of other disciplines such as pediatrics, psychiatry, family medicine, along with medical students can be very helpful in finding resources, building bridges, and educating.
    • Involving people with expertise in both qualitative and quantitative analysis, and health economists, can strengthen the ability of a program to conduct robust research and evaluation.
  • Employment placements for clients: Many clients of HVIPs have criminal records which can make finding employment difficult. Some dependable options in many communities include philanthropic organizations such as Goodwill, animal rescue venues, truck driving, arborist programs, and a city’s department of public works. Job readiness and vocational training programs offered “in-house” or with partners can greatly augment placement. Convincing hospital administration to allow desirable clients to become hospital volunteers will go a long way.

Identify Your "Hospital Champion"

The hospital champion is a person committed to the advocacy of the program, inside and outside of the hospital, and often plays a large role in development, implementation, and sustainability of programs. Representation by a clinician aids in incorporating the program into the fabric of the trauma center, increases exposure of the program, aids in fundraising/grant writing, and often helps direct the front line staff and the ongoing evaluation process. The hospital champion, often a trauma surgeon or emergency medicine physician is commonly affiliated with other hospital-based programs, professional injury prevention efforts, and hospital-affiliated medical schools. These connections further efforts in strengthening the effectiveness of these programs and educating students and professionals in the public health approach to violence prevention both locally and nationally.

Potential Pitfalls

  • Lack of dependability on partner organizations for risk reduction: Organizations may not have enough resources for the services they provide whether it be mental health, GED programming, etc. To ensure that all roles and expectations are clear when partnering with community organizations, it is really important to establish Memoranda of Understandings (MOU).
  • Leaving out a vital component of the hospital or the community: This can lead to feelings of exclusions and distrust and poor future communication. This work really “takes a village” and is very emotionally charged at times.