How did you become involved in hospital-based violence prevention work?
Sheila Regan: I was the crime victim advocate at Mt. Sinai Hospital, working with 500 to 600 shooting victims a year. I immediately came to understand two things. Number one, there was not a comprehensive network of services that were available to these people. There was nobody serving the population that I was trying to work with at Sinai.
The second thing I realized was that the population I was working with didn’t want the services we had. You could offer a counseling referral, and they would say no thank you. That’s when I started looking for someone who would be effective with this population, and I came across CeaseFire—that’s what Cure Violence was called back then.
The director of evaluation there was piloting hospital-based interventions at Christ Hospital, and we started working together with patients at Sinai. I saw an immediate difference. When you mentioned CeaseFire to patients, either they had already had experience with the organization or they could name a person that they knew that worked there. They’d say, “Oh, so-and-so who’s with CeaseFire will come visit me? You can make that happen? Sure, I’d like that.”
Eventually, I joined CeaseFire and built out the hospital program there.
LeVon Stone: For myself, I’ve been in a wheelchair since 1992. I was shot and paralyzed. When I got myself stable, I wanted to give back to the doctor at Christ Hospital that had treated me, so I started volunteering with new spinal cord injury patients. It’s an injury that requires a lot maintenance—you’ve got a whole workflow you need to understand and do just to survive every day. I had that experience, so I volunteered working with that population for 10 years.
In 2003, a friend of mine who had come home from prison told me about Cure Violence, how they were using people from the community who had the same experience as the population they were trying to help. I started volunteering and doing outreach for them, and I became like a community liaison for another friend who was working in the Cure Violence pilot at Christ. Anytime someone would be shot in a specific area, he would call me to talk to people that was from that community. He was kind of an older guy, and he knew I had that contact and relationship with those young people. Another guy at Christ was the brother of a friend of mine—we had gone to prison together—and he would ask me to help them out every now and then with some of the high-risk individuals.
In this line of work, what’s really critical is who you are in that population, your relationships, who you know, and how well known you are. There are times when we may know the assailant as much as we know the victim. I mean, I knew the guy who shot me.
What led you to start Acclivus?
Sheila: Von and I had been leading the hospital response project at Cure Violence almost from the beginning. At some point we realized that to take the work further, it needed to live on its own. Hospital work is different from street outreach work. Just like every patient is part of a family and a community, every hospital is a part of a much larger healthcare infrastructure, which has its own needs and norms. With our hospital background, we understand that; it’s part of what makes us effective.
LeVon: We wanted to build a model that really prioritized the needs of patients and hospitals. We both had that experience, and we both felt passionate about the population and about health care.
How do you prepare someone who’s from the community to come into a hospital and work?
LeVon: The hospital is a subculture, just like the community is a subculture. You need to recognize that. When I first came to the hospital as a responder, based on how I was dressed there was like a stereotype that people were responding to. I was able to change some of that based on conversations and relationships with key individuals.
If a patient come in the hospital right now and he’s got certain tattoos, he come from a certain area, if a certain violent incident happened to him, there’s a stereotype about who that person is, no matter what. You could be taking your garbage out right now, but if you got tatoos and if you get shot, the perception is you’re a bad person. So we train our staff in the culture of the hospital, and through relationships and conversations and our work, we “train” the hospital staff. You have to change the mindset and perceptions on both sides.
Sheila: As far as integrating staff, there are so many things we do. We ask our staff to conform to the dress code of the hospital, for example. We train them on procedural things they need to know, like HIPPA, but we also make sure that they are clear about who and what takes precedence. The first priority in a hospital is to save a life, to treat people with physical or mental illnesses. The hospital is the client, and the responder is there to help them care for the patient successfully. They are there as a guest in the house of the clinician.
LeVon: When you work inside the hospital, you interact with every layer of the hospital: security, trauma surgeons and nurses, the trauma coordinator, social workers, techs. As the relationships deepen, they rely on you more and more. We’ve even had staff asking can you speak to their church, can you talk to their grandkids or their kids. Again, as people start seeing what we do and the effect that we have on that patient population and family members, we become more and more part of the team.
What is it that makes this work effective?
LeVon: If I had to use one word, I would say understanding. Understanding is better than love. You could care about something, but if you don’t understand, then like, oh, yeah, that’s cool, you care. But so what?
Sheila: Like Sheila at Mt. Sinai. I cared, but I didn’t understand enough to do anything about it.
LeVon: And when I use the word understanding, I mean understanding all the parts of it. Understanding the patient. Understanding what the family going through. Understanding what the hospital is going through. What the security is going through. What the community is going through. Understanding the multiple layers of what the problem could be and what the solution needs to look like. That’s what we’re bringing: 20 years of experience in understanding, easily.
Sheila: We tell that to staff, too. We can train you how to work in a hospital, what the priorities are, how to work as a guest in that space and be effective, but no one can backfill that historical knowledge you have of the community. You know how long these two people have been into it with each other, or how long these two families have been into it with each other. You understand what this is like. I think that’s why our people are so successful.
LeVon: Another thing, too, is people feel comfortable talking to us. There are things that we could ask a patient that doctors aren’t comfortable asking, or aren’t going to ask.
Sheila: Or if the doctors ask, the patients are not comfortable answering.
LeVon: Or will lie about. We’re really good at handling those situations, at kind of interpreting for the hospital staff what’s going on.
Is your program kind of “plug and play,” or can hospitals change things, depending on circumstances?
Sheila: We’ve been doing this a long time, long enough to know that what we do works. So yes, we have a set program, a way we do things. But we also know that every system has constraints. I think we’ve learned a lot along the way about how to keep the core principles of the program—the things that make it functional and effective—while adapting to a variety of different environments with their own specific needs.
We have replicated this program in multiple hospitals and in other cities, and there are accommodations that actually need to be made for patient population, which can change from hospital to hospital, and for different locales. Institutions themselves change. They may change their target demographic, for instance, which might change how and whether they even want to approach this issue. They may want to be known as a hospital that’s proactively addressing violence, they may not. We’ve accommodated those kinds of shifts even within a single institution over time.
Are there any policy changes that you think would help either prevent violence or help those affected by it—whether it’s a victim, family, community, or perpetrator?
Sheila: There are a couple I can think of, but the overarching theme is that we don’t have a good system in the United States for forgiveness. Do we really believe you should be held accountable for whatever you did at 18 for the rest of your life? Even if the answer is yes, I don’t think we’re being reasonable with how we apply that belief. Because a lot of the constraints we’re placing on individuals who have had brushes with the law end up disabling whole communities of people from having any access to traditional resources, whether economic, civic, or social.
Crime victim compensation, for example: you’re precluded from access to these funds if you’re not an “innocent victim.” The rules literally say that, but I’m putting it in air quotes because who even knows what it really means? In practice, it means that if a police officer ever documents that he or she suspects you were in a gang, that alone can be enough to preclude you from ever getting compensation. And the compensation we’re talking about is not a stack of cash, it’s money for expenses you’ve incurred as a result of being a victim.
LeVon: There’s no system that answers the question, What’s enough punishment? Part of what we’re building out at Acclivus is a process to help change that. Because that has to be part of it. The goal of hospital response is to provide a necessary service to victims and families, but it’s also to make a change—to prevent the next cycle of violence. You can’t do that unless you’re willing to believe in the real possibility of redemption and act on that belief.