Elizabeth Dugan, LICSW, is the Clinical Director of the Violence Intervention Advocacy Program in the Department of Emergency Medicine at Boston Medical Center.
Melanie Cole (Host): Today we’re talking about how Boston Medical Center is changing lives by guiding victims of violence through recovery with a trauma informed approach. My guest is Elizabeth Dugan, she’s the Clinical Director of the Violence Intervention Advocacy Program in the Department of Emergency Medicine at Boston Medical Center. Elizabeth, what’s the prevalence of violence in this country and what is the impact economically and societally and on families?
Elizabeth Dugan (Guest): Well good morning. I think the answer to that is complex. The violence in Boston, Boston Medical Center, actually receives 75% of all gunshots, stabbing victims citywide that are brought to our trauma room and from there by our program becomes involved right at the bedside estimating costs around savings and livelihood, hospital costs are exorbitant. I don’t think really you can even gauge that. Violence is very prevalence and Boston Medical Center receives about 75% of all injured victims involved in it.
Host: Elizabeth, tell us a little bit about your program and the population that it serves. Tell us about the Violence Intervention Advocacy Program at Boston Medical Center.
Elizabeth: Sure, VIAP as we call it was founded in 2006 by an emergency room doctor named Dr. Thea James here at BMC and it was in response to a request from the former mayor, Thomas Menino to take a look at where there were gaps in service for victims of – surviving victims of community violence and also homicide victims. So at that point, there was a small amount of funding made available to address the victims and their family members that were coming into the hospital and leaving with no support for services. So in 2006, the VIAP program was born out of basically a gap analysis that there were no connections being made at the hospital for victims or their family members.
Host: What have you found to be the biggest need for this population and how has your program addressed that need?
Elizabeth: Well I think that is a multifold answer. I think that BMC does a really great job at addressing not just the injury but the whole person using a trauma informed client centered approach. What we find the majority of the time is that social determinance of health that are existing in this person’s life are interfering or not complementing or supporting a fast and rapid recovery physically, mentally, or spiritually because they’re dealing with housing crisis, housing instability, food insecurity, educational gaps, work and employment gaps in history of their work employment, so I think that addressing social determinance of health is critical to people being able to move on and be self-sufficient because you have no where safe place to be living, then it’s very challenging to be on time for a job everyday or be able to go home and take care of your children if you’re experiencing food insecurity. So I think the approach that we take is unique and comprehensive.
Host: What services do you provide? What can advocates actually do? Tell us a little bit about what’s involved in crisis intervention, support, and advocacy.
Elizabeth: Sure, we have advocates that respond 24 hours a day. So if a victim is entering the emergency department at BMC, we’re informed and alerted of that and our intervention starts right at the bedside in the trauma room and in the family waiting room with the families. So after that connection is made in the trauma room and once the crisis is over and people are stabilized, we really defer to the victim as the expert in their own life and look at a plan that will not only empower them but keep them engaged and another important component is including the family members in the plan and we do have family advocates that work with family members because if you are working with a client and you have all these great ideas and you’re putting things into place and then they get sent back, living in an environment where the rest of their family members are not tuned into or engaged or invested in the plan, then it usually won’t work. So we really try to include family in making the plan and the plan can really include whatever the client and their advocate have identified as areas that they need help with. So if a victim wants to complete their high school or GED then academic assistance would be part of the plan. We do support with navigating safety issues around housing because if somebody gets shot in their own neighborhood, then it’s very difficult to feel safe in your own home. So we do a lot of housing advocacy. We provide support to [inaudible 00:06:34] clients when they have either something from the actual violent incident or other that requires [inaudible 00:06:44] attention and we also have a workforce development program here within the VIAP program that we have employment partners that include Boston Medical Center, which is one of our six partners, but also partners in the community that work on employment placement for our victim survivors. We also provide free mental health care through our partner here in the hospital, the Community Violence Response Team. They’re an integrated partner. They’re an advocate and a mental health clinician work in tandem with each other to provide comprehensive services to the victim.
Host: I’m glad you mentioned how the families were involved and what community resources that you can look to. Tell us some of your proudest moments regarding your work through the SMSV grant?
Elizabeth: So that specific -well we had a gentleman that was working at the hospital here. He got a job through our employment program. He had a lot of trauma he was dealing with from the incident and he was trying to work through things. He was not doing well with the job here and he ended up leaving. On pursing what – not just what would make ends meet for him, but what his actual passion was and what he wanted to do for a career, not just a job, we ended up supporting him going for a coding class and then he did an internship for Google in one of our small business community partners hired him as an intern. He was creating apps around him being a great dad and him doing parenting and things, but this small business that he was working for does websites for nonprofits and I think one of the things I enjoyed the most is some of the staff from our program went to his graduation at Google and his parents were there and they were so proud of him and grateful of the transformation of him not doing well, not prospering because he was at a place that wasn’t of his choosing; it wasn’t his passion. To just watch the transformative experience of getting the right person in the right role and just watch it blossom and see his parents involved in supporting him and proud of him and his child was at the graduation and the pride he took in being a good dad, those are the kinds of rewards we get to see every day. So I think being there and witness to the transformation never ceases to amaze me. It’s very humbling and it’s what we do.
Host: What are some common feelings and actions that happen to these patients after a trauma and what’s your best advice about some things that can help them as well as looking to the VIAP program at Boston Medical Center?
Elizabeth: For anyone who is shot or stabbed or injured or assaulted in any kind of way, first and foremost there’s always fear. Fear around mortality and what just happened and you get all different levels of involvement. You have young people who are involved in community violence and we do work with some youth who are “gang involved.” So when a victim comes in, there are a lot feelings that range from fear around safety and retaliation to trauma about something they have witnessed previously in the community because the majority of our clients have some kind of exposure to community violence and things can be very triggering for them. So I think using the incident as a teachable moment is something that we do very well and try to capitalize on the fact that somebody just could’ve died and you didn’t, you survived, and now what do we do.
Host: Wrap it up for us, what you would like people to take away from this segment, about the Violence Intervention Advocacy Program at Boston Medical Center and the community resources that you look to, how you can help people who have been affected by violence in the Boston area?
Elizabeth: Well I would say that you need to first and foremost listen and listen with respect and solutions that understanding violence from an intergenerational, multifaceted society, structural, racism, poverty, education, all of those factors and really believing that through partnerships, communication, and community building, things can get better. To see victims and family move on to be self sufficient and be healthy, happy members of the community is achievable in the city of Boston if we all just working together.
Host: Thank you so much Elizabeth, what a rewarding job that you must have. Thank you so much for joining us and explaining the program to us. This is Boston Med Talks with Boston Medical Center and for more information on the Violence Intervention Advocacy Program at Boston Medical Center, you can go to bmc.org, that’s bmc.org. This is Melanie Cole, thanks so much for listening.