Gun violence has been on the rise nationwide since the COVID-19 pandemic, according to the Pew Research Center; in June, U.S. Surgeon General Vivek Murthy declared it a public health crisis.
Guns are also the leading cause of death for children and teenagers in Virginia. Dr. Michel Aboutanos created a first-in-the-nation program called “Bridging the Gap” to stop gun violence in the commonwealth. He’s the medical director at VCU Health’s Trauma Center.
He joined VPM News Morning Edition Host Phil Liles to talk about the program and how it’s now being implemented across Virginia.
This interview has been edited for length and clarity.
Phil Liles: Your program is called Bridging the Gap, and it has a very personal beginning. Can you explain that?
Dr. Michel Aboutanos: The program officially began around 2007. There was a 17-year-old kid that came in. The kid was shot right in the groin, with significant injuries to his blood vessels, and at high risk of losing his leg.
We were able to put all the effort and save his leg, and he spent a lot of time in the hospital. I was incredibly proud of the team and that they were able to do that, and I was proud of how the kid improved and rehabbed, etc. And then we finally discharged him. He went home — only to have the kid come back within a period of a couple of months after we left him. Now he's shot in the abdomen, and he ended up with a bag, with what we call an ostomy in his belly, and multiple organ injuries. But he survived this. And I was, again, incredibly proud of the team. We finally discharged him home, only to have him come back again, and this time, he [was] shot in the head. I watched this 17-year-old kid die in our emergency room. There was nothing we could do for him, and I felt that we were just a Band-Aid.
We're putting all these resources, and we're taking care of the immediate medical aspect. We're saving people that would not be saved anywhere else if they didn't come to our Level I trauma center, but there was something missing.
We're not reaching across and really being involved in the whole community of solutions. We had to bridge that gap — that’s where that name came from.
The whole aspect is: Can we intervene [while they’re] in the hospitals, instead of just treating [them] medically? You use that trust relationship, that patient-provider relationship, but then you go a step further and say: Can I put you in a program that will change the course of where you're at?’
We start with intervention within the hospital, where they are most susceptible. Because suddenly the idea that “that won’t happen to me” is gone, because now it is happening to them, and they almost died. Then we go from that to intensive case management, and then we follow them in the community, and we find programs that will help them stay out of the cycle of violence.
We were the first in the country that developed this program. Theand so the recidivism or the reinjury rate across the country is up to 50%; here in our hospital, it's about 20%; if you are in our program, we're able to reduce that to 3.6%.
Now we partner with [VCU’s Health Hub Ambassadors program], and we got funding from the [Virginia] Department of Criminal Justice [Services], and we work with the Attorney General. This program is being spread across Virginia and all the other trauma centers.
What do the recipients receive through this program, step by step?
At the beginning, we do a very long assessment in terms of: What are the risk factors? What are the protective factors? What’s the family construct that could even exist a lot of times? And then what are the resources that exist in the community that this child or this adult who are involved in violence would need?
We address what we call the six-step approach. We address the consequences of what you've been through, and what are your protective measures? What [is] your ability for conflict resolution? What's your ability to know how to interview for a job or get a job? And then we determine what this person needs, then we help them to [meet] the needs that they have.
We looked at the question: Have any of these people been in our health system before? And we found out those who are at high risk of injury or violence actually have been at VCU before, and we just never looked at it. I bet you that's happening across the state and across the nation.
So, we’ve developed a prevention arm now to our Bridging the Gap model. It's called Emerging Leaders. We identify those who are at risk and then intervene earlier. It is how to look at a problem in different ways, like what we call the public health approach. Truly define what the problem is. Define what are the risks. But then, you have to invest in it.
What impact does the US Surgeon General's declaration that gun violence is a public health crisis have for care providers, and has that helped you?
We've all known it’s a public health crisis. That's been our focus for the past few years, especially after the pandemic. I think one of the big impetuses of it is the fact that currently the number-one cause of death in our youth is firearm-related. So it is very much needed. We're very glad it finally came out and that the surgeon has done that, so now the biggest hope is that that [will] be translated into more federal funding and more emphasis on funding effective programs.
Another major part is finally looking at violence as a disease that has a cause. There's a way to treat it, a way to follow it. It has risk factors. I think the surgeon general's message that we need a public health approach to it is right on target.
Recently, you received a $5 million grant? What would that grant be used for?
So, the $5 million grant was awarded actually to [the Veterans Health Administration] and centers across Virginia. That's one thing I'm actually very proud of, that we are collectively working to use the funds. So the funds are really to help other programs establish these community violence intervention programs, and use an evidence-based model. Believe it or not, $5 million spread across the state goes very, very quickly,
Well, I want to thank you for your time. I know you're very, very busy, but thank you for coming in and speaking with me today.
Thank you for having me.
