Community organizations across the Denver metro area having been working for decades to prevent community violence and provide support to injured victims. Aligned to their focus and commitment to collaboration, the University of Colorado Firearm Injury Prevention Initiative (FIPI) partners with these organizations to integrate the latest research and education on community violence prevention with goal of amplifying their impact.
Community violence typically occurs between unrelated individuals, who may or may not know each other, outside the home. In cases where violence by firearm is involved, FIPI faculty and staff see an opportunity to offer their subject matter expertise and serve as academic and hospital partners.
“Our work evolves and changes, as society evolves and changes, and we have to be able to respond and pivot with communities,” says FIPI’s Collaborations and Partnerships Coordinator Renu (Re) Gupta-Fitzgerald. “We navigate our response to what communities need. There’s a historical distrust of academic institutions and medicine. Acknowledging that first is going to be more successful in community connection and partnership.”
Hospital-based interventions
The At-risk Intervention and Mentoring (AIM) program was created in 2010 at Denver Health to respond to youth and young adults, generally between the ages of 14-45, who come to the emergency department after a traumatic injury. AIM was established as part of Denver Youth Program’s Gang Rescue and Support Project (GRASP), first in partnership with Denver Health (2010) and now with UCHealth University of Colorado Hospital (2020) and Children’s Hospital of Colorado (2023).
Catherine Velopulos, MD, FIPI’s community violence lead, Eric Sigel, MD, FIPI’s youth and adolescence lead, and Ben Li, MD, FIPI faculty affiliate, serve as medical directors for AIM at UCHealth, Children’s Hospital Colorado, and Denver Health. AIM was one of the founding members of the Health Alliance for Violence Intervention (The HAVI), which is the national network of hospital-based violence intervention programs (HVIPs) and is the sole HVIP provider in the Rocky Mountain region.
AIM employs and trains violence prevention professionals (VPPs), who are community members, to assess the patient needs during and beyond the hospital stay. Within an hour of the patient arriving in the emergency department, at their most critical moment of injury, AIM sends a trained VPP to respond to the patient at the hospital bedside. HVIPs like AIM can play a key role in the healing process of injured individuals and are still defining measures for effectiveness. One study showed that assault-injured adolescents indicated the need for mental health, educational, and legal support post-injury, and another study indicates that mental health and employment support, through intensive case management, are predictors of success. “There is still a need for more holistic measures of biopsychosocial healing”, says FIPI faculty member Ginny McCarthy, DrPH, MPH.
AIM is unique for its seamless connection to GRASP, the Denver Youth Program that provides follow up case management after the patient leaves the hospital. There are secondary gang violence professional specialists, providing an “interruption arm” and “prevention arm” to the program to best handle cases. Some of these professionals are referred to as “community violence interrupters,” serving as the interruption arm, who assess the scene of the act in-person and reporting on the landscape of the violence. The prevention arm of the program works with the victim personally to address steps to prevent the injury from happening in the future.
The At-risk Intervention and Mentoring (AIM) team.
“GRASP promotes the idea that the key to good intervention is prevention,” McCarthy says. “They hope to work with the victim to understand what piece, what moment, what series of events led to the violent occurrence to prevent it from happening again.”
McCarthy, who works closely with Denver Youth Program, is helping to launch a community-led post-discharge clinic, coordinating and expanding current efforts to support victims of community-based interpersonal violence, called the Respect, Empowerment, Accountability, Community, Healing (REACH) Clinic. With support from the Colorado Health Foundation, Yield Giving, and other key supporters, the clinic is set to launch in fall 2024.
The FIPI team is also working closely with AIM to provide clients with REACH kits and wound care instructions, community resources, case management, mentorship, employment opportunities, and access to the outdoors. They are also partnering with Therapists of Color Collaborative to connect patients with mental health support, free of charge to AIM clients and families through grant support.
“We know that the need for healing after violent injury extends beyond physical healing to include psychological, emotional, and social healing. Holistic healing is needed for individuals and for communities,” McCarthy says. “In my role as FIPI faculty, I will support the team not only to establish the REACH Clinic, but to continue working with our trained VPP research team to define our hopes for healing and the tools we can use to evaluate its effectiveness. The ultimate goal is to expand the reach of Denver Youth Program into the community to remove barriers to healing so that each client can heal to the fullest.”
Creating prevention resources alongside communities
FIPI hosted a meeting in May that brought together more than 15 Denver metro area community violence intervention and prevention organizations to explore responsive, prosocial, and actionable strategies for youth and discuss the potential for a coordinated, regional approach to community violence prevention. Victims often seek help through these organizations and collaboration between the groups help to strengthen the entire metro area’s effort.
“Some of these organizations prioritize cultural responsiveness,” Gupta-Fitzgerald says. “For example, if a victim is Spanish-speaking and the community member from one organization isn’t bilingual, they can contact another organization or community member to assist and get them the proper care.”
Gupta-Fitzgerald describes her role as an academic partner as “connecting pieces.” She recently compiled a list of resources for community violence intervention responders and interrupters to use when they’re serving members of their community. The resource kit is comprehensive and includes everything from information on mental health support, workforce readiness, education and employment, support for children who have maybe witnessed violence, cash assistance, rental assistance, and more.
“We have evidence that shows that when survivors are supported and more participants are involved in their healing, the better their outcome,” she says.
Gupta-Fitzgerald has also partnered with the CU Resident Leadership Council, an Office of Diversity, Equity, Inclusion and Community Engagement initiative, and with local law enforcement leadership to enhance co-responder models such as partnering with community violence interrupters.
A Resident Leadership Council meeting with local law enforcement, which Gupta-Fitzgerald co-organized.
The Resident Leadership Council at another meeting.
“When we see an uptick in community violence, having a co-responder from a community organization or nonprofit provides a different level of safety intervention and prevention,” Gupta-Fitzgerald says. “We’ve seen the impact from other cities’ community violence intervention teams and how they’ve brought down the levels of violence in that area.”
Gupta-Fitzgerald also highlights the importance of mapping community violence intervention response data. Mapping data on where violence occurs and who is responding can give the city and state evidence to increase youth success and violence prevention efforts.
“We can look at responders’ case logs to get nuanced information on the violence and find out whether it was youth-involved, adults, retaliation from a previous log, and more,” she says. “We can even look at what was missing in that area; what kind of grocery stores, community centers exist, what are the graduation rates at the local high school, and what activities are youth involved in after school.”
Academic-community partnership
“Being an academic partner is about capacity building, true partnership, where community really leads,” McCarthy says. “The Denver metro area feels like it has all the pieces to have a concerted effort (in violence prevention) that’s streamlined and collaborative. I’m hopeful we can get everyone in a ‘room’ and use what we’re each good at to do better for the area.”
As an academic partner, FIPI’s goal is to learn how to best support community organizations in real-time.
“These organizations have been doing it on their own for so long, but if there are ways in which academic support can ‘level up’ and reduce the burden of community in ways that align with academic purposes and academic training, then I think that's the sweet spot,” McCarthy says.
McCarthy explains that initiatives like FIPI can ask what barriers groups have encountered, what has worked, what hasn’t, and use skills tied to academia to support their efforts. McCarthy has assisted organizations by seeking grant opportunities, grant writing, leading project implementation, collecting data, and analyzing reports.
“Being an academic partner is about capacity building, true partnership, where community really leads,” she says. “The Denver metro area feels like it has all the pieces to have a concerted effort (in violence prevention) that’s streamlined and collaborative. I’m hopeful we can get everyone in a ‘room’ and use what we’re each good at to do better for the area.”
Members of the FIPI team at the 2023 HAVI conference.
Ben Li, MD, is second from the left; Ginny McCarthy, DrPH, MPH, is third from the left; and Re Gupta-Fitzgerald is third from the right.
Gupta-Fitzgerald also emphasizes the significance of focusing on creating resources for underrepresented communities.
“Historically, communities of color have been overlooked and excluded, but have survived for centuries without more formalized institution, so there’s a wealth of healing and resiliency we can learn from them to inform prevention strategies,” she says. “We want to create resources for these communities on how violence might seep into your life, steps you can take to keep you and your neighbors safe, distilling down info on laws, information on safe firearm storage, extreme risk protection orders, and more.”
These bigger topics, such as firearm storage to reduce injuries and deaths and research on violence prevention, need to be translated into digestible pieces, “giving humanity to the data environment,” as Gupta-Fitzgerald describes.
