How treating gun violence as public-health issue could help children
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Stacy Teicher Khadaroo Staff writer
When he visits his grandmother in West Philadelphia, 16-year-old Horace Ryans III sometimes hears gunshots. It鈥檚 scary. But the gunshot that affects him the most happened before he was born. It killed his uncle, sitting defenseless in a car in the neighborhood.
鈥淎 picture [of him] hangs on my grandmother鈥檚 wall, and every time I walk into her house I see him,鈥� Horace says. 鈥淚f I one day get put into a terrible situation where I am a victim of gun violence, that could be me on my grandmother鈥檚 wall.鈥�
Horace, a sophomore at Science Leadership Academy, participated in the walkouts on March 14, conducting interviews on gun violence and registering students to vote. As a member of the Philadelphia Youth Commission, he鈥檚 helping with a March 22 youth-voices forum on the topic, and he plans to attend Saturday鈥檚 March for Our Lives in Washington.
Whether they鈥檙e shouting from capitol rotundas or speaking volumes through 17 minutes of mass silence, young people like Horace are determined to make the country hear facets of the gun control debate. From their perspective, narrow proposals to boost school security, while necessary, don鈥檛 satisfy.
More and more, adults who research violence and work to prevent it are listening 鈥� and bringing youth voices to the center as they try to better understand the role firearms play in young people鈥檚 lives.
鈥淐hildren 鈥� are really begging for adults to help them feel safe,鈥� says Joel Fein, an emergency room physician and co-director of the Violence Prevention Initiative at Children鈥檚 Hospital of Philadelphia (CHOP). 鈥淲hat they know innately is when a child doesn鈥檛 feel safe, they cannot develop 鈥� in terms of the social, emotional, and intellectual growth that they need to become healthy adults.鈥�
An estimated 19 children a day die from or are treated for gunshot wounds in the United States. Among all high-income countries, the US accounts for 91 percent of firearms deaths for children up to age 14, a reports.
Yet being shot 鈥� intentionally or accidentally 鈥� isn't the only form of harm young people face, experts say. What about the child who sees her mother threatened with a gun by a boyfriend? Or the teen robbed at gunpoint on the way to school?
Despite two decades in which it鈥檚 been difficult to get federal funding for gun research, a number of projects are taking stock of the effects of firearms on children 鈥� and also the factors that may boost their resiliency. They are part of a growing movement to treat gun violence as a public-health problem.
Listening to young people about guns
Kimberly Mitchell and her colleagues at the University of New Hampshire鈥檚 Crimes against Children Research Center have been listening extensively to young people talk about the role of guns in their lives.
In an Appalachian community in Tennessee, in Boston, and in Philadelphia, they've asked older children (and parents, on behalf of young ones) about hearing and seeing gunshots and being threatened with firearms. They've asked how upset or scared each incident made them feel and whether it made them hide or change their route to school.
These are among many questions being tested as they develop Youth-FiRST, a pioneering assessment tool that will cover firearm exposure, access, and safety practices.
鈥淚鈥檓 a big believer in self-report data, because so much of [what we鈥檙e asking about] does not even reach the attention of officials,鈥� says Dr. Mitchell, a psychology research professor.
Mitchell estimated in that 1 in 33 children nationally have been directly or indirectly victimized by a highly lethal weapon such as a knife or gun at least once during their lifetime.
Her current work is funded by the National Institutes of Health. Mitchell hopes to have data analyzed within a few months and to eventually develop a national assessment.
Gun safety practices are another element her survey covers.
Twenty-six years ago, the American Academy of Pediatrics noted that households without firearms were safest for children, but that risk could be reduced if guns were stored locked and unloaded.
Yet progress on this front has been slow. Among households with children at risk for self harm, 43 percent have guns, an article this month in . Of those households, 35 percent store the guns locked and unloaded, slightly more than the 32 percent of homes where the children have no history of risk factors.
When people receive safe-storage counseling from doctors, they tend to improve their practices, Fein says. He and colleagues from the University of Pennsylvania are researching better ways to get pediatricians to do more of that counseling.
Determining levels of risk
Emergency-department doctors have known for some time that youths seeking treatment for a violence-related injury are at greater risk for future gun violence 鈥� either as a victim or a perpetrator. But Jason Goldstick and colleagues at the University of Michigan have developed a scoring system to better sort out levels of risk even among those who come in for nonviolent injuries.
They analyzed data from a two-year study of 14- to 24-year-olds who had been treated by an emergency department in Flint, Mich.
The survey items that proved most practical and predictive, according to the researchers, were the frequency with which the person had been threatened with a gun, the frequency of hearing gunshots, how many of their friends carried weapons, and how many fights they鈥檇 had in the past six months.
Those items became a 10-point 鈥淪aFETy鈥� score, published last year by . Among youths who scored 9 or 10 on the scale, 100 percent were involved in firearm violence within two years of their emergency department visit. For scores of 6 to 8, 81 percent; for scores of 0, only 18 percent.
The study only involved youths who reported substance use (mostly marijuana), but if further research externally validates it as a screening tool, the SaFETy score could be useful in urban emergency departments 鈥� 鈥渃ritical access points [for] 鈥� difficult-to-reach populations that you might not find in school,鈥� Dr. Goldstick says.
Moving away from 'treat and street'
In Philadelphia, homicide is the leading cause of death for teens and young adults, and 1 in 8 high-schoolers carries a weapon to school in a given month, CHOP reports.
The hospital鈥檚 Violence Intervention Program (VIP) seeks to assist victims and their families break cycles of interpersonal violence. They provide counseling and help them navigate complex medical, municipal, and social support agencies. It鈥檚 part of CHOP鈥檚 larger Violence Prevention Initiative, which addresses everything from domestic violence to school bullying.
CHOP鈥檚 work is recognized as a model and is one of 32 members of of such programs. These hospitals are shifting away from the traditional 鈥渢reat and street鈥� approach that many took when 鈥渋t was thought there was nothing we could do鈥� about cycles of violence, Fein says.
After young people in VIP spend three to six months learning about trauma and working on recovery goals, some become peer educators.
鈥淭hey are so resilient and take what has happened to them and turn it around to make sure it doesn鈥檛 happen to someone else,鈥� Fein says. That鈥檚 also what鈥檚 been so encouraging to him about the recent wave of youth activism in the wake of the Parkland, Fla., shooting. 鈥淲e draw strength from the people that we are supposed to be taking care of.鈥�
