An Intervention That Needs an Intervention

Day-to-day operations at two Maryland hospital programs designed to help gun violence victims recover—and ultimately avoid involvement in further shootings—substantially suffered during the COVID-19 pandemic, a new University of Maryland study shows.

The research, published this month in Preventive Medicine, sheds new light on the difficulty of providing social services amid the convergence of two public health crises: COVID and rising gun violence. Led by William Wical, Ph.D. ’24, a doctoral candidate in anthropology, the study is based on interviews with staff and participants of hospital-based violence intervention programs (HVIPs) at the state’s two busiest trauma centers: one serving residents of the Baltimore area, and the other the residents of Prince George’s County and Washington, D.C.

Pre-pandemic data shows that the HVIP in Baltimore successfully reduces a participant’s likelihood of being readmitted to the hospital—early, informal analyses of the Prince George’s County HVIP suggest the same. However, program staff at both locations told Wical that operations, financed entirely by grants, struggled with the resulting unstable funding and staffing even then, and that those issues only deteriorated further during the pandemic and the November 2021-March 2022 period of Wical’s study.

HVIPs are designed to offer robust, comprehensive services that connect people to mental health resources, transportation, housing, food and other basic needs that people frequently experience after becoming a shooting victim, but Wical found that hospital support for the programs fell while gun violence rates went in the opposite direction: Homicides and nonfatal shootings increased by 121% in Prince George’s County and 36% in Washington, D.C. from 2019-21, and Baltimore’s rates, among the highest in the nation, stayed steadily high as well.

“I had hoped that the hospitals would be responding with increased efforts to support HVIPs, and to be sensitive to the fact that people are really dealing with these two major public health crises at the same time, but this is not what happened; the programs really ground to a halt,” he said.

From the staff members’ perspective, the halt was driven by three key frustrations: a lack of support from hospital administrators, staffing shortages and program inaccessibility.

In Prince George’s County, where there was only one part-time front-line case worker, a shift to virtual HVIP meetings created accessibility and privacy issues for participants who don’t have internet connections, mobile devices or—especially if they were living in a shelter—a secluded area to discuss what they’re struggling with. The program also had to reduce the transportation services it offered to clients to attend follow-up appointments, impacting both their physical and psychological health.

In Baltimore, the HVIP’s four-person staff was halved and the program manager quit. In June 2021, when the city had its highest one-month homicide total since 2016, the program had no case workers at all and stopped taking on new long-term HVIP participants.

“To date, the Baltimore HVIP still doesn’t have a program manager or director,” said Wical. “You can only imagine what that looks like for the staff who are there now.”

From his interviews with the HVIP program participants, Wical identified another problem: a lack of understanding from hospital administrators about what participants truly deal with in terms of mental health and social instability.

As one program participant who lives in Washington, D.C., told him: “I knew programs like these would go away because they always do. The people higher-up in the hospital don't know what I've been through, and they’re not interested in being able to support me for the rest of life. This isn't something I'm going to get better from in one year or two years.”

Study co-author Joseph Richardson, the Joel and Kim Feller Professor of African American Studies and Anthropology, helped guide Wical’s research. (Wical works as a research assistant in Richardson’s Transformative Research and Applied Violence Intervention Lab.)

“I want people to know that Black and brown communities were and continue to disproportionately suffer from the intersection of two epidemics occurring simultaneously, COVID and gun violence, which puts a strain on the response from the healthcare system,” Richardson said. “Will’s research speaks to what it really looked like on the ground for these programs, their staff and participants during the pandemic. These narratives are coming from the trenches of the health care system, not from 30,000 feet; he was actually there, fully immersed in the context, and I wish more qualitative researchers would embrace this approach.”