Street violence and its victims are focus of specialized social workers

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

Doctors and nurses and medical technicians at Upstate repair the physical wounds of patients who are victims of street violence. Specialized social workers focus on preventing recurrence of that street violence. With me to explain the role of Upstate's Violence Education Prevention Outreach Program (VEPOP) are Rubina Dhillon and Renee Gregg. They're both social workers at Upstate.

Welcome to "The. Informed Patient," Ms. Dhillon and Ms. Gregg.

Rubina Dhillon: Thank you.

Renee Gregg: Thank you.

Host Amber Smith: Upstate University. Hospital is designated as a Level I trauma center, which means it has expertise in caring for trauma patients and people who suffer gunshot wounds or stabbings or assaults.

They often receive treatment at Upstate, so it makes sense that the hospital would have a violence prevention program. Can you tell us how this program began, Ms. Gregg?

Renee Gregg: So our program began in 2015.

We were trying to design something that would stand out, that is policy driven and research based, that works with anyone who comes in for non-incidental injuries. And, in April of this year, we added another program, which is called SNUG: Should Never Use Guns, and Rubina, please tell us about that.

Rubina Dhillon: My program began back in 2009, when 10 cities and the state of New York received funding to work to prevent gun and gang violence.

And then, in 2019, SNUG received additional funding to not only expand but also to integrate a social worker and case manager position. We all know that gun violence is a public health issue, and statistics actually show that 60% of the homicides in the U.S., a gun is the weapon that is being used. And sowhat we try to do is recognize that violence is a learned behavior that can be prevented. So SNUG tries to use a "Cure Violence" model from Chicago in addressing violence reduction.

Renee Gregg: Yeah. And in Syracuse, in 2021, which was last year, we had 31 murders related to street violence.

Host Amber Smith: So it's a known problem and Upstate, it sounds like, has stepped up to try to help solve it.

Rubina Dhillon: Yes, absolutely.

Host Amber Smith: Well, tell me a little bit about what you do as social workers in these programs. Are you located physically in the hospital, both of you?

Renee Gregg: Yes. I'm in the hospital and in the community. I do home visits to our patients' homes, go with them to doctors' appointments and that (sort of) thing, and Rubina is located right here in the hospital.

But what we do is we meet the patient at their most vulnerable point. That's when they come into the hospital emergency room with their injuries. We introduce ourselves, and we try to establish relationships with them so that we can eventually provide life-changing services to them.

Rubina Dhillon: Yes. So we try to provide "trauma-informed" counseling. We like to meet the patient where they're at, assist in advocacy, assistance with filing a victim compensation application -- that is through the state -- and we try to connect the individuals with other services that are either identified or needed. So really we work with survivors of violence, whether, as mentioned, it's gunshot wounds, assault or a stabbing.

But we did want to note that we, we don't follow self-inflicted or, DV cases,

Host Amber Smith: So you don't, handle the self-inflicted, wounds or domestic violence cases.

Renee Gregg: Nor child abuse or elderly abuse.

Host Amber Smith: OK. Because there's already other programs in place for those things, right?

Renee Gregg: Correct. Correct.

Rubina Dhillon: Exactly.

Host Amber Smith: So I'm curious, I guess the physicians and nurses in the emergency department, they must notify you when they have someone who's been impacted by street violence. Is that how you find (out)?

Renee Gregg: So we have a pager system here in the hospital, which is pretty much like the pagers of old, where they would page you and you just come, you don't know exactly what you're coming to. We report to the trauma bay, so we really meet the patient when they first come through the building.

Rubina Dhillon: Yeah, we'll have the initial contact with them. So really we don't go to the patients. They kind of come to us here, at the ED (emergency department).

Host Amber Smith: So you go to the patient, who also may have family members with them, right? Do you find yourself dealing with family situations, as well?

Renee Gregg: Yes. Unfortunately, COVID has changed a lot of things we do. So we have families ... on one occasion I had 300 people in the parking lot of the hospital.

Host Amber Smith: Wait, 300?

Renee Gregg: (We) had six people come in shot, two people were run over by vehicles at the incident, and there was about 300 people in the parking lot. And I had to run and try to figure out what was going on.

Host Amber Smith: Lots of people that needed your services that day.

Renee Gregg: And many of them didn't really need services. They were just being nosy. But I had to ascertain who was the family member, and who was the nosy one (laughs).

Rubina Dhillon: But a lot of hands on deck, working with not only the survivor, but also the family members, because, of course, you know they're also affected.

Renee Gregg: Yes.

Host Amber Smith: In general, what are the gender and age range of the people that you work with?

Rubina Dhillon: Renee and I have actually both noticed a pattern of working with patients who identify as being males. And the age range varies. I mean, I think last week I was just working with a patient who was in his 50s, but Renee, I think you said you worked with an 11-month-old?

Renee Gregg: Last year now, we had an 11-month-old who was shot three times and eventually died, so I've had an 11-month-old, two (in their) 70s, and ...

Host Amber Smith: Well, that just shows that street violence really affects a wide range of people.

Renee Gregg: Everyone.

Host Amber Smith: So how do you find people are receptive or not to making changes in their lives?

Renee Gregg: When we introduce ourself, we tell them the services we provide, and it's up to them to accept, so they can defer, they can say they don't want it, they can say, We'll talk about this later. Rubina does a good job with following up with people, (in) two weeks?

Rubina Dhillon: Uh-huh. Yep. I'll follow up post-discharge. I mean, there's a lot that goes on when a patient comes in through the ED, right? The medical attention is No. 1 in priority. So we also have to remember that change does start from within, so they may not even be thinking about what sort of resources or needs they'd need addressed post-discharge. And so what we really try to do is, we'll follow up with the patients after a couple weeks and just kind of assess and see where they're at.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith, and I'm talking with social workers Rubina Dhillon and Renee Gregg.

I'd like to understand what can be done to reduce repeated violence. Can you explain how that works?

Rubina Dhillon: As mentioned, we really do try to use a public health approach in reducing shootings and firearm-related deaths. So, what we do is, we use a three-pronged approach to preventing violence.

You know, the first is to interrupt the transmission, and then we try to identify and change the thinking of the highest potential transmitters, and then to be able to help change the group norms that come with that.

Renee Gregg: Yeah. And personally, I just believe that we need to educate our community, our children, on what happens when somebody is injured.

They need to know what happens here in the hospital, from the trauma bay to the morgue. A program in Philadelphia, It's called cradle to grave, and they actually bring the children in and teach them what happens.

But then, the perpetrators need to know what's going to happen to them. And dying is easy. So before you die, understand what your family's going to go through after you die. Education is just imperative in making a change in anybody. And with this public health issue, it needs to be done early and continuously.

Host Amber Smith: For people who agree to sign on and join this violence prevention program, what are the sorts of services that you can provide them? What's the benefit to them joining?

Renee Gregg: For me, the VEPOP social worker, I work with the injured patient, his family and his friends.

And I say "his," because, like we said earlier, it's normally a male, but we have had a lot of women. And we help them to cope with the injury itself, because the extent of the injury can be death, it could be losing a limb, it could be prolonged PTSD, or it could be a combination of those things.

We help them to make sure that they get the follow-up care they need, and to connect them with community resources to promote healthy choices and to avoid street violence. At post-discharge is when I go into the home or into the community, and we provide supportive case management. And it's intense. And we help them to obtain employment, to secure safe housing, to resume or obtain your education, to get hooked up with mental health services, to assist them in navigating the health care field, making sure that they have a PCA (personal care assistant), and that they're keeping their appointments, and also making sure that if they have drug and alcohol use or abuse issues, that they get the support they need.

Rubina Dhillon: So Renee wears a lot of hats at VEPOP, whereas SNUG, we actually have a case manager on site to help address any sort of case management needs.

We also have a social worker, so, as mentioned, I'm the social worker here at the hospital, and then we have a social worker in the community through SNUG and then we also have an outreach team. The role of the outreach team is really just to help respond in shootings to prevent retaliation.

And in order to prevent retaliation, it's done through mediation. We assist family members to those who have been injured or killed, and also just mentor the high-risk youth and young adults that are involved in the program. And, you know, really just try to connect them into goals, in any sort of like job opportunities, educational needs, as mentioned, drug and alcohol treatment. and, overall, to promote positive life skills.

Host Amber Smith: How much of the street violence in Syracuse is related to gang activity?

Rubina Dhillon: That's a tough one. I mean, there really isn't a way to measure that per se. A lot of the survivors that we work with, you know, oftentimes we'll hear that the incident was "wrong place at the wrong time," so it's kind of hard to pinpoint how much is related to gang activity.

Host Amber Smith: What about poverty?

Rubina Dhillon: Well, I'm all about the research, so research actually does show that communities with fewer resources have higher rates of violence, and it could be for many reasons, right? But I think it's important to remember that violence prevention programs are in place to hopefully help build the community up.

Host Amber Smith: What happens if a victim of street violence feels that they need to move to a different neighborhood to get away from the violence? Can you help them accomplish that?

Renee Gregg: Yes. With funding from New York State Crime Victims (Office of Victim Services), we can help relocate people. We can't pay their rent for a year or anything like that, and they must find their own shelter.

So I moved a family to North Carolina. New York state kept her in a hotel for 30 days, and as soon as she found a place to live and was approved, we sent her first month's rent and her security deposit to that place and provided the movers for her to take her stuff from the storage place to the apartment. After that, she had to use her own resources to pay her rent, and she was lucky she found a job before she found a house, so she was able to just fit herself back into what she was used to doing.

We've moved people, I've moved people, from Butternut Street to Prospect, and that's a very short, distance. But for that mother with three kids, it was just changing location so that she felt that she was in a safer neighborhood. We helped her with calling her landlord and getting another apartment through the same company.

And everything worked out fine. So each month we do a lot of moving, because safety is a big issue.

Rubina Dhillon: And I think it's important to note, too, that VEPOP and SNUG, we don't help with rapid rehousing, but we do have funds to help assist in relocation.

Host Amber Smith: And not everyone, I'm assuming, would want to move or be able to move. and you've got ways to help people stay in their homes and still stay out of the violence, right?

Renee Gregg: Yes.

Rubina Dhillon: And that's where we'll kind of assess for safety and create a safety plan with the patient.

Renee Gregg: And fortunately, everybody is not from a violent community, so we have suburban people who just need to pay their rent because they can't go to work because of their injuries.

So we solicit the crime victims, and they'll help pay mortgages or rent to keep them in their home, in their safe location, while they're recuperating.

Host Amber Smith: So what do you say to someone who's reluctant to sign on and commit to trying to reduce violence in their life? How do you convince them that this is the way to go?

Renee Gregg: I think the best thing is giving information. Information is education. So they'll hear about what we do, and they might not want to be actively involved, but they need a resume wrote because they haven't had a job in a while, and they would like to have a resume. I meet the person where they're at and help them with what they think they need.

I'm not trying to give them my values. I want them to feel comfortable making the changes on their own and always telling them to keep my card or my pamphlet because if they ever need me, they can make that phone call.

Rubina Dhillon: We can provide the tools and the skills, but really, again, as mentioned, the, change has to happen from within, right?

They have to want to make that change and to move forward in a healthy manner, right?

Host Amber Smith: Ms. Gregg, let me ask you, what do you hope to accomplish through VEPOP?

Renee Gregg: My goal is to save a life, or to save lives. And I believe that's done through education and resources. Just making sure people have what they need to have productive, healthy lives.

That's my goal. I believe that's the hospital's goal also.

Host Amber Smith: And Ms. Dhillon, the Should Never Use Guns program: What are you hoping to accomplish with that?

Rubina Dhillon: I've seen a pattern of a lot of survivors of violence that come from various backgrounds. And coming from a cultural background, I want to really break down the cultural barriers and to be able to normalize mental health. I think it's important that we discuss our feelings and move past the saying, "what goes on in the household stays in the household," right?

So that's really a goal of mine, to be able to normalize. If we can take medication daily and why can't we go see a therapist or seek help when needed?

Host Amber Smith: I appreciate both of you making time for this interview.

Rubina Dhillon: Thank you.

Renee Gregg: Thank you.

Host Amber Smith: My guests have been social workers Renee Gregg and Rubina Dhillon from the Violence Education Prevention Outreach Program and Should Never Use Guns program. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

Find our archive of previous episodes at upstate.edu/informed. This is your host, Amber Smith, thanking you for listening.