Getting 'Beyond Violence'
American College of Healthcare Executives
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Health systems are synonymous with healing, and for survivors of interpersonal violence, a well-resourced, post-discharge support system is essential to promote safety and resilience. That sort of support system is in place at John Muir Health, a nonprofit healthcare leader in Northern California, with Beyond Violence, a hospital-based violence prevention program that provides bedside intervention to people affected by intentional interpersonal violence, defined as the use of intentional force to cause harm from one person to another or group of people.
John Muir Health’s integrated system of doctors, hospitals, outpatient centers and community services operates primarily in Contra Costa County, the area’s only trauma center. While recovering in the hospital, survivors of assaults, stabbings or shootings are in stages of deep reflection, recounting their violent experience. At this critical juncture, John Muir Health social workers engage Beyond Violence intervention specialists, or community-based paraprofessionals, to provide them with timely bedside support, crisis management, linkage to a robust network of health and social services, and a connection to nonprofit partner organizations post-hospital discharge. To date, the program has provided healing services to more than 700 clients since its launch in 2010.
By using a health equity approach, Beyond Violence offers crisis management, education, employment, trauma recovery, legal intervention, and a connection to food, housing and emergency funding resources. This model has achieved highly successful outcomes for clients while they are enrolled in the program:
The program serves people in Contra Costa County who are survivors of intentional violence, have been historically underserved and who have experienced systemic racism. Since the program’s inception, 90% of clients identify as people of color. The program’s geographic reach spans throughout the county, with most cases occurring in the cities of Pittsburg, Antioch, Richmond and Concord.
Who Are Beyond Violence’s Clients?
Beyond Violence clients are people who have faced tremendous adversity and multiple layers of trauma, oppression, discrimination and marginalization. They are incredibly resilient and deserve healing and liberation individually and collectively. Clients say the program has changed their lives, provided help and given them hope.
Who Are Beyond Violence’s Intervention Specialists?
At the program’s core, intervention specialists provide personalized care to each client. These specialists are paraprofessionals from the community hired by John Muir Health’s partner nonprofit organizations based on their knowledge and lived experience in the local community, cultural alignment and linguistic capacity, and commitment to equity.
An intervention specialist is involved with the client throughout their involvement in the program, which typically spans three months to one year. The combination of immediate intervention at the hospital bedside followed by community-based intensive case management has reduced risk factors for hospital readmission and improved overall health outcomes.
Intervention specialists provide crisis intervention, visit clients in their homes, provide regular check-ins and drive clients to health appointments, specifically to John Muir Health’s Mobile Health Clinic or Trauma Follow-Up Clinic for wound care and other medical needs. They also help connect clients to community resources such as mental health services, substance use treatment, academic support, vocational and recreational programs, and legal, food and housing assistance.
The end goal for each client is preventing reinjury, avoiding involvement with law enforcement, healing, empowering individuals to reintegrate back into the community such as by re-enrolling in school or applying for jobs, and improving their overall quality of life. This program model recognizes the direct link between social determinants of health and factors that influence violence.
A Collaborative Model
The Beyond Violence program is collaborative, with each stakeholder playing an integral and unique role. John Muir Health provides hospital-based funding and administrative services and partners with five Contra Costa County nonprofit organizations to provide community-based services. Each partner organization is provided grant funding via community benefit funding to support program staff, which includes intervention specialists and mental health therapists. Partner organizations are culturally competent, led by people of color and intentionally hire people who are rooted in the communities they serve. Current partners include One Day at a Time, RYSE Center, Center for Human Development, Fred Finch Youth & Family Services, and The Family Justice Center.
As part of its ongoing efforts, John Muir Health convenes biannual all-partner meetings for coalition building and interagency collaboration. During these sessions, stakeholders discuss population needs, staffing and financial resources, and client interactions and experiences. Following the meetings, program adjustments are made.?
Adapting the Program
Beyond Violence’s initial goal was limited to filling a gap in post-hospital discharge services for people ages 15 to 25 affected by interpersonal violence. Partnering with a youth-serving nonprofit social services organization, the program provided continuity of care for patients and supported sustained safety and healing.?
Since the program’s inception, geographies, age ranges and support services have been expanded to meet the population’s growing needs. The program’s partners identified that Beyond Violence clients needed culturally responsive, trauma-informed mental health services. To meet that need, in 2018, John Muir Health launched a partnership with a mental health services agency to provide free, confidential and culturally appropriate services for program clients. To date, more than 160 clients have received direct therapy from a licensed professional.
To expand geography and age range, John Muir Health analyzed data from the organization’s Trauma Center patient registry. The data showcased a potential to serve an additional 30 to 60 people in Antioch and 45 to 90 people in Richmond annually. In 2022, John Muir Health forged a new nonprofit partnership to launch two new program sites in addition to the county’s three existing sites.
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Program Funding
As a nonprofit health system, John Muir Health invests in the community through financial contributions and direct services to support uninsured, low-income and vulnerable community members. Beyond Violence is the health system’s signature community benefit program, and funding to support program staff comes directly from the organization.?
To support program partnerships, John Muir Health offers financial contributions to partnering nonprofit organizations to cover community partner overhead costs and staffing. To support program expansion, the John Muir Health Foundation pursues external grants from local foundations, state programs and private philanthropic funding opportunities. So far, Beyond Violence has received more than $3.5 million in external grant support, including significant contributions from the Carestar Foundation and the California Violence Intervention and Prevention program.
Achieving Safety for All
The Beyond Violence program has been successful in achieving its goals with individuals and families who participate. Interpersonal violence, however, continues to plague our communities and, specifically, low-income people of color.
As a society, we have a tremendous road ahead to ultimately achieve safety for all. Healthcare leaders must collectively commit to societal improvement, resilience and equity. This needs to be a multipronged approach that includes meaningful gun safety policies, law enforcement trainings, social-emotional learning programs at schools and many other strategies. John Muir Health is proud to lead the Beyond Violence program and play a small role in our collective fight for community safety and resilience.
Jamie Elmasu is director, Community Health Improvement, John Muir Health, Walnut Creek, Calif.
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Outstanding program and well done by John Muir Health!
Director | Community Health Improvement | John Muir Health
1 周Thank you, American College of Healthcare Executives, for showcasing this critical hospital-based violence intervention and prevention work! Highlighting our work is critical during this time, as federal funding for violence prevention efforts is currently under threat. The program's long-standing success stems from a true partnership model, working alongside 5 internal health system departments at John Muir Health and 5 nonprofit partners serving Contra Costa County. Current nonprofit partners that deserve to be recognized include: One Day at a Time, RYSE Center, Center for Human Development, Fred Finch Youth & Family Services, and The Family Justice Center.