4. Hospital Response: Doing the Work

Determining what staff do and how was a major question for this study. Staff in both service programs were, therefore, asked several questions to solicit understanding of their work and their views about their work, the organization, and the clients and communities they serve. This section describes findings from interviews with staff from the hospital responders unit. Responders partner with hospital trauma unit staff to help patients who are shot, stabbed, or beaten. They are on call and are expected to respond to requests from the hospital unit within an hour. They provide prompt bedside support to patients and their families and friends and work to curb retaliation.

Staff working as members of the hospital response unit were asked what they viewed as the major aim or purpose of the hospital response unit. Assisting the victim was identified as a top priority. Assistance was broad, including preventing further violence and aiding the victim in obtaining basic resources and special services during and after the hospital stay. Some answers suggested that the hospital intervention was viewed as an opportunity to get victims on a path of transformation.

• The major purpose is to quickly respond ASAP to patients who are victims of violence and to guide and assist them in getting any medical services they may need.
• I can say that the team’s goals are to be able to connect patients with any resources they may need; allow patients to meet their needs; prevent crimes and retaliation; and connect them with resources and benefits they may not know they are entitled to.
• Its goal is to first find out what happens to the victims that resulted in their being taken to the hospital, then help to de-escalate the situation and help victims get on the right track.
• Safety first. Because most shootings are gang related. What is more important is to make sure if the person is safe, and that there is no retaliation.
• The goal is to prevent the gun shot or stabbing victim from being reinjured and prevent family members/friends from retaliating. It also is our goal to help post-release with issues such as employment, physical therapy, counseling, housing, education. That help is for both the former patient and the family.

Staff conveyed different approaches that the hospital response program unit uses to see that the program’s overall purpose is carried out and aims and goals are met. Some persons addressed how the unit worked together and supported each other. Others focused on de-escalation strategies or the importance of providing social service supports and resources.

• For the majority of the work you have to have the (right/a good) type of communication on the streets. You have to use your resources of the streets. If I go to the hospital and the patient tells me that he is afraid for his family, I have to go on the phone to get my team for intelligence in order to decide how to proceed to deescalate.
• We have a lot of agencies we network and work with. When we do not have the services the patients need, we refer them out.
• We have mandatory meetings every week which allows us to evaluate how things are going and exchange information in order to improve our assistance to patients. We pour out everything we have experienced through the week with the patients. We try to see which patients might be a priority we should focus on.
• We are trained to do what is needed. Most of the team have been in similar situations before and they know what to do. Listening to the patient’s story; making sure they get appropriate medical attention; inquiring with them about the safety of their loved ones; trying to understand about the different groups involved in the situation if the patient is willing to talk with us. Yet, generally they do because they trust me when I tell them I was in the same situation before and can relate to them.
• We meet people where they are. But first and foremost, we establish trust that we have their best interest as our priority. We find a mutual contact that they know and trust that can provide us with a reference.

When talking about their unique qualifications for the hospital response unit, staff referred to their familiarity with the circumstances and life situations of patients seen in hospitals’ trauma care units. They viewed this knowledge as very important in helping them understand and respond appropriately to patients.

• Many of my patients come from areas where I was raised in. Thus, I am able to respond quickly and know how to treat them, talk with them and appropriately assess their needs because they trust me.
• It is my faith. Being a God-fearing man, knowing what God has done for me. I operate in faith, through faith, with the understanding that this is my assignment in life. Even if I was not with Acclivus, I would still find ways to continue helping others… I am a young man who came from the streets. I feel connected to these individuals spiritually.
• I know a lot of people and I can relate to them on many planes. I can relate to them because I used to be out there a lot and was involved in situations I am not proud of now. Thus, I know how to communicate with patients. I know how to better assist them because I know the street culture.
• First, I was a gun violence victim; second, I associate at the street level; third, I am very influential on the street, so my work comes in natural in a positive way.

One person contrasted this type street knowledge or credibility with what some may refer to as book learning.

• There are two types of people (workers). There are those who are clerical workers; those have to gather information from a database first before doing the work. The second group are people who are experienced. They are street knowledgeable; they have street education. They understand people’s stories; they do not judge the book by its cover. They do not have (book?) knowledge; they have street education… Their speech is different. I speak like my patients. I use my true identity to convey meaning.

Hospital responders described their roles and work. Similar to their descriptions of unit aims and purpose, roles and responsibilities were described as being broad and including efforts to prevent violence as well as efforts that address basic resource needs and personal development. Staff talked about their formal roles as might be found in job descriptions and also about what they do that may be considered “over and beyond” job expectations.

• As a hospital responder, my role is to respond to violent crimes, batteries, and assaults, and to assist victims and patients at the hospital. As soon as we arrive, we do an initial assessment of victims to see if they have papers and insurance and how to assist them. We check which victims services to provide. We guide them to appropriate services they need in the hospital.
• Basically, my role is to help my patients not go back to the life of crime that led to the situation, to prevent crimes from spreading, happening in the community, preventing retaliation, providing one on one moral support. If I have 100 patients, I give them my cards; they can call me at any time. I connect them with health assistance. They connect with me when they need help. It goes beyond my job. It is beyond seeing them only one time. I help them get jobs, giving them referrals.
• I connect with the patients regarding their stories… When you see people in bed at hospital and they see you and start crying because they feel being treated humanely and with people who understand them. I can be on the side of the bed and be thinking that it could be me in the bed. What about if it was me? I always go with that type of mentality. I provide services that might not be on my job description because I care about people. I feel connected with patients I serve and their stories. Thus, when I am having a one-on-one conversation with a young man trying to hurt someone or himself, I give all I got, my life experience; this is a heart-to-heart connection. You are my brother, and I see my heart in you. I walked into a medical unit and I saw an individual crying, saying “You made me cry” and I said, “Why am I making you cry?” He said, “It is because of the way you talked to me.” It is a spiritual connection. We need more of that in our job.
• I go to the hospital and meet with patient victims of violence. After that, I do an assessment of the patient’s situation, then I decide what is going on with the patient. I determine their needs. I try to go back to the community where the situation occurred. When the patients are discharged, I have to have educational and job referrals ready to help them based on their abilities and needs.
  I do whatever is necessary to help them the best I can to prevent them from going back to the situation that led them to become victims of violence in the first place.
  I assist other hospital responders by coordinating resources they need. I assist them in hospitals where they are overwhelmed.
• Safety is first to make sure no retaliation occurs. I seek enough information to help the patient to get back to what is normal and help prevent them from any mental health issues. I help them to get back to where they can be safe and be productive. Make sure they do not go back to where they were. When I first approach the patient, I introduce myself; I ask them to describe their situation, if they have any insurance, and if they fear any retaliation. Sometimes, they talk to me. If they do not want to talk I tell my story, and they open up to me more.
• I am hands on 24/7 management, assessing the situations of gunshot wound or stabbing victims and making sure that they and their families are connected to resources and assistance.

To better understand the dynamics of the work involved in hospital response situations staff were asked to describe a significant thing that had happened during their time as a responder and to talk about a case they had in the last few months. Their stories conveyed the difficult and intense situations hospital response work entails. Situations varied in terms of their immediacy, intensity and danger. One person talked about helping a family who lost a member to gun violence make funeral arrangements.

• I have a connection with a funeral home and I used that relation to help the dead patient’s family. I met them at the funeral home and connected them and helped as much as I could in the process. They were grateful to me, it was a relief for them. Because death is hard, to lose someone, and not knowing how to bury the person, it is hard. It is different from having someone just injured. I was happy to have helped that family put their loved one to peace.
• One of our patients was a young man who had been beaten up and had a drug addiction. I referred him to outpatient treatment. He started doing the outpatient treatment and abruptly stopped care. He went to inpatient treatment in another hospital for the same issue. I made a difference in his life because I took him to services. I took them to services in my car. I knew his mom and it became personal.
• My assistance to a 2-year-old child who was shot in a drive-by and his mother to get away and be protected from a violent dad was a great accomplishment. Without my help, both the injured child and the mom may have been hurt further by the dad.
• A famous performer was shot; he came to the hospital. A lot of his family, friends, and fans came to the hospital, and were planning violence. The hospital had to reinforce their security. They had to call on the Chicago police for help. People wanted to fight the security. I was able to de-escalate the whole situation. I told the crowd of over 400 people that they were not helping the shooting victim. It won’t do any good to the victim for them to go to jail trying to create violence. The victim would not be happy knowing that people trying to show love to him also did violent things that led them to jail. Right away, the crowd got my point and they understood and calmed down. The hospital could not actually believe I was able to de-escalate the whole situation. The next day, for follow-up, his dad and mom were very grateful to me, the victim too was grateful that I helped de-escalate the volatile situation. The victim wanted to get back to do performing.
• Each and every case I have taken is important and significant. I do not pick my cases. All our patients are provided the same respect and care.
• After his discharge, one of my patients wanted to change his life around. He had no SSN and no birth certificate.
  I helped him apply for these important documents. He said to me that “I have helped him more than anyone in just one day.” I helped him apply for different positions. He got a factory job; now, I am trying to help him to get back to school. I have not seen him recently but I talked to him on the phone. He is trying to get his cousins out of a bad situation. Because of what I did to help him he is out
  of trouble.
• I helped a female victim of a gunshot wound roll back to school to get her GED. It was not difficult for me to do so because I was there before, and I was able to be a role model for her. The female violence survivor is progressing to finish the GED program. I am like a mentor to her now. The mom was trying to get her to school for a long time in vain. For me having her to get back into school was a relief for everybody.

The broad aims of the unit and of staff’s views of their roles and the importance of their work are reflected in their assessments of the hospital response team’s work and accomplishments. Hospital responders saw the prevention and interruption of violence and helping victims receive the care they need as important indicators of success and effectiveness.

• I think my team is one of the most successful ones at Acclivus because our role is critical when any violence victims need first care. Being very close to victims of violence and being able to identify and guide them through the healthcare system make my team special. Also, because I was there before and struggled to get any help, I know how to navigate the system to assist my patients to the best of my ability.
• Very successful. We prevent a lot of violence, prevent people from retaliating. Trying and de-escalating volatile situations, we are successful speaking to parties involved in violence, trying to understand what happened, and doing our best to prevent the worsening of the situations created, and using our community connections to bring peace. We make sure the victims of violence and their families are protected against further violence, and prevent them from retaliating by all costs.
• My team is successful. We have weekly meetings. There are things we cannot discuss with anyone else; we are like family. Someone on my team might not have resources, and others on the team can assist. You cannot deal alone with the whole process.
• How many people we have helped? A lot. In the last two months we have helped more people; we have helped more than at any time. Just last weekend, there were 50 shootings and five deaths. We were very busy. One thing about this job, is that my mental perspective is that when I save one, I make a difference. You cannot save every one.
• My team is successful. They respond to hospital calls within the golden hour and they provide ongoing services to victims and their families.

The prevailing view of Acclivus as a successful and effective organization is reflected in staff’s responses to questions about suggestions for change or ways to further enhance the organization. Responses centered primarily on continuing or expanding the work that is currently being done.

• It will be important for Acclivus’ leadership to expand the role of hospital response teams to other areas of the city. The hospital I work at only receives patients from specific certain areas of the city.
• If we can provide more resources to assist my patients, that will be good. We still have more work to do in the field. More resources for the team – housing resources, human resources, schooling resources, food, health assistance resources.
• I would implement more staff when it comes to high volume hospitals. We could do more follow-up when patients are admitted and in the hospital or back in the community. For those that need support, we could stay in touch with them.
• More financial support is needed to help participants. Hiring more people to relieve us from more work would
  be good.
• The only thing is we need more resources. We can go out as individuals, but in some places, people say they do not have resources. Due to COVID, they are struggling for resources. It has been a life struggle. We need resources from outside. A lot of patients suffer from PTSD and do not have resources to help them.
• We need more individuals to work with us, with similar experience, the right individuals, so that we can take our jobs to higher standards. We do not need to overstretch ourselves. With more staff you can be more impactful to your patient.
• We could look at the schedule so that persons are not on call all the time.

Some participants stated that no changes were needed and there were no areas to strengthen or enhance. Their responses reflected the opinion that the organization was doing quite well as is.

• If it ain’t broke don’t fix it.
• Change nothing. The leaders of our organization are doing a wonderful job.
• I would not change anything because I have been with Acclivus for a long time. It has expanded; it has become a better organization. There is nothing to change.