Written by Margie Batek, MSW, LCSW, social work supervisor in the Emergency Department at St. Louis Children’s Hospital
The Victims of Violence program at the St. Louis Children’s Hospital seeks to curb the re-occurrence of interpersonal violence in the lives of children who have been shot, stabbed or assaulted, involved in domestic violence, and Fit for Confinement evaluations. The emergency department treats approximately 250 children annually due to interpersonal violence and a significant number of them are seen repeatedly due to subsequent violence.
The pilot study conducted by the emergency unit social workers has indicated that the mentor working with these children has seen significant progress in the patient’s development of conflict resolution skills, anger management skills, the ability to connect consequences to decisions they have made and to recognize their control of situations based on their actions.
Even a minimal amount of intervention has the ability to impact the trajectory of these children’s lives.
Homicide is a major cause of death for children ages 10–24. Many of the children who have been the victim of interpersonal violence will go on to initiate violence toward others leading to unsafe communities and further injury and death.
As a level one trauma center in an inner city location this public health issue is significant, and addressing it can positively impact not only the children and their families, but the communities we serve as well.
How the program works
- We serve children ages 8–19 years who have been involved in interpersonal violence. Each is offered a mentor, if they were residents of St. Louis City or St. Louis County.
- Contact begins in the Emergency Department (ED), with ED social workers approaching the family, developing rapport with family and child and introducing them to the program, providing brochures and business cards and informing them that a mentor will contact them within 24 hours.
- The mentor makes contact with the family within 24 hours of them being seen in the ED. If they are discharged the mentor will see them in the community and if they are admitted they will be seen inpatient.
- The first visit is made with caretaker and child and if they agree to participate in the mentor program regular meetings are held at a mutually agreed upon site. These meetings may or may not include the caretaker but at some point the child will have time alone with the mentor to begin to develop goals and treatment plans and to process the reasons that led up to the ED treatment.
- Mentors provide their (hospital furnished) cell phone numbers to the children and are available by telephone 24/7 for emergencies.
- Mentors work with parents who are willing to engage and provide mediation and therapeutic counseling as well as modeling of parenting skills.
- There are no limits to the time frame of the services or set intervals for meetings, these are determined by the needs of each child. The services and intervals are adjusted as the child progresses in the program.
- Discharge is mutually agreed upon by the child and the mentor and the door is left open for contact should they want to talk or need guidance.
- To be engaged in the program a minimum of 6 sessions with the mentor is required. Some children will withdraw before reaching the 6 sessions others will become inactive after 6 sessions but will maintain sporadic contact. After prolonged periods of no contact the mentor will close the case (these are lost to follow up and fall into the category of unable to retain).
- Letters are mailed with self-addressed stamped envelopes to ask the child/family if they are interested in continuing in the program before closing the case. If no contact is made within two weeks the case is closed but they are encouraged to contact the mentor if they should change their mind.
- Mentors communicate with school personnel, deputy juvenile officers, court personnel, police officers and community agency staff who are involved with the families/child.
- We reached out to City and County Police, City and County Family Court, City and County School Districts, School Social Workers in St. Louis City Schools, as the program began to inform them of the program and build working relationships with them.
First year statistics
As we approach the end of the first year of our program we have seen 142 children who were involved in interpersonal violence and who meet the age and residency requirements. Sixty eight of these children have declined services (47%). We have lost one to follow up of those who completed the 6 sessions. Forty three of the children are females, we have 57 open cases and 48 of them are active (children on the run are inactive, in psychiatric facilities or detention, etc).
Ninety children were assaulted, 42 were shot, 3 were stabbed, and 7 were seen for Fit for Confinement Evaluations.
Of those children seen during the two years of the study and the year of the program we saw over 400 children for interpersonal violence. Since that time we have had three who declined or did not qualify for the study die of from interpersonal violence, two return with subsequent gunshot wounds, one with warrants for assaulting a police officer, 3 with subsequent assaults. Of those children who we have worked with, even those who did not complete the full 6 sessions, none have returned for interpersonal violence save one for a sexual assault.
Implications so far
Although the program is still relatively new, we can draw some preliminary conclusions from our results:
- That even a minimal amount of intervention has the ability to impact the trajectory of these children’s lives. I do not think it is an accident that none of those who have been served by this program have been killed or returned for interpersonal violence.
- Studies do not work for this population. Services will be accepted but they are skeptical of studies, and with good reason.