- Associated Press - Monday, November 24, 2014

FLINT, Mich. (AP) - Could youth violence be considered a chronic disease?

A University of Michigan Injury Center study that was done at Hurley Medical Center in Flint found that it should be considered such a malady. Researchers also believe it’s a much more serious issue that some may think, The Flint Journal (https://bit.ly/1Eojhg3 ) reported.

“We’ve been working for a long time to understand youth violence and how to prevent youth from experiencing reoccurring violence over a long time,” said Dr. Rebecca Cunningham, director of University of Michigan’s Injury Center and co-director of the Michigan Youth Violence Prevention Center. “Understanding how large of a problem this is helps understand what resources people need to help prevent reoccurring injuries.”

It’s believed the first six months after a young person seeks care for a violence-related injury are crucial. If they come back to the emergency room with another injury within that time, it’s more likely to become a reoccurring event for that young person, Cunningham said.

The question now is what can be done to prevent it.

In youth violence, injuries include bruises, concussions, broken bones, puncture wounds and firearm injuries from fistfights, muggings, assaults and shootings.

The research started in 2009. The team did multiple interviews and medical chart reviews over a two-year period with nearly 600 residents between the ages of 14 and 24 starting when each one sought emergency care at Hurley.

Nearly 350 of them were treated for assault injuries at that first encounter.

“I think a lot of things about the study help us understand what could be done next. This helps us understand how critical it is that we use our emergency departments (to make contact with the youth),” Cunningham said. “It’s important to look at violence not as an accident but more from a public health perspective.”

The study states that 85 percent of the young people enrolled were still in the study at 24 months. Five of the participants died before the study period ended, three from violence, one from a drug overdose and one in a motor vehicle crash.

Nearly 37 percent of those who qualified for this study because they were being treated for assault-related injuries wound up back in the ER for another violent injury within two years, most of them within six months, Cunningham said.

“That needs intervention,” she said. “I think we all knew that kids that came in with some violence injuries (on reoccurring occasions). But I think the rates of repeat injury are really stunning. And really demand some action.”

The reoccurring visits to the ER are 10 percentage points higher than the rate for what is traditionally seen for chronic disease, Cunningham said about the study. Yet there is no system of standard medical care for young people who come to ERs for injuries suffered in a violent incident.

The hope is that this study can change that.

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Just like a chronic disease, violent injuries have predictable risks and they can be preventable. There are things that can be done to make it better, just like asthma, Cunningham said.

It applies to violence, although it’s not the way people typically look at it, she said.

“People are having violence in their life, reoccurring. There’s great morbidity and it’s killing many of them the same way a chronic disease would, killing more than asthma and cancer and motor vehicle crashes,” Cunningham said.

And it’s not just Flint. It’s across the country, she said. Nationally, violent injuries are the leading cause of death for African American youth, she said.

More than 707,000 young people ages 10 to 24 years had physical assault injuries treated in U.S. emergency departments in 2011 - an average of 1,938 each day, according to the Centers for Disease Control and Prevention.

Flint and Hurley were chosen for this study because, like many urban communities nationally, they have high rates of violence and Flint is similar in a lot of ways to other cities that are struggling across the country.

The pediatric trauma service at Hurley evaluated many patients in the emergency department in 2014 and admitted 274 patients to the hospital with 30 percent of admissions transferred in for a higher level of care, according to data from Hurley officials.

“Flint is a place where we can better understand this problem,” Cunningham said.

So what can help reduce the prevalence of reoccurring youth violent? The suggestion is interventions and programs that reach the youth when they are vulnerable and in need of help.

Where there are other programs and resources across the county and state, this study looks at the role emergency rooms can play in this issue, Cunningham said.

“We need to use it as an opportunity to talk with kids, to connect them with services that they need. Help them find different options,” Cunningham said. “(After) recognizing the violence, it’s an opportunity to engage the youth and have conversations with them on how they can be safer for the next six months. That’s the highest-risk time for repeat injury and possibly death.”

Dr. Michael McCann, chief of Hurley’s Trauma and Surgical Care Unit, said Hurley sees quite a few injuries from violent crimes, because it is equipped to handle them.

Where Hurley already has a neuropsychologist to help those with brain injuries, more can be done for those with violent injuries, he said.

The hospital sees multiple assaults a week and three to six gunshot wounds or stabbings a week across all age ranges. Hurley should be used for studies, because it has a lot of resources to offer, McCann said.

“Hurley is an excellent source of information. There’s so much we can do and should do. We have a lot to offer,” McCann said. “The next part would be more outreach, set up some sort of program to look at PTSD (Post Traumatic Stress Disorder).”

It would not only look at youth with head injuries, but with other injuries and make them part of a protocol to get help with violent injuries, McCann said.

“Screen more of these kids and get them help,” he said, which could include counseling within the program.

For Whaley Children’s Center in Flint, youth violence is something they are always concerned with and research like this is a step in the right direction in reducing reoccurring incidents, said Kevin Roach, president and CEO of Whaley.

Ongoing trauma and aggression can have long-lasting effects into adulthood, Roach said. It affects post-traumatic stress disorder, social skills, life skills, holding down a job and critical thinking, he said.

“I think it’s one (study) that’s probably long overdue. It’s a study that’s been needed to be done in really gaining an understanding of the brutality of youth violence and how to break that cycle,” Roach said.

Interventions and programs are needed to give youth other opportunities than spending time with negative activities and just being on the street. Organizations such as the YMCA and Boys and Girls Club of Flint are examples of that, but there still needs to be more, Roach said.

Churches, nonprofits communities and after-school programs are also a good start, he said. It has to be a collaborative effort.

“Much more extensive and coordinated efforts must be done in the community, a more coordinated response can be done amongst our stakeholders in our community that would include the medical community and the law enforcement community,” Roach said. “How do we treat and combat violence. How do they break free once and for all?

“It’s a significant issue that we were glad such a study was commissioned.”

What makes the study unique is that in the emergency room, staff have the opportunity to reach youth at their most vulnerable and helpless states, Roach said.

If youths are affected by help, they could go and help others in their community. It could be a catalyst for change, Roach said.

“It’s a start. It’s a step forward. It’s something that of course is not going to address everything,” Roach said. “He or she can impact those around them. That’s going to have some staying power.”

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Information from: The Flint Journal, https://www.mlive.com/flint

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