Community Intervention Focus of Pediatrics Event

She talked about how pediatric residents, faculty and students connected with members of community organizations, and about the ideals they discussed and the “high hopes” they had for mitigating health care disparities in Western New York through engagement and collaboration.

“It was May 13th,” recalled Ventre, clinical assistant professor of pediatrics, a physician with UBMD Pediatrics and conference organizer, nodding in response to the audible gasp that came from the audience. The next day, the racist massacre at the Tops Market on Jefferson Avenue took place, which, she said, sent the entire community “into survival mode.”

The community is still dealing with the aftermath of the collective trauma of that event on May 14. But, Ventre noted, that trauma happens every day in marginalized neighborhoods and much of it is preventable. That was the focus of the conference’s keynote presentation by Christopher St. Vil, PhD, assistant professor in the School of Social Work. His talk was titled “All Hands on Deck: Implementing a Community Violence Intervention Ecosystem in Buffalo, N.Y., Grounded in a Multidisciplinary Approach.”

The conference, hosted by the Department of Pediatrics residency program, took place on May 5 at the Jacobs School of Medicine and Biomedical Sciences. About 100 medical residents, faculty, students, and community leaders and organizers attended in person, with about 45 more participating online.

St. Vil’s research focuses on trauma and the experiences of victims of violent injury, and he began his talk with sobering statistics that reflect the magnitude of the problem of gun violence in the United States. In this country, the sheer number of guns outnumber people and the nation’s homicide rate is estimated to be eight times greater than Canada’s and 22 times greater than those of Europe and Australia.

“We have a lot of guns in America and Americans continue to buy them out of fear,” he said.

But, he noted, mass shootings, which are happening more frequently and take up the lion’s share of news about gun violence, are actually not the main problem. The much larger problem, he said, is the gun violence that has been taking place in marginalized communities on a daily basis.

Black Americans are 10 times more likely to die from gun violence than whites, St. Vil said. Blacks make up 13% of the population, but make up 61% of victims of gun violence in this country.

“America has a gun problem,” he said, “but racially it breaks down differently. White males have a suicide problem and Black males have a homicide problem.

“We cannot incarcerate our way out of this issue,” he said. A public health approach to the gun violence problem reveals that gun violence is a symptom of problems that are rooted much more deeply in society, he added.

“Gun violence is concentrated in a small number of neighborhoods among a small group of young men,” he said. “They wake up in communities where they’re depressed and have no hope.” Their neighborhoods are characterized by a lack of employment opportunities and a general lack of trust in law enforcement, where long histories of disinvestment have eroded public attitudes.

He introduced the concept of community violence intervention (CVI), which is focused on giving support to the people in the community who are at the highest risk of engaging in violence. “CVI attempts to engage these young men and to figure out how to treat those at the highest risk of engaging in violence,” he said.

He underscored several times the point that this is a very small group, but that they are the ones responsible for so much of the violence happening in their communities.

“These are the toughest kids, the ones nobody wants to work with anymore,” he said. “How do you engage with them? You need a community violence intervention ecosystem driven by city leadership.”

He noted that Buffalo has a unique opportunity to create a community violence intervention ecosystem. “Buffalo is one of the only areas in the state with a hospital-based and community-based response,” he said. “We have the support of hospital administrators and a plethora of organizations engaged in pulling youth away from violence.”

The hospital support is demonstrated by the fact that two key organizations — Should Never Use Guns (SNUG) and Buffalo Rising Against Violence (BRAVE) — are located at Erie County Medical Center, where they work together and with victims to combat violence.

A key piece of the CVI ecosystem, St. Vil pointed out, is development of credible messengers, who come from the community where the violence is taking place. “They have a level of social capital to mediate conflicts, and we know trust is a big issue,” he continued. “And for credible messengers to be credible, they can’t be talking to law enforcement.”

This is critical, he said, to rebuilding trust among communities. “We need to move away from the public safety approach,” he said, to identify the small group of kids at risk for engaging in violence and refer them to organizations that can provide them with opportunities for positive engagement.

In addition to SNUG and BRAVE, he cited the efforts of the Erie County Department of Health led by Commissioner Gale R. Burstein, MD, who is also a UB clinical professor of pediatrics, and UB’s Community Health Equity Research Institute, that are starting to make a difference in combating social determinants of health that contribute to violence.

After the talk, UB pediatrics residents gave poster presentations on their community advocacy projects, which were followed by a panel discussion on “Breaking Down Silos: Finding an Approach to Trauma Prevention That Fits into Your Roles.”