Being Proactive Upstream: A Collaborative Effort to Prevent Urban Gun Violence

Contributors: Andrew Woods and Andrew Gluck
To learn more about Andrew W. and Andrew G., click here.

 

image002.jpgIn 1999, the non-profit organization Hartford Communities That Care (HCTC) embarked on a journey to prevent and reduce urban gun violence, centering efforts on data-driven youth leadership development.  Out of necessity, the original mission soon expanded to crisis response, amidst an upsurge of homicides in Hartford, CT in the early 2000s. 

Ever since, HCTC has built new partnerships that more systemically address the causes and consequences of violent crime. The HCTC-Trinity-Saint Francis Medical Center crisis response team (HCRT) was formed in 2004. As of October 1, 2019, the HCRT had responded to and supported more than 820 shooting victims and their families, connecting with them at moments of significant crisis.   

Confronting an average of 100-plus shootings per year – and the PTSD among victims, their families, and loved ones – HCTC in recent years has continuously ramped up clinical care, ranging from grief and funeral counseling to home nursing and trauma treatment. Ground zero is the 06120 zip code in the city’s North end and literally a “target” clientele: young men of color.

Although not foreseen at its founding, HCTC’s preventive efforts increasingly have been enhanced by victim-service partnerships with law enforcement and medical professionals.  This expanded further in 2018, when the HCRT became the state’s first member of the National Network of Hospital-Based Violence Intervention Programs (NNHVIP), and its community-based and hospital-linked services began operating 24-7 as the only such crisis response team in the state. 

image002.pngAugust 2019 brought an even firmer foothold:  After struggling for two decades with poorly resourced victim services, HCTC attracted congressional and State legislative support for a federal Victims of Crime Act (VOCA) focus on unserved – and underserved – young men of color.  

Integrating services to connect with this marginalized population, HCTC with its fiduciary and compliance lead, the YWCA Hartford Region – and its grassroots partner Mothers United Against Violence – received the state’s first-ever VOCA funding to directly address the deeply rooted conditions of urban gun violence faced by young men of color.

Sufficiently funded hospital-linked violence intervention programs promise to save lives and achieve substantial savings in Medicaid, which among HCRT clients pays more than 95 percent of the gunshot victims’ medical costs.1 

In pure dollar terms, the annual costs of treating gunshot victims in American hospitals are nearly $3 billion, according to a 2017 Johns Hopkins University School of Medicine analysis.2  Moreover, the American College of Surgeons has reported interpersonal violence recidivism rates as high as 55 percent.3  

HCTC continues to quantify the return on investment (ROI) from its efforts to prevent and reduce gun violence, in terms of healthcare delivery savings, violent crime cost reduction, and clients’ pro-social lifetime trajectories.  Using actual costs data to study the ROI implications for the hospital, Medicaid, and the tax-paying public, the Social Capital Valuations (SCV) firm has developed an Expected Value-Return on Investment (EV-ROI) predictive model, which in HCTC’s case examined the average costs of emergency room and hospitalization care for 82 gunshot victims over the past three years, looking at lifetime healthcare costs savings.4 

To derive 2017 costs, SCV used a medical cost calculator.5  Its estimated success rate of 10 percent amounts to Medicaid savings of nearly $2 million.6

The net public benefit estimated for the HCRT cohort includes:

  • Healthcare Delivery Savings of $420,264 (a return of $3.42 for every dollar invested in crisis intervention, home health service, and outpatient care in connection with 48 responses to gunshot victims and their families);
  • A Violent Crime Cost Reduction of $469,712 (a return of $5 for every dollar invested in clinical intervention with individualized sustainability plans emphasizing social/emotional learning, anger management, conflict resolution, job readiness, etc.); and
  • A Public Benefit from Pro-Social Lifetime Trajectories of $2,915,059 (the net public benefit of 10 percent success – in this case, eight additional high school graduates – in increased lifetime tax revenue, decreased public assistance costs, and productive years not on Medicaid). 

Thus, the 2017 investment of $290,976 in the preventive work of the HCRT, including after-care by home health nurses, produced an estimated net public benefit of $3,805,035, according to the EV-ROI model.

The HCRT logic model shows the inputs from partners, their activities in service to victims and their families, the numbers of clients receiving services, and the short- and long-term outcomes.7  Social Capital Valuations has applied this predictive model not only in the case of HCTC, but also in healthcare and wellness analyses for a variety of states and cities.

Under the partnership-based NNHVIP approach, the HCRT seeks to further increase the human and economic benefits from prevention and intervention efforts upstream, before the flood of catastrophe.8

References

  1. According to Saint Francis Hospital Medicaid cost data for years 2015, 2016 and 2017.
  2. Online source: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0625.
  3. Online source: “Violence Intervention Programs: A Primer for Developing a Comprehensive Program within Trauma Centers,” American College of Surgeons Committee on Trauma, https://www.facs.org/quality-programs/trauma/advocacy/ipc/firearm-injury/hvip-primer.
  4. The Lifetime Per Capita Expenditure between the ages of 20 and 65 is $137,801 in Year 2000 dollars.  “The Lifetime Distribution of Healthcare Costs,” Berhanu Alemayehu and Kenneth E. Warner. HSR: Health Services Research 39:3 (June 2004).
  5. https://www.halfhill.com/inflation_js.html
  6. The Medicaid savings would accrue from participants having productive careers with medical insurance covered by employers and not Medicaid.  With 45 Productive Years not on Medicaid (age 20 to age 65), the individual savings would be $242,086, or $1,936,688 for 10 percent, or eight of the 82 young men receiving counseling and therapy and presumed to graduate high school and successfully transition to a productive career.  Adjusting down (96.4%) for men and using a medical cost inflation calculator to find that value in 2017, yields a cost of $242,086 per male for the 45-year productive work life. Multiplying $242,086 times the 8 young men equals a shift of $1,936,688 to other payers.   
  7. “First Generation EV-ROI Model for Hartford Communities That Care’s HCRT/ Hospital-Linked Violence Intervention Program,” Social Capital Valuations, August 2019.
  8. Hospital-based Violence Intervention: Practices and Policies to End the Cycle of Violence,” National Network of Hospital-Based Violence Intervention Programs Policy White Paper. 

 

Contact Andrew Woods at:
AWoods@hartfordctc.org

Contact Andrew Gluck at:
andrew@socialcapitalvaluations.com