RED! Interviews Out of the Crossfire’s Dr. Jennifer Williams

Stop the Violence:

by Sarah J. Stephens
March 2008

“Have we not come to such an impasse in the modern world that we must love our enemies – or else? The chain reaction of evil – hate begetting hate, wars producing more wars – must be broken, or else we shall be plunged into the dark abyss of annihilation.”

Martin Luther King, Jr.

 

 

 

 

 

 

In a small room, no bigger than 5 ft by 6 ft, across from the fifth floor nurse’s station, at University Hospital in Cincinnati, Ohio, Dr. Jennifer Williams, Program Director of Out of the Crossfire, creates miracles. Through the program Williams offers victims of gun violence an alternative to the perpetual cycle of violence that brought in over 306 victims in the last year.

Out of the Crossfire is the joint effort of University Hospital and The Cincinnati Bar Foundation. The vision of two doctors, Dr. Jay Johannigman and Dr. Kenneth Davis of the Adult Trauma Center at University Hospital, has become a reality through the work of Dr. Williams.  This program provides victims of gun violence with the opportunity to have a life that is not saturated with violence. It offers hope that we can, as a society, help each other to heal and live with a level of dignity that has previously not existed. In the following interview, Dr. Williams explains Out of the Crossfire: what she does and why she does it.

Are there any other programs like this in Ohio?
We are unique in Ohio.  There are all kinds of prevention efforts out there, and all kinds of re-entry programs, but as far as re-entry from a gun shot or a violent injury back into the community, as far as having any sort of an intervention to gun violence and other traumatic penetrating traumas as we call them, I am not aware of any. 

How did you decide on the structure of the program?
This program was modeled after the violence intervention program in Baltimore, the Shock Trauma Center, where Dr. Darnell Cooper is having great success. It is a hospital-based violence intervention program, and has been a role model big brother. It has been in operation for 10 years. They have data that can show impact. We who have just opened our doors in August ’06 are at the very beginning. They’ve been very generous with their technical assistance and knowledge, even sharing some of the data collection instruments that they use. We are actually benefiting from some of the mistakes or pitfalls that they have made.

Do they have a similar demographic as Cincinnati?
The cost of living, demographics, and the socioeconomic conditions of the Baltimore center is very similar to that of Cincinnati. They have more gun related injuries. In fact, the Shock Trauma Center is a place where medical professionals who might be deployed to Iraq or Afghanistan are often sent to train because the incidence, the complexity, and the severity of gun violence rival that of a battlefield. So where we (University Hospital) had 306 gun shot wounds last year, they (Baltimore Shock Trauma Center) had double or triple that amount.

Why do you think Cincinnati has seen an increase in gun related violence in the last 5 years?
The fact that we have had some major challenges along the lines of racial tensions and whether real or perceived, the incidence of African Americans, young African American males in particular, having limited access to valid, legal kinds of ways to make a living. Many of them are turning to other ways of survival, which is a natural instinct to do. I think that is further intensified by the fact that our school system is failing, so the high incidence of drop outs, particularly among African American males, is deplorable.  The last figure that I heard was about a 29% graduation rate for African American males. The fact that there have been on-going historical tensions between the African American community and the police department.  That creates disparities when it comes to charges for certain crimes being tried, convicted and incarcerated.  That creates more animosity and frustration. All are conditions that would result in some of the numbers we are seeing in violence & violent injury.  I mention African American males because our data shows that 80-85% of the gun shot wounds that we treat are African American males. There is something out of balance. There’s just a whole lot of reasons for that: for one, the Racial uprising in 2001;  and prior to that there have been quite a few incidents involving the police and African American males that have created a lot of frustration and tension and things finally exploded in 2001. That sort of parallels the 5- year period.

How did you get involved in the program?
The short answer is divine providence, I think. I am a native Cincinnatian and have been in the behavioral health profession for quite a while. And also I am licensed counselor, and I have a consultancy program that does evaluation, education, and social research.  I quit my job to pursue my business full time. I was involved in doing some community work with the ACLU and the collaborative agreement—facilitating public education meetings to let the public know just how the collaborative agreement was progressing. They hired an evaluator from California, and so I was asked on 3 occasions to facilitate a meeting between those facilitators coming with their technical jargon and make it user-friendly for the public. Doing that work I got involved with, and got to know, some of the lead figures in the ACLU and the African American community. And they didn’t have any money to pay me. I believe it was Mr. Al Gekhardts, who has been a champion for the collaborative agreement and an angel in terms of advocating for Out of the Crossfire, who learned that they were looking for a coordinator and facilitator for Out of the Crossfire.   He forwarded my email to Dr. Johannigmann and Dr. Davis who envisioned the whole concept about 2000-2001. Through a long interview process I was finally selected to be the individual to head it up.  Now there was some struggle on my part because I was not really looking for a job, because I had been independent for a year.  I also was afraid that it was a huge job and I knew that the public had been expecting something of this job and position for quite a while. It was really frightening.  So very carefully I consulted with everyone that I trust, and finally it just seemed like, why not me?

What did you see in the job that attracted you?
There are all the things that I care about, that I have a passion for. It’s not just a job to me, but I have family members and neighbors who are close to me who are part of the target population that I serve.  So I do have people who have been involved in gun violence who are now in wheel chairs, who are permanently disabled.   I’ve got family members who are dead as a result of gun violence.   I have family members who are incarcerated as a result of gun violence.  It just seemed like that’s where all of my very disparate kind of experiences have been leading—to this position because it does require somebody who has the ability to provide counseling & behavior health services to the clients. It requires someone who has a good feel for the community and community contacts, and who can develop relationships with other service providers.  It required somebody who had a handle on collecting data and analyzing data so that we can show accountability and impact, that’s where the market research and program evaluation came in, someone who could write grant proposals and solicit funding.  That’s a part of what I had to do for my business; that’s a part of what I had to do as an evaluator. So just a lot of different experiences.  The majority of my counseling when I was doing direct services was with people who had substance abuse problems and many of my clients have those kinds of issues.  It all just came together; it seemed like the right thing to do.

Why University Hospital?
University Hospital, being a level one trauma center for adults, is equipped and expected to take care of the most serious injuries, and gun shots usually fit into that category.  As soon as a patient is brought in for a penetrating trauma, and they come in from a 150 mile radius because we are the only level one trauma center in SW Ohio or in the tri-state area actually, as soon as they are medically stable and able to consent I will go to their bedside and introduce the opportunity to them.

How do you identify potential clients?
I learn about them from a couple of different sources. I get census sheets. Everyday they produce census sheets of who is in the hospital for trauma surgery service. I get a list of those. I get a list from orthopedic services of those who come in there who are A.K.A., which is a designation that we give people who have been deliberately injured violently so that the people who hurt them will not be as easily successful of coming back and finishing the job off.  They can’t just walk up here and get to that person.  It is also for the safety of the staff too. They are put on a list of where they identify who is safe to release information to.  There can only be five people on that list. That A.K.A. designation is on the census sheets. I’ll go through that sheet and see where they are, several are in intensive care.

When do you approach the client?
I’ll generally wait, and if I have the time I’ll go and talk to their families while they are in intensive care, because the client usually can’t, or isn’t in a position to be able to give informed consent. But the families really derive a lot of hope knowing that there is something beyond just patching the body up that might be helpful for their loved one.  Typically though, my hands are full with just those who are already admitted and on the floor.  As soon as they are medically stable and able to consent I will go to their bedside and introduce the opportunity to them, and see if they are interested in having an alternative to retaliation, an alternative to living the high risk behaviors that often got them shot or injured in the first place.

How does the program work?
If they say yes, I will conduct a pretty in-depth social history interview. It takes about an hour.   I usually break it into two parts, although sometimes I have to get it all at one time because trauma surgery, trauma service, is an acute service. We get them stabilized and they may need to then go on to a nursing home or some other rehabilitation facility so they don’t stay here any longer than necessary. They go to a less expensive and a less intense level of care, so I have to get them while I can.  I conduct the interview, and identify what their needs, their goals, their deficits or lacks, and their strengths might be, and then I go out into the community and identify the services and resources that will offset those deficits or risk factors.

What risk factors do you look for?
Those risk factors tend to be: males, most between the ages of 18-34, but we do get them as young as 14, and we recently discharged a seventy-year- old, so age is not a factor as far as gun violence. About 80-85% of my clients that come in with gun shot wounds tend to be unemployed and uninsured, 80-85% have a history of incarceration and a history of substance abuse or dealing drugs, 80-85% of them have dropped out of school, and so education is a factor.  Those are the risk factors and so I’m going to identify the things that will give them an opportunity to make a living that is legal and non-violent, to help them learn life skills that will keep them from coming back here or from having further adverse interaction with the criminal justice system.

In what ways can you help these clients?
It might involve getting them back in school, or if they have completed their 12th grade education, they may be interested in college, or getting them a job, often or sometimes for the first time, which means they need job skills or development.  So we’ll provide that or identify the services for that. Often people need counseling, and often they don’t quite recognize that need, so that’s kind of a sales job and also education awareness.  It’s a cultural reality that in the black community many people are socialized to not share family business outside of the family, you just don’t talk about the personal stuff.  Here however, especially engaging them in the hospital when they had a near death experience, they tend to be a little bit more reflective and a little bit more open to considering how they’ve been living and maybe changing their lifestyles.  When we identify, and they accept, the need for counseling we want to get them in as soon as possible and that is not only mental health counseling but also substance abuse counseling. Part of the addiction is the denial and not recognizing the fact that doing what you are doing is not helping you reach your goals  We also provide legal advocacy. There are people who have gotten on the wrong side of law and need some help getting back on the right side without fearing being locked up as a first response. So really advocating and identifying the root sources for why people are doing what they are doing instead of just locking them up and throwing away the key. Also legal advocacy to help them apply for services that they may be eligible for like victims of crime assistance. There are certain criteria that some of my clients would qualify for.   Depending on the extent of their injuries they may qualify for social security benefits.   Applying for those benefits can be very intimidating for the average person, so we can provide pro bono lawyers that will help them with that.

 


 

The Cincinnati Bar Foundation has pledged to raise “a quarter of a million dollars,” to financially support Out of the Crossfire.  At the time of this interview in 2007, Dr. Williams was patiently waiting, but in desperate need of these funds.  Once the money is received she will be able to hire a staff and manage the volunteer effort more efficiently.  The program has great potential to make a difference in the lives of all Cincinnati citizens. As program manager, Dr. Williams is determined to be successful.

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