Working With Victims of Gun Violence by maw19089


OVC, July 2001, NCJ 186155. (16 pages).

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									U.S. Department of Justice
Office of Justice Programs
Office for Victims of Crime

              J U LY 2 0 01

Working With Victims of                                                                         About This
Gun Violence                                                                                     Bulletin
      by Judith Bonderman
                                                                                              Gun violence in America crosses the
                                                                                          demographic lines of age, race, ethnicity,
                                             s   Identify promising or successful as-     religion, gender, and class—very few
                                                 sistance programs for victims of
Introduction                                     gun violence.
                                                                                          Americans have not been affected by
                                                                                          the scourge of gun violence. Gun
                                                                                          violence corrodes the fabric of our
        n March 3, 2000, the Office for

O       Victims of Crime (OVC) spon-
        sored a roundtable discussion
about the effects of gun violence on indi-
                                             s   Develop recommendations for how
                                                 federal and state crime victims’
                                                 funds could be used to address
                                                 unmet needs.
                                                                                          communities, traumatizing victims,
                                                                                          witnesses, families, communities, and
                                                                                          even our Nation, as recent high-
                                                                                          profile school shootings have shown.
vidual victims, their families, and their
                                                                                          To understand and respond effectively
communities. This 1-day meeting in           The 18-person group reflected a wide         to violence in our society, we must
Washington, D.C., brought together a di-     range of expertise—from a trauma sur-        build on many disciplines, including the
verse group of professionals who work        geon who operates on gun victims to a        victim assistance and criminal justice
with victims of gun violence: physicians,    counselor who accompanies families to        fields, health care, social services, educa-
social workers, mental health providers,                                                  tion, and the clergy.To guide our efforts
                                             the morgue to a judge who hears victim
prosecutors, nurses, lawyers, teachers,                                                   in serving victims of gun violence, the
                                             impact statements. Although each partic-     Office for Victims of Crime (OVC)
school principals, victim compensation       ipant’s contribution to the discussion was   sponsored a multidisciplinary group of
administrators, and judges. Several gun-     shaped by his or her unique experience,      national experts in March 2000 to iden-
shot victims and survivors who lost          the major concerns raised by all partici-    tify key victim issues and needs, develop
family members to gun violence also          pants were remarkably consistent and         recommendations for using federal
participated. This interdisciplinary         supported by the growing literature on       funds to address victims’ needs, and
discussion was designed to                                                                identify promising practices to serve
                                             gun victimization. This bulletin high-
                                                                                          victims of gun violence.
                                             lights the issues raised and the recom-
s   Identify key victim issues stemming
                                             mendations developed by the roundtable.      Not surprisingly, this bulletin indicates
    from firearm violence.                                                                that some demographic groups are dis-
                                             While our focus was victims of gun
                                             crime, as mandated by the Victims of         proportionately victimized by gun vio-
s   Increase understanding of the full                                                    lence and that many victims never
    range of gun victims’ needs and how      Crime Act (VOCA) administered by
                                                                                          receive needed services.And while we
    they differ from the needs of other      OVC, we recognize that victims of all        typically think of gun violence victims as
    crime victims.                           types of gun trauma—including uninten-       victims of homicide, we were reminded
                                             tional shootings and suicides—have
                                                                                                                Continued on page 2
OVC Bulletin

                                               geographic boundaries—from inner cities       between the ages of 15 and 24 have the
   About This Bulletin                         to remote rural areas to upscale suburbs      highest firearm homicide rate of any de-
   Continued from page 1                       and in homes, public housing communi-         mographic group. Their firearm homicide
                                               ties, schools, workplaces, recreational       rate of 103.4 deaths per 100,000 is 10
   that there are many more victims who        areas, bars, and on the street. Gun vio-      times higher than the rate for white males
   survive their injuries, often with long-
                                               lence victims are young and old, male         in the same age group (10.5 deaths per
   term physical and psychological disabili-
                                               and female, African-American and white.       100,000). In 1997, 92 percent of homi-
   ties.Addressing the needs of secondary
   victims, including children and adults      In some cases, the shooter and victim are     cides of young African-American men
   who witness violence, is another chal-      strangers, but in many others, they are       occurred by firearms, compared to 68
   lenge for practitioners, and one that we    intimately related.                           percent of homicides by firearms in the
   are just beginning to address systemati-                                                  general population.5 Even though violent
   cally in the victim assistance and com-     In spite of the pervasive nature of gun       crime rates, including crimes committed
   pensation fields.This bulletin not only     violence, some demographic groups are         with guns, have declined each year since
   outlines the many challenges before us      disproportionately represented in the gun     1993, according to Federal Bureau of
   but also describes some promising
                                               crime victim population. The 13,252 gun       Investigation trend reports,6 guns remain
   practices in communities across our
                                               homicide victims recorded in the mortali-     the leading cause of death for young
   Nation to serve victims and stop the
   violence.We believe that the informa-       ty statistics for 1997 included 5,110 who     African-American males.7
   tion provided in this bulletin will ad-     were 15 to 24 years old. Firearm homi-
   vance the field’s understanding of how      cide2 was the second leading cause of
   gun violence affects victims and their      death for the 15- to 24-year-old group. In
   communities and will help OVC identify      the 25- to 34-year-old group, there were
   and support improved services for vic-                                                      If all Americans were killed with
                                               3,706 deaths from gun homicide; at
   tims of gun violence.                                                                       firearms at the same rate as African-
                                               younger ages (5–14), there were 284
                                                                                               American males between the ages
                                               firearm homicides. In fact, firearm homi-
                                                                                               of 15 and 24 (103.4 per 100,000),
many of the same needs that can be met         cide was within the top 10 causes of death
                                                                                               there would be 276,843 firearm
with help from victim service providers.       for all age groups from 5 to 44 years.
                                                                                               homicide victims annually in the
                                               Gun homicide victims are disproportion-         United States. (Based on 1997
                                                                                               CDC numbers and a total population
Who Are the Victims                            ately young and predominantly male.
                                               According to CDC, 84 percent were male          of 267,636,061.)
of Gun Violence?                               in 1997. At ages 15 to 19 years, the gun
                                               homicide rate for males was 8 times the
The Death Toll                                 rate for females in 1997.3 The Bureau of
         hen confronted with the ques-         Justice Statistics (BJS) reports that males   The Nonfatal Gun Crime

W        tion, “Who are the victims of gun
         violence?” we usually think first
about the fatalities. According to death
                                               of all ages were 3.2 times more likely
                                               than females to be murdered in 1998.
                                               Moreover, the circumstances of firearm
                                                                                                For every firearm death, there are ap-
                                                                                             proximately three nonfatal firearm in-
certificate data compiled by the National      violence differ significantly for men and
                                                                                             juries that show up in hospital emergency
Center for Health Statistics, a part of the    women. In contrast to men, women are
                                                                                             rooms. With no mechanism, such as a na-
Centers for Disease Control and Prevention     far more likely to be killed by a spouse,
                                                                                             tional registry, to collect uniform national
(CDC), a total of 32,436 persons died          intimate acquaintance, or family member
                                                                                             data on nonfatal firearm injuries, this is,
from firearm injuries in the United            than by a stranger.4
                                                                                             at best, an estimate based on a sample of
States in 1997. The majority of these
                                               Firearm homicide also disproportionately      hospitals.8 There may be many more non-
deaths—54.2 percent—were suicides,
                                               affects African-Americans. Approximately      fatal firearm victims who do not go to
41.7 percent were homicides, and the
                                               52 percent of gun homicide victims are        hospital emergency rooms for treatment.
remaining 4.1 percent were uninten-
                                               African-American, even though they rep-       Others have estimated four to six non-
tional shootings or deaths of an undeter-
                                               resent less than 13 percent of the total      fatal injuries for each gun death.9 In
mined nature.1 The effects of gun
violence cross all socioeconomic and           population. African-American males

                                                                                             WORKING WITH VICTIMS OF GUN VIOLENCE

addition, many crime victims may be            beyond the lives lost and injuries inflict-
traumatized by the presence of a gun dur-
ing a crime, whether or not the gun was
fired. According to the National Crime
                                               ed. According to a report from the U.S.
                                               Department of Housing and Urban
                                               Development, public housing residents
                                                                                                 “Even thosea who are aware
                                                                                                 encountered gun
                                                                                                                  have never

Victimization Survey (NCVS) in 1998,           are more than twice as likely as other            of the widespread presence
victimizations involving a firearm repre-      members of the population to suffer from          of guns in our communities,
sented 23 percent of the 2.9 million vio-      firearm victimization, one in five resi-
lent crimes of rape and sexual assault,        dents reports feeling unsafe in his or her        witness news reports of gun-
robbery, and aggravated assault. In 1998,      neighborhood, and children show symp-             related crime, domestic
670,500 crime victims reported facing an       toms of posttraumatic stress disorder
                                                                                                 murders, and high-profile
assailant with a gun.10                        (PTSD) similar to those seen in children
                                               exposed to war or major disasters.11 This         shootings at schools, churches
Secondary Victims                              is consistent with numerous studies find-         and other public places. The
   The number of deaths and injuries is        ing high rates of exposure to violence
                                               particularly among youth in urban com-
                                                                                                 ever-present fear that some-
just a crude index of the effects of gun
violence in the United States. There is        munities. In one study, almost two-thirds         one we love might be killed or
an even greater number of secondary vic-       of high school students had witnessed a           injured is another form of gun
tims, sometimes called covictims or sur-       shooting, and in another, 70 percent of
vivors of homicide. These are the parents,
children, siblings, spouses, and others
                                               the youth ages 7 to 18 in a public housing
                                               project had witnessed a shooting and 43
who have lost a loved one or friend to         percent had seen a murder.12 Recent data            —From The Bell Campaign’s
gun homicide. In the aftermath of a            also indicate substantial exposure to                World Wide Web site at
homicide, covictims must deal with law         gun violence among suburban school-age
enforcement, the medical examiner, the
                                                                                                       The Bell Campaign is now referred to
press, and the court system, among oth-                                                            as The Million Mom March Foundation.
ers. They may have to clean up a crime
                                               Multiple-Victim Shootings
scene, pay the homicide victim’s medical          While the number of crimes commit-
bills, and arrange for a funeral and burial.   ted with firearms has been falling to lev-       the most secondary victims as whole
                                               els not seen since the mid-1980s,14 media        classrooms of first graders, cafeterias full
Secondary victims also include those who       coverage and public awareness of gun             of teenagers, and hundreds of fellow
are touched by or witness gun violence in      crime are increasing. In the past few            workers witness a mass shooting. The
their homes, schools, or workplaces or on      years, a rash of multiple-victim tragedies       media coverage alone multiplies the num-
the street. In the Nation’s largest public     has erupted in schools, workplaces,              ber of persons victimized by the crime.
housing projects, the damage goes well         churches, nursing homes, fast food restau-
                                               rants, shopping malls, and transportation.
                                               These are very public venues—places              Needs of Gun Victims
 “It is estimatedisthat each                   that we frequent on a daily basis and
                                                                                                     he roundtable participants were asked

                                               where we should feel safe. When a gun
 homicide victim survived                      massacre interrupts play in a daycare cen-            to consider how gun victims may be
 by an average of three loved                  ter, prayer in a church, or commuters                 different from other crime victims
                                               going home from work, it shatters our            and how the differences might affect the
 ones for whom the violent                                                                      services they need or receive. The main
                                               most basic sense of security. Consequently,
 death produces a painful and                  even though the percentage of homicides          themes that emerged were 1) the gun as
 traumatic grief.
                       ”                       involving five or more victims was less
                                               than 0.05 percent in 1998,15 these are
                                                                                                the weapon of violence, 2) the young age
                                                                                                of the victims, 3) the high cost of gun
                                                                                                violence, and 4) the extraordinary media
           —Deborah Spungen                    the ones that receive the overwhelming
                                               majority of the media’s attention. In            attention given to a small subset of gun
           Homicide: The Hidden Victims
               Sage Publications, 1998         addition, the multiple-victim shootings          crimes.
                                               in public places may be ones that create

OVC Bulletin

1. The Gun as the Weapon of
    Much has been written on why gun               Bystander Victims
use increases the deadliness of attacks;
for example, because guns inflict more             Durham, North Carolina: April 7, 1998. While walking with his mother, a
damage than other instruments, they                5-year-old boy was hit by a stray bullet from a gunfight. The bullet severed his
can be fired multiple times with little ef-        spine, and Taquan Mikell may never walk again. The bullet struck him more
fort, firearms have a greater range, and           than half a block away from the gunfight.
assailants intending to kill choose the
most efficient instrument.16 Whatever              Nashville, Tennessee: July 2, 1999. Nashville teenager Eric Harvey Hazelitt
the impact of these different factors, it          was fatally shot in the chest when gunfire erupted at the John Henry Hale pub-
is clear that the fatality rate from gun           lic housing complex in Nashville. Just 14 years old, he was caught in the cross-
assaults is much higher than that from             fire of two groups shooting at each other.
other weapons. This is true regardless of
the relationship between the victim and            Referenced from In the Crossfire: The Impact of Gun Violence on Public
shooter, as the presence of a gun can turn         Housing Communities, published by the U.S. Department of Housing and Urban
a robbery, an argument, or an abusive              Development, February 2000.
relationship into a homicide.17
                                                   Washington, D.C.: June 21, 1999. Helen Foster-El, a 55-year-old grandmother,
According to a 1996 BJS report, 29 per-            was outside her home in the 100 block of 56th Place SE. watching neighbor-
cent of firearm homicide victims were              hood children play when gunfire erupted between two groups. On hearing the
killed because of an argument; 21 percent          gunfire, Ms. Foster-El began to shepherd the children into one of the neighbor-
were killed during the commission of an-           hood homes for their safety. As she was doing so, she was struck in the back by
other crime, such as a robbery or drug             a stray bullet and died instantly.
crime; and 6 percent died as a result of a
                                                   Harrisburg, Pennsylvania: June 10, 1999. Raphael Rivera, 14, was in the im-
gang-related shooting.18 Offenders report
                                                   mediate area of an altercation involving several individuals. When the alterca-
firing a gun within 15 seconds of bran-
                                                   tion escalated into gunfire, Raphael, who was not involved in the argument,
dishing it, even when they had not in-
                                                   sustained a fatal wound to the chest.
tended to shoot the victim.19 Gun victims
include those shot during traffic alterca-         Referenced from The Death Toll Since Columbine, a report of the U.S.
tions, gambling disputes, and verbal               Conference of Mayors, Washington, D.C., January 2000.

The lethality effect is not lost on the vic-
tims. Participants repeatedly spoke of the
                                               victims putting their hands in front of        gang members intent on retaliating shoot
nature of the weapon used. “An impor-
                                               them and “holding up articles of all kinds     at random victims when they can’t find
tant difference is the gun itself. Guns are
                                               in their last moments in the magical be-       the rivals they intended to kill.21 Other
the only instrument developed to kill;
                                               lief that even a sheet of paper might          participants talked about small children
victims facing a gun suffer the trauma of
                                               save them.”20                                  sleeping in bathtubs to hide from stray
death or the fear of death,” said family
                                                                                              bullets penetrating bedroom walls at
bereavement counselor Kevin O’Brien.
                                               Gun violence also is frequently more           night.
Meanwhile, participant DeLano Foster,
                                               random than other types of criminal vic-
an OVC Program Specialist and survivor
                                               timization. One participant noted that         The bystander victim represents the most
of multiple homicides, offered that “the
                                               “bullets don’t always have a name on           impersonal type of crime. But participants
difference between an armed robbery and
                                               them. You can be shot from a great dis-        commented that, even when the shooter
a homicide could be the time it takes
                                               tance even with a bullet meant for some-       targets a particular victim, the gun crime is
the victim to hand over his wallet.”
                                               one else.” Young men can be “casualties        somewhat impersonal. The gun, as an in-
Eyewitness accounts frequently report
                                               of a war they did not partake in” when         strument of both power and detachment,

                                                                                            WORKING WITH VICTIMS OF GUN VIOLENCE

allows the shooter to remain physically           the lunchtime crowd, killing 23              specify the clothing in which they want
and emotionally distanced from his or her         people before shooting himself.22            to be buried. A psychological counselor
victims. When the victims are shot in the                                                      for teenagers in Baltimore, Maryland, Dr.
back, as many are, they never even see        Moreover, gun victims face constant re-          Rosetta Graham, spoke of the need to do
the shooter’s face. This may increase the     minders of their trauma from the ever-           much more for this age group: “Around
“Why me?” response of so many gun vic-        present gun seen on television programs          age 14 or 15 they become more private
tims, similar to the feelings of victims of   and commercials and in films and videos.         and hold in their grief. They are caught
drunk driving.                                Even American slang, for example, “one           between adults who know how to make
                                              shot,” “take aim,” and “set your sights,”        their needs known and young children
The ability of mentally disturbed individ-    takes its toll on some victims. Some             whose caregivers speak for them.” Studies
uals to kill at a distance, together with     participants reported that any loud              of urban youth show a high correlation
the enormous firepower of semiautomatic       noise, like balloons popping and cars            between exposure to violence and depres-
weapons, may have facilitated the gun         backfiring, could “trigger” a response. The      sion and PTSD.24
rampages that have taken so many lives        exorbitant media attention paid to each
in recent years. Participant Michelle         new multiple-victim shooting also is re-         The hopelessness of this population was a
Scully Hobus was shot and her husband         traumatizing for gun victims of similar          recurring theme. The participants agreed
killed when a crazed gunman armed with        tragedies. Security changes, such as metal       that one major shooting, or the daily loss
two semiautomatic TEC–9 pistols roamed        detectors in schools, hidden cameras,            of friends and classmates, can have a pro-
a San Francisco, California, law firm,        dress codes, and guards in the halls, are        found effect on young people just begin-
shooting 15 people, killing 9 before tak-     constant visual reminders of school              ning to explore their independence and
ing his own life. It was a long time before   shootings.                                       develop plans for their future. While
she could shake the feeling of danger.                                                         some hold in their grief, others become
“Even though I knew that the gun mas-         Like other crime victims, gun victims            suicidal or act out their feelings on the
sacre at the law firm was an extremely        seek redress against their shooters through      street. Even in suburban settings where
rare event, I kept having the feeling that    the criminal justice and civil justice sys-      violence is rare, a highly publicized
it would happen again. I couldn’t sit with    tems. Many victims, like participants            school gun massacre can have a signifi-
my back to the door; I thought someone        Scully Hobus and Jaquie Algee, have              cant impact. Counselors working with
would come in and blow everyone away.”        become activists.                                students at Columbine High School in
                                                                                               Littleton, Colorado, worried about kids
                                              RECOMMENDATION: Clinical evidence sup-
s   Just as Larry Gene Ashbrook did           ports the therapeutic value of victims           who were somewhat depressed and doing
    on September 15, 1999, when he            working as change agents, in grassroots or       drugs before the shooting. In the months
    shot 14 people (7 dead) in the            church activities, informal support groups,      since the shooting, they have seen an in-
    Wedgwood Baptist Church in Fort           and anticrime organizations.23
                                                                                               crease in drunk driving, suicide attempts,
    Worth, Texas.                                                                              and fighting. Disaffected students—or
                                              2. The Young Age of the
                                              Victims                                          those who feel alienated or rejected—
s   Just as Mark Barton did on July 29,                                                        don’t trust anyone, don’t feel safe, and
    1999, when he shot 22 people (9              As previously noted, gun crime dispro-        don’t do well in school. Similarly, after
    dead) at two brokerage firms in           portionately affects young people. Their         the 1998 shooting of 22 students at
    Atlanta, Georgia.                         injuries and grief must be understood in         Thurston High School in Springfield,
                                              this context. The participants who work          Oregon, there was a 600-percent increase
s   Just as Kip Kinkel did on May 21,         with adolescents spoke of the pessimism          in referrals to the school nurse and a 400-
    1998, when he shot 24 people (2           and despair, particularly in the inner           percent increase in arguments and fights
    dead) at Thurston High School in          cities, where communities are losing chil-       reported to the principal. Many students,
    Springfield, Oregon.                      dren to gun violence daily. Youngsters           even some who were not present at the
                                              whose relatives and friends have been            school but who watched the news cover-
s   Just as George Hennard did on
                                              shot automatically think that sooner or          age, experienced a loss of control, a feel-
    October 16, 1991, when he drove
                                              later it will happen to them. They plan          ing of being violated, and a sense of guilt
    his truck into Luby’s Cafeteria in
                                              their funerals, write their obituaries, and      that they survived.
    Killeen, Texas, and opened fire on

OVC Bulletin

For many students, the fear of gun vio-         Different problems arise and different         to help them because of the high risk of
lence is strong enough to interfere with        types of interventions are needed to           reinjury and subsequent acts of violence
the quality of their lives and their per-       address chronic gun violence. For the          by the victim.
formance in school; they also may suffer        past 10 years at least, young African-
from increased absentee, truancy, and           American males have experienced vio-           The myth that all adolescent victims
dropout rates. Participants who work with       lent crime at a rate significantly higher      are “bad” kids is particularly harmful for
children explained the importance of get-       than the rate for other age groups.26          young African-American men growing up
ting them to talk about their fears. They       Sandra DeLeon, Director of the Rise            in neighborhoods rife with drugs and gun
are hungry for information and may dis-         Above It violence prevention program           violence. Generalizations about “predator
tort facts and think they could have            in West Orange, New Jersey, reported
prevented the shooting. They need to            that 60 percent of the students they serve
understand that the school shootings on
the evening news are rare events and that
                                                know someone who has been shot. In
                                                their neighborhoods, gun violence is
                                                                                                “ After myChicago, I went
                                                                                                was shot in
                                                                                                            19-year-old son

schools are safe places.                        more predictable than random. They
                                                come to school worrying about the gun-
                                                                                                to many support groups, com-
Although exposure to violence will affect       shots they heard the night before. The          munity organizations, and
all adolescents to some extent, different       students need to hear, preferably from          church-affiliated meetings, but
services are needed when the shooting is        peer counselors, that there is a future to
an isolated tragedy versus when there is a      look forward to and they are not destined       I really wasn’t getting what I
daily threat of violence in the communi-        to be either buried or behind bars in jail.     needed. I needed to be more
ty.25 In the high-profile school and work-      But the participants also agreed that this
place shootings, crisis response teams
                                                                                                active in the movement to
                                                is an uphill battle. The strong correlation
“debrief” the victims and witnesses, often      between poverty and violent crime means         reduce gun trauma. I found
in a group setting. The interventions for       that those with the fewest resources are        comfort in joining The Bell
schools and communities that witness vi-        the most vulnerable. In some cases, the
olence are based on the assumption that         parents of homicide victims are very
                                                                                                Campaign, a grassroots
the incidents they witnessed are one-time       young. An enormous amount of preven-            victim-based organization,
horrific events. Participants who had the       tive counseling is needed to keep them
benefit of this type of crisis response serv-
                                                                                                modeled after Mothers
                                                from exacting retribution while they
ice felt a sense of security while the teams
were there and a great void when they
                                                struggle to get daycare, buy food, and
                                                arrange for the burial of a loved one.
                                                                                                Against Drunk Driving.
left. In the absence of organized training,                                                                   —Jaquie Algee,
teachers, school administrators, and guid-      The literature on children and adolescent                 Southeast Regional
ance counselors are scrambling to get up        victims reinforces the group’s findings
to speed on crisis response. Many profes-       about the vulnerabilities of young gun                   Director for The Bell
sionals who helped care for the students        victims. A Task Force on Adolescent                                 Campaign
who were shot or witnessed a massacre of        Assault Victim Needs, convened by the
their classmates also became depressed          American Academy of Pediatrics, recom-
                                                                                               youth” cause added grief for gun victims
and suicidal. According to School               mends addressing the psychosocial needs
                                                                                               and stigmatize them and their families
Superintendent Jamon Kent, the shoot-           of young victims along with their physical
                                                                                               unfairly. Future employers may refuse to
ing at Thurston High took place May 21,         injuries.27 To do this effectively, the task
                                                                                               hire a young man with a bullet in his
1998, and the aftershocks still occupy          force noted that health care providers
                                                                                               arm, assuming that he was a gang mem-
one-third of his time in the office.            must acknowledge and address three
                                                                                               ber or a bad person because he’d been
                                                myths: 1) that all adolescent victims are
RECOMMENDATION: Participants recom-                                                            shot.28 On the other hand, the tendency
mended that communities victimized by
                                                “bad” kids who probably deserve what           to use violence is considered a serious po-
gun massacres be offered long-term assis-       they got, 2) that it is dangerous to care      tential consequence of being a young vic-
tance and training so they can more effec-      for adolescent victims who may be mem-         tim of gun violence. In fact, “a new study
tively be involved in the healing process.      bers of a gang, and 3) that it is hopeless

                                                                                             WORKING WITH VICTIMS OF GUN VIOLENCE

by the National Center on Crime and           who have been raised in a subculture of           and the frequent need for rehospitaliza-
Delinquency finds that one of the best        violence in the home may have addition-           tion, the lifetime medical costs are very
predictors of whether a teenager will         al risk factors for long-term psychosocial        high, around $35,500 per victim. For all
commit a crime is whether he or she           consequences.33 Effects also can be seen          victims of firearm injuries (assaults) and
has been a victim.”29 Siblings of gunshot     in somatic disturbances. According to             deaths (homicides) in 1994, the life-
victims are frequently preoccupied with       participant Marianne Z. Wamboldt,                 time medical costs totaled $1.7 billion.
revenge fantasies and may be encouraged       M.D., a child psychiatrist in Denver,             Government programs, primarily Medi-
and assisted by their peers in exacting       Colorado, clinicians have noted a rela-           caid, are the primary payers for 50 per-
vigilante justice. Once having resorted to    tionship between the general stress in            cent of hospitalized gunshot injury cases
violence, young men engage in more risk-      the community after the shooting at               due to violence.37
taking behavior. Thus, a cycle of violence    Columbine High and an increase in asth-
continues, and being shot once becomes                                                          The growing cost of gun violence can af-
                                              ma cases and deaths among preschoolers.
the greatest predictor for being targeted                                                       fect the trauma care available for all com-
again.30 However, the risk factors for        RECOMMENDATION: The roundtable consen-            munity members. At King/Drew Medical
this group are often overcome by the          sus was that much more research is need-
                                                                                                Center in Los Angeles, California, hospi-
resourcefulness and determination of          ed to develop services that take into
                                              account the full range of effects that gun        tal expenses, not including professional
families surviving in the inner city.         violence has on children. OVC should work         fees, were more than $270.7 million for
                                              with other offices in the Office of Justice
RECOMMENDATION: Participants agreed that      Programs (OJP), such as the National
                                                                                                the 34,893 patients hospitalized for gun-
assistance for gun victims, particularly      Institute of Justice, the Office of Juvenile      shot injuries from 1978 to 1992.38 Some
young African-American men, must include      Justice and Delinquency Prevention (OJJDP),       96 percent of these costs were paid with
programs designed to teach victims to re-     the Violence Against Women Office (VAWO),
gain their self-respect and status in the                                                       public funds.39 Between 1983 and 1990,
                                              and BJS, to develop a research agenda con-
community without resorting to more vio-      cerning the needs of gun violence victims.        the financial strain of treating uninsured
lence. Quick outreach and support to newly    The evaluation of promising direct service        patients contributed to the closure of 10
bereaved families can help redirect their     programs for child victims of gun violence
grief toward positive efforts to honor the                                                      out of 23 trauma centers in Los Angeles
                                              should be encouraged and funded by OJP.
memory of their loved ones.                                                                     County.40
                                              3. The High Cost of Gun
Although much of the roundtable discus-                                                         In addition to direct health care and re-
sion centered on teenage youth, elemen-                                                         lated expenditures, gun violence exacts a
tary school-age children also are frequent       Gunshot injury and death place a               substantial economic toll on its victims
witnesses to gun violence and often           burden on the health care system in the           and society in general in terms of lost
display symptoms of PTSD and other            United States that far exceeds the toll           productivity, use of the criminal justice
trauma-related disorders.31 Some children     of other types of criminal victimization.         system, pain and suffering, and dimin-
are afraid of school, and many become         Because of the traumatic nature and ex-           ished quality of life. Economists and pub-
fatalistic. Some engage in aggressive play    tent of their injuries, gunshot victims are       lic health statisticians estimate an annual
and perform poorly in school,32 while oth-    more likely than other crime victims to           bill of more than $100 billion for all of
ers become desensitized to violence and       require overnight hospitalization and             these gun violence costs. An examination
lose the ability to recognize and avoid       followup care. BJS reports that gunshot           of more than 1,000 jury awards in cases
dangerous situations. The few research        victims represented only 5 percent of the         involving shooting victims yields an aver-
studies that were available to participants   estimated 1.4 million hospital emergency          age loss of more than $3 million for a sin-
suggested that witnessing gun violence        department patients treated in 1994 for           gle family of a homicide victim.41
affects children in many different ways,      violence-related nonfatal injuries. But
depending on the type of wound, the           while the majority of crime victims are           The economic loss is even more stagger-
proximity to the shooter, the relationship    treated and released, gunshot victims             ing for victims who sustain spinal cord
of the shooter and victim, and whether        represent a third of those requiring hospi-       injuries (SCIs) from gunshot wounds.
the shooting took place in a context gen-     talization.34 The average cost of acute           These relatively rare catastrophic cases
erally considered safe, among other           care treatment ranges from $14,85035 to           account for the lion’s share of the medical
things. Different reactions can be expect-    $32,00036 per hospital admission. Because         costs for gun injuries. Each year, approxi-
ed from boys and girls. Child witnesses       of the young average age of the victims           mately 10,000 persons suffer an SCI and

OVC Bulletin

require hospitalization. Nearly a quarter     surviving months with tubes in their bod-    School shootings in particular are trau-
of these injuries are caused by acts of       ies face a daunting challenge in school.     matizing for children because they all
violence, primarily gunshot wounds.           Paralyzed for life, they never will be the   go to school.45 After Columbine, pre-
Violence-related SCIs have increased          same active teenagers again. The practi-     schoolers in Colorado began talking
dramatically since the early 1970s, over-     cal and social problems like calling ahead   about where they would be going to
taking falls as the second leading cause of   and waiting hours for transportation,        school as the place where they would die.
SCIs (after motor vehicle accidents) in       wheelchair access to classrooms, and         School systems around the country saw
the past 4 years.42 The average first-        dealing with colostomy bags are difficult    the phenomenon of school-phobic kids,
year expenses have been estimated at          enough without the added fears of testify-   as both the news media and talk shows
$217,868 (in 1995 dollars) for violence-      ing in court and being targeted again by     exaggerated a child’s risk of being shot at
related SCIs, although the amount varies      the shooter. Those with violence-related     school. Although participants thought
considerably depending on the extent of       SCIs are more likely than other SCI pa-      that such news coverage should carry a
neurological damage. With recurring an-       tients to have intractable pain and com-     warning caption for parents about the
nual charges for violence-related SCIs        mit suicide. For others, the cost of acute   possible adverse effects on young chil-
calculated at $17,275, the lifetime           care and rehabilitation, among other         dren, they also felt that older children are
charges are estimated to be more than         things, can lead to the dim prospect of      hungry to know what has happened and
$600,000 for each victim. This includes       constant dependence on the Government        have a great need for information. In all
charges incurred as a direct result of the    or family.44                                 cases, parents and teachers need to help
injury, such as emergency medical                                                          children process the information they see
services, hospitalizations, attendant care,   4. The Extraordinary Media                   on television, so they can realistically
equipment, supplies, medications,             Attention to a Small Subset                  assess their own safety in school.
environmental modifications, physician        of Gun Crimes
and outpatient services, nursing homes,                                                    Unfortunately, the misconceptions about
                                                  On April 20, 1999, the world watched
household assistance, vocational rehabili-                                                 the risk of school shootings are pervasive
                                              as two high school students, armed with
tation, and similar miscellaneous items. It                                                in all age groups. A recent analysis of
                                              automatic weapons and shotguns, killed
does not include indirect costs, such as                                                   opinion polls taken after the shootings in
                                              12 students and a teacher and wounded
lost wages, fringe benefits, productivity,                                                 Jonesboro, Arkansas, and Littleton found
                                              23 others before turning the guns on
pain and suffering, and diminished quality                                                 a 49-percent increase in parents’ anxiety
                                              themselves. The tragedy at Columbine
of life, which could be twice as much as                                                   about children’s safety in the classroom,
                                              High School is considered a defining
the direct costs.43                                                                        even though statistical studies by the U.S.
                                              moment in the public’s consciousness
                                                                                           Department of Justice (DOJ) and the
                                              about gun violence. The nonstop real-
A handful of gunshot SCI victims have                                                      National School Safety Center showed a
                                              time media coverage of this horrendous
fared better than most. For example, the                                                   40-percent decrease in school-associated
                                              massacre, both on the air and in print,
SCI students from the Columbine shoot-                                                     violent deaths in 1998–1999, the school
                                              was traumatizing to the victims’ families
ings have had the benefit of a community-                                                  year including the Columbine shooting.
                                              and friends, the community, the state
wide effort to raise funds for remodeling                                                  These tragic events are truly rare—with
                                              of Colorado, the United States, and the
living areas, paying for medical and living                                                52 million students enrolled in public
                                              world. The roundtable participants dis-
expenses, specially equipped vans, and                                                     school, the chance that a school-aged
                                              cussed this media coverage, focusing on
even college scholarships. But these are                                                   child would die in school in 1998–1999
                                              its impact on children and its message
atypical cases. The majority of people                                                     was 1 in 2 million.46
                                              for those haunted by the unpublicized
with violence-related SCIs are young
                                              loss of a loved one to gun violence.
African-Americans with low socioeco-                                                       The gap between public fear and reality
nomic status. Many in this group have         RECOMMENDATION: Participants agreed          is not surprising, as media coverage
been targets of gun violence and have         that the media should be more sensitive      is focused on less than 1 percent of
                                              to how their coverage of gun violence        homicides—those with multiple victims.
sustained most of their injuries because of   affects victims and children. OVC should
drug- or gang-related activity. Those who     develop training materials and guidelines    Even within a group of multiple-victim
return to their communities after             for media coverage of gun massacres.

                                                                                           WORKING WITH VICTIMS OF GUN VIOLENCE

gun homicides, the rarest events get the                                                          segment of the population and
most media attention. For example,
                                              Services for Gun                                    perpetuate racial stereotyping.
s   December 4, 1999: Sacramento,
    California. A 31-year-old Asian man            he roundtable participants were            Crime Victim
    shot and killed his daughter and four
    sons, reportedly after having an ar-
    gument with his wife. A shotgun
                                              T    asked to consider how VOCA-
                                                   funded programs, both compensa-
                                              tion and direct services, are useful for
                                                                                                      rime victim compensation pro-

    and a high-powered rifle were found
    in the apartment.

    December 5, 1999: Baltimore,
                                              gun violence victims. Two points made
                                              throughout the day were reiterated in this
                                              discussion:                                     C       grams—operating in all 50 states,
                                                                                                      the District of Columbia, the
                                                                                              Commonwealth of Puerto Rico, the U.S.
    Maryland. Five women were found           s   Communities most at risk for gun            Virgin Islands, the Commonwealth of
    shot to death in their Northeast              violence need ongoing prevention            Northern Mariana Islands, American
    Baltimore row house. Police said the          work. Even though the Federal               Samoa, and Guam—provide financial as-
    women, who were not involved in               VOCA Victim Assistance Final Pro-           sistance to victims for crime-related out-
    drug activity, were shot to send a            gram Guidelines preclude the use of         of-pocket expenses, such as medical care,
    message to a relative who was in-             Crime Victims Fund moneys for “ac-          mental health counseling, lost wages,
    volved in the drug trade.                     tivities exclusively related to crime       and, in cases of homicide, funerals, loss of
                                                  prevention,” direct services and            support, and counseling for secondary vic-
s   December 6, 1999: Fort Gibson,                compensation for gun victims could          tims. Many programs also pay for crime
    Oklahoma. Five students were in-              have a secondary preventive effect          scene cleanup, durable medical equip-
    jured when a 13-year-old opened fire          by minimizing the risk of retaliation       ment like wheelchairs and hospital beds,
    at a middle school with a 9 mm                and repeat victimization. Compre-           transportation to medical providers, reha-
    handgun he took from his home.                hensive programs that provide direct        bilitation, physical therapy, and ramps or
                                                  services and help break the cycle of        modifications to homes for paralyzed vic-
The family homicide, an all-too-common            violence in the community typically         tims. All state victim compensation pro-
occurrence, was reported only by the              have more than one funding source.          grams are “payors of last resort,” covering
California press. The Baltimore shooting          For example, a program could re-            losses not recouped from other sources
was prime-time news for a day and then            ceive VOCA funding to support               such as public or private insurance, em-
was eclipsed by the middle school shoot-          direct victim services and funding          ployee benefits, offender restitution, or
ing in a rural community in Oklahoma.             from another federal agency, such as        civil judgments. The state programs set
                                                  DOJ’s OJJDP or the U.S. Depart-             their own administrative rules and reim-
Even among victims of the same shoot-                                                         bursement maximums, which average
                                                  ment of Health and Human Serv-
ing, the media may focus on one or two                                                        $25,000 and range from a low of $10,000
                                                  ices, to support prevention
to represent the face on the story. Perhaps                                                   to no limit for medical expenses (as in
because of their pronounced activism on                                                       New York). A few states set higher limits
the gun issue or because of some other        s   Gun violence disproportionately af-         for catastrophic or permanent injuries
special attribute, these chosen victims           fects young African-American men.           that could be used for special home and
become the story of the massacre. In              The health care, criminal justice,          health aids. In view of the large medical,
Homicide: The Hidden Victims, A Guide for         and media response to these victims         rehabilitative, and counseling expenses
Professionals, Deborah Spungen describes          may be less sympathetic than re-            faced by gun victims, participants agreed
how individual victims of multiple-victim         sponses to other crime victims.             that VOCA- and state-funded compensa-
shootings “tend to get lost in the scale of       Whatever the reason for the                 tion programs provide much-needed
the horror,” while “covictims who have            disparate treatment of these victims,       financial assistance. Although there is
had a loved one selected for the [poster          we must not ignore them. Assump-            no available estimate of the number of
victim] may experience feelings of reluc-         tions about the blameworthiness of          gun victims who benefit from these pro-
tance, exploitation, loss of control, and         young African-Americans and                 grams,48 Program Director of the D.C.
anger.”47                                         Hispanics shortchange a large               Superior Court’s Crime Victims

OVC Bulletin

Compensation Program Laura Banks                  housing modifications, and occupa-         program staff should be trained to under-
Reed stated that 30 percent of claims paid        tional therapy. For the most severely      stand and be sensitive to the fears of these
by her program are to gun victims.                injured victims, durable medical
                                                  equipment such as a powered                s   Most compensation programs have
We are in a new era of crime victim               wheelchair can cost anywhere from              time limits for filing compensation
compensation: program funding is more             $20,000 to $25,000, in addition to             applications. Although many states
secure than ever before, and state admin-         other equipment that may be need-              have specific exceptions or will
istrators are more responsive to the needs        ed. Many have living arrangements              waive filing limits for minors, the
of crime victims and flexible in adminis-         that can’t be modified to meet their           time limits may still disqualify some
tering their programs. Participants identi-       needs—their third- or fourth-floor             teen and young adult gun victims
fied special needs of gun violence victims        walk-up apartments are not wheel-              who need mental health counseling
and made the following recommendations            chair accessible, and they cannot              but are embarrassed to come forward
for state crime victim compensation               afford to move. In many cases, the             at first and admit they need help.
programs.                                         parents or family members don’t
                                                  have the resources or services to stay     RECOMMENDATION: Compensation programs
s   Survivors of serious gunshot injuries         home and care for the injured per-         should waive time limits for filing applica-
    may require long-term mental health                                                      tions to avoid penalizing young victims.
                                                  son; there are a large number of 21-
    counseling. Currently, the states im-         year-olds on ventilators in nursing
    pose many different limits on mental          homes being covered by Medicaid.
    health claims, for example, limits                                                       Direct Victim Services
    on the total dollar amount and the        RECOMMENDATION: Limits on medical ex-
                                              penses should be raised for catastrophic in-            VC makes annual VOCA crime
    number of sessions. As a result, the
    percentage of compensation dollars
    spent by the states on mental health
    claims varies enormously. Nearly all
                                              juries, and programs should be flexible in
                                              defining eligible expenses as the needs of
                                              gun victims become clear to them. For ex-
                                              ample, New Jersey pays for childcare and
                                              daycare services along with domestic help
                                                                                             O        victim assistance formula grants to
                                                                                                      all 50 states to support the provi-
                                                                                             sion of direct services to victims of crime.
    states pay for grief counseling for                                                      The state VOCA administrators, in turn,
                                              at a rate of $50 a day. This type of innova-
    survivors of homicide, and some pay       tive benefit allows family members to con-     subgrant the funds to victim service
    for mental health counseling for          tinue working rather than having to stay       providers. Ten percent of each VOCA
                                              home to care for a minor victim or an          state grant must be allocated to victims of
    family members who witness the
    crime.                                                                                   violent crime who have been previously
                                                                                             underserved in that state. Underserved
RECOMMENDATION: Where necessary, state
                                              s   Although eligibility requirements
                                                                                             victims include, but are not limited to,
compensation caps and limits should be            vary somewhat from state to state,
                                                                                             victims of federal crimes, survivors of
raised for mental health counseling to            they all require victim (or claimant)
permit long-term counseling. States should                                                   homicide victims, and victims of assault,
                                                  cooperation with police and prose-
consider extending benefits to more sec-                                                     robbery, gang violence, hate and bias
ondary victims, such as students or co-           cutors. These requirements may be
                                                                                             crimes, intoxicated drivers, and elder
workers who witness a shooting, even if           difficult for gun violence victims in
they are not family members and were                                                         abuse. States also may define underserved
                                                  some cases and may discourage them
not threatened by the shooter.                                                               victims according to their status as sen-
                                                  from applying for compensation
                                                                                             ior citizens, persons with disabilities,
s   In addition to medical and mental             benefits.
                                                                                             racial or ethnic minorities, and residents
    health expenses, victims whose            RECOMMENDATION: Encouraging victim co-         of rural areas or inner cities. Eligible di-
    brains have been damaged or spinal        operation with law enforcement is a valid      rect services include programs that 1) re-
    cords have been injured as a result of    goal of state compensation programs.
                                              However, the Federal VOCA Victim Com-          spond to the emotional and physical
    gun violence may require long-term        pensation Final Program Guidelines en-         needs of crime victims, 2) assist primary
    care, special transportation services,    courage program administrators to be           and secondary victims of crime to stabilize
                                              flexible about cooperation requirements
                                                                                             their lives after a victimization, 3) assist
                                              in cases where they may present special
                                              barriers for the victim. Law enforcement       victims to understand and participate
                                              personnel, prosecutors, and compensation       in the criminal justice system, and

                                                                                             WORKING WITH VICTIMS OF GUN VIOLENCE

4) provide victims of crime with a meas-      The Recover program in Washington,                victims. Program staff are available to as-
ure of safety and security, such as board-    D.C., has a professional grief counselor in       sist families of all emergency patients at
ing up broken windows and replacing or        the Office of the Chief Medical Examiner          the hospital. If the patient dies, the pro-
repairing locks.                              to offer emotional support before, during,        gram advocates help the decedent’s family
                                              and after the process of identification of a      navigate the next steps—decisions about
Many of the current VOCA subgrantees          loved one. Recover staff do an early assess-      organ transplant, hospital procedures,
may provide services that are used by vic-    ment of needs, including inquiring about          meeting with police officers, answering
tims of gun violence, such as homicide        children who may be affected, and set             media inquiries, and referrals to counsel-
support groups and victim advocates in        up case management services. Staff or             ing or pastoral services. This program is
prosecutors’ offices. Because there are       trained volunteers are available for practi-      staffed primarily with retired D.C. homi-
no data on how many existing programs         cal and emotional support, including              cide detectives.
serve gun victims and no service directory    planning a funeral, explaining the griev-
of gun victim programs, the roundtable                                                          RECOMMENDATION: OVC should support the
                                              ing process, talking to children about            development of promising multiservice pro-
participants identified a few promising       death, driving the family to the store,           grams that reach families of gun victims
practices and discussed the types of pro-     helping with paperwork, or simply listen-         within 24 hours after the shooting and re-
grams they would like to see funded           ing. Recover also makes referrals to mental       main available to assist with longer term
                                                                                                needs. State VOCA administrators should be
under VOCA to benefit gun victims.            health counseling and other services but          encouraged to fund programs like Recover,
Clearly, many innovative programs are         recognizes that these may be premature            the Family Bereavement Center, and the
not known outside their limited geo-          and/or insufficient for victims having            Family Advocacy Program. Evaluation stud-
graphical area.                                                                                 ies for these and similar programs should
                                              trouble getting out of the house, getting         be encouraged and funded by OJP.
                                              food on the table, and dealing with funer-
RECOMMENDATION: Participants recom-
mended that a database of providers serv-     al homes and police investigators.                2. Support Groups for Nonfatal
ing gun victims be established and that                                                         Gunshot Victims
OVC increase efforts to publicize promising   The Family Bereavement Center in Balti-
programs and encourage states to fund         more, Maryland, is funded by a VOCA                  Victims who had been shot and sur-
them.                                                                                           vived their wounds spoke of the need
                                              subgrant and administered by the state’s
RECOMMENDATION: If gun violence victims       attorney’s office. The center reaches out         to tell their stories many times. They
have been underserved, states should be       to every homicide victim’s family by              stressed the importance of peer support
encouraged to fund programs that serve                                                          groups. But unlike for rape victims,
gun victims as part of their required 10-
                                              sending a letter encouraging them to call
                                              for services. Center staff provide liaison        victims of domestic abuse, victims with
percent minimum allocation of VOCA sub-
grants for underserved victim populations.    services with the police department, the          severe SCIs, and parents/friends of mur-
                                              medical examiner, and the state’s attor-          dered children, there are few, if any, spe-
                                              ney’s office. They offer crime scene              cialized services or organized support
1. Holistic Care for Families of                                                                groups for “plain, old-fashioned assault.”
                                              cleanup services, court support and escort
Homicide Victims                                                                                These victims, who are shot, one by one,
                                              services, notification of case status and
   Participants who counsel surviving         victims’ rights, assistance in applying for       day in and day out, have bullets removed
family members spoke of the need to as-       victim compensation, and individual and           in emergency rooms and then are released
sist with day-to-day problems to reduce       group grief counseling sessions. They also        to carry on with their lives.
the immediate, ongoing, and long-term         sponsor educational and support activities
effects of traumatic loss. Programs that                                                        Participants recommended developing
                                              such as memorial services, weekend
operate at the community level and pro-                                                         gun violence assistance centers modeled
                                              camps for adolescents and younger chil-
vide a range of free services and referrals                                                     on the Thurston High Assistance Center
                                              dren who have lost family and friends to
are preferred. They might be administered                                                       in Springfield. This center was estab-
                                              violence, and a quarterly newsletter.
by the law enforcement or prosecutor’s of-                                                      lished in the aftermath of the Thurston
fice, a hospital, a church, or an independ-   The Family Advocacy Program at the Wash-          High shootings and functions as a clear-
ent private agency. Three multiservice        ington Hospital Center in Washington,             inghouse for services, activities, and re-
programs were discussed in detail at the      D.C., also provides coordinated services          sources related to healing individuals and
roundtable.                                   for family members of gun homicide                the community. The proposed centers

OVC Bulletin

could be located within a YMCA or             recurrent nature of assaultive trauma,         s   Review the violent incident.
recreation center already functioning in      with hospital readmission rates as high as
the community and should be available         44 percent in some areas and subsequent        s    Explore alternative strategies for
to secondary victims like friends, neigh-     homicide rates as high as 20 percent.               conflict resolution.
bors, and family. They would be safe-         Medical personnel working with social
haven drop-in sites where victims could       workers and counselors could turn the
                                                                                             s    Provide information on risk factors
meet with each other and with a multi-        crisis of injury into an opportunity to             for violence.
disciplinary support team. Ideally, the       intervene and interrupt this pattern of
                                                                                             s    Explore coping skills and safety plans.
centers would coordinate all services for     violence. According to participant Dr.
gun victims in the community, such as         Caesar Ursic, Director of Trauma Services      s    Arrange for followup contacts.
medical and mental health evaluations,        for the Alameda County Medical Center
counseling services, family assistance,       in Oakland, California, there are anec-        The recovery period in a hospital and
help with schoolwork or job applications,     dotal evidence and some data suggesting        rehabilitation center offers victims an
referrals to other programs, applications     that such programs diminish the psycho-        opportunity to be exposed to supportive
for victim compensation, emergency            logical impact of the injury, prevent retal-   services. After victims have been dis-
housing, and victim/witness protection.       iatory violence, minimize violent injury       charged, followup visits are scheduled for
The centers also could be integrated with     recidivism, decrease future involvement        a minimum of 12 months. The CC pro-
prevention efforts, such as community         with guns, and increase the likelihood of      gram uses trained peer counselors, many
policing and afterschool programs.            success in school.                             in wheelchairs because they too were
                                                                                             victims of gun violence.
Participants who worked with young gun        The Caught in the Crossfire (CC) program
violence victims felt that the support of     in Oakland has been hailed as a model          RECOMMENDATION: OVC should continue to
other victims would help reduce the stig-     program. It maintains a hotline for the        recommend that VOCA subgrants be award-
                                                                                             ed to hospital-based gun victim programs.49
ma associated with talking to the police      Alameda County Medical Center to call          The elements critical to a model program
and testifying against an accused shooter.    when a youth between the ages of 12 and        should be identified for replication. Where
The centers could encourage cooperation       19 is admitted to the emergency room           funding is not available for comprehensive
                                                                                             programs, emergency rooms should imple-
with the criminal justice system and non-     with a gunshot wound. CC crisis inter-         ment protocols to assess the risk of recur-
violent ways of solving disputes.             vention specialists visit the patient at       rent injury and provide counseling services
                                              bedside and—                                   for young gunshot victims and their
RECOMMENDATION: OVC should fund the de-                                                      families.
velopment of model gun violence assistance
centers that could be replicated in commu-
nities across the country.

3. Multidisciplinary Hospital-
Based Programs for Adolescent                          Recover, a program of the William Wendt Center for Loss and Healing
Gun Victims                                             4880–A MacArthur Boulevard NW., Washington, DC 20007–1557
   Although virtually all U.S. trauma
centers have some sort of counseling and                             Family Bereavement Center, a program of the
referral services for victims of violence                            State’s Attorney’s Office for Baltimore City
and violence prevention clubs exist in a                          10 South Street, Suite 502, Baltimore, MD 21202
majority of SCI units, there are fewer                                             410–396–7351
than a dozen hospital centers nationwide
that offer comprehensive counseling, inter-                                  Family Advocacy Program
vention, and inpatient treatment pro-                         Office of Decedent Affairs, Washington Hospital Center
grams to victims of gun violence.                                 110 Irving Street NW., Washington, DC 20010
Participants agreed that this should be a                                         202–877–8351
high priority for DOJ funding. Urban
trauma centers have reported the

                                                                                            WORKING WITH VICTIMS OF GUN VIOLENCE

4. School-Based Peer Counseling               part of more comprehensive victim serv-          from those of other crime victims. By
for Violence Prevention                       ice initiatives, including crisis interven-      sponsoring this roundtable, OVC has
                                              tion, age-specific courses on victim             opened the door for a full and frank dis-
   The power of peer counseling, evident
                                              trauma, and stress reaction training.50 As       cussion of these issues. Participants ex-
in the hospital-based programs, also is an
                                              Dr. Enid Margolies with the New York             pressed the hope that there would be
important component of school-based
                                              City public school system observed, vio-         other opportunities to continue this
violence prevention programs. The Rise
                                              lence prevention and victim response             discourse. For example,
Above It program was launched in 1995
                                              issues must be folded into a school’s core
in direct response to an increasing num-                                                       s   Once a national-scope search of
                                              curriculum, as funding for separate pro-
ber of severe SCIs and gunshot wounds in                                                           providers and programs serving
                                              grams is difficult.
young people in the Newark, New Jersey,                                                            the needs of gun trauma victims is
area. Program presenters, like Hashim         RECOMMENDATION: OVC should recommend                 concluded, OVC should reconvene
Garrett, the Violence Prevention              that VOCA subgrants be awarded to qualify-
                                              ing school-based victim services programs.           this or a similar group to identify
Coordinator for Rise Above It, are indi-      School boards should be encouraged to in-            unmet needs and make additional
viduals who were paralyzed as a result of     clude victim services and violence preven-           recommendations for funding new
violent acts. They are teamed with            tion as part of a school’s core curriculum.
able-bodied peer educators to let the
students see the long-lasting effects of                                                       s   Smaller focus groups of gun victims
gunshot wounds and to teach them skills                                                            should be held regionally to identify
to deal with anger and prevent fights.                                                             their needs and learn about the
The classes are part of the public school                                                          services they used to meet those
                                                        Caught in the Crossfire
health sciences curriculum and have                                                                needs.
                                                            Youth Alive
reached more than 10,000 students. The
                                                          3300 Elm Street
program has been posttested—meaning                                                            s   Focus groups should be held on
                                                        Oakland, CA 94609
that the program surveyed students before                                                          particular topics that were not fully
and after they participated in the pro-                                                            covered in the roundtable. For
gram, asking questions about their                          Rise Above It                          example, we know that guns and do-
behavior and their beliefs about the con-         Kessler Anti-Violence Program                    mestic violence terrorize, injure, and
sequences of fighting—and shows positive         Kessler Institute for Rehabilitation              kill women every day. On average,
results as both students and teachers re-            1199 Pleasant Valley Way                      in 1997, more than one woman a
port a decrease in arguments and violent              West Orange, NJ 07052                        day (393 women total) was shot and
incidents.                                           973–731–3600, ext. 2253                       killed by her husband or intimate
                                                                                                   acquaintance during an argument.51
School-based peer counseling programs                                                              The use of guns in domestic violence
like Rise Above It are designed as violence                                                        situations and its impact on victims
prevention initiatives. But roundtable                                                             should be explored further by both
participants found it difficult to draw a                                                          OVC and VAWO. Some key issues
line between the victim services provided     Next Steps                                           were raised during OVC’s September
and the prevention aspects of the pro-                                                             2000 Intimate Partner Homicide
                                                   his roundtable was the first time

grams. The victim presenters are empow-                                                            Forum. These issues and recommen-
ered by their ability to speak in front of         that OVC focused exclusively on                 dations on how to identify trends
an audience and become whole again by              the needs of victims of gun violence.           and factors associated with intimate
sharing their stories and acting as change    Participants found the process extremely             partner homicide will be addressed
agents for a violent school-age communi-      useful and were satisfied that many key              in a future OVC bulletin.
ty. And many in the classroom are also        victim issues stemming from firearm vio-
victims, suffering physical or emotional      lence were identified. As indicated in this      s   OVC should develop training materi-
harm from the violence they experience        bulletin, gun violence victims have some             als and sponsor training and technical
daily. These types of programs could be       unique concerns and needs that differ

OVC Bulletin

    assistance programs for state VOCA        Nonfatal Firearm-Related Injuries:          267:3043–3047. (When a gun is involved
    administrators and compensation           Beyond the Tip of the Iceberg,” The         in a domestic dispute, it is at least 12
    programs to help them identify the        Journal of the American Medical             times more likely that the dispute will
    diverse needs of victims of gun vio-      Association, 1995; 273:1749–1754.           end in death.)
    lence and how to respond to them.
                                              10. Available online at                     18. Zawitz, Marianne, Firearm Injury From
                                                 Crime, U.S. Department of Justice,
Notes                                         11. In the Crossfire: The Impact of
                                                                                          Bureau of Justice Statistics, 1996.

1. Hoyert, D.L., K.D. Kochanek, and S.L.      Gun Violence on Public Housing              19. “Firearm-Associated Homicides
Murphy, “Deaths: Final Data for 1997,”        Communities, U.S. Department of             Among Family Members, Relatives, or
National Vital Statistics Reports, 1999; 47   Housing and Urban Development,              Friends—Ohio,” Epidemiologic Notes
(19).                                         February 2000.                              and Reports, Morbidity and Mortality
                                                                                          Weekly Report, 1989; 38 (15):253–256.
2. The terms “gun homicide” and “firearm      12. Bell, C.C., and E.J. Jenkins,
homicide” have the same definition and        “Exposure and Response to Community         20. Larson, Eric, Lethal Passage, Vintage
are used interchangeably throughout the       Violence Among Children and                 Books, 1995, p. 86. (Describing student
bulletin.                                     Adolescents,” in Children in a Violent      holding up French textbook to ward off
                                              Society, Osofsky, ed., The Guilford         bullets from a Cobray M 11/9 semiauto-
3. Available online at the National           Press, 1997.                                matic pistol shot by a fellow student.)
Center for Injury Prevention and
Control’s database at                         13. Campbell, C., and Donald F.             21. Slevin, Peter, “District Teen Gets 127                    Schwarz, “Prevalence and Impact of          Years in Random Shooting of Four,” The
                                              Exposure to Interpersonal Violence          Washington Post, Jan. 6, 2000, p. B2.
4. Kellermann, A.L., and J.A. Mercy,          Among Suburban and Urban Middle
“Men, Women, and Murder: Gender-              School Students,” Pediatrics, 1996;         22. A list of multiple-victim shootings in
Specific Differences in Rates of Fatal        98:396–402.                                 the United States is available online at
Violence and Victimization,” The Journal                                        
of Trauma, 1992; 33:1–5.                      14. Available online at
                                                 23. Temple, Scott, “Treating Inner-City
5. Hoyert, D.L., K.D. Kochanek, and S.L.                                                  Families of Homicide Victims: A
Murphy, “Deaths: Final Data for 1997,”        15. Available online at                     Contextually Oriented Approach,”
National Vital Statistics Reports, 1999; 47             Family Process, 1997; 36 (2):133–149.
(19).                                         multiple.htm.
                                                                                          24. Schwab-Stone, Mary E., Tim S.
6. Available online at     16. See, e.g, Reiss, A.J., and J.A. Roth,   Ayers, Wesley Kasprow, Charlene Voyce,
bjs/glance/guncrime.htm.                      Understanding and Preventing Violence,      Charles Barone, Timothy Shriver, and
                                              National Academy Press, 1993, pp.           Roger P. Weissberg, “No Safe Haven: A
7. Available online at                        260–261; Zimring, F.E., and G. Hawkins,     Study of Violence Exposure in an Urban                    Crime Is Not the Problem: Lethal Violence   Community,” Journal of the American
                                              in America, Oxford University Press,        Academy of Child and Adolescent
8. “Nonfatal and Fatal Firearm-Related
                                              1997, pp. 106–123.                          Psychiatry, 1995; 34 (10):1343–1352.
Injuries—United States, 1993–1997,”
Centers for Disease Control and               17. Saltzman, L.E., J.A. Mercy, P.W.        25. Duncan, David, “Growing Up Under
Prevention, Morbidity and Mortality           O’Carroll, M.L. Rosenberg, and P.H.         the Gun: Children and Adolescents
Weekly Report, 1999; 48:1029–1034.            Rhodes, “Weapon Involvement and             Coping With Violent Neighborhoods,”
                                              Injury Outcomes in Family and               Journal of Primary Prevention, 1996;
9. Annest, J.L., J.A. Mercy, D.R. Gibson,
                                              Intimate Assaults,” The Journal of the      16:343–356.
and G.W. Ryan, “National Estimates of
                                              American Medical Association, 1992;

                                                                                           WORKING WITH VICTIMS OF GUN VIOLENCE

26. Bastian, Lisa, and B. Taylor, Young        The Journal of the American Medical            45. The National Education Association
Black Male Victims, U.S. Department of         Association, 1999; 282:447–454.                has issued Advice for Journalists covering
Justice, Bureau of Justice Statistics, 1994.                                                  school shootings. See
                                               36. Kizer, K.W., M.J. Vassar, R.L. Harry,      issues/safescho.
27. “Adolescent Assault Victim Needs: A        and K.D. Layton, “Hospitalization
Review of Issues and a Model Protocol,”        Charges, Costs, and Income for Firearm         46. Brooks, K., V. Schiraldi, and J.
Pediatrics, 1996; 98:991–999.                  Related Injuries at a University Trauma        Zeidenberg, School House Hype: Two Years
                                               Center,” The Journal of the American           Later, Justice Policy Institute/Children’s
28. Slevin, Peter, “District Teen Gets 127     Medical Association, 1995; 273:1768–           Law Center, 2000. Available online at
Years in Random Shooting of Four,” The         1773.                                
Washington Post, Jan. 6, 2000, p. B2.
                                               37. Cook, P.J., B.A. Lawrence, J. Ludwig,      47. Spungen, Deborah, Homicide: The
29. Jackman, Tom, “Group Urges More            and T.R. Miller, “The Medical Costs of         Hidden Victims, A Guide for Professionals,
Help for Victims of Crimes,” The               Gunshot Injuries in the United States,”        Sage Publications, 1998, pp. 110–111.
Washington Post, Dec. 15, 2000, p. B5.         The Journal of the American Medical
                                               Association, 1999; 282:447–454.                48. While a recent survey conducted for
30. Christoffel, K.K., “Youth Violence                                                        OVC indicates that 23 percent of the
Prevention: The Physician’s Role,”             38. Ordog, G.J., J. Wasserberger, and G.       programs enter information into their
medical student Journal of the American        Ackroyd, “Hospital Costs of Firearm            databases about whether the crime was
Medical Association (msJAMA).                  Injuries,” The Journal of Trauma, 1995;        gun related, OVC does not require states
                                               38:291–298.                                    to report the number of claimants who
31. Nader, Kathi, Robert Pynoos, Lynn                                                         were victims of gun violence, although
Fairbanks, and Calvin Frederick, “Child-       39. Ibid.                                      states do report categories of “assault”
ren’s PTSD Reactions One Year After a                                                         (34 percent of claims) and “survivors of
Sniper Attack at Their School,” The            40. Klein, S.R., I.J. Kanno, D.A. Gil-         homicide” (11 percent of claims).
American Journal of Psychiatry, 1990;          more, and S.E. Wilson, “The Socio-
147:1526–1530.                                 economic Impact of Assault Injuries            49. In October 1996, OVC recommend-
                                               on an Urban Trauma Center,” The                ed that hospital-based counseling and
32. Bell, C.C., and E.J. Jenkins, “Expo-       American Surgeon, 1991; 57:793–797.            prevention programs be established in
sure and Response to Community                                                                medical facilities that provide services to
Violence Among Children and                    41. Goldman, H., “Gun Violence in the          adolescent gunshot victims and victims
Adolescents,” in Children in a Violent         U.S. Costs More Than $100 Billion a            of gang violence. In May 1998, OVC
Society, Osofsky, ed., The Guilford Press,     Year,” Bloomberg News, available online        made the same recommendation in New
1997.                                          through Deseret News Archives at               Directions From the Field: Victims’ Rights
                                                                    and Services for the 21st Century.
33. Richters, John E., and Pedro
Martinez, “The NIMH Community                  42. Available online at                        50. Gregorie, Trudy, School Violence—
Violence Project: I. Children as Victims                   Are You Prepared To Respond? National
of and Witnesses to Violence,” Psychiatry,     Factsheets/factsheet2.html.                    Center for Victims of Crime, 1999.
1993; 56:7–21.                                                                                Available online at
                                               43. DeVito, M.J., “Causes and Costs of
34. Rand, M.R., Violence Related               Spinal Cord Injury in the United States,”
Injuries Treated in Hospital Emergency         Spinal Cord, 1997; 35:809–813.                 51. Brock, K., When Men Murder Women:
Departments, U.S. Department of Justice,                                                      An Analysis of 1997 Homicide Data:
Bureau of Justice Statistics, 1997.            44. Holicky, R., “Violently Acquired
                                                                                              Females Murdered by Males in Single
                                               SCI: A Recipe for Inequity.” Available
                                                                                              Victim/Single Offender Incidents, Violence
35. Cook, P.J., B.A. Lawrence, J. Ludwig,      online at (reprinted
                                                                                              Policy Center, 1999.
and T.R. Miller, “The Medical Costs of         from New Mobility, March 2000).
Gunshot Injuries in the United States,”

OVC Bulletin

                                           This document was prepared under the direction of the Office for Victims of Crime, Office of
                                           Justice Programs, U.S. Department of Justice.The opinions, findings, conclusions, and recommen-
  Judith Bonderman, J.D., M.P.H.,          dations expressed in this document are those of the author and do not necessarily represent the
  teaches a course on gun violence pre-    official position or policies of the U.S. Department of Justice.
  vention at the George Washington
                                           The Office for Victims of Crime is a component of the Office of Justice Programs, which also in-
  University School of Public Health       cludes the Bureau of Justice Assistance, the Bureau of Justice Statistics, the National Institute of
  and Health Services. She thanks the      Justice, and the Office of Juvenile Justice and Delinquency Prevention.
  roundtable participants for sharing
  their experiences and for their can-
                                                                                                                                 NCJ 186155
  did and full discussion of the issues.

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