2021 COMBAT Funding: $235,450.00

In TMC's Own Words

Purpose

Truman Medical Center’s (TMC) RISE Program is a comprehensive, stepped-care treatment program that seeks to provide nonfatal shooting victims and their families with timely mental health supports in the immediate aftermath of a shooting. The RISE (Responsive Individualized Support and Early Intervention) Program consists of an interdisciplinary team of nurses, social workers, chaplains, and behavioral health professionals working to make sure that people affected by gun violence have all the resources they need to recover. 

All Shooting Victims Eligible For Services

All nonfatal shooting victims ages 13 and above seeking medical care for bullet-to-skin gunshot wounds and their families are eligible to receive services through TMC’s RISE Program. 

Services/Activities Provide

Services are provided across three levels of intervention:

The first level of intervention provides nonfatal shooting victims with information, crisis intervention, and advocacy in the immediate aftermath of a shooting. Victims at this level are also screened for risk of developing chronic post traumatic stress symptoms associated with the injury to ensure that those victims at greatest risk of trauma-related mental problems receive additional intervention to promote resilience and recovery. 

Admitted patients are screened for risk of developing chronic post traumatic stress symptoms once the victim is alert and medically stable. Victims treated and released from the Emergency Room (ER) are provided with psychoeducation about common trauma reactions and information on coping, and post traumatic stress risk screening is completed within one to two days after release by the RISE project team, who also provide survivors with practical assistance and linkage to care during this acute post-injury period. 

This crisis intervention and advocacy occurs in the form of Psychological First Aid (PFA). PFA is an evidence-informed early intervention developed by the National Center for PTSD and the National Child Traumatic Stress Network. 

PFA is based on research suggesting that practical, social, and emotional support can buffer against development of longer-term problems in trauma victims. PFA can be delivered within hours or days of a traumatic event, in-person or by phone, and in one or more contacts, as needed. This practical assistance and access to supportive resources serves to immediately reduce risk of re-victimization and/or retaliation as a first step forward toward healing. 

The second level of intervention provides nonfatal shooting victims with readily accessible, continuous mental health support in the weeks and months after a shooting to bolster resilience and recovery. Continuous trauma support in the weeks and months after the shooting is achieved through offering survivors with ongoing distress or high risk for chronic mental health problems “stepped-up” care in the form of skills and tools to address a range of issues relevant to gunshot victims and their families, including: 

• Physical/medical concerns 

• Emotional concerns 

• Safety concerns 

• Financial/legal concerns 

• Links to social support 

• Access to basic necessities (like food, shelter, or transportation to appointments), and 

• Relationship issues 

Skills and tools addressing these issues are taught using a “stepped-up” intervention in the form of Skills for Psychological Recovery (SPR). 

SPR is a culturally-informed, structured intervention developed by the National Child Traumatic Stress Network and the National Center for PTSD. SPR utilizes skills-building components from cognitive-behavioral treatments for trauma-related mental health problems to facilitate recovery and enhance functioning in the aftermath of a traumatic event. Skills include:

1) Building problem-solving skills

2) Promoting positive activities

3) Managing physical and emotional reactions to upsetting situations

4) Promoting helpful thinking

5) Rebuilding healthy social connections 

This component will be provided by UMKC Clinical Psychology Doctoral Students—all of whom have already completed the on-boarding process at TMC and have security access to TMC resources to allow them to track and document encounters with nonfatal gunshot victims. Furthermore, all students have already completed extensive training in SPR. 

Skills are taught to the survivor in a flexible manner. To maximize reach and mitigate barriers to care, nonfatal gunshot victims are given the option of receiving “stepped-up” care in the form of in-person or home-based telemedicine services.

In the context of the COVID-19 pandemic, our team has enhanced our capacity to provide SPR to victims using home-based telemedicine via HIPAA-compliant videoconferencing platforms to ensure that services can be provided to victims safely and effectively while maintaining appropriate social distancing measures. Over the next project year, we plan to continue expanding our capacity for telehealth outreach to victims and their families.

The third level of intervention provides nonfatal shooting victims with chronic, unresolved post traumatic stress symptoms access to evidence-based mental health treatments. Evidence-based, trauma-focused mental health treatments for post traumatic stress disorder (PTSD) can include the following individual or group-based treatments: 

• Prolonged Exposure (PE) Therapy is designed to reduce PTSD symptoms by assisting clients in learning to tolerate distress and to face their trauma memories. An individual PE treatment package is typically 8-15 ninety-minute sessions. 

• Cognitive Processing Therapy (CPT) uses techniques to assist clients in working through troublesome, trauma-related thoughts toward recovery. CPT treatment packages are approximately 12 sixty-minute individual sessions and 12 ninety-minute group sessions. 

As with SPR, these treatments can be safely delivered via telemedicine to victims with telehealth capacity in their home. To facilitate more engagement in PTSD treatment for those requiring more intensive care, and with the support of COMBAT funding, our goal for the next year is to have our UMKC Psychology intervention team fully trained in these interventions and capable of delivering these interventions from our Hospital Hill location. These three levels of intervention, or Stepped Care Interventions, provide responsive, individualized supports for nonfatal gunshot victims and their families that will go a long way in reducing unnecessary suffering.

Goals

The specific goals of TMC's RISE Program are: 

1) To identify nonfatal shooting victims at greatest risk for chronic, impairing post traumatic stress symptoms; 

2) To provide nonfatal shooting victims with information, crisis intervention, and advocacy in the immediate aftermath of a shooting; 

3) To provide readily accessible, continuous mental health support in the weeks and months after a shooting to bolster resilience and recovery.

Expected Program Outcome

Anticipated program outcome is reducing rates of chronic PTSD and associated rates of re-victimization and retaliation for nonfatal gunshot victims and their families.