By Mary Alice Miller

A shooting happened at a sweet sixteen party this past December. Six young people were shot. Four were taken to Brookdale Hospital. They were all under the age of 17.
Recently, an 11-year-old stabbed a 13-year-old at the playground after school. In another incident, a 13-year-old was shot near his school, two blocks from his home.

“At One Brooklyn Health there is an upward tick in violence injuries for patients between 13 and 21,” said Akeisha Knights-Ogudoro, MIA, LMSW, SIFI, OBH Director of Community Violence Intervention and Prevention. “We have seen a significant increase among young people under age 21 during the past year.”

Violence does not happen in a vacuum. Generally, there is higher rates of violence June through September when it is warmer outside. Substance abuse use increases during the warmer months. “The shootings I mentioned happened during the winter months,” said Knights-Ogudoro.

Social determinants of health are major factors leading to an increase in violence among young people.
“I think one of the biggest things is social media. The beefs are not only happening in person anymore, or it can happen in person but is perpetuated via social media. That is how all people are communicating but especially youth. It has an adverse impact on their emotional wellbeing,” said Knights-Ogudoro. “It starts on social media and then they see each other at school or in the community and then the physical, interpersonal violence happens. Then we meet them.”

Knights-Ogudoro added, “Mental health plays a role, not necessarily that there is a mental health diagnosis, but the emotional toll of peer pressure through social media. They just are not being taught emotional well-being skills to equip themselves to diffuse conflicts. A lot of them feel that violence is the only way.”
OBH provides bedside interventions and support for individuals who present to the hospital with violence-related injuries such as stabbing, gunshots, and assaults.

Violence Intervention Through Advocacy and Leadership (VITAL) is the overall umbrella for community-based violence intervention at One Brooklyn Health.
“One of the core tenets of our program is trauma care. This is really an emotional situation for them. It’s very traumatic,” said Knights-Ogudoro. “We refer to mental health services within the hospital and external providers based on the patient’s preference. Mental health referrals are the second most requested service that patients request after safety housing transfers.”
During bedside intake, young patients are asked if they would benefit from talking to someone who would help them manage or support them with any emotional feelings that come up.

One Brooklyn Health offers various mental health services for teenagers affected by violence.
“For teenagers who have acutely experienced violence, we have a 24-hour Child and Adolescent comprehensive psychiatric emergency room at our Brookdale Campus where a teenager can be seen.

Such patients can also receive acute stabilization at our child inpatient unit at our Brookdale campus,” said Dr. Tolu Olupona the Program Director for the Department of Psychiatry and Behavioral Health, OBH Interfaith Campus. “We also have outpatient clinics at both our Interfaith and Brookdale campuses where teenagers can receive trauma-informed psychiatric outpatient treatment for longer term management.”

“I like to make referrals and recommend telehealth (video call) services for teens because that is the modality that they are used to communicating in. With their friends they are on social media, they are talking on Facetime. It is easier for them,” said Knights-Ogudoro.
“In terms of potential revenge retaliation, it is the role of the clinician to walk through that with the patient.

To assess if there is any risk for them actually committing that and at the beginning of therapeutic health with patients, we do a disclosure that what we do here is confidential unless they are a risk to themselves or eminent risk to others,” Knights-Ogudoro explained.

She continued, “If the patient discloses they want to harm themselves we would walk through do they have the means to harm themselves. If they are talking about harming others, we walk through it to ascertain if it is a threat or not.”
Knights-Ogudoro added, “With teens, they are still developing, their psyche is still developing, their brains are still developing. Teen mental health is a crucial part of a preventative approach to reduce violence.”

Most of the times parents experience secondary vicarious trauma.
“We not only support the patient, we support family members. We communicate primarily with the parent because the patients are minors in most cases,” said Knights-Ogudoro. “Their child, in many situations, is seriously injured. We provide support by connecting them with community partners or connecting with the schools directly that can help them navigate if the child needs an emergency transfer within the school system.”

The parent may need support themselves because they are living in fear for the wellbeing of their child. Many of them have other minor children at home. One parent said she wants to move out of the neighborhood. OBH was able to support with an emergency safety transfer, which was necessary because the 13-year-old was shot near his school, two blocks from his home.
Professional care givers are also impacted by community-based violence.

“We do Healing from Within, where we do trauma processing for clinicians and hospital staff who work with patients who experience violence,” said Knights-Ogudoro. “It is a mutual aid support group, in partnership with All Kings, an emotional wellness group co-facilitated with myself. We not only work with doctors and staff, but also with our community-based partners that do violence prevention work. We invite partners from the violence prevention community.”

OBH utilizes a trauma-informed lens for program development.
“Our goal is to normalize mental health, destigmatizing it,” said Knights-Ogudoro. “OBH looks to address mental health on both sides of the spectrum, intervention and prevention. Right now, it is more focused on the intervention side because we are dealing with what we are seeing. We are also addressing mental health and emotional wellness from a holistic perspective because youth are dependent on their families and the providers that they interact with.

That is why we provide support not only for them, but also their loved ones, their parents, grandparents, siblings, as well as providing emotional wellness for the doctors and community partners who are doing the work because they, too are impacted. It is a holistic, multi-dimensional approach.”