Staffers in the emergency room at St. Joseph Medical Center find themselves treating a victim of violence almost daily, says Michele Jones, who for the past six years has directed emergency services at St. Joseph, which is located in Reading, Pa.
On any given day, doctors and nurses may see a middle schooler who's been punched in the face during a fistfight, a woman assaulted by her husband or a young man stabbed or shot during a drug deal.
In the fall of 2010, four students at Reading High School were shot to death in separate off-campus incidents, spurring their classmates to form a group called Project Peace. Students have marched and held rallies in an effort to end the cycle of violence, not only at Reading High School but in the entire Reading School District, which saw 1,216 incidents of violence in the 2009-2010 school year, according to a locally produced School Safety Annual Report. But violence is intractable, and, in January, a 16-year-old Reading High School student was killed and one of his two 15-year-old companions mortally wounded when they attacked a 65-year-old man, who was riding his bike on a bike path. The district attorney said the biker had acted in self-defense and no charges would be filed against him.
Widespread poverty
Violence is not the only issue in Reading. In September, the U.S. Census Bureau released new data showing that the city is the poorest in the country for its population size. More than 41 percent of Reading's 88,000 residents live below the federal poverty line, which is less than a $22,000 yearly income for a family of four.
Jones believes she sees evidence of poverty in her emergency room, too, with more people out of work and lacking health insurance.
"The impact of poverty on health care has been one of those quiet creeps,'' she says. "More and more, we see people showing up as self-pays." When ER patients say they can't even pay for an antibiotic prescription, staffers refer them to a hospital's social worker for assistance. But many times, people won't reveal that they can't afford treatment, Jones says.
"I'm not a statistician," adds Jones, but she believes "on a gut level" that there is a direct correlation between "the rising poverty level in our community and the amount of violence that we see."
Lack of education is another challenge for Reading, where just 8 percent of residents have a bachelor's degree, lagging far behind the national average of about 28 percent. According to the Reading School District, only 65 percent of its students graduate from high school. This compares with an average statewide graduation rate of 91 percent.
Community-building grants
Faced with these problems, a number of organizations in Reading have joined with St. Joseph to develop solutions to revive their city. St. Joseph is sponsoring and supporting more than $2 million in community-building grants for the following projects:
$840,000 for the "Reading Youth Violence Prevention Initiative," which seeks to reduce violence among youth with a variety of programs, including working with students, parents and schools to support positive relationships and keep young people in school.
$850,000 for "Building Brighter Futures," which focuses on the largely Hispanic community in Reading. The effort provides job training in the health care field, including for careers as certified nurse assistants and home health aides.
$250,000 to expand "Right from the Start," which seeks to increase the school-readiness skills of children by identifying and working with infants and toddlers at risk of developmental delays.
$260,000 to help recruit and train volunteers to make regular visits to the elderly, to help seniors stay in their homes as long as possible in Berks County, which includes Reading, and in the southern part of the neighboring county of Schuylkill.
Preventing violence
Except for the job training project, all of the grant money is coming from St. Joseph's parent organization, Catholic Health Initiatives of Englewood, Colo. In mid-2009, CHI launched "United Against Violence," a national violence prevention campaign backed to date by $5 million in grants from CHI's Mission and Ministry Fund.
Through that initiative, CHI provided planning grant money in 2009 to St. Joseph to assess what already was being done in Reading to reduce violence. From that effort, the Reading community decided to focus on preventing youth violence, developing its "Blueprint for Action" toward that goal, says Kelly Altland, vice president for development at the St. Joseph Medical Center Foundation, and the person who oversaw the proposals for the $2 million in grants.
One of the first things the Reading community did was to form a collaboration of more than 100 people who represented all types of organizations, including police, schools, businesses, churches and the juvenile justice system, to name a few, says Altland.
"We said, 'Let's not duplicate the good work that's already being done, let's see what we can enhance and do better,''' Altland says.
With money from the 2009 planning grant, an antiviolence committee awarded three mini-grants totaling $45,000 for projects such as "Challenging Gender Norms that Lead to Violence: A Men & Boys Initiative," which teaches young men and boys how to manage their anger, build healthy relationships with girls and women and make positive contributions to society.
A second mini-grant sent some of the Reading high schoolers who formed Project Peace to an intense leadership training class in California, so that they could better communicate an antiviolence message to their peers.
Another $100,000 from the grant money is expected to be awarded shortly to community programs selected by a Youth Violence Prevention Project committee. The project's first goal is to reduce by 5 percent those 1,216 incidents of violence in the Reading School District by 2014.
Collaborative approach
"The best part of this entire initiative is the fact that it's been such a grassroots effort,'' says Scott Rehr, executive director of Berks Connections/Pretrial Services, who helped develop the Blueprint for Action.
"St. Joe's has provided the leadership, but they really opened it up to the entire community to participate in the decision-making process," says Rehr. "Too often things are top down, but there's literally been hundreds of people involved in this process over the past two years."
Reading already has benefited from collaboration, says Altland. At a meeting on preventing youth violence that included police and school officials, participants learned there was no policy in place for the schools to alert police after a confrontation or fight between students during the school day, so that officers could be aware that violence might continue after school. That policy is now in place, says Altland.
Some might question why a hospital is leading efforts to prevent violence, create job training and ensure a child's readiness for school, but John R. Morahan, St. Joseph's president and chief executive, says the CHI's public health approach to violence prevention and its funding of community-building efforts is in line with the medical center's historic mission.
"We're improving the lives of people in our community, and I don't think that's anything different than in 1873, when three sisters of St. Francis came to Reading and opened the first hospital,'' says Morahan. "They also took care of the people, and this is just an extension and continuation of that mission."