In my work as a public health researcher, I am reminded every day that the health risks of childhood aren’t limited to communicable diseases, playground falls, and sports-related bumps and bruises. Youths in America far too often suffer intentional injuries inflicted by assaults from peers, strangers, and even caregivers in the course of seemingly routine activities of adolescence — going to school, shopping with friends, or playing outside their homes.
While our medical system can usually fix the physical trauma, it is largely unprepared to address the emotional trauma that follows being a victim of an assault. Young patients are often discharged back into the same environment in which the injury occurred, with an ongoing risk for retaliation, re-injury, and sometimes even death.
Boys and young men of color experience a disproportionate burden of assaults. It’s easy to imagine that they would be unwilling to seek support for mental health concerns after these injuries. But when my colleagues and I at the Children’s Hospital of Philadelphia explored that idea, we were surprised by our results. In a recent paper in the Journal of Adolescent Health, we discovered the range of needs that adolescent boys express following violent injury. Nearly all of the young men ages 12 to 17 who were participating in a voluntary post-injury case management program wanted access to mental health care, and identified diverse other goals for their recovery.
From earlier research, we learned that the period immediately following injury is when boys and young men are at greatest risk for retaliation or re-injury. Young men treated for relatively minor injuries in the emergency department were more concerned about their safety upon discharge than those who required hospitalization. That’s likely because the assault creates a new reality. Routines such as travel to school or playing in a neighborhood playground may no longer be safe. Peers once thought to be friends may now be enemies.
Youths who have been assaulted, and their families, are forced to navigate the often complicated legal and medical systems, with little direction or support. Following violent injury, youths frequently have no control over the care they receive following injury and as a result, many experience fear, powerlessness, and a deep sense of loss. It is no wonder that young men want support in addressing these complicated and challenging emotions.
As adults responsible for their wellbeing, we must be willing to help youths identify ways to stay safe and reduce the barriers to accessing care. For many injured youths, the event that brings them to the emergency department is rarely isolated, but rather one in a continuing series of violent experiences.
The nearly three dozen members of the National Network for Hospital-based Violence Intervention Programs are part of a growing movement to address violence as a health issue. These member programs assist injured youths, young adults, and their families with accessing the resources needed after medical treatment ends and share a common goal of preventing re-injury and helping to restore youths’ quality of life. The network helps programs across the country collaborate to develop and share best practices, undertake rigorous research, and advocate for policy change that better supports individuals affected by violence.
We often believe that injuries are only physical and that all wounds heal with time. The often-hidden emotional trauma, however, can linger for a long time. That’s why the role of health care providers must not end when a young patient’s physical injuries from an assault are attended to. In some ways, that’s when our work is just beginning.
Rachel Myers, Ph.D., is a research associate and Violence Prevention Initiative Fellow at Children’s Hospital of Philadelphia.