Addressing the gun violence epidemic with a complex of tools |

Injury epidemiologist Kathleen Carlson, Ph.D., is launching the OHSU Gun Violence Prevention Research Center with support from the Faculty Excellence and Innovation Award at OHSU. The center is making it possible to bring together the many projects being conducted by Carlson and collaborators at the OHSU-PSU School of Public Health, where she is an associate professor, and researchers at the VA Portland Health Care System, where she is a core investigator. We sat down to talk about her new and ongoing work.

What are some of the projects you’re working on right now?

“We’re in the very fortunate place of being able to thinking creatively and for the long term.” The Center for Gun Violence Prevention Research, which is just getting off the ground, recently has taken on projects ranging from an evaluation of OHSU’s new hospital violence intervention program to a collaboration with the Multnomah County District Attorney’s office to develop a Gun Violence Review Commission. We’re also conducting a data analysis of Oregon’s Extreme Risk Protection Order, or ERPO, law, which is our “red flag” law, and collecting and analyzing data on firearm injuries treated in emergency departments across the state.

These projects primarily fall into the categories of gathering data and building and assessing evidence-based approaches. These span systems and spaces — the built environment, health care, criminal justice systems — and both population- and individual-level approaches. .

Why is there so much focus on data?

“Good data provide us with insights to understand all the complexities of the problem and shape upstream solutions.” We really need more data on every aspect of gun violence and gun violence prevention. Epidemiologically-speaking, we don’t know how many people are injured by firearms each year, how many go to the hospital and what the myriad physical and social outcomes are. We need data to point us toward best practices for gun violence reduction. What programs work best and with which populations?

We are catching up on more than two decades of what was effectively a freeze on any gun violence research. The Dickey Amendment basically halted most research on the topic from 1996 to 2020. There is a significant lack of data and that puts us at a deficit for developing strategies to prevent gun violence.

Good data provide us with insights to understand all the complexities of the problem and shape upstream solutions. Our group is working on a number of exciting projects, thinking innovatively about how to address the social and political determinants of gun violence, to implementing tried-and-true public health approaches to prevention. An example of the latter is our new Gun Violence Review Commission, which was born from a series of meetings with the Multnomah County District Attorney (Mike Schmidt) and his office. They reached out to us in 2021 to talk about gun violence prevention. The D.A.’s team and public health teams each explained, step by step, how our professions analyze gun violence. Our approaches, not surprisingly, were starkly different.

The D.A.’s team focuses on collecting evidence and data with an eye toward successfully prosecuting cases, as well as keeping victims and witnesses safe. The public health researchers look at the same events from a different lens. We ask questions about the physical or built environments, about social systems and how they may be better leveraged for prevention, about firearms or ammunition and how they were accessed, or about the interplay with other public health issues like substance abuse or homelessness. We’re interested in data that reveal causes and conditions in order to determine how to change those factors before we ever get to a violent event.

The DA’s office saw the value that our perspective brings. They asked us to collaborate and found a way to help us get funding, and will serve as a source of data that will let us tease out information that is important to determining public health responses.

We’re also working on a project on understanding the use of our state’s ERPO law, Oregon’s red flag law, that will address big gaps in data on a law that passed in 2017. “This work is at the intersection of public health and health care settings.”The law makes it possible for family members or law enforcement to petition to have weapons temporarily removed from a person who poses an immediate threat, either to themselves or to others. These laws can prevent not only mass shootings, but the more common forms of gun violence, like suicide and homicides.

We need more data, though. For instance, how many ERPO petitions have been filed, what action was taken and what were the consequences, both to the petitioner and the respondent. This particular study will also survey a large sample of nurses and physicians across Oregon. We want to find out what their knowledge is of the law and their likelihood to counsel patients about its use, should they be at risk. This work is at the intersection of public health and health care settings.

What is the hospital-initiated violence intervention program at OHSU?

Healing Hurt People is a trauma-informed program for survivors of violent injury, primarily youth and young adults from oppressed backgrounds, that was developed in Philadelphia and has now been implemented in multiple hospitals around the country. It includes evidence-based therapy, supportive case management, and peer services to survivors or witnesses of stabbings, shootings and other assaults. It’s a longer-term approach to preventing repeat or cascading gun violence, and is known to be effective.

“We’re anxious to collect novel data to inform our state’s prevention efforts as well as those in other areas around the country.”

The peer services component of Healing Hurt People pairs ‘credible messengers’ with young individuals of color who come into the ED with injuries due to an assault. These credible messengers are interventionist specialists who have lived experience that lets them understand these patients’ backgrounds and connect to them through their own experience. They work with their clients over the course of 18 months to address trauma, prevent post-traumatic stress symptoms, and connect them with opportunities and services that will help them avoid further violence.

Data from other hospital violence prevention programs show that patients who enroll are less likely to get reinjured and also less likely to subsequently be involved in the criminal justice system. The Oregon legislature passed a policy this year to provide funding for these types of programs across the state. Our team received pilot funding from the School of Public Health to evaluate the implementation and outcomes of Healing Hurt People at OHSU. We’re anxious to collect novel data to inform our state’s prevention efforts as well as those in other areas around the country.

Where do you go from here?

“Having a core, a known point of knowledge, is so important to the overall project of eliminating gun violence.”

I’ve only mentioned a few of the projects that we’re working on — and more opportunities keep opening up. Truly, the Faculty Excellence and Innovation Award is allowing us to integrate all these projects under one “roof” at the Gun Violence Prevention Research Center. This makes it possible for each of the projects to inform the others. It’ll take time, but we’re growing and developing our team so that we can take on more projects and provide the data to those who need it in a centralized, readily-accessible way.

The City of Portland has asked us to play a role in evaluating their Safer Summer PDX program, which is a data-driven and community-informed violence intervention initiative to curb the rising gun violence in our city. The OHSU-PSU School of Public Health and the Gun Violence Prevention Research Center will be providing expertise on the latest evidence on gun violence reduction strategies and sources of data to monitor outcomes of the initiative. This is where it’s important to have data — and to have a credible, central source for that data.

How does having a Gun Violence Prevention Research Center help?

Having a core, a known point of knowledge, is so important to the overall project of eliminating gun violence. We can be a central site for the knowledge that we and others gather and analyze, and we can focus on sharing that knowledge with the community — neighborhood groups, other researchers, healthcare providers, lawmakers — it is going to take all of it to get through this epidemic.

Each of our current initiatives represent one more tool in the gun violence prevention toolbox — data collection, ERPO analysis, hospital-based prevention, criminal justice systems and community violence intervention programs — the center lets us bring it all together. And more possibilities are opening in extraordinary ways, and our funding makes it possible for us to take on much more than we’d imagined.

We’re in the very fortunate place of being able to thinking creatively and for the long term.