KAVI - Kings Against Violence Initiative
Kings Against Violence Initiative
Interview with Dr. Rob Gore
Written by Sam Shulimson, DO
Edited by John Purakal, MD
Dr. Rob Gore was the assistant program director for the Kings County-SUNY Downstate Emergency Medicine Residency Program for four years. He is the founder and currently the executive director of the KAVI (Kings Against Violence Initiative), a hospital and school-based youth violence intervention prevention and empowerment program targeting teens that have been injured as a result of violence or at risk for violent and recurrent violent injury. www.kavibrooklyn.org
He is the founder and director of the Minority Medical Student Emergency Medicine (MMSEM) Summer Fellowship, which is a mentoring and enrichment program for underrepresented minorities interested in Emergency Medicine with a focus on project development.
In this Initiative Feature, Dr. Gore sits down with Dr. Samuel Shulimson to discuss his work with KAVI.
Can you tell me a little bit about KAVI?
KAVI itself is a hospital, community, and school violence intervention and prevention program. We also try to focus on strategies to change the scope of violence that is impacting the community. Trauma and violence can come from so many different avenues, and as an emergency physician we often see the physical aspects of violence. I practice across the street from my elementary school, and I also live about 15 minutes away. So when cases come in, sometimes these come in from areas that I have spent time in, sometimes they come from my own neighborhood. On more than one occasion, the people that we treat I myself might now or someone on my team might know. When something touches you from such a personal framework...it moves beyond stabilization. Our job is to keep you alive, but keeping you alive and well is something completely different. So [KAVI tries to answer] how do we keep you alive and well as a thriving member of society? Once you experience a great deal of trauma, how do you recover from it? How do we ensure that your safety is maintained and you’re understanding how to cope with loss? What does [the patient’s] future hold? Our ultimate goal is to ensure that members of our community are in the best possible position to be alive, well-functioning, and thriving.
What motivated you to start KAVI?
I always knew that when I practiced medicine, it would be a blend of clinical medicine and preventative health. I originally wanted to do global health. I had no interest in thinking about violence and trauma, but [I had a] key moment during my senior grand rounds at Cook County. I found out I was going to present in February of 2006, and I wanted to present on hypothermia because I can’t think of a colder place on the planet than Chicago in February, but someone else was presenting that topic and my PD said why don’t you present something more meaningful. He said to check out this book Freakonomics so I read the book. There was this chapter that really stood out that talked about the economics of violence, gang activity, and drug dealing, so I started thinking about presenting on gang violence. In August 2005, I’m working in the trauma emergency department, and I’m on a 24 hour call. Usually in summertime Chicago, it’s really hot and on those days it’s chaotic, but this day was in the 50s, cold, and raining. One of my co-residents said, ‘I’m bored, I hope something exciting comes in.’ I paused.
I started thinking: every time something exciting comes in, that means it’s usually penetrating trauma, which means that you can get your procedures and every time we get a penetrating trauma, it’s usually a young black or latino person…I started looking around the room and the only two people of color are me and one of the clerks, so it kinda bugged me, and I started thinking… ‘I’m the same age as a lot of the victims of trauma, and if I was in the wrong place at the wrong time, are people going to be excited because they get a chance to do procedures not realizing that these are people’s lives who are affected?’
The first thing I realized was that we need to change the language that we use in trauma because it sounds like it is purely transactional. So, starting Freakonomics and having that incident in the ER was pivotal because I realized I’d rather be in the situation where the trauma wasn’t coming in because those are young lives being lost. They are brothers, sons, daughters. They are family members and loved ones whose lives are being cut short because of violent activities. I threw myself into this world of violence prevention. I came in contact with this paper by Dr. John Rich, who is the head of the center for non-violence at Drexel, and this paper that he had written…it was the first time I ever read someone describe violence as a public health problem where you have these risk factors that are identifiable and just like any other disease process. If you mitigate the impact of those different risk factors, you can potentially change the outcome of the people and populations who are being impacted…[I started thinking] if this person had had an intervention earlier on, this entire person’s life trajectory could be completely different. I started reading about this stuff like a mad person, and I started identifying other people who had done these interventions and started meeting with them. I went to ACEP in October of my chief year…and I started talking to some people about their community programs. As I did my research on gun violence and gang violence, I realized that there aren’t very many intervention programs out there…and I wanted to be one of the first people to start a program in [New York City], and I went on this tirade trying to find out what are the best ways to implement these type of programs.
Tell me about the evolution of KAVI, and how you feel KAVI has impacted the community since its inception?
KAVI…and our other community partners (Man Up, Inc. and SOS) have helped fill a void [in New York City]. When I first got to Kings County, we had a program called Doctors Against Murder (DAM) which was more of an advocacy group and didn’t really provide wrap around services for patients. We had a team of physicians who were working on [advocating for victims of trauma], but there was no infrastructure to provide large scale programing. One of the founders of DAM is one of my mentors, (Dr. Ray Austin), and he said that we had to do something different. [Dr. Austin said] whatever was created would need to have the financial support and infrastructure that would allow it to be sustainable. This means that the program could have a short term and long-term positive impacts on patient care. When we launched KAVI, we had some issues with hospital politics and funding, so we decided to focus on the school first and find a way to build it into the hospital later. We had some contacts in the high schools, and we realized that if we worked with students who were at risk, then we could prevent them from becoming trauma patients in the future. We started our in-school programming, but it was supposed to be temporary, and then we would build our after-school community programming. However, after a couple of weeks, we had close to 200 kids in our workshops, and we knew we were on to something and had to continue. After the school program, we launched the hospital program and when the money came (much later) we had in-school programming 5 days a week, programming in the hospital, and an after-school tutorial program. We finally achieved our vision of a full-fledged 3-pronged program.
You talk about the impact we were able to have…having someone who has been through trauma themselves and can talk you through this process [is so important]. [Our team] works with the patient after this initial process of injury, and they make sure that these patients know that someone is advocating for them on their behalf. In the school, there’s a support system both for the school social workers and the school guidance counselors. We do our in-school workshops which focus on everything from mediation, restorative justice, life skills development, conflict resolution, and even academic support. We provide those services, but we are also there as mentors; we are there as friends; we are there to help support the school’s administration. We are there to help support the students’ parents. We have our own office and own classroom and are in the school 5 days a week so the students can come to talk to us and be in a safe space. Our office often does the mediations, and we are there to help them understand what they experience from [the trauma] which helps reduce the negative impact on their learning and education. Think about what life is like when we have a support system, whether it’s parents or loved ones or caretakers at home. Look at our success as medical students or physicians, we didn’t do this stuff by ourselves. For some of our students from marginalized communities, that support system isn’t always there. For those students, we are their support system.
What have been some of the success stories that you have had with the program?
We have students that are in college, one student from our first group is in medical school at Brown. We have students at my [alma mater] at Morehouse College in Atlanta. We have students that are now at the different city schools around New York. We are at the point in our organization where former participants are now working with us. Five of our employees are former participants, and they’re doing everything from school-based interventions to working with our hospital-based intervention program. I talk with my parents who grew up during the civil rights era of the 60’s (my dad was a member of Southern Christian Leadership Conference with Dr. Martin Luther King Jr.) and the one thing that they articulated about these organizations is that people need to make sure that they pass on that torch. You must have future leaders who can run [the organization] when the time comes or else these great ideas…wind up dying with the founders. For my entire career (pre-med, med student, resident, and attending) I’ve always made sure that mentoring has always been an integral part of what I do. I launched a pipeline program called MMSEM (Minority Medical Student Summer Fellowship) which was geared toward increasing the number of minority students in emergency medicine. [Right now] we’re entering our 11th year of MMSEM and… some of the folks who were participants of MMSEM are now helping to run MMSEM. We hope the same thing will happen with KAVI itself. The goal is to continue to have this long-standing impact where lives benefit and there’s this overall sense of community well-being. If you train people to lead, then they’re in the position [to impact their community]. That’s the beauty of social emergency medicine.
What have been some challenges that you have faced with the initiative?
[laughing] I think the hardest part was starting. Physicians in general tend to be type A personalities. We understand that there is a process of trial and error, but we don’t like to do something unless it’s perfect. KAVI itself existed on paper…but we didn’t start programming until almost 2011. When we finally did start, we had to scale back from this grandiose vision. What we are doing now with the multi-pronged approach is what I initially envisioned 10+ years ago. However, it was hard to implement because it was hard to create a program from an academic standpoint instead of a business standpoint. The other issue is funding. People think that you need the funding to start a project, but the bigger issue is you need the project to be sustainable because nobody wants to invest in something that is trying to get up and running.
The other thing that is challenging is presenting our mission in a way people understand. We need to make sure people understand what we are doing and make it appealing to a nurse, to a high school kid, or a kid from the community. The ER is a traumatizing place, so how do you make it so that that person sitting in their office upstairs gets what you’re trying to convey? The messaging you use, the examples you use, the language you use, how do you make sure that your message can appeal to someone in the middle of nowhere in Thailand, or somebody from central Brooklyn, or suburban Maryland? How can you make sure they understand it regardless of their age and socioeconomic factors? You must start learning the dialogue and learning the language.
Another issue is realizing that the initiative is a dynamic process that will change. One example is when we first started in 2011 social media existed, but not in the way it does now. Instagram didn’t exist, there was no Snapchat, people weren’t using Facebook to gang-bang and to put out threats. However, now we realized we must address this and make sure that our team members understand social media and start talking to the people that we work with about how they address people on social media. As a violence initiative, you need to be aware of all the ways that things can change. You can’t be this unwavering, impenetrable organization because the goal is to be able to adapt to change around you. Like the tree in Antigone if you can be flexible, you will survive the storm, but if you’re too rigid and unable to adapt, you’ll break. So, this was a very pivotal model as to how to adapt to the specific needs of our community.
What changes do you see KAVI undergoing in the future?
We are going to be expanding and adding more school sites. We see clients in the ER, work with the schools and, see people in the trauma clinic, but right now we are trying to increase access at all the clinics to ensure that follow up and follow through is maintained. The other thing that we are implementing is increasing our training, and training others on a larger scale. We are working on some platforms to educate more people and more physicians on a larger scale. The goal is for us to become obsolete.
What advice would you give to other ER docs that are trying to reduce violence in their communities?
Meet with the people who are affected by the violence, talk to the patients, talk to the clients. Sometimes we are better at talking AT patients than we are at talking with them, but if you’re interested in doing this kind of work you need to meet with the people who are impacted most and then bring them in as an integral part of the team.
How can others get involved with KAVI?
You can check us out on our website kavibrooklyn.org, you can email us at info@kavi.org; however before people even sign up to volunteer for our organization, I like to ask them ‘What is it that you hope to fix? What are the problems that you want to solve?’ I like asking them what kind of problems they want to fix, because based off [that answer] we find something that we can work off. The more specific that you can be, the easier it is [to find how you can help].
I think some people assume that if they don’t have a particular background, ethnicity, or geographic location; that they can’t do community work. However you can do community work within your area of expertise…can you balance a budget, can you design a website, can you develop apps…there’s so many things you can do to help community programs even if you didn’t necessarily share the same background as the people you are trying to help.
What was something unexpected that your experience with KAVI has taught you?
When my friend and mentee, Willis, was killed, it was incredibly painful and a lot of us took his death personally because he was really close to us, worked with us, and was a friend to us. [This experience] showed me the importance of self-care. The way that physicians and care-takers process trauma became very real. We often assume that we have to have everything perfect for perception or leadership purposes. We don’t often realize that sometimes we need to chill out, to take a break, or to talk to a therapist. After Willis died [that same day], another patient came that had been shot multiple times, and [we stabilized him]. It turns out I pronounced the patient’s little brother dead a few years before, and the mother actually recognized me. There were all these triggers. I wasn’t resting, and I wasn’t sleeping properly. You don’t realize that all of this has a cumulative effect. Recognizing the need to take a step back and process what you’re experiencing. It’s a stressful thing that happens when any young person loses their life but if you don’t take the time to process it, it doesn’t allow you to adapt and move on to the next and maintain your own sense of well-being. [If you don’t maintain your well-being] how are you able to carry forth your mission? Understanding your limitations, and what you bring to the table with what you’re experiencing, it’s necessary to do this work in the long term. It’s one of those hard lessons that I’ve had to learn, and I’m still learning; making sure that you are mentally well, physically well, and eating healthy, and resting properly…If you aren’t at your best then how do you expect to continue?