Grant Helps Project Ujima Reduce Repeat Injuries

Ujima is a Swahili word for "working together to make things right." Project Ujima, a collaborative effort of the Medical College of Wisconsin, Children's Hospital of Wisconsin, and the UW-Milwaukee Department of Psychology, will be able to continue doing just that, thanks to a $30,000 grant from the Allstate Foundation. The funds will be used in Milwaukee for activities related to Allstate's Safe and Vital Communities campaign to use to meet its mission of reducing repeat injuries among children and teenagers caused by violence.

The Allstate Foundation grant isn't the only good news received this year by the program. A prestigious national Award for Professional Innovation in Victim Services was presented to Project Ujima by the Department of Justice Office for Victims of Crime at a ceremony attended by several project staff members in Washington, D.C.

Most importantly, the Children's Hospital emergency department has witnessed a decrease in repeat injuries from violence in recent years, including a dramatic downturn in the number of children and teenagers presenting with firearm injuries.

"Safe and Vital Communities is a continuing Allstate program," said Marlene Melzer-Lange, MD, Medical College Professor of Pediatrics and Medical Director of Project Ujima for Children's Hospital. "In each community they decide what the issue is going to be, and over the last few years they've decided that it should be centered on community safety related to violence. They're looking to reduce gang involvement and minimize unsafe conditions related to guns. The main interest now is in youth, particularly in taking at-risk youth and giving them other alternatives.

"In addition to the financial support, local Allstate agents assist Project Ujima with their own volunteer time and access to injury prevention resources. This adds to the partnership between Allstate and Project Ujima.

"We've opened a community center on Teutonia Avenue in Milwaukee that's a great place to be doing the activities. Every summer, Project Ujima has done some youth development activities with our youth, but we didn't have funding to do what we'd really like to do. With the Allstate funding we're able to do much more in the way of youth leadership, training young people how to be spokespersons for nonviolence, training youth on entrepreneurship, and on good self-esteem. It's a variety of things, and throughout the summer we're going to have camps that will be funded by Allstate to address these important issues."

Violence as a Health Care Issue
Violence prevention is an important element in contemporary health care, Dr. Melzer-Lange said, as conditions in the community, the drug trade, and teen parenthood have all been shown to be factors in increasing risk for violent injury and the need for medical treatment.

"If you have good self-esteem you're not going to be involved in gangs, you tend to be much less likely to fight, and you're going to be fostering better relationships with your brothers and sisters," said Dr. Melzer-Lange. If we take one youth, the whole family becomes part of our mission. We work with the parents, we work with the injured youth and their brothers and sisters, and if they have friends that they want to bring along they can bring them along, too.

"Project Ujima's priorities have always been to decrease repeat injuries to youth who have gotten hurt, who have been victims of violence. The young people coming to Project Ujima are 7- to 18-year-olds who have been injured through an assault, stabbing or gunshot wound, and have been brought to the Children's Hospital Emergency Department. We introduce the program to them in the ED, and then we do a home visit and support the youth and family. The home visit is done by community liaisons, mental health workers and a nurse. We have the nurse involved not only for their injury but also for preventive health care.

"Many of our youth are sexually active and a lot of them are at risk for becoming teen parents, which then generates a much higher risk for violence. Teen parents are at higher risk for domestic violence. And child abuse is more likely among teen parents, who are more likely to hit their children than older parents. There are many reasons to assure planned follow-up medical care as part of this program, both for the care of their violent injuries as well as health education."

Tailored to Family Needs
Project Ujima sees about 220 children and teenagers in the Children's Hospital Emergency Department each year, Dr. Melzer-Lange said. Of those, parents of about half of them give consent for Project Ujima to be involved with their child.

"We make about 120 home visits each year," said Dr. Melzer-Lange. "And then it's really about tailoring it to each family. A lot of families, up front, will say 'I don't need services' or 'we don't need the mental health part of this,' and then later they call us back and say that their child isn't sleeping or they're afraid to let them outside because they may get shot again, or he's not going to school because he doesn't want to let anybody know that he's got a limp.

"They ask if we can come back and help them out. Some of the people turn us down in the ED, and then when we come to a month or so downstream and things aren't going so well they call us up and say, 'you know, I'd like you to come over.' We have youth who struggle with violence in their community and the parents say, 'You were right. The first time I thought it was just a fluke and he wasn't at risk, but now I really do.'"

Young victims of violence often suffer from a variety of problems that go beyond the injury itself, Dr. Melzer-Lange said, including chronic sleep disorders, paranoia and post-traumatic stress syndrome. "Because we have a relationship with the Department of Psychology at UW-Milwaukee, we are able to provide mental health services in the home," she said. "We're really lucky in that regard and because two of the psychologists are very interested in groups, so now we have a boys group going that meets every Monday night after school, and a girls group that meets on Saturdays.

"Even though they don't look at it as mental health - they look at it as boys group - what's coming out is a lot of mental health issues. These guys have a lot of feelings and they work them out. The kids now really look forward to the meetings and having this discussion, to the point where they say 'we need more time to talk."

Gunshot Injuries Down
Firearm injuries among the Project Ujima population treated at Children's Hospital are down from more than 140 in 1995 to about 60 in 2003, according to Dr. Melzer-Lange, in keeping with a positive nationwide trend that she noted cannot be attributed to a single cause.

"I think that there may be less gang involvement right now," said Dr. Melzer-Lange. "Or it may be that enough people have seen kids getting killed that they're being a little bit more careful about the guns (improved gun safety practices are among the goals of the Allstate program). I believe our communities are strengthening to promote decreased access to guns."

Dr. Melzer-Lange said that the drug trade was probably the biggest cause of a spike in violent injuries among young people in 1995, and that she fears another injury epidemic if the trade in heroin continues to rise in Milwaukee and elsewhere as has been reported in recent months. "People who deal drugs do have guns," she said, "and I don't know if they're choosing right now to have kids do less of the dirty work. I don't think so."

Much of the funding for Project Ujima comes from the Wisconsin Victim of Crime Assistance Program, Dr. Melzer-Lange said, with other funding from the Allstate Foundation, Children's Hospital of Wisconsin, Medical College of Wisconsin, Allstate, and sources like the Danceworks arts agency (through United Way funding of "Girls Express" camps) and Theatre X funding a summer theater group.

Dan Ullrich
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.