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Breaking the Cycle of Abuse Violence Prevention Programs at UCSF 05.08.06 
For too many Bay Area residents, violence has become a familiar part of life. Health care professionals are confronted with it on a daily basis. Emergency physicians see battered or raped women; pediatricians uncover domestic violence in the homes of their young patients; and trauma surgeons routinely come face to face with the victims of gang shootings and street stabbings. Troubled by the human toll, many UCSF physicians, psychologists and students have applied their minds and consciences to help break the cycle of abuse. They are spearheading programs to reduce violence, whether it begins at home, on the streets, or in a bar or nightclub. Living in a Nonviolent Community (LINC) It's one of the darkest secrets in medicine: the numbers of men, women and children who are victims of domestic violence. They come into doctors' offices with various complaints, such as headaches, depression, and anxiety. Some women suffer chronic pelvic pain and vaginal bleeding. Among children and teens, symptoms can manifest as sleep disturbances, clinginess, hyper-vigilance, aggression, school troubles, or drug use. Alarmed by the scope of domestic violence and child trauma that they encountered, UCSF physicians and medical social workers in the Department of Pediatrics, and clinical psychologists in the Department of Psychiatry at SFGH founded Living in a Nonviolent Community (LINC) in 1999. The program is part of the UCSF National Center of Excellence in Women's Health. LINC provides individual and family counseling and case management to children and families affected by domestic violence. It also conducts community education on domestic violence. A large part of its work involves training medical professionals to screen for abuse (see sidebar for information on training video.) The program is based on the principle that violence is a public health problem and a pediatric issue - one that can be prevented through community education and clinical treatment. Jessica Lipkind, Psy.D., LINC's post-doctoral clinical psychology fellow, treats younger children with play therapy, counsels adolescents, and works with parents. She says that she has seen domestic violence affect families from the Western Addition to Pacific Heights. "When it comes to domestic violence, it spans the socioeconomic spectrum." "Watch Your Drink" Campaign Another type of violence is making the rounds at night. In the city's bars and nightclubs, date rape drugs, such as gamma hydroxybutyrate (GHB), rohypnol (“roofies”), and others , continue to make their way into drinks. When victims - mostly, but not exclusively women - swallow the drugs, "they feel dizzy, nauseated and confused," says Alicia Boccellari, PhD, director of the Division of Psychosocial Medicine a the UCSF/SFGH Department of Psychiatry. "When they wake up, they're not sure where they are. They wake up on the street or in the apartment of someone they don’t know." Unfortunately, many have been sexually assaulted, although they may have no memory of the event. Under the leadership of nurse practitioner Ann Brennan, the UCSF/SFGH Trauma Recovery Center has partnered with the Adult Sexual Assault Task Force of the City of San Francisco, which includes the SF Police Department and San Francisco Women Against Rape, among other community agencies, to educate the public about ways to prevent alcohol- and drug-related sexual assaults. Guarding one's drink carefully so that drugs can't be slipped into it, is one such measure. Brennan says that people should watch their drinks being poured, use a buddy system, and avoid accepting drinks from strangers. They should also alert a friend right away if they feel unusually impaired after only one or two drinks. And everyone should be mindful that consuming too much alcohol by itself may put a person at risk. 
The campaign is educating bar and nightclub owners about the issue, and customers who frequent these venues can now find postcards with educational info printed on them. The campaign has also spread the message at street fairs. "The word is getting out," Boccellari says. The Wraparound Project As a trauma surgeon, UCSF Assistant Professor of Surgery Rochelle Dicker, MD, has treated plenty of patients who have been shot or stabbed during street or gang violence. Again and again, she noticed the same young men being admitted to San Francisco General Hospital. "Some people would come back in a short period of time, re-injured," she says. "We had one 19-year-old who was shot, we dealt with the injury, and he was shot again two weeks later." That's when Dicker realized that healing the wounds wasn't enough. "It prompted an interest in me to do more than just sew someone up and send them back out again," she says. Three years ago, Dicker started the Wraparound Project. So far, 64 clients have gone through the program, about 96% of them young men, most of them having felony backgrounds. Wraparound is open to youths and adults ages 14 to 30. After patients have been treated for injuries related to youth or street violence, they're eligible to meet with Wraparound's case manager, who came out of a background similar to those of the young people he helps. For at least six months, sometimes longer, the case manager works with them, connecting them to community resources that assist with education, employment, anger management and substance abuse. Early data have been encouraging; participation in the program seems to lower the rate of recidivism from 40% down to 10%. By reducing the risk factors for violence - including substance abuse, unstable family and housing situations, and poverty - the Wraparound Project hopes to help young people steer clear of the pernicious dangers that leave too many hospitalized, often fighting for their lives. Source: Katherine Kam  |
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