Featured Sunnybrook Magazine Sunnybrook Magazine - Winter 2021 Trauma

Breaking a dangerous cycle of violent injury through the new BRAVE program

From left to right: Michael Lewis, case manager, BRAVE; Illana Perlman, social worker, Tory Trauma Program; and Dr. Avery Nathens, surgeon-in-chief at Sunnybrook.

From left to right: Michael Lewis, case manager, BRAVE; Illana Perlman, social worker, Tory Trauma Program; and Dr. Avery Nathens, surgeon-in-chief at Sunnybrook.

The repeat experience of injuries resulting from gun- or stabbing-related incidents is often the result of unmet social needs.

“We see it time and again where a patient is treated for a minor gunshot wound and then returns with a more severe injury from another shooting incident,” says Dr. Avery Nathens, medical director of Sunnybrook’s Tory Trauma Program. “We have an opportunity to intervene and prevent the second injury that may end – or significantly change – the patient’s life forever.”

Patients who experience the physical and psychological impact of violence can benefit from a hospital-based violence intervention program and approach that incorporates trauma-informed care with traditional medical care. Such programs are proven effective in reducing risk factors and optimizing the outcomes of young people negatively affected by community violence.

The Tory Trauma Program, under Trauma Services Manager Corey Freedman, launched Breaking the Cycle of Violence with Empathy (BRAVE) in October 2020. BRAVE supports people aged 17 to 30 who have been treated for a gun or stabbing injury by connecting them to a case manager to support them through their recovery for approximately six months.

“BRAVE uses the ‘teachable moment’ approach to intervene early and support the patient’s overall physical, social and psychological needs,” says Brandy Tanenbaum, injury prevention coordinator at Sunnybrook, who designed BRAVE based on models out of San Francisco and other U.S. cities.

With shooting incidents in Toronto doubling since 2014 and Sunnybrook seeing a rise in the number of violent injury patients, Dr. Nathens and Tanenbaum recognized an urgent need for this kind of program. A $100,000 grant from the City of Toronto to run BRAVE as a one-year pilot made it possible.

The BRAVE journey begins with patients still in recovery. They are visited by Michael Lewis, the program’s case manager, who brings extensive experience in community youth violence prevention. He is able to develop a rapport with patients and their families who are often looking for additional support, but do not know how to find it. Lewis continues his work after discharge by visiting patients as they continue their recovery in rehab or at home. In these visits, he learns about the patients’ circumstances.

“I get to know the patients as people and understand what their needs and goals are and begin to develop a case plan to implement over time as they are ready,” Lewis says.

Through conversations, Lewis is able to assess patients’ needs and start connecting them and their family with services. Connections can include victim services, peer support, education counselling, mental health and addiction services and more. Most important is the mentorship Lewis provides to the young patients, without the judgment or bias so often experienced by this patient population.

Support can look different for different patients, says Lewis. He recalls one young man with numerous gunshot wounds who was recovering very slowly and kept losing weight. With BRAVE, the patient was supported throughout his physical and psychological recovery. “Now back home and getting stronger, that young man has plans to study engineering,” Lewis adds.

Lewis says his job is to provide an empathetic ear, help people connect to services and nudge them to move ahead with their lives.

“When you meet people in trauma, you often run into patients who’ve been looking to make a change for a long time.”

About the author

Diane Peters