The Problem. When Scott Charles calls Philadelphia “the deadliest big city in the United States,” the numbers bear him out: More than 9,000 homicides in the city since 1988. And the neighborhood surrounding Temple University Hospital, where he works as outreach coordinator of the trauma center, is the city’s deadliest. There were almost 17,000 shooting incidents in the city between 2002 and 2011 and half of the victims were between the ages of 14 and 24.
One piece of the problem, Charles says, is that most people don’t realize the harsh reality of getting shot. In the inner city, he says, another piece is the street code that if one is shamed, shooting people in retaliation is honorable. How could he change attitudes toward gun violence among young people?
A Death in the ER. An inner-city teen has been gunned down. Clustered in a stifling section of an emergency room, about 20 high school students hear Scott Charles describe the last moments of Lamont Adams’ short life. Lamont, 16, was shot at least a dozen times several days after the police broke up a dice game that he had run from with his winnings. Other players apparently thought he had snitched. Police rushed him to Temple University Hospital with 24 entry and exit bullet holes in his body, two of them in hands he had likely raised to beg for mercy. He never left the ER.
The room is kept hot, Charles explains, because extreme loss of blood makes a person unable to regulate his or her body temperature. “Where’s Lamont’s blood?” Charles asks and answers himself: “It's on the floor of the squad car.”
Several of the students wince and one leaves the room. Charles keeps on. With one student lying on a gurney as a demonstrator, he describes how a tube is jammed down the victim’s windpipe, how ribs are sawed and separated, how the heart is lifted from the chest cavity, hopefully to be massaged back to life. Electrified shock paddles? Only on TV. Anesthesia? Sorry, no time for that.
The rest of the two-hour program gets no gentler. Students are ushered to the morgue, perhaps to see gunshot victims lying there. Then comes a class session including pictures of gunshot victims so gruesome they could not be shown in a family newspaper. The students are given morgue toe tags and asked to write the value of their life on one side. On the other, Charles asks them to write the names of people who would mourn their death.
“You've got the easy part, dude,” he tells them. “When you die, you die once. The people you leave behind die every day.”
From the Streets of Sacramento to the Streets of Philadelphia. Scott Charles grew up in a tough neighborhood in Sacramento, lost his father at nine and—like his four siblings—became a drug addict. Unlike the others, he beat the habit and has been sober for 27 years. Raised by an uncle who ran a Black weekly newspaper, he soon found his calling, working with youths who grew up the way he had. At age 21, he was hired as a consultant by the state of California to do just that. He went full time to create a statewide “rites of passage” curriculum for young Black males, many of them former gang members.
He met his wife, Camille, an academic, in 1994 and followed her to Ohio State University where he became a 28-year-old freshman. When she moved on to the University of Pennsylvania as a sociology professor, he went to work for Need in Deed, a Philadelphia nonprofit specializing in service learning projects.
One of the projects involved a group of students from North Philadelphia “who wanted to tell the stories of kids who’d been killed, and to highlight who these kids really were …. They felt that Philadelphians’ really didn't know these kids’ stories …. They were numbers.” Charles contacted Amy Goldberg, MD, chief of trauma surgery at Temple University Hospital, and “I found she had a passion for the very same thing.”
The two of them did a project, Charles said, “and she was blown away by the experience. The kids asked such good questions of the doctors.” Goldberg created a position for a trauma outreach coordinator and the following year, Charles started Cradle to Grave. This was in 2006, two years after Lamont Adams was killed.
In addition to counseling gunshot victims, also part of his job at the hospital, Charles was putting 50 youths a week through the program. As of 2013, some 7,000 had gone through it. At first, most were referred by the juvenile justice system, but soon he began to get requests from regular high schools. In addition to bringing home how terrible it is to get shot, he tries to disabuse the youths of the notion that “shooting people is honorable.”
Cradle to Grave Results. Unlike Lamont Adams, six out of seven people brought to Temple Hospital with gunshot wounds leave there alive. But they re-enter a culture where gun violence is common and retaliation and revenge are deeply embedded, Charles says. When he asks youths in his program how many know someone who has been shot, usually most in the group raise their hands.
An analysis of Cradle to Grave’s effect on inner-city students’ attitudes towards gun violence indicated, however, that even a two-hour program can make a difference. In a study published in the journal Injury, the authors reported administering a social science assessment tool, “Attitudes Towards Guns and Violence Questionnaire,” to 43 eighth and ninth graders attending inner-city high schools.
Students took the test two weeks before the program and again four weeks afterwards. The second test showed a reduction of about 24 percent on the subscale “Aggressive Response to Shame.”
“This effect is most pronounced in subjects who already display increased tendencies toward violence,” Charles, Goldberg and the other authors reported. “These results suggest that hospitals offer a unique opportunity to address the public health crisis posed by inner-city firearm violence.”
Growing up on the wrong side of the tracks, Charles says, “does give me a little bit of an advantage” in dealing with inner-city Philadelphia youths. “It provides me a bit of insight.”
But he quickly adds that “to be quite frank, the neighborhood I grew up in pales in comparison to the neighborhoods these kids grow up in …. I don’t know if I could have made it given these circumstances. It’s apples and oranges. I grew up in an area where people fought with their fists. You might get hit or, at worst, you might get stabbed.
“All kids should grow up feeling safe and it saddens me that these are kids who can’t,” he says. “What drives me is a sense of how unfair that is … not to be able to socialize without the threat of violence hanging over their head.”
Much work remains to be done, of course. In the early days of Cradle to Grave, Charles used to say with pride that no youth who had gone through the program had returned to Temple University Hospital as a gunshot victim.
“We no longer can make that claim,” he says, sadly. “I wish we could, but we can’t.”
RWJF Community Health Leader Perspective: Charles used part of the $20,000 personal award toward obtaining a graduate degree, a Master of Arts in Positive Psychology, at the University of Pennsylvania.
The professional portion of $105,000 went to hiring staff, including a recruiter/program coordinator, and getting materials necessary to expand the program.
“The award has been tremendous in terms of the attention we’re drawing to the program,” he said, including a recent story in the New York Times. “It took us to the next level. We’re no longer a small mom and pop operation that no one ever heard about. Now we’re getting more attention than we can handle, for better or for worse.”
RWJF Perspective. RWJF recognized the first 10 Community Health Leaders in 1993. They are unsung and inspiring individuals who work in their communities—often among the most disenfranchised populations—to address some of the nation’s most intractable health care problems. The formal recognition of these Robert Wood Johnson Foundation Community Health Leaders and their programs often launches them to greater levels of influence and extends their reach to serve more vulnerable populations. For more information on the program see Program Results Report.
Under the RWJF Community Health Leaders award, each year RWJF has provided a $125,000 award to 10 individuals and their organizations ($105,000 supports a project at their organization and $20,000 goes directly to the leader for personal development). RWJF also connects the RWJF Community Health Leaders with each other so they can continue their work with the support and experience of their peers and previous award winners.
“Community Health Leaders are characterized by three specific traits—they are courageous, they are creative, and they are committed,” says National Program Director Janice Ford Griffin. "The Foundation recognizes the tremendous resource of experience among the leaders and we look forward to mining that resource as we consider future initiatives."
“Through the Robert Wood Johnson Foundation Community Health Leaders award, we at the Foundation have the opportunity to recognize innovative and courageous local leaders behind ground-breaking efforts in communities across the United States,” said Sallie George, MPH, program officer at RWJF. “These individuals remind us that one person can have a powerful impact on health and health care within their communities.”
The last round of leaders was chosen in the fall of 2012.