How an Intervention Program Stops the Revolving Door of Violent Injuries

Darius Irvin grew up in violent neighborhoods in Oakland and San Francisco. While Irvin was never in a gang, he was around them a lot. One winter when he was back home in Oakland from his freshman year of college up in Chico, he knocked on the door of his barbershop. He wanted a local haircut to show off when he returned to school. Before he could get inside, though, he heard gunshots and felt a piercing pain in his buttock. He'd been shot.

He survived, but the recovery took almost two years. Then he was shot again, this time at a party in Oakland. A stray bullet hit him in the back right shoulder, where it remains today. After more recovery, he planned to move to San Francisco for a fresh start.

While job searching, he stopped at a convenience store in the city. There again, the gunshots found him. "I pretty much remember the freezer glasses busting, chip bags popping over the shots ringing out," Irvin says. He fell to the ground, sitting in his own blood, thinking "Is this true? This can’t be happening right now."

This time he was shot with nine bullets, again by someone he did not know. He was rushed to San Francisco General Hospital.

It was there something unexpected happened. "All I know is I woke up and there was Popeyes," Irvin recalls, referring to one of his favorite fast food restaurants. "I had some Popeyes chicken on my bed, and I love Popeyes."

That’s because the Wraparound Project had stepped in to help. It's a program based at San Francisco General Hospital. Wraparound's goal is to reduce re-injury for young people who have been violently hurt, through either a shooting or stabbing.

Repeat injury for survivors of violent crime is remarkably high. Studies show 44 percent of people who have been shot or stabbed get violently injured again within five years, and that one out of five of those people die.

UC San Francisco professor and doctor Rochelle Dicker saw this in her own practice. During her internship years ago at the SFGH Trauma Center, she stitched up a 16-year-old who'd been violently injured, only to see him return some weeks later with even worse injuries.

Dr. Dicker started to look at violent injuries as a public health issue. "Unless you go upstream a little bit to figure out ways to prevent future injury," she says, "you’re really not putting a lasting effect on the idea of improving population health and improving individuals."

With that, Dicker created the Wrapround Project in 2006. The program literally provides "wraparound" services like mentorship, job training and even getting clients their favorite foods. The program serves 10- to 30-year olds who end up at SFGH. And there's no cutoff date for support.

Since the program's founding 10 years ago, the return visit rate for violent injuries at the hospital has fallen from 16 to 4.5 percent. Programs based on Dicker's work have started in Indianapolis and Davis.

This type of intervention work is expanding nationwide. Wraparound is part of the National Network of Hospital-based Violence Intervention Programs (NNHVIP), a growing group of programs across the United States that not only focus on re-injury prevention, but also on reducing retaliation for crimes.

Wraparound's case managers come from the same communities as the clients, which gets at the program's goal of providing culturally competent services, and staff like case manager Mike Texada intervene right as patients wake up and realize they’re alive.

"We call it the teachable moment," he says. "That’s when you have time to offer services, you got time to have a conversation, you got time to have dialogue with that individual who’s injured."

When Texada met Darius Irvin, the case manager immediately saw Irvin light up when they talked about college. Irvin had lost hope about ever attending a four-year university after all his health setbacks.

"When I visited Darius at bedside and I told him about college he was like, 'Man, quit trying to gas me up,' " Texada says about Irvin's incredulity. "And I was like, 'Dude, I’m serious.' "

He was. Texada connected Irvin to a program that helped him get into San Francisco State University, a college Irvin had dreamed of attending since high school.

Now at 26, Irvin's a sophomore at SFSU. He studies juvenile justice and sociology, and he’s on the honor roll.

"It’s crazy," he says walking through the green, bustling campus. "It’s kind of too good to be true." He points out his favorite spots on campus. "Everything I’ve been wanting and looking for is coming to me on behalf of the university."

Looking at Irvin, you’d never know what he’s been through, or that he questioned if he'd ever be able to walk regularly again. But now he walks seamlessly, smoothly. When asked about it, he laughs and says, "Chin up with a positive stride. It's called a 'thankful walk.' "

Music in the audio version of this story is "Father Lee" by Black Ant from "Free Beats Sel. 3," and "Only Knows," "The Collector," and "Note Drop" by Broke For Free from "Layers."