Are Doctors the Key to Ending Philly Gun Violence?

Stephen Leff, Ruth Abaya, and Joel Fein of CHOP’s Violence Intervention Program. Photo by Claudia Gavin

The sunlight and the tease of perfectly mild weather lured Nikki Jones and her son out of their low-slung West Philadelphia rowhouse on March 23rd.

Jones planted herself on her porch. Nasir, 14, was right by her side. It was late in the afternoon, and the temperature had edged into the 70s. All of the kids in the neighborhood were running around outside, but Nasir didn’t budge. Jones is the kind of mother who worries about of all of the things that can go wrong once her son leaves her line of sight from her perch on Callowhill Street near 63rd.

A flurry of motion caught her eye across the street. It was Zakee Watkins, 17, waving at Jones and her boy. “He had his little earphones in. We waved back,” Jones says. “I’ve known him since he was a little kid, maybe like 10 years old.”

By that point in the day, three people had already been shot in Philadelphia. At 5:04 p.m., Watkins became the fourth. Six others also fell to the ground across the city that night, after gunmen punched holes into their bodies. Watkins lingered somewhere between this world and the next for a day or two at Penn Presbyterian Medical Center. And then he was gone.

This story —  a young man dying at the hands of an equally young triggerman on the streets of a hollowed-out neighborhood that aches with despair — has been told countless times in Philadelphia over the last decade or two. Everyone is sick of the senseless bloodshed, including doctors at Children’s Hospital of Philadelphia. And now they’re wading waist-deep into our inner city war zones, trying to disrupt the seemingly endless cycle of youth violence.

They’re downright optimistic — a word that doesn’t get thrown around lightly in these parts — that they can steer some of the city’s at-risk youth towards better, safer paths in life by continuing to treat them even after their wounds have been patched up, and digging into the problems the kids face at home, in their neighborhoods and at school, the supposedly safe spaces that are often anything but. This is more than just pie-in-the-sky talk; CHOP has invested at least $1 million annually during the last three years on fighting youth violence.

The hospital’s efforts caught the attention of City Council’s Committee on Public Safety when it held a day-long hearing on youth gun violence last month. Joel Fein, the co-director of CHOP’s Violence Prevention Initiative, testified about a promising program that is changing the way juveniles think about the world around them, and the choices they make. So on a recent rainy afternoon, I met in University City with Fein and two of his colleagues — Stephen Leff, VPI’s other co-director, and Ruth Abaya, who spent three years in CHOP’s emergency department as a fellow, and another one as an attending physician —  to discuss the hospital’s Violence Intervention Program.

Fein, 53, said the program grew out of the aftermath of the 2012 Sandy Hook Elementary School massacre in Newton, Conn., and internal discussions about how CHOP could respond to the ever-growing instances of kids becoming gunshot victims. There was no question this was an issue crying out for new ideas; when the city made an earlier attempt at addressing youth violence under then-Mayor Michael Nutter, his administration reported that 5,051 juveniles had been shot or murdered in the city between 2006 and 2012. More innovative approaches were clearly, desperately needed.

Since 2013, CHOP has screened more than 108,000 juveniles for bullying and behavioral health issues including depression, suicidal thoughts and access to firearms. Out of that total, 75 young patients and their families have received the extensive, individualized care that VIP offers. And at least 3,400 school kids have received bullying prevention lessons in school classrooms.

Here’s how VIP works: CHOP social workers screen all juveniles who come into the emergency room to be treated for violent injuries, and refer ones who are clearly grappling with deep-rooted problems to members of the VIP team, like Fein or Abaya. They carefully try to get the kids to explain their backstory. Simple questions come first — What led to you visiting the hospital today? What’s going on at home? — and then tougher ones.

Abaya said juveniles are asked if they’re capable of getting their hands on a gun within 24 hours…if they don’t have one already. A chilling number of the children not only confirm that they could find a gun that quickly, but also outline the steps they’d take to acquire it. “They’ve thought this through,” she says. “They’ll say, ‘I would do this, then I would do this, then I would call this guy.'”

The conversations don’t end there, though. Abaya says the kids are told to imagine what would happen if they did have a gun, and then encountered the person who hurt them, or someone else they’re upset with. How would that scenario end? The juveniles are also asked who could stop them from picking up a gun, or pulling a trigger. Often, Abaya says, the answer is a strong female presence in their lives: a grandmother, a mother, a sister.

If the Q&A sessions go well, and the kids agree to continue working with CHOP docs, more intensive sessions follow. VIP specialists meet with kids at the hospital and in their homes, touching base at least once a week, for six months to a year.  “It’s hard for them to imagine something they’ve never seen before,” says Abaya, 32. “So if you’ve never seen a conflict resolution pattern that didn’t involve a violent resolution, it’s hard to conceive of anything else.”

Most of the teens the doctors have worked with have confessed that they don’t want to live a world that involves life-or-death choices at an age when they’re supposed to be focused on simpler things, like playing sports or video games and going to the movies with their friends. The hope, Abaya says, is that CHOP is providing them with tools they can use to navigate dangerous situations, and emerge in one piece.

Convincing teens to talk about their feelings, and hypothetically explore the violent things they’d consider doing to protect themselves isn’t an easy task. But CHOP has something going for it that the Police Department and the District Attorney’s Office don’t: the doctors themselves. The juveniles who participate in VIP have shown a willingness to listen to medical professionals who are tending to their physical and psychological wounds, more than they would with a detective or a prosecutor. “Some patients will expressly articulate that because you guys are doctors, we we want to know what you have to say,” Abaya says.

It’s difficult to quantify the impact that an effort like VIP has. You can’t definitively say that because CHOP has worked with 60 troubled teens, 60 shootings or murders have been averted. And there are other programs working with youths who have either been the victim of a violent act or seem likely to commit one themselves, like Healing Hurt People, which is based at Drexel University’s College of Medicine and the emergency department at Hahnemann University Hospital.

But CHOP is now planning to measure outcomes for kids who participate in VIP. In the meantime, the program has led to tangible success stories, Fein says. Local kids who were clearly teetering on an edge have gone on to attend college and find their first jobs, simple things that all parents want their kids to experience.  There have been few instances of the program’s participants getting re-injured. The city needs more silver linings like that.

“People ask us, why is CHOP involved in violence prevention? I think we’re basically trying to create situations where children grow up into healthy adults,” he says. “A lot of these kids don’t see themselves as having a future much past adolescence because they’re living in an environment where they see things happening all the time, and it’s traumatizing them to a point where they’re not necessarily seeing their future. But we know they do have a future, and we want to make sure that future is a kind of healthy, happy one just like anyone else would want.”

IT’S AROUND LUNCHTIME on Tuesday on Callowhill Street, and Nikki Jones winces as a sudden gust of wind yanks her screen door out of her hand. She wants to be as optimistic as Fein about the future that awaits the kids in her neighborhood. She tells her son that he needs to focus on his grades, to set goals and dream about what he wants to be as an adult. “You don’t have to stay in the so-called hood all your life. You don’t have to be a product of this environment. You can look beyond that,” she says.  “I don’t like that excuse, ‘Well this is how I grew up.’ It’s bullshit. You don’t have to do this.”

But the everyday reality that she sees is often crushing — teen pregnancies, deep poverty and unending danger. “Kid walk around here with guns like they are the police,” she says. “Back when I was younger, that would have scared me. If one of my friends got killed, I’d be nervous, scared. Nowadays, it’s not a big deal….this generation is lost.”

A few blocks from Jones’ home, rain falls on a small memorial for Watkins that his friends left on a walkway near Cobbs Creek Park. Two teddy bears sit next to a baby blue bunny rabbit that is facedown on the pavement. Votive candles surround the saturated stuffed animals, their flames long since extinguished.

Watkins’ slaying is thus far unsolved. According to police records, an eyewitness who was standing at 63rd and Race streets on March 23rd called 9-1-1 and described the scene that played out in front of him: a thin black man who appeared to be around 18-years-old and about 5-foot-6 just started firing at Watkins, who was hanging out in nearby Cobbs Creek Park. A young woman who was walking near Watkins heard him yell out one word — “Run!” — as the gunshots erupted. Patrol cops raced to the scene. They found Watkins in the creek, shot in the back.

The shooter fled, despite efforts of one witness to hold him at the scene until the cops arrived. Watkins, meanwhile, had no vital signs by the time police transported him to Penn Presbyterian. Doctors revived him — briefly. No one answered the door earlier this week at the house that was listed as Watkins’ address at 64th and Callowhill.

Police records show that Watkins had a handful of prior arrests — two for narcotics, one for theft, one for assault. Whether those incidents had anything to do with his murder is unclear. Fein cautions that people often look for a line like that, about prior arrests, as a reason to shrug and disengage. “They all want to know that [the victims] were bad kids,” he says, “but these kids want to grow up to be good people. Sometimes there are things going on around them that are out of their control.”

“It’s sad. A lot of kids around here die young,” Jones says, letting out a heavy sigh. “They’re babies. They don’t even experience life. This generation, this is all you hear about: guns. Especially in the inner city. It’s like they’re forgotten about.”

On March 29th, six days after Watkins was shot, his loved ones gathered for a vigil. A few hours after the event ended, the neighborhood was once again peppered with the sound of gunfire, with shots being reported on Simpson Street near Race shortly after 9 p.m. Then a 14-year-old from Yeadon turned up on 60th Street near Callowhill with a gunshot wound in his back. Two of the teen’s friends told police they simply found on him splayed out on the ground. He survived the shooting, but investigators have had a difficult time getting to the bottom of how the boy ended up with a bullet in his back.

Hopefully, his story won’t end with another pile of teddy bears and tiny candles growing soggy in the rain.