May 2003

(Editor's note: Dr. Calvin Johnson, formerly a consultant to Philadelphia Safe and Sound and featured in this article, was recently nominated by Pennsylvania Governor Ed Rendell to be secretary of the state Health Department.)

Like many cities, Philadelphia is instituting a weapon-related injury surveillance system (WRISS). The extraordinary thing about Philadelphia's WRISS is that in an attempt to decrease the city's repeat injury and fatality rates, it includes an intervention component so that many firearm victims can get the services they need.

The rationale behind WRISS has both macro and micro factors, according to Dr. Calvin Johnson, who as a consultant to Philadelphia Safe and Sound led the development of the current system. "The epidemiology of intentional injury is not well known," he says. "Understanding the circumstances surrounding these injuries will help the city to better target prevention and intervention efforts."

For individuals, though, WRISS will help prevent a situation of "victim today and shooter tomorrow, or injury today and fatality tomorrow."

Under the system, when a firearm victim comes to an emergency room, hospital personnel report the situation by simply calling 911. The police department gathers data on the injury, as part of its normal investigation process.

"We realized that the police gather valuable public health information, for example information about demographics or situational information," says Johnson. "Police get more accurate information; the initial information that hospitals get may not be accurate particularly if the shooting occurred under suspicious circumstances."

Then, the police department shares the data with adult and juvenile probation, the Department of Human Services, and the Department of Public Health. With the information, probation and human services can see if the victim is part of their current caseload and, if so, intervene with the individual according to their existing protocol and define a course of action. Some things they might look at are whether or not there are other kids in the household and what other risk factors may be involved. The department of health uses the information for public health planning.

Since the Philadelphia City Council passed an ordinance mandating reporting of all weapon-related injuries in 1995, the development of WRISS has overcome several challenges, including hesitancy by the medical community to participate due to confidentiality and other issues, and limited enforcement by the city.

In 1999, the system was redesigned. The reporting process for hospitals is now simpler, and some confidentiality issues have been resolved.

But there are still challenges ahead, according to Johnson. These include the limited scope of the system, now covering only firearm injuries; a goal is to include other weapons. Also, the system now results in interventions only for those victims currently part of the probation or human service caseloads. Johnson says the next step is to further address confidentiality so that interventions can be given to victims not currently involved with probation and human services.
.

Also, Johnson believes WRISS needs to be institutionalized so that the system works even after the individuals within the various agencies who now are a part of it are no longer in their current jobs.

Those challenges mean WRISS is still somewhat in an evolutionary phase. Nevertheless, Philadelphia's WRISS is already unique in the country. To get it developed, Johnson says Safe and Sound was "the initiator, facilitator and convener that got all the disparate and large bureaucracies together to make it happen."

For more information on this website about Philadelphia Safe and Sound, click here. For more articles on this website about youth violence prevention, click here.