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Bridging the Gap:

Community Violence Intervention at the Bedside


statistics for re-injury ratesBridging the Gap began as a pilot study in 2003, with services provided to Richmond area youth, ages 10-24, who had been admitted to VCU Health for intentional injuries such as gunshot wounds, stab wounds, and assaults.

Though no longer a study, BTG is a voluntary program that continues to focus on this population with the goal of reducing the rate of re-injury, and subsequent health care demands and costs often associated with violent injuries, by providing youth and their families with the services required to break the cycle of violence.

In addition to supporting and helping to coordinate appropriate follow up health care post-discharge, Bridging the Gap provides survivors of violence and their families with intensive case management services in the home and community environments in order to connect them with community resources that help with housing, enrolling in educational and vocational programs, assisting in finding positive social outlets, and accessing mental health services.

In addition to the BTG services described above, an intervention specialist meets with intentionally injured patients of any age admitted to VCU Health and assists with completing an in-hospital assessment and offer information on community resources that benefit victims of crime. In addition, the intervention specialist provides as-needed follow up with patients after they're discharged from the hospital.

Common Reactions to Community Violence

It takes time and support to heal from a traumatic event. Meeting with a counselor or joining a support group is often very helpful in the healing processCommunity violence is a violent crime that has a traumatic impact on victims, significant others, and the wider community. Although each person reacts differently in a crisis, it is normal to experience a wide range of emotions. Some common reactions to traumatic loss are listed below.

If you have been affected by community violence, we encourage you to be gentle with yourself, and to reach out to those who care about you for support. These feelings do not disappear immediately.

Shock, numbness, confusion: Comprehending the reality of the loss may be impossible: you may avoid full awareness of a reality too painful to absorb.

Excessive vigilance: You are constantly watchful and on guard, as if you are expecting a sudden attack and do not want to be caught unaware.

Increased reactivity: You are easily startled, others perceive you as "jumpy", you may lose your temper over relatively minor matters, or you may be unable to concentrate.

Intrusive recollections: Distressing images, thoughts, and memories of the traumatic events arise spontaneously and get in your way as you try to focus on daily tasks.

Reliving the experience: You act or feel as if you are back in the time and place you were when the incident happened or when you first learned of your loss.

Anger, resentment: Rage toward those who committed these crimes is normal; however, you may find yourself taking out the anger on others, such as your friends, relatives, or strangers.

Guilt: You may feel responsible for being unable to control the situation better, or simply for having survived.

Physical complaints: You may experience headaches, sleep and digestive disturbance, nausea, fatigue, and lowered immune function.

Withdrawal, isolation, avoidance: You may feel reluctant to go out, or unable to participate in activities you used to enjoy; you may seek to avoid reminders of the event(s).

Fear, anxiety, panic: You may feel that the world is no longer safe or predictable.

Pessimism: You may have a sense of a foreshortened future; for example, you may not expect to have a full life span or to reach normal milestones such as graduation.

Disorganized, distracted: You may be unable to perform routine activities, such as making shopping lists or paying bills.

Sudden temporary upsurges of grief: Suddenly you are overwhelmed by intense sorrow and anguish, even months or years after your loss, when there are "triggers" such as anniversaries, certain places or people, seeing something on TV, etc. 

* If you are having a mental health emergency or feel like you may harm yourself, please call 911 *

Contact Information

If you have been the victim of community violence —not related to domestic violence—live in the Richmond area, and would like to talk to someone about it, please contact the Bridging the Gap Intervention Manager, Zanda Miller, at (804) 628-2355, or you can email at zanda.miller@vcuhealth.org.

Bridging the Gap continues to work to identify agencies and organizations in the greater Richmond area that can offer resources and opportunities to serve youth and their families who are enrolled in our program.

Facts and Statistics on Youth Violence

When not accounting for race, unintentional injury (57.6%) is the leading cause of death in youth ages 10 to 24 in the United States, with homicide coming in second (20.2%).* But for black youth, homicide (55.3%) continues to be the leading cause of death. In Richmond, we have seen a significant drop in homicide rates among youth ages 10 to 24. We have decreased from a high of 120.74 per 100,000 in 2003 to 34.79 per 100,000 in 2015.

The below chart compares homicides for youth ages 10 to 24 in 2015 across the United States as a whole*, Virginia* and then Richmond**.

U.S. 7.94 Virginia 7.65 Richmond 35.79


In Richmond, nearly all of the homicide victims aged 10 to 24 are black. This is unchanged from 2003 through 2015.

Table of Characteristics of Homicide Victims aged 10-24 years

Race specific homicide rate (10-24 years)

Source: VCU Clark-Hill Institute for Positive Youth Development

  • From 2004 through 2017 there has been a decrease in the rate of 10 to 24-year-olds visiting the VCU Medical Center Emergency Department with injuries. A high of 64.6 per 1,000 was reached in 2006, and a new low of 42.0 was achieved in 2017.
  • Intentional injury rates dropped by more than half in from 2004 to 2017 (9.8 in 2004 to 4.0 per 1,000 in 2017).

Rate of VCU ED Injury Visits 10 to 24 year olds


  • While the overall trend for intentional injuries and homicides is trending downwards, the numbers in Richmond are still significantly higher than state or national averages. The work of our Injury and Violence Prevention Programs continue to be vital.

*Statistics from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System (WISQARS™)

**Statistics from VCU’s Clark-Hill Institute for Positive Youth Development; Mascho, SM and Bishop, DL. April 2018. Trends in Homicide Among Youth in Richmond, Virginia, 2003-2015. Accessed May 31, 2019.