The boy sprawled on a gurney in the hallway of Johns Hopkins Hospital's emergency room is wearing a cervical collar. Blood flows from under it, stretching down the left side of his chest and armpit. The boy, named Corey, says a 13-year-old female friend of his girlfriend's stabbed him during a fight over a borrowed cup of sugar, but no one's believing him.

Corey, 16, will be OK — the blade missed his carotid artery and his wound has been closed by a couple of staples. He'll walk out of the hospital in a matter of hours. But for members of a program designed to stop retaliatory violence in a city that regularly registers more than 300 homicides per year, the worry is just beginning.

For more than a decade, Child Development-Community Policing (CD-CP) trauma response teams have tried to put themselves between victims like Corey and those whom they might, in turn, victimize. CD-CP is made of up of 300 mostly volunteer members who have each gone through 24 hours of training. Using a model adopted and modified by researchers at the Bloomberg School of Public Health, the teams learn how to defuse situations that can too often result in cyclones of violence.

"They endangered mine!" he says.

"You need to let this go!"

"Not unless they going to."

Desireé Glover, a counselor at a community mental health partnership run by Johns Hopkins Hospital, tries a different tack, asking Corey if his family has suffered violence before. "My mother tried to stab my father a long time ago," he says, adding he hasn't seen his parents in years. His mother is in jail and he lives with his grandmother.

Corey mentions that he and his girlfriend have a 3-month-old son. Glover senses an opening. If Corey's retaliation were to escalate to a new round of violence that hurts him or his girlfriend, the child's future would become clouded. "Don't you want your son to have both parents around?" she says.

The 16-year-old nods, then becomes quiet.

Last year, CD-CP members made more than 400 visits, checking on victims under the age of 18 to discuss how they were injured and what they planned to do to those who hurt them; giving talks in neighborhoods that have asked for help in stemming a tide of violence; and making calls on families of children who have been injured in accidents, as was the case with two toddlers who were recently run over by a van on the city's west side.

The trauma response process starts with a call on a police pager that Essex Weaver, the retired police officer on Corey's team, carries with him 24 hours a day. After being beeped about an incident, he'll call a police dispatcher to confirm the victim's age, then assemble a team of three or four. Although they want to make their first contact with victims in the hospital, they don't rush. If a victim is under 16, they can't legally talk with him or her without parental consent. "We want to give the families time to get there," Weaver says. "Our goal is to let them know we can help them manage the trauma and defuse the situation. We give them brochures on how to deal with it and offer them support for then and for later, when we can hopefully talk with them in their homes."

Orlando Fleming, the community liaison on Corey's team, says such conversations often lead to talk of payback. The more young people present at the hospital with a victim, he says, the more likely it is the trauma response team will hear about the prospect of brutal revenge. "We always ask about retaliation," he says. "In this case, we don't know whether Corey was hurt because he's a gang member or whether the girl who stabbed him is. We do what we can to get to the bottom of it."

CD-CP was conceived 12 years ago after Philip J. Leaf, director of the Center for the Prevention of Youth Violence, noticed that kids enrolled in another program he had designed were being shot at an alarming rate. From his prior academic experience at Yale, Leaf knew of a program in New Haven, Connecticut, that dispatched specially trained police and child psychiatrists to visit kids immediately after they had been subjected to violence. He contacted the Yale team and linked them up with Baltimore police and community advocates. "Unfortunately, we sent the Yale team on some drive-alongs [with police] in the late afternoon and evening. As a result, the Yale team concluded that Baltimore would never be able to mount a trauma response team because of the level of violence," says Leaf.

Leaf persevered, using funds from a Hopkins-led mental health partnership to send a group of volunteers to New Haven to be the Baltimore program's first trainees. Even though the program is now long established, Leaf worries that CD-CP — financed at various times by Baltimore City, the state of Maryland, and federal grants to Hopkins — hasn't gotten enough support to perform scientific evaluations of its work. "Without the advocacy of Hopkins, there would be no proactive trauma responses in Baltimore for victims of gun violence," Leaf says. He has been heartened by the fact that the office of Baltimore Mayor Sheila Dixon has inquired about collaborating with CD-CP on developing responses to homicides.

As for Corey, trauma team members hope they planted the thought in his head that he can call them for help. "I'd certainly like to think he'd make himself available for a follow-up," Glover says. "I'd hope his grandparents could give us some idea of the family dynamics behind this, the story behind it, so we can understand how to help."
— MA

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