AMRPA Conference Coverage

Victims of violence go public for prevention

Prevention model fits large and small efforts

Imagine training young men who survived being shot in the head or back during gang violence to speak with children and youths about avoiding violent situations, helping not only the children but also the ex-gangsters by giving them a meaningful role to perform despite their severe injuries. This is exactly the sort of work that many rehab facilities now are doing as part of a national violence prevention effort that is promoted by the Think First National Injury Prevention Foundation of Rolling Meadows, IL.

More than 125 rehab facilities participate in the Think First program and, while most of them do not work with former gang members, all have patients who were injured because of violence or car crashes, says Dorothy Zirkle, MSN, RN, chief executive officer of the Think First Foundation, which has 258 chapters in the United States and 40 chapters internationally. (Web:

VIPs reach out to youth

Called VIPs, which stands for Voices for Injury and Violence Prevention, people, ages 18 to 40, who have suffered from traumatic brain injuries or spinal cord injuries serve as a cornerstone of the prevention program. They train to be speakers who promote violence prevention to children and youths, she says. "The work gets people back into the community, and it gets them up out of bed," Zirkle explains. "They build self-worth and value in their lives, and their depression decreases as their productivity increases." Children who have had traumatic injuries also may participate in after-school events, such as health fairs, she says.

VIPs often are paid for their time, and their skill at speaking is developed with practice and mentoring by rehab nurses and therapists who also participate in the program, Zirkle adds.

The key to Think First’s success is its dual role in providing a needed service to the community and in providing goals and positive work to people who have disabilities due to violence. "There are ex-gangbangers like some VIPs in San Diego who were shot in the head or back or who were beaten over the head with a bat, locked in a trunk, and shot," she continues. "These are kids who had no aspirations before and now have become part of the program and are productive citizens."

These ex-gang member VIPs go to juvenile halls to speak with at-risk kids about their own injuries and violence, Zirkle says. "Our VIPs have tattoos on the back of their heads; these were bad kids, and they were severely at-risk youths who were killing people," she says. "And now they’ve turned their lives around by going to rehabilitation and being approached by our program to go out and speak with kids."

Some of the VIPs were so empowered by their speaking experiences that they’ve returned to school and even enrolled in college courses, adds Zirkle.

Likewise, rehab patients who had been injured in car crashes also prove to be good prevention speakers. "Most of our speakers are motor vehicle crash victims," she says. "We call it car crash and not accident because chances are that no matter what it was it could have been prevented.

"Motor vehicle crashes are the leading cause of death and injury for people before age 34," Zirkle says. "The unique thing about creating your own injury prevention, community-based program is that whatever is happening in your community, those are the kids who will end up in your rehab center."

If there’s a problem with snow machine and skiing accidents, then those are the patients from whom a rehab facility could recruit VIPs, she notes. "VIPs usually talk about who they were before the injury, how they sustained the injury, and what their life is like now," Zirkle says. "It’s not meant to be a downer — it’s a very positive program that is more encouraging than depressing."

VIPs answer questions from kids, and the rehab staff or other speaker will provide the audience with background information about that person’s experience in rehabilitation and trauma centers, she adds. "The VIP is never out there by himself."

The person who accompanies the VIP will facilitate the speech by telling the VIP’s story the first time the VIP is speaking before an audience and then asking the VIP to fill in certain details, she points out. "You nurture and guide these kids, helping them create a craft and enhancing their voice," Zirkle says.

The rehabilitation professionals also may fill in with an introductory video and information about anatomy, physiology, the permanency of injury, statistics, and the possibility of becoming injured based on age, she says.

Rehab facilities pay $500 to start a Think First chapter, a price that includes training, Zirkle says. "You can grow the program to whatever cost you want it to be," she explains. "It can be as minimal as utilizing individuals working for the rehab facility and using volunteer VIPs and finding grants to cover expenses."

Or it could grow to a program that is budgeted at $500,000 a year from philanthropic sources, as is the program at Sharp HealthCare in San Diego, where the program includes 19 paid VIPs, five full-time community health educators, and research and injury prevention activities, Zirkle says. "When [Sharp] started the program, the nurses were expected to drive their own cars and the families drove the VIPs to the schools where they’d speak," she says.

Now, 15 years later, Sharp’s Think First program has two wheelchair accessible vans for transporting VIPs and health educators, and the program connects with 300,000 people each year, Zirkle adds.