University Hospitals Rainbow Babies & Children’s Hospital researchers say their violence intervention program provides a template for addressing the cycle of gun violence in Cleveland as a recent study shows their participants were less likely to face repeat violence.
The Antifragility Initiative provides young gunshot victims and victims of other types of physical assault with mental health counseling to treat symptoms of traumatic stress, grief and loss.
"Antifragility is really what happens after the child is done with their surgeries, after the child's been discharged from the hospital," said Matthew Krock, the program's coordinator.
The program was developed in 2019 in response to a study showing many victims face violence again within a year of admittance, he said.
Reduction in repeat violence
That 2017 study showed 29% of Cleveland youth, ages 6 to 15, were reinjured violently within a year of being admitted to the hospital for gunshot wounds. However, a recent study by the Antifragility Initiative found much lower rates of repeat violence among the more than 600 youth who participated in the program, Krock said.
"After about five years, we were able to reduce that by about 10 points, so we thought that was pretty significant," he added.
These findings come as Cleveland faces an epidemic of gun violence, with one of the highest gun-related homicide rates in the country and the number of children being killed increasing by 50% between 2022 and 2023.
Gun violence is so common in the city that residents treat it as an accepted part of life, Krock said.
“I would hear things like, ‘I remember the first time I was shot,’ just things that indicated just how regular, normal these things were," he said. "There’s almost a sense of hopelessness about it.”
Addressing the trauma of gun violence is particularly important for youth, Krock said.
“Children are particularly at risk because they're not fully formed," he said. "I think trauma tends to affect them more and sometimes more profoundly in ways that we can't even really appreciate until much later.”
Antifragility also provides services, like mentorship and career advice, to build victims’ self-confidence and help them have more successful lives. The idea is for gun violence victims to become “antifragile,” emerging from their trauma stronger than before the incident.
The program was based upon similar initiatives in Chicago, Milwaukee, Philadelphia and Pittsburgh.
Push for more support
The study showing a drop in repeat violence from 29% to 19% is likely just the first of such studies as Dr. Michael W. Dingeldein, Antifragility's new director, wants to increase research funding, said Kathryn Wesolowski, the hospital’s director of community outreach. Dingeldein took over for Dr. Edward Barksdale in September 2024.
Such research is important to make a case for needed financial support for the program, Krock said.
“Long-term funding and consistent funding, it's definitely been a challenge and an obstacle,” he said.
Another funding option is Medicaid reimbursement for violence intervention work. This possible funding stream provides a more reliable source of support so Antifragility and programs like it, “don't always have to rely on the kind of waxing and waning grant funds that might come their way," Krock said. "I think that would go a long way towards shoring up long-term consistent funding for these kind of programs.”
Dr. Kyle Fischer, policy and advocacy director for the Health Alliance for Violence Intervention, which advocates on behalf of hospital-based programs like the Antifragility Initiative, said he is in talks with Ohio government officials to secure Medicaid reimbursement. Those talks will be ongoing for the next few months, he said.
One advantage to violence intervention programs is they are bipartisan, Fischer said.
“It's a way to address gun violence without getting into Second Amendment debates," he said.
The push for additional support comes as President Donald Trump is considering cuts to Medicaid and targeting programs focused on minority populations.
However, Wesolowski remains optimistic about securing financial support.
"I have found our hospital's philanthropic community and the Cleveland philanthropic community to be incredibly social justice-minded, to be incredibly committed to children and to be incredibly committed to closing health disparities," she said.
But Wesolowski acknowledged there could be difficulties ahead.
"I'm not going to be so Pollyannaish to say that what is happening on a global or national level could never impact us," she said. "But what I am saying is I'm incredibly grateful to our philanthropic community who has been steadfast in their commitment to programs that impact children and their families. I don't see any reason why they would end that commitment."
Looking ahead, the Antifragility Initiative wants to provide additional mental health counseling, potentially offering long-term group therapy, Wesolowski said.
“We recognize that there is a great deal of psychological trauma to children who are injured and hospitalized post-injury and that all of those children could possibly need some more support,” she said.
There's also a long-term goal to provide this support a wider patient population, Wesolowski said.
"I think that the hope is that as we grow, that we can provide even more services to not just the Antifragility patients, but to all of our patients who are traumatized by serious injuries and hospitalizations," she said.
