The most courageous people Clinician Keith Gilliam knows are victims and families who cope with attempted homicide or the loss of a loved one. Their circumstances are all too common in the emergency room at Boston Medical Center.

Last year, there were 191 victims of gunshot wounds and 264 victims of stabbings treated at the hospital—including more than half of all reported homicides in 2011. Out of the four level-one trauma centers in the city, Boston Medical Center consistently receives the highest number of homicide victims for emergency services.  

Although the Violence Intervention Advocacy program was already in place, the need to provide immediate and long-term medical services was clear. In August of last year, the Community Violence Response Team began providing free counseling services to those impacted by violence. The group is made up of one child and one adult clinician, including Gilliam, a licensed medical health counselor who sees the older patients.

“The mental health component is so important and a necessary piece. The clients -the survivors- are some of the strongest people that I’ve ever met,” he said.

In the first six months since the team’s inception, Gilliam and his colleague Andrea Malagon-Meagher have already seen 162 patients and family members affected by attempted homicide and 44 people coping with the loss of a sibling, child or parent. Dealing with trauma is different in each incident, but the recovery process is always a long one, he says.

Gilliam continues to check in with patients from the start of his term. Many of them come to him from doctor referrals. But often times, he begins therapy with victims right at their bedside when they wake from surgery. Whether it’s counseling a family member or a person who has suffered a gunshot or stab wound, each person manifests grief and trauma in their own way. Gilliam says he has to be as accommodating as possible when understanding his patients’ needs. At the same time he has to ensure they are safe after being discharged.

“I think the most important part is to be as flexible as possible,” Gilliam says. “Everyone grieves differently and experiences trauma differently. And you have to understand where folks are in the grieving process and be as supportive as you can be.”

Safety issues are at the forefront after a homicide or an attempt has occurred. Gilliam may work with a social worker to find alternative housing with a relative or at a shelter outside of the city. He also has to determine if the person was a victim for any negative activity in the community.

Gilliam reinforces the number of different components to trauma counseling. He tells his patients that what they are going through—increased anxiety, anger, denial and post-traumatic stress symptoms—are all normal. In turn, they are able to express what they need to get out of sessions, which he says is crucial.

“Grief is a journey, and there’s a lot of hard, difficult patches at times,” he reminds his clients. “There’s no time limit for when someone stops grieving. You’re always going to carry that loved one with you.”

The Community Violence Response Team’s trauma services are part of an overarching commitment of injury prevention, research and practice. Funding for the group is provided by a one-year grant from the Massachusetts Office of Victim Assistance through the American Recovery and Reinvestment Act and the Victims of Crime Act. Boston Medical Center is the only institution in Boston to receive the grant.