At the height of the COVID-19 pandemic, Chuka Emezue watched as a few men in the domestic violence intervention program he directed struggled to stay awake or were distracted in remote video calls. Though some participants disliked the virtual instruction brought on by social distancing, a small but promising group was engaged by the flexibility it provided. Participants who responded well inspired Emezue to look into a rehabilitative solution rarely discussed: How technology could be used to reach Black youth who are exposed to violence.
In a study published earlier this year, Emezue, a nursing professor at Rush University, analyzed the use of technology to deliver mental healthcare remotely to high schoolers from minority backgrounds who may not have the resources to travel to a therapist. He and his team found that students who carried a gun in the past year were 4.8 times more likely to use mental telehealth services, like virtual therapy, than those who didn’t carry one.
“For young people who are carrying guns, we have to take a look at the violence that they are exposed to,” Emezue told me. “They are often victims and witnesses to violence themselves, and they are seeking out these services because they need support. These young people are hyper-vigilant and feel like they need to protect themselves, so imagine living your life like that — every day like it’s a war zone, and for some of them, it is.”
As gun violence surges in rural communities and program funding remains precarious, virtual healthcare options provide an opportunity to reach areas with limited resources.
Telehealth, or the delivery of healthcare at a distance, can be facilitated through various media like video conferencing, smartphone apps, and audio or text messaging. The method has been researched since the 1960s when physicians monitored the health of astronauts in space, but it went largely underused until the COVID-19 pandemic forced many patients and physicians, as well as gun violence prevention workers, to adapt. The growth was unprecedented, but it also revealed challenges to virtual healthcare’s sustainability and accessibility.
Research has found that telehealth access is limited because of broadband availability, insurance options, and policy restrictions. Nationally, rural populations and communities of color are especially vulnerable to those factors, including sparse and spotty internet service. But when those variables are controlled for or changed, more people use virtual options.
In recent years, gun violence in rural communities and Southern states has skyrocketed, with gun homicides among Black rural youth now on par with those in urban areas; after decades of similar outcomes, the homicide rate for Black rural youth is now four times higher than the rate among white youth in similar areas.
People in rural communities have started to speak out about the lack of resources to address the crisis. Most gun violence prevention programs nationwide are delivered through partnerships with hospital-based programs or urban-based community violence programs, which are often not accessible in rural communities because of the lack of funding or hospital infrastructure. In the absence of other gun violence prevention models, telehealth could be the link to bridging the gap.
Emezue is part of a group of researchers and engineers who are developing a digital tool, the BrotherlyACT App, which would provide mental health resources to Black youth exposed to violence and substance abuse. “Researchers, funders, parents, and young people should give technology a chance,” he said.
The app has multiple elements including videos, comic books, and a chatbot feature for users to share their mental health concerns. During the testing phase, developers learned that there were key factors that made participants feel more comfortable using the app, including seeing people who looked like themselves in the treatment videos, guaranteed confidentiality, and real conversations with real people. The developers hope that the app can connect its users with support that they would not otherwise have access to, whether because of a lack of insurance or transportation.
Researchers have found success with remote healthcare in treating other health issues in sparsely populated communities, including cancer, diabetes, and HIV infections. In recent years, there has been a focus on how virtual tools could make mental healthcare — which has been found to have a direct connection to reducing suicide risk — more accessible, but that support hasn’t been consistent. During the pandemic, for example, states poured money into virtual options, but that funding has begun to wane. On the fringes of the conversation about access to remote mental health care, there have been mentions of firearm violence intervention, but the way these tools are used specifically in gun violence prevention is relatively unknown.
For young people who are carrying guns, we have to take a look at the violence that they are exposed to. They are often victims and witnesses to violence themselves, and they are seeking out these services because they need support.
Chuka Emezue, nursing professor at Rush University and a member of the team developing the BrotherlyACT App
Outside of the uncertainties, researchers are interested in the potential that telehealth has in sharing information about gun violence, and how that information could lead to harm reduction, particularly among gun owners and people at risk.
“It is very important to talk to survivors and victims about safety planning, but on the other hand, it’s also important to develop early prevention and intervention strategies with the gun owners,” said Ping-Hsin Chen, a professor at Rutgers University who, with a team, developed and researched a virtual training tool to share information about gun violence. A 2021 study showed the efforts of their work: Of all the topics discussed, participants initially knew the least about gun violence epidemiology compared to other health-related issues like depression or substance abuse. But when participants were presented with information on gun violence-related topics, and then surveyed, the average test score was 98 out of 100.
Those at the forefront of the telehealth movement underscore that, while remote treatment can aid in increasing access to support, it is not a one-for-one replacement for current firearm violence prevention strategies. One such model, hospital-based violence intervention programs, identifies patients who are at risk of retaliatory acts or reinjury, like after a patient is shot, and works to mitigate those risks.
Health researcher William Wical’s graduate work at the University of Maryland explored how the pandemic forced these hospital-based programs to transition to remote forms of treatment. He found that limited financial resources and an overburdened workforce led to difficulties in remote programming, specifically for groups most vulnerable to firearm homicide. Though he’s optimistic that something groundbreaking can be done to improve support services through technology, Wical also cautioned that it may fall short in meeting the needs of Black men with gun violence trauma, “because we have not truly addressed and thought about the root causes of why Black men’s health is devalued in society.”
The deep-rooted inequities in the American health care system are felt on many levels, and technology is no different.
“We live in a different world now where everything is advancing through the use of technology and everything is getting more sophisticated, but there is this thought process of when it comes to something like behavioral health for Black boys — how dare we try to sophisticate that,” said Emezue, the professor who developed the app for youth exposed to violence.
“Technology can’t replace what we already have on the ground,” he said. “It can only augment or supplement, and allow us to meet people where they are to get them the treatment they deserve.”
