In 2022, there were 877 non-fatal shootings in Milwaukee, nearly double the number from 2019. More than 600 of those injured in 2022 were treated at the adult Level I Trauma Center at Froedtert Hospital campus, part of the Froedtert & the Medical College of Wisconsin health network.

But for many of these patients, serious, untreated socio-environmental and psychological issues complicated by their injuries linger long after physical healing.

That’s where the Trauma Center’s Trauma Quality of Life Clinic (TQoL) team steps in to tend to the complex mental health and social service needs of gun violence survivors. Created in 2020, the clinic – the only one in the nation with centralized, comprehensive resources – uses a holistic, multidisciplinary team approach. More than 300 patients treated for gunshot wounds at the Trauma Center took advantage of resources at the TQoL.

“We are addressing what has historically been poor long-term quality of life outcomes for gun violence survivors,” said Colleen Trevino, NP, PhD, director of the TQoL Clinic and Medical College of Wisconsin faculty member.

Violence Interruption Program to Aid in Recovery

The Trauma Center works in tandem with 414LIFE, the City of Milwaukee’s team of “violence interrupters,” taking a public health approach to de-escalating violence by treating it as a disease that can spread and impact lives if left unchecked. A key element to the success of the 414LIFE program is engaging community members as violence interrupters in Milwaukee County neighborhoods — and in the hospital setting. In 2019, the Trauma Center developed Milwaukee’s first hospital-based violence interruption program as medical support for 414LIFE. The Hospital-Based Violence Interruption Program focuses on 15- to 35-year-olds with gunshot injuries. Patients are connected with a Froedtert & MCW violence interrupter, as well as resources from the community and Froedtert Hospital to help with recovery and deflect future violence. The TQoL is part of this effort designed to bring patients through the aftermath of their injuries.

Colleen Trevino, NP, PhD

“We know patients with firearm injuries are at higher risk than patients with any other type of traumatic injury for developing chronic pain, post-traumatic stress disorder (PTSD), depression, anxiety and chronic physical disabilities,” Trevino said. “Social issues such as retaliation violence and a lack of safe places to go after discharge from the hospital also contribute to poorer outcomes.”

In fact, TQoL screenings show that 78% of patients were risk-positive for PTSD, 48% were at risk for depression, and 78% were likely to suffer from chronic pain that moderately interferes with daily living.

Others struggle to find transportation to get to follow-up appointments, to take care of their families, pay rent or even buy food due to the impact of their injuries.

“It’s safe to say that there’s much more to healing than the gunshot wound itself,” Trevino said.

Team Effort for Intensive Trauma Care

Becca Laszkiewicz, MSN, RN

TQoL staffing reflects the clinic’s multidisciplinary approach. It includes a trauma nurse practitioner, nurse navigator, clinical psychologist, physical therapist, social worker and a violence interventionist, all available during the same appointment. Becca Laszkiewicz, MSN, RN, the clinic’s nurse navigator, meets patients when they’re admitted to the hospital, then acts as their personal liaison for post-discharge care.

“I’m a familiar face throughout every phase of their care,” she said. “This helps keep patients engaged – they know they always have someone to talk to.”

Laszkiewicz also educates patients about what to expect after discharge. She calls to see if any unexpected issues pop up. This periodic check-in helps prevent unnecessary trips to emergency rooms for issues like pain management or infections that can be addressed through the TQoL. Laszkiewicz also reminds patients about upcoming appointments and ensures they have transportation.

Laszkiewicz is a critical link because most patients she sees do not have a primary care physician. Furthermore, consistent personal contact helps build trust with patients who otherwise might be wary about obtaining medical care. The multidisciplinary approach is another key component.

“We have so many people supporting our patients,” Laszkiewicz said. “That team aspect is vital.”

Patients Engaged in Recovery

How well is the program working? A key indicator is the 12% no-show rate for follow-up appointments, down from 45% the year before the TQoL clinic opened. It indicates most patients are engaged in their recovery.

“Working with patients in the TQoL is one of the most satisfying interactions I’ve had in my entire career,” Trevino said. “All of us here get back way more than we give.”