Working with Gun Violence Survivors: The Social Worker's Role in Crisis Intervention and Prevention

Abstract

The United States is experiencing one of the most unprecedented upticks in gun violence in our nation’s history. National statistics indicate that the number of mass murders committed by violent assailants possessing guns is rising at an alarming rate nationwide, placing the safety of American families at risk. Researchers at The Centers for Disease Control and Prevention assert that the deregulation of gun control laws by conservative lawmakers represents a substantial threat to public safety that undermines basic security at the community level. A review of published data from the National Gun Violence Archive in 2021 reveals that twenty thousand murders and twenty-four thousand suicides in the U.S. are attributable to gun violence each year. This chapter will examine how social workers can provide clinical services that help survivors overcome the traumatic effects of gun violence and implement programs to prevent these tragedies from reoccurring in communities at risk.

1. Introduction

The United States is one of only three countries in the international community where the right to own firearms is protected constitutionally with few restrictions [1]. The U.S. has become one of a handful of nations where the national figures for dangerous weapons held by private citizens exceed those of all other countries in both per capita gun ownership and the absolute number of firearms available. According to an article in the Washington Post on October 5^, 2015, there are more than now enough guns available in the United States to arm everyone in the general population with a deadly weapon. National statistics indicate that gun manufacturers have distributed more than three hundred fifty million firearms to gun dealers across America, with approximately 30% of these weapons ending up in the hands of private U.S. citizens [2, 3].

The staggering increase in gun ownership has precipitated one of the worst epidemics of violence in American history. Daily reports of mass shootings that disrupt the lives of hundreds of Americans and compromise the safety and stability of local communities have become commonplace in recent years, coinciding with the rapid expansion of gun ownership by private citizens across the country. National surveys by federal agencies and nonprofit organizations provide substantive evidence that rising incidence rates for severe violence in American cities are closely tied to the nationwide expansion of gun ownership. Results of national tracking polls by the U.S. Centers for Disease Control and Prevention, the Federal Bureau of Investigation, and other public health agencies have determined that gun violence is one of the nation’s leading contributors to the increase in preventable death and injuries resulting in severe life-long disability. An analysis of C.D.C. tracking data by John Gramlich, the Pew Research Center associate director, supports this contention. Findings reveal that 48,830 Americans lost their lives to injuries sustained from gunshot wounds in 2021. Of those fatalities, 26,328 (54%) were identified as suicides, 20,958 (43%) were classified as homicides or accidental deaths, and the remaining 1544 (3%) were said to be of undetermined origin. National statistics indicate that from 2019 to 2021, the average number of gun-related murders reported to law enforcement agencies rose by 45%, and the nationwide death toll attributed to firearm-related suicide increased by 10% in the general U.S. population. The investigation also underscores the fact that serious injuries related to firearms are fast becoming one of the more frequent causes of mortality reported on death certificates across the country. This was especially the case during the high point of the COVID-19 pandemic when law enforcement agencies determined eight out of ten gun-related murders and more than half of all suicides involving firearms reported were attributable to social hysteria associated with the spread of viral infection [4]. A study published in the Morbidity and Mortality Weekly Report in May 2022 supports this contention. Findings show that during the pandemic, firearm-related homicide rates in the United States rose to one of the highest levels since the mid-1990s, with the most significant disproportionate increases occurring among young African American males aged 10 to 44 and indigenous males of American Indian and Alaska Native descent aged 25 to 44 two subgroups with the most substantial vulnerability to this form of violence [5]. The research provides further evidence documenting the significant relationship between the pandemic and the nationwide increase in gun-related fatalities.

2. The impact of gun violence on children and adolescents

A more recent analysis of C.D.C. mortality data by Pew Research Center investigators in April of 2023 shows that children and adolescents are disproportionally affected by gun violence. Data analysis indicates that the annual figures for gun-related deaths among children and adolescents under the age of 18 reported by federal agencies rose from 1732 in 2019 to 2590 in 2021, an increase of 50% within 2 years [6]. Evidence confirming the national increase in child and adolescent mortality related to firearms is revealed in the results of a joint investigation conducted by researchers at the Peterson-KFF Health Tracking Project. Findings show that between 2020 and 2021, gun violence contributed to the death of more children in this country than any other cause of disease, disability, or severe injury. Statistics also indicate that the nation’s child mortality rate related to firearms has doubled over time. C.D.C. health tracking data provides substantial evidence that child and adolescent mortality caused by firearms increased significantly between 2013 an 2021. National figures show that the average number of gun-related deaths among children and adolescents reported rose from an historic low of 1.8 to an unprecedented high of 3.7 per 100,000 in this subsection of the U.S. population. Based on these figures, investigators confirm that the nationwide death rate for children and adolescents killed in gun-related incidents of violence has risen substantially. Data analysis reveals a 68% escalation in the number of child and adolescent gun-related deaths since the year 2000 with an additional 107% uptick in firearm fatalities recorded since the national decline in 2013. When investigators compared the international data for firearm-related deaths from all known causes among children and adolescents in the United States with peer industrialized nations, the U.S. ranked number one in every category of increased mortality. For example, researchers noted a significant link between the dramatic spike in the child and adolescent mortality rate and the nationwide expansion of firearm-related assault in 2021. Data analysis corroborates this assertion by revealing that the mortality rate for children and adolescents who died in gun-related assaults reached a national high of 3.9 fatalities per 100,000 in the general population of the United States. A figure indicating a 7% increase in deadly firearm assaults against children and teenagers since 2020 and a 50% jump in these types of attacks since 2019. The national data also suggests that the firearm suicide mortality rate among children and adolescents rose significantly, to an average rate of 21% between 2019 and 2021, further substantiating the disproportionate impact of gun violence on America’s children, particularly those of color living in urban areas where poverty and crime are highly concentrated [7].

3. The effects of gun violence on the U.S. healthcare system

Research by investigators at the U.S. General Accounting Office provides additional evidence that supports the assertion by Pew Research Center investigators that the rising tide of gun violence is having a significant adverse effect on America’s most vulnerable social institutions, particularly the healthcare system. Public health data shows that in 2019, an estimated 40,000 Americans died of life-threatening injuries caused by guns, and twice as many were hospitalized with non-fatal medical injuries associated with the use of firearms. The study revealed that the physical and emotional harm caused by gun violence is responsible for 30,000 inpatient hospitalizations and 50,000 emergency room visits each year, raising the financial bar of treatment services for health-related incidents of this type to new heights. G.A.O. investigators analyzed available hospital data for 2016 and 2017, further substantiating this claim. The review determined that the financial burden of firearm-related injuries costs the healthcare industry more than one billion dollars a year in treatment and aftercare services to help patients reestablish stability in their lives following a gun violence incident. They assert that serious injuries caused by guns have contributed significantly to the 20% price hike in physician fees across the spectrum of clinical services rendered by medical institutions. The investigation also identified other economic factors influencing the rising cost of in-house care for patients injured by gunfire. Central among them is the fact that a considerable share of patients treated for gunshot injuries at healthcare facilities across the country are on Medicaid, a federally funded health insurance program for people experiencing poverty that tends to offer a lower level of financial reimbursement for clinical services rendered than private health insurance companies, an economic factor that researchers contend makes a substantial contribution to the more than 60% rise in medical costs for treatment services administered to firearm survivors. In addition, G.A.O. findings disclosed that the rate of first-year readmission for the treatment of medical complications following initial hospitalization is considerably higher for gun violence survivors than it is for patients receiving follow-up care for other severe medical conditions, an economic factor that is further exacerbating the financial cost aftercare services for gunshot survivors. Data analysis indicates that 16% of patients who survive initial gunshot-related injuries reenter the hospital at least once within the first year after discharge for follow-up care related to complications from their original injury—with an average cost of 8000 to 11,000 dollars per patient. Finally, G.A.O. investigators assert that patients who survive traumatic injuries caused by gun violence are more likely to have significant difficulty adjusting to the physical, behavioral, and economic challenges that accompany their changing healthcare needs post-hospitalization, many of which will require continuous lifetime monitoring by medical professionals. They conclude that the adjustment problems experienced by gun violence survivors after discharge create substantial socioeconomic barriers that prohibit them from accessing adequate follow-up services designed to help them cope with their emerging health issues, greatly enhancing the financial burden of post-hospitalization care.

On the clinical side, in addition to the prohibitive economic burden of in-house aftercare services, the G.A.O. study points to subsequent clinical and institutional factors that compromise gun violence survivors’ chances of receiving appropriate follow-up treatment for their physical injuries after hospitalization. These include pre-existing conditions like high blood pressure, obesity, diabetes, and asthma that cause medical complications that can lead to unforeseen clinical procedures such as limb amputation, which extend the recovery period for gun violence survivors significantly. Clinicians also note that gun violence survivors who sustain multiple physical injuries generally require healthcare services for a more extended period because medical professionals must separate treatment options for each injury. For example, physicians contend that a gun violence survivor sustaining a spinal cord injury in conjunction with an upper-body fracture resulting from a firearm assault requires two separate rehabilitation periods to allow the patient to recover from each injury fully. They further contend that gun violence survivors who remain in intensive care units for extended periods are at higher risk of developing other physical, cognitive, and psychiatric symptoms that increase the need for extensive healthcare services after discharge. Medical experts also informed G.A.O. investigators that survivors of firearm injuries experience mental health conditions such as clinical depression and post-traumatic stress disorder (PTSD) after firearm injuries that require clinical intervention by mental health professionals trained to administer behavioral healthcare services after leaving the hospital. Mental health professionals stress that the type and duration of behavioral healthcare services survivors need post-hospitalization primarily depend on the circumstances under which the firearm injury occurred. They contend that a patient whose gun-related injuries were a direct consequence of interpersonal violence will require treatment with a support strategy that is clinically different than the one used for patients whose firearm injuries have been determined to stem from self-infliction. They also maintain that a gun violence survivor with a severe physical injury that leads to permanent disability is more likely to require inpatient psychiatric care and extended mental health services after discharge to achieve a complete and successful recovery. For example, clinicians have observed gunshot survivors who sustain brain damage resulting from the physical trauma of a gunshot incident require extensive psychotherapy both in-house and after discharge to assist the patient in adjusting to the physical limitations of their impaired neurological function.

Clinical experts interviewed informed G.A.O. researchers that many of the physical and psychological disabilities inflicted on gun violence survivors are not well-managed or understood by the medical professionals providing their care, constituting another social barrier that slows the rehabilitation process and dramatically impedes patient recovery. The clinicians also told the investigators that along with the economic, medical, and psychological obstacles that firearm injury survivors encounter when they seek post-hospitalization care, the institutional policies and available resources of the healthcare facilities that admit them play a critical role in influencing their ability to access follow-up care after discharge. Two classic illustrations of this type of policy-driven inhibitor to the delivery of care that providers touched upon in their interviews with G.A.O. investigators are documented by the fact that post-acute rehabilitation facilities such as nursing homes often provide gun violence survivors with a lower standard of aftercare services because of a reduction in the rate of financial reimbursement they receive from the patient’s health insurance plan. In addition, medical experts in the study described other institutional barriers that prohibit gun violence survivors from accessing necessary care after discharge, such as restrictions on prescriptions issued by medical professionals that do not allow service providers to implement rehabilitation services to firearm injury survivors from communities of color because of racial bias subsequently raising the bar of patient mistrust in the healthcare system further disrupting their recovery from their injuries [8].

Results of a public health tracking poll focusing on the adverse impact of gun violence on the general population in the United States by researchers at the K.F.F. Public Opinion Survey Organization in 2023 support many of the clinical findings of the G.A.O. study 2 years earlier. The investigation compiled data from a nationwide sample of 1271 adults through online and phone interviews between March 14th and 23rd^, 2023. Data analysis revealed:

• Experience with gun-related incidents is a multifaceted phenomenon that is shared throughout the U.S. adult population. One in five American adults surveyed, 21%, reported that they have personally had their lives threatened with a firearm. A similar percentage, 19%, say that a gun played a pivotal role in the death of a family member, either through a self-inflicted gunshot wound or through direct contact with an assailant. Almost as many, 17%, disclosed having personally witnessed a shooting. Two smaller segments of adult respondents revealed that they had either used a gun in self-defense 4% or had sustained a personal injury caused by a firearm 4%. In total, the researchers determined that over half of adults in the United States, 54%, have experienced one or more of these traumatic events related to violence associated with a gun.

• The incidence of gun-related injuries and death, as well as worries about gun violence, are disproportionately more prevalent among U.S. adults living in communities of racial diversity. Three in ten Black adults, 31%, and one-fifth of Hispanic adults, 22%, surveyed proclaimed that they have personally witnessed someone shot by a gun. Survey data further revealed one-third of Black adults, 34%, reported that they had a family member who was killed by a gun, twice the share of White adults, 17% in the investigation issuing the same disclosure. In addition, survey results indicated that one-third of Black adults, 32%, and Hispanic adults, 33%, said they worry every day or almost every day about the possibility of a loved one becoming the victim of gun violence compared to just one in ten White adults, voicing the same concern.

• When researchers asked participants of color in the survey to describe their personal feelings about safety and security in their local communities related to firearms, one in five Black adults 20% and Hispanic adults 18% said they had persistent feelings of insecurity in their local communities associated with gun-related crimes, injuries, and death that place a consistent risk to their safety. More than double the share of White adults 8% expressing the same views about violence in their communities linked to guns.

• When investigators asked respondents to describe preventive measures taken to increase safety in the wake of gun violence, 84% of U.S. adults interviewed said they initiated at least one preventive strategy to protect themselves and their families from the possibility of death or injury associated with a firearm. Data analysis revealed that over half of the adults surveyed, 58%, reported having one or more open discussions with their children and other family members about gun safety, and more than 44% admitted purchasing another type of defensive weapon, such as a knife or pepper spray, to ward off assaults by gun perpetrators. More than 40% of adult respondents surveyed indicated that they have attended a gun safety class or gone to a structured firing range to practice shooting a gun.

• When asked to disclose specific changes in their daily interaction with other people implemented to reduce the risk of gun violence, about a third of adults surveyed 35% reported that they avoid going to crowded public places like music festivals, bars, and nightclubs as a risk reduction strategy for gun violence against them and their families from the possibility of gun violence. Three in ten adults, 29%, surveyed responded the main reason they purchased a firearm was self-defense against perpetrators who might harm them or their families with a gun. A minor portion of the sample responded they had taken other precautions to protect themselves and their families from the harm associated with firearms. These strategies include avoiding using public transportation 23%, changing the school their child attends 20%, nonattendance at religious services and cultural celebrations 15%, and relocating their family to a residential neighborhood where violent crime rates are low 15%.

• The investigation also revealed data that highlighted the significance of service provider intervention in gun violence prevention. Data analysis indicated one in seven adults, 14% surveyed, reported that a doctor or another health professional had inquired if they owned a gun or if one or more firearms were present in their home. One in four parents, 26% with children under age 18, reported that their child’s pediatrician inquired about guns in their home. Less than 5% of adults in the survey said that a health service provider had spoken to them about gun safety.

• Finally, when the researchers asked participants about firearm safety in their homes, more than half the adults sampled 52% responded that the gun in their home is stored in the exact location as the ammunition, 44% replied that the gun in their home was held in an unlocked place, and 36% said that the firearm stored in their home was loaded. The percentage of adults with children giving responses about gun safety was similar. About four in ten adults with children below 18, 44%, stated that a gun is present in their household. One-third of those parents, 32%, further responded that a loaded firearm is kept in the home, and an additional 32% answered that the gun inside their home is held in a place that is not secured by a lock. More than half of the parents, 61%, also stated that the gun present in their home is in the same location as the ammunition [9].

4. Social factors contributing to the risk of gun violence

An analysis of data from a national tracking poll of 5115 adults conducted by investigators at the Pew Research Center in June of 2023 corroborates the results of the gun violence research by Dr. Schumacher and her colleagues. The study identified a variety of social factors contributing to the rise of gun violence in American culture. Survey data revealed that four in ten U.S. adults live in households where a firearm is present, and 32% say they own one. National tracking data indicates factors like party affiliation, gender, community of residence, and race play a crucial role in influencing favorable attitudes among specific segments of the American population toward owning a gun. Findings show that 45% of Republican and Republican-leaning independents say they own a gun, compared to 20% of Democratic or Democrat-leaning independents making the same claim. Men are more likely to be gun owners than women. Polling data reveals that 40% of men surveyed admitted to firearm ownership, compared to just 25% of women making the same admission.

The investigation also noted a close association between gun ownership and the type of community setting respondents lived in. When researchers interviewed adults in rural areas about gun ownership, 47% said they owned a firearm, compared to a lower share of suburban and urban dwellers making the same pronouncement. The research disclosed that 30% of suburban and 20% of urban adults said they were gun owners. The study further noted significant differences in the percentage of gun owners by race. Pew polling data revealed that 38% of gun owners in the U.S. are White, 24% are Black, 20% are Hispanic, and 10% are Asian. When researchers asked adults surveyed to disclose their reasons for owning a firearm, more than three-quarters of those responding, 72%, said self-protection was the primary reason for gun ownership. Secondary reasons for owning a firearm that emerged from the analysis include hunting at 32%, sport shooting at 30%, gun collecting at 15%, and part of their job at 7%.

Pew investigators proclaim that American attitudes toward gun ownership had only undergone a modest change from those revealed in an earlier survey in 2017 when 67% of respondents reported self-protection as the main reason for owning a firearm. Data compiled in the June 2023 survey were further indicative that gun owners tend to have more positive feelings about having a firearm in the home than the non-owners they live with. For example, 71% of gun owners stated they enjoy owning a gun, compared to 31% of non-owners living in households where a firearm is present, who expressed the same positive feelings toward gun ownership. A significant proportion of gun owners sampled, 81%, proclaimed that having a gun in the house enhanced their feelings of safety and security. In contrast, a more narrow margin of non-owners, 57%, held the same sentiments about having a firearm in their home.

Additionally, the study disclosed that non-owners of guns tended to be more likely to have substantially higher levels of worry about the presence of a firearm in the home than owners. Statistical analysis of the Pew data revealed a 27–12% respective split between non-gun owners and owners supporting this assertion. The investigation determined that social forces substantially influence the split reaction linked to emotional sentiments about gun ownership. For instance, researchers noted that Republican respondents were likelier to reveal positive feelings of enjoyment and safety in connection to gun ownership. Democrats, on the other hand, were more likely to express deep feelings of concern about the prospect of having a firearm located within the home. A similar split reaction was elicited when investigators asked non-owners about their intention of becoming gun owners in the future. Results of the Pew study revealed that more than half of adult respondents, 52% identifying as non-owners, said they could never see themselves owning one. A lesser share, 47%, responded that they could picture themselves owning a firearm at a future date. The investigators further noted transparent differences in reactionary responses from non-owners of guns based on gender, political affiliation, and race. Findings reveal that 56% of men surveyed said they could envision themselves as gun owners 1 day, in contrast to just 40% of women issuing the same response. Among non-owners holding, 61% of Republican-affiliated respondents said they could conceive of themselves as gun owners in the future, compared to only 40% of non-owners with Democratic alliances, which gave the same response.

A similar split on this question was noted among respondents from diverse races and ethnic backgrounds. Analysis of Pew data reveals that more than half of all Black adults 56% who identified as non-owners of a gun responded they could see themselves owning a firearm 1 day, in comparison to lower percentages of White 48%, Hispanic 40%, and Asian 38% non-owners responding the same. The study also indicates that views about safety enhancement through gun ownership are evenly split among American adults surveyed. Empirical evidence of the split opinion on this issue is revealed in the data analysis, showing that almost half of the adults surveyed, 49%, say owning a gun increases safety because the weapon protects them from the harm caused by assailants. In contrast, an equal share of participants also replied that giving too many people access to firearms leads to a reduction in safety by increasing the potential for violence.

Additionally, the investigation revealed residential and political factors play a significant role in influencing the intensity of split opinions about gun safety. For example, data analysis shows that 79% of Republican respondents believe that ownership of a gun does more to increase the safety and overall security of individuals and communities at risk of violence than other protective measures. An almost identical proportion of Democratic respondents, 78%, say they believe gun ownership reduces public safety by raising the potential risk of violence. Respondents residing in urban and rural parts of the country also noted sharp differences in views about public safety related to gun ownership. Findings show that among adults living in urban areas, 64% say owning a gun reduces public safety. In comparison, 34% replied possessing a firearm increases safety and security in urban communities. Among adults living in rural areas, 65% of those responding said owning a gun increases safety in their community, compared to 33% replying the opposite was the case.

When researchers asked participants to disclose their perceptions about the magnitude of the gun violence problem in American culture at present, six in ten adults replied that the growth of violent incidents related to firearms represents one of the most monumental social concerns facing our society today. Data analysis indicates that 23% of adults surveyed perceive the size of the gun violence problem in the United States as moderate; in contrast to two in ten, 13% said they view it as small or nonexistent, 4%. Furthermore, when investigators asked respondents to give their opinion about whether they expect the level of gun violence in America to increase, decrease, or remain the same within the next 5 years, 62% replied they expect the current level of firearm-related violence to increase significantly. Double the share of the 31% of respondents answering they expect the present level of gun violence in America to remain stagnant. In comparison, only 7% of those responding expressed optimism about the national level of gun violence declining during that period. Researchers noted the majority of Americans held widely different views on issues related to gun control. Analysis of national data indicates that 61% of respondents surveyed said that it is far too easy to gain access to a gun in this country legally.

In contrast, 30% replied that the ease with which an individual can obtain a firearm legally is entirely acceptable under present gun control laws. Another 9% claim that gaining legal access to a deadly weapon is extremely difficult because of restrictive gun control policies administered by the federal government. The survey further indicated that the consensus of public opinion on regulatory policy is significantly divided among Americans who do and do not own a gun. Nationwide data reveals a 73–38% favorability split between gun owners and non-owners on this issue. Findings show that respondents who were non-owners of firearms were twice as likely to say that federal regulations related to gun ownership are too lenient compared to owners. Researchers also noted a similar split reaction of 48–20% between gun owners and non-owners on the issue of acceptable government standards that regulate firearm acquisition.

Results show that gun owners were two times more likely to rate the current level of government regulation that pertains to gun acquisition as favorable in comparison to non-owners. Findings further indicated the national consensus among gun owners and non-owners on issues related to federal standards that control access to firearms is influenced significantly by political ideology and the demographic stratification of respondents surveyed. The national data shows that 86% of Democrats polled said it is far too easy to gain legal access to a firearm in America, in contrast to only 34% of Republicans who gave the same response. Demographic analysis indicates the vast majority of urban dwellers, 72%, and those living in suburban communities, 63% said accessing a gun legally in this country is much too easy. On the other hand, rural residents were much more divided on this issue. The national data shows that 47% of rural residents surveyed said restrictions governing access to firearms are too lenient under current gun control laws.

In comparison, 41% said current legal limits on firearm access are acceptable, and 11% claimed that getting such weapons under restricted ownership is challenging. When investigators asked adults surveyed about the favorability of stricter gun laws, six in ten 58% responded that they were in favor of tighter regulations. In contrast, 26% replied that the laws are acceptable the way they are and that no further restrictions are necessary. The remaining 15% responded that they favored fewer restrictions on owning this type of weapon.

The investigation also reveals that while American views on firearms control substantially influence gun ownership in our nation, some federal proposals to reduce access to these weapons have met with consistent controversy and storch debate along partisan lines. National polling data generated from surveys by investigators at the Pew Research Center suggest robust to moderate support among the majority of U.S. adults in both political parties regarding two gun control policies that restrict access to firearms by persons with a history of mental health disorders and those below the age of 21. Data analysis indicates that 88% of Republicans and 89% of Democrats surveyed said they are in favor of placing substantial restrictions on firearm purchases by those with mental illness. Nationwide polls further disclose that 69% of Republicans and 90% of Democrats favor raising the minimum age requirement to 21 to purchase a gun legally. The study also revealed a considerable share of partisan agreement on restrictions that disallow people to carry concealed weapons without a permit. Pew polling data shows that 60% of Republicans and 91% of Democrats are in opposition to this gun control policy.

In contrast, the national polls show a lower share of bipartisan agreement on gun control policy proposals banning assault weapons. Data analysis indicates 85% of Democrats or Democrat-leaning independents say they support proposed federal legislation that places a national ban on assault weapons, compared to just 45% of Republicans or Republican-leaning independents who replied they would back such controversial restrictions. The polls further indicate that most Republicans are in favor of federal legislation that increases the number of teachers and school officials who carry firearms in public school facilities legally. Pew Research Center results reveal that close to three-quarters of Republicans, 74%, favorably support the implementation of such legislative action in local school districts nationwide. They also disclose that more than 70% of Republicans favor legislation allowing individuals to carry concealed weapons in public places legitimately [10].

Substantive evidence supporting Schaeffer’s analysis is documented in a previous Pew Research Center survey of 3757 U.S. adults in the fall of 2022. The study highlights ongoing concerns about school shootings among a national sample of parents with at least one child in the kindergarten through the twelfth-grade school system. Results show a definitive relationship between parents’ economic status and level of apprehension about the possibility of a school shooting incident. Findings reveal that 49% of low-income parents surveyed said they felt very apprehensive about the prospect of gun violence at their child’s school. Compared to lower shares of 26% of middle and 19% of upper-income parents expressing similar levels of concern about in-house violence connected to a firearms incident at school. The analysis also indicated other social factors such as race and ethnicity, gender, residential status, and political affiliation play a vital role in fueling parental concerns about gun violence in school. For example, the national data reveals mothers were considerably more likely than fathers to report extreme levels of worry about the potential for gun violence in their school district. Statistical analysis shows that 39% of mothers surveyed reported having severe concerns about the possibility of their child being killed or injured by gun violence at school. A lower share of mothers, 23%, said they were not overly worried about this prospect. Among fathers in the Pew survey, results indicated that 24% reported that they were very apprehensive about the possibility of their child being harmed by a firearm at school. While a higher proportion, 41%, said they were not very worried about a violent incident related to guns in their child’s school. Survey results also indicate similar levels of varying concern about school shootings among different racial and ethnic groups. National polling data shows that 50% of Hispanic parents of kindergarten through twelfth-grade students said they were very apprehensive about the prospect of a shooting at their children’s school.

In contrast, 20% of Hispanic parents surveyed said this issue does not greatly concern them. Nationwide data suggests similar divisive views about school shootings among Black, Asian, and White parents of K12 students. Statistics indicate that 40% of Black, 35% of Asian, and 22% of White parents surveyed say they are highly concerned about the potential for gun violence in school. Compared to 27% of Black, 19% of Asian, and 39% of White parents who say that they are not profoundly apprehensive about a violent gun-related incident of this kind happening at school. Additionally, the investigation noted that parents’ residential status and political affiliation had a decisive impact on their views of gun violence in the public school system. The national data reveals that 46% of parents residing in urban areas said they were extremely apprehensive about school shootings in their communities compared to lower shares of suburban, 28%, and rural, 25% parents with the same concern. Results also show that Democratic and Democrat-leaning parents of K-12 students were more concerned about the prospect of a school shooting than their Republican and GOP-leaning counterparts. Data analysis indicates that 40% of parents surveyed affiliated with the Democratic party said they were highly concerned about gun violence in their school district compared to just 22% of parents with G.O.P. connections expressing the same level of concern tied to this problem.

In terms of developing concrete strategies to combat gun violence in the public education system, the findings of the 2022 Pew Research Center survey indicate there is considerable agreement among majorities in both political parties that implementing improved mental health screenings and more effective methods of psychiatric treatment would be an effectively prevent school shootings. Data analysis reveals that 63% of parents with children under 18 believe initiating the utilization of better mental health practices on a national scale would constitute a highly effective approach to preventing death and serious injuries caused by gun violence in school. The results also point to other practical strategies that parents view as possible solutions for preventing gun violence in school. These include having more police or armed security guards stationed in and around school buildings. The analysis indicates that close to half of the parents surveyed, 49%, stated they view this strategy as an efficient method of eliminating the potential for violent firearms incidents at school. Findings also reveal that 45% of parents favor a national ban on assault weapons as a significant deterrent to gun-related violence in school. Another 41% proclaim they prefer placing metal detectors at strategic locations inside school facilities to route out violent assailants carrying concealed firearms into the classroom. A comparatively smaller share of parents surveyed, 24%, strongly support the recommendation that teachers and administrators be allowed to bring guns into school as a practical approach to ending the traumatic violence tied to firearms.

Amid the staggering uptick in gun violence incidents in public schools and on college campuses across the country in recent years, there has been widespread discussion among Democrats and Republicans on Capital Hill about the adoption of effective policies and enhanced security procedures that can put an end to such tragic incidents. Even though the empirical evidence from the research discussed thus far in this chapter demonstrates that gun violence in the American education system has become a significant national crisis that compromises the health and safety of our nation’s children. Congressional leaders have yet to advocate for the development of legislative proposals that adequately address this critical issue. National polling data from the Pew Research Center suggests that the lack of a unified commitment by the Republican and Democratic lawmakers to adopt specific gun control policies to end school shootings has led to conflicting views internally among parents in both parties regarding which approach to firearms prevention to support. Polling results indicate varied internal support for specific gun violence prevention policies by parents in both parties. The survey revealed Republican and Republican-leaning mothers are more likely than G.O.P. fathers to have robust support for policies that improve mental health screening and treatment to prevent school shootings. Data analysis shows a 59–49% split between G.O.P. mothers and fathers who said they would back this prevention policy to elevate gun violence in school. A similar internal division among G.O.P. parents is also reflected in varied support for other controversial policies related to preventing gun violence in school, such as assault weapons bans and installing metal detection devices to identify those who might attempt to bring concealed weapons into school facilities. Findings show that 25% of Republican mothers surveyed reported they support bans on assault weapons because they perceive it as a practical approach to preventing school shootings in comparison to just 12% of G.O.P. fathers who replied they have the same supportive views of this type of prevention policy.

Regarding the utilization of metal detection devices in school as a deterrent to gun violence, the investigator noted a similar supportive division on the effectiveness of this prevention strategy among G.O.P. parents. Data analysis indicates that 43% of Republican mothers surveyed said they think the use of metal detectors in school is an exceptionally effective method of preventing gun violence in school and would support it, as opposed to only 30% of G.O.P. fathers who responded they felt the same way.

In addition, the national data indicated Republican fathers were more likely than G.O.P. mothers to support a proposed firearms prevention policy that allows teachers and administrators to carry guns in school. Results show that 46% of Republican fathers reported they would advocate for implementing this strategic approach to eliminating gun violence in the classroom as compared to 37% of G.O.P. mothers who said they would favorably back such a policy decision.

On the other end of the political spectrum, the national data indicated that parents of both genders who identified as either Democrats or Democratic-leaning independents were more likely to have positive opinions about the effectiveness of most of the practical approaches to gun violence prevention in educational institutions previously discussed, except for having police officers or armed security guards stationed inside school facilities. Statistical analysis shows that 41% of Democratic mothers and 35% of Democratic fathers reported they are in agreement that proposed strategies for gun violence prevention in school are very effective and would support the implementation of these policies. The analysis also showed that the attitudes of Democratic parents toward assault weapons bans varied by the community of residence. An estimated 72% of Democratic mothers and 68% of Democratic fathers surveyed living in urban and suburban communities responded banning assault weapons has a very beneficial effect on preventing incidents of gun violence in public schools, compared to 54% of Democratic parents in rural communities who responded the same way [11].

5. The mental health of gun violence survivors

The research findings reviewed document the fact that gun violence presents a significant threat to the mental health of the American public. Scholars studying the complex social factors that contribute to mental health problems associated with violence linked to firearms assert that despite mounting evidence from studies in the social science literature that highlight the presumptive causes of these incidents, it remains a challenge for researchers and clinicians to make definitive determinations about the exact number of Americans whose psychological functioning has been severely harmed by the multilevel exposure to the consequences this type of violence. Mental health professionals assert that recent surveys of gunshot survivors indicate that individuals who receive multiple exposures to violent episodes connected to firearms experience significant long-term post-effects of emotional trauma that require psychiatric intervention. Clinical evidence supporting this assertion is provided by the results of a 2022 survey of 650 gun violence survivors conducted by the research and policy program of the Everytown for Gun Safety Support Fund. One of the main findings of the investigation was that 90% of survivors surveyed reported struggling with one or more symptoms of psychological stress after exposure to gun violence that necessitated the need to seek crisis intervention services from a trained trauma specialist. Investigators note the most frequent trauma-related symptoms that gun violence survivors reported struggling with were clinical depression, severe anxiety, sleep disorders, post-traumatic stress syndrome (PTSD), physical illness, and enhanced substance abuse. The study disclosed that more than half of the survivors surveyed who experienced gun violence within the last year said the impact of the trauma harmed their sense of emotional well-being and significantly compromised their cognitive ability to perform mental tasks effectively. Results further indicate that two-thirds of survivors injured by gunfire expressed a need for psychotherapy and other types of supportive services to help them restore stability to their lives.

Data analysis shows that in addition to mental health support, 49% of survivors reported that they need the legal services of an attorney to advocate in court for monetary damages, which compensate them financially for the harm caused by their gunshot injury. In addition, 40% told investigators that they needed financial assistance to help them cover the cost of medical services and equipment associated with the physical harm caused by their firearm-related injuries. Another 25% of survivors surveyed said they needed homecare services because the gunshot injuries they sustained hurt their physical functioning, making it more challenging for them to perform tasks of daily living independently, and 7% said they required financial assistance to cover funeral expenses for their deceased loved ones. Researchers assert that survivors who seek mental health services to manage their symptoms after exposure to gun violence face psychological and social barriers to care that can complicate their recovery. Among them are:

• Complex feelings of sadness, bereavement, and extended grief associated with firearm deaths caused by homicide and suicide.

• Trauma-related feelings of anger, fear, and intimidation connected to membership in racial, ethnic, or religious minority groups at risk of being targeted for hate crimes involving gun violence in the community.

• Mental health professionals assert that a critical contributor to firearm injury and death in Black communities is the rising rate of police violence against people of color that exacerbates the collective trauma in these vulnerable communities, leaving survivors feeling unsafe and insecure in their homes and elsewhere. Statistics show that police officers shoot and kill Black Americans at three times the rate of White Americans, and unarmed Black men are four times more likely to die at the hands of law enforcement officials than their unarmed White peers. A social deterrent that inhibits many Black survivors of gun violence from seeking specialized trauma-centered services that could help them recover [12, 13].

In addition to the traumatic outcomes of gun violence for America’s adult population, a significant share of service providers recognize that this kind of trauma can have a profound impact on the mental health of children and adolescents in the United States. According to a meta-analysis studies documented in a 2022 article in the New England Journal of Medicine, significant exposure to the aftereffects of gun violence, whether it be through a one-time occurrence or multiple incidents documented on social media platforms, has considerable long-term consequences for the emotional stability of children and teenagers that can harm their overall health. Findings point out that direct exposure to gun violence contaminates the consciousness of young people, particularly those with underlying severe mental health issues. They highlight the contention that, like their adult counterparts, young people who witness incidents of mass shootings are more likely to develop symptoms of post-traumatic stress disorder (PTSD), which can interfere with their psychological and social development substantially. The study revealed that depending on the circumstances coinciding with the shooting, a single incident of firearm-connected violence can leave emotional scars on youth, which can do severe psychological damage to their behavior in the long term. The results of the studies reviewed further demonstrate the chronic trauma of gun violence that children and adolescents living in war zone neighborhoods where crime is high regularly experience has a direct impact on their social interaction with the adult world. Research has shown that young men exposed to multiple episodes of violence related to firearms are more likely to develop feelings of low self-esteem, interpersonal distrust, shame, and dependency that can severely compromise their ability to have meaningful social relationships with those outside their peer group. Investigators further assert that the normalization of firearm incidents in many at-risk communities of color causes many young people to become what scholars call child soldiers, subsequently organizing themselves into gangs to protect their neighborhoods from the violence caused by assailants. This situation, many academics say, raises the potential for these gang members to engage in gun violence themselves, further highlighting the necessity for clinical intervention to help survivors rebuild their lives through the implementation of specific types of social services [14].

6. Treatment interventions

As advocates for social justice, social workers are aware of their professional responsibility to address the traumatizing effects of gun violence in American society, which is jeopardizing the mental health of individuals and the collective safety and stability of communities. Social work educators contend the response of the profession to the gun violence crisis involves a multifaceted approach to finding practical solutions to the problem. According to a social justice brief issued by the National Association of Social Workers, addressing public health problems that significantly affect the well-being of individuals, families, and communities through evidence-based approaches to clinical intervention and prevention has been a long-standing tradition in the social work profession for over a century. Public health social workers typically utilize the interdisciplinary connection between social work and public health theories, research, and practice to develop effective social frameworks that encourage community resilience at the macro level through strategic approaches to organizing, policy transformation, and public advocacy that facilitate necessary action to resolve critical issues associated with crises [15]. Such is the case of mental health problems experienced by gun violence survivors. Social work professionals working with clients affected by gun violence can use a variety of trauma-centered interventions to help them cope with the emotional effects of the incident. The most common methods of clinical intervention used by social workers in these types of cases are:

• Trauma-focused cognitive behavioral therapy (TFCBT): an evidence-based counseling technique designed to help gun violence survivors understand the connections between their thoughts, feelings, and behaviors related to the incident.

• Eye movement desensitization and reprocessing (EMDR): an NASW-endorsed counseling technique used for the treatment of trauma that involves having the gun violence survivor recall painful memories of the incident while undergoing a form of bilateral sensory stimulation such as eye movements. Based on the theory that the human mind can heal from the adverse effects of psychological trauma much the same way as the human body recovers from physical trauma. Social workers with specialized training in EDMR have found it a valuable tool that enables survivors to reduce the psychological intensity of unwanted repeated recollections of traumatic events and other distressing symptoms of PTSD associated with the original gun violence incident.

• Narrative exposure therapy (N.E.T.): a therapeutic technique that social workers can implement to teach survivors how to integrate and process the traumatic events surrounding their experience of the gun violence incident into the larger context of their own life story. Studies have shown that N.E.T. is a very effective method of reducing PTSD symptoms in gun violence survivors, particularly in communities of race and ethnic diversity, where cultural sensitivity is an essential therapeutic goal of the process of clinical intervention.

• Group therapy: a therapeutic technique that social workers can use to create a supportive environment where gun violence survivors can feel safe to share the traumatic effects of the incident with others going through the same experience. The efficacy of this approach is backed up by clinical evidence that suggests social support is an essential element of the recovery process for those who are survivors of this type of violence.

• Play therapy and Art therapy: these are two age-appropriate therapeutic techniques that social workers can use with young children affected by gun violence to help them communicate their feelings connected to this type of traumatic experience more effectively than other, more traditional forms of verbal interaction between the clinician and the survivor. In both cases, social workers utilize various toys and other play materials as therapeutic tools to develop a safe place where children can talk about their innermost thoughts and emotions tied to gun violence incidents. Social workers note that these methods have shown clinical evidence of being effective ways of helping children impacted by gun violence to make sense of their experience and develop healthy coping mechanisms that build the resilience needed to enable them to recover.

7. Community-based strategies for gun violence prevention

In addition to providing crisis intervention services in the form of individual and group counseling to promote psychological healing among gun violence survivors, social workers can also use their professional community organizing skills to enhance understanding of the broader social determinants of the epidemic through education and the provision of tangible resources containing information outlining preventive measures residents in high-risk urban areas can implement to reduce the devastating consequences of this type of violence. To accomplish this goal, social workers must develop partnerships with local law enforcement agencies, political officials, and other stakeholders in the community to facilitate their engagement in grassroots action to address this critical problem effectively. Some of the evidence-based measures that social workers can introduce to motivate stakeholder engagement in grassroots actions to reduce the potential for gun violence at the community level are the following:

• Work with community-based organizations to promote the establishment of a variety of firearm prevention programs that foster resilience and support networks that mitigate the traumatic effects of gun violence.

• Work collaboratively with stakeholders in communities impacted by high numbers of gun violence incidents as advocates for the introduction of policy measures, such as stricter gun control laws and improved access to mental health services for those individuals identified as being at increased risk of using guns to commit acts of violence.

• Work to engage stakeholders in research projects focused on developing a greater understanding of the social factors that motivate gun violence. Then, use that knowledge to educate the general public and policymakers about the most effective prevention strategies to reduce and eliminate such incidents.

• Work to establish education and training programs in high-risk communities to teach other healthcare professionals, law enforcement officials, and the general public about the adverse effects of gun violence and the importance of implementing trauma-informed care for survivors.

• Work to establish partnerships with local institutions in the community, such as schools and religious houses of worship, which have recently become more vulnerable to mass shooting incidents, to sponsor gun safety presentations focused on responsible firearm use and storage. They can also supply informational resources that residents can use if they encounter someone in their neighborhood who is at risk of misusing a gun.

• Work with community leaders to increase public funding for the implementation of enhanced prevention services that address the specialized needs of individuals and communities affected by the burden of poverty and social inequality that place them at higher risk for the onset of gun violence [16].

8. Recommendations and conclusions

The research findings reviewed document the social determinants of the uptick in gun violence in American society. The treatment methods discussed emphasize the critical importance of building a trusting relationship between social workers and clients to support the process of healing following episodes of violence related to firearms. The strategic methods of intervention described demonstrate how social workers utilize their organizing skills at the community level to educate and engage stakeholders in grassroots action to facilitate the reduction of incidents of violence related to guns in their neighborhoods and prevent future occurrences through the elimination of risk factors for this behavior.

In the aftermath of several high-profile mass shootings across the nation, such as the one at the Robb Elementary School in Uvalde, Texas, where the assailant, 18-year-old Salvador Ramos, used a military-grade AR-15 firearm to kill 19 fourth-grade children and two teachers while severely injuring 17 others in a brutal attack on May 24, 2022 [17]. The National Association of Social Workers called upon congressional leaders to take immediate action to pass federal legislation to end the epidemic of these terrible acts, which have devastated so many innocent lives. Three pieces of proposed federal legislation in 2021 representing significant steps toward curbing the gun violence crisis in this country that has received the backing of the NASW are the Bipartisan Background. Checks Acts (H.R. 8), the Enhanced Background Checks Act (H.R. 1446), and the Extreme Risk Protection Order Act (S. 1819/H.R. 3480), which are designed to expand and strengthen background checks for Americans who want to purchase a gun and restrict access to firearms to those individuals at-risk of harming themselves or others with a weapon.

In a public statement, the association’s president, Dr. Mildred Joyner, remarked thoughts and prayers are a wonderful sentiment in the wake of such tragic events as school shootings. However, they do not resolve critical issues related to gun violence without implementing effective government legislation focused on firearm prevention. With this in mind, she recommends that social workers support the election of political officials who focus on finding legislative solutions to the gun violence epidemic [18].

The Prevention Institute offers similar recommendations for the reduction of gun violence in vulnerable communities that coincide with those suggested by the NASW. Using a public health approach to gun violence reduction to promote public safety, the institute makes the following recommendations to improve gun control laws in communities at risk for firearm violence. They recommend the adoption of the following evidence-based strategies for the reduction of violence associated with firearms:

• Implement sensible gun laws to reduce access to dangerous weapons by those at risk for violence.

• Expand the use of universal background checks for every American who wants to purchase a gun from local dealers that do not contain loopholes to keep firearms out of the hands of those with the potential to commit violence.

• Implement sufficient waiting periods that require a certain amount of days between when individuals purchase a firearm and when they can take formal possession of the weapon to prevent impulsive acts of gun violence like homicides and suicides.

• Establish a culture of gun safety to stabilize communities at high risk for firearm violence.

• Reduce firearm access by youth with a previous history of domestic violence, substance abuse, criminal conviction, and mental health problems through support for federal legislation such as domestic violence prevention bills and court-sanctioned gun violence restraining orders.

• Hold the gun industry accountable for ensuring adequate oversight of the marketing and sale of firearms and ammunition.

• Engage responsible gun dealers and owners in developing practical solutions to combat gun violence through the establishment of community-based firearm prevention measures.

• Support government legislation mandating nationwide training and licensing of gun owners.

• Develop safeguards for gun violence prevention at the community level through the implementation of public health initiatives such as Lock-It-Up, which teaches neighborhood residents how to store their guns safely [19].

  Besides, the recommended guidelines for gun violence prevention put forward by the NASW and the Prevention Institute studies by researchers at the Johns Hopkins Center for Gun Violence Solutions show that several types of violence intervention programs can reduce acts of violence related to firearms in high-risk communities. Two conceptual models of service implementation that have made substantial strides in the battle to reduce the risk of gun violence in vulnerable communities of color nationwide are street outreach and violence interruption programs and hospital-based violence intervention programs. Street outreach and violence interruption programs use several types of evidence-based behavior modification techniques to reduce the potential for gun violence among high-risk individuals. These techniques include:

• Individual intervention sessions in which two or more community residents engaged in a dispute use a mediator to settle their differences without the potential risk of violence that could result in a shooting incident.

• The promotion of non-violent alternative responses to conflict situations that can trigger. A potential assailant to engage in acts of gun violence.

• The provision of social service support and coaching to individuals in the community with a previous history of engaging in high-risk behaviors that predispose them to episodes of violence involving the use of firearms.

  Similar outcomes were also reported among high-risk patients receiving social services from hospital-based violence intervention programs, revealing a significant decrease in episodes of retaliatory behavior among patients previously injured in gun violence attacks and a substantial decline in engagement in future acts of victimization and violence related to guns. Clinical assessment of intervention programs such as these provides conclusive evidence that they are highly successful in reducing acts of gun-related violence among those at risk [20].