Five years of BRAVE: Helping to break a dangerous cycle of violent injury
Michael Lewis’ journey with patients who have a gunshot or stabbing injury begins in the early days of their admission to the hospital. As one of two case managers for Sunnybrook’s BRAVE (Breaking the Cycle of Violence with Empathy) Program, he visits youth while they’re still inpatients, and through discharge into rehab, or back home into our communities.
“I get to know patients as people to understand what their needs and goals are,” explains Lewis. “After that, I develop a case plan to implement over time as they are ready.”
The BRAVE Program began in 2020, with support from the City of Toronto, to promote positive alternatives to violence to reduce retaliation, criminal involvement, and re-injury among youth injured by violence.
For Lewis, and his colleague case manager, Elena Gordon, this means developing a rapport with patients and their families who are often looking for additional support, but don’t know how to find it. He adds that his job is to provide an empathetic ear, help people connect to services and nudge them to move ahead with their lives.
Lewis recalls one young man with numerous gunshot wounds who was recovering at home very slowly and losing weight. With BRAVE, the patient was supported throughout his physical and psychological recovery. “Now he’s much stronger, and enrolled in an engineering program,” says Lewis.
The repeat experience of injuries resulting from gun or stabbing-related incidents is often the result of unmet social needs. Through conversations, Lewis and Gordon assess patients’ needs and start connecting them and their families with services. This includes victim services, mental health and addiction services, services for education, food security, employment, housing, and more. What stands out is the mentorship the case managers provide to the young patients, without the judgment or bias so often experienced by this patient population.
BRAVE’s impact by the numbers:
| Patients enrolled | Number of community visits by case managers | Number of risk factors identified - including food insecurity, inadequate housing, education/employment needs | Number of services patients referred to |
|---|---|---|---|
|
282 |
2053 |
1198 |
1042 |
“We see it time and again where a patient is treated for a minor gunshot wound and then returns with a more severe injury from another shooting incident,” says Dr. Avery Nathens, medical director of Sunnybrook’s Tory Trauma Program. “We have an opportunity to intervene and prevent the second injury that may end – or significantly change – the patient’s life forever.”
Sunnybrook’s Tory Trauma Program continues to care for a significant number of patients injured by violence, with over 300 stabbing or shooting victims a year.
“We are immensely grateful to the City of Toronto for multiple renewed funding extensions,” says Dr. Andy Smith, President and CEO of Sunnybrook. “This public health approach to violence prevention, quite simply, works. It is beginning to change our communities. This is all possible because of the partnership and funding support from the City of Toronto.”
Read more at sunnybrook.ca/BRAVE.
BRAVE Program milestones:
January 2019 to Summer 2020: Initial proposal to the Centre for Injury Prevention to develop a hospital-based violence intervention program, followed by consultations with the City of Toronto. Toronto City Council approval and contract finalized in July 2020.
September 23, 2020 – BRAVE’s first Case Manager, Michael Lewis starts in the role, with the first BRAVE patient enrolled days later.
September 2022 – BRAVE enrolls 100th patient.
March 2023 - The City of Toronto provides additional funding to support Sunnybrook in the hiring and oversight of two part-time BRAVE case managers for Scarborough Health Network and Humber River Hospital.
July 2024 – BRAVE enrolls 200th patient.
June 2025 – City of Toronto renews funding for BRAVE for a fifth time.
