U.S. Department of Justice

Office of Justice Programs

Office for Victims of Crime

Working With Victims of

Gun Violence

by Judith Bonderman

J ULY 2001

Introduction

O n March 3, 2000, the Office for

Victims of Crime (OVC) sponsored a roundtable discussion

about the effects of gun violence on individual victims, their families, and their

communities. This 1-day meeting in

Washington, D.C., brought together a diverse group of professionals who work

with victims of gun violence: physicians,

social workers, mental health providers,

prosecutors, nurses, lawyers, teachers,

school principals, victim compensation

administrators, and judges. Several gunshot victims and survivors who lost 

family members to gun violence also 

participated. This interdisciplinary 

discussion was designed to

■ Identify key victim issues stemming

from firearm violence.

■ Increase understanding of the full

range of gun victims’ needs and how

they differ from the needs of other

crime victims.

■ Identify promising or successful assistance programs for victims of 

gun violence.

■ Develop recommendations for how

federal and state crime victims’

funds could be used to address

unmet needs.

The 18-person group reflected a wide

range of expertise—from a trauma surgeon who operates on gun victims to a

counselor who accompanies families to

the morgue to a judge who hears victim

impact statements. Although each participant’s contribution to the discussion was

shaped by his or her unique experience,

the major concerns raised by all participants were remarkably consistent and

supported by the growing literature on

gun victimization. This bulletin highlights the issues raised and the recommendations developed by the roundtable.

While our focus was victims of gun

crime, as mandated by the Victims of

Crime Act (VOCA) administered by

OVC, we recognize that victims of all

types of gun trauma—including unintentional shootings and suicides—have

About This

Bulletin

Gun violence in America crosses the

demographic lines of age, race, ethnicity,

religion, gender, and class—very few

Americans have not been affected by

the scourge of gun violence. Gun 

violence corrodes the fabric of our

communities, traumatizing victims,

witnesses, families, communities, and

even our Nation, as recent highprofile school shootings have shown.

To understand and respond effectively

to violence in our society, we must

build on many disciplines, including the

victim assistance and criminal justice

fields, health care, social services, education, and the clergy.To guide our efforts

in serving victims of gun violence, the

Office for Victims of Crime (OVC)

sponsored a multidisciplinary group of

national experts in March 2000 to identify key victim issues and needs, develop

recommendations for using federal

funds to address victims’ needs, and

identify promising practices to serve

victims of gun violence.

Not surprisingly, this bulletin indicates

that some demographic groups are disproportionately victimized by gun violence and that many victims never

receive needed services.And while we

typically think of gun violence victims as

victims of homicide, we were reminded 

Continued on page 2
OVC Bulletin

2

many of the same needs that can be met

with help from victim service providers.

Who Are the Victims

of Gun Violence?

The Death Toll

When confronted with the question, “Who are the victims of gun 

violence?” we usually think first

about the fatalities. According to death

certificate data compiled by the National

Center for Health Statistics, a part of the

Centers for Disease Control and Prevention

(CDC), a total of 32,436 persons died

from firearm injuries in the United 

States in 1997. The majority of these

deaths—54.2 percent—were suicides,

41.7 percent were homicides, and the

remaining 4.1 percent were unintentional shootings or deaths of an undetermined nature.1 The effects of gun 

violence cross all socioeconomic and 

geographic boundaries—from inner cities

to remote rural areas to upscale suburbs

and in homes, public housing communities, schools, workplaces, recreational

areas, bars, and on the street. Gun violence victims are young and old, male

and female, African-American and white.

In some cases, the shooter and victim are

strangers, but in many others, they are

intimately related.

In spite of the pervasive nature of gun 

violence, some demographic groups are

disproportionately represented in the gun

crime victim population. The 13,252 gun

homicide victims recorded in the mortality statistics for 1997 included 5,110 who

were 15 to 24 years old. Firearm homicide2 was the second leading cause of

death for the 15- to 24-year-old group. In

the 25- to 34-year-old group, there were

3,706 deaths from gun homicide; at

younger ages (5–14), there were 284

firearm homicides. In fact, firearm homicide was within the top 10 causes of death

for all age groups from 5 to 44 years.

Gun homicide victims are disproportionately young and predominantly male.

According to CDC, 84 percent were male

in 1997. At ages 15 to 19 years, the gun

homicide rate for males was 8 times the

rate for females in 1997.3 The Bureau of

Justice Statistics (BJS) reports that males

of all ages were 3.2 times more likely 

than females to be murdered in 1998.

Moreover, the circumstances of firearm

violence differ significantly for men and

women. In contrast to men, women are

far more likely to be killed by a spouse,

intimate acquaintance, or family member

than by a stranger.4

Firearm homicide also disproportionately

affects African-Americans. Approximately

52 percent of gun homicide victims are

African-American, even though they represent less than 13 percent of the total

population. African-American males

between the ages of 15 and 24 have the

highest firearm homicide rate of any demographic group. Their firearm homicide

rate of 103.4 deaths per 100,000 is 10

times higher than the rate for white males

in the same age group (10.5 deaths per

100,000). In 1997, 92 percent of homicides of young African-American men

occurred by firearms, compared to 68

percent of homicides by firearms in the

general population.5 Even though violent

crime rates, including crimes committed

with guns, have declined each year since

1993, according to Federal Bureau of

Investigation trend reports,6 guns remain

the leading cause of death for young

African-American males.7

The Nonfatal Gun Crime

Victimization

For every firearm death, there are approximately three nonfatal firearm injuries that show up in hospital emergency

rooms. With no mechanism, such as a national registry, to collect uniform national

data on nonfatal firearm injuries, this is,

at best, an estimate based on a sample of

hospitals.8 There may be many more nonfatal firearm victims who do not go to

hospital emergency rooms for treatment.

Others have estimated four to six nonfatal injuries for each gun death.9 In

About This Bulletin

that there are many more victims who

survive their injuries, often with longterm physical and psychological disabilities.Addressing the needs of secondary

victims, including children and adults

who witness violence, is another challenge for practitioners, and one that we

are just beginning to address systematically in the victim assistance and compensation fields.This bulletin not only

outlines the many challenges before us

but also describes some promising

practices in communities across our

Nation to serve victims and stop the 

violence.We believe that the information provided in this bulletin will advance the field’s understanding of how

gun violence affects victims and their

communities and will help OVC identify

and support improved services for victims of gun violence.

Continued from page 1

If all Americans were killed with

firearms at the same rate as AfricanAmerican males between the ages

of 15 and 24 (103.4 per 100,000),

there would be 276,843 firearm

homicide victims annually in the 

United States. (Based on 1997

CDC numbers and a total population

of 267,636,061.)
3

addition, many crime victims may be

traumatized by the presence of a gun during a crime, whether or not the gun was

fired. According to the National Crime

Victimization Survey (NCVS) in 1998,

victimizations involving a firearm represented 23 percent of the 2.9 million violent crimes of rape and sexual assault,

robbery, and aggravated assault. In 1998,

670,500 crime victims reported facing an

assailant with a gun.10

Secondary Victims

The number of deaths and injuries is

just a crude index of the effects of gun 

violence in the United States. There is

an even greater number of secondary victims, sometimes called covictims or survivors of homicide. These are the parents,

children, siblings, spouses, and others

who have lost a loved one or friend to

gun homicide. In the aftermath of a

homicide, covictims must deal with law

enforcement, the medical examiner, the

press, and the court system, among others. They may have to clean up a crime

scene, pay the homicide victim’s medical

bills, and arrange for a funeral and burial.

Secondary victims also include those who

are touched by or witness gun violence in

their homes, schools, or workplaces or on

the street. In the Nation’s largest public

housing projects, the damage goes well

beyond the lives lost and injuries inflicted. According to a report from the U.S.

Department of Housing and Urban

Development, public housing residents

are more than twice as likely as other

members of the population to suffer from

firearm victimization, one in five residents reports feeling unsafe in his or her

neighborhood, and children show symptoms of posttraumatic stress disorder

(PTSD) similar to those seen in children

exposed to war or major disasters.11 This

is consistent with numerous studies finding high rates of exposure to violence

particularly among youth in urban communities. In one study, almost two-thirds

of high school students had witnessed a

shooting, and in another, 70 percent of

the youth ages 7 to 18 in a public housing

project had witnessed a shooting and 43

percent had seen a murder.12 Recent data

also indicate substantial exposure to 

gun violence among suburban school-age

children.13

Multiple-Victim Shootings

While the number of crimes committed with firearms has been falling to levels not seen since the mid-1980s,14 media

coverage and public awareness of gun

crime are increasing. In the past few

years, a rash of multiple-victim tragedies

has erupted in schools, workplaces,

churches, nursing homes, fast food restaurants, shopping malls, and transportation.

These are very public venues—places

that we frequent on a daily basis and

where we should feel safe. When a gun

massacre interrupts play in a daycare center, prayer in a church, or commuters

going home from work, it shatters our

most basic sense of security. Consequently,

even though the percentage of homicides

involving five or more victims was less

than 0.05 percent in 1998,15 these are 

the ones that receive the overwhelming

majority of the media’s attention. In

addition, the multiple-victim shootings

in public places may be ones that create

the most secondary victims as whole

classrooms of first graders, cafeterias full

of teenagers, and hundreds of fellow

workers witness a mass shooting. The

media coverage alone multiplies the number of persons victimized by the crime.

Needs of Gun Victims

T

he roundtable participants were asked

to consider how gun victims may be

different from other crime victims

and how the differences might affect the

services they need or receive. The main

themes that emerged were 1) the gun as

the weapon of violence, 2) the young age

of the victims, 3) the high cost of gun 

violence, and 4) the extraordinary media

attention given to a small subset of gun

crimes.

WORKING WITH VICTIMS OF GUN VIOLENCE

“Even those who have never

encountered a gun are aware

of the widespread presence 

of guns in our communities,

witness news reports of gunrelated crime, domestic 

murders,and high-profile

shootings at schools, churches

and other public places. The

ever-present fear that someone we love might be killed or

injured is another form of gun

trauma.”

—From The Bell Campaign’s

World Wide Web site at 

www.bellcampaign.org

The Bell Campaign is now referred to 

as The Million Mom March Foundation.

“It is estimated that each

homicide victim is survived

by an average of three loved

ones for whom the violent

death produces a painful and

traumatic grief.”

—Deborah Spungen

Homicide: The Hidden Victims

Sage Publications, 1998
OVC Bulletin

4

1. The Gun as the Weapon of

Violence

Much has been written on why gun

use increases the deadliness of attacks;

for example, because guns inflict more

damage than other instruments, they 

can be fired multiple times with little effort, firearms have a greater range, and

assailants intending to kill choose the

most efficient instrument.16 Whatever 

the impact of these different factors, it

is clear that the fatality rate from gun

assaults is much higher than that from

other weapons. This is true regardless of

the relationship between the victim and

shooter, as the presence of a gun can turn

a robbery, an argument, or an abusive

relationship into a homicide.17

According to a 1996 BJS report, 29 percent of firearm homicide victims were

killed because of an argument; 21 percent

were killed during the commission of another crime, such as a robbery or drug

crime; and 6 percent died as a result of a

gang-related shooting.18 Offenders report

firing a gun within 15 seconds of brandishing it, even when they had not intended to shoot the victim.19 Gun victims

include those shot during traffic altercations, gambling disputes, and verbal 

disagreements.

The lethality effect is not lost on the victims. Participants repeatedly spoke of the

nature of the weapon used. “An important difference is the gun itself. Guns are

the only instrument developed to kill;

victims facing a gun suffer the trauma of

death or the fear of death,” said family

bereavement counselor Kevin O’Brien.

Meanwhile, participant DeLano Foster,

an OVC Program Specialist and survivor

of multiple homicides, offered that “the

difference between an armed robbery and

a homicide could be the time it takes

the victim to hand over his wallet.”

Eyewitness accounts frequently report

victims putting their hands in front of

them and “holding up articles of all kinds

in their last moments in the magical belief that even a sheet of paper might 

save them.”20

Gun violence also is frequently more 

random than other types of criminal victimization. One participant noted that

“bullets don’t always have a name on

them. You can be shot from a great distance even with a bullet meant for someone else.” Young men can be “casualties

of a war they did not partake in” when

gang members intent on retaliating shoot

at random victims when they can’t find

the rivals they intended to kill.21 Other

participants talked about small children

sleeping in bathtubs to hide from stray

bullets penetrating bedroom walls at

night.

The bystander victim represents the most

impersonal type of crime. But participants

commented that, even when the shooter

targets a particular victim, the gun crime is

somewhat impersonal. The gun, as an instrument of both power and detachment,

Bystander Victims

Durham, North Carolina: April 7, 1998. While walking with his mother, a 

5-year-old boy was hit by a stray bullet from a gunfight. The bullet severed his

spine, and Taquan Mikell may never walk again. The bullet struck him more

than half a block away from the gunfight.

Nashville, Tennessee: July 2, 1999. Nashville teenager Eric Harvey Hazelitt

was fatally shot in the chest when gunfire erupted at the John Henry Hale public housing complex in Nashville. Just 14 years old, he was caught in the crossfire of two groups shooting at each other.

Referenced from In the Crossfire: The Impact of Gun Violence on Public

Housing Communities, published by the U.S. Department of Housing and Urban

Development, February 2000.

Washington, D.C.: June 21, 1999. Helen Foster-El, a 55-year-old grandmother,

was outside her home in the 100 block of 56th Place SE. watching neighborhood children play when gunfire erupted between two groups. On hearing the

gunfire, Ms. Foster-El began to shepherd the children into one of the neighborhood homes for their safety. As she was doing so, she was struck in the back by

a stray bullet and died instantly.

Harrisburg, Pennsylvania: June 10, 1999. Raphael Rivera, 14, was in the immediate area of an altercation involving several individuals. When the altercation escalated into gunfire, Raphael, who was not involved in the argument,

sustained a fatal wound to the chest.

Referenced from The Death Toll Since Columbine, a report of the U.S.

Conference of Mayors, Washington, D.C., January 2000.
5

WORKING WITH VICTIMS OF GUN VIOLENCE

allows the shooter to remain physically

and emotionally distanced from his or her

victims. When the victims are shot in the

back, as many are, they never even see

the shooter’s face. This may increase the

“Why me?” response of so many gun victims, similar to the feelings of victims of

drunk driving.

The ability of mentally disturbed individuals to kill at a distance, together with

the enormous firepower of semiautomatic

weapons, may have facilitated the gun

rampages that have taken so many lives

in recent years. Participant Michelle

Scully Hobus was shot and her husband

killed when a crazed gunman armed with

two semiautomatic TEC–9 pistols roamed

a San Francisco, California, law firm,

shooting 15 people, killing 9 before taking his own life. It was a long time before

she could shake the feeling of danger.

“Even though I knew that the gun massacre at the law firm was an extremely

rare event, I kept having the feeling that

it would happen again. I couldn’t sit with

my back to the door; I thought someone

would come in and blow everyone away.”

■ Just as Larry Gene Ashbrook did

on September 15, 1999, when he

shot 14 people (7 dead) in the

Wedgwood Baptist Church in Fort

Worth, Texas.

■ Just as Mark Barton did on July 29,

1999, when he shot 22 people (9

dead) at two brokerage firms in

Atlanta, Georgia.

■ Just as Kip Kinkel did on May 21,

1998, when he shot 24 people (2

dead) at Thurston High School in

Springfield, Oregon.

■ Just as George Hennard did on

October 16, 1991, when he drove

his truck into Luby’s Cafeteria in

Killeen, Texas, and opened fire on

the lunchtime crowd, killing 23 

people before shooting himself.22

Moreover, gun victims face constant reminders of their trauma from the everpresent gun seen on television programs

and commercials and in films and videos.

Even American slang, for example, “one

shot,” “take aim,” and “set your sights,”

takes its toll on some victims. Some 

participants reported that any loud 

noise, like balloons popping and cars

backfiring, could “trigger” a response. The

exorbitant media attention paid to each

new multiple-victim shooting also is retraumatizing for gun victims of similar

tragedies. Security changes, such as metal

detectors in schools, hidden cameras,

dress codes, and guards in the halls, are

constant visual reminders of school

shootings.

Like other crime victims, gun victims

seek redress against their shooters through

the criminal justice and civil justice systems. Many victims, like participants

Scully Hobus and Jaquie Algee, have 

become activists.

RECOMMENDATION: Clinical evidence supports the therapeutic value of victims

working as change agents, in grassroots or

church activities, informal support groups,

and anticrime organizations.23

2. The Young Age of the

Victims

As previously noted, gun crime disproportionately affects young people. Their

injuries and grief must be understood in

this context. The participants who work

with adolescents spoke of the pessimism

and despair, particularly in the inner

cities, where communities are losing children to gun violence daily. Youngsters

whose relatives and friends have been

shot automatically think that sooner or

later it will happen to them. They plan

their funerals, write their obituaries, and 

specify the clothing in which they want

to be buried. A psychological counselor

for teenagers in Baltimore, Maryland, Dr.

Rosetta Graham, spoke of the need to do

much more for this age group: “Around

age 14 or 15 they become more private

and hold in their grief. They are caught

between adults who know how to make

their needs known and young children

whose caregivers speak for them.” Studies

of urban youth show a high correlation

between exposure to violence and depression and PTSD.24

The hopelessness of this population was a

recurring theme. The participants agreed

that one major shooting, or the daily loss

of friends and classmates, can have a profound effect on young people just beginning to explore their independence and

develop plans for their future. While

some hold in their grief, others become

suicidal or act out their feelings on the

street. Even in suburban settings where

violence is rare, a highly publicized

school gun massacre can have a significant impact. Counselors working with

students at Columbine High School in

Littleton, Colorado, worried about kids

who were somewhat depressed and doing

drugs before the shooting. In the months

since the shooting, they have seen an increase in drunk driving, suicide attempts,

and fighting. Disaffected students—or

those who feel alienated or rejected—

don’t trust anyone, don’t feel safe, and

don’t do well in school. Similarly, after

the 1998 shooting of 22 students at

Thurston High School in Springfield,

Oregon, there was a 600-percent increase

in referrals to the school nurse and a 400-

percent increase in arguments and fights

reported to the principal. Many students,

even some who were not present at the

school but who watched the news coverage, experienced a loss of control, a feeling of being violated, and a sense of guilt

that they survived.
OVC Bulletin

6

For many students, the fear of gun violence is strong enough to interfere with

the quality of their lives and their performance in school; they also may suffer

from increased absentee, truancy, and

dropout rates. Participants who work with

children explained the importance of getting them to talk about their fears. They

are hungry for information and may distort facts and think they could have

prevented the shooting. They need to

understand that the school shootings on

the evening news are rare events and that

schools are safe places.

Although exposure to violence will affect

all adolescents to some extent, different

services are needed when the shooting is

an isolated tragedy versus when there is a

daily threat of violence in the community.25 In the high-profile school and workplace shootings, crisis response teams

“debrief” the victims and witnesses, often

in a group setting. The interventions for

schools and communities that witness violence are based on the assumption that

the incidents they witnessed are one-time

horrific events. Participants who had the

benefit of this type of crisis response service felt a sense of security while the teams

were there and a great void when they

left. In the absence of organized training,

teachers, school administrators, and guidance counselors are scrambling to get up

to speed on crisis response. Many professionals who helped care for the students

who were shot or witnessed a massacre of

their classmates also became depressed

and suicidal. According to School

Superintendent Jamon Kent, the shooting at Thurston High took place May 21,

1998, and the aftershocks still occupy

one-third of his time in the office.

RECOMMENDATION: Participants recommended that communities victimized by

gun massacres be offered long-term assistance and training so they can more effectively be involved in the healing process.

Different problems arise and different

types of interventions are needed to 

address chronic gun violence. For the 

past 10 years at least, young AfricanAmerican males have experienced violent crime at a rate significantly higher

than the rate for other age groups.26

Sandra DeLeon, Director of the Rise

Above It violence prevention program 

in West Orange, New Jersey, reported

that 60 percent of the students they serve

know someone who has been shot. In

their neighborhoods, gun violence is

more predictable than random. They

come to school worrying about the gunshots they heard the night before. The

students need to hear, preferably from

peer counselors, that there is a future to

look forward to and they are not destined

to be either buried or behind bars in jail.

But the participants also agreed that this

is an uphill battle. The strong correlation

between poverty and violent crime means

that those with the fewest resources are

the most vulnerable. In some cases, the

parents of homicide victims are very

young. An enormous amount of preventive counseling is needed to keep them

from exacting retribution while they

struggle to get daycare, buy food, and

arrange for the burial of a loved one.

The literature on children and adolescent

victims reinforces the group’s findings

about the vulnerabilities of young gun

victims. A Task Force on Adolescent

Assault Victim Needs, convened by the

American Academy of Pediatrics, recommends addressing the psychosocial needs

of young victims along with their physical

injuries.27 To do this effectively, the task

force noted that health care providers

must acknowledge and address three

myths: 1) that all adolescent victims are

“bad” kids who probably deserve what

they got, 2) that it is dangerous to care

for adolescent victims who may be members of a gang, and 3) that it is hopeless

to help them because of the high risk of

reinjury and subsequent acts of violence

by the victim.

The myth that all adolescent victims 

are “bad” kids is particularly harmful for

young African-American men growing up

in neighborhoods rife with drugs and gun

violence. Generalizations about “predator

youth” cause added grief for gun victims

and stigmatize them and their families

unfairly. Future employers may refuse to

hire a young man with a bullet in his

arm, assuming that he was a gang member or a bad person because he’d been

shot.28 On the other hand, the tendency

to use violence is considered a serious potential consequence of being a young victim of gun violence. In fact, “a new study

After my 19-year-old son

was shot in Chicago, I went

to many support groups, community organizations, and

church-affiliated meetings, but

I really wasn’t getting what I

needed. I needed to be more

active in the movement to 

reduce gun trauma. I found

comfort in joining The Bell

Campaign, a grassroots 

victim-based organization,

modeled after Mothers

Against Drunk Driving.”

—Jaquie Algee, 

Southeast Regional

Director for The Bell

Campaign

“
WORKING WITH VICTIMS OF GUN VIOLENCE

by the National Center on Crime and

Delinquency finds that one of the best

predictors of whether a teenager will

commit a crime is whether he or she 

has been a victim.”29 Siblings of gunshot

victims are frequently preoccupied with

revenge fantasies and may be encouraged

and assisted by their peers in exacting

vigilante justice. Once having resorted to

violence, young men engage in more risktaking behavior. Thus, a cycle of violence

continues, and being shot once becomes

the greatest predictor for being targeted

again.30 However, the risk factors for

this group are often overcome by the

resourcefulness and determination of 

families surviving in the inner city.

RECOMMENDATION: Participants agreed that

assistance for gun victims, particularly

young African-American men, must include

programs designed to teach victims to regain their self-respect and status in the

community without resorting to more violence. Quick outreach and support to newly

bereaved families can help redirect their

grief toward positive efforts to honor the

memory of their loved ones.

Although much of the roundtable discussion centered on teenage youth, elementary school-age children also are frequent

witnesses to gun violence and often 

display symptoms of PTSD and other

trauma-related disorders.31 Some children

are afraid of school, and many become 

fatalistic. Some engage in aggressive play

and perform poorly in school,32 while others become desensitized to violence and

lose the ability to recognize and avoid

dangerous situations. The few research

studies that were available to participants

suggested that witnessing gun violence 

affects children in many different ways,

depending on the type of wound, the

proximity to the shooter, the relationship

of the shooter and victim, and whether

the shooting took place in a context generally considered safe, among other

things. Different reactions can be expected from boys and girls. Child witnesses

who have been raised in a subculture of

violence in the home may have additional risk factors for long-term psychosocial

consequences.33 Effects also can be seen

in somatic disturbances. According to

participant Marianne Z. Wamboldt,

M.D., a child psychiatrist in Denver,

Colorado, clinicians have noted a relationship between the general stress in

the community after the shooting at

Columbine High and an increase in asthma cases and deaths among preschoolers.

RECOMMENDATION: The roundtable consensus was that much more research is needed to develop services that take into

account the full range of effects that gun

violence has on children. OVC should work

with other offices in the Office of Justice

Programs (OJP), such as the National

Institute of Justice, the Office of Juvenile

Justice and Delinquency Prevention (OJJDP),

the Violence Against Women Office (VAWO),

and BJS, to develop a research agenda concerning the needs of gun violence victims.

The evaluation of promising direct service

programs for child victims of gun violence

should be encouraged and funded by OJP.

3. The High Cost of Gun

Violence

Gunshot injury and death place a 

burden on the health care system in the

United States that far exceeds the toll 

of other types of criminal victimization.

Because of the traumatic nature and extent of their injuries, gunshot victims are

more likely than other crime victims to

require overnight hospitalization and 

followup care. BJS reports that gunshot

victims represented only 5 percent of the

estimated 1.4 million hospital emergency

department patients treated in 1994 for

violence-related nonfatal injuries. But

while the majority of crime victims are

treated and released, gunshot victims 

represent a third of those requiring hospitalization.34 The average cost of acute

care treatment ranges from $14,85035 to

$32,00036 per hospital admission. Because

of the young average age of the victims

and the frequent need for rehospitalization, the lifetime medical costs are very

high, around $35,500 per victim. For all

victims of firearm injuries (assaults) and

deaths (homicides) in 1994, the lifetime medical costs totaled $1.7 billion.

Government programs, primarily Medicaid, are the primary payers for 50 percent of hospitalized gunshot injury cases

due to violence.37

The growing cost of gun violence can affect the trauma care available for all community members. At King/Drew Medical

Center in Los Angeles, California, hospital expenses, not including professional

fees, were more than $270.7 million for

the 34,893 patients hospitalized for gunshot injuries from 1978 to 1992.38 Some

96 percent of these costs were paid with

public funds.39 Between 1983 and 1990,

the financial strain of treating uninsured

patients contributed to the closure of 10

out of 23 trauma centers in Los Angeles

County.40

In addition to direct health care and related expenditures, gun violence exacts a

substantial economic toll on its victims

and society in general in terms of lost

productivity, use of the criminal justice

system, pain and suffering, and diminished quality of life. Economists and public health statisticians estimate an annual

bill of more than $100 billion for all of

these gun violence costs. An examination

of more than 1,000 jury awards in cases

involving shooting victims yields an average loss of more than $3 million for a single family of a homicide victim.41

The economic loss is even more staggering for victims who sustain spinal cord 

injuries (SCIs) from gunshot wounds.

These relatively rare catastrophic cases

account for the lion’s share of the medical

costs for gun injuries. Each year, approximately 10,000 persons suffer an SCI and

7
OVC Bulletin

8

require hospitalization. Nearly a quarter

of these injuries are caused by acts of 

violence, primarily gunshot wounds.

Violence-related SCIs have increased 

dramatically since the early 1970s, overtaking falls as the second leading cause of

SCIs (after motor vehicle accidents) in

the past 4 years.42 The average firstyear expenses have been estimated at

$217,868 (in 1995 dollars) for violencerelated SCIs, although the amount varies

considerably depending on the extent of

neurological damage. With recurring annual charges for violence-related SCIs

calculated at $17,275, the lifetime

charges are estimated to be more than

$600,000 for each victim. This includes

charges incurred as a direct result of the

injury, such as emergency medical

services, hospitalizations, attendant care,

equipment, supplies, medications,

environmental modifications, physician

and outpatient services, nursing homes,

household assistance, vocational rehabilitation, and similar miscellaneous items. It

does not include indirect costs, such as

lost wages, fringe benefits, productivity,

pain and suffering, and diminished quality

of life, which could be twice as much as

the direct costs.43

A handful of gunshot SCI victims have

fared better than most. For example, the

SCI students from the Columbine shootings have had the benefit of a communitywide effort to raise funds for remodeling

living areas, paying for medical and living

expenses, specially equipped vans, and

even college scholarships. But these are

atypical cases. The majority of people

with violence-related SCIs are young

African-Americans with low socioeconomic status. Many in this group have

been targets of gun violence and have

sustained most of their injuries because of

drug- or gang-related activity. Those who

return to their communities after 

surviving months with tubes in their bodies face a daunting challenge in school.

Paralyzed for life, they never will be the

same active teenagers again. The practical and social problems like calling ahead

and waiting hours for transportation,

wheelchair access to classrooms, and 

dealing with colostomy bags are difficult

enough without the added fears of testifying in court and being targeted again by

the shooter. Those with violence-related

SCIs are more likely than other SCI patients to have intractable pain and commit suicide. For others, the cost of acute

care and rehabilitation, among other

things, can lead to the dim prospect of

constant dependence on the Government

or family.44

4. The Extraordinary Media

Attention to a Small Subset 

of Gun Crimes

On April 20, 1999, the world watched

as two high school students, armed with

automatic weapons and shotguns, killed

12 students and a teacher and wounded

23 others before turning the guns on

themselves. The tragedy at Columbine

High School is considered a defining 

moment in the public’s consciousness

about gun violence. The nonstop realtime media coverage of this horrendous

massacre, both on the air and in print,

was traumatizing to the victims’ families

and friends, the community, the state 

of Colorado, the United States, and the

world. The roundtable participants discussed this media coverage, focusing on

its impact on children and its message 

for those haunted by the unpublicized 

loss of a loved one to gun violence.

RECOMMENDATION: Participants agreed 

that the media should be more sensitive

to how their coverage of gun violence 

affects victims and children. OVC should

develop training materials and guidelines 

for media coverage of gun massacres.

School shootings in particular are traumatizing for children because they all

go to school.45 After Columbine, preschoolers in Colorado began talking

about where they would be going to

school as the place where they would die.

School systems around the country saw

the phenomenon of school-phobic kids,

as both the news media and talk shows

exaggerated a child’s risk of being shot at

school. Although participants thought

that such news coverage should carry a

warning caption for parents about the

possible adverse effects on young children, they also felt that older children are

hungry to know what has happened and

have a great need for information. In all

cases, parents and teachers need to help

children process the information they see 

on television, so they can realistically

assess their own safety in school.

Unfortunately, the misconceptions about

the risk of school shootings are pervasive 

in all age groups. A recent analysis of

opinion polls taken after the shootings in

Jonesboro, Arkansas, and Littleton found

a 49-percent increase in parents’ anxiety

about children’s safety in the classroom,

even though statistical studies by the U.S.

Department of Justice (DOJ) and the

National School Safety Center showed a

40-percent decrease in school-associated

violent deaths in 1998–1999, the school

year including the Columbine shooting.

These tragic events are truly rare—with

52 million students enrolled in public

school, the chance that a school-aged

child would die in school in 1998–1999

was 1 in 2 million.46

The gap between public fear and reality

is not surprising, as media coverage

is focused on less than 1 percent of 

homicides—those with multiple victims.

Even within a group of multiple-victim 
WORKING WITH VICTIMS OF GUN VIOLENCE

gun homicides, the rarest events get the

most media attention. For example,

■ December 4, 1999: Sacramento,

California. A 31-year-old Asian man

shot and killed his daughter and four

sons, reportedly after having an argument with his wife. A shotgun

and a high-powered rifle were found

in the apartment.

■ December 5, 1999: Baltimore,

Maryland. Five women were found

shot to death in their Northeast

Baltimore row house. Police said the

women, who were not involved in

drug activity, were shot to send a

message to a relative who was involved in the drug trade.

■ December 6, 1999: Fort Gibson,

Oklahoma. Five students were injured when a 13-year-old opened fire

at a middle school with a 9 mm

handgun he took from his home.

The family homicide, an all-too-common

occurrence, was reported only by the

California press. The Baltimore shooting

was prime-time news for a day and then

was eclipsed by the middle school shooting in a rural community in Oklahoma.

Even among victims of the same shooting, the media may focus on one or two

to represent the face on the story. Perhaps

because of their pronounced activism on

the gun issue or because of some other

special attribute, these chosen victims

become the story of the massacre. In

Homicide: The Hidden Victims, A Guide for

Professionals, Deborah Spungen describes

how individual victims of multiple-victim

shootings “tend to get lost in the scale of

the horror,” while “covictims who have

had a loved one selected for the [poster

victim] may experience feelings of reluctance, exploitation, loss of control, and

anger.”47

Services for Gun

Victims

T

he roundtable participants were

asked to consider how VOCAfunded programs, both compensation and direct services, are useful for

gun violence victims. Two points made

throughout the day were reiterated in this

discussion:

■ Communities most at risk for gun

violence need ongoing prevention

work. Even though the Federal

VOCA Victim Assistance Final Program Guidelines preclude the use of

Crime Victims Fund moneys for “activities exclusively related to crime

prevention,” direct services and

compensation for gun victims could

have a secondary preventive effect

by minimizing the risk of retaliation

and repeat victimization. Comprehensive programs that provide direct

services and help break the cycle of

violence in the community typically

have more than one funding source.

For example, a program could receive VOCA funding to support

direct victim services and funding

from another federal agency, such as

DOJ’s OJJDP or the U.S. Department of Health and Human Services, to support prevention

initiatives.

■ Gun violence disproportionately affects young African-American men.

The health care, criminal justice,

and media response to these victims

may be less sympathetic than responses to other crime victims.

Whatever the reason for the

disparate treatment of these victims,

we must not ignore them. Assumptions about the blameworthiness of

young African-Americans and

Hispanics shortchange a large

segment of the population and

perpetuate racial stereotyping.

CrimeVictim

Compensation

Crime victim compensation programs—operating in all 50 states,the District of Columbia, the

Commonwealth of Puerto Rico, the U.S.

Virgin Islands, the Commonwealth of

Northern Mariana Islands, American

Samoa, and Guam—provide financial assistance to victims for crime-related outof-pocket expenses, such as medical care,

mental health counseling, lost wages,

and, in cases of homicide, funerals, loss of

support, and counseling for secondary victims. Many programs also pay for crime

scene cleanup, durable medical equipment like wheelchairs and hospital beds,

transportation to medical providers, rehabilitation, physical therapy, and ramps or

modifications to homes for paralyzed victims. All state victim compensation programs are “payors of last resort,” covering

losses not recouped from other sources

such as public or private insurance, employee benefits, offender restitution, or

civil judgments. The state programs set

their own administrative rules and reimbursement maximums, which average

$25,000 and range from a low of $10,000

to no limit for medical expenses (as in

New York). A few states set higher limits

for catastrophic or permanent injuries

that could be used for special home and

health aids. In view of the large medical,

rehabilitative, and counseling expenses

faced by gun victims, participants agreed

that VOCA- and state-funded compensation programs provide much-needed 

financial assistance. Although there is 

no available estimate of the number of

gun victims who benefit from these programs,48 Program Director of the D.C.

Superior Court’s Crime Victims

9
OVC Bulletin

10

Compensation Program Laura Banks

Reed stated that 30 percent of claims paid

by her program are to gun victims.

We are in a new era of crime victim

compensation: program funding is more

secure than ever before, and state administrators are more responsive to the needs

of crime victims and flexible in administering their programs. Participants identified special needs of gun violence victims

and made the following recommendations

for state crime victim compensation

programs.

■ Survivors of serious gunshot injuries

may require long-term mental health

counseling. Currently, the states impose many different limits on mental

health claims, for example, limits 

on the total dollar amount and the

number of sessions. As a result, the

percentage of compensation dollars

spent by the states on mental health

claims varies enormously. Nearly all

states pay for grief counseling for

survivors of homicide, and some pay

for mental health counseling for

family members who witness the

crime.

RECOMMENDATION: Where necessary, state

compensation caps and limits should be

raised for mental health counseling to

permit long-term counseling. States should

consider extending benefits to more secondary victims, such as students or coworkers who witness a shooting, even if

they are not family members and were

not threatened by the shooter.

■ In addition to medical and mental

health expenses, victims whose

brains have been damaged or spinal

cords have been injured as a result of

gun violence may require long-term

care, special transportation services, 

housing modifications, and occupational therapy. For the most severely

injured victims, durable medical

equipment such as a powered 

wheelchair can cost anywhere from

$20,000 to $25,000, in addition to

other equipment that may be needed. Many have living arrangements

that can’t be modified to meet their

needs—their third- or fourth-floor

walk-up apartments are not wheelchair accessible, and they cannot

afford to move. In many cases, the

parents or family members don’t

have the resources or services to stay

home and care for the injured person; there are a large number of 21-

year-olds on ventilators in nursing

homes being covered by Medicaid.

RECOMMENDATION: Limits on medical expenses should be raised for catastrophic injuries, and programs should be flexible in

defining eligible expenses as the needs of

gun victims become clear to them. For example, New Jersey pays for childcare and

daycare services along with domestic help

at a rate of $50 a day.This type of innovative benefit allows family members to continue working rather than having to stay

home to care for a minor victim or an

adult.

■ Although eligibility requirements

vary somewhat from state to state,

they all require victim (or claimant) 

cooperation with police and prosecutors. These requirements may be

difficult for gun violence victims in

some cases and may discourage them

from applying for compensation 

benefits. 

RECOMMENDATION: Encouraging victim cooperation with law enforcement is a valid

goal of state compensation programs.

However, the Federal VOCA Victim Compensation Final Program Guidelines encourage program administrators to be

flexible about cooperation requirements 

in cases where they may present special

barriers for the victim. Law enforcement

personnel, prosecutors, and compensation 

program staff should be trained to understand and be sensitive to the fears of these

victims.

■ Most compensation programs have

time limits for filing compensation

applications. Although many states

have specific exceptions or will

waive filing limits for minors, the

time limits may still disqualify some

teen and young adult gun victims

who need mental health counseling

but are embarrassed to come forward

at first and admit they need help.

RECOMMENDATION: Compensation programs

should waive time limits for filing applications to avoid penalizing young victims.

Direct Victim Services

O VC makes annual VOCA crime

victim assistance formula grants to

all 50 states to support the provision of direct services to victims of crime.

The state VOCA administrators, in turn,

subgrant the funds to victim service

providers. Ten percent of each VOCA

state grant must be allocated to victims of

violent crime who have been previously

underserved in that state. Underserved

victims include, but are not limited to,

victims of federal crimes, survivors of

homicide victims, and victims of assault,

robbery, gang violence, hate and bias

crimes, intoxicated drivers, and elder

abuse. States also may define underserved

victims according to their status as senior citizens, persons with disabilities,

racial or ethnic minorities, and residents

of rural areas or inner cities. Eligible direct services include programs that 1) respond to the emotional and physical

needs of crime victims, 2) assist primary

and secondary victims of crime to stabilize

their lives after a victimization, 3) assist

victims to understand and participate

in the criminal justice system, and 
WORKING WITH VICTIMS OF GUN VIOLENCE

4) provide victims of crime with a measure of safety and security, such as boarding up broken windows and replacing or

repairing locks.

Many of the current VOCA subgrantees

may provide services that are used by victims of gun violence, such as homicide

support groups and victim advocates in

prosecutors’ offices. Because there are

no data on how many existing programs

serve gun victims and no service directory

of gun victim programs, the roundtable

participants identified a few promising

practices and discussed the types of programs they would like to see funded

under VOCA to benefit gun victims.

Clearly, many innovative programs are

not known outside their limited geographical area.

RECOMMENDATION: Participants recommended that a database of providers serving gun victims be established and that

OVC increase efforts to publicize promising

programs and encourage states to fund

them.

RECOMMENDATION: If gun violence victims

have been underserved, states should be

encouraged to fund programs that serve

gun victims as part of their required 10-

percent minimum allocation of VOCA subgrants for underserved victim populations.

1. Holistic Care for Families of

Homicide Victims

Participants who counsel surviving

family members spoke of the need to assist with day-to-day problems to reduce

the immediate, ongoing, and long-term

effects of traumatic loss. Programs that

operate at the community level and provide a range of free services and referrals

are preferred. They might be administered

by the law enforcement or prosecutor’s office, a hospital, a church, or an independent private agency. Three multiservice

programs were discussed in detail at the

roundtable.

The Recover program in Washington,

D.C., has a professional grief counselor in

the Office of the Chief Medical Examiner

to offer emotional support before, during,

and after the process of identification of a

loved one. Recover staff do an early assessment of needs, including inquiring about

children who may be affected, and set 

up case management services. Staff or

trained volunteers are available for practical and emotional support, including

planning a funeral, explaining the grieving process, talking to children about

death, driving the family to the store,

helping with paperwork, or simply listening. Recover also makes referrals to mental

health counseling and other services but

recognizes that these may be premature

and/or insufficient for victims having

trouble getting out of the house, getting

food on the table, and dealing with funeral homes and police investigators.

The Family Bereavement Center in Baltimore, Maryland, is funded by a VOCA

subgrant and administered by the state’s

attorney’s office. The center reaches out

to every homicide victim’s family by

sending a letter encouraging them to call

for services. Center staff provide liaison

services with the police department, the

medical examiner, and the state’s attorney’s office. They offer crime scene

cleanup services, court support and escort

services, notification of case status and

victims’ rights, assistance in applying for

victim compensation, and individual and

group grief counseling sessions. They also

sponsor educational and support activities

such as memorial services, weekend

camps for adolescents and younger children who have lost family and friends to

violence, and a quarterly newsletter.

The Family Advocacy Program at the Washington Hospital Center in Washington,

D.C., also provides coordinated services

for family members of gun homicide 

victims. Program staff are available to assist families of all emergency patients at

the hospital. If the patient dies, the program advocates help the decedent’s family

navigate the next steps—decisions about

organ transplant, hospital procedures,

meeting with police officers, answering

media inquiries, and referrals to counseling or pastoral services. This program is

staffed primarily with retired D.C. homicide detectives.

RECOMMENDATION: OVC should support the

development of promising multiservice programs that reach families of gun victims

within 24 hours after the shooting and remain available to assist with longer term

needs. State VOCA administrators should be

encouraged to fund programs like Recover,

the Family Bereavement Center, and the

Family Advocacy Program. Evaluation studies for these and similar programs should

be encouraged and funded by OJP.

2. Support Groups for Nonfatal

Gunshot Victims

Victims who had been shot and survived their wounds spoke of the need 

to tell their stories many times. They

stressed the importance of peer support

groups. But unlike for rape victims,

victims of domestic abuse, victims with

severe SCIs, and parents/friends of murdered children, there are few, if any, specialized services or organized support

groups for “plain, old-fashioned assault.”

These victims, who are shot, one by one,

day in and day out, have bullets removed

in emergency rooms and then are released

to carry on with their lives.

Participants recommended developing

gun violence assistance centers modeled

on the Thurston High Assistance Center

in Springfield. This center was established in the aftermath of the Thurston

High shootings and functions as a clearinghouse for services, activities, and resources related to healing individuals and

the community. The proposed centers 

11
OVC Bulletin

12

could be located within a YMCA or

recreation center already functioning in

the community and should be available

to secondary victims like friends, neighbors, and family. They would be safehaven drop-in sites where victims could

meet with each other and with a multidisciplinary support team. Ideally, the

centers would coordinate all services for

gun victims in the community, such as

medical and mental health evaluations,

counseling services, family assistance,

help with schoolwork or job applications,

referrals to other programs, applications

for victim compensation, emergency

housing, and victim/witness protection.

The centers also could be integrated with

prevention efforts, such as community

policing and afterschool programs. 

Participants who worked with young gun

violence victims felt that the support of

other victims would help reduce the stigma associated with talking to the police

and testifying against an accused shooter.

The centers could encourage cooperation

with the criminal justice system and nonviolent ways of solving disputes.

RECOMMENDATION: OVC should fund the development of model gun violence assistance

centers that could be replicated in communities across the country.

3. Multidisciplinary HospitalBased Programs for Adolescent

Gun Victims

Although virtually all U.S. trauma

centers have some sort of counseling and

referral services for victims of violence

and violence prevention clubs exist in a

majority of SCI units, there are fewer

than a dozen hospital centers nationwide

that offer comprehensive counseling, intervention, and inpatient treatment programs to victims of gun violence.

Participants agreed that this should be a

high priority for DOJ funding. Urban

trauma centers have reported the

recurrent nature of assaultive trauma,

with hospital readmission rates as high as

44 percent in some areas and subsequent

homicide rates as high as 20 percent.

Medical personnel working with social

workers and counselors could turn the

crisis of injury into an opportunity to

intervene and interrupt this pattern of

violence. According to participant Dr.

Caesar Ursic, Director of Trauma Services

for the Alameda County Medical Center

in Oakland, California, there are anecdotal evidence and some data suggesting

that such programs diminish the psychological impact of the injury, prevent retaliatory violence, minimize violent injury

recidivism, decrease future involvement

with guns, and increase the likelihood of

success in school.

The Caught in the Crossfire (CC) program

in Oakland has been hailed as a model

program. It maintains a hotline for the

Alameda County Medical Center to call

when a youth between the ages of 12 and

19 is admitted to the emergency room

with a gunshot wound. CC crisis intervention specialists visit the patient at

bedside and—

■ Review the violent incident.

■ Explore alternative strategies for

conflict resolution.

■ Provide information on risk factors

for violence.

■ Explore coping skills and safety plans.

■ Arrange for followup contacts.

The recovery period in a hospital and

rehabilitation center offers victims an

opportunity to be exposed to supportive

services. After victims have been discharged, followup visits are scheduled for

a minimum of 12 months. The CC program uses trained peer counselors, many

in wheelchairs because they too were

victims of gun violence.

RECOMMENDATION: OVC should continue to

recommend that VOCA subgrants be awarded to hospital-based gun victim programs.49

The elements critical to a model program

should be identified for replication. Where

funding is not available for comprehensive

programs, emergency rooms should implement protocols to assess the risk of recurrent injury and provide counseling services

for young gunshot victims and their

families.

Recover, a program of the William Wendt Center for Loss and Healing

4880–A MacArthur Boulevard NW., Washington, DC 20007–1557

202–333–4880, www.lossandhealing.org

Family Bereavement Center, a program of the 

State’s Attorney’s Office for Baltimore City

10 South Street, Suite 502, Baltimore, MD 21202

410–396–7351

Family Advocacy Program

Office of Decedent Affairs, Washington Hospital Center

110 Irving Street NW., Washington, DC 20010

202–877–8351
WORKING WITH VICTIMS OF GUN VIOLENCE

4. School-Based Peer Counseling

for Violence Prevention

The power of peer counseling, evident

in the hospital-based programs, also is an

important component of school-based

violence prevention programs. The Rise

Above It program was launched in 1995

in direct response to an increasing number of severe SCIs and gunshot wounds in

young people in the Newark, New Jersey,

area. Program presenters, like Hashim

Garrett, the Violence Prevention

Coordinator for Rise Above It, are individuals who were paralyzed as a result of

violent acts. They are teamed with

able-bodied peer educators to let the

students see the long-lasting effects of

gunshot wounds and to teach them skills

to deal with anger and prevent fights.

The classes are part of the public school

health sciences curriculum and have

reached more than 10,000 students. The

program has been posttested—meaning

that the program surveyed students before

and after they participated in the program, asking questions about their

behavior and their beliefs about the consequences of fighting—and shows positive

results as both students and teachers report a decrease in arguments and violent

incidents.

School-based peer counseling programs

like Rise Above It are designed as violence

prevention initiatives. But roundtable

participants found it difficult to draw a

line between the victim services provided

and the prevention aspects of the programs. The victim presenters are empowered by their ability to speak in front of

an audience and become whole again by

sharing their stories and acting as change

agents for a violent school-age community. And many in the classroom are also

victims, suffering physical or emotional

harm from the violence they experience

daily. These types of programs could be

part of more comprehensive victim service initiatives, including crisis intervention, age-specific courses on victim

trauma, and stress reaction training.50 As

Dr. Enid Margolies with the New York

City public school system observed, violence prevention and victim response

issues must be folded into a school’s core

curriculum, as funding for separate programs is difficult.

RECOMMENDATION: OVC should recommend

that VOCA subgrants be awarded to qualifying school-based victim services programs.

School boards should be encouraged to include victim services and violence prevention as part of a school’s core curriculum.

Next Steps

T

his roundtable was the first time 

that OVC focused exclusively on

the needs of victims of gun violence.

Participants found the process extremely

useful and were satisfied that many key

victim issues stemming from firearm violence were identified. As indicated in this

bulletin, gun violence victims have some

unique concerns and needs that differ

from those of other crime victims. By

sponsoring this roundtable, OVC has

opened the door for a full and frank discussion of these issues. Participants expressed the hope that there would be

other opportunities to continue this 

discourse. For example,

■ Once a national-scope search of

providers and programs serving 

the needs of gun trauma victims is

concluded, OVC should reconvene

this or a similar group to identify

unmet needs and make additional

recommendations for funding new

programs.

■ Smaller focus groups of gun victims

should be held regionally to identify

their needs and learn about the

services they used to meet those

needs.

■ Focus groups should be held on

particular topics that were not fully

covered in the roundtable. For

example, we know that guns and domestic violence terrorize, injure, and

kill women every day. On average,

in 1997, more than one woman a

day (393 women total) was shot and

killed by her husband or intimate

acquaintance during an argument.51

The use of guns in domestic violence 

situations and its impact on victims

should be explored further by both

OVC and VAWO. Some key issues

were raised during OVC’s September

2000 Intimate Partner Homicide

Forum. These issues and recommendations on how to identify trends

and factors associated with intimate

partner homicide will be addressed

in a future OVC bulletin.

■ OVC should develop training materials and sponsor training and technical 

13

Caught in the Crossfire

Youth Alive

3300 Elm Street

Oakland, CA 94609

510–594–2588

Rise Above It 

Kessler Anti-Violence Program

Kessler Institute for Rehabilitation

1199 Pleasant Valley Way

West Orange, NJ 07052

973–731–3600, ext. 2253
assistance programs for state VOCA

administrators and compensation

programs to help them identify the

diverse needs of victims of gun violence and how to respond to them.

Notes

1. Hoyert, D.L., K.D. Kochanek, and S.L.

Murphy, “Deaths: Final Data for 1997,”

National Vital Statistics Reports, 1999; 47

(19).

2. The terms “gun homicide” and “firearm

homicide” have the same definition and

are used interchangeably throughout the

bulletin.

3. Available online at the National

Center for Injury Prevention and

Control’s database at

www.cdc.gov/ncipc/wisqars.

4. Kellermann, A.L., and J.A. Mercy,

“Men, Women, and Murder: GenderSpecific Differences in Rates of Fatal

Violence and Victimization,” The Journal

of Trauma, 1992; 33:1–5.

5. Hoyert, D.L., K.D. Kochanek, and S.L.

Murphy, “Deaths: Final Data for 1997,”

National Vital Statistics Reports, 1999; 47

(19).

6. Available online at www.ojp.usdoj.gov/

bjs/glance/guncrime.htm.

7. Available online at 

www.cdc.gov/ncipc/wisqars.

8. “Nonfatal and Fatal Firearm-Related

Injuries—United States, 1993–1997,”

Centers for Disease Control and

Prevention, Morbidity and Mortality

Weekly Report, 1999; 48:1029–1034.

9. Annest, J.L., J.A. Mercy, D.R. Gibson,

and G.W. Ryan, “National Estimates of 

Nonfatal Firearm-Related Injuries:

Beyond the Tip of the Iceberg,” The

Journal of the American Medical

Association, 1995; 273:1749–1754.

10. Available online at

www.ojp.usdoj.gov/bjs/guns.htm.

11. In the Crossfire: The Impact of 

Gun Violence on Public Housing

Communities, U.S. Department of

Housing and Urban Development,

February 2000.

12. Bell, C.C., and E.J. Jenkins,

“Exposure and Response to Community

Violence Among Children and

Adolescents,” in Children in a Violent

Society, Osofsky, ed., The Guilford 

Press, 1997.

13. Campbell, C., and Donald F.

Schwarz, “Prevalence and Impact of

Exposure to Interpersonal Violence

Among Suburban and Urban Middle

School Students,” Pediatrics, 1996;

98:396–402.

14. Available online at

www.ojp.usdoj.gov/bjs/guns.htm.

15. Available online at

www.ojp.usdoj.gov/bjs/homicide/

multiple.htm.

16. See, e.g, Reiss, A.J., and J.A. Roth,

Understanding and Preventing Violence,

National Academy Press, 1993, pp.

260–261; Zimring, F.E., and G. Hawkins,

Crime Is Not the Problem: Lethal Violence

in America, Oxford University Press,

1997, pp. 106–123.

17. Saltzman, L.E., J.A. Mercy, P.W.

O’Carroll, M.L. Rosenberg, and P.H.

Rhodes, “Weapon Involvement and

Injury Outcomes in Family and 

Intimate Assaults,” The Journal of the

American Medical Association, 1992; 

267:3043–3047. (When a gun is involved

in a domestic dispute, it is at least 12

times more likely that the dispute will

end in death.)

18. Zawitz, Marianne, Firearm Injury From

Crime, U.S. Department of Justice,

Bureau of Justice Statistics, 1996.

19. “Firearm-Associated Homicides

Among Family Members, Relatives, or

Friends—Ohio,” Epidemiologic Notes

and Reports, Morbidity and Mortality

Weekly Report, 1989; 38 (15):253–256.

20. Larson, Eric, Lethal Passage, Vintage

Books, 1995, p. 86. (Describing student

holding up French textbook to ward off

bullets from a Cobray M 11/9 semiautomatic pistol shot by a fellow student.)

21. Slevin, Peter, “District Teen Gets 127

Years in Random Shooting of Four,” The

Washington Post, Jan. 6, 2000, p. B2.

22. A list of multiple-victim shootings in

the United States is available online at

www.millionmommarch.com.

23. Temple, Scott, “Treating Inner-City

Families of Homicide Victims: A

Contextually Oriented Approach,”

Family Process, 1997; 36 (2):133–149.

24. Schwab-Stone, Mary E., Tim S.

Ayers, Wesley Kasprow, Charlene Voyce,

Charles Barone, Timothy Shriver, and

Roger P. Weissberg, “No Safe Haven: A

Study of Violence Exposure in an Urban

Community,” Journal of the American

Academy of Child and Adolescent

Psychiatry, 1995; 34 (10):1343–1352.

25. Duncan, David, “Growing Up Under

the Gun: Children and Adolescents

Coping With Violent Neighborhoods,”

Journal of Primary Prevention, 1996;

16:343–356.

OVC Bulletin

14
WORKING WITH VICTIMS OF GUN VIOLENCE

26. Bastian, Lisa, and B. Taylor, Young

Black Male Victims, U.S. Department of

Justice, Bureau of Justice Statistics, 1994.

27. “Adolescent Assault Victim Needs: A

Review of Issues and a Model Protocol,”

Pediatrics, 1996; 98:991–999.

28. Slevin, Peter, “District Teen Gets 127

Years in Random Shooting of Four,” The

Washington Post, Jan. 6, 2000, p. B2.

29. Jackman, Tom, “Group Urges More

Help for Victims of Crimes,” The

Washington Post, Dec. 15, 2000, p. B5.

30. Christoffel, K.K., “Youth Violence

Prevention: The Physician’s Role,” 

medical student Journal of the American

Medical Association (msJAMA).

31. Nader, Kathi, Robert Pynoos, Lynn

Fairbanks, and Calvin Frederick, “Children’s PTSD Reactions One Year After a

Sniper Attack at Their School,” The

American Journal of Psychiatry, 1990;

147:1526–1530.

32. Bell, C.C., and E.J. Jenkins, “Exposure and Response to Community

Violence Among Children and

Adolescents,” in Children in a Violent

Society, Osofsky, ed., The Guilford Press,

1997.

33. Richters, John E., and Pedro

Martinez, “The NIMH Community

Violence Project: I. Children as Victims

of and Witnesses to Violence,” Psychiatry,

1993; 56:7–21.

34. Rand, M.R., Violence Related 

Injuries Treated in Hospital Emergency

Departments, U.S. Department of Justice,

Bureau of Justice Statistics, 1997.

35. Cook, P.J., B.A. Lawrence, J. Ludwig,

and T.R. Miller, “The Medical Costs of

Gunshot Injuries in the United States,”

The Journal of the American Medical

Association, 1999; 282:447–454.

36. Kizer, K.W., M.J. Vassar, R.L. Harry,

and K.D. Layton, “Hospitalization

Charges, Costs, and Income for Firearm

Related Injuries at a University Trauma

Center,” The Journal of the American

Medical Association, 1995; 273:1768–

1773.

37. Cook, P.J., B.A. Lawrence, J. Ludwig,

and T.R. Miller, “The Medical Costs of

Gunshot Injuries in the United States,”

The Journal of the American Medical

Association, 1999; 282:447–454.

38. Ordog, G.J., J. Wasserberger, and G.

Ackroyd, “Hospital Costs of Firearm

Injuries,” The Journal of Trauma, 1995;

38:291–298.

39. Ibid.

40. Klein, S.R., I.J. Kanno, D.A. Gilmore, and S.E. Wilson, “The Socioeconomic Impact of Assault Injuries 

on an Urban Trauma Center,” The

American Surgeon, 1991; 57:793–797. 

41. Goldman, H., “Gun Violence in the

U.S. Costs More Than $100 Billion a

Year,” Bloomberg News, available online

through Deseret News Archives at 

deseretnews.com.

42. Available online at

www.spinalcord.org/resource/

Factsheets/factsheet2.html. 

43. DeVito, M.J., “Causes and Costs of

Spinal Cord Injury in the United States,”

Spinal Cord, 1997; 35:809–813.

44. Holicky, R., “Violently Acquired

SCI: A Recipe for Inequity.” Available

online at www.spinlife.com (reprinted

from New Mobility, March 2000).

45. The National Education Association

has issued Advice for Journalists covering

school shootings. See www.nea.org/

issues/safescho.

46. Brooks, K., V. Schiraldi, and J.

Zeidenberg, School House Hype: Two Years

Later, Justice Policy Institute/Children’s

Law Center, 2000. Available online at

www.cjcj.org/schoolhousehype/shh2.html.

47. Spungen, Deborah, Homicide: The

Hidden Victims, A Guide for Professionals,

Sage Publications, 1998, pp. 110–111.

48. While a recent survey conducted for

OVC indicates that 23 percent of the

programs enter information into their

databases about whether the crime was

gun related, OVC does not require states

to report the number of claimants who

were victims of gun violence, although

states do report categories of “assault”

(34 percent of claims) and “survivors of

homicide” (11 percent of claims).

49. In October 1996, OVC recommended that hospital-based counseling and 

prevention programs be established in

medical facilities that provide services to

adolescent gunshot victims and victims

of gang violence. In May 1998, OVC

made the same recommendation in New

Directions From the Field: Victims’ Rights

and Services for the 21st Century.

50. Gregorie, Trudy, School Violence—

Are You Prepared To Respond? National

Center for Victims of Crime, 1999.

Available online at www.ncvc.org/newsltr/

schvio.htm.

51. Brock, K., When Men Murder Women:

An Analysis of 1997 Homicide Data:

Females Murdered by Males in Single

Victim/Single Offender Incidents, Violence

Policy Center, 1999.

15
OVC Bulletin

This document was prepared under the direction of the Office for Victims of Crime, Office of

Justice Programs, U.S. Department of Justice.The opinions, findings, conclusions, and recommendations expressed in this document are those of the author and do not necessarily represent the

official position or policies of the U.S. Department of Justice.

The Office for Victims of Crime is a component of the Office of Justice Programs, which also includes the Bureau of Justice Assistance, the Bureau of Justice Statistics, the National Institute of

Justice, and the Office of Juvenile Justice and Delinquency Prevention.

Judith Bonderman, J.D., M.P.H.,

teaches a course on gun violence prevention at the George Washington

University School of Public Health

and Health Services. She thanks the

roundtable participants for sharing

their experiences and for their candid and full discussion of the issues. NCJ 186155

U.S. Department of Justice

Office of Justice Programs

Office for Victims of Crime

Washington, DC 20531

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