National Spotlight
Preventing violence before it starts
How Green Dot and Sources of Strength are changing school culture in Eastern Kentucky
When you picture the healthcare sector and gun violence, you might imagine the chaotic rush of an emergency room — sirens, gurneys and medical teams urgently working to save a life after a shooting.
At CHI Saint Joseph Health in the heart of Kentucky, two programs — Green Dot and Sources of Strength — are quietly reshaping school culture and saving lives. Supported by philanthropic gifts to CommonSpirit Health Foundation and run by violence-prevention managers embedded in the school systems, the programs train students not only to recognize warning signs of harm — bullying, dating violence, cyber abuse, suicidal ideation, and more — but also to become active "green dots" who step in, delegate help, or distract to interrupt danger.
“The hospital goes well beyond just the walls of the hospital,” said Brian Hill, the Violence Prevention Manager for Madison County. “Prevention is the best way to do that and creating a culture where we're making healthy choices.”
Meet the Leaders: Keith Stewart and Brian Hill
Keith Stewart, the Violence Prevention Manager at Montgomery County High School and assistant in Madison County, came to this role after a career as a high school baseball coach.
“I absolutely love my job,” Keith said. He's passionate about bringing awareness of bystander intervention to students, teaching them to "see something, say something, and take action."
He is grateful for the opportunity to do work he never imagined — an opportunity he owes to Brian, who introduced him to the program.
"This job is awesome. We really love the impact that we get to make with students," Brian states, attributing his path to a "God thing."
Brian, the Violence Prevention Manager for Madison County, began his journey 11 years ago. Seeking a role closer to home due to family health issues, he discovered Green Dot and was immediately drawn to its mission.
Reflecting a growing understanding in health care that the best medicine is prevention and that community health extends far beyond hospital walls, staff and community partners are moving outside and stepping upstream. Brian and Keith partner with local school districts and train students how they can spot warning signs, intervene as bystanders, and build safer communities long before an incident ever reaches the ER.
“Be a Green Dot”: What the programs look like on the ground
The Green Dot program combines large-group education with deeper, sustained student leadership development.
At the start of the year, schools host overview sessions — 45-minute introductions for staff and separate 45-minute sessions for students — to build buy-in.
From those sessions, 30–50 students are selected for intensive all-day Green Dot trainings (about eight hours) where they learn to first, identify "red dots" (incidents or threats that indicate risk). Then they practice the "3 D’s" of intervention:
- Do (direct action)
- Delegate (get help)
- Distract (interrupt a situation safely)
Sources of Strength complements Green Dot by focusing on resilience. Rather than intervention techniques specifically, Sources of Strength asks students to identify personal protective factors — the "strength wheel", including physical and mental health, trusted adults, family support, and positive friends.
Groups of 30–60 students meet regularly to craft campaigns (e.g., trusted-adult sign-ups, classroom presentations) that lift peer networks and normalize help-seeking. While Sources of Strength is used at middle-school levels, Green Dot is deployed in high schools, colleges, and community settings; in Madison County, program leaders are now expanding Green Dot into healthcare and faith communities to pursue citywide cultural change.
Brian and Keith serve multiple schools — eight to nine middle and high schools across the two counties — and adapt their approach to fit each school’s size, schedule, and culture. Club days and repeat visits keep trained students engaged after the initial all-day experience and help spread campaigns schoolwide.
Measuring impact
Training numbers tell one part of the story: program staff report directly impacting over 910 students in the most recent year and more than 5,000 over a decade. But the program’s heart is in the individual stories — students who were checked on in time, youth who stayed on the phone with a friend experiencing a crisis, and young people who found a trusted person to turn to rather than act on suicidal thoughts.
- A junior approached trainers after a session and tearfully said she had struggled with suicidal ideation for years; learning there were people who cared and resources available made an immediate difference.
- In one case at a middle school, friends who knew a peer had brought a weapon were finally compelled to speak up; the potential for tragedy was averted and the district expanded prevention efforts into middle schools as a result.
- A student who attempted suicide by firearm did not succeed — his gun failed — and because a Green Dot-trained friend was reachable and acted immediately (calling parents and staying on the phone, getting help), the student survived, later finding faith and ongoing stability.
- Students have also used Green Dot skills to intervene in instances of dating violence rumors and cyberbullying, preventing spirals into self-harm and social ruination.
- These examples show both the immediacy of bystander intervention and the power of building a school culture in which students feel safe to speak up and ask for help.
Addressing modern risks: phones, social media, and the law
A striking theme in trainers’ work is how much of modern harm travels through phones and social media. Since the COVID pandemic, reported incidents of cyberbullying and online harm have risen markedly. Trainers have witnessed fights triggered during in-school sessions because a social-media post led a student to storm out.
Trainers also educate students about serious legal implications: sharing sexual images of minors — even if the sender and recipient are peers — can constitute child pornography with criminal penalties. These conversations give students a clearer sense of the stakes and the need to err on the side of caution when someone mentions suicidal thoughts or appears in crisis.
Investing in prevention
CommonSpirit’s support for Green Dot and Sources of Strength stems from the recognition that health is shaped well outside inpatient settings. Preventing violence, reducing suicidal behavior, and strengthening resilience are not just social services; they are fundamental to population health.
Preventive programs reduce trauma, limit avoidable emergency care, and help young people develop lifelong coping strategies and help-seeking behaviors. For a health system, investing in school-based prevention is a direct investment in community well-being — preventing illness before it reaches the clinic.
Local leaders are not content to stop at the schools. By training hospital staff and engaging faith communities, they aim to saturate entire cities with "green dot" behavior — so that violence and harmful norms are actively challenged whenever they appear. The ambition to make a citywide culture of intervention has already taken root in other Kentucky cities; Madison County leaders are pursuing a similar model, planning hospital-based training and outreach to dozens of churches in Berea.
Green Dot and Sources of Strength demonstrate how targeted, school-centered prevention can have immediate life-saving effects while also laying the foundation for healthier, more resilient communities. Supported by CommonSpirit Health, its fundraising arm, and other local partners, the programs show that hospitals’ role in community health goes far beyond treatment: it includes investing in the conditions that prevent trauma, support young people, and create cultures where nobody is left feeling alone.
For donors, policymakers, and healthcare leaders looking for high-impact prevention, this work in Eastern Kentucky offers a compelling, human-centered model — one green dot at a time.
Learn more about support efforts like this with a gift to CommonSpirit Health Foundation's Violence Prevention and
Human Trafficking Response.
About CommonSpirit Health
CommonSpirit Health, headquartered in Chicago, Illinois, is one of the largest nonprofit health systems in the U.S. With more than 175,000 employees, 35,000 physicians and advanced practice clinicians, and 45,000 nurses, CommonSpirit operates 150 hospitals and 2,400 care sites in 24 states serving 22 million patients each year. CommonSpirit is committed to creating healthier communities, delivering exceptional patient care, and ensuring every person has access to quality health care. Learn more at CommonSpirit.org.
CommonSpirit has 80 fundraising entities located across the U.S. Over the past five years, these foundations have raised a combined $1.4 billion to ensure that it can continue to serve the vulnerable and build healthy communities. The organization does this nationally through CommonSpirit Health Foundation, and locally through its network of regional and community-based fundraising entities.
About CommonSpirit Health Foundation
CommonSpirit Health Foundation is making the promise of health justice a reality across the country by funding pioneering programs that ensure greater access, create community partnerships and advocate for the underserved and most vulnerable. The foundation inspires investments and donations from individuals, private foundations, corporate foundations and other entities — to support programs and initiatives that address the root causes of poor health and enable all people to be healthy and safe. Learn more at CommonSpiritHealthPhilanthropy.org/Foundation.
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