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Hospital-based violence intervention programs (HVIPs) address intervention and prevention of community-based interpersonal violence. HVIPs employ Violence Prevention Professionals (VPPs) as first responders to the hospital bedside for patients who present with injuries resulting from community-based interpersonal violence, including firearm injury, stab wounds, and assault. Despite the growing presence of HVIPs in the U.S., the model lacks process and outcome measures to gauge program fidelity and effectiveness. This study utilized a research team of predominantly VPP researchers to conduct key informant interviews with 3 key groups of participants engaged with a regional HVIP, including clients (n = 7), VPPs (n = 9), and healthcare collaborators (n = 8). Analysis of interview data produced 6 overarching themes, including 3 process-based themes: (1) establish the relationship with the hospital site(s) and clients; (2) foundational client engagement; (3) The Work, and 3 outcome-based themes: (1) transition from relationship to partnership; (2) ongoing commitment; (3) The Change that span hospital- to community-based care. Further, the team identified 4 foundational programmatic goals of the HVIP: (1) inspire positive personal change, (2) reduce engagement in violence and other high-risk activity, 3) reduce risk of reinjury and justice system involvement, and (4) reignite young people as beacons of hope. The 6 process-and outcome-related themes and the 4 foundational programmatic goals produced a conceptual framework for the HVIP and a logic model that maps with the conceptual framework. These elements can guide evaluation of HVIP fidelity and effectiveness. Future work can explore the application of these measures at other sites to build the evidence base of the HVIP models in violence intervention and prevention of community-based interpersonal violence, as well as further define the role HVIPs play within the CVI ecosystem.

Among Hospital Based Violence Intervention programs (HVIPs), little is known about variation in services provided, funding sources, or populations served. Twenty-eight member programs of Health Alliance for Violence Intervention participated in a survey administered by the American College of Surgeons Committee on Trauma. Questions were quantitative and qualitative. For qualitative analysis, questions pertaining to the domains were assessed for common themes and assessed across all subject domains. All programs enroll patients injured by community violence, some by intimate partner violence (IPV), trafficking, and rarely by child or elder abuse. Programs with more funding (≥$300,000 per year) were more likely federally, state, or city funded. Lower funded programs (≤$300,000 per year) were funded by foundations or philanthropy. In both qualitative and quantitative analysis, barriers to starting or sustaining HVIPs included funding, and lack of risk reduction and mental health resources. Successful programs had stable funding, adequate staffing, and buy in from hospitals and staff. HVIPs serve diverse populations in variable models. There is opportunity to expand the reach of HVIPs, and the experience if existing programs is an invaluable resource. •Hospital-Based Violence Intervention Programs represent a growing field.•Barriers include funding, training, and the availability of outside support.•Opportunities exist within the American College of Surgeon-Committee on Trauma and the Health Alliance for Violence Intervention.

Hospital-centered violence intervention programs (HVIPs) reduce violent injury recidivism. However, dedicated cost analyses of such programs have not yet been published. We hypothesized that the HVIP at our urban trauma center is a cost-effective means for reducing violent injury recidivism. We conducted a cost-utility analysis using a state-transition (Markov) decision model, comparing participation in our HVIP with standard risk reduction for patients injured because of firearm violence. Model inputs were derived from our trauma registry and published literature. The 1-year recidivism rate for participants in our HVIP was 2.5%, compared with 4% for those receiving standard risk reduction resources. Total per-person costs of each violence prevention arm were similar: $3,574 for our HVIP and $3,515 for standard referrals. The incremental cost effectiveness ratio for our HVIP was $2,941. Our HVIP is a cost-effective means of preventing recurrent episodes of violent injury in patients hurt by firearms.

Background: Firearm violence remains a critical public health issue in the United States, disproportionately impacting youth and communities of color while imposing significant emotional and economic costs. Hospital-Based Violence Intervention Programs (HVIPs) have emerged as effective, multidisciplinary strategies with the goal of interrupting cycles of violence by providing trauma-informed care and community services initiated during hospitalization. To develop a strong HVIP, it is imperative to collaborate with local stakeholders, and the aim of this study was to create and evaluate the effectiveness of a novel approach to the creation of a community advisory board (CAB) for a local HVIP. Methods: This study presents a novel approach to the creation of a CAB to inform an HVIP in Houston, Texas. The CAB included diverse stakeholders such as community leaders, youth advocates, healthcare professionals, law enforcement professionals, and people with firearm violence lived experiences. Using a modified Intervention Mapping (IM) framework and the Community and Stakeholder Engagement Studio (CSES) model, the CAB convened through a series of structured meetings to identify community priorities, define modifiable risk factors, and inform HVIP programming. Results: CAB engagement led to the identification and development of key HVIP program components. The collaborative process emphasized transparency and mutual respect, fostering trust and increasing the likelihood of program acceptance and sustainability. CAB feedback was instrumental in shaping both short- and long-term implementation strategies. Conclusion: Integrating equitable, community-driven stakeholder engagement into HVIP development enhances cultural relevance and responsiveness. This approach not only strengthens program design but also builds community trust.

Purpose The purpose of this paper is to present strategies for cultivating internal support, community partnerships and practitioner engagement for Hospital-based Violence Intervention Programs (HVIPs). In response to growing concerns about community violence and calls to engage the community in its solutions, HVIPs have increased in popularity as innovative and transdisciplinary approaches to violence intervention. HVIPs are one strategy under the broad purview of public health approaches to crime and violence – focusing on reaching recent victims of violence in emergency departments and leveraging this “teachable moment” to offer wrap-around services geared toward preventing future violence or revictimization. Design/methodology/approach This paper uses an autoethnographic and case study approach of Project HEAL (Help, Empower and Lead), a newly established HVIP at Jersey Shore University Medical Center. Findings While there is no “standard” approach, the importance of strong community partnerships and practitioner engagement prior to and during the HVIP implementation process is second to none. Research limitations/implications This case study of Project HEAL’s initial implementation will provide information that can assist other HVIPs in creating and sustaining necessary internal support, community partnerships and practitioner engagement, and potentially help navigate forthcoming statewide and federal efforts. Originality/value Development of meaningful community partnerships and achievement of a high level of engagement from practitioners are key to the successful implementation of HVIPs, the processes of which are not always documented in literature.

Background Our pediatric tertiary care hospital sees a high rate of firearm injuries. Hospital-based violence intervention programs (HVIPs) reduce violent injury recidivism rates in victims. However, significant gaps exist in the delivery of trauma-informed services to families. Our specific aim was to increase our HVIP referral rate by 20% over a 12-month time frame for children seen for interpersonal violence in the emergency department (ED). Methods Our quality improvement study was done at a pediatric tertiary care hospital and encompassed patients 0 to 18 years of age who presented to our ED for assault-related concerns from December 26, 2021 to June 23, 2024. The primary outcome measure was percentage of HVIP-eligible patients who received a referral from the ED. We conducted a root cause analysis by interviewing stakeholders including HVIP staff, ED providers, nurses, and social workers to understand gaps in the referral process. Key drivers included electronic medical record (EMR) trigger tools for referral placement, accessibility of HVIP staff, and staff knowledge of HVIP eligibility and services. We integrated three main EMR-based interventions on June 15, 2023 that triggered referrals to the HVIP. Results Our ED HVIP referral rate during the pre-intervention period (December 26, 2021 to June 15, 2023) was 53.6%. During our post-intervention phase (June 15, 2023 to June 23, 2024), the referral rate reached and sustained at 93.5%, a 74.4% increase. Conclusions We identified a large percentage of missed HVIP-eligible referrals and developed interventions that significantly increased our referral rate. However, this did not translate into increased enrollment, indicating the need for additional efforts.

Violent trauma has lasting psychological impacts. Our institution’s Community Violence Response Team (CVRT) offers mental health services to trauma victims. We characterized implementation and determined factors associated with utilization by pediatric survivors of interpersonal violence-related penetrating trauma. Analysis included survivors (0–21 years) of violent penetrating injury at our institution (2011–2017). Injury and demographic data were collected. Nonparametric regression models determined factors associated with utilization. There was initial rapid uptake of CVRT (2011–2013) after which it plateaued, serving >80% of eligible patients (2017). White race and higher injury severity were associated with receipt and duration of services. In post-hoc analysis, race was found to be associated with continued treatment but not with initial consultation. Successful implementation required three years, aiding >80% of patients. CVRT is a blueprint to strengthen existing violence intervention programs. Efforts should be made to ensure that barriers to providing care, including those related to race, are overcome. •Mental Health Services program successfully implemented in 3 years.•Strengthens existing hospital-based violence intervention programs.•Race associated with continued use of services but not initial engagement.•More work is needed to ensure that barriers to providing care are overcome.

Interpersonal violence is the leading cause of death in adolescents. Hospital-based violence intervention programs (HVIPs) address the emotional and behavioral sequelae of assault and homicide. Few studies have been published on pediatric HVIPs, and no study offers a conceptualization model for treatment approaches. This paper demonstrates the use of empirically supported practices by outlining the services provided and subsequent treatment trajectory of an adolescent receiving care from an HVIP at a Level 1 Pediatric Trauma Center. This case study follows the Case Study Report (CARE) guidelines and is the first to demonstrate the use of intensive case management, Psychological First Aid (PFA), and Skills for Psychological Recovery (SPR) in the treatment of an adolescent presenting to the emergency department (ED) due to assault associated with bullying. Through the use of these treatment approaches to address symptoms of posttraumatic stress, the patient moved from physical recovery to posttraumatic growth. Assessment and trauma-informed treatment suggestions are provided to support evidence-based practices within HVIPs.

With a reduction in primary barriers to healthcare access as a result of the Affordable Care Act, there is an increased need to address secondary barriers faced by low-income young Black male survivors of violent injury. While transportation is often characterized as a barrier for individuals with chronic disease and disability, it also acts as a significant barrier in accessing cognitive behavioral therapy and mentoring services through hospital-based violence intervention programs (HVIPs). These services address the traumatic stress associated with surviving gun violence. Although there are many challenges associated with the current practices of non-emergency medical transportation, participants in HVIPs face additional risk factors. We highlight the application of a digital transportation intervention to increase the use of psychosocial services among low-income young Black male survivors of violent injury participating in an HVIP. Digital non-emergency medical transportation services (DNEMT) address issues concerning financial barriers, personal safety, program credibility, and program participation. We conducted qualitative interviews and a focus group with this population to assess the impact of Uber Health, a DNEMT service, on their participation in an HVIP located in a suburban Maryland hospital immediately outside of Washington, D.C. Survivors identified the use of Uber Health as essential to addressing the multifaceted and interconnected barriers to treatment. These barriers included reluctance to use alternative forms of transportation services (i.e., bus or subway) due to potential encounters with rivals, increased risk of repeat violent victimization, the need to carry a weapon for protection, stigmatization, and symptoms associated with traumatic stress. We found that integrating digital transportation services into the standard practices of HVIPs, as a part of a patient-centered outcomes framework, contributes to a reduction in violent injury and re-traumatization by addressing the multi-layered risks experienced by survivors of gun violence.

Challenges in participant recruitment and retention limit the effectiveness of hospital-based violence intervention programs (HVIPs). This study aimed to determine if an outpatient violence intervention program (VIP) could be integrated into a trauma clinic and increase uptake of violence prevention services. Patients previously hospitalized for intent-to-harm being seen for outpatient follow-up were eligible. VIP counselors met with participants during their clinic visit, administered the survey, and offered violence prevention services (April to June 2019). Patients were followed for 6 months to assess involvement. The primary outcome of interest was long-term participation in the VIP, defined as uptake of services at 6 months, in comparison to inpatient recruitment. Out of 76 patients, 34 (44.7%) did not appear for their appointment. The remainder (n = 42) were offered participation in the study, of which 32 (76.2%) completed the survey. From the group offered VIP services, 57.1% expressed interest, and 5 (20.8%) ultimately took part yielding an overall participation rate of 11.9% at 6 months. The inpatient recruitment rate in 2019 was 2.4%. An outpatient VIP program can be integrated into a clinic setting but suffers from the same challenges faced by inpatient programs resulting in low rates of long-term participation in services. Although a high proportion of participants reported interest, actual engagement at 6 months was low. Reasons behind low participation in VIP services must be investigated.