Hospital-Based Violence Intervention Programs
HVIPs weave social care into medical care to prevent recurrent firearm injury
Hospital-based violence intervention programs provide comprehensive care to violently injured patients, addressing psychological trauma, risk factors for violence, and social determinants of health.
Hospital-based violence intervention programs (HVIPs) seek to reduce community violence that occurs outside the home, such as assault by strangers and acquaintances, violence perpetrated during criminal activity, and violence in workplaces and schools.
Community violence is often a result of inequity, shaped by social determinants of health like poverty, racism, and lack of educational and employment opportunity. Motivated by this broad view, HVIPs take a public health approach to violence prevention, partnering with community organizations and incorporating social supports into traditional medical care. HVIPs provide violently injured patients with connections to a variety of services. These aim to address many of the social-ecological factors that may have contributed to their initial injury and risk of future injury.
HVIPs disrupt cycles of violence by connecting survivors of violent injury with services.
Reducing Risk of Reinjury
Patients who are admitted to the hospital following a firearm-related assault face high risk of fatal or nonfatal reinjury.1,2 HVIPs intervene during hospitalization to reduce this risk. Hospitalization for a firearm injury can serve as a period in which victims of violence may be more likely to recognize their own vulnerability and more willing to make changes. In HVIPs, culturally-affirming Intervention Specialists go to the bedside of injured patients to establish a relationship for long-term case management that may last for months or years. Depending on individual circumstances and local resources, victims of violence are linked to an array of risk reduction resources in the community. These may include substance use services, mental health treatment, tattoo removal, housing, education, job training, employment, court advocacy, and victim of crime assistance.
Today, over 40 HVIPs exist in the US, and there is promising evidence of their effectiveness.
Some studies have shown HVIPs significantly reduce rates of re-hospitalization for violent injury, reduce arrests for violent crime, decrease lengths of future incarceration, and increase rates of employment in participants.3,4 A systematic review of HVIPs concluded that the evidence was promising but inconclusive, in part due to the design and scale of the published evaluations.5
What You Can Do
The Health Alliance for Violence Intervention is an umbrella network of these programs and has many strong partnerships in the trauma field. Clinicians should be aware if their hospital has an HVIP, which are often based in trauma centers and can be consulted by the treating clinicians. The American College of Surgeons has produced a “Primer” to assist trauma centers in developing and sustaining HVIPs.6
Dr. Rochelle Dicker from the David Geffen UCLA School of Medicine and the Founding Director of the Wraparound Project contributed to this content.
Click to view references
- Firearm-related hospitalization and risk for subsequent violent injury, death, or crime perpetration: a cohort study. Annals of Internal Medicine.
- Risk factors for assaultive reinjury and death following a nonfatal firearm assault injury: a population-based retrospective cohort study. Preventative Medicine.
- A decade of hospital-based violence intervention: Benefits and shortcomings. The Journal of Trauma and Acute Care Surgery.
- Saving lives and saving money: hospital-based violence intervention is cost-effective. The Journal of Trauma and Acute Care Surgery.
- The effects of health care-based violence intervention programs on injury recidivism and costs: a systematic review. The Journal of Trauma and Acute Care Surgery.
- Violence intervention programs: A primer for development of a comprehensive program for trauma centers. American College of Surgeons Bulletin.
For more information, see these peer-reviewed articles.
Walker, G. N., Dekker, A. M., Hampton, D. A., et al. (2020). A Case for Risk Stratification in Survivors of Firearm and Interpersonal Violence in the Urban Environment. The Western Journal of Emergency Medicine.
Juillard, C., Cooperman, L., Allen, I., et al. (2016). A decade of hospital-based violence intervention: Benefits and shortcomings. The Journal of Trauma and Acute Care Surgery.
Strong, B. L., Shipper, A. G., Downton, K. D., & Lane, W. G. (2016). The effects of health care-based violence intervention programs on injury recidivism and costs: A systematic review. The Journal of Trauma and Acute Care Surgery.
Juillard, C., Smith, R., Anaya, N., et al. (2015). Saving lives and saving money: hospital-based violence intervention is cost-effective. The Journal of Trauma and Acute Care Surgery.
Corbin, T. J., Rich, J. A., Bloom, S. L., et al. (2011). Developing a trauma-informed, emergency department-based intervention for victims of urban violence. Journal of Trauma & Dissociation : The Official Journal of the International Society for the Study of Dissociation.
Additional Resources on Hospital-Based Violence Intervention Programs
The HAVI: Training and Resources
Training and resources on trauma informed care and hospital-based violence intervention programs.
Healing Justice Alliance: Resources
Handouts, posters, and publications for trauma-informed work by the Healing Justice Alliance.
We’ve Got Your Back: How Service Providers can Support Male Survivors of Violence
Video on the importance of a culturally-responsive and trauma-informed approach to care for boys and men who are survivors of violence.
Violence Intervention Programs: A Primer for Developing a Comprehensive Program for Trauma Centers
A comprehensive approach to institute a sustainable HVIP by the members of the ACS COT Injury Prevention and Control Committee’s Violence Prevention Programs Workgroup.
Key Components of Hospital-based Violence Intervention Programs
A summary of the discussions at The National Symposium of Hospital-based Violence Intervention Programs by Youth Alive, and funded by Kaiser Permanente’s Northern California Community Benefit Programs.
Best Practices for Training Frontline Violence Intervention Workers
Trainings, support, and professional development opportunities for frontline violence intervention workers based on the standards for certification by the Health Alliance for Violence Intervention (HAVI) as a Violence Prevention Professional.