In a new study published in the Annals of Internal Medicine, researchers from Boston University School of Public Health examined Boston Medical Center’s hospital-based violence intervention program (called the Violence Intervention Advocacy Program) and evaluated whether it reduced future violence among “young adults aged 16 to 34 years who survived a shooting or stabbing.” The authors used a “target trial emulation using observational data,” comparing two treatment strategies: “any treatment”—engaging “within 1 month of injury”—and “sustained treatment”—initiating within 1 month and “engaging more than 4 of the first 8 weeks” post-hospitalization. Researchers tracked a combined outcome—“violent reinjury or violence perpetration”—using “hospital and police data” at 1, 2, and 3 years after the index injury.
Notably, the researchers found that patients who received “sustained treatment” were linked to “considerably lower cumulative incidence” of violence at 1, 2, and 3 years—with risk reductions exceeding 50% at two- and three-year follow-up. Other key findings:
- Sustained Engagement Was Associated With Much Lower Risk. In the “sustained engagement analysis,” treatment was linked to “considerably lower cumulative incidence … 6.4% … at 3 years” versus “14.3%” in the control strategy … with “risk reductions … 55.3% … at 3 years.”
- Dosage Mattered. The authors conclude that HVIPs can improve long-term violence outcomes, but that “these effects seem to require intensive participant engagement.” That’s in contrast to the “any-treatment analysis,” where researchers found that “estimated cumulative incidence was roughly equal between the treatment and control strategies.”
- Models Vary. The findings affirm the “violence prevention potential of HVIPs,” but researchers caution that because “there is no single, agreed-upon package of services for all HVIPs,” “it is unknown how our results may generalize to other HVIPs.”
Two More Hospital-Based Violence Intervention Programs Showing Promise:
- In Virginia, Hospital-Based Violence Intervention Programs Across The State See “A Sharp Decline In Re-Injury Rates.” For The Virginia Mercury, Charlotte Rene Woods reports that the 12 HVIPs across the state, which “provide wraparound services… [to] victims of violence” are receiving a funding boost of $8.5 million from the state to continue their vital work. Since 2019, the newspaper notes, “more than 8,000 victims of violence have been served” by HVIPs across the state, which has produced “over $82 million in health care costs avoided due to preventing and reducing re-injury rates,” nearly half of that “estimated to be direct savings to the state.” A recent report from the American Hospital Association estimated that the total cost of violence to U.S. hospitals was roughly $18 billion annually. Moreover, the state’s Hospital and Healthcare Association, which oversees the hospitals providing violence intervention programming, announced that the effort has “resulted in a sharp decline in re-injury rates—the national average is 40 percent, compared to 3 percent for HVIP patients” in the state.
- In Georgia, Grady Memorial Hospital’s Interrupting Violence In Youth and Young Adults Project Sees Reinjury Rate “Far Below The National Standard.” Emory University School of Medicine, which helps to oversee the IVVY program that runs out of the Level 1 Trauma Center at Grady Memorial Hospital, recently announced that the program is making a significant impact in reducing violence in the region, with “less than two percent of patients treated in coordination with the IVVY Project have returned with a gunshot wound—a reinjury rate far below the national standard of 30-40 percent.”
A recent paper published in Trauma Surgery & Acute Care Open by some of the physicians working in the IVVY program outlined the hospital-based violence program’s novel “three-pronged continuum of care model” called the “Bedside, Clinic, Community” model, which extends violence intervention beyond the hospital stay. Its three pillars include:- “Bedside” care, where violence intervention specialists meet patients at the hospital bedside during the acute treatment phase, “providing immediate care to victims of violence at the time of injury” ensuring that they receive “medical treatment and psychological support” while creating “a seamless transition to ongoing wraparound services” in the later phases of treatment.
- A multidisciplinary “Clinic,” a “one-stop shop” that combines ongoing medical care beyond the acute treatment phase as well as social services, including “physicians, advanced practice providers, wound care specialists, mental health experts, a social worker…” The clinic serves as a “critical bridge between immediate bedside care and long-term community resources.”
- A “Community” partnership that connects patients to organizations for ongoing wraparound supports addressing “mental health services,” “education,” “employment,” “financial,” and “legal aid,” and broader housing, transportation, and food security programs.