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Policy Intelligence

Hospital-Based Community Violence

The Basics
01
What Is This?
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Hospital-based violence intervention programs — HVIPs — station trained specialists inside hospital trauma units to meet gunshot and stabbing victims at their bedside while they are still receiving medical care. When a patient arrives in the emergency department with a penetrating wound, an intervention specialist is paged (sometimes automatically through a trauma notification system, sometimes through a physician or nurse) and goes to the bedside. Dr. Lindsey Dunkelberger, a trauma surgeon at Prisma Health Richland Hospital in Columbia, South Carolina, explains what her team has observed: as physicians “treat physical wounds, survivors become open to interventions to break the cycle of violence.”1

The patient will be discharged, sometimes within hours and sometimes within days, and return to the neighborhood, the network, and the circumstances that produced the injury. Historical data from Minneapolis showed 41% of gunshot victims would be shot again within five years.2 At VCU Medical Center in Richmond, Virginia, Dr. Michel Aboutanos, a Level 1 trauma surgeon who helped establish that hospital’s program, has cited national recidivism rates for gunshot wounds at “almost up to 50%, if not a little bit higher.”3

  1. Dr. Lindsey Dunkelberger, trauma surgeon, Prisma Health Richland Hospital, Columbia, SC; quoted in WLTX/CBS News affiliate report on the program’s launch. ↩

  2. Minneapolis Next Step program data, as reported by WCCO CBS Minneapolis; five-year historical baseline for gunshot victims in the program’s service area. ↩

  3. Dr. Michel Aboutanos, Level 1 trauma surgeon, VCU Medical Center, Richmond, VA; quoted in NBC12 Richmond segment on the Virginia program expansion. ↩

  4. Atlanta Grady Memorial Hospital IVYY program description; Dr. Randi Smith quoted in WXIA NBC Atlanta and 11Alive coverage of the program. ↩

  5. Dwayne Johnson, Director, Violence Recovery Program, University of Chicago Medicine; UChicago civic engagement profile; UChicago Medicine trauma resiliency page confirming Johnson named Director in 2024. ↩

  6. Dr. Amy Makley, Trauma Medical Director, UC Health, Cincinnati; quoted in Cincinnati Enquirer/Cameron Knight reporting. ↩

  7. Atlanta Grady Hospital IVYY program description; Alive 11/Liza Lucas reporting. ↩

  8. Boston University School of Public Health study of Boston Medical Center Violence Intervention Advocacy Program; Annals of Internal Medicine, 2026; DOI: 10.7326/ANNALS-25-01678; sustained treatment linked to 55.3% risk reduction at 3 years; any-treatment group outcomes “roughly equal between treatment and control strategies.” ↩

  9. Atlanta Grady Memorial Hospital IVYY program description; Dr. Randi Smith quoted in WXIA NBC Atlanta and 11Alive coverage of the program. ↩

  10. Nkosi Cave, violence intervention specialist, IVYY Project, Grady Memorial Hospital; 11Alive/Aisha Howard reporting on IVYY two-year results. ↩

  11. Prisma Health Richland Hospital program description; WLTX/CBS News affiliate reporting and ColaDaily reporting with Dr. Lindsey Dunkelberger. ↩

  12. UChicago Medicine Violence Recovery Program; UChicago Medicine annual community benefit report; UChicago civic engagement materials describing Christine Goggins as lead violence recovery specialist and licensed social worker. ↩

  13. UChicago Medicine trauma resiliency page confirming 11,000+ patients since 2018; Dwayne Johnson named Director in 2024; national training workshop with OSF Strive in Rockford, IL. ↩

  14. Dr. Randi Smith, Founder and Medical Director, IVYY Project, Grady Memorial Hospital; quoted in 11Alive/Alive 11 coverage. ↩

  15. Dr. Simbo Ige, Commissioner, Chicago Department of Public Health; quoted at press conference announcing Chicago’s $3 million HVIP investment; confirmed current as of March 2026. ↩

  16. Dr. Randi Smith; WXIA NBC Atlanta reporting on Grady IVYY program outcomes. ↩

  17. Virginia Mercury/Charlotte Rene Woods reporting on 12 Virginia HVIPs and state coverage gap; 2025. Virginia Hospital and Healthcare Association materials. ↩

  18. Health Alliance for Violence Intervention (HAVI); organizational description of hospital-based programs as post-injury intervention distinct from community-based prevention programs; HAVI program materials. ↩

  19. Buffalo Trauma Recovery Center launch; Spectrum News/Mark Goshgarian reporting. ↩

  20. Dr. Amy Makley, Trauma Medical Director, UC Health, Cincinnati; quoted in Cincinnati Enquirer/Cameron Knight reporting. ↩

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02
Why Does This Exist?
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Dr. Ashley Williams Hogue, a trauma surgeon at USA Health University Hospital in Mobile, Alabama, described the experience that drives support for intervention programs: she has “operated on the same victims who’ve been shot in separate incidents.”1 Dr. Michel Aboutanos at VCU Medical Center in Richmond put national numbers on it: gunshot wound recidivism runs at “almost up to 50%, if not a little bit higher.”2 Minneapolis Next Step’s baseline data showed 41% of victims were shot again within five years.3

  1. Dr. Ashley Williams Hogue, trauma surgeon, USA Health University Hospital, Mobile, AL; quoted in NBC News report on Mobile’s HALO program launch. ↩

  2. Dr. Michel Aboutanos, Level 1 trauma surgeon, VCU Medical Center, Richmond, VA; quoted in NBC12 Richmond reporting on the Virginia HVIP expansion. ↩

  3. Minneapolis Next Step program; historical five-year baseline data reported by WCCO CBS Minneapolis. ↩

  4. Dr. Lindsey Dunkelberger, trauma surgeon, Prisma Health Richland Hospital; quoted in WLTX/CBS and ColaDaily reporting. ↩

  5. Former Mayor Sandy Stimpson, Mobile, AL (served through November 2025); quoted at press conference announcing HALO program; Fox10/NBC News reporting. ↩

  6. IVYY program at Grady Hospital; description of the post-surgery retaliation window from program materials including Dr. Randi Smith interviews in 11Alive/Alive 11 coverage and the IVYY program launch description. ↩

  7. Dr. Kirsten Bechtel, physician and professor of pediatrics, Yale School of Medicine; quoted in WTNH New Haven and Yale program materials. ↩

  8. Dr. Randi Smith, IVYY Project Founder and Medical Director, Grady Memorial Hospital; WXIA NBC Atlanta reporting. ↩

  9. Dr. Amy Makley, Trauma Medical Director, UC Health, Cincinnati; Cincinnati Enquirer/Cameron Knight reporting. ↩

  10. Daniel Blum, CEO, Sinai Hospital and Grace Medical Center, Baltimore; quoted in NBC Baltimore affiliate/Lisa Robinson reporting. ↩

  11. Dr. Randi Smith, IVYY Founder and Medical Director, Grady Memorial Hospital; retaliation timeline (2am/2pm) from IVYY program materials; cited in 11Alive/Alive 11 coverage and Safer Cities Hospital-CVI newsletter. ↩

  12. Cooper C, Eslinger DM, Stolley PD. “Hospital-Based Violence Intervention Programs Work.” Journal of Trauma: Injury, Infection, and Critical Care. 2006;61(3):534-537. Study population: repeat victims of violence on parole/probation admitted for injuries inflicted by violent acts, 1999-2001. Control group was three times more likely to be arrested for a violent crime, twice as likely to be convicted of any crime, four times more likely to be convicted of a violent crime. ↩

  13. Cheng TL, Haynie D, Brenner R, Wright JL, Chung SE, Simons-Morton B. “Effectiveness of a Mentor-Implemented, Violence Prevention Intervention for Assault-Injured Youths Presenting to the Emergency Department: Results of a Randomized Trial.” Pediatrics. 2008;122(5):938-946. Johns Hopkins University. Population: youth aged 10-15, peer assault injury, two large urban hospital EDs. Results showed trends toward reduced misdemeanor activity (rate ratio 0.29), reduced aggression scores, and increased self-efficacy. Most results did not reach conventional statistical significance; the study describes “a trend toward significant program effects.” Reported by Aqeela Sherrills, The Grio. ↩

  14. U.S. Surgeon General advisory designating gun violence a public health crisis; Dr. Simbo Ige cited this advisory when announcing Chicago’s HVIP investment; confirmed in Chicago Department of Public Health announcement. ↩

  15. American Medical Association, American College of Surgeons, and American Public Health Association positions framing community violence as a public health issue; cited in HAVI field literature and program advocacy materials. ↩

  16. Dr. Simbo Ige, Commissioner, Chicago Department of Public Health; quoted at Chicago $3 million HVIP investment announcement; confirmed current as of March 2026. ↩

  17. Virginia Mercury/Charlotte Rene Woods reporting on $8.5 million Virginia state investment in 12 HVIPs; Virginia Hospital and Healthcare Association announcement; 2025. ↩

  18. American Hospital Association report on cost of violence to U.S. hospitals; cited in Virginia Hospital and Healthcare Association press materials; 2024. ↩

  19. Analysis of HVIP cost savings; estimated cost savings range of $82,765 to $4 million per participant over five-year model; cited in HAVI field literature review of HVIP cost-effectiveness research. Source: HAVI program materials and research summary documents. ↩

  20. Health Alliance for Violence Intervention (HAVI) and Everytown for Gun Safety Support Fund HVIP cost calculator; available at thehavi.org. Purpose stated: ‘cities and funders need to understand the key costs of implementing Hospital-Based Violence Intervention Programs.’ ↩

  21. Daniel Blum, CEO, Sinai Hospital and Grace Medical Center, Baltimore; NBC affiliate reporting. ↩

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03
How Is This Different?
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Daniel Blum, chief executive of Sinai Hospital and Grace Medical Center in Baltimore, named the prior standard plainly: “patch and release.”1 Dr. Ashley Williams Hogue, a trauma surgeon at USA Health University Hospital in Mobile, has described what that standard produces: she has “operated on the same victims who’ve been shot [and then shot again] in separate incidents.”2

HVIPs add a separate workforce to the trauma unit whose job begins where surgery ends.

  1. Daniel Blum, CEO, Sinai Hospital and Grace Medical Center, Baltimore; NBC affiliate reporting. ↩

  2. Dr. Ashley Williams Hogue, trauma surgeon, USA Health University Hospital, Mobile, AL; NBC News reporting by Andrea Ramey on Mobile HALO program launch. ↩

  3. Thomas Stuckey, former police officer and professor of criminal justice, Indiana University-Purdue; Chronicle of Philanthropy piece on Indianapolis Prescription for Hope program at Eskenazi Hospital; initial study data on 3% vs. 8.7% repeat injury rate. ↩

  4. Virginia Hospital and Healthcare Association; 3% re-injury rate for HVIP patients vs. 40% national average; VHHA announcement on Virginia hospital violence intervention programming. ↩

  5. Virginia Mercury/Charlotte Rene Woods; 12 HVIPs statewide; 8,000+ violence victims served since 2019; $82.5 million in healthcare costs avoided; $8.5 million state investment; 2025. ↩

  6. Dr. Michel Aboutanos, Level 1 trauma surgeon, VCU Medical Center, Richmond; NBC12 Richmond reporting; 3.6% five-year recidivism vs. national baseline near 50%., former police officer and professor of criminal justice, Indiana University-Purdue; Chronicle of Philanthropy piece on Indianapolis Prescription for Hope program at Eskenazi Hospital; initial study data on 3% vs. 8.7% repeat injury rate. ↩

  7. Atlanta Grady Memorial Hospital IVYY program description; Dr. Randi Smith quoted in WXIA NBC Atlanta and 11Alive coverage. ↩

  8. Nkosi Cave, violence intervention specialist, IVYY Project, Grady Memorial Hospital; 11Alive/Aisha Howard reporting. ↩

  9. University of Chicago Medicine Violence Recovery Program; approximately 20 violence recovery specialists working around the clock; UChicago Medicine reporting and Dwayne Johnson/Franklin Cosey-Gay program materials. ↩

  10. Christine Goggins, lead violence recovery specialist and licensed social worker, UChicago Medicine VRP; curriculum development and national training role; UChicago Medicine annual community benefit report and UChicago civic engagement materials.; approximately 20 violence recovery specialists working around the clock; confirmed in UChicago Medicine reporting and Dwayne Johnson/Franklin Cosey-Gay program materials. ↩

  11. Prisma Health Richland Hospital; WLTX/CBS News affiliate reporting and ColaDaily reporting. ↩

  12. Dr. Lindsey Dunkelberger, trauma surgeon, Prisma Health Richland Hospital, Columbia, SC; WLTX/CBS News affiliate report on program launch. ↩

  13. Dr. Amy Makley, Trauma Medical Director, UC Health, Cincinnati; Cincinnati Enquirer reporting. ↩

  14. Minneapolis Next Step program; WCCO CBS Minneapolis reporting. ↩

  15. Boston University School of Public Health study of Boston Medical Center’s Violence Intervention Advocacy Program, published in Annals of Internal Medicine 2026; DOI: 10.7326/ANNALS-25-01678; “target trial emulation using observational data”; sustained treatment defined as initiating within 1 month and engaging more than 4 of first 8 weeks; 55.3% risk reduction at 3 years (6.4% vs. 14.3%). ↩

  16. Multi-program HVIP research review; 89% employment/diploma/GED completion rate among program graduates; original review language from HAVI field literature on HVIP outcomes. Source: HAVI program research summary documents. ↩

  17. Louisville Office of Violence Prevention annual report, October 2025; 628 patients, 85% enrollment, 62% gun violence reduction in target neighborhoods; Louisville Public Media reporting, October 6, 2025. ↩

  18. Grady Hospital IVYY program; warm handoff to community-based organizations for housing, job, and food assistance; Alive 11/Liza Lucas and 11Alive reporting. ↩

  19. University of Chicago Medicine Violence Recovery Program; 60+ community-based social and behavioral health agency connections; UChicago Medicine program materials. ↩

  20. Dwayne Johnson, Director, UChicago Medicine Violence Recovery Program; UChicago Medicine civic engagement profile and program materials. ↩

  21. Virginia Hospital and Healthcare Association; statewide network of 12 HVIPs; VHHA announcement on Virginia hospital violence intervention programming; Virginia Mercury reporting. ↩

  22. Dr. Randi Smith, IVYY Founder and Medical Director, Grady Memorial Hospital; 11Alive/Aisha Howard reporting; paper in Trauma Surgery & Acute Care Open describing the bedside-clinic-community model. Citation: Castater C, Hart L, Metchik A, Jackson K, Wright R, Cave N, Alexander C, Clemons J, Sarumi P, Smith RN. Trauma Surgery & Acute Care Open. 2025;10(4):e001869. ↩

  23. University of Chicago Medicine Violence Recovery Program; approximately 20 violence recovery specialists working around the clock; UChicago Medicine reporting and Dwayne Johnson/Franklin Cosey-Gay program materials. ↩

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On the Ground
04
What Calls Does This Handle?
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Hospital-based violence intervention programs are not dispatched. They are triggered by an admission. When a patient arrives in a hospital emergency department with a penetrating wound (gunshot, stab wound, or in some programs, other forms of intentional interpersonal violence) the HVIP team is notified and deploys to the bedside.

Street-based community violence intervention programs respond to intelligence gathered through community relationships. Mobile crisis teams respond to 911 calls. HVIPs respond to a person who is already in the hospital, already receiving medical care.

The notification can come through several routes depending on how the program is structured. The University of Cincinnati’s Hope and Shield Network uses dedicated trauma pagers: physicians carry pagers “so they can be notified when an injured patient arrives and can immediately engage with patients and families during inpatient stays and at outpatient follow-up.”1 Some programs use automatic CAD-style alerts built into the hospital’s electronic health record system. Others rely on a nurse, physician, or social worker making a direct call to the HVIP team when a qualifying patient arrives. The Pittsburgh program has used QR codes that nurses can scan to instantly notify the intervention team.2 The most common trigger in newer programs is a nurse or physician making a manual notification when violence-related trauma presents.

  1. University of Cincinnati Medical Center and Children’s Hospital Hope and Shield Network; physicians carry “trauma pagers so they can be notified when an injured patient arrives”; Citizen Portal/Cincinnati reporting. ↩

  2. Pittsburgh HVIP program; QR code notification system for nurses; referenced in Pittsburgh Reimagine Reentry program materials. Note: primary press source not independently verified; cited in HVIP program documentation. ↩

  3. Grady Memorial Hospital IVYY Project; ages 14-34; Dr. Randi Smith, 11Alive/Alive 11 reporting. ↩

  4. Yale School of Medicine HVIP; focus on “children admitted into the emergency room with firearm injuries”; WTNH New Haven reporting and Yale program description. ↩

  5. University of Chicago Medicine Violence Recovery Program; described as “the only hospital-based violence intervention program in Chicago that serves both adults and children”; UChicago civic engagement materials. ↩

  6. Minneapolis Next Step program; focus on youth; WCCO CBS Minneapolis reporting. ↩

  7. Louisville Pivot to Peace; 628 patients with gunshot wounds or stab wounds at UofL Hospital, 2024-2025; Louisville Office of Violence Prevention report, October 2025; Louisville Public Media/LPM reporting. ↩

  8. Austin Travis County HVIP; notification when patient arrives with “evidence of violence — either a gun shot, a stab wound or signs of abuse”; Austin American-Statesman/Nicole Villalpando reporting. ↩

  9. Dr. Randi Smith; two-thirds of 14-24-year-old gunshot patients face food insecurity, housing instability, financial precarity; WXIA NBC Atlanta reporting. ↩

  10. Dr. Randi Smith; bedside-clinic-community model; Trauma Surgery & Acute Care Open paper. Citation: Castater C, Hart L, Metchik A et al. Trauma Surgery & Acute Care Open. 2025;10(4):e001869. ↩

  11. Austin Travis County HVIP; most common patient needs; KXAN/Brianna Hollis reporting; Austin American-Statesman. ↩

  12. Dr. Amy Makley, Trauma Medical Director, UC Health, Cincinnati; Cincinnati Enquirer/Cameron Knight reporting. ↩

  13. Grady Hospital IVYY program warm handoff; Alive 11/Liza Lucas reporting. ↩

  14. University of Chicago Medicine Violence Recovery Program; 60+ community agency connections; UChicago Medicine program materials. ↩

  15. Austin Travis County HVIP; most common patient needs; KXAN/Brianna Hollis reporting; Austin American-Statesman. ↩

  16. Austin Travis County HVIP; notification when patient arrives with “evidence of violence — either a gun shot, a stab wound or signs of abuse”; Austin American-Statesman/Nicole Villalpando reporting. ↩

  17. Yale New Haven Hospital violence intervention program cash stipend pilot; $1,000 for homicide victim family members; $500 (two payments) for violence victims; WTNH New Haven/Jayne Chacko reporting. ↩

  18. Virginia Mercury/Charlotte Rene Woods reporting on $8.5 million investment in 12 Virginia HVIPs; 2025. Virginia Hospital and Healthcare Association announcement. ↩

  19. Health Alliance for Violence Intervention (HAVI); organizational description of HVIP as one component of a broader CVI ecosystem; HAVI program materials. ↩

  20. Terra Tucker, Alliance for Safety and Justice; Austin Travis County HVIP and Trauma Recovery Center connection; KXAN/Brianna Hollis reporting. ↩

  21. Buffalo Trauma Recovery Center; transportation for ongoing medical and mental health treatment; Spectrum News/Mark Goshgarian reporting. ↩

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05
Does It Work?
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The evidence base includes a randomized controlled trial, a 2025 observational study with a target trial emulation design, and program-level outcome data across multiple cities.

Three caveats apply across the entire evidence base. First, most documented outcomes come from a small number of well-resourced programs in major urban medical centers; rural, community hospital, and smaller-city results are largely undocumented. Second, program-reported data — which constitutes most of the available evidence — is not independently verified, and some programs may have enrolled a more motivated population that would have done better regardless. Third, the evidence on long-term outcomes beyond three years remains thin.

  1. Two separate RCTs document criminal justice effects. (1) Cooper, Eslinger & Stolley (2006), Journal of Trauma: control group three times more likely to be arrested for a violent crime; population: repeat victims of violence on parole/probation. (2) Cheng et al. (2008), Pediatrics, Johns Hopkins: trend toward reduced misdemeanor activity, reduced aggression scores, increased self-efficacy; population: youth aged 10-15, peer assault injury, two large urban hospital EDs. Most findings in the Cheng study did not reach conventional statistical significance. Reported by Aqeela Sherrills, The Grio (cited as Johns Hopkins RCT in original source). ↩

  2. Two separate RCTs document criminal justice effects. (1) Cooper, Eslinger & Stolley (2006), Journal of Trauma: control group three times more likely to be arrested for a violent crime; population: repeat victims of violence on parole/probation. (2) Cheng et al. (2008), Pediatrics, Johns Hopkins: trend toward reduced misdemeanor activity, reduced aggression scores, increased self-efficacy; population: youth aged 10-15, peer assault injury, two large urban hospital EDs. Most findings in the Cheng study did not reach conventional statistical significance. Reported by Aqeela Sherrills, The Grio (cited as Johns Hopkins RCT in original source). ↩

  3. Webster DW, Richardson J, Meyerson N, Vil C, Topazian R. “Research on the Effects of Hospital-Based Violence Intervention Programs: Observations and Recommendations.” Annals of the American Academy of Political and Social Science. 2022;704(1):137-157. doi: 10.1177/00027162231173323. Authors: Johns Hopkins Bloomberg School of Public Health. ↩

  4. Boston University School of Public Health study of Boston Medical Center Violence Intervention Advocacy Program; Annals of Internal Medicine, 2026; DOI: 10.7326/ANNALS-25-01678; ages 16-34, shooting or stabbing survivors; target trial emulation design; “any treatment” vs. “sustained treatment”; 55.3% risk reduction at 3 years for sustained engagement group (6.4% vs. 14.3%). ↩

  5. Boston University School of Public Health study of Boston Medical Center Violence Intervention Advocacy Program; Annals of Internal Medicine, 2026; DOI: 10.7326/ANNALS-25-01678; ages 16-34, shooting or stabbing survivors; target trial emulation design; “any treatment” vs. “sustained treatment”; 55.3% risk reduction at 3 years for sustained engagement group (6.4% vs. 14.3%). ↩

  6. Minneapolis Next Step; 41% baseline (5-year cumulative data) vs. 3% first-year program rate; WCCO CBS Minneapolis; note on differing measurement windows applies to any direct comparison. ↩

  7. Indianapolis Prescription for Hope, Eskenazi Hospital; Thomas Stuckey, Indiana University-Purdue; Chronicle of Philanthropy; initial study finding 3% vs. 8.7% repeat emergency department visit for violent injury. ↩

  8. VCU Medical Center, Richmond, VA; Dr. Michel Aboutanos; NBC12 Richmond reporting; five-year 3.6% recidivism vs. national baseline near 50%. ↩

  9. Virginia Hospital and Healthcare Association; 12 HVIPs statewide; 3% re-injury rate for HVIP patients vs. 40% national average; Virginia Mercury/Charlotte Rene Woods reporting; $8.5 million state grant announcement, 2025. ↩

  10. Emory University School of Medicine IVYY Project announcement; “less than two percent of patients… have returned with a gunshot wound — a reinjury rate far below the national standard of 30-40 percent.” Program website and 11Alive reporting. ↩

  11. Grady Memorial Hospital IVYY Project first-year data; 1% reinjury among 450+ gunshot victims; WXIA NBC Atlanta/Liza Lucas reporting. ↩

  12. Cleveland University Hospitals; 600+ participants; reinjury reduced from 29% to 19% over five-year program period. Source: program data cited in HAVI field documentation. Note: independently published outcome study not identified; this is program-reported data. ↩

  13. Cincinnati Hope and Shield Network; University of Cincinnati Medical Center and Children’s Hospital network; 50 patients enrolled, zero repeat injuries in first six months; Citizen Portal reporting; presented to Cincinnati City Council Public Safety and Governance Committee. ↩

  14. Louisville Pivot to Peace; Office of Violence Prevention report, October 2025; 628 patients, 85% enrollment; 62% violent crime reduction in target neighborhoods (first half 2025); Louisville Public Media/LPM, October 6, 2025. ↩

  15. Cleveland University Hospitals; 600+ participants; reinjury reduced from 29% to 19% over five-year program period. Source: program data cited in HAVI field documentation. Note: independently published outcome study not identified; this is program-reported data. ↩

  16. Cincinnati Hope and Shield Network; University of Cincinnati Medical Center and Children’s Hospital network; 50 patients enrolled, zero repeat injuries in first six months; Citizen Portal reporting; presented to Cincinnati City Council Public Safety and Governance Committee. ↩

  17. VCU Medical Center, Richmond, VA; Dr. Michel Aboutanos; NBC12 Richmond reporting; five-year 3.6% recidivism vs. national baseline near 50%. ↩

  18. Multi-program HVIP research review; 89% employment/diploma/GED completion; participants who gained employment four times more likely to succeed in intervention. Source: Research review findings summarized in HAVI field literature; cited in Hospital-CVI Newsletter compilation. Original review language: “89% of program graduates either obtained employment, received a diploma, or completed general educational development… participants who gained employment were four times more likely to succeed in the intervention.” This figure comes from a multi-program review, not a single independently verified controlled study. ↩

  19. Virginia Mercury; $82.5 million in health care costs avoided; nearly half direct state savings; $8.5 million Virginia grant to 12 HVIPs; 2025. ↩

  20. HVIP cost-effectiveness analysis; $82,765-$4 million per participant over five-year model; from research review cited in HAVI field literature on HVIP cost-effectiveness. Source: HAVI program research summary documents. ↩

  21. American Hospital Association report; total cost of violence to U.S. hospitals approximately $18 billion annually; cited in Virginia Hospital and Healthcare Association announcement, 2024. ↩

  22. Health Alliance for Violence Intervention (HAVI) and Everytown for Gun Safety Support Fund HVIP cost calculator; available at thehavi.org. ↩

  23. Boston University School of Public Health study of Boston Medical Center Violence Intervention Advocacy Program; Annals of Internal Medicine, 2026; DOI: 10.7326/ANNALS-25-01678; ages 16-34, shooting or stabbing survivors; target trial emulation design; “any treatment” vs. “sustained treatment”; 55.3% risk reduction at 3 years for sustained engagement group (6.4% vs. 14.3%). ↩

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06
Where Is This Happening?
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Hospital-based violence intervention programs now operate in hospitals across more than 30 cities, with the field expanding steadily since the early 2010s and accelerating notably between 2022 and 2025. The Health Alliance for Violence Intervention (HAVI), the national membership organization for hospital-based programs, has tracked consistent field growth; a 2023 Academic Medicine paper noted the field encompassed “nearly 40 hospital-based violence intervention programs in urban communities” at the time of publication, with new programs launching in additional cities in the years since. Concentration remains in Level 1 Trauma Centers in major urban areas, but state-level infrastructure is emerging in Virginia and other states that is beginning to close the gap with community and rural hospitals.

The geographic picture is uneven, with documented programs concentrated in major urban medical centers and significant gaps in rural and community hospital settings.1

  1. Virginia Mercury/Charlotte Rene Woods; Virginia Hospital and Healthcare Association materials on coverage gaps between Level 1 Trauma Centers and rural/community hospitals; 2025. ↩

  2. University of Chicago Medicine Violence Recovery Program; Dwayne Johnson named Director in 2024 (UChicago Medicine Trauma Resiliency page); 11,000+ patients since 2018; 2023 data: approximately 2,000 patients; 60+ community agencies; Recovery Legal Care; Chicago $3 million investment; Dr. Simbo Ige. Sources: UChicago Medicine program materials; UChicago 2023 Annual Community Benefit Report; CDPH announcement. ↩

  3. Louisville Pivot to Peace; Office of Violence Prevention report, October 2025; 628 patients, 85% enrollment, 62% gun violence reduction in target neighborhoods; Mayor Craig Greenberg statements; LPM/Louisville Public Media reporting, October 6, 2025. ↩

  4. Grady Memorial Hospital IVYY Project; Dr. Randi Smith, Founder and Medical Director; launched January 2023; 650+ participants; less than 2% reinjury; DOJ grant; 11Alive/Aisha Howard and Emory University announcements. ↩

  5. Minneapolis Next Step; Kentral Galloway, director; nearly 1,000 survivors; 41% to 3% reinjury; WCCO CBS Minneapolis. ↩

  6. Project Ujima, Children’s Wisconsin, Milwaukee; Lamicka Lovelace, program director; Spectrum News 1/Haley Kosik reporting. ↩

  7. New York City citywide HVIP system; 3,500+ patients; unified multidisciplinary approach; expansion to all six NYC Health + Hospitals Level 1 trauma centers. Source: NYC Health + Hospitals announcement; cited in Hospital-CVI Newsletter. ↩

  8. Penn Trauma, University of Pennsylvania; physician quote on barriers to safe discharge. Source: Philadelphia program materials cited in Hospital-CVI Newsletter compilation. Note: specific physician name and original publication not independently verified. ↩

  9. Yale School of Medicine HVIP; Dr. Kirsten Bechtel; cash stipend pilot; WTNH New Haven reporting; Connecticut first-state Medicaid reimbursement. ↩

  10. VCU Medical Center; Dr. Michel Aboutanos; 3.6% five-year recidivism; NBC12 Richmond; Virginia $8.5 million investment; Virginia Mercury/Charlotte Rene Woods; 2025. ↩

  11. UC Davis Health Center; Michele Knight, clinical psychologist and TRC director; CBS News/Ashley Sharp reporting on TRC launch. ↩

  12. Prisma Health Richland Hospital; Dr. Lindsey Dunkelberger; WLTX/CBS News affiliate Columbia SC reporting. ↩

  13. Mobile HALO program; USA Health University Hospital; former Mayor Sandy Stimpson (left office November 2025); Dr. Ashley Williams Hogue; Fox10/Daeshen Smith and NBC News/Andrea Ramey reporting. ↩

  14. Austin Travis County HVIP; KXAN/Brianna Hollis reporting; Austin American-Statesman/Nicole Villalpando reporting; Terra Tucker, Alliance for Safety and Justice. ↩

  15. Harris County HVIP; 44 patients since November launch. Source: Hospital-CVI Newsletter reporting on Harris County HVIP launch. Note: primary press source not independently verified; cited in newsletter compilation. ↩

  16. Pittsburgh Reimagine Reentry/Focus on Renewal; $50 million investment; QR code notification system. Source: Pittsburgh program materials; cited in HVIP program documentation. Note: primary press source for this program not independently verified. ↩

  17. Buffalo Trauma Recovery Center; Spectrum News/Mark Goshgarian reporting; launched in direct partnership with pre-existing HVIP. ↩

  18. VCU Medical Center; Dr. Michel Aboutanos; 3.6% five-year recidivism; NBC12 Richmond; Virginia $8.5 million investment; Virginia Mercury/Charlotte Rene Woods; 2025. ↩

  19. Medicaid reimbursement for CVI programs; five states (CA, CT, IL, MD, OR) as of early 2023; Health Affairs article/Dr. Kyle Fischer; CVI Newsletter reporting. ↩

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The Politics
07
Do People Support This?
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No large-scale national poll has asked the public specifically about hospital-based violence intervention programs. The model is newer, more institutionally housed, and less politically charged than some other alternative response programs, which means it has attracted less dedicated survey research. What exists instead are three types of evidence: proxy polling on adjacent programs and values, institutional acceptance rates from the programs themselves, and the political behavior of officials who have championed these programs in public.

Each tells something real. Together they sketch a picture of a program that does not generate organized opposition, operates in political terrain that is broadly favorable, and has not yet been tested by a sustained hostile campaign.

  1. No dedicated HVIP-specific polling exists. The proxy evidence referenced in this card draws on adjacent program polling and institutional behavior. Where Safer Cities proprietary polling is referenced, it is the organization’s own survey research, not independently published data. ↩

  2. American Hospital Association 2024 report; total cost of violence to U.S. hospitals approximately $18 billion annually. Source: AHA report cited in Virginia Hospital and Healthcare Association materials. ↩

  3. Grady Memorial Hospital IVYY Project; 98% eligible patient acceptance rate; WXIA NBC Atlanta/Alive 11 reporting. ↩

  4. Louisville Office of Violence Prevention annual report, October 2025; 85% of 628 patients agreed to speak with intervention specialist; Louisville Public Media reporting. ↩

  5. Dr. Kirsten Bechtel, physician and professor of pediatrics, Yale School of Medicine; WTNH New Haven reporting on Yale HVIP program. ↩

  6. Yale New Haven Hospital violence intervention program cash stipend pilot; $1,000 for family members of homicide victims; $500 (two payments) for violence survivors; WTNH New Haven/Jayne Chacko reporting. ↩

  7. Former Mayor Sandy Stimpson, Mobile, AL (served 2013–November 2025); Fox10/NBC News reporting on HALO program launch. ↩

  8. Mayor Craig Greenberg, Louisville; Office of Violence Prevention report October 2025; reelection bid announced October 2025. ↩

  9. Dr. Simbo Ige, Commissioner, Chicago Department of Public Health; $3 million HVIP investment announcement; confirmed current as of March 2026. ↩

  10. Christy Lopez, Georgetown Law Center on Poverty and Inequality; critique of CVI programs as insufficient scope without structural reforms. Source: Lopez, C., “The Limits of Violence Interruption,” Georgetown Law; cited in The Appeal and multiple CVI policy discussions. ↩

  11. Christy Lopez, Georgetown Law Center on Poverty and Inequality; critique of CVI programs as insufficient scope without structural reforms. Source: Lopez, C., “The Limits of Violence Interruption,” Georgetown Law; cited in The Appeal and multiple CVI policy discussions. ↩

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08
Who Are the Key Stakeholders?
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Trauma Surgeons At every well-documented HVIP in the field, a trauma surgeon founded or co-founded the program. Dr. Ashley Williams Hogue describes what drives that pattern: “She’s operated on the same victims who’ve been shot and then shot again in separate incidents.”1

Dr. Randi Smith, Founder and Medical Director of the IVYY Project at Grady Memorial Hospital, established Atlanta’s program in January 2023 after years of treating returning patients in her trauma bay. She describes the motivation: “Every day, I would see patients coming in through our trauma bay injured by violence, and I knew I wanted to be part of the solution. I wanted to figure out what was bringing them here in the first place and prevent them from coming back.”2

Dr. Michel Aboutanos, Level 1 trauma surgeon at VCU Medical Center in Richmond, established Virginia’s model program, which now serves as the template for the state’s 12-hospital HVIP network and $8.5 million state investment.3

Dr. Amy Makley, Trauma Medical Director at UC Health in Cincinnati, has championed Hope and Shield (her hospital’s HVIP) before city council and in media coverage, grounding the program’s case in PTSD and mental health data.4

Dr. Ashley Williams Hogue, trauma surgeon at USA Health University Hospital in Mobile, Alabama, has been the medical face of the HALO program, describing from direct clinical experience the pattern of operating on the same patients repeatedly.5

Dr. Lindsey Dunkelberger, trauma surgeon at Prisma Health Richland Hospital in Columbia, South Carolina, leads the multidisciplinary team there and has described to local media what her team observes daily.6

Program Directors and Violence Recovery Specialists The operational leadership of most HVIPs sits with a program director or lead specialist, often someone who combines clinical training with community credibility.

Dwayne Johnson, Director of the University of Chicago Medicine’s Violence Recovery Program since 2024 (founding specialist since 2018), is the national figure most associated with HVIP program development and replication. His work on training other hospitals and on building the peer support infrastructure within a major academic medical center has defined the UChicago model. He describes the mission: “Our goal is to have our model duplicated throughout the nation. I truly believe this program is life-changing, and other institutions see that.”7

Kentral Galloway, director of Minneapolis’s Next Step program, has been the program’s public voice in local reporting and articulated what recovery from gun violence actually requires — addressing not just physical wounds but “not wanting to leave their house or go to certain areas of the city.”8

Lamicka Lovelace, who oversees Project Ujima at Children’s Wisconsin in Milwaukee, has described the immediate activation model: “They will meet the family right there in the emergency room to talk about services and resources.”9

Public Health Departments

Dr. Simbo Ige, Commissioner of the Chicago Department of Public Health, administers the city’s $3 million HVIP investment, which she has framed explicitly as treating “the psychological and emotional aspects” of violence alongside its physical manifestations.10 That framing, treating violence as a public health crisis, gives the program a policy home that is distinct from and complementary to its clinical home in the hospital.

Mayors and Political Officials

Mayor Craig Greenberg of Louisville has made Pivot to Peace central to his public safety platform, citing it by name in press conferences and his State of the City address, and is seeking reelection in 2026 on public safety results that include the program’s outcomes.11

Former Mayor Sandy Stimpson of Mobile (left office November 2025) launched the HALO program and described the problem in terms that resonated across partisan lines: a victim of crime who leaves the hospital and returns to the same neighborhood becomes either a victim again or a perpetrator.12

Hospital Leadership and Boards Daniel Blum, chief executive of Sinai Hospital and Grace Medical Center in Baltimore, has articulated the institutional case: “Hospitals are no longer in the business of patch and release. They want to treat victims of violence in ways that will keep them from being victimized again or even becoming perpetrators.”13

Community-Based Organizations HVIPs are not effective in isolation. Their value depends on connections to the community organizations that can provide sustained wraparound services after the hospital phase ends. The University of Chicago VRP maintains active connections to more than 60 community-based social and behavioral health agencies.14 Grady Hospital provides warm handoffs to community organizations for housing, job, and food assistance rather than leaving patients to navigate referral lists independently.15

The Metropolitan Peace Academy in Chicago represents one model of community partnership — a training organization for street outreach workers that has developed relationships with UChicago Medicine’s VRP, creating mutual understanding between hospital-based and street-based violence intervention.16 Louisville’s Pivot to Peace routes services through Goodwill and Volunteers of America, drawing on their existing employment and job training infrastructure rather than building HVIP-specific capacity from scratch.17

Philanthropy Private philanthropy has played an unusually significant role in building the national HVIP field. The Block Hassenfeld Casdin Collaborative for Family Resilience, a $9.1 million investment at UChicago Medicine, funded research, evaluation, community partner grants, and vicarious trauma support for staff — the infrastructure that makes evidence generation possible and evidence generation is what produced the case for public funding.18 The Arthur M. Blank Family Foundation committed $25 million to Atlanta violence prevention efforts that include Dr. Smith’s IVYY Project work.19

The Metropolitan Peace Academy in Chicago represents an important community partner model — a training organization for street outreach workers that has developed relationships with UChicago Medicine’s VRP, creating mutual understanding and trust between hospital-based and street-based violence intervention.20

Patients and Families At Grady Hospital in Atlanta, 98% of eligible patients agreed to receive program services.21 At Louisville’s Pivot to Peace, 85% agreed to speak with an intervention specialist.22 Lamicka Lovelace, director of Project Ujima at Children’s Wisconsin, describes the family component: “They will meet the family right there in the emergency room to talk about services and resources. It’s letting them know that, yes, you did go through this traumatic incident, but hoping that through our resources and interventions, you can get through this.”23

  1. Dr. Ashley Williams Hogue, trauma surgeon, USA Health University Hospital, Mobile, AL; NBC News reporting by Andrea Ramey on Mobile HALO program. ↩

  2. Dr. Randi Smith, IVYY Founder and Medical Director, Grady Memorial Hospital; 11Alive reporting. ↩

  3. Dr. Michel Aboutanos, Level 1 trauma surgeon, VCU Medical Center, Richmond; NBC12 Richmond reporting; Virginia Mercury on $8.5 million state investment. ↩

  4. Dr. Amy Makley, Trauma Medical Director, UC Health, Cincinnati; Cincinnati Enquirer reporting; presentation to Cincinnati City Council. ↩

  5. Dr. Ashley Williams Hogue, USA Health University Hospital, Mobile, AL; NBC News reporting. ↩

  6. Dr. Lindsey Dunkelberger, Prisma Health Richland Hospital, Columbia, SC; WLTX/CBS News and ColaDaily reporting. ↩

  7. Dwayne Johnson, Director, UChicago Medicine Violence Recovery Program (named Director 2024, founding specialist 2018); UChicago Medicine press materials and civic engagement profile. ↩

  8. Kentral Galloway, director, Minneapolis Next Step; WCCO CBS Minneapolis reporting. ↩

  9. Lamicka Lovelace, director, Project Ujima, Children’s Wisconsin; Spectrum News 1/Haley Kosik reporting. ↩

  10. Dr. Simbo Ige, Commissioner, Chicago Department of Public Health; Chicago $3 million announcement; confirmed current March 2026. ↩

  11. Mayor Craig Greenberg, Louisville; Louisville OVP report October 2025; LPM reporting; reelection campaign materials, 2026. ↩

  12. Former Mayor Sandy Stimpson, Mobile, AL (served through November 2025); Fox10/NBC News reporting on HALO launch. ↩

  13. Daniel Blum, CEO, Sinai Hospital and Grace Medical Center, Baltimore; NBC Baltimore affiliate reporting. ↩

  14. UChicago Medicine VRP; 60+ community agencies; UChicago Medicine program materials. ↩

  15. Grady Hospital IVYY; warm handoffs to community organizations; Alive 11/11Alive reporting. ↩

  16. Metropolitan Peace Academy; UChicago Medicine relationship with street outreach workers; UChicago Medicine Forefront article on breaking cycles of violence. ↩

  17. Louisville Office of Violence Prevention annual report, October 2025; Goodwill and Volunteers of America partnership structure. ↩

  18. Block Hassenfeld Casdin Collaborative for Family Resilience; $9.1 million gift from Ellen & Ronald Block Family Foundation and Hassenfeld Family Foundation; UChicago 2023 Annual Community Benefit Report. ↩

  19. Arthur M. Blank Family Foundation; $25 million investment in Grady violence prevention work; Dr. Randi Smith LinkedIn post referenced in Grady Health profile. ↩

  20. Metropolitan Peace Academy; UChicago Medicine relationship with street outreach workers; UChicago Medicine Forefront article on breaking cycles of violence. ↩

  21. Grady Memorial Hospital IVYY Project; 98% patient acceptance rate; Alive 11/Liza Lucas reporting. ↩

  22. Louisville Office of Violence Prevention report, October 2025; 85% enrollment rate; Louisville Public Media reporting. ↩

  23. Lamicka Lovelace, director, Project Ujima, Children’s Wisconsin; Spectrum News 1/Haley Kosik reporting. ↩

  24. Daniel Blum, CEO, Sinai Hospital and Grace Medical Center, Baltimore; NBC Baltimore affiliate reporting. ↩

  25. Christy Lopez, Georgetown Law Center on Poverty and Inequality; CVI programs as “band-aid on a bullet wound” framing. Source: Lopez writings on CVI scope limitations; cited in The Appeal and criminal justice reform policy discussions. ↩

  26. Congressional Research Service; concern that CVI program evidence base is “insufficient to justify federal funding at proposed levels.” Source: Congressional Research Service report on Community Violence Intervention programs; available through congress.gov. ↩

  27. Congressional Research Service; concern that CVI program evidence base is “insufficient to justify federal funding at proposed levels.” Source: Congressional Research Service report on Community Violence Intervention programs; available through congress.gov. ↩

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09
What Are the Risks?
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Funding instability and program discontinuity: The Health Alliance for Violence Intervention’s primary advocacy focus has been sustainable funding, which reflects the field’s experience with grant-dependent programs that face reduction or closure when initial funding expires.1 No named HVIP has fully closed and reopened in the documented record.

Undercapacity as a failure mode: The University of Chicago model runs roughly 20 specialists around the clock for a Level 1 Trauma Center with high gunshot volume. Dwayne Johnson, the VRP’s director, describes this as the staffing level required to actually reach patients consistently.2 Most programs do not approach that scale.

  1. Health Alliance for Violence Intervention (HAVI); organizational advocacy focus on sustainable funding; HAVI program materials and field communications. ↩

  2. Dwayne Johnson, Director, UChicago Medicine Violence Recovery Program; program description of staffing scale; UChicago Medicine trauma resiliency page. ↩

  3. Dr. Randi Smith; workforce constraints on IVYY program; implicit in program scale (650+ participants with limited staff); 11Alive reporting. ↩

  4. University of Chicago Medicine VRP; vicarious trauma support program launched 2022; noted in UChicago 2023 annual community benefit report. ↩

  5. Cooper et al. (2006) J Trauma: adult repeat victims on parole/probation, “three times more likely to be arrested” (control group). Cheng et al. (2008) Pediatrics, Johns Hopkins: youth 10-15, peer assault, two urban EDs, trends toward significance. Webster et al. (2022) Johns Hopkins review of 7 RCTs: “mixed” evidence, underpowered studies. Jay et al. (2026) Boston University Annals of Internal Medicine: one program (Boston Medical Center), young adults 16-34, target trial emulation design. Evidence tier limitations noted throughout. ↩

  6. Boston University School of Public Health study; Annals of Internal Medicine, 2026; DOI: 10.7326/ANNALS-25-01678; three-year follow-up; generalizability caveat quoted directly. ↩

  7. Virginia Mercury; 12 Virginia HVIPs; $8.5 million state grant; 2025. ↩

  8. Connecticut Medicaid model; “first state in the nation to sponsor Medicaid reimbursement for community services to do violence intervention outreach.” Source: WTNH New Haven reporting on Yale HVIP; confirmed in Health Affairs article on Medicaid CVI reimbursement (Dr. Kyle Fischer et al.). ↩

  9. Minneapolis Next Step; 41% (five-year cumulative) vs. 3% (one-year program rate); WCCO reporting; different measurement windows noted explicitly. ↩

  10. Hospital setting safety considerations for HVIP workers; no documented safety incidents in peer-reviewed or news record; acknowledged as ongoing management consideration by program directors in program materials and practitioner accounts. ↩

  11. Virginia Mercury; 12 Virginia HVIPs; $8.5 million state grant; 2025. ↩

  12. Post-discharge environment constraints; implicit in program design literature and the structural conditions described in patient population data (two-thirds facing food insecurity, housing instability, financial precarity — Dr. Randi Smith/WXIA reporting). ↩

  13. Boston University School of Public Health study; Annals of Internal Medicine, 2026; DOI: 10.7326/ANNALS-25-01678; three-year follow-up; generalizability caveat quoted directly. ↩

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Making It Happen
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How Are Cities Designing These Programs?
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Cities and health systems building HVIPs have made distinct choices across six areas.

  1. Dr. Randi Smith; bedside-clinic-community model; Trauma Surgery & Acute Care Open. Citation: Castater C, Hart L, Metchik A et al. Trauma Surgery & Acute Care Open. 2025;10(4):e001869. ↩

  2. Grady IVYY bedside-clinic-community model; three phases described; Trauma Surgery & Acute Care Open paper; 11Alive/Aisha Howard reporting. ↩

  3. UC Davis Health violence intervention specialist and connected Trauma Recovery Center; CBS News/Ashley Sharp reporting; Michele Knight, TRC director. ↩

  4. Hope and Shield Network, University of Cincinnati Medical Center and Children’s Hospital; trauma pager system; Citizen Portal reporting. ↩

  5. Pittsburgh HVIP QR code notification system for nurses. Source: Pittsburgh Reimagine Reentry program materials. Note: independently published press source for this specific feature not identified; cited in program documentation. ↩

  6. Sinai Hospital Baltimore Digital Violence Responder; WYPR Baltimore, Wambui Kamau reporting. Described as “first-in-the-nation effort.” Staff member “monitors social media for credible threats and alerts a call center that sends trained mediators to defuse the conflicts.” Model described as building on community-based violence interrupter efforts, using “trusted messengers — and now digital tools — to intervene early.” ↩

  7. Grady IVYY bedside-clinic-community model; three phases described; Trauma Surgery & Acute Care Open paper; 11Alive/Aisha Howard reporting. ↩

  8. Yale New Haven Hospital cash stipend pilot; $1,000 for homicide victim family members; $500 (two payments) for violence survivors; WTNH New Haven/Jayne Chacko reporting. ↩

  9. Grady IVYY bedside-clinic-community model; three phases described; Trauma Surgery & Acute Care Open paper; 11Alive/Aisha Howard reporting. ↩

  10. UChicago Medicine Recovery Legal Care; embedded civil lawyers; launched December 2022 with Legal Aid Chicago; UChicago Medicine annual community benefit report 2023. ↩

  11. Yale New Haven Hospital cash stipend pilot; $1,000 for homicide victim family members; $500 (two payments) for violence survivors; WTNH New Haven/Jayne Chacko reporting. ↩

  12. UC Davis Health violence intervention specialist and connected Trauma Recovery Center; CBS News/Ashley Sharp reporting; Michele Knight, TRC director. ↩

  13. Institutional trust dynamics; UChicago VRP Metropolitan Peace Academy relationship with street outreach workers; UChicago Medicine Forefront article on breaking cycles of violence; implicit in all credible messenger workforce literature. ↩

  14. Dr. Randi Smith; $2 million DOJ grant under Community Violence Intervention and Prevention Initiative; Emory University School of Medicine news release, 2023. ↩

  15. Dr. Amy Makley; PTSD and mental health disease in violence survivors; Cincinnati Enquirer reporting; structural gap between PTSD prevalence and treatment capacity in most HVIP programs. ↩

  16. Institutional trust dynamics; UChicago VRP Metropolitan Peace Academy relationship with street outreach workers; UChicago Medicine Forefront article on breaking cycles of violence; implicit in all credible messenger workforce literature. ↩

  17. UChicago VRP training; OSF Strive workshop; $99,000 Illinois Department of Public Health grant; UChicago Medicine annual community benefit report 2023; Christine Goggins as lead trainer. ↩

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How Is It Funded?
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Most programs assemble budgets from multiple sources — municipal grants, hospital institutional support, federal awards, state appropriations, philanthropic contributions, and in a growing number of jurisdictions, Medicaid reimbursement — while none of those sources covers the full operating cost.

  1. Chicago Department of Public Health, $3 million HVIP investment. Dr. Olusimbo “Simbo” Ige, Commissioner, Chicago Department of Public Health. Announcement reported in Chicago press coverage of Mayor Brandon Johnson’s community safety plan. ↩

  2. Louisville Office of Violence Prevention. “Pivot to Peace” HVIP enrollment data: 85% of 628 patients arriving at University of Louisville Hospital with gunshot or stab wounds enrolled, 2024–2025. Source: Louisville Office of Violence Prevention annual report, October 2025. Mayor Craig Greenberg quoted in Louisville Public Media, October 6, 2025. ↩

  3. Louisville Office of Violence Prevention 2025 report. 62% decline in gun violence in target neighborhoods (Russell, Taylor Berry, Newburg, Algonquin) in first half of 2025 vs. same period over prior four years. 22% citywide homicide decline. Source: Louisville Office of Violence Prevention report; Mayor Greenberg weekly update, LouisvilleKY.gov. ↩

  4. Mobile HALO program. Three-way partnership: City of Mobile, Mobile County Health Department, USA Health University Hospital. Former Mayor Sandy Stimpson (served 2013–November 2025) quoted in NBC News reporting by Andrea Ramey. Program launched during Stimpson’s tenure. ↩

  5. University of Chicago Medicine Violence Recovery Program. 11,000+ patients since 2018; roughly 20 violence recovery specialists; Block Hassenfeld Casdin Collaborative $9.1 million gift. UChicago 2023 Annual Community Benefit Report. ↩

  6. Dwayne Johnson, Director, UChicago Medicine VRP; OSF Strive training workshop description; UChicago Medicine civic engagement profile. 11,000+ patients since 2018 launch; roughly 20 violence recovery specialists; 60+ community agencies. Block Hassenfeld Casdin Collaborative for Family Resilience: $9.1 million gift from Ellen & Ronald Block Family Foundation and Hassenfeld Family Foundation. Sources: UChicago 2023 Annual Community Benefit Report; UChicago Medicine Trauma Resiliency page (2024); Dwayne Johnson, program director. ↩

  7. Virginia Hospital and Healthcare Association. “Sharp decline in re-injury rates — the national average is 40 percent, compared to 3 percent for HVIP patients.” Source: VHHA announcement on Virginia hospital violence intervention programming. ↩

  8. Virginia HVIPs. 12 programs statewide; 8,000+ violence victims served since 2019; $82.5 million in healthcare costs avoided; $8.5 million state investment. Source: Virginia Mercury, Charlotte Rene Woods reporting; American Hospital Association report cited by Virginia Hospital and Healthcare Association. ↩

  9. Dr. Randi N. Smith, IVYY Project, Grady Memorial Hospital. $2 million DOJ grant under Community Violence Intervention and Prevention Initiative (CVIPI). Source: Emory University School of Medicine 2023 news highlights. ↩

  10. UChicago VRP and Recovery Legal Care. $4.92 million NIH grant, November 2024, to study impact of free legal help on recovery and violence prevention. Source: UChicago Medicine Trauma Resiliency page (2024). ↩

  11. Connecticut Medicaid reimbursement for violence intervention outreach. “First state in the nation to sponsor Medicaid reimbursement for community services to do violence intervention outreach.” Source: Yale HVIP reporting; WTNH New Haven. ↩

  12. Five states (California, Connecticut, Illinois, Maryland, Oregon) using Medicaid to support CVI programming as of early 2023. Source: Health Affairs article, Dr. Kyle Fischer, Colleen Morris, and Dan Piening; Biden administration guidance on Medicaid eligibility for CVI models providing long-term health services. Reported in CVI Newsletter source material. ↩

  13. Yale School of Medicine HVIP, New Haven. Focus: children admitted with firearm injuries. Services: psychiatric care, substance use treatment, victim compensation and housing assistance. Leader: Dr. Kirsten Bechtel, physician and professor of pediatrics. Source: WTNH reporting; Yale New Haven Hospital program documentation. ↩

  14. Health Alliance for Violence Intervention (HAVI) and Everytown for Gun Safety Support Fund. Cost calculator and accompanying report examining hospital-based programs. Purpose: help cities and funders understand key HVIP implementation costs. Source: HAVI/Everytown tool, cited in multiple newsletter editions. ↩

  15. UChicago Medicine Block Hassenfeld Casdin (BHC) Collaborative for Family Resilience. $9.1 million gift, launched 2019. Source: UChicago 2023 Annual Community Benefit Report. ↩

  16. Virginia 12 HVIPs. $82.5 million in healthcare cost avoidance since 2019; approximately half in direct state savings. Source: Virginia Mercury, Charlotte Rene Woods; VHHA announcement; American Hospital Association. ↩

  17. Virginia 12 HVIPs. $82.5 million in healthcare cost avoidance since 2019; approximately half in direct state savings. Source: Virginia Mercury, Charlotte Rene Woods; VHHA announcement; American Hospital Association. ↩

  18. HVIP cost savings range. “$82,765 to $4 million across a five-year model” per program from reduced injury recidivism. Source: Review of HVIP programs cited in newsletter; note that this range reflects program variation in scale and population, not a prospective cost-benefit trial. ↩

  19. American Hospital Association estimate: total cost of violence to U.S. hospitals approximately $18 billion annually. Source: AHA report cited by Virginia Hospital and Healthcare Association announcement. ↩

  20. Angela Kimball, CEO, Inseparable (behavioral health advocacy organization); capacity vs. encounter-based funding structural mismatch. Source: Kimball, A., published commentary on behavioral health program funding structures; Inseparable organizational materials at inseparable.us. ↩

  21. Health Alliance for Violence Intervention (HAVI); organizational advocacy focus on sustainable funding mechanisms; HAVI program materials. “First state in the nation to sponsor Medicaid reimbursement for community services to do violence intervention outreach.” Source: Yale HVIP reporting; WTNH (New Haven ABC affiliate). ↩

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12
How Are Leaders Talking About This?
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Curated from program launches, press coverage, legislative testimony, and program leadership statements.

Overview

The trauma surgeon saves a life at 2 a.m. By 2 p.m., that same patient is getting calls about who shot them, where to find a gun, and when to strike back.

“In lots of places, people are just patched up and sent right back out into the neighborhoods and circumstances that led to the injuries in the first place. We are understanding the root causes and focused on addressing those social drivers of health that impact how patients do when they leave the hospital.”

Dr. Randi N. Smith, Founder and Medical Director, IVYY Project, Grady Memorial Hospital1

Dr. Smith launched Atlanta’s IVYY Project in January 2023 and has kept nearly 1,000 patients from returning to the trauma bay. She is one of a growing number of trauma surgeons who have come to the same conclusion: treating the wound and discharging the patient is not medicine. It is a brief interruption of a cycle.

The cities that have built these programs (Chicago, Atlanta, Louisville, Minneapolis, Richmond, Cincinnati, New Haven, Sacramento, Buffalo) describe the same logic across very different political environments. Daniel Blum, chief executive of Sinai Hospital and Grace Medical Center in Baltimore, framed the institutional shift this way: hospitals are “no longer in the business of patch and release.” They want to treat victims “in ways that will keep them from being victimized again or even becoming perpetrators.”2

The argument that has proven most durable across political lines is not about gun violence in the abstract. It is about the specific, documented problem of the same patient returning to the same emergency department, shot again: a pattern that trauma surgeons describe not as a statistic but as something they watch happen. NBC News reported that Dr. Ashley Williams Hogue, a trauma surgeon at University Hospital in Mobile, Alabama, “has operated on the same victims who’ve been shot and then shot again in separate incidents.”3 That clinical reality, the one trauma surgeons live, is the foundation on which all HVIP advocacy rests.

Hospital-based violence intervention programs break that cycle. Right at the bedside, when someone is rethinking everything, a trained specialist who has walked this path steps in. Not with judgment, but with a way out: counseling, job training, relocation help, whatever it takes to make this the last time they are wheeled into trauma.

Three Themes That Appear Across Successful Programs

  1. Dr. Randi N. Smith, MD, MPH, Founder and Medical Director, IVYY Project, Grady Memorial Hospital; Associate Professor, Emory University School of Medicine. Program description quote from 11Alive/Aisha Howard reporting. “Giving people hope” quote from Alive 11/Liza Lucas reporting on first-year results. ↩

  2. Daniel Blum, chief executive, Sinai Hospital and Grace Medical Center, Baltimore. “Patch and release” and “no longer in the business of patch and release” quotes. Source: NBC Baltimore affiliate (Lisa Robinson) reporting on Baltimore HVIP expansion. ↩

  3. Dr. Ashley Williams Hogue, trauma surgeon, University Hospital, Mobile, Alabama. NBC News reporting by Andrea Ramey on Mobile HALO program launch. ↩

  4. Former Mayor Sandy Stimpson, Mobile, Alabama (served 2013–November 2025). NBC News/Fox10 reporting on HALO program launch. Stimpson left office November 3, 2025; succeeded by Mayor Spiro Cheriogotis. ↩

  5. Dr. Olusimbo “Simbo” Ige, Commissioner, Chicago Department of Public Health. CDPH announcement of $3 million HVIP investment. Dr. Ige confirmed in role as of March 2026 (Crain’s Chicago Business, Women of Influence, February 2026). ↩

  6. Dr. Kirsten Bechtel, physician and professor of pediatrics, Yale School of Medicine. WTNH (New Haven ABC affiliate) and Yale program documentation. ↩

  7. Jorge X. Camacho, criminal law professor, Yale Law School. “Trend of increasing enthusiasm by police officials to collaborate with these types of crisis intervention methods.” Yale Daily News, Ariela Lopez and Kenisha Mahajan reporting. ↩

  8. Jorge X. Camacho, criminal law professor, Yale Law School; same source as 7. ↩

  9. IVYY program at Grady Memorial Hospital; 24-hour specialist availability description; cited in program materials and Dr. Randi Smith interviews. ↩

  10. Chicago Department of Public Health; $3 million HVIP investment; Mayor Brandon Johnson community safety plan announcement. “Trend of increasing enthusiasm by police officials.” Yale Daily News, Ariela Lopez and Kenisha Mahajan reporting. ↩

  11. Thomas Stuckey, former police officer, professor of criminal justice, Indiana University-Purdue. Prescription for Hope (Eskenazi Hospital, Indianapolis): 3% vs. 8.7% repeat emergency department visit rate. Chronicle of Philanthropy. ↩

  12. Nkosi Cave, violence intervention specialist, IVYY Project, Grady Memorial Hospital. 11Alive/Aisha Howard reporting on IVYY two-year results. ↩

  13. Boston University School of Public Health study, Annals of Internal Medicine (2026). Boston Medical Center Violence Intervention Advocacy Program. Sustained treatment linked to 55% lower cumulative violence incidence at 3 years (6.4% vs. 14.3%). Researchers’ caution: “there is no single, agreed-upon package of services for all HVIPs.” URL: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01678 ↩

  14. HVIP staff safety record; no documented safety incidents in peer-reviewed or news record; program directors describe it as an ongoing management consideration; acknowledged in program materials and practitioner accounts. ↩

  15. HVIP Messaging Guide; developed for program advocates and public officials communicating about hospital-based violence intervention programs. Contains word substitution recommendations, counter-messaging grids, and framing guidance for common objection scenarios. On file with Safer Cities. ↩

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