What Is This?

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

The Two-Phase Model

The intervention has two distinct phases that virtually every documented program uses, regardless of institutional setting or team composition.

Phase One — Bedside: Specialists arrive while the patient is still hospitalized. The goals in this phase are immediate: establish rapport, conduct safety planning for discharge, assess the patient’s immediate social needs (housing stability, food security, financial situation, active threats), and connect the patient to services before they leave. At Atlanta’s Grady Memorial Hospital, this work is led by what the program calls “credible messengers” — staff members with their own lived experience of violence who can reach patients that a clinician without that background cannot.⁴ At the University of Chicago Medicine’s Violence Recovery Program, specialists meet patients and families “at the door of the ED,” providing support that ranges from getting food and water for a waiting family to arranging transportation and making calls on the patient’s behalf.⁵

Phase Two — Sustained Follow-Up: The relationship continues after discharge for months, not days. Dr. Amy Makley, trauma medical director at UC Health in Cincinnati, describes the shift: “Instead of helping the victim for a day or two treating their physical wounds, the support will continue for months after leaving the hospital.”⁶ This second phase typically involves ongoing case management, trauma counseling, legal services, work placement or school enrollment assistance, victim compensation navigation, housing and food support, and warm handoffs to community organizations for wraparound services. Atlanta’s program provides that warm handoff to “community-based groups that assist with wraparound services such as housing, job, and food assistance.”⁷

A 2025 study from Boston University School of Public Health found that sustained engagement — initiating within one month of injury and engaging more than four of the first eight weeks — was associated with a 55% risk reduction at three years. Patients who received only initial contact without sustained follow-up showed outcomes “roughly equal between treatment and control strategies.”⁸ Programs that end at discharge do not produce the outcomes that sustained-engagement programs produce.

The workforce model varies by program. At Atlanta’s Grady Memorial Hospital, the IVYY Project employs what the program explicitly calls “credible messengers” — staff members with their own lived experience of violence who can reach patients that a clinician without that background cannot.⁹ Nkosi Cave, a violence intervention specialist at the IVYY Project, describes the dynamic: “When we meet people at the bedside, we kind of see a reflection of ourselves and our communities in our patients. A lot of times, we’re meeting people that we might’ve known in the community. We come from some of the same communities as these people, so we talk the same language.”¹⁰

Some programs, notably Prisma Health in Columbia, South Carolina, deploy multidisciplinary teams that combine credible messengers with clinical staff: “trauma, internal medicine, psychiatry, and injury prevention specialists, and university researchers” working together.¹¹ The University of Chicago’s Violence Recovery Program employs licensed social workers alongside community-based specialists, with lead violence recovery specialist Christine Goggins providing clinical infrastructure alongside Dwayne Johnson’s community-based leadership.¹²

The University of Chicago program has now supported more than 11,000 patients and families since its 2018 launch, maintains roughly 20 violence recovery specialists working around the clock, and hosts multi-day training workshops for hospitals seeking to replicate the model.¹³

The Public Health Frame

Dr. Randi Smith, founder and medical director of the Interrupting Violence in Youth and Young Adults (IVYY) Project at Grady Memorial Hospital in Atlanta, articulates the framework directly: “I truly believe violence is a public health problem. What that means is that we treat it just like any infectious disease. When there is an outbreak we contain it, we understand the root causes and prevent its spread.”¹⁴ Dr. Simbo Ige, Chicago’s Public Health Commissioner, framed the city’s $3 million HVIP investment in the same terms: “Violence is a public health crisis, and just as we treat the physical manifestations of violence, we must also treat the psychological and emotional aspects for both victims and their families.”¹⁵

Who Is Served

Most documented programs concentrate on victims of penetrating trauma (gunshot and stab wounds) arriving at emergency departments. The age range varies by program, with many targeting young people between 14 and 34.

Two-thirds of 14- to 24-year-old gunshot victims who arrive at Grady Hospital face “issues like food insecurity, housing issues and financial instability,” according to data from Dr. Smith’s program.¹⁶

Programs operate primarily in Level 1 Trauma Centers and major urban hospitals. Community hospitals, rural hospitals, and suburban trauma centers are largely unserved by the current program landscape.¹⁷

What This Is Not

Not street-based community violence intervention. Street CVI programs like Safe Streets in Baltimore and Advance Peace in Sacramento use proactive outreach to reach people before shootings happen. HVIPs activate at hospital admission after a shooting has occurred. The Health Alliance for Violence Intervention describes the two models as operating at different points in the violence cycle, with street CVI focused on prevention and HVIPs on intervention after injury.¹⁸

Not Trauma Recovery Centers. Buffalo’s first Trauma Recovery Center was explicitly designed to work “in close relationship to a pre-existing hospital-based violence intervention program,” with the hospital program handling “crisis response to patients presenting in the Emergency Department” while the recovery center offers “cognitive behavioral therapy, as well as grief and loss counseling.”¹⁹ The two models serve sequential phases of the same patient’s recovery.

Not general victim services. The IVYY program at Grady describes the distinction in practice as being available “when someone answers the phone at 10pm when you’re thinking about retaliation”¹⁵ — sustained personal contact, not administrative navigation.

Not expanded discharge planning. Many programs operate in parallel to, not as a replacement for, existing hospital social work. Dr. Makley at UC Health describes the difference in duration: “Instead of helping the victim for a day or two treating their physical wounds, the support will continue for months after leaving the hospital.”²⁰