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Pivot to Peace — Louisville (UofL Hospital)

City Profile: Louisville, Kentucky

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Pivot to Peace — Hospital-Based Violence Intervention Program

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University of Louisville Hospital / Office of Violence Prevention

Program type: Hospital-based violence intervention program,

integrated within city-wide CVI strategy

Institutional home: University of Louisville Hospital; operated

through partnership with the city’s Office of Violence Prevention,

Goodwill, and Volunteers of America

Mayor: Craig Greenberg (elected 2022; announced re-election bid

October 2025)

Target population: Patients arriving at University of Louisville

Hospital with gunshot wounds or stabbing injuries

Scale: 628 patients in 2024–2025; 85% enrollment rate

Key outcome: 62% decline in gun violence in target neighborhoods

(first half of 2025 vs. same period prior four years); homicides down

22% citywide in 2025

Reporting: Louisville Office of Violence Prevention annual report,

October 2025

Background: Louisville’s Violence Peak and Recovery

Louisville’s gun violence reached a documented peak in 2021 when 177

people were killed — the highest homicide count in the city’s

history. The pandemic-era surge hit hardest in a handful of

neighborhoods: Russell, Taylor Berry, Newburg, and Algonquin. These four

areas, historically among the city’s highest-violence concentrations,

became the focus of the city’s violence prevention strategy after Mayor

Craig Greenberg took office in January 2023.

Greenberg’s approach integrated hospital-based intervention with

street-level CVI, directed through a single infrastructure: the Office

of Violence Prevention (OVP), which oversees the Pivot to Peace program.

The HVIP component is the hospital anchor of a broader system that also

includes Anti-Violence Coalitions (community-led interventions in nine

neighborhoods) and intensive outreach and case management for at-risk

youth and young adults.^[1]

Program Design

Hospital entry point: When a patient arrives at University of

Louisville Hospital with a gunshot or stab wound, violence specialists

and medical staff provide immediate emotional support. Pivot to Peace’s

HVIP enrolled 85% of the 628 patients who presented with these injuries

during 2024 and 2025 — a capture rate that reflects both the

program’s staffing model and the city’s investment in making the

hospital a consistent intervention point.^[2]

The program’s Louisville OVP report describes the hospital intervention

as “a timely intervention that is key to breaking cycles of violence

and offering hope during a period of intense vulnerability.”^[3]

Comprehensive service delivery: After the bedside intervention, the

program delivers what the OVP report characterizes as: “mental health

counseling, substance abuse treatment, legal assistance, and help with

securing stable housing and employment” — a service set “designed to

tackle the various factors contributing to violence and instability in

an individual’s life.”^[4]

Long-term follow-up: The program’s distinctive characteristic,

documented in the OVP report, is its “commitment to following up with

long-term care.” Specialists offer “guidance, encouragement, and

consistent access to resources” over an extended period, not just at

the point of hospital discharge. This long-term structure is what the

Boston University study (published in the Annals of Internal Medicine,

2026) identified as the mechanism most associated with reduced violence

outcomes: sustained engagement over the first eight weeks after injury

was linked to 55% lower cumulative violence incidence at three years,

compared to brief or no engagement.^[5]

The Goodwill and Volunteers of America partnership: By routing the

program through two established social service organizations (Goodwill

and Volunteers of America) rather than building an entirely

hospital-housed team, Louisville distributed both the capacity and the

community connection requirements of HVIP across organizations with

existing employment, job training, and community service infrastructure.

Goodwill’s job training pipeline, for example, is directly relevant to

the employment component of the post-discharge case management.^[6]

Outcomes (October 2025 OVP Report)

The Louisville OVP’s October 2025 report, presented publicly by Mayor

Greenberg, is one of the most detailed HVIP outcome documents released

by any city. Key findings:

HVIP-specific:

628 patients arrived at UofL Hospital with gunshot wounds or stab

wounds in 2024–2025

85% agreed to speak with an intervention specialist

Comprehensive services delivered: mental health counseling,

substance abuse treatment, legal assistance, housing and employment help

**Citywide violence data (all OVP programs combined):**

Homicides down 22% in 2025 compared to the same point in 2024

Gun violence in the four target neighborhoods (Russell, Taylor

Berry, Newburg, Algonquin) down 62% in the first half of 2025, compared to the same period over the prior four years

Nonfatal shootings down by nearly a quarter in the four target sites

between 2021 and 2024 (four-year baseline)

Pivot to Peace’s broader outreach and case management program

served more than 600 at-risk youth and young adults

Anti-Violence Coalitions contributed a 35% reduction in gun-related

incidents in nine neighborhoods^[7]

**Attribution caveat:** The 62% and 22% figures reflect the full Pivot

to Peace model, which combines hospital-based intervention with

street-level CVI outreach and Anti-Violence Coalition work. The data

does not isolate the HVIP component’s contribution from the

community-based components. This is consistent with how most cities

report HVIP outcomes — the hospital program operates as one layer of

an integrated violence reduction strategy, not as an isolated

intervention whose contribution can be cleanly separated.

Mayor Greenberg’s Role

Mayor Craig Greenberg has made violence prevention the defining theme of

his administration, framing it consistently as both a moral and a

data-driven commitment. At the October 2025 OVP report presentation, he

described the violence problem in terms that speak to both policy

communities and affected families: “There still is too much violent

crime that happens in our city. We wake up too many mornings hearing

about something that happened overnight, go to too many memorials for

victims who are lost and families who are suffering.”^[8]

Greenberg has used the city’s Gun Violence Dashboard data and OVP

reporting to make the case for violence prevention investments.

Everytown for Gun Safety has described the dashboard as a “national

model.”^[9]

Greenberg announced his re-election bid in October 2025, emphasizing

violence reduction as a central campaign theme. Louisville’s 2026

mayoral election will be nonpartisan following a 2024 change in state

law.^[10]

Context: Why Louisville Is a Useful Case Study

Louisville is the 27th largest city in the country. Mayor Greenberg has

simultaneously pursued hospital-based intervention through Pivot to

Peace and traditional enforcement through a Gun Violence Task Force with

state and federal prosecutors.^[11]

Louisville’s 85% enrollment rate compares to Grady Hospital’s reported

98%. The OVP report does not break out whether the trust reflected in

the enrollment rate is a function of the specialist workforce model, the

institutional partnership structure, or both.

Program Structure Features

Integrated with city violence strategy: The HVIP is routed through

the OVP alongside the city’s street-level CVI strategy, Anti-Violence

Coalition work, and the Gun Violence Dashboard — a single

infrastructure administering multiple intervention types

simultaneously.^[12]

Goodwill/Volunteers of America partnership: The program partners

with Goodwill and Volunteers of America rather than building an entirely

hospital-housed team, drawing on their existing employment and job

training infrastructure.^[13]

Mayoral public ownership: Mayor Greenberg presents OVP outcomes

publicly through press conferences, weekly updates, and the annual

report — making the program’s results a matter of public record. The

OVP annual report is available at LouisvilleKY.gov.^[14]

Anti-Violence Coalitions: The Broader Pivot to Peace Ecosystem

The HVIP is one component of a three-part Pivot to Peace model. The

city’s Anti-Violence Coalitions operate in nine neighborhoods with a

$1 million OVP investment, reporting a 35% reduction in gun-related

incidents in their service areas. A third component provides intensive

outreach and case management for more than 600 at-risk youth and young

adults annually. The Gun Violence Dashboard — described by Everytown

for Gun Safety as a “national model” — tracks all three components’

outcomes in real time and is publicly available at

LouisvilleKY.gov.^[15]

What the Evidence Does and Does Not Show

Louisville’s Pivot to Peace data is among the most current and detailed

available in the HVIP field, but it carries the same attribution

challenge that most multi-component violence reduction strategies face:

the numbers reflect the full program ecosystem, not the hospital

intervention in isolation.

The 62% decline in gun violence in the four target neighborhoods during

the first half of 2025 reflects the combined effect of hospital-based

intervention, street-level CVI through Anti-Violence Coalitions,

intensive outreach and case management for at-risk youth, and a broader

law enforcement strategy that includes a Gun Violence Task Force with

state and federal prosecutors. Disentangling those contributions is not

possible from the public data. The HVIP component is one input into a

multi-element strategy.

What the HVIP-specific data does show is high uptake: 85% of 628

patients arriving with qualifying injuries agreed to speak with an

intervention specialist. That figure does not tell us what percentage

completed sustained case management, or what the reinjury rate is for

enrolled patients — the OVP report does not break out those figures at

the level of granularity that the Indianapolis, Minneapolis, or VCU

programs have published. For a city in its first two years of formal

HVIP operation, this is understandable; it is also the measurement gap

that sustained investment should close.

The data Louisville does have is meaningful. The enrollment rate, the

citywide violence trend, and the sustained political support from a

mayor seeking reelection on these results constitute a case study in

what institutional ownership of an HVIP looks like in practice.

Louisville has not yet published independently verified reinjury data at

multi-year follow-up comparable to what Indianapolis and Richmond have

documented. The OVP report does not break out the reinjury rate for

enrolled patients specifically — the enrollment rate (85%) is

reported, but what percentage of those enrolled patients were reinjured

within the first year of program participation is not published in the

October 2025 document.^[16]

Footnotes

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^[1]: Louisville violence peak 2021 (177 homicides) and program context.

Office of Violence Prevention annual report (October 2025); Mayor

Greenberg weekly update (LouisvilleKY.gov, October 2025); Louisville

Public Media reporting (October 6, 2025). Anti-Violence Coalitions:

nine neighborhoods, $1 million OVP investment, 35% reduction in

gun-related incidents.

^[2]: 628 patients, 85% enrollment rate, 2024–2025. Source: Louisville

Office of Violence Prevention annual report, presented October 2025.

Louisville Public Media, Spectrum News 1 (October 6, 2025).

^[3]: 628 patients, 85% enrollment rate, 2024–2025. Source: Louisville

Office of Violence Prevention annual report, presented October 2025.

Louisville Public Media, Spectrum News 1 (October 6, 2025).

^[4]: OVP report service description: “mental health counseling,

substance abuse treatment, legal assistance, and help with securing

stable housing and employment.” Source: Louisville OVP annual

report (2025).

^[5]: Boston University School of Public Health study: sustained

engagement (more than 4 of first 8 weeks post-injury) linked to 55%

lower cumulative violence incidence at 3 years. Published in Annals

of Internal Medicine (2026). URL:

[[https://www.acpjournals.org/doi/10.7326/ANNALS-25-01678]{.underline}](https://www.acpjournals.org/doi/10.7326/ANNALS-25-01678).

Note: Study is observational using target trial emulation, not an

RCT. Researchers caution that generalizability across HVIP programs

is unknown given variation in service models.

^[6]: Pivot to Peace partnership structure: Louisville Office of

Violence Prevention, Goodwill, and Volunteers of America. Source:

Spectrum News 1 (October 6, 2025); Mayor Greenberg weekly update.

^[7]: Outcome figures: 62% decline in gun violence in target

neighborhoods (first half 2025 vs. same period prior four years);

22% homicide decline citywide (2025 vs. same point 2024); 600+ Pivot

to Peace outreach participants; 35% Anti-Violence Coalition

reduction. Sources: Louisville OVP annual report (2025); Mayor

Greenberg weekly update (October 2025); Mayor Greenberg 2025

Accomplishments page (LouisvilleKY.gov); Louisville Public Media

(October 6, 2025).

^[8]: Mayor Craig Greenberg: “There still is too much violent crime

that happens in our city. We wake up too many mornings hearing about

something that happened overnight…” Source: Louisville Public

Media (October 6, 2025).

^[9]: Everytown for Gun Safety description of Louisville Gun Violence

Dashboard as “national model.” Source: Mayor Greenberg weekly

update (LouisvilleKY.gov).

^[10]: Craig Greenberg re-election bid announcement October 2025.

Louisville 2026 mayoral election will be nonpartisan following 2024

state law change. Source: Wikipedia — Craig Greenberg article

(updated March 2026); Craig Greenberg campaign website

(greenbergformayor.com).

^[11]: Craig Greenberg re-election bid announcement October 2025.

Louisville 2026 mayoral election will be nonpartisan following 2024

state law change. Source: Wikipedia — Craig Greenberg article

(updated March 2026); Craig Greenberg campaign website

(greenbergformayor.com).

^[12]: Louisville violence peak 2021 (177 homicides) and program

context. Office of Violence Prevention annual report (October 2025);

Mayor Greenberg weekly update (LouisvilleKY.gov, October 2025);

Louisville Public Media reporting (October 6, 2025). Anti-Violence

Coalitions: nine neighborhoods, $1 million OVP investment, 35%

reduction in gun-related incidents.

^[13]: Pivot to Peace partnership structure: Louisville Office of

Violence Prevention, Goodwill, and Volunteers of America. Source:

Spectrum News 1 (October 6, 2025); Mayor Greenberg weekly update.

^[14]: Louisville HVIP evidence limitations noted. The OVP report

presents aggregate violence reduction data for the full Pivot to

Peace model. HVIP-specific reinjury rate data at multi-year

follow-up has not been published as of the OVP’s October 2025

report. Source: Louisville OVP annual report (2025); Louisville

Public Media (October 6, 2025). Louisville 2026 mayoral election

will be nonpartisan following 2024 state law change. Source:

Wikipedia — Craig Greenberg article (updated March 2026); Craig

Greenberg campaign website (greenbergformayor.com).

^[15]: Everytown for Gun Safety description of Louisville Gun Violence