Sustained participation in hospital-based intervention programs reduces future community violence

1. In this retrospective cohort study, sustained participation in hospital-based violence intervention programs (HVIPs) reduced the risk of future violence, including violent reinjury and violence perpetration.

2. Sustained engagement was associated with higher rates of needs identification and fulfillment compared with participants who engaged with an HVIP within 4 weeks post-injury.

Evidence Rating Level: 2 (Good)

Study Rundown: Survivors of community violence often face significant mental and physical health challenges in the aftermath of an incident. Moreover, their risk of involvement in subsequent violence remains elevated for many years compared to the general population. Hospital-based violence intervention programs (HVIPs) have emerged as a standard approach to address this risk, connecting individuals to services that support their social and healthcare needs. To date, research on HVIPs has not shown a consistent reduction in repeated involvement in community violence. This study used observational data to examine whether engagement with HVIPs reduces violent reinjury or violence perpetration among young adults hospitalized for violence-related injuries. Analysis of participants who engaged with an HVIP within four weeks of injury (any engagement) showed no reduction in community violence. However, among individuals who participated for more than four weeks during the first eight weeks post-hospitalization (sustained engagement), substantial long-term reductions were observed. Participants with sustained engagement also had more of their identified needs met, including education and employment, which were described as the most challenging needs to address. The generalizability of these findings is limited by the observational design and potential confounding from unmeasured factors influencing program engagement. Nevertheless, the study suggests that HVIPs may help prevent violence perpetration among survivors who consistently commit to these programs.

Click to read this study in AIM

Relevant Reading: Hospital-based violence intervention programs targeting adult populations: an Eastern Association for the Surgery of Trauma evidence-based review

In-Depth [retrospective cohort]: 

This target trial emulation examined whether engagement with a hospital-based violence intervention program (HVIP) reduces violent reinjury or violence perpetration among young adults hospitalized for violence-related injuries. Data were from patients presenting to Boston Medical Center between 2013 and 2022. All survivors of violent penetrating injuries were eligible for the Violence Intervention Advocacy Program (VIAP). Two trials were conducted with the same eligibility criteria and control group but differing interventions: any engagement (contact with a VIAP advocate within 4 weeks post-injury) and sustained engagement (contact for >4 of the first 8 weeks post-injury). The primary outcome was a composite of violent reinjury and violence perpetration. Follow-up lasted up to 3 years, until outcome occurrence, or December 31, 2023. The study included 1,328 participants: 68% Black, 25% Hispanic, 85% cisgender male, 55% with gunshot wounds; mean age 24.2 years. Of these, 42.5% (n = 565) engaged early, and 58 (10.2% of engagers; 4.4% of total) had sustained engagement. Gunshot injuries and hospital admission were associated with engagement, while male sex was associated with less engagement. Non-early engagers had almost no VIAP contacts (median 0; interquartile range [IQR], 0–0), early engagers averaged 3 contacts (IQR, 1–7), and high-frequency early engagers averaged 15.5 (IQR, 11–23). Within 3 years, 12.0% of any-engagement participants and 15.7% of controls experienced community violence; any engagement was not associated with reduced risk. Sustained engagement, however, was linked to significantly lower incidence: 4.5% vs. 8.7% at 1 year, 5.1% vs. 12.3% at 2 years, and 6.4% vs. 14.3% at 3 years, corresponding to risk reductions of 47.6%, 58.5%, and 55.3%. Sustained-engagement participants had 69% more needs identified and 86% more needs met than any-engagement participants, with higher success for education (41% vs. 34%) and employment (76% vs. 59%), though housing needs remained low (51% vs. 46%). Overall, sustained engagement in an HVIP may reduce future violent reinjury and perpetration among young adult survivors of community violence, particularly when participants consistently engage and their social needs are addressed.

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