Hospital-Based Violence Intervention Programs: An Introduction

September 13, 2021

By a Biometrica staffer

In 2018, there were 1.2 million emergency department visits for assault in the United States, the Centers for Disease Control and Prevention (CDC) says on its website. Over 19,000 people died due to homicides, more than 14,000 of them from firearm-related homicides in 2019, the CDC adds. One in three women will experience rape, physical violence or stalking in her lifetime, the American Psychological Association (APA) says.

Interpersonal violence can take several forms. For instance, the APA advocates in the areas of child abuse, domestic and sexual violence, community violence, and international violence prevention (i.e., support for survivors of human trafficking and preventing mass atrocities). Individuals with disabilities, people of color, and non-gender-conforming individuals have a heightened risk of domestic and sexual abuse.

Injuries that are a result of interpersonal violence are all too common in the U.S. and disproportionately affect minority populations. Trauma centers are on the front lines of this, and with injury recidivism rates typically tending to trend on the higher side, a comprehensive approach is necessary. It also makes the prevention of interpersonal violence a matter of public health. And this is where hospital-based violence intervention programs (HVIPs) come in.

In this piece, we give you a brief introduction into HVIPs, when they began, and what their goals typically are, and discuss some other concepts connected with HVIPs.

HVIPs have now existed for over 20 years. It was in 1994 that the first one was established when Youth ALIVE!, a non-profit public health agency based in Oakland, California, set up “Caught in the Crossfire.” In the years that followed, similar programs were launched in Milwaukee and Baltimore. In March 2009, Youth ALIVE! convened 30 medical directors, program directors, board chairs, and clinicians to begin a dialogue on the key components and best practices of successful hospital-based intervention.

At the end of the two-day symposium, the National Network of Hospital-Based Violence Intervention Programs, made up of eight programs from across the country, was born. That network is now known as the Health Alliance for Violence Intervention (HAVI). Under this umbrella, HVIPs grew and expanded greatly in the early 2000s. The HAVI is an organization that fosters hospital and community collaborations to advance equitable, trauma-informed care and violence intervention and prevention programs.

The program relies on peer-based crisis intervention specialists to visit violently injured youth in hospitals and to convince them, their families, and their friends to avoid seeking revenge, while they offer youth mentoring and social services. In order to heal communities affected by violence, the HAVI fosters hospital and community collaborations to advance HVIPs

These programs, usually present in urban hospitals, attempt to connect victims of violent crimes (i.e., shootings, stabbings, and blunt trauma) to community services to prevent further victimization of the same person or retaliation against another, the Center for Public Safety Initiatives, Rochester Institute of Technology said in a working paper on the overview of HVIPs published in 2014.. In general, hospitals refer patients to an outside non-profit or community-based organization, whose staff usually visits the patient and/or family prior to release from the hospital.

Typically, each program has its own target or focus population that they serve, but most programs within the HAVI focus on victims of violent crime between 15 and 25 years old, the paper said. At-risk youth make up most of these target populations because they are more easily influenced at a younger age and experience the highest levels of violence of any age group. Program staff are thought to be more likely to help rehabilitate these youth and turn their lives around and prevent further retaliatory violence.

There are two crucial, fundamental ideas behind any HVIP. One is the age of intervention for patients, and the other is the timing of when a specialist reaches out to a potential client after they are victimized. There’s a window of opportunity in the time lapse between a violent crime victim’s admission into and time of release from the hospital. This window, experts say, contains an even smaller period of time called the “Teachable Moment.” That’s when program staff can most effectively engage a victim of violence and stop the cycle of violence, the working paper from 2014 said.

HVIP services generally begin with the in-hospital consultation before a patient’s discharge. That meeting includes an assessment of whether it is safe, both for the patient and for others, for the client to be discharged from the hospital. It’s where the “Teachable Moment” can encourage new clients to follow through with post-discharge services. Those include mentoring, parental home visits, information and referral services, case management, healthcare, conflict resolution skills training, advocacy services, and group counseling and support sessions. Advocacy services help the client with legal, educational, financial, entitlement, and/or housing issues.

HVIPs rely on official records, like hospital/Emergency Room records and police, probation, or parole records, as well as self-reports from program participants to record its impact.

The broad goals of HVIPs are to reduce violent retaliations, re-injuries, and criminal justice involvement, and to impede repeated violent victimization by providing violently injured victims with culturally sensitive, comprehensive, and multifaceted intervention programs, the John Jay College of Criminal Justice says on its website. And violence — like infectious diseases — the post says, is transmitted through close contact with others and is one of the leading causes of death in the United States, particularly among teenagers and young adults.

If HVIPs programs are able to prevent further violence, re-injury, and death, they can save lives and lessen the heavy financial, social, and human costs associated with future violence, the John Jay College of Criminal Justice says.