Expanding Hospital Violence Intervention Programs to Reduce Gun Violence

Summary

In 2024, New York City Health + Hospital’s Stand Up to Violence (SUV) program and New York State’s Department of Criminal Justice Services SNUG program committed to expand hospital violence intervention programs (HVIP) to additional trauma centers in New York State. Building on the success of the SUV program in the Bronx, the goal is to achieve a first- of- its- kind statewide HVIP network to improve violent trauma patient outcomes throughout New York state. HVIPs connect trauma response and clinical care with social support and violence intervention community outreach programs. Thise commitment scales HVIPs to state trauma centers at Albany Medical Center, Erie County Medical Center in Buffalo, Upstate Medical Center in Syracuse, and Rochester General Hospital, alongside ongoing programming at Bronx-based Montefiore Hospital. Hospital violence intervention programs across the five facilities will directly reach 1900 individuals over the next two years.

Approach

New York City Health + Hospital’s Stand Up to Violence (SUV) program together with New York State’s Department of Criminal Justice Services (DCJS) SNUG program commit to expanding hospital violence intervention programs (HVIP) to four additional trauma centers in New York State, applying lessons from the success of the SUV program in the Bronx. Since its launch in 2014, the SUV program has statistically decreased the incidence of community gun-shot wounds by 54% (p<.001) and has decreased the odds of re-injury in admitted violent trauma patients by 59% (OR 0.41 [0.22-0.75]) , and has improved rates of post-discharge follow up two-fold (OR 2.29 [1.59-2.29]) . The local HVIP programming in the Bronx, overseen by New York State DCJS-SNUG, has established a data-driven, evidence-based multidisciplinary approach to the treatment of violent trauma patients, by incorporating a social work, physician, and community outreach worker component. This multi-disciplinary approach consisting of designated social workers, collaborating physicians, and violence intervention community outreach programs, will be scaled to State trauma centers at Albany Medical Center, Erie County Medical Center in Buffalo, Upstate Medical Center in Syracuse, and Rochester General Hospital. New York State SNUG will provide the funding, training, and oversight for these new sites along with monitoring data for outcomes of interest, with the goal of achieving a first of its kind statewide HVIP network that helps improve violent trauma patient outcomes throughout NY State. Hospital violence intervention programs across the five facilities will directly reach 1900 individuals by 2026.. Challenges will include local barriers to implementation in different hospital systems, local physician and medical care provider understanding of a public health approach. to violence intervention/Prevention, and overcoming barriers of community-based SNUG programming being incorporated into local HVIP programming. As part of this effort, SUV and SNUG will work closely with the target program supervisor, social work supervisor, and physician leadership at the implementation sites on planning and the roll-out of the initiative, to optimize a multidisciplinary programmatic approach to HVIP implementation.[commitment-title title='Action Plan'] NY State Division of Criminal Justice Services assigned Social Work Director, Medical Director, and Supervisor will provide monthly oversight of data entry and program implementation to ensure adherence to New York State DCJS-SNUG HVIP standards. In addition to patients served and connected to SNUG community outreach services, barriers to program implementation at local hospitals will be discussed along with HVIP position vacancies in need of being filled. Year 1 (2024-2025) Q1-Q4 2024 Scale HVIP programs to additional 4 sites Q1-Q2 2025 Health workforce trained on HVIP approach Year 2 (2025-2026) Q1-Q4 2025 Patients connected to SNUG community outreach services, including mental health, housing, job training, and education[commitment-title title='Background'] Firearm related injuries and other forms of violent trauma victimization result in significant patient morbidity and mortality in the United States (US) and disproportionately affect Black and Hispanic individuals 15-34 years of age. Firearm related injury is now the leading cause of death among those aged 1-19 years of age, and is one of the top five leading causes of death for individuals up to 44 years of age (CDC WONDER) . The effects of violent trauma extend beyond individual victims. Community violence is now classified as its own separate Adverse Childhood Experience (ACE) and can result in long-term deleterious mental health and developmental effects in children. The increased associated morbidity/mortality with violent trauma victimization has resulted in increased interest in implementation of Hospital Violence Intervention Programs (HVIPs) . HVIP's, including NYC Health + Hospital's Stand Up to Violence (SUV) program, have offered a promising approach to violence mitigation and have demonstrated a documented statistically significant decreased rates of re-injury (OR 0.41 [0.22-0.75]) and improved rates of follow up after discharge (OR 2.8 [1.59-3.29]) in admitted young violent trauma patients.[commitment-title title='Progress Update'] [commitment-title title='Partnership Opportunities'] The SNUG program seeks media support to get the message of our HVIP program expansion out for others to learn from, along with potential connections to potential implementing partners that can help SNUG HVIP programming connect violent trauma patients to more resources., The SNUG program will offer existing best practice guidelines for program implementation, financial resources for program support, and oversight utilizing its existing leadership framework. In addition, SNUG has been implementing community based violence interventions for over 14 years, and has fully funded its first HVIP in Bronx SUV since 2014 and provides significant topic expertise.