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Hospital-based violence intervention programs

Overview

A hospital-based violence intervention program (HVIP) is a community violence intervention strategy that helps people who receive medical care at hospitals for violence-related injuries. HVIPs provide victims of violence—including from gunshot wounds—with support and guidance during and after their clinical care to reduce the risk of re-injury and future involvement in violence. Black and Latino men aged 10–24 are often a focus of these efforts as they are at highest risk of being injured or killed by firearm violence.

HVIPs use trusted and credible messengers—individuals with shared identity, community, or personal experiences with community violence—to engage patients in the emergency department or at the hospital bedside immediately following the injury.

After patients finish treatment at the hospital, credible messengers then:

  • Provide long-term case management services to provide wound care as well as mental and emotional health support.
  • Build relationships with individuals and their families and help them access community resources that support their needs related to life
  • circumstances, living situations, health-related behaviors, and/or hopelessness (similar to community violence intervention services).

As of 2025, there is only one HVIP in the Rocky Mountain region: the At-risk Intervention and Mentoring (AIM) program led by Denver Youth Program. This program has formal partnerships with Denver Health, UC Health, and Children’s Hospital to provide HVIP services and meet patients at the bedside.  

How to implement HVIPs

  • Identify the organizations and individuals in your community that are already or could be involved in providing HVIP services to individuals receiving care at an emergency department or hospital due to a violent injury. These individuals (or organizations who employ these individuals) should be credible messengers.
  • If an HVIP does not currently exist in a local hospital in your community, health care organizations can consider initiating partnerships with community organizations who employ credible messengers to provide HVIP services.
  • If starting an HVIP, health care organizations and community partners can consult with the Health Alliance for Violence Intervention (HAVI), the national organization of HVIPs, to receive advice and support on how to incorporate best practices for launching and sustaining an HVIP.

  • Invest in capacity building of credible messengers who can interact with individuals who have been injured as a result of community violence, including by gunshot wounds.
  • In partnership with health care organizations, reach out to individuals who have been violently injured through outreach in the emergency department or at the hospital bedside to provide immediate support to them following their traumatic experience.
  • Provide comprehensive and community-based health services through initiatives such as the REACH Clinic in Denver to address wound care, pain management, and physical and mental recovery from a violent event.
  • Connect individuals with resources and wraparound services that can improve their living circumstances, such as job placements, education, housing, recreation, and food security.
  • Model and create opportunities where youth and community members can connect with fellow community members, family, and friends to increase their social support and civic engagement.
  • Train credible messengers in models of cognitive behavioral therapy designed for CVI work. These approaches help individuals change negative thoughts and emotions so that they can develop healthier coping mechanisms and improve their mental health.
  • Use trauma-informed approaches to ensure individuals have access to resources that support comprehensive healing and recovery.

Evidence supporting HVIPs

There is limited and mixed data regarding the effectiveness of HVIPs in reducing firearm-related harms in communities where they exist. Research shows HVIPS can improve mental health and reduce re-injury, violent behavior, substance use, and involvement with the justice system, particularly among youths. Studies from Chicago and Baltimore reported that re-injury and rehospitalization rates were lower among patients who participated in an HVIP compared to those who did not. An HVIP in Oakland found that its patients were less likely to engage with the criminal justice system following participation in the program. Continued research on patient-centered outcomes of HVIPs and the availability of long-term funding mechanisms will influence the success of HVIPs moving forward.

  1. Affinati, S., Patton, D., Hansen, L., Ranney, M., Christmas, A. B., Violano, P., Sodhi, A., Robinson, B., & Crandall, M. (2016). Hospital-based violence intervention programs targeting adult populations: An Eastern Association for the Surgery of Trauma evidence-based review. Trauma Surgery & Acute Care Open, 1(1), e000024. https://doi.org/10.1136/tsaco-2016-000024 
  2. CDC (Centers for Disease Control and Prevention) WISQARS. (n.d.). Retrieved from https://wisqars.cdc.gov/ 
  3. Cooper, C., Eslinger, D. M., & Stolley, P. D. (2006). Hospital-based violence intervention programs work. Journal of Trauma and Acute Care Surgery, 61(3), 534–540. https://doi.org/10.1097/01.ta.0000236576.81860.8c 
  4. HAVI (The Health Alliance for Violence Intervention). (n.d.). What is a hospital-based violence intervention program (HVIP)? Retrieved September 11, 2023, from https://www.thehavi.org/what-is-an-hvip   
  5. Karraker, N., Cunningham, R. M., Becker, M. G., Fein, J. A., & Knox, L. M. (2011). Violence is preventable: A best practices guide for launching & sustaining a hospital-based program to break the cycle of violence. U.S. Department of Justice, Office of Justice programs. https://www.ojp.gov/ncjrs/virtual-library/abstracts/violence-preventable-best-practices-guide-launching-sustaining 
  6. Shibru, D., Zahnd, E., Becker, M., Bekaert, N., Calhoun, D., & Victorino, G. P. (2007). Benefits of a hospital-based peer intervention program for violently injured youth. Journal of the American College of Surgeons, 205(5), 684–689. https://doi.org/10.1016/j.jamcollsurg.2007.05.029 
  7. Zun, L. S., Downey, L., & Rosen, J. (2006). The effectiveness of an ED-based violence prevention program. The American Journal of Emergency Medicine, 24(1), 8–13. https://doi.org/10.1016/j.ajem.2005.05.009