Harmonizing Hospital-Based Violence Intervention Programs with a Novel Medical-Legal Partnership – the HVIP-MLP Model

Project Abstract: National trauma center verification relies on a commitment to injury prevention efforts, including against community-level violence. Hospital-Based Violence Recovery Programs (HVIPs) have expanded across the country as extensions of Level I and II trauma centers to address trauma recidivism with individual behavioral modification during the “teachable moment”. There is no evidence to date that has demonstrated effectiveness in this approach for HVIPs, despite proliferation across the country. A criticism of this approach to violence prevention is the difficulty for community-based violence prevention specialists from HVIP programs to address the larger inequities in the Structural and Social Determinants of Health (SSDOH) that lead to violence through individual behavior modification. Medical-Legal Partnerships have been one approach that has demonstrated evidence and success in improving health outcomes and reducing health-harming legal needs of patients, by connecting legal experts to medical experts for holistic care. This has yet to be done for trauma patients and has, to our knowledge, not been incorporated into any HVIP approach thus far, for a Medical-Legal Partnership (MLP). In our biphasic proposal, our UG3 aims are to clearly identify the types of health-harming legal needs of our patients and families affected by firearm violence and examine the population-level differences in types of legal needs by sociodemographic and geographic factors. We them aim to develop the HVIP-MLP model for implementation at our urban, Level I Trauma Center on the South Side of Chicago. Our UH3 aims would be to then examine implementation outcomes (acceptability and feasibility) of our novel MLP compared to standard of care with our HVIP. We would then examine health outcomes via a pragmatic clinical trial measuring primary health outcomes (stress and health-related quality of life) and secondary, validated SSDOH outcomes [improvements in income, housing & utilities, employment, legal needs and personal & family stability (I-HELP)]. As a developmental exploratory aim, we will also measure stress and health-related quality of life in our HVIP- affiliated violence recovery specialists that engage their patients in the MLP model, as well access the intervention themselves, as needed. Close coordination with the CLIP-VP Coordinating Center will be essential specifically for data handling, measurement, analytics support and consultation with future public/stakeholder engagement and dissemination to demonstrate our public health impact. This novel HVIP-MLP approach has the potential to broadly impact the HVIP model to include an MLP component to all trauma centers for verification to support patients, families and providers alike in this important public health work.