Launching the Houston-HVIP: Developing and Evaluating a Hospital-Based Intervention to Reduce Recurrent Violence

Each year, millions of people present to emergency departments with violence-related injuries. Individuals who sustain a violent injury are at increased risk of experiencing another violent injury and being rehospitalized or dying in the months following discharge. Given the elevated risk of violent reinjury, emergency departments are well-positioned settings to identify and engage violently injured patients with services aimed at reducing future injury and improving health outcomes over time. Hospital-based violence intervention programs (HVIPs) have emerged as a promising strategy to interrupt cycles of violence by leveraging the immediate post-injury period to provide individualized case management and connect patients to services that address risk factors for future violence and hospitalization. Despite growing national interest in HVIPs, few programs have been evaluated using randomized controlled trial (RCT) designs, and none currently exist citywide in Houston, Texas—the fourth largest city in the United States. This study will develop, implement, and evaluate the Houston Hospital-Based Violence Intervention Program (Houston-HVIP) at Memorial Hermann Hospital in the Texas Medical Center, one of only two adult Level 1 trauma centers serving over 7 million residents in the Greater Houston area. The project follows a two-phase research structure. In Aim 1 (UG3 phase, 2023–2025), we will establish an advisory board to oversee the development of the Houston HVIP and training procedures for study and hospital staff, pilot test study procedures, and finalize the intervention protocol. In Aim 2 (UH3 phase, 2025–2028), we will conduct an RCT with at least 274 patients ages 16–35 who present to the hospital for a firearm injury stemming from interpersonal violence. Participants will be randomly assigned to either receive standard care (resource lists and light-touch two-week follow-up) or intensive HVIP case management with individualized service referral for six months. The primary outcome is any subsequent firearm violence measured via electronic medical records, death records, and self-report during the 12-month follow-up period. Secondary outcomes include any violent injury, aggression, PTSD symptoms, attitudes toward violence, and self-rated health. A subset of hospital and HVIP study staff (n = 30) and study participants (n = 40) will participate in surveys and qualitative interviews to collect feedback on program implementation and perceived value of the Houston-HVIP. This study will be one of the largest RCTs of an HVIP in the United States. If effective, the Houston-HVIP model may be adapted to other hospitals in Texas and throughout the United States.