Evidence demonstrates that hospital violence intervention programs (HVIPs) reduce violent
injury recidivism, PTSD symptoms, improve receipt of supportive services, and demonstrate
cost-savings for the healthcare system. However, it is unknown if these outcomes can be
replicated in under-studied communities in the Southeast (S.E.) where few HVIPs have been
implemented, and other potentially valuable outcomes remain unexamined. These may include
but are not limited to, improvement in patients' healthcare experiences, self-confidence,
violence risk reduction, and overall recovery. In addition, multi-sector stakeholder
perspectives on how HVIPs can improve or expand to better meet communities' needs are
lacking in the literature. For instance, family members and loved ones are often
supported by HVIP services, but little is known about how they benefit from the
intervention. Also, HVIPs integrate into the healthcare team, augmenting the care
provided by the clinical staff. Little is known about how healthcare teams benefit from
the work of HVIPs or how the quality of care provided is influenced by these programs.
These questions are imperative to informing the implementation of HVIPs and how success
might be better defined through a public health lens that considers outcomes beyond
violent injury recidivism for patients, families, healthcare systems, and communities.
Further, evaluating HVIPs in under-studied communities is critical to advancing the
model's evidence base, especially in communities where violence intervention investment
remains low. The S.E. U.S., for example, experiences a disproportionate burden of firearm
homicide, but few hospitals have adopted HVIPs. S.E. trauma centers and HVIPs uniquely
serve large urban and rural geographic areas that face complex racial and economic
disparities yet have fewer investments in violence prevention and safety net policies and
services.
Investigators propose conducting a comprehensive evaluation of an established HVIP
(Turning the Tide Violence Intervention Program, TTVIP) at an academic, non-profit level
1 trauma center in Charleston, SC that serves youth and young adult victims of community
and interpersonal violence in Charleston, Dorchester, and Berkeley Counties. Most
patients served by the TTVIP are victims of firearm injury (>90%), reside in the
cities of Charleston and North Charleston - the latter of which ranks among U.S. cities
with the highest firearm assault and homicide rates - and are disproportionately young
Black males from neighborhoods with high deprivation and are Medicaid funded or
uninsured. This study will advance the knowledge on HVIP outcomes, implementation from
the perspective of survivors, families and healthcare team members, in addition to
examining the impact of an HVIP in a S.E. state that disproportionately experiences
firearm violence. The study's goal is to perform an evaluation of a S.E. HVIP (TTVIP)
that includes comprehensive patient outcomes, perceived benefits of HVIPs from the
perspectives of multiple stakeholders, and opportunities for HVIP improvement.
Aim 1: Assess healthcare experience, supportive service utilization, violence risk,
mental health outcomes, self-confidence, perceived risk of violence and re-injury among
violently injured youth and young adults, including TTVIP enrolled patients and
non-enrolled patients. Investigators hypothesize that individuals that experienced
violent injury and enrolled in the TTVIP will report a) more positive perception of their
healthcare experience, b) higher service utilization, c) lower rates of depression and
PTSD, d) lower risk of violence, e) higher confidence, and f) lower rates of violent and
non-violent re-injury compared to non-enrolled victims of violence. Investigators
anticipate similar rates of perceived violence risk between the two groups.
Aim 2: Examine perceptions of HVIP services, benefits, and recommendations for service
improvement among HVIP enrollees and their primary caregivers/loved ones.
Aim 3: Assess perceptions of HVIP services, benefits to the healthcare team and patients,
and recommendations for service improvements among healthcare staff.
