Research on the Effects of Hospital-Based Violence Intervention Programs: Observations and Recommendations

Published date01 November 2022
AuthorDaniel W. Webster,Joseph Richardson,Nicholas Meyerson,Christopher Vil,Rachel Topazian
Date01 November 2022
Subject MatterThe Efficacy of Interventions
ANNALS, AAPSS, 704, November 2022 137
DOI: 10.1177/00027162231173323
Research on the
Effects of
and Recom-
We conducted a review of studies on the effects of
hospital-based violence intervention programs (HVIPs)
on subsequent involvement in violence as a victim or
perpetrator that included a nontreated control group.
We identified seven randomized controlled trials
(RCTs) and six observational studies. Most HVIPs
evaluated relied principally on credible messengers to
engage potential participants and intensive case man-
agement to provide social services. Evidence of linkage
of HVIPs to community violence intervention pro-
grams was lacking. RCTs of the most robust HVIPs
showed some evidence of protective effects, but overall
evidence of reduced risks for violence was mixed. RCTs
were underpowered, and all but one were vulnerable to
selection bias. Stronger interventions and research
methods are needed to advance our understanding of
the potential for HVIPs to reduce risks for future vio-
Keywords: hospital-based violence intervention pro-
grams; violence prevention; trauma-
informed care
The Need for Effective
Interventions for Victims of Gun
Homicide rates have been increasing since
2014 and have surged since early 2020 in cities
across the U.S. Decades of epidemiologic and
criminological research underscore that risks
for involvement in gun violence are highly con-
centrated by place (Braga, Andresen, and
Lawton 2017) and social networks (Tracy,
Braga, and Papachristos 2016). Whether cities
Daniel W. Webster is Bloomberg Professor of American
Health at the Johns Hopkins Bloomberg School of
Public Health, where he is Distinguished Scholar at the
Center for Gun Violence Solutions. He has led research
and published widely on the effects of policies and pro-
grams on gun violence, suicides, and the diversion of
guns for use in crime.
and communities struggling with high rates of gun violence can effectively
address the problem depends on their ability to implement effective interven-
tions that reach those at highest risk and alter their risk trajectory. Hospital-based
violence intervention programs (HVIPs) can potentially be helpful in reaching a
subset of those at highest risk with effective interventions at a critical time.
Survivors of gunshot wounds due to interpersonal violence are at heightened risk
for future involvement in violence (Rowhani-Rahbar et al. 2015) as well as sub-
stance abuse and mental illness (Song et al. 2022).
Being shot, stabbed, or otherwise seriously injured in a violent attack can
potentially lead the individual to make changes in their behavior or lifestyle to
lessen risks of subsequent violent injury or could lead the individual or their
associates to commit retaliatory acts of violence or engage in behaviors that may
elevate their risks of involvement in future violence such as gun carrying. It is
well known that gun violence can act as a social contagion, with each shooting
elevating the risks for multiple “transmissions” or future shootings if there are no
effective interventions to disrupt the infectious process. Research led by
Papachristos, Braga, and Hureau (2012) has demonstrated, for example, that
when an individual is shot, the risk of being shot goes up exponentially among the
victim’s social network with whom they have engaged in criminal activity, espe-
cially among those closest to the victim. Rivalries between street groups can lead
to ongoing back-and-forth acts of violence, each shooting being justified or moti-
vated by prior shootings (Brantingham, Yuan, and Herz 2021). Reviews of the
backgrounds of victims and perpetrators of gun violence in cities reveal consider-
able similarities with respect to prior arrests and history of victimization (Broidy
et al. 2006).
Effective interventions with victims of gun violence, thus hold the potential to
prevent future violence among victims treated for gunshot wounds. By prevent-
ing new cases of violence, these interventions could prevent the ripple effects
Joseph Richardson Jr. is the Joel and Kim Feller Endowed Professor of African-American
Studies and Anthropology at the University of Maryland. His research focuses on gun violence;
the intersections of structural violence, interpersonal violence, and trauma among Black boys
and young men; the intersection of the criminal justice and healthcare systems in lives of young
Black men; and parenting strategies for low-income Black male youth. This endowment sup-
ports his research on gun violence and trauma among Black boys and young Black men.
Nicholas Meyerson is a PhD student in the Department of Health Policy and Management at
the Johns Hopkins Bloomberg School of Public Health. His work has investigated gun violence
involvement, health disparities, police-involved violence, and long-term needs of youth
involved in the juvenile justice system.
Christopher St. Vil focuses on improving support services for Black males with an emphasis on
those living in urban contexts. His research illuminates the disproportionate contextual risks
experienced by Black males in the domains of lack of positive role models and the increased
likelihood of victimization.
Rachel Topazian is a doctoral student in health and public policy at the Johns Hopkins
Bloomberg School of Public Health, where she is a research assistant with the Center for Gun
Violence Solutions. Her interests include research ethics and the considerations surrounding
informed consent and ethical conduct of research studies.

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