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

• Published date: 01 November 2022
• DOI: http://doi.org/10.1177/00027162231173323
• Author: Daniel W. Webster,Joseph Richardson,Nicholas Meyerson,Christopher Vil,Rachel Topazian
• Date: 01 November 2022
• Subject Matter: The Efficacy of Interventions

ANNALS, AAPSS, 704, November 2022 137

DOI: 10.1177/00027162231173323

Research on the

Effects of

Hospital-Based

Violence

Intervention

Programs:

Observations

and Recom-

mendations

By

DANIEL W. WEBSTER,

JOSEPH RICHARDSON .,

NICHOLAS MEYERSON,

CHRISTOPHER ST. VIL,

and

RACHEL TOPAZIAN

1173323ANN THE ANNALS OF THE AMERICAN ACADEMYEFFECTS OF HOSPITAL-BASED VIOLENCE INTERVENTION PROGRAMS

research-article2023

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-

lence.

Keywords: hospital-based violence intervention pro-

grams; violence prevention; trauma-

informed care

The Need for Effective

Interventions for Victims of Gun

Violence

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

Correspondence: dwebste2@jhu.edu

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.

138 THE ANNALS OF THE AMERICAN ACADEMY

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.