Exploring Factors That Impact Implementation of Hospital-Based Violence Intervention Programs

Background and Purpose

Hospital-based violence intervention programs (HVIP’s) provide youth victimized by gun violence access to intensive case management services while they receive treatment in the hospital for their injuries. These programs can reduce violence recidivism, retribution, criminal activity and aggressive behaviors, while improving employment and educational outcomes. A key element of HVIP’s is engaging patients ‘at their bedside’ during a time when they and their families may be most motivated to accept services due to the close temporality of their injuries. Despite mounting evidence of the benefits of HVIP’s as a promising practice to reduce the social and economic costs of community-based violence, limited information is available about how to best implement HVIP’s across multiple hospitals and systems within a single geographic area. This study sought to explore the perceived factors that may facilitate and hinder the effective implementation of an HVIP across four large level-one trauma centers in a metropolitan city in the Midwest with high rates of community-based gun violence.

Methods

This study used in-depth qualitative interviews with a purposive sample of seventeen professionals across medicine (n=5), social work (N=10), nursing (N=1), and spiritual care (N=1) who worked directly with victims of gun violence in four large level-one trauma centers. Participants were recruited from a citywide HVIP Coalition comprised of academic and hospital partners. Interviews were guided by a semi-structured protocol developed with input from key informants who were leaders within the HVIP Coalition to enhance authenticity and credibility. Interviews were coded and analyzed using ATLAS TI software. Grounded theory was used to develop an in-depth understanding of how participants perceived the main facilitators and barriers to HVIP implementation. This process involved generating initial codes that were attached to data within and across transcripts and which were then compared and contrasted to generate categories and general themes grounded in the data. Trustworthiness was established through peer-debriefing, triangulation, memo-notes, theoretical sampling, analysis of counter-narratives, and continuing interviews until saturation.

Results

Several themes emerged from the data. First, participants reported that current hospital policies and procedures provided little follow-up resources to victims of community violence after discharge. Participants identified the need for services focused on family therapy, mentoring, employment and accessing community resources. Second, participants also identified the need for interprofessional training in motivational interviewing, transdiagnostic approaches to trauma and other common disorders such as depression and anxiety, suicide assessment, and safety planning. Third, the need for improved intra- and inter-hospital communication and data sharing structures were emphasized. Lastly, supervision models within and across multiple hospital sites were identified.

Conclusions and Implications

Effective implementation of HVIP’s across hospital systems requires coordination and integration of resources through collaborative partnerships between multiple stakeholders. This will require integration of billing, records and communication systems within and across hospitals. It may also require the redesign of job functions and the development of multi-site inter-professional teams. Leveraging local resources in the form of university-community-hospital partnerships can assist in the cultivation of adequate services, personnel and training resources.