Strengthening the Safety Net: Piloting a Hospital-Based Violence Intervention Program within a Level 1 Pediatric Trauma Center

Olivia Frank, MPH
Emma Cornell, MPH
Chethan Sathya, MD, MSc, FRCSC, FACS

Hospital-based violence intervention programs (HVIPs) are an evidence-based strategy to address the impacts of community violence and reduce incidence of reinjury and hospital readmission. However, there are limited examples of HVIPs designed to meet the unique needs of violently injured pediatric patients and their families. The integration of HVIPs into pediatric care settings could help identify high risk patients and use incidents of violent injury as “teachable moments” to promote behavior change. We piloted an HVIP within the emergency department (ED) of a level 1 pediatric trauma center, with the goals of (1) describing the pediatric patient population affected by violent injuries at our site, and (2) assessing the feasibility of providing HVIP services (safety planning, resource referral, and trauma-informed care) to these patients.

In August 2023, we piloted an HVIP program in the ED of the largest level 1 pediatric trauma center in New York state, servicing both New York City and surrounding counties. Patients were eligible if they were <18 years of age at time of admission and had sustained a gunshot wound, a stab wound, and/or injuries from a violent altercation. Patients with injuries as a result of self-harm were not eligible. Program managers used the automated trauma activation system and input from clinical staff to identify eligible patients in the ED; hospital responders then met patients and families at bedside to offer crisis support and explain the HVIP. Enrollment occurred at any point in care, including post-discharge, and required verbal consent from both the patient and a guardian. Once enrolled, responders used motivational interviewing techniques to conduct a needs assessment, followed by safety planning and referrals to health system or community-based support services as appropriate. Data analyzed were extracted from electronic medical records and case management notes; standard descriptive analyses were conducted using SPSS.

Between August 1, 2023, and May 30, 2024, the HVIP engaged with 35 patients between 4-17 years old, who sustained violent injury from a firearm (40%), a stabbing (37.1%), or a violent altercation (22.9%). The majority of patients were male (88.6%), self-identified as Black/African American (65.7%) or multi-racial (14.3%) and were 15-17 years old (68.7%). Among patients who requested referrals (45.7%), 100% were successfully linked to appropriate health system and/or community-based services. Support relating to safe housing, educational assistance, and community violence intervention were the most common requests. Among patients not linked to resources, 22.9% did not request any referrals and 14.3% were lost to follow up (LTF) after discharge.

Pediatric HVIPs are a feasible intervention that pediatric trauma centers can implement to help identify and connect violently injured patients and their families to wrap-around support services. It also highlights the importance of sustainable partnerships with local community organizations in facilitating successful transitions post-discharge. Future goals include long-term patient follow-up and a formal process evaluation of the program’s implementation.

1. Attendees will be able to describe the patient population enrolled in a pediatric HVIP pilot program, including demographic makeup and injury mechanisms.
2. Attendees will be able to identify facilitators and barriers to the implementation of an HVIP in a pediatric emergency care setting.
3. Attendees will be able to apply the results and lessons learned to inform the implementation of a similar program at their institution.