Harmonizing Hospital-Based Violence Intervention Programs with a Novel Medical-Legal Partnership for Equity in the Social and Structural Determinants of Health – the HVIP-MLP Model -- Supplement

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Project Abstract: Parent Grant: Trauma center verification requires injury prevention efforts, often in the form of Hospital- based Violence Intervention Programs (HVIPs). Limitations exist in how well they address the Structural & Social Determinants of Health (SSDOH) that lead to violence. Medical-Legal Partnerships (MLPs) address the SSDOH of patients, by connecting legal & medical experts to improve health outcomes. No MLP exists to date in a trauma center, incorporated into HVIP activities. In our biphasic proposal, our UG3 aims are to identify the SSDOH of our firearm injured patients after creating & implementing the HVIP-MLP model into our South Side trauma center. Our UH3 aims examine implementation & clinical outcomes, including trauma re- injury. This novel HVIP-MLP approach may enhance the HVIP injury prevention model in trauma centers to better support patients, families & communities in their recovery & prevention of future firearm injury. Proposed Supplement: One challenge with our HVIP-MLP model is the standardized screening of all patients, regardless of age. Our preliminary data indicate that firearm- injured youth have unique SSDOHs that are different from those of adults. This is a crucial distinction since firearm injury is the #1 cause of mortality for youth <20 years. If we do not understand the unique SSDOH of our youth, our HVIP-MLP intervention may be of limited impact in the most vulnerable group affected. Similarly, burnout is a significant concern for our Violence Recovery Specialists (VRS) who work in our HVIPs. Also affected by a history of trauma, VRS are credible messengers from violence-affected communities, and often experience vicarious trauma when caring for violently-injured patients from the same communities. MLP resilience & empowerment may counteract burnout experienced by VRS, but this has not yet been studied. In this Supplement we propose a mixed-methods approach to determine the impact that our HVIP-MLP model has on firearm-injured youth and our VRS, representing vulnerable populations in both the patient & provider spheres of care. In Aim 1, we will understand the specific SSDOH of firearm-injured youth compared to adults. In Aim 2, we will measure the impact of the HVIP-MLP model on the vicarious trauma, resilience & empowerment of our VRS. Appreciating that the upstream SSDOH are related to firearm violence, Aim 3 will center on engaging in research-to-action policy change. With the initial 1-year Supplement (extending into year 2 after UH3 transition) our candidate will gain skills in mixed-methods research & submit a K application using pilot data from this Supplement.