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

项目摘要： 国家创伤中心的核实有赖于对伤害预防工作的承诺，包括针对 社区层面的暴力。以医院为基础的暴力恢复方案(HVIP)已扩展到 国家作为一级和二级创伤中心的延伸，通过个人行为来解决创伤再犯问题 在“教书育人的时刻”进行修改。到目前为止，还没有证据表明有效。 尽管在全国各地都在扩散，但这种方法适用于HVIP。对这种暴力方式的批评 预防是来自HVIP项目的社区暴力预防专家要解决的困难 结构和社会健康决定因素(SSDOH)中更大的不平等通过以下方式导致暴力 个人行为改正。医疗-法律合作伙伴关系是一种已经证明 在改善健康结果和减少患者损害健康的法律需求方面的证据和成功，通过 将法律专家与医疗专家联系起来，提供全面护理。这还没有为创伤患者和 据我们所知，到目前为止还没有将医疗-法律伙伴关系纳入任何HVIP方法 (MLP)。在我们的两阶段提案中，我们的UG3目标是明确确定以下危害健康的法律需求的类型 我们的患者和受枪支暴力影响的家庭，并检查人口水平在类型上的差异 按社会人口和地理因素划分的法律需求。我们的目标是为以下对象开发HVIP-MLP模型 在我们位于芝加哥南侧的城市I级创伤中心实施。我们的UH3目标将是 然后检查我们新的MLP的实施结果(可接受性和可行性)，并与 关心我们的HVIP。然后，我们将通过一项务实的临床试验来检查健康结果，该试验测量了初级 健康结果(压力和与健康相关的生活质量)和次要的、有效的SSDOH结果 [收入、住房和公用事业、就业、法律需求以及个人和家庭稳定的改善(i-Help)]。 作为一个发展探索性目标，我们还将在我们的HVIP中测量压力和与健康相关的生活质量- 附属暴力康复专家，让他们的患者参与MLP模式，以及访问 根据需要进行干预。与CLIP-VP协调中心的密切协调至关重要 专门用于数据处理、测量、分析支持和与未来公众/利益相关者的咨询 参与和传播，以展示我们对公共卫生的影响。这种新的HVIP-MLP方法具有 可能广泛影响HVIP模型，将MLP组件包括到所有创伤中心进行验证 在这项重要的公共卫生工作中支持患者、家属和提供者。

Project Abstract: National trauma center verification relies on a commitment to injury prevention efforts, including against community-level violence. Hospital-Based Violence Recovery Programs (HVIPs) have expanded across the country as extensions of Level I and II trauma centers to address trauma recidivism with individual behavioral modification during the “teachable moment”. There is no evidence to date that has demonstrated effectiveness in this approach for HVIPs, despite proliferation across the country. A criticism of this approach to violence prevention is the difficulty for community-based violence prevention specialists from HVIP programs to address the larger inequities in the Structural and Social Determinants of Health (SSDOH) that lead to violence through individual behavior modification. Medical-Legal Partnerships have been one approach that has demonstrated evidence and success in improving health outcomes and reducing health-harming legal needs of patients, by connecting legal experts to medical experts for holistic care. This has yet to be done for trauma patients and has, to our knowledge, not been incorporated into any HVIP approach thus far, for a Medical-Legal Partnership (MLP). In our biphasic proposal, our UG3 aims are to clearly identify the types of health-harming legal needs of our patients and families affected by firearm violence and examine the population-level differences in types of legal needs by sociodemographic and geographic factors. We them aim to develop the HVIP-MLP model for implementation at our urban, Level I Trauma Center on the South Side of Chicago. Our UH3 aims would be to then examine implementation outcomes (acceptability and feasibility) of our novel MLP compared to standard of care with our HVIP. We would then examine health outcomes via a pragmatic clinical trial measuring primary health outcomes (stress and health-related quality of life) and secondary, validated SSDOH outcomes [improvements in income, housing & utilities, employment, legal needs and personal & family stability (I-HELP)]. As a developmental exploratory aim, we will also measure stress and health-related quality of life in our HVIP- affiliated violence recovery specialists that engage their patients in the MLP model, as well access the intervention themselves, as needed. Close coordination with the CLIP-VP Coordinating Center will be essential specifically for data handling, measurement, analytics support and consultation with future public/stakeholder engagement and dissemination to demonstrate our public health impact. This novel HVIP-MLP approach has the potential to broadly impact the HVIP model to include an MLP component to all trauma centers for verification to support patients, families and providers alike in this important public health work.