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： 国家创伤中心的验证依赖于对伤害预防工作的承诺，包括防止 社区暴力。基于医院的暴力恢复计划（HVIP）已在整个 国家作为一级和二级创伤中心的延伸，以解决创伤复发与个人行为 在“可教时刻”进行修改。迄今为止，没有证据表明其有效性 尽管在全国范围内扩散，对这种暴力方式的批评 预防是HVIP项目中以社区为基础的暴力预防专家要解决的难题 健康的结构和社会决定因素（SSDOH）中存在更大的不平等，导致暴力， 个人行为矫正医疗法律伙伴关系是一种方法， 在改善健康结果和减少损害健康的患者法律的需求方面的证据和成功， 将法律的专家与医疗专家联系起来，进行整体护理。这一点还有待于创伤患者和 据我们所知，到目前为止，还没有被纳入任何医疗法律伙伴关系的HVIP方法中 （MLP）。在我们的双阶段提案中，我们的UG 3目标是明确确定健康损害的法律的需求类型， 我们的患者和家庭受枪支暴力的影响，并检查人口水平的差异， 法律的需要由社会人口和地理因素。我们的目标是开发HVIP-MLP模型， 在芝加哥南部的城市一级创伤中心实施。我们的UH 3目标是 然后检查我们的新的MLP的实施结果（可接受性和可行性）相比， 关注我们的HVIP。然后，我们将通过一项务实的临床试验来检查健康结果， 健康结局（压力和健康相关生活质量）和次要的、经验证的SSDOH结局 [收入、住房和公用事业、就业、法律的需要以及个人和家庭稳定性的改善（I-HELP）]。 作为一个发展探索性的目标，我们还将在我们的HVIP中测量压力和健康相关的生活质量- 附属的暴力康复专家，使他们的病人在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、分析支持以及与未来公众/利益相关者的咨询 参与和传播，以展示我们的公共卫生影响。这种新颖的HVIP-MLP方法具有 广泛影响HVIP模型的潜力，包括所有创伤中心的MLP组件，以进行验证 在这项重要的公共卫生工作中为患者、家庭和提供者提供支持。

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.