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

将基于医院的暴力干预计划与新型医疗法律伙伴关系相协调，以实现健康的社会和结构性决定因素的公平 — HVIP-MLP 模型

• 批准号: 10613225
• 负责人: Tanya L Zakrison
• 金额: $ 161.49万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10613225
• 关键词: Address; Adoption; Affect; American College of Surgeons; Behavior Therapy; Caring; Chicago; Clinical; Collaborations; Communities; Complex; Consultations; Country; Data; Development; Education; Effectiveness; Employment; Equipment and supply inventories; Exclusion; Family; Family Violence; Financial Support; Firearms; Future; Geographic Factor; Gun injury; Gunshot wound; Health; Homicide; Hospitals; Housing; Income; Individual; Inequality; Injury; Intervention; Interview; Lead; Legal; Legal Status; Life; Link; Measurement; Measures; Medical; Mental Health; Methodology; Modeling; Morals; Nature; Outcome; Patient Self-Report; Patients; Perception; Phase; Plant Roots; Population; Pragmatic clinical trial; Prevention; Prevention program; Process; Provider; Public Health; Recommendation; Recovery; Reproducibility; Sampling; Side; Specialist; Standardization; Stress; Surveys; Time; Trauma; Trauma patient; Victimization; Violence; Violent injury; Vulnerable Populations; Work; acceptability and feasibility; base; black patient; burnout; data handling; demographics; evidence base; gun violence; health related quality of life; implementation outcomes; improved; injury prevention; intervention program; member; novel; physical conditioning; programs; prospective; recidivism; screening; social; social health determinants; social structure; sociodemographic factors; standard of care; success; trauma centers; treatment as usual; violence prevention

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.

项目摘要： 国家创伤中心的核查依赖于对伤害预防工作的承诺，包括针对 社区层面的暴力。医院暴力康复计划 (HVIP) 已在全球范围内扩展 国家作为一级和二级创伤中心的延伸，以解决个人行为创伤累犯问题 在“受教时刻”进行修改。迄今为止没有证据表明其有效性 尽管全国范围内都有这种做法，但 HVIP 仍采用这种方法。对这种暴力方式的批评 预防是来自 HVIP 计划的社区暴力预防专家需要解决的难题 健康的结构和社会决定因素（SSDOH）中更大的不平等导致暴力 个人行为矫正。医疗法律合作伙伴关系是一种已经证明的方法 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， 将法律专家与医学专家联系起来，提供整体护理。对于创伤患者和 据我们所知，迄今为止尚未将医疗法律合作伙伴关系纳入任何 HVIP 方法 （MLP）。在我们的双阶段提案中，我们的 UG3 目标是明确确定损害健康的法律需求类型 我们受枪支暴力影响的患者和家庭，并研究了枪支暴力类型的人口水平差异 社会人口和地理因素的法律需求。我们的目标是开发 HVIP-MLP 模型 在芝加哥南区的城市一级创伤中心实施。我们的 UH3 目标是 然后检查我们的新颖 MLP 的实施结果（可接受性和可行性），并与标准进行比较 关心我们的 HVIP。然后，我们将通过一项测量主要疾病的实用临床试验来检查健康结果 健康结果（压力和健康相关的生活质量）和次要的、经过验证的 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性的改善（I-HELP）]。 作为发展探索性目标，我们还将衡量 HVIP 中的压力和健康相关的生活质量 附属的暴力康复专家让患者参与 MLP 模型，并访问 根据需要自行干预。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 可能广泛影响 HVIP 模型，将 MLP 组件纳入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、家人和提供者等。