American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes


Essential Elements to Start an HVIP

  • Stakeholder buy-in: Hospital Admin, Emergency Medicine, and Trauma Departments, Community, City, Department of Public Health.
  • Culturally competent case managers who can approach victims at the “teachable moment” after injury and shepherd clients to risk reduction activities (as opposed to just handing people fliers for places to go).
  • Capacity for in-house or referral to mental health services.
  • A basic referral base to risk reduction resources (GED/school, jobs, housing).
  • Court advocacy from the case managers.
  • Capacity for long-term follow up with program participants (at least 3-6 months).
  • Evaluation from the very start.
  • An in-hospital champion (usually a clinician).

Once a secure funding stream has been established and the value of the program has been appreciated, it is time to expand. The following represents an ideal comprehensive program.

Elements of a “Dream” HVIP

  • Enough case managers to screen all victims of violence.
  • Sustainable funding: line-item in city budget or ideally payment for service of case managers (there is taxonomy for this now!).
  • In-house mental health services.
  • Long-term follow up model.
  • Mature quantitative and qualitative analysis expertise.
  • Partnerships (MOUs) with risk reduction resources in community and city: vocational training, jobs, GED/school, tattoo removal, victim of crime office, housing.

Key Resources


  1. Aboutanos MB, Jordan A, Cohen R, Foster RL, Goodman K, Halfond RW, Poindexter R, Charles R, Smith SC, Wolfe LG, et al. Brief violence interventions with community case management services are effective for high-risk trauma patients. J Trauma. 2011;71:228–36; discussion 236–7.
  2. Chong VE, Smith R, Garcia A, Lee WS, Ashley L, Marks A, Liu TH, Victorino GP. Hospital-centered violence intervention programs: a cost-effectiveness analysis. Am J Surg. 2015;209(4):597-603.
  3. Corbin TJ, Purtle J, Rich LJ, Rich JA, Adams EJ, Yee G, Bloom SL. The prevalence of trauma and childhood adversity in an urban, hospital-based violence intervention program. J Health Care Poor Underserved. 2013;24(3):1021-1030.
  4. Corbin TJ, Rich JA, Bloom SL, Delgado D, Rich LJ, Wilson AS. Developing a trauma-informed, emergency department-based intervention for victims of urban violence. J Trauma Dissociation. 2011;12(5):510-525.
  5. Dicker RA, Jaeger S, Knudson MM, et al. Where do we go from here? Interim analysis to forge ahead in violence prevention. J Trauma. 2009;67(6):1169-1175.
  6. Fischer K, Purtle J, Corbin T. The Affordable Care Act’s Medicaid expansion creates incentive for state Medicaid agencies to provide reimbursement for hospital-based violence intervention programmes. Inj Prev. 2014;20(6):427-430.
  7. Hemenway D, Miller M. Public health approach to the prevention of gun violence. N Engl J Med. 2013;368(21):2033-2035.
  8. James TL, Bibi S, Langlois BK, Dugan E, Mitchell PM. Boston Violence Intervention Advocacy Program: A qualitative study of client experiences and perceived effect. Acad Emerg Med. 2014;21(7):742-751.
  9. Juillard C, Cooperman L, Allen I et al. A decade of hospital-based violence intervention. J Trauma Acute Care Surg. 2016;81(6):1156-1161.
  10. Juillard C, Smith R, Anaya N, Garcia A, Kahn JG, Dicker RA. Saving lives and saving money: Hospital-based violence intervention is cost-effective. J Trauma Acute Care Surg. 2015;78(2):252-258.
  11. Karraker N, Cunningham RA, Becker M, Fein JA, Knox LM. Violence is Preventable: A Best Practices Guide for Launching & Sustaining a Hospital-based Program to Break the Cycle of Violence. Youth ALIVE!. 2011.National Network of Hospital-based Violence Prevention Programs. 2017. Available at
  12. Kramer EJ, Dodington J, Hunt A, et al. Violent reinjury risk assessment instrument (VRRAI) for hospital-based violence intervention programs May 11 2017 [Epub ahead of print]. J Surg Res. 2017. doi: 10.1016/j.jss.2017.05.023.
  13. Law Center to Prevent Gun Violence, PICO National Network. Healing Communities in Crisis: Lifesaving solutions to the urban gun violence epidemic. 2016. Available at
  14. Little GL, Robinson KD. Moral Reconation Therapy: A systematic step-by-step treatment system for treatment resistant clients. Psychological Reports. 1988;62(1):135-151.
  15. Loveland-Jones C, Ferrer L, Charles S, Ramsey F, van Zandt A, Volgraf J, Santora T, Pathak A, Dujon J, Sjoholm L, Rappold J. A prospective randomized study of the efficacy of “Turning Point,” an inpatient violence intervention program. J Trauma Acute Care Surg. 2016;81(5):834-842.
  16. Purtle J, Rich LJ, Bloom SL, Rich JA, Corbin TJ. Cost-benefit analysis simulation of hospital-based violence intervention program. Am J Prev Med. 2015;48(2):162-169
  17. Purtle J, Rich JA, Fein JA, James T, Corbin TJ. Hospital-based violence prevention: Progress and opportunities. Ann Intern Med. 2015;163(9):715-717.
  18. Purtle J, Cheney R, Weibe DJ, Dicker RA. Scared safe? Abandoning the use of fear in urban violence prevention programmes. Inj Prev. 2015; 21(2):140-141.
  19. Purtle J, Dicker RA, Cooper C, et al. Hospital-based violence intervention programs save lives and money. J Trauma Acute Care Surg. 2013;75(2):331-333.
  20. Smith R, Dobbins S, Evans A, Balhotra K, Dicker RA. Hospital-based violence intervention: risk reduction resources that are essential for success. J Trauma Acute Care Surg. 2013;74(4):976-980.
  21. Smith R, Dobbins S, Evans A, Balhotra K, Dicker R. Hospital-based violence intervention. J Trauma Acute Care Surg. 2013;74(4):976-982.
  22. Smith R, Evans A, Adams C, Cocanour C, Dicker RA. Passing the torch: evaluating exportability of a violence intervention program. Am J Surg. 2013; 206(2):223-228.
  23. Sood AB, Berkowitz SJ. Prevention of Youth Violence: A Public Health Approach. Child Adolesc Psychiatr Clin N Am. 2016;25(2):243-256.
  24. The Wraparound Project. University of California San Francisco Department of Surgery. 2017.