Violence Intervention Program

The University of Maryland Prince George’s Hospital Center now named University of Maryland Capital Region Medical Center (UMCAP) is a nonprofit, level II trauma center that serves Prince George’s County and surrounding areas. The hospital-based Capital Region Violence Intervention Program “CAP-VIP” engages violently injured patients aged 15-35 while in the hospital to assess medical and social needs providing intense case management that continues after discharge. The program preferentially hires individuals with lived experience related to our participants. There has previously been success in reducing both recurrent injury and criminal recidivism, increases in job acquisition and mitigation of participant crises. Funds will support maintenance and expansion of the program providing personnel, improved data systems, participant support.

Violent injury and its consequences are major public health issues in the United States. Interpersonal violence among Black males ages 15-34 is the leading cause of chronic disability and death (CDC 2020). Young Black men are more likely to be victims of violent crime and have higher rates of serious non-fatal violent injury than all other racial groups (Kwon et. al., 2023). An incremental increase in neighborhood deprivation is associated with a 13% increase in risk of violence perpetration indicating not only risk to the individual but also the community (Pino et. al., 2023). The Prince George’s County’s age-adjusted death rate due to homicide from 2018 to 2020 was high at 11.7, compared to Maryland overall at 10.2 and the U.S. at 6.6 per 100,000 population (Prince George's County Community Health Assessment, 2022). There were 3,161 violent crimes in 2020 and 138 residents in Prince George’s County died by homicide in that year alone (Prince George's County Community Health Assessment, 2022). The University of Maryland Capital Region Medical Center (UMCAP) treats violently injured patients on daily basis including a disproportionate number of the County's low-income residents who are often uninsured with limited access to resources.

UMCAP is the second busiest trauma center in the state of Maryland. UMCAP treats on average 750 victims of violent injury per year. Approximately 90 percent of the Maryland residents treated for violent injury at UMCAP are residents of Prince George's County. In response to the high rates of violent injury, specifically gunshot wounds and stabbings, UMCAP developed the Capital Region Violence Intervention Program (CAP-VIP) for patients age 15-35 years. CAP-VIP is a hospital-based violence intervention program (HVIP) that was established in September 2017. CAP-VIP uses a trauma-informed care approach to provide comprehensive psychosocial services and intensive case management to reduce the likelihood of recurrent injury, provide psychosocial support and services related to the social determinants of health.

Historically, a case-control study was performed to establish a target population for our program. Independent risk factors for recurrent injury included being an African-American male, unemployed or income less than $10,000 annually, and a drug user or drug dealer (Cooper et. al, 2000). HVIP participants had significant improvements when compared with a control group experiencing an 83% decrease in repeat hospitalization, a 66.7% decrease in violent crime, and an 82% employment rate at the time of follow-up (Cooper et. al. 2006). Nationally HVIPs have shown a significant reduction of risk factors, decreased reinjury, decreased violent behaviors, decreased criminal justice involvement, positive attitudes or behavioral change and improved health outcomes (Nofi et. al. 2023; Gorman et. al., 2022). As recurrent injury can be difficult to show and woefully inaccurate in large urban areas with multiple trauma centers, there is an ongoing need for objective measures of participant progress and program success. One of these is the self-sufficiency matrix (SSM) which measures 18 domains related to the social determinants of health. The tool is repeated every 90 days and has been validated in disadvantaged populations (Grimbergen and Fassaert, 2022). We incorporated the SSM into our intake assessment during the previous FY cycle and look forward to the impact of the results.

Currently, 90% of our participants are male and 86% are Black non-Hispanic. The average age of our participants is 25 years. The most common needs of our participants include housing acquisition, job placement, legal services, crisis intercession, counseling and application for the Crime Victims Compensation act. The most represented zip code among our program participants is 20747, District Heights, Prince George’s County, Maryland.  CAP-VIP has provided services to greater than 100 participants over the past year. We have also provided upwards of 250 prevention and education activities. With our recent increase in frontline staff as supported in the previous FY cycle, we have been able to increase our proportion of eligible participants contacted by 56%.

Victims of violent injury are more at risk for perpetration of violent injury of others than other trauma survivors (Pino et al., 2023).  In addition to the costs of repeat hospitalizations, those who experience recurrent injury are more likely to be uninsured and in need of care related to postoperative complications (Campbell & Taheri, 2008). Their repeat victimization places them at increased risk for morbidity, mortality and disability when compared to the general population. In 2015, the American College of Surgeons participated in a call to action involving eight health professional organizations and the American Bar Association to address firearm-related injury and death. One major goal of the consensus-based approach tertiary prevention through HVIPs to treat ramifications from injury (Stewart et. al,. 2018). The American College of Surgeons has since developed a primer for the management of HVIPs that is utilized by CAP-VIP. Identifying those suffering from recurrent injury during the vulnerable moments after injury as CAP-VIP does and targeting them with preventive methods greatly reduces the volume of patients and the complications that the health care system needs to manage.

The Health Alliance for Violence Intervention (HAVI) is a national network of HVIPs that acts as a repository for resources and advocacy efforts. CAP-VIP is a member of this intricate network. HAVI provides the Violence Prevention Provider training necessary for Medicaid reimbursement of violence prevention services. HAVI also sponsors an annual conference for frontline staff and bi-monthly meetings for the leaders of HVIPs. (https://thehavi.com). The CAP-VIP program is evidence based with the purpose of reducing gun violence in concordance with Performance Incentive Grant Fund Initiative 3: Support for Victims and Victims’ Rights and Initiative 4: Training and Education with a focus on a priority population being victims of crime.