Bridging the Gap Intervention for Violent Injury

Overseen By Nicholas Thomson, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Virginia Commonwealth University

Disqualifiers: Non-English, Age <18, Prisoners

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

616 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether a program called Bridging the Gap can help reduce violence in adults treated in hospitals after violent injuries, such as gunshot wounds. The study aims to determine if participants in the program exhibit fewer signs of violence and risky behaviors compared to those receiving regular hospital care. Participants will either receive standard hospital treatment or join the Bridging the Gap program, which includes a violence prevention plan and firearm counseling over six months. Ideal participants are English-speaking adults living in Richmond City or nearby areas who have been treated for violence-related injuries. As an unphased trial, this study offers participants the chance to contribute to innovative research that could lead to new approaches in violence prevention.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that the Bridging the Gap intervention is safe?

Research has shown that the "Bridging the Gap" program, a hospital-based violence intervention, has been well-received by participants in previous studies. This program provides support to survivors of violence and their families through detailed assistance both in the hospital and in the community.

Reports have not linked any negative effects directly to the program. Instead, studies have found positive results, such as a significant drop in re-injury rates and improved skills in handling conflict and risk factors. Overall, the program appears safe for participants, aiming to reduce violence and aid recovery without any noted safety issues. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Bridging the Gap (BTG) intervention because it offers a comprehensive approach to violence prevention that extends beyond the hospital setting. Unlike standard care, which typically involves basic medical treatment and discharge, BTG includes a hospital-based violence prevention program coupled with six months of community case management and firearm counseling. This holistic strategy not only addresses immediate physical injuries but also aims to reduce the risk of future violent incidents by supporting individuals in their communities, potentially leading to long-term positive outcomes.

What evidence suggests that the Bridging the Gap intervention is effective for reducing violence?

Research has shown that the "Bridging the Gap" program, which helps prevent violence, successfully reduces repeat injuries from violence. An early study found a 10.4% drop in repeat violent incidents among participants. In this trial, some participants will receive the "Bridging the Gap" intervention, which includes support from community case managers and advice on gun safety, aiming to change behaviors linked to violence. The program also seeks to understand and meet the needs of individuals after they leave the hospital, potentially reducing risky behaviors and improving safety over time. Other participants will receive standard hospital treatment. ^{3 4 6 7 8}

Who Is on the Research Team?

Nicholas Thomson, PhD

Principal Investigator

Virginia Commonwealth University

Are You a Good Fit for This Trial?

This trial is for English-speaking adults over 18 who live in Richmond City or nearby counties and are treated at the hospital for injuries from violence like gunshot wounds. It's not open to minors, non-English speakers, or prisoners.

Inclusion Criteria

I am being treated in the hospital for an injury caused by violence.

They are eligible for BTG services (which includes living within the BTG catchment area for the hospital; Richmond City and neighboring counties)

You can speak English.

Exclusion Criteria

I am under 18 years old.

Prisoners

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

In-hospital Intervention

Participants receive a hospital-based violence prevention program and firearm counseling

During hospital stay

1 visit (in-person)

Community Case Management

Participants receive 6 months of community case management services

6 months

Follow-up

Participants are monitored for outcomes related to firearm-related violence, re-injury, and mortality

12 months

2 follow-up assessments at 6 and 12 months

What Are the Treatments Tested in This Trial?

Interventions

• Bridging the Gap

Trial Overview The study tests 'Bridging the Gap,' a hospital-based program aimed at reducing retaliatory gun violence among violently injured adults. Researchers will compare outcomes of participants with and without this intervention.

How Is the Trial Designed?

Group I: In-hospital intervention Experimental Treatment 1 Intervention

Adults randomized to Bridging the Gap (BTG) services will receive a hospital-based violence prevention program with 6-months of community case management and a firearm counseling program.

Group II: Treatment as usual Active Control 1 Intervention

Adults who will not receive BTG services and will receive treatment as usual (TAU) in the hospital.

Bridging the Gap is already approved in United States for the following indications:

Approved in United States as Bridging the Gap for:

• Violence prevention
• Reducing retaliatory gun violence
• Firearm use reduction
• Drug use reduction
• Aggression reduction
• Risky behavior reduction
• Violent re-injury prevention

Who Is Running the Clinical Trial?

Virginia Commonwealth University

Lead Sponsor

Trials

732

Recruited

22,900,000+

Centers for Disease Control and Prevention

Collaborator

Trials

902

Recruited

25,020,000+

Published Research Related to This Trial

The study analyzed electronic health records of patients with violent trauma at a level 1 trauma center, revealing that assault injuries were the most common cause, particularly among black males with an average age of 33.

The findings suggest that Hospital Violence Intervention Programs (HVIPs) are essential for providing comprehensive care and standardized follow-up for patients, as nearly 80% of cases lacked documentation on the assailant's relationship, indicating a need for better risk assessment and management strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Characteristics of Adult Patients for Violence-Related Injuries Presenting to a Level 1 Trauma Center in Midwest United States. Hiranniramol, K., Moran, V., Israel, H., et al.[2023]

Trauma centers are expanding their focus beyond just treating physical injuries from violence to include violence prevention and intervention as essential parts of trauma care.

Hospital-based violence intervention programs are showing promise in reducing repeat trauma incidents by using the immediate aftermath of violence to provide support services and assess the risk of re-injury.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

What Is the Institutional Duty of Trauma Systems to Respond to Gun Violence? Scarlet, S., Rogers, SO.[2019]

Hospital-based violence intervention programs (HVIPs) can lead to significant cost savings, with estimates ranging from $82,765 to $4,055,873 over 5 years for a hypothetical group of 180 violently injured patients, depending on the model used.

The study provides a systematic framework for evaluating the economic impact of HVIPs, suggesting that these programs not only help prevent violent reinjury but also offer substantial financial benefits to healthcare and criminal justice systems.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cost-benefit analysis simulation of a hospital-based violence intervention program. Purtle, J., Rich, LJ., Bloom, SL., et al.[2017]

Out of 2,243 violently injured patients, 839 (37.4%) engaged with the Boston Violence Intervention Advocacy Program (VIAP), with younger age, Black race, and more severe injuries being significant predictors of engagement.

Clients who engaged with VIAP faced challenges in achieving goals related to education, employment, and housing, indicating that while the program is effective in reaching its target population, there is a need for tailored strategies to address these complex needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Boston Violence Intervention Advocacy Program: Challenges and Opportunities for Client Engagement and Goal Achievement. Pino, EC., Fontin, F., James, TL., et al.[2021]

This study is part of a larger initiative involving 12 demonstration projects aimed at evaluating the effectiveness of hospital-based violence intervention programs (HBVIPs) through a randomized control trial with male victims of violence, comparing standard treatment to enhanced services over one year.

The primary goal is to assess whether enhanced services can significantly reduce trauma recidivism and improve mental health and quality of life, using robust statistical methods to analyze outcomes like death and recidivism.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Testing the efficacy of a hospital-based violence intervention programme: protocol and design. St Vil, C., Hall, EC., Sheppard, M., et al.[2022]

The CeaseFire program, which integrates hospital resources with community violence interrupters, aims to reduce penetrating trauma rates in a specific area (zip code 70113) by providing support from the moment of injury through recovery and community reintegration.

While the overall incidence of penetrating trauma in Orleans Parish increased during the study period, the target area (70113) experienced a slower rate of increase compared to adjacent zip codes, suggesting that the program may have a positive impact on violence reduction over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Operation CeaseFire-New Orleans: an infectious disease model for addressing community recidivism from penetrating trauma. McVey, E., Duchesne, JC., Sarlati, S., et al.[2014]

A quality improvement project at a pediatric emergency department successfully increased the referral rate to the Hospital-based Violence Intervention Program (HVIP) from 32.5% to 61.1% for eligible patients aged 7-18 with violent injuries, representing an 88% increase.

Key interventions included educating healthcare providers about eligibility, encouraging timely referrals by nurses, and improving communication about the program, which collectively enhanced the connection of youth to essential medical and social services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing improvements in emergency department referrals to a hospital-based violence intervention program. Watkins, J., Scoggins, N., Cheaton, BM., et al.[2021]

The Violence Intervention Program (VIP) provided intensive psychosocial support to repeat victims of violence, resulting in significantly lower rates of violent crime arrests and convictions compared to a control group that received standard treatment.

Participants in the control group were three times more likely to be arrested for violent crimes and faced longer projected incarceration times, highlighting the effectiveness of the VIP intervention in reducing repeat violent behavior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hospital-based violence intervention programs work. Cooper, C., Eslinger, DM., Stolley, PD.[2022]

Hospital-based violence intervention programs (HVIPs) aim to reduce future injuries by engaging individuals who have experienced violence, and a study involving 79 practitioners identified key outcomes like posttraumatic stress symptoms and emotional regulation that should be prioritized in assessing program effectiveness.

The findings suggest that measuring psychosocial health and well-being, alongside traditional outcomes like repeat violence, is crucial for a comprehensive understanding of recovery and can enhance the relevance of HVIP effectiveness studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Generating a Core Set of Outcomes for Hospital-Based Violence Intervention Programs. Monopoli, WJ., Myers, RK., Paskewich, BS., et al.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12340368/

Hospital-based Violence Intervention Programs May ... The initial randomized control trial assessing the feasibility and efficacy of CEDVIP demonstrated a 10.4% absolute reduction in repeat violent ...

2. withpower.com withpower.com/trial/phase-6-2021-3fce4

Bridging the Gap Intervention for Violent Injury The purpose of this research study is to find out if a hospital-based violence intervention (Bridging the Gap) is effective for reducing violence.

3. surgjournal.com surgjournal.com/article/S0039-6060(23)00438-5/abstract

The gap between hospital-based violence intervention ... Data extracted included program structure, hospital-based violence intervention program services, and client needs assessments before and after ...

4. researchgate.net researchgate.net/publication/316632405_Bridging_the_Gap_Hospital_Community-Based_Youth_Violence_Prevention_Program-Pitfalls_and_Lessons_Learned

Hospital Community-Based Youth Violence Prevention ... A review of VCUTC data revealed that 62% of patients presenting with violent injuries were <25 years of age, and nearly 96% of assault-related ...

5. tsaco.bmj.com tsaco.bmj.com/content/1/1/e000050

Hospital-based violence intervention: an emerging practice ... The questions remain: (1) how do we stop the cycle of violence through prevention and address this public health issue and (2) how do we measure effectiveness.

6. vcuhealth.org vcuhealth.org/services/injury-and-violence-prevention/ivpp-programs/bridging-the-gap/

Bridging the Gap | Injury & Violence Prevention Program Bridging the Gap provides survivors of violence and their families with intensive case management services in the home and community environments.

7. rgvhealthconnect.org rgvhealthconnect.org/promisepractice/index/view?pid=3782

Bridging the Gap: Youth Violence Reduction Bridging the Gap is a hospital-based intervention that includes a review of the incident, a discussion of conflict resolution strategies and risk factors for ...

8. vcuhealth.org vcuhealth.org/news/vcu-healths-bridging-the-gap-program-awarded-part-of-5-million-grant/

VCU Healths Bridging the Gap program awarded part of 5 ... Research has shown that Bridging the Gap participants reduce reinjury rates by 76%, meaning those who have experienced gun violence in the ...