The HVIP+ Community Model: A Community Violence Prevention Program in a Southern State - Arkansas is a rural southern state with a high toll of homicide relative to its total population (AR ranks 6th nationally in firearm homicide rates). Furthermore, most counties in Arkansas are considered rural and have severely limited healthcare services appropriate for survivors of violent assault (e.g. physical therapy, supportive medical care, behavioral health services, etc.). The University of Arkansas for Medical Sciences (UAMS), the lead institution for the proposed research, is the only Level 1 trauma center in the state and provides healthcare to Arkansans in nearly every county, largely through regional satellite clinics and telemedicine services. Importantly, UAMS recently partnered with the City of Little Rock and other community agencies to start up the first and only hospital based violence intervention program (HVIP) in the state of Arkansas. While the focus of this HVIP is on residents of Little Rock, our proposed study will extend the reach of the UAMS program to include counties within the Central Arkansas region, many of which have sizable rural populations impacted by community violence. Importantly, our proposed research extends the reach of our City of Little Rock based efforts and incorporates multiple enhancements such that it is a more comprehensive approach to addressing community violence. In this application, we propose to engage community partners throughout Central Arkansas in a multi-level, multi-faceted intervention to reduce the toll of violent assault on individuals and communities. Our proposal will engage community at every stage such that it will be contextually appropriate, community-informed and community led. We will use an optimization randomized control trial (ORCT) design to test the preliminary efficacy of our multi-level intervention with an explicit focus on secondary violence prevention through hospital-community partnerships to prevent escalation of firearm violence among survivors living in counties in Central Arkansas, the region of the state where violent assault is greatest. We will also incorporate key implementation science metrics to evaluate the feasibility and reach of our proposed intervention.
