Abstract In the United States, firearm-related violence has reached epidemic proportions and has become a major public health problem. To help prevent the high rates of firearm-related deaths, most violence intervention programs have targeted youth (<18 years old) in the hope to slow the rapid increase of violence seen in early adulthood. However, most victims of firearm-related violence are adults (>18 years old), and national statistics show young adults (18-35 years) in particular are the most likely to die from firearm-related violence. It is important to recognize that this risk is not evenly shared among subpopulations of adults, and it is young African American men who come from economically disadvantaged communities with high rates of exposure to violence that are the most vulnerable to firearm-related violence. Unfortunately, they are difficult to engage in community-based intervention efforts. More recently, however, hospital-based violence intervention programs have become increasingly popular because of their success at engaging individuals who have suffered a violent injury. Violently injured adults are not only victims in the present, but 40% will be violently re-injured and 20% will be killed within 5 years; these patients are also 88 times more likely to commit retaliatory violence (Cunningham et al., 2009). It is clear that these adults are in dire need of effective violence intervention. At Virginia Commonwealth University (VCU) Health, we have developed Bridging the Gap (BTG), a promising violence intervention strategy that includes a hospital-based violence intervention, a firearm counseling program, and 6-months of community case management to victims of violence. BTG was originally developed for violently injured youth and results indicate it is effective for reducing youth violence. However, it is yet to be established if it is effective for reducing firearm- related violence in adults. It is also yet to be established if BTG is a cost effective strategy for reducing firearm- related violence and injury. The present study addresses Objective Two of this funding announcement; to rigorously evaluate the effectiveness of innovative and promising strategies to keep individuals safe from firearm- related injuries, deaths, and crime. This research proposal falls under Funding Option B; which supports research projects that collect new data. The goal of the present study is to assess the efficacy of BTG using a randomized control trial design in a large sample of 616 adult victims of violence over a 1-year follow-up period. Efficacy will be assessed using multiple sources of data for firearm-related violence (e.g., criminal arrest records, self-report, semi-structured clinical assessment of non-convicted firearm-related violence) and firearm-related re-injury and mortality (e.g., hospital records). To improve our understanding of the impact BTG has on firearm-related violence, we will test for psychosocial mediators linking BTG to reductions in firearm-related violence. We also aim to understand what psychosocial vulnerabilities may weaken the impact of BTG on firearm-related violence. Lastly, a cost-benefit analysis will determine the economic benefits of implementing BTG. Collectively, results from this study may support the use of BTG as a firearm-related violence intervention for adult victims of violence.

Project Narrative Hospital-based violence intervention is a unique and effective strategy for targeting difficult to reach and high- risk violently injured patients. This project evaluates Bridging the Gap (BTG), a promising hybrid intervention model that provides a hospital-based violence intervention, a hospital-and community-based firearm counseling program, and 6-months of intensive community case management. It will conduct a rigorous randomized control trial to determine the effectiveness of BTG for reducing firearm-related violence and injury in adult victims of violence, as well as evaluating the economic benefits of BTG to determine its scalability as a firearm-related violence and injury intervention strategy.