Abstract Every day in the US approximately 100 people are injured by a firearm through violence1, and three-quarters of all homicides are firearm related1. Although firearm-related violence impacts all communities and populations, youth are high-risk for firearm-related violence, injury, and mortality. In particular, violently injured youth are highly susceptible to retaliatory firearm-related violence, as well as becoming violently re-injured or killed6. Therefore, the hospital has become a critical opportunity to prevent retaliatory violence in youth. At Virginia Commonwealth University (VCU) Health, we have adapted our comprehensive hospital-based violence intervention program, Bridging the Gap (BTG). BTG is a novel hybrid intervention model that capitalizes on the hospital-based intervention approach using a brief violence intervention to prevent retaliatory violence but also provides community-based support to youth and their families by providing 3-months of community case management to help ensure lasting change. BTG in its current form has shown promise for reducing aggression and violence-related risk factors. However, it is yet to be established if it is effective for reducing firearm-related violence, injury, and mortality for youth. To address the surge in firearm-related violence in youth (10-17 years), we have further adapted BTG to include a dual-generation firearm safety counseling program delivered in the home. Using a randomized control trial design, the present study aims to rigorously evaluate the effectiveness of BTG for preventing firearm-related violence, injury, and mortality among violently injured youth (N=220). Firearm-related violence, injury, and mortality outcomes will be assessed over 6 months using multiple sources of data (e.g., semi-structured clinical interviews, self-and caregiver-report assessments, and hospital-, state- and national-level databases). In addition to understanding BTG effectiveness for preventing firearm-related outcomes, we aim to understand what psychosocial mediators explain the reductions in firearm-related violence in response to treatment, and what moderators may reduce treatment effectiveness. These data will prove beneficial for developing and tailoring new and existing youth firearm violence prevention strategies.

Project Narrative Violently injured youth are at high risk for perpetrating retaliatory firearm-related violence and becoming re- injured or killed, which is why there is an urgency to understand what works to prevent firearm-related violence, injury, and mortality. Hospital-based violence interventions are an effective approach to engage high-risk youth in prevention. This project uses a rigorous randomized control trial to evaluate a promising hospital-based youth violence intervention that incorporates 3-months of community case management and an in-home firearm counseling program to prevent youth from engaging in retaliatory firearm-related violence and becoming injured or killed.