My training goals outlined in this K23 Career Development Award include to: (1) develop the skills to effectively conduct high-quality, clinically-relevant, mixed-methods analyses of barriers and facilitators of hospital-based violence intervention program (HVIP) enrollment; and (2) complete an individually-tailored training program centered in Community Based Participatory Research (CBPR) and Dissemination and Implementation (D&I) Science. This will support my long-term career goal to become an independent investigator of firearm injury prevention by developing, testing, implementing, and continually refining HVIPs. HVIPs share common outcome goals (decreasing reinjury and death rates among participants), and are, by design, individualized programs that provide counseling and social- and case-based services to achieve additional goals that are unique to each participant. For this reason, I will train in mixed methods study design that supports real-world applicability and adaptability of our findings. I will use this award to study CBPR and D&I science to develop the skills necessary to become a leader in HVIP innovation. My career development plan includes a: (1) robust mentoring plan that provides specific details on mentorship roles and development milestones to capitalize on the complementary areas of expertise among mentorship team members; and (2) didactic training plan through the Master of Science in Clinical Investigation program. My research project is a multi-center, mixed-method analysis of barriers and facilitators of enrollment in Life Outside Violence (LOV), the St. Louis region-wide HVIP. The cycle of violence is an under addressed public health threat that disproportionately affects Black patients, especially in St. Louis, which has a very high rate of violent crime. LOV's mission is to facilitate healing and decrease incidences of retaliation, criminal involvement, reinjury, and death. In early analysis of 158 LOV enrolled patients, three (2%) have suffered a recurrent violent reinjury— well below the national rate (up to 77%). However, only 13% of eligible patients enrolled in the LOV program. To address this enrollment gap, I will investigate the following specific aims, to: (1) Apply multilevel regression models to the STL-HVIP-DR to identify sociodemographic, service delivery, organization, and geographic characteristics associated with LOV program enrollment; (2) Assess barriers and facilitators of enrollment in the LOV program through individual and group interviews with a purposive sample (n~45) of LOV mentors, community members, and patients who enrolled in LOV and those who did not; and (3) Use CBPR methods to design and assess an improved engagement pathway to approach violently injured patients for enrollment in the LOV program. My proposed career development and research plan will address actionable HVIP implementation barriers and facilitators in real-world conditions. We will disseminate our findings to other HVIPs through subsequent R01 applications to scale up the new engagement pathway and identify implementation factors that are consistent across communities to decrease mortality among high-risk patients.

PROJECT NARRIATIVE The cycle of violence is an under addressed public heath treat that disproportionately affects Black children and young adults in the United States (US) through the impact of structural and systemic racism. Life Outside Violence (LOV), the St. Louis region-wide hospital-based violence intervention program, is an individualized program that provides counseling and social- and case-based services to promote healing and prevent re- injury and death in patients who have presented to a LOV partner hospital with a violent injury. This project is a multi-center, mixed-methods study of barriers and facilitators of LOV enrollment informed by the social- ecologic model that uses community-based participatory research methods with an intervention mapping operational structure to design and assess an improved pathway to engage violently injured patients in the program.