PROJECT SUMMARY Firearm violence is a leading cause of death in the United States and disproportionately impacts minoritized racial groups, given its high concentration in communities of color that have experienced decades of racism and health inequity. Victims of firearm violence are often stuck in a cycle of violence, as they are twice as likely to die or be hospitalized from a violent event compared to those without a history of violent victimization. Therefore, hospital-based intervention programs (HVIPs) can be crucial to provide holistic services and connections to critical community-based violence interventions that support firearm violence victims and reduce reinjury risk. Developing interventions to impact firearm violence requires a transdisciplinary approach with community–city–hospital interventions. The lack of a current HVIP in the greater Houston area– the fourth largest city in the United States–highlights the need to develop and implement this program as a critical community-based intervention to reduce firearm violence. Therefore, the current study aims to create the Houston-Hospital-Based Violence Intervention program at Memorial Hermann Hospital in the Texas Medical Center in Houston, Texas, as a community-level response to firearm violence. In Aim 1, during the UG3 phase, we will develop a coalition of internal and external stakeholders to advise on the formation and oversee the implementation of the Houston-HVIP. We an during effectiveness will create the culture prime for the reception of the HVIP by developing inter-professional, trauma-informed care educational platform with a health equity lens. In our second aim, the UG3 phase, we will implement and evaluate the Houston-HVIP program to determine the of reducing repeat violent events by a program participant. The Houston-HVIP will feature a clustered randomized controlled trial, with a fully immersive hospital violence intervention program and an enhanced case manager program tailored to the firearm victim's needs. The program is guided by critical stakeholders, including hospital leadership, public health advocates, law enforcement, community and city leaders, and a multidisciplinary team of experts in injury prevention, health science analysis, and mixed methods evaluations. This intervention will be rigorously evaluated to understand program effectiveness and acceptability, the impact of reinjury on those enrolled in each arm of the program, and the role of social determinants of health on firearm injury to the participant and the community. Also, we will examine the program's impact on racial and ethnic disparities in those impacted by firearm violence.

PROJECT NARRATIVE One of the most significant risk factors for violent injury is having a previous violent injury; thus, it is imperative to develop mechanisms to intervene with patients in the hospital setting to reduce the risk of reinjury through violence intervention programs. This study develops and implements the Houston Hospital-Based Violence Intervention Program in the Texas Medical Center. We will evaluate the impact of the violence intervention program on violent reinjury and determine the effect of the program on social determinants of health and reducing racial inequality in firearm violence, thus ultimately improving community safety and promoting more significant community-health equity.