PROJECT SUMMARY AND ABSTRACT Arkansas is a rural southern state with a high burden of homicide relative 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, trauma-informed 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 has recently partnered with the City of Little Rock and other community agencies to stand 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 which are disproportionately 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 burden of violent assault on individuals and communities. Our proposal will engage community at every stage such that it will be culturally appropriate, community-informed and community led. We will test the feasibility and acceptability, as well as preliminary efficacy, of our multi-level intervention with an explicit focus on secondary violence prevention through hospital-community partnerships to prevent escalation or revictimization from firearm violence among African Americans 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 reach and sustainability of our proposed intervention.

PROJECT NARRATIVE The proposed study represents a unique collaboration between an academic health system and a myriad of community partners working to address community-based violence. We will test the feasibility and acceptability, as well as preliminary efficacy, of a multi-level intervention with an explicit focus on secondary violence prevention through hospital-community partnerships to prevent escalation or revictimization from firearm violence among African American men 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 reach and sustainability of our proposed intervention.