Description of original award (Fiscal Year 2022, $500,000)
Intentional, interpersonal violent injuries, including firearm-related, stabbings, and assaults, are a public health crisis in the United States (US). Violent injuries in 2020 accounted for 16,000 deaths and 1 million emergency department (ED) visits, amounting to medical and societal costs in excess of $300 billion. People of color are disproportionately affected by violent injuries, with homicide being the first- and second-leading cause of death in Black and Hispanic individuals, respectively, aged 14–28 years. In Denver, Colorado, rates of interpersonal violence have mirrored national trends, with marked recent increases in firearm-related homicides and assaults.
Denver Health is the City and County of Denver’s only Level I trauma center. At-risk Intervention and Mentoring (AIM), Denver Health’s hospital-based violence intervention program, relies on certified Violence Prevention Professionals (VPPs) to perform bedside interventions to violently injured individuals, followed by individual mentorship and intensive case management. This secondary prevention model aims to address all the social determinants of health, in order to prevent violent injury recidivism and death. AIM’s VPPs also uniquely perform a multitude of trauma- and culturally-informed primary prevention services throughout the community, in order to stop violent injuries before they occur in the first place.
Current gaps exist in the referral process to AIM, as well as the mental health assessments of clients. Based on a recent evaluation, the overall referral rate to the AIM program was only 18%, primarily driven by a low rate of referral for blunt assaults. Reasons are likely multifactorial, and will be addressed by: (1) creating a best practices advisory (BPA) in the electronic health record (EHR), which will automatically trigger an alert to the ED clinician for eligible patients; (2) creating an EHR referral order, which will be linked to the BPA, and; (3) increasing and systematizing educational efforts to ED staff.
The mental health of clients has been a longstanding priority of AIM, but successful implementation of an assessment tool has faced barriers, resulting in a lack of routine administration and impaired sustainability. We will use the Adoption and Maintenance elements of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify facilitators and barriers to implementation, in order to derive effective solutions for sustainability. AIM is applying for both priority considerations: 1(A), promoting racial equity and removal of barriers to access and opportunity, and; 1(B), as a culturally specific organization.