The HVIP+ Community Model

Arkansas is a rural southern state with a high toll of homicide relative to its total population (AR ranks 8th nationally in firearm homicide rates). This study will engage community partners throughout Central Arkansas in a multi-level, multi-faceted intervention to reduce the toll of violent assault on individuals and communities. An optimization randomized control trial (ORCT) design will be used to test the preliminary efficacy of a multi-level intervention with an explicit focus on secondary violence prevention through hospital-community partnerships to prevent escalation of firearm violence among survivors living in counties in Central Arkansas, the region of the state where violent assault is greatest. The study will also incorporate key implementation science metrics to evaluate the feasibility and reach of the proposed intervention.

• Brief Bedside (Behavioral): * Initial support (in-hospital or shortly after if discharged early) * Needs assessment * Resource Sheet of Vetted Partners
• Peer Support (Behavioral): * Weekly Check-ins * Status Check (Personal/family; Health; Mental Health; Spiritual, etc.) * Encouragement/Motivation (Staying safe, Doing right, etc.) * In-Person Visits (Home, Rehab, etc.) * Peer Social/Skill-building Activities (Money management, Job interviewing, Computer literacy, Creative arts, Critical thinking film discussions, etc.)
• Case Management + Voucher (Behavioral): * Service Plan \& Referrals * Service Check-in/Follow up with partners and participants * Navigation of Health Care and Social Service Follow up appointments * Transportation Assistance * Basic life skills for service provision (riding bus/public transportation, zoom, etc.) * Vouchers for Immediate Needs/Obstacles
• SELF Group Therapy Sessions (Behavioral): * Virtual Bi-weekly Group Therapy * SELF Curriculum- Trauma Focused Cognitive Behavioral Therapy * Lead by Therapists and Community Peer Volunteers * One-on-one Introductory/Intake Orientations

Primary outcomes

• Change in Risky Firearm Behaviors [Baseline, 3-month, 6-month, 9-month, and 12 months]: Composite measure uses items adapted from the Tulane University National Youth Study capturing frequency and severity of risky firearm-related behaviors (i.e. carriage, threats, etc.) (0=Never; 6=20+ Times)

Secondary outcomes

• Change in PTSD [Baseline, 3-month, 6-month, 9-month, and 12 months]: The Posttraumatic Stress Disorder Checklist (PCL-5) is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD (0=Not at all; 4=Extremely)
• Change in Anxiety [Baseline, 3-month, 6-month, 9-month, and 12 months]: OASIS is a brief measure of overall anxiety severity and impairment. (0=No/None; 4=Constant/Extreme)
• Change in Depression [Baseline, 3-month, 6-month, 9-month, and 12 months]: The PHQ-9 is a validated, self-reported tool used for screening, diagnosing, and measuring the severity of depression. (0= Not at all; 3=Nearly every day)
• Change in Feasibility and Acceptability of Intervention [3-month, 6-month, 9-month, and 12 months]: Composite measure uses items adapted from the Feasibility of Intervention Measure (FIM) and Acceptability of Intervention Measure (AIM), four-item measures of implementation outcomes. (1= Completely disagree; 5= Completely Agree)

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Be at least 18 years of age or older
* Currently live in Central Arkansas
* Currently being treated for a penetrating gun assault injury at a local hospital

Exclusion Criteria:

Participants must not:

* Report any medical problems that would limit their ability to express thoughts and answer questions (i.e. active intoxication, developmental delays, dementia, psychosis, etc.)
* Be currently under arrest or in police custody

• Nakita Lovelady, PhD, MPH, Principal investigator, University of Arkansas

NIH grants: 4UH3MD019172-02