A hospital-based program that supports victims of gun and knife violence can reduce the likelihood that those victims will be reinjured or commit violence themselves, according to a new Boston University study.
The findings offer hope for similar programs nationwide and may encourage cities to target investment in them to reduce gun violence, according to lead researcher Jonathan Jay , a BU School of Public Health associate professor of community health sciences. Jay calls the study of the Boston Medical Center (BMC)–founded Violence Intervention Advocacy Program (VIAP) "my most important work," because of its potential to provide advocates with evidence in support of such efforts: "If we invest more in hospital-based violence intervention programs, will that help cities get their gun violence levels down?"
For survivors of gunshot and knife wounds treated in the emergency department, VIAP provides post-discharge help with mental health and family support services and assistance, if necessary, with connections to housing, food, employment, education, and other needs. The study found consistent engagement with the program could reduce the likelihood of being revictimized, or committing violence, by 50 percent two to three years after discharge. BMC, BU's primary teaching hospital, is among more than 60 hospitals in the country with a hospital-based violence intervention program.
"When people's basic social and emotional needs are met, they are far less likely to be involved in violence," says Jay. "People who get shot or stabbed are vastly more likely to have been excluded from systems—kicked out of school, kicked out of housing, to have some history of criminal legal system involvement so that it's harder for them to get a job."
The study, published in the Annals of Internal Medicine , analyzed the records of 1,300-plus shooting or stabbing survivors, ages 16 to 34, who were at high risk of violence. Almost half of them worked with VIAP sometime in the first month after their discharge, and the researchers found that brief interaction did not appreciably lessen the risk of future violence when compared with patients who never used the program. But the roughly 10 percent of survivors who regularly worked with VIAP in the first two months after discharge saw their likelihood of being involved in violence cut in half.
"There's an old saying that hurt people hurt people, and that really applies to the work we do," says Lavon Anderson, VIAP's housing coordinator. "VIAP helps prevent future violence by helping people heal from trauma, stabilize their lives, and work toward goals that may not have felt possible before. When people feel supported and hopeful, they're much less likely to return to cycles of violence."
Currently, when someone is admitted to the hospital with a violent penetrating injury, they meet with VIAP patient advocates during their stay or soon after. Those advocates build relationships and conduct needs assessments to help target issues—from safety planning to mental health to housing insecurity—that could slow recovery or increase potential involvement in future violence. Many of the advocates have lived experience in the communities the program serves. The mental health support is given in collaboration with BMC's Community Violence Response Team .
While VIAP especially benefits those who frequently avail themselves of the program, Jay says that some patients probably need just a few visits to get back on track post-violence. Other hospital-based violence intervention programs provide stipends to encourage attendance, but Anderson is wary of that approach: "From my experience, we see a higher success rate with participants who engage because they're genuinely ready for change. They're self-motivated, and our program serves as a tool to support the direction they've already chosen."
Data from Jay's broader research into gun violence, adds Anderson, suggests that "when one person chooses not to feed into violence, hundreds of people can be affected—family members, peers, and the broader community. Seeing both the scale of that impact and how engagement influences the likelihood of someone returning to harmful behavior was eye-opening. That insight directly led me to increase my engagement with those who are on the fence, striking a careful balance between not pushing and being clearly present when they're ready."
VIAP differs from other intervention programs, Jay says, in its unusually robust services—it has 13 staffers. Although the study focused on young adults, VIAP is more flexible than many other programs, he says, in its availability to violence victims outside of the highest-risk groups and in letting participants decide how often to avail themselves of its services.
While other programs may limit eligibility—to young adults, for instance—and dictate weekly attendance, according to Jay, "VIAP says, we don't care about that. If you're the victim of violence and you were at the emergency department at BMC, we will help you."
Jay's previous research has examined young people's exposure to gun violence, the connections between urban environments and health/safety risks, and strategies for reducing racial disparities in youth firearm injuries. What makes his VIAP study so pivotal, he says, is its potential to boost support for similar programs, especially since strategies such as gun safety laws are losing ground in many states. The United States saw almost 47,000 gun-related deaths in 2023, the latest year for complete data.
"A lot of other [hospitals] could show these results to hospital administrators and other funders," says Jay.
Anderson has fingers crossed. "I'm hopeful that Professor Jay's findings will support expansion of the program and further strengthen our work. We already share our approach with programs nationwide, and I think his research can really help fine-tune what we do."
The Violence Intervention Advocacy Program study was supported by a Fund for a Safer Future grant and included researchers from Boston University's School of Public Health, Chobanian & Avedisian School of Medicine, and Sargent College of Health & Rehabilitation Sciences; Boston Medical Center; Children's Hospital of Philadelphia; Health Alliance for Violence Intervention; and the University of Michigan, Ann Arbor.
