Many patients with firearm injuries are treated at hospitals with violence intervention programs, but few ultimately receive these services
Violence intervention programs are reaching at-risk trauma patients, but only about 1 in 5 eligible patients receive these services when available
Key Takeaways
- Violence intervention programs identify patients at risk of repeat violent injury and connect them with hospital and community-based resources to address underlying risk factors for violence.
- A national analysis found that although nearly two-thirds of patients with firearm injuries are treated at trauma centers with violence intervention programs, only about 1 in 5 of eligible patients ultimately receive services.
- Patients with assault-related injuries were the most likely to participate in violence intervention programs. Participation was also higher among Black patients, those with Medicaid coverage, individuals with documented mental illness, and those with more severe injuries.
CHICAGO — Many patients with firearm injuries are treated at hospitals with violence intervention programs, but only about 1 in 5 ultimately receive these services, according to a national analysis published in the Journal of the American College of Surgeons (JACS).
The study is the first national, multicenter analysis of patient characteristics and participation in violence intervention programs among trauma patients with firearm injuries.
Developed largely in the 1990s, violence intervention programs identify patients who have sustained traumatic injuries and are at risk of repeat violence, connecting them with hospital- and community-based resources to address underlying risk factors. Prior research shows these programs can improve patient outcomes, including reducing the risk of re-injury and post-traumatic stress, but their use across trauma systems remains unclear.
To better understand who these programs reach, researchers analyzed data from patients with firearm injuries using the American College of Surgeons (ACS) Committee on Trauma (COT) Firearm Study Research Dataset, which includes data from Level I-III trauma centers.
Study Results
- Of 15,455 patients included in the study, 64% were treated at trauma centers with a violence intervention program. Among those treated at hospitals with violence prevention programs, only 18.5% received services based on an analysis of their discharge records.
- Patients treated at trauma centers with these programs were more likely to be younger (median age 29.8 vs. 30.3), Hispanic, unemployed (47.5% vs. 42.4%), and to have histories of incarceration and prior assault-related injury (41% vs. 28.5%; 33.8% vs. 24.1%). They also experienced longer hospital stays (7.1 vs. 6.2 days) and were more likely to receive post-discharge rehabilitation and psychosocial support.
- Patients with assault-related injuries were the most likely to participate in violence intervention programs. Participation was also higher among Black patients, those with Medicaid coverage, individuals with documented mental illness, and those with more severe injuries.
- The findings suggest that referral and participation may be concentrated among patients with more visible clinical or psychosocial complexity, and that high-risk individuals without these markers may be missed, the authors wrote.
“Violence intervention programs are reaching the patients they are designed to serve, but not at a consistent level,” said lead author Sara Larosiliere, a fourth-year medical student at The Frank H. Netter M.D. School of Medicine at Quinnipiac University in North Haven, Connecticut. “Improving access and integration of these programs could have a meaningful impact on recovery and outcomes after injury.”
Despite the availability of these programs, inconsistent uptake may reflect barriers such as limited capacity or other hospital- and patient-level factors, including patient refusal, the authors said. The dataset, which includes only participating trauma centers, does not capture differences in program structure, delivery, or other factors that may influence participation levels. The authors also noted that participation in violence intervention program services is usually reflected in patient discharge records, which may underestimate engagement initiated or completed after discharge.
Firearm-related injuries are among the leading causes of death for people ages 1-44 in the U.S., and the number one cause of death among children and teens ages 1–19, according to the Centers for Disease Control and Prevention. The Improving Social Determinants to Attenuate Violence (ISAVE) Workgroup of the ACS COT recognized violence intervention programs as one important strategy that can help trauma centers better address the root causes of violence and incorporate social care into trauma care.
“Violence intervention programs play an integral role in connecting patients disproportionately affected by violence with long-term recovery services and preventing re-injury among high-risk individuals,” said Jeffrey D. Kerby, MD, PhD, FACS, Medical Director, ACS Trauma Education, who was not involved with the JACS study. “These programs are rooted in evidence showing that structured medical, social, and educational support can address survivors’ needs across multiple domains. Future studies should examine gaps in use and assess long-term outcomes for participants.”
Study co-authors are Amir Ebadinejad, MD; Vincent Parise, MD; Jonathan Gates, MD, MBA, FACS; and Jane Keating, MD, FACS.
The study is published as an article in press on the JACS website.
Citation: Larosiliere S, Ebadinejad A, Parise V, et al. Access to and Utilization of Violence Intervention Programs: A Retrospective Analysis of the National ACS COT Firearm Study Research Dataset. Journal of the American College of Surgeons, 2026. DOI: 10.1097/XCS.0000000000001826
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About the American College of Surgeons
The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The ACS is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The ACS has more than 95,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the ACS.
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Journal
Journal of the American College of Surgeons
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Access to and Utilization of Violence Intervention Programs: A Retrospective Analysis of the National ACS COT Firearm Study Research Dataset
Article Publication Date
7-Apr-2026
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