Gun Shot Wound
Conditions
Keywords
Violence prevention, Community-based interventions, Health economics of violence, Clinical trial on violence prevention, Firearm injury prevention, Retaliation and reinjury
Brief summary
This clinical trial is designed to evaluate the effectiveness of three interventions aimed at preventing violence and supporting those affected by it. Over next three years, the impact of these interventions on key areas will be measured, including the incidence of firearm injuries, the recovery of victims, the occurrence of retaliation and re-injury, and health economics. The interventions are developed based on data collected from a comprehensive needs assessment, community summit, retrospective medical chart reviews, and focus group sessions. The defined interventions are as follows: Intervention A - Integration of an existing community-based intervention program with Hospital services intervention B - Unrestricted Cash Assistance Intervention C - Mobile Community Support Services Additionally, the investigators will implement a detailed violence-focused survey for firearm survivors at the time of study enrollment. Follow-up is planned at 3,6 and 12 months. The results of this trial (including analyses of firearm injury rates, recovery outcomes, retaliation/re-injury occurrences, and economic data) will be shared with the affected communities and stakeholders to promote ongoing improvement and support.
Detailed description
To achieve the goals of this trial, the investigators will activate community-focused interventions developed during the first phase of the study to help enroll participants in the study using a stepped wedge cluster design based on their dwelling addresses. The investigators will formalize the 9 clusters using geographic and demographic data specific to Jackson, Mississippi. Patients presenting in the ER with gunshot injuries will be randomized based on their dwelling address, which will be matched to their corresponding cluster's randomization assignments for the interventions of VIP (Operation Good), Cash Assistance, and Mobile Community Support Services. Any patient with a gunshot injury, regardless of their dwelling address, will be eligible for consent to participate in the longitudinal follow-up of the study. Those not in a currently active clusters at the time of injury will serve as controls for the survey results. Study investigators plan to enroll up to 15 active patients per cluster per year for this follow-up, and community events will be aligned with the same cluster random assignments used for patient interventions.
Interventions
BEHAVIORALHospital-Linked Violence Intervention Program
Activation of Operation Good, our community partner with a history of direct violence interruption in the streets and longitudinal health and wellness services to firearm injured patient (i.e. linking and aiding those who have suffered from violent injury to mental healthcare, job services, educational services)
BEHAVIORALMobile Community Event Support
A menu of services provided to the community in an activated cluster where funding will be provided to assist that community in holding events that support overall health and wellness (community clean-up, legal advisory services, pop-up clinic for blood pressure checks).
BEHAVIORALUnrestricted Cash Assistance
A participant in an activated cluster after firearm injury will receive two disbursements of 500$. One at the time of initial hospital evaluation and a second disbursement \ 1 month later to offset the financial burden associated with firearm injury on the individual.
Sponsors
National Institutes of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
University of Mississippi Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Jackson, MS will be divided into 9 clusters (with defined geographic boundaries and know population totals) and those clusters will undergo randomization for activation. 3 clusters will be activated each year for three years and those living in the activated clusters will receive the interventions upon activation. Results from participants living in active clusters will be compared to those not in active clusters until at the end of the three years study period all clusters will be activated.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 years or older * Firearm injury within the last 24 hours prior to their arrival at the University of Mississippi Medical Center * Residency/home address within one of the designated clusters. * Be approached by the research team within 72 hours of arrival. * Ability to understand the clinical trial, sign the consent form, and commit to follow-ups. * Ability and willingness to engage in all aspects of the intervention arm (must agree to Operation Good, Survey Participation, and Unrestricted Cash Assistance, these interventions/evaluations cannot be separated)
Exclusion criteria
* Self-inflicted gunshot wounds * Less than 18 years of age * Patients who are incarcerated or in-custody * Patients who are unable to understand the clinical trial or sign consent (whether from intoxication, injury, or other cause) * Patients unable to commit to follow-up or be contacted through routine means
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of death and gunshot injuries | Three years starting upon implementation of the intervention protocol | The data will be collected from hospital and JPD records. Excluding self-inflicted such as suicide or adjudicated to be accidental/unintentional. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of PTSD, Score of perceived stress and social cohesion | Three years starting upon implementation of the intervention protocol | Individual level longitudinal measure and includes incidence of PTSD, score of perceived stress and social cohesion collected by individual level surveys. |
Countries
United States
Contacts
Primary ContactLei Zhang, PHD
Backup ContactMasoumeh Karimi, PHD
Outcome results
None listed