One link in the Chain: Project HEAL as a hospital-based violence intervention program within a fragmented ecology of care Authorship

One link in the Chain: Project HEAL as a hospital-based violence intervention program within a fragmented ecology of care Authorship | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article One link in the Chain: Project HEAL as a hospital-based violence intervention program within a fragmented ecology of care Authorship Cortney VanHook, Octavia Goodman, Shamecia Pullem, Naomi Nguyen, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7761799/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Hospital-based violence intervention programs (HVIPs) aim to disrupt cycles of violence by providing trauma-informed, client-centered care to survivors of violent injury. Project HEAL, a HVIP established in 2021 at Jersey Shore University Medical Center, offers case management, mental health support, and connections to legal, housing, and employment resources for individuals impacted by violence in Monmouth and Ocean Counties, New Jersey. Methods: This qualitative study explored the lived experiences of Project HEAL clients (N = 9). Semi-structured interviews were conducted, and transcripts were analyzed using thematic analysis by a team of three coders. The coding process was iterative, with oversight from senior researchers to ensure analytic rigor. Results: Participants described Project HEAL as effective in reducing barriers to care and providing personalized, compassionate case management. The program was valued for its role in supporting mental health and fostering empowerment. However, clients also identified persistent unmet needs, particularly in areas such as youth opportunities, housing, employment, and social services—needs that extend beyond the program’s reach. The findings highlight Project HEAL’s essential but partial role within a fragmented ecosystem shaped by structural inequities. Conclusion: Project HEAL demonstrates the strengths and limitations of HVIPs in addressing the complex needs of survivors of community violence. While the program effectively reduces immediate barriers and fosters supportive relationships, broader systemic challenges persist. These results underscore the need for a sustained coordinated community response and policy advocacy to address structural barriers that HVIPs alone cannot overcome. Hospital-based violence intervention programs trauma-informed care case management structural barriers community violence Introduction Hospital-based violence intervention programs (HVIPs) are multidisciplinary programs that integrate trauma-informed clinical care with community-based services to disrupt cycles of violence. These programs engage violently injured patients during hospitalization to reduce the risk of re-injury and/or retaliation and, when implemented effectively, can also be cost-effective by preventing future hospitalizations and justice system involvement [1-2]. HVIPs are structured around three core components: (1) an initial intervention at hospital bedside or in the emergency department by trained Violence Intervention Specialists (VIS); (2) continued care in the months following the injury consisting of intensive, community-based management services; and (3) sustained follow-up through connections to community resources, mentoring, home visits, long-term support services, and continued case management [3]. HVIPs have demonstrated success in reducing repeat victimization, hospital debt associated with repeat violent injuries among victims, and imprisonment rates [4-5]. Strengths of HVIPs include its community-centered approach, emphasis on racial equity, and reliance on partnerships between healthcare systems and trusted community advocates. Despite their promise, HVIPs face notable limitations, particularly in addressing the broader social determinants of health that are critical to long term community safety and individual well-being. While HVIPs are effective in meeting immediate needs such as mental health care, legal support, and victim compensation, they often fall short in addressing systemic barriers related to employment, education, housing, and attaining a driver’s license [6]. These unmet needs are essential to fostering long term recovery, reducing recidivism, and promoting sustainable healing for individuals and communities impacted by violence [7]. These limitations underscore the importance of situating participants lived experiences within a unified ecological framework, allowing practitioners, researchers, and policymakers to better identify how family, community, and policy systems influence an individual’s sense of safety. Project HEAL (Help, Empower, and Lead), founded in 2021 by Hackensack Meridian Health at Jersey Shore University Medical Center, is a HVIP serving Monmouth and Ocean Counties, New Jersey. Designed to support survivors of community violence, Project HEAL [8] delivers trauma-informed care through a team of case managers, counselors, and medical professionals. Services include bedside intervention, healthcare navigation, counseling, and case management with connections to victim compensation, job training, housing, and behavioral health services. Project HEAL embodies the HVIP model while also striving to address social inequities and restore hope, healing, and resilience among those most affected by violence. This study is important because understanding the lived experiences of Project HEAL clients offers critical insight into how hospital-based violence intervention programs can address both immediate and long-term needs of survivors, as well as where gaps remain within the broader support ecosystem. By exploring client perspectives, we hope to identify effective practices, persistent barriers, and opportunities for system-level improvement that can inform the future development and scaling of HVIPs and related community interventions. Methodology A thematic analysis was conducted to explore participant experiences and perceptions. Three coders (CV, OG, SP) independently reviewed the interview transcripts, employing an iterative process to ensure analytic rigor. The coding process occurred in two rounds: the initial round focused on identifying preliminary codes and patterns, while the second round allowed for refinement and consolidation of codes into broader categories. Following this, the team applied a thematic analysis approach as described by Braun and Clarke [9], which involves familiarization with the data, generating initial codes, searching for themes, reviewing and defining themes, and producing the final narrative. One senior author (SR) reviewed the codebook and coding process for accuracy and coherence, and both senior authors (SR, AS) approved the final set of themes produced. Thematic analysis is a widely used qualitative method for identifying, analyzing, and reporting patterns (themes) within data. It provides a flexible approach to examining perspectives across a dataset, allowing for both inductive and deductive theme development [9]. Through this method, themes are constructed to capture important elements related to the research questions and to reflect the meaning and significance of participant experiences [9]. A total of nine participants were included in the qualitative interviews. This sample size is appropriate for in-depth thematic analysis, as it allows for the identification of recurring patterns and meaningful variation within a qualitative dataset. Prior research and methodological guidance indicate that a sample of this size can be sufficient to reach theme saturation, where no new themes are likely to emerge from additional interviews [10]. The sample (Table 1) reflected a diverse range of ages, with participants spanning from 18 to 64 years old. Specifically, one participant was in the 18–24 years old, three were 25–34 years old, one was 45–54 years old, and four were 55–64 years old. In terms of race and ethnicity, four participants identified as Black or African American, three as Hispanic or Latino, and one as White or Caucasian. The majority of participants identified as women (seven), with two identifying as men; none identified as transgender or nonbinary. Most participants were active clients of Project HEAL at the time of interview, while three indicated they were previous clients. Time engaged with Project HEAL varied, ranging from less than 1 month to nearly 2 years, with most reporting between 6–23 months of involvement. Table 1: Participant Demographics Participant Age Group Race/Ethnicity Gender Identity Client Status Participation Duration 1 45-54 years Black or African American Man Current client 6-11 months 2 25-34 years Hispanic or Latino Woman Previous client 1 year to 1 year 11 months 3 55-64 years Hispanic or Latino Woman Current client 1 year to 1 year 11 months 4 25-34 years Black or African American Woman Current client 1 year to 1 year 11 months 5 18-24 years Black or African American Man Current client 6-11 months 6 25-34 years White or Caucasian Woman Current client 6-11 months 7 55-64 years Black or African American Woman Previous client Less than 1 month 8 55-64 years Black or African American Woman Current client 6-11 months 9 55-64 years Black or African American Woman Previous client 1-5 months Interviews with Project HEAL clients were conducted using three methods: online over the video call platform Zoom, over the phone, and in-person at the participating Project HEAL location. A project coordinator (NN) interviewed each participant, with secondary help from authors (SR and KP). A research assistant transcribed each interview for a total of nine transcripts. Recruitment ran for approximately a month from late March to early April using over the phone recruitment with information provided from Project HEAL staff. The first interview was conducted on April 1st of 2025. The last interview was conducted on May 3rd of 2025. Results Thematic analysis of participant interviews revealed a nuanced picture of Project HEAL’s strengths, limitations, and role within the broader community context. Six major themes emerged, reflecting both the successes and constraints of a hospital-based violence intervention program operating within a complex social ecology. Participants highlighted Project HEAL’s effectiveness in removing barriers to access and engagement, the value of personalized and compassionate case management, and the program’s ability to offer vital mental health and emotional support. At the same time, interviews illuminated significant unmet community needs, particularly in areas beyond the program’s immediate scope, such as youth opportunities and systemic obstacles related to housing, employment, and social services. Together, these findings illustrate both the meaningful impact of Project HEAL and the persistent challenges faced by individuals and families navigating cycles of violence and recovery further highlighting the need for a long term funded and sustained coordinated community response [7] that brings together all sectors of human services to ensure HVIP clients have the appropriate resources to prevent further victimization and negative psychological outcomes. Theme 1: Project HEAL’s Success in Removing Barriers to Access and Engagement Participants consistently described Project HEAL, a hospital-based violence intervention program, as a resourceful and supportive initiative that actively dismantled barriers to care, such as transportation, eligibility confusion, and lack of information. Through flexible scheduling, clear communication, and direct connections to staff, clients were able to access services regardless of their county of residence or other challenges. One participant identified insurance as a potential barrier that was eliminated by Project HEAL: “You didn't need necessarily Medicaid to be involved with Project HEAL, which was great because some people don't have Medicaid.” (P1) Describing the program’s more comfortable environment, a participant noted: “And what is really different about it [Project HEAL] is, it doesn't seem like you're in a doctor's office, like, professional setting, which I like because it makes it feel more personal” (P6) Highlighting the program’s scheduling flexibility and telehealth access, one participant noted: “Towards the end [of my time at Project HEAL], it was great because I was able to talk to my therapist through Zoom because my job had asked me to work some extra hours, so I was able to incorporate that in with Project HEAL. And they were very flexible and worked around me. So, it was great for me.” (P9) Describing the program’s more comfortable environment, a participant noted, “Because when you got a situation like Project HEAL and [Program 2], not saying that they're bad, but, you never know how a person feels that day. Project HEAL's not gonna have a hundred people in the building as opposed to those [other programs]. You know, you got a hundred people in the building, ten of them feeling bad, causing trouble. It's just a lot going on in those situations.” (P1) Participants’ narratives highlight Project HEAL’s ongoing commitment to ‘meeting clients where they are’ both literally and figuratively. The program’s proactive approach to dismantling logistical and bureaucratic obstacles such as transportation support, nonrestrictive eligibility, and direct staff engagement stands in stark contrast with traditional service models that often have rigid requirements and impersonal systems. This responsiveness not only facilitated engagement but also fostered a sense of agency and belonging among clients. Importantly, the emphasis on dignity, such as receiving quality goods and individualized attention, reflects trauma informed principles, which have been shown in the literature to improve both uptake and outcomes in social services [11]. Additionally, participants’ comparisons with other programs illuminate a perceived reduction in stress, stigma, and unpredictability often associated with accessing community-based resources. Collectively, these findings suggest that Project HEAL’s model could serve as a template for reducing structural barriers in similarly marginalized or underserved populations. Theme 2: Personalized and Compassionate Case Management Participants described case management and social work services as confidential, individualized, and genuinely caring. Social workers took time to understand clients’ unique backgrounds and goals, fostering comfort and respect. One client described their social worker’s approach as encouraging and collaborative: "She [my social worker] always explain it to me, and they told me, 'You can do this. Just come to the office. We’re doing it together, and I tell you what you need to do.'" (P3) Illustrating advocacy beyond paperwork, a client recalled “I had somebody [from Project HEAL] come to social services with me and sit with me the whole time I was there.” (P6) Highlighting ongoing follow-up support management after program completion, one participant shared: “I stay in contact with [Case Manager 2]. He helps me on trying to get an apartment. Checks in just to make sure my life is good and I'm on a positive note.” (P5) The approach to case management described transcends the conventional service broker model and aligns with best practices in client centered and strengths-based care. Rather than simply directing clients through bureaucratic procedures, social workers were experienced as advocates, educators, and trusted allies. This fostered a strong therapeutic alliance, which is widely recognized in literature as a key determinant of positive outcomes in both social work and mental health interventions [12–14]. The sense of partnership and mutual respect reported by participants points to a shift in the power dynamic, empowering clients to become active agents in their own progress. By demystifying complex processes, such as applying for benefits or navigating the legal system, case managers helped reduce anxiety and build clients’ confidence and skills for future self-advocacy. These findings highlight the broader systemic importance of relational continuity and personalized care, particularly for individuals with histories of trauma or service system disenfranchisement. Theme 3: Unmet Community Needs While programs like Project HEAL provided vital ecological supports, participants identified persistent gaps in community-based services such as lack of information, strict eligibility criteria, and long wait times for resources. Here a participant identifies gaps in communication on available resources in the community: "You can’t go forward if you ain’t got the information.” (P7) One participant described the dire situation of community residents with mental illness: “Then, you do have people that are in the streets. People are using hard drugs and they have mental health problems. There's no places for them to go anymore. They closed down all the institutions that was in the area.” (P1) Addressing children’s needs, one caregiver lamented, “They don't have nothing good for those kids. Nothing. Nothing. Nothing. Nothing at all. They got a park right there. It's a small park...Now, I see they got the lock. And then I say, 'Where am I supposed to take the girls [my granddaughters]?'" (P3) While participants expressed gratitude for available supports, their testimonies simultaneously expose enduring gaps that perpetuate cycles of disadvantage. The interplay of information scarcity, restrictive eligibility, and insufficient program capacity creates a landscape in which only the most resourceful or well-connected individuals can reliably access help. This reflects broader social determinants of health, wherein systemic inequities, such as underfunded services, fragmented communication, and lack of safe community spaces, compound the challenges faced by vulnerable populations. The concern for children and individuals with behavioral health challenges underscores the multigenerational impact of these deficits. These accounts echo findings in community health research that stress the necessity of coordinated outreach [7], flexible eligibility criteria [15], and hospital system investment in community infrastructure [16]. Without addressing these upstream factors, even the most innovative programs risk being palliative rather than transformative. Theme 4: Supporting the Next Generation—Opportunities and Challenges for Youth Participants emphasized the importance of creating opportunities for youth, particularly around employment, education, and self-esteem building. They expressed hope that programs like Project HEAL could make a meaningful difference for the next generation. One participant expressed concern about the prospects of Gen Z: “The younger generation out there. They need jobs. (P7) Another reflected on the need for safe spaces, stating: “I think more community action, meaning a place for them to come do their homework that's safe. Things for them to do. You know what I mean? It's all free. You don't pay a damn dime. We take these kids to different places. I think that that will help them break outta a lot of things, especially gang activity and, you know, just having idle time, doing stupid stuff.” (P1) Participants’ reflections on youth needs reveal both a sense of urgency and a nuanced understanding of the risks facing young people in marginalized communities. Most of the participants interviewed were parents, grandparents, or caregivers for minors. The concern they expressed for youth in the community was intense which indicates that victims of gun violence have heightened distress for the safety of youth in the community. The absence of safe, structured environments and meaningful opportunities is linked to negative outcomes such as youth violence [17], substance use [18], and academic struggles [19]. Participants’ advocacy for free, accessible programming aligns with evidence that youth development is strongly shaped by the availability of protective factors including mentorship, community engagement, and constructive activities [20]. The hope that Project HEAL could expand or inspire such supports points to the potential for cross generational impact, where interventions with adults also benefit their families and neighborhoods. These findings suggest that sustainable change requires investment not only in direct service provision, but also in creating ecosystems that nurture youth agency, aspiration, and resilience. Theme 5: Mental Health Empowerment and Emotional Support through Project HEAL As a hospital-based violence intervention program, Project HEAL provided a confidential, supportive space for participants to address mental health challenges. The program emphasized the importance of self-care and offered emotional encouragement. As one participant recalled about their therapist: “She [therapist] reminded me that it's okay to put myself first. So, I guess being reminded that it's okay to be a little selfish. Because in order to get better you have to focus on yourself." (P2) This participant described meaningful therapeutic support that eased isolation and fostered comfort: “I'd come here [to Project HEAL] and the therapist, she helps me. She helped me a lot. Before I even thought about therapy I was miserable, you know, trying to figure out problems by myself. And it seemed like the more I tried, the worser I felt.” (P8) The emphasis on self-care, empowerment, and validation reflects an alignment with recovery oriented and trauma informed care frameworks, which prioritize client autonomy and holistic wellbeing [21]. Participants’ willingness to articulate and address their struggles suggests a shift from internalized stigma to self-advocacy which is essential for long term recovery [22]. Programs that are both trauma-informed and empowering can provide an environment for victims of violence to prosper. Theme 6: Navigating Essential Needs—Work, Housing, and Social Services Barriers and Support Participants described the interconnected challenges of finding work, securing housing, and accessing social services. Project HEAL provided crucial guidance and referrals, but systemic barriers persisted. One participant described their sense of urgency: “I know that the housing is only available for one year. So, my thing was, as soon as I got it, I was hitting the road like, look- 'I need to put myself in position before this year is up because that goes by very, very fast,' a year. So, at the end of the year, you know, I'm right back at square one.” (P1) Another highlighted the breadth of support received: “I got [Social Worker 2] as the social worker. She’s doing a lot of legal paperwork because I'm trying to get my granddaughters [legal custody]. Sometimes, she take me shopping. Sometimes, she take me to the welfare office, or sometimes I go to Social Security office." (P3) The intersection of employment, housing, and social services depicted by participants exemplifies the web of disadvantage that can trap individuals in cycles of instability. While Project HEAL’s wraparound supports provided essential relief, the persistence of systemic barriers, such as time limited housing assistance and bureaucratic complexity, highlight the limitations of programmatic solutions in the absence of structural reform. Participants’ experiences of urgency and precarity are echoed in research on housing insecurity and benefit churn, which demonstrate that without sustained investment and policy coordination, clients often face recurring crises [23]. The individualized support offered by Project HEAL mitigated some of these risks, yet the broader implication is that meaningful change requires an integrated, multi sector approach that addresses root causes rather than just symptoms. This theme calls for advocacy not only at the client level but also in policy and systems design. Discussion The findings from this study of Project HEAL resonate strongly with extant research on hospital-based violence intervention programs (HVIPs), while also surfacing key areas where the lived experiences of clients reveal both the promise and persistent limitations of the model. Prior studies have consistently demonstrated that HVIPs, rooted in trauma informed care and community engagement, can effectively reduce rates of violent reinjury, improve psychosocial outcomes, and bridge gaps between acute care and longer-term recovery [4,24]. The client narratives in this study reaffirm these strengths, especially in Project HEAL’s success at lowering barriers to access, providing personalized case management, and fostering mental health empowerment. These themes echo prior research documenting the importance of intervening in the hospital setting during times of heightened receptivity after injury [25], the centrality of trusted relationships with Violence Intervention Specialists or case managers [26,2], and the value of flexible, client centered approaches in engaging populations who may distrust traditional medical or social services [27]. Project HEAL’s approaches to transportation, eligibility, and direct outreach align with best practices for reducing logistical and bureaucratic hurdles [6], reinforcing the literature on how trauma informed, dignity preserving systems enhance both engagement and outcomes. This study also reveals the boundaries of program impact in the face of entrenched structural inequities. Consistent with previous work [6,28], participants described persistent gaps in community resources, restrictive eligibility requirements, fragmented services, and a lack of safe infrastructure for youth. These are factors that HVIPs alone cannot resolve. This study amplifies these concerns by highlighting how systemic barriers, such as time limited housing support and inadequate employment opportunities, create ongoing instability despite the presence of strong individual level interventions. The recurring theme of ‘one link in the chain’ mirrors critiques in the field that HVIPs, while effective at addressing immediate post injury needs, are often constrained by broader policy and funding structures that fall short of addressing social determinants of health [6,29-30]. This study underscores the need for a more comprehensive approach that integrates community development, policy advocacy, and multi sector collaboration to create more equitable and sustainable environments for recovery and growth. A notable contribution of this study is the clients' emphasis on intergenerational impact and the desire for expanded youth programming. While HVIP literature has increasingly recognized the importance of family and community context [29,31], participant narratives here pointed to a heightened sense of responsibility for and anxiety about the safety, wellbeing, and opportunities for young people. HVIPs should determine the efficacy of deeper engagement with ecological systems, advocating not only for wraparound services but also for upstream investments in youth enrichment, safe spaces, and community infrastructure. This study is also subject to several methodological limitations. As participants were recruited from a single HVIP in a specific geographic area, findings may not be transferable to programs operating in different sociopolitical or resource contexts. The voluntary nature of participation introduces the possibility of selection bias, as those with more positive (or negative) experiences may have been more likely to participate. Social desirability bias may have influenced participant responses during interviews, potentially leading to overreporting of positive outcomes or underreporting of persistent barriers. While the coding process involved multiple coders and iterative review, no formal assessment of intercoder reliability was conducted. Additionally, the cross-sectional design limits our ability to assess changes in client experiences over time or the long-term impact of the program. Future studies should consider larger, more diverse samples and longitudinal approaches to better understand both immediate and sustained effects of HVIPs like Project HEAL. Conclusion In summary, Project HEAL’s client experience supports the growing evidence base on the value and limitations of HVIPs. The program’s trauma-informed, relationship centered approach aligns with best practices and demonstrates meaningful impact at the individual level. Yet, the persistent structural barriers and ecological gaps described by participants reinforce the necessity of moving from programmatic innovation toward system level change, ensuring that the promise of HVIPs can be fully realized across the communities they serve. Declarations Ethics approval statement: This study received IRB approval from the Montclair State University Institutional Review Board on March 4, 2025. (#IRB-FY23-24-3838) Data availability statement: The data that support the findings of this study are available on request from the corresponding author, [CV]. The data are not publicly available due to their containing information that could compromise the privacy of research participants. Human subjects: Informed consent was obtained from participants, ensuring their participation was voluntary, they understood the study's risks and benefits, and their rights were respected. The consent form outlined the study's purpose, procedures, foreseeable risks, benefits, alternatives, and confidentiality measures. Author contributions: CV: formal analysis; writing – original draft, writing – review & editing, visualization; OG: writing – original draft; SP: writing - original draft, visualization, formal analysis; NN: data curation, investigation; KP: data curation, investigation; AS: investigation, writing – original draft, resources, conceptualization; SR: writing – original draft, writing – review & editing, conceptualization, methodology, data curation, resources, investigation, software, supervision, project administration, funding acquisition Funding statement: This research was supported partially by the Bureau of Justice Assistance under award number O-BJA-2022-171282 Financial and non-financial interests: The authors have no relevant financial or non-financial interests to disclose. Consent to Publish declaration: not applicable Consent to Participate declaration: not applicable References Brouillette K, Gebru J, Malhotra AK, McKechnie T, Shakil H, Tropiano J, et al. 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Hospital-based violence intervention programs to address social determinants of health and violence. Curr Trauma Rep. 2020;6(4):278-83. Ranjan S, Strange CC, Pugliese K. Medicaid reimbursement for community violence intervention and prevention (CVI): a multi-state policy implementation case study. Health Justice. 2025;13(1):5. Mueller KL, Moran V, Anwuri V, Hohl SD, Rivara FP, Rowhani-Rahbar A, et al. An exploration of factors impacting implementation of a multisystem hospital-based violence intervention program. Health Soc Care Community. 2022;30(6):e6522-e6532. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7761799","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":545564751,"identity":"8e3f49f4-b059-411f-8c5f-63d6bb1771d2","order_by":0,"name":"Cortney VanHook","email":"","orcid":"","institution":"University of Illinois","correspondingAuthor":false,"prefix":"","firstName":"Cortney","middleName":"","lastName":"VanHook","suffix":""},{"id":545564752,"identity":"fc8ba210-6f7f-423b-b6af-f5c5235e4355","order_by":1,"name":"Octavia Goodman","email":"","orcid":"","institution":"Old Dominion University","correspondingAuthor":false,"prefix":"","firstName":"Octavia","middleName":"","lastName":"Goodman","suffix":""},{"id":545564753,"identity":"2d036bd7-ca7e-44e5-b71f-d6a0ab647555","order_by":2,"name":"Shamecia Pullem","email":"","orcid":"","institution":"Montclair State University","correspondingAuthor":false,"prefix":"","firstName":"Shamecia","middleName":"","lastName":"Pullem","suffix":""},{"id":545564754,"identity":"6c7551b8-054f-452e-a061-460d05cf8ea9","order_by":3,"name":"Naomi Nguyen","email":"","orcid":"","institution":"Montclair State University","correspondingAuthor":false,"prefix":"","firstName":"Naomi","middleName":"","lastName":"Nguyen","suffix":""},{"id":545564755,"identity":"d8ad20a7-9aec-48f6-80c4-d04998d9ab1e","order_by":4,"name":"Katheryne Pugliese","email":"","orcid":"","institution":"John Jay College of Criminal Justice/CUNY Graduate Center","correspondingAuthor":false,"prefix":"","firstName":"Katheryne","middleName":"","lastName":"Pugliese","suffix":""},{"id":545564756,"identity":"311695ce-6738-436f-bbf1-845dd42c0ffb","order_by":5,"name":"Aakash Shah","email":"","orcid":"","institution":"Jersey Shore University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Aakash","middleName":"","lastName":"Shah","suffix":""},{"id":545564757,"identity":"85b8b5a4-de31-4998-8796-e7fc4fc67384","order_by":6,"name":"Sheetal Ranjan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYJACAyCWgzALGHhAlAQxWoyBmLEByCROCwgkNkC1MBDUYt5+9kDBzx116Wvbe48/+GFgJ2PewHzwNg8eLTJn8hIMe88czt125lxiY49BMo/MAbZka3xaJBhyDAx42w7kbruRY9jMYMDMI8HAYyaNVwv/GwPDv2116WYQLfVALfzf8GuRyDEw5m1jToBqOQyyhY2AljcGxrJthw23nTljOLPH4DiPBDObseUcvA7LMTN821Ynb3a8x+DDj4pqewn25oc33uDRAgRsBqh8ZvzKwUoeEFYzCkbBKBgFIxoAAFh/Q2/AK7Y4AAAAAElFTkSuQmCC","orcid":"","institution":"Montclair State University","correspondingAuthor":true,"prefix":"","firstName":"Sheetal","middleName":"","lastName":"Ranjan","suffix":""}],"badges":[],"createdAt":"2025-10-01 18:23:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7761799/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7761799/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96270392,"identity":"f78b1738-1010-4201-830e-7e4f0b186686","added_by":"auto","created_at":"2025-11-19 09:17:09","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":43670,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript100125revised.docx","url":"https://assets-eu.researchsquare.com/files/rs-7761799/v1/96068a0265309e42385d9310.docx"},{"id":96270393,"identity":"4f184fd3-b31a-4b8e-b457-4305717bde59","added_by":"auto","created_at":"2025-11-19 09:17:09","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9370,"visible":true,"origin":"","legend":"","description":"","filename":"01d7c8a1c856406193e80ebccb1b6569.json","url":"https://assets-eu.researchsquare.com/files/rs-7761799/v1/3d030cd7fcc930d83d39a445.json"},{"id":107518195,"identity":"fc433ac3-44c5-4fff-b1d2-f733a4c8f46f","added_by":"auto","created_at":"2026-04-22 08:43:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":430194,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7761799/v1/451f2bd1-f10f-4e0b-88c6-de8a01adf868.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"One link in the Chain: Project HEAL as a hospital-based violence intervention program within a fragmented ecology of care Authorship","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHospital-based violence intervention programs (HVIPs) are multidisciplinary programs that integrate trauma-informed clinical care with community-based services to disrupt cycles of violence. These programs engage violently injured patients during hospitalization to reduce the risk of re-injury and/or retaliation and, when implemented effectively, can also be cost-effective by preventing future hospitalizations and justice system involvement [1-2]. HVIPs are structured around three core components: (1) an initial intervention at hospital bedside or in the emergency department by trained Violence Intervention Specialists (VIS); (2) continued care in the months following the injury consisting of intensive, community-based management services; and (3) sustained follow-up through connections to community resources, mentoring, home visits, long-term support services, and continued case management [3]. HVIPs have demonstrated success in reducing repeat victimization, hospital debt associated with repeat violent injuries among victims, and imprisonment rates [4-5]. Strengths of HVIPs include its community-centered approach, emphasis on racial equity, and reliance on partnerships between healthcare systems and trusted community advocates.\u003c/p\u003e\n\u003cp\u003eDespite their promise, HVIPs face notable limitations, particularly in addressing the broader social determinants of health that are critical to long term community safety and individual well-being. While HVIPs are effective in meeting immediate needs such as mental health care, legal support, and victim compensation, they often fall short in addressing systemic barriers related to employment, education, housing, and attaining a driver\u0026rsquo;s license [6]. These unmet needs are essential to fostering long term recovery, reducing recidivism, and promoting sustainable healing for individuals and communities impacted by violence [7]. These limitations underscore the importance of situating participants lived experiences within a unified ecological framework, allowing practitioners, researchers, and policymakers to better identify how family, community, and policy systems influence an individual\u0026rsquo;s sense of safety.\u003c/p\u003e\n\u003cp\u003eProject HEAL (Help, Empower, and Lead), founded in 2021 by Hackensack Meridian Health at Jersey Shore University Medical Center, is a HVIP serving Monmouth and Ocean Counties, New Jersey. Designed to support survivors of community violence, Project HEAL [8] delivers trauma-informed care through a team of case managers, counselors, and medical professionals. Services include bedside intervention, healthcare navigation, counseling, and case management with connections to victim compensation, job training, housing, and behavioral health services. Project HEAL embodies the HVIP model while also striving to address social inequities and restore hope, healing, and resilience among those most affected by violence.\u003c/p\u003e\n\u003cp\u003eThis study is important because understanding the lived experiences of Project HEAL clients offers critical insight into how hospital-based violence intervention programs can address both immediate and long-term needs of survivors, as well as where gaps remain within the broader support ecosystem. By exploring client perspectives, we hope to identify effective practices, persistent barriers, and opportunities for system-level improvement that can inform the future development and scaling of HVIPs and related community interventions.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eA thematic analysis was conducted to explore participant experiences and perceptions. Three coders (CV, OG, SP) independently reviewed the interview transcripts, employing an iterative process to ensure analytic rigor. The coding process occurred in two rounds: the initial round focused on identifying preliminary codes and patterns, while the second round allowed for refinement and consolidation of codes into broader categories. Following this, the team applied a thematic analysis approach as described by Braun and Clarke [9], which involves familiarization with the data, generating initial codes, searching for themes, reviewing and defining themes, and producing the final narrative. One senior author (SR) reviewed the codebook and coding process for accuracy and coherence, and both senior authors (SR, AS) approved the final set of themes produced.\u003c/p\u003e\n\u003cp\u003eThematic analysis is a widely used qualitative method for identifying, analyzing, and reporting patterns (themes) within data. It provides a flexible approach to examining perspectives across a dataset, allowing for both inductive and deductive theme development [9]. Through this method, themes are constructed to capture important elements related to the research questions and to reflect the meaning and significance of participant experiences [9]. A total of nine participants were included in the qualitative interviews. This sample size is appropriate for in-depth thematic analysis, as it allows for the identification of recurring patterns and meaningful variation within a qualitative dataset. Prior research and methodological guidance indicate that a sample of this size can be sufficient to reach theme saturation, where no new themes are likely to emerge from additional interviews [10].\u003c/p\u003e\n\u003cp\u003eThe sample (Table 1) reflected a diverse range of ages, with participants spanning from 18 to 64 years old. Specifically, one participant was in the 18\u0026ndash;24 years old, three were 25\u0026ndash;34 years old, one was 45\u0026ndash;54 years old, and four were 55\u0026ndash;64 years old. In terms of race and ethnicity, four participants identified as Black or African American, three as Hispanic or Latino, and one as White or Caucasian. The majority of participants identified as women (seven), with two identifying as men; none identified as transgender or nonbinary. Most participants were active clients of Project HEAL at the time of interview, while three indicated they were previous clients. Time engaged with Project HEAL varied, ranging from less than 1 month to nearly 2 years, with most reporting between 6\u0026ndash;23 months of involvement.\u003c/p\u003e\n\u003cp\u003eTable 1: Participant Demographics\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRace/Ethnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGender Identity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eClient Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eParticipation Duration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45-54 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBlack or African American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCurrent client\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6-11 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25-34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHispanic or Latino\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePrevious client\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 year to 1 year 11 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55-64 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHispanic or Latino\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCurrent client\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 year to 1 year 11 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25-34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBlack or African American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCurrent client\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 year to 1 year 11 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18-24 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBlack or African American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCurrent client\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6-11 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25-34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWhite or Caucasian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCurrent client\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6-11 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55-64 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBlack or African American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePrevious client\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLess than 1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55-64 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBlack or African American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCurrent client\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6-11 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55-64 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBlack or African American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePrevious client\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1-5 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eInterviews with Project HEAL clients were conducted using three methods: online over the video call platform Zoom, over the phone, and in-person at the participating Project HEAL location. A project coordinator (NN) interviewed each participant, with secondary help from authors (SR and KP). A research assistant transcribed each interview for a total of nine transcripts. Recruitment ran for approximately a month from late March to early April using over the phone recruitment with information provided from Project HEAL staff. The first interview was conducted on April 1st of 2025. The last interview was conducted on May 3rd of 2025.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThematic analysis of participant interviews revealed a nuanced picture of Project HEAL\u0026rsquo;s strengths, limitations, and role within the broader community context. Six major themes emerged, reflecting both the successes and constraints of a hospital-based violence intervention program operating within a complex social ecology. Participants highlighted Project HEAL\u0026rsquo;s effectiveness in removing barriers to access and engagement, the value of personalized and compassionate case management, and the program\u0026rsquo;s ability to offer vital mental health and emotional support. At the same time, interviews illuminated significant unmet community needs, particularly in areas beyond the program\u0026rsquo;s immediate scope, such as youth opportunities and systemic obstacles related to housing, employment, and social services. Together, these findings illustrate both the meaningful impact of Project HEAL and the persistent challenges faced by individuals and families navigating cycles of violence and recovery further highlighting the need for a long term funded and sustained coordinated community response [7] that brings together all sectors of human services to ensure HVIP clients have the appropriate resources to prevent further victimization and negative psychological outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1: Project HEAL\u0026rsquo;s Success in Removing Barriers to Access and Engagement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants consistently described Project HEAL, a hospital-based violence intervention program, as a resourceful and supportive initiative that actively dismantled barriers to care, such as transportation, eligibility confusion, and lack of information. Through flexible scheduling, clear communication, and direct connections to staff, clients were able to access services regardless of their county of residence or other challenges.\u003c/p\u003e\n\u003cp\u003eOne participant identified insurance as a potential barrier that was eliminated by Project HEAL: \u0026ldquo;You didn\u0026apos;t need necessarily Medicaid to be involved with Project HEAL, which was great because some people don\u0026apos;t have Medicaid.\u0026rdquo; (P1)\u003c/p\u003e\n\u003cp\u003eDescribing the program\u0026rsquo;s more comfortable environment, a participant noted: \u0026ldquo;And what is really different about it [Project HEAL] is, it doesn\u0026apos;t seem like you\u0026apos;re in a doctor\u0026apos;s office, like, professional setting, which I like because it makes it feel more personal\u0026rdquo; (P6)\u003c/p\u003e\n\u003cp\u003eHighlighting the program\u0026rsquo;s scheduling flexibility and telehealth access, one participant noted: \u0026ldquo;Towards the end [of my time at Project HEAL], it was great because I was able to talk to my therapist through Zoom because my job had asked me to work some extra hours, so I was able to incorporate that in with Project HEAL. And they were very flexible and worked around me. So, it was great for me.\u0026rdquo; (P9)\u003c/p\u003e\n\u003cp\u003eDescribing the program\u0026rsquo;s more comfortable environment, a participant noted, \u0026ldquo;Because when you got a situation like Project HEAL and [Program 2], not saying that they\u0026apos;re bad, but, you never know how a person feels that day. Project HEAL\u0026apos;s not gonna have a hundred people in the building as opposed to those [other programs]. You know, you got a hundred people in the building, ten of them feeling bad, causing trouble. It\u0026apos;s just a lot going on in those situations.\u0026rdquo; (P1)\u003c/p\u003e\n\u003cp\u003eParticipants\u0026rsquo; narratives highlight Project HEAL\u0026rsquo;s ongoing commitment to \u0026lsquo;meeting clients where they are\u0026rsquo; both literally and figuratively. The program\u0026rsquo;s proactive approach to dismantling logistical and bureaucratic obstacles such as transportation support, nonrestrictive eligibility, and direct staff engagement stands in stark contrast with traditional service models that often have rigid requirements and impersonal systems. This responsiveness not only facilitated engagement but also fostered a sense of agency and belonging among clients. Importantly, the emphasis on dignity, such as receiving quality goods and individualized attention, reflects trauma informed principles, which have been shown in the literature to improve both uptake and outcomes in social services [11]. Additionally, participants\u0026rsquo; comparisons with other programs illuminate a perceived reduction in stress, stigma, and unpredictability often associated with accessing community-based resources. Collectively, these findings suggest that Project HEAL\u0026rsquo;s model could serve as a template for reducing structural barriers in similarly marginalized or underserved populations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2: Personalized and Compassionate Case Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants described case management and social work services as confidential, individualized, and genuinely caring. Social workers took time to understand clients\u0026rsquo; unique backgrounds and goals, fostering comfort and respect.\u003c/p\u003e\n\u003cp\u003eOne client described their social worker\u0026rsquo;s approach as encouraging and collaborative: \u0026quot;She [my social worker] always explain it to me, and they told me, \u0026apos;You can do this. Just come to the office. We\u0026rsquo;re doing it together, and I tell you what you need to do.\u0026apos;\u0026quot; (P3)\u003c/p\u003e\n\u003cp\u003eIllustrating advocacy beyond paperwork, a client recalled \u0026ldquo;I had somebody [from Project HEAL] come to social services with me and sit with me the whole time I was there.\u0026rdquo; (P6)\u003c/p\u003e\n\u003cp\u003eHighlighting ongoing follow-up support management after program completion, one participant shared: \u0026ldquo;I stay in contact with [Case Manager 2]. He helps me on trying to get an apartment. Checks in just to make sure my life is good and I\u0026apos;m on a positive note.\u0026rdquo; (P5)\u003c/p\u003e\n\u003cp\u003eThe approach to case management described transcends the conventional service broker model and aligns with best practices in client centered and strengths-based care. Rather than simply directing clients through bureaucratic procedures, social workers were experienced as advocates, educators, and trusted allies. This fostered a strong therapeutic alliance, which is widely recognized in literature as a key determinant of positive outcomes in both social work and mental health interventions [12\u0026ndash;14]. The sense of partnership and mutual respect reported by participants points to a shift in the power dynamic, empowering clients to become active agents in their own progress. By demystifying complex processes, such as applying for benefits or navigating the legal system, case managers helped reduce anxiety and build clients\u0026rsquo; confidence and skills for future self-advocacy. These findings highlight the broader systemic importance of relational continuity and personalized care, particularly for individuals with histories of trauma or service system disenfranchisement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3: Unmet Community Needs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile programs like Project HEAL provided vital ecological supports, participants identified persistent gaps in community-based services such as lack of information, strict eligibility criteria, and long wait times for resources.\u003c/p\u003e\n\u003cp\u003eHere a participant identifies gaps in communication on available resources in the community: \u0026quot;You can\u0026rsquo;t go forward if you ain\u0026rsquo;t got the information.\u0026rdquo; (P7)\u003c/p\u003e\n\u003cp\u003eOne participant described the dire situation of community residents with mental illness: \u0026ldquo;Then, you do have people that are in the streets. People are using hard drugs and they have mental health problems. There\u0026apos;s no places for them to go anymore. They closed down all the institutions that was in the area.\u0026rdquo; (P1)\u003c/p\u003e\n\u003cp\u003eAddressing children\u0026rsquo;s needs, one caregiver lamented, \u0026ldquo;They don\u0026apos;t have nothing good for those kids. Nothing. Nothing. Nothing. Nothing at all. They got a park right there. It\u0026apos;s a small park...Now, I see they got the lock. And then I say, \u0026apos;Where am I supposed to take the girls [my granddaughters]?\u0026apos;\u0026quot; (P3)\u003c/p\u003e\n\u003cp\u003eWhile participants expressed gratitude for available supports, their testimonies simultaneously expose enduring gaps that perpetuate cycles of disadvantage. The interplay of information scarcity, restrictive eligibility, and insufficient program capacity creates a landscape in which only the most resourceful or well-connected individuals can reliably access help. This reflects broader social determinants of health, wherein systemic inequities, such as underfunded services, fragmented communication, and lack of safe community spaces, compound the challenges faced by vulnerable populations. The concern for children and individuals with behavioral health challenges underscores the multigenerational impact of these deficits. These accounts echo findings in community health research that stress the necessity of coordinated outreach [7], flexible eligibility criteria [15], and hospital system investment in community infrastructure [16]. Without addressing these upstream factors, even the most innovative programs risk being palliative rather than transformative.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 4: Supporting the Next Generation\u0026mdash;Opportunities and Challenges for Youth\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants emphasized the importance of creating opportunities for youth, particularly around employment, education, and self-esteem building. They expressed hope that programs like Project HEAL could make a meaningful difference for the next generation.\u003c/p\u003e\n\u003cp\u003eOne participant expressed concern about the prospects of Gen Z: \u0026ldquo;The younger generation out there. They need jobs. (P7)\u003c/p\u003e\n\u003cp\u003eAnother reflected on the need for safe spaces, stating: \u0026ldquo;I think more community action, meaning a place for them to come do their homework that\u0026apos;s safe. Things for them to do. You know what I mean? It\u0026apos;s all free. You don\u0026apos;t pay a damn dime. We take these kids to different places. I think that that will help them break outta a lot of things, especially gang activity and, you know, just having idle time, doing stupid stuff.\u0026rdquo; (P1)\u003c/p\u003e\n\u003cp\u003eParticipants\u0026rsquo; reflections on youth needs reveal both a sense of urgency and a nuanced understanding of the risks facing young people in marginalized communities. Most of the participants interviewed were parents, grandparents, or caregivers for minors. The concern they expressed for youth in the community was intense which indicates that victims of gun violence have heightened distress for the safety of youth in the community. The absence of safe, structured environments and meaningful opportunities is linked to negative outcomes such as youth violence [17], substance use [18], and academic struggles [19]. Participants\u0026rsquo; advocacy for free, accessible programming aligns with evidence that youth development is strongly shaped by the availability of protective factors including mentorship, community engagement, and constructive activities [20]. The hope that Project HEAL could expand or inspire such supports points to the potential for cross generational impact, where interventions with adults also benefit their families and neighborhoods. These findings suggest that sustainable change requires investment not only in direct service provision, but also in creating ecosystems that nurture youth agency, aspiration, and resilience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 5: Mental Health Empowerment and Emotional Support through Project HEAL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs a hospital-based violence intervention program, Project HEAL provided a confidential, supportive space for participants to address mental health challenges. The program emphasized the importance of self-care and offered emotional encouragement.\u003c/p\u003e\n\u003cp\u003eAs one participant recalled about their therapist: \u0026ldquo;She [therapist] reminded me that it\u0026apos;s okay to put myself first. So, I guess being reminded that it\u0026apos;s okay to be a little selfish. Because in order to get better you have to focus on yourself.\u0026quot; (P2)\u003c/p\u003e\n\u003cp\u003eThis participant described meaningful therapeutic support that eased isolation and fostered comfort: \u0026ldquo;I\u0026apos;d come here [to Project HEAL] and the therapist, she helps me. She helped me a lot. Before I even thought about therapy I was miserable, you know, trying to figure out problems by myself. And it seemed like the more I tried, the worser I felt.\u0026rdquo; (P8)\u003c/p\u003e\n\u003cp\u003eThe emphasis on self-care, empowerment, and validation reflects an alignment with recovery oriented and trauma informed care frameworks, which prioritize client autonomy and holistic wellbeing [21]. Participants\u0026rsquo; willingness to articulate and address their struggles suggests a shift from internalized stigma to self-advocacy which is essential for long term recovery [22]. Programs that are both trauma-informed and empowering can provide an environment for victims of violence to prosper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 6: Navigating Essential Needs\u0026mdash;Work, Housing, and Social Services Barriers and Support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants described the interconnected challenges of finding work, securing housing, and accessing social services. Project HEAL provided crucial guidance and referrals, but systemic barriers persisted.\u003c/p\u003e\n\u003cp\u003eOne participant described their sense of urgency: \u0026ldquo;I know that the housing is only available for one year. So, my thing was, as soon as I got it, I was hitting the road like, look- \u0026apos;I need to put myself in position before this year is up because that goes by very, very fast,\u0026apos; a year. So, at the end of the year, you know, I\u0026apos;m right back at square one.\u0026rdquo; (P1)\u003c/p\u003e\n\u003cp\u003eAnother highlighted the breadth of support received: \u0026ldquo;I got [Social Worker 2] as the social worker. She\u0026rsquo;s doing a lot of legal paperwork because I\u0026apos;m trying to get my granddaughters [legal custody]. Sometimes, she take me shopping. Sometimes, she take me to the welfare office, or sometimes I go to Social Security office.\u0026quot; (P3)\u003c/p\u003e\n\u003cp\u003eThe intersection of employment, housing, and social services depicted by participants exemplifies the web of disadvantage that can trap individuals in cycles of instability. While Project HEAL\u0026rsquo;s wraparound supports provided essential relief, the persistence of systemic barriers, such as time limited housing assistance and bureaucratic complexity, highlight the limitations of programmatic solutions in the absence of structural reform. Participants\u0026rsquo; experiences of urgency and precarity are echoed in research on housing insecurity and benefit churn, which demonstrate that without sustained investment and policy coordination, clients often face recurring crises [23]. The individualized support offered by Project HEAL mitigated some of these risks, yet the broader implication is that meaningful change requires an integrated, multi sector approach that addresses root causes rather than just symptoms. This theme calls for advocacy not only at the client level but also in policy and systems design.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings from this study of Project HEAL resonate strongly with extant research on hospital-based violence intervention programs (HVIPs), while also surfacing key areas where the lived experiences of clients reveal both the promise and persistent limitations of the model. Prior studies have consistently demonstrated that HVIPs, rooted in trauma informed care and community engagement, can effectively reduce rates of violent reinjury, improve psychosocial outcomes, and bridge gaps between acute care and longer-term recovery [4,24]. The client narratives in this study reaffirm these strengths, especially in Project HEAL\u0026rsquo;s success at lowering barriers to access, providing personalized case management, and fostering mental health empowerment. These themes echo prior research documenting the importance of intervening in the hospital setting during times of heightened receptivity after injury [25], the centrality of trusted relationships with Violence Intervention Specialists or case managers [26,2], and the value of flexible, client centered approaches in engaging populations who may distrust traditional medical or social services [27]. Project HEAL\u0026rsquo;s approaches to transportation, eligibility, and direct outreach align with best practices for reducing logistical and bureaucratic hurdles [6], reinforcing the literature on how trauma informed, dignity preserving systems enhance both engagement and outcomes.\u003c/p\u003e\n\u003cp\u003eThis study also reveals the boundaries of program impact in the face of entrenched structural inequities. Consistent with previous work [6,28], participants described persistent gaps in community resources, restrictive eligibility requirements, fragmented services, and a lack of safe infrastructure for youth. These are factors that HVIPs alone cannot resolve. This study amplifies these concerns by highlighting how systemic barriers, such as time limited housing support and inadequate employment opportunities, create ongoing instability despite the presence of strong individual level interventions. The recurring theme of \u0026lsquo;one link in the chain\u0026rsquo; mirrors critiques in the field that HVIPs, while effective at addressing immediate post injury needs, are often constrained by broader policy and funding structures that fall short of addressing social determinants of health [6,29-30]. This study underscores the need for a more comprehensive approach that integrates community development, policy advocacy, and multi sector collaboration to create more equitable and sustainable environments for recovery and growth.\u003c/p\u003e\n\u003cp\u003eA notable contribution of this study is the clients\u0026apos; emphasis on intergenerational impact and the desire for expanded youth programming. While HVIP literature has increasingly recognized the importance of family and community context [29,31], participant narratives here pointed to a heightened sense of responsibility for and anxiety about the safety, wellbeing, and opportunities for young people. HVIPs should determine the efficacy of deeper engagement with ecological systems, advocating not only for wraparound services but also for upstream investments in youth enrichment, safe spaces, and community infrastructure.\u003c/p\u003e\n\u003cp\u003eThis study is also subject to several methodological limitations. As participants were recruited from a single HVIP in a specific geographic area, findings may not be transferable to programs operating in different sociopolitical or resource contexts. The voluntary nature of participation introduces the possibility of selection bias, as those with more positive (or negative) experiences may have been more likely to participate. Social desirability bias may have influenced participant responses during interviews, potentially leading to overreporting of positive outcomes or underreporting of persistent barriers. While the coding process involved multiple coders and iterative review, no formal assessment of intercoder reliability was conducted. Additionally, the cross-sectional design limits our ability to assess changes in client experiences over time or the long-term impact of the program. Future studies should consider larger, more diverse samples and longitudinal approaches to better understand both immediate and sustained effects of HVIPs like Project HEAL.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, Project HEAL\u0026rsquo;s client experience supports the growing evidence base on the value and limitations of HVIPs. The program\u0026rsquo;s trauma-informed, relationship centered approach aligns with best practices and demonstrates meaningful impact at the individual level. Yet, the persistent structural barriers and ecological gaps described by participants reinforce the necessity of moving from programmatic innovation toward system level change, ensuring that the promise of HVIPs can be fully realized across the communities they serve.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval statement:\u003c/strong\u003e This study received IRB approval from the Montclair State University Institutional Review Board on March 4, 2025. (#IRB-FY23-24-3838)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u003c/strong\u003e The data that support the findings of this study are available on request from the corresponding author, [CV]. The data are not publicly available due to their containing information that could compromise the privacy of research participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman subjects:\u003c/strong\u003e Informed consent was obtained from participants, ensuring their participation was voluntary, they understood the study\u0026apos;s risks and benefits, and their rights were respected. The consent form outlined the study\u0026apos;s purpose, procedures, foreseeable risks, benefits, alternatives, and confidentiality measures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e CV: formal analysis; writing \u0026ndash; original draft, writing \u0026ndash; review \u0026amp; editing, visualization; OG: writing \u0026ndash; original draft; SP: writing - original draft, visualization, formal analysis; NN: data curation, investigation; KP: data curation, investigation; AS: investigation, writing \u0026ndash; original draft, resources, conceptualization; SR: writing \u0026ndash; original draft, writing \u0026ndash; review \u0026amp; editing, conceptualization, methodology, data curation, resources, investigation, software, supervision, project administration, funding acquisition\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement:\u003c/strong\u003e This research was supported partially by the Bureau of Justice Assistance under award number O-BJA-2022-171282\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial and non-financial interests:\u003c/strong\u003e The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration:\u003c/strong\u003e not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration:\u0026nbsp;\u003c/strong\u003enot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBrouillette K, Gebru J, Malhotra AK, McKechnie T, Shakil H, Tropiano J, et al. From Tragedy To Opportunity: Hospital-based Violence Intervention Programs May Address Root-Cause Health Disparities for Violent Traumatic Injury Patients. J Prim Care Community Health. 2025;16:21501319251356386.\u003c/li\u003e\n\u003cli\u003eRanjan S, Strange CC, Wojcik MLT, Shah A, Solhkhah R, Alcera E. Setting up violence intervention specialists for success: Bridging the gap between concept and practice in hospital-based violence intervention programs. Am J Surg. 2023;226(1):140-2.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Toole K, Schnippel K, Larson S. The evolving role of hospital-based violence intervention programs. Health Aff (Millwood). 2025;44(2):123-31.\u003c/li\u003e\n\u003cli\u003eEvans AR, Vega A. Critical Care: The Important Role of Hospital-Based Violence Intervention Programs. New York, NY: Research and Evaluation Center, John Jay College of Criminal Justice, City University of New York; 2018.\u003c/li\u003e\n\u003cli\u003eLee P, Espat NN, Zagales R, Chin B, Bundschu I, O\u0026apos;Connor B, et al. Evaluating the structural, financial, and legal aspects of hospital-based violence intervention programs implementation on psychosocial outcomes and violence reduction: A systematic review. Injury. 2025;56(3):112181.\u003c/li\u003e\n\u003cli\u003eJang A, Thomas A, Slocum J, Tesorero K, Danna G, Saklecha A, et al. The gap between hospital-based violence intervention services and client needs: A systematic review. Surgery. 2023;174(4):1008-20.\u003c/li\u003e\n\u003cli\u003eRanjan S, Dmello JR. Proposing a Unified Framework for Coordinated Community Response. Violence Against Women. 2022;28(8):1873-89.\u003c/li\u003e\n\u003cli\u003eHackensack Meridian Health. Project HEAL [Internet]. [cited 2025 Oct 1]. Available from: https://www.hackensackmeridianhealth.org\u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101.\u003c/li\u003e\n\u003cli\u003eFugard AJB, Potts HWW. Supporting thinking on sample sizes for thematic analyses: A quantitative tool. Int J Soc Res Methodol. 2015;18(6):669-84.\u003c/li\u003e\n\u003cli\u003eGoldstein E, Chokshi B, Melendez-Torres GJ, Rios A, Jelley M, Lewis-O\u0026apos;Connor A. Effectiveness of Trauma-Informed Care Implementation in Health Care Settings: Systematic Review of Reviews and Realist Synthesis. Perm J. 2024;28(1):135-50.\u003c/li\u003e\n\u003cli\u003eHowgego IM, Yellowlees P, Owen C, Meldrum L, Dark F. The therapeutic alliance: the key to effective patient outcome? A descriptive review of the evidence in community mental health case management. Aust N Z J Psychiatry. 2003;37(2):169-83.\u003c/li\u003e\n\u003cli\u003ede Leeuw M, Van Meijel B, Grypdonck M, Kroon H. The quality of the working alliance between chronic psychiatric patients and their case managers: process and outcomes. J Psychiatr Ment Health Nurs. 2012;19(1):1-7.\u003c/li\u003e\n\u003cli\u003eArdito RB, Rabellino D. Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Front Psychol. 2011;2:270.\u003c/li\u003e\n\u003cli\u003eMcCurley JL, Fung V, Levy DE, McGovern S, Vogeli C, Clark CR, et al. Assessment of the massachusetts flexible services program to address food and housing insecurity in a medicaid accountable care organization. JAMA Health Forum. 2023;4(6):e231191.\u003c/li\u003e\n\u003cli\u003eHacke R, Deane KG. Improving community health by strengthening community investment: Roles for hospitals and health systems. Robert Wood Johnson Foundation; 2017. Available from: https://www.rwjf.org/en/insights/our-research/2017/03/improving-community-health-by-strengthening-community-investment.html\u003c/li\u003e\n\u003cli\u003eUllman R, Lereya ST, Glendinnin F, Deighton J, Labno A, Liverpool S, et al. Constructs associated with youth crime and violence amongst 6-18 year olds: A systematic review of systematic reviews. Aggress Violent Behav. 2024;75:101906.\u003c/li\u003e\n\u003cli\u003eTrucco EM. A review of psychosocial factors linked to adolescent substance use. Pharmacol Biochem Behav. 2020;196:172969.\u003c/li\u003e\n\u003cli\u003eKanaan DZ. Social disorganization, community engagement, and public high school performance. Educ Urban Soc. 2023;55(6):718-43.\u003c/li\u003e\n\u003cli\u003eShek DT, Dou D, Zhu X, Chai W. Positive youth development: current perspectives. Adolesc Health Med Ther. 2019;10:131-41.\u003c/li\u003e\n\u003cli\u003eMelillo A, Sansone N, Allan J, Gill N, Herrman H, Cano GM, et al. Recovery-oriented and trauma-informed care for people with mental disorders to promote human rights and quality of mental health care: a scoping review. BMC Psychiatry. 2025;25(1):125.\u003c/li\u003e\n\u003cli\u003eCorrigan PW, Druss BG, Perlick DA. The impact of mental illness stigma on seeking and participating in mental health care. Psychol Sci Public Interest. 2014;15(2):37-70.\u003c/li\u003e\n\u003cli\u003eDe La Rue L, Ortega L, Rodriguez GC. System-based victim advocates identify resources and barriers to supporting crime victims. Int Rev Victimol. 2023;29(1):16-26.\u003c/li\u003e\n\u003cli\u003eChong VE, Smith R, Garcia A, Lee WS, Ashley L, Marks A, et al. Hospital-centered violence intervention programs: A cost-effectiveness analysis. Am J Surg. 2015;209(3):597-603.\u003c/li\u003e\n\u003cli\u003eThomas YM, Regan SC, Quintana E, Wisnieski E, Salzman SL, Chow KL, et al. Violence Prevention Programs Are Effective When Initiated During the Initial Workup of Patients in an Urban Level I Trauma Center. Am J Mens Health. 2022;16(5):15579883221125007.\u003c/li\u003e\n\u003cli\u003eDecker HC, Hubner G, Nwabuo A, Johnson L, Texada M, Marquez R, et al. \u0026quot;You don\u0026apos;t want anyone who hasn\u0026apos;t been through anything telling you what to do, because how do they know?\u0026quot;: Qualitative analysis of case managers in a hospital-based violence intervention program. PLoS One. 2020;15(6):e0234608.\u003c/li\u003e\n\u003cli\u003eHorowitz D, Guyer M, Sanders K. Psychosocial approaches to violence and aggression: contextually anchored and trauma-informed interventions. CNS Spectr. 2015 Jun;20(3):190-9. doi: 10.1017/S1092852915000280. Epub 2015 May 11. PMID: 25959809.\u003c/li\u003e\n\u003cli\u003eVoith LA, Lee H, Salas Atwell M, King J, McKinney S, Russell KN, Withrow A. A phenomenological study identifying facilitators and barriers to Black and Latinx youth\u0026apos;s engagement in hospital-based violence intervention programs. Health Soc Care Community. 2022 Nov;30(6):e4873-e4884. doi: 10.1111/hsc.13900. Epub 2022 Jul 8. PMID: 35801394; PMCID: PMC10084157.\u003c/li\u003e\n\u003cli\u003eBonne S, Dicker RA. Hospital-based violence intervention programs to address social determinants of health and violence. Curr Trauma Rep. 2020;6(4):278-83.\u003c/li\u003e\n\u003cli\u003eRanjan S, Strange CC, Pugliese K. Medicaid reimbursement for community violence intervention and prevention (CVI): a multi-state policy implementation case study. Health Justice. 2025;13(1):5.\u003c/li\u003e\n\u003cli\u003eMueller KL, Moran V, Anwuri V, Hohl SD, Rivara FP, Rowhani-Rahbar A, et al. An exploration of factors impacting implementation of a multisystem hospital-based violence intervention program. Health Soc Care Community. 2022;30(6):e6522-e6532.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hospital-based violence intervention programs, trauma-informed care, case management, structural barriers, community violence","lastPublishedDoi":"10.21203/rs.3.rs-7761799/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7761799/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Hospital-based violence intervention programs (HVIPs) aim to disrupt cycles of violence by providing trauma-informed, client-centered care to survivors of violent injury. Project HEAL, a HVIP established in 2021 at Jersey Shore University Medical Center, offers case management, mental health support, and connections to legal, housing, and employment resources for individuals impacted by violence in Monmouth and Ocean Counties, New Jersey.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This qualitative study explored the lived experiences of Project HEAL clients (N = 9). Semi-structured interviews were conducted, and transcripts were analyzed using thematic analysis by a team of three coders. The coding process was iterative, with oversight from senior researchers to ensure analytic rigor.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eParticipants described Project HEAL as effective in reducing barriers to care and providing personalized, compassionate case management. The program was valued for its role in supporting mental health and fostering empowerment. However, clients also identified persistent unmet needs, particularly in areas such as youth opportunities, housing, employment, and social services—needs that extend beyond the program’s reach. The findings highlight Project HEAL’s essential but partial role within a fragmented ecosystem shaped by structural inequities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Project HEAL demonstrates the strengths and limitations of HVIPs in addressing the complex needs of survivors of community violence. While the program effectively reduces immediate barriers and fosters supportive relationships, broader systemic challenges persist. These results underscore the need for a sustained coordinated community response and policy advocacy to address structural barriers that HVIPs alone cannot overcome.\u003c/p\u003e","manuscriptTitle":"One link in the Chain: Project HEAL as a hospital-based violence intervention program within a fragmented ecology of care Authorship","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 09:17:04","doi":"10.21203/rs.3.rs-7761799/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bde52df4-6d7c-4eb6-94df-f44833010a21","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T08:42:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-19 09:17:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7761799","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7761799","identity":"rs-7761799","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}