At 16 years old, Jonathan Baldwin was shot seven times while relaxing at a reunion with his family. In an instant, he almost became another fatal victim amid an alarming increase in deaths due to firearms, now the leading cause of death in children in America. Though he survived the physical injuries thanks to Children’s Wisconsin, he faced a long road to recovery — emotionally, socially, and mentally.
“Kids who are victims of violence score worse in psychological function than our kids who have cancer,” said Michael Levas, MD, associate professor pediatric emergency medicine Children’s Wisconsin. “From that standpoint, it’s worse to be shot.”
Without intervention, kids like Jonathan face a startling high risk of re-injury. Patients treated for a violent injury experience recidivism rates as high 45% and death rates as high as 20% within the first five years of discharge. Victims of violence also face a higher risk of becoming perpetrators of violence.
“We know that hurt people hurt people,” said Edward M. Barksdale Jr. MD, surgeon-in-chief at UH Rainbow Babies and Children’s Hospital in Cleveland, Ohio. “Violence affects the whole person and becomes a cycle.”
Research shows that patients are more receptive to interventions just after a violent injury — a period known as “the golden hour” or “a teachable moment.” They’re more likely to accept support services that can prevent retaliation, re-injury, or involvement in further violence.
Dozens of children’s hospitals across the country have developed programs to intervene during this critical time and help break the cycle of violence. These Hospital-Based Violence Intervention Programs (HVIPs) have demonstrated effectiveness in decreasing rates of re-injury and retaliation and increasing mental well-being.
For Jonathan, Children’s Wisconsin’s HVIP was just as important as the life-saving care he received at the hospital. “Without that support, I don’t know what life would’ve turned out to be," he said. “I know one thing — I wouldn’t be here.”
Understanding hospital-based violence intervention programs
HVIPs are comprehensive, multidisciplinary initiatives using a public health and trauma-informed approach to interrupt the cycle of violence. The programs provide case management and wraparound support for patients who experience a violent injury: connecting the patient to mental health services, providing mentors, teaching coping mechanisms, offering school support, and addressing challenges like housing instability and food insecurity.
The core components of HVIPs typically include:
- Immediate intervention: Trained intervention specialists, often with backgrounds in social work or community outreach, connect with patients at the bedside or shortly after injury to offer support.
- Comprehensive assessment: Case managers conduct evaluations to identify needs and guide HVIP’s support for physical and psychosocial recovery to promote healing and safety.
- Resource connection: Patients are linked to services including mental health counseling, educational support, job training, legal assistance, and mentoring.
- Long-term follow-up: Continuous support is provided to keep patients engaged with services and to monitor progress, with the goal of fostering resilience and reducing the likelihood of future violence.
Most programs are funded through a combination of hospital operations, foundation support, state and federal grants, and philanthropy.
Examples of children's hospital intervention programs
Numerous children's hospitals have established successful HVIPs, serving as models for integrating health care and violence prevention.
Children’s Wisconsin: Project Ujima
Project Ujima, named after the Swahili word for “collective work and responsibility,” integrates hospital, home, and community-based services to support children affected by violence. A multidisciplinary team, including community health advocates, mental health professionals, and nurses, provides case management, trauma-informed crisis support, and follow-up care. “We see ourselves as part of the ecosystem of violence intervention,” Levas said.
The program equips kids with coping skills and violence-avoidance techniques, reducing the risk of future harm. Mentorship is a core focus, helping children identify stable adult influences. “Everyone's born with resiliency, but we know that no one can access their own inner resiliency without having at least four or five stable adult people in their lives,” Levas said.
Since 2004, participants have had a recidivism rate of less than 1%, along with improvements in anxiety, anger, and depression.
UH Rainbow Babies & Children’s Hospital: The Antifragility Initiative
To combat rising pediatric gun violence in Cleveland, UH Rainbow Babies & Children’s Hospital launched the Antifragility Initiative, inspired by a Japanese art form called kintsugi where broken clay pots are repaired with gold epoxy. “This broken but repaired vessel becomes more valuable than it was in its native state,” said Barksdale, who founded the program. “To me, that applies to the human condition. Like kintsugi, I wanted to make patients stronger — creating post-traumatic growth and new meaning for their lives.”
Within 48 hours of discharge, staff from the program meet with the patient in their home and get to know them. Then, working with community, civic, and philanthropic partners, they help meet basic needs like food, clothing, and housing security and connect them to other services like mental health therapy, academic support, and vocational services. Of the 56 patients who’ve gone through the yearlong program, only two have been retraumatized.
Children’s Hospital of Philadelphia (CHOP): Violence Intervention Program
CHOP's trauma-informed and family-led Violence Intervention Program operates on four pillars: psychosocial assessment, trauma-focused therapy, peer-led support groups, and wraparound services for families, including legal aid, education, and employment assistance. "We serve as a bridge from that initial point of care for an injury back into community-based services and care to support recovery,” said Rachel K. Myers, PhD, co-director of CHOP’s HVIP.
Violence prevention specialists provide immediate psychoeducation, safety planning, and resource navigation. A comprehensive intake assessment identifies recovery needs across 11 domains, including medical care, mental health, basic needs, legal support, and education. "We’re really thinking about what are the systems barriers that can prevent recovery and how can we work to advocate and address them,” Myers said. “Do you need a school uniform because you had to transfer schools for safety? We will get that uniform return to learning as quickly as possible.”
Mental health, basic necessities, and education consistently rank among the top three needs identified. Nearly 70% of its patients’ assaults take place in school or directly after it, and most families need help navigating the complexities within the educational and legal systems.
Most participants engage for five to six months, gaining stability and support to prevent re-injury and navigate life beyond trauma.
Breaking the cycle
Gun violence affects more than just the individuals injured, rippling through families, schools, and entire communities. HVIPs offer a path to healing that goes beyond the emergency room, addressing the deeper challenges that contribute to and are worsened by violence.
By combining medical care with mental health support, mentorship, and community connections, these programs are rewriting the stories of young people impacted by violence. Whether it’s at Children’s Wisconsin, UH Rainbow Babies & Children’s Hospital, or CHOP, children’s hospitals are proving that they can be more than places of treatment — they can be places of hope and transformation.
