Violence Intervention Program

The Violence Intervention Program (VIP) at Children's Hospital of Philadelphia (CHOP) was established in 2012 to go beyond healing physical wounds in the Emergency Department (ED) and bring a public health and trauma-informed care approach to treating assault-injured youth. VIP is a community- and family-focused model that works directly with youth between 8 and 18 years old who are treated at CHOP for an injury due to interpersonal, community violence. VIP serves as a bridge to community-based services and support, providing trauma-informed advocacy and intensive case management to help youth and their families recover, reestablish safety, and navigate systems, including legal, mental health, medical, education, and employment, after a violent event.

VIP's multidisciplinary team includes experts from social work, medicine, psychiatry, psychology, community members, public health, and research and program evaluation to meet the diversity of needs VIP youth and families identify, measure our impact, and ensure we are using evidence-based practices.

What VIP Does

CHOP’s Emergency Department (ED) and Trauma Unit treat approximately 500 patients per year with assault-related injuries. While these youth may leave with their acute medical needs resolved, they and their families often require on-going support to fully recover—physically, mentally, and emotionally. VIP identifies youth treated in the CHOP ED, Trauma Unit, or Concussion Clinic who have experienced an injury related to community violence to offer support and help youth and families to heal. Families are introduced to VIP as a voluntary service, at bedside if youth are inpatient, or by phone following their discharge and return home. The majority of the VIP’s work begins after youth are discharged home from the hospital.

VIP measures its impact by rigorous tracking of each patient’s needs, goals, and outcomes. Since 2015, we have consistently maintained engagement, with over 75% of youth and families who consented to VIP services through to program completion. Loss to follow-up rarely occurs among youth and families once enrolled in VIP, indicating a high-level of rapport and engagement, which is also highlighted in consistently high program participant satisfaction feedback.

VIP is Trauma-informed and Family-centered

VIP not only serves the assault-injured youth but wraps services around the entire family, including caregivers and siblings, understanding that violence and trauma impact the entire family. VIP assigns case managers, called Violence Prevention Specialists, to families who opt to enroll. Violence Prevention Specialists provide immediate psycho-education regarding trauma symptoms, safety planning, and resources to support families through the post-injury period. Our team conducts a comprehensive intake assessment with each youth and family to learn more about families and their identified recovery needs. Needs commonly occur within 14 domains, ranging from medical needs to basic needs, such as housing and food insecurity, and can be identified at any time from the intake visit to program graduation. Most youth and families participate in VIP services for 3 to 6 months, but that time period may be longer as needs require.

Common Needs — Needs most commonly identified by families are in the mental health, education, and legal domains. Examples of activities VIP provides in each of these domains are described.

VIP Supports Families Through a Combination of System Navigation and Direct Support

VIP helps youth and families navigate complex systems of care to meet needs in their communities. VIP serves as a bridge to long-term support for youth and families and increases families’ ability to successfully engage in community-based services. Our team builds relationships and partnerships with service providers and community agencies across Philadelphia to facilitate access to the services and programs that youth require to achieve recovery and safety, such as medical care, mental health care, educational supports, extracurricular activities, employment, and legal advocacy. In addition to community-based work and advocacy, VIP also provides direct therapeutic services, including mental health therapy, supportive counseling, and hosts psychoeducational groups (Building Resilience after Violent Experiences (BRAVE)) to foster resilience and help youth build coping skills.

VIP's Participants and Impact

Who Does VIP Serve?

Through support from the Pennsylvania Commission on Crime and Delinquency (PCCD)* as well as that of the Hospital, federal, state and foundation grants, and community donations, our intensive community-focused model provides services to approximately 75 families annually.

The majority of program participants (70%) reside in neighborhoods within West and Southwest Philadelphia.
The average age at injury of VIP participants is 14 years, 89% are Black or African-American, and we serve equal numbers of male and female youth.
Approximately 70% of our patients’ assaults occur in school or directly after school.

What Do VIP Participants Say?

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VIP's Research and Evaluation Projects

Addressing Community Violence-related Traumatic Stress Symptoms in Children

Study PI: Joel Fein, MD, MPH

Study Team: Steve Berkowitz, MD; Nancy Kassam-Adams, PhD; Rachel Myers, PhD, MS; Guy Diamond, PhD; Justine Shults, PhD; Laura Vega, DSW; Stephanie Garcia, MPH

Study Sponsor: NIH/NICHD

Project Goals: We are conducting this prospective, randomized control trial to evaluate the effectiveness of the 5-8 session Child and Family Traumatic Stress Intervention (CFTSI) provided soon after a physically violent traumatic event. The study will continue to enroll youth and families through 2022. We are evaluating whether CFTSI, provided in addition to VIP services, can produce significant and sustained reduction in posttraumatic stress symptoms (PTSS) among youth aged 8-18 years.

Formative Evaluation of a Pediatric Hospital-based Violence Intervention Program

Study PI: Rachel Myers, PhD, MS

Study Team: Nancy Kassam-Adams, PhD; Joel Fein, MD, MPH; Laura Vega, DSW; Hillary Kapa, MPH

Study Sponsor: National Institute of Justice

Project Goals: The objective of this project is to rigorously describe the components and outcomes of the victim service program offered by the CHOP VIP. Through this study, we will develop and define the tools and resources needed to support program implementation, including possible measure of program fidelity and key outcome metrics, defined with diverse stakeholder input. Additionally, this grant will develop tools to support trauma informed supervision for pediatrics HVIPs.

Assessing the Intersection of Bullying and Physical Violence among Patients Seeking Primary Care

Study PI: Rachel Myers, PhD, MS

Study Team: Tracy Waasdorp, PhD; Hillary Kapa, MPH

Study Sponsor: Children’s Hospital of Philadelphia Foerderer Award

Project Goals: The objective of this study is to describe the burden of pediatric injuries treated in primary care following intentional interpersonal violence and the intersection between bullying and physical victimization to inform prevention and intervention efforts.

Seasonal Variation of Assault Victimization in a Pediatric Center and its Association with the Academic School Calendar

Study PI: Ashlee Murray, MD, MPH

Study Team: Joel Fein, MD, MPH; Rachel Myers, PhD, MS

Project Goals: The purpose of this study is to describe the temporal variation in assault injuries presenting to a single, urban pediatric ED, and to test the hypothesis that there is an association between the incidence of pediatric assault victimization and the academic calendar.

Client Satisfaction Questionnaire

Project Goals: Few standardized tools exist to capture experiences of clients participating in hospital-based violence intervention programs (HVIP) to ensure program relevance and responsiveness. As a quality improvement initiative, we developed a tool to measure client satisfaction utilizing feedback from youth and caregivers participating in the VIP at CHOP. Created with client feedback, our 12- item tool, the Pediatric HVIP Client Satisfaction Questionnaire (CSQ), systematizes collection of HVIP client satisfaction and supports the inclusion of client and caregiver voices in quality improvement and evaluation efforts. At present, the VIP at CHOP administers the CSQ to all clients and caregivers at the conclusion of their services as part of ongoing program evaluation.

Completed Research Studies

Generating a Core Set of Outcomes for Hospital-Based Violence Intervention Programs

The post-injury needs of someone who has been violently assaulted are varied and complex. To reduce future re-injuries, hospital-based violence intervention programs (HVIPs), including CHOP’s Violence Intervention Program, provide violently injured individuals with support and case management following discharge from the hospital. This study addresses the types of outcomes these programs can and should look to achieve for their clients to create safety in the aftermath of violent injury.

Read a blog post about this study.

The Psychosocial Needs of Adolescent Males Following Interpersonal Assault

This study found that among 49 young men of color ages 12-17 who voluntarily enrolled in CHOP’s VIP program from 2012-2016, the vast majority (89%) self-identified a need for mental health care, with specific goals including therapy, psychiatric evaluation, and suicide safety planning. Adolescent boys also identified legal, education/school, employment, medical, and safety needs.

View an infographic about this study.

Read a blog about this study.

Recommended Resources

VIP Brochure

Download the VIP brochure to learn more.

CHOP Publications on Treating Assault Injured Youth

W Monopoli J, Myers RK, Paskewich B, Bevans KB, Fein JA. Generating a Core Set of Outcomes for Hospital-Based Violence Intervention Programs. Journal of Interpersonal Violence. 2018:886260518792988
Myers RK, Vega L, Culyba AJ, Fein JA. The Psychosocial Needs of Adolescent Males Following Interpersonal Assault. Journal of Adolescent Health. 2017.
Fein JA, Mollen CJ, Greene MB. The Assault-Injured Youth and the Emergency Medical System: What Can We Do? Clinical Pediatric Emergency Medicine. 2013;14(1):47-55.
Fein JA. The Assault-injured Youth: What We Know, How We Use It. J Adolesc Health. 2012;50(3):213-4.
Wiebe DJ, Blackstone MM, Mollen CJ, Culyba AJ, Fein JA. Self-reported Violence-related Outcomes for Adolescents Within Eight Weeks of Emergency Department Treatment for Assault Injury. J Adolesc Health. 2011;49(4):440-2.
Cunningham R, Knox L, Fein JA, et al. Before and After the Trauma Bay: The Prevention of Violent Injury Among Youth. Ann Emerg Med. 2009;53(4):490-500.
Blackstone MM, Wiebe DJ, Mollen CJ, Kalra A, Fein JA. Feasibility of an Interactive Voice Response Tool for Adolescent Assault Victims. Acad Emerg Med. 2009;16(10):956-62.
Hausman AJ, Hohl B, Hanlon AL, et al. Translating Community-specified Indicators of Program Success into Measurable Outcomes. J Public Health Manag Pract. 2009;15(6):E22-30.
Cohn JM, Ginsburg KR, Kassam-Adams N, Fein JA. Adolescent Decisional Autonomy Regarding Participation in an Emergency Department Youth Violence Interview. Am J Bioeth. 2005;5(5):70-4; discussion W14.
Fein JA, Kassam-Adams N, Gavin M, Huang R, Blanchard D, Datner EM. Persistence of Posttraumatic Stress in Violently Injured Youth Seen in the Emergency Department. Arch Pediatr Adolesc Med. 2002;156(8):836-40.
Fein JA, Kassam-Adams N, Vu T, Datner EM. Emergency Department Evaluation of Acute Stress Disorder Symptoms in Violently Injured Youths. Ann Emerg Med. 2001;38(4):391-6.
Fein JA, Ginsburg KR, McGrath ME, Shofer FS, Flamma JC, Datner EM. "Violence Prevention in the Emergency Department: Clinician Attitudes and Limitations." Arch Pediatr Adolesc Med. 2000;154(5):495-8.

Relevant Publications

Aboutanos MB, Jordan A, Cohen R, Foster RL, Goodman K, Halfond RW, Ivatury RR. Brief Violence Interventions With Community Case Management Services Are Effective for High-Risk Trauma Patients. Journal of Trauma and Acute Care Surgery. 2011;71(1), 228-237 210.
Becker MG, Hall JS, Ursic CM, Jain S, & Calhoun D. Caught in the Crossfire: The Effects of a Peer-based Intervention Program for Violently Injured Youth. Journal of Adolescent Health. 2004;34(3): 177-183.
Cheng TL, Wright JL, Markakis D, Copeland-Linder N, & Menvielle E. Randomized Trial of a Case Management Program for Assault-injured Youth: Impact on Service Utilization and Risk for Reinjury. Pediatric Emergency Care. 2008;24(3): 130-136.
Cheng TL, D Haynie, et al. Effectiveness of a Mentor-Implemented, Violence Prevention Intervention for Assault-Injured Youths Presenting to the Emergency Department: Results of a Randomized Trial. Pediatrics. 2008;122(5): 938-946.
Cooper C, Eslinger DM, & Stolley PD. Hospital-based Violence Intervention Programs Work. Journal of Trauma-Injury Infection & Critical Care. 2006;61(3): 534-537.
Corbin TJ, Purtle J, Rich LJ, Rich JA, Adams EJ, Yee G, Bloom SL. The Prevalence of Trauma and Childhood Adversity in an Urban, Hospital-Based Violence Intervention Program. Journal of Health Care for the Poor and Underserved. 2013;24(3): 1021-1030.
Corbin TJ, Rich JA, Bloom SL, Delgado D, Rich LJ, Wilson AS. Developing a Trauma-Informed, Emergency Department-Based Intervention for Victims of Urban Violence. Journal of Trauma and Dissociation. 2011;12(5): 510-525.
Karakker N, Cunningham RM, Becker MG, Fein JA, Knox LM. A Best Practices Guide for Launching & Sustaining a Hospital-based Program to Break the Cycle of Violence. Online PDF courtesy of the National Network of Hospital-based Violence Intervention Programs and Youth ALIVE! 2011.
Purtle J, Dicker R, Cooper C, Corbin T, Greene MB, Marks A, Creaser D, Topp D, Moreland D. Hospital-based Violence Intervention Programs Save Time and Money. Journal of Trauma and Acute Care Surgery. 2013;75(2): 331-333.
Shibru DE, Zahnd E, Becker M, Bekaert N, Calhoun D, & Victorino GP. Benefits of a Hospital-based Peer Intervention Program for Violently Injured Youth. Journal Of The American College Of Surgeons. 2007;205(5): 684-689.
Zun LS, Downey L & Rosen J. The Effectiveness of an ED-based Violence Prevention Program. American Journal of Emergency Medicine. 2006;24(1): 8-13.

Information on Hospital-based Violence Intervention Programs (HVIPs)

CHOP’s VIP is one of more than 45 member programs in The Health Alliance for Violence Intervention (The HAVI), and we are recognized as a model in pediatric hospital-based violence intervention programs (HVIPs). Through The HAVI, VIP collaborates on clinical best practices, workforce development, and research scholarship to identify opportunities to evaluate, inform, and disseminate HVIP best practices.

* VIP is supported by PCCD Subgrant # 2018/2019/2020-VF-05-32915, awarded by the Pennsylvania Commission on Crime and Delinquency (PCCD). The awarded funds originate with the Office of Justice Programs, U.S. Department of Justice or U.S. Department of Education or U.S. Department of Health and Human Services. VIP is also supported by PCCD Subgrant #s 2019-SS-02-31382 and 2020-SS-03-34728. The opinions, findings and conclusions expressed within this publication/program/exhibition are those of the author(s) and do not necessarily reflect the views of PCCD or applicable federal agency.