HRiA at APHA 2025

Moderator: Melissa Mercado, PhD MSc MA, Health Alliance for Violence Intervention (HAVI), BOSTON, MA, 

Panelists: G Bomani Gray, Wayne State University, Detroit, MI; Ciera Reneé, FORCE Detroit, Detroit, MI; Evan Goldstein, PhD, MPP, University of Utah, Salt Lake City, UT; Heriberto Escamilla, National Compadres Network, San Diego, CA; Saul Ruben Serrano, Hope and Heal Fund, Santa Barbara, CA; and Felix Yirdong, The Graduate Center, City University of New York (CUNY), Corona, NY

The Kaiser Permanente Center for Gun Violence Research & Education 3rd Annual Gun Violence Research Breakfast panel will feature an interdisciplinary group of firearm injury prevention practitioners, researchers, and community leaders advancing community violence and firearm suicide research through innovative methods, novel population engagement strategies, and groundbreaking approaches.  Join researchers from across the country, break bread with the leading minds in the field, learn about KP Center opportunities, and meet KP Center leaders. Session sponsored by Kaiser Permanente Center for Gun Violence Research & Education.

Authors: Stephanie Walker, MPH¹, Ariadna Capasso, PhD¹, Ariel Slifka, MPH¹, Zhaniya Aldekeyeva, MPH¹, Lauren Ferreira Cardoso, PhD², Nickolas Zaller, PhD² and Fatimah Loren Dreier, MBA² (1)Health Resources in Action, Boston, MA, (2)The Health Alliance for Violence Intervention, Boston, MA

Background: In 2023, over 46,000 people died due to firearm-related injuries in the United States (U.S.), and many more (97,000) were injured. Firearm-related injury is now the leading cause of death among children and disproportionately affects Black, Latinx, and Indigenous communities. The healthcare sector can play an important role in preventing firearm-related injuries. Many people who were injured by or died from firearm wounds had recent contact with a healthcare provider. On average, 53% of people who died by suicide had contact with a mental health provider and 77% with a primary care provider in the year before death. People injured by firearms also require emergency medical attention and may require extended services. These encounters provide opportunities to prevent reinjury. Despite this, healthcare-focused interventions to prevent firearm injury have not been systematically studied. The Kaiser Permanente Center for Gun Violence Research and Education conducted a scoping review of healthcare-centered gun violence interventions to codify how the healthcare sector is contributing to firearm-injury prevention and to better understand the state of the evidence regarding these interventions.

Methods: We conducted a scoping review of the peer-reviewed and gray literature and held discussions with subject matter experts to identify interventions aimed at addressing firearm-related injuries that engaged the healthcare sector. The review included interventions that took place in a healthcare setting or otherwise engaged the healthcare sector and addressed firearm suicide prevention and/or community violence. The review excluded policy interventions and interventions that did not involve the healthcare sector. The interventions identified were coded by key components and strategies, intended outcomes, violence domain (community violence or firearm suicide), primary setting (e.g., emergency department, pediatrics, etc.), and prevention level (primary, secondary, tertiary).

Results: We found the following eight types of interventions that fit our search criteria: Risk Screening that help providers identify individuals at higher risk of firearm injury, allowing for timely intervention; Safety Behaviors Counseling or Anticipatory Guidance offered to promote the behaviors to reduce firearm-related risks; Secure Gun Storage entailing safety locks provision and/or availability of offsite storage locations; Lethal Means Counseling focuses on reducing access to firearms during crises, particularly for those at risk of suicide; Hospital-based Violence Intervention Programs (HVIPs) and Trauma Recovery Centers provide wholistic support and care for victims of violence, addressing both immediate and long-term needs; Medical-Legal Partnerships integrate legal aid into healthcare settings to address legal social determinants of health; and Zero Suicide is a systemwide approach prioritizing suicide prevention across all levels of the healthcare system. Additionally, monitoring care utilization and outcomes data for firearm-injured patients is critical to systemwide quality-improvement efforts.

Conclusions: This scoping review codified existing healthcare-focused interventions to prevent firearm injury. To maximize the healthcare sector’s contribution to firearm injury prevention, additional research is needed to assess their effectiveness and sustainability.

Authors: Meghan Guptill, MPH, Kathleen McCabe, MPA, Ben Wood, MPH, Kelly Danckert, MPH, Ariel Slifka, MPH and Lex Vazquez

Abstract: Political attacks at local, state, and federal levels have created climates of uncertainty and fear for LGBTQ+ communities, with transgender and gender non-conforming people disproportionately impacted by harmful legislation. Program cuts, data erasure, and systems and policy changes threaten the physical, mental, financial, and social health of LGBTQ+ people. It is imperative that public health commits to systems transformation for equity to protect the lives and well-being of LGBTQ+ communities.

This session focuses on an active engagement in New Hampshire, led by Health Resources in Action (HRiA) in partnership with a coalition of equity-focused and LGBTQ+ serving organizations. Understanding that the experience may be instructive for others, HRiA is documenting learnings about the successes and challenges in building effective and proactive long-term strategies to advance LGBTQ+ rights. This effort began with a landscape assessment of the state’s LGBTQ+ population, informing discussions about shared narratives and messaging, community power building, and local policy opportunities, with a goal of building a coalition of advocates and shifting harmful narratives about LGBTQ+ people in New Hampshire. By aligning siloed efforts and engaging new partners, this project aims to build collective power and elevate a replicable model for policy and systems change in politically fraught climates.

This session will discuss the development and implementation of this effort, focusing on considerations for working with populations under political threat. Participants will learn about conducting research for systems transformation and explore how assessment findings can catalyze narrative change and community power building, creating pathways for grassroots-led systemic change.

Authors: Ariadna Capasso, PhD¹ (presenter), Yolanda Villarreal, PhD², Sebastian Juarez Casillas, MS², Brittany Manuel, BSN, RN², Abigail Dorow, BA², Shelsea Zelaya, RN², Mia Xu, MPH³, Jennifer Brown, PhD, HSPP⁴, Angela Stotts, PhD² and Ralph DiClemente, PhD³ (1) Health Resources in Action, Boston, MA, (2) UTHealth McGovern Medical School, Houston, TX, (3) New York University, New York, NY, (4) Purdue University, West Lafayette, IN

Background: Prenatal alcohol exposure can cause lifelong physical and cognitive challenges known as fetal alcohol spectrum disorders (FASD). Over 1 in 10 U.S. pregnancies are alcohol exposed. In addition to identifying evidence-based interventions to reduce alcohol use among pregnant women, successful implementation of these interventions is critical for their adoption and scale-up. Launched in 2024, Safe Start is a hybrid intervention set in an urban OB/GYN clinic aimed at reducing alcohol-exposed pregnancies among women who are underprivileged. This abstract seeks to bridge the gap between evidence and practice by systematically identifying factors that affected implementation during the initial planning phase of Safe Start.

Methods: We are conducting an implementation science study to document factors associated with study implementation according to the four constructs of the Consolidated Framework for Implementation Research (CFIR): 1) Innovation: Characteristics of the implemented program; 2) Inner Setting: The setting in which the innovation is implemented; 3) Outer Setting: The context in which the inner setting exists, and which affects how the intervention is implemented; and 4) Implementation Process: The activities and strategies used to carry out the innovation. Data collection methods include guided periodic reflections with the core study team.

Results: Our qualitative analysis identified themes and subthemes relevant to developing, planning, and launching the program along the four core CFIR components. Themes include factors associated with developing and tailoring study protocols to specific clinical settings (e.g., workflow, space, resources), strategies to maximize participant enrollment (complexity, time), and procedures necessary to optimize study roll-out and increase retention (e.g., team connection, responsiveness).

Conclusions: The work to reduce alcohol-exposed pregnancies, particularly among low-income women in underprivileged urban settings is urgent. Implementation lessons inform ongoing study rollout and may be useful to other practitioners as they develop similar treatment programs.

Authors: Eva Chow (presenter), Derrick Sosa, BSE, Angelia Fontes, BA, Brin Myles, Natalie Johnson, MPH, Mo Barbosa, and Camerino Salazar, PhD

Background/Purpose:
Community violence is a public health crisis that disproportionately affects historically marginalized communities and undermines health, safety, and community cohesion. Boosting Organizational Capacity for Community Violence Intervention (BoostCVI), implemented by Health Resources in Action (HRiA) and funded by the Bureau of Justice Assistance (BJA), aims to strengthen the infrastructure, effectiveness, and long-term sustainability of community violence intervention (CVI) strategies. By investing in the capacity of five Massachusetts-based community-based organizations (CBOs), the initiative centers community leadership in advancing safety, healing, and public health equity. BoostCVI directly supports the national priority of integrating public health approaches into violence prevention efforts.

Methods:
BoostCVI uses a collaborative and adaptive model to assess and strengthen organizational capacity. Core strategies include the administration of an Organizational Readiness Tool, adapted from the CVI-Rose Tool, to evaluate grantee capacity across key operational domains, the development of individualized technical assistance (TA) plans, and the implementation of a formative evaluation framework. This evaluation approach integrates semi-structured interviews, continuous feedback mechanisms, and real-time adaptation of TA based on organizational progress and input.

Results/Outcomes:
The initiative successfully selected and onboarded five CBOs with demonstrated commitment to reducing community violence through culturally grounded, community-centered approaches. Organizations have diverse areas of capacity-building focus, including CVI program development and organizational infrastructure. Each organization participated in a baseline capacity assessment, which provided a foundation for developing customized TA plans aligned with their goals and growth areas. On a 1 to 4 scale—where higher scores indicate stronger self-reported capacity—cohort-wide baseline scores revealed moderate capacity in program design (2.5), and highlighted opportunities for support in financial management (2.2), program and performance management (2.2), data, monitoring, and evaluation (2.2), and partnerships and engagement (2.3). These findings reflect the structural challenges many grassroots organizations face in sustaining CVI work, and affirm the importance of tailored, long-term capacity-building investments.

In response to the assessment findings and ongoing feedback, the initiative is providing a range of supports including individualized technical assistance, peer learning opportunities, and curated resources. The embedded evaluation framework is also intended to facilitate continuous engagement with grantees, surface actionable insights, and ensure that TA remains aligned with evolving CBO priorities.

Conclusions:
BoostCVI illustrates how strategic investment in community-rooted organizations can advance public health–centered violence prevention. By embedding evaluation and feedback into a tailored capacity-building approach, the initiative strengthens local infrastructure while amplifying the voices and leadership of those closest to the work. As the field increasingly recognizes violence prevention as a public health imperative, BoostCVI offers a model for how public health-centered systems can partner with CBOs to build sustainable, community-driven solutions. Elevating these efforts is essential to making the public’s health a national priority.

Moderator: Timmeka Perkins, Baltimore, MD.

Panelists: Mo Barbosa, Boston, MA; DeVone Boggan, Richmond, CA; Tony Woods, Chicago, IL

Abstract: Using voices from throughout the field, this presentation will provide relevant data on gun violence and effective strategies, information on the public health approach to safety, and describe a comprehensive community safety ecosystem and alignment with health-focused philanthropic priorities.

Objectives

By the conclusion of this presentation, participants will be able to:

• Define the public health approach to community safety and violence reduction
• Describe tangible alignments between health-focused philanthropic missions and priorities and root causes of gun violence and various aspects of the community safety ecosystem
• Articulate adaptations to application and reporting requirements that could benefit organizations working to drive down violence

Content Description

In 2024, the U.S. Surgeon General declared gun violence as a public health crisis. Because of gun violence’s disproportionate impact on communities of color, it is a leading health disparity that exacerbates other health disparities. Similarly, a recent study by Pew Charitable Trust notes that half of Americans see gun violence as a major problem. Data demonstrates the effectiveness of coordinated, community-based efforts at driving down rates of violence when consistently resourced and implemented. However, many false narratives around gun violence data, root causes of violence and effective strategies to combat exist; this panel combats these narratives using data.

While many health-focused funders are interested in safer communities, they note difficulties in funding violence reduction efforts. Using voices from throughout the field, this presentation will: provide relevant data on gun violence and effective strategies; define the public health approach to community safety, and; describe the aspects of a comprehensive community safety ecosystem and alignment with health-focused philanthropic priorities.

Key presentation content includes:

• Data demonstrating the effectiveness of community violence intervention (CVI) strategies
• CVI Participant data demonstrating the relationship between health disparities and risk factors for involvement in gun violence
• Gun violence data and trends, including demographic data
• The key characteristics of a public health approach to gun violence
• Components of a comprehensive community safety ecosystem, successful examples and challenges
• Alignment between the community safety ecosystem and existing health-funder/public health priorities

Authors: Ariel Slifka, MPH¹ (presenter), Meghan Guptill, MPH², Stephanie Walker, MPH³ and Hannah Carliner, ScD, MPH¹
(1)Health Resources in Action, Boston, MA, (2)Pittsburgh, PA, (3)Loveland, OH

Policy, Systems, and Environmental (PSE) change approaches aim to address the root causes of health disparities and racial inequities, and require a long time-frame to shift institutional, power, and social structures. Many leaders and funders are reluctant to invest in these approaches because it is difficult to show tangible progress and impact within shorter-term funding cycles or other time or political constraints. Measurement of process, progress, and impact can be difficult to compare across varied PSE initiatives, making it hard to judge success. Moreover, PSE change has a long time horizon, so measuring intermediary and often somewhat intangible impacts is vitally important for continued funding.

In this session, we will present a newly-developed tool called the “PSE change Approaches Report and Inventory” (PSE-ARI) that seeks to measure progress and impact of PSE initiatives across a range of topic areas and populations. The tool was developed to evaluate the over-arching impact of a growing group of over 75 grantees working towards dismantling structural racism and improving health equity through community-based PSE change approaches in the State of Massachusetts. Our equitable evaluation approach engaged an Evaluation Workgroup of current grantees in the development, piloting, and administration of this tool among our grantees.

The PSE-ARI combines quantitative survey questions and short answer responses, and is based on the Water of Systems Change framework (Kramer, MR., et al., FSG, May 2018). We adapted the tool and created six categories of Systems Change approaches: National, State, and Local Policies; Internal/Organizational Policies, Practices, and Processes; Resource Distribution and Access to Services; Relationships, Connections, and Community Engagement; Power Shifting; and Mental Models, Beliefs and Narratives. Survey questions ask about activities, strategies, and tools used; and current progress.

There is currently a lack of standardized, ready-to-use tools available for organizations or funders to utilize in evaluating the impact of PSE change initiatives. We hope that this new tool will increase the ability to compare approaches across scope, topic area, population, time, and geographic area. This will enable funders and public health practitioners to measure quantifiable results of PSE work, thereby demonstrating the tangible products of PSE change efforts.