A Hospital-based Intervention for Youth Injured Through Violence

The firearm violence epidemic is a major public health problem, especially for youth. Every day in the US, approximately 100 people fall casualty to firearms through forms of violence, such as homicide, suicide, and unintentional or accidental injuries. Among youth, firearm violence remains the leading cause of death, and each year the rate of firearm-related mortality is increasing. Beyond the significant and devastating cost of human life, firearm violence is an enormous economic burden to the US, which totals an estimated $229 billion annually. In urban communities with high rates of firearm-related violence, firearm-related emergency department visits are extremely draining on the hospital system. At the national level, firearm-related injuries account for $2.8 billion annually in emergency department care each.

Study Overview

• Status: Recruiting
• Conditions: Violence
• Intervention / Treatment: Other: Elevate Virtual Reality (VR); Other: Assessement completion

Detailed Description

In the state of Virginia, the rates of firearm-related fatalities are over seven times higher than the national rates, and the pandemic has made this worse, as we have seen a 52% increase in firearm-related hospitalizations. With the surge in firearm violence seen nationwide, there is a dire need for new, innovative, and effective interventions for preventing firearm-related violence, injury, and mortality among youth. Hospital-based brief violence interventions can result in long-term improvement. There is a plethora of research supporting that brief violence interventions can result in long-term improvements, including interventions for violence. Less is known about the extent to which they are effective for reducing firearm-related violence. Hospital-based brief violence interventions save lives and money. Most of the people who are violently injured are indigent and without health insurance. Inpatient costs for injury at VCU Trauma Center ranging from $33,000 to $300,000 per youth, and a national cost of violence estimated at $21 billion annually. The goal of this project is to evaluate Elevate VR an effective and innovative virtual reality (VR) brief violence intervention to prevent firearm-related violence, injury, and mortality among youth.

• Study Type: Interventional
• Enrollment (Estimated): 360
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Terri Sulivan; Phone Number: 804-828-9304; Email: tnsulliv@vcu.edu
• Study Contact Backup: Name: Nicholas Thomson; Phone Number: 804-628-5541; Email: nthomson2@vcu.edu

Study Locations

• United States
  • Virginia
    • Richmond, Virginia, United States, 23298
      • Recruiting
      • Virginia Commonwealth University
      • Contact: Nicholas Thomson; Phone Number: 804-628-5541; Email: nthomson2@vcu.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Youth participant inclusion criteria:

• Aged 13-17 years old
• English speaking

Youth participant exclusion criteria:

• Youth aged <13 years and >17 years old
• Non-English speaking
• Youth of caregivers younger than 18 years old

Adult/caregiver participant inclusion criteria:

- Aged 18 years or older

Adult/caregiver participant exclusion criteria:

- Aged younger than 18 years

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Youth; Youth (aged 13-17 years) who received treatment in the hospital for an intentional or unintentional injury, or youth recruited from community partners and other referrals.	Other: Elevate Virtual Reality (VR); Elevate VR is a brief violence intervention program founded on the principles of positive psychology, motivational goal setting (via gameplay), psychoeducation, cognitive-behavioral therapy, and dialectical behavioral therapy. Elevate VR includes five psychoeducational topic modules creating a 40-minute brief violence intervention. This duration is similar to well-established brief hospital-based violence interventions.
Experimental: Caregiver; Caregivers of youth participants (18 years and older).	Other: Elevate Virtual Reality (VR); Elevate VR is a brief violence intervention program founded on the principles of positive psychology, motivational goal setting (via gameplay), psychoeducation, cognitive-behavioral therapy, and dialectical behavioral therapy. Elevate VR includes five psychoeducational topic modules creating a 40-minute brief violence intervention. This duration is similar to well-established brief hospital-based violence interventions.; Other: Assessement completion; Questionnaires will be administered to assess Firearm-related violence ( The Gun Violence Questionnaire), Violent crime (Violent Crime Assessment) and Firearm-related attitudes and beliefs (Firearm Aggression Questionnaire)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Firearm-related violence assessment	The Gun Violence Questionnaire is a 4-item screening tool used primarily in healthcare settings to predict the risk of future firearm violence among youth and young adults. Individuals are classified into low-risk (0 points), medium-risk (1-5 points), or high-risk (≥ 6 points)	Baseline, Follow-up at 1 and 3 months post baseline
Violent crime assessment	Violent Crime Assessment is a process used by forensic, legal, and clinical professionals to estimate the likelihood, nature, and severity of future violent behavior. A 26-item tool that measures 6 static and 20 dynamic variables to assess both risk and potential for treatment change. Total scores typically range from -32 to +40; higher scores indicate a higher probability of re-offending.	Baseline, Follow-up at 1 and 3 months post baseline
Firearm-related attitudes and beliefs assessment	Firearm Aggression Questionnaire contains subscales for reactive violence (e.g., using a gun when provoked) and proactive violence (e.g., using a gun to take things from others). Items are rated on a 3-point scale (0 = never, 1 = sometimes, 2 = often), with higher total scores indicating a greater frequency of firearm violence.	Baseline, Follow-up at 1 and 3 months post baseline
Firearm-related re-injury	Number of injuries with and without hospitalization count. The lower the number is desired.	Baseline, Follow-up at 1 and 3 months post baseline
Risky behaviors	Youth Risk and Behavior Survey (YRBS) is a survey monitoring health-risk behaviors among U.S. high school students (grades 9-12). It tracks six main areas: injury/violence, sexual behaviors, substance use, diet, physical activity, and mental health. The Youth Risk Behavior Survey (YRBS) is not "scored" like a typical academic or clinical test where individuals receive a personal score. Instead, it is a surveillance tool used to calculate prevalence estimates (percentages) for specific health-risk behaviors across a population.	Baseline, Follow-up at 1 and 3 months post baseline
Personality traits	Behavior Assessment System for Children is a comprehensive, multi-method tool used by professionals (such as school psychologists and clinicians) to evaluate the individual behavioral and emotional status of children and young adults . BASC-3 results are reported as T-scores, which have a mean of 50 and a standard deviation of 10. The higher the score, the higher the risk.	Baseline, Follow-up at 1 and 3 months post baseline
Future aspirations	The Positive Outlook Survey used to measure a student's psychological well-being, resilience, and optimism. Likert scales (e.g., 1 to 5) used to calculate a total "positivity" or "optimism" score. The higher the score, the higher the optimism.	Baseline, Follow-up at 1 and 3 months post baseline

Collaborators and Investigators

• Sponsor: Virginia Commonwealth University
• Collaborators: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
• Investigators: Principal Investigator: Nicholas Thomson, Virginia Commonwealth University

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): October 1, 2028
• Study Completion (Estimated): October 1, 2028

Study Registration Dates

• First Submitted: March 11, 2026
• First Submitted That Met QC Criteria: March 11, 2026
• First Posted (Actual): March 16, 2026

Study Record Updates

• Last Update Posted (Actual): March 16, 2026
• Last Update Submitted That Met QC Criteria: March 11, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Virtual Reality; Fire-arm violence among youth
• Other Study ID Numbers: HM20029563; R01HD112416 (U.S. NIH Grant/Contract)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No