Discussion
TRUE HAVEN is a novel multi-level intervention package that aims to reduce rates of community gun violence through three strategies that focus on increasing housing stability (individual/family level), mental well-being (neighborhood/community level), and addressing structurally racist policies (city/state level) in New Haven, CT. Several aspects make our study innovative. First, our study applies a novel theoretical framework of collective well-being to upend the effects of centuries of structural racism that has resulted high prevalence of gun violence. This differs from traditional approaches to gun violence that focus on the victim in isolation or on remediating the perpetrator of gun violence, as we recognize that the family and community context has a greater long-term influence on behaviors and outcomes.Second, we design this multi-system strategy to strengthen the community’s self-sufficiency across multiple domains of collective well-being. We recognize that single-system approaches like supporting housing or increasing access to mental healthcare alone are insufficient to sustain positive outcomes because of other counteracting community-level forces.Third, we apply advanced and novel methods in implementation science and experimental design to study the effectiveness and impact of the intervention package. We embed this research in an implementation science framework to systematically assess whether change in processes (e.g., convening a community advisory board) and progress towards achieving outcomes related to addressing structural racism (e.g., percent homeownership and number of racist policies changed), reduces the rates and effects of gun violence, and improves the health and overall well-being of all in our community. We employ a stepped wedge design that sequentially randomizes the six neighborhoods with among the highest rates of gun violence in the New Haven Area. Our community-based implementation science approach, coupled with the stepped wedge design, will be the first time such a design is used to evaluate an intervention package on gun violence through addressing structural racism in an integrated manner. We will collect multi-level data at the implementer level, individual level, neighborhood-level, and city level on the adoption, implementation, reach, effectiveness and maintenance of components of the intervention package. Such an effort can help inform future implementation efforts both in New Haven and in other community contexts.Fourth, we have engaged institutions that have benefited from structural racism to actively re-invest in these communities. We will establish a process for strengthening and shifting the power balance towards these historically marginalized communities to realize their untapped and oppressed potential. New Haven has a community of powerful local institutions including hospitals, universities, and city leaders who have recognized 