Effectiveness of a Mentor-Implemented, Violence Prevention Intervention for Assault-Injured Youths Presenting to the Emergency Department: Results of a Randomized Trial

Abstract

Context-The emergency department has been described as a promising setting to initiate interventions with assault-injured youth to reduce the risk of re-injury and reactive perpetration. Efforts to intervene have received little study.Objective-To assess the impact of a mentor-implemented violence prevention intervention on reducing aggression, fighting and re-injury among assault-injured youth. Design-Randomized controlled trial Setting-Two large urban hospital emergency departmentsParticipants-Youth age 10-15 presenting with peer assault injury were recruited and randomly assigned to intervention and comparison groups.Intervention-Intervention youth received a mentor who implemented a 6 session problem-solving curriculum while parents received 3 home visits with a health educator to discuss family needs and facilitate service use and parental monitoring. The comparison group received a list of community resources with 2 follow-up phone calls to facilitate service use.Main Outcome Measures-Youth and parents were interviewed at baseline and 6 months to assess attitudes about violence, risk factors, fighting and repeat injury.Results-227 families were recruited with 23% refusing participation and 4% partial interview completion. 166 families were enrolled with 87 randomized to the intervention group and 79 in the comparison group; 118 (71%) completed both youth and parent follow-up interviews and 113 had usable data. Intervention and comparison groups were not significantly different at baseline on demographics or risk factors except for increased knife carrying and less deviant peers in the intervention group. After adjustment for baseline differences, there was a trend toward significant program effect including reducing misdemeanor activity (rate ratio 0.29, confidence interval 0.08- Conclusions-A community-based, mentor-implemented program with assault-injured youth presenting to the ED trended in the direction of decreased violence with reduced misdemeanors and increased self efficacy. The ED may be an important contact location, and injuries an important context, for augmenting self efficacy for violence prevention.

Cost−Benefit Analysis Simulation of a Hospital-Based Violence Intervention Program

“…7,8 HVIPs have shown effectiveness in preventing violent reinjury and perpetration; in improving employment, education, and healthcare utilization; and in reducing aggressive behaviors. 14,[27][28][29][30][31][32] More than 20 HVIPs operate across the U.S. under the National Network of HospitalBased Violence Intervention Programs (NNHVIP) 33 and well-established HVIPs have begun to be replicated. 34 The U.S. Department of Justice (DOJ) has acknowledged the value of HVIPs, recommending that "Hospital-based counseling and prevention programs should be established in all hospital emergency departments (EDs)-especially those that provide services to victims of violence" (p. 13).…”

Role of the Pediatrician in Youth Violence Prevention

“…For example, homicide is the second leading cause of death in the United States for ages 15 to 19, but it is the leading cause of death among black 15-to 24-year-olds. 18 Cross-national analyses have demonstrated similar rates of violencerelated behaviors among adolescents in this country compared with international peers, yet the United States continues to lead the industrialized world in rates of youth homicide and suicide. [19][20][21] Approximately 3% of direct medical expenses in this country are related to interpersonal assault injuries, and the total cost to society of gun violence is approximately $100 billion, of which $15 billion is attributable to firearm injuries to children.…”

Firearm Possession Among Adolescents Presenting to an Urban Emergency Department for Assault

“…45,82 Interventions for hospitalized assault-injured youth have shown promise linking hospitalized youth with community-level resources. 17,30,[83][84][85][86] Future ED-based injury-prevention interventions or case management approaches for youth with assault-related injuries may have the potential to decrease the likelihood that a youth who is seeking care today with an assault-related injury will use a firearm lethally or be a victim of firearm violence.…”