Violent reinjury risk assessment instrument (VRRAI) for hospital-based violence intervention programs

Abstract

Background Violent injury is the second most common cause of death among 15–24 year-olds in the US. Up to 58% of violently injured youth return to the hospital with a second violent injury. Hospital-based violence intervention programs (HVIP) have been shown to reduce injury recidivism through intensive case management. However, no validated guidelines for risk assessment strategies in the HVIP setting have been reported. We aimed to use qualitative methods to investigate the key components of risk assessments employed by HVIP case managers and to propose a risk assessment model based on this qualitative analysis. Materials and Methods An established academic hospital-affiliated HVIP served as the nexus for this research. Thematic saturation was reached with 11 semi-structured interviews and 2 focus groups conducted with HVIP case managers and key informants identified through snowball-sampling. Interactions were analyzed by a four-member team using Nvivo 10, employing the constant comparison method. Risk factors identified were used to create a set of models presented in 2 follow-up HVIP case managers and leadership focus groups. Results Eighteen key themes within seven domains (environment, identity, mental health, behavior, conflict, indicators of lower risk, case management) and 141 potential risk factors for use in the risk assessment framework were identified. The most salient factors were incorporated into eight models that were presented to the HVIP case managers. A 29-item algorithmic structured professional judgment model was chosen. Conclusions We identified four tiers of risk factors for violent re-injury that were incorporated into a proposed risk assessment instrument, VRRAI.

Trauma Recidivism and Mortality Following Violent Injuries in Young Adults

“…HVIPs have been shown to dramatically reduce the risk of reinjury, with one study citing a fourfold reduction after implementation of changes to screen patients for reinjury risk and provide resources for mentorship, mental health services, and risk factor modifications. [22][23][24] In addition, cost-effectiveness analysis of HVIPs have demonstrated clear benefits in reducing patient and hospital costs, largely due to reduced recidivism rates. 25,26 There are several limitations present in this study.…”

Implementing psychosocial programming at a level 1 trauma center: results from a 5-year period

“…Major goals of such programming are to increase patient education and engagement, to promote recovery and well-being in the community, and to limit recidivism in this high-risk group. Although new to our institution, other hospitals around the country have investigated the impact of similar violence intervention programs 30–34. These programs have noted a number of benefits including reduced recidivism, cost savings, and transformed attitudes about violence and shame 32–34.…”

Serious Workplace Violence against healthcare providers in China in the past 15 years

“…(1) Losing control of emotions, including:"being drunk", "having a diagnosed or suspected mental disorder". Previously, Bataille found alcohol abuse is one of the most common triggers of WPV in ED [34]; a lot of other research has similarly found drunkenness and mental disorders are often associated with physical violence against healthcare providers [24,[35][36][37][38].…”