Hospital-based Violence Prevention Research Articles

Systematic Screening and Assessment of Hospital-Based Youth Violence Prevention Programs.

Youth violence is a preventable public health issue. Few hospital-based programs intentionally focus on youth violence prevention. This project aimed to describe the Systematic Screening and Assessment (SSA) methodology used to identify existing hospital-based youth violence prevention (HBYVP) programs ready for future rigorous evaluation. To identify promising HBYVP programs currently in use and assess readiness for evaluation, data from the 2017 American Hospital Association (AHA) Annual Survey of Hospitals was used to identify hospitals with Level I-III trauma centers with reported HBYVP programs. Information for each program was gathered via environmental scan and key informant interviews. A total of 383 hospital-based violence prevention programs were identified. Two review panels were conducted with violence prevention experts to identify characteristics of programs suitable for an evaluability assessment (EA). Fifteen programs focused on youth (10-24 years old) and were identified to be promising and evaluable. Three of the 15 programs were determined to have the infrastructure and readiness necessary for rigorous evaluation. Lessons learned and best practices for SSA project success included use of streamlined outreach efforts that provide program staff with informative and culturally tailored project materials outlining information about the problem, project goals, proposed SSA activities, and altruistic benefit to the community at the initial point of contact. In addition, success of review panels was attributed to use of software to streamline panelist review processes and use of evaluation and data analysis subject matter experts to serve as panel facilitators. Communities experiencing high youth violence burden and hospitals serving these communities can improve health outcomes among youth by implementing and evaluating tailored HBYVP programs.

Hospital-based violence prevention programmes in South Wales Emergency Departments: A process evaluation protocol.

Addressing violence related harm is a global public health priority. While violence is primarily managed in the criminal justice system, healthcare supports and manages those injured by violence. Emergency Departments (EDs), the primary destination for those seriously injured, have emerged as a candidate location for violence prevention initiatives. There is limited evaluation of ED-based violence prevention, and a lack of guidance for the implementation and delivery of them. Nurse-led Violence Prevention Teams (VPTs) have been developed and implemented in two EDs in Wales, UK. This protocol describes methods used in the process evaluation of these VPTs. To understand how VPTs function, how they were implemented, and mechanisms of impact, as well as the exploration of wider contextual factors influencing their function. Adopting a critical realist approach and informed by the Medical Research Council (MRC) guidance for process evaluations, the process evaluation will employ qualitative methods to collect and analyse data: a scoping review of evidence of effectiveness that considers the causal mechanisms underpinning violence; a documentary analysis to determine operational considerations concerning the development, implementation and delivery of the VPTs; a descriptive analysis of routine ED data to characterise the prevalence of violence-related attendances in each ED; interviews with professional stakeholders (N = 60) from the violence prevention ecologies in which the VPTs are embedded. This protocol outlines a process evaluation of a novel, nurse led violence prevention intervention. Findings will be used to inform policy makers' decision making on whether and how VPTs should be used in practice in other EDs across the UK, and the extent that a single operational model should be adjusted to address the local characteristic of violence. To the authors knowledge, this is the first process evaluation of a UK-based, nurse led Emergency Department Violence Prevention Team. Protocol registration ISRCTN: 15286575. Registered 13th March, 2023.

Emergency Department Visits for Firearm Injuries Before and During the COVID-19 Pandemic — United States, January 2019–December 2022

During the COVID-19 pandemic, the U.S. firearm homicide rate increased by nearly 35%, and the firearm suicide rate remained high during 2019-2020 (1). Provisional mortality data from the National Vital Statistics System indicate that rates continued to increase in 2021: the rates of firearm homicide and firearm suicide in 2021 were the highest recorded since 1993 and 1990, respectively (2). Firearm injuries treated in emergency departments (EDs), the primary setting for the immediate medical treatment of such injuries, gradually increased during 2018-2019 (3); however, more recent patterns of ED visits for firearm injuries, particularly during the COVID-19 pandemic, are unknown. Using data from the National Syndromic Surveillance Program (NSSP),* CDC examined changes in ED visits for initial firearm injury encounters during January 2019-December 2022, by year, patient sex, and age group. Increases in the overall weekly number of firearm injury ED visits were detected at certain periods during the COVID-19 pandemic. One such period during which there was a gradual increase was March 2020, which coincided with both the declaration of COVID-19 as a national emergency† and a pronounced decrease in the total number of ED visits. Another increase in firearm injury ED visits occurred in late May 2020, concurrent with a period marked by public outcry related to social injustice and structural racism (4), changes in state-level COVID-19-specific prevention strategies,§ decreased engagement in COVID-19 mitigation behaviors (5), and reported increases in some types of crime (4). Compared with 2019, the average number of weekly ED visits for firearm injury was 37% higher in 2020, 36% higher in 2021, and 20% higher in 2022. A comprehensive approach is needed to prevent and respond to firearm injuries in communities, including strategies that engage community and street outreach programs, implement hospital-based violence prevention programs, improve community physical environments, enhance secure storage of firearms, and strengthen social and economic supports.

Improving Adolescent Violent Trauma Outcomes With a Hospital-Based Violence Prevention Initiative.

Violent trauma results in significant morbidity/mortality in Black/Hispanic males aged 15 to 24 years. Hospital- and community-level interventions may improve patient and community outcomes. To determine if a hospital-based violence prevention intervention using community outreach workers was associated with improved violent trauma patient postdischarge follow-up and reinjury rates. This is a retrospective, single-center, cohort study of admitted violent trauma patients to a public hospital in the Bronx, NY. Data were collected from a convenience sample of patients aged 15 to 24 years admitted with International Classification of Diseases, 10th Revision, codes for gunshot wound, stab wound, or physical assault from August 2014 to April 2018. The exposure variable was documentation of intervention team evaluation during admission. The outcome variables included attending >50% scheduled postdischarge follow-up visits, and subsequent violent reinjury (gunshot wound, stab wound, blunt assault) during the study time period. Multivariable regression models were used to determine the association between the exposure and outcome variables. A total of 535 patients were evaluated and were primarily male (92.5%), Black (54%)/Latino (36.4%), with mean age of 19.1 years. Patients in the exposure group had increased odds of attending >50% of scheduled clinic postdischarge follow-up visits (odds ratio, 2.29; 95% confidence interval 1.59-3.29) and decreased odds of subsequent violent reinjury presentation (odds ratio, 0.41; 95% confidence interval 0.22-0.75) 3 months after hospital discharge. A hospital-based violence prevention intervention may be associated with decreased odds of violent reinjury and increased odds of postdischarge scheduled appointment adherence in admitted pediatric violent trauma patients.

Defense, Disrespect, and #Deadly: A Qualitative Exploration of Precursors to Youth Violence Informed Through Hospital-Based Violence Prevention Program Follow Up

Success of youth violence intervention and prevention effects, particularly for gun violence, will be enhanced when efforts are appropriately informed by the antecedents and context of violence. Youth violence is guided by social and cultural norms that are shifting with the rise of technology. Bullying, gang violence, and self-directed violence is increasingly found to occur in the online space influencing peer groups across contexts. Through focus groups with youth at risk for violence and victimization, this study finds three themes emerge as common precursors to violence: defense of self or others, disrespect of self or family occurring in traditional community-based interactions, and threats or disrespect occurring through social media platforms. Youth violence prevention programs should consider how using social cognitive intervention framework could build knowledge, attitudes, and skills needed for violence intervention and prevention informed by precursors to violence found in this analysis.

Review 1 of "Defense, disrespect, and #deadly: A qualitative exploration of precursors to youth violence informed through hospital-based violence prevention program follow up"

Review 1 of "Defense, disrespect, and #deadly: A qualitative exploration of precursors to youth violence informed through hospital-based violence prevention program follow up"

Review 2 of "Defense, disrespect, and #deadly: A qualitative exploration of precursors to youth violence informed through hospital-based violence prevention program follow up"

Review 2 of "Defense, disrespect, and #deadly: A qualitative exploration of precursors to youth violence informed through hospital-based violence prevention program follow up"

Review 3 of "Defense, disrespect, and #deadly: A qualitative exploration of precursors to youth violence informed through hospital-based violence prevention program follow up"

Review 3 of "Defense, disrespect, and #deadly: A qualitative exploration of precursors to youth violence informed through hospital-based violence prevention program follow up"

Laser Tattoo Removal: A New Tool for Hospital-based Violence Prevention?

Gang-related tattoos may increase an individual's risk for violent victimization. We present our early experience using a physician-staffed tattoo removal initiative as 1 component of a violence prevention program. Surgeons from our trauma department in partnership with a community advocacy group performed voluntary laser tattoo removal for individuals within our catchment area. Clients were asked to complete a voluntary, anonymous survey. This survey addressed tattoo acquisition, identified motives and goals for tattoo removal, and reported if those goals were met by the tattoo removal service. Issues involving gang affiliation and interpersonal violence were specifically queried. Results are listed as simple percentages. 81 of 122 (66%) program enrollees completed the survey. The average number of laser removal sessions at the time of questionnaire was 3 (range 1-15). 41% of respondents possessed gang or "crew" related tattoos. 22% of respondents possessed a tattoo related to an intimate partner who was gang affiliated. 21% of respondents desired tattoo removal for the motive of leaving gang affiliation with 94% of those respondents reporting success. 59% of respondents sought tattoo removal to improve employment opportunities with 81% of those respondents reporting success. 30% of respondents desired tattoo removal to improve personal safety or avoid violence with 80% of those respondents reporting success. Stated client goals for tattoo removal and their subjective reports of success achieving these goals demonstrate the possible effectiveness of laser tattoo removal as a tool to help clients avoid future violence and progress toward gang disengagement. Trauma departments should consider laser tattoo removal as part of future violence prevention initiatives.

Evaluating Outcomes for Youth Receiving Hospital-based Violence Prevention With and Without a Community-level Initiative

Evaluating Outcomes for Youth Receiving Hospital-based Violence Prevention With and Without a Community-level Initiative

Hospital-Based Violence Prevention: Progress and Opportunities.

Ideas and Opinions3 November 2015Hospital-Based Violence Prevention: Progress and OpportunitiesJonathan Purtle, DrPH, MSc, John A. Rich, MD, MPH, Joel A. Fein, MD, MPH, Thea James, MD, and Theodore J. Corbin, MD, MPPJonathan Purtle, DrPH, MScFrom Drexel University School of Public Health, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, and Drexel University College of Medicine, Philadelphia, Pennsylvania, and Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this author, John A. Rich, MD, MPHFrom Drexel University School of Public Health, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, and Drexel University College of Medicine, Philadelphia, Pennsylvania, and Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this author, Joel A. Fein, MD, MPHFrom Drexel University School of Public Health, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, and Drexel University College of Medicine, Philadelphia, Pennsylvania, and Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this author, Thea James, MDFrom Drexel University School of Public Health, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, and Drexel University College of Medicine, Philadelphia, Pennsylvania, and Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this author, and Theodore J. Corbin, MD, MPPFrom Drexel University School of Public Health, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, and Drexel University College of Medicine, Philadelphia, Pennsylvania, and Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0586 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail A substantial body of research shows that violently injured patients are at high risk for violent reinjury, violence perpetration, and symptoms of posttraumatic stress (1, 2). The standard of care for assault injury, however, does not reflect this knowledge—physical wounds are treated and patients are discharged, often to return with repeated injuries. Although many physicians wish to act on this knowledge, as evidenced by a recent call to action endorsed by 8 medical societies (3), little concrete guidance on what they can do is available. In this commentary, we describe how hospital-based violence intervention programs (HVIPs) work to translate research ...

Community‐based Participatory Research: Development of an Emergency Department–based Youth Violence Intervention Using Concept Mapping

Emergency departments (EDs) see a high number of youths injured by violence. In Ontario, the most common cause of injury for youths visiting EDs is assault. Secondary prevention strategies using the teachable moment (i.e., events that can lead individuals to make positive changes in their lives) are ideal for use by clinicians. An opportunity exists to take advantage of the teachable moment in the ED in an effort to prevent future occurrences of injury in at-risk youths. However, little is known about perceptions of youths, parents, and community organizations about such interventions in EDs. The aims of this study were to engage youths, parents, and frontline community workers in conceptualizing a hospital-based violence prevention intervention and to identify outcomes relevant to the community. Concept mapping is an innovative, mixed-method research approach. It combines structured qualitative processes such as brainstorming and group sorting, with various statistical analyses such as multidimensional scaling and hierarchical clustering, to develop a conceptual framework, and allows for an objective presentation of qualitative data. Concept mapping involves multiple structured steps: 1) brainstorming, 2) sorting, 3) rating, and 4) interpretation. For this study, the first three steps occurred online, and the fourth step occurred during a community meeting. Over 90 participants were involved, including youths, parents, and community youth workers. A two-dimensional point map was created and clusters formed to create a visual display of participant ideas on an ED-based youth violence prevention intervention. Issues related to youth violence prevention that were rated of highest importance and most realistic for hospital involvement included mentorship, the development of youth support groups in the hospital, training doctors and nurses to ask questions about the violent event, and treating youth with respect. Small-group discussions on the various clusters developed job descriptions, a list of essential services, and suggestions on ways to create a more youth-friendly environment in the hospital. A large-group discussion revealed outcomes that participants felt should be measured to determine the success of an intervention program. This study has been the springboard for the development of an ED-based youth violence intervention that is supported by the community and affected youth. Using information generated by youth that is grounded in their experience through participatory research methods is feasible for the development of successful and meaningful youth violence prevention interventions.

A Hospital-Based Violence Prevention Tour: A Collaborative Approach to Empower Youth

Youth violence is a significant problem in the United States with high recidivism rates. Considering these high recidivism rates in youths after an initial injury, we hypothesized a hospital-based violence prevention program aimed at increasing awareness, empowering positive conflict resolution, and promoting future vocational goals would benefit at-risk youth before they are injured. A feasibility study was completed on our Violence and Injury Prevention (VIP) tour program at our urban Level I trauma center. Participants were at-risk youth, aged 11 years to 17 years. Anonymous data were collected using an Audience Response System. One hundred eighty-five students participated from January 2007 to August 2008. Sixty-three percent were 6th to 8th graders, 70% were boys. Seventy-nine percent stated that they knew someone who had been injured or killed because of violence, with significantly more boys than girls (p = 0.05). More boys than girls stated that they have access to a gun (p < 0.05). Almost 60% of the participants stated that they had engaged in violence within the past 6 months, with no difference by gender (p = 0.085). Of the respondents, 84.2% reported an increase in their awareness on the consequences of violence. This was more significant for girls than boys (p < 0.05). Of the participants, 86.3% reported increased understanding of hospital care for a trauma patient. Participants stated that they would recommend VIP to others. VIP educated local urban youth about violence and increased their awareness of the injuries resulting from violence. In addition, at-risk youths were exposed to career opportunities in health care.

An analysis of inner-city students’ attitudes towards violence before and after participation in the “Cradle to Grave” programme

Background Cradle to Grave (C2G), a hospital-based violence prevention programme, brings inner-city youth into an urban Level I trauma centre to follow the path of an adolescent gunshot victim from trauma bay to morgue. We hypothesised that C2G alters student attitudes towards gun violence. Methods Eighty-eight adolescents were prospectively enrolled. With parental and student consent, students completed the Attitudes Towards Guns and Violence Questionnaire (AGVQ), a previously validated and reliable social science assessment tool. Two weeks later, the students participated in C2G. The survey was re-administered four weeks after C2G participation. AGVQ results are reported both as a total score and as a breakdown of the four component subscales. Higher AGVQ scores indicate proclivity towards violence. ANOVA compared scores with respect to demographics and type of school (public vs. charter). Results C2G altered student's attitudes towards guns and violence. Of 43 public school students, total scores decreased following C2G ( p = 0.02). The greatest attitudinal change occurred in subscale 1, “Aggressive Response to Shame” ( p < 0.01). C2G failed to produce significant changes AGVQ scores in the 45 students attending a city charter school. The two groups were found to have baseline differences, with public school students showing higher baseline tendencies towards violence. Conclusions Our hospital-based programme is capable of positively impacting adolescents’ attitudes towards guns and violence. This effect is most pronounced in subjects who already display increased tendencies towards violence. These results suggest that hospitals offer a unique opportunity to address the public health crisis posed by inner-city firearm violence.

Before and After the Trauma Bay: The Prevention of Violent Injury Among Youth

Despite a decline in the incidence of homicide in recent years, the United States retains the highest youth homicide rate among the 26 wealthiest nations. Homicide is the second leading cause of death overall and the leading cause of death for male blacks aged 15 to 24 years. High rates of health care recidivism for violent injury, along with increasing research that demonstrates the effectiveness of violence prevention strategies in other arenas, dictate that physicians recognize violence as a complex preventable health problem and implement violence prevention activities into current practice rather than relegating violence prevention to the criminal justice arena. The emergency department (ED) and trauma center settings in many ways are uniquely positioned for this role. Exposure to firearm violence doubles the probability that a youth will commit violence within 2 years, and research shows that retaliatory injury risk among violent youth victims is 88 times higher than among those who were never exposed to violence. This article reviews the potential role of the ED in the prevention of youth violence, as well as the growing number of ED- and hospital-based violence prevention programs already in place.

A hospital-based violence prevention intervention reduced hospital recidivism for violent injury and arrests for violent crimes

A hospital-based violence prevention intervention reduced hospital recidivism for violent injury and arrests for violent crimes

Hospital-Based Violence Intervention Programs Work

Hospital-based violence prevention programs have emerged at trauma centers nationwide; however, none has been thoroughly evaluated for effectiveness. Our Violence Intervention Program (VIP) conducted a prospective randomized control study to evaluate the effectiveness of intervention for repeat victims of violence. Patients admitted between 1999 and 2001 for treatment of injuries inflicted by a violent act were identified. Repeat victims of violence on parole/probation were invited to join the study. Participants were given a history-gathering questionnaire and randomized into two groups. Cases (intervention [n = 56]) received intensive psychosocial follow-up services, family or group therapy, and assisted with substance abuse treatment. Controls (nonintervention [n = 44]) received standard medical treatment and follow-through in accordance with standard parole or probation procedures. There was no significant difference in the number of arrests in the two groups. The control group was three times more likely to be arrested for a violent crime, two times more likely to be convicted of any crime, and four times more likely to be convicted of a violent crime. The projected time of incarceration is significantly longer for the control group. Repeat violent criminal activity was significantly more evident in the control group. Significant differences exist between the VIP intervention and nonintervention groups in terms of the quantity and severity of criminal activity.

Estimating Hospital Charges Associated With Intimate Violence

The cost of treating intimate violence can be estimated by using data collected by hospital-based programs that identify and document such violence. This article examines previous methods applied to estimate hospital charges associated with violence as well as our own experience using data collected by a hospital-based violence prevention program in Chicago, Illinois. Five basic steps for estimating hospital charges associated with treating intimate violence are described. These steps, and the discussion of difficulties associated with accomplishing them, are to guide researchers in examining hospital costs of intimate violence victims identified by hospital-based violence prevention programs.