Violence Intervention Programs Research Articles

Determining Whether State Policy Is in Line With Substance- and Alcohol-Related Best Practices for Domestic Violence Intervention Programs

Enhancing the effectiveness of Domestic Violence Intervention Programs (DVIPs) is necessary and may require up-to-date state-specific or national guidance. Currently, many U.S. states provide recommendations and requirements for DVIP length, content, and treatment curriculum through one or more of three types of documents: state laws, standards, and/or guidelines. However, these documents are updated irregularly and vary substantially in length, content, enforceability, and authorship expertise (i.e., legislators versus domestic violence [DV] experts and/or DV coalition members). Meanwhile, one robust yet controversial finding is that DV perpetrators with co-occurring substance use conditions have increased difficulty engaging with, sustaining attendance at, and benefiting from standard DVIP treatment (Jewell & Wormith, 2010). Yet, the degree to which state-specific DVIP documents address how perpetrator substance use is to be assessed and treated within DVIPs is understudied. To fill this gap, guiding state documents were obtained as available (n= 47 states; 94%); these were coded with excellent interrater reliability (agreement = 91%). Consistent with research advances, state documents generally encouraged DVIPs to assess perpetrator substance use at intake (n= 41). However, fewer documents directed DVIP facilitators to address the link between substance use and DV within their curriculum (n= 25). Some state documents even prohibited substance use-related messages to be incorporated into the DVIP curriculum (n= 19). Unfortunately, even fewer states’ documents recommended follow-up of the perpetrator’s substance use during DVIP participation or after a substance abuse-related referral (n= 14). Efforts to align DVIP-guiding documents with knowledge related to increasing DVIP treatment effectiveness are necessary as is determining adherence to guiding documents.

A Framework for Understanding Credibility: What Makes Credible Messengers “Credible” in a New York City–Based Sample of Gun Violence Intervention Programs?

The use of credible messengers to deliver violence reduction programs has spread rapidly since it was first used in a criminal justice context by Cure Violence in 1999. However, there is no clear conceptualization of what a credible messenger is, aside from vague definitions contained in the evaluation literature. We provide a “broad strokes” framework for developing a general theory of credibility that might extend from criminal justice across disciplines. The framework also provides the basis for developing a middle theory on credibility within the area of violence intervention. We demonstrate how this might be done, using the theoretical framework to explore a set of 22 interviews with credible messenger staff.

The Potential Impact of Hospital Violence Intervention Programs.

The Potential Impact of Hospital Violence Intervention Programs.

A Multi-site Examination of Relationship Violence Intervention Program Attrition for Male and Female Clients

The current study addresses the paucity of research on relationship violence intervention program (RVIP) attrition examining both male and female clients and risk factors for attrition across gender. Bivariate comparison tests and logistic regression were used to examine gender differences among participants from four RVIPs in Maryland that serve both male and female clients ( n = 1,307). Findings showed significant bivariate differences by gender for 14 of the factors examined. Less than half of clients (48%) completed RVIP, and women were significantly more likely to complete than men. A greater number of factors predicted attrition for male clients, but unemployment was the strongest predictor of attrition for both men and women. Implications for integrating gender-responsive practices into RVIP are discussed.

Factors Associated With Recurrent Pediatric Firearm Injury : A 10-Year Retrospective Cohort Analysis.

Firearm injuries are the leading cause of death among children aged 0 to 17 years in the United States. To examine the factors associated with recurrent firearm injury among children who presented with acute (index) nonfatal firearm injury in the St. Louis region. Multicenter, observational, cohort study. 2 adult and 2 pediatric level I trauma hospitals in St. Louis, Missouri. Pediatric patients aged 0 to 17 years presenting with an index firearm injury between 2010 and 2019. From the St. Louis Region-Wide Hospital-Based Violence Intervention Program Data Repository, we collected data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and mortality. The Social Vulnerability Index was used to characterize the social vulnerability of the census tracts of patients' residences. Analysis included descriptive statistics and time-to-event analyses estimating the cumulative incidence of experiencing a recurrent firearm injury. During the 10-year study period, 1340 children presented with an index firearm injury. Most patients were Black (87%), non-Hispanic (99%), male (84%), and between the ages of 15 and 17 years (67%). The estimated risk for firearm reinjury was 6% at 1 year and 14% at 5 years after initial injury. Male children and those seen at an adult hospital were at increased risk for reinjury. Our data set does not account for injuries occurring outside of the study period and for reinjuries presenting to nonstudy hospitals. Children who experience an initial firearm injury are at high risk for experiencing a recurrent firearm injury. Interventions are needed to reduce reinjury and address inequities in the demographic and clinical profiles within this cohort of children. National Institutes of Health.

A hospital and community-based violence intervention program for Black & Latino youth and their caregivers.

Black and Latino youth are disproportionately affected by trauma from community violence, but to date, few data support the benefit of evidence-based treatments for these youth or of including peer support to engage these youth in mental health services. From 2018 until 2020, a hospital and community-based violence intervention program in Philadelphia pilot tested the integration of home and community-based Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) with peer services and case management for youth impacted by community violence. This study describes the implementation of this intervention. Data was gathered by querying the program's database. The Child Post Traumatic Stress Symptom Severity Scale (CPSS-SR-5) and the Short Mood and Feelings Questionnaire (SMFQ) were utilized to evaluate the participants' pre- and post-intervention assessment of PTSD and depression. The sample (N = 50) consisted of Black and Latino youth, mean age 14. Twenty-nine (58%) completed TF-CBT, and 82% met peer and case management goals. Youth who completed therapy showed significant improvement in both PTSD and depression symptoms at post-test. To our knowledge, this is the first study describing the implementation of home and community-based TF-CBT with peer support and case management. The study's limitations and need for further research are discussed.

Characterizing Pediatric Patients at Risk for Violence-Related Injuries at a Trauma Center in the Midwest United States

Introduction Hospital-based violence intervention programs (HVIPs) have emerged nationwide to help address the societal and economic costs of violence. Little literature exists regarding selecting those patients most likely to benefit from intensive case management. The study aims to describe the pediatric patient population presenting at a Level 1 ACS trauma center with a chief complaint of violent trauma and identify the characteristics of patients most at risk. Methods This retrospective study examined patients between the ages of eight- and nineteen-years old presenting with traumatic injury during the year 2019. Child abuse and non-accidental trauma patients were excluded. Results A total of 333 patients were included in the analysis. They were predominantly African American and male. The three-group design included those 8–11, 12–13, and 14–19 years. Most patients were over 14 years old (60.2%). “Classmates” was the most common relationship between assailant and victim overall (33.9%) and most prevalent in the youngest age group (8–11 year). The middle age group (12–13 year) were two times more likely to suffer from ADHD, and ADHD was a risk factor for self-harm in this age category. The oldest age group (14–19 year) suffered higher rates of gun violence and were attacked more often by unknown assailants. Conclusions There was a difference in the needs of the older and younger pediatric patients cared for. HVIPs should tailor their interventions to address the different age groups’ needs. HVIPs could also benefit from the integration of targeted mental health services and collaboration with local educational institutions.

Personal goals of young survivors of violent injury: implications for practice

IntroductionFirearm injuries are the leading cause of death among young people in the USA and disproportionately impact communities of colour and those experiencing socioeconomic distress. Understanding the personal goals of...

Machine learning classification of new firearm injury encounters in the St Louis region: 2010-2020.

To improve firearm injury encounter classification (new vs follow-up) using machine learning (ML) and compare our ML model to other common approaches. This retrospective study used data from the St Louis region-wide hospital-based violence intervention program data repository (2010-2020). We randomly selected 500 patients with a firearm injury diagnosis for inclusion, with 808 total firearm injury encounters split (70/30) for training and testing. We trained a least absolute shrinkage and selection operator (LASSO) regression model with the following predictors: admission type, time between firearm injury visits, number of prior firearm injury emergency department (ED) visits, encounter type (ED or other), and diagnostic codes. Our gold standard for new firearm injury encounter classification was manual chart review. We then used our test data to compare the performance of our ML model to other commonly used approaches (proxy measures of ED visits and time between firearm injury encounters, and diagnostic code encounter type designation [initial vs subsequent or sequela]). Performance metrics included area under the curve (AUC), sensitivity, and specificity with 95% confidence intervals (CIs). The ML model had excellent discrimination (0.92, 0.88-0.96) with high sensitivity (0.95, 0.90-0.98) and specificity (0.89, 0.81-0.95). AUC was significantly higher than time-based outcomes, sensitivity was slightly (but not significantly) lower than other approaches, and specificity was higher than all other methods. ML successfully delineated new firearm injury encounters, outperforming other approaches in ruling out encounters for follow-up. ML can be used to identify new firearm injury encounters and may be particularly useful in studies assessing re-injuries.

Keeping Safe Together: A Brief Report on Children’s Experiences of One ‘All of Family’ Domestic Violence Intervention Program in Melbourne, Australia

Abstract Purpose To develop a response to an identified service gap for domestic violence (DV) victim-survivors who are living with their abusive partner and have children in their care, Keeping Safe Together (KST) was designed as an ‘all of family’ program and piloted over 18-months in Victoria, Australia. The purpose of this brief report is to explore how children had experienced the KST program, and what, if any, changes to their safety and situations they experienced because of the program. Methods Interviews were conducted with eight children engaged in the program alongside their family members. Thematic analysis of the data was undertaken to draw out themes. Results The children were aware of the impact of the violence and conflict on their families. They demonstrated strong empathy for their family members’ wellbeing, and a desire for change. The children saw the KST program as having a positive impact on their own and their families’ safety and circumstances, particularly in terms of reducing their fathers’ abusive behaviors. The program supported them to increase their own sense of control, happiness, and development of coping strategies. Conclusions The findings indicate that the program met a significant support gap and improved the lives of children in this sample who were living with fathers using violence against their mothers. Further trial and evaluation of ‘all of family’ programs such as KST is needed to build the evidence base on their effectiveness for children.

Identifying mental health outcomes and evidence-based psychological interventions for supporting pediatric gunshot wound patients: A systematic review and proposed conceptual model

BackgroundAccidental and assault gunshot wounds (GSWs) are the second leading cause of injury in the United States for youth ages 1- to 17-years-old, resulting in significant negative effects on pediatric patients’ mental health functioning. Despite the critical implications of GSWs, there has yet to be a systematic review synthesizing trends in mental health outcomes for pediatric patients; a gap the present review fills. Additionally, this review identifies evidence-based psychological interventions shown to be effective in the treatment of subclinical symptoms of psychological disorders in the general population.MethodsA comprehensive search was conducted using five databases: American Psychological Association (APA) PsycInfo, APA PsycArticles, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resource Information Center (ERIC), and Medical Literature Analysis and Retrieval Systems Online (MEDLINE). Twenty-two articles met inclusion criteria.ResultsFindings suggest pediatric GSW patients are at a significantly elevated risk for mental health disorders when compared to other- (e.g., motor vehicle collision) and non-injured youth. Disorders include post-traumatic stress, disruptive behavior, anxiety, depression, and substance use. Hospital-based violence intervention programs, cultivating supportive relationships with adults in one’s community, and trauma-focused outpatient services were identified as effective interventions for treating subclinical psychological symptoms.ConclusionsDepicted in the proposed conceptual model, the present study delineates a direct association between pediatric GSWs and subsequent onset of mental health disorders. This relation is buffered by evidence-based psychological interventions targeting subclinical symptoms. Results suggest brief psychological interventions can help treat mental health challenges, minimizing risk for significant long-term concerns. Cultural adaptations to enhance the utility and accessibility of interventions for all patients are recommended.

Empowering Victims of Lived Violence: Delaware's Hospital Violence Intervention Program (HVIP).

Hospital Violence Intervention Programs (HVIP) are increasingly implemented across a variety of healthcare-associated contexts to prevent and address violent intentional injury. We describe the establishment of a health system funded HVIP in Delaware and the direct experiences of staff and violence-specialized Community Health Workers.

“I am a survivor!”: Violently Injured Black Men’s Perceptions of Labeling After a Violent Firearm Injury

Self-appraisal after a life-altering event is a critical process for individuals, often comprised by assigned labels that may not align with an individuals’ perceptions of themselves or of their situation. Existing research within this victim-survivor dichotomy largely rests in the interpersonal violence space, with a victim assuming legal recourse and wrongdoing, and a survivor associating with positive personal characteristics like grit and resilience. Much existing literature on self-appraisal after interpersonal injury is heavily concentrated within the sexual violence literature, and this study applies these concepts to a sample of Black men injured by firearms. Ten Black men enrolled in a hospital-based violence intervention program (HVIP) were interviewed to understand how they label their experience of firearm injury, and if their perceptions aligned with common labels seen among other populations and/or in other areas of study (e.g., cancer, domestic violence). Each participant assigned themselves their own label, with three labels emerging: survivor, victim and survivor, and neither victim nor survivor. The results illustrate the nuance of experiences beyond the victim-survivor dichotomy, and how labels and personal identities may shift following injury into new terms and considerations of resilience and trauma processing. More research is warranted to understand the factors that shape self-labeling within this population, including influences of masculine norms, racialized stereotypes, community context, and availability of services. Findings support public awareness campaigns to reframe surviving violence as a strength, and for community partners and practitioners to increase access to culturally competent and trauma-informed mental healthcare.

Hospital Based Violence Intervention Programs Using Peer Support Specialists: A Concise Review.

Interpersonal violence remains a significant public health problem in the United States. The toll of violence has spurred the development of hospital-based violence intervention programs that use peer support specialists or navigators. Yet, their effectiveness remains uncertain. This study aims to concisely review the recent literature on the effectiveness of hospital-based violence intervention programs using the peer support specialist role. A systematic search of articles from PubMed, OVID, and Google Scholar was performed for this review. Peer reviewed studies addressing hospital-based violence intervention programs using peer support specialists between 2017 and 2022 were selected. Key data points were extracted and analyzed by consensus of the authors. Eight of the 232 studies reviewed met eligibility requirements. Across these studies, the recidivism rate was reduced between 43% and 95% in victims participating in hospital-based violence intervention programs with peer support specialists. The peer support specialist (navigator) role is central to the success of the violence intervention programs. This role guides and coordinates health services for victims of violence, extending after discharge into the community. Programs showed the most success with helping victims reach short-term goals focused on immediate basic needs but are more challenged meeting longer-term goals, such as education or relocation. This review reveals that hospital-based violence intervention programs using peer support specialists (navigators) lead to the achievement of meeting victim goals and reduce recidivism rates.

Regionalization of Hospital-based Violence Intervention Programs: One Trauma Center Cannot Do It Alone

Regionalization of Hospital-based Violence Intervention Programs: One Trauma Center Cannot Do It Alone

Assessing primary health care provider and organization readiness to address family violence in Alberta, Canada: development of a Delphi consensus readiness tool

BackgroundFamily violence, which includes intimate partner abuse, child abuse, and elder abuse, is a serious public health concern. Primary healthcare (PHC) offers a vital opportunity to identify and address family violence, yet barriers prevent the effective implementation of family violence interventions in PHC settings. The purpose of this study is to improve family violence identification and response in Alberta’s PHC settings by exploring readiness factors.MethodsAn integrated knowledge translation approach, combining implementation science and participatory action research, was employed to develop a readiness assessment tool for addressing family violence within PHC settings in Alberta. The research involved three phases: phase 1 involved a rapid evidence assessment, phase 2 engaged a panel of healthcare and family violence experts to explore readiness components in the Alberta context, and phase 3 utilized a 3-round Delphi consensus-building process to refine readiness indicators.ResultsPhase 1 findings from a rapid evidence assessment highlighted five main models/tools for assessing readiness to implement family violence interventions in PHC settings. In phase 2, additional concepts were identified through exploration with healthcare and family violence expert panel members, resulting in a total of 16 concepts for assessing family violence readiness within the Alberta PHC context. The 3-round Delphi consensus-building process in Phase 3 involved nine panelists, who collectively agreed on the inclusion of all concepts and indicators, yielding a total of 60 items for the proposed readiness assessment tool for addressing family violence in PHC within Alberta.ConclusionThe current study lays the groundwork for future family violence intervention programs, offering insights into key components that promote readiness for implementing comprehensive programs and supporting PHC organizations in effectively addressing family violence.

Examining adverse childhood experiences and Black youth's engagement in a hospital-based violence intervention program using administrative data.

Stemming from poverty and systemic racism, Black youth are disproportionately represented in hospital-based violence intervention programs (HVIPs) due to greater violence exposure. HVIPs are a critical intervention that have been shown to reduce rates of reinjury in urban hospitals and trauma centers across the United States; however, they are plagued by low enrollment and engagement rates. Few studies have examined factors related to engagement, particularly among Black youth. Guided by Trauma Theory and Critical Race Theory, this study uses a retrospective cohort design. Between-group differences of adverse childhood experiences (ACEs) among engaged youth compared to nonengaged youth who were violently injured and recruited for a HVIP were examined using chi-square and logistic regression. ACEs were approximated using a novel approach with administrative data. Results indicated that the total ACE score was not significantly associated with engagement status. Individual ACEs were tested across age groups. This study highlights a novel approach to understanding ACEs among a hard-to-reach population and illuminates the significant level of ACEs faced by violence-exposed Black youth at young ages. Considering theory, Black families may be more reluctant to engage due to fear and past harms in social service systems stemming from systemic racism. Though ACEs did not predict engagement in this study, considering the high rates of ACEs experienced by Black youth and their families in the context of systemic racism suggests that HVIPs should acknowledge historical harms and foster trauma-informed and healing-centered interactions during recruitment and later stages of engagement.

Qualitative study of factors affecting engagement with a hospital-based violence intervention programme in Indianapolis, Indiana

BackgroundThere are few qualitative studies of firearm injury survivors and hospital-based violence intervention programme (HVIP) participants. The original study aimed to identify facilitators and barriers to survivors’ utilisation of mental...

Codeveloping theories of change for improved community-based violence intervention evaluation.

Community-based violence intervention (CVI) programs are considered important strategies for preventing community violence and promoting health and safety. Mixed and inconclusive results from some prior CVI evaluations, as well as our general lack of understanding about the reasons for such varied findings, may be explained in part by misalignment of program theories of change and evaluation measures. Furthermore, most prior evaluations have focused solely on deficit-based outcomes; this narrow focus is inconsistent with the premise of CVI and may fail to capture improvements in health and well-being that are on the hypothesized pathway from intervention to violence reduction. This article describes the process and results of codeveloping a theory of change for community-based youth firearm violence intervention and prevention programs in Washington state through a community-researcher partnership. We followed a multistep iterative process, involving (1) CVI program documentation review, (2) individual meetings, and (3) a day-long workshop. The theory of change included six key domains: (1) root causes, (2) promotive factors, (3) activities, (4) intermediate outcomes, (5) longer-term outcomes, and (6) multilevel context (youth/family, staff/organizational, community, and societal). Root causes were social and structural drivers of community violence. Promotive factors were assets and resources among the community, youth/their families, and community organizations that promote health and safety. Activities were supports and services the program provided to youth and their families, staff, and, potentially, the broader community. Intermediate and longer-term outcomes were the changes among youth, their families, staff, and the community that resulted from program activities. Intermediate outcomes may be felt within 6 months to 1 year, and longer-term outcomes may be felt after 1 to 2 years and beyond. The theory of change we codeveloped provides a common lens to conceptualize, compare, and evaluate CVI programs in Washington state and may support more rigorous and equity-centered evaluations. Diagnostic Test/Criteria; Level V.

Integration of medical legal services into a hospital-based violence intervention program: A survey and interview-based provider needs assessment.

Violent injury among trauma surgery patients is strongly associated with exposure to harmful social determinants of health and negative long-term health outcomes. Medical-legal partnerships in other settings successfully provide patients with legal services to address similar health-harming legal needs and may offer a promising model for the care of violently injured patients. An electronic survey tool was distributed to clinicians and staff affiliated with the hospital-based violence intervention program at a single urban level one trauma center. Semistructured follow-up interviews were conducted with participants, and interviews were coded using thematic analysis and grounded theory. Participants reported many health-harming legal needs among their violently injured patients. The most commonly identified needs were: health insurance denials (62.5%); difficulty accessing crime victims compensation funds (56.3%); trouble accessing official documents (50%); and problems with non-SSDI public benefits (50%). Participants reported inconsistent methods for learning about and responding to patients' health-harming legal needs. The most common barriers to addressing these needs included the following: lack of awareness that a lawyer could help with the issue (68.8%); prioritization of other needs (68.8%); previous negative legal experiences (62.5%); and cost (62.5%). Identified needs encompass issues traditionally addressed by MLPs as well as more novel challenges faced by violent injury survivors. This survey and interview-based study identifies complex health-harming legal needs present among violently injured trauma surgery patients. Medical-legal partnerships specially designed for the setting of violent injury appear well-suited to meet these needs, potentially reducing risk of violent reinjury, long-term negative health outcomes, and health care system costs. Prognostic and Epidemiological; Level IV.