Violence Intervention Programs Research Articles

Women's Formal Help-Seeking Before and After Their Abusive Partner Initiates Relationship Violence Treatment.

Intimate partner violence survivors (N = 122) reported on formal help-seeking before and after their male partners enrolled in a Relationship Violence Intervention Program (RVIP). At baseline, only 20% of survivors had ever received domestic abuse (DA) counseling. DA counseling was more common among survivors with more extensive partner abuse exposures, and for black women residing in suburban versus urban communities. New help-seeking was associated with survivor perceptions of the abusive partner's stage of change. RVIP impact may be enhanced through culturally sensitive survivor outreach that is responsive to a broad range of needs and includes repeated contact over time.

Racial and Ethnic Disparities in Violent Penetrating Injuries and Long-Term Adverse Outcomes.

Violent injury is known to be a chronic, recurrent issue, with high rates of recidivism following initial injury. While the burden of violence is disproportionately felt among young Black men and in communities of color, examination of distinct risk factors and long-term outcomes for other racial and ethnic groups could lead to improved violence intervention strategies. In this study, we examined the risk of violent penetrating injury and long-term adverse outcomes by race and ethnicity. This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a violent penetrating injury between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) for the risk of all-cause mortality and violent re-injury at one and 3years after surviving a penetrating injury.Of the 4191 victims of violent injury, 12% were White, 18% were Hispanic, and the remaining 70% self-identified as Black. Within 3years after initial injury, Black patients were at the greatest risk of all-cause violent re-injury (vs. Hispanic: HR = 1.46, 95%CI[1.15,1.85], p = 0.002; vs. White: HR = 1.89, 95%CI[1.40,2.57], p < 0.0001), particularly by gunshot wound (vs. Hispanic: HR = 2.04, 95%CI[1.29,3.22] p = 0.002; vs. White: HR = 2.34, 95%CI[1.19,4.60], p = 0.01). At 3-years following initial injury, White patients were at 2.03 times the risk for all-cause mortality, likely due to a 4.96 times greater risk of death by drug or alcohol overdose for White patients compared to Black patients (HR = 4.96, 95%CI[2.25,10.96], p < 0.0001). In conclusion, Black survivors of violent injury have a significantly higher risk of violent re-injury, particularly by gun violence, while White patients are at the highest risk for mortality due to the incidence of drug and alcohol overdose. Violence intervention programs with similar patient populations should explore options to collaborate with drug treatment programs to reach this vulnerable population.

Implementation of a Novel Home Visiting Nurse Pilot Program for Victims of Violent Penetrating Injury.

Survivors of violent injuries are at risk for readmission, rehospitalization, and reinjury. In 2017, a novel home visiting nurse pilot program was implemented within a hospital-based violence intervention program (HVIP) to address disparities in care and combat the limited health care literacy and access, and the general mistrust of health care institutions among much of this population. The purpose of this study was to review the design and implementation of the home visiting nurse component of the HVIP and to report the demographics, clinical characteristics, home care needs, and short-term health outcomes of the pilot sample. This retrospective study was performed using a cohort of patients presenting to the emergency department at an urban, Level I trauma center for a violent penetrating injury between 2017 and 2018. The χ2 and Wilcoxon rank sum tests were used to compare patient demographics and injury characteristics. Cox proportional hazards regression models were used to estimate health outcomes. Of the 742 victims of violence included in this analysis, the 57 patients enrolled in the home visiting nurse pilot program were more likely to have severe gunshot wounds (68.4% vs. 40.3%, p < .001) requiring hospitalization (80.7% vs. 53.3%, p < .001), with 3.5% requiring rehospitalization within 90 days. The primary interventions provided by the home visiting nurse involved medical navigation and education, wound care, and consultation, underscoring the critical importance of health literacy and outreach for this vulnerable population. The nurse-advocate partnership provides the foundation for this novel program to aid a marginalized population in overcoming health inequities.

Characteristics of Adult Patients for Violence-Related Injuries Presenting to a Level 1 Trauma Center in Midwest United States

Background Hospital violence intervention programs (HVIPs) have recently been initiated in trauma centers across the United States. However, violence-related injuries have unique factors and issues that should be addressed in the health care provided in emergency departments. Purpose This study aimed to characterize the patient population presenting at a level 1 ACS verified trauma center, with a chief complaint of violent trauma, and identify characteristics of patients most at risk for violence-related trauma. Methods The cross-sectional retrospective study examined patients’ electronic health records, at least 18 years, with a diagnosis of blunt or penetrating injury treated by the emergency and trauma team at level 1 ACS verified trauma center in the Midwest. Results Assault injuries accounted for most of the mechanisms that required treatment at the hospital and disposed to home. Nearly 80% of the population had no documentation of the relationship of the assailant. The average age of the patients was 33 years and black males. Eleven patients were treated in the emergency department twice for a trauma-related injury during the six-month data collection. Conclusion Injuries from violence require comprehensive care from various healthcare disciplines, similar to managing acute and chronic illnesses. The American College of Surgeons (ACS) guidelines support the development of an HVIP to identify risk factors and treatment plans for any patient exposed to violence. This research demonstrates that HVIPs should provide standardized screening and follow-up care while in the emergency department or immediately following the hospital to reduce the cyclical events.

Firearm Injury and Mortality Prevention in Pediatric Health-care Settings.

Firearm Injury and Mortality Prevention in Pediatric Health-care Settings.

Use of an Electronic Referral Application to Address Post-Injury Needs of Victims of Firearm Injury in a Hospital-Based Violence Intervention Program.

Wraparound referrals are a cornerstone of hospital-based violence intervention programs, which have proven to be an effective public health approach for mitigating violence and recidivism. We hypothesized that replacing a manual referral process with an electronic referral application would increase the number of generated referrals and improve compliance with follow-up visits. The population for this single center quantitative study was a convenience sample of firearm-injured patients. Data from 74 patients were collected using the electronic health record, the electronic referral application, and the trauma registry before and after the intervention. Post-implementation of the electronic referral application showed an increased number of generated referrals, increased emergency department and inpatient utilization of trauma recovery center services, and an increase in second follow-up visit compliance. This study demonstrated an increase in the number of referrals and greater likelihood of completion of post-injury follow-up visits after implementing the electronic referral system.

Epidemiology of Firearm Injury in Children at US Trauma Centers

Epidemiology of Firearm Injury in Children at US Trauma Centers

Sexual Violence Against Women With Disabilities: Experiences With Force and Lifetime Risk

Emerging research suggests that people with disabilities experience an increased risk of sexual violence. However, few studies have examined the relationship between disability types and various forms of sexual violence, involving either physical or nonphysical force. This cross-sectional study used nationally representative data from years 2011-2017 of the National Survey of Family Growth among women aged 18-44 years. Analyses were conducted in March 2020-June 2021. Using binary and multinomial logistic regression models, lifetime risk of sexual violence and experience of physical or nonphysical force at first intercourse were modeled as a function of disability type (sensory, physical, cognitive, or ≥2 disabilities). Models also controlled for relevant demographic confounders. Women with any type of disability reported experiencing sexual violence in their lifetime approximately double the proportion of that experienced by nondisabled women (∼30% vs 16.9%), with women with multiple disabilities experiencing the greatest prevalence (42.1%) and risk (AOR=2.94, p<0.001) than nondisabled women. Women with cognitive disabilities or multiple disabilities were significantly more likely to experience either physical (cognitive: AOR=1.55, p<0.001; multiple: AOR=1.50, p<0.05) or nonphysical force (cognitive: AOR=2.28, p<0.01; multiple: AOR=2.74, p<0.001) during their first intercourse than nondisabled women. Results of this study suggest that future research should focus on the association between various types of disability and sexual violence. The development of inclusive evidence-based violence intervention and prevention programs for girls and women with disabilities is recommended.

The Persistent Effect of Violent Trauma on Urban Communities 25 Years After Tupac Shakur's Murder.

The Persistent Effect of Violent Trauma on Urban Communities 25 Years After Tupac Shakur's Murder.

"Isn't There Any Other Way than Calling the Cops?": How Differences in Initiation of Police Intervention Influence Survivor Safety.

As formal crisis responders, police are trained in de-escalation tactics that are expected to mitigate intimate partner violence and promote survivor safety. However, the alignment between expected and actual practice of police intervention varies, especially when the survivor does not initiate the call, police treat the survivor poorly, or provide an undesirable arrest outcome. At best, unsuccessful interventions do not change survivors' risk level, and at worse, elevate their risk of experiencing harm. The purpose of this qualitative study was to explore survivors' perspectives on the process of police intervention, specifically how variations in initiation, quality of engagement, and arrest influence survivors' safety. Twenty-four women whose partners were in a relationship violence intervention program were recruited to participate in the study. Results showed that many survivors described a range of ongoing, strategic violence perpetrated by their partners that required intervention; yet the complex nature of the violence often extended beyond police capacity. Either survivors called the police, or they were initiated externally by neighbors or strangers; some survivors had dual initiations. Whether survivors reported that police used safety practices during the intervention was related to who initiated the police. Arrests of abusive partners were inconsistent, and they varied based on number of previous calls to the police and visible signs of injury. Survivors of color, specifically Black women, self-initiated at higher rates, experienced fewer safety strategies used by police, and had fewer arrests. No matter the outcomes of police intervention, survivors actively engaged in strategies outside of formal systems to protect themselves and their families. Study results imply that police intervention may be ill-suited to support survivors' safety goals and highlight a need for alternative interventions focused on de-escalation and prevention.

A Collaborative Approach to Safety, Equity, and Fairness by Medical Staff, Graduate Medical Education, Human Resources, and Law Enforcement.

A Collaborative Approach to Safety, Equity, and Fairness by Medical Staff, Graduate Medical Education, Human Resources, and Law Enforcement.

States should use Medicaid to support violence intervention efforts.

In recent years, calls to address gun violence through public health approaches have increased. However, securing funding for health-based community violence intervention models has remained a challenge. New actions suggest that this may be shifting. Upon taking office, the Biden administration announced a series of funding opportunities for these programs, which ranged from competitive grant programs to a proposed 8-year, $5 billion plan. Less publicized, but just as important, is the administration's announcement that Medicaid can be used to reimburse this work, specifically noting the eligibility of hospital-based violence intervention and prevention programs. For these programs, this creates a predictable and reliable funding source that has not existed to date. This integration of violence prevention programming in the traditional health care and financing systems represents a critical inflection point in the United States' shifting response to community violence. However, the decision to use this optional benefit lies with each state. States should strongly consider harnessing Medicaid as a wise investment to address the United States' gun violence epidemic. Economic and value-based evaluation, level IV.

Shook Ones: Understanding the Intersection of Nonfatal Violent Firearm Injury, Incarceration, and Traumatic Stress Among Young Black Men

Violent injury is a leading cause of death and disability among young Black men, with the highest rates occurring in low-income urban populations. Hospital-based violence intervention programs (HVIPs) offer a promising opportunity to address the biopsychosocial factors that adversely affect this population. However, there are major gaps between the needs of young Black male survivors of violent injury and the forms of care provided by HVIPs. Patient-centered outcomes research provides a useful mode of inquiry to develop strategies to decrease these differences. Care for survivors, including treatment for traumatic stress disorders, must be reconceptualized to center the lived experiences of young Black men. This paper qualitatively explores how these survivors of gun violence express symptoms of traumatic stress and the ways in which their narratives can inform the implementation of the biopsychosocial model in HVIPs. A phenomenological variant ecological systems theory framework was used to analyze participant narratives to aid in understanding their symptoms of traumatic stress and post-injury affective changes as both psychologically and socially important experiences. Such insight may inform changes to HVIP practice to address persistent health disparities related to violence.

Integration of Civil Legal Services into Hospital-Based Violence Intervention Programs

Integration of Civil Legal Services into Hospital-Based Violence Intervention Programs

Bursting bubbles: outcomes of an intergroup contact intervention within the context of a community based violence intervention program

ABSTRACT Intergroup contact theory has received much quantitative support. However few efforts have attempted to apply qualitative methodologies to understand the perceptions of individuals who experience these contacts. we conducted 19 interviews to explore the perceptions of stakeholders of a community-based fitness program whose goal was to increase intergroup contact among its stakeholders. Participants reflected on the program reducing their social isolation, increasing opportunities for engagement outside one’s own group, and expanded world views.

143EMF Acute and Recurrent Firearm Injury Rates Among Patients Presenting to St. Louis Level I Trauma Hospitals from 2010-2019

Firearm violence is the leading causes of homicide in the United States, and is the third leading cause of death for adults aged 15-34. Longitudinal, linked data on firearm injuries is needed to permit more nuanced research and interventions for survivors of a firearm injury. State-wide trauma registries do not reliably capture patients who are discharged directly from the ED without a trauma service evaluation. The St. Louis Hospital-based Violence Intervention Program Data Repository (STL-HVIP-DR) launched in 2018.

Implementation of programming for survivors of violence-related trauma at a level 1 trauma center

BackgroundPrior investigation of violence intervention programs has been limited. This study will describe resources offered by Victims of Crime Advocacy and Recovery Program (VOCARP), their utilization, and effect on recidivism.MethodsVOCARP...

Assessing improvements in emergency department referrals to a hospital-based violence intervention program

BackgroundYouth violence is a major public health concern in the United States. Hospital-based Violence Intervention Programs (HVIPs) are integral in connecting youth sustaining interpersonal violence-related injuries to medical, mental health, and social services. At our pediatric emergency department, our baseline referral rate to the established HVIP was 32.5%. From November 2018–2019, we aimed to increase the percent of eligible patients referred to our HVIP from 32.5 to 70% for patients aged 7–18 years who present to our Level 1 emergency department/trauma center with a violent injury.MethodsFor this quality improvement project, we recorded key aspects of the referral process, such as patient eligibility, who placed referrals, and when referrals were placed in relation to the ED admission. Key stakeholders were interviewed to identify specific interventions. Our key interventions were: 1. Educating providers on eligibility requirements. 2. Encouraging nurses to enter consults at the time of admission. 3. Publishing information about program referrals in the weekly nursing newsletter. 4. Updating social workers on eligibility requirements for the HVIP. We used PDSA cycles to inform our project. Our primary outcome measure was the number of eligible patients referred to our HVIP and measures were analyzed using statistical process control charts.ResultsThe HVIP-eligible population had the following demographics: 31.1% female and a mean age 14.3 ± 2.7, 82.6% assaults and 17.4% gunshot wounds. From 11/2018 to 11/2019, there were 78 referrals to the HVIP, out of 167 eligible patients. The referral rate improved from 32.5% pre-interventions to 61.1% post-interventions, showing an 88% increase.Conclusion(s)We noted an increase in referrals to our HVIP following our interventions that centered on educating, advertising, and encouraging. Future studies will focus on analyzing other aspects of the enrollment process, such as obtaining patient consent.

Trauma-Informed Acute Care of Patients With Violence-Related Injury.

Violently-injured individuals presenting to the emergency department (ED) have an elevated risk of repeat injury after being discharged from acute care settings and a high rate of unaddressed mental health and social needs. While there is a growing body of programmatic interventions to address these needs, including hospital-based violence intervention programs, there is a lack of data regarding physician perspectives of current practice for this patient population. Understanding current practice is critical for integrating new programs into workflow and developing evidence-based medical education to improve care. The aim of this study is to elucidate current trauma-informed care practices of emergency medicine and general surgery trainee physicians to inform future curriculum development surrounding care of violently injured patients. In this study, emergency medicine and surgical trainees with at least one year of residency experience participated in simulation-primed interviews in pairs or small groups. Interviews garnered perspectives on the physician role in treating violently injured youth, using simulation as a priming event focused on previously known patient concerns. Qualitative themes that emerged were participants (1) perceived their role as managing medical/surgical concerns and seek others to build trust and manage psychosocial and legal concerns, (2) had a high level of knowledge of ED stressors and de-escalation strategies, (3) perceived that patient distrust can negatively impact their ability to provide care, and (4) perceived that law enforcement can negatively impact care and are sometimes uncertain about how to interact with law enforcement. These findings support that medical education for providers should focus on medicolegal issues, particularly managing law enforcement presence in the ED, structural and interpersonal causes of distrust of medical providers and the medical system, and addressing postdischarge mental health and social needs.

Understanding the makeup of a growing field: A committee on trauma survey of the national network of hospital-based violence intervention programs

BackgroundAmong Hospital Based Violence Intervention programs (HVIPs), little is known about variation in services provided, funding sources, or populations served. Study designTwenty-eight member programs of Health Alliance for Violence Intervention participated in a survey administered by the American College of Surgeons Committee on Trauma. Questions were quantitative and qualitative. For qualitative analysis, questions pertaining to the domains were assessed for common themes and assessed across all subject domains. ResultsAll programs enroll patients injured by community violence, some by intimate partner violence (IPV), trafficking, and rarely by child or elder abuse. Programs with more funding (≥$300,000 per year) were more likely federally, state, or city funded. Lower funded programs (≤$300,000 per year) were funded by foundations or philanthropy. In both qualitative and quantitative analysis, barriers to starting or sustaining HVIPs included funding, and lack of risk reduction and mental health resources. Successful programs had stable funding, adequate staffing, and buy in from hospitals and staff. ConclusionHVIPs serve diverse populations in variable models. There is opportunity to expand the reach of HVIPs, and the experience if existing programs is an invaluable resource.