Violence Intervention Programs Research Articles

Training Hospital Personnel in Trauma-Informed Care: Assessing an Interprofessional Workshop With Patients as Teachers.

Trauma-informed care (TIC) and violence intervention programs (VIPs) facilitate psychosocial healing and reduce injury recidivism for children and families affected by community violence. To integrate a VIP into 2 Level 1 Pediatric Trauma Centers, an educational initiative was developed and co-taught by pediatricians and former patients. The primary aim was to increase provider-driven patient referrals to the VIP. A secondary aim was to improve all participants' comfort levels in 5 areas of TIC. Referrals to the VIP from 2014 to 2018 were tracked and analyzed. A curriculum based on Five Points of TIC was developed and offered to interprofessional groups of hospital employees. Pediatricians and former patients recovering from violent injury facilitated the workshops. Twenty-two workshops were attended by 318 providers and hospital staff members from 2015 to 2018. Pre- and postworkshop surveys asked participants to rate their comfort levels with 5 areas of TIC. Provider-driven patient identification increased from 34.8% to 86.8% over the study period. For the entire cohort, participants' self-assessment of comfort levels with TIC improved by 21% (P < .001), with medical students' scores improving the most (24%). Residents were less likely to complete the workshop than fellows or attendings (P=.03). This novel curriculum was associated with a change in practice patterns, as well as a closer relationship between the VIP and pediatric hospital systems. All professional groups experienced an improvement in comfort levels with the Five Points of TIC. Future study on information retention and other patient care-related outcomes is needed.

Reducing intimate partner violence: a pilot evaluation of an intervention program

The current study describes a 20-week community-based intimate partner violence (IPV) intervention program delivered in British Columbia, Canada, and provides a preliminary evaluation of program impacts. The Men in Healthy Relationships program targets men who have perpetrated IPV and who voluntarily choose to participate in a program to learn healthy intimate partner relationship strategies. The intervention was evaluated across three program cycles in a pretest–posttest single group design, with a total of 46 participants enrolled. Twenty-eight men completed the pretest survey; analyses focus on the subset of 17 participants who reported having a current intimate partner and who completed the Abusive Behavior Inventory, and the 14–21 participants who completed pretest and posttest questions regarding knowledge and skills learned in the program. Results from the pilot evaluation suggest that the Men in Healthy Relationships program is a promising approach to decreasing abusive behavior, with participants showing significant decreases in both physical and psychological abuse. In addition, participants increased their knowledge and use of calming techniques and “time-outs” to reduce feelings of anger. Limitations and future research are discussed, along with implications for IPV intervention programing for voluntary participants.

Predictive Validity of Minnesota Multiphasic Personality Inventory-2-Restructured Form Scale Scores in an Intimate Partner Violence Intervention Program

Intimate partner violence intervention programs (IPVIPs) are intended to rehabilitate individuals charged with intimate partner violence (IPV) offenses, but these programs evidence high rates of treatment dismissal and recidivism. Applying the risk-needs-responsivity framework to improve IPVIP effectiveness has been suggested, and the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) may be used to inform risk estimates in this context. Past research has evaluated MMPI-2-RF Restructured Clinical scale scores in an IPVIP setting, but the remaining MMPI-2-RF substantive scales have yet to be evaluated. We tested the predictive validity of conceptually relevant MMPI-2-RF Higher-Order, Specific Problems, and Personality Psychopathology Five scale scores among a large sample of men who were court-mandated to treatment. Hierarchical logistic regression analyses indicated that several MMPI-2-RF scores incremented predictions of treatment dismissal and various recidivism variables beyond intake variables. Relative risk ratio analyses demonstrated promising utility of the measure in IPVIP settings.

The conditional association of problematic drinking with suicidal ideation by alcohol expectancies

PurposeTheory has identified alcohol expectancies as a facilitating factor in the association between problematic drinking and suicidal ideation. In the first test of this question, we explored whether the impact of problematic drinking on suicidal ideation depended on alcohol expectancies. MethodsWe conducted a secondary analysis of cross-sectional, observational, survey data from a convenience sample of 444 individuals court-ordered to domestic violence intervention programs (69.5% non-Hispanic White; 78.6% Male-identified; Mage = 32.53, SDage = 10.10). ResultsParallel analysis and exploratory factor analysis revealed a three-factor structure of the Effects of Drinking Alcohol Scale, including alcohol expectancies related to 1) disinhibition and negative mood, 2) positive mood, and 3) physical and cognitive effects. Multiple linear regression employing bootstrapping procedures tested the moderating effects of these expectancies on the association between problematic drinking and suicidal ideation, while controlling for gender and depressive symptoms. Problematic drinking was negatively associated with suicidal ideation at low levels of disinhibition and negative mood expectancies, and this association became more positive as these expectancies increased. Problematic drinking was negatively associated with suicidal ideation at high levels of positive mood and became more positive as these expectancies decreased. DiscussionThese preliminary findings suggest that expectancies related to the mood-altering and disinhibiting effects of alcohol may play a role in whether problematic drinking facilitates suicidal thinking. Future intensive longitudinal designs are needed to test whether this moderation is replicated during periods of acute alcohol intoxication and when other psychiatric symptoms are controlled.

Identifying participants for inclusion in hospital-based violence intervention: An analysis of 18 years of urban firearm recidivism.

Identifying individuals at highest risk maximizes efficacy of prevention programs in decreasing recidivist gunshot wound (GSW) injury. Characteristics of GSW recidivists may identify this population. Hospital-based violence intervention programs (HVIPs) are one effective strategy; however, programs are expensive, therefore, when possible, epidemiologic data should guide inclusion criteria. Seventeen years of all GSW patients presenting to an urban Level I trauma center were reviewed. Countywide murders were reviewed from the same timeframe. Recidivists were any patient presenting twice, either to the hospital or once to the hospital and subsequently dying by firearm. Demographics and characteristics of future recidivists were compared with nonfuture recidivists. There were 9,699 unique intentional, GSW cases reviewed and 1,426 died, leaving 8,273 at risk of recidivism. Five hundred fourteen (6.2%) became recidivists. Most recidivists were African-American men and were younger at first GSW. Median time between incidents was 2.5 years, with a range of 0 days to 16 years. Nearly half were treated and released from the emergency department at their first episode of GSW. For recidivists who died, 128 died at the second incident, 29 at later incidents. Mortality from a second incident of firearm injury is 10% higher than first injuries, second hospitalizations are US $5,000 more expensive, and loss of life has a societal cost of US $167 billion in this community alone. The most appropriate population for inclusion in HVIPs at our hospital are young black men. The HVIP services are needed in the emergency department to address those treated and released at first GSW. Recidivists have higher mortality, and hospitalizations are significantly more expensive at the second injury. The investment in prevention is justified and may lead to a decrease in recidivism. Therapeutic/Care Management level III.

Centrality of traumatic events and men’s intimate partner violence perpetration.

The event centrality model indicates that the development and maintenance of posttraumatic stress symptoms (PTSSs) occurs when a traumatic event becomes central to one's identity, marking a key turning point in one's life narrative and influencing the meaning assigned to subsequent posttrauma events. Previous research has shown that event centrality is associated with PTSSs among survivors of intimate partner violence (IPV). However, research has not yet determined whether event centrality may explain associations between trauma exposure and IPV among perpetrators of IPV. Trauma and PTSSs are key risk factors for IPV perpetration, but many questions remain about the mechanisms that explain these associations. Study participants came from a sample of 134 men presenting for treatment at a community-based relationship violence intervention program in the Baltimore-Washington, DC metro area between July 2013 and July 2015 during routine program intake. In the hypothesized serial model, exposure to potentially traumatic events predicted event centrality, which predicted PTSSs, which predicted IPV perpetration and relationship problems. The serial mediation model was significant for physical assault, psychological aggression, emotional abuse, and relationship problems, but not for sexual coercion. The results indicate that the extent to which a trauma becomes central to one's identity is important in understanding the links between trauma exposure, PTSSs, and IPV perpetration. These findings support the development and application of trauma-informed interventions to reduce IPV perpetration and reduce event centrality in this population. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Hospital-Based Violence Intervention Programs to Address Social Determinants of Health and Violence

This review seeks to help the reader understand the current state of hospital-based violence intervention programs (HVIPs) and discuss the next steps in creating a widely adaptable public health model for violence intervention. HVIPs are an emerging practice in hospitals and trauma centers. These programs employ public health principles to reduce the impact of social determinants of health on at-risk populations. To date, evaluation of these programs demonstrates increased positive intermediate outcomes and decreased recidivism. Interest in HVIPs is growing due largely to a surge in the trauma community’s engagement in solutions to the epidemic of community violence and due to the development of a best practices HVIP model. National partnerships and organizations have become key to the dissemination of this public health model. With increased interest and positive outcomes, key stakeholders, including cities and states, are investing in the dissemination of these programs as a strategy to decrease violence, including firearm injury, in their populations.

A System Dynamics Model of Violent Trauma and the Role of Violence Intervention Programs

BackgroundViolence intervention programs (VIPs) can reduce interpersonal violence (IPV); however, optimizing the implementation of VIPs is challenging, given the complex dynamics of IPV. System dynamics models (SDMs) provide a means of visualizing dynamic and causal relationships in such complex systems. We use the IPVSDM to characterize and examine the relationship between IPV, VIPs, and the social determinants of health (SDH). Materials and methodsThe simulation model was created from a diagram that links putative causal relationships between VIPs, SDH, and IPV events. Simulation rules are then used to calculate a risk of violence parameter based on the SDH, which drives the transition from low-risk to high-risk populations and in turn influences IPV event rates. A qualitative relational approach was used to evaluate long-term effects of VIP on IPV events. ResultsThe model produced qualitatively plausible behavior with respect to IPV events, population transitions, and relative overall VIP effect. Simulation runs converged to stable steady states with an exponential benefit of VIP on reducing IPV that is best appreciated after 1-2 y. The VIP functioned in a recognizable fashion by slowing the shift from low-risk to high-risk populations. ConclusionsThis initial implementation of the IPVSDM produced recognizable baseline behavior while incorporating the possible effects of a VIP. The model allows causality and counterfactual testing, which is impractical in vivo. Community-level VIP efforts should show benefit particularly after a couple years. Future work will emphasize adding complexity to the IPVSDM and identifying real-world metrics to aid in testing, validation, and prediction of the model.

Feasibility and efficacy of a hospital-based violence intervention program on reducing repeat violent injury in youth: a randomized control trial.

To determine feasibility and efficacy of an Emergency Department Violence Intervention Program (EDVIP) to reduce violence related injuries in youth. One hundred and thirty youth aged 14-24 presenting to an emergency with violence related injury were randomized in parallel to receive EDVIP for 1 year (n = 65) or a waitlist control (n = 65). The primary outcome was to determine feasibility. Secondary outcomes are incidence, number/severity of repeat violence related injury, justice and education systems interactions, substance misuse and mental health presentations, and ED length of stay (LOS). This study established feasibility in recruitment, outcomes collection and safety. Fidelity and adherence measures required optimization during the study. Efficacy analysis of EDVIP vs. the control group demonstrates an absolute decrease of 10.4% in repeat violence related injury (13.7% vs. 24.1%) (p = 0.15), reduction in new interactions in the justice system (OR = 0.36 (0.07-1.77)), improved engagement in education (11.8% EDVIP vs. 7.6% control, p = 0.42) and no change in repeat visits for substance or mental health. LOS decreased by 59.5 min (p = 0.21). This program is feasible for ED implementation and for completion of a future RCT to measure effectiveness.

Latent constructs in the measurement of risk and protective factors for violent reoffending using the HCR-20v3 and SAPROF: implications for conceptualizing offender assessment and treatment planning

ABSTRACTThis paper describes a retrospective data analysis, examining the relationship between protective factors against violence, as measured by the Structured Assessment of Protective Factors for Violence Risk (SAPROF), and conceptually similar risk factors assessed in the Historical-Clinical-Risk Management-20 Version 3. The sample comprised 201 adult male violent offenders who completed a violence intervention programme in an Australian prison. Structural equation modelling revealed that conceptually similar risk and protective factors loaded onto correlated, but independent, factors. This suggests that these items from the two assessment tools may assess distinct latent constructs relevant to violence risk. SAPROF items did not, however, load onto the domains that are commonly targeted in violence treatment programmes. This study’s conclusion that assessment of protective factors may offer supplementary conceptual value in clinical practice with violent offenders is tempered by limitations, including the retrospective file review design, small sample, and lack of predictive validity of SAPROF ratings.

Evaluating the Effects of an Adolescent Family Violence Intervention Program on Recidivism among Court-Involved Youth

Child to family violence is a significant problem, and research on effective programs is lacking. The current study evaluates Step Up, a group intervention program for youth and parents to address youth-initiated patterns of violence. In this retrospective evaluation, we compared 115 court-involved youth who participated in Step Up between 2006 and 2015 to a propensity score weighted group of court-involved youth who had never participated in the program on three outcomes: general recidivism, assault-related recidivism, and domestic violence (DV)-related recidivism. The two groups were adequately balanced on 13 variables capturing background risk prior to outcome analyses. After propensity score weighting, the treatment group showed a significantly lower risk of general recidivism within 12 months, regardless of program completion (21.7% versus 30.9% for the comparison group). Program completion appeared to further boost positive results, as the risk of general recidivism was 14.7%, compared to 27.3% for the weighted comparison sample. However, program participation was not significantly related to either assault-related recidivism or DV-related recidivism, after controlling for background risk. The results of this study indicate that Step Up shows some promise as an effective program to reduce recidivism for youth engaged in child to family violence. However, the results are somewhat mixed, given the lack of effect on future assault-related and DV-related court referrals. Implications for policy and practice are discussed.

American Association for the Surgery of Trauma Prevention Committee topical update: Impact of community violence exposure, intimate partner violence, hospital-based violence intervention, building community coalitions and injury prevention program evaluation.

An effective injury prevention program is an important component of a successful trauma system. Maintaining support for a hospital-based injury prevention program is challenging, given competing institutional and trauma program priorities and limited resources. In light of those pressures, the American College of Surgeons Committee on Trauma mandates that trauma centers demonstrate financial support for an injury prevention program as part of the verification process, recognizing that hospital administrators might see such support as discretionary and ripe as a target for expense reduction efforts. This Topical Update from the American Association for the Surgery of Trauma Injury Prevention Committee focuses on strategies to be more effective with the limited resources that are allocated to hospital-based injury prevention programs. First, this review tackles two of the many social determinates of violence, including activities aimed at mitigating the impact of both community violence exposure and intimate partner/domestic violence. Developing or participating in coalitions for injury prevention, both in general with any injury prevention initiative, and specifically while developing a hospital-based violence intervention program, efficiently extends the hospital's efforts by gaining access to expertise, resources, and influence over the target population that the hospital might otherwise have difficulty impacting. Finally, the importance of systematic program evaluation is explored. In an era of dwindling resources for injury prevention, both at the national level and the institutional level, it is important to measure the effectiveness of injury prevention efforts on the target population, and when necessary, make changes to programs to both improve their effectiveness and to assist organizations in making wise choices in the use of their limited resources.

Intersectionality and sex and gender-based analyses as promising approaches in addressing intimate partner violence treatment programs among LGBT couples: A scoping review

Although Intimate Partner Violence (IPV) is an important health and social issue, less is known about IPV among sexual orientation and gender-minoritized (SOGI) populations such as Lesbian, Gay, Bi...

Acknowledging the victim to perpetrator trajectory: Integrating a mental health focused trauma-based approach into global violence programs

Abstract Violence prevention and intervention programming continues to overlook conclusive findings from biopsychosocial research that demonstrates the salience of early interpersonal trauma in subsequent perpetration of violent behavior. As a result, programs struggle to achieve significant and sustained behavior change in individuals whose past experiences of early interpersonal violence predispose them to use violence against others. A robust research literature unequivocally links early interpersonal trauma experience with future violence perpetration. Though legal consequences have demonstrated some success in curtailing future violence among those involved with the legal system and only in situation in which law enforcement and judicial processes protect victims, there is growing recognition that rehabilitation and treatment of perpetrators is necessary. Globally, studies demonstrate that exposure to early interpersonal violence negatively impacts brain development, interpersonal skills, and emotional resilience and escalates risk for future violence perpetration. Studies of youth and adult violence perpetrators consistently demonstrate that individuals who engage in violent behavior are much more likely to have experienced early interpersonal trauma. It is essential to integrate a mental health approach into public health frameworks to address the core of violence perpetration. Unaddressed early trauma greatly distorts the normal developmental trajectory of cognitive and psychological/emotional abilities. Unsurprisingly, many of the affected systems are also linked to violence perpetration. This position paper outlines the interconnections between early trauma and violence perpetration, and demonstrates the necessity of integrating a mental health, trauma-based framework into global violence interventions.

A Phenomenological Inquiry Into Men’s Desistance From Intimate Partner Violence

This research sought a deeper understanding of the experiences of men who have perpetrated intimate partner violence and subsequently participated in treatment and desisted from perpetrating violence in their intimate relationships. Phenomenological methods were used to conduct in-depth, qualitative interviews with men who had perpetrated intimate partner violence and participated in violence treatment programs to determine what assists individuals to desist from perpetration of intimate partner violence. Few participants who begin intimate partner violence programs successfully complete treatment, making it difficult to learn what helps men to successfully end their use of violence in their intimate relationships. This work adds to the small body of qualitative literature, which examines the ways by which men change their violent behavior and the motivating factors that assist with those changes. Results detail men’s experiences before entering programming, experiences while attending treatment programming, and experiences after attending treatment. Understanding how to help men to end their violent behavior not only increases women’s safety but also improves men’s lives. Future directions for treatment interventions are discussed.

Generating a Core Set of Outcomes for Hospital-Based Violence Intervention Programs

Hospital-based violence intervention programs (HVIPs) engage individuals who have experienced violent victimization in postmedical care programming, with the goal of reducing the incidence and impact of future injuries. Although there is some empirical support for HVIPs' impact on violence and crime-related outcomes, proper impact assessment is limited by a lack of systematized research on outcomes that relate to the proximal goals and activities of the programs themselves. To address this critical gap, we conducted a two-stage Delphi method to elicit and prioritize these outcomes using the wisdom and experience of those who are engaged in service delivery (i.e., HVIP community-based practitioners, program coordinators, and embedded researchers; N = 79). Through this process, respondents prioritized outcomes related to posttraumatic stress symptoms, beliefs about aggression, coping strategies, and emotional regulation, which have not been consistently measured using validated or standardized tools. Results suggest that, rather than limiting program outcomes to those related to repeat violent injury or criminality, hospital- and community-based violence prevention programs seek to improve and measure mental health and socioemotional outcomes as a benchmark for healing and recovery after a violent injury. Prioritization of these outcomes broadens the definition of recovery to include psychosocial health and well-being. In addition, inclusion of these outcomes in effectiveness studies will serve to bolster the relevance of findings, and provide support for continued development and refinement of HVIP practice.

Readiness to Change as a Predictor of Treatment Engagement and Outcome for Partner Violent Men

Resistance to change has been long recognized as a barrier to successful intervention for partner violent individuals. Using archival data from a community-based intimate partner violence (IPV) intervention program, the current study investigated readiness to change as a predictor of treatment engagement and outcome in cognitive behavioral therapy (CBT) for IPV, and examined whether court referral status, antisocial personality characteristics, and borderline personality characteristics moderate these associations. During program intake, male IPV perpetrators (N = 195) provided structured interview data on demographics and referral source, and self-report data on readiness to change, borderline personality traits, and antisocial personality traits. During group CBT, participants and their therapists completed measures of the working alliance, and the therapists completed ratings of compliance with behavior change homework assignments. Criminal recidivism data were gathered from public records for 2 years after scheduled completion of treatment. Readiness to change significantly predicted client ratings of the working alliance, but not therapist ratings of the working alliance, CBT homework compliance, or criminal recidivism. Court referral status moderated predictive associations between readiness to change and working alliance ratings, and borderline and antisocial characteristics moderated predictive associations between readiness to change and working alliance as well as criminal recidivism. Interestingly, readiness to change is a stronger predictor of positive treatment response for court- versus self-referred individuals and for those with either very low or very high levels of borderline and antisocial characteristics. Hence, strategies to enhance motivation to change may be particularly be important for IPV perpetrators with these characteristics.

What Is the Institutional Duty of Trauma Systems to Respond to Gun Violence?

In the past, trauma centers have almost exclusively focused on caring for patients who suffer from physical trauma resulting from violence. However, as clinicians' perspectives on violence shift, violence prevention and intervention have been increasingly recognized as integral aspects of trauma care. Hospital-based violence intervention programs are an emerging strategy for ending the cycle of violence by focusing efforts in the trauma center context. These programs, with their multipronged, community-based approach, have shown great potential in reducing trauma recidivism by leveraging the acute experience of violence as an opportunity to introduce services and assess risk of re-injury. In this article, we explore the evolving role of trauma centers and consider their institutional duty to address violence broadly, including prevention.

ANOTHER “LETHAL TRIAD”—RISK FACTORS FOR VIOLENT INJURY AND LONG-TERM MORTALITY AMONG ADULT VICTIMS OF VIOLENT INJURY

BackgroundMental illness, substance abuse, and poverty are risk factors for violent injury, and violent injury is a risk factor for early mortality that can be attenuated through hospital-based violence intervention programs. Most of these programs focus on victims under the age of 30 years. Little is known about risk factors or long-term mortality among older victims of violent injury. ObjectivesTo explore the prevalence of risk factors for violent injury among younger (age < 30 years) and older (age 30 ≥ years) victims of violent injury, to determine the long-term mortality rates in these age groups, and to explore the association between risk factors for violent injury and long-term mortality. MethodsAdults with violent injuries were enrolled between 2001 and 2004. Demographic and injury data were recorded on enrollment. Ten-year mortality rates were measured. Descriptive analysis and logistic regression were used to compare older and younger subjects. ResultsAmong 541 subjects, 70% were over age 30. The overall 10-year mortality rate was 15%, and was much higher than in the age-matched general population in both age groups. Risk factors for violent injury including mental illness, substance abuse, and poverty were prevalent, especially among older subjects, and were each independently associated with increased risk of long-term mortality. ConclusionMental illness, substance abuse, and poverty constitute a “lethal triad” that is associated with an increased risk of long-term mortality among victims of violent injury, including both younger adults and those over age 30 years. Both groups may benefit from targeted risk-reduction efforts. Emergency department visits offer an invaluable opportunity to engage these vulnerable patients.

Long-term evaluation of a hospital-based violence intervention program using a regional health information exchange.

Hospital-based violence intervention programs (HVIP) aim to reduce violent-injury recidivism by providing intensive case management services to high-risk patients who were violently injured. Although HVIP have been found effective at reducing recidivism, few studies have sought to identity how long their effects last. Additionally, prior studies have been limited by the fact that HVIP typically rely on self-report or data within their own healthcare system to identify new injuries. Our aim was to quantify the long-term recidivism rate of participants in an HVIP program using more objective and comprehensive data from a regional health information exchange. The study included 328 patients enrolled in Prescription for Hope (RxH), an HVIP, between January 2009 and August 2016. We obtained RxH participants' emergency department (ED) encounter data from a regional health information exchange database from the date of hospital discharge to February 2017. Our primary outcome was violent-injury recidivism rate of the RxH program. We also examined reasons for ED visits that were unrelated to violent injury. We calculated a 4.4% recidivism rate based on 8 years of statewide data, containing 1,575 unique encounters. More than 96% of participants were matched in the state database. Of the 15 patients who recidivated, only five were admitted for their injury. More than half of new violence-related injuries were treated outside of the HVIP-affiliated trauma center. The most common reasons for ED visits were pain (718 encounters), followed by suspected complications or needing additional postoperative care (181 encounters). Substance abuse, unintentional injuries, and suicidal ideation were also frequent reasons for ED visits. The low, long-term recidivism rate for RxH indicates that HVIPs have enduring positive effects on the majority of participants. Our results suggest that HVIP may further benefit patients by partnering with organizations that work to prevent suicide, substance use disorders, and other unintentional injuries. Therapeutic study, level III.