Violence Intervention Programs Research Articles

Risk factors for recurrent violent injury among black men

BackgroundBlack men are disproportionately overrepresented among victims of repeat violent injury. However, little is known about the risk factors that influence violent trauma recidivism among black men. We hypothesize that the following risk factors would be significant among black male victims of repeat violent injury: disrespect; being under the influence; being in a fight and using a weapon in the past year; and previous incarceration when comparing trauma recidivists versus nonrecidivists. MethodsUsing secondary data analysis, we identified a sample of 191 (n = 191) urban low-income black men treated by a level I trauma unit in Baltimore for violent injury (e.g., gunshot wound, stabbing, or assault) who participated in a hospital-based violence intervention program from 1998 to 2011. Participants in the program completed a risk factor for violent injury questionnaire to assess: exposure to chronic violence, criminal justice involvement, substance abuse, and disrespect (code of the street). ResultsWe found that 58% of the sample is characterized as trauma recidivists (defined as hospitalization two or more times for violent injury). Black male patients of violent injury who engage in the following: substance abuse; had previously been in a fight or used a weapon in the past year; perceived disrespect as a precursor to violence; and experienced a previous incarceration were more likely to have multiple hospitalizations for violent injury. ConclusionsTrauma recidivism among urban black male victims of violent injury is a major public health issue. Hospital-based violence intervention programs should be engaged in reducing trauma recidivism among this population.

Gender Differences in Posttraumatic Stress Symptoms Among Participants of a Violence Intervention Program at a Pediatric Hospital: A Pilot Study.

Hospital-based violence intervention programs (HVIPs) have emerged as a strategy to address posttraumatic stress (PTS) symptoms among violently injured patients and their families. HVIP research, however, has focused on males and little guidance exists about how HVIPs could be tailored to meet gender-specific needs. We analyzed pediatric HVIP data to assess gender differences in prevalence and type of PTS symptoms. Girls reported more PTS symptoms than boys (6.96 vs 5.21, P = .027), particularly hyperarousal symptoms (4.00 vs 2.82, P = .002) such as feeling upset by reminders of the event (88.9% vs 48.3%, P = .005). Gender-focused research represents a priority area for HVIPs.

Effects of nurse-led child- and parent-focused violence intervention on mentally ill adult patients and victimized parents: A randomized controlled trial

BackgroundChild-to-parent violence is an often hidden serious problem for parental caregivers of mentally ill adult children who experience violence toward them. To date, the comprehensive dyadic parent-adult child intervention to manage child-to-parent violence is scarce. ObjectiveTo evaluate the effect of Child- and Parent-focused Violence Program, an adjunctive intervention involved with both violent adult children with mental illness and their victimized biological parent (parent–adult child dyads) on violence management. DesignOpen-label randomized controlled trial. SettingA psychiatric ward in a teaching hospital and two mental hospitals in Southern Taiwan. ParticipantsSixty-nine patients aged ≥20 years, with thought or mood disorders, having violent behavior in the past 6 months toward their biological parent of either gender were recruited. The violent patients’ victimized biological parents who had a major and ongoing role in provision of care to these patients, living together with and being assaulted by their violent children were also recruited. The parent–adult child dyads were selected. MethodsThe intervention was carried out from 2011 to 2013. The parent–adult child dyads were randomly assigned to either the experimental group (36 dyads), which received Child- and Parent-focused Violence Intervention Program, or to the control group (33 dyads), which received only routine psychiatric care. The intervention included two individualized sessions for each patient and parent, separately, and 2 conjoint sessions for each parental-child dyad for a total of 6 sessions. Each session lasted for at least 60-min. Data collection was conducted at 3 different time frames: pre-treatment, post-treatment, and treatment follow-up (one month after the completion of the intervention). ResultsOccurrence of violence prior to intervention was comparable between two groups: 88.9% (n=32) parents in the experimental group versus 93.9% (n=31) in the control group experienced verbal attack, and 50% (n=18) versus 48.5% (n=16) received body attack and were injured. The intervention significantly reduced violence, improved impulsivity, changed patients’ and parents’ violence attributions, and fostering active coping processes in the experimental group as compared to the control group (p<0.05). No significant reductions were found in verbal aggression, cognitive and social reactions in the parent's reactions to assault, attentional subscale of impulsivity and wishful thinking (p>0.05). ConclusionsChild- and Parent-focused Violence Intervention Program is effective on child-to-parent violence management in parent–adult child dyads. Thus, the intervention can be helpful for patients who have just been diagnosed with mental illness and had an episode of violence toward their parents within a narrow time frame.

Development of an Emergency Department Violence Intervention Program for Youth: An Integrated Knowledge Translation Approach.

Violent interpersonal injury is a common presentation to emergency departments (EDs) and is increasingly being treated as a preventable condition. Given the complexity of the issue, it is key to ensure interventions are feasible and acceptable within the communities that are affected by violence. Our team consists of ED staff, community members who work with youth affected by violence, people who were affected by violence in their youth, and researchers. We describe how an integrated knowledge translation (KT) process was used to develop an ED violence intervention program (EDVIP) for youth affected by violence. We used the Canadian Institutes of Health Research Guidelines for integrated KT (iKT) to develop an EDVIP. Specifically, we report the Knowledge to Action process which involves both knowledge creation and an action cycle. Our team determined the research question, the research approach, assessed feasibility and determined outcomes for our study. Using the iKT approach facilitated initiation of a funded trial that is now active. This paper highlights the benefit of including community experts at the beginning of and throughout the research process.

Changing Hostile Beliefs towards Women through Partner Abuse Intervention Programs

This research project examined hostile beliefs towards women held by men who completed a Duluth Model partner violence intervention program. Changes in beliefs are foundational to change in the cessation of violence within the Duluth model. Hostile beliefs towards women establish a context for objectification and suspicion of women, and justification for violence. Although there was not a significant reduction in hostility scores, there was a significant reduction in aggression scores. Hostility scores were significantly correlated with the aggression scores indicating encouraging results that partner abuse intervention programs may influence the reduction of hostile beliefs towards women and thus may impact perpetration of violence.

Domestic Violence Intervention Programs for Perpetrators in Latin America and the Caribbean

Research on intervention programs for domestic violence (DV) perpetrators in the United States and in Europe has started to shed light on these interventions and the challenges they face in determining “what works” in those regions. In Latin America, the research is almost nonexistent. This study presents a literature review of studies and program protocols in Latin America and the Caribbean, as well as the results of a continental survey on characteristics and suggested standards for DV perpetrator programs in this region. Findings indicate perpetrator interventions in this part of the world are in their earliest stages along with the remaining challenges these involve. Suggested standards in the areas of program effectiveness, evidence-based intake assessments, tailoring of programs to minority group’s needs, the conceptualization of DV, influential risk factors, and liaisons between academia and practice are discussed.

A Survey of Domestic Violence Perpetrator Programs in the United States and Canada: Findings and Implications for Policy and Intervention

A 15-page questionnaire, the North American Domestic Violence Intervention Program Survey, was sent to directors of 3,246 domestic violence perpetrator programs (also known as batterer intervention programs, or BIPs) in the United States and Canada. Respondent contact information was obtained from state Coalitions Against Domestic Violence and from various government agencies (e.g., Attorney General) available on the Internet. Two hundred thirty-eight programs completed and returned the questionnaire, a response rate of 20%. The survey yielded descriptive data on respondent characteristics; program philosophy, structure, content, and service; client characteristics; treatment approach and adjunct services; and group facilitator views on intervention approaches and domestic violence policy and treatment standards. The programs varied in the extent to which they adhere to treatment approaches suggested by the empirical research literature. In addition, chi-square analyses were conducted on the associations between several factors. Significant correlations were found between respondent low level of education and adherence to a feminist-gendered program philosophy; respondent low level of education and use of a shorter assessment protocol; feminist-gendered program philosophy and incorrect facilitator knowledge about domestic violence; and feminist-gendered program philosophy and a program focus on power and control as the primary cause of domestic violence.

How Have Academic Theories of Domestic Violence Influenced Western Physical Domestic Violence Treatment Programs in Recent Years?

Domestic violence (DV) in Australia is a pressing issue that continually needs to be addressed. Just as important to consider is how individuals who commit these offences are treated to attempt to prevent instances of reoffending. As such, treatment programs and how they are constructed from a theoretical perspective is an important consideration. The current study examined what academic theories are being used in the rationale and implementation of DV treatment programs in Australia. It also examined whether differing schools of thought (i.e., biological, psychological, social) are being used in conjunction with one another in these programs or separately. In total, 60 male domestic violence treatment programs were analysed using thematic analysis. Overall, results indicated that all of the treatment programs analysed had underlying tones that represented academic influence. Secondly, the results demonstrated that in most cases multiple schools of thought are included in the development of DV treatment programs. Future research could focus on evaluating what models of intervention are most effective and whether or not ‘multi-pronged’ approaches are more effective in reducing DV recidivism.

Perceived Sexual Abuse and Quality of Life of Female Workers of Unorganized Sector- An Exploratory Study from Four Districts of West Bengal

Women workers today play an essential and significant role in the economic structure of the country and 94% of women make up the unorganized sector of India. Domestic Violence affects women’s productivity in all forms of life i.e. assaulted women will always get agonized and emotionally disturbed and are often bruised after occurrence of the torment. A working woman may lose her efficiency in work or drop out from work in some cases. The present study aims to explore the magnitude of sexual abuse by intimate partners and the quality of life of women aged 18 -35 years in 4 districts of West Bengal. Close ended questionnaire and focused group discussions were conducted to understand their experiences regarding perception of sexual abuse. The contributing factors to violence were alcohol abuse, desire to gain control over another family member and unjustified suspicion. This analysis might be used to improve future partner violence prevention and treatment programs.

Who Shot Ya? How Emergency Departments Can Collect Reliable Police Shooting Data.

This paper examines an alternative solution for collecting reliable police shooting data. One alternative is the collection of police shooting data from hospital trauma units, specifically hospital-based violence intervention programs. These programs are situated in Level I trauma units in many major cities in USA. While the intent of these programs is to reduce the risk factors associated with trauma recidivism among victims of violent injury, they also collect reliable data on the number of individuals treated for gunshot wounds. While most trauma units do a great job collecting data on mode of injury, many do not collect data on the circumstances surrounding the injury, particularly police-involved shootings. Research protocol on firearm-related injury conducted in emergency departments typically does not allow researchers to interview victims of violent injury who are under arrest. Most victims of nonfatal police-involved shootings are under arrest at the time they are treated by the ED for their injury. Research protocol on victims of violent injury often excludes individuals under arrest; they fall under the exclusion criteria when recruiting potential participants for research on violence. Researchers working in hospital emergency departments are prohibited from recruited individuals under arrests. The trauma staff, particularly ED physicians and nurses, are in a strategic position to collect this kind of data. Thus, this paper examines how trauma units can serve as an alternative in the reliable collection of police shooting data.

Perceptions of sexual violence among men who have sex with men and individuals on the trans-feminine spectrum in Mongolia

ABSTRACTWith the growing realisation that sexual violence poses pressing health and human rights concerns for men who have sex with men (MSM) and individuals on the trans-feminine spectrum, research has focused on the context in which sexual violence takes place. Rape myths and other perceptions of sexual violence affect the prevalence of perpetration and the availability of services and support for survivors. Little research has been conducted on rape myths among sexual and gender minority groups, especially in low- and middle-income countries. Two focus groups and 30 in-depth interviews were conducted with MSM and individuals on the trans-feminine spectrum in Ulaanbaatar, Mongolia. A number of rape myths previously noted to be prevalent among Western, heterosexual men, and women were expressed by participants, including the myth that males are never raped, rape as a cause of homosexuality or transgenderism, conceptualisations of prototypical rape as requiring overwhelming force, and victim blaming. However, many of these perceptions appeared to have different origins and effects in these populations. This study illustrates interesting similarities and differences compared to rape myths explored in Western, heterosexual male samples, and draws attention to the need to address community perceptions of sexual violence in sexual health and violence intervention programming.

Specialist Domestic Violence Courts: Planning (and Researching) for Long Haul System Change

The numbers of specialist domestic violence courts in the USA is over 400; there are about 70 in Canada and 140 or so in the United Kingdom. Recently some of the first such courts in Australia – those in Western Australia – were announced to close and Queensland’s first has just commenced a pilot phase. This presentation reflects on what researchers and policy-makers alike might learn from this picture. Drawing on experience with two long established criminal family violence courts – the ACT Family Violence Intervention Program (Australia) and the Manitoba Family Violence Court (Canada) – it is argued that clarity of problem-analysis, and longer term thinking and planning is critical.

WITHDRAWN: Domestic violence screening and intervention programmes for adults with dental or facial injury.

Domestic violence exists in all communities across the world. Healthcare services have a pivotal role in the identification, assessment and response to domestic violence. As the face is a common target in assault, dentists and oral and maxillofacial surgeons are in a unique position to screen for domestic violence in the context of presentation of dental and facial injury. Owing to lack of training, dentists and oral and maxillofacial surgeons may not be the best persons to give advice to someone experiencing domestic violence. Improper advice such as encouragement to leave an abusive relationship may escalate the frequency of violence. It may be more appropriate to refer to specialist agencies for intervention and support. It would, therefore be useful to know whether screening and intervention programmes are effective.(1) To assess the benefits and harms of intervention programmes employed to reduce and or prevent domestic violence in adults with dental and/or facial injuries.(2) To assess the benefits and harms of screening and the use of different screening tools in the detection of the proportion of adult victims of domestic violence who present with dental and/or facial injury.We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO and Lilacs databases. No language restrictions were applied. Personal contacts were used and international domestic violence organisations were contacted to identify any unpublished trials. Last search was done February 2004.Randomised controlled trials involving adults aged 16 years and over presenting with dental and/or facial injury relating to domestic violence in any healthcare setting.Screening of eligible studies was conducted in duplicate and independently by two reviewers. Results were to be expressed as random effects models using weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence interval. Heterogeneity was to be investigated including both clinical and methodological factors.No eligible randomised controlled trials (RCTs) were identified.There is no evidence to support or refute that screening for domestic violence in adults with dental or facial injury is beneficial nor that it causes harm. Screening tools to detect domestic violence exist but no RCTs have specifically evaluated their effectiveness for patients presenting with facial and or dental injuries. There is also lack of evidence that intervention programmes are effective at reducing frequency of physical assaults and at reducing the severity of facial injuries.

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 ...

Assessing Attitude and Reincarceration Outcomes Associated With In-Prison Domestic Violence Treatment Program Completion

Studies indicate that as many as 30%–56% of incarcerated men have perpetrated domestic violence, and that factors related to domestic violence perpetration are associated with long-term recidivism after release. The current study evaluates the effectiveness of an in-prison domestic violence treatment program called STOP and Change Direction to increase positive attitudes toward women, decrease levels of criminal thinking, and reduce general recidivism rates for program completers. Two research designs are used: a single-group pretest–posttest design to assess the attitude-related outcomes, and a quasiexperimental design with a comparison group created using propensity score matching to assess the impact of program participation on reincarceration. Paired samples t tests revealed significant increases in positive attitudes toward women and decreases in criminal thinking. Binary logistic regressions revealed no significant differences in the 5- and 7-year reincarceration rates, although examination of the 95% confidence intervals suggests encouraging clinical implications of program completion.

Turning Point-Rethinking Violence: A Youth Violence Reduction Intervention

Objectives: In response to a significant increase in adolescent violence, a multi-dimensional, multi-agency program involving at-risk adolescents and their parents was implemented, housed at the urban Level One Trauma Center of a southeastern hospital. “Turning Point: Re-Thinking Violence,” (TPRV) was initiated in 1999 as a focused 14-hour alternative to the standard sentence of 100 hours of “community service” for first time violent juvenile offenders. Juvenile participants attended a total of six group sessions which included: trauma experience activities; a victim impact panel; a processing and psycho educational group focused on anger management, conflict resolution, and communication skills; community networking; and a program graduation. This study analyzes the long-term effect both in rates of Violence Recidivism (VR) and program efficiency as indicated by maintained therapeutic effect. Methods: VR of TPRV consenting program participants (N=115) during seven years of TPRV was compared to the initial cohort sentenced to the “traditional” community service. TPRV participants were then stratified by year of program entry, and compared among themselves. Results: For the six year duration of TPRV, the VR rate still remains significantly below that which was reported in the index group. Stratified annual analysis demonstrates a statistically significant decrease in VR as TPRV has evolved. Conclusions: These data suggest that TPRV is an efficient and effective violence intervention program as compared to traditional sentencing options for first-time adolescent violent offenders and that the treatment effect of TPRV is sustained over time and is judged to be a successful strategy for addressing the epidemic of adolescent violence.

‘I Miss My Little One A Lot’: How Father Love Motivates Change in Men Who Have Used Violence

This paper presents selected findings from a research‐based evaluation of a men's domestic violence intervention programme, which aims to assist men to develop alternative ways of relating to their partners, children and others. The qualitative component of this evaluation involved conducting interviews with 21 group participants after their completion of the course. These interviews investigated several issues, including participants' perceptions of their relationships with their children. The main theme underpinning all discussions of children was an expression of love, in that love for their children served as a motivation to stop using violence and to develop alternative ways of relating to all family members. The paper concludes by discussing the potential of men's relationships with their children as powerful contexts, or points of leverage, through which the impact of their violent behaviour can be realised and confronted. By realising the impact that violent behaviour can have on children's wellbeing and fathers' interpersonal relationships with them, it is argued that intervention programmes can support men to develop more appropriate ways of relating to their children, and thus safeguard children from potential long‐term consequences of domestic abuse. Copyright © 2015 John Wiley &amp; Sons, Ltd.‘The main theme underpinning all discussions of children was an expression of love’Key Practitioner Messages Men attending domestic violence intervention programmes demonstrate a wide range of attitudes towards their partners and former partners, but unanimously report a desire to maintain meaningful relationships with their children. Men who have used violence in their family relationships can be challenged and motivated to change through realising the impact of their behaviour on their children's wellbeing and their father‐child relationships. ‘Unanimously report a desire to maintain meaningful relationships with their children’

Associations between Gun Violence Exposure, Gang Associations, and Youth Aggression: Implications for Prevention and Intervention Programs

Using cross-sectional data collected from three middle schools in Southeast Los Angeles, we assessed the association of neighborhood violence exposure, gang associations, and social self-control with past week aggression in a sample of minority youth (n=164). Results from Poisson and logistic regression models showed that direct exposure to gun violence, having friends in gangs, and low social self control were all positively associated with past week aggression. Among girls, having gang affiliated family members was positively associated with aggression, whereas among boys having friends in gangs was associated with past week aggression. Subjective expectations of engagement in future interpersonal violence were associated with being male, having friends in gangs, and fear of neighborhood gun violence. We recommend that youth violence prevention and intervention programs address the impact of family, peers, and gun violence on student coping and identify students with low social self-control who could benefit from social and emotional skills training.

Saving lives and saving money: hospital-based violence intervention is cost-effective.

Victims of violence are at significant risk for injury recidivism, including fatality. We previously demonstrated that our hospital-based violence intervention program (VIP) resulted in a fourfold reduction in injury recidivism, avoiding trauma care costs of $41,000 per injury. Given limited trauma center resources, assessing cost-effectiveness of interventions is fundamental to inform use of these programs in other institutions. This study examines the cost-effectiveness of hospital-based VIP. We used a decision tree and Markov disease state modeling to analyze cost utility for a hypothetical cohort of violently injured subjects, comparing VIP versus no VIP at a trauma center. Quality-adjusted life-years (QALYs) were calculated using differences in mortality and published health state utilities. Costs of trauma care and VIP were obtained from institutional data, and risk of recidivism with and without VIP were obtained from our trial. Outcomes were QALYs gained and net costs over a 5-year horizon. Sensitivity analyses examined the impact of uncertainty in input values on results. VIP results in an estimated 25.58 QALYs and net costs (program plus trauma care) of $5,892 per patient. Without VIP, these values are 25.34 and $5,923, respectively, suggesting that VIP yields substantial health benefits (24 QALYs) and savings ($4,100) if implemented for 100 individuals. In the sensitivity analysis, net QALYs gained with VIP nearly triple when the injury recidivism rate without VIP is highest. Cost-effectiveness remained robust over a range of values; $6,000 net cost savings occur when 5-year recidivism rate without VIP is at 7%. VIP costs less than having no VIP with significant gains in QALYs especially at anticipated program scale. Across a range of plausible values at which VIP would be less cost-effective (lower injury recidivism, cost of injury, and program effectiveness), VIP still results in acceptable cost per health outcome gained. VIP is effective and cost-effective and should be considered in any trauma center that takes care of violently injured patients. Our analyses can be used to estimate VIP costs and results in different settings. Economic and value-based evaluation, level 2.

The Truth N’ Trauma Project: Addressing Community Violence Through a Youth-Led, Trauma-Informed and Restorative Framework

This paper describes the implementation and evaluation of a youth violence prevention and intervention program on Chicago’s south side. Forty-four high school-age youth from violence-exposed urban communities participated in a nine-month, multidisciplinary, after-school program aimed at supporting their development and positively impacting their communities. Restorative practice principles informed planning, implementation, and evaluation of the program. The youth developed skills in leadership, trauma-informed practice, documentary production, theatre, and participatory action research. This paper discusses the program, an initial evaluation of its impact, and potential practice and research implications.