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Gwata D, Ventriglio A, Hughes P, Deahl M. Structural inequalities, knife crime: A qualitative study. Int J Soc Psychiatry 2024; 70:667-678. [PMID: 38557268 DOI: 10.1177/00207640231221092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The importance and impact of youth violence is increasingly being recognised and is a cause of international concern. In the UK, youth violence, specifically knife crime, is on the increase and has resulted in the deaths of many young people. In order to explore the impact of knife crimes on mental health and wellbeing of individuals, a number of focus groups were conducted with 24 professionals from multiple agencies. Qualitative analysis showed various emerging themes, which included ineffective mental health systems, structural violence and inequalities, policing, safety and community engagement, vulnerability and resilience in minority communities. Equity in mental health services, further development and roll-out of public mental health approaches and training accompanied by sufficient resources is needed.
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Affiliation(s)
| | | | | | - Martin Deahl
- Institute of Psychiatry, Kings College, London, UK
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2
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Khazanchi R, South EC, Cabrera KI, Winkelman TNA, Vasan A. Health Care Access and Use Among U.S. Children Exposed to Neighborhood Violence. Am J Prev Med 2024; 66:936-947. [PMID: 38416088 DOI: 10.1016/j.amepre.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Neighborhood violence is an adverse childhood experience which impacts millions of U.S. children and is associated with poor health outcomes across the life course. These effects may be mitigated by access to care. Yet, the ways in which exposure to neighborhood violence shapes children's health care access have been understudied. METHODS This is a cross-sectional analysis of 16,083 children (weighted N=67,214,201) ages 1 to <18 years from the 2019 and 2021 National Health Interview Survey. Guardians were asked about preventive care access, unmet health needs, and health care utilization in the last year. Changes associated with exposure to neighborhood violence were estimated using marginal effects from multivariable logistic regression models adjusted for year, age, sex, race/ethnicity, parental education, family structure, rurality, income, insurance type, insurance discontinuity, and overall reported health. RESULTS Of 16,083 sample children, 863 (weighted 5.3% [95% CI 4.8-5.7]) reported exposure to neighborhood violence, representing a weighted population of ∼3.5 million. In adjusted analyses, exposure to violence was associated with forgone prescriptions (adjusted difference 1.2 percentage-points (pp) [95%CI 0.1-2.3]; weighted national population impact 42,833 children), trouble paying medical bills (7.7pp [4.4-11.0]; 271,735), delayed medical (1.5pp [0.2-2.9]; 54,063) and mental health care (2.8pp [1.1-4.6]; 98,627), and increased urgent care (4.5pp [0.9-8.1]; 158,246) and emergency department utilization (6.4pp [3.1-9.8]; 227,373). CONCLUSIONS In this nationally representative study, neighborhood violence exposure among children was associated with unmet health needs and increased acute care utilization. Evidence-based interventions to improve access to care and reduce economic precarity in communities impacted by violence are needed to mitigate downstream physical and mental health consequences.
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Affiliation(s)
- Rohan Khazanchi
- Harvard Internal Medicine-Pediatrics Residency Program at Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center, Boston, Massachusetts; FXB Center for Health and Human Rights, Harvard University, Boston, Massachusetts; Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.
| | - Eugenia C South
- Urban Health Lab, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keven I Cabrera
- Urban Health Lab, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Aditi Vasan
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Zufer I, Fix RL, Stone E, Cane R, Sakran JV, Nasr I, Hoops K. Documentation of Trauma-Informed Care Elements for Young People Hospitalized After Assault Trauma. J Surg Res 2024; 296:665-673. [PMID: 38359681 DOI: 10.1016/j.jss.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 01/01/2024] [Accepted: 01/16/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Violent traumatic injury, including firearm violence, can adversely impact individual and community health. Trauma-informed care (TIC) can promote resilience and prevent future violence in patients who have experienced trauma. However, few protocols exist to facilitate implementation of TIC for patients who survive traumatic injury. The purpose of the study is to characterize documentation of TIC practices and identify opportunities for intervention in a single academic quaternary care center. METHODS This study is a retrospective chart review analyzing the documentation of trauma-informed elements in the electronic medical record of a random sample of youth patients (ages 12-23) admitted for assault trauma to the pediatric (n = 50) and adult trauma (n = 200) services between 2016 and mid-2021. Descriptive statistics were used to summarize patient demographics, hospitalization characteristics, and documentation of trauma-informed elements. Chi-square analyses were performed to compare pediatric and adult trauma services. RESULTS Among pediatric and adult assault trauma patients, 36.0% and 80.5% were hospitalized for firearm injury, respectively. More patients admitted to the pediatric trauma service (96%) had at least one trauma-informed element documented than patients admitted to the adult service (82.5%). Social workers were the most likely clinicians to document a trauma-informed element. Pain assessment and social support were most frequently documented. Safety assessments for suicidal ideation, retaliatory violence, and access to a firearm were rarely documented. CONCLUSIONS Results highlight opportunities to develop trauma-informed interventions for youth admitted for assault trauma. Standardized TIC documentation could be used to assess risk of violent reinjury and mitigate sequelae of trauma.
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Affiliation(s)
- Insia Zufer
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca L Fix
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth Stone
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rachel Cane
- Division of Pediatric Hospital Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - Joseph V Sakran
- Johns Hopkins Medicine, Department of Surgery, Baltimore, Maryland
| | - Isam Nasr
- Johns Hopkins Medicine, Department of Surgery, Baltimore, Maryland
| | - Katherine Hoops
- Department of Anesthesiology and Critical Care Medicine, Department of Health Policy and Management, Johns Hopkins Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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Hipple NK, Lentz TS, Lewis SD. The Influence of Routine Health care on Reoffending in a Sample of Gun Involved Youths. J Community Health 2024; 49:277-285. [PMID: 37932628 DOI: 10.1007/s10900-023-01294-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/08/2023]
Abstract
In the wake of heightened concerns about gun violence and its impacts on youth, "what works" in gun violence prevention remains a critical public health concern. Gun violence prevention in the U.S. is increasingly interdisciplinary, involving both the criminal legal system and the health care system in developing an evidence base for promising programs and policies. The current study contributes to the literature by examining recidivism outcomes (i.e., rearrest) for a cohort of n = 409 Indianapolis youth involved in gun violence who were court-ordered to complete a health education-based prevention program called Project Life. The youth in our sample were predominantly from marginalized communities, all had been charged with a gun-involved or violence offense, 96% were detained by the juvenile justice system for some time, and 64% received at least one routine well check within five years prior to Project Life. Survival analyses of merged juvenile court records and health records show that routine health care (i.e., well visits) and completing the Project Life program were protective against recidivism, whereas time spent in detention increased risk. The findings provide evidence for the value of interdisciplinary approaches that include the health system in disrupting cycles of gun violence, while reducing the carceral footprint on youth.
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Affiliation(s)
| | - Theodore S Lentz
- Department of Criminal Justice & Criminology, Helen Bader School of Social Welfare, University of Wisconsin - Milwaukee, Milwaukee, WI, USA
| | - Stuart D Lewis
- Division of Geriatrics and Primary Care, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Puppalla P, Pick C, Graves J, Harfouche M. Youth Violence Does not Discriminate: Inclusive Violence Prevention Support Services Focused on Counseling and Peer Support are Essential for Youth and Young Adults. Am Surg 2024:31348241244640. [PMID: 38557219 DOI: 10.1177/00031348241244640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Violence disproportionately affects individuals of low socioeconomic status, and rates of injury amongst youth and young adults (YYAs) are rising. Little is known about how the social needs of this high-risk subgroup compared to the overall violently injured population. METHODS This is a retrospective review of an intake assessment of violently injured victims admitted to a level I trauma center (Jan 2022-Aug 2023). Data collected include race, age, mechanism of injury, and protective and predisposing factors for violent injury. We compared the risk factors of YYAs (=≤ 24 years) to those of adults (>24) and evaluated rates and types of violence prevention services requested by age group. RESULTS Of 350 individuals surveyed, 94 (27%) were <= 24 years and 256 (73%) were >24 years. Younger patients were less likely to be male (77% vs 86%, P = .03) and experienced more firearm injury (76% vs 51%, P < .001). They reported less alcohol use (20% vs 38%, P < .001), similar rates of mental illness (25% vs 26%, P = .62), less housing instability (5% vs 22%, P < .001), and similar access to government benefits (20% vs 29%, P = .2) compared to the older cohort. Services were requested by 41% of the study population (N = 142); the younger cohort was 2.9 times more likely to request non-financial services (P = .042). DISCUSSION Violently injured youth and young adults (YYAs) experience disproportionately high rates of gun violence. Efforts should be made to prioritize legal, peer support, and mental health services over financial services for this population.
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Affiliation(s)
| | - Carly Pick
- University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Justin Graves
- University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
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Roden-Foreman JW, Pettigrew M, Edmundson PM, Glenn C, Tibbs B. Safer neighborhoods? Violent crime and trauma volume pre/post targeted police interventions in Dallas, Texas. Injury 2024; 55:111202. [PMID: 37995626 DOI: 10.1016/j.injury.2023.111202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Project Safe Neighborhoods: Dallas (PSND) is part of a national initiative that partners federal, state, and local stakeholders and law enforcement to reduce violent crime, especially firearm violence, in select communities. The authors' hospital is located centrally in PSND's target areas, and the trauma center's service area fully covers the target areas. This cohort study evaluated PSND's effectiveness by examining if PSND's April 2018 launch was associated with decreases in (1) violent crime or (2) the rate of patients presenting with firearm and assaultive injuries. METHODS Data on violent crime (murder/non-negligent homicide, robbery, and aggravated assault) were obtained from all municipalities in the county for January 2015 - December 2020. Patient volume data were queried from the trauma registry for the same period. Nonlinear spatiotemporal models were used to calculate estimated rates and confidence intervals; derivatives were used to determine periods of significant change. Spatial point pattern tests assessed potential relocation of criminal activity. Given the importance of reducing violent crime, alpha was set at 0.05. RESULTS The target areas' violent crime rate remained higher than the non-target areas' throughout the study period, and target area violent crime non-significantly increased after PSND's launch. Violent crime in the non-target area increased significantly between February 2018 and February 2019. Part of this increase was attributable to a 7-fold increase (odds ratio [95% confidence interval] = 7.32 [2.58, 30.65], p < 0.001) in one police patrol beat just outside of the target areas. After years of decreases, rates of patients presenting with assaultive injuries or firearm injuries began significantly increasing and nearly doubled within two years of PSND. CONCLUSIONS Results suggest PSND was ineffective. Criminal activity in the target area was not reduced relative to its pre-intervention levels or relative to the non-target areas. Offenders may have moved outside the target areas to evade increased scrutiny. Additionally, rates of firearm and assaultive injuries increased. As trusted third parties, trauma centers should consider evaluating local crime and injury prevention programs for effectiveness.
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Affiliation(s)
- Jacob W Roden-Foreman
- Trauma Administration, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231, USA.
| | - Morgan Pettigrew
- Department of Surgery, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231, USA
| | - Philip M Edmundson
- Department of Surgery, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231, USA
| | - Catherine Glenn
- Trauma Administration, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231, USA
| | - Brian Tibbs
- Department of Surgery, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231, USA
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Simske NM, Rivera T, Ren BO, Breslin MA, Furdock R, Vallier HA. Impact of novel psychosocial programming on readmission and recidivism rates among patients with violence-related trauma. Arch Orthop Trauma Surg 2023; 143:7043-7052. [PMID: 37558824 DOI: 10.1007/s00402-023-05019-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION The Victims of Crime Advocacy and Recovery Program (VOCARP) provides advocacy, mental health resources, and educational materials. This study will report complications, readmissions, and recidivism among crime victims, and who used or did not use victim services. MATERIALS AND METHODS Patients engaged with programming from 3/1/17 until 12/31/18 were included. Control groups were patients injured by violent trauma without VOCARP use (N = 212) and patients injured by unintentional injuries (N = 201). Readmissions, complications, reoperations, and trauma recidivism were reported. RESULTS 1019 patients (83%) used VOCARP. VOCARP users were less often male (56% vs. 71%), less commonly married (12% vs. 41%), and had fewer gunshot wounds (GSWs, 26% vs. 37%) and sexual assaults (4.1% vs. 8%), all p < 0.05. Of all 1,423 patients, 6.6% had a readmission and 7.4% developed a complication. VOCARP patients had fewer complications (4.5% vs. 13.7%), infections (2% vs. 9%), wound healing problems (1% vs. 3.3%), and deep vein thromboses (0.3% vs. 1.9%), all p < 0.05, but no differences in unplanned operations (4.5%). GSW victims had the most complications, readmissions, and unplanned surgeries. Prior trauma recidivism was frequent among all groups, with crime victim patients having 40% prior violence-related injury (vs 9.0% control, p < 0.0001). Trauma recidivism following VOCARP use occurred in 8.5% (vs 5.7% for non-users, p = 0.16). CONCLUSION Crime victims differ from other trauma patients, more often with younger age, single marital status, and unemployment at baseline. Complications were lower for VOCARP patients. GSW patients had the most complications, readmissions, and unplanned secondary procedures, representing a population for future attention.
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Affiliation(s)
| | - Trenton Rivera
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Bryan O Ren
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Mary A Breslin
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Ryan Furdock
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Heather A Vallier
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA.
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Schenck CS, Dodington J, Paredes L, Gawel M, Nedd A, Vega P, O’Neill KM. Implementation of an emerging hospital-based violence intervention program: a multimethod study. Trauma Surg Acute Care Open 2023; 8:e001120. [PMID: 38020854 PMCID: PMC10660964 DOI: 10.1136/tsaco-2023-001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Individuals who experience assaultive firearm injury are at elevated risk for violent reinjury and multiple negative physical and psychological health outcomes. Hospital-based violence intervention programs (HVIPs) may improve patient outcomes through intensive, community-based case management. Methods We conducted a multimethod evaluation of an emerging HVIP at a large trauma center using the RE-AIM framework. We assessed recruitment, violent reinjury outcomes, and service provision from 2020 to 2022. Semistructured, qualitative interviews were performed with HVIP participants and program administrators to elicit experiences with HVIP services. Directed content analysis was used to generate and organize codes from the data. We also conducted clinician surveys to assess awareness and referral patterns. Results Of the 319 HVIP-eligible individuals who presented with non-fatal assaultive firearm injury, 39 individuals (12%) were enrolled in the HVIP. Inpatient admission was independently associated with HVIP enrollment (OR 2.6, 95% CI 1.3 to 5.2; p=0.01). Facilitators of Reach included engaging with credible messengers, personal relationships with HVIP program administrators, and encouragement from family to enroll. Fear of disclosure to police was cited as a key barrier to enrollment. For the Effectiveness domain, enrollment was not associated with reinjury (OR 0.70, 95% CI 0.16 to 3.1). Participants identified key areas of focus where needs were not met including housing and mental health. Limited awareness of HVIP services was a barrier to Adoption. Participants described strengths of Implementation, highlighting the deep relationships built between clients and administrators. For the long-term Maintenance of the program, both clinicians and HVIP clients reported that there is a need for HVIP services for individuals who experience violent injury. Conclusions Credible messengers facilitate engagement with potential participants, whereas concerns around police involvement is an important barrier. Inpatient admission provides an opportunity to engage patients and may facilitate recruitment. HVIPs may benefit from increased program intensity. Level of evidence IV.
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Affiliation(s)
| | - James Dodington
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lucero Paredes
- Department of Surgery, Maine Medical Center, Portland, Maine, USA
| | - Marcie Gawel
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Antwan Nedd
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Pepe Vega
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Kathleen M O’Neill
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Barnett HM, Wilson JM, Kunapaisal T, Nehra D, Vavilala MS, Hoffman JM, Crane DA. Utilization of rehabilitation services in violent versus nonviolent traumatic spinal cord injury. PM R 2023. [PMID: 37937373 DOI: 10.1002/pmrj.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Violence is the third leading cause of spinal cord injury (SCI) in the United States, and people with violence-related SCI have worse long-term outcomes compared to other traumatic SCI etiologies. Little is known, however, about the underlying reasons for these differences. Access to and utilization of rehabilitation services may differ in this population, but their outpatient care has not been previously investigated. OBJECTIVE To evaluate differences in utilization patterns of outpatient rehabilitation services between people with violence-related SCI and other traumatic SCI etiologies. DESIGN Retrospective cohort study. SETTING Academic tertiary care hospital system. PATIENTS A total of 41 patients with violence-related SCI residing in King County at the time of injury who completed inpatient rehabilitation (IPR) in our institution were identified from the hospital trauma registry and matched with 41 control patients with nonviolent traumatic SCI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) The number of appointments attended, canceled, and missed during the first year after discharge from IPR were obtained by chart review for physical medicine & rehabilitation (PM&R) physicians and therapy services. RESULTS People with violence-related SCI had decreased follow-up with outpatient rehabilitation services after IPR discharge compared to non-violent traumatic SCI, including PM&R (2.50 ± 2.44 vs. 3.76 ± 2.21 visits, β = -1.28, p = .017), physical therapy (8.91 ± 11.02 vs. 17.57 ± 15.26, β = -9.79, p = .009), occupational therapy (4.28 ± 7.90 vs. 10.04 ± 14.42, β = -6.18, p = .033), and recreational therapy (0.293 ± 0.955 vs. 1.37 ± 2.86, β = -1.07, p = .035). The rate of missed appointments was also higher among people with violence-related SCI compared to controls for PM&R (25.2% ± 28.5% vs. 9.9% ± 16.5%, β = 14.6%, p = .014) and physical therapy (26.0% ± 32.0% vs 4.2% ± 13.2%, β = 22.1%, p = .009). CONCLUSIONS Individuals with violence-related SCI had fewer follow-up appointments with PM&R physicians and other allied health professionals and were more likely to miss scheduled appointments compared to other traumatic SCI etiologies. Decreased outpatient follow-up may affect long-term outcomes for people with violence-related SCI.
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Affiliation(s)
- Heather M Barnett
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Josh M Wilson
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Thitikan Kunapaisal
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Deepika Nehra
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Deborah A Crane
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Nofi CP, Roberts BK, Cornell E, Tijerina M, Tussing O, Henry MC, Sathya C. Hospital-Based Violence Intervention Programs to Reduce Firearm Injuries in Children: A Scoping Review. J Pediatr Surg 2023; 58:2212-2221. [PMID: 37217364 DOI: 10.1016/j.jpedsurg.2023.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Hospital-based violence intervention programs (HVIPs) have shown promise in preventing reinjury and enhancing recovery from violent injuries, including those related to firearms. Historically, HVIPs have primarily focused on at-risk adolescents and young adults. The aim of this study is to perform a scoping review of HVIPs targeting children under the age of 18, describe the evidence supporting these programs, and deduce the potential impact of expanding HVIPs to younger children. METHODS A scoping review was performed utilizing PubMed database with search terms "violence intervention program" and pediatric, or children, or youth. Articles were screened for youth-inclusive violence programs, and the literature was analyzed for program descriptions, evidence supporting interventions, and barriers to evaluation. RESULTS 36 studies (covering 23 programs) were identified that met criteria (including patients ≤18 years old), with only 4 programs including children under 10. Many HVIPs utilize brief hospital interventions with longitudinal wraparound outpatient services. Despite heterogeneity in programs and studied outcomes, many HVIPs demonstrated positive outcomes, such as reduction of risk factors, decreased reinjury, decreased violent behaviors, decreased criminal justice involvement, and positive attitude or behavioral changes. Only a few studies reported increased odds of enrollment and positive impact in younger patients specifically. CONCLUSIONS Children are an impressionable population in which HVIPs may have significant impact; however, there remains a gap in targeted programs. Given that firearm injuries are the leading cause of death in children and adolescents, priority should be given to piloting, implementing, and evaluating HVIPs among younger age groups. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Colleen P Nofi
- Cohen Children's Medical Center at Northwell Health, New Hyde Park, NY, USA; Donald and Barbara Zucker School of Medicine, Hempstead, NY, USA.
| | - Bailey K Roberts
- Cohen Children's Medical Center at Northwell Health, New Hyde Park, NY, USA; Donald and Barbara Zucker School of Medicine, Hempstead, NY, USA
| | - Emma Cornell
- Center for Gun Violence Prevention, Northwell Health, New Hyde Park, NY, USA
| | | | | | - Marion C Henry
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Chethan Sathya
- Cohen Children's Medical Center at Northwell Health, New Hyde Park, NY, USA; Donald and Barbara Zucker School of Medicine, Hempstead, NY, USA; Center for Gun Violence Prevention, Northwell Health, New Hyde Park, NY, USA
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Dickson EA, Blackburn L, Duffy M, Naumann DN, Brooks A. Engagement with a youth violence intervention programme is associated with lower re-attendance after violent injury: A UK major trauma network observational study. PLoS One 2023; 18:e0292836. [PMID: 37851622 PMCID: PMC10584091 DOI: 10.1371/journal.pone.0292836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 09/29/2023] [Indexed: 10/20/2023] Open
Abstract
The hospital based Redthread Youth Violence Intervention Programme (YVIP) utilises experienced youth workers to support 11-24 year olds following an episode of violent injury, assault or exploitation who present to the Emergency Department (ED) at the East Midlands Major Trauma Centre (MTC), Nottingham, UK. The YVIP aims to promote personal change with the aim of reducing the incidence of further similar events. We conducted a retrospective, observational, cohort study to examine the association between engagement with the YVIP and re-attendance rates to the ED following a referral to Redthread. We also examined factors associated with engagement with the full YVIP. We found that 573 eligible individuals were referred to the YVIP over two years. Assault with body parts 34.9% (n = 200) or a bladed object 29.8% (n = 171) were the commonest reason for referral. A prior event rate ratio (PERR) analysis was used to compare rates of attendance between those who did and did not engage with the full YVIP. Engagement was associated with a reduction in re-attendances of 51% compared to those who did not engage (PERR 0.49 [95% 0.28-0.64]). A previous attendance to the ED by an individual positively predicted engagement. (OR 2.82 [95% CI 1.07-7.42], P = 0.035). A weekend attendance (OR 0.26 [0.15-0.44], P<0.001) and a phone call approach (OR 0.25 [0.14-0.47], P = 0.001), rather than a face-to-face approach by a Redthread worker, negatively impacted engagement. In conclusion, assaults with or without a weapon contributed to a significant proportion of attendances among this age group. The Redthread YVIP was associated with reduced rates of re-attendance to the East Midlands MTC among young persons who engaged with the full programme.
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Affiliation(s)
- Edward A. Dickson
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Lauren Blackburn
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Miriam Duffy
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
| | - David N. Naumann
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
- Academic Department of Military, Surgery and Trauma, Royal Centre for Defence Medicine, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, United Kingdom
| | - Adam Brooks
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
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Courtepatte A, Dugan E, Pino EC. Differences in Risks for Recurrent Injury and Death Among Survivors of Violence by Homeless Status. J Urban Health 2023; 100:972-983. [PMID: 37747650 PMCID: PMC10618134 DOI: 10.1007/s11524-023-00781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/26/2023]
Abstract
A better understanding of the unique risks for survivors of violence experiencing homelessness could enable more effective intervention methods. The aim of this study was to quantify the risks of death and reinjury for unhoused compared to housed survivors of violent injuries. This retrospective study included a cohort of patients with known housing status presenting to the Boston Medical Center Emergency Department between 2009 and 2018 with a violent penetrating injury. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the risks of all-cause mortality and violent reinjury. Of the 2330 patients included for analysis, 415 (17.8%) were unhoused at the time of index injury. Within 3 years of the index injury, there were 319 (13.9%) violent reinjuries and 55 (2.4%) deaths. Unhoused patients were more likely than housed patients to be violently reinjured by all causes (HR = 1.39, 95% CI = 1.06-1.83, p = 0.02), by stab wound (HR = 2.34, 95% CI = 1.33-4.11, p = 0.0003), and by blunt assault (HR = 1.52, 95% CI = 1.05-2.21, p = 0.03). Housed and unhoused patients were equally likely to die within 3 years of their index injury; however, unhoused patients were at greater risk of dying by homicide (HR = 2.89, 95% CI = 1.34-6.25, p = 0.006) or by a drug/alcohol overdose (HR = 2.86, 95% CI = 1.17-6.94, p = 0.02). In addition to the already high risks that all survivors of violence have for recurrent injuries, unhoused survivors of violence are at even greater risk for violent reinjury and death and fatal drug/alcohol overdose. Securing stable housing for survivors of violence experiencing homelessness, and connecting them with addiction treatment, is essential for mitigating these risks.
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Affiliation(s)
- Alexa Courtepatte
- Violence Intervention Advocacy Program, Department of Emergency Medicine, Boston Medical Center, 800 Harrison Ave, Boston, MA, 02118, USA
| | - Elizabeth Dugan
- Violence Intervention Advocacy Program, Department of Emergency Medicine, Boston Medical Center, 800 Harrison Ave, Boston, MA, 02118, USA
| | - Elizabeth C Pino
- Violence Intervention Advocacy Program, Department of Emergency Medicine, Boston Medical Center, 800 Harrison Ave, Boston, MA, 02118, USA.
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Boodoo R, Lagman JG, Eisele C, Saunders EFH. Highlighting Areas for Gun Violence Advocacy, as a Part of Medical Education in the USA. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:466-468. [PMID: 37651037 DOI: 10.1007/s40596-023-01846-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Ramnarine Boodoo
- Pennsylvania State University College of Medicine, Hershey, PA, USA.
| | | | - Caroline Eisele
- Pennsylvania State University College of Medicine, Hershey, PA, USA
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Trigylidas TE, Schnitzer PG, Dykstra HK, Badolato GM, McCarter R, Goyal MK, Lichenstein R. Firearm Deaths among Youth in the United States, 2007-2016. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1359. [PMID: 37628358 PMCID: PMC10453890 DOI: 10.3390/children10081359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/25/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023]
Abstract
We sought to compare risk factors contributing to unintentional, homicide, and suicide firearm deaths in children. We conducted a retrospective review of the National Fatality Review Case Reporting System. We included all firearm deaths among children aged 0-18 years occurring from 2007 to 2016. Descriptive analyses were performed on demographic, psychosocial, and firearm characteristics and their relationship to unintentional, homicide, and suicide deaths. Regression analyses were used to compare factors contributing to unintentional vs. intentional deaths. There were 6148 firearm deaths during the study period. The mean age was 14 years (SD ± 4 years), of which 81% were male and 41% were non-Hispanic White. The most common manners of death were homicide (57%), suicide (36%), and unintentional (7%). Over one-third of firearms were stored unlocked. Homicide deaths had a higher likelihood of occurring outside of the home setting (aOR 3.2, 95% CI 2.4-4.4) compared with unintentional deaths. Suicide deaths had a higher likelihood of occurring in homes with firearms that were stored locked (aOR 4.2, 95% CI 2.1-8.9) compared with unintentional deaths. Each manner of firearm death presents a unique set of psychosocial circumstances and challenges for preventive strategies. Unsafe firearm storage practices remain a central theme in contributing to the increased risk of youth firearm deaths.
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Affiliation(s)
- Theodore E. Trigylidas
- Division of Emergency Medicine, Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010, USA; (G.M.B.); (M.K.G.)
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20037, USA;
| | - Patricia G. Schnitzer
- The National Center for Fatality Review & Prevention, 2395 Jolly Road Suite 120, Okemos, MI 48864, USA; (P.G.S.); (H.K.D.)
| | - Heather K. Dykstra
- The National Center for Fatality Review & Prevention, 2395 Jolly Road Suite 120, Okemos, MI 48864, USA; (P.G.S.); (H.K.D.)
| | - Gia M. Badolato
- Division of Emergency Medicine, Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010, USA; (G.M.B.); (M.K.G.)
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20037, USA;
| | - Robert McCarter
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20037, USA;
| | - Monika K. Goyal
- Division of Emergency Medicine, Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010, USA; (G.M.B.); (M.K.G.)
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20037, USA;
| | - Richard Lichenstein
- Department of Pediatrics, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD 21201, USA;
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Mancini MA, Mueller KL, Moran V, Anwuri V, Foraker RE, Chapman-Kramer K. Implementing a hospital-based violence intervention program for assault-injured youth: implications for social work practice. SOCIAL WORK IN HEALTH CARE 2023; 62:280-301. [PMID: 37463018 DOI: 10.1080/00981389.2023.2238025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/05/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
Youth in the U.S. experience a high rate of assault-related injuries resulting in physical, psychological and social sequelae that require a wide range of services after discharge from the hospital. Hospital-based violence intervention programs (HVIP's) have been developed to engage youth in services designed to reduce the incidence of violent injury in young people. HVIP's combine the efforts of medical staff with community-based partners to provide trauma-informed care to violently-injured people and have been found to be a cost-effective means to reduce re-injury rates and improve social and behavioral health outcomes. Few studies have explored the organizational and community level factors that impact implementation of these important and complex interventions. The objective of this study was to develop an in-depth understanding of the factors that impact HVIP implementation from the perspectives of 41 stakeholders through qualitative interviews. Thematic analysis generated three themes that included the importance of integrated, collaborative care, the need for providers who can perform multiple service roles and deploy a range of skills, and the importance of engaging clients through extended contact. In this article we explore these themes and their implications for healthcare social work.
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Affiliation(s)
| | | | - Vicki Moran
- Trudy Busch Valentine School of Nursing, St. Louis University, Saint Louis, USA
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Neufeld MY, Plaitano E, Janeway MG, Munzert T, Scantling D, Allee L, Sanchez SE. History repeats itself: Impact of mental illness on violent reinjury and hospital reencounters among female victims of interpersonal violence. J Trauma Acute Care Surg 2023; 95:143-150. [PMID: 37068014 PMCID: PMC10407825 DOI: 10.1097/ta.0000000000003984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Violence-related reinjury impacts both patients and health care systems. Mental illness (MI) is prevalent among violently injured individuals. The relationship between preexisting MI and violent reinjury among women has not been fully characterized. Our objective was to determine if risk of hospital reencounter-violent reinjury and all-cause-was associated with preexisting MI at time of index injury among female victims of violence. METHODS All females (15-100 + years) presenting to a level I trauma center with violent injury (2002-2019) surviving to discharge were included (N = 1,056). Exposure was presence of preexisting MI. The primary outcome was hospital reencounters for violent reinjury and all-cause within one year (through 2020). The secondary outcome was the development of a new MI within one year of index injury. Odds of reencounter and development of new MI for those with and without preexisting MI were compared with multivariable logistic regression, stratified for interaction when appropriate. RESULTS There were 404 women (38%) with preexisting MI at time of index injury. Approximately 11% of patients with preexisting MI experienced violent reinjury compared to 5% of those without within 1 year ( p < 0.001). Specifically, those with MI in the absence of concomitant substance use had more than three times the odds of violent reinjury (adjusted Odds Ratio, 3.52 (1.57, 7.93); p = 0.002). Of those with preexisting MI, 64% had at least one reencounter for any reason compared to 46% of those without ( p < 0.001 ) . Odds of all-cause reencounter for those with preexisting MI were nearly twice of those without (adjusted Odds Ratio, 1.81 [1.36, 2.42]; p < 0.0001). CONCLUSION Among female victims of violence, preexisting MI is associated with a significantly increased risk of hospital reencounter and violent reinjury within the first year after index injury. Recognition of this vulnerable population and improved efforts at addressing MI in trauma patients is critical to ongoing prevention efforts to reduce violent reinjury. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Miriam Y Neufeld
- From the Department of Surgery (M.Y.N., T.M., D.S., L.A., S.E.S.), Boston Medical Center; Department of Surgery (M.Y.N., D.S., L.A., S.E.S.), Boston University School of Medicine; Undergraduate Program in Neuroscience (E.P.), Boston University College of Arts and Sciences, Boston, Massachusetts; and Department of Surgery (M.G.J.), University of Michigan, Ann Arbor, Michigan
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Portnoy J, Schwartz JA. Adolescent Violent Delinquency Associated With Increased Emergency Department Usage in Young Adulthood. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023; 67:739-756. [PMID: 34963357 DOI: 10.1177/0306624x211066835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Limited research has examined the extent to which adolescent delinquency predicts healthcare usage in young adulthood, including emergency department (ED) visits. This study used data from 3,310 adolescents (52.05% female; mean age at Wave I = 16.04 years) from the sibling subsample of the National Longitudinal Study of Adolescent to Adult Health (Add Health). We examined whether adolescent delinquency at Wave I predicted ED visits at Wave III using sibling fixed effects models to adjust estimates for within-family unobserved heterogeneity. Increased violent, but not nonviolent, delinquency predicted a higher number of ED visits in early adulthood in the sibling fixed effects models. To our knowledge, this is the first study to examine the relationship between delinquency and ED usage using a sibling fixed effects design. Findings demonstrate that violent adolescent delinquency may increase healthcare usage and suggest the potential role of healthcare providers in improving outcomes for delinquent youth.
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Affiliation(s)
- Jill Portnoy
- University of Massachusetts Lowell, Lowell, MA, USA
| | - Joseph A Schwartz
- Florida State University, Tallahassee, FL, USA
- King Abdulaziz University, Jeddah, Saudi Arabia
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Mueller KL, Chapman-Kramer K, Cooper BP, Kaser T, Mancini M, Moran V, Vogel M, Foraker RE, Anwuri V. A Regional Approach to Hospital-Based Violence Intervention Programs Through LOV. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:306-316. [PMID: 36961541 DOI: 10.1097/phh.0000000000001716] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
CONTEXT Community violence is an underaddressed public health threat. Hospital-based violence intervention programs (HVIPs) have been used to address the root causes of violence and prevent reinjury. OBJECTIVE In this article, we describe the methodology of the St Louis Region-wide HVIP, Life Outside Violence (LOV) program, and provide preliminary process outcomes. DESIGN Life Outside Violence mentors intervene following a violent injury to decrease risk of subsequent victimization and achieve goals unique to each participant by providing therapeutic counseling and case management services to patients and their families. PARTICIPANTS AND SETTING Eligible patients are victims of violent injury between the ages of 8 and 24 years, who are residents of St Louis, Missouri, and present for care at a LOV partner adult or pediatric level I trauma hospital. INTERVENTION Enrolled participants receive program services for 6 to 12 months and complete an individual treatment plan. MAIN OUTCOME MEASURES In this article, we report LOV operational methodology, as well as process metrics, including program enrollment, graduation, and qualitative data on program implementation. RESULTS From August 15, 2018, through April 30, 2022, 1750 LOV-eligible violently injured patients presented to a partner hospital, 349 were approached for program enrollment, and 206 consented to enroll in the program. During this pilot phase, 91 participants graduated from the LOV program and have process output data available for analysis. CONCLUSIONS Life Outside Violence has been implemented into clinical practice as the first HVIP to influence across an entire region through partnership with multiple university and hospital systems. It is our hope that methods shared in this article will serve as a primer for organizations hoping to implement and expand HVIPs to interrupt community violence at the regional level.
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Affiliation(s)
- Kristen L Mueller
- Department of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri (Dr Mueller); Institute for Public Health, Washington University in St Louis School of Medicine, St Louis, Missouri (Mss Chapman-Kramer, Kaser, and Anwuri, Mr Cooper, and Dr Foraker); Saint Louis University School of Social Work, St Louis, Missouri (Dr Mancini); Trudy Busch Valentine School of Nursing, Saint Louis University, St Louis, Missouri (Dr Moran); and School of Criminal Justice, University at Albany, Albany, New York (Dr Vogel)
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19
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Bernardin ME, Spectorsky K, Gu H, Fairfax C, Cutler K. Child Firearm Injury Circumstances and Associations With Violence Intervention Program Enrollment. J Surg Res 2023; 285:67-75. [PMID: 36652770 DOI: 10.1016/j.jss.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/07/2022] [Accepted: 12/25/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Pediatric firearm injuries are the leading cause of death among American children. While assault is the most commonly cited cause, few studies have investigated circumstances surrounding such injuries. Violence intervention programs (VIPs) have been utilized to combat firearm violence, though a similar lack of knowledge exists regarding possible associations between firearm injury circumstances and youth VIP enrollment. METHODS This cross-sectional study included children aged 6-17 y who presented to an urban level 1 pediatric trauma center with firearm injuries from 2014 to 2017. Victim demographics and enrollment in a VIP were obtained from medical records, as well as circumstances surrounding the injuries based on account of the victim, victim's family/friends, and/or police present at the hospital. Circumstances included location of the shooting, if the shooter was known to the victim, and if the shooting was confirmed by the victim or their contacts to have been accidental or an intentional assault. Medical record numbers were used to locate victims in our trauma registry in order to obtain their assigned international classification of disease codes. Wilcox-rank sum, Pearson's chi-squared and Fisher's exact tests were used to detect associations between demographics, VIP enrollment, and shooting circumstances. RESULTS 156 victims of firearm injury were described, including primarily Black adolescent males. 72% of victims were shot outdoors by an unknown shooter, the motivation of which was unknown in 93% of cases. 36% of these shootings were "drive-by". The majority of victims received international classification of disease codes for assault, though shootings that were confirmed by the victim to have been intentional assaults were relatively uncommon (13.4%). Most children lived in the same zip code in which they were shot (71%), and three particular zip codes accounted for 40% of shootings. 26% of victims chose to enroll in the VIP, and those that were victims of confirmed assaults (odds ratio 3.5) as well as those admitted to the hospital (odds ratio 2.4) were significantly more likely to enroll. CONCLUSIONS Based on victim account, children living in an urban setting are more frequently victims of unclearly motivated, outdoor neighborhood shootings rather than intentional assaults. More accurate understanding of the causes of pediatric firearm injuries should inform both recruitment into VIPs, as well as a balancing of VIPs with community-level interventions to address firearm violence.
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Affiliation(s)
- Mary Elizabeth Bernardin
- Department of Emergency Medicine, University of Missouri School of Medicine, Division of Pediatric Emergency Medicine, Columbia, Missouri; Department of Pediatrics, Washington University School of Medicine, Division of Pediatric Emergency Medicine, St. Louis, Missouri.
| | - Kathryn Spectorsky
- Department of Pediatrics, Washington University School of Medicine, Division of Pediatric Emergency Medicine, St. Louis, Missouri
| | - Hongjie Gu
- Washington University School of Medicine, Division of Biostatistics, St. Louis, Missouri
| | - Connor Fairfax
- Trauma Services, St. Louis Children's Hospital, St. Louis, Missouri
| | - Keven Cutler
- Department of Emergency Medicine, University of Missouri School of Medicine, Division of Pediatric Emergency Medicine, Columbia, Missouri
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Pino EC, Jacoby SF, Dugan E, Jay J. Exposure to Neighborhood Racialized Economic Segregation and Reinjury and Violence Perpetration Among Survivors of Violent Injuries. JAMA Netw Open 2023; 6:e238404. [PMID: 37099300 PMCID: PMC10134006 DOI: 10.1001/jamanetworkopen.2023.8404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/02/2023] [Indexed: 04/27/2023] Open
Abstract
Importance Much is unknown about how individual and neighborhood factors converge in the association with risk for violent reinjury and violence perpetration. Objectives To investigate the association of exposure to neighborhood racialized economic segregation with reinjury and use of violence against others among survivors of violent penetrating injury. Design, Setting, and Participants This retrospective cohort study was performed using data obtained from hospital, police, and state vital records. The study was performed at Boston Medical Center, an urban, level I trauma center that is the largest safety-net hospital and busiest trauma center in New England. The cohort included all patients treated for a nonfatal violent penetrating injury from 2013 to 2018. Patients with no Boston metropolitan area home address were excluded. Individuals were followed up through 2021. Data were analyzed from February to August 2022. Exposure American Community Survey data were used to measure neighborhood deprivation using the racialized economic Index of Concentration at the Extremes (ICE) for patient residential address upon hospital discharge. ICE was measured on a scale from -1 (most deprived) to 1 (most privileged). Main Outcomes and Measures Primary outcomes were violent reinjury and police-reported perpetration of violence within 3 years of an index injury. Results Of 1843 survivors of violence (median [IQR] age, 27 [22-37] years; 1557 men [84.5%]; 351 Hispanic [19.5%], 1271 non-Hispanic Black [70.5%], and 149 non-Hispanic White [8.3%] among 1804 patients with race and ethnicity data), the cohort was skewed toward residing in neighborhoods with higher racialized economic segregation (median [IQR] ICE = -0.15 [-0.22 to 0.07]) compared with the state overall (ICE = 0.27). There were police encounters for violence perpetration among 161 individuals (8.7%) and violent reinjuries among 214 individuals (11.6%) within 3 years after surviving a violent penetrating injury. For each 0.1-unit increase in neighborhood deprivation, there was a 13% (hazard ratio [HR], 1.13; 95% CI, 1.03 to 1.25; P = .01) increase in risk of violence perpetration but no difference in risk for violent reinjury (HR, 1.03; 95% CI, 0.96 to 1.11; P = .38). The greatest occurrence for each outcome was within the first year after index injury; for example, incidents of violence perpetration occurred among 48 of 614 patients (7.8%) at year 1 vs 10 of 542 patients (1.8%) at year 3 in tertile 3 of neighborhood deprivation. Conclusions and Relevance This study found that living in a more economically deprived and socially marginalized area was associated with increased risk of using violence against others. The finding suggests that interventions may need to include investments in neighborhoods with the highest levels of violence to help reduce downstream transmission of violence.
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Affiliation(s)
- Elizabeth C. Pino
- Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Sara F. Jacoby
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
| | - Elizabeth Dugan
- Boston Violence Intervention Advocacy Program, Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts
| | - Jonathan Jay
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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Zheng N, Abram KM, Welty LJ, Aaby DA, Meyerson NS, Teplin LA. Nonfatal Firearm Injury and Firearm Mortality in High-risk Youths and Young Adults 25 Years After Detention. JAMA Netw Open 2023; 6:e238902. [PMID: 37083667 PMCID: PMC10122168 DOI: 10.1001/jamanetworkopen.2023.8902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Importance Youths, especially Black and Hispanic males, are disproportionately affected by firearm violence. Yet, no epidemiologic studies have examined the incidence rates of nonfatal firearm injury and firearm mortality in those who may be at greatest risk-youths who have been involved with the juvenile justice system. Objectives To examine nonfatal firearm injury and firearm mortality in youths involved with the juvenile justice system and to compare incidence rates of firearm mortality with the general population. Design, Setting, and Participants The Northwestern Juvenile Project is a 25-year prospective longitudinal cohort study of 1829 youths after juvenile detention in Chicago, Illinois. Youths were randomly sampled by strata (sex, race and ethnicity, age, and legal status [juvenile or adult court]) at intake from the Cook County Juvenile Temporary Detention Center. Participants were interviewed at baseline (November 1995 to June 1998) and reinterviewed as many as 13 times over 16 years, through February 2015. Official records on mortality were collected through December 2020. Data analysis was conducted from November 2018 to August 2022. Main Outcomes and Measures Participants self-reported nonfatal firearm injuries. Firearm deaths were identified from county and state records and collateral reports. Data on firearm deaths in the general population were obtained from the Illinois Department of Public Health. Population counts were obtained from the US census. Results The baseline sample of 1829 participants included 1172 (64.1%) males and 657 (35.9%) females; 1005 (54.9%) Black, 524 (28.6%) Hispanic, 296 (16.2%) non-Hispanic White, and 4 (0.2%) from other racial and ethnic groups (mean [SD] age, 14.9 [1.4] years). Sixteen years after detention, more than one-quarter of Black (156 of 575 [27.1%]) and Hispanic (103 of 387 [26.6%]) males had been injured or killed by firearms. Males had 13.6 (95% CI, 8.6-21.6) times the rate of firearm injury or mortality than females. Twenty-five years after the study began, 88 participants (4.8%) had been killed by a firearm. Compared with the Cook County general population, most demographic groups in the sample had significantly higher rates of firearm mortality (eg, rate ratio for males, 2.8; 95% CI, 2.0-3.9; for females: 6.5; 95% CI, 3.0-14.1; for Black males, 2.5; 95% CI, 1.7-3.7; for Hispanic males, 9.6; 95% CI, 6.2-15.0; for non-Hispanic White males, 23.0; 95% CI, 11.7-45.5). Conclusions and Relevance This is the first study to examine the incidence of nonfatal firearm injury and firearm mortality in youths who have been involved with the juvenile justice system. Reducing firearm injury and mortality in high-risk youths and young adults requires a multidisciplinary approach involving legal professionals, health care professionals, educators, street outreach workers, and public health researchers.
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Affiliation(s)
- Nanzi Zheng
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karen M Abram
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leah J Welty
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David A Aaby
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nicholas S Meyerson
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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O'Neill KM, Dodington J, Gawel M, Borrup K, Shapiro DS, Gates J, Gregg S, Becher RD. The effect of the COVID-19 pandemic on community violence in Connecticut. Am J Surg 2023; 225:775-780. [PMID: 36253316 PMCID: PMC9540704 DOI: 10.1016/j.amjsurg.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Natural disasters may lead to increases in community violence due to broad social disruption, economic hardship, and large-scale morbidity and mortality. The effect of the COVID-19 pandemic on community violence is unknown. METHODS Using trauma registry data on all violence-related patient presentations in Connecticut from 2018 to 2021, we compared the pattern of violence-related trauma from pre-COVID and COVID pandemic using an interrupted time series linear regression model. RESULTS There was a 55% increase in violence-related trauma in the COVID period compared with the pre-COVID period (IRR: 1.55; 95%CI: 1.34-1.80; p-value<0.001) driven largely by penetrating injuries. This increase disproportionately impacted Black/Latinx communities (IRR: 1.61; 95%CI: 1.36-1.90; p-value<0.001). CONCLUSION Violence-related trauma increased during the COVID-19 pandemic. Increased community violence is a significant and underappreciated negative health and social consequence of the COVID-19 pandemic, and one that excessively burdens communities already at increased risk from systemic health and social inequities.
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Affiliation(s)
- Kathleen M O'Neill
- Division of General Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, Department of Surgery, New Haven, CT, 06520, USA; Investigative Medicine Program, Yale School of Medicine, Yale Graduate School of Arts and Sciences, New Haven, CT, 06510, USA.
| | - James Dodington
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, 06510, USA; Violence Intervention Program, Yale New Haven Hospital, USA.
| | - Marcie Gawel
- Violence Intervention Program, Yale New Haven Hospital, USA.
| | - Kevin Borrup
- Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, 06106, USA; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, 06032, USA.
| | - David S Shapiro
- Department of Surgery, Saint Francis Hospital & Medical Center, USA; Associate Professor of Surgery University of Connecticut School of Medicine & Frank L. Netter Schools of Medicine, USA.
| | - Jonathan Gates
- Department of Surgery, Hartford Healthcare Hartford Hospital, USA.
| | - Shea Gregg
- Trauma, Burns and Surgical Critical Care, Bridgeport Hospital, USA.
| | - Robert D Becher
- Division of General Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, Department of Surgery, New Haven, CT, 06520, USA.
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Reitz ACW, Hawk SR, Schwimmer HD, Hanna T, Payne DES. Utilizing a combined hospital and criminal justice database to identify risk factors for repeat firearm injury or violent-crime arrest among firearm victims. MEDICINE, SCIENCE, AND THE LAW 2023; 63:93-104. [PMID: 35726447 DOI: 10.1177/00258024221103695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Introduction: Identifying firearm victims with the greatest risk of repeat-firearm exposure and offering interventions has the potential to disrupt recurrent violence. This study explored risk factors associated with repeat violence among survivors of intentional firearm injury in a unique clinical and criminal justice (CJ) dataset. Methods: This study analyzed a retrospective cohort (n = 4058) of persons injured by nonfatal intentional firearm violence from 2013 to 2016 in one metropolitan area. Data were collected from a single level I trauma center, city police records, and state CJ databases from 1948 to 2019. The primary outcome of interest was another firearm injury or violent-crime arrest (defined as a violent or firearm felony offense). Results: Among 4058 nonfatal intentional firearm victims, 1202 (29.6%) individuals had a repeat-firearm injury or violent-crime arrest. In a bivariate analysis, history of mental, physical, and/or emotional abuse (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.40-1.86), mental health diagnosis (OR, 1.88; 95% CI, 1.51-2.35), or illegal substance use (OR, 2.87; 95% CI, 2.48-3.32) was associated with increased risk of repeat-firearm injury or violent-crime arrest. Prior felony arrest (OR, 3.68; 95% CI, 3.19-4.24), prior incarceration (OR, 3.72; 95% CI, 3.04-4.56), prior firearm charge (OR, 4.06; 95% CI, 3.33-4.96), and suspected gang membership (OR, 8.69; 95% CI, 6.14-12.32) demonstrated the greatest association with significant repeat violence. Conclusions: Thirty percent of those who experienced an intentional firearm injury were found to have a repeat-firearm injury or violent-crime arrest multi-disciplinary interventions that address the complex needs of a CJ-involved population are needed to mitigate significant repeat violence.
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Affiliation(s)
- Alexandra C W Reitz
- Department of Surgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Tarek Hanna
- Department of Radiology and Imaging Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
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Kaufman EJ, Richmond TS, Hoskins K. Youth Firearm Injury: A Review for Pediatric Critical Care Clinicians. Crit Care Clin 2023; 39:357-371. [PMID: 36898779 PMCID: PMC9662754 DOI: 10.1016/j.ccc.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Firearms are now the leading cause of death among youth in the United States, with rates of homicide and suicide rising even more steeply during the SARS-CoV-2 pandemic. These injuries and deaths have wide-ranging consequences for the physical and emotional health of youth and families. While pediatric critical care clinicians must treat the injured survivors, they can also play a role in prevention by understanding the risks and consequences of firearm injuries; taking a trauma-informed approach to the care of injured youth; counseling patients and families on firearm access; and advocating for youth safety policy and programming.
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Affiliation(s)
- Elinore J Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Penn Presbyterian Medical Center, MOB Suite 120, 51 North 39th Street, Philadelphia, PA 19104, USA
| | - Therese S Richmond
- University of Pennsylvania School of Nursing, Fagin Hall 330, 418 Curie Boulevard, Philadelphia, PA 19104, USA.
| | - Katelin Hoskins
- University of Pennsylvania School of Nursing, Fagin Hall 312, 418 Curie Boulevard, Philadelphia, PA 19104, USA
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25
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Timmer-Murillo SC, Schroeder ME, Trevino C, Geier TJ, Schramm AT, Brandolino AM, Hargarten S, Holena D, de Moya M, Milia D, deRoon-Cassini TA. Comprehensive Framework of Firearm Violence Survivor Care: A Review. JAMA Surg 2023; 158:541-547. [PMID: 36947025 DOI: 10.1001/jamasurg.2022.8149] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Importance Firearm violence is a public health crisis placing significant burden on individuals, communities, and health care systems. After firearm injury, there is increased risk of poor health, disability, and psychopathology. The newest 2022 guidelines from the American College of Surgeons Committee on Trauma require that all trauma centers screen for risk of psychopathology and provide referral to intervention. Yet, implementing these guidelines in ways that are responsive to the unique needs of communities and specific patient populations, such as after firearm violence, is challenging. Observations The current review highlights important considerations and presents a model for trauma centers to provide comprehensive care to survivors of firearm injury. This model highlights the need to enhance standard practice to provide patient-centered, trauma-informed care, as well as integrate inpatient and outpatient psychological services to address psychosocial needs. Further, incorporation of violence prevention programming better addresses firearm injury as a public health concern. Conclusions and Relevance Using research to guide a framework for trauma centers in comprehensive care after firearm violence, we can prevent complications to physical and psychological recovery for this population. Health systems must acknowledge the socioecological context of firearm violence and provide more comprehensive care in the hospital and after discharge, to improve long-term recovery and serve as a means of tertiary prevention of firearm violence.
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Affiliation(s)
| | - Mary E Schroeder
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Colleen Trevino
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Timothy J Geier
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Andrew T Schramm
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Amber M Brandolino
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Stephen Hargarten
- Division of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - Daniel Holena
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Marc de Moya
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - David Milia
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
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26
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Romo ND, Castillo C, Green J, Lin J, Mendelsohn E, Dawkins-Hamilton C, Reddy SH, Blumberg SM. Improving Adolescent Violent Trauma Outcomes With a Hospital-Based Violence Prevention Initiative. Hosp Pediatr 2023; 13:153-158. [PMID: 36597702 DOI: 10.1542/hpeds.2021-006428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Violent trauma results in significant morbidity/mortality in Black/Hispanic males aged 15 to 24 years. Hospital- and community-level interventions may improve patient and community outcomes. OBJECTIVE To determine if a hospital-based violence prevention intervention using community outreach workers was associated with improved violent trauma patient postdischarge follow-up and reinjury rates. METHODS This is a retrospective, single-center, cohort study of admitted violent trauma patients to a public hospital in the Bronx, NY. Data were collected from a convenience sample of patients aged 15 to 24 years admitted with International Classification of Diseases, 10th Revision, codes for gunshot wound, stab wound, or physical assault from August 2014 to April 2018. The exposure variable was documentation of intervention team evaluation during admission. The outcome variables included attending >50% scheduled postdischarge follow-up visits, and subsequent violent reinjury (gunshot wound, stab wound, blunt assault) during the study time period. Multivariable regression models were used to determine the association between the exposure and outcome variables. RESULTS A total of 535 patients were evaluated and were primarily male (92.5%), Black (54%)/Latino (36.4%), with mean age of 19.1 years. Patients in the exposure group had increased odds of attending >50% of scheduled clinic postdischarge follow-up visits (odds ratio, 2.29; 95% confidence interval 1.59-3.29) and decreased odds of subsequent violent reinjury presentation (odds ratio, 0.41; 95% confidence interval 0.22-0.75) 3 months after hospital discharge. CONCLUSION A hospital-based violence prevention intervention may be associated with decreased odds of violent reinjury and increased odds of postdischarge scheduled appointment adherence in admitted pediatric violent trauma patients.
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Affiliation(s)
- Noé D Romo
- Departments of Pediatrics.,Departments of Pediatrics
| | | | - Jaylen Green
- Departments of Pediatrics.,Departments of Pediatrics
| | - Juan Lin
- Biostatistics, The Albert Einstein College of Medicine, Bronx, New York
| | - Erika Mendelsohn
- Social Work, NYC Health + Hospitals/Jacobi, Bronx, New York.,New York State Department of Criminal Justice Services, SNUG Anti-Violence Initiative, Albany, New York
| | - Carjah Dawkins-Hamilton
- Social Work, NYC Health + Hospitals/Jacobi, Bronx, New York.,New York State Department of Criminal Justice Services, SNUG Anti-Violence Initiative, Albany, New York
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27
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Harfouche MN, Shields T, Curriero FC. Geospatial analysis of firearm injuries in an urban setting: Individual rather than community characteristics affect firearm injury risk. Am J Surg 2023; 225:1062-1068. [PMID: 36702734 DOI: 10.1016/j.amjsurg.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/09/2023] [Accepted: 01/15/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND The relationship between individual/socioeconomic characteristics and firearm injury risk in an urban center was evaluated. METHODS A hospital registry was used to identify individuals in Baltimore City who experienced interpersonal firearm injury in 2019 (FA). Injuries that did not satisfy this criterion were used as a comparison group (NF). Socioeconomic characteristics were linked to home address at the block group level. Regression analysis was used to determine predictors of firearm injury. Clusters of high and low firearm relative to non-firearm injuries were identified. RESULTS A total of 1293 individuals were included (FA = 277, NF = 1016). The FA group lived in communities with lower income (p = 0.005), higher poverty (p = 0.007), and more Black residents (p < 0.001). Individual level factors were stronger predictors of firearm injury than community factors on multivariate regression with Black race associated with 5x higher odds of firearm injury (p < 0.001). Firearm injury clustered in areas of low socioeconomic status. CONCLUSIONS Individual versus community factors have a greater influence on firearm injury risk. Prevention efforts should target young, Black men in urban centers.
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Affiliation(s)
- Melike N Harfouche
- University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, 21201, USA; Johns Hopkins University School of Public Health, 615 N Wolf St, Baltimore, MD, 21205, USA.
| | - Timothy Shields
- Johns Hopkins University School of Public Health, 615 N Wolf St, Baltimore, MD, 21205, USA.
| | - Frank C Curriero
- Johns Hopkins University School of Public Health, 615 N Wolf St, Baltimore, MD, 21205, USA.
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28
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Beyond Recidivism: Hospital-Based Violence Intervention and Early Health and Social Outcomes. J Am Coll Surg 2022; 235:927-939. [PMID: 36102509 DOI: 10.1097/xcs.0000000000000409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hospital-based violence intervention programs (HVIPs) are aimed at decreasing recurrent injury and improving the social determinants of health. We hypothesized that the HVIP intervention should be evaluated by how well it can address the immediate health and social needs of patients after injury. Our study sought to describe the experience of our nascent HVIP. STUDY DESIGN Case management records of patients treated by the HVIP of a level 1 trauma center from July 1, 2017 to October 1, 2020 were reviewed. Inclusion criteria were as follows: age between 18 and 60 with injury mechanisms that resulted from intentional violence. Patient-stated goals and social worker designation of patient services provided were analyzed. A subset of HVIP patients who completed the three planned study visit surveys at discharge and 1 and 3 months were compared with a cohort of violently injured patients to whom HVIP services were not available. Participants in both groups were asked to complete a battery of validated surveys to assess social outcomes and post-traumatic stress disorder (PTSD). Repeated-measures ANOVA was used to compare the two groups. RESULTS Two hundred and ninety-five patients met the inclusion criteria. One hundred and forty-six patients (49%) achieved their stated goals within 6 months of hospital discharge. Sixteen patients who achieved their stated goals disengaged from the program. Engagement in the HVIP resulted in significantly less PTSD at the time of hospital discharge. HVIP patients also experienced higher positive affect at hospital discharge, as described in the Positive and Negative Affect Schedule. HVIP participants were significantly more likely to achieve early positive health outcomes, such as completion of victim of crime compensation and return to school. CONCLUSIONS Our HVIP successfully achieved patient-stated short-term health and social goals in nearly half of all enrollees, indicating that HVIP patients are more likely to improve their social determinants of health than non-HVIP patients. Short-term health and social outcomes were improved in HVIP patients compared with non-HVIP patients, indicating increased engagement with the healthcare system. We suggest that these outcomes should replace recidivism as a metric for the efficacy of HVIP programs.
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29
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Wical W, Harfouche M, Lovelady N, Aguilar N, Ross D, Richardson JB. Exploring emergent barriers to hospital-based violence intervention programming during the COVID-19 pandemic. Prev Med 2022; 165:107232. [PMID: 36084752 PMCID: PMC9446660 DOI: 10.1016/j.ypmed.2022.107232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 11/24/2022]
Abstract
National rates of gun violence have risen during the COVID-19 pandemic. There are many contributing factors to this increase, including the compounding consequences of social isolation, unstable housing, decreased economic stability, and ineffective and violent policing of communities of color. The effects of these factors are exacerbated by the pandemic's impact on the provision and availability of psychosocial services for individuals in marginalized communities, particularly those who have been violently injured. Hospital-based violence intervention programs (HVIPs) have been identified as a crucial intervention strategy in reducing repeat violent injury. The ongoing COVID-19 pandemic has engendered, significant barriers in HVIPs' attempts to assist program participants in achieving their health-related and social goals. This research offers insight into the complexities of providing social services during the convergence of two public health crises-COVID-19 and gun violence-at the HVIPs associated with the two busiest trauma centers in the state of Maryland. In considering the effects of inadequate financial support and resources, issues with staffing, and the shift to virtual programming due to restrictions on in-person care, we suggest possible changes to violence prevention programming to increase the quality of care provided to participants in a manner reflective of their unique structural positions.
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Affiliation(s)
- William Wical
- Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland College Park, 1141 Taliaferro Building, College Park, MD 20742, United States of America.
| | - Melike Harfouche
- Department of Surgery, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, United States of America.
| | - Nakita Lovelady
- Department of Health Behavior and Health Education, College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, United States of America.
| | - Nathan Aguilar
- Columbia University School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, United States of America.
| | - David Ross
- Rebuild, Overcome, and Rise Center, University of Maryland, Baltimore, 520 W Fayette Street, Suite 320, Baltimore, MD 21201, United States of America.
| | - Joseph B Richardson
- Department of African American Studies and the Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland College Park, 1141 Taliaferro Building, College Park, MD 20742, United States of America.
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30
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Mueller KL, Moran V, Anwuri V, Foraker RE, Mancini MA. An exploration of factors impacting implementation of a multisystem hospital-based violence intervention program. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6577-e6585. [PMID: 36373272 DOI: 10.1111/hsc.14107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 08/06/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
Community violence, particularly gun violence, is a leading cause of morbidity and mortality in young people in the United States. Because persons experiencing violence-related injuries are likely to receive medical care through emergency departments, hospitals are increasingly seen as primary locations for violence intervention services. Currently, there is little research on how best to implement hospital-based violence intervention programs (HVIPs) across large hospital systems. This study explored the factors influencing the implementation of a multi-site HVIP using qualitative interviews with a purposive sample of 20 multidisciplinary stakeholders. Thematic analysis was used to generate several themes that included: (1) reframing gun violence as a public health issue; (2) developing networks of community-hospital-university partners; (3) demonstrating effectiveness and community benefit; and (4) establishing patient engagement pathways. Effective implementation and sustainment of HVIPs requires robust and sustained multidisciplinary partnerships within and across hospital systems and the establishment of HVIPs as a standard of care.
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Affiliation(s)
- Kristen L Mueller
- Washington University in St. Louis School of Medicine, St Louis, Missouri, USA
| | - Vicki Moran
- St. Louis University Trudy Busch Valentine School of Nursing, St Louis, Missouri, USA
| | - Victoria Anwuri
- Washington University in St. Louis School of Medicine, St Louis, Missouri, USA
| | - Randi E Foraker
- Washington University in St. Louis School of Medicine, St Louis, Missouri, USA
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31
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Holler, MPH E, Ortiz, MD D, Mohanty, MD, MS S, Meagher, MD, MPH AD, Boustani, MD, MPH M, Zarzaur, MD, MPH BL, Simons, MD CJ. Violent injury prevention does not equal to violent crime prevention: an analysis of violence intervention program efficacy using propensity score methods. Trauma Surg Acute Care Open 2022; 7:e000905. [PMID: 36267559 PMCID: PMC9577934 DOI: 10.1136/tsaco-2022-000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022] Open
Abstract
Objective The purpose of this study was to determine if exposure to Prescription for Hope (RxH), a hospital-based violence intervention program (HVIP), is associated with reduced violent reinjury and new convictions for violent crime in the 2-year period after index hospitalization for a violent injury. Methods This was a retrospective cohort study analyzing patients from two level I trauma centers in Indianapolis, Indiana. RxH participants (n=260) enrolled between January 1, 2015 and December 31, 2018 and who had trauma registry data were included. RxH eligibility criteria: admitted for a violent injury (excluding sexual violence), at least 15 years of age, live in Marion County, Indiana, and stay in the hospital for at least 24 hours. RxH exclusion criteria: heavy active substance use, acute psychosis, dementia, severe traumatic brain injury, intentional self-harm, and incarceration. All patients admitted to IU Health Methodist Hospital, a nearby level I trauma center, for an assault, stabbing, or gunshot wound during the same period and met the RxH eligibility criteria were included as a comparison group (n=732). Doubly adjusted logistic regression with inverse probability of treatment weighting was used to estimate the average treatment effect of RxH participation on violent reinjury and new convictions for violent crime. Results Data from 992 patients were analyzed. RxH was significantly associated with reduced odds of violent reinjury (OR=0.35, 95% CI 0.20 to 0.59) and increased odds of conviction for a violent crime (OR=2.43, 95% CI 1.64 to 3.61). Conclusion RxH was associated with decreased odds of violent reinjury but increased odds of new conviction for a violent crime. Our results highlight the importance of robust, routine evaluation of HVIP efficacy and recommend inclusion of other outcomes in addition to violent reinjury when evaluating program success. High-quality randomized controlled trials are needed to further investigate the impact of HVIPs on a variety of outcomes. Level of evidence IV: retrospective study with more than one negative criterion ((1) limited control of confounding and (2) heterogeneous populations).
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Affiliation(s)
- Emma Holler, MPH
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, Indiana, USA
| | - Damaris Ortiz, MD
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA,Eskenazi Health, Eskenazi Health Hospital, Indianapolis, Indiana, USA
| | - Sanjay Mohanty, MD, MS
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA,Methodist Hospital, Indiana University Health, Indianapolis, Indiana, USA
| | - Ashley D Meagher, MD, MPH
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA,Methodist Hospital, Indiana University Health, Indianapolis, Indiana, USA
| | | | - Ben L Zarzaur, MD, MPH
- Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Clark J Simons, MD
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA,Eskenazi Health, Eskenazi Health Hospital, Indianapolis, Indiana, USA
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32
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Thomas YM, Regan SC, Quintana E, Wisnieski E, Salzman SL, Chow KL, Mack CF, Stone L, Giloth B, Smith-Singares E. Violence Prevention Programs Are Effective When Initiated During the Initial Workup of Patients in an Urban Level I Trauma Center. Am J Mens Health 2022; 16:15579883221125007. [PMID: 36114706 PMCID: PMC9490468 DOI: 10.1177/15579883221125007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
This study represents the first attempt at evaluating the ability of the CureViolence Hospital-Response Intervention Program (previously CeaseFire) to disrupt the pattern of violent reinjury. The clinical data points of 300 African American men who presented to our trauma center with a gunshot wound and received intervention at the bedside between 2005 and 2007 (with a 48-month follow-up) were collected. This cohort was matched with a post hoc historical control group using hospital records from 2003 to 2005. The mean age for both groups was 23.9 years. Odds ratios and 95% confidence intervals were obtained. Using a binary logistical regression model, we assessed the performance of three variables of interest: age at the time of the initial injury, treatment group, and initial disposition group to predict recidivism. We utilized the Nagelkerke R square method, which described the proportion of the variance of the reinjury rate and validated our findings using the Hosmer-Lemeshow test (for goodness-of-fit). Six percent (n = 18) of subjects in the treatment group and 11% (n = 33) in the control group returned with a new injury, yielding a total reinjury rate of 8.5%. Most patients returned only once with another violent injury. Individuals who did not receive CureViolence services were nearly twice as likely (odds ratio = 1.94; 95% confidence interval = 1.065, 3.522) to return with a violent reinjury. This finding suggests that Hospital-Response Intervention Programs (HRIP) have a protective effect in violently injured patients. We therefore conclude our HRIP positively affected at-risk patients and prevented violent reinjury.
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Affiliation(s)
- Yalaunda M. Thomas
- Department of Surgery, Division of Trauma Critical Care, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | | | | | | | - Steven L. Salzman
- Department of Surgery, Division of Trauma Critical Care, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Kevin L. Chow
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Charles F. Mack
- CeaseFire Chicago, Chicago, IL, USA,Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - LeVon Stone
- CeaseFire Chicago, Chicago, IL, USA,Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Barbara Giloth
- CeaseFire Chicago, Chicago, IL, USA,Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Eduardo Smith-Singares
- Clinical Professor of Surgery, Elson S Floyd College of Medicine at Washington State University, USA,Medical Director for Trauma & Emergency Surgical Services, Kadlec Medical Center, Richland, WA, USA,Eduardo Smith-Singares, Clinical Professor of Surgery, Elson S Floyd College of Medicine at Washington State University, 412 E Spokane Falls Blvd., Spokane, WA 99202, USA.
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33
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Harfouche MN, Walton EC, Richardson JB, Scalea TM. Implementation of an Outpatient Violence Intervention Program to Increase Service Uptake. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 24:535-540. [PMID: 36006598 PMCID: PMC9403958 DOI: 10.1007/s11121-022-01428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/27/2022]
Abstract
Challenges in participant recruitment and retention limit the effectiveness of hospital-based violence intervention programs (HVIPs). This study aimed to determine if an outpatient violence intervention program (VIP) could be integrated into a trauma clinic and increase uptake of violence prevention services. Patients previously hospitalized for intent-to-harm being seen for outpatient follow-up were eligible. VIP counselors met with participants during their clinic visit, administered the survey, and offered violence prevention services (April to June 2019). Patients were followed for 6 months to assess involvement. The primary outcome of interest was long-term participation in the VIP, defined as uptake of services at 6 months, in comparison to inpatient recruitment. Out of 76 patients, 34 (44.7%) did not appear for their appointment. The remainder (n = 42) were offered participation in the study, of which 32 (76.2%) completed the survey. From the group offered VIP services, 57.1% expressed interest, and 5 (20.8%) ultimately took part yielding an overall participation rate of 11.9% at 6 months. The inpatient recruitment rate in 2019 was 2.4%. An outpatient VIP program can be integrated into a clinic setting but suffers from the same challenges faced by inpatient programs resulting in low rates of long-term participation in services. Although a high proportion of participants reported interest, actual engagement at 6 months was low. Reasons behind low participation in VIP services must be investigated.
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Affiliation(s)
- Melike N Harfouche
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, 21201, USA.
| | - Erin C Walton
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, 21201, USA
- Center for Injury Prevention and Policy, University of Maryland Medical Center, Baltimore, MD, 21201, USA
| | - Joseph B Richardson
- University of Maryland, College Park, USA
- Department of African American Studies, University of Maryland, College Park, MD, 20742, USA
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, 21201, USA
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34
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Baseline Needs Assessment for a Hospital-Based Violence Intervention Program 1-Year Pilot. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2020030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objectives of the present study were to measure and describe the baseline participant needs of a hospital-based violence intervention 1-year pilot program, assess differences in expected hospital revenue based on changes in health insurance coverage resulting from program implementation and discuss the program’s limitations. Methods: Between September 2020 and September 2021 Encompass Omaha enrolled 36 participants. A content analysis of 1199 progress notes detailing points of contact with participants was performed to determine goal status. Goals were categorized and goal status was defined as met, in process, dropped, or participant refusal. Results: The most frequently identified needs were help obtaining short-term disability assistance or completing FMLA paperwork (86.11%), immediate financial aid (86.11%), legal aid (83.33%), access to food (83.3%), and navigating medical issues other than the primary reason for hospitalization (83.33%). Conclusions: Meeting the participants’ short-term needs is critical for maintaining their engagement in the long-term. Further, differences in expected hospital revenue for pilot participants compared with a control group were examined, and this analysis found a reduction in medical and facility costs for program participants. The pilot stage highlighted how complex the needs and treatment of victims of violence are. As the program grows and its staff become more knowledgeable about social work, treatment, and resource access processes, the program will continue to improve.
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35
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Bliton JN, Zakrison TL, Vong G, Johnson DA, Rattan R, Hanos DS, Smith RN. Ethical Care of the Traumatized: Conceptual Introduction to Trauma-Informed Care for Surgeons and Surgical Residents. J Am Coll Surg 2022; 234:1238-1247. [PMID: 35703822 DOI: 10.1097/xcs.0000000000000183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trauma-informed care (TIC) is a set of principles and practices designed to improve the ways professionals treat people who have been traumatized. This study reviews fundamental concepts of TIC and applies them to the work of surgeons. TIC is described in relation to fundamental medical ethical concepts, and evidence for TIC-based intervention is reviewed. Implementation of TIC in medical education is also described, and recommendations for practice changes are made.
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Affiliation(s)
- John N Bliton
- From the Wellstar Atlanta Medical Center, Atlanta, GA (Bliton)
| | - Tanya L Zakrison
- Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, IL (Zakrison, Johnson)
| | - Gerard Vong
- Emory University, Center for Ethics, Atlanta, GA (Vong)
| | - Dwane A Johnson
- Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, IL (Zakrison, Johnson)
| | - Rishi Rattan
- Division of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL (Rattan)
| | - Dustin S Hanos
- Emory University School of Medicine, Grady Hospital, Atlanta, GA (Hanos, Smith)
| | - Randi N Smith
- Emory University School of Medicine, Grady Hospital, Atlanta, GA (Hanos, Smith)
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Hassett-Walker C. The Longitudinal Impact of Arrest, Criminal Conviction, and Incarceration on Smoking Classes. Tob Use Insights 2022; 15:1179173X221089710. [PMID: 35634273 PMCID: PMC9134438 DOI: 10.1177/1179173x221089710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background Previous research identifies three to six smoking classes over the life course. This study expands on earlier work about the impact of getting arrested in early adulthood on individuals' smoking classes, by including additional, more serious measures of justice system involvement (JSI), specifically criminal conviction and incarceration. Family processes were examined as secondary outcomes. Method Data from seventeen waves (1997-2015) of the National Longitudinal Survey of Youth were analyzed via group-based trajectory modeling (GBTM), multinomial logistic regression, and latent transition analyses (LTA). Smoking behavior through age 36 is examined. Marital status, parenthood, juvenile smoking, juvenile arrest, and prior crime victimization experiences were also included in the models. Results Seven smoking classes were revealed: two low- or non-smoking classes; two decreasing classes; and three "problem" smoking (e.g., increasing, or chronic) classes. All JSI types increased the likelihood of being in a smoking class rather than a non-smoking class. Arrest and conviction had larger odds ratios than the most severe form of JSI-incarceration-with respect to respondents' likelihood of being in an increasing or chronic smoking class. Juvenile smoking was the most robust predictor of smoking in adulthood. Conclusion Involvement with the justice system in all forms remains a negative health factor that increases smoking. While not typically a goal of criminal justice officials, attention should be paid to this unintended consequence of involvement with the justice system-increased smoking-given smoking's connection to serious illnesses such as cancer. As juvenile smoking is a strong risk factor for adult smoking, smoking prevention and cessation programs should start with youth; and be part of the offerings to individuals ensnared in the justice system at all levels.
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Hiranniramol K, Moran V, Israel H, Flood R. Characteristics of Adult Patients for Violence-Related Injuries Presenting to a Level 1 Trauma Center in Midwest United States. Hosp Top 2022; 101:352-359. [PMID: 35446753 DOI: 10.1080/00185868.2022.2065398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
| | - Vicki Moran
- Saint Louis University, St. Louis, MO, USA
- Trauma Research, SSM Health Saint Louis University, St. Louis, MO, USA
| | - Heidi Israel
- Orthopaedic Surgery, Saint Louis University, St. Louis, MO, USA
| | - Robert Flood
- Pediatrics - Emergency Medicine, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, MO, USA
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Dezman ZDW, Thurman P, Stockwell I. The actual, long-term cost of intentional injury care among a cohort of Maryland Medicaid recipients. J Trauma Acute Care Surg 2022; 92:567-573. [PMID: 34610619 PMCID: PMC9090177 DOI: 10.1097/ta.0000000000003424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intentional injury (both self-harm and interpersonal) is a major cause of morbidity and mortality, yet there are little data on the per-person cost of caring for these patients. Extant data focus on hospital charges related to the initial admission but does not include actual dollars spent or follow-up outpatient care. The Affordable Care Act has made Medicaid the primary payor of intentional injury care (39%) in the United States and the ideal source of cost data for these patients. We sought to determine the total and per-person long-term cost (initial event and following 24 months) of intentional injury among Maryland Medicaid recipients. METHODS Retrospective cohort study of Maryland Medicaid claims was performed. Recipients who submitted claims after receiving an intentional injury, as defined by the International Classification of Diseases, Tenth Revision, between October 2015 and October 2017, were included in this study. Subjects were followed for 24 months (last participant enrolled October 2017 and followed to October 2019). Our primary outcome was the dollars paid by Medicaid. We examined subgroups of patients who harmed themselves and those who received repeated intentional injury. RESULTS Maryland Medicaid paid $11,757,083 for the care of 12,172 recipients of intentional injuries between 2015 and 2019. The per-person, 2-year health care cost of an intentional injury was a median of $183 (SD, $5,284). These costs were highly skewed: min, $2.56; Q1 = 117.60, median, $182.80; Q3 = $480.82; and max, $332,394.20. The top 5% (≥95% percentile) required $3,000 (SD, $6,973) during the initial event and $8,403 (SD, $22,024) per served month thereafter, or 55% of the overall costs in this study. CONCLUSION The long-term, per-person cost of intentional injury can be high. Private insurers were not included and may experience different costs in other states. LEVEL OF EVIDENCE Economic and Value Based Evaluations; level III.
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Affiliation(s)
- Zachary D W Dezman
- From the Department of Emergency Medicine (Z.D.W.D.), Department of Epidemiology and Public Health (Z.D.W.D.), and R Adams Shock Trauma Center, University of Maryland School of Medicine, Baltimore (P.T.); Hilltop Institute (I.S.), Erickson School of Aging Studies (I.S.), and Information Systems (I.S.), University of Maryland, Baltimore County, Catonsville, Maryland
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Pino EC, Fontin F, James TL, Dugan E. Mechanism of penetrating injury mediates the risk of long-term adverse outcomes for survivors of violent trauma. J Trauma Acute Care Surg 2022; 92:511-519. [PMID: 34284465 DOI: 10.1097/ta.0000000000003364] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND While hospital-based violence intervention programs are primarily designed to aid youth victims of gun violence at high risk for reinjury, the root causes and complex outcomes of community violence are varied. In this study, we examined the risk factors for violent penetrating injury and how the risk of adverse outcomes for survivors differs by injury type (stabbing vs. gunshot wound). METHODS This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a penetrating injury due to community violence between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the risk of all-cause mortality and violent reinjury within 3 years after surviving a penetrating injury. RESULTS Of the 4,280 survivors of the initial violent penetrating injury, there were 88 deaths (2.1%) and 568 violent reinjuries (13.3%) within 3 years. Compared with gunshot wound victims, stab wound victims were 31% less likely to be reinjured with a gunshot wound (HR, 0.69; 95% CI, 0.51-0.93), 72% more likely to be reinjured with a stab wound (HR, 1.72; 95% CI, 1.21-2.43), and 49% more likely to be reinjured by assault (HR, 1.49; 95% CI, 1.14-1.94). While survivors of stabbing and firearm injuries were equally at risk for 3-year all-cause mortality, stab wound victims were 3.75 times more likely to die by a drug/alcohol overdose (HR, 3.75; 95% CI, 1.11-20.65). CONCLUSION Patients surviving a stab wound have a significantly higher risk of violent reinjury by stabbing or assault, and risk of death by drug/alcohol overdose. Hospital-based violence intervention programs with similar patient populations should explore options to expand partnerships with drug treatment programs. These results illustrate two distinct populations of victims of violence-gunshot victims and stabbing/assault victims-with separate risk factors and outcomes, mediated by substance use disorder. LEVEL OF EVIDENCE Prognostic and Epidemiologic; level III.
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Affiliation(s)
- Elizabeth C Pino
- From the Boston Violence Intervention Advocacy Program, Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts
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O'Neill KM, Jean RA, Dodington J, Davis K, Becher RD. Evaluation of Firearm-related Reinjury in Connecticut: An Opportunity for Gun Violence Prevention. J Surg Res 2022; 274:23-30. [PMID: 35121547 DOI: 10.1016/j.jss.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 11/01/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The regional extent of the risk of repeat firearm-related injury (FRI) and homicide mortality for victims of firearm injury in Connecticut is unknown. In this study, we evaluate the risk of repeat firearm injury in survivors of firearm violence in Connecticut. METHODS Using medical record data from the Yale New Haven Health (YNHH) system and data from the Connecticut Office of the Chief Medical Examiner, we conducted a cohort study of patients with an FRI in 2014 to determine their risk of a repeat firearm injury or mortality from homicide in the ensuing 5 years compared with nonviolence-related trauma patient controls. RESULTS We identified 94 patients with an FRI in the YNHH system from 2014 who survived to discharge. Of these patients, 8.5% (8 of 94) had a repeat FRI and 2% (2 of 94) died from homicide within the next 5 years. Compared with nonviolence-related trauma patients from 2014 (n = 2001), those with an FRI had 12 times the odds of a repeat firearm injury (odds ratio: 12.0, P = 0.047) in the next 5 years after adjustment for relevant covariates. CONCLUSIONS Of the patients presenting with an initial FRI in the YNHH system, one in twelve will experience another firearm injury within the next 5 years. These data indicate that firearm-related reinjury is common in Connecticut and suggest the need for further violence prevention efforts.
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Affiliation(s)
- Kathleen M O'Neill
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut; Investigative Medicine Program, Yale School of Medicine, Yale Graduate School of Arts and Sciences, New Haven, Connecticut.
| | - Raymond A Jean
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - James Dodington
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Kimberly Davis
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Robert D Becher
- Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Zavala C, Buggs SA, Fischer KR. States should use Medicaid to support violence intervention efforts. J Trauma Acute Care Surg 2022; 92:e25-e27. [PMID: 35081099 DOI: 10.1097/ta.0000000000003471] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT 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. LEVEL OF EVIDENCE Economic and value-based evaluation, level IV.
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Affiliation(s)
- Claudia Zavala
- From the Department of Strategic Partnerships and Research (C.Z.), Health Alliance for Violence Intervention, Jersey City, New Jersey; Department of Emergency Medicine (S.B.), University of California Davis, Sacramento, California; and Department of Emergency Medicine (K.R.F.), University of Maryland School of Medicine, Baltimore, Maryland
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Walsh C, Smyth R. Partners in prevention: the role of health systems in the prevention of youth violence in post-conflict Northern Ireland. CRIME PREVENTION AND COMMUNITY SAFETY 2022; 24:369-386. [PMCID: PMC9461464 DOI: 10.1057/s41300-022-00159-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 06/28/2023]
Abstract
Interpersonal violence is a wicked and complex issue with youth disproportionately affected. Its effects are multifaceted, placing an additional burden across systems. Despite this, there continues to be an exclusive focus on police recorded crime data in the context of post-conflict Northern Ireland. Given the enduring issue around police legitimacy, it is likely that police-related crime data are limited in its capacity to estimate incidences and trends of youth violence. Leveraging insights from other sources of data can add significant value in the prevention of youth violence. For example, there is significant utility in the use of health-related data in the prevention of higher-harm violence; however, in the context of Northern Ireland this has been under-evaluated. This retrospective cohort study sought to illustrate what could be gleaned using a novel approach to Emergency Department (ED) data. Routinely collected data captured from youth aged 12–25 attending an ED trauma centre for violence-related injuries between August 2020 and August 2021 were collated, coded and analysed. We found that young men were most likely to present to ED with violence-related injuries; incidences were temporally clustered across several months of the year (i.e. Summer); and younger aged youth were at greater risk of violence-related injuries during the afternoon and early evening. These findings illustrate the utility of health data for violence prevention and the potential for integrating administrative datasets in the design of prevention policy. Limitations and implications for practice are discussed.
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Affiliation(s)
- Colm Walsh
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Ryan Smyth
- Western Health and Social Care Trust, Londonderry, Northern Ireland
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Hawks L, Lopoo E, Puglisi L, Cellini J, Thompson K, Halberstam AA, Tolliver D, Martinez-Hamilton S, Wang EA. Community investment interventions as a means for decarceration: A scoping review. LANCET REGIONAL HEALTH. AMERICAS 2021; 8:100150. [PMID: 36778729 PMCID: PMC9903691 DOI: 10.1016/j.lana.2021.100150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There is growing support to reverse mass incarceration in the United States, especially in the wake of the COVID-19 pandemic. Little is known about what types and scale of community investments are most effective to support mass decarceration. Using a public health prevention framework, we conducted a scoping review to examine community-based programs that reduced criminal legal involvement. We searched PubMed, Embase and three EBSCO databases from 1990 through September 2019 for all experimental or quasi-experimental studies testing interventions pertaining to education, housing, healthcare, employment, or social support services and how they affected an individual's criminal legal outcomes. Our review identified 53 studies that demonstrated the efficacy of early childhood educational interventions and nurse-family partnership programs, post-secondary education for incarcerated students, navigation programs linking incarcerated people to community resources, and peer support upon release to reduce criminal legal system exposure. In concert with legislative action to end mass incarceration, additional research is needed to test interventions designed to achieve mass decarceration which cross multiple domains, interrogate community-level impacts and ascertain long-term outcomes.
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Affiliation(s)
- L Hawks
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI,Corresponding Author: Laura Hawks, MD, MPH, Medical College of Wisconsin, Division of General Internal Medicine, 8701 Watertown Plank Rd., Milwaukee, WI 53226-3596. Tel: 414-955-7566; Fax: 414-805-0855.
| | - E Lopoo
- Square One Project, Columbia University Justice Lab, New York, NY
| | - L Puglisi
- Yale School of Medicine, New Haven, CT,SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT
| | - J Cellini
- Countway Library, Harvard TH Chan School of Public Health, Boston, MA
| | - K Thompson
- Yale School of Medicine, New Haven, CT,National Clinical Scholars Program, Yale School of Medicine, New Haven, CT
| | | | - D Tolliver
- Yale School of Medicine, New Haven, CT,National Clinical Scholars Program, Yale School of Medicine, New Haven, CT
| | | | - EA Wang
- Yale School of Medicine, New Haven, CT,SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT
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Leeper SC, Patel MD, Lahri S, Beja-Glasser A, Reddy P, Martin IB, van Hoving DJ, Myers JG. Assault-injured youth in the emergency centres of Khayelitsha, South Africa: A prospective study of recidivism and mortality. Afr J Emerg Med 2021; 11:379-384. [PMID: 34527508 PMCID: PMC8430267 DOI: 10.1016/j.afjem.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/08/2021] [Accepted: 07/11/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Violence is a major cause of death worldwide among youth. The highest mortality rates from youth violence occur in low and middle-income countries (LMICs). We sought to identify risk factors for violent re-injury and emergency centre (EC) recidivism among assault-injured youth in South Africa. METHODS A prospective follow up study of assault injured youth and controls ages 14-24 presenting for emergency care was conducted in Khayelitsha, South Africa from 2016 to 2018. Sociodemographic and behavioral factors were assessed using a questionnaire administered during the index EC visit. The primary outcomes were return EC visit for violent injury or death within 15 months. We used multivariable logistic regression to compute adjusted odds ratios (OR) and 95% confidence intervals (CI) of associations between return EC visits and key demographic, social, and behavioral factors among assault-injured youth. RESULTS Our study sample included 320 assault-injured patients and 185 non-assault-injured controls. Of the assault-injured, 80% were male, and the mean age was 20.8 years. The assault-injured youth was more likely to have a return EC visit for violent injury (14%) compared to the control group (3%). The non-assault-injured group had a higher mortality rate (7% vs 3%). All deaths in the control group were due to end-stage HIV or TB-related complications. The strongest risk factors for return EC visit were prior criminal activity (OR = 2.3, 95% CI = 1.1-5.1), and current enrollment in school (OR = 2.1, 95% CI = 1.0-4.6). Although the assault-injured group reported high rates of binge drinking (73%) at the index visit, this was not found to be a risk factor for violence-related EC recidivism. DISCUSSION Our findings suggest that assault-injured youth in an LMIC setting are at high risk of EC recidivism and several sociodemographic and behavioral factors are associated with increased risk. These findings can inform targeted intervention programs.
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Affiliation(s)
- Sarah C. Leeper
- University of Maryland Medical Center, Emergency Medicine, Cheverly, MD, USA
| | - Mehul D. Patel
- University of North Carolina at Chapel Hill School of Medicine, Department of Emergency Medicine, Chapel Hill, NC, USA
| | - Sa'ad Lahri
- Khayelitsha Hospital, Khayelitsha, Cape Town, South Africa
- University of Stellenbosch, Division of Emergency Medicine, Tygerberg, Cape Town, South Africa
| | | | - Priscilla Reddy
- Human Sciences Research Council Pretoria, HSRC Bldg, Arcadia, Pretoria, South Africa
| | - Ian B.K. Martin
- Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, WI, USA
| | - Daniël J. van Hoving
- University of Stellenbosch, Division of Emergency Medicine, Tygerberg, Cape Town, South Africa
| | - Justin G. Myers
- University of North Carolina at Chapel Hill School of Medicine, Department of Emergency Medicine, Chapel Hill, NC, USA
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Allee L, Faul M, Guntipalli P, Burke PA, Rao SR, Reed DN, Gross R, Duncan TK, Palmieri TL, Cooper Z, Bulger EM, Stewart RM, Kuhls DA. The Role of the US Trauma Centers in Older Adult Fall Prevention: A National Survey. Am Surg 2021:31348211047509. [PMID: 34748452 DOI: 10.1177/00031348211047509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Approximately 27.5% of adults 65 and older fall each year, over 3 million are treated in an emergency department, and 32 000 die. The American College of Surgeons and its Committee on Trauma (ACSCOT) have urged trauma centers (TCs) to screen for fall risk, but information on the role of TC in this opportunity for prevention is largely unknown. METHODS A 29-item survey was developed by an ACSCOT Injury Prevention and Control Committee, Older Adult Falls workgroup, and emailed to 1000 trauma directors of the National Trauma Data Bank using Qualtrics. US TCs were surveyed regarding fall prevention, screening, intervention, and hospital discharge practices. Data collected and analyzed included respondent's role, location, population density, state designation or American College of Surgeons (ACS) level, if teaching facility, and patient population. RESULTS Of the 266 (27%) respondents, 71% of TCs include fall prevention as part of their mission, but only 16% of TCs use fall risk screening tools. There was no significant difference between geographic location or ACS level. The number of prevention resources (F = 31.58, P < .0001) followed by the presence of a formal screening tool (F = 21.47, P < .0001) best predicted the presence of a fall prevention program. CONCLUSION Older adult falls remain a major injury risk and injury prevention opportunity. The majority of TCs surveyed include prevention of older adult falls as part of their mission, but few incorporate the components of a fall prevention program. Development of best practices and requiring TCs to screen and offer interventions may prevent falls.
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Affiliation(s)
- Lisa Allee
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Mark Faul
- Liaison to ACS COT, 1242Injury Prevention and Control Committee, USA
| | | | - Peter A Burke
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Sowmya R Rao
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Donald N Reed
- Texas Health Resources, 2910Texas Woman's University, Dallas, TX, USA
| | | | | | - Tina L Palmieri
- Shriners Hospital for Children, 8789UC Davis Health, Davis, CA, USA
| | - Zara Cooper
- 1861Brigham and Women's Hospital, Boston, MA, USA
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Simske NM, Rivera T, Ren BO, Benedick A, Simpson M, Kalina M, Hendrickson SB, Vallier HA. Implementation of programming for survivors of violence-related trauma at a level 1 trauma center. Trauma Surg Acute Care Open 2021; 6:e000739. [PMID: 34693023 PMCID: PMC8499348 DOI: 10.1136/tsaco-2021-000739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Prior 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. Methods VOCARP was established in 2017 at our center, and all patients who engaged with programming (n=1019) were prospectively recorded. Patients are offered services in the emergency department, on inpatient floors and at outpatient clinic visits. Two control groups (patients sustaining violent injuries without VOCARP use (n=212) and patients with non-violent trauma (n=201)) were similarly aggregated. Results During 22 months, 96% of patients accepted education materials, 31% received financial compensation, 27% requested referrals, and 22% had crisis interventions. All other resources were used by <20% of patients. Patients who used VOCARP resources were substantially different from those who declined services; they were less often male (56% vs. 71%), more often single (79% vs. 51%), had greater unemployment (63% vs. 51%) and were less frequently shot (gunshot wound: 26% vs. 37%), all p<0.05. Overall recidivism rate was 9.4%, with no difference between groups. Use of mental health services was linked to lower recidivism rates (4.4% vs. 11.7%, p=0.016). While sexual assault survivors who used VOCARP resources had lower associated recidivism (2.4% vs. 12%, p=0.14), this was not statistically significant. Discussion This represents the largest violence intervention cohort reported to date to our knowledge. Despite substantial engagement, efficacy in terms of lower recidivism appears limited to specific subgroups or resource utilization. Level of evidence Level II. Therapeutic.
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Affiliation(s)
| | - Trenton Rivera
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Bryan O Ren
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Alex Benedick
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Megen Simpson
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Mark Kalina
- Orthopedic Surgery, MetroHealth System, Cleveland, Ohio, USA
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Richardson JB, Wical W, Kottage N, Bullock C. Shook Ones: Understanding the Intersection of Nonfatal Violent Firearm Injury, Incarceration, and Traumatic Stress Among Young Black Men. Am J Mens Health 2021; 14:1557988320982181. [PMID: 33356779 PMCID: PMC7768853 DOI: 10.1177/1557988320982181] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Joseph B Richardson
- Joel and Kim Feller Professor of African-American Studies and Anthropology, Department of African-American Studies and the Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland College Park, College Park, MD, USA
| | - William Wical
- Department of Anthropology and the Department of African-American Studies, Transformative Research and Applied Violence Intervention Lab (TRAVAIL), College of Behavioral and Social Sciences, University of Maryland College Park, College Park, MD, USA
| | - Nipun Kottage
- Department of Anthropology and the Department of African-American Studies, Transformative Research and Applied Violence Intervention Lab (TRAVAIL), College of Behavioral and Social Sciences, University of Maryland College Park, College Park, MD, USA
| | - Che Bullock
- Department of African-American Studies, Transformative Research and Applied Violence Intervention Lab (TRAVAIL), College of Behavioral and Social Sciences, University of Maryland College Park, College Park, MD, USA
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Watkins J, Scoggins N, Cheaton BM, Nimmer M, Levas MN, Baumer-Mouradian SH, Melzer-Lange MD. Assessing improvements in emergency department referrals to a hospital-based violence intervention program. Inj Epidemiol 2021; 8:44. [PMID: 34517900 PMCID: PMC8436440 DOI: 10.1186/s40621-021-00333-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background Youth 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. Methods For 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. Results The 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.
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Affiliation(s)
- Jayda Watkins
- Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
| | - Na'il Scoggins
- Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | | | - Mark Nimmer
- Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Michael N Levas
- Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
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Semenza DC, Stansfield R. Community gun violence and functional disability: An ecological analysis among men in four U.S. cities. Health Place 2021; 70:102625. [PMID: 34280714 DOI: 10.1016/j.healthplace.2021.102625] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/09/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022]
Abstract
This study uses data on neighborhoods in four U.S. cities over five years to examine the relationship between fatal and non-fatal gun violence and rates of functional disability among men. Descriptive analyses indicate significant disparities in shooting rates across neighborhoods and heightened associated disability in high shooting communities. Multivariate results show that rates of non-fatal shootings correspond to greater functional disability among young men, but not older men. Fatal gun violence is not associated with increased community disability. The findings suggest that improvements in local gun violence prevention may serve to address broader community disparities in health and well-being.
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Affiliation(s)
- Daniel C Semenza
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, United States.
| | - Richard Stansfield
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, United States
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Feasibility and efficacy of a hospital-based violence intervention program on reducing repeat violent injury in youth: a randomized control trial. CAN J EMERG MED 2021; 22:313-320. [PMID: 31645229 DOI: 10.1017/cem.2019.406] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To determine feasibility and efficacy of an Emergency Department Violence Intervention Program (EDVIP) to reduce violence related injuries in youth. METHODS 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). RESULTS 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). CONCLUSIONS This program is feasible for ED implementation and for completion of a future RCT to measure effectiveness.
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