A phenomenological study identifying facilitators and barriers to Black and Latinx youth's engagement in hospital-based violence intervention programs

"I Have More Friends That Died Than Fingers and Toes": Service Utilization Needs and Preferences for Violence and Substance Use Prevention Among Young Black Boys and Men

Young Black men (YBM) disproportionately face the most severe forms and consequences of youth violence (YV) and substance use disorders, but are less likely to access and be retained in services for these high-risk behaviors. Investigating service uptake disparities and the role of barrier-reducing intervention delivery models is essential; so is understanding the service needs and preferences of YBM. This study explores the experiences of violence-involved and substance-disordered YBM and service providers working with them from racially and economically diverse communities, focusing on their service needs and preferences. Additionally, we examine the potential benefits and drawbacks of digital health interventions in addressing crucial structural barriers to service access and promoting equity for Black boys in high-violence environments. Individual interviews were conducted with 16 YBM (selected from a larger pool of 300 participants from a pilot study) and 7 service providers (four females, three males). Data analysis utilized an Interpretive Description (ID) approach guided by the Phenomenological Variant of Ecological Systems Theory (PVEST). Four themes emerged: (1) Revolving Doors and Histories of Violence; (2) Benefits of Violence: "You Do Something to Me, I Do Something to You"; (3) Positive and Negative Perceptions of Violence and Substance Use Prevention Programs; and (4) Need for Equity-Focused and Barrier-Mitigating Digital Health Interventions. Our findings identified avoidance mechanisms utilized by YBM at both individual and community levels and highlighted perceptions of existing community-based programs and digital interventions as crucial tools for mitigating barriers to care. This study also confirms the prevalence of critical service gaps and program uptake issues, even in cities with abundant programs. Thus emphasizing the need for equity-focused interventions co-designed with and for YBM in high-violence and substance use contexts.

The gap between hospital-based violence intervention services and client needs: A systematic review

BACKGROUND

Survivors of intentional interpersonal violence face social challenges related to social determinants of health that led to their initial injury. Hospital-based violence intervention programs reduce reinjury. It is unclear how well they meet clients' reported needs. This systematic review aimed to quantify how well hospital-based violence intervention program services addressed clients' reported needs.

METHODS

Medline, The Cochrane Library, CINAHL Plus with Full Text, and PsycInfo were queried for studies addressing hospital-based violence intervention programs services and intentional injury survivors' needs in the United States. Case reports, reviews, editorials, theses, and studies focusing on pediatric patients, victims of intimate partner violence, or sexual assault were excluded. Data extracted included program structure, hospital-based violence intervention program services, and client needs assessments before and after receiving hospital-based violence intervention program services.

RESULTS

Of the 3,339 citations identified, 13 articles were selected for inclusion. Hospital-based violence intervention programs clients' most reported needs included mental health (10 studies), employment (7), and education (5) before receiving hospital-based violence intervention programs services. Only 4 studies conducted quantitative client needs assessments before and after receiving hospital-based violence intervention program services. All 4 studies were able to meet at least 50% of each of the clients' reported needs. The success rate depended on the need and program location: success in meeting mental health needs ranged from 65% to 90% of clients. Conversely, time-intensive long-term needs were least met, including employment 60% to 86% of clients, education 47% to 73%, and housing 50% to 71%.

CONCLUSION

Few hospital-based violence intervention programs studies considered clients' reported needs. Employment, education, and housing must be a stronger focus of hospital-based violence intervention programs.

Childhood injury prevention: Where we've been and where we need to be

Injury remains the leading cause of death for children and adolescents in the US, and firearm injury has overtaken motor-vehicle crashes as the leading mechanism in the US since the topic of injury prevention was last reviewed in this journal. The success of injury prevention efforts relies on multidisciplinary collaboration, and pediatric surgeons play a central role as clinicians who provide and coordinate the care for injured children, as trauma program leaders, and as advocates for children's health and safety. This review will provide a concise history of injury prevention in the US and highlights three areas where pediatric surgeons have an opportunity to impart impactful change in their communities that could lead to lower injury rates.