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Hoffmann JA, Carter CP, Olsen CS, Chaudhari PP, Chaudhary S, Duffy S, Glomb N, Goyal MK, Grupp-Phelan J, Haasz M, Ketabchi B, Kravitz-Wirtz N, Lerner EB, Shihabuddin B, Wendt W, Cook LJ, Alpern ER. Pediatric Firearm Injury Emergency Department Visits From 2017 to 2022: A Multicenter Study. Pediatrics 2023; 152:e2023063129. [PMID: 37927086 PMCID: PMC10842699 DOI: 10.1542/peds.2023-063129] [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] [Accepted: 08/30/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Pediatric firearm injuries increased during the coronavirus disease 2019 pandemic, but recent trends in firearm injury emergency department (ED) visits are not well described. We aimed to assess how pediatric firearm injury ED visits during the pandemic differed from expected prepandemic trends. METHODS We retrospectively studied firearm injury ED visits by children <18 years old at 9 US hospitals participating in the Pediatric Emergency Care Applied Research Network Registry before (January 2017 to February 2020) and during (March 2020 to November 2022) the pandemic. Multivariable Poisson regression models estimated expected visit rates from prepandemic data. We calculated rate ratios (RRs) of observed to expected visits per 30 days, overall, and by sociodemographic characteristics. RESULTS We identified 1904 firearm injury ED visits (52.3% 15-17 years old, 80.0% male, 63.5% non-Hispanic Black), with 694 prepandemic visits and 1210 visits during the pandemic. Death in the ED/hospital increased from 3.1% prepandemic to 6.1% during the pandemic (P = .007). Firearm injury visits per 30 days increased from 18.0 prepandemic to 36.1 during the pandemic (RR 2.09, 95% CI 1.63-2.91). Increases beyond expected rates were seen for 10- to 14-year-olds (RR 2.61, 95% CI 1.69-5.71), females (RR 2.46, 95% CI 1.55-6.00), males (RR 2.00, 95% CI 1.53-2.86), Hispanic children (RR 2.30, 95% CI 1.30-9.91), and Black non-Hispanic children (RR 1.88, 95% CI 1.34-3.10). CONCLUSIONS Firearm injury ED visits for children increased beyond expected prepandemic trends, with greater increases among certain population subgroups. These findings may inform firearm injury prevention efforts.
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Affiliation(s)
- Jennifer A Hoffmann
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Camille P Carter
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Cody S Olsen
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Sofia Chaudhary
- Division of Emergency Medicine, Department of Pediatrics and Department of Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Susan Duffy
- Departments of Emergency Medicine and Pediatrics, Brown University, Hasbro Children's Hospital, Providence, Rhode Island
| | - Nicolaus Glomb
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, George Washington University, Washington, District of Columbia
| | - Jacqueline Grupp-Phelan
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California
| | - Maya Haasz
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Bijan Ketabchi
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Nicole Kravitz-Wirtz
- Department of Emergency Medicine, University of California, Davis, Sacramento, California
| | - E Brooke Lerner
- Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Bashar Shihabuddin
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Wendi Wendt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lawrence J Cook
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Elizabeth R Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
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2
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Raman U, Coupet E, Dodington J. Assault Injury and Community Violence. Pediatr Clin North Am 2023; 70:1103-1114. [PMID: 37865433 DOI: 10.1016/j.pcl.2023.06.007] [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: 10/23/2023]
Abstract
Community violence happens between unrelated individuals, who may or may not know each other, generally outside the home, and often results in assaultive injuries. Community violence interventions can prevent assaultive injuries and assist victims of community violence. Trauma-informed care is foundational to the success of community violence intervention. Place-based environmental interventions can decrease community violence on the population level, and further research and developments are needed in this area. Substance use is a significant barrier to intervention program involvement and greater research and program development is needed to support substance use treatment of those impacted by community violence.
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Affiliation(s)
- Uma Raman
- Pediatric Critical Care, Yale New Haven Hospital, Yale School of Medicine, 100 York Street, Suite 1F, New Haven, CT 06511, USA
| | - Edouard Coupet
- Yale School of Medicine, Core Faculty, Addiction Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06890, USA
| | - James Dodington
- Yale School of Medicine, Yale New Haven Center for Injury and Violence Prevention, 100 York Street, Suite 1F, New Haven, CT 06511, USA.
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3
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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: 6] [Impact Index Per Article: 6.0] [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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4
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Jang A, Thomas A, Slocum J, Tesorero K, Danna G, Saklecha A, Wafford E, Regan S, Stey AM. The gap between hospital-based violence intervention services and client needs: A systematic review. Surgery 2023; 174:1008-1020. [PMID: 37586893 DOI: 10.1016/j.surg.2023.07.011] [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: 03/01/2023] [Revised: 06/22/2023] [Accepted: 07/08/2023] [Indexed: 08/18/2023]
Abstract
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.
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Affiliation(s)
- Angie Jang
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Arielle Thomas
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. https://twitter.com/ac_thomas7
| | - John Slocum
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Giovanna Danna
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL
| | - Anjay Saklecha
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Eileen Wafford
- Galter Health Sciences Librarian and Learning Center, Feinberg School of Medicine, Northwestern University
| | | | - Anne M Stey
- Feinberg School of Medicine, Northwestern University, Chicago, IL.
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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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6
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Hoffmann JA, Pulcini CD, Hall M, De Souza HG, Alpern ER, Chaudhary S, Ehrlich PF, Fein JA, Fleegler EW, Goyal MK, Hargarten S, Jeffries KN, Zima BT. Timing of Mental Health Service Use After a Pediatric Firearm Injury. Pediatrics 2023; 152:e2023061241. [PMID: 37271760 PMCID: PMC10694862 DOI: 10.1542/peds.2023-061241] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVES To examine how timing of the first outpatient mental health (MH) visit after a pediatric firearm injury varies by sociodemographic and clinical characteristics. METHODS We retrospectively studied children aged 5 to 17 years with a nonfatal firearm injury from 2010 to 2018 using the IBM Watson MarketScan Medicaid database. Logistic regression estimated the odds of MH service use in the 6 months after injury, adjusted for sociodemographic and clinical characteristics. Cox proportional hazard models, stratified by previous MH service use, evaluated variation in timing of the first outpatient MH visit by sociodemographic and clinical characteristics. RESULTS After a firearm injury, 958 of 2613 (36.7%) children used MH services within 6 months; of these, 378 of 958 (39.5%) had no previous MH service use. The adjusted odds of MH service use after injury were higher among children with previous MH service use (adjusted odds ratio, 10.41; 95% confidence interval [CI], 8.45-12.82) and among non-Hispanic white compared with non-Hispanic Black children (adjusted odds ratio, 1.29; 95% CI, 1.02-1.63). The first outpatient MH visit after injury occurred sooner among children with previous MH service use (adjusted hazard ratio, 6.32; 95% CI, 5.45-7.32). For children without previous MH service use, the first MH outpatient visit occurred sooner among children with an MH diagnosis made during the injury encounter (adjusted hazard ratio, 2.72; 95% CI, 2.04-3.65). CONCLUSIONS More than 3 in 5 children do not receive MH services after firearm injury. Previous engagement with MH services and new detection of MH diagnoses during firearm injury encounters may facilitate timelier connection to MH services after injury.
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Affiliation(s)
- Jennifer A. Hoffmann
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christian D. Pulcini
- Department of Emergency Medicine & Pediatrics, University of Vermont Medical Center and Children’s Hospital, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS, USA
| | | | - Elizabeth R. Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter F. Ehrlich
- Section of Pediatric Surgery, CS Mott Children’s Hospital University of Michigan Ann Arbor, Michigan, USA
| | - Joel A. Fein
- Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Eric W. Fleegler
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School; Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Monika K. Goyal
- Department of Pediatrics, Children’s National Hospital, George Washington University, Washington, DC, USA
| | - Stephen Hargarten
- Department of Emergency Medicine, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kristyn N. Jeffries
- Department of Pediatrics, Section of Hospital Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Bonnie T. Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
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7
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Reppucci ML, Tong S, Simon SL, Nolan MM, Jujare S, Moulton SL, Kaar JL. Factors associated with new mental health diagnoses and resource utilization among pediatric patients following trauma admission. J Pediatr Surg 2023; 58:118-124. [PMID: 36273919 DOI: 10.1016/j.jpedsurg.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/15/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Injured children are at risk for a variety of physical and emotional sequelae that may impair their ability to return to prior function. The effect of traumatic injury on mental health in children is not well characterized or understood. We sought to determine factors associated with new mental health diagnoses and/or mental health resource utilization following admission to a Level 1 pediatric trauma center for traumatic injury. METHODS A retrospective chart review of patients admitted for accidental trauma between 2016 and 2019 was performed. Demographic data, injury characteristics, new mental health diagnoses and/or mental health resource utilization following hospitalization were extracted. Patients with prior mental health diagnosis, psychotropic prescription(s), or resource utilization were excluded from this cohort. A multivariable logistic regression model was used to examine predictors of new mental health diagnoses and/or resource utilization. RESULTS The prevalence of new mental health diagnoses or resources utilization was 9.5% (363/3828). The most common diagnoses were anxiety disorders and nonbipolar depression. The most common psychotropic medication prescribed was antidepressants. Patients with new mental illness were older (odds ratio [OR] 1.1 [95% CI: 1.06, 1.12]), more likely to sustain burn injuries (OR 6.3 [4.2, 9.5]), have non-sports related injuries (OR 3.5 [2.1, 6.0]), and be pedestrian struck (OR 2.7 [1.5, 4.8]). They additionally were more likely to sustain head, neck, and spine injuries (OR 3.8 [2.9, 5.1], 2.4 [1.1, 5.5], and 2.1 [1.3, 3.3], respectively). CONCLUSIONS There are a variety of demographic and injury specific factors associated with new mental health diagnoses and/or resource utilization in children following admission for trauma. Knowledge of these risk factors may ensure patients are allocated adequate resources to promote timely access to appropriate mental health services after hospitalization. TYPE OF STUDY Retrospective comparative study LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Marina L Reppucci
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO 80045, United States; Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Suhong Tong
- Children's Hospital Center for Research in Outcomes for Children's Surgery, Children's Hospital Colorado, Aurora, Colorado, United States
| | - Stacey L Simon
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Margo M Nolan
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Swati Jujare
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Steven L Moulton
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO 80045, United States; Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jill L Kaar
- Children's Hospital Center for Research in Outcomes for Children's Surgery, Children's Hospital Colorado, Aurora, Colorado, United States; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
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8
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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: 9] [Impact Index Per Article: 4.5] [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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9
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Jacoby SF, Smith RN, Beard JH. Rethinking "recidivism" in firearm injury research and prevention. Prev Med 2022; 165:107221. [PMID: 36002055 DOI: 10.1016/j.ypmed.2022.107221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022]
Abstract
Interpersonal firearm injuries pose a persistent public health threat in the United States (US). Strategic interventions to curb these injuries require evaluation of measurable outcomes that prove effectiveness and substantiate efforts for wider scaling and implementation. One common outcome of interest used among injury prevention researchers and practitioners is 'recidivism' referring to recurrent injury from acts of violence in a previously firearm injured person. In this commentary we urge that the term which can insinuate racialized criminality and reinforce stigma, no longer be used to describe people who experience firearm injuries. We also advocate for reconsideration of 'recidivism' as an ideal evaluation metric for the success of tertiary firearm injury prevention programs.
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Affiliation(s)
- Sara F Jacoby
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, USA.
| | - Randi N Smith
- Department of Surgery, Emory University School of Medicine, USA
| | - Jessica H Beard
- Division of Trauma and Surgical Critical Care, Department of Surgery, Lewis Katz School of Medicine, Temple University, USA
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10
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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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11
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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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12
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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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13
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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: 25] [Impact Index Per Article: 8.3] [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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14
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Floyd AS, Lyons VH, Whiteside LK, Haggerty KP, Rivara FP, Rowhani-Rahbar A. Barriers to recruitment, retention and intervention delivery in a randomized trial among patients with firearm injuries. Inj Epidemiol 2021; 8:37. [PMID: 34304738 PMCID: PMC8311948 DOI: 10.1186/s40621-021-00331-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We discuss barriers to recruitment, retention, and intervention delivery in a randomized controlled trial (RCT) of patients presenting with firearm injuries to a Level 1 trauma center. The intervention was adapted from the Critical Time Intervention and included a six-month period of support in the community after hospital discharge to address recovery goals. This study was one of the first RCTs of a hospital- and community-based intervention provided solely among patients with firearm injuries. MAIN TEXT Barriers to recruitment included limited staffing, coupled with wide variability in length of stay and admission times, which made it difficult to predict the best time to recruit. At the same time, more acutely affected patients needed more time to stabilize in order to determine whether eligibility criteria were met. Barriers to retention included insufficient patient resources for stable housing, communication and transportation, as well as limited time for patients to meet with study staff to respond to follow-up surveys. These barriers similarly affected intervention delivery as patients who were recruited, but had fewer resources to help with recovery, had lower intervention engagement. These barriers fall within the broader context of system avoidance (e.g., avoiding institutions that keep formal records). Since the patient sample was racially diverse with the majority of patients having prior criminal justice system involvement, this may have precluded active participation from some patients, especially those from communities that have been subject to long and sustained history of trauma and racism. We discuss approaches to overcoming these barriers and the importance of such efforts to further implement and evaluate hospital-based violence intervention programs in the future. CONCLUSION Developing strategies to overcome barriers to data collection and ongoing participant contact are essential to gathering robust information to understand how well violence prevention programs work and providing the best care possible for people recovering from injuries. TRIAL REGISTRATION ClinicalTrials.gov NCT02630225 . Registered 12/15/2015.
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Affiliation(s)
- Anthony S Floyd
- Addictions, Drug & Alcohol Institute, University of Washington, 1107 NE 45th. Street, Suite 120, Seattle, WA, 98125, USA.
| | - Vivian H Lyons
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA.,Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Lauren K Whiteside
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Department of Emergency Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Kevin P Haggerty
- School of Social Work, University of Washington, Seattle, WA, USA.,Social Development Research Group, University of Washington, Seattle, WA, USA
| | - Frederick P Rivara
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
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15
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Neufeld MY, Janeway MG, Lee SY, Miller MI, Smith EA, Kalesan B, Allee L, Dechert T, Sanchez SE. Utilization of mental health services in pediatric patients surviving penetrating trauma resulting from interpersonal violence. Am J Surg 2021; 221:233-239. [PMID: 32690211 PMCID: PMC7736092 DOI: 10.1016/j.amjsurg.2020.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Violent trauma has lasting psychological impacts. Our institution's Community Violence Response Team (CVRT) offers mental health services to trauma victims. We characterized implementation and determined factors associated with utilization by pediatric survivors of interpersonal violence-related penetrating trauma. METHODS Analysis included survivors (0-21 years) of violent penetrating injury at our institution (2011-2017). Injury and demographic data were collected. Nonparametric regression models determined factors associated with utilization. RESULTS There was initial rapid uptake of CVRT (2011-2013) after which it plateaued, serving >80% of eligible patients (2017). White race and higher injury severity were associated with receipt and duration of services. In post-hoc analysis, race was found to be associated with continued treatment but not with initial consultation. CONCLUSION Successful implementation required three years, aiding >80% of patients. CVRT is a blueprint to strengthen existing violence intervention programs. Efforts should be made to ensure that barriers to providing care, including those related to race, are overcome.
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Affiliation(s)
- Miriam Y Neufeld
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
| | - Megan G Janeway
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
| | - Su Yeon Lee
- Montefiore Medical Center, 111 E 210th St, Bronx, NY, 10467, USA.
| | - Matthew I Miller
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
| | - Erin A Smith
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
| | - Bindu Kalesan
- Boston University School of Medicine and Public Health, 715 Albany St, Boston, MA, 02118, USA.
| | - Lisa Allee
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
| | - Tracey Dechert
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
| | - Sabrina E Sanchez
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
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16
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Abstract
Hoping to reduce the number of repeat visitors, one Washington, D.C., hospital is providing short- and long-term support to victims of violence.
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Affiliation(s)
- T R Goldman
- This article is part of a series on transforming health systems published with support from The Robert Wood Johnson Foundation. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt, and build upon this work, for commercial use, provided the original work is properly cited. See https://creativecommons.org/licenses/by/4.0/ . T. R. Goldman ( trgoldman1@gmail. com ) is a Washington, D.C.-based freelance journalist
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