Trauma Center Based Youth Violence Prevention Programs: An Integrative Review.

Trauma Center Based Youth Violence Prevention Programs: An Integrative Review

TRAUMA, VIOLENCE, & ABUSE 1-20 ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1524838015584373 tva.sagepub.com

Judy Nanette Mikhail1 and Lynne Sheri Nemeth1

Abstract Objective: Youth violence recidivism remains a significant public health crisis in the United States. Violence prevention is a requirement of all trauma centers, yet little is known about the effectiveness of these programs. Therefore, this systematic review summarizes the effectiveness of trauma center–based youth violence prevention programs. Methods: A systematic review of articles from MEDLINE, CINAHL, and PsychINFO databases was performed to identify eligible control trials or observational studies. Included studies were from 1970 to 2013, describing and evaluating an intervention, were trauma center based, and targeted youth injured by violence (tertiary prevention). The social ecological model provided the guiding framework, and findings are summarized qualitatively. Results: Ten studies met eligibility requirements. Case management and brief intervention were the primary strategies, and 90% of the studies showed some improvement in one or more outcome measures. These results held across both social ecological level and setting: both emergency department and inpatient unit settings. Conclusions: Brief intervention and case management are frequent and potentially effective trauma center–based violence prevention interventions. Case management initiated as an inpatient and continued beyond discharge was the most frequently used intervention and was associated with reduced rearrest or reinjury rates. Further research is needed, specifically longitudinal studies using experimental designs with high program fidelity incorporating uniform direct outcome measures. However, this review provides initial evidence that trauma centers can intervene with the highest of risk patients and break the youth violence recidivism cycle. Keywords youth violence, community violence, violent offenders

In the United States, violent injury is the leading cause of death for black males aged 15–24 years, and the second leading cause of death for all young people aged 10–24 years. For every violence-related death, there are an estimated 11 nonfatal injuries (Centers for Disease Control and Prevention [CDC], 2009). Youth violence–related injury recidivism is common with as many as 40% of violently injured youth returning to the hospital with repeat injuries, and as many as 20% are victims of homicide within 5 years of admission (Goins, Thompson, & Smipkins, 1992). A recent longitudinal study of 2062 trauma patients found that those with intentional trauma were most likely to die from a subsequent violent injury (Haider et al., 2014). This pattern of repeated injury from violence with an increased likelihood of death is the patient trajectory that many inner-city trauma centers see on a continuing basis. For this reason, trauma centers are uniquely positioned to break this recidivism cycle.

trauma centers and even fewer centers are engaged in youth violence prevention efforts (McDonald et al., 2007; Tellez & Mackersie, 1996). Identified barriers to trauma personnel involvement in violence prevention efforts include inadequate time, funding, reimbursement, knowledge, training, and even concerns about one’s own safety (Fein et al., 2000; McDonald et al., 2007; Raden, 2001). However, clinician awareness of effective interventions remains a major obstacle (Garrettson, Weiss, McDonald, & Degutis, 2008; McDonald et al., 2007; Wilkinson, Kurtz, Lane, & Fein, 2005). Thus, the purpose of this review is to identify and assess the effectiveness of trauma center–based youth violence prevention programs in the United States. Universal or primary prevention programs target the general population. Yet, trauma center programs that distribute brochures and flyers at safety fairs or teach prevention principles to the general public have been shown to be largely ineffective

Trauma Centers and Injury Prevention

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The American College of Surgeons (2014) requires injury prevention efforts by all Level I and II trauma centers, yet collectively little is known about trauma centers’ efforts to deal with violence. Injury prevention efforts are inconsistent across

Corresponding Author: Judy Nanette Mikhail, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA. Email: [email protected]

Medical University of South Carolina, Charleston, SC, USA

Downloaded from tva.sagepub.com at CALIFORNIA STATE UNIV FRESNO on July 23, 2015

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TRAUMA, VIOLENCE, & ABUSE

in changing behavior (Cohen & Swift, 1999). Trauma center– based secondary violence prevention programs are those targeting ‘‘at-risk’’ youth and are offered in a variety of settings including schools (Gainer, Webster, & Champion, 1993), detention centers (Hayward, Simons, John, Waymire, & Stucky, 2011), and hospitals (Chang, Cornwell, Sutton, Yonas, & Allen, 2005; Goldberg et al., 2010; Kunkel et al., 2010; Scott, Tepas, Frykberg, Taylor, & Plotkin, 2002). Tertiary violence prevention programs focus on youth already injured by violence (Cohen & Chehimi, 2010) and are the interest of this integrative review. These programs capitalize on ‘‘the teachable moment’’ (Johnson et al., 2007, p. 553), which is a period of thoughtfulness that can follow traumatic assault, thereby providing a potential window for trauma center intervention. Trauma center–based tertiary violence prevention programs incorporate brief intervention, based on motivational interviewing techniques or comprehensive case management programs employed shortly following injury. Brief interventions are defined as time-limited patient intervention contacts (one or two contacts) following screening for hazardous and harmful behaviors (Newton et al., 2013) while case management refers to coordination of health services by a case manager who guides the patient through recovery often extending into the community (Kumar & Klein, 2013). Few systematic reviews of violence prevention in clinical settings exist, and none focused on admitted trauma patients. One report found that individual-level injury prevention strategies restricted to unintentional injury were most effective with multicomponent strategies such as counseling, demonstrations, the provision of subsidized safety devices, and reinforcement tactics (DiGuiseppi & Roberts, 2000), while another pediatric-focused program found that few effective youth violence prevention programs exist (W. O. Cooper, Lutenbacher, & Faccia, 2000). Limbos et al. (2007) examined youth violence interventions across all levels of prevention but focused only on school-based programs. Lastly, one report addressed youth violence initiatives; however, this review was restricted to the emergency department (Snider & Lee, 2009). The purpose of this review is to assess the effectiveness of both emergency department and inpatient-based trauma center tertiary youth violence prevention programs.

Table 1. Search Terms.

Theoretical Framework

Inclusion Criteria and Definitions

Bronfenbrenner’s (1979) social ecological model (SEM) guided this review. This model asserts that an individual’s behavior is affected by both personal characteristics and the social environment. The model serves as a primary component of the Centers CDC’s violence prevention framework (Dahlberg & Krug, 2002), which considers the effect of individual elements (e.g., biological and personal history), interpersonal affiliations (e.g., peers and family), community influences (e.g., schools and neighborhoods), and society (e.g., societal standards and social rules).

Published studies were eligible for inclusion (Table 2) if they were peer-reviewed, evaluated an intervention, were trauma center based, and targeted youth injured by violence. Multiple reports from the same violence prevention program with overlapping samples were extracted separately and compared with one study selected as the primary study for inclusion (Littell, Corcoran, & Pillai, 2008). Studies were limited to the United States, given evidence to suggest that violence risk and protective factors are country-specific (Hoffman & Summers, 2001). Youth violence was operationally defined as a threatened or actual physical force or power initiated by an individual that results in, or has a high likelihood of resulting in, physical or psychological injury or death in young people between the ages of 10 and 24 (Bulson, Mattice, & Bulson, 2012). An

Method An integrative review was conducted following the modified framework of Whittemore and Knafl (2005) and the Preferred

Medical Subject Headings (MeSH) Youth Violence Trauma center Prevention Program evaluation

Truncation Terms/Text Words Youth, adolescent, young adult Violence, homicide, firearms, wounds, injuries, epidemiology Emergency department, emergency service, hospital, trauma center Accident prevention, prevention and control, preventive health services, preventive medicine Intervention studies, health promotion, evaluation, program evaluation/methods, treatment outcomes

Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic review of health care interventions (Moher, Liberati, Tetzlaff, Altman, & Group, 2009). Standardized data extraction was performed, and data were organized into categories and compared to determine patterns. A summary of key themes is provided as well as gaps and implications for future research.

Search Strategy and Terms Peer-reviewed articles were retrieved from three databases: MEDLINE, Cumulative Index to Nursing and Allied Health, and PsychINFO published between 1970 and 2013 was performed in September 2012. The start date of 1970 was arbitrarily selected to ensure complete capture of all likely programs. A hand search of articles by key researchers and cited literature of retained articles was also performed. A verification search was performed to update findings in March 2014. The search strategy developed with a medical librarian included five main search themes—youth, violence, trauma center, prevention, and program evaluation, which were combined using the Boolean operator ‘‘and’’ as Medical Subject Headings (MeSH). MeSH search terms (Table 1), as well as truncation terms and text words, were searched since not all databases support the use of medical subject headings.


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Table 2. Inclusion Exclusion Criteria. Inclusion Criteria

Exclusion Criteria

Peer-reviewed studies Evaluated a violence prevention intervention Targeted patients injured by youth violence RCTs and observational studies

Intimate partner violence Child abuse Suicide Non-U.S. studies

Multiple reports from the same violence program Program Name and City Within Our Reach Chicago, IL Caught in the Crossfire Oakland, CA Take Charge Baltimore and Washington, DC Wrap Around Project San Francisco, CA

Program Study Citations Zun, Downey, and Rosen (2003) Zun, Downey, and Rosen (2004) Zun, Downey, and Rosen (2006) Becker, Hall, Ursic, Jain, and Calhoun (2004) Shibru et al. (2007) Cheng, Wright, Markakis, Copeland-Linder, and Menvielle (2008) Cheng, Haynie, et al. (2008) Dicker et al. (2009) R. Smith, Dobbins, Evans, Balhotra, and Dicker (2013)

Included Study

Excluded Studies X X

X X X X X X X

Note. RCTs ¼ randomized control trials.

intervention was defined as a specific set of activities developed to prevent youth violence and the factors that contribute to it (Thornton, Craft, Dahlberg, Lynch, & Baer, 2002).

Data Extraction and Methodological Quality Assessment Data extraction was performed according to the Cochrane Handbook for Systematic Reviews of Interventions (Higgins & Green, 2011). An extraction tool was developed (Appendix), and one reviewer independently extracted study design, study characteristics, patient population, setting, intervention components, primary and secondary outcomes, and results. The methodological quality of the included studies was assessed using process and outcome criteria based on those of the Cochrane Collaboration Handbook for Systematic Reviews of Interventions (Higgins & Green, 2011) and A Guide to the Continuum of Evidence of Effectiveness (Puddy & Wilkins, 2011).

Data Synthesis Assessment of study characteristics included study design, sample size, setting, intervention, key issues, framework, socioecologic level, outcome measures, program fidelity, methodological quality, and funding. The small number and significant heterogeneity in study design reported outcome measures and quality (based on risk of bias assessment) precluded meta-analysis. Therefore, qualitative literature synthesis was conducted, and themes identified as presented in Tables 3–7.

Results Flow Diagram The study selection process is shown in Figure 1. Search strategies resulted in 629 abstracts, of which 252 studies remained

after duplicates were removed. Further screening of titles and abstracts resulted in 168 studies for full-text review with 15 meeting inclusion criteria. One violence prevention program was represented in two studies performed in different cities and therefore were considered as separate studies (R. Smith, Dobbins, Evans, Balhotra, & Dicker, 2013; R. Smith, Evans, Adams, Cocanour, & Dicker, 2013). Four prevention programs had multiple publications of which only 1 was selected; therefore, 5 studies were excluded (Table 2) bringing the total number of studies to 10. Characteristics of the selected studies are shown in Table 3.

Study Characteristics Given the multidisciplinary nature of violence prevention work, the primary author disciplines were broad, including surgeons, emergency medicine physicians, pediatricians, public health researchers, nurses, and social workers. The 10 studies retained were published since 2000 from nine different violence prevention programs in 10 cities. Four studies were federally funded; the remaining six studies were supported by state or city governments or by private corporations or foundations. Participants per study averaged 200. Study populations included comparable numbers of male, female, Black, White, and Hispanic participants. While all the 10 studies addressed trauma patients injured by violence, C. Cooper, Eslinger, and Stolley (2006) specifically targeted an even higher risk cohort of trauma patients, who were already repeat victims of violence (recidivists) whereas Walton et al. (2010) included a mix of patients, who presented to the emergency department for medical illness (possibly lower risk patients) as well as those presenting for injuries. Ages ranged from 10 to 50 years, with the majority of studies, eight (80%), restricting to ages 10–30 years. Study recruitment periods ranged from 1 to 7 years, but 80% were completed


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Zun, Downey, and Rosen (2006) Within Our Reach Program Mount Sinai Hospital Medical Center Chicago, IL

C. Cooper et al. (2006) Violence Intervention Program (VIP) R. Adams Cowley Shock Trauma Center, Baltimore, MD

Cheng et al. (2008) Youth Violence Prevention Program Children’s National Medical Center Washington, DC/ Johns Hopkins Hospital Baltimore, MD

RCT

RCT

Author Program Location

RCT

Study Design

Table 3. Study Characteristics.

Up to 2.5 years of CM with psychosocial follow-up services for patient and family. Home visitation, weekly group sessions

List of community 6 months CM: resources and two services for patient follow-up phone and family Assigned calls community mentor, completion of sixsession skill building, and facilitated service use

n ¼ 100 Recidivist trauma patients injured by violence. Ages > 17

n ¼ 113 Trauma patients injured by violence Ages 10–15

Standard medical treatment and parole or probation procedures

List of community services

6 months CM primary care and social services referrals, anger management, conflict resolution, referral to Boys and Girls Clubs of Chicago


Comparison Conditions

Intervention Description

Sample Size Population

Attitudes Selfefficacy Number of fights Weapon carrying

Attitudes Behavior Referral rates Self-reported reinjury Self-reported arrest State-reported incarceration State Registry reinjury rate Reinjury Rearrest Incarceration Employment

Primary Outcomes

CM by community mentors resulted in only a trend toward reduced aggression. Program impact was associated with number of sessions attended

Inpatient CM for high-risk recidivists can decrease reinjury risk

Emergency department CM with community referrals can result in reduced selfreported reinjury rates

Key Themes

Framework: social cognitive theory Level: individual Relationship Community

Framework: not specified Level: Individual Relationship Community

Framework: developmental– cological model Level: individual relationship community

Socioecological Framework Level

(continued)

Strengths: study design Blinded Possible dose response Low attrition Use of peers for CM Limitations: generalizability Older age-groups CM dose and intensity individualized to needs challenged program fidelity Strengths: research design Focus on younger age Family approach Limitations: generalizability Self-report dataHigh attrition Limited study power Variable intervention group adherence Difficulty finding reliable/ committed community mentors

Strengths: study design Limitations: nonblinded Self-report data Response bias Report recall bias Short CM duration Limited referral service availability and quality inadequate funding

Strengths Limitations

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Brief Intervention Therapist Delivered Duration not reported

12 months peerbased CM for patients and family with referrals individualized to meet needs



Aboutanos et al. (2011) Bridging the Gap Virginia Commonwealth University Medical Center Richmond, VA

Shibru et al. (2007) Caught in the Crossfire Highland Hospital Oakland, CA

Cohort Retrospective Comparative Double

Brief Intervention (35 min) based on motivational interviewing and skills training delivered by computer or research therapist

n ¼ 726 ED patients for medical illness or injury who reported past-year alcohol use and aggression Ages 14–18

RCT



Walton et al. (2010) SafERteens Hurley Medical Center Flint, MI


RCT

Study Design

Table 3. (continued)

Self-reported: aggression alcohol use and consequences

Primary Outcomes

Trauma patients from trauma registry matched for age, gender, race/ethnicity, type of injury, and year of admission

Reinjury Rearrest Death

Brief Intervention Reinjury with 6 months of Alcohol use CM: for patient and Referral use family with referrals for vocational training, employment, education, housing, mental health, substance abuse

Brochure of community resources


Use of peer-based CM results in significant cost savings compared to incarceration costs. Age appears to mediate the association between program participation and criminal justice with younger ages achieving better results

Expansion of the teachable moment to the inpatient setting is possible, but requires a strong link to community resources

Computer-delivered customized feedback can assist in translating standardized intervention delivery to broad clinical settings

Key Themes

Framework: not specified Level: relationship Community

Framework: cognitive behavioral therapy Level: individual Relationship Community

Framework: social ecological Model Level: individual


(continued)

Strengths: research design Sample size and power Low attrition Validated measures Novel computer use High program fidelity Limitations: self-report data Social desirability bias Short-term follow-up Population different with lower injury severity than other studies Strengths: research design BI extends to inpatient Limitations: low enrollment due to short hospital stay/staffing Low program fidelity Short follow-up time, 6 months Small sample size Self-report data Response bias Strengths: use of peer CM capped at 20 Limitations: generalizability Small sample size Self-selection bias (control group included patients who agreed to participate but did not)


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Marcelle (2001) Project UJIMA Medical College of Wisconsin, Milwaukee, WI

6 to 12 months CM: intensive and individualized to needs and linked to community resources

6–12 months CM: individualized plan to address needs and goals with links to community resources

12 months CM: services for patient and family, links to community resources

n ¼ 95 Trauma patients injured by violence Ages10–30

n ¼ 64 Trauma patients injured by violence Ages18–50


6–12 months CM: intensive and individualized to needs and linked to community resources


R. Smith, Dobbins, et al. (2013) Wrap Around Project San Francisco General Hospital San Francisco, CA

R. Smith, Evans, et al. (2013b) Wrap Around Project University of California Davis Medical Center Sacramento, CA Gomez et al. (2012) Prescription for Hope (R H) Wishard Memorial Hospital Indianapolis, IN




Historical control

Replication study: comparison of process and impact with San Francisco General (original Wrap Around Project site) Baseline needs and historical recidivism rate

CM dose (time spent per client) stratified by low, medium, moderate, and high


Referral rate Reinjury rate

Reinjury Needs Met

Recruitment Enrollment Cultural match between client and case manager Needs met

Reinjury Needs met

Primary Outcomes

Note. CM ¼ case management; BI ¼ brief intervention; ED ¼ emergency department; RCT ¼ randomized control trial.

Case series

Case series

Crosssectional

Cohort Retrospective single group

Study Design

Table 3. (continued)

Framework: none identified Level: relationship Community

Framework: Public Health Model Level: relationship Community

Framework: Public health Model Level: relationship Community


The earliest CM Framework: not specified program in Levels: individual existence found Relationship that it can increase the number of community referrals made for victims of violence

CM program found that among all needs, mental health services and employment assistance were most significantly associated with program success. CM dose (intensity) and early timing were also markers of success CM program replication is possible if both program model and program infrastructure are exported and adaptable Adequate staffing is the primary variable for hospital-based CM program success

Key Themes

Strengths: community resources Limitations: moderate enrollment Inadequate staffing Moderate attrition Low program fidelity Selection bias Small sample Short time period Strengths: real-world setting High CM dose Limitations: research design Moderate enrollment Referral follow-up unknown Attrition unknown

Strengths: program fidelity Limitations: short-term follow-up Limited funding/staffing Limited community public health infrastructure

Strengths: community resources Program staffing High enrollment Funding No attrition Limitations: small sample size Missing data Generalizability Selection bias


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Table 4. Risk of Bias Assessment. Citation Quality Criteria For Randomized Controlled Trials Study design Adequate sequence generation? (selection bias) Adequate allocation concealment? (selection bias) Adequate blinding? (performance bias/ detection bias) Incomplete outcome data addressed? (attrition bias) Free of selective outcome reporting? (reporting bias) Free of other bias? Use of direct (validated) outcome measures

Zun, Downey, and Rosen (2006)

C. Cooper, Eslinger, and Stolley (2006)

Cheng et al. (2008)

Walton et al. (2010)

Aboutanos et al. (2011)

RCT N

RCT N

RCT N

RCT Y

RCT N

Y

N

Y

Y

N

N

Y

Y

Y

N

NC

Y

Y

Y

NC

Y

Y

Y

Y

Y

P

Y

N

N

P

Citation Quality criteria for observational studies Study design Developed and applied proper eligibility criteria? Adequate measurement of both exposure and outcome? Adequate control of confounding? Accurate measurement of all known prognostic factors Matched for prognostic factors and/or risk adjustment in statistical analysis Complete follow-up Free of other bias? Use of direct (validated) outcome measures

Shibru et al. (2007)

R. Smith, Dobbins, et al. (2013)

R. Smith, Evans, et al. (2013)

Gomez et al. (2012)

Marcelle (2001)

CO Y

CO Y

CRS Y

CS Y

CS Y

Y

P

P

P

NC

Y Y Y

NA

NA

NA

NA

Y Y

P Y

N N

N N

NC P

Note. CO ¼ cohort; CRS ¼ cross-sectional study; CS ¼ case series; N ¼ no; NA ¼ not applicable; NC ¼ not clear; P ¼ partly; RCT ¼ randomized control trial; Y ¼ yes.

within 1 and 3 years. Recruitment and initiation of the intervention took place in the emergency department in four studies and on inpatient units for the remaining six studies. Enrollment rates varied from 20% to 97% with an average of 55%. The average study attrition rate was 18%. The period from intervention until outcomes were measured varied between as short as 6 weeks to as long as 2.5 years. Three studies had more than one end point for outcome measure. Six studies used theoretical frameworks, including the cognitive behavioral theory, developmental ecological model, public health model, social cognitive theory, and SEM. Case management was the primary intervention in eight studies, and brief intervention was used in two studies. One study (Aboutanos et al., 2011) evaluated both case management and brief intervention and was counted in both categories.

Methodological Quality Methodological quality across the 10 studies varied. The risk of bias assessment is shown in Table 4. Five of the 10 studies were

randomized control trials (RCTs), where incomplete details, in reporting the sequence generation and allocation concealment, were the main reasons for decreasing methodological quality. Only three of the five RCTs were blinded, and only two used allocation concealment, which may reflect the complex nature of the intervention, where blinding and concealment is difficult to achieve. However, bias associated with lack of blinding and concealment has been shown to be greater in trials with subjective outcomes and four of the five RCTs relied heavily on self-report measures (Wood et al., 2008). Regarding selective outcome reporting only one study reported the use of a protocol. Still, all five studies were assessed as subject to low risk of bias, as it was assumed that the published reports included all outcomes. The five remaining studies included two cohort studies, one cross-sectional, and two case series. These observational studies are subject to bias through unmeasured or unadjusted confounding (Gorin, Badr, Krebs, & Prabhu Das, 2012). Participant eligibility, screening, refusal, and retention across studies were inconsistently described and challenging to interpret.


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Anger management Conflict resolution Decision making/goal setting Coping/problem solving Faith-based counseling Family counseling Community resources Driver’s license Education/tutoring/GED Employment Financial assistance Housing Job training Legal assistance Medical health services Mental health services Recreational activities Substance abuse services Tattoo removal

X

N Y 1–2þ yr

X

N N 6 mo

X

X

X X

X

X X

X X

X

X X

X

X

N INP GRPS 4

Y INP 1

CM INPT 2.5 yr 2

CM ED 6 mo 1.2

Y Y 3 mo/6 mo

X

NA INP COM NA

BI ED 35 min NA


X X

3

N INP

Y Y 6 wk/6 mo

NA

NA INP

BI CM INPT INPT NC 6 mo NA 2.5


X X X X X

X

X

X X X X

X X X X

X X X X X X X

X X

X X X X X X

Intervention strategies grouped by SEM

Y N 8 mo

X X

N INP PH NC

CM ED 6 mo 1

Cheng C. Cooper, et al. Eslinger, and Stolley (2006) (2008)

Intervention Strategies by Citation

X

X X X X

X X

N Y 18 mo

X

Y INP PH NC

CM INPT 12 mo 2.4


X

X

X X X

X X X

X

N Y 12 mo

X

N INP PH 3

CM INPT 7–13.6 mo varied

X

X

X X X

X X X

X

Y Y 6 mo

X

N INP PH 1

CM INPT 6–12 mo NC

X X X X

X

X X

X

N NC 6–12 mo

X

N INP PH 2

CM INPT 6–12 mo 4.5

X X

X X

N N 12 mo

X

NC

N INP

CM ED 12 mo NC

R. Smith, Dobbins, R. Smith, Gomez Marcelle et al. (2013) Evans, et al. (2013) et al. (2012) (2001)

Note. BI ¼ brief intervention; CM ¼ case management; COM ¼ computer; ED ¼ emergency department; GRPS ¼ group sessions; GED ¼ general educational development; INPT ¼ inpatient; INP ¼ in person; min ¼ minimum; mo ¼ month; NA ¼ not applicable; NC ¼ Not clear; N ¼ No; PH ¼ phone; PNA ¼ personalized normative assessment; wk ¼ week; Y ¼ Yes; yr ¼ year; SEM ¼ social ecological model. ‘‘X’’ represents what interventions were implemented.

Community

Relationships

Individual

Number of case managers Case manager titles Social worker/case manager/coordinator Peer (former convict or patient) Community mentors Worker credentials/training described? Cultural competence addressed? Time to outcome measurement

Type Enrollment/initiation of intervention setting Intervention duration Intervention dose (minimum # patient contacts per case manager per month) CM capped at specific number of clients? Form of contact

Intervention strategies


Table 5. Intervention Strategies by Citation and SEM.

9


$a

$

$ # #

"

NA

Y $

$ #

RCT CM INPT 2.5 yr 1–2þ yr

RCT CM ED 6 mo 6 mo


# #

$ # $ $

$ $

$ $

$

" $ #

$

Y

RCT BI/CM INPT 6 mo 6 wk/6 mo


Y $

RCT BI ED NA 3 mo/6 mo


Y $ $ $

RCT CM ED 6 mo 8 mo

Cheng, Haynie, et al. (2008)

$ $

#

NA

CO CM INPT 12 mo 18 mo


#

"

NA

CO CM INPT 6–12 mo 12 mo

R. Smith, Dobbins, et al. (2013)

"

NA

CRS CM INPT 6–12 mo 6 mo

R. Smith, Evans, et al. (2013)

#

"

NA

CS CM INPT 6–12 mo 6–12 mo

Gomez et al. (2012)

#

"

NA

CS CM ED 12 mo 12 mo

Marcelle (2001)

Note. BI ¼ brief intervention; CM ¼ case management; CO ¼ cohort; CRS ¼ cross-sectional study; CS ¼ case series; ED ¼ emergency department; INPT ¼ inpatient; mo ¼ month; NA ¼ not applicable; RCT ¼ randomized control trial; wk ¼ week; Y ¼ yes; yr ¼ year; " ¼ improved (in favor of the intervention); $ ¼ no difference between groups; # ¼ decreased (in favor of the intervention). a State trauma registry.

Type of study Intervention Enrollment initiation setting CM duration Time(s) to measurement Indirect measures Self-report measures Validated assessment tools Attitudes (aggression) Attitudes (self-efficacy) Alcohol Drug use Alcohol consequences Weapon carrying Fighting Rearrest Reinjury Other measures Referrals made Referrals utilized (confirmed) Post-discharge clinic visits Post-discharge ED visits Needs met Employment (confirmed) Direct measures Rearrest (police data) Convictions (court data) Reinjury (registry data) Death (medical examiner)


Table 6. Visual Assessment of Outcome Measure Results.

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100% 0% X X

X NA NC

X

85% 18% X X

NA Yes

X X X X

X

X

X

X X

RCT CM


X

X

X X

RCT CM


X X X

NA NC

X

73% 31% X

X

X

NA NA

X

88% 14% X

X

X

X

X

X X X

RCT BI


X

RCT CM

Cheng et al. (2008)

X

X

X

X X NA Yes

X

20% 19%

X

X

X X

RCT BI/CM


X

NA NC

X

97% 3%

X

X

X

X

X

CO CM


X

X X X NA NC

X X

71% 0%

X X

X

X

X

X

CO CM

Smith, R. Dobbins et al. (2013)

X X

NA Yes

X

44% 21%

X X

X

X

X

X

CRS CM

Smith, R. Evans, et al. (2013)

X X

NA NC

X

X

44% 19%

X

X

X

CS CM

Gomez et al. (2012)

X X

NA NC

X

55% 0%

X

X

X

CS CM

Marcell (2001)

Note. BI ¼ brief intervention; CM ¼ case management; CO ¼ cohort; CRS ¼ cross-sectional study; CS ¼ case series; IRB ¼ institutional review board; NA ¼ not applicable; NC ¼ not clear; RCT ¼ randomized control trial. X indicates 0.05.

Study design Intervention Effectiveness by primary outcomes Some evidences of effectiveness Rearrest/conviction Reinjury (recidivism) Internal validity Control or comparison group Multiple measurement points Identify/control confounders Replication Program replication Implementation guidance (fidelity) Comprehensively described Partially described Not reported External and ecological validity >2 applied studies—different settings >2 applied studies—similar settings Real-world informed settings Feasibility Enrollment rate Attrition rate Use of financial incentives—gift card Program staffing described Program costs/savings described Funding National State/city Private/professional organization Potential harms of the intervention Partner with existing community programs Other benefits: at-risk siblings program Potential barriers to implementation Inadequate CM staffing Limited community services/quality Population difficult to engage Difficulty finding qualified mentors Ethical constraints (IRB concerns)

Table 7. Program Evidence of Effectiveness.

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Six of the 10 studies reported difficulty staffing the case management intervention on all shifts putting them at risk for unintentional selection bias. Refusal to participate and lost to follow-up rates across studies also threaten generalizability, as results may be biased by baseline openness to screening or continued involvement in the intervention (Sudsawad, 2007). Sample size limited several of the studies, and only 4 of the 10 studies performed a power analysis and of those, only 2 were adequately powered to discern small differences in behavior or reinjury.

SEM Framework Individual-level factors. The SEM’s individual-, relationship-, and community-level factors provided a useful framework to examine hospital-based violence prevention strategies (Table 5). Extensive variation in individual level influences related to youth violence makes it unlikely that any single prevention program applied across trauma centers will produce uniform effects. Individual level factors, which can moderate intervention effects, include demographic characteristics such as gender, ethnicity, age, levels of baseline aggression, and other high-risk behaviors, as well as degree of participation in the intervention (Christoffel & Gallagher, 2006). Two studies demonstrated conflicting results on the influence of age as moderating prevention effects. Shibru et al. (2007) established that a trauma center–based peer intervention program reduces the risk of criminal justice system involvement in injured youth. Logistic regression analysis, however, showed that after controlling for age, gender, ethnicity, or race, only patients under age 17 were associated with a positive effect. In contrast, C. Cooper et al. (2006) demonstrated decreased serious criminal activities with an extensive case management program where fully 40% of the patients were 30 years or older, theorizing that the success was partly due to the older patient’s readiness to change. Further research is needed to clarify the influence of age and or readiness to change as moderators of prevention efforts. Only 1 of the 10 programs targeted individual-level interventions alone. Walton et al. (2010) using an RCT design studied brief intervention applied in the emergency department setting targeting individual-level factors such as anger management, conflict resolution, alcohol refusal, problem recognition, motivation, and self-efficacy. Adolescents were randomized to receive a brochure, a 35-min motivational intervention delivered by a therapist or a self-administered animated computer intervention. Positive results were noted for few outcomes, effect sizes were small, and none of the observed 3-month benefits were sustained at 6 months. Computer-delivered interventions did not affect any of the violence-related outcomes except being the recipient of peer violence at 6 months. Therapist counseling had a modest effect (13% absolute reduction in peer aggression compared with controls) for all three violencerelated outcomes at 3 months but not at 6 months. Aboutanos et al. (2011) was the only other study to examine brief intervention by comparing the effects of hospital-based brief intervention alone and in combination with intensive community-based

case management services. The two groups were similar in demographics and injury profiles. The brief intervention plus case management group showed higher hospital and community service utilization, and risk factor reduction at 6 weeks and 6 months. However, there were no differences in reinjury rates at 6 months. Relationship-level factors. Peer and family relationships may also influence how individuals respond to intervention modalities. Parental factors such as monitoring and involvement, parental support for fighting, and parental support for nonviolence exerted direct effects on youth aggression (Farrell, Henry, Mays, & Schoeny, 2011). While all nine (90%) case management studies included family counseling as a strategy, only one evaluated family involvement as a moderator of the effects of a trauma center–based violence prevention program. Cheng, Haynie, et al. (2008) RCT to assess the receptiveness of families to violence prevention interventions examined a case management program for injured patients, implementing a sixsession problem-solving curriculum where both parent and child underwent baseline and posttest assessment of youth aggression. Nonsignificant results revealed a trend toward program effects, including reduced misdemeanor activity and youth-reported aggression scores and increased youth selfefficacy. The level of parental involvement directly moderated the intervention effects. Community-level factors. All nine case management intervention programs used community-level strategies (Table 5). Significant heterogeneity among case management interventions existed across the nine studies. In order of the highest frequency, seven studies addressed education initiatives and mental health services, five targeted employment, legal assistance, and recreational activities, while four included housing assistance and substance abuse services. Although all 10 studies included community interventions, only one evaluated client needs met as moderators of the effects of a trauma center–based violence prevention program. R. Smith, Dobbins, Evans, Balhotra, and Dicker’s (2013) retrospective cohort study over a 7-year period found that while controlling for all other needs being met, mental health services and employment as risk reduction resources were significantly associated with program success. C. Cooper et al. (2006) also reported increased employment as a positive outcome of an over 2-year case management intervention while Aboutanos et al. (2011) using only 6-month case management duration did not.

Outcome Measures Outcome measures and results are shown in Table 6. Indirect measures are often subjective and relatively short term such as self-report surveys that serve as a proxy for more direct long-term measures of violence such as rearrests and reinjury rates (Castillo, 2012). Seven of the 10 studies used a combination of indirect and direct outcome measures and all but one employed more than one outcome measure. The most frequent



Identification

12

Records idenﬁed through database searching (n = 623)

Additional records identified through other sources (n = 6)

Included

Eligibility

Screening

Records after duplicates removed (n = 252)

Records screened (n = 168)

Exclusions based on screening of titles/abstract: unrelated topic, not original study(n=84)

Full-text articles assessed for eligibility (n = 15)

Full-text articles excluded: Non-youth violence, non-clinical settings, no comparative data (n = 153)

Studies included in qualitative synthesis (n = 10)

Studies excluded: overlapping studies of same program (n = 5)

Studies included in quantitative synthesis (meta-analysis) (n = 0)

Figure 1. Study selection flow diagram.

use of self-report measures included those measuring attitudes on aggression or retaliation or reported alcohol and drug use. However, research has shown that changes in knowledge and attitudes do not necessarily translate into changes in behavior or injury rates (Gielen, Sleet, & DiClemente, 2006). Validity of self-reported high-risk behavior has also been questioned due to recall error and/or the influence of situational factors such as social desirability bias or fear of reprisal (Brener, Billy, & Grady, 2003). Two of the 10 studies attempted to minimize this potential bias through the use of technology. Cheng, Haynie, et al. (2008) used audiotapes to collect data by having participants listen to questions asked on a tape recorder and then write numeric answers on the answer sheet that did not have the printed questions. Walton et al. (2010) employed laptop computers displaying tailored feedback using a stand-alone interactive animated program with touch screens and audio via headphones to ensure privacy. Indirect self-report measures. Outcome measures varied considerably across all 10 studies. The first group of indirect measures is the self-report group. Sixteen self-report outcomes within four RCTs, measured with validated assessment tools, found that only four (25%) of the measures demonstrated a positive

association with the intervention. Zun, Downey, and Rosen (2006) showed that a 6-month case management intervention resulted in decreased self-reported injury that, however, was not supported by direct measure trauma registry data. Walton et al. (2010) studied the effect of brief intervention on five self-report measures and found only one positive effect, at 6 months for reduced alcohol consequences. Finally, Aboutanos et al. (2011) found decreased self-report of alcohol and drug use with brief intervention used in combination with case management.

Indirect ‘‘other measures’’. The next group of indirect outcome measures included the ‘‘other measures group’’ reporting the highest intervention success. These included the number of referrals made, referrals utilized, post-discharge emergency department and clinic visits, and needs met. Nine of these measures were used across seven studies, and seven (78%) showed a positive association with the case management intervention. Three studies evaluated the effect of case management on needs met and all reported increases in needs met (Gomez et al., 2012; R. Smith, Dobbins, et al., 2013; R. Smith, Evans, et al., 2013).


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Direct measures. The last of the outcome measures were direct measures (Table 6). Thirteen direct measures across seven studies reported mixed conclusions. For example, across rearrest outcomes, only one of three studies (Shibru et al., 2007) showed improvement with case management. Across conviction outcomes, one of two studies (Beach et al., 2006) was associated with improvement; however, the case management duration was 4½ times longer than that used by Aboutanos et al. (2011) who showed no effect. Reinjury rate or trauma recidivism is often considered the principal outcome for trauma center violence prevention efforts (Martin-Mollard & Becker, 2009). Of the seven studies that measured reinjury, four (57%) showed improvement with case management within 6 months to 2.5 years.

Intervention Duration Across studies, case management duration and time to outcome measurement relative to program success were inconsistent. C. Cooper et al.’s (2006) RCT had the longest case management duration and time to measurement (over 2 years), which ended with mixed results finding no change in rearrest, but improvement with convictions and reinjury. While Shibru et al.’s (2007) double comparative cohort design had the next longest case management duration of 12 months and outcome measurement of 18 months, directly opposite results were noted: decreased rearrest rate but no change in reinjury or death. Longer intervention duration and time to follow-up may be necessary to determine actual program effects on trauma recidivists. R. S. Smith, Fry, Morabito, and Organ’s (1992) urban trauma center recidivists averaged 8 months between injuries, and in patients with fatal repeat trauma, the mean time between initial injury and death was 18.8 months. Gomez et al. (2012), in another urban trauma center, found that the average time between violence-related reinjury was 2 years. From a criminal justice perspective, Bingenheimer, Brennan, and Earls (2005) found that being the victim of a gunshot wound doubles the probability that a youth will commit violence within 2 years.

Intervention Setting Tertiary violence prevention efforts began in the emergency department and extended to the inpatient unit. Several of the study authors noted the importance of case managers developing rapport and trust with patients while they were still hospitalized to increase client engagement and reduced program attrition (C. Cooper, Eslinger, & Stolley, 2006; Gomez et al., 2012; Shibru et al., 2007; R. Smith, Dobbins, et al., 2013). While intuitive and compelling, this relationship was not substantiated by case management study attrition rates.

Prevention Program Evidence of Effectiveness Practical means to assist clinicians in examining the evidence of prevention programs are provided by the Centers for Disease Control (Puddy & Wilkins, 2011). An adaptation of this

framework, including the following dimensions such as effect, internal validity, replication, program fidelity, external and ecological validity, feasibility, cost, barriers, and ethical constraints, applied to the 10 prevention programs is shown in Table 7. Effect. Effectiveness was highly variable across programs and outcomes, likely related to the heterogeneity of program design, duration of intervention, and outcome measures selected. Every program except Cheng, Haynie, et al. (2008) showed some evidence of effectiveness in at least one outcome measure, and none showed harm. Internal validity. Internal validity, the assurance that the effects seen are a result of the program and not something else is enhanced by study design, multiple measurement points, and control of prognostic factors (Puddy & Wilkins, 2011). Half of the studies were RCTs, and 6 of the 10 studies employed a control with a comparison group and four controlled for confounders. Replication. Replication involves implementing a program in a different trauma center setting. This shows whether a prevention program can be ‘‘exportable’’ or repeated and still be effective. Only 1 of the 10 studies was a replication study (R. Smith, Evans, et al., 2013), which reflects the developing and yet emerging nature of this field of research. Smith exported the successful Wrap Around Project from San Francisco General hospital to the University of California Davis Medical Center. A comparison of recruitment, enrollment rates, and cultural match between client and case manager and percent of needs met was performed in a cross-sectional study. Results indicate that while the patient recruitment and enrollment were significantly decreased compared to the original site, the program could be replicated in a different trauma center environment. Program fidelity. Implementation guidance includes the services or descriptive materials that aid in the implementation of the program in a different setting. Programs that follow comprehensive implementation guidelines are more likely to have high fidelity, meaning that the outcomes can be attributed to the program and not other factors (Hasson, Blomberg, & Duner, 2012). Elements of program fidelity include adherence to the intervention, exposure or dose, quality of delivery, participant responsiveness, and program differentiation (Carroll et al., 2007). As seen in Table 5, the interventions used across programs varied in duration, dose, form of contact, worker credentials, cultural competence, and training. All 10 programs used in-person case management contacts while an additional five used phone calls and one used group sessions. Case management dosage was labeled differently across studies, including hours/week, number of contacts/month, mean number of contacts/case manager, which were converted to estimate the number of patient contacts/case manager/month) for comparison. Additionally, two programs capped the number of clients/case manager to help ensure some level of intervention consistency


14


(Shibru et al., 2007; Zun, Downey, & Rosen, 2006). Case manager training was described in only 4 of the 10 studies. The importance of case manager cultural competence was highlighted in 6 of the 10 studies. Two programs employed former convicts or trauma patients as peer case managers. One study examined the race and gender distribution of clients/case manager and found that there was no difference by gender, but there was a difference in racial/ethnic distribution. The discrepancy was attributed to the client’s willingness to trust specific case managers based on shared cultural experiences (R. Smith, Dobbins, et al., 2013). Across the 10 studies, only 3 comprehensively described the program implementation, 4 partially, and 3 did not report any guidance. Only R. Smith, Dobbins, et al. (2013) analyzed the influence of case management exposure or dose on reported outcomes, finding a high dose of case manager exposure in the first 3 months was associated with a higher rate of success. The mean time spent in the program by client/case manager was significantly different, ranging from an average of 13.6 months to 7 months (p < .0001); however, no difference was found in success between case managers. External and ecologic validity. External validity refers to whether a program can demonstrate preventive effects among a wide range of populations (generalizability), while ecologic validity refers to whether a program approximates the real-life conditions of a specific setting (Rivera, Cummings, Koepsell, Grossman, & Maier, 2001). To date, only one program has been implemented in more than one site with similar populations (R. Smith, Evans, et al., 2013). Feasibility. Feasibility denotes whether a program can be successful, given the resources available and the economic, social, geographic, and historical aspects of the current setting (Puddy & Wilkins, 2011). Metrics selected to evaluate feasibility among the 10 violence prevention studies include enrollment, attrition, use of incentives, description of program staffing, and costs (Table 7). Descriptions varied significantly across studies on screening, eligibility, enrollment, lost to follow-up, refusal to participate, and attrition making comparisons difficult. Enrollment rates ranged from 20% to 100%. Attrition varied across studies, ranging from 0% to 31%. Historically, the suggested threshold for acceptable loss to follow-up is less than 20% (Guyatt et al., 2011), which occurred in all but one (Cheng, Haynie, et al., 2008) of the 10 studies. The most common reason cited for low enrollment was inadequate program funding and or case management staffing, especially during night and weekend hours when violence-related admissions peak. Only 6 of the 10 studies adequately described the case management staffing model that ranged from one to four case managers. Costs. Three of the studies identified program costs. Zun et al. (2006) estimated the cost of $45,000 per year plus benefits for one case manager to treat 40 youths annually. Shibru et al. (2007) estimated the cost of roughly $350,000 per year plus

benefits for four case managers to treat 75–100 youths annually. R. Smith, Dobbins, et al. (2013) estimated a budget of roughly $320,000 per year for three case managers to treat 50 youths annually. Averaged, they provide an estimate that one case manager can see and treat roughly 25–30 clients per year. Given the eligible number of patients per center and relatively high enrollment rates found in these three programs, 85%, 97%, and 71%, respectively, one can estimate the number of case managers needed relative to trauma center violence volume. Regarding cost savings, two of the studies presented a cost savings analysis after implementation of a case management intervention. C. Cooper et al. (2006) estimated the cost savings attributed to reducing reinjury hospitalizations finding total cost of hospitalization for three recidivists from the intervention group $138,000, compared to $736,000 for the 16 recidivists from the nonintervention group. Shibru et al. (2007) estimated the cost savings attributable to reduced criminal justice involvement and showed that the total cost reduction derived annually from the number needed to treat basis was estimated to be $750,000 to $1.5 million. Barriers to implementation. Identified barriers to program implementation included inadequate funding and case management staffing, limited availability of community partners, and questionable quality of community services provided (Cheng, Haynie, et al., 2008). Difficulty engaging the high-risk population and finding qualified community mentors was noted in a program to implement a community mentor model Cheng, Haynie, et al. (2008). Ethical constraints. Institutional review board concerns were noted in four studies. Three studies were denied the ability to have a control group without intervention (Aboutanos et al., 2011; Cheng, Haynie, et al., 2008; Zun et al., 2006) while Walton was restricted from blinding participants to the intervention condition. Lack of a pure control group required researchers to provide a modified intervention or ‘‘enhanced’’ control group, which can reduce the ability to detect effects (Cheng, Haynie, et al., 2008; Zun et al., 2006). Alternatively, Aboutanos et al. (2011) was denied the use of a control group without intervention on the grounds of lack of clinical equipoise after extensive and successful marketing of their prevention program in the hospital and surrounding community. This led to the use of historical controls as the only option to obtain comparison data.

Discussion This integrative review aimed to investigate the effectiveness of hospital-based tertiary violence prevention programs. Although there were noted inconsistencies in results across studies, case management was found to be positively associated with a reduction of violence outcome measures. Ninety percent of the studies showed some improvement in one or more outcome measures. These results held across social ecological level and setting (emergency department and inpatient). Interpreting program success, however, is heavily influenced by the


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outcome measure selected. Short-term indirect measures such as referral utilization or met needs were associated with greatest program success while self-report indirect measures such as change in attitude was least related to program success. Indirect measures may be necessary for the short term for preliminary program evaluation. However, as more patients are enrolled with extended follow-up periods, then transitioning to direct long-term outcome measures such as rearrest or reinjury rates will be more informative. The only study to directly compare brief intervention and case management demonstrated that while inhospital brief intervention can capitalize on the teachable moment and extend beyond the emergency department, brief intervention alone appears to be insufficient to reduce trauma recidivism. Rather, case management with incorporation of multilevel strategies across community resources demonstrates greater success than brief intervention alone. Finally, although the descriptions of the case management programs varied extensively, the intervention dose, quality, intensity, and duration appear to correlate with improved outcomes. Aspects that correlate with higher success include high-intensity followup, early after injury, and the availability of mental health services and vocational training and or employment opportunities. The success of the trauma center case management programs makes clear that an integrated hospital-community approach is superior to a hospital stand-alone intervention like brief intervention. It is increasingly apparent that to intervene with the most disadvantaged, violently injured youth requires trauma centers to reexamine their role in the health care and social support system. This reevaluation includes the recognition of the importance of transitions of care and postdischarge care coordination. Trauma care should not end at hospital discharge. Rather, case management programs allow trauma centers to move beyond that of providing physical care only, to that of addressing the social determinants of violence by addressing upstream inequities that promote downstream injury. The successful case management programs stressed the importance of incorporating the community into risk reduction strategies. Trauma center partnerships with nonprofit, forprofit, and public sectors, including various social service agencies can provide the array of resources necessary to break the cycle of violence for the most vulnerable. Further, connecting the patient with community resources is not enough. Guidance offered in a structured case management format lasting between 1 and 2 years post injury appears necessary to ensure actual utilization of needed services and to make effective life changes.

Strengths and Limitations This study is limited by only one author performing the review of studies. Through the use of a systematic approach to searching, screening, reviewing, and extracting data using a standardized audit tool this study has demonstrated rigorous application of methods. To encompass the broadest

range of hospital-based tertiary violence prevention programs, a wide search strategy inevitably resulted in a heterogeneous group of studies. This strategy was chosen a priori, as few pertinent RCTs have been published. The dearth of RCTs may reflect the ethical and practical difficulty in the implementation of studies evaluating complex interventions for vulnerable populations. The studies’ heterogeneity in design and outcomes prevented performing quantitative meta-analyses. Therefore, publication bias could not be assessed with a funnel plot or a sensitivity analysis. The multiple-source search strategy reduced the risk of publication bias, but it cannot be excluded completely.

Implications Current evidence regarding the use of brief intervention and case management for youth violence is limited by variation in outcome reporting, dose, and study quality. More RCTs are needed with extended follow-up periods beyond 2 years to examine violence-related injury recidivism. Because programs are relatively new, they will require longer follow-up to show sustained reduction of injury recidivism. Research rigor could be improved by more consistent attention to program fidelity especially regarding case management dose, intensity, and quality as well as the type of case manager (professional, peer, or community volunteer). Future studies would benefit from uniform outcome measurement, which would facilitate comparability across studies. Research to identify effective components of current programs, cost-effectiveness, and reproducibility is needed. Many questions remain to be answered. Are there specific resources that are more effective than others at changing the trajectory of a patient injured by violence? What is the optimal duration of post discharge case management? What level of education and training do case managers require? Future research should also consider the influence of age and injury severity as moderators of program effects. Finally, identified gaps include the feasibility of implementing and funding these programs, in cash-strapped communities with already high unemployment and limited public health infrastructure.

Conclusions Current evidence indicates that the trauma center is a viable setting to provide tertiary violence prevention. Trauma center– based violence prevention programs are effective in targeting interventions at the individual, relationship, and community levels of the SEM. While trauma centers may feel ill equipped to cope with the many social ills that place patients at risk for being repeat victims of violence, they are capable of interrupting the violence trajectory and facilitating community connections between the client and the services needed. This review demonstrates that trauma centers can offer effective tertiary violence prevention to the highest risk group, the trauma recidivist and make an impact.


QUESTION


Outcomes

Comparison

Intervention

Patients

Citation:

Table A1. Data Extraction Tool.

Appendix

Subgroups: Age Sex Race/ethnicity SES Risk behavior Trauma patients

Individuals

3

2

Groups 1

Time Frame:

DEPENDENT VARIABLE □ Behavior □ Other mediating outcome □ Non-fatal health effect □ Severity of illness / injury □ Death □ Surrogate outcomes

Instrument Psychometrics

□Retrospective

□Prospective

Data Source:

Describe:

Description of groups or individuals:

n

sample

n

sample

Comparison

Observation

□ Primary Prevention □ Secondary Prevention □ Tertiary Prevention

Feasibility: _Costs _Ease of implementation _Potential harms _Barriers _Community acceptance/involve _Ethical constraints/IRB Issues

sample

n sample

n

__Urban __ Suburb __ Rural __ Mixed __ Unk

Population Density:

(continued)

Number Analyzed

OPERATIONAL DEFINITIONS:

Setting:

Place: City / State

Intervention

Theory / Framework:

Comparison

Allocation

Diffs in Groups?

Attrition

Time Collected

Size (n)

Intervention

Where

Who

How

Assignment: □ Random □ Convenience What

Sampling: □ Simple random □ Stratified random □ Cluster sample □ Convenience sample

INDEPENDENT VARIABLE □ Provision of info only: □ General □ High risk □ Professional □ Behavioral interventions: □ General □ High risk □ Professional □ Environmental interventions □ Physical □ Social □ Legislation/Regulation/Enforcement □ Clinical □ Public health or medical care system interventions Was the intervention part of a larger intervention effort? □ Yes □ No

POPULATION:

Author Research Group/University: Funding Source: Type of Data Set Used:

16 TRAUMA, VIOLENCE, & ABUSE


Appendix: Data Extraction Tool



LIMITATIONS

Notes

Systematic review (with homogeneity) of RCT's Individual RCT (with narrow confidence intervals) All and none studies Systematic review (with homogeneity) of cohort studies Individual cohort study and low quality RCTs Outcome research; ecological studies Systematic review (with homogeneity) case-control studies Individual case-control study Case-series & (poor quality cohort & case control studies) Expert opinion without explicit critical appraisal

Grading Criteria

(CEBM, 2009)

EXTERNAL VALIDITY Is the population generalizable? Is the treatment feasible in my setting? Will the potential benefits outweigh potential harm?

1 1b 1c 2a 2b 2c 3a 3b 4 5

Level

LEVEL OF EVIDENCE

Note: IRB = institutional review board, n = number, RCT = randomized control trial, SES = socioeconomic status, Unk = unknown.

CONCLUSIONS

STUDY QUALITY

APPRAISAL

Table A1. (continued)

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Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

References Aboutanos, M. B., Jordan, A., Cohen, R., Foster, R. L., Goodman, K., Halfond, R. W., . . . Ivatury, R. R. (2011). Brief violence interventions with community case management services are effective for high-risk trauma patients. Journal of Trauma Injury Infection & Critical Care, 71, 228–236. American College of Surgeons. (2014). Resources for optimal care of the injured patient (6th ed.). Chicago, IL: Author. Beach, M., Gary, T., Price, E. G., Robinson, K., Gozu, A., Palacio, A., . . . Cooper, L. (2006). Improving health care quality for racial/ethnic minorities: A systematic review of the best evidence regarding provider and organization interventions. BMC Public Health, 6, 104. Becker, M. G., Hall, J. S., Ursic, C. M., Jain, S., & Calhoun, D. (2004). Caught in the crossfire: The effects of a peer-based intervention program for violently injured youth. Journal of Adolescent Health, 34, 177–183. Bingenheimer, J. B., Brennan, R. T., & Earls, F. J. (2005). Firearm violence exposure and serious violent behavior. Science, 308, 1323–1326. doi:10.1126/science.1110096 Brener, N. D., Billy, J. O., & Grady, W. R. (2003). Assessment of factors affecting the validity of self-reported health risk behavior among adolescents: Evidence from the scientific literature. Journal of Adolescent Health, 33, 436–457. Bronfenbrenner, U. (1979). Contexts of child rearing: Problems and prospects. American Psychologist, 34, 844–850. doi:10.1037/ 0003-066X.34.10.844 Bulson, J., Mattice, C., & Bulson, T. (2012). A systematic approach to very important person preparedness for a trauma center. Journal of Trauma Nursing, 19, 11–14. Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2, 40. Castillo, R. C. (2012). Functional outcomes. In G. Li & S. P. Baker (Eds.), Injury Research (pp. 357–369). New York, NY: Springer. Centers for Disease Control and Prevention. (2009). Preventing youth violence program activities guide. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved from http://www.cdc. gov/ViolencePrevention/pub/PreventingYV.html Chang, D. C., Cornwell, E. E. 3rd, Sutton, E. R., Yonas, M. A., & Allen, F. (2005). A multidisciplinary youth violence-prevention initiative: Impact on attitudes. Journal of the American College of Surgeons, 201, 721–723. Cheng, T. L., Haynie, D., Brenner, R., Wright, J. L., Chung, S. E., & Simons-Morton, B. (2008). Effectiveness of a mentor-implemented, violence-prevention intervention for assault-injured youths

presenting to the emergency department: Results of a randomized trial. Pediatrics, 122, 938–946. doi:10.1542/peds.2007-2096 Cheng, T. L., Wright, J. L., Markakis, D., Copeland-Linder, N., & Menvielle, E. (2008). Randomized trial of a case management program for assault-injured youth: Impact on service utilization and risk for re-injury. Pediatric Emergency Care, 24, 130–136. Christoffel, T., & Gallagher, S. (2006). Injury prevention and public health practical knowledge, skills, and strategies (2 ed.). Sudbury, MA: Jones and Bartlett Cohen, L., & Chehimi, S. (2010). Beyond brochures: The imperative for primary prevention. In L. Cohen, V. Chavez & S. Chehimi (Eds.), Prevention is Primary: Strategies for Community Well Being (2 ed., pp. 3–24). San Francisco, CA: Jossey-Bass. Cohen, L., & Swift, S. (1999). The spectrum of prevention: Developing a comprehensive approach to injury prevention. Injury Prevention, 5, 203–207. Cooper, C., Eslinger, D. M., & Stolley, P. D. (2006). Hospital-based violence intervention programs work. Journal of Trauma, 61, 534–537; discussion 537–540. doi:10.1097/01.ta.0000236576. 81860.8c Cooper, W. O., Lutenbacher, M., & Faccia, K. (2000). Components of effective youth violence prevention programs for 7- to 14-yearolds. Archives of Pediatrics and Adolescent Medicine, 154, 1134–1139. doi:10.1001/archpedi.154.11.1134 Dahlberg, L. L., & Krug, E. G. (2002). Violence—a global public health problem. In E. Kurg, L. L. Dahlberg, J. A. Mercy, A. B. Zwi, & R. Lorano (Eds.), World report on violence and health (pp. 1–56). Geneva, Switzerland: World Health Organization. Dicker, R. A., Jaeger, S., Knudson, M. M., Mackersie, R. C., Morabito, D. J., Antezana, J., & Texada, M. (2009). Where do we go from here? Interim analysis to forge ahead in violence prevention. Journal of Trauma Injury Infection & Critical Care, 67, 1169–1175. DiGuiseppi, C., & Roberts, I. G. (2000). Individual level injury prevention strategies in the clinical setting. The Future of Children, 10, 53–82. Farrell, A. D., Henry, D. B., Mays, S. A., & Schoeny, M. E. (2011). Parents as moderators of the impact of school norms and peer influences on aggression in middle school students. Child Development, 82, 146–161. Fein, J. A., Ginsburg, K. R., McGrath, M. E., Shofer, F. S., Flamma, J. C. Jr., & Datner, E. M. (2000). Violence prevention in the emergency department: Clinician attitudes and limitations. Archives of Pediatrics and Adolescent Medicine, 154, 495–498. Gainer, P. S., Webster, D., & Champion, H. R. (1993). A youth violence prevention program. Archives of Surgery, 128, 303–308. Garrettson, M., Weiss, H. B., McDonald, E. M., & Degutis, L. (2008). A survey of ED injury prevention activities. Journal of Emergency Nursing, 34, 61–68. Gielen, A. C., Sleet, D. A., & DiClemente, R. J. (Eds.). (2006). Injury and violence prevention. San Francisco: John Wiley. Goins, W. A., Thompson, J., & Smipkins, C. (1992). Recurrent intentional injury. Journal of the National Medical Association, 84, 431–435.


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Goldberg, A. J., Toto, J. M., Kulp, H. R., Lloyd, M. E., Gaughan, J. P., Seamon, M. J., & Charles, S. P. (2010). An analysis of inner-city students’ attitudes towards violence before and after participation in the ‘‘Cradle to Grave’’ programme. Injury, 41, 110–115. doi: 10.1016/j.injury.2009.09.024 Gomez, G., Simons, C., St John, W., Creasser, D., Hackworth, J., Gupta, P., . . . Kemp, H. (2012). Project prescription for hope (RxH): Trauma surgeons and community aligned to reduce injury recidivism caused by violence. American Journal of Surgery, 78, 1000–1004. Gorin, S. S., Badr, H., Krebs, P., & Prabhu Das, I. (2012). Multilevel interventions and racial/ethnic health disparities. Journal of the National Cancer Institute Monographs, 2012, 100–111. doi:10. 1093/jncimonographs/lgs015 Guyatt, G. H., Oxman, A. D., Vist, G., Kunz, R., Brozek, J., AlonsoCoello, P., . . . Schunemann, H. J. (2011). GRADE guidelines: 4. Rating the quality of evidence—study limitations (risk of bias). Journal of clinical epidemiology, 64, 407–415. Haider, A. H., Young, J. H., Kisat, M., Villegas, C. V., Scott, V. K., Ladha, K. S., . . . Efron, D. T. (2014). Association between intentional injury and long-term survival after trauma. Annals of Surgery, 259, 985–992. doi:10.1097/sla.0000000000000486 Hasson, H., Blomberg, S., & Duner, A. (2012). Fidelity and moderating factors in complex interventions: A case study of a continuum of care program for frail elderly people in health and social care. Implementation Science, 7, 23. doi:10.1186/17485908-7-23 Hayward, T. Z., Simons, C. J., John, W. S., Waymire, M., & Stucky, T. D. (2011). Impacting the problem of inner-city youth violence: ‘‘Educating kids about gun violence’’ program. American Surgeon, 77, 451–457. Higgins, J. P. T., & Green, S. (Eds.). (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Hoboken, NJ: Wiley-Blackwell. Hoffman, A. M., & Summers, R. W. (2001). Teen violence: A global view. Westport, CT: Greenwood Press. Johnson, S. B., Bradshaw, C. P., Wright, J. L., Haynie, D. L., SimonsMorton, B. G., & Cheng, T. L. (2007). Characterizing the teachable moment: Is an emergency department visit a teachable moment for intervention among assault-injured youth and their parents? Pediatric Emergency Care, 23, 553–559. Kumar, G. S., & Klein, R. (2013). Effectiveness of case management strategies in reducing emergency department visits in frequent user patient populations: A systematic review. The Journal of Emergency Medicine, 44, 717–729. doi:http://dx.doi.org/10.1016/j. jemermed.2012.08.035 Kunkel, P., Thomas, C. J., Seguin, C., Dereczyk, D., Rajda, C., & Brandt, M. M. (2010). A hospital-based violence prevention tour: A collaborative approach to empower youth. Journal of Trauma Injury Infection & Critical Care, 68, 289–293. Limbos, M. A., Chan, L. S., Warf, C., Schneir, A., Iverson, E., Shekelle, P., & Kipke, M. D. (2007). Effectiveness of interventions to prevent youth violence a systematic review. American Journal of Preventive Medicine, 33, 65–74. doi:10.1016/j.amepre.2007.02.045 Littell, J. H., Corcoran, J., & Pillai, V. (2008). Systemic reviews and meta-analysis. New York, NY: Oxford University Press.

Marcelle, D. R., & Melzer-Lange, M. D. (2001). Project UJIMA: working together to make things right. Wisconsin Medical Journal, 100(2), 22–25. Martin-Mollard, M., & Becker, M. (2009). Key components of hospital-based violence intervention programs. The National Symposium of Hospital-Based Violence Intervention Programs. Retrieved from http://nnhvip.org/wp-content/uploads/2010/09/ key.pdf McDonald, E. M., MacKenzie, E. J., Teitelbaum, S. D., Carlini, A. R., Teter, J. H., & Valenziano, C. P. (2007). Injury prevention activities in U.S. trauma centres: Are we doing enough? Injury, 38, 538–547. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Group, P. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Journal of Clinical Epidemiology, 62, 1006–1012. doi:10.1016/j.jclinepi.2009.06. 005 Newton, A. S., Dong, K., Mabood, N., Ata, N., Ali, S., Gokiert, R., . . . Wild, T. C. (2013). Brief emergency department interventions for youth who use alcohol and other drugs: A systematic review. Pediatric Emergency Care, 29, 673–684. doi:10.1097/PEC. 0b013e31828ed325 Puddy, R. W., & Wilkins, N. (2011). Understanding evidence part 1: Best available research evidence. A guide to the continuum of evidence of effectiveness. Atlanta, GA: Centers for Disease Control and Prevention. Raden, A. S. (2001). Youth violence prevention: How does the health care sector respond? Washington, DC: National Health Policy Forum. Rivera, F. P., Cummings, P., Koepsell, T. D., Grossman, D. C., & Maier, R. V. (2001). Injury control. New York, NY: Cambridge University Press. Scott, K. K., Tepas, J. J. 3rd, Frykberg, E., Taylor, P. M., & Plotkin, A. J. (2002). Turning point: Rethinking violence—Evaluation of program efficacy in reducing adolescent violent crime recidivism. Journal of Trauma, 53, 21–27. Shibru, D., Zahnd, E., Becker, M., Bekaert, N., Calhoun, D., & Victorino, G. P. (2007). Benefits of a hospital-based peer intervention program for violently injured youth. Journal of the American College of Surgeons, 205, 684–689. Smith, R., Dobbins, S., Evans, A., Balhotra, K., & Dicker, R. A. (2013). Hospital-based violence intervention: Risk reduction resources that are essential for success. Journal of Trauma and Acute Care Surgery, 74, 976–980; discussion 980–972. Smith, R., Evans, A., Adams, C., Cocanour, C., & Dicker, R. (2013). Passing the torch: Evaluating exportability of a violence intervention program. American Journal of Surgery, 206, 223–228. doi:10. 1016/j.amjsurg.2012.11.025 Smith, R. S., Fry, W. R., Morabito, D. J., & Organ, C. H., Jr. (1992). Recidivism in an urban trauma center. Archives of Surgery, 127, 668–670. Snider, C., & Lee, J. (2009). Youth violence secondary prevention initiatives in emergency departments: A systematic review. Canadian Journal of Emergency Medical Care, 11, 161–168. Sudsawad, P. (2007). Knowledge translation: Introduction to models, strategies, and measures. Austin, TX: Southwest Educational


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Development Laboratory, National Center for the Dissemination of Disability Research. Tellez, M. L., & Mackersie, R. C. (1996). Violence prevention involvement among trauma surgeons: Description and preliminary evaluation. Journal of Trauma Injury Infection & Critical Care, 40, 602–606. Thornton, T. N., Craft, C. A., Dahlberg, L. L., Lynch, B. S., & Baer, K. (2002). Best practices of youth violence prevention: A sourcebook for community action (rev. ed.). Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Walton, M. A., Chermack, S. T., Shope, J. T., Bingham, C. R., Zimmerman, M. A., Blow, F. C., & Cunningham, R. M. (2010). Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: A randomized controlled trial. Journal of the American Medical Association, 304, 527–535. doi:10.1001/jama. 2010.1066 Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52, 546–553. Wilkinson, D. L., Kurtz, E. M., Lane, P., & Fein, J. A. (2005). The emergency department approach to violently injured patient care: A regional survey. Injury Prevention, 11, 206–208. Wood, L., Egger, M., Gluud, L. L., Schulz, K. F., Juni, P., Altman, D. G., . . . Sterne, J. A. (2008). Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: Meta-epidemiological study. British Medical Journal, 336, 601–605. doi:10.1136/bmj.39465.451748.AD Zun, L. S., Downey, L. V., & Rosen, J. (2003). Violence prevention in the ED: Linkage of the ED to a social service agency. American Journal of Emergency Medicine, 21, 454–457.

Zun, L. S., Downey, L., & Rosen, J. (2004). An emergency department-based program to change attitudes of youth toward violence. Journal of Emergency Medicine, 26, 247–251. Zun, L. S., Downey, L., & Rosen, J. (2006). The effectiveness of an ED-based violence prevention program. American Journal of Emergency Medicine, 24, 8–13.

Author Biographies Judy Nanette Mikhail, MSN, MBA, RN, is the nurse researcher with the Michigan Trauma Quality Improvement Program at the University of Michigan. Ms. Mikhail is completing her doctoral training in nursing at the Medical University of South Carolina with an emphasis on trauma disparities and youth violence. Her interests involve trauma center quality improvement, quality collaboratives, trauma disparities, and identifying evidence-based trauma center injury prevention programs and strategies for clinicians who take care of youth injured by violence. Lynne Sheri Nemeth, PhD, RN, FAAN, is a professor in the College of Nursing at Medical University of South Carolina. Her research interests and experience over the past decade include translation of research into practice, implementation science, community-engaged research, health information technology, and mobile health applications. The majority of this work has been accomplished within a practice-based research network (PPRNet). Prior to this research experience, her clinical and administrative background includes deep experience in trauma systems at all phases of the continuum including emergency, intensive care, acute care/discharge planning. She currently mentors doctoral student research and dissertations and teaches Qualitative and Mixed Methods Research.


Constructing "Packages" of Evidence-Based Programs to Prevent Youth Violence: Processes and Illustrative Examples From the CDC's Youth Violence Prevention Centers.

Scaling Up a Multifaceted Violence Prevention Package: County-Level Impact of the North Carolina Youth Violence Prevention Center.

Enhancing violence prevention in at-risk youth.

Cost analysis of youth violence prevention.

The Center for Disease Control and Prevention's (CDC) Youth Violence Prevention Centers: Paving the Way to Prevention.

A review of educational-based gambling prevention programs for adolescents.

A Review of Teen Dating Violence Prevention Research: What About Hispanic Youth?

Understanding small business engagement in workplace violence prevention programs.

Benefits of violence prevention for African-American youth.

Population-based screening programs for nonalcoholic fatty liver disease in youth and clues to prevention.

Towards an integrative approach to trauma study.

Unrelenting violence: an analysis of 6,322 gunshot wound patients at a Level I trauma center.

Empowering parents for evidence-based fever management: An integrative review.

[Methods for evaluating large-scale nutrition programs in latin america: an integrative review].

An integrative review of self-efficacy measurement instruments in youth with type 1 diabetes.

Accelerated Master's Programs in Nursing for Non-Nurses: An Integrative Review of Students' and Faculty's Perceptions.

Neighborhood Factors and Dating Violence Among Youth: A Systematic Review.

Evidence-based programs registry: blueprints for Healthy Youth Development.

An AIDS prevention program for homeless youth.

A Systematic Review of School-Based Alcohol and other Drug Prevention Programs.

Tobacco Use Prevention by Integrating Inside and Outside of School Based Programs: A Systematic Review Article.

Systematic review: internet-based program for youth smoking prevention and cessation.

Dating Violence and Injury Among Youth Exposed to Violence.

Barriers to Effective Implementation of Programs for the Prevention of Workplace Violence in Hospitals.