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Feasibility and efficacy of a hospital-based violence intervention program on reducing repeat violent injury in youth: a randomized control trial

  • Carolyn E. Snider (a1), Depeng Jiang (a2), Sarvesh Logsetty (a2), Wanda Chernomas (a3), Elaine Mordoch (a3), Carla Cochrane (a4), Jamil Mahmood (a5), Heather Woodward (a2) and Terry P. Klassen (a2)...

Abstract

Objectives

To determine feasibility and efficacy of an Emergency Department Violence Intervention Program (EDVIP) to reduce violence related injuries in youth.

Methods

One hundred and thirty youth aged 14–24 presenting to an emergency with violence related injury were randomized in parallel to receive EDVIP for 1 year (n = 65) or a waitlist control (n = 65). The primary outcome was to determine feasibility. Secondary outcomes are incidence, number/severity of repeat violence related injury, justice and education systems interactions, substance misuse and mental health presentations, and ED length of stay (LOS).

Results

This study established feasibility in recruitment, outcomes collection and safety. Fidelity and adherence measures required optimization during the study. Efficacy analysis of EDVIP vs. the control group demonstrates an absolute decrease of 10.4% in repeat violence related injury (13.7% vs. 24.1%) (p = 0.15), reduction in new interactions in the justice system (OR = 0.36 (0.07–1.77)), improved engagement in education (11.8% EDVIP vs. 7.6% control, p = 0.42) and no change in repeat visits for substance or mental health. LOS decreased by 59.5 min (p = 0.21).

Conclusions

This program is feasible for ED implementation and for completion of a future RCT to measure effectiveness.

Objectif

L’étude visait à déterminer la faisabilité et l'efficacité d'un programme d'intervention contre la violence, mené au service des urgences (SU), dans le but de réduire le nombre de lésions causées par des gestes de violence chez les jeunes.

Méthode

Au total, 130 jeunes âgés de 14 à 24 ans, ayant consulté au SU pour des lésions causées par des gestes de violence ont été inscrits au hasard et en parallèle soit au programme d'intervention pour une durée de 1 an (n = 65), soit sur une liste d'attente témoin (n = 65). Le principal critère d’évaluation visait à déterminer la faisabilité du programme, et les critères d’évaluation secondaires comprenaient l'incidence et la gravité des lésions causées par des gestes répétés de violence, de même que leur nombre, les interactions avec les systèmes de justice et d’éducation, l'abus d'alcool et de drogues ou des troubles de santé mentale ainsi que la durée du séjour (DS) au SU.

Résultats

L’étude a permis d’établir la faisabilité du recrutement de participants et de la collecte de données sur les résultats ainsi que l'innocuité de l'essai. Les mesures de fidélité et de respect ont dû être optimisées en cours d’étude. L'analyse de l'efficacité du programme a révélé, par rapport à celle de la liste témoin, une réduction absolue de 10,4% du nombre de lésions causées par des gestes répétés de violence (13,7% contre [c.]. 24,1%) (p = 0,15), une diminution du nombre de nouvelles interactions avec le système de justice (risque relatif approché = 0,36 [0,07–1,77]), une scolarisation accrue (11,8% pour le programme c. 7,6% pour la liste témoin; p = 0,42), mais une absence de changement quant au nombre de reconsultations motivées par l'usage d'alcool ou de drogues ou par des troubles de santé mentale. La DS a diminué de 59,5 min (p = 0,21).

Conclusion

L’étude a confirmé la faisabilité de la mise en œuvre du programme au SU ainsi que la réalisation d'un futur essai comparatif, à répartition aléatoire visant à en mesurer l'efficacité.

Copyright

Corresponding author

Correspondence to: Dr. Carolyn Snider, Department of Emergency Medicine, St. Michael's Hospital, 1-008 Bond Wing, 30 Bond St. Toronto, ON M5S 1W8; Email: sniderca@smh.ca

References

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Keywords

Feasibility and efficacy of a hospital-based violence intervention program on reducing repeat violent injury in youth: a randomized control trial

  • Carolyn E. Snider (a1), Depeng Jiang (a2), Sarvesh Logsetty (a2), Wanda Chernomas (a3), Elaine Mordoch (a3), Carla Cochrane (a4), Jamil Mahmood (a5), Heather Woodward (a2) and Terry P. Klassen (a2)...

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