WrapAround Care for Youth Injured by Violence
Condition: Trauma; Injuries; Violence
Study type: Interventional

Summary: 
      Youth injured by violence is a major public health concern in Canada. It is the fourth cause
      of death and the leading reason for a youth to visit an emergency department (ED). In
      Winnipeg, 20% of youth who visit an emergency department with an injury due to violence have
      a second visit for a subsequent violent injury within the following year. This is consistent
      with studies in other jurisdictions that demonstrate that violent injury is a chronic
      condition. Youth injured by violence are in a reflective and receptive state of mind,
      rendering the emergency department setting appropriate for intervention. The investigators
      propose a WrapAround Care model delivered by a support worker with lived experience with
      violence, supported by a social worker, an addictions and mental health counsellor, a family
      counsellor and links to multiple community partners. Support workers will be on call 24 hours
      a day, 7 days a week in order to start the intervention in the ED and take advantage of the
      "teachable moment". The proposed study is a pilot randomized control trial to assess the
      feasibility of a randomized control trial designed to assess efficacy. For the pilot trial
      the investigators will assess recruitment, treatment fidelity, participant adherence and
      safety. The intervention arm will receive wraparound care initiated at the time of their
      visit for injury due to violence. The control arm will receive standard of care (usually a
      list of community contacts). The investigators will use an adapted pre-consent randomization
      methodology. This intervention has been developed using a community based participatory
      research approach. Our team includes clinicians, nurses, social workers, community youth
      workers, ex-gang members, elders and researchers.
    

Detailed description: 
      Youth injured by violence is a major public health concern in Canada. It is the fourth cause
      of death and the leading reason for a youth to visit an emergency department. In Winnipeg 20%
      of youth who visit an emergency department with an injury due to violence have a second visit
      for a subsequent violent injury within the following year. This is consistent with studies in
      other jurisdictions that demonstrated that violent injury is a chronic condition.

      Youth injured by violence have been shown to be in a reflective and receptive state of mind,
      rendering the emergency department setting appropriate for intervention. There are some
      hospital-based intervention programs for youth injured by violence in the U.S.; however, they
      have not been evaluated to assess repeat injury using a randomized control trial (RCT) and
      given the cost of this intervention, significant equipoise exists. It is essential to
      evaluate this intervention rigorously using RCT methodology. A pilot RCT is prudent prior to
      the main RCT.

      The investigators propose a WrapAround Care model delivered by a support worker with lived
      experience with violence, supported by a social worker, an addictions and mental health
      counsellor, a family counsellor and links to multiple community supports. These community
      supports include partnerships with aboriginal and newcomer youth cultural programs as many
      youth impacted by violence are aboriginal and new immigrants to Canada. Support workers will
      be on call 24 hours a day, 7 days a week in order to start the intervention in the ED and
      take advantage of the "teachable moment".

      This pilot study RCT will enroll 180 youth (aged 14 - 24) over one year (90 to each arm). The
      treatment arm will be the WrapAround care model initiated at the time of injury (i.e. in the
      emergency department). The control arm will be providing youth with a list of community
      programs and will be a waitlist control. The primary outcomes of the pilot study will
      evaluate evaluate recruitment, adherence, fidelity and safety of the intervention. The
      primary outcome for the main trial is repeat visit to any emergency department in Winnipeg
      for a subsequent injury due to interpersonal violence. This will be measured using a
      combination of administrative data and chart review to ensure high follow-up. The secondary
      outcomes include measurement of counts and severity of injury and housing and education
      changes. This intervention has been developed using a community based participatory research
      approach. Our team includes clinicians, nurses, social workers, community youth workers,
      former gang members, elders and researchers.
    

Intervention name(s): WrapAround Care
Intervention type(s): Behavioral
Intervention description(s): Wraparound care is an established care model that starts with linking an individual with a support￼￼￼ worker who works with them to address risk factors and enable the individual to make positive choices. It is hypothesized that by working with youth to address the risk factors in their control, the likelihood of future violence is reduced.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Trauma; Injuries; Violence; Adolescent; WrapAround care