At-risk Intervention and Mentoring Evaluation

Study Overview
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Brief Summary
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The purpose of this study is to determine if a hospital-based violence intervention programs can make sustainable behavior changes in at-risk youth using two key components, brief intervention at the hospital bedside and case management.

Detailed Description
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This study will be a randomized controlled trial. Youth presenting to the emergency department with an intentional injury (gunshot wound, stab wound, or assault) will be given a behavioral assessment. Participants will be categorized according to risk (low, moderate, high). Only moderate or high youth will continue in the study and be randomized. Low risk youths will receive the medical standard of care and be re-assessed at 18 months. Randomization will place participants in one of two arms. Arm 1 will receive the standard of care PLUS a brief intervention with AIM outreach workers. Arm 2 will receive standard medical care PLUS a brief intervention PLUS case management. Every randomized youth will be assessed for risk and protective factors and have have data collected at 6-month intervals (0, 6, 12, 18 months).

Official Title
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Program Evaluation of a Hospital-based Violence Intervention Program (At-risk Intervention and Mentoring)

Conditions
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Violence

Intervention / Treatment
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* Behavioral: Brief Intervention
* Behavioral: Case Management
* Behavioral: Standard Medical Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 14-24 years of age , Intentional Injury (Gunshot Wound, Stab Wound, Assault) Exclusion Criteria: Younger than 14, 25 or older, non-English speaking, unable to give informed consent/assent, sexual assaults, domestic violence, child neglect/abuse.

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 24 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: SMC + BI + Case Management<br>This arm will include all interventions in Standard Medical Care + Brief Intervention Arm. Case management will also be given to this arm. General needs based assessments will be conducted by the outreach worker. These assessments will be done at the hospital or at the youth's home, whichever they prefer. This assessment tool addresses education, vocational training, employment, housing, medical insurance, follow-up care and pro-social activities. Although each youth in this arm will receive the same needs-based assessment, individual youth will have variable needs, which will guide each unique and individualized case management plan. | Behavioral: Brief Intervention<br>* Goals of the bedside intervention will be to help the patient understand their risky behaviors that resulted in the injury and to assess and deescalate any threat of retaliatory violence by the patient. The outreach worker will: (1) develop a rapport with the patient by introducing themselves and describing their (outreach worker's) background and reason for the bedside visit; (2) assess the emotional response to the current injury; (3) ensure the patient and/or family understand the nature of the injury and ED course; (4) address any immediate concerns of the patient; and (5) develop a plan for staying safe following discharge.<br>Behavioral: Case Management<br>* Case management based on needs-assessment. Resource connection and mentoring.<br>Behavioral: Standard Medical Care<br>* This will include physician discretion for medical treatment and potentially a social worker visit as the physician sees fit for the patient. This will also include a list of resources that are typically needed and used for violently injured youth.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Violence Risk Scale | Violence Risk Scale (VRS) will be measured with each youth at 4 time points. Change over time will be assessed and compared among study arms. | 0, 6, 12, 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Composite Score | Composite Score measures both risk and protective factors. This weighted scale uses the interplay between risk and protective factors to determine overall risk for youth to become violently injured. | 0, 6, 12, 18 months | 
| School Enrollment | Self-report for school enrollment will be measured and compared among arms. | 0, 6, 12, 18 months | 
| Hospital Recidivism | Every six month, patients' medical records will be scanned to determine if there has been violent injury recidivism. Medical release of Information forms will allow medical record searches from other local hospitals. | 0, 6, 12, 18 months | 
| Justice System Recidivism | Self-report of criminal history. | 0, 6, 12, 18 months | 
| Employment | Self-report of employment status. | 0, 6, 12, 18 months | 
| Resource Utilization | Self report of resource utilization for health care and social needs. | 0, 6, 12, 18 months. | 
| Mortality | Mortality will be assessed every 6 months. | 0, 6, 12, 18 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Violence, At-risk youth, Intentional Injury, Violence Intervention, Youth, recidivism