A decade of hospital-based violence intervention: Benefits and shortcomings

Introduction: Initial analyses of hospital-based violence intervention programs (VIPs) have demonstrated decreased violent injury recidivism. Long term VIP performance has not been assessed. VIP quality improvement requires evaluation to identify shortcomings and client sub-populations warranting additional resources. We evaluated our case manager-based VIP's to identify modifiable risk factors that most impact violent injury recidivism and determine sub-populations that need modification of targeted services.

Methods: Demographic variables, socio-economic factors, needs, and injury recidivism from 2005 to 2014 was collected through our VIP database. Possible client needs included housing, education, employment, court advocacy, driver's license obtainment, and "other." Case managers assessed needs as "not needed," "identified (unmet)," and "met". Chi-square and non-parametric tests were used to identify factors associated with recidivism reduction.

Results: Over the 10-year period, 466 clients were enrolled in VIP. During the program period the violent re-injury rate was 4%, as compared to a historical control of 8% from 2000-2004. Women had lower rates of re-injury than men (3% vs 13%, respectively, p=0.023). Blacks had the lowest recidivism (2%, p<0.0001), while a higher rate (11%) was observed among Latinos. Though a minority of clients (5%), 100% of White clients were re-injured. Mental health services (51%), Victim of Crime compensation (48%), employment (36%), and housing (30%) were the most frequently identified needs. Expressing the need for education was significantly associated with likelihood of re-injury, an effect that was completely reversed when the need was met.

Conclusion: This evaluation of a VIP demonstrates sustained recidivism reduction and success in addressing client needs from a traditionally underserved population. Efforts to identify and address root causes of Latino and White client re-injury should be increased. VIP prioritization of housing needs may reduce future re-injury. This study demonstrating sustainable success underscores the importance of increased integration of VIP into trauma centers nationally.

This article is included in the PCORI Social Needs Interventions to Improve Health Outcomes Evidence Map. Click here to access evidence map.