Effectiveness of a mentor-implemented violence prevention intervention for assault-injured youth presenting to the emergency department: Results of a randomized trial

Context: The emergency department has been described as a promising setting to initiate interventions with assault-injured youth to reduce the risk of re-injury and reactive perpetration. Efforts to intervene have received little study. Objective: To assess the impact of a mentor-implemented violence prevention intervention on reducing aggression, fighting and re-injury among assault-injured youth. Design: Randomized controlled trial. Setting: Two large urban hospital emergency departmentsParticipantsYouth age 10–15 presenting with peer assault injury were recruited and randomly assigned to intervention and comparison groups. Intervention: Intervention youth received a mentor who implemented a 6 session problem-solving curriculum while parents received 3 home visits with a health educator to discuss family needs and facilitate service use and parental monitoring. The comparison group received a list of community resources with 2 follow-up phone calls to facilitate service use. Main Outcome Measures: Youth and parents were interviewed at baseline and 6 months to assess attitudes about violence, risk factors, fighting and repeat injury. Results: 227 families were recruited with 23% refusing participation and 4% partial interview completion. 166 families were enrolled with 87 randomized to the intervention group and 79 in the comparison group; 118 (71%) completed both youth and parent follow-up interviews and 113 had usable data. Intervention and comparison groups were not significantly different at baseline on demographics or risk factors except for increased knife carrying and less deviant peers in the intervention group. After adjustment for baseline differences, there was a trend toward significant program effect including reducing misdemeanor activity (rate ratio 0.29, confidence interval 0.08–0.98), youth-reported aggression scores (rate ratio .63, 0.4–1.00) and increasing youth self efficacy (beta=2.28, p<.05). Program impact was associated with number of intervention sessions received. Conclusions: A community-based, mentor-implemented program with assault-injured youth presenting to the ED trended in the direction of decreased violence with reduced misdemeanors and increased self efficacy. The ED may be an important contact location, and injuries an important context, for augmenting self efficacy for violence prevention.