A hospital based violence prevention intervention reduced hospital recidivism for violent injury and arrests for violent crimes
Q In victims of violence who are on parole or probation, can a hospital based violence prevention intervention reduce hospital recidivism for violent injury and arrests for violent crimes?
randomised controlled trial.
unclear allocation concealment.
Follow up period:
median 1–2 years.
hospital trauma centre in Baltimore, Maryland, USA.
100 patients ⩾18 years of age (median age <30 y, 96% men) who were admitted to hospital for an injury related to a violent assault for at least the second time and were on parole or probation in the criminal justice system.
56 patients were allocated to the Violence Intervention Programme (VIP), which involved meetings with a social or case worker at least every 2 weeks to devise and implement a service plan (including, as appropriate, substance abuse rehabilitation, employment training and services, educational services, conflict resolution, and family development), regular meetings with a parole and probation officer involved in the study, weekly group encounter sessions, and home visits by the VIP team. 44 patients were allocated to regular meetings with the parole and probation agent who had previously handled their case (control group).
hospital recidivism for violent injury, arrest, conviction, projected jail time, and employment.
Patient follow up:
100% (intention to treat analysis).
Patients in the VIP group were less likely to be readmitted to hospital for violent injury or arrested or convicted for a violent crime, and more likely to be employed than those in the control group (table). Among those who were convicted of a crime, mean projected jail time was shorter in the VIP group than in the control group (13 v 26 mo).
In victims of violence who were on parole or probation, a hospital based violence prevention intervention reduced hospital recidivism for violent injury and arrests for violent crimes.
- Kelvin Ford, RMN, Psychol D, MA, MPhil, MSc
To date, there has been a dearth of research on the effectiveness of violence intervention programmes. The study by Cooper et al focused on predominantly male patients who were admitted to a trauma unit after an injury secondary to a violent assault and were involved in the criminal justice system. The intervention to prevent future acts of violence is unique in its focus on the victim rather than the perpetrator. The VIP was a complex and multifaceted intervention that was implemented in a trauma unit, a healthcare setting that traditionally has not addressed the social and environmental factors related to violent injuries. The authors found that patients who received the VIP had significantly better employment rates, decreased incarceration rates, and decreased trauma admissions to hospital over a short follow up period. Although the study was done in the US, it is reasonable to assume that such interventions could potentially achieve similar results in the UK and elsewhere.
It would have been useful to isolate which particular aspect of the intervention was most effective. The authors hypothesised that the individual counselling component, offering support in areas such as education, was the most effective element of the intervention.
Findings from the study by Cooper et al highlight the potential value of violence intervention programmes, although further research with more participants and in different countries would contribute to knowledge in this area. Nurses and social care workers, particularly those working in trauma units, will find this study relevant and useful. However, the implications of the study are also of interest to those working in domestic violence support services, the police, and the prison service. Setting up a violence prevention programme presents challenges, particularly in terms of securing resources, administration, optimal skill mix, and ideal infrastructure. However, eventual cost savings may offset the initial investment, a factor that will be of great interest to policy makers and those concerned with reducing hospital and prison admissions.
For correspondence: Dr C Cooper, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.
Source of funding: not stated.