A decade of hospital-based violence intervention: Benefits and shortcomings
A decade of hospital-based violence intervention: Benefits and shortcomings
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DOI：
10.1097/ta.0000000000001261
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发表时间：
2016-12-01
影响因子：
3.4
通讯作者：
Dicker, Rochelle Ami
中科院分区：
文献类型：
--
作者：
Juillard, Catherine;Cooperman, Laya;Dicker, Rochelle Ami
简介：对医院暴力干预计划 (VIP) 的初步分析表明，暴力伤害累犯率有所下降。长期 VIP 绩效尚未评估。暴力干预计划质量的提高需要进行评估，以确定缺陷和需要额外资源的客户群体。我们评估了基于案例经理的 VIP，以确定对暴力伤害累犯影响最大的可改变风险因素，并确定需要修改目标服务的亚人群。方法：通过我们的 VIP 数据库收集 2005 年至 2014 年有关人口变量、社会经济因素、需求和伤害累犯的数据。客户可能的需求包括住房、教育、就业、法庭辩护、驾驶执照获取和“其他”。案例经理将需求评估为“不需要”、“已识别（未满足）”和“已满足”。使用 chi(2) 和非参数检验来确定与减少累犯相关的因素。结果：在 10 年期间，有 466 名客户加入了 VIP。项目期间，暴力再伤害率为 4%，而 2000 年至 2004 年的历史对照为 8%。女性的再伤害率低于男性（分别为 3% 和 13%，p = 0.023）。黑人的累犯率最低（2%，p < 0.0001），而拉丁裔的累犯率较高（11%）。尽管只有少数顾客（5%），但 100% 的白人顾客再次受伤。心理健康服务（51%）、犯罪受害者赔偿（48%）、就业（36%）和住房（30%）是最常见的需求。表达教育需求与再次受伤的可能性显着相关，而当需求得到满足时，这种影响会完全逆转。结论：对 VIP 的评估表明，累犯率持续减少，并成功满足了传统上服务不足的人群的客户需求。应加大力度查明和解决拉丁裔和白人顾客再次受伤的根本原因。暴力干预计划优先考虑住房需求可能会减少未来的再次伤害。这项研究证明了可持续的成功，强调了加强 VIP 融入全国创伤中心的重要性。版权所有 (C) 2016 Wolters Kluwer Health, Inc. 保留所有权利。
INTRODUCTION: Initial analyses of hospital-based violence intervention programs (VIPs) have demonstrated decreased violent injury recidivism. Long-term VIP performance has not been assessed. Violence intervention program quality improvement requires evaluation to identify shortcomings and client subpopulations warranting additional resources. We evaluated our case manager-based VIPs to identify modifiable risk factors that most impact violent injury recidivism and determine subpopulations that need modification of targeted services.METHODS: Data on demographic variables, socioeconomic factors, needs, and injury recidivism from 2005 to 2014 were 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(2) And nonparametric 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 reinjury rate was 4%, as compared with a historical control of 8% from 2000 to 2004. Women had lower rates of reinjury than men (3% vs 13%, respectively, p = 0.023). Blacks had the lowest recidivism (2%, p < 0.0001), whereas a higher rate (11%) was observed among Latinos. Although a minority of clients (5%), 100% of white clients were reinjured. 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 reinjury, 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 reinjury should be increased. Violence intervention program prioritization of housing needs may reduce future reinjury. This study demonstrating sustainable success underscores the importance of increased integration of VIP into trauma centers nationally. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.