Identifying the causal mechanisms of a hospital-based violence intervention program.

摘要 黑人和拉丁裔青年背负着不平等的逆境和创伤负担，在 有严重暴力伤害和枪伤的急诊科，影响深远 对他们的健康和福祉的发展影响，包括增加再次受害的风险、报复性的 行动和死亡。努力解决青年严重暴力的悲惨性质和深远影响 暴露导致了一种新兴的护理标准，在这种标准下，基于医院的暴力干预 项目(HIP)在出院时提供病例管理服务。然而，很少有研究表明 审查了促进减少再次受害和促进福祉的因果机制 在HVIP中暴露于暴力的青年中。阻碍HVIP领域发展的限制包括不发达 指导理论方向，研究范围狭窄的风险和保护因素，以及测量 患者数据和比较组的局限性。我们提议的研究将把二次数据整合到 审查以创伤和复原力框架为基础的新风险和保护因素，这可能会预防 未来受害情况、青少年犯罪和6-15岁儿童不良学习成绩 严重的袭击和枪伤。反脆弱性倡议(AI)是一种新开发的HVIP，它提供 病例管理服务，重点是促进复原力和创伤后增长(PTG) 暴力伤害后12个月暴露于暴力的青年。这是第一次旨在促进PTG的干预 有这么多人。考虑到程序开发的早期阶段，我们将测试(目标1)假设 更少的不良童年经历(ACE)，以及年轻人中更高的复原力和PTG比率 参与人工智能将显著降低暴力受害者、累犯率和青少年犯罪率 在控制发展风险因素时，使用 纵向、前瞻性设计。我们还将(目标2)使用倾向分数匹配技术来 审查参与该计划的青少年是否有较低的暴力受害、累犯率和青少年犯罪率 在出院后12个月，与匹配的对照组相比，学习成绩更好 入场。次要数据包括青年关于复原力、创伤后成长(PTG)和ACE的自我报告 在基线、6个月和12个月收集；医院记录；以及纵向的、预期的社会服务记录 从一个全面的综合数据系统开始，对逆境和社会复杂性指标进行评估。 这项研究将首次提出创伤和复原力框架，使用独特的纵向， 综合数据集，以评估旨在促进有色人种青年行为和健康的计划 儿科急救，并将作为未来研究的垫脚石。这项研究与 儿科创伤和危重病科的优先事项是检查心理和精神疾病的独特方面 身体创伤，这些创伤的复杂相互作用，以及它们在护理和治疗中如何相互作用。

ABSTRACT Black and Latinx youth bear an unequal burden of adversity and trauma and are over-represented in emergency departments with severely violent injuries and gunshot wounds, which have long-reaching developmental impacts on their health and well-being, including an increased risk of revictimization, retaliatory actions, and death. Efforts to address the tragic nature and profound effects of youth's severe violence exposure have resulted in an emerging standard of care in which hospital-based violence intervention programs (HVIPs) provide case management services upon hospital discharge. Yet, few studies have examined causal mechanisms facilitating the reduction of revictimization and the promotion of well-being among violence-exposed youth in HVIPs. Limitations stymieing the HVIP field include underdeveloped guiding theoretical orientations, a narrow scope of risk and protective factors under study, and measurement limitations of patient data and comparison groups. Our proposed research will integrate secondary data to examine novel risk and protective factors grounded in a trauma and resilience framework that may prevent future victimization, juvenile delinquency, and poor school performance among 6–15-year-olds exposed to severe assaults and gunshot wounds. The Antifragility Initiative (AI) is a newly developed HVIP that provides case management services, focusing on the promotion of resilience and posttraumatic growth (PTG) with violence-exposed youth for 12 months post-violent injury. It is the first intervention designed to promote PTG with this population. Given the early stage of program development, we will test (Aim 1) the hypothesis that fewer adverse childhood experiences (ACEs), and higher rates of resilience and PTG among youth participating in AI will significantly predict lower rates of violent victimization recidivism and juvenile delinquency and better academic outcomes when controlling for developmental risk factors, using a longitudinal, prospective design. We will also (Aim 2) employ propensity score matching techniques to examine if HVIP-participant youth have lower rates of violent victimization recidivism and juvenile delinquency and better academic outcomes compared with a matched comparison group at 12 months post-hospital admission. Secondary data include youth self-report on resilience, post-traumatic growth (PTG), and ACEs collected at baseline, 6, and 12 months; hospital records; and longitudinal, prospective social service records of adversity and social complexity indicators beginning at birth from a comprehensive integrated data system. This study will be the first to advance a trauma and resilience framework using a unique longitudinal, integrated dataset to evaluate a program aimed at behavioral and health promotion for youth of color in pediatric emergency care, and will serve as a stepping stone for future studies. This study aligns with the Pediatric Trauma and Critical Illness Branch's priority to examine the distinctive aspects of psychological and physical trauma, the complex interplay of those traumas, and how they interact in care and treatment.