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

摘要 黑人和拉丁裔青年承受着不平等的逆境和创伤负担， 严重暴力伤害和枪伤的急诊室， 发展对其健康和福祉的影响，包括增加再次受害的风险， 行动和死亡。努力处理青年严重暴力行为的悲剧性质和深刻影响 暴露导致了一种新兴的护理标准，其中医院暴力干预 医疗保健计划（HVIP）在出院时提供病例管理服务。然而，很少有研究 审查了有助于减少再次受害和增进福祉的因果机制 暴力暴露的年轻人中阻碍HVIP领域的限制包括不发达 指导性的理论方向，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。我们提议的研究将整合二级数据， 研究基于创伤和复原力框架的新风险和保护因素， 未来的受害，青少年犯罪，以及6-15岁儿童在学校表现不佳， 严重袭击和枪伤反脆弱性倡议（AI）是一项新开发的HVIP， 个案管理服务，重点是促进复原力和创伤后成长， 暴力伤害后12个月的暴力暴露青年。这是第一个旨在促进PTG的干预措施 与这个人口。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），以及青年中更高的韧性和PTG率 参与AI将显着预测暴力受害率较低，累犯和青少年 青少年犯罪和更好的学术成果时，控制发展风险因素，使用 纵向、前瞻性设计。我们还将（目标2）采用倾向得分匹配技术， 检查HVIP参与者的青少年暴力受害率、累犯率和青少年犯罪率是否较低 出院后12个月，与匹配的对照组相比，学习成绩更好 入院次要数据包括青年自我报告的弹性，创伤后成长（PTG），和ACE 在基线、6个月和12个月时收集;医院记录;以及纵向、前瞻性社会服务记录 从一个全面的综合数据系统诞生之日起，就开始使用逆境和社会复杂性指标。 这项研究将是第一个使用独特的纵向， 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， 儿科急诊护理，并将作为未来研究的垫脚石。本研究与 儿科创伤和危重病分支的优先事项，以审查心理和 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.