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

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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.