Preventing Firearm Violence in Youth: A hospital-based prevention strategy

摘要 在美国，每天大约有100人被枪支暴力打伤，其中四分之三的人 所有杀人案都与枪支有关。尽管与枪支有关的暴力影响到所有社区和人口， 青年是与枪支有关的暴力、伤害和死亡的高危人群。特别是，受暴力伤害的青少年 极易遭受与枪支有关的报复性暴力，以及再次受到暴力伤害或被打死。 因此，医院成为预防青少年报复性暴力的关键机会。在弗吉尼亚州 英联邦大学(VCU)健康，我们已经调整了我们全面的基于医院的暴力 干预计划，弥合差距(BTG)。BTG是一种新型的混合干预模式，它利用了 以医院为基础的干预方法，使用短暂的暴力干预来防止报复性暴力，但也 通过提供为期3个月的社区案例，为青少年及其家人提供社区支持 管理，以帮助确保持久的变化。BTG目前的形式显示出减少攻击性的希望 以及与暴力相关的风险因素。然而，它是否对减少与枪支有关的问题有效还有待确定 年轻人的暴力、伤害和死亡。为了解决青年(10-17岁)中与枪支有关的暴力激增问题， 我们对BTG进行了进一步调整，加入了在 回家。本研究采用随机对照试验设计，旨在严格评价其疗效。 预防暴力伤害青年中与枪支有关的暴力、伤害和死亡(N=220)。 与枪支有关的暴力、伤害和死亡结果将使用多种来源在6个月内进行评估 数据(例如，半结构化临床访谈、自我和照顾者报告评估，以及医院、州和 国家级数据库)。除了了解BTG在预防与枪支有关的 结果，我们的目标是了解心理社会调解人是如何解释与枪支有关的暴力事件减少的 对治疗的反应，以及哪些调节剂可能降低治疗效果。这些数据将证明 有利于制定和调整新的和现有的青年枪支暴力预防战略。

Abstract Every day in the US approximately 100 people are injured by a firearm through violence1, and three-quarters of all homicides are firearm related1. Although firearm-related violence impacts all communities and populations, youth are high-risk for firearm-related violence, injury, and mortality. In particular, violently injured youth are highly susceptible to retaliatory firearm-related violence, as well as becoming violently re-injured or killed6. Therefore, the hospital has become a critical opportunity to prevent retaliatory violence in youth. At Virginia Commonwealth University (VCU) Health, we have adapted our comprehensive hospital-based violence intervention program, Bridging the Gap (BTG). BTG is a novel hybrid intervention model that capitalizes on the hospital-based intervention approach using a brief violence intervention to prevent retaliatory violence but also provides community-based support to youth and their families by providing 3-months of community case management to help ensure lasting change. BTG in its current form has shown promise for reducing aggression and violence-related risk factors. However, it is yet to be established if it is effective for reducing firearm-related violence, injury, and mortality for youth. To address the surge in firearm-related violence in youth (10-17 years), we have further adapted BTG to include a dual-generation firearm safety counseling program delivered in the home. Using a randomized control trial design, the present study aims to rigorously evaluate the effectiveness of BTG for preventing firearm-related violence, injury, and mortality among violently injured youth (N=220). Firearm-related violence, injury, and mortality outcomes will be assessed over 6 months using multiple sources of data (e.g., semi-structured clinical interviews, self-and caregiver-report assessments, and hospital-, state- and national-level databases). In addition to understanding BTG effectiveness for preventing firearm-related outcomes, we aim to understand what psychosocial mediators explain the reductions in firearm-related violence in response to treatment, and what moderators may reduce treatment effectiveness. These data will prove beneficial for developing and tailoring new and existing youth firearm violence prevention strategies.