Efficacy of a Universal Brief Intervention for Violence Among Urban Emergency Department Youth

Abstract

Background

Violent injury is the leading cause of death among urban youth. Emergency department (ED) visits represent an opportunity to deliver a brief intervention (BI) to reduce violence among youth seeking medical care in high-risk communities.

Objective

To determine the efficacy of a universally applied Brief Intervention (BI) addressing violence behaviors among youth presenting to an urban ED.

Methods

ED youth (14-to-20 years-old) seeking medical or injury- related care in a Level-1 ED (October 2011–March 2015) and screening positive for a home address within the intervention or comparison neighborhood of a larger youth violence project were enrolled in this quasi-experimental study. Based on home address, participants were assigned to receive either the 30-min therapist-delivered BI (Project Sync) or a resource brochure (enhanced usual care [EUC] condition). The Project Sync BI combined motivational interviewing and cognitive skills training, including a review of participant goals, tailored feedback, decisional balance exercises, role-playing exercises, and linkage to community resources. Participants completed validated survey measures at baseline and a 2-month follow-up assessment. Main outcome measures included self-report of physical victimization, aggression, and self-efficacy to avoid fighting. Poisson and Zero-inflated Poisson regression analyses analyzed the effects of the BI, as compared to the EUC condition on primary outcomes.

Results

409 eligible youth (82% participation) were enrolled and assigned to either receive the BI (n=263) or the EUC condition (n=146). Two-month follow-up was 91% (n=373). There were no significant baseline differences between study conditions. Among the entire sample, mean age was 17.7 y/o (SD 1.9), 60% were female, 93% were African-American, and 79% reported receipt of public assistance. Of participants, 9% presented for a violent injury, 9% reported recent firearm carriage, 20% reported recent alcohol use, and 39% reported recent marijuana use. Compared with the EUC group, participants in the therapist BI group showed self-reported reductions in frequency of violent aggression (therapist, -46.8%; EUC, -36.9%; Incident rate ratio [IRR], 0.87; 95% confidence interval [CI], [0.76-0.99]) and increased self-efficacy for avoiding fighting (therapist, +7.2%; EUC, -1.3%; IRR, 1.09; 95% CI, 1.02-1.15). No significant changes were noted for victimization.

Conclusions

Among youth seeking ED care in a high-risk community, a brief, universally applied BI shows promise in increased self-efficacy for avoiding fighting and a decrease in the frequency of violent aggression.

This article is protected by copyright. All rights reserved.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/22Ikqgb