The effects of healthcare-based violence intervention programs on injury recidivism and costs: A systematic review.

Background: Youth violence affects thousands annually with homicide being the third leading cause of death for those aged 10-24. This systematic review aims to evaluate the published evidence for the effects of healthcare-based violence intervention programs (VIPs), which focus on reducing recurrent presentations for injury due to youth violence ("recidivism"). Methods: Health literature databases were searched. Studies were retained if peer-reviewed and if programs were healthcare-based, focused on intentional injury, addressed secondary or tertiary prevention (i.e. preventing recidivism and reducing complications), included participants aged 14-25, had greater than 1 month follow-up, and evaluated outcomes. Studies of child and sexual abuse, workplace, intimate partner and self-inflicted violence were excluded. Extracted data subject to qualitative analysis included enrollment and retention, duration of follow up, services provided, statistical analysis, and primary and intermediate outcomes. Results: Of the 2144 citations identified, 22 studies were included in the final sample. Twelve studies were randomized control trials (RCTs) representing 8 VIPs. Injury recidivism was assessed in 6/8 (75%) with a significant reduction in 1/6 (17%). Of the RCTs showing no difference in recidivism, all were either underpowered or did not include a power analysis. Two observational studies also showed significant reduction in recidivism. Significant intermediate outcomes included increased service use, attitude change, and decreases in violence-related behavior. Reductions in injury recidivism led to reductions in healthcare and criminal justice system costs. Conclusions: Three studies showing reduced injury recidivism, and several studies showing positive intermediate outcomes identify VIPs as a promising practice. Many studies were limited by poor methodological quality, including high losses to follow-up. Level of Evidence: III Systematic Review (C) 2016 Lippincott Williams & Wilkins, Inc.

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