A Regional Approach to Hospital-Based Violence Intervention Programs Through LOV

Firearm Injury Prevention and Survivor Interventions: A Scoping Review

PURPOSE

To examine components of firearm injury prevention and survivor response programs, their outcomes, and gaps in this body of research.

METHOD

A total of 100 publications were identified across four databases: PubMed/Medline, PsycInfo, CINAHL, and Scopus. Articles were screened for inclusion in the scoping review and details were extracted into an electronic table for synthesis.

RESULTS

A total of 27 articles were included. Education on firearm injury prevention was shown to be feasible and acceptable in health care settings, including emergency departments. Firearm survivor interventions to reduce violent injury recidivism may include peer or mentored support along with case management for coordination of mental health services, vocational training, and other services to address social determinants of health. Other community initiatives to clean up abandoned lots and engage community members in creating safe neighborhoods have been shown to reduce overall gun violence.

CONCLUSION

Multi-level interventions that encompass education on reducing firearm injuries, strategies to improve psychosocial conditions and access to mental health services, as well as meeting the needs of firearm injury survivors, their families, and communities, are needed. Health sector and community partnerships can lead to integrated and sustainable programs to achieve safer neighborhoods and improve psychosocial outcomes for individuals affected by gun violence and impacted communities. [Journal of Psychosocial Nursing and Mental Health Services, 63(4), 12-19.].

Factors Associated With Recurrent Pediatric Firearm Injury : A 10-Year Retrospective Cohort Analysis

BACKGROUND

Firearm injuries are the leading cause of death among children aged 0 to 17 years in the United States.

OBJECTIVE

To examine the factors associated with recurrent firearm injury among children who presented with acute (index) nonfatal firearm injury in the St. Louis region.

DESIGN

Multicenter, observational, cohort study.

SETTING

2 adult and 2 pediatric level I trauma hospitals in St. Louis, Missouri.

PARTICIPANTS

Pediatric patients aged 0 to 17 years presenting with an index firearm injury between 2010 and 2019.

MEASUREMENTS

From the St. Louis Region-Wide Hospital-Based Violence Intervention Program Data Repository, we collected data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and mortality. The Social Vulnerability Index was used to characterize the social vulnerability of the census tracts of patients' residences. Analysis included descriptive statistics and time-to-event analyses estimating the cumulative incidence of experiencing a recurrent firearm injury.

RESULTS

During the 10-year study period, 1340 children presented with an index firearm injury. Most patients were Black (87%), non-Hispanic (99%), male (84%), and between the ages of 15 and 17 years (67%). The estimated risk for firearm reinjury was 6% at 1 year and 14% at 5 years after initial injury. Male children and those seen at an adult hospital were at increased risk for reinjury.

LIMITATION

Our data set does not account for injuries occurring outside of the study period and for reinjuries presenting to nonstudy hospitals.

CONCLUSION

Children who experience an initial firearm injury are at high risk for experiencing a recurrent firearm injury. Interventions are needed to reduce reinjury and address inequities in the demographic and clinical profiles within this cohort of children.

PRIMARY FUNDING SOURCE

National Institutes of Health.

Personal goals of young survivors of violent injury: implications for practice

INTRODUCTION

Firearm injuries are the leading cause of death among young people in the USA and disproportionately impact communities of colour and those experiencing socioeconomic distress. Understanding the personal goals of violently injured patients is essential to identifying protective factors and developing interventions that promote them. However, limited research characterising these personal goals exists.

OBJECTIVE

The objective of this study was to use qualitative thematic analysis to analyse and describe the personal goals of young people who enrolled in a region-wide hospital-based violence intervention programme after surviving a violent injury.

METHODS

A qualitative coding framework was developed, evaluated, and implemented using data from Life Outside of Violence, the St. Louis Area Hospital-Based Violence Intervention Programme. Chart abstraction procedures were used to compile qualitative data on Life Outside of Violence participants' personal goals documented by clinical case managers during individual treatment planning sessions with participants (n=168). Descriptive analyses are reported and implications for practice are discussed.

RESULTS

Key findings reveal that (1) violent injury survivors have unmet therapeutic and resource needs, indicating the importance of having service providers with both clinical and case management skills, (2) anger management is a common clinical goal, and (3) employment opportunities are a common resource need.

CONCLUSIONS

Findings from this study inform the implementation of the Life Outside of Violence programme and offer a roadmap to other hospital-based violence intervention programmes operating nation-wide. Our results provide insight into participants' needs, desires, and motivations, allowing unique opportunities for improved participant engagement and service delivery.

Firearm injury among people experiencing homelessness: Cross-sectional evidence from a national survey of United States emergency departments

Objectives

Persons experiencing homelessness (PEH) are at high risk for violent victimization. This study leverages unique data from a national study in the United States of America to provide estimates of non-fatal firearm injury among PEH and to describe the contexts related to injury, such as substance use, intent of the injury, and precipitating interpersonal factors.

Study design

Cross-sectional.

Methods

Data from the 1993-2020 National Electronic Injury Surveillance System-Firearm Injury Surveillance Study (NEISS-FISS) were used to describe the context and characteristics of non-fatal firearm injury among PEH aged 16 years or older. Homeless status and substance use data were extracted from a de-identified narrative field. Estimates were weighted to account for the NEISS-FISS complex sampling design.

Results

Probable homelessness was identified in 0.10% of cases (n = 3,225). Substance use was documented in 22.73% of cases. Assault comprised 82.64% of injuries. Patients were mostly male (81.38%). Missing data were common on contextual variables: verbal argument (64.62%), physical fight (54.48%) or other criminal activity (62.33%).

Conclusions

Assault is a leading cause of non-fatal firearm injury for PEH and is greater than rates of assault in non-fatal firearm injuries in the general population. Substance use was documented in nearly one quarter of patients, although this is less than expected given prior evidence. Reliance on narrative fields for key variables likely underestimates rates of PEH and substance use.

Implementing a hospital-based violence intervention program for assault-injured youth: implications for social work practice

Youth in the U.S. experience a high rate of assault-related injuries resulting in physical, psychological and social sequelae that require a wide range of services after discharge from the hospital. Hospital-based violence intervention programs (HVIP's) have been developed to engage youth in services designed to reduce the incidence of violent injury in young people. HVIP's combine the efforts of medical staff with community-based partners to provide trauma-informed care to violently-injured people and have been found to be a cost-effective means to reduce re-injury rates and improve social and behavioral health outcomes. Few studies have explored the organizational and community level factors that impact implementation of these important and complex interventions. The objective of this study was to develop an in-depth understanding of the factors that impact HVIP implementation from the perspectives of 41 stakeholders through qualitative interviews. Thematic analysis generated three themes that included the importance of integrated, collaborative care, the need for providers who can perform multiple service roles and deploy a range of skills, and the importance of engaging clients through extended contact. In this article we explore these themes and their implications for healthcare social work.