Psychosocial Treatment of an Adolescent in a Hospital-Based Violence Intervention Program

Interpersonal violence is the leading cause of death in adolescents. Hospital-based violence intervention programs (HVIPs) address the emotional and behavioral sequelae of assault and homicide. Few studies have been published on pediatric HVIPs, and no study offers a conceptualization model for treatment approaches. This paper demonstrates the use of empirically supported practices by outlining the services provided and subsequent treatment trajectory of an adolescent receiving care from an HVIP at a Level 1 Pediatric Trauma Center. This case study follows the Case Study Report (CARE) guidelines and is the first to demonstrate the use of intensive case management, Psychological First Aid (PFA), and Skills for Psychological Recovery (SPR) in the treatment of an adolescent presenting to the emergency department (ED) due to assault associated with bullying. Through the use of these treatment approaches to address symptoms of posttraumatic stress, the patient moved from physical recovery to posttraumatic growth. Assessment and trauma-informed treatment suggestions are provided to support evidence-based practices within HVIPs.

Trauma-Informed Acute Care of Patients With Violence-Related Injury

Violently-injured individuals presenting to the emergency department (ED) have an elevated risk of repeat injury after being discharged from acute care settings and a high rate of unaddressed mental health and social needs. While there is a growing body of programmatic interventions to address these needs, including hospital-based violence intervention programs, there is a lack of data regarding physician perspectives of current practice for this patient population. Understanding current practice is critical for integrating new programs into workflow and developing evidence-based medical education to improve care. The aim of this study is to elucidate current trauma-informed care practices of emergency medicine and general surgery trainee physicians to inform future curriculum development surrounding care of violently injured patients. In this study, emergency medicine and surgical trainees with at least one year of residency experience participated in simulation-primed interviews in pairs or small groups. Interviews garnered perspectives on the physician role in treating violently injured youth, using simulation as a priming event focused on previously known patient concerns. Qualitative themes that emerged were participants (1) perceived their role as managing medical/surgical concerns and seek others to build trust and manage psychosocial and legal concerns, (2) had a high level of knowledge of ED stressors and de-escalation strategies, (3) perceived that patient distrust can negatively impact their ability to provide care, and (4) perceived that law enforcement can negatively impact care and are sometimes uncertain about how to interact with law enforcement. These findings support that medical education for providers should focus on medicolegal issues, particularly managing law enforcement presence in the ED, structural and interpersonal causes of distrust of medical providers and the medical system, and addressing postdischarge mental health and social needs.