Beyond Recidivism: Hospital-Based Violence Intervention and Early Health and Social Outcomes.
Academic Article
Overview
abstract
BACKGROUND: Hospital Based Violence Intervention Programs (HVIPs) are aimed at decreasing recurrent injury and improving the social determinants of health. We hypothesized that the HVIP intervention should be evaluated by how well it can address the immediate health and social needs of patients following injury. Our study sought to describe the experience of our nascent HVIP. STUDY DESIGN: Case management records of patients treated by the HVIP of a level 1 trauma center from July 1, 2017 - October 1, 2020 were reviewed. Inclusion criteria: age 18-60 with injury mechanisms that resulted from intentional violence. Patient-stated goals and social worker designation of patient services provided were analyzed. A subset of HVIP patients who completed the three planned study visit surveys at discharge, one and three months were compared to a cohort of violently injured patients to whom HVIP services were not available. Participants in both groups were asked to complete a battery of validated surveys to assess for social outcomes and Post-Traumatic Stress Disorder (PTSD). Repeated measures ANOVA was used to compare the two groups. RESULTS: 295 patients met inclusion criteria. 146 patients (49%) of participants achieved their stated goals within 6 months of hospital discharge. 16 patients who achieved their stated goals disengaged from the program. Engagement in the HVIP resulted in significantly less PTSD at the time of hospital discharge. HVIP patients also experienced higher positive affect at hospital discharge, as described in Positive and Negative Affect Schedule (PANAS). HVIP participants were significantly more likely to achieve early positive health outcomes, such as completion of victim of crime compensation and return to school. CONCLUSION: Our HVIP successfully achieved patient-stated short-term health and social goals in nearly half of all enrollees, indicating that HVIP patients are more likely to improve their social determinants of health than non-HVIP patients. Short term health and social outcomes were improved in HVIP patients compared to non-HVIP patients, indicating increased engagement with the healthcare system. We suggest that these outcomes should replace recidivism as a metric for efficacy of HVIP programs.
