Hospital Violence Intervention Program for Physical Violence

Overseen By Ashley Hink, MD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Medical University of South Carolina

Disqualifiers: Severe untreated mental illness, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 6

220 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Turning the Tide Violence Intervention Program for reducing physical violence?

Research on hospital-based violence intervention programs shows they can reduce repeat violent injuries. For example, one study found that a similar program, Prescription for Hope, was linked to fewer violent reinjuries and new violent crime convictions within two years. ^{1 2 3 4 5}

Is the Hospital Violence Intervention Program safe for participants?

The research on hospital-based violence intervention programs, including nonviolent crisis intervention training, suggests they are generally safe and focus on reducing violence and improving safety in hospital settings. These programs aim to create a safer environment for both patients and staff by decreasing violent incidents and the need for restraints. ^{1 6 7 8 9}

How is the Turning the Tide Violence Intervention Program different from other treatments for physical violence?

The Turning the Tide Violence Intervention Program is unique because it uses a comprehensive approach that includes watching a trauma resuscitation video, meeting with a gunshot wound survivor, and undergoing psychiatric assessment, which is not typically part of standard violence intervention programs. ^{1 7 9 10 11}

What is the purpose of this trial?

The study's goal is to perform an evaluation of a Southeastern hospital violence intervention program (HVIP) that includes comprehensive patient outcomes, perceived benefits and opportunities for improvement of an HVIP from the perspectives of multiple stakeholders including patients, family members and healthcare providers.

Research Team

Ashley Hink, MD

Principal Investigator

Medical University of South Carolina

Eligibility Criteria

This trial is for individuals aged 16-35 treated at MUSC Charleston who have been injured due to interpersonal or community violence and are fully conscious with a Glasgow coma score of 15 at the time they join the study.

Inclusion Criteria

I am between 16-35 years old and was treated for an injury from violence at MUSC Charleston.

I am fully alert and oriented.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Enrollment and Baseline Assessment

Participants are enrolled and baseline assessments are conducted, including surveys on healthcare experience, mental health, and social determinants of health.

1 week

1 visit (in-person)

Intervention and Monitoring

Participants receive services from the hospital violence intervention program (TTVIP) and are monitored for outcomes such as mental health, self-esteem, and risk of violence.

12 months

Assessments at baseline, 3 months, 6 months, and 12 months

Follow-up

Participants are monitored for safety and effectiveness after the intervention, with assessments on outcomes like repeat injury and social determinants of health.

3 months

2 visits (in-person)

Treatment Details

Interventions

• Turning the Tide Violence Intervention Program

Trial Overview The study evaluates the Turning the Tide Violence Intervention Program at a Southeastern hospital, assessing patient outcomes and gathering insights on benefits and areas for improvement from patients, their families, and healthcare providers.

Participant Groups

Group I: Patients, family members and healthcare providers Experimental Treatment 1 Intervention

Patients that experience violent injuries or are high risk of violence between ages of 15-35 and treated at MUSC Charleston will be enrolled. The hospital violence intervention program is incorporated into regular care of patients, and they may opt to receive services from the program (TTVIP) if they qualify and opt to participate. There is no randomization or assignment. Investigators will assess outcomes of these patients and outcomes will be assessed for between group differences between those that receive services from the program and those that do not. Patient family members and healthcare providers that care for patients will be included and are exposed to the regular healthcare and services provided to patients.

Who Is Running the Clinical Trial?

Medical University of South Carolina

Lead Sponsor

Trials

994

Recruited

7,408,000+

Findings from Research

Over a 10-year period, a hospital-based violence intervention program (VIP) reduced violent reinjury rates to 4%, compared to a historical control rate of 8%, indicating sustained effectiveness in preventing recidivism among participants.

The study identified that addressing specific client needs, particularly in housing and education, significantly impacts reinjury rates, highlighting the importance of tailored support for underserved populations, especially among Latino and white clients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A decade of hospital-based violence intervention: Benefits and shortcomings. Juillard, C., Cooperman, L., Allen, I., et al.[2018]

The Prescription for Hope (RxH) program significantly reduced the odds of violent reinjury among participants, with a 65% lower chance of being reinjured after a violent incident, based on a study of 992 patients over a 2-year period.

However, participation in RxH was also associated with increased odds of new convictions for violent crime, suggesting that while the program may help prevent further injuries, it may not address underlying issues related to violent behavior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Violent injury prevention does not equal to violent crime prevention: an analysis of violence intervention program efficacy using propensity score methods. Holler Mph, E., Ortiz Md, D., Mohanty Md Ms, S., et al.[2022]

Out of 2,243 violently injured patients, 839 (37.4%) engaged with the Boston Violence Intervention Advocacy Program (VIAP), with younger age, Black race, and more severe injuries being significant predictors of engagement.

Clients who engaged with VIAP faced challenges in achieving goals related to education, employment, and housing, indicating that while the program is effective in reaching its target population, there is a need for tailored strategies to address these complex needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Boston Violence Intervention Advocacy Program: Challenges and Opportunities for Client Engagement and Goal Achievement. Pino, EC., Fontin, F., James, TL., et al.[2021]

The Violence Prevention Community Meeting (VPCM), a new nurse-led intervention, significantly reduced patient violence on an acute-care psychiatric unit, with an 89% decrease during the day shift when the meetings were held twice a week.

Overall, there were significant reductions in both verbal and physical violence across all shifts, indicating the effectiveness of the VPCM treatment over a 20-week study period.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reducing violence against nurses: the violence prevention community meeting. Lanza, ML., Rierdan, J., Forester, L., et al.[2019]

The hospital-based violence intervention program (VIP) significantly reduced recidivism rates from 16% to 4% over six years, indicating its effectiveness in preventing repeat violent injuries.

Key factors for success in the VIP included meeting clients' mental health and employment needs, with odds ratios of 5.97 and 4.41 respectively, and providing moderate to high levels of intensive case management in the first three months.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hospital-based violence intervention: risk reduction resources that are essential for success. Smith, R., Dobbins, S., Evans, A., et al.[2022]

Nonviolent crisis intervention (NCI) training in an emergency department with over 75,000 annual visitors led to a significant 23% decrease in violent incidents requiring emergency security team involvement, known as 'code purples'.

The study demonstrated a negative correlation between the frequency of violence and the amount of NCI training received in the previous 90-150 days, supporting the effectiveness of the training in enhancing staff safety and patient care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nonviolent crisis intervention training and the incidence of violent events in a large hospital emergency department: an observational quality improvement study. Gillam, SW.[2014]

The Violence Intervention Program (VIP) provided intensive psychosocial support to repeat victims of violence, resulting in significantly lower rates of violent crime arrests and convictions compared to a control group that received standard treatment.

Participants in the control group were three times more likely to be arrested for violent crimes and faced longer projected incarceration times, highlighting the effectiveness of the VIP intervention in reducing repeat violent behavior.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hospital-based violence intervention programs work. Cooper, C., Eslinger, DM., Stolley, PD.[2022]

The violence safety program at Elmhurst Hospital Center, implemented in 2001, led to a significant reduction in the use of restraints and seclusion, promoting a safer and more therapeutic environment for patient recovery.

Data from the program showed improvements in self-injurious behaviors, altercations, and the use of emergency medication, indicating that alternative methods to manage patient behavior were effective in maintaining safety without resorting to restraints.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reducing restraints: alternatives to restraints on an inpatient psychiatric service--utilizing safe and effective methods to evaluate and treat the violent patient. Sullivan, AM., Bezmen, J., Barron, CT., et al.[2019]

Hospital-based violence intervention programs (HVIPs) can lead to significant cost savings, with estimates ranging from $82,765 to $4,055,873 over 5 years for a hypothetical group of 180 violently injured patients, depending on the model used.

The study provides a systematic framework for evaluating the economic impact of HVIPs, suggesting that these programs not only help prevent violent reinjury but also offer substantial financial benefits to healthcare and criminal justice systems.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cost-benefit analysis simulation of a hospital-based violence intervention program. Purtle, J., Rich, LJ., Bloom, SL., et al.[2017]

The Turning Point program, which includes trauma education and support for gunshot and stabbing victims, significantly reduced aggressive responses and comfort with aggression by 50% and 29%, respectively, compared to standard care.

Overall, participants in the Turning Point program showed a 19% reduction in their inclination toward violence, indicating that the program effectively changes attitudes about guns and violence among victims of penetrating trauma.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A prospective randomized study of the efficacy of "Turning Point," an inpatient violence intervention program. Loveland-Jones, C., Ferrer, L., Charles, S., et al.[2018]

A quality improvement project at a pediatric emergency department successfully increased the referral rate to the Hospital-based Violence Intervention Program (HVIP) from 32.5% to 61.1% for eligible patients aged 7-18 with violent injuries, representing an 88% increase.

Key interventions included educating healthcare providers about eligibility, encouraging timely referrals by nurses, and improving communication about the program, which collectively enhanced the connection of youth to essential medical and social services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing improvements in emergency department referrals to a hospital-based violence intervention program. Watkins, J., Scoggins, N., Cheaton, BM., et al.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

A decade of hospital-based violence intervention: Benefits and shortcomings. [2018]

2. England pubmed.ncbi.nlm.nih.gov

Violent injury prevention does not equal to violent crime prevention: an analysis of violence intervention program efficacy using propensity score methods. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Boston Violence Intervention Advocacy Program: Challenges and Opportunities for Client Engagement and Goal Achievement. [2021]

4. England pubmed.ncbi.nlm.nih.gov

Reducing violence against nurses: the violence prevention community meeting. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Hospital-based violence intervention: risk reduction resources that are essential for success. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Nonviolent crisis intervention training and the incidence of violent events in a large hospital emergency department: an observational quality improvement study. [2014]

7. United States pubmed.ncbi.nlm.nih.gov

Hospital-based violence intervention programs work. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Reducing restraints: alternatives to restraints on an inpatient psychiatric service--utilizing safe and effective methods to evaluate and treat the violent patient. [2019]

9. Netherlands pubmed.ncbi.nlm.nih.gov

Cost-benefit analysis simulation of a hospital-based violence intervention program. [2017]

10. United States pubmed.ncbi.nlm.nih.gov

A prospective randomized study of the efficacy of "Turning Point," an inpatient violence intervention program. [2018]

11. England pubmed.ncbi.nlm.nih.gov

Assessing improvements in emergency department referrals to a hospital-based violence intervention program. [2021]