HVIP Outcomes and Stakeholder Insights

Official title

Advancing the Evidence for HVIPs in the Southeast: Comprehensive Patient- Centered Outcomes & Stakeholder Insights

Overview

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.

Detailed description

Evidence demonstrates that hospital violence intervention programs (HVIPs) reduce violent injury recidivism, PTSD symptoms, improve receipt of supportive services, and demonstrate cost-savings for the healthcare system. However, it is unknown if these outcomes can be replicated in under-studied communities in the Southeast (S.E.) where few HVIPs have been implemented, and other potentially valuable outcomes remain unexamined. These may include but are not limited to, improvement in patients' healthcare experiences, self-confidence, violence risk reduction, and overall recovery. In addition, multi-sector stakeholder perspectives on how HVIPs can improve or expand to better meet communities' needs are lacking in the literature. For instance, family members and loved ones are often supported by HVIP services, but little is known about how they benefit from the intervention. Also, HVIPs integrate into the healthcare team, augmenting the care provided by the clinical staff. Little is known about how healthcare teams benefit from the work of HVIPs or how the quality of care provided is influenced by these programs. These questions are imperative to informing the implementation of HVIPs and how success might be better defined through a public health lens that considers outcomes beyond violent injury recidivism for patients, families, healthcare systems, and communities.

Further, evaluating HVIPs in under-studied communities is critical to advancing the model's evidence base, especially in communities where violence intervention investment remains low. The S.E. U.S., for example, experiences a disproportionate burden of firearm homicide, but few hospitals have adopted HVIPs. S.E. trauma centers and HVIPs uniquely serve large urban and rural geographic areas that face complex racial and economic disparities yet have fewer investments in violence prevention and safety net policies and services.

Investigators propose conducting a comprehensive evaluation of an established HVIP (Turning the Tide Violence Intervention Program, TTVIP) at an academic, non-profit level 1 trauma center in Charleston, SC that serves youth and young adult victims of community and interpersonal violence in Charleston, Dorchester, and Berkeley Counties. Most patients served by the TTVIP are victims of firearm injury (\>90%), reside in the cities of Charleston and North Charleston - the latter of which ranks among U.S. cities with the highest firearm assault and homicide rates - and are disproportionately young Black males from neighborhoods with high deprivation and are Medicaid funded or uninsured. This study will advance the knowledge on HVIP outcomes, implementation from the perspective of survivors, families and healthcare team members, in addition to examining the impact of an HVIP in a S.E. state that disproportionately experiences firearm violence. The study's goal is to perform an evaluation of a S.E. HVIP (TTVIP) that includes comprehensive patient outcomes, perceived benefits of HVIPs from the perspectives of multiple stakeholders, and opportunities for HVIP improvement.

Aim 1: Assess healthcare experience, supportive service utilization, violence risk, mental health outcomes, self-confidence, perceived risk of violence and re-injury among violently injured youth and young adults, including TTVIP enrolled patients and non-enrolled patients. Investigators hypothesize that individuals that experienced violent injury and enrolled in the TTVIP will report a) more positive perception of their healthcare experience, b) higher service utilization, c) lower rates of depression and PTSD, d) lower risk of violence, e) higher confidence, and f) lower rates of violent and non-violent re-injury compared to non-enrolled victims of violence. Investigators anticipate similar rates of perceived violence risk between the two groups.

Aim 2: Examine perceptions of HVIP services, benefits, and recommendations for service improvement among HVIP enrollees and their primary caregivers/loved ones.

Aim 3: Assess perceptions of HVIP services, benefits to the healthcare team and patients, and recommendations for service improvements among healthcare staff.

Interventions

• Behavioral Turning the Tide Violence Intervention Program (hospital violence intervention program)
  TTVIP is already integrated into the regular care of patients who are violently injured and treated at MUSC Charleston. Client advocates provide immediate support, help with communication and provide anti-retaliation messaging to victims of violence and their families, in addition to helping support their healthcare. Patients that opt to be followed for long-term wrap-around services and live in the surrounding 3-county area are supported for months (up to 1 year) after injury and provided mento

Primary outcome measures

• Post Traumatic Stress Disorder [Time frame: Victims of violence will be screened at baseline enrollment, 3 months, 6 months and 12 months after enrollment]
• Self-Esteem [Time frame: Victims of violence will be assessed at baseline, 3 months, 6 months and 12 months]
• Future Firearm Violence Risk [Time frame: Victims of violence will be assessed at baseline, 3 months, 6 months and 12 months after enrollment.]
• Depression [Time frame: Victims of violence will be assessed at baseline enrollment, 3 months, 6 months and 12 months after enrollment.]
• Benefits of hospital violence intervention program implementation [Time frame: Healthcare providers will be assessed with baseline assessment at enrollment (1 time cross-sectional survey)]
• Percentage of Patients with Criminal justice system involvement [Time frame: Victims of violence will be assessed at baseline enrollment, 3 months, 6 months and 12 months after enrollment]
• Percentage of Patients with Adverse Social Determinants of Health [Time frame: Victims of violence will be assessed at baseline, 3 months, 6 months and 12 months after enrollment]
• Percentage of patients with perceived risk of violence [Time frame: Victims of violence will be assessed at baseline enrollment, 3 months, 6 months and 12 months after enrollment.]
• Percentage of patients experiencing a repeat injury [Time frame: Victims of violence will be assessed at 3 months, 6 months and 12 months after enrollment]
• Percentage of patients with recovery service needs [Time frame: Victims of violence will be assessed at baseline enrollment, 3 months, 6 months and 12 months after injury. Patient loved ones/caregivers will be assessed at baseline and 3-6 months after injury.]

Eligibility criteria

Inclusion Criteria (patients):

• Patients ages 16 and above treated at MUSC Charleston that experience an injury due to interpersonal or community violence
• Glasgow coma score (GCS) of 15 at the time of study enrollment

Exclusion Criteria (patients):

• Lack of capacity to consent due to altered mental status (AMS) or severe untreated mental illness
• Being under arrest or incarcerated at the time of assessment for enrollment
• Non-English speaking patients
• Ages under 16

Inclusion Criteria (loved ones/caregivers):

-Loved ones (partners), caregivers and family members of patients that enroll in the study that experienced violent injuries

Exclusion Criteria (loved ones/caregivers):

• Non-English speaking
• Cognitive impairment
• Under age 16

Inclusion Criteria (Healthcare Providers):

-Healthcare team members that cared for victims of violence in the past 6 months

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Health services research

Study locations

United States · 1 center

• Medical University of South Carolina — Charleston

Publications

• Goldstick JE, Carter PM, Walton MA, Dahlberg LL, Sumner SA, Zimmerman MA, Cunningham RM. Development of the SaFETy Score: A Clinical Screening Tool for Predicting Future Firearm Violence Risk. Ann Intern Med. 2017 May 16;166(10):707-714. doi: 10.7326/M16-1927. Epub 2017 Apr 11. PMID 28395357
• Kegler SR, Dahlberg LL, Vivolo-Kantor AM. A descriptive exploration of the geographic and sociodemographic concentration of firearm homicide in the United States, 2004-2018. Prev Med. 2021 Dec;153:106767. doi: 10.1016/j.ypmed.2021.106767. Epub 2021 Aug 17. PMID 34416223
• Monopoli WJ, Myers RK, Paskewich BS, Bevans KB, Fein JA. Generating a Core Set of Outcomes for Hospital-Based Violence Intervention Programs. J Interpers Violence. 2021 May;36(9-10):4771-4786. doi: 10.1177/0886260518792988. Epub 2018 Aug 10. PMID 30095028
• Purtle J, Rich LJ, Bloom SL, Rich JA, Corbin TJ. Cost-benefit analysis simulation of a hospital-based violence intervention program. Am J Prev Med. 2015 Feb;48(2):162-169. doi: 10.1016/j.amepre.2014.08.030. Epub 2014 Nov 6. PMID 25442223
• Smith R, Dobbins S, Evans A, Balhotra K, Dicker RA. Hospital-based violence intervention: risk reduction resources that are essential for success. J Trauma Acute Care Surg. 2013 Apr;74(4):976-80; discussion 980-2. doi: 10.1097/TA.0b013e31828586c9. PMID 23511134
• Gorman E, Coles Z, Baker N, Tufariello A, Edemba D, Ordonez M, Walling P, Livingston DH, Bonne S. Beyond Recidivism: Hospital-Based Violence Intervention and Early Health and Social Outcomes. J Am Coll Surg. 2022 Dec 1;235(6):927-939. doi: 10.1097/XCS.0000000000000409. Epub 2022 Nov 15. PMID 36102509

Identifiers

NCT: NCT06582953 · Pro00138225

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗