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Hospital-based violence intervention: Risk reduction resources that are essential for success

Smith, Randi MD, MPH; Dobbins, Sarah MPH; Evans, Abigail BA; Balhotra, Kimen BS; Dicker, Rochelle Ami MD

Journal of Trauma and Acute Care Surgery: April 2013 - Volume 74 - Issue 4 - p 976–982
doi: 10.1097/TA.0b013e31828586c9
AAST 2012 Plenary Papers

INTRODUCTION Hospital-based violence intervention programs (VIPs) aim to reduce violent injury and recidivism. The aim of this study was to determine the most significant risk reduction variables associated with success in our VIP. We hypothesized that our recidivism rate declined since VIP’s inception and that we could identify risk reduction variables that were independent determinants of program success.

METHODS We analyzed our prospectively collected data for 2005–2011 from our VIP database. Success was defined as more than 50% needs met without recidivism or attrition. Impact and outcome evaluation was performed per a model promoted by the Centers for Disease Control. Rates of risk reduction and injury recidivism were calculated. Case management time spent per client (dose) was defined as low (0–1 hours per week), medium (1–3 hours per week), moderate (3–6 hours per week), and high (>6 hours per week). Correlation coefficients and logistic regression were used to examine associations between variables and success in the VIP.

RESULTS Two hundred fifty-four clients received services. Meeting needs in mental health (odds ratio, 5.97; 95% confidence interval, 2.72–13.07) and employment (odds ratio, 4.41:95% confidence interval, 1.56–12.46) proved significantly associated with success (p < 0.005). The 6-year program recidivism rate was 4% versus historical control of 16% (p < 0.05). Moderate and high exposure to intensive case management in the first 3 months was also significantly associated with success (p < 0.05). Success in our VIP was not associated with age, gender, education level, previous incarceration, probation status, or length of time in program.

DISCUSSION For 6 years, our recidivism rate has decreased fourfold compared with the rate before VIP inception. For startup and maintenance of a VIP, it is essential to know where to focus collaborative efforts in communities to target the most critical risk reduction resources. This study provides guidance—securing mental health care and employment for our clients appears to be predictive of success. The value of early “high-dose” intensive case management is also essential for reducing recidivism.

LEVEL OF EVIDENCE Care management study, level III.

From the San Francisco General Hospital, University of California, San Francisco.

Submitted: September 19, 2012; Revised: December 21, 2012; Accepted: December 21, 2012.

This research was funded by Centers for Disease Control (grant no. R49 CE001178-04)

This study was presented at the 71st annual meeting of the American Association for the Surgery of Trauma, September 12–15, 2012, in Kauai, Hawaii.

Address for reprints: Rochelle Ami Dicker, MD, Department of Surgery, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Ave, Building 3A, Box 0807, San Francisco, CA, 94143; email:;

© 2013 Lippincott Williams & Wilkins, Inc.