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Randomized Trial of a Case Management Program for Assault-Injured Youth: Impact on Service Utilization and Risk for Reinjury

Cheng, Tina L. MD, MPH*; Wright, Joseph L. MD, MPH; Markakis, Diane MS*; Copeland-Linder, Nikeea PhD, MPH*; Menvielle, Edgardo MD, MSHS§

doi: 10.1097/PEC.0b013e3181666f72
Original Articles

Objectives: The purposes of this study were to (1) assess receptiveness of families to violence prevention interventions initiated after an assault injury and (2) assess the effectiveness of a case management program on increasing service utilization and reducing risk factors for reinjury among assault-injured youth presenting to the emergency department.

Design/Methods: A randomized controlled trial of youth, aged 12 to 17 years, presenting to a large urban hospital with peer assault injury was conducted. Youth and parents were interviewed at baseline and 6 months to measure service utilization, risk behavior, attitudes about violence, mental health, and injury history.

Intervention: Intervention families received case management services by telephone or in person during 4 months by a counselor who discussed sequelae of assault injury and assessed family needs and facilitated service use. Controls received a list of community resources.

Results: Eighty-eight families were enrolled; 50 (57%) completed both youth and parent follow-up interviews. Intervention and control groups were not significantly different at baseline on demographics, service utilization, and risk factors. Fighting was common in both groups. Most parents and youth identified service needs at baseline, with recreational programs, educational services, mentoring, and counseling as most frequently desired. There was no significant program effect on service utilization or risk factors for injury. Although intervention families were satisfied with case management services, there was no significant increase in service utilization compared with controls.

Conclusions: Youth and parents were receptive to this violence prevention intervention initiated after an emergency department visit. This pilot case management program, however, did not increase service utilization or significantly reduce risk factors for injury. More intensive violence prevention strategies are needed to address the needs of assault-injured youths and their families.

*Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; †Division of Emergency Medicine, ‡The Child Health Advocacy Institute and §Division of Psychiatry, Children's National Medical Center, Washington, DC.

This project was supported by the Robert Wood Johnson Foundation Generalist Faculty Scholars Program (Dr Cheng), Centers for Disease Control and Prevention R49/CCR331657, and Maternal and Child Health Bureau (Title V Social Security Act), Health Resources and Services Administration, Department of Health and Human Services, R40MC00174, 4H34MC00025.

Address correspondence and reprint requests to Nikeea Copeland-Linder, PhD, MPH, 200 North Wolfe St, 2063, Baltimore, MD 21287-2530. E-mail: nlinder1@jhmi.edu.

© 2008 Lippincott Williams & Wilkins, Inc.