Newswise – Opportunities to reach teens at risk for violence and substance abuse are rare. There may be only a small window of time to avoid violent and often fatal injuries.
Researchers have long wanted to learn how to intervene during this critical time when young people are at high risk for violence, but before they are stuck in a perpetual cycle with devastating consequences for them and their families.
“Safeteens, An evidence-based behavioral intervention, is designed to engage young people in this high-risk time and reduce their involvement in violence. Two recently published studies demonstrate that this intervention, considered best practice by the Centers for Disease Control and Prevention, can be successfully integrated into the provision of routine medical care in emergency and primary care settings.
Health care providers are disheartened, seeing young people repeatedly returning to emergency departments with violent injuries, said Jessica Roche., MPH, general manager of the UM Institute for the Prevention of Firearm Injury.
“They recognize that these deaths and injuries are preventable and ask what further help they can give high-risk youth to prevent these injuries from happening in the first place,” Roche said. “The SafeRteens intervention enables clinical staff to intervene early in the cycle of violence to prevent these violent injuries. ”
SafeRteens was developed in 2006 by Rebecca Cunningham, MD, and Maureen Walton, Ph.D., MPH. The intervention is designed for a trained therapist to work with a teenager for 30 minutes during their emergency room visit to identify positive life goals and ways to reduce their own involvement in violence, as well as others. behaviors that increase the risk of violence, such as alcohol use.
The intervention has been rigorously tested in several clinical trials and demonstrated that the approach could significantly reduce violent behavior among young people who received it. Subsequent analyzes have shown that this approach is cost effective, especially if it is widely implemented in trauma centers, since the program costs are much less than the expenditure for medical treatment of seriously injured adolescents.
The original research studies showed that SafERteens was effective in reducing violence, but a particular challenge is how to ensure that these types of evidence-based programs fit into routine clinical practice once studies have been completed. research completed.
“The goal of the current research was to try to identify ways to accelerate the normal timeline of implementing evidence-based research programs into routine clinical practice while retaining the successful elements of the original intervention. ” noted Patrick Carter, MD, lead author of the emergency services-based study, director of the CDC-funded UM Injury Prevention Center, co-director of the UM Institute for Firearm Injury Prevention, and associate professor of emergency medicine at Michigan Medicine.
Youth violence intervention in the emergency room, primary care clinics
Carter, Walton, and a team of researchers have created a web-based toolkit of response components, along with key training resources, to help emergency personnel at Hurley Medical Center in Flint, Mich., To deploy the intervention as a component of routine clinical care. care. The toolkit, Walton notes, was developed by working with adolescents and using feedback from clinical staff in these medical settings.
The research team tested different methods of implementing SafERteens in clinical care, including delivery by on-site hospital staff and delivery using a telehealth program by a remote therapist. Adolescents coming to the emergency services who had tested positive for violence were divided between the intervention of Saferteens in person or remotely and two parallel control groups.
The results, published in the Emergency Medicine Journal, reveal that a majority of adolescents have completed the program and that 85% of those who responded to the post-test survey felt it was very helpful to talk to a health counselor on how to reduce fighting and stay safe in their neighborhoods. Both groups receiving SafERteens interventions demonstrated a greater increase in self-efficacy in avoiding fighting and a decrease in pro-violence attitudes. The intervention delivered at a distance was also associated with less violence and subsequent consequences than the group that did not receive the intervention (the control group).
“This study demonstrates that despite the challenges of a busy clinical setting, this type of preventive intervention can be performed during an emergency department visit and has the potential to have a critical impact on the outcomes of violence. long term in young people if implemented widely in all emergency departments across the country, ”Carter said.
Researchers used a similar setting for SafERteens at primary care clinics in Ypsilanti, Mich., Where behavioral health clinicians performed the interventions. Due to the shorter nature of primary care visits, the procedure was performed online or in person after the initial appointment.
Participants receiving the intervention demonstrated greater reductions in violence and the consequences of substance use, according to the results published in Prevention of injuries.
“Clinic staff and the youth participating in the program have found the intervention useful,” said Golfo Tzilos Wernette, Ph.D., co-author of the article and associate professor at the Michigan Medicine Department of Family. Medicine. “The primary care setting is underutilized for prevention programs addressing behavioral risks in young people, including violence, and the results of these staff members have shown that there is effective work that can have an impact. impact. “
Obstacles to Successful Violence Prevention
Despite all the successful interventions and positive feedback from providers and adolescents, staff availability and costs emerged as barriers to widespread implementation. After the research team’s support was withdrawn, delivery of SafERteens declined at all three sites as providers struggled to maintain robust screening and intervention delivery in competition with other clinical demands. Carter notes that the combination of limited resources and a busy clinical environment were clearly factors.
“Overall, the program is cost effective in terms of cost savings to the medical system, and the results suggest that we should reimburse health care providers for providing this service in multiple health system settings,” Carter said. . “Reimbursement for these clinical services will allow additional dedicated staff to be available to provide this service and reduce the risk of violence among at-risk youth. “
Future applications for Saferteens
The University of Michigan recently received a multi-million dollar grant from the CDC that will, in part, help spread this program by funding a multi-site implementation of SafERteens at six clinical sites in Muskegon and Grand Rapids, Michigan. This effort is part of a collaboration between the Youth violence prevention Center, led by Marc Zimmerman, Ph.D., at the UM School of Public Health, and community partners at several clinical sites in Muskegon.
“This project is designed to show whether large-scale implementation of the program in multiple clinical settings can cumulatively reduce community rates of youth violence by reaching large numbers of at-risk youth accessing a wide range of medical settings.” Carter said.
The funding, which is part of the UM Institute for Firearm Injury Prevention, is part of a larger five-year project focused on reducing gun violence among youth.
To learn more about SafeRteens, resources are available on the website, saferteens.org. The website contains training manuals for clinics, implementation support, resource brochures and more.
Cited Articles / DOI: “Translating violence prevention programs from research to practice: implementing SafeRteens in an urban emergency department”, The Journal of Emergency Medicine. DO I: # 10.1016 / j.jemermed.2021.09.003
“Establishment of a violence prevention program among young people in primary care”, Injury prevention. DO I: # 10.1136 / pre-2021-044293 injury