Core Set of Outcomes for Programs Designed for the Prevention of Violence

Introduction: Violently injured adolescents are more likely than adults to develop retaliatory attitudes, which often perpetuate further aggression, victimization, (re)injury or even death (Cunningham et al., 2012). Nearly 40% of adolescents treated in hospital emergency departments for violence-related injuries are retreated for similar injuries within one year (Copeland-Linder et al., 2012). Hospital-based violence intervention programs (HVIPs) aim to disrupt this cycle of violence by intervening immediately after a victimization experience or violent injury when adolescents are likely to be most receptive (Morti, 1999) and then providing case management after hospital discharge.  A National Network of Hospital-Based Violence Intervention Programs (NNHVIP), inclusive of 22 hospitals in urban, economically disadvantaged areas, was established to promote collaboration around best practices and research, and to effect policy change related to violence prevention efforts in healthcare contexts. The goal of this study was to support NNHVIP’s mission to identify a “core set” of high-priority patient outcomes and measurement tools that will enable cross-program comparative effectiveness evaluations.

Method: An initial list of patient outcomes targeted by HVIPs was generated through a systematic literature review and an open elicitation questionnaire administered to 79 HVIP directors and case managers. In a subsequently administered survey, program staff rated the relative importance of the identified outcomes using a Max-Diff prioritization procedure (Louviere et al., 2013).   

Results: Program staff generated 572 responses to the initial outcome elicitation survey (range: 1-10; M = 7.24, SD = 2.43). Of these, 183 (32.0%) responses characterized the 22 outcomes identified in the literature review. The remaining 389 (68.0%) responses represented 29 unique patient outcomes. Program staff identified reduced victimization, hospital recidivism, violence exposure, PTSD symptoms, and retaliatory behavior as among the top HVIP outcome priorities. Highly prioritized outcomes not yet considered in research on HVIPs included constructs such as improved emotion regulation, better coping strategies, and relational support from a positive adult role model.

Discussion: The identification by program staff of 29 unique outcomes not currently researched by HVIPs is a significant contribution to the literature and represents the importance of taking a patient-centered, stakeholder-informed approach to program evaluation.  Better coping strategies and improved emotion regulation may be essential for HVIPs to address because these strategies may enable clients to be less likely to respond to provocations with aggression (Sullivan et al., 2010). Additionally, mentorship by a positive adult role model may help clients endorse non-aggressive problem solving strategies (Hurd et al., 2011).  Results of this study can shape the goals and evaluation of prevention programs, and consequently bolster evidence-based practice as well as address broader health inequities relevant to urban violence.