Cheng, T., Haynie, D., Brenner, R., Wright, J., Chung, S., & Simons-Morton, B. (2008). Effectiveness of a mentor-implemented, violence prevention intervention for assault-injured youths presenting to the emergency department: Results of a randomized trial. Pediatrics, 122, 938-946.
Effectiveness of mentor-implemented, violence prevention intervention for assault-injured youths
In the United States, violent injuries are one of the leading causes of death among adolescents. Specifically in urban areas, intentional violent injuries account for 85% of injury related adolescent deaths (Cheng, Wright, Fields, et al., 2001); the youths who survive this violence are at 88 times the risk for recurrent injury and/or fatal violence than those teens who have not been exposed to violent injury (Dowd, 1998). It is believed that emergency department interventions can be ” a teachable moment, a time of introspection and vulnerability after an injury event.” Thus the current study developed a prevention intervention program to target this group of assault-injured youths by incorporating
- parent and family based programs,
- early childhood home visitation,
- social-cognitive interventions, and
- mentoring strategies.
Youths with assault-injuries from 2 urban emergency departments were recruited for the study. A baseline interview was conducted with the youth and the parents, separately before being randomly assigned to either the intervention (N=87) or comparison group (N=79). The intervention group was assigned a mentor (gender-matched) with who they were to meet with 6 or more times over a 2 to 6 month period. Mentors were trained via a set curriculum which highlighted role playing to attend to teen communication and conflict situations. The mentors and youths completed a 6-session violence prevention program which focused on skill building in the areas of conflict management, problem-solving, weapon safety, decision making and goal setting. Mentors were supervised through a variety of methods and were compensated $240 for their time and activity expenses. In addition, parents in the intervention group received 3 home visits from a health educator who recapped the youth curriculum, provided information on the importance of parental monitoring and involvement, as well as offering case management. The comparison group also received case management, but it was in the form of 2 telephone calls; referrals were made for a variety of programs and treatments based on the families’ requests. At baseline and 6 month follow-up, youths from both groups were assessed on their attitudes about interpersonal violence and their risk factors for violence.
The intervention group was split up into high-adherence and low-adherence based upon whether or not the families received the full intervention.
- Significant increases were found in youth self-efficacy in both high- and low-adherence groups
- Significant decreases in misdemeanor behavior and physical aggression were found in the high-adherence group only.
- The follow-up assessment revealed additional reductions for the intervention group in reports of fighting and subsequent fight-related injuries.
- The intervention families reported high satisfaction with the program with the overwhelming majority of youths feeling that their “mentor understands my needs” and “cares about me.”
- Parents also had high satisfaction with 88% reporting that the health educator understood them very well.
Overall, the families in the intervention group were very satisfied with the violence prevention intervention implemented after an emergency department visit. This program was effective in reducing some problematic youth behaviors as well as increasing youth’s sense of self-efficacy. Level of program adherence was found to be an important factor in the effectiveness of the intervention.
Mentoring was an effective method for implementing the violence prevention intervention in high-risk assault-injured youths. The high levels of both parent and youth satisfaction offer promise in terms of family receptiveness for the further dissemination of this prevention intervention.
Although compensation for the mentors was shown to be effective, it will be important to see if a mentor compensation affects mentor competence, program adherence, and youth satisfaction.
Overall, the study shows that a mentoring program implemented immediately following an assault-injured youths visit to the emergency department can act as an important intervention access point in reducing problem behaviors and promoting positive outcomes in these very high-risk youth.
summarized by UMass Boston clinical psychology doctoral student, Laura Yoviene