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      Implementation of programming for survivors of violence-related trauma at a level 1 trauma center


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          Prior investigation of violence intervention programs has been limited. This study will describe resources offered by Victims of Crime Advocacy and Recovery Program (VOCARP), their utilization, and effect on recidivism.


          VOCARP was established in 2017 at our center, and all patients who engaged with programming (n=1019) were prospectively recorded. Patients are offered services in the emergency department, on inpatient floors and at outpatient clinic visits. Two control groups (patients sustaining violent injuries without VOCARP use (n=212) and patients with non-violent trauma (n=201)) were similarly aggregated.


          During 22 months, 96% of patients accepted education materials, 31% received financial compensation, 27% requested referrals, and 22% had crisis interventions. All other resources were used by <20% of patients. Patients who used VOCARP resources were substantially different from those who declined services; they were less often male (56% vs. 71%), more often single (79% vs. 51%), had greater unemployment (63% vs. 51%) and were less frequently shot (gunshot wound: 26% vs. 37%), all p<0.05. Overall recidivism rate was 9.4%, with no difference between groups. Use of mental health services was linked to lower recidivism rates (4.4% vs. 11.7%, p=0.016). While sexual assault survivors who used VOCARP resources had lower associated recidivism (2.4% vs. 12%, p=0.14), this was not statistically significant.


          This represents the largest violence intervention cohort reported to date to our knowledge. Despite substantial engagement, efficacy in terms of lower recidivism appears limited to specific subgroups or resource utilization.

          Level of evidence

          Level II. Therapeutic.

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          Most cited references39

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          Deaths: Leading Causes for 2017.

          Objectives-This report presents final 2017 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2017," the National Center for Health Statistics' annual report of final mortality statistics. Methods-Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2017. Causes of death classified by the International Classification of Diseases, 10th Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. Results-In 2017, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Accidents (unintentional injuries); Chronic lower respiratory diseases; Cerebrovascular diseases; Alzheimer disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2017 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Newborn affected by maternal complications of pregnancy; Sudden infant death syndrome; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Diseases of the circulatory system; Respiratory distress of newborn; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods.
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            Pathways to recurrent trauma among young Black men: traumatic stress, substance use, and the "code of the street".

            Recurrent interpersonal violence is a major cause of death and disability among young Black men. Quantitative studies have uncovered factors associated with reinjury, but little is known about how these factors work together. We interviewed young Black male victims to understand their experience of violence. Qualitative analysis of their narratives revealed how their struggle to reestablish safety shaped their response to injury. Aspects of the "code of the street" (including the need for respect) and lack of faith in the police combined with traumatic stress and substance use to accentuate their sense of vulnerability. Victims then reacted to protect themselves in ways that could increase their risk of reinjury. We describe a model with implications for reducing rates of recurrent violent injuries.
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              Hospital-based violence intervention programs work.

              Hospital-based violence prevention programs have emerged at trauma centers nationwide; however, none has been thoroughly evaluated for effectiveness. Our Violence Intervention Program (VIP) conducted a prospective randomized control study to evaluate the effectiveness of intervention for repeat victims of violence.

                Author and article information

                Trauma Surg Acute Care Open
                Trauma Surg Acute Care Open
                Trauma Surgery & Acute Care Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                7 October 2021
                : 6
                : 1
                [1]departmentOrthopedic Surgery , MetroHealth System , Cleveland, Ohio, USA
                Author notes
                [Correspondence to ] Dr Heather A Vallier; hvallier@ 123456metrohealth.org
                © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                Original Research
                Custom metadata

                violence, intervention, recidivism


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