Where do we go from here? Interim analysis to forge ahead in violence prevention

Area of Science:

• Public Health
• Trauma Surgery
• Social Work

Background:

• Interpersonal violent injury disproportionately affects African Americans and Latinos.
• Injury recidivism rates range from 35% to 50%, highlighting a critical need for intervention.
• Hospital-based, culturally competent case management (CM) programs can leverage the "teachable moment" post-injury to reduce risk.

Purpose of the Study:

• To perform a detailed intermediate evaluation of the Wraparound Project (WP), a hospital-based, case-managed violence prevention program.
• To assess the feasibility and early programmatic efficacy of the WP.
• To identify areas for improvement to strengthen the program and enhance its effectiveness in reducing injury recidivism.

Main Methods:

• An 18-month-old program was evaluated using a Centers for Disease Control and Prevention-recommended instrument for injury prevention.
• Process evaluation was used to test the feasibility of the WP.
• Impact evaluation was employed to assess intermediate goals of risk reduction and early efficacy.

Main Results:

• The WP successfully screened 73% of gunshot victims and 57% of stab wound victims.
• Fifty-four percent of screened individuals had identified needs and received CM services, with a low refusal rate of 13%.
• For high-risk clients receiving full services (N=45), 60% were African American and 30% were Latino; 60% of African American clients lacked paternal contact. Case managers spent significant time (>6 hours/week) with clients, addressing multiple needs, and the overall attrition rate was only 4%.

Conclusions:

• Wraparound Project case managers built trust and developed risk reduction plans for high-risk clients, with cultural competency being a vital component.
• The program successfully addressed at least 50% of six out of seven major identified needs.
• The program's demonstrated value and positive results have secured municipal funding for an additional case manager, reinforcing the framework for reducing recidivism through culturally competent CM and risk factor modification.