De Vos E, Stone D A, Goetz M A, Dahlberg L L
Education Development Center, Inc., Newton, MA 02158-1060, USA.
Am J Prev Med. 1996 Sep-Oct;12(5 Suppl):101-8.
To decrease adolescent morbidity and mortality and improve the quality of life, a violence-prevention consultation is offered to hospitalized victims of nondomestic violence. The context is a violence-prevention team approach to patient assessment, treatment, and follow-up. Psychoeducational counseling emphasizes the individual through a cognitive behavioral approach and also recognizes the individual in the proximal social setting through referrals to community resources. The in-hospital component draws on the health beliefs model, self-efficacy, the theory of reasoned action and their synergy with cognitive mediation theory as expressed in developmental psychology. The target group for the intervention is adolescents (12-17 years of age) who have been victims of violent assaults severe enough to warrant treatment at a Level One trauma center. The six steps in the intervention are to (1) review and assess the incident, (2) review the patient's conflict-resolution strategies and introduce nonviolent alternatives, (3) provide information on the prevalence of violence/homicide and determine the patient's risk status, (4) explore the patient's coping skills and support system, (5) develop a plan to stay safe, and (6) refer patient to services for follow-up activities. Approximately 15 study participants are identified each month, half of whom are randomly assigned to receive the intervention. Over the 12-month recruitment interval, approximately 180 adolescent patients will be identified. Baseline data are collected through hospital intake procedures and chart reviews. A battery of standardized measures supplemented by a brief structured, closed-ended interview is collected four months after the youths leave the hospital. Preliminary baseline data for 39 youths are reported. The "typical" youth is a 16-year-old African-American male. Even though nearly one third of victims had been shot, the typical patient was injured in a fight during which he was kicked, bitten, or beaten with or without a blunt instrument. The majority of incidents involved only one attacker who was known to the victim. Nearly half the injuries were precipitated by an argument or fight. No statistically significant differences between intervention subjects and nonintervention controls in terms of baseline variables have been observed. For inner-city adolescent victims of violent assaults, a hospital-based intervention offers a unique opportunity for reduction of the incidence of reinjury. We describe the elements of the intervention, including the theoretical basis and implementation; detail the overall evaluation design including modifications; and present preliminary analyses of baseline data.
为降低青少年发病率和死亡率并提高生活质量，我们为住院的非家庭暴力受害者提供预防暴力咨询服务。其背景是采用预防暴力团队方法进行患者评估、治疗及随访。心理教育咨询通过认知行为方法强调个体，并通过转介社区资源在近端社会环境中认识个体。医院内部分借鉴健康信念模型、自我效能、理性行动理论以及它们与发展心理学中认知调解理论的协同作用。干预的目标群体是12至17岁的青少年，他们是遭受暴力袭击的受害者，袭击严重到需要在一级创伤中心接受治疗。干预的六个步骤是：（1）回顾和评估事件；（2）回顾患者的冲突解决策略并引入非暴力替代方法；（3）提供暴力/杀人发生率信息并确定患者的风险状况；（4）探索患者的应对技能和支持系统；（5）制定安全保障计划；（6）将患者转介至后续活动服务机构。每月约确定15名研究参与者，其中一半被随机分配接受干预。在为期12个月的招募期间，约将确定180名青少年患者。基线数据通过医院入院程序和病历审查收集。在青少年出院四个月后，收集一系列标准化测量数据，并辅以简短的结构化、封闭式访谈。报告了39名青少年的初步基线数据。“典型”青少年是一名16岁的非裔美国男性。尽管近三分之一的受害者中枪，但典型患者是在一场打斗中受伤，期间他被踢、咬或被钝器殴打，无论是否使用钝器。大多数事件仅涉及一名受害者认识的袭击者。近一半的伤害是由争吵或打斗引发的。在基线变量方面，未观察到干预组与非干预对照组之间存在统计学显著差异。对于市中心暴力袭击的青少年受害者，基于医院的干预为降低再次受伤发生率提供了独特机会。我们描述了干预的要素，包括理论基础和实施；详细说明了总体评估设计，包括修改内容；并呈现了基线数据的初步分析结果。
