Abstract
Background
Violent injury is the second most common cause of death among 15- to 24-year olds
in the US. Up to 58% of violently injured youth return to the hospital with a second
violent injury. Hospital-based violence intervention programs (HVIPs) have been shown
to reduce injury recidivism through intensive case management. However, no validated
guidelines for risk assessment strategies in the HVIP setting have been reported.
We aimed to use qualitative methods to investigate the key components of risk assessments
employed by HVIP case managers and to propose a risk assessment model based on this
qualitative analysis.
Materials and methods
An established academic hospital-affiliated HVIP served as the nexus for this research.
Thematic saturation was reached with 11 semi-structured interviews and two focus groups
conducted with HVIP case managers and key informants identified through snowball sampling.
Interactions were analyzed by a four-member team using Nvivo 10, employing the constant
comparison method. Risk factors identified were used to create a set of models presented
in two follow-up HVIP case managers and leadership focus groups.
Results
Eighteen key themes within seven domains (environment, identity, mental health, behavior,
conflict, indicators of lower risk, and case management) and 141 potential risk factors
for use in the risk assessment framework were identified. The most salient factors
were incorporated into eight models that were presented to the HVIP case managers.
A 29-item algorithmic structured professional judgment model was chosen.
Conclusions
We identified four tiers of risk factors for violent reinjury that were incorporated
into a proposed risk assessment instrument, VRRAI.
Keywords
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Article info
Publication history
Published online: May 11, 2017
Accepted:
May 5,
2017
Received in revised form:
March 14,
2017
Received:
February 9,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
