Youth violence is a significant public health problem, resulting in almost 5000 deaths (3rd leading cause of death among youth 14-24) and over 450,000 ED visits a year. This study had two aims: 1) To develop and pilot test the feasibility and acceptability of an integrated, theory-supported remote therapy intervention (SafERteens BI + Remote Health Coach) with at-risk youth (14-20 years old) seeking Emergency Department care and screening positive for recent alcohol use and violent behaviors; and 2) To expand on our prior brief intervention work to develop and pilot test the feasibility and acceptability of an 8-session remote therapy intervention that combined motivational interviewing, cognitive behavioral therapy and care management with youth (14-24 years old) seeking Emergency Department care and screening positive for an assault injury and drug use.
For aim 1, youth (age 14-20) seeking care in the ED were approached for recruitment; those screening positive for past 2-month alcohol use and violent aggression (with peers or dating partners) were enrolled in the open pilot. For aim 2, youth (age 14-24) with assault injuries were approached in the ED; those screening positive for past 6-month drug use were enrolled in the open pilot.
In both aims, the open pilot consisted of an ED-based therapy session plus 8 sessions of Remote Therapy Intervention (RTI), which combined elements of motivational interviewing and cognitive behavioral therapy for substance use/violence (e.g., refusal skills, conflict resolution, anger management). For the aim #2 intervention, youth also received strengths-based care management to actively link youth with community resources (active linkage beyond simply providing resources). The sessions were delivered in-person by a therapist during the ED visit (~35 min) and remotely (e.g., phone) in the 12 weeks following the ED visit. Computerized assessments were completed at baseline, ~weekly prior to therapy sessions, and at a 4-month follow-up. Results were analyzed descriptively and with paired tests (baseline, follow-up).
For aim 1, 16 youth participated [M age=18.8; 31% male; 50% African-American; 75% public assistance]. Although >90% rated the sessions as very/extremely helpful, 50% completed >5 sessions and 75% completed the follow-up. Paired analyses showed a significant decrease in aggression, victimization, alcohol consequences, and violence consequences; although not significant, use of alcohol also decreased from 100% to 40% in this condition.
For aim 2, 20 youth were enrolled in the open pilot trial [M age=21; 55% female; 60% African-American; 70% public assistance; 90% past 2-month marijuana use]. The RTI was found to be acceptable and feasible, with 91% enrollment of eligible youth, 100% of enrolled youth completing the in-person ED session, 65% completing ≥5 remote sessions, and >80% completing the 4-month follow-up. Participants rated therapy sessions highly, with 80% reporting that it was very/extremely helpful to have post ED phone sessions. Pre-post comparisons demonstrated a decrease in violence prevalence (p<0.01) and a trend, but not significance, towards decreased frequency of drug use (3.2±2.0 vs. 2.7±2.4; NS), violence (4.8±4.1 vs. 2.9±6.1; NS), and violence consequences (1.6±1.8 vs. 0.9±1.5, NS).
Multi-session interventions for drug/alcohol use and violence delivered remotely are acceptable and feasible. Based on these initial findings, further study in fully powered randomized control trials is warranted to determine the efficacy of both RTIs for their respective patient populations (i.e., at-risk youth; assault-injured drug using youth).
Assistant Professor, Emergency Medicine, University of Michigan