Translation of an Intervention for Violence among Adolescents in Emergency Departments

A lack of translational research in the area of violence prevention exists, and, subsequently, programs that are demonstrated efficacious in highly controlled randomized trials have not been disseminated to determine effectiveness in real world settings. This translational research study aims to determine the effectiveness of the SafERteens brief intervention (BI) when delivered by clinical staff in real-world ED settings to help reduce youth violence.

Violent behaviors (i.e., physical aggression) are prevalent among adolescents residing in urban communities and have enormous impacts on morbidity and mortality. The urban emergency department (ED) represents an underutilized venue for delivering violence interventions among adolescents. A recent study demonstrated the efficacy of a brief intervention (BI) called SafERteens on reducing violent behaviors, peer victimization, and violence-related consequences (Walton et al., 2010). In order to reduce violence on a broader scale, studies are needed to determine the effectiveness of the SafERteens BI when delivered by clinical staff in real world ED settings. Using a RE-AIM model framework, we propose a study to determine the reach, effectiveness, adoption, implementation, and maintenance of the SafERteens BI prevention as delivered by ED social workers as part of routine clinical practice at Children’s Hospital of Philadelphia (CHOP). This study will provide standardization and easy access to training to address needs over time from a variety of locations (e.g., Web/DVD-based tools; internet video-based standardized patient skill assessment and supervision). Next, this study will integrate screening questions into computerized ED triage procedures to increase feasibility. Further, the use of computers for structuring delivery of tailored SafERteens BI content by ED social workers offers a unique solution to fidelity challenges. Finally, in order to boost intervention effects in a real-world setting, text messaging will be used to provide reminders of key content. The specific aims of this study are: 1) To refine and package training materials (i.e., manual, tablet computer assessment and standardized tailored BI content elements, web/DVD training, and internet video based standardized patient supervision) essential to translating an efficacious ED-based BI for violence (SafERteens); and 2) To conduct a translation study using the RE-AIM model to determine the reach (number of social workers trained) effectiveness (violence outcomes 3 months post intervention), adoption (number of screening assessments and interventions delivered during the effectiveness trial), implementation (quality of intervention delivery during the effectiveness trial and 6 months later), and maintenance (number of screening assessments and interventions delivered over a 6-month period post effectiveness trial) of the modified ED-based BI for violence among adolescents ages 14-18. This is an innovative project in that it addresses translating an efficacious BI for violence (SafERteens) using state-of-the-art technology for training (i.e., web/DVD, internet video based standardized patient), intervention delivery (i.e., computerized tailored content to structure therapist BI), and reminder boosters (via text messaging) that standardize the delivery and fidelity of BIs for high-intensity urban ED settings. The proposed research is significant because: 1) there is an urgent need to translate efficacious adolescent violence interventions; 2) it addresses a critical unmet need among a high risk group of adolescents, those seeking care at an urban ED who report engaging in violent behaviors who otherwise would not be identified or offered interventions; and, 3) translation of evidence-based interventions to determine reach, effectiveness, adoption, implementation, and maintenance in clinical practice is the critical next step to widespread implementation of youth violence prevention protocols in ED settings.