At a glance
- Screening tools and interventions used in healthcare settings could help prevent future violence and suicide among people at risk.
- This page gives summaries of recent research projects related to hospital-based interventions.
Overview
Hospitals and medical facilities are the primary places where treatment of injuries from firearms occurs. A recent study found that gun violence survivors treated in the emergency department had a nearly one in six chance of experiencing another firearm injury within eight years.1Visits to medical facilities can be opportunities for critical interventions to prevent future firearm injuries and suicide.
In the following studies, CDC-funded researchers explored several important questions related to violence and suicide prevention in healthcare settings. They examined how screening tools can effectively identify patients at risk for violence and investigated what healthcare facilities can do to enhance counseling about secure firearm storage during routine primary care and mental health visits. Additionally, the studies looked into how hospital interventions can influence future experiences with violence and considered strategies for scaling up the number of hospital-based violence intervention programs within a state.
Terms to know
Brief violence interventions occur after a person has come to a hospital for treatment of injuries from violence. Interventions include discussing the violent incident and talking about conflict resolution strategies. They can also include assessing the patient's risk for violence by looking at the prevalence of violence among their peers. Finally, an intervention could be exploring coping skills and support systems.
Hospital-based violence intervention programs (HVIPs) can include brief violence interventions as well as provide other services. Medical staff and trusted community messengers offer patients immediate support and tools for preventing injury and violence. Support can continue after discharge from the hospital and is tailored to an individual's needs. This may include continued access to healthcare, mentoring and home visits, as well as broader services.
Key findings
Researchers from the University of Michigan wanted to determine if the SaFETy score screening tool could help predict future firearm violence risk. Researchers designed the SaFETy score to be used in emergency departments.
The tool consists of four questions about fighting, friends carrying weapons, hearing gunshots in the neighborhood, and receiving firearm-related threats. Participants receive a score out of 10, and a higher score means a higher risk for future firearm violence.
Researchers analyzed data from young adults in hospitals in Seattle, Philadelphia, and Flint, MI. Findings revealed that people who had experienced firearm violence in the past six months were more likely to have higher SaFETy scores.
For example, over 30% of people with a score of six or higher reported firearm violence in the past six months. In contrast, less than 1% of people with a score of zero reported firearm violence in the past six months.
An advantage of the SaFETy score is that it is quick to complete. Researchers believe it offers an effective way to predict future firearm injury risk. Using the tool with high risk patients could lead to providing better prevention services.
"Lock to Live" (L2L) is an online tool that helps people at risk of suicide make more informed decisions about securely storing firearms. Securely storing firearms may reduce the risk of suicide.
L2L provides information on storage options and encourages users to choose an option that aligns with their values and preferences. Healthcare providers may not have much experience discussing firearm safety with patients. Similarly, patients themselves may be hesitant to talk about firearms. L2L is helpful in suicide prevention because it makes it easier for these important conversations to take place.
Researchers from the Kaiser Foundation for Health studied patient and clinician preferences about L2L and suicide prevention. They studied this through interviews and focus groups. These preferences informed the ways medical facilities in Washington state implemented and evaluated L2L in primary care and mental health facilities.
After integrating L2L into existing suicide safety planning resources, clinicians found it easier to use and were able to reach more patients. Clinicians didn't have to remember to use it because it was already part of their toolkit for supporting patients.
As a result, L2L adoption rates among primary care clinicians increased from 2% to 29%. Among mental health clinicians, adoption rates increased from less than 1% to 48%. Combining safety planning with counseling on secure storage shows promise for reducing suicides by reaching more at-risk patients with risk reduction methods.
Researchers from Virginia Commonwealth University conducted a study on brief violence interventions among people ages 10 to 24 admitted to the hospital after experiencing a violent injury. The study compared the effectiveness of brief violence interventions alone in a hospital setting versus brief violence interventions with follow up case management services. Case management services provide personalized and coordinated services to the patient and their family for six months after leaving the hospital.
The findings suggest that both brief violence intervention alone and brief violence intervention with case management services may effectively reduce the chances of patients experiencing violence again. Among all patients who received an intervention, only one experienced a minor injury during the six-month follow-up period. This was much lower than historical averages at the researchers' hospital in Richmond, Virginia.
Additionally, both interventions helped change attitudes related to violence. By six months after hospital admission, brief violence intervention with case management services resulted in decreased acceptance of using violence compared to brief violence intervention alone. These findings highlight the importance of hospital-based interventions to prevent violence.
Researchers at Virginia Commonwealth University also conducted a study examining how to expand hospital-based violence intervention programs across the state. Hospital-based violence intervention programs (HVIPs) offer support and tools to patients receiving treatment after an injury. Research shows that these programs can reduce future injuries caused by violence.
In this study, the researchers focused on how connecting and coordinating HVIPs through a technical assistance center can be beneficial. After establishing the technical assistance center, researchers enrolled eight new hospitals during the two-year study period, which then established HVIPs.
Over 2,000 patients received violence prevention services across these hospitals. The technical assistance center held trainings and seminars and conducted site visits at hospitals. The center enhanced access to resources and services for patients across the state.
What's important about these studies?
These studies showcase promising or innovative strategies for preventing firearm violence and suicide in hospitals or other healthcare settings. They also demonstrate how to improve existing interventions.
Engaging with patients getting care in medical settings can be an opportunity to provide support, resources, and education. This may help prevent future firearm injuries or deaths.
- Mueller, K. L., Cooper, B. P., Moran, V., Lew, D., Ancona, R., Landman, J. M., ... & Foraker, R. E. (2023). Incidence of and factors associated with recurrent firearm injury among patients presenting to St. Louis trauma centers, 2010 to 2019: a cohort study. Annals of internal medicine, 176(9), 1163-1171.