The gap between hospital-based violence intervention services and client needs: A systematic review

Abstract

Background

Survivors of intentional interpersonal violence face social challenges related to social determinants of health that led to their initial injury. Hospital-based violence intervention programs reduce reinjury. It is unclear how well they meet clients’ reported needs. This systematic review aimed to quantify how well hospital-based violence intervention program services addressed clients’ reported needs.

Methods

Medline, The Cochrane Library, CINAHL Plus with Full Text, and PsycInfo were queried for studies addressing hospital-based violence intervention programs services and intentional injury survivors’ needs in the United States. Case reports, reviews, editorials, theses, and studies focusing on pediatric patients, victims of intimate partner violence, or sexual assault were excluded. Data extracted included program structure, hospital-based violence intervention program services, and client needs assessments before and after receiving hospital-based violence intervention program services.

Results

Of the 3,339 citations identified, 13 articles were selected for inclusion. Hospital-based violence intervention programs clients’ most reported needs included mental health (10 studies), employment (7), and education (5) before receiving hospital-based violence intervention programs services. Only 4 studies conducted quantitative client needs assessments before and after receiving hospital-based violence intervention program services. All 4 studies were able to meet at least 50% of each of the clients’ reported needs. The success rate depended on the need and program location: success in meeting mental health needs ranged from 65% to 90% of clients. Conversely, time-intensive long-term needs were least met, including employment 60% to 86% of clients, education 47% to 73%, and housing 50% to 71%.

Conclusion

Few hospital-based violence intervention programs studies considered clients’ reported needs. Employment, education, and housing must be a stronger focus of hospital-based violence intervention programs.

Introduction

Disadvantaged minorities, especially young Black males from a low socioeconomic background, have been disproportionately affected by intentional interpersonal violence.¹ This reflects ingrained racial disparities in social determinants of health, including safe housing, education, and employment.2, 3, 4 The violence reinjury rate for survivors varies from 16% to 44%.4, 5, 6, 7, 8, 9 The major contributing factor has been that violence survivors have been discharged to identical social conditions that led to the initial injury. They face the same social determinants of health needs before the injury and new post-injury needs, such as accessing follow-up medical care and legal concerns.^10,11 Survivors also have dealt with new physical disability, financial difficulties, and mental health consequences that have increased distrust and isolation from their communities.¹²

Hospital-based violence intervention programs (HVIPs) have addressed clients’ social determinants of health needs to reduce re-injury.13, 14, 15, 16, 17 These programs have intervened during the “teachable moment” of hospitalization from an intentional interpersonal violent injury where survivors have engaged with the healthcare system. Hospital-based violence intervention programs have prevented violent re-injury by engaging with survivors through peer-based case management using hospital-based resources and referring to community-based services.^18,19 There has been great heterogeneity between HVIPs.¹⁹ Numerous studies have assessed HVIPs and determined effectiveness based on reduction in violence re-injury rates.¹⁹ However, no systematic literature review has assessed effectiveness from clients’ perspectives. Hospital-based violence intervention program effectiveness should be based on how well they meet clients’ reported needs.

The aim of this systematic literature review was to answer the following PICOS (Population, Intervention, Comparison, and Outcome) question: among survivors of intentional interpersonal violence (participants) who received HVIP services postdischarge (intervention), what were their self-reported social determinants of health needs (outcome), and how well were these needs met as captured in observational studies and qualitative studies (study design). The secondary aim was to assess the HVIP structures and services that enabled programs to better meet clients’ reported needs.