Researchers from the University of Maryland School of Medicine have found that a hospital-based violence intervention program can help break the cycle of violence and violent crimes that often lead to traumatic injuries. The study, conducted at the R Adams Cowley Shock Trauma Center in Baltimore, part of the University of Maryland Medical Center, was published in the September issue of the Journal of Trauma. The researchers found that patients who participated in the trauma center’s Violence Intervention Program (VIP) were three times less likely to be arrested for a subsequent violent crime and four times less likely to be convicted later of a violent crime.

Violence is a public health problem of major significance in the United States,” says Carnell Cooper, M.D., an associate professor of surgery at the University of Maryland School of Medicine who founded the Shock Trauma Center Violence Intervention Program in 1998. “Trauma centers are well equipped to deal with blood loss, tissue destruction and death, but they are not routinely able to deal with the social ills that put patients at risk for being repeat victims of violence. It is within this environment, after a life-threatening injury, that individuals may be most open to behavioral change. We thought that a culturally sensitive, comprehensive, and multifaceted intervention program offered at this opportune time would interrupt the cycle of violence.”

The goal of the program is to reduce the number of repeat patients who returned to Shock Trauma for treatment of intentional violent injuries (gunshots, stabbings and beatings). Dr. Cooper and his colleagues aimed to put together a comprehensive program that would address the social issues facing the majority of these patients in an effort to break the cycle.

“What Shock Trauma does best is save lives, and we thought that intervening to prevent further violence would have an additional impact on saving lives,” says Dr. Cooper. “The VIP’s goal is to reduce the frequency and severity of recidivism for violent injury and criminal activity among people living in and around Baltimore City.”

For the study, one hundred Shock Trauma patients who suffered from violence-related injuries were enrolled in a clinical trial from 1999 to 2002 to evaluate VIP’s success at helping them avoid a repeat violent injury and criminal activity. Each study volunteer was placed at random in either the intervention group or a control group.

Those in the intervention group answered a questionnaire to assess their level of education, family dynamics, income, exposure to violence, and criminal history. “These are not the usual questions we ask patients in Shock Trauma,” Dr. Cooper says. “But we found that the majority of these patients were young, African American males who had less than a 10th grade education, made less than $10,000 a year, had a history of substance abuse and had been previously incarcerated for an average of 24 months.”

Individuals in the intervention group met with a social worker or case manager and a parole and probation officer to review the results of the questionnaire and to create a customized intervention plan with services such as substance abuse rehabilitation, employment training, educational services, conflict resolution, new housing, and family development. After the patient was discharged from Shock Trauma, the social worker and parole and probation officers met with him at regular intervals to assess his progress. Home visits and weekly group counseling sessions were also conducted.

As a result, VIP participants were three times less likely to be re-arrested for a violent crime, two times less likely to be convicted of any crime and four times less likely to be convicted of a violent crime when compared to the control group. The VIP also had a positive affect on repeat hospital admissions. The VIP group’s trauma center re-admission rate was five percent while the control group’s was 36 percent.

Since the study concluded in 2002, the VIP has continued to provide services to any patient admitted to Shock Trauma because of a violent injury. It now consists of peer support groups, individual counseling, advocacy, case management, family support, parole and probation supervision, community education, and focus groups and tours for adolescents.

“Our study shows that the VIP has had a broader impact than we ever imagined it would,” says Dr. Cooper. “Our original goal was simply to reduce the number of patients re-admitted to Shock Trauma because of violent injuries. Not only have we achieved that goal, but we are also seeing less criminal activity among our program participants as well as families being reunited, fathers getting jobs, paying taxes and paying child support. It’s turned out to be a very cost-effective program overall.”