Counseling helps cut weapons carrying among injured teens

By Anne Harding

NEW YORK (Reuters Health) - A collaborative care intervention for adolescents hospitalized after an injury sharply reduces the likelihood that they will report carrying a weapon a year later, a new randomized controlled trial shows.

One third of the study participants admitted to carrying a gun, knife, or club when they were interviewed in the hospital after their injury. But a year later, 7.3% of the adolescents who received the intervention said they currently carried a weapon, versus 21.3% of the control group.

Post-traumatic stress disorder (PTSD), violence, substance abuse, and injury risk behaviors have been found to be "endemic" among adolescents who suffer traumatic physical injury, Dr. Douglas Zatzick of Harborview Injury Prevention and Research Center in Seattle, Washington and colleagues write in their report, published online April 14 in JAMA Pediatrics.

The collaborative care model has shown success in treating patients with comorbid physical and psychological problems, Dr. Zatzick explained in an interview with Reuters Health, such as individuals with depression and diabetes, so he and his colleagues decided to investigate whether it would also be helpful for these at-risk adolescents.

The intervention, delivered by a social work and nurse practitioner team based in the trauma center, involved care management and motivational interviewing that targeted risky behavior and substance abuse.

"The injury is dealt with by the pediatricians and surgeons, then we come in as mental health providers and deal with the behavioral issues in a team-based way," Dr. Zatzick said.

The mean total time spent with each study participant was 13.1 hours.

The relative risk of weapon carrying 12 months after the injury was 0.31 among the 59 patients who received the intervention, compared to the 61 patients in the control group. Alcohol and drug abuse problems and high levels of PTSD and depressive symptoms were not as common among the study participants as weapon carrying, and there was no significant effect of the intervention on these measures.

"It was sort of a surprising finding that a third of them were carrying a weapon - a knife, gun, or club - in the year before their injury," Dr. Zatzick said. For this reason, he added, weapon carrying was not used as a primary outcome when the study was designed.

The intervention would be fairly easy to implement in any trauma center, according to Dr. Zatzick. While the motivational interviewing technique requires some training, he said, it can be delivered by bachelor's and master's degree level clinicians.

The next step in his own research, he added, will be to use electronic medical records and other technological innovations to identify teens who are at risk of carrying weapons, to make the intervention more efficient.

"This general technique can be applied to so many problems," he added. "These are real world rollouts; these are not rarefied efficacy trials."

If the current findings are replicated, he added, "we think there should be universal screening for adolescent violence risk factors like weapon carrying."

SOURCE: http://bit.ly/1n8zRfo

JAMA Pediatr 2014.

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