Background and objectives Youth violence is an alarming public health problem, yet, violence screening and interventions are not systematically offered in primary care (PC). This paper describes data from a pilot effectiveness-implementation trial of an efficacious youth violence prevention programme (SafERteens).
Methods The study was conducted in two PC clinics: a university-affiliated satellite clinic and a community health centre. In phase 1, we obtained stakeholder feedback to customise the SafERteens package and enrolled a comparison group of adolescents (age 14–18) seeking care in two clinics. In phase 2, clinical staff delivered the SafERteens-PC intervention with adolescents, which is a single, behavioural health therapy session delivered one-on-one from clinic providers to youth patients, followed by text message (TM) reminders. In phase 3, we assessed planned maintenance. All participants reported past-year violent behaviour at intake and completed a 3-month follow-up assessment.
Results Based on stakeholder interviews (n=13), we created a web-based SafERteens-PC programme package, including a three-item past-year violence screen, 30 min motivational interviewing-based brief intervention delivery tool, training videos and 2 months of TM boosters. We enrolled a comparison group (n=49) first, then an intervention group (n=61). Intervention delivery characteristics varied by clinic, including completion of intervention (75.9%; 62.5%), modality (100% delivered via telehealth; 60% via telehealth/40% in-person) and enrolment in TMs (81.8%; 55.0%); 91.8% completed the follow-up. Using an intention-to-treat approach, the intervention group showed significantly greater reductions in severe peer aggression (p<0.05), anxiety (p<0.05) and substance use consequences (p<0.05) relative to the comparison group. Participant and staff feedback were positive and identified challenges to long-term implementation, such as lack of availability of reimbursement for youth violence prevention.
Conclusions If these challenges could be addressed, routine provision of behavioural health services for violence prevention in PC could have high impact on health outcomes for adolescents.
- primary care
- implementation / translation
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Contributors JR is the guarantor of this work. MW conceptualised and designed the study, conducted the initial analyses and reviewed and revised the manuscript. PMC and RC conceptualised and designed the study, and critically reviewed and critically revised the manuscript for intellectual content. MLP-K collected the data and critically reviewed and critically revised the manuscript for intellectual content. JSR conducted the initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript. ES, ABE, GTW and KR contributed substantially to the study conception and design, and critically reviewed and critically revised the manuscript for intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Funding This work was funded by the University of Michigan Injury Prevention Centre by the Centres for Disease Control and Prevention (CDC) Award Number R49-CE-002099 and R49-CE-003085.
Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the funding agencies. No honoraria, grants or other form of payment were received for producing this manuscript.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.