America's greatest resource is its youth, but that resource is increasingly threatened by violence and disproportionately affects minority communities. Violent injury is a major cause of morbidity and mortality among adolescents. The presence of a positive adult role model is a well-established protective factor against violence and other maladaptive outcomes among youth. Big Brothers Big Sisters of America (BBBS) is the largest U.S. mentoring organization and is the only such program recognized by Blueprints for Violence Prevention for its demonstrated effectiveness. However, the magnitude and consistency of the program's effects on violence-related outcomes leave room for improvements and study of the integration of new communication and information technology (IT) is also needed. Further, the emergency department (ED) offers a critical opportunity for the health sector to link youth at high risk for violence prevention activities. Youth presenting with violent injury for acute trauma care are at high risk for repeat injury. Two key research-based opportunities for mentoring enhancement are incorporating structured activities for mentors and youth and increasing parent involvement. These practices are a focus of Take Charge! (TC), a mentor and professional-implemented intervention with 10-15 year old assault-injured youth presenting to EDs. A randomized trial by the PI of this proposal demonstrated that TC improved perceived self efficacy for avoiding violence, decreased aggression and misdemeanors. The goal of this proposal is to further enhance the effectiveness of a TC-BBBS intervention to prevent violence and crime among high-risk, assault-injured youth in a multi-site randomized trial.
Aims : A) To incorporate information and communication technology and further refine, finalize and manualize activities of a scalable, research informed program, TC that is designed to enhance the efficacy ofthe BBBSxommunity program model;B) To conduct a randomized trial in which assault-injured youth recruited from EDs in two cities (Baltimore, DC) are randomly assigned to standard ED care or TC- BBBS intervention with assessment of violence-related outcomes (fighting, fight injury, aggression, weapon carrying and problem behavior), mental health and educational outcomes over an 18 month period;and C) To accurately measure the programmatic costs associated with the TC-BBBS model.
Youth violence is a major contributor to health disparities. The ED visit is a prime opportunity for initiating violence prevention with a particularly high risk group. Prevention strategies with early adolescents involving trusted adults - parents and mentors - offers promise. This study is a critical next step in translating evidence-based research to real-world settings and practice.
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