Child and adolescent violence remains one of our most pressing public health problems today. Health care providers often serve critical roles when treating the results of violence. As with other injuries, pediatric providers serve as one of the necessary agents for prevention. Consequently, major health organizations have issued guidelines for incorporating violence prevention into routine primary care for children and adolescents. Currently, only limited tools are available to help pediatric clinicians address violence prevention-related issues in a consistent manner during the routine office visit. Moreover, no empirical evidence exists for the effectiveness of such approaches on parents or children's behaviors. Wake Forest University School of Medicine (WFUSM) and the American Academy of Pediatrics (AAP) Center for Child Health Research (CCHR) will collaborate to evaluate the effectiveness of a pediatric clinician's intervention that has been extensively pilot tested. Pediatric Research in Office Settings (PROS), a program of the CCHR, is a national network comprised of practice- based clinicians experienced in research participation. Their membership consists of more than 500 practices and 1500 clinicians across the country. PROS practices will be randomly assigned to either the intervention arm (Safety Check) or the control arm with an attention placebo. Safety Check will address four areas of behavior: media use; parental use of physical disciplining techniques; gun ownership and storage; and family/peer physical fights. Each arm of the study will have 68 practices, 136 providers, and 3,536 patients. The study will aim to gather data on sufficient numbers of Latino and African American patients to evaluate if the intervention has different effects on differing cultures/ethnicities. The intervention consists of 4 components: (1) a community violence prevention worksheet (to guide practices in identifying community specific violence prevention resources), (2) a household behavior survey for patient families with children 2-11 years to complete in the waiting room, identifying problem areas, (3) a recommendation guide that the provider directly utilizes to educate and engage the patient family on these issues, and (4) """"""""tangible tools"""""""" to help the family adhere to provider recommendations. The two primary outcomes evaluated will be the pediatric provider's anticipatory guidance behaviors and the patient family's behaviors, e.g. media use, discipline, gun storage, and family/peer fights. Data will be collected at the baseline visit with patient family follow-up 1 and 6 months later via telephone interviews. Efforts to reduce the social morbidity of youth violence are essential. This study breaks new ground, serving as the first national randomized controlled trial focused on testing the effectiveness of a comprehensive violence prevention program for pediatric providers. As yet, there are no data driving the guidelines issued by major medical organizations; this study will provide scientifically sound data to do so.
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