Intervention significantly reduces teens’ violent behavior, anxiety, illicit substance use

A primary care intervention that consisted of one-on-one counseling and text messages significantly reduced violent behavior, anxiety and substance use among adolescents, data show.

A previous study indicated that adolescents who were threatened or injured with a weapon were more than three times likely to commit an act of violence as an adult, which the study authors said signifies “a need to expand prevention and intervention programs for individuals and communities” and that “programs that target high-risk youth like our participants — in addition to targeting the neighborhoods where they live — will have the greatest impact.”

However, access to such prevention programs is lacking in communities, Jessica Roche, MPH, the managing director of the Institute for Firearm Injury Prevention at the University of Michigan and co-author of the new study, told Healio.

Roche and her colleagues created SafERteens-PC for use in the primary care setting.

“Primary care clinics were chosen as a point of delivery for this implementation, as they are an often underused opportunity to interact with youth around prevention programming,” Roche said.

SafERteens-PC is based on a previously validated, ED-based intervention that significantly decreased the likelihood of fighting, pro-violent attitudes, non-partner aggression and acts of violence among adolescents at risk for committing acts of violence. In the primary care version, clinical staff who had previously been trained to provide violence prevention counseling asked adolescent patients who are victims of violence if they had, in the past 12 months, thrown an object at someone or pushed, grabbed, shoved or slapped someone; kicked, bit or hit someone with a fist, hit or tried to hit them with something or beat up and choked someone; and/or threatened violence with a knife or gun or used a knife or fired a gun on someone.

A positive response to any of the questions, according to the researchers, prompted a counseling session that concluded with the clinical staff member offering the adolescent frequent tailored text messages for the next 2 months. These text messages were used to assess SafER-teen-PC’s effectiveness in limiting acts of aggression, feelings of anxiety and use of alcohol, illicit drugs and prescription drugs. The text messages also provided patients with tips on how to cope with bad days and avoid fighting.

The validity of SafERteens-PC was tested on an intervention group of 61 adolescents and a comparison group of 49 adolescents at a university-affiliated satellite clinic and a community health center. All patients, regardless of whether they received the text messages, were interviewed 3 months after the intervention’s completion so that the researchers could assess changes from baseline. Most of the participants in both cohorts were Black girls aged about 16 years old.

After 3 months, patients in the SafERteens-PC cohort were significantly less likely to be aggressive towards a non-partner (P < .05), feel anxious (P < .05) and misuse alcohol, illicit drugs and prescription drugs (P < .05) than patients in the comparison cohort, according to the researchers. Adolescents who received the intervention via a university-affiliated satellite clinic were more likely to complete it than those who received it at the community health center (75.9% vs. 62.5%), as were those who received the intervention via telehealth compared with those who received it in person (100% vs. 60%). Intervention recipients who were treated at the university-affiliated satellite clinic were also more likely to enroll in the text messages component of SafERteens-PC (81.8% vs. 55%).

“The main barrier that was encountered in implementing [SafERteens-PC] was the lack of public or private payer reimbursement for brief violence prevention interventions,” Roche said. “Even though clinic staff believed that the program was needed for their patients, the lack of reimbursement codes meant that staff could not sustain delivery of the program when not receiving compensation. We need to adjust our models of care to address this.”

To overcome this obstacle, Roche said she and her colleagues hope to convince insurance companies “to develop reimbursement codes for this evidence-based, urgently-needed program.”

When talking to adolescent patients about violence, Roche told Healio that health care providers should focus on listening rather than making judgments and remember that “the youth they are encountering are experts in their own lives.” She urged primary care providers to ask patients for permission before giving them advice.

References

Carter PM, et al. J Emer Med. 2021;doi:10.1016/j.jemermed.2021.09.003.

Roche JS, et al. Inj Prev. 2021;doi:10.1136/injuryprev-2021-044293.

Roche JS, et al. Acad Emerg Med. 2018;doi:10.1111/acem.13495.

Teplin LA, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2020.34208.

Youth violence prevention program finds success in emergency room, primary care settings. https://www.eurekalert.org/news-releases/936875. Published Dec. 6, 2021. Accessed Dec. 22, 2021.