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One Therapy Session in ER Can Cut Teen Violence
Date:8/3/2010

By Amanda Gardner
HealthDay Reporter

TUESDAY, Aug. 3 (HealthDay News) -- Having a therapist talk to kids who go to an emergency room with a violent injury and who also admit to previous alcohol use can reduce repeat episodes, new research finds.

The authors calculated that for every 10 kids seen, a single 30-minute intervention would prevent one violent episode in the future.

The study was funded by the National Institute on Alcohol Abuse and Alcoholism.

"The leading cause of death for adolescents who reside in inner city settings is violence and other injuries," said Maureen Walton, lead author of a study appearing in the Aug. 4 issue of the Journal of the American Medical Association. "These adolescents are less likely to attend school regularly, they're not likely to have a primary care physician and the emergency room is a popular place for a variety of reasons. We decided this would be a good setting for prevention."

Previous studies had shown good results from similar interventions addressing alcohol but no studies have yet looked at violence. These authors combined the two.

"Kids who drink are also likely to fight, whether they actually drink at the time of the fight, and are likely to be involved in other problematic behaviors," Walton explained.

These authors tested outcomes of a program called SafERteens. The study involved more than 700 kids aged 14 to 18 who had visited an emergency department in Flint, Mich., from noon and 11 p.m. any day of the week between September 2006 and September 2009.

Kids who admitted to using alcohol or being involved in a fight in the past year were randomly assigned to three groups: one in which kids talked with a therapist (along with computerized feedback and structure); a computer-only group in which a virtual "buddy" walked kids through a set of questions including some about goals and reasons to avoid drinking to reach those goals; and a control group receiving a brochure with referrals to community resources.

After three months, participants in the therapist arm showed a 70 percent to 76 percent reduction in violence, including peer aggression, compared with the controls.

At six months, those in the therapist group also had a greater reduction in alcohol consequences than those in the computer intervention group, although both showed improvement.

"The therapist intervention is what showed promise for violence," Walton reported. "For alcohol, both the therapist and the computer-alone interventions were effective as compared to the brochure."

The researchers noted some limitations to the study, including self-reported data, and are now collecting 12-month follow-up data.

Walton reported that follow-up rates exceeded 85 percent in the study and that although a lot of the participants frequently moved from home to home, the researchers were able to track them down by simply calling their cell phones or by locating them on MySpace or Facebook.

How realistic is it to think emergency rooms across the country will adopt this or a similar approach?

"There is some cost. The hospital administration is not going to see the results but at the societal/community level we will definitely see results," said Dr. Michael Kamali, acting chair of the department of emergency medicine at the University of Rochester Medical Center. "But if you've been in an emergency department on any given evening, there's a lot of trauma. If you can influence life-long decisions, hopefully this gives pause."

The emergency room at the University of Rochester hospital admits kids who are likely to experience another trauma within days. "It's a cooling-off period so we can avert having them be a victim again, and so they don't retaliate," said Kamali.

Walton said that some alcohol interventions were reimbursed, and that she and her colleagues are reaching out to emergency rooms across the country about implementing similar measures.

More information

The National Library of Medicine has more on teen violence.

SOURCES: Maureen A. Walton, Ph.D., research associate professor, department of psychiatry, Addiction Research Center, University of Michigan, Ann Arbor; Michael Kamali, M.D., acting chair, department of emergency medicine, University of Rochester Medical Center; Aug. 4, 2010, Journal of the American Medical Association.


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