Grant: Operating Grant

Youth injured by violence is a major public health concern in Canada. It is the fourth leading cause of death in youth and the foremost reason youth visit an emergency department (ED). In Winnipeg, an alarming 20% of youth who visit an ED with an injury due to violence will have an ED visit for a subsequent violent injury within one year. We propose a RCT comparing a hospital-based violence intervention (HVIP) vs. usual care. We will randomize 476 youth (238 to each arm) over 4 years. We have successfully completed a CIHR-funded pilot and have demonstrated that completion of this full-scale RCT is feasible. The HVIP will be a wraparound care model delivered by support workers with lived experience with violence under the direction of social workers. Support workers will meet youth in the ED at the time of their injury and work with them for ~1 year to address the issues that the youth identifies as putting them at risk of future violence. Support workers will be on call 24/7 in order to take advantage of the "teachable moment". This HVIP was developed using a community based participatory research approach. The primary outcome is repeat visit to any ED in Winnipeg for a subsequent injury due to interpersonal violence. Secondary outcomes include visits for substance use and mental health, interactions with the justice system and changes in education status. We are poised to have near complete follow-up using administrative data and chart review due to our partnership with the Manitoba Centre for Health Policy which houses all health data and links it to multiple social databases. This will be the first RCT of a HVIP powered to detect a difference in repeat injury, to study its effect on visits for substance use and mental health, education and justice and the first to complete a formal cost-effectiveness analysis. Our team has demonstrated that we have the expertise, environment and support necessary to complete it.