Understanding the service needs of assault-injured, drug-using youth presenting for care in an urban Emergency Department.

Bohnert KM, Walton MA, Ranney M, Bonar EE, Blow FC, Zimmerman MA, Booth BM, Cunningham RM. Understanding the service needs of assault-injured, drug-using youth presenting for care in an urban Emergency Department. Addictive Behaviors. 2015 Feb 1; 41:97-105.

Related HSR&D Project(s)

• CDA 11-245 – VA Healthcare Delivery for OEF/OIF Veterans with Mental & Substance Use Disorders

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Abstract:

BACKGROUND: Violence is a leading cause of injury among youth 15-24years and is frequently associated with drug use. To inform optimal violence interventions, it is critical to understand the baseline characteristics and intent to retaliate of drug-using, assault-injured (AI) youth in the Emergency Department (ED) setting, where care for violent injury commonly occurs. METHODS: At an urban ED, AI youth ages 14-24 endorsing any past six-month substance use (n = 350), and a proportionally-sampled substance-using comparison group (CG) presenting for non-assault-related care (n = 250), were recruited and completed a baseline assessment (82% participation). Medical chart review was also conducted. Conditional logistic regression was performed to examine correlates associated with AI. RESULTS: Over half (57%) of all youth met the criteria for drug and/or alcohol use disorder, with only 9% receiving prior treatment. Among the AI group, 1 in 4 intended to retaliate, of which 49% had firearm access. From bivariate analyses, AI youth had poorer mental health, greater substance use, and were more likely to report prior ED visits for assault or psychiatric evaluation. Based on multivariable modeling, AI youth had greater odds of being on probation/parole (AOR = 2.26; CI = 1.28, 3.90) and having PTSD (AOR = 1.88; CI = 1.01, 3.50) than the CG. CONCLUSIONS: AI youth may have unmet needs for substance use and mental health treatment, including PTSD. These characteristics along with the risk of retaliation, increased ED service utilization, low utilization of other health care venues, and firearm access highlight the need for interventions that initiate at the time of ED visit.