title: Where do we go from here? Interim analysis to forge ahead in violence prevention.
abstract: BACKGROUND
  The severity and disparity of interpersonal violent injury is staggering. Fifty-three per 100,000 African Americans (AA) die of homicide yearly, 20 per 100,000 in Latinos, whereas the rate is 3 per 100,000 in Caucasians. With the ultimate goal of reducing injury recidivism, which now stands at 35% to 50%, we have designed and implemented a hospital-based, case-managed violence prevention program uniquely applicable to trauma centers. The Wraparound Project (WP) seizes the "teachable moment" after injury to implement culturally competent case management (CM) and shepherd clients through risk reduction resources with city and community partners. The purpose of this study was to perform a detailed intermediate evaluation of this multi-modal violence prevention program. We hypothesized that this evaluation would demonstrate feasibility and early programmatic efficacy. We looked to identify areas of programmatic weakness that, if corrected, could strengthen the project and enhance its effectiveness.
  
  
  METHODS
  We performed intermediate evaluation on the 18-month-old program. We selected the Centers for Disease Control and Prevention-recommended instrument used for unintentional injury prevention programs and applied it to the WP. The four sequential stages in this methodology are formative, process, impact, and outcome. To test feasibility of WP, we used process evaluation. To evaluate intermediate goals of risk reduction and early efficacy, we used impact evaluation.
  
  
  RESULTS
  Four hundred thirty-five people met screening criteria. The two case managers were able to make contact and screen 73% of gun shot victims, and 57% of stab wound victims. Of those not seen, 48% were in the hospital for <or=2 days. Fifty-four percent of those screened had identified needs and received CM services. Thirteen percent refused services. Of the high-risk clients receiving full services (N = 45), 60% were AA and 30% were Latino. Sixty percent of the AA had no contact with their fathers. CM "dose": In the first 3 weeks of enrollment, 40% of the time, case managers spent >6 h/wk with the client. Forty-one percent of the time, they spent 3 hours to 6 hours. Seventeen of 18 people who required >6 hours had two to three needs. Attrition rate is only 4%. The table demonstrates percent success thus far in providing risk reduction resources.
  
  
  CONCLUSIONS
  WP case managers served high-risk clients by developing trust, credibility, and a risk reduction plan. Cultural competency has been vital. Six of seven major needs were successfully addressed at least 50% of the time. The value of reporting these results has led WP to gain credibility with municipal stakeholders, who have now agreed to fund a third CM position. Intermediate evaluation provided a framework in our effort to achieve the ultimate goal of reducing recidivism through culturally competent CM and risk factor modification.
authors.affiliation: Department of Surgery, University of California-San Francisco and Division of Acute Care Surgery, San Francisco General Hospital, San Francisco, California, USA. dickerr@sfghsurg.ucsf.edu
authors.forename: Rochelle A
authors.initials: RA
authors.lastname: Dicker
authors.forename: Sebastian
authors.initials: S
authors.lastname: Jaeger
authors.forename: Mary M
authors.initials: MM
authors.lastname: Knudson
authors.forename: Robert C
authors.initials: RC
authors.lastname: Mackersie
authors.forename: Diane J
authors.initials: DJ
authors.lastname: Morabito
authors.forename: Javier
authors.initials: J
authors.lastname: Antezana
authors.forename: Michael
authors.initials: M
authors.lastname: Texada
mesh_terms: D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D016730:Program Development; D015397:Program Evaluation; D012495:San Francisco; D014193:Trauma Centers / Q000458:organization & administration*; D014754:Violence / Q000517:prevention & control*; D014948:Wounds, Gunshot / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control*; D014951:Wounds, Stab / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control*; D055815:Young Adult