One-on-one talk with therapist reduces peer aggression

Teens in the ER got the message about avoiding fights and drinking, study shows

 A brief, motivational talk in the emergency room reduced by half the chances that teenagers would experience peer violence or problems due to drinking, according to a study published Aug. 4 in a theme issue of the Journal of the American Medical Association.

The special issue on violence and human rights includes the work of University of Michigan Health System researchers who immersed themselves at the Hurley Medical Center Emergency Department, in Flint, Mich., for three years.

Researchers offered help to 726 adolescents, ages 14-18, who reported they experienced aggression or had a drink of beer, wine or liquor at least two or three times in the past year.

A one-on-one talk with a therapist resulted in a 34 percent reduction in peer aggression. Teens who received only a brochure had a 16 percent drop in aggression over the next three months.

The study showed similar drops in alcohol use after teens heard prevention messages delivered by a therapist or while using a role-playing computer program.

"Violence and alcohol use are preventable behaviors and the emergency department can be a key location for reaching high-risk teenagers," says senior author Rebecca Cunningham, M.D., an emergency room physician and director of the University of Michigan Injury Research Center.

Violence and injuries are the leading causes of deaths among adolescents in the United States and the incidents are often fueled by alcohol. The U-M study showed ED interventions can also reduce alcohol-related problems by as much as 32 percent for six months.

The talks with teens were more complex than a parent talking to a child about the dangers of drinking and how to avoid peer pressure.

"Therapists used motivational interviewing which is well-suited for adolescent development," says study lead author Maureen Walton, M.P.H., Ph.D., research associate professor in the U-M Department of Psychiatry, Addiction Research Center. "It doesn't preach or tell teens what to do, but allows adolescents to weigh the pros and cons of their choices in reference to their goals."

The therapists' talks with teens also included role play exercises and tools to cope with risky situations with regard to drinking and violence and referrals to community services.

"Most of the adolescents had high aspirations - they wanted to go to college, be a good role model for their younger siblings. They didn't want to make the mistakes they see happening around them," Walton explains. "We talked to them about the discrepancies between their behavior and what they wanted to do with their lives."

Motivational Interviewing, with proper training, can be used effectively by healthcare providers as well those without a professional healthcare background. Study co-author Stephen T. Chermack, Ph.D, a clinical psychologist and addiction specialist at the U-M Health System and the VA Healthcare System in Ann Arbor is a member of the Motivational Interviewing Network of Trainers (MINT).

Adolescents in the study reported to the emergency department at Hurley Medical Center between noon and 11 p.m., between September 2006 and September 2009.

All patients completed computerized screening questions regarding alcohol use and violence and were randomized into three groups: a control group receiving a brochure, or one of two groups receiving a 35-minute brief intervention delivered by a computer or a therapist in the emergency room.

Authors say the computer screening worked well with teenagers because of their comfort with using technology. The computer program included animated role playing and provided exercises and tools to cope with risky behavior such as drinking and driving and conflicts.

"The study tells us that technology can aid in assisting high risk youth in busy clinical settings, as well as deliver important prevention messages," says Cunningham who is also an associate professor of emergency medicine at the U-M Medical School and associate professor of health behavior & health education at the U-M School of Public Health. "Emergency staff are busy and not all hospitals have the resource of a social worker or therapist present at all times in the emergency department."

The ED can be a prime location for reaching high risk teenagers since many may skip school, consider themselves too old to go to a pediatrician, yet often do not have a primary care doctor.

"We see the consequences our patients face from violence," says Cunningham who is part of the team of U-M physicians who work in the Flint emergency department.

"But in addition to treating the immediate wounds from violence, the Emergency department can offer opportunities to help the teens we see prevent future problems with alcohol and violence."