Violently-injured adolescent males of color treated at urban pediatric ED need mental health care

Adolescent males of color treated for violent injury and discharged from an urban pediatric emergency department (ED) overwhelmingly identified a need for mental health care, according to research from Children's Hospital of Philadelphia (CHOP)'s Violence Intervention Program (VIP), published today in the Journal of Adolescent Health.

"We know that it is vitally important to listen to the voices and needs of youth," said lead study author Rachel Myers, PhD, research scientist at CHOP. "This work highlights how adolescent males receiving care in the ED with what may be physically minor injuries are suffering significant trauma. We also know that with real support, young people are resilient, go back to school, and go on to graduate and pursue their goals."

The study examined data from 49 adolescent males who were treated at CHOP's ED between January 2012 and August 2016 after suffering a violence-related injury, typically from peer assaults, and elected to enroll in VIP. Participants, predominantly young men of color between the ages of 12 and 17 years old, identified their needs and goals for recovery at intake and during the course of their participation in case management.

At intake to the CHOP VIP, nearly two-thirds of the adolescents reported significant traumatic stress symptoms. Most (75 percent) of the injuries were non-penetrating.

Nearly 90 percent of participants felt they needed mental health services, including therapy and suicide counseling. More than half (60 percent) said they needed legal help, including obtaining police reports. About half (56 percent) also identified a need for psychosocial support, and said they would attend peer group sessions with other injured youth. Adolescent males treated and discharged from the ED were significantly more likely to identify safety needs, such as addressing peer relationships in school and community, as compared to those admitted to the hospital, who may have experienced more serious injuries.

"Assault victims describe feeling constantly tense and 'on guard,' and having nightmares or unwanted flashbacks of the assault. Unfortunately, many youth also begin to avoid talking about the event or avoiding the places or people that remind them of the assault-- school, friends, normal adolescent activities," said Myers. "It shows us that just treating the external wounds is not enough. Young men not only need, but want help to cope with their fears and difficult emotions in the aftermath of injury."

The researchers say they are seeing more violently-injured youth in CHOP's ED each year, with 150 youths since January 1 who would qualify for VIP's direct case work. These services include comprehensive assessment, support navigating services such as medical, legal, and education, peer-facilitated group therapy, and trauma-informed mental health therapy. Recovery goals are developed in partnership with youth and their families, respecting youths' voice and choice.