Computerized survey in ED changes attitudes on violence.

CHICAGO -- A brief computerized intervention conducted while violent youths are in the emergency department is feasible, well received, and effective at changing their attitudes toward aggression and alcohol, according to Dr. Rebecca Cunningham.

Data from the first 2 years of a 5-year study of adolescents aged 14-18 years entering an urban level I emergency department in Flint, Mich., were presented at the annual meeting of the Society for Academic Emergency Medicine.

"Violent injury is a leading cause of morbidity for urban teens and often is associated with alcohol misuse. Their visits to emergency departments may represent a teachable moment to address the problem of aggression and binge drinking," said Dr. Cunningham of the department of emergency medicine at the University of Michigan, Ann Arbor.

Between September and November 2006, all youths aged 14-18 years entering the emergency department were asked to complete a computerized survey of risk behaviors. Teens who had attempted suicide, were victims of sexual assault, or had unstable vitals were excluded.

Teens with a history of violence in the preceding year or alcohol use were randomly assigned to one of three arms: a 30-minute interactive brief intervention delivered via a computer; a brief intervention by a research therapist; or a control group that received an informational brochure dealing with drinking and violence.

The brief intervention contained a review of goals, tailored feedback on risk behaviors, role playing for practicing risk reduction, and referrals, Dr. Cunningham explained.

Because of the low literacy rate among these patients, those using computers wore earphones through which everything was read to them. They simply listened and tapped out the responses, she said.

The program, which is tailored to individuals based on their screening results, also draws out the youths' own goals. "That helps the kids to think about what they would like their lives to be, to think about the consequences of their behavior, then to realize how these two might be discrepant," Dr. Cunningham said.

Of the 648 youths screened during the recruitment phase of the study, 22% met risk criteria both for past alcohol use and aggressive behavior often involving the carrying of weapons, Dr. Cunningham said.

Of the total cohort, 48% were male and half were African American. So far, all but 5% have completed the intervention prior to discharge.

"All parts of the brief intervention can be stopped and started at any time without interfering with clinical care," she said, adding that few teens needed assistance with the computer survey (6%) or intervention (2%).

After the intervention, patients showed significant changes in attitudes toward alcohol use and violence, including the carrying of weapons. In addition, the intervention was well received, with almost a third of the participants saying they "'liked it a lot,'" Dr. Cunningham said.

More work is needed to evaluate the effectiveness of the brief intervention on reducing violent behavior among urban teens in the ED, she concluded.

BY BRUCE K. DIXON

Chicago Bureau