Nov 3 2008
Researchers in the U.S. say young victims of violence can benefit from 'one on one' counseling - they say mentoring about how to safely avoid conflict and diffuse threats makes them far less likely to become victims again.
The researchers from the Johns Hopkins Children's Center and the Children's National Medical Center in Washington, D.C. make these claims following a study of 113 children and teens physically victimized by peers.
The study was conducted on 10- to 15-year-olds treated for assault injuries, including gunshot, knife and fist-fight wounds, in the emergency rooms between 2001 and 2004 and the conclusion was reached that 'one-on-one' mentoring about how to safely avoid conflict and diffuse threats made them far less likely to become victims again if guidance was initiated in the immediate aftermath of the attack.
The researchers say half of the victims were treated then referred by an ER doctor for at least six sessions with a mentor for 'one-on-one' counseling and three parent home visits, while the other half were referred to community resources and received two follow-up phone calls.
It was found that those who received the personalized counseling and forged a mentoring relationship with their counselors reported 25% fewer fights and 42% fewer fight injuries six months later, compared to those who received referrals only.
When the researchers compared the attitudes and behaviours of the two groups after six months, they found that teens who received mentoring reported less aggression and fewer misdemeanors and were more likely to think about the consequences and take steps to avoid fighting and also take 'time out' when faced with a conflict.
The researchers say although not all risky behaviours showed statistically significant improvement, the results suggest that such interventions can significantly offer children acceptable options for behaving in ways that prevent violence, and that the ER is a critical point for initiating the intervention.
The counseling focused on practical tips for the children and their families, such as ways to think about conflict and how to identify and avoid 'hot buttons' or triggers of anger.
The youths were taught about weapon safety and given scenarios and engaged in role play to facilitate conflict resolution and getting out of dangerous situations in appropriate ways.
Home visits were designed to inform the victims' parents about skills taught to their children and help them better monitor their children's safety.
The researchers say serious fights and assaults are rarely isolated episodes, but may portend future, sometimes worse or even fatal, injuries.
Lead investigator Dr Tina Cheng says there can be a cycle of violence fueled by fear and retaliatory feelings and when young people appear with assault injuries in ER, it represents a golden window of opportunity to step in and interrupt this cycle.
Dr Cheng says their findings suggest that pairing teens with mentors who teach them problem-solving skills can help decrease the risk of future violence.
The study's investigators advise emergency room doctors treating teen victims of violence to refer youth and their families to mentoring and family counseling programs before discharging the patient from the ER and this strategy is supported by previous research which shows that people may be most receptive to preventive messages in the immediate aftermath of a traumatic event.
The researchers also suggest the development of standard guides to help ER physicians.
Dr Cheng says there are clear protocols on how to treat suicidal youth or victims of child abuse, but when it comes to youth injured in peer assaults, few questions are asked, they are treated and released.
Dr Cheng says the study suggests that things can be done that make a difference, such as asking more probing questions about the incident and quickly referring the patients to mentoring and counseling programs.
According to the Centers for Disease Control and Prevention, in the United States, murder is the fourth leading cause of death among 10 to 14-year-olds and the second leading cause of death among 15 to 19-year-olds, and for every youth murdered, there are more than 100 nonfatal injuries.
The research appears in the November issue of Pediatrics.
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