Purpose: Homicide and violent injury are leading causes of child morbidity and mortality in urban areas. Previous violent injury is a major risk factor for reinjury and death. Hospital-based violence intervention programs (HVIPs) have been effective in reducing reinjury. While the ultimate objective of HVIPs is to prevent reinjury, research is needed to elucidate intermediate measures of success. In our urban community, violent injuries disproportionately affect Black or African American children. The purpose of this study is to evaluate the engagement, retention rate, and ability to address participant needs in the first year of the Antifragility Initiative (AI), a novel pediatric HVIP. We hypothesize that programmatic success will be contingent upon effective fulfillment of participants’ core needs. Methods: AI enrolls consenting patients aged 6-15 years who present to an urban Level 1 Pediatric Trauma Center (PTC) with a violent injury. Enrolled participants receive individualized, holistic case management services for 12 months. Case managers conduct regular visits with patients and families, offering coordination of care, safety and emergency services, academic support, vocational services, and psychological support to build resiliency and post-traumatic growth. We assessed participant eligibility, enrollment, retention, demographics, and needs (safety, basic, housing, mental health, substance use, education, interpersonal, and legal) following 10 months of programmatic activity. Results: In year one, 141 patients were seen for a violent injury and met program qualifications. Of eligible patients, 38% (n=53) consented to participate, while 25% could not be reached. 74% (n=39) of consented patients remain actively enrolled, while the rest were lost to follow-up. 45% of participants are male, 55% female, the average age is 13 years old, and 92% are African-American. Of the 141 patients initially seen, 58% were male and 94% were African-American. 18% (n=7) of active participants have a history of a prior violent injury as recorded in a database capturing pediatric violent injuries from January 2010 - December 2018. Basic needs and mental health were the most cited participant needs (Fig 1). During engagement with AI, 34% of reported needs were met, and 47% are being actively addressed at the time of review (Fig 2). Conclusions: Our data indicate that our holistic HVIP effectively engages and adequately addresses the needs of our population of victims of violence along the predominant domains basic needs, mental health, and education. The capacity to fully address safety and employment domains may impact retention. The AI engages predominantly African-American children, and can contribute to improving minority health. Although we have not seen reinjury in this group, long term follow-up is needed to assess program effectiveness in reducing violent reinjury outcomes and promoting post-traumatic growth in urban youth.

Figure 1

Identified needs of AI participants throughout participation in the AI program. Basic needs include health, clothing, food, and transportation. Interpersonal needs include family relationships, positive role models, bullying, or other peer relationships.

Figure 1

Identified needs of AI participants throughout participation in the AI program. Basic needs include health, clothing, food, and transportation. Interpersonal needs include family relationships, positive role models, bullying, or other peer relationships.

Close modal
Figure 2

Total number of participants who identified needs in each category. Identified needs are classified as “met”, “unmet”, or “actively addressing”.

Percent of Participants who Identified Needs

Program Engagement with Participant Needs

Figure 2

Total number of participants who identified needs in each category. Identified needs are classified as “met”, “unmet”, or “actively addressing”.

Percent of Participants who Identified Needs

Program Engagement with Participant Needs

Close modal