DiversityNursing Blog

Written by James McIntosh

While violence intervention programs have demonstrated that they can be an effective way of preventing violent injury, little has been known about their financial implications. A new study now suggests that these interventions could save various sectors millions of dollars.

Researchers from Drexel University have analyzed the cost-benefit ratio of hospital-based violence intervention programs (HVIPs) and report that - as well as benefiting victims' lives - HVIPs can make costs savings of up to $4 million over a 5-year period in the health care and criminal justice sectors.

"This is the first systematic economic evaluation of a hospital-based violence intervention program, and it's done in a way that can be replicated as new evidence emerges about the programs' impacts across different sectors," states lead author Dr. Jonathan Purtle.

As a major cause of disability, premature mortality and other health problems worldwide, HVIPs have a crucial role to play in helping victims from experiencing further suffering.

The provision of case-management and counseling from combinations of medical professionals and social workers has been associated with not only reducing rates of aggressive behavior and violent re-injury but also improving education, employment and health care utilization for service users.

Many HVIPs still require a sustainable source of funding

Intervention typically begins in the period immediately after a violent injury has been sustained. Not only is this a critical moment in terms of physical health, but it can also be a time when victims may start thinking about retaliation or making changes in their lives.

"The research literature has poetically referred to the time after a traumatic injury as the 'golden hour,'" says study co-author Dr. Ted Corbin.

In 2009, around six programs were in operation and, as word of their success has spread, more and more HVIPs have been initiated.

Calculating the potential financial benefits of HVIPs is crucial, as for many of these programs a stable and sustainable source of funding does not exist. Instead, many rely on a variety of different financial sources such as insurance billing, institutional funding, local government funding and private grants.

For the study, published in the American Journal of Preventive Medicine, the researchers conducted a cost-benefit analysis simulation in order to estimate what savings an HVIP could make over 5 years in a hypothetical population of 180 violently injured patients. Of these, 90 would receive HVIP intervention and 90 would not.

Costs, rates of violent re-injury and violent perpetration incidents that a population would be estimated to experience were calculated by the authors using data from 2012.

The authors made a comparison between the estimated costs of outcomes that would most likely be experienced by the 90 hypothetical patients receiving HVIP intervention - including $350,000 per year costs of the HVIP itself - and the costs of outcomes predicted for 90 patients not receiving any HVIP intervention.

The net benefit of the interventions

A total of four different simulation models were constructed by the researchers to estimate net savings and cost-benefit ratios, and three different estimates of HVIP effect size were used.

Costs that were factored into the simulations included health care costs for re-injury, costs to the criminal justice system if the victims then became perpetrators and societal costs for potential loss of productivity.

Each simulation calculated that HVIPs produced cost savings over the course of 5 years. The simulation model that only included future health costs for the 90 individuals and their potential re-injury produced savings of $82,765. The simulation model including all costs incurred demonstrated savings of over $4 million.

Dr. Purtle acknowledges that estimated lost productivity costs may have been slightly high due to an assumption in their data that all individuals in the simulation were employed. However, he believes that there are also many social benefits to HVIPs that cannot be financially quantifiable:

"Even if the intervention cost a little more than it saved in dollars and cents to the health care system, there would still be a net benefit in terms of the violence it prevented."

The authors believe that the findings of their study could be useful in informing public policy decisions. By demonstrating that HVIPs can be financially beneficial, the study suggests that an investment in HVIPs is one that pays off for everyone concerned.

Source: www.medicalnewstoday.com

By Lisa Esposito

When forensic nurse examiners work with survivors of violence – sexual assault, child abuse, elder abuse or domestic assault – they’re painstakingly collecting and documenting evidence that can hold up in a potential court case. And they’re taking care of a person who’s just been traumatized, often by someone they know well. Forensic nursing takes a balance of objectivity, skill and compassion, and it’s more than just a job for the professionals who do it.

Experts on the Stand

Whatever type of assault they’ve endured, survivors’ first encounter with law enforcement or medicine “paves the way for their entire future,” says Trisha Sheridan, a forensic nurse and clinical assistant professor at Texas A&M Health Science Center College of Nursing.

Victims face a higher risk of post-traumatic stress disorder, depression, suicide and medical problems in the aftermath, she says, and those who “have a positive experience with someone who’s trained to deal with victims of violence” tend to not only have better legal outcomes, but better quality of life than others who receive standard emergency care. But in Texas, especially the more rural areas, forensic nurse examiners are few and far between.

While certified forensic nurse examiners undergo extensive skills training, Sheridan believes graduate programs can move forensic nurses to the next level, with a deeper understanding of the science behind the evidence they’re collecting, helping them explain the pathology and ramification of victims’ injuries in a courtroom. For instance, she says that information helped the jury “make a better-informed” decision when she testified in two recent cases of strangulation.

Taking On Domestic Violence

Strangulation is one of the most frequent injuries in domestic violence, yet symptoms are subtle and often downplayed, says Heidi Marcozzi, coordinator of the Intimate Partner Violence Program, started last year as a branch of District of Columbia Forensic Nurse Examiners, which also works with victims of sexual assault.

Forensic nurses look not only for bruises and scratches, but less obvious symptoms such as petechiae (small red or purple spots on the skin), voice changes, cough and headaches, Marcozzi says. They ask patients about loss of bowel and bladder function, which is a good indicator that they lost consciousness during the attack.

“Domestic violence is a huge issue” in the nation’s capital, Marcozzi says. The program’s 30 forensic nurses respond to these calls from MedStar Washington Hospital Center, anytime day or night. Within an hour of getting the call for a domestic violence case, the forensic nurse arrives at the hospital, where ER staff have already made sure the patient is in a quiet, private space rather than the waiting room.

Before the exam, the forensic nurse walks the patient through the whole process. “We see a fair amount of drug-facilitated sexual assaults, so we want to make sure it’s very clear that the patient is able to consent,” Marcozzi says. “Then we do a medical exam head to toe to make sure they’re physically stable.” Nurses pays close attention while patients describe the incident and use that account to guide where they collect evidence, including swabs that will later go to the crime lab for analysis.

The FNE photographs any injuries and examines the patient using a high-powered light source that can reveal hard-to-see signs like bruising. The light also helps the nurse locate "foreign secretions ... things will fluoresce under certain wavelengths – semen, urine, saliva,” Marcozzi says.

More Than Just a ‘Rape Kit’

Victims of sexual assault go through essentially the same process, with the addition of a pelvic exam, which takes an additional 15 minutes or so. Examiners photograph the genitals for signs of injury, and then collect swabs as indicated. Treatment comes next. If appropriate, patients can receive Plan B emergency contraception to prevent unwanted pregnancy, or medications to protect against HIV and other prevalent sexually transmitted infections.

In sexual assault cases covered by DCFNE, an advocate with Network for Victim Recovery of DC accompanies the nurse to the hospital and helps patients with crisis management, discharge plans, crime victim’s compensation and referrals for counseling.

Preventing the Worst

For domestic violence victims, the DCFNE program teams up with Survivors and Advocates for Empowerment, a nonprofit that provides advocacy and crisis intervention, and works to hold offenders accountable. SAFE runs the lethality assessment project for the District of Columbia – trying to determine which victims are at highest risk for being killed by their abusers.

Advocates evaluate the victim’s environment for cues – such as whether the abuser has easy access to weapons, or even “if there’s a child in the home who doesn’t belong to him, which, believe it or not, increases the severity of the risk,” says Natalia Marlow-Otero, SAFE director.

Of the 5,000 or so domestic violence cases SAFE sees each year, up to 1,900 are deemed high-lethality cases. Isolation is a “huge” factor among the women – and some men – who are victims of domestic violence. Isolation and abuse are even more prevalent among immigrant clients, Marlow-Otero says, so SAFE provides an English/Spanish helpline (1-866-962-5048). People can also call the National Domestic Violence Hotline at 1-800-799-7233 (1-800-​799-SAFE). ​

Source: http://health.usnews.com