Nicholas Thomson - US grants

Project Summary The consequences of youth violence have a massive financial toll on society, as well as long-term psychosocial and physical effects on the victim and communities. Perpetrators of violence also face many challenges, such as problems with mental and physical health, school performance, employment, and engaging and maintaining healthy relationships. Without a doubt, youth violence has a tremendous impact on everyone involved. Fortunately, youth violence is a preventable epidemic. Yet, high-risk youth are often difficult to reach and engage in prevention strategies. A solution to this problem is hospital-based violence prevention. Each day over 1,300 youths are admitted to the emergency department for violence-related injuries. This traumatic event can serve as a powerful precipitant for change. Hospital-based violence prevention programs, such as Bridging the Gap (BTG), capitalize on this catalyst and engage these high-risk youth. Unfortunately, many of these youths come from impoverished communities, where resources are low, protective factors are sparse, and community-levels of violence are high. Without a community-level prevention strategy, hospital-based violence prevention programs may be limited in keeping youth from engaging in violence once they leave the hospital. Thus, it may be that an integrative approach is the best strategy for cross-cutting violence prevention for high-risk violently injured youth. Using a sample of 120 violently injured youth (12-17 years) recruited from Virginia Commonwealth University Trauma Center (VCUTC), we aim to evaluate if BTG youth have greater reductions in multiple forms violence when the youth comes from a community receiving Communities that Care Prevention System and Walker-Talker/Plain Talk Community Engagement Model (BTG+CTC Plus) versus BTG youth from communities without CTC Plus. Also, we aim to evaluate the economic efficiency of BTG and BTG+CTC Plus using surveillance data. Lastly, we aim to test the presence and strength of mediators that may link early adversities to violent behavior for youth who receive BTG in communities with CTC Plus as compared to youth who receive BTG in communities without CTC Plus. To achieve these aims, the candidate and mentorship team (Drs. Sullivan and Farrell) have developed a comprehensive training plan outlining a series of training and research goals. These goals include training in risk/protective factors for multiple forms of violence, hospital-and community- based violence programs, program evaluation, and economic efficiency evaluation. This K01 proposal will capitalize on the existing expertise of the candidate. The research represents an important contribution towards understanding what works for cross-cutting violence prevention in violently injured youth. The institutional environment is recognized by the CDC as an Academic Center of Excellence in Youth Violence Prevention, and the mentors have shown longstanding success mentoring and implementing violence prevention research. The institutional environment enhances the candidate's goal of developing research independence as a highly trained scientist, with the ultimate aim to reduce and prevent violence, consistent with NCIPC's research priorities.

Abstract In the United States, firearm-related violence has reached epidemic proportions and has become a major public health problem. To help prevent the high rates of firearm-related deaths, most violence intervention programs have targeted youth (<18 years old) in the hope to slow the rapid increase of violence seen in early adulthood. However, most victims of firearm-related violence are adults (>18 years old), and national statistics show young adults (18-35 years) in particular are the most likely to die from firearm-related violence. It is important to recognize that this risk is not evenly shared among subpopulations of adults, and it is young African American men who come from economically disadvantaged communities with high rates of exposure to violence that are the most vulnerable to firearm-related violence. Unfortunately, they are difficult to engage in community-based intervention efforts. More recently, however, hospital-based violence intervention programs have become increasingly popular because of their success at engaging individuals who have suffered a violent injury. Violently injured adults are not only victims in the present, but 40% will be violently re-injured and 20% will be killed within 5 years; these patients are also 88 times more likely to commit retaliatory violence (Cunningham et al., 2009). It is clear that these adults are in dire need of effective violence intervention. At Virginia Commonwealth University (VCU) Health, we have developed Bridging the Gap (BTG), a promising violence intervention strategy that includes a hospital-based violence intervention, a firearm counseling program, and 6-months of community case management to victims of violence. BTG was originally developed for violently injured youth and results indicate it is effective for reducing youth violence. However, it is yet to be established if it is effective for reducing firearm- related violence in adults. It is also yet to be established if BTG is a cost effective strategy for reducing firearm- related violence and injury. The present study addresses Objective Two of this funding announcement; to rigorously evaluate the effectiveness of innovative and promising strategies to keep individuals safe from firearm- related injuries, deaths, and crime. This research proposal falls under Funding Option B; which supports research projects that collect new data. The goal of the present study is to assess the efficacy of BTG using a randomized control trial design in a large sample of 616 adult victims of violence over a 1-year follow-up period. Efficacy will be assessed using multiple sources of data for firearm-related violence (e.g., criminal arrest records, self-report, semi-structured clinical assessment of non-convicted firearm-related violence) and firearm-related re-injury and mortality (e.g., hospital records). To improve our understanding of the impact BTG has on firearm-related violence, we will test for psychosocial mediators linking BTG to reductions in firearm-related violence. We also aim to understand what psychosocial vulnerabilities may weaken the impact of BTG on firearm-related violence. Lastly, a cost-benefit analysis will determine the economic benefits of implementing BTG. Collectively, results from this study may support the use of BTG as a firearm-related violence intervention for adult victims of violence.

ABSTRACT: Conduct disorder (CD) is one of the most prevalent and debilitating psychiatric disorders impacting our youth. Unfortunately, the effects of CD are not limited to these early years. Youth with CD are more likely to develop lifelong mental and physical health problems, which is why CD is responsible for 5.75 million years of healthy life lost. There is mixed evidence supporting the effectiveness of treatment for CD, and this may be because youth with CD have differing etiological mechanisms. Research has shown that there is heterogeneity among youth with CD, with a subgroup of CD youth displaying more severe behavioral and personality symptoms, called callous-unemotional (CU) traits. CU traits is a specifier for CD that designates a high-risk group of youth who engage in chronic violence and criminal behavior, placing a significant burden on families and society. The key distinction is that these youth show distinct personality symptoms that current CD interventions are not equipped to treat, such as callousness towards others, lack of empathy and guilt for their harmful behaviors, and shallow/diminished affect. Understanding the mechanisms behind CU traits is essential for equipping interventions with the knowledge needed to employ a targeted approach for treating CU traits. Longstanding theories suggest that fearlessness is a key mechanism in the development of CU traits. However, biological evidence supporting the association between CU traits and fearlessness is deficient, and the current state of this examination has been restricted because of ecological validity. We will examine the association between fear and CU traits in youth (13-17 years) with CD by measuring sympathetic (pre-ejection period) and parasympathetic nervous system reactivity (respiratory sinus arrhythmia) during immersion in cutting edge virtual reality (VR) fear induction. We will concurrently apply facial electromyography to assess levels of positive and negative valence. We will also determine sex differences in these associations, as well as provide evidence of how biological fear profiles contribute to the stability of CU traits over 12 months during the adolescent period. The potential benefits of the proposal are high. Based on our pilot data, we will test our hypothesis that youth with CU traits will display a unique biological profile to fear that cannot be explained by fearlessness, and these associations are sex-specific. Confirming this finding in youth with CD may lead to reshaping prior developmental theories of CU traits that could lead to improved screening and more favorable gender-responsive treatment strategies for our youth.

Abstract The goal of this project is to support a National Center of Excellence in Youth Violence Prevention to implement and evaluate a comprehensive prevention strategy to reduce and prevent community rates of youth violence in Richmond, Virginia and similar communities across the United States. The project?s specific objectives are: (1) To implement a comprehensive approach to youth violence prevention at the community-level with the following violence prevention strategies: (a) two complementary participatory action research prevention strategies including Youth Voices, a culturally responsive curriculum for African American adolescents, and the SEED Method, an evidenced-based process where youth and adults join together to identify strategies and develop an action plan to address social and structural conditions that create inequities in positive youth development opportunities, (b) a hospital-based prevention strategy, Emerging Leaders, that offers a brief hospital-based violence intervention followed by 6-months of wrap-around community case management, a firearm safety counseling program, and a psychoeducational workshop series for youth who have experienced an intentional or violence-related injury, and (c) stakeholder education strategies to build funding and resource capacity for youth-serving grassroots organizations through workshops and technical assistance in grant-writing, to expand the Walker-Talker community engagement model to increase community members? knowledge of and access to positive youth development opportunities, and to offer evidenced-based workshops for organizations to promote youths? developmental assets; (2) To evaluate the community-level impact of this comprehensive approach through continuous collection of surveillance data on community-level indicators of youth violence exposure using a multiple baseline design in three economically disadvantaged communities; (3) To evaluate the effectiveness of each prevention strategy with this comprehensive approach by assessing their impact on specific risk and protective factors they address; (4) To develop a Youth Advisory Council that will be actively involved in the development, implementation, and evaluation of the prevention strategies, and (5) To mentor and provide training to doctoral-level students, postdoctoral fellows, and faculty in the area of youth violence prevention. The project focuses on three economically disadvantaged communities in the City of Richmond, Virginia that were selected based on community input and review of surveillance data indicating high rates of community youth violence. Youth homicide accounted for the majority of all homicides and intentional injury deaths (96%) between 1999 and 2019 (CDC-WISQARS) ? a rate that is nearly two times to 10.5 times greater than the national average (CDC-WISQARS, 2020). Violence in Richmond disproportionately impacts African American youth, and 92% of all youth who died from intentional and violence-related injuries were African American (Bishop & Chapman, 2019). Given these statistics, is essential to identify strategies that prevent and decrease community rates of youth violence in Richmond.