Building a Developmental Profile for Youth Exposed to Severe Violence: Harnessing Hospital and Administrative Data

Introduction: Black and Latinx youth bear an unequal burden of adversity and trauma, with 61% of Black non-Hispanic and 51% of Hispanic children having experienced at least one adverse childhood experience (ACE) compared with 40% of White and 23% of Asian children. These disparities are evident with some of the most extreme forms of adversity, namely, severe assaults and gun violence. Black youth are killed in gun-related incidents at rates 2-10 times higher than all other races. For youth who survive, 37% will return to the emergency department within two years with another assault-related injury. Despite significant advances in technology, few studies have harnessed the power of integrated system data to better understand the experiences of some of the most vulnerable youth. Researchers have called for more comprehensive patient data to aid the development and evaluation of programming, such as hospital-based violence intervention programs, which is essential to systematically build and synthesize knowledge for violence prevention and intervention.

Methods: 452 pediatric trauma patients admitted with either assault or gunshot injuries to a large hospital system in Cleveland, OH between 2017-2018 and a comparison sample (n= 20,525) of similarly-aged youth enrolled in the Cleveland Metropolitan School District in 2017-2018 were matched to a rich individual-level, prospective, integrated administrative dataset, i.e., the Child Household Integrated Longitudinal Data (CHILD) System. A comprehensive profile including juvenile delinquency involvement, education (e.g., attendance), birth and family characteristics (e.g., born to a teenage mother), public assistance receipt, lead testing, homelessness, and child welfare involvement was created. Within- and between-group differences were tested using t-tests for continuous data and chi-square tests for categorical data.

Results: On average, individuals in both the patient and comparison samples were 12 years old, and the majority were male (58%, 52% respectively) and African American (93%, 64% respectively). In the patient sample, 83% were admitted for assault injuries, the remainder for gunshot wounds. Within the patient sample, statistically significant differences (p<.05) were observed, with gunshot victims more likely to be older and male than assault victims. Between the patient and comparison samples, there were statistically significant differences, with the patient sample showing more positive lead test results or missing tests, child maltreatment and foster care involvement, public assistance usage, homelessness, juvenile delinquency, and chronic school absenteeism. The patient sample also had statistically lower maternal education.

Conclusion/Implications: This report represents a first attempt to link pediatric trauma data on violent injuries to individual-level records held in an integrated data system. Matching administrative records beginning at birth and spanning through youth’s development with hospital records unearths a profile rich in adversity evident among youth exposed to severe violence. Though this vulnerable youths’ exposure to adversity is not in itself a novel finding, the comprehensive and robust nature of the profile highlights critical information that can inform program planning and service delivery. Future research should explore if patterns exist, such as the co-occurrence and frequency of certain types of adversity. Additionally, an index of social complexity could advance the field to better serve pediatric trauma patients.