A study of 113 children and teens physically
victimized by peers concludes that one-on-one
mentoring about how to safely avoid conflict and diffuse
threats makes them far less likely to become
victims again if guidance is initiated in the immediate
aftermath of the attack.
The research, by investigators at Johns
Hopkins Children's Center and Children's National
Medical Center in Washington, D.C., was conducted with 10-
to 15-year-olds treated for assault
injuries, including gunshot, knife and fistfight wounds, in
their emergency rooms between 2001 and
Writing in the November issue of Pediatrics,
the researchers said that half 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.
Those who got the personalized counseling and forged a
mentoring relationship with their
counselors reported 25 percent fewer fights and 42 percent
fewer fight injuries six months later,
compared to those who received referrals only. Comparing
their attitudes and behaviors after six
months, researchers found that teens who received mentoring
reported less aggression and fewer
misdemeanors and were more likely to "think about the
consequences," take steps to avoid fighting and
"take a time out" when faced with a conflict.
Although not all risky behaviors showed statistically
significant improvement, the researchers
said that the results suggest that such interventions can
go a long way to giving these 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 youth were
taught about weapon safety and engaged in role playing 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 to help them
better monitor their children's safety.
Serious fights and assaults are rarely isolated
episodes, the researchers said, but may portend
future — sometimes worse, or even fatal —
"There can be a cycle of violence fueled by fear and
retaliatory feelings," said study lead
investigator Tina Cheng, head of General Pediatrics and
Adolescent Medicine at the Johns Hopkins
Children's Center. "When we see youth with assault injuries
in the ER, we have a golden window of
opportunity to step in and interrupt this cycle, and our
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
physicians treating teen victims of violence to
refer youth and their families to mentoring and family
counseling programs before discharging the
patient from the ER. Past research shows that people may be
most receptive to preventive messages
in the immediate aftermath of a traumatic event.
The researchers also suggest development of standard
guides to help ER physicians do so.
"We have clear protocols on how to treat suicidal
youth or victims of child abuse, but when it
comes to youth injured in peer assaults, we tend to ask a
few questions, treat and release," Cheng said.
"Our study suggests that we can do things that make a
difference, such as asking more probing
questions about the incident and quickly referring the
patients to mentoring and counseling programs."
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, according to the Centers for
Disease Control and Prevention. For every slain youth,
there are more than 100 nonfatal injuries.
Also involved in the study was the National Institute
of Child Health and Human Development.
Other investigators were Shang-en Chung, of Johns
Hopkins; Denise Haynie, Bruce Simmons-
Morton and Ruth Brenner, of the National Institute of Child
Health and Human Development; and
Joseph L. Wright, of the Child Health Advocacy Institute,
Children's National Medical Center.
The research was funded by the Department of Health
and Human Services' Maternal and Child
Health Bureau and the National Center on Minority Health
and Health Disparities.