Grantee: University of Washington. The full study report is linked here.
Description of the Intervention. This project was a randomized controlled trial (RCT) of an adaptation of Critical Time Intervention (CTI) for hospitalized gunshot wound victims. The CTI adaptation — provided for six months after hospital discharge — connected gunshot wound victims with necessary community services, ensured they had an appropriate support system, and helped them develop a plan for achieving long-term goals (e.g., employment, education). While still hospitalized, patients were provided Motivational Interviewing designed to encourage their engagement in CTI. Both CTI and Motivational Interviewing are backed by promising evidence of effectiveness from prior RCTs in other policy contexts. In the study described below, the intervention was generally well-implemented (e.g., 99% of treatment group members in the final sample received motivational interviewing and 61% received CTI).
Study Design. The study randomly assigned 146 calendar weeks over approximately a three – year period (2016−2018) to treatment versus control conditions. Gunshot wound victims admitted to Seattle’s Harborview Medical Center during “treatment” weeks were eligible to receive the intervention, and those admitted during “control” weeks received usual services. A total of 366 gunshot wound patients met the study’s eligibility criteria (e.g., they were older than 18, and lived in certain pre-specified surrounding counties at the time of their hospitalization). Of these eligible patients, 232 consented to participate in the study.
Impact on the Primary Outcome. Over an average follow-up period of 16 months after random assignment (10 months post-intervention)1, the intervention was found to have no statistically significant effect on patients’ likelihood of subsequent arrest (34.7% of the treatment group were arrested during the follow-up period vs. 36.8% of the control group). Arrest outcomes were measured with administrative data maintained by the Washington State Administrative Office of the Courts and the Washington State Patrol.
Study Quality. Based on a careful review, we believe the study was generally well-conducted and likely produced valid findings2.
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1
Follow-up ranged from 0-33 months post-random assignment depending on when patients were enrolled in the study.
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For example, the study had successful random assignment (as evidenced by highly similar treatment and control groups) and valid analyses that were publicly pre-registered and accounted for the fact that weeks, rather than individual patients, were randomly assigned. One potential concern is sample attrition – specifically, arrest data were unavailable for 38% of treatment group patients and 40% of control group patients (primarily due to patients’ refusing consent or not responding to researchers’ requests for consent, as well as a few patients’ relocation to another state). However, concern that attrition may have undermined the study’s validity by creating differences between the treatment and control groups is mitigated by the fact that: (i) attrition rates were nearly identical for the two groups (and the combined attrition and differential attrition rates thus fall within What Works Clearinghouse attrition standards for a well-conducted RCT); and (ii) treatment and control group members at the end of the study (i.e., after sample attrition) were still highly similar in their observed pre-program characteristics.
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