METHODS

We analyzed our prospectively collected data for 2005–2011 from our VIP database. Success was defined as more than 50% needs met without recidivism or attrition. Impact and outcome evaluation was performed per a model promoted by the Centers for Disease Control. Rates of risk reduction and injury recidivism were calculated. Case management time spent per client (dose) was defined as low (0–1 hours per week), medium (1–3 hours per week), moderate (3–6 hours per week), and high (> 6 hours per week). Correlation coefficients and logistic regression were used to examine associations between variables and success in the VIP.

RESULTS

Two hundred fifty-four clients received services. Meeting needs in mental health (odds ratio, 5.97; 95% confidence interval, 2.72–13.07) and employment (odds ratio, 4.41: 95% confidence interval, 1.56–12.46) proved significantly associated with success (p< 0.005). The 6-year program recidivism rate was 4% versus historical control of 16%(p< 0.05). Moderate and high exposure to intensive case management in the first 3 months was also significantly associated with success (p< 0.05). Success in our VIP was not associated with age, gender, education level, previous incarceration, probation status, or length of time in program.

DISCUSSION

For 6 years, our recidivism rate has decreased fourfold compared with the rate before VIP inception. For startup and maintenance of a VIP, it is essential to know where to focus collaborative efforts in communities to target the most critical risk reduction resources. This study provides guidance—securing mental health care and employment for our clients appears to be predictive of success. The value of early “high-dose” intensive case management is also essential for reducing recidivism.