Taking teachable moments to cut risk of violence

PROJECT

Youth Violence Intervention Programme

PURPOSE

To present pathways out of violence and exploitation to young people in the Midlands

FUNDING

Funding includes £500,000 from the Health Foundation’s Scaling Up Improvement programme and £100,000 from Nottingham Hospitals Charity

BACKGROUND

Charity Redthread started working with King’s College Hospital in 2006, embedding youth workers in the emergency department. The success of the programme led to an expansion into four other London hospitals, funded by the London Mayor’s Office. However, youth violence is not a problem limited to the capital. Redthread was approached by three hospitals in Birmingham and Nottingham in 2017, asking whether the model could be rolled out in the Midlands. “The clinicians recognised they were seeing a pattern of a crisis, followed by another crisis, and were aware that a medical intervention isn’t of itself enough to stop that violence or exploitation continuing,” says Redthread chief executive John Poyton.

Between 2012 and 2016, there were 463 assault-related injuries seen at the Queen’s Medical Centre in Nottingham, while in Birmingham, 335 victims of assault under the age of 25 came into the Queen Elizabeth Hospital between October 2015 and September 2016. The Youth Violence Intervention Programme launched as a three-year pilot at the Queen’s Medical Centre in February 2018 and at the Heartlands and Queen Elizabeth Hospitals in July 2018. The programme is now established in all three hospitals as an ongoing intervention.

ACTION

Three youth workers have been embedded in the three hospitals, with the aim of working with young people aged 11 to 24 who come to the emergency department as victims of serious assault or major trauma. Based in the A&E department, they aim to identify and support these young people as soon as possible after they arrive. “They might be invited to be in the resus bay [for treatment of patients with critical conditions] awaiting the arrival of an ambulance, because the clinicians see the youth worker as a crucial advocate for the young person,” says Poyton. “The youth worker will be talking to and calming the young person, while the medical team gets to work.”

If the young person agrees, the youth worker works with them to assess their risks and needs and to put together a risk reduction plan. If appropriate, the young person then gives written consent for support to be provided, both in hospital and beyond.

The intervention is tailored to the needs of the individual and usually continues for around 12 weeks. The youth worker might support the young person to put together a map of safe places and spaces for them in their community, coach them in problem-solving, and use activities to foster emotional self-regulation and build self-esteem. Youth workers support young people to access services such as the police, mental health, social care, housing and education, and may accompany them to formal and informal meetings and assessments after they have left hospital.

The approach centres on the “teachable moment”, with the youth workers aiming to use the immediate aftermath of violence as an opportunity for young people to voluntarily address the factors in their life that put them at risk. Redthread youth workers undergo an induction and core training programme and receive ongoing training throughout their time with the charity. They receive clinical supervision as well as line management. Most are already experienced youth workers with backgrounds in mental health, youth justice services and social work.

Redthread was able to move into the Midlands due to funding from The Health Foundation’s Scaling Up Improvement programme, which supports teams to take successful interventions and expand them. “It is one of the most innovative and creative programmes we have supported,” says Will Warburton, director of improvement at The Health Foundation.

In the Midlands, Redthread has developed an innovative “hub and spoke” model, in order to widen the project’s reach. In Birmingham, there is one “hub” hospital and two “spokes”. In Nottingham, there is currently one hub and one spoke with scope to expand in both areas. “Working in the major trauma centres, with the most severely injured young people, there is a concern that we are offering too little, too late,” says Poyton. “By the time the young person is coming in they have already been the victim of violence and exploitation.” The new model sees youth workers attending smaller hospitals for a few days a week, without being embedded in the team. “We can work with young people sooner and do interventions when they are presenting with lower level injuries,” explains Poyton.

Another development is the expansion of Redthread’s network of clinical champions within the NHS. Redthread has always had a clinical lead in each site who helps embed the team but in Nottingham the organisation is training a wider group on Redthread’s approach who can then promote it to colleagues.

The pandemic enforced a temporary shift to remote working between April and June 2020 but in July the youth workers returned to the hospitals. “After the first lockdown we saw a significant increase in referrals,” says Poyton.

OUTCOME

Since the project launched, Redthread has supported 863 young people across the three Midlands sites, 317 through an intensive programme that, explains Poyton, involves “longer term work that continues after discharge from hospital”. More than 50 clinical champions have been engaged and over 500 community practitioners and hospital staff have received training in supporting young victims of violence and exploitation.

Between April 2018 when the service went live at the Queen’s Medical Centre, Nottingham and the end of March 2020, 90 per cent of the young people who were supported did not return to hospital for a violence-related injury. According to Redthread’s own statistics, 100 per cent of beneficiaries from the three Midlands sites felt as safe or safer than they had before the incident that brought them to hospital, and 93 per cent of young people’s risk of continuing a lifestyle that exposed them to further harm had been reduced or prevented from escalating.

A Health Foundation evaluation published in December 2020 found the NHS could not offer “best practice in assessment, practical and psycho-social support and safe discharge for young people after violence and exploitation” without the support of specialist services such as Redthread.

WHAT’S NEXT?

The intervention’s success in the Midlands has shown it can be scaled up to other parts of the country, says Poyton. Where the model currently targets young people affected by violence, there is potential to investigate establishing a multi-disciplinary team to support young people presenting with self-harm and alcohol and substance-misuse related injuries as well, he says.

The programme is also working on ensuring young women are supported as well as young men. “Young women will often present with a sexual health issue, rather than say they have been assaulted, and clinicians have to know to ask the right questions,” says Poyton. “It’s a strategic priority for us to address the ways in which young women might be affected by violence both within and outside an intimate relationship.”

An increasing policy emphasis on alternative approaches to violence reduction and integrated work between health, social services, the criminal justice system and the community and voluntary sector could help Redthread expand further. “The development of Violence Reduction Units, for example, should give a forum where the NHS, criminal justice and other organisations can come together to commission and support this kind of work,” says Warburton. Violence Reduction Units are collaborative, place-based responses to violence, and have been launched or planned in 18 English cities.

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