Research suggests that children or young people who attend emergency departments for care because of violence are at greater risk of experiencing this again. Dr Sarah Bekaert PhD describes schemes that are putting extra support in place to try to change future outcomes.
Is there a navigator scheme for young people in your local hospital?
These are a valuable resource and growing in number. Navigators provide support to young people who attend the hospital as a result of violence. Connecting with young people at a moment of injury or crisis, where they me be more open to intervention, the navigator works with the young person to potentially stop violence escalation. A navigator offers immediate assistance, at this reachable moment, and a pathway of support beyond the hospital.
Navigators are non-medical or nursing staff, often with youth work training, co-located with the staff in the emergency department (ED). They reach out to the young person in crisis, listen, and potentially link them into ongoing support in the community.
Young people appreciate the normality of this interaction in a fast-paced, alien environment; trust is developed, and therefore they are more likely to continue with this support beyond the hospital setting.
In one example, the Thames Valley Hospital Navigator Scheme, implemented in five emergency departments by five voluntary community sector organisations, 70% of young people referred engage with the service. In this service, referrals are made for young people who have either directly experienced violence, or the possible root causes of violence such as substance abuse or mental health crisis.
While a specific incident may bring young people to the ED, the cause may be a combination of wider issues requiring wider support such as housing, substance misuse or counselling. The navigator begins to work with the young person on these wider or ongoing challenges, starting in the hospital and continuing into the community.
The Thames Valley Hospital Navigator Scheme also brings people with lived experience such as previous drug use or mental health challenges – into the navigator role. This adds value as the young people can see how it is possible to change the pathway.
Through flexible contact and support, offered over time by navigators, positive relationships are developed with the young people.
Not having set parameters around the type of support offered is a strength of the service. They may, for example, accompany young people to community-based services, or advocate for the young person with housing or the GP. Sometimes a formal referral can be made, such as to mental health services or mentorship programmes. The navigator journeys alongside the young person to a point of stability and thriving beyond.
Evaluation of the Thames Valley scheme has shown that most benefitted from a short-term intervention, with 52% achieving a successful outcome within three months. A further 24% received signposting – a brief intervention where the young person was linked straight into appropriate services – and 24% required support beyond three months.
In the hospital, navigators provide invaluable support to the ED team. Navigators can step in to reassure and calm patients, freeing up nursing and medical staff time. More specifically, the support has been shown to respond to a gap in services for young adults – the transition years between child and adult services. For example, in the Thames Valley scheme, 35% of young people referred into the scheme were aged between 18 and 25 years, representing the largest age group supported by the service.
The service also responds to another current societal need, offering rapid response to young people experiencing mental health challenges. While 37% were referred for violence, a significant 27% were referred for mental health support.
Such services also have the potential to contribute to reduced ED reattendance. For example, in the Thames Valley scheme, 77% of young people who accepted navigator support did not re-attend the emergency department within a six-month follow-up period – early signs of an effective demand reduction approach.
There is potential cost saving by reducing ED reattendance, and wider socio-economic savings for society. The cost-benefit saving of hospital navigator schemes has been estimated to be £4.90 per £1 spent with the financial benefits across several public agencies, including acute health.
Consequences of violence have implications for the individual, community and society – these include anxiety, depression, drug and alcohol use, and the likelihood of reactive perpetration. Considering the wider societal impact of an initiative aimed at reducing and preventing violence related injury, the cost benefit of such early intervention schemes has been estimated at £82 for every £1 spent.
In the Crime Survey for England and Wales figures, 1.1 million violent offences were recorded for the year ending December 2022. These occurrences of violence often result in hospital care. A Youth Endowment Fund report states that in 2021, for young people there was a 12% increase in violence against the person – offences such as harassment, common assault, actual or grievous bodily harm.
In 2019, the UK Home Office commissioned 18 Violence Reduction Units to develop effective ways of tackling violent crime and its causes. One approach adopted has been to provide support to vulnerable young people in specific settings, such as healthcare, as an early intervention approach. Many have implemented a navigator scheme within local Trust EDs.
There is a growing recognition in the UK of the benefits of schemes able to reach young people at a moment of crisis and/or injury such as hospital navigator schemes. The model is also being effectively implemented in other settings such as schools and custody. A focus on young people is an opportunity for early intervention and support to interrupt the cycle of violence and promote positive pathways into adulthood.
Dr Sarah Bekaert PhD is a senior lecturer in child health at Oxford Brookes University, registered nurse (RN) Child and research manager for the Thames Valley Violence Reduction Unit.
This article was originally published by our sister publication Nursing in Practice.
