How a reachable moment in A&E can reduce youth violence and exploitation
25 March 2024
Youth violence is a national problem. Hospital emergency departments see thousands of children and young people every year who have an injury related to violence – whether they’ve been in a fight or been the victim of violent assault or exploitation.
Redthread is a charity that supports young people in crisis. Its hospital-based Youth Violence Intervention Programme began in London hospitals and, with the support of the Health Foundation, has since been rolled out more widely across cities in the Midlands.
Using crisis as a reachable moment
Redthread’s programme embeds specialist youth workers in emergency departments, ready to work with young people aged 11–25 who are affected by violence or exploitation.
Each day youth workers start their shift by checking in with the A&E team to identify any patients who have come in because they’ve been assaulted or who might have been affected in less obvious ways by violence or exploitation. They then visit them while in hospital or as soon as possible after discharge, offering a chance to talk and providing tailored, holistic support.
Rich Collinson is Head of Fundraising at Redthread. He says this approach is based on the idea of the ‘reachable moment’; that the moment of crisis, when the young person is vulnerable and in need of support, can be a catalyst for pursuing positive change.
Redthread’s interventions are designed to support and empower young people to lead safer, healthier lives. The team build a relationship with the young person while they are in hospital and then continue to offer ongoing support once they are back in their community.
Hospital staff respond well to having the Redthread team on site, acknowledging that the youth workers have the time and skills to engage with young people in ways doctors and nurses often can’t.
‘In a busy A&E department, it's difficult to really give that time… So obviously having a team like Redthread there... they spend time with the patient, help them settle down and hopefully get that information, [and find out] if there's any concerns.' – Dr Asif Rahman, A&E Consultant, Imperial College Healthcare NHS Trust, interviewed here.
Evaluations of the service show that the police also acknowledge that having a youth worker not in uniform or representing any statutory services can break down barriers and build trust with young people, helping to disrupt the repeat cycle of involvement in violence.
Support to spread beyond London
Seeing the success of this approach in London, the Health Foundation supported Redthread between 2018–20 to spread their intervention to hospitals in other cities, with Nottingham and Birmingham both identified as areas that could benefit.
With support from two hospital trusts and other funders, youth workers were embedded in Queen’s Medical Centre hospital in Nottingham, and Queen Elizabeth and Heartlands hospitals in Birmingham. Hospital staff were also trained to identify and support young people affected by violence and exploitation.
Spreading the intervention proved highly successful. Across the three hospitals, 863 young people were supported over the two-year project, along with 500 members of staff. Six months after the intervention, 100% of the young people said they felt as safe or safer than before.
The evaluation also reported that young people who engaged in the programme were 51% less likely to attend hospital again than those who didn't, while a cost benefit analysis found that every £1 spent led to £4.90 in economic and social benefits.
What’s been the longer-term impact of the Health Foundation’s support?
Since the Health Foundation funding ended, Redthread have continued to run services from the Birmingham and Nottingham hospitals while also expanding further. The programme has been running in eight hospitals in London, and five across the Midlands.
This growth has had a big impact on the number of young people Redthread is able to reach.
Rich told us, ‘Since April 2020, our youth workers have gone on to provide holistic support and advocacy to over 7,000 children and young people presenting to hospitals in London, Birmingham and Nottinghamshire. Redthread has also delivered training to thousands of professionals to build their confidence to identify and better support children and young people affected by violence and exploitation.’
The impact on youth violence
Independent evaluations conducted since 2020 have continued to show positive outcomes from the work, including risk reductions and lower hospital re-attendance rates for young people.
Redthread’s own assessment data shows that in 2022–23, of the children and young people supported by their Youth Violence Intervention Programme:
- 80% reported feeling safer
- 57% decreased their risk of exploitation
- 61% were less likely to be involved in crime
- 55% were more likely to engage in education training and employment
- And 54% were more likely to engage with other services.
Supporting girls who are victims of violence
The charity has also since expanded its work with girls who are victims of gangs and violence, embedding a Young Women’s Service in four of their hospital sites in London.
Henna Khalique is Violence Against Women and Girls Lead at Redthread. Interviewed for this recent feature on Channel 4 news about the work with young women, she says it's easy to underestimate how many young women are being affected by violence, abuse, and sexual and criminal exploitation due to their involvement in gangs, as it’s often not as visible.
‘If we focus on just the assaults and the physical injuries, then we will continue to miss these young women.’
That’s why being based within the emergency department means workers can pick up on the more subtle signs that someone may benefit from some targeted help and support.
Plans for the future
Redthread plans to sustain and develop existing services wherever possible, with the support of funders and other partners. Unfortunately, due to lack of funding, services at the two Nottinghamshire sites and one of the Birmingham sites are ending in April. However, Redthread will continue to operate their Youth Violence Intervention Programme in ten hospitals in London and Birmingham.
Rich says, ‘We know that other professionals recognise the importance of the services we deliver, and it’s been great to see this support continue to grow. It is a challenging funding climate, and our priority is to sustain our existing services. Our ambition is also to scale our impact through greater local collaborations, innovation, knowledge sharing and working in partnership with a range of providers to ensure that young people in crisis are empowered by us now and for many years to come.'
To find out more, visit the Redthread website.
This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.
