Every year, thousands of young people aged 11-24 find themselves in hospital following a serious assault or incident of exploitation. Redthread’s Youth Violence Intervention Programme embeds specialist youth workers in all four of London’s Major Trauma Centres, where we aim to reduce serious youth violence and have transformed the support available to these young victims.

Redthread youth workers are embedded in the hospital alongside the clinical teams. They utilise this unique position to engage the young victims in their moment of crisis and vulnerability – the ‘Teachable Moment’. The youth workers meet each young person as soon as they can, often when they are still receiving emergency medical treatment. They assess each young person’s situation and needs and devise an action plan that is specific to them. They mentor and advise the young person and make relational referrals to specialist partner organisations and services so that this traumatic incident can become the catalyst for positive and healthy changes. Each of the four teams are referred around 450 young people a year.

Key to both our model and approach, is the belief that violence is a health issue. Traditionally viewed as a social and criminal justice issue, we believe that changing the way we all understand violence is crucial to effectively treating it.

It is clear that being involved in and witnessing violence negatively affects a person’s physical and mental health, but further research by Dr Slutkin, founder of US-based Cure Violence, identifies that it behaves much like tuberculosis, cholera and other epidemics.

Exposure to violence is the greatest cause of further violence; it transmits like a contagious disease.

This is certainly something we see in our work. Clinicians tell us that they often treat the same young person again and again, and so many of the young people we work with tell us that they have been exposed to violence throughout their life: at home and in the community. This cycle of violence and trauma is one that, without support, is very hard to break away from. Our programme aims to support young people to do exactly this, by being there in the ‘teachable moment’ and interrupting violence at the point of transmission.

Working with patients who have been the victim of serious violence or exploitation is often challenging, as hospital teams up and down the country know. Violence, trauma and the overwhelming nature of the situation can affect the way a young person acts when at hospital. This behaviour can be difficult to deal with, but it is important to be aware that this moment is likely to be a terrifying experience for a young person and that this negative or abusive behaviour is often a consequence of trauma.

These behaviours might include:

being aggressive and rude to staff

reacting with suspicion to treatment, or denying treatment at all

minimising the incident – a ‘blasé’ attitude to a traumatic event

withdrawn behaviour

hyper vigilance or paranoia

These behaviours can be incredibly frustrating and distressing for hospital staff who are doing their best to treat and care for patients, but reacting to this behaviour with hostility is not beneficial for staff or for the young people. Violence can often lead to psychological as well as physical wounds and whilst in the hospital, victims find themselves confronted with the effects of their choices and behaviour.

Many feel as though they are facing an unprecedented and life-changing decision: to change their way of life or to carry on as normal – which may involve retaliation. Many of the young people are discharged back into the hostile environments in which they were hurt which can have devastating effects, with many re-attending with worse or even fatal injuries. In most cases, busy clinicians are simply unable to offer support beyond medical treatment, and the ‘teachable moment’ passes, but by encouraging young people to reflect during this time, we can support them to change their lives.

Being embedded in the hospital where we are on hand to offer support at a moment’s notice is key to our programme, as is being recognised as fellow healthcare professionals. We aim to be the bridge between the young people and the hospital staff, helping young people to remain calm for treatment, or helping them to navigate an environment they may at first appear hostile to. Support from a youth worker can also help to calm a young person, allowing medical teams to prioritise medical treatment.

Co-written by Mary Dawood RN, BSc (Hons) MSc Consultant Nurse at Imperial College NHS Trust, and a Redthread youth worker based at St Mary’s, this article illustrates this close relationship. It discusses the case of a young man who attended the hospital with multiple stab wounds. The article details the experiences of this young man, the support he received from the clinicians and Redthread, as well as the support the youth worker was able to offer the clinical team.

Due to the high number of referrals, we aim to link young people in with services for any long term support they may need. Each of our hospital teams have strong links with services in their communities, making sure that young people are supported after discharge. After assessing a young person’s needs in hospital, and arranging a plan for their next steps together, we are able to provide support with issues such as housing, counselling, education and training.

Redthread’s unique position also gives us the opportunity to follow up cases when clinicians have suspicions surrounding a young person’s involvement in violence or exploitation.

‘Suzie,’ attended St Mary’s Hospital after being assaulted at Notting Hill Carnival. Suzie was discharged before being seen by one of the Redthread team, but a youth worker phoned her the next day.

On the phone, Suzie agreed to meet up with one of our youth workers in a safe and confidential space to discuss any support she would like. During this meeting Suzie told the youth worker about the physical and sexual abuse she had been suffering from since childhood. Suzie did not have any other professional support. The Redthread youth worker worked closely with Suzie over a number of weeks. This work helped prepare Suzie for long-term change, and the youth worker was able to successfully refer her to Solace Women’s Aid to receive specialist support from an Independent Domestic Violence Advocate and to New Horizon Youth Centre for support in securing education, employment or training. It was critical that Redthread were able to meet Suzie following her hospital visit. Thanks to the referral from a clinician she was offered life-changing support at a vital time.

Violence can have terrible consequences for individuals, families and communities, but in A&E we have a unique opportunity to support young people. By intervening in this moment of intense crisis and vulnerability we can help them to make healthy choices and positive plans to turn their lives around.

Find out more about Redthread here.