Analysis

Making a safe space for victims of knife crime

Emergency departments call on youth workers to help deal with traumatised victims of assault

Emergency departments call on youth workers to help deal with traumatised victims of assault

Knife_crime
Picture: iStock

Hospitals in England last year recorded more than 4,400 finished consultant episodes (FCEs) in which a patient was a victim of ‘assault by sharp object’.  

Knife crime, as such assaults are more commonly known, is on the rise. This is partly due to improvements in recording practices, but a 2017 increase in FCEs of 7.6% on the previous year, and of nearly 22% since 2015, represents a ‘persistent and worrying concern’, says a parliamentary briefing paper published in June.

Young people are usually both victims and perpetrators

Nurses encounter first-hand the frightened, bloodied players in these brutal fights and feuds. But in the turmoil of the emergency department (ED) their priority is rightly to save lives rather than to change them.

34,700

Offences involving a knife or sharp instrument in England and Wales in year ending March 2017

Increasingly, however, clinical staff in EDs are working with outside agencies to try to turn young people away from violence.  

Birmingham is the latest city to place youth workers in EDs, with a three-year pilot recently underway at University Hospitals Birmingham NHS Foundation Trust.

Working with the charity Redthread, the trust has embedded specialist teams in the EDs at Queen Elizabeth and Heartlands hospitals. Their purpose is to engage with children and young people aged 11-24 who are victims of serious assault.

Opportunities to change

David Hornsby, ED matron at the Queen Elizabeth Hospital, says the trust has seen an increase in the number of young patients presenting with penetrating or blunt trauma injuries, ‘from relatively minor all the way up to life-threatening’.

He adds: ‘Organisations such as Redthread that can intervene in these young people’s lives at a critical moment and give them an opportunity to change direction are a massive help.’

21%

of offences for possession of a knife or offensive weapon in year ending March 2018 were by juveniles aged 10-17

In London, Redthread has been running a similar youth violence intervention programme at King’s College Hospital for 13 years.

But the fact that the charity’s services are now in demand beyond the capital indicates that serious violence is a factor in more and more young people’s lives.

Redthread began in Dulwich, south London, in 1995. Parishioners at local churches thought the area’s children and young people could be more involved in the community if facilities and activities were available to them.

A youth club was among the first projects to be established. Although no longer linked with the churches, the charity remains grounded in a fundamental belief in the importance of building communities.

Patterns of violence

Imran Mahomed, Redthread’s programme manager in the Midlands, says placing specialists in EDs helps to interrupt patterns of violence.

‘The youth worker is not a clinician, doctor or nurse, and is not there as a police officer or a parent. They’re just there as a concerned adult who can support young people and help them reflect on where they’re at.’

Mr Hornsby agrees that the distinction between roles is important.

‘For A&E nurses, it’s sometimes difficult to gain the trust of this type of patient. They’ve come from a threatening or frightening incident, they’ve already got a level of mistrust of uniforms, and we’re just another uniform.

6.2%

Of 10-15 year olds said they know someone who carries a knife for their own protection

‘But if they’ve got a youth worker who can relate to them, translate some of the medical jargon and de-escalate some of the stress involved, then there’s an opportunity to make inroads and gain trust.

‘The youth worker can also make them aware of other opportunities, other directions, other locally available support networks, and get them on to a different track.’

Rhythms of acuity

A good induction for Redthread staff is vital, says Mr Hornsby. ‘They get to know the department, and its rhythms of acuity and presentations.’

He acknowledges, however, that these rhythms are becoming less predictable, with the traditional increase in violence-related injuries on Friday and Saturday nights no longer so discernible.

‘We see a lot more midweek patterns of traumatic injury now. But it’s very difficult to say with any accuracy what times of day these kinds of injuries will come in. They seem to happen at any time.’

Currently, youth workers cover in the ED from early morning until 8pm or 9pm, with some cover at weekends too. They attend the nursing handover and take referrals verbally or in writing.  

‘We’re right there in the thick of it,’ says Mr Mahomed. ‘Just being that little moment of calm in a busy emergency department can be massively powerful for the young person,’ he says.

‘And while the initial work is there in the hospital, what we’re also trying to do is help the young person identify what else they can be doing to make sure they don’t end up in there again – whether that’s about education, work, finding a safe place to live, or any number of other things that might be going on.

‘We ask: “What do we need to do to help you make changes so you don’t end up back here again?”.’

It is too early to assess the impact of the Birmingham scheme, but Mr Hornsby is confident of success.

‘It’s providing young adults with an opportunity they may never have otherwise been exposed to and a chance to take a different path.

‘I can’t predict what the result will be for each individual who comes into contact with Redthread, but just having a kid with an opportunity to do something different with their life – I can’t overestimate the value of that.’

‘This is a safe place’

Brummie_Redthread
Left to right: Midlands programme manager Imran Mahomed; Redthread team members
Beth Daley, Tesfa Blackman and Lydia Hextall; University Hospitals Birmingham NHS Foundation
Trust doctor Katie Wright; Redthread team members Sean Monaghan, Nicola Shilliday,
Jodie Berry and Jo Gibson. Picture: Adrian Wressell

Redthread programme manager Imran Mahomed describes a case that exemplifies how the charity’s youth violence support workers based in emergency departments intervene.

‘He was a really big young man, very imposing. He’d been stabbed in the shoulder, close to his throat.

‘As he’s being brought into the emergency department he’s struggling, trying to push people away.

‘The youth worker saw straight away that this is a young man who’s just had somebody try and stab him in the throat and now he’s been brought into this place where people are trying to hold him down, and doctors are trying to put needles in him.

‘The difficulty this young person has is in actually processing what’s going on and thinking, “This is a safe place for me – these people are trying to help me, support me”. That doesn’t register because he’s so emotionally elevated.

That’s where the youth worker has got a really wonderful opportunity to be that little bridge between the clinical teams and the young people – calming the young person down, reassuring them that these people are here to help so you must let them do what they need to do to keep you safe, keep you alive.

‘It’s amazing how well that works.’

 

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