Hospital youth work project

Aim

This service aims to ensure that all young people aged 11–17 attending A&E are screened for social risk factors, particularly where these relate to issues that might lead them to be involved in violence or to be criminally exploited. Resulting youth work interventions seek to help them navigate extra support in the community, to prevent them from coming to harm in the future.

Description

Youth workers provide non-judgemental support to young people from across Sussex who attend the Emergency Department at Brighton’s Royal Alexandra Children's Hospital (RACH) with a violence-related injury or other social risk factors.

two youth workers

Most of the young people are referred to the service by hospital staff in the Emergency Department or its safeguarding team. They may have experienced violence, victimhood or criminal exploitation, and they may have attended A&E more than once.

Having a resource based right where it’s needed, in the Emergency Department, means that these vulnerable young people can be identified and helped at a 'reachable and teachable’ moment – the point when additional support is most likely to be successful.

The service also provides a hub for signposting and referrals to support services (such as refuges, housing services, and drug and alcohol services) that promote a positive and safe lifestyle.

Partners

The service is delivered by the Trust for Developing Communities and funded by the Sussex Violence Reduction Partnership and the Rockinghorse Children’s Charity.

Partners include:

  • National Health Service
  • Sussex Police
  • Brighton & Hove City Council: Adolescent Health Service, substance misuse, social work
  • Child and Adolescent Mental Health Service (CAMHS)

Intended outcomes and benefits

For participating children and young people

  • Reflect on issues that may affect their safety and well-being
  • Encourage and enable the development of good behaviours
  • Prevent violence from escalating to serious criminality

For partner organisations

  • Improve the system of support (clinical and community)

Features of good practice

Project workers deliver teaching and training to A&E staff, improving their confidence and expertise in managing these complex adolescent patients, which is of benefit to staff, patients and families.

Feedback and testimonials

Children and young people

  • “I've had difficulties with substances and drinking and stuff. So he's introduced me to a lot of different things to help me out with that."
  • "[After spending time with the hospital youth worker] I've been staying out of trouble, to be fair. Yeah. It's just been better than what it was before I overdosed and all. Yeah. Haven't been doing as many drugs. Haven't been getting in fights and all that. Haven't been getting arrested."

Parents and carers

  • "My son came in really upset, after a distressing week. Our connection and relationship has been really difficult for a long time and his mental ill health was making it unsafe at home. [The youth worker] helped to put some support in place for my son and for me too! … What I particularly valued was his sensitivity, communication skills and clear ability to assess and understand our situation. I was also really impressed with his signposting to relevant organisations. He even took the time to follow us up and to make a referral for me. He made a dreadful situation a little more bearable.“
  • “As a parent I really appreciated someone else being able to step in and bring calm to an otherwise extremely emotional and difficult situation.”

Hospital staff

  • "We don't know what we'd do without them, they're essential to making sure that our young people get support when they leave - because it's all very well us patching them up, but we need stuff to be happening outside in the community."
  • “As a team we do the best we can during the time these young people are in hospital, but we simply don’t have the time to explore some of the underlying issues resulting in their visit to A&E or follow up cases in a way that might prevent them from needing to be re-admitted. We can now point these vulnerable teenagers, who present to our Emergency Department, to someone who might be able to help steer them in the right direction.”

Youth workers

  • “Being based right where young people come into the hospital when they are at crisis point means I am in a position to help them straight away. Once the doctors and nurses have triaged their presenting condition, I can begin working with them to discover some of the reasons they came to the A&E in the first place. I can then help them to look at helping them where they want help, managing some of the challenges and working on strategies to help improve their life.”

Referral partners

  • "Whereas the nurses and the doctors are all there very much to medically save [young people], those youth workers are there to support him being regulated, calm, having someone to talk to who empathises with them."
  • "To have someone who's interested in them enough to find out how they can make their lives better once they leave hospital, I just think that's enormous."

Evaluation

National evidence suggests that A&E navigator programmes like this one can prevent further violence.

The National Children’s Bureau (NCB) carried out an independent evaluation of the service in 2023-24.

The Centre for Education and Youth (CfEY) previously carried out an external evaluation in 2022.

Awards

The service won a 2023 Children & Young People Now Award in the Safeguarding category.

In 2024 it was recognised with a personal award from the High Sheriff of East Sussex, Richard Bickersteth.

Overall impact

The scheme has received positive anecdotal evidence supporting its impact, including from partners. Children and young people struggling because of violence and/or exploitation can get the help they need at an early stage, before it’s too late.

Learning

The project has identified the following learning.

  • The service is most effective when it can engage with young people directly and quickly, so it prioritises direct delivery in the emergency department of the children’s hospital.
  • Spreading the service too thinly had the potential to erode service quality, so the referral criteria have been narrowed since the project started in April 2022.

Next steps

Following their visit to the project in July 2023, a team of Senior Policy Advisors from the office of the Children’s Commissioner for England are interested in using the work in Sussex as a case study, for wider learning across the country.