Youth violence intervention programme for vulnerable young people attending emergency departments in London: a rapid evaluation.

J. Appleby, T. Georghiou, J. Ledger, Lucina Rolewicz, C. Sherlaw-Johnson, S. Tomini, Jason M Frerich, P. L. Ng
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This study evaluates one such initiative run by the charity Redthread in partnership with a NHS trust.\n\n\nObjectives\nTo evaluate the implementation and impact of a new youth violence intervention programme at University College London Hospital NHS Trust and delivered by the charity Redthread: (1) literature review of studies of hospital-based violent crime interventions; (2) evaluation of local implementation and of University College London Hospital staff and relevant local stakeholders concerning the intervention and its impact; (3) assessment of the feasibility of using routine secondary care data to evaluate the impact of the Redthread intervention; and (4) cost-effectiveness analysis of the Redthread intervention from the perspective of the NHS.\n\n\nMethods\nThe evaluation was designed as a mixed-methods multiphased study, including an in-depth process evaluation case study and quantitative and economic analyses. The project was undertaken in different stages over two years, starting with desk-based research and an exploratory phase suitable for remote working while COVID-19 was affecting NHS services. A total of 22 semistructured interviews were conducted with staff at Redthread and University College London Hospital and others (e.g. a senior stakeholder involved in NHS youth violence prevention policy). We analysed Redthread documents, engaged with experts and conducted observations of staff meetings to gather more in-depth insights about the effectiveness of the intervention, the processes of implementation, staff perceptions and cost. We also undertook quantitative analyses to ascertain suitable measures of impact to inform stakeholders and future evaluations.\n\n\nResults\nRedthread's service was viewed as a necessary intervention, which complemented clinical and other statutory services. It was well embedded in the paediatric emergency department and adolescent services but less so in the adult emergency department. The diverse reasons for individual referrals, the various routes by which young people were identified, and the mix of specific support interventions provided, together emphasised the complexity of this intervention, with consequent challenges in implementation and evaluation. Given the relative unit costs of Redthread and University College London Hospital's inpatient services, it is estimated that the service would break even if around one-third of Redthread interventions resulted in at least one avoided emergency inpatient admission. This evaluation was unable to determine a feasible approach to measuring the quantitative impact of Redthread's youth violence intervention programme but has reflected on data describing the service, including costs, and make recommendations to support future evaluation.\n\n\nLimitations\nThe COVID-19 pandemic severely hampered the implementation of the Redthread service and the ability to evaluate it. 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In the light of problems with routine patient data systems and linkages, we have also been able to reflect on data describing the service, including costs, and made recommendations to support future evaluation.\n\n\nFuture work\nNo future work is planned.\n\n\nFunding\nNational Institute for Health and Care Research Health Services and Delivery Research programme (RSET: 16/138/17).","PeriodicalId":73204,"journal":{"name":"Health and social care delivery research","volume":"11 10 1","pages":"1-122"},"PeriodicalIF":0.0000,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health and social care delivery research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3310/hsdr-tr-133641","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
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Abstract

Background Youth violence intervention programmes involving the embedding of youth workers in NHS emergency departments to help young people (broadly aged between 11 and 24 years) improve the quality of their lives following their attendance at an emergency department as a result of violent assault or associated trauma are increasing across the NHS. This study evaluates one such initiative run by the charity Redthread in partnership with a NHS trust. Objectives To evaluate the implementation and impact of a new youth violence intervention programme at University College London Hospital NHS Trust and delivered by the charity Redthread: (1) literature review of studies of hospital-based violent crime interventions; (2) evaluation of local implementation and of University College London Hospital staff and relevant local stakeholders concerning the intervention and its impact; (3) assessment of the feasibility of using routine secondary care data to evaluate the impact of the Redthread intervention; and (4) cost-effectiveness analysis of the Redthread intervention from the perspective of the NHS. Methods The evaluation was designed as a mixed-methods multiphased study, including an in-depth process evaluation case study and quantitative and economic analyses. The project was undertaken in different stages over two years, starting with desk-based research and an exploratory phase suitable for remote working while COVID-19 was affecting NHS services. A total of 22 semistructured interviews were conducted with staff at Redthread and University College London Hospital and others (e.g. a senior stakeholder involved in NHS youth violence prevention policy). We analysed Redthread documents, engaged with experts and conducted observations of staff meetings to gather more in-depth insights about the effectiveness of the intervention, the processes of implementation, staff perceptions and cost. We also undertook quantitative analyses to ascertain suitable measures of impact to inform stakeholders and future evaluations. Results Redthread's service was viewed as a necessary intervention, which complemented clinical and other statutory services. It was well embedded in the paediatric emergency department and adolescent services but less so in the adult emergency department. The diverse reasons for individual referrals, the various routes by which young people were identified, and the mix of specific support interventions provided, together emphasised the complexity of this intervention, with consequent challenges in implementation and evaluation. Given the relative unit costs of Redthread and University College London Hospital's inpatient services, it is estimated that the service would break even if around one-third of Redthread interventions resulted in at least one avoided emergency inpatient admission. This evaluation was unable to determine a feasible approach to measuring the quantitative impact of Redthread's youth violence intervention programme but has reflected on data describing the service, including costs, and make recommendations to support future evaluation. Limitations The COVID-19 pandemic severely hampered the implementation of the Redthread service and the ability to evaluate it. The strongest options for analysis of effects and costs were not possible due to constraints of the consent process, problems in linking Redthread and University College London Hospital patient data and the relatively small numbers of young people having been engaged for longer-term support over the evaluation period. Conclusions We have been able to contribute to the qualitative evidence on the implementation of the youth violence intervention programme at University College London Hospital, showing, for example, that NHS staff viewed the service as an important and needed intervention. In the light of problems with routine patient data systems and linkages, we have also been able to reflect on data describing the service, including costs, and made recommendations to support future evaluation. Future work No future work is planned. Funding National Institute for Health and Care Research Health Services and Delivery Research programme (RSET: 16/138/17).
伦敦急诊科针对弱势青年的青年暴力干预方案:快速评估。
背景青年暴力干预计划涉及将青年工作人员安置在NHS急诊部门,以帮助年轻人(年龄在11至24岁之间)在因暴力袭击或相关创伤而去急诊科就诊后提高生活质量,这在整个NHS范围内正在增加。这项研究评估了慈善机构Redthread与英国国家医疗服务体系信托基金合作开展的一项此类举措。目的评估慈善机构Redthread在伦敦大学学院医院NHS信托基金会实施的一项新的青少年暴力干预计划的实施情况和影响:(1)对基于医院的暴力犯罪干预研究的文献综述;(2) 对当地实施情况以及伦敦大学学院医院工作人员和当地相关利益攸关方有关干预及其影响的评估;(3) 评估使用常规二级护理数据评估Redthread干预影响的可行性;以及(4)从NHS的角度对Redthread干预的成本效益分析。方法将评估设计为混合方法的多阶段研究,包括深入的过程评估案例研究以及定量和经济分析。该项目在两年多的时间里分为不同阶段进行,首先是基于桌面的研究,然后是在新冠肺炎影响NHS服务时适合远程工作的探索阶段。共对Redthread和伦敦大学学院医院的工作人员以及其他人(例如参与NHS青少年暴力预防政策的高级利益相关者)进行了22次半结构化访谈。我们分析了Redthread文件,与专家进行了接触,并对工作人员会议进行了观察,以收集关于干预措施的有效性、实施过程、工作人员的看法和成本的更深入的见解。我们还进行了定量分析,以确定适当的影响衡量标准,为利益攸关方和未来的评估提供信息。结果Redthread的服务被视为一种必要的干预措施,补充了临床和其他法定服务。它在儿科急诊科和青少年服务中得到了很好的应用,但在成人急诊科则不那么普遍。个人转诊的不同原因、确定年轻人的各种途径以及提供的具体支持干预措施的组合,共同强调了这种干预措施的复杂性,以及随之而来的实施和评估挑战。考虑到Redthread和伦敦大学学院医院住院服务的相对单位成本,据估计,如果大约三分之一的Redthread干预措施导致至少一人避免了紧急住院,该服务将实现收支平衡。这项评估无法确定一种可行的方法来衡量Redthread青年暴力干预计划的数量影响,但已经反映了描述该服务的数据,包括成本,并提出了支持未来评估的建议。限制新冠肺炎大流行严重阻碍了Redthread服务的实施和评估能力。由于同意程序的限制,无法提供最有力的效果和成本分析选项,将Redthread和伦敦大学学院医院的患者数据联系起来的问题,以及在评估期间参与长期支持的年轻人相对较少。结论我们已经能够为伦敦大学学院医院实施青少年暴力干预计划的定性证据做出贡献,例如,这表明NHS工作人员认为这项服务是一项重要和必要的干预措施。鉴于常规患者数据系统和联系存在的问题,我们还能够反思描述服务的数据,包括成本,并提出建议以支持未来的评估。未来的工作没有计划未来的工作。资助国家卫生和护理研究所卫生服务和交付研究方案(RSET:16/138/17)。
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