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

John Appleby, Theo Georghiou, Jean Ledger, Lucina Rolewicz, Chris Sherlaw-Johnson, Sonila M Tomini, Jason M Frerich, Pei Li Ng
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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).

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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:青年暴力干预方案涉及在国民保健制度急诊科安置青年工作人员,以帮助年轻人(年龄一般在11至24岁之间)在因暴力袭击或相关创伤而到急诊科就诊后改善生活质量,这种方案在全国保健制度中正在增加。这项研究评估了由慈善机构Redthread与NHS信托机构合作开展的一项此类倡议。目的:评估由慈善机构Redthread提供的伦敦大学学院医院NHS信托新青年暴力干预方案的实施和影响:(1)对基于医院的暴力犯罪干预研究的文献综述;(2)评估当地实施情况,以及伦敦大学学院医院员工和当地相关利益相关者对干预措施及其影响的评估;(3)评估使用常规二级护理数据评估Redthread干预效果的可行性;(4) NHS视角下Redthread干预的成本-效果分析。方法:采用多阶段混合方法进行评价,包括深入的过程评价案例研究、定量分析和经济分析。该项目在两年多的时间里分不同阶段进行,从基于桌面的研究开始,到适合在COVID-19影响NHS服务时远程工作的探索阶段。与Redthread和伦敦大学学院医院的工作人员以及其他人(例如参与国民保健制度预防青少年暴力政策的高级利益攸关方)共进行了22次半结构化访谈。我们分析了Redthread文件,与专家进行了接触,并对员工会议进行了观察,以收集有关干预措施有效性、实施过程、员工看法和成本的更深入见解。我们还进行了定量分析,以确定适当的影响措施,以告知利益相关者和未来的评估。结果:Redthread的服务被认为是必要的干预措施,是对临床和其他法定服务的补充。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。个别转介的不同原因、甄别青少年的不同途径,以及所提供的具体支助干预措施的混合,共同强调了这种干预措施的复杂性,随之而来的是在实施和评估方面的挑战。考虑到Redthread和伦敦大学学院医院(University College London Hospital)住院服务的相对单位成本,据估计,如果大约三分之一的Redthread干预措施至少避免了一名紧急住院病人入院,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青少年暴力干预项目的定量影响,但它反映了描述该服务的数据,包括成本,并提出建议,以支持未来的评估。限制:2019冠状病毒病大流行严重阻碍了红线服务的实施和评估能力。由于同意程序的限制、在将红线与伦敦大学学院医院的病人数据联系起来方面存在问题,以及在评估期间获得长期支持的年轻人数量相对较少,因此不可能有最有力的选择来分析效果和成本。结论:我们已经能够提供关于伦敦大学学院医院实施青年暴力干预方案的定性证据,例如,表明NHS工作人员将该服务视为重要和必要的干预措施。鉴于常规患者数据系统和联系的问题,我们也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。未来工作:没有未来工作计划。资助:国家卫生和保健研究所卫生服务和提供研究方案(RSET: 16/138/17)。
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