Youth Support in the Emergency Department: A hospital intervention to reduce youth violence Yaél Ilan-Clarke, Jeffrey De Marco, Amanda Bunn & Professor Antonia Bifulco Re-Imagining Youth Justice: Howard League 2 nd April, 2014 Centre for Abuse and Trauma Studies Applied research in the digital age Oasis Youth Guys & St Thomas’ Hospital

Session Plan The OYS intervention Evaluation methods Findings Evidence for change: Quant Qual findings: Trust and support Summing up Slide 2

Why the Emergency Department (ED?) ED use highest amongst young males from disadvantaged areas ED ideal as young people attend but not reported to other services i.e. police ED & youth work intervention not stigmatised “Teaching moment’ – opportunity for change Slide 3

The intervention Oasis Youth Support (OYS) service Slide 4 ED attendance Referral to OYS Intervention One to one mentoring Behaviour Change Immediate needs Long term support Positive community engagement Evaluation Short and long term follow up Based in St. Thomas’ Emergency Department (ED), London 2010 – present Inclusion criteria: 12-20* Southwark & Lambeth Any Type of violence

The Evaluation - Mixed methods: Questionnaires – baseline (76) and follow up (31) Exit survey (51) [Focus group - Baseline data gathering with matched sample] Follow up interviews (10) Slide 5

Young people – Questionnaires: Questionnaires:  Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997) – Psychopathology,  Emotional, conduct, hyperactivity, peer, and prosocial  ASSETT Self-Report – ‘What Do You Think’ ▫ Family and where you live ▫ School/college/work ▫ Lifestyle and area ▫ Substance use ▫ Health ▫ Thinking and behaviour ▫ What you think about your injury and how it affects you (Adapted from original WDYT!)  Exit survey – satisfaction with the service Slide 6

Service-access and referral (20 March 2014) Slide 5 Overall referred = 813 Out of area = 213 (26%) Inappropriate referrals = 22 (2%) Eligible =578 (71%) Declined = 135 (23%) Unable to contact = 112 (19%) Support already in place = 90 (15%) Other misc = 41 (7%) Pending = 7 (1%) Engaged = 193 (33%) Drop out/Loss of contact = 61 (10%) Intervention complete = 117 (20%) Live = 15 (2%)

Evaluation Results: Characteristics of 103 YP in service Gender: –79% Male, 21% Female Age: –Mean = 14.8 (Boys), 14.2 (Girls) –Range: Ethnicity: –39% Black/Ethnic minority Family: –41% Live with Single Parents/ 2% Care Slide 8

Nature of violence (n=101) Slide 9

FINDINGS: ASSETT WDYT 1) Change in lifestyle risk (n=31) P<.001 P<.01P<.002 Slide 10

SDQ symptoms questionnaire i) Change in disorder levels (n=31) Slide 11 P<.001 P<.003 Change in SDQ disorder*: Baseline to follow up * Case or Borderline case level

Exit Survey i) Perceived benefits (n=51) Slide 12 Perceived best aspects of OYS: -Support -Mentoring -Activities -Friendship

Summary of quantitative findings A significant change in YP seen at follow up, particularly in: –Family relationships –Thinking and behaviour / Conduct disorder The intervention was endorsed by young people, who reported that the best thing was the relationship with mentor Slide 13

Qualitative findings 1) YPs views of the service and youth workers YP appreciated the positive relationships and felt these to be a vehicle for change Slide 14 ‘After I finished working with T it seemed pretty much the same, but then you know when occasions came up when I had to pick if to go into a fight or not, T’s interviews and chats would pop up so it did change my attitude to these things...’ (A25)

Qualitative findings 2) Imagining a better future The discussions YP had with the YWs provided them with an avenue to explore more positive futures that they hadn’t previously considered. Slide 15 ‘...it doesn’t only help you with frustration and anger wise, it helps you to learn about how hard it is to work in the outside life and how important it is to do college or school work…[its] not only helping YP sort their life out, [its] helping them understand where they could be in the future and what they have planned, instead of getting involved with all the violent gangs, they can come out of that and do something positive’.

Limitations Evaluation Lack of control group Follow up duration Assessment standardised but not a clinical interview Small numbers Intervention Slide 16 Mixed perps/victims /self-inflicted Nature of intervention variable “Active ingredient”?

Clinical and Social implications Impact on aggression & conflict reoccurrence / family relationships / lifestyle risk Improvement in lifestyle markers of risk cooccured with psychopathology. Evidence for impact on ED re-admission rate accruing Small N but significant findings, continuation of service supported Slide 17

Click to edit Master title style Yael Ilan-Clarke Centre for Abuse and Trauma studies (CATS) Middlesex University Slide 18 THANK YOU.