Learning for nurses from a cross-sectional quantitative analysis of youth engagement in an emergency department-based violence reduction scheme

Abstract

Background:

Multi-agency public health interventions to address violence, including hospital-based initiatives, are increasingly being implemented. Nurses occupy a critical early-intervention role, identifying at-risk individuals, facilitating referral to community support and contributing to ongoing care pathways. However, evidence relating specifically to children and young people remains limited.

Aims:

To examine the relationships between age, referral reasons, engagement and Emergency Department (ED) reattendance of the multi-site Hospital Navigator scheme implemented in five EDs in the United Kingdom.

Methods:

Two hundred and nineteen participants (6–24 years) presenting to EDs with violent injuries or vulnerabilities associated with violence (including mental health needs, substance misuse or homelessness) participated between March 2021 and July 2022. Variables included age, index ED attendance reason, scheme referral reason, engagement and future ED reattendance. Descriptive and exploratory analyses were undertaken.

Results:

Mental health and violence were the most common referral reasons. Over half (55%) engaged with the scheme, most on a short-term basis, with younger participants less likely to engage. Although most (87.7%) did not reattend the ED, mental health was the predominant reason for those who did.

Conclusions:

Policy and practice should prioritise EDs as early-intervention hubs, embedding Hospital Navigator Schemes and co-locating voluntary sector partners, with nurse-led coordination.

Keywords

early intervention emergency department hospital violence violence reduction youth

Introduction

Violence remains a major public health concern with significant implications for health and social care services (World Health Organization [WHO], 2024; Zhou et al., 2024). The latest Crime Survey for England and Wales estimated over 1.5 million violent offences, whereas police figures suggest 2.1 million incidents were recorded in the year ending September and March 2022 (Office for National Statistics, 2023a, 2023b). Hospital admission rates further illustrate the scale of harm, with 41.9 per 100,000 population (71,043 admissions) between 2018 and 2021 (UK Health Security Agency & Department of Health and Social Care, 2022). The associated costs of violence extend beyond the criminal justice system to include healthcare expenditure, productivity losses and long-term physical and emotional harm to victims (Home Office, 2018). In Wales (United Kingdom), short-term healthcare costs of violence alone are estimated at approximately £39 million (Jones, 2021).

For young people, the burden of violence is particularly acute. Although some national indicators suggest a decline in youth violence, the scale and impact remain concerning. The Children’s Commissioner (Dempsey, 2021) reported that approximately 27,000 children identified as gang members, with 318,000 knowing or being related to a gang member. Violence against the person remains the most common conviction for those aged 10–17, with children aged 15–17 accounting for 80% of youth cautions or sentences. Boys comprised 86% of this group, with disproportionate representation among Black (12%) and mixed ethnicity (10%) children. These patterns highlight the urgent need for targeted prevention and early intervention schemes to interrupt the ‘cycle of violence’ and address its individual, community and societal costs.

Nurses and emergency department (ED) staff are often the first point of contact for individuals presenting with violence-related injuries, crises or underlying vulnerabilities that increase their risk of involvement in crime or violence (Normandin, 2020). Their proximity to these patients positions them at the forefront of early identification and response efforts, making nursing practice critical to violence prevention within acute settings. To work effectively in these contexts, nurses must employ trauma-informed care and safeguarding practices, while navigating complex ethical challenges relating to confidentiality, patient trust and inter-agency information sharing (Royal College of Nursing, 2019; Sweeney et al., 2018).

The ED encounter represents a critical moment in which adolescents may be more receptive to reflection and behavioural change following crisis (Weinstein and Englander, 2021). This aligns with developmental theory. Havighurst’s (1972) developmental task framework posits that adolescence involves mastering tasks such as identity formation, autonomy and responsible social behaviour. Crisis presentations often signal disruption in these tasks, creating opportunities for timely intervention. Timely support leverages this window by offering trauma-informed engagement, relational trust-building and goal-oriented guidance. Adolescent developmental theory further emphasises evolving cognitive capacity, future orientation and susceptibility to peer and environmental influences (Steinberg, 2014). Tailored communication can enhance agency and scaffold decision-making, supporting progression through developmental tasks while mitigating risk trajectories.

Hospital-based violence reduction schemes, supported by multi-agency collaboration, are recommended as vital components of public health approaches to violence reduction (Bellis et al., 2012; Home Office, 2023). Such practice aligns with international frameworks such as the World Health Organization’s INSPIRE strategies to end violence against children, which emphasise collaborative, prevention-oriented healthcare responses (WHO, 2016). The underlying principle of hospital-based interventions is the concept of the reachable moment, in which contact at the ED provides a critical opportunity to engage with individuals at a point of crisis or injury who might otherwise be difficult to reach but may be receptive to change (Weinstein and Englander, 2021). The United Kingdom has operationalised this approach through several hospital-based initiatives supported by Home Office funding (Home Office, 2023).

International evaluations suggest these programmes can reduce re-injury and re-arrest rates related to violence (Brice and Boyle, 2020; Strong et al., 2016), while also demonstrating potential cost savings (Goodall, 2017b; Juillard et al., 2015; Strong et al., 2016). However, robust quantitative evaluations remain limited, particularly for children, adolescents and young adults (Williams et al., 2014).

Within the Thames Valley region, the Violence Reduction Unit, now the Thames Valley Violence Prevention Partnership (TVVPP), developed and implemented the Hospital Navigator Scheme in 2019 in response to rising presentations of violence-related injuries among young people. Within the Hospital Navigator Scheme, individuals presenting to EDs with violent injuries, or with vulnerabilities linked to violence involvement (e.g. substance misuse, mental health issues, homelessness), are offered tailored support by trained Navigators from local Voluntary and Community Sector Organisations. This support continues into the community, with referrals made to specialist services as needed (Bekaert and Cook, 2024).

There are currently around 40 hospital-based violence reduction schemes operating across the United Kingdom (Llan-Clarke et al., 2013; National Health Service, 2022). Although these show promising qualitative outcome data, further rigorous, quantitative data-driven evaluation is essential to inform nursing practice, guide service development and support evidence-based policy at national and international levels. Understanding engagement, outcomes and contextual factors is key to sustaining effective and scalable interventions.

This paper contributes to the existing evidence base by providing an exploratory quantitative analysis of the Thames Valley Hospital Navigator Scheme, focusing on children, adolescents and young adults (aged 0–24 years). This age range reflects the developmental continuum of adolescence into young adulthood (Sawyer et al., 2018) and aligns with extended transition practices within health and social care (Fiorentino et al., 1998).

Specifically, the study aims to:

Describe the age profile of children, adolescents and young adults referred into the scheme.

Examine reasons for index ED attendance, Hospital Navigator Scheme referral reasons and levels of engagement.

Analyse the frequency and reasons for any reattendance at ED among those who engaged.

Explore associations between age, engagement and key outcomes (future reattendance, reason for reattendance).

Through examining demographic patterns, referral complexity, engagement and reattendance trajectories, this study seeks to inform integrated nursing and public health responses, enabling policymakers and commissioners to optimise early-intervention pathways and resource allocation within scalable Hospital Navigator provision.

Methodology

Participants and recruitment

The current paper reports descriptive data (about the individuals, their engagement in the scheme and future reattendance at the ED), collected from individuals who consented to take part in the Hospital Navigator Scheme, commissioned and overseen by the Thames Valley Violence Prevention Partnership. The current analysis includes data collected from five sites in the Thames Valley; The Royal Berkshire Hospital (Reading, Berkshire), Wexham Park Hospital (Slough, Berkshire), Milton Keynes Hospital (Buckinghamshire), Stoke Mandeville Hospital (Buckinghamshire) and The John Radcliffe Hospital (Oxfordshire).

Individuals were eligible if they presented at one of the participating site EDs and presented due to violence, vulnerability of related risk factor (e.g. mental health or substance misuse) and provided consent. A total of 592 people participated in the scheme – primarily aimed at supporting young people – between March 2021 and December 2022. The current analysis sought to describe and explore children’s, adolescents’ and young adults’ involvement in the scheme and reattendance at the ED. Therefore, any individual aged 25 years or over (N = 80) were excluded from analysis as were those missing information regarding their age (N = 50). In addition, to allow sufficient comparison across participants with regarding to engagement and reattendance, only individuals who had been in the scheme for 6 months or more were included (N = 181 were excluded from analysis). For ED reattendance data, sufficient detail was required to determine reattendances, which resulted in further exclusions (missing information regarding reattendance in the ED N = 60). This provided a standard followed up period to enable analysis of those who engaged with the scheme across a short (<3 months), medium (3–6 months) and longer term (6+ months) basis. Once data had be refined accordingly and checked for completeness a sample of 219 remained (Figure 1).

Figure 1.

Participant flow diagram.

The current paper is based on a final sample of N = 219 children and young people, aged 6 to 24 years (M = 16.89, SD = 3.57).

Measures

A template was created by the researchers based on the monitoring data collected and reported on a quarterly basis from the five sites to the Violence Prevention Partnership to capture initial referral details (age, reason for original ED attendance and Hospital Navigator Scheme referral reason), engagement with the scheme (whether there has been engagement on a positive pathway in the community, that is, ongoing contact with the Navigator mentor and/or connected with a community-based support service, and if so, duration of engagement), and any further ED attendances (including reason). Data were populated by partner Voluntary Community Sector Organisation scheme coordinators and ED staff.

Sites recorded participant date of birth, for analysis purposes this was translated into an age at the date of referral. For some analyses the sample was broken down into two age groups: ‘Children and adolescents’ for under 18s and ‘Young Adults’ for those aged 18 to 24 years. This division accounted for variation in statutory processes in the United Kingdom relating to safeguarding and consent which differs for those under aged 18 years of age compared to those aged 18 years and over (Children Act, 2004; 1989). Whilst those under 18 years are legally considered children, 19 to 24 years represents young adulthood which whilst legally adulthood, is an emergent life stage identified through the increasing knowledge of adolescent brain development that extends into the mid-20s (Johnson et al., 2009) combined with the developmental stage of social development in Erikson’s psychosocial developmental stages in the early 20s (Erikson, 1959a, 1959b).

There was variation in the data provided for key variables such as referral and reattendance reason across individuals and sites. These were independently reviewed and coded by the researchers; inter-rater reliability was discussed and discrepancies were resolved through iterative consensus review. For referral, these were collapsed to the four most common referral reasons: mental health (encapsulating anxiety, self-harm, suicidal ideation or overdose), substance misuse (any form of drug or alcohol misuse), violence-related (any form of assault or injury sustained against the person) and multiple (two or more reasons at point of referral). Additional categories included domestic violence, medical (any medical-specific reason) and other (e.g. when there was insufficient detail to adequately categorise the reason). As only one participant was referred for domestic violence-related reasons, this was included in the ‘violence-related’ category for statistical analyses.

Reattendance was defined as any further visit to the ED within a 6 months period of initial referral into the scheme. Reattendances were categorised according to the same reasons as for referral. In addition, engagement with the scheme (e.g. engaging with community-based groups or services) was reported as yes/no. Sites also reported how long people engaged with the scheme, these were grouped and categorised into three durations (up to 3 months, 3–6 months and 6+ months). There were missing data across the dataset, and each reported analysis uses the sample size available which is reported in the text.

Ethical approval was obtained from the Oxford Brookes University Research Ethics Committee, number: 221604. The study is reported in line with STROBE guidelines (von Elm et al., 2007, see Supplemental Material).

Statistical analysis

Statistical analysis was completed in SPSS 27 (IBM Corporation, 2020). Descriptive statistics are used to present details across the scheme. Where assumptions were met, chi-square tests were conducted to explore differences between key groups in the data. To understand more about the children, adolescents and young adults in the study, t-tests and exploratory ANOVAs for age were conducted on key variables of interest, including referral reason. Analyses focused on referral reasons into the scheme, age, engagement in the scheme and reattendance within 6 months. Independent t-tests and ANOVAs were employed for exploratory group comparisons; analyses were designed to identify statistical associations rather than infer causal relationships.

Results

Descriptive results of key variables across the whole sample are presented for: (i) age, (ii) index ED attendance and referral into the scheme reason, (iii) engagement with the scheme and (iv) reattendance in the ED. Each key variable is followed by an exploratory statistical analysis exploring the predictive relationship between variables on key outcomes: engagement with the scheme, duration of engagement and future ED reattendance.

Descriptive statistics

Two hundred and nineteen children, adolescents and young people took part in the scheme between March 2021 and June 2022 (Site 1 n = 45, Site 2 n = 13, Site 3 n = 30, Site 4 n = 67 and Site 5 n = 64).

Age

Participants were aged 6–24 years. See Table 1 for different measures of central tendency of the sample when split into ‘children and adolescents’ (0–17) and ‘young adults’ (18–24 years).

Table 1.

Measures of central tendency for children and adolescent and young adult age groups (in years).

Age category	N	Mean (SD)	Median (IQR)	Mode
Children and adolescents	141	14.65 (1.82)	15 (2)	15
Young adults	78	20.95 (2.03)	21 (4)	21

Index ED attendance and referral into scheme reason

Two chi-square goodness-of-fit tests for index ED attendance reason, based on data available for 79.1% of the sample (X² = 129.78, df = 6, p < 0.001) and reason for referral into the scheme (X² = 120.10, df = 5, p < .001) were significant (see Figure 2). As the scheme initially targeted those attending for violence-related reasons, it would be expected that the proportions for this category would be higher than the expected frequency if all else was equal. In addition to violence-related reasons, both mental health and substance misuse reason cell values were all higher than the expected cell counts.

Figure 2.

ED attendance and referral reason into the scheme.

The average age across most common reasons for referral into the scheme were explored. A one-way ANOVA found a significant main effect of age for the reasons the participants were referred into the scheme, F(4, 214) = 3.40, p = 0.010, n² = .06. Post hoc tests using the Tukey correction showed those referred for multiple reasons were significantly older than those referred for violence-related, substance misuse and ‘other’ reasons. As shown in Table 2, a greater proportion of children were referred for violence-related, mental health and substance misuse reasons. The majority of those referred for multiple reasons were from the young adult group. However, only 14.1% of young adults were referred for multiple reasons.

Table 2.

HNS referral reason by age group.

HNS referral reason	Mean age (years)	SD	Children and adolescents, N (%)	Young adults, N (%)
Violence-related	16.47	3.78	50 (69.4)	22 (30.6)
Mental health	17.17	3.54	42 (60.9)	27 (39.1)
Substance Misuse	16.51	3.11	31 (68.9)	14 (31.1)
Multiple	19.80	3.12	4 (26.7)	11 (73.3)
Other	16.00	3.25	14 (77.8)	4 (22.2)
Total	16.89	3.57	141 (64.1)	78 (35.6)

Engagement with the scheme

Of the participants (n = 210) whose engagement was reported, n = 115 (54.8%) had engaged with the scheme, whereas n = 95 (45.2%) had not engaged. There was a significant difference in age between those who did or did not engage, t (204.57) = 3.23, p = 0.001, Cohen’s d = 0.45. Those who did not engage were younger (M = 15.97, SD = 3.39) than those who engaged with the scheme (M = 17.53, SD = 3.60).

Of those who had engaged, the duration of engagement is reported (Table 3). A one-way ANOVA for age by duration of engagement was not significant, F (2, 112) = 0.74, p = 0.478.

Table 3.

The duration of engagement, of those who had engaged, on a positive pathway.

Engagement on positive pathway (duration)	Frequency (%)*	Child N (%)	Young adult N (%)
Less than 3 months	85 (73.9)	45 (68.2)	40 (81.6)
3–6 months	16 (13.9)	11 (16.7)	5 (10.2)
6+ months	14 (12.1)	10 (15.2)	4 (8.2)

Based on n = 115 reported durations.

Future reattendance at the ED

Based on data for reattendance at the ED within 6 months of referral, the majority did not reattend, whilst n = 25 (11.4%) did. Those who reattended were older (M = 19.85, SD = 3.28) than those who did not reattend (M = 16.47, SD = 3.41), t (217) = −4.84, p < .001. About 20 of the 27 (74.1%) individuals who reattended the ED were classed by age as young adults.

Of the 27 participants who did reattend the ED within 6 months, this was for a mean = 3.00 (SD = 1.92) visits (minimum = 1 to maximum = 10 visits, median = 3, IQR = 1, mode = 3).

A chi-square test between ED reattendance and whether or not the participants engaged with the scheme was significant, χ² = 5.17, df = 1, p = .023. Of those who did not reattend, there was no difference between whether they engaged with the scheme or not (see Table 4). Of those who reattended the ED, n = 19 (76.0%) engaged with the scheme.

Table 4.

ED reattendance by whether or not the participants engaged with the scheme.

ED reattendance	Engaged on a positive pathway	Did not engage on a positive pathway	Total
Yes	19 (76.0%)	6 (24%)	25
No	96 (51.9%)	89 (48.1%)	185
Total	115 (54.8%)	95 (45.2%)	210

ED reattendance reasons were provided for a maximum of three ED reattendances (which occurred within the 6-month follow-up period). There were a total of 64 reattendances for which referral reasons were provided (see Figure 3). The most common reason for reattending the ED from these was for mental health (n = 18 individuals reattended in total n = 32 times). The second most common reason for reattending was for medical reasons (n = 11 individuals reattended in total n = 17 times). For violence-related reasons, six individuals reattended for a total of 7 times. Four individuals reattended for substance misuse reasons once each.

Figure 3.

ED reattendance reasons.

Based on the 25 participants with ED reattendance dates (N = 2 participants were missing ED reattendance dates, but were included in previous analyses as they had been in the scheme for exactly 6 months), first reattendance to the ED was between 1 and 200 days post-referral into the scheme (mean = 55.28, SD = 61.23, median = 38.00, IQR = 61.00). Over two-fifths reattended within 30 days (44.0%, n = 11), nearly three-quarters reattended within 60 days (72.0%, n = 18) and over three-quarters reattended within 90 days (80%, n = 20).

Reasons for HNS referral and relationship to future reattendance

When considering the relationship between original referral reason and reattendance reason, the most common reason for referral to the scheme for those who reattended the ED was for mental health (see Table 5).

Table 5.

Frequency and percentage distribution of reasons for HNS referral during the index ED visit among those who reattended the ED.

Reason for referral into HNS	Frequency (%)
Mental health	12 (44.4)
Substance misuse	4 (14.8)
Violence	3 (11.1)
Multiple	7 (25.9)
Other	1 (3.7)

Eighty-five percent of those who reattended on at least one occasion reattended for a reason relating to their referral reason into the scheme (see Table 6). Of those who had at least one ED reattendance that matched their referral reason into the scheme, 52.2% were referred for mental health reasons, 21.7% were referred for multiple reasons and 17.4% were referred for substance misuse.

Table 6.

Comparison between the reasons for HNS referral between index ED visit and reattendance.

HNS referral reason	YesN (%)	NoN (%)	Unknown/not reportedN (%)	TotalN (%)
Violence-related	2 (66.7)	1 (33.3)	0 (0.0)	3
Mental health	12 (100.0)	0 (0.0)	0 (0.0)	12
Substance misuse	4 (100.0)	0 (0.0)	0 (0.0)	4
Other	0 (0.0)	0 (0.0)	1 (100.0)	1
Multiple	5 (71.4)	2 (28.6)	0 (0.0)	7
Total	23 (85.2)	3 (11.1)	1 (3.7)	27

Discussion

The findings position EDs as important early-intervention touchpoints for children and young people experiencing violence and related vulnerabilities. Within this context, ED-based Hospital Navigator Schemes, multi-agency interventions embedded in EDs that provide crisis-point engagement and onward referral to community support, offer a structured mechanism for identifying and supporting at-risk young people. The predominance of mental health referrals, alongside violence-related presentations, suggests substantial overlap between psychological distress and violence exposure within this cohort. Engagement by over half of participants (55%) indicates that crisis-point referral within the ED setting is acceptable to many young people, with the predominance of short-term involvement implying that timely, focused support may be sufficient to stabilise immediate risk for a proportion of cases. Furthermore, the low rate of ED reattendance (87.7% did not return) provides tentative support for the preventative potential of the scheme, although the concentration of reattendance among those with mental health needs highlights the complexity and persistence of this vulnerability.

These findings demonstrate the interconnected nature of mental health, violence and substance misuse among young people and underline the ED’s role as a critical site for early identification and intervention (Aqtam, 2025). Nurses have a unique position as first responders capable of delivering trauma-informed care, initiating safeguarding and coordinating multidisciplinary support such as referral into such hospital-based youth support schemes as the Thames Valley Hospital Navigator Scheme, which works across acute and community settings.

A model for nursing practice in violence reduction schemes

Developmental insight

The analysis revealed developmental differences in referral reasons and engagement patterns. Younger participants (under 18) were less likely to engage, whereas older participants (19–24) were more frequently referred for multiple, compounding issues, reflecting both developmental processes and the accumulation of risk over time (Sawyer et al., 2018) – where early intervention opportunities during childhood and adolescence may have been insufficient or unavailable, leading to escalation of need. Lower engagement among younger participants may also relate to lack of agency, family involvement and communication style. Older adolescents may recognise the value of support more readily, consistent with cognitive and psychosocial development (Erikson, 1959a, 1959b; Piaget, 1976). From a nursing perspective, these findings highlight the importance of developmentally informed and trauma-sensitive practice. For example, when presenting to the ED with drug misuse, a 14-year-old may require clear, concrete explanations about immediate risks, reassurance and sensitive exploration of safeguarding concerns, often alongside appropriate parental involvement, consistent with emerging abstract reasoning and ongoing identity formation. In contrast, a 20-year-old is more likely to engage in open, adult-to-adult discussion regarding substance use patterns, harm reduction and referral to support services, demonstrating greater capacity for future-oriented thinking, insight and collaborative decision-making. Nurses require the capacity to assess cognitive, emotional and social development to tailor their approach effectively. Integrating such developmental competencies into nursing education and ED practice is critical to improving engagement with support services and outcomes.

The ED as a reachable moment

Consistent with other UK hospital-based violence reduction schemes (Bellis et al., 2012; NHS, 2022), mental health, violence and substance misuse were leading referral reasons. The study findings suggest that the ED does provide a ‘reachable moment’ (Weinstein and Englander, 2021) when young people may be more open to change following a crisis. For nurses, this moment offers a unique professional opportunity for trauma-informed assessment, therapeutic communication and safeguarding expertise. Nurses are often the first professionals to identify underlying vulnerabilities, stabilise acute risk and initiate multi-agency referrals, including referral to schemes such as the Hospital Navigator Scheme.

Furthermore, the Hospital Navigator Scheme model, delivered in partnership with Voluntary and Community Sector Organisations, complements the nursing role by extending care beyond the clinical setting. This collaboration exemplifies how nursing practice can operate within a broader public health model, bridging acute care and community support to address the social determinants of health. Such collaboration aligns with national and international frameworks advocating for multi-agency approaches to reduce violence and promote well-being (Home Office, 2023; WHO, 2016).

Mental health demand in acute settings

A striking finding was the predominance of mental health concerns as the leading reason for ED attendance, Hospital Navigator Scheme referral and ED reattendance. This mirrors international and national evidence showing a rise in children and young people’s mental health challenges (Aqtam et al., 2025; Children’s Commissioner, 2024; Newlove-Delgado et al., 2023) and reflects systemic gaps in service provision. Many young people fall through the cracks between child and adult mental health services (Singh and Tuomainen, 2015), whereas school nursing and other community preventive roles have been eroded (School and Public Health Nurses Association, 2024; Sutton and White, 2024).

As frontline witnesses to these gaps, acute sector nurses play a pivotal advocacy role, identifying recurrent crisis presentations as signs of unmet need, and that ED reattendance should be interpreted cognisant of this context. For some young people, repeat attendance may represent ongoing distress or a positive act of help-seeking, demonstrating trust in the ED as a safe space. Nurses are uniquely placed to recognise reattendance as a potential point of re-engagement, using these opportunities to further build trust, reassess risk and connect patients with sustained community support.

In the light of this more holistic approach, outcome measures for future evaluations should extend beyond attendance metrics to capture further insight, that is, well-being, safeguarding and education or employment outcomes.

Strengths and limitations

This evaluation draws on multi-site, real-world data from the Hospital Navigator Scheme across the Thames Valley, offering practice-based insight into engagement with young people presenting to the ED with violence-related risk factors. The use of routinely collected administrative data enabled analysis of service reach and reattendance patterns across a relatively large operational cohort, reflecting delivery under naturalistic conditions.

However, several limitations should be considered. Selection bias is likely, as participants were limited to those who consented to the scheme; individuals declining support may differ systematically in motivation, risk profile or help-seeking orientation. The absence of a control group limits causal inference, making it difficult to attribute outcomes such as non-reattendance directly to scheme involvement. In addition, the 6-month follow-up period may be insufficient to capture longer-term trajectories related to violence exposure, safeguarding risk or mental health outcomes.

The analysis was further constrained by unmeasured confounders, including socio-economic status, family support, prior service engagement and developmental stage. Developmental maturity may shape both receptivity to intervention and perceived value of support. Such factors were not captured within the dataset.

Data quality limitations were inherent to reliance on routinely recorded metrics. Variables available for analysis were restricted to those embedded within scheme monitoring processes, with dependence on consistent reporting from participants, ED staff and Navigator workers across five sites. Variability in recording practices, coding consistency and data completeness may have affected analytic precision. Moreover, multi-site delivery allowed for local adaptation in implementation and monitoring, introducing potential site-level heterogeneity.

ED reattendance alone is unlikely to represent a sufficient proxy indicator of scheme effectiveness. A fuller understanding of impact requires broader outcome measurement. Future evaluations should incorporate linked statutory datasets to triangulate findings, including police, custody and social care data, alongside qualitative work exploring lived experience and implementation processes. Multi-agency, early-intervention approaches to violence prevention are advocated internationally (WHO, 2016) and within UK public health strategy (Public Health England, 2019), yet data-sharing infrastructure remains inconsistently operationalised despite evidence of benefit (Florence et al., 2011; Ofsted et al., 2024).

Finally, as the analysis was limited to Thames Valley sites, local service configurations and population need may restrict generalisability to other regions or age groups.

Conclusion

This study reinforces that nurses are pivotal to the success of ED-based Hospital Navigator Schemes – interventions embedded in EDs to engage at-risk young people and link them to community support. Their frontline position enables them to identify and refer vulnerable children, adolescents and young adults at a reachable moment. Nurses also play a crucial role in co-working with Voluntary and Community Sector partners, ensuring that care plans are coordinated across acute and community settings.

From an evaluative perspective, caution should be applied if using ED reattendance as the sole indicator of such schemes’ success. Alternative or complementary outcome measures, such as well-being, safeguarding and education or employment outcomes, align more closely with the holistic goals of public health interventions and would provide a more accurate reflection of positive impact.

From a policy and commissioning perspective, the findings demonstrate the feasibility of co-locating Voluntary Community Sector Organisations within acute settings and reinforce the need for investment in integrated, multi-agency models of early intervention. These insights can guide workforce development, service planning and national policy, ensuring that multidisciplinary partnerships are equipped to address the mental health and violence-related challenges faced by young people.

Ultimately, discussion highlights that nurses are central drivers of successful Hospital Navigator Scheme implementation, facilitating interprofessional collaboration to ensure that vulnerable young people receive timely, holistic and sustained support. Looking forward, there is a clear policy imperative to move beyond viewing nurses solely as referral agents and instead embed them as core clinical-public health leaders within violence prevention and early-intervention infrastructures. Formal recognition of this leadership role within commissioning frameworks, workforce strategies and integrated care policy will be critical to scaling and sustaining ED-based public health models capable of responding to the complex social and health needs of at-risk young populations.

Key points for nursing policy, practice and research

The Hospital Navigator Scheme refers to an ED–embedded, multi-agency intervention designed to identify and support children and young people who have experienced or are at risk of involvement in violence, providing crisis engagement and referral to community services.

Embed nurses as central coordinators within Hospital Navigator Scheme teams, ensuring their expertise in trauma-informed care, safeguarding and holistic assessment anchors the intervention.

Incorporate developmental theory, violence prevention and motivational communication into pre- and post-registration nursing curricula to prepare the workforce for these complex encounters.

Strengthen the nurse–navigator interface to promote continuity of care, shared care planning and interventions responsive to age and developmental stage.

Position nursing leadership within the governance of violence reduction partnerships, ensuring that nursing practice informs strategic priorities in youth health and community safety.

Supplemental Material

sj-docx-1-jrn-10.1177_17449871261440379 – Supplemental material for Learning for nurses from a cross-sectional quantitative analysis of youth engagement in an emergency department-based violence reduction scheme

Supplemental material, sj-docx-1-jrn-10.1177_17449871261440379 for Learning for nurses from a cross-sectional quantitative analysis of youth engagement in an emergency department-based violence reduction scheme by Georgia Cook, Kirsty Walter, Kelly Reed and Sarah Bekaert in Journal of Research in Nursing

Footnotes

Acknowledgements

The authors would like to thank all members of the Hospital Navigator Scheme for their involvement in the initial data collection for this study.

Author contributions

Georgia Cook: Conceptualisation; Data curation; Formal analysis; Investigation; Methodology; Project administration; Resources; Supervision; Validation; Visualisation; Writing – original draft; Writing – review & editing.

Kirsty Walter: Formal analysis; Methodology; Visualisation; Writing – original draft; Writing – review & editing.

Kelly Reed: Conceptualisation; Data curation; Investigation; Resources; Writing – review & editing.

Sarah Bekaert: Conceptualisation; Data curation; Funding acquisition; Investigation; Methodology; Project administration; Resources; Supervision; Validation; Writing – review & editing.

Declaration of conflicting interests

The author(s) declared the following potential conflict of interest with respect to the research, authorship, and/or publication of this article: Sarah Bekaert is Co‑Editor in Chief of the Journal of Research in Nursing.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was conducted as part of the Hospital Navigator Scheme evaluation project kindly funded by Thames Valley Police Violence Reduction Unit.

Ethical approval

All participants provided informed consent to participate in the Hospital Navigator Scheme. Thames Valley Police Violence Reduction Unit was the data controller of the scheme and all data collected. An appropriate data sharing agreement was in place, and ethical approval was obtained from the Oxford Brookes University Research Ethics Committee (221664) to conduct an analysis of the data collected as part of the scheme and reported in the current paper.

ORCID iDs

Georgia Cook

Sarah Bekaert

Supplemental material

Supplemental material for this article is available online.

Georgia Cook is a chartered psychologist and research fellow at Oxford Brookes University, with expertise in complex intervention development and evaluation. She is experienced in quantitative and qualitative research designs, methodologies and analysis.

Kirsty Walter is a psychology demonstrator at Oxford Brookes University, with expertise in quantitative research methodologies and statistics.

Kelly Reed is a detective inspector at Thames Valley Violence Prevention Partnership, with extensive policing experience, crime and justice degrees and was involved in commissioning and oversight of the Hospital Navigator scheme.

Sarah Bekaert is an associate professor at Oxford Brookes University, England. With extensive experience in public health nursing for adolescents, she is research manager for the Thames Valley Violence Prevention Partnership.

References

Aqtam

(2025) A narrative review of mental health and psychosocial impact of the war in Gaza. Eastern Mediterranean Health Journal 31: 89–96. DOI: 10.26719/2025.31.2.89.

Aqtam

Naghnaghiyeh

Zubaide

, et al. (2025) Psychological impact of political conflict: Prevalence and severity of PTSD among children and adolescents in the North and Middle West Bank following the October 7, 2023, events. Nursing Research and Practice 2025(1):.7304673. DOI: 10.1155/nrp/7304673.

Bekaert

Cook

(2024) Thames Valley Hospital Navigator scheme: Phase II evaluation report. Available at: https://www.tvvpp.co.uk/wp-content/uploads/2024/07/Thames-Valley-Hospital-Navigator-Scheme-Phase-II-Evaluation-Report-July-2024-1.pdf. Oxford: Oxford Brookes University.

Bellis

Hughes

Perkins

, et al. (2012) Protecting people promoting health. A public health approach to violence prevention for England. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216977/Violence-prevention.pdf.

Brice

Boyle

(2020) Are ED-based violence intervention programmes effective in reducing revictimisation and perpetration in victims of violence? A systematic review. Emergency Medicine Journal 37: 489–495. DOI: 10.1136/emermed-2019-208970

Children Act 1989, c. 41. Available at: https://www.legislation.gov.uk/ukpga/1989/41

Children Act 2004, c. 31. Available at: https://www.legislation.gov.uk/ukpga/2004/31

Children’s Commissioner (2024) Children’s mental health services 2022-23. Available at: https://www.childrenscommissioner.gov.uk/resource/childrens-mental-health-services-2022-23/

Dempsey

(2021) Still not safe: The public health response to youth violence. Available at: https://assets.childrenscommissioner.gov.uk/wpuploads/2021/02/cco-still-not-safe.pdf

10.

Erikson

(1959a) Theory of identity development. In: Erikson

(ed.) Identity and the life cycle. New York: International Universities Press.

11.

Erikson

(1959b) Identity and the life cycle. New York: International Universities Press.

12.

Fiorentino

Phillips

Walker

, et al. (1998) Leaving paediatrics: The experience of service transition for young disabled people and their family carers. Health & Social Care in the Community 6: 260–270. DOI: 10.1046/j.1365-2524.1998.00124.x.

13.

Florence

Shepherd

Brennan

, et al. (2011) Effectiveness of anonymised information sharing and use in health service, police, and local government partnership for preventing violence related injury: Experimental study and time series analysis. BMJ 342: d3313. DOI: 10.1136/bmj.d3313.

14.

Havighurst

(1972) Developmental Tasks and Education, 3rd edn. New York: McKay.

15.

Home Office (2018) The Economic and Social Costs of Crime, 2nd edn. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/732110/the-economic-and-social-costs-of-crime-horr99.pdf. London, UK: Home Office.

16.

Home Office (2023) Violence Reduction Units, year ending March 2022 evaluation report, Available at: https://www.gov.uk/government/publications/violence-reduction-units-year-ending-march-2022-evaluation-report/violence-reduction-units-year-ending-march-2022-evaluation-report#section3.

17.

IBM Corporation (Released 2020) IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp.

18.

Johnson

Blum

Giedd

(2009) Adolescent maturity and the brain: The promise and pitfalls of neuroscience research in adolescent health policy. Journal of Adolescent Health 45: 216–221.

19.

Jones

(2021) Demonstrating the costs of violence to the healthcare system. Available at: https://lancsvrn.co.uk/wp-content/uploads/2021/09/Costs-of-Violence-to-the-Healthcare-System-Lancashire.pdf.

20.

Juillard

Smith

Anaya

, et al. (2015) Saving lives and saving money: Hospital-based violence intervention is cost-effective. Journal of Trauma and Acute Care Surgery 78: 252–258. DOI: 10.1097/TA.0000000000000527.

21.

Llan-Clarke

Bunn

DeMarco

, et al. (2013) Setting up a youth violence prevention project in a London hospital emergency department. Journal of Public Mental Health 12: 80–92. DOI: 10.1108/JPMH-09-2012-0005.

22.

National Health Service (2022) NHS London Violence Reduction Programme. Available at: https://www.england.nhs.uk/london/wp-content/uploads/sites/8/2022/03/In-Hospital-Violence-Reduction-Services-A-Guide-to-Effective-Implementation-FINAL.pdf.

23.

Newlove-Delgado

Marcheselli

Williams

, et al. (2023) Mental Health of Children and Young People in England, 2023. NHS England, Leeds. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2023-wave-4-follow-up.

24.

Normandin

(2020) Forensics and emergency nursing. Journal of Emergency Nursing 46: 268–274. DOI: 10.1016/j.jen.2020.03.010.

25.

Office for National Statistics (2023a) Crime in England and Wales: Year ending September 2022. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/bulletins/crimeinenglandandwales/yearendingseptember2022.

26.

Office for National Statistics (2023b) The nature of violent crime in England and Wales: Year ending March 2022. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/thenatureofviolentcrimeinenglandandwales/yearendingmarch2022.

27.

Ofsted, Care Quality Commission, HM Inspectorate of Constabulary & Fire & Rescue Services & His Majesty’s Inspectorate of Probation. (2024). Multi-agency responses to serious youth violence: Working together to support and protect children. Available at: https://www.gov.uk/government/publications/multi-agency-responses-to-serious-youth-violence-working-together-to-support-and-protect-children.

28.

Piaget

(1976) Piaget’s theory. In: Inhelder

Chipman

Zwingmann

(eds) Piaget and His School. Springer, Berlin, Heidelberg, pp. 11–23.

29.

Public Health England (2019) A whole-system multi-agency approach to serious violence prevention. Available at: https://assets.publishing.service.gov.uk/media/5e38133d40f0b609169cb532/multi-agency_approach_to_serious_violence_prevention.pdf.

30.

Royal College of Nursing (2019) Safeguarding children and young people: Roles and competencies for healthcare staff. Available at: https://www.rcn.org.uk/professional-development/publications/pub-007366

31.

Sawyer

Azzopardi

Wickremarathne

, et al. (2018) The age of adolescence. The Lancet: Child & Adolescent Health 2: 223–228. DOI: 10.1016/S2352-4642(18)30022-1.

32.

School and Public Health Nurses Association (2024) A school nurse for every school report. Available at: https://saphna.co/news/a-school-nurse-in-every-school-campaign/.

33.

Singh

Tuomainen

(2015) Transition from child to adult mental health services: Needs, barriers, experiences and new models of care. World Psychiatry 14: 358–361. DOI: 10.1002/wps.20266.

34.

Steinberg

(2014) Age of Opportunity: Lessons from the New Science of Adolescence. Houghton Mifflin Harcourt, New York.

35.

Strong

Shipper

Downton

, et al. (2016) The effects of health care–based violence intervention programs on injury recidivism and costs: A systematic review. Journal of Trauma and Acute Care Surgery 81: 961–970. DOI: 10.1097/TA.0000000000001222.

36.

Sutton

White

(2024) The role of the school nurse in the UK: Where are we now?. Paediatrics and Child Health 34: 99–103. DOI: 10.1016/j.paed.2023.12.004.

37.

Sweeney

Filson

Kennedy

, et al. (2018) A paradigm shift: Relationships in trauma-informed mental health services. BJPsych Advances 24: 319–333. DOI: 10.1192/bja.2018.29.

38.

UK Health Security Agency & Department of Health and Social Care (2022) Public Health Outcomes Framework: Commentary — February 2022. Available at: https://www.gov.uk/government/statistics/public-health-outcomes-framework-february-2022-data-update/public-health-outcomes-framework-commentary-february-2022.

39.

von Elm

Altman

Egger

, et al. (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Journal of Clinical Epidemiology 61: 344–349. DOI: 10.1016/j.jclinepi.2007.11.008.

40.

Weinstein

Englander

(2021) Reachable moment: Hospital-based interventions. In: Wakeman

Rich

(eds) Treating Opioid use Disorder in General Medical Settings. Cham, Springer, pp. 43–56.

41.

Williams

Currie

Linden

, et al. (2014) Addressing gang-related violence in Glasgow: A preliminary pragmatic quasi-experimental evaluation of the Community Initiative to Reduce Violence (CIRV). Aggression and Violent Behavior 19: 686–691. DOI: 10.1016/j.avb.2014.09.011.

42.

World Health Organisation (2016) INSPIRE: Seven strategies for Ending Violence against Children. Available at: https://www.who.int/publications/i/item/inspire-seven-strategies-for-ending-violence-against-children

43.

World Health Organisation (2024) Injuries and violence: Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence.

44.

Zhou

Cheng

, et al. (2024) Global burden of self-harm and interpersonal violence and influencing factors study 1990–2019: Analysis of the global burden of disease study. BMC Public Health 24: 1035. DOI: 10.1186/s12889-024-18151-3.

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