A&E navigators – supporting victims and perpetrators of violent crime on the emergency service frontline

About the A&E Navigators

Inspirational A&E Navigators are supporting victims and perpetrators of violent crime on the emergency service frontline. In the last year, they have supported more than 100 young people, and had more than 1,000 interactions with young people attending in crisis.

The team of A&E Navigators, based at Bradford Royal Infirmary, have been working with frontline NHS staff and emergency services, to support victims and perpetrators of violent crime, who attend in crisis. The navigators are a committed workforce of qualified youth workers who have decades of experience of working with young people and families from across Bradford’s communities.

The service, which has been running for just over a year, operates 365 days a year during peak hours of the evening and night-time, and so far, has supported more than 100 vulnerable young people. It has been vital in helping young people across the city following the Covid-19 pandemic which has taken its toll on people’s wellbeing.

The reasons behind violence and admission to an emergency department can be complicated, and beyond the surface are not always directly related to the health of an individual. The youth workers as navigators are there to care, guide and provide practical support in a non-judgemental way to people who may be experiencing trauma and serious adversity, which may be preventing them from living a safe and positive lifestyle. There is no pressure for people to engage with navigators, but the service provides a safe environment which allows for open conversation.

Support can also extend beyond discharge, through referral to services who can continue to help such as The Buddies Service or Breaking the Cycle. If people want, the navigators can also work closely with families and loved ones to follow up on care and advice.

As well as supporting victims and perpetrators, the navigators also provide a vital role for NHS staff working in the emergency department. It allows staff to focus on treatment, and working with the navigators, understand the real issues behind an attendance.

Case studies

Please note that these case studies have been anonymised to protect the identity of those who have lived these experiences.

Attendance in crisis (A)

One of the A&E navigators (youth worker) met A in A&E whilst they were waiting for treatment for a medical emergency. The emergency was linked to a gang-related retaliation attack on young people from their peers, connected to an ongoing social media feud.

The youth worker delivered a brief and concise intervention to A and their parent. This involved giving reassurance and helping A reflect on the seriousness of past and current issues, as well as building trust and rapport.

By advocating on behalf of A and their family, the youth worker was able to support in contacting the police, explaining processes, as well as providing support with contacting school and college.

A was already known to youth workers through education routes. Therefore, a Signs of Safety Plan (a relationship approach to child protection practice) was established, as well as regular check-ins following discharge from hospital.

As the incident was in relation to an ongoing social media feud, the youth worker explored appropriate use of social media, managing difficult relationships with peers and had meaningful discussion with A on their views on life. Over six months, within education and in the community setting, these discussions helped A to make informed choices around their next steps to achieve a more positive future and support their interests.

Through the trust and rapport built by the youth worker, A consented to working with other services which could help. As a result, their attendance has improved at college, their Signs of Safety risk assessment had decreased, and they have been made aware of how to deal with risky situations in the future, including keeping safe online.

A is now making fantastic progress towards creating a bright and positive future. This turn around started as a result of the trust, rapport and key services working together during initial crisis point in the emergency department.

A now receives regular support from the Child and Adolescent Mental Health Service (CAMHS) and others. They are also getting a sense of achievement and release of energy though boxing three times a week. A has now passed their course at college and has improved knowledge, skills and awareness of dealing with trauma, alongside engagement with positive activities, all enabling them to have a better, brighter future.

Supporting young people through attendance in hospital (B)

The youth workers who work as A&E Navigators also support young people who are staying in hospital. B had been in hospital for a few weeks and had developed very low self-confidence due to the length of stay.

On every visit to the inpatient wards, youth workers proactively engaged with B to establish how they could support in building back self-confidence and enabling that individual to thrive.

The youth workers used a number of different tools to help B express emotions and manage wellbeing. This included using positive affirmations, keeping a diary, techniques for managing thoughts and drawing and colouring.

B was introduced to an educational card game, which was the highlight of each of the visits. Playing games helped to develop new skills, find different ways to play and increased awareness of how to manage wellbeing when feeling low.

The youth workers also introduced B to Kooth which is a free online support network for young people. They talked through how to use the various functions on the website including the chat function, the forum and accessing peer support. This explanation has helped B use the Kooth website to get information and advice, enabling more resilience during crisis point. B has also built confidence to be able to share personal experiences with others.

By exploring hobbies and interests with the youth workers, B has engaged more with baking and cooking. Since being discharged from hospital, B has joined a girls group which is provided by the Bradford Youth Service who work alongside the Breaking Cycle Project.

Supporting vulnerable people in crisis (C)

On one Saturday night in the emergency department, the A&E Navigators noticed a young person who was in quite a lot of distress.

C was in a wheelchair accompanied by an adult. At first glance, it would have been assumed that the individuals were father and child. However, once the A&E Navigators engaged, it transpired that C was the victim of a hit and run mugging incident. C had been given a lift to the hospital by a good Samaritan, who was able to tell staff more about the incident.

C was frustrated, did not wish to give any personal details, and was resistant to the medical staff having a look at their injuries. After an hour, C made the decision to walk out of the emergency department, however this was difficult given the nature of their injuries. The A&E navigators worked closely with the hospital staff to make sure C was safe as they walked down Duckworth Lane, and continued to spend time with them to convince them to come back to the emergency department so the injuries could be seen to. After about an hour, C was determined to go and see their family, and the A&E Navigators had no choice but to let them go.

However, an hour later C came back to the emergency department with a family member (mother) who was so grateful for the help received from both the navigators and medical staff.

The navigators were able to work with C and their mother to establish their identity and confirmed that they were already on a Breaking the Cycle programme (a programme for vulnerable young people who are or at risk of being groomed into criminal activity). The details of C’s attendance were then passed through to their youth worker who was able to follow up appropriately. C remains on the Breaking the Cycle programme.

Supporting vulnerable people in crisis – eating disorder (D)

D attended hospital due to an eating disorder. At the time D was 12 years old and did not talk about family life or how the eating disorder began. Although able to talk about and discuss food, at meal-times D struggled.

D had the support of a family member (mother) who almost always stayed in the hospital too and joined in playing a range of educational games with D and the youth workers. The mother was very happy for the youth worker to support D and wanted them to spend as much time with them as possible, as participation in these activities were helping as a distraction technique.

There was a concern from D that they would not be able to stay in touch with the youth workers once discharge from hospital. Although, in hospital for three months, once discharged D began to attend sessions at a youth centre close to home. They continue to see one of the youth workers from the hospital every week. D is on the path to recovery and establishing a more positive relationship with food, enjoying baking and life as a healthy teenager.

For further information

Email the Bradford District and Craven Health and Care Partnership communications team on communications@bradford.nhs.uk