Research Associate Jordan Van Godwin shares insights from his recent studies on violence prevention.
Overview
In this blog I will provide a brief overview some of the violence prevention research I’ve been leading or co-leading since 2022. The specific focus is on two projects, one an example of settings-based intervention for violence prevention The other is an example of systems-based research on a national violence prevention framework. Both projects, based in Wales, were led by a multi-disciplinary partnership between DECIPHer and the Violence Research Group (VRG) housed in the Security, Crime and Intelligence Innovation Institute. The core team for both these projects were myself, Megan Hamilton, Prof Graham Moore and Prof Simon Moore.
My reflections
As with all areas of public service and academia, there are challenges facing violence prevention work and research. Unsurprisingly, these often relate to funding restrictions and limitations as well as staff time, burden and capacity. However, since moving into this area of research in 2022, what has really struck me is the strong willingness and desire across professional groups, including Local Authorities, Health, the Police and the Third Sector, for collaboration and partnership working. There is also clear gap in the Welsh violence prevention space regarding complexity science, intervention design and the effective use of routine and ‘big data’, which I believe DECIPHer and colleagues at the VRG, led by Prof Simon Moore, are uniquely placed to fill. After providing a (very!) brief overview of violence as a public health priority, I’ll take you through the DECIPHer and VRG-led Violence Prevention Research that has been conducted to date. I’ll then finish up by talking about the pathways to impact from this research and the next steps we’ll be taking to advance our work in this area of research.
Violence globally and nationally
Violence is a global public health concern and cause of premature mortality and morbidity. It has enduring impacts on communities and individuals and can lead to an increased risk of behavioural, emotional and physical health problems
In the UK, violence presents as a significant multilevel burden across systems including healthcare, social care and policing as well as having a significant impact at the community and local level. Young people are often disproportionately affected by violence, with violent offences rising across the UK since 2013/2014. There is therefore significant focus in the UK on trying to reduce violence.
Research study 1: Process Evaluation of South Wales Hospital Based Violence Intervention Programmes (PREVIP)
Background
Violence Prevention Teams (VPTs) are nurse-led, hospital-based violence intervention programmes (HVIPs) which adopt a public health approach to identify patients attending ED due to violence, assess patients for psychosocial vulnerabilities, and refer patients to services for further support. DECIPHer and the Security, Crime and Intelligence Innovation Institute were funded by the Youth Endowment Fund (YEF) to conduct a process evaluation of the VPTS. The evaluation explored a range of implementation questions, including how embedded VPTs have become in two hospital Emergency Departments (EDs), to what extent delivery aligned with the desired model, to what extent patients engaged with the intervention and what strategies and practices are used to support good implementation. The National Institute for Health and Care Research (NIHR) funded an accompanying effectiveness and cost-effectiveness evaluation which is currently being finalised for publication.
Methods
Semi-structured interviews with professionals working in relevant roles. (N=49). Documentary analysis (N=46) of local and national policies, and guidance relating to VPT development and delivery was conducted as well as secondary analysis of routine data.
Findings
VPT acceptability was high amongst professionals. VPT staff were perceived to address patient needs via referrals to health and community-based services and provide a service that supported and trained ED staff. VPTs gathered and shared unique intelligence on violence with multi-agency partners. VPTs were delivered with fidelity but were negatively impacted by staff shortages and generalised burden across services. ED data suggests that VPTs improved the identification of patients who had experienced violence. Between 2019-2022, one VPT identified 2,312 patients who had experienced violence with 1780 engaging in the intervention. From 2022-2023, the other VPT identified 602 patients with 304 engaging with the intervention.
Conclusions
The VPTs can provide opportunities to increase patient ascertainment and onward referrals and contribute to local and regional violence prevention initiatives through data-sharing. Continuation of the VPTs could facilitate multi-agency violence prevention efforts across the violence prevention system.
End of study report:
Academic papers:
- Hospital-based violence prevention programmes in South Wales Emergency Departments: A process evaluation protocol
- Practitioner experiences of developing and implementing two UK ED-based hospital violence intervention programmes: a process evaluation
Research study 2: Wales Without Violence Framework Evaluability Assessment (WAVE)
Background
DECIPHer and the Security, Crime and Intelligence Innovation Institute were commissioned by the Violence Prevention Unit (VPU) and funded by the South Wales Police and Crime Commissioner’s Office to conduct an evaluability assessment of the Wales Without Violence Framework. The evaluability assessment explored the design, development and implementation of the Framework, the availability of data, the size of any expected effects, existing professional views and engagement and use (or lack of), and whether a future evaluation of the Framework would be feasible.
Methods
Interviews with key stakeholders (N=13) including professionals from across Wales at local, regional and national level covering primarily strategic and management roles. Documentary analysis (n=18): documentation related to the design, delivery and implementation of the Framework and selected documentation from external sources (Serious Violence Duty Partnerships and Local Authorities). Exploration of Routine Data: to explore, through interviews, what routine data is needed to support a future evaluation and what is currently available and accessible.
Key Findings
Acceptability: The Framework was acceptable to the stakeholders interviewed with variation in its perceived value and around clarity on what contribution it could make to professional practice. It was described as a useful resource that could serve as a foundation for practice, offering a strategic direction of travel for violence prevention work in Wales.
Suitability: It was considered suitable for work with all populations of young people including those considered at risk or most vulnerable to violence.
Framework uncertainties: A series of implementation outcomes were identified. Uncertainties regarding the delivery mechanisms and mechanisms of change for the Framework were identified by the development team, interviewees and the research team, with further clarification needed regarding what is required to bring about change. Uncertainties also exist regarding the definition and application of the concepts, principles and strategies in the Framework.
Measuring outcomes and impact: The challenges associated with evidencing change and impact related to the Framework and Frameworks in general were highlighted by stakeholders.
The wider context: There are well-established existing partnership structures in Wales. Agencies’ willingness to work in partnerships and engage in processes. Unpredictable and unstable political and financial climate. Budget restrictions and short-term funding. Limited staff capacity and heavy workload burden on staff across agencies and sectors. Linked to this, the number guidance, frameworks, strategies they are sent or have to engage with as part of their roles.
Sustainability: Longer-term funding and buy-in from policy and government were considered essential. The Framework should align to legislative and other statutory requirements of target agencies.
Summary
The Framework is a multi-component model attempting to influence multi-level systems and populations in multiple ways. Its design and development adopted recommended intervention development principles, namely: Engagement with evidence and research; Engagement with policy; Consultation with target populations and professionals as well as consideration of the national, regional and local contexts in Wales.
Recommendations by the research team
We recommended a mixed-methods process evaluation focused on acceptability, utilisation, embeddedness, reach, fidelity and costs (staff, resources) associated with design, delivery and ongoing attempts to support implementation of the Framework.
Final report and academic papers
Yet to published but will be added here.
Next steps for DECIPHer’s violence research and pathways to impact
The impact pathways from this work are multi-level. Internally, I have set-up a DECIPHer Violence Research Team and a programme of work is in development aligning with DECIPHer’s priorities regarding health inequalities and broader alignment with methodological approaches. There is a clear pathway for DECIPHer and VRG colleagues to contribute to national and potentially international violence prevention research and practice. The networks continue to develop between DECIPHer, VRG and external stakeholders. As well as the advancing collaborative approaches, we also have a series of outputs already developed or in development targeting national and international conferences and journals. We are working with colleagues in Public Health Wales and the South Wales Police and Crime Commissioner’s Office to develop briefing documents to support the l future rollout of VPT intervention across the NHS as well as a policy orientated document to support future funding applications. With further research funding bids in development, this is an area that DECIPHer, with its knowledge and expertise, is uniquely poised to contribute to.
