Prof Simon Moore
Jordan Van Godwin; Prof Graham Moore; Dr David O’Reilly
Violence is a global public health concern which can lead to numerous negative life-long impacts on people including increased risk of behavioural, emotional and physical health problems. Violence also causes a significant burden on public services, particularly health services and emergency departments. There is significant focus in UK on trying to reduce violence with the Home Office Serious Violence Strategy (2018) emphasising the need for partnership working and that other services have a responsibility for violence prevention. Organisations like healthcare and the police are therefore required to work together to help prevent violence.
Emergency Departments (EDs) in hospitals have been identified as an important setting for violence prevention. This is because staff in EDs have access to people who have been seriously injured because of violence. Those who have serious injuries will usually go straight to ED and therefore the police and other services, also involved with violence prevention, will be unaware of their circumstances. It is possible that violence prevention programmes in EDs may reduce the chances of people becoming victims again. This motivated police and healthcare partners in South Wales to set up Violence Prevention Teams (VPTs) in two EDs. The VPTs are led by nursing staff, who identify patients attending ED because of violence. The nurses work with those patients to identify the reasons why they have been exposed to violence and they support and refer patients to organisations within and outside of the NHS who can offer additional support.
Rationale, Aims and Objectives
Despite violence prevention interventions regularly being set-up in EDs, no detailed evaluations have taken place to find out how and whether they work. Our research team, based at Cardiff University, has been funded by the Youth Endowment Fund (YEF) to evaluate the VPTs in South Wales. We aim to understand how the VPTs have been set-up and how they are currently working. We also aim to understand what impact the VPTs are having on the violence prevention ecology, including other clinical staff. Because VPTs will probably work best if they respond to local needs, we will explore the similarities and differences between the teams in the two EDs.
We have developed nine primary and two secondary research questions for this process evaluation. The research questions were co-produced with key stakeholder partners: YEF; the Home Office; the Violence Prevention Unit (VPU) and Public Health Wales (PHW).
Our primary research questions are:
1. To what extent have VPTs become embedded within broader hospital systems?
2. To what extent do implementers adhere to the intended delivery model?
3. How much of the intended intervention has been delivered?
4. How well are the different components of the intervention being delivered?
5. To what extent does the intervention reach cover the entirety of all assault-related ED attendances?
6. To what extent do patients engage with the intervention?
7. How were in-hospital referral pathways developed for patients, and to what extent were patients supported across institutional transitions?
8. What is the perceived need for and benefit of the intervention amongst the implementers and related stakeholders?
9. What strategies and practices are used to support high quality implementation?
Our secondary research questions are:
10. What adaptations were undertaken to use the VPT model in Swansea following its establishment in Cardiff, and why?
11. What are stakeholders’ views on the types of setting to which the model is likely to be more or less transferable?
To answer our research questions, our process evaluation will consist of the following stages:
1. A scoping review of emergency care-based interventions for those who experience violence and the underpinning causal mechanisms of violence.
2. Document analysis of materials including role descriptors for members of the VPTs and hospital Standard Operating Procedures, particularly those focused on managing assault-related injuries.
3. A descriptive analysis of routine ED data (anonymised and aggregated) relating to patients (age, gender) and comparing VPT ascertainment and engagement rates of assault-related injuries with number of ED unscheduled attendees with injuries consistent with an assault.
4. Undertake qualitative interviews with 60 stakeholders involved in the violence prevention ecology across South Wales, including those who work with and for the VPTs.
It is hoped that our evaluation will be used to:
1. Understand how the VPTs have been developed, implemented and delivered.
2. Identify what’s working well and if anything could be improved with the VPTs.
3. Inform policy makers’ decision making on whether and how the VPTs could be used in practice in other EDs in the UK.
The primary end of study output of this research will be the YEF Research Report. We will also discuss the dissemination and utilisation of our research findings with our funder as the study progresses and following this the final report will be shared with key policy and practice partners. Further outputs will include a protocol paper and a peer-reviewed research paper describing the primary outcomes of this evaluation.
Further information and publications