PICH 18/19 Learning Seminar July 2019

Thanks Hannah Zhu for these notes from our final seminar of the academic year:


Red Thread – integrated care with youth workers, ED, police, social care

We need to take a public health approach to youth violence! Youth workers going to emergency departments to work with young people aged 10-24 who are victims of violence.

Youth Violence is:

–          Prevalent: 300,000 ED admissions caused by violence every year

–          Expensive

–          Contagious

–          Damaging

–          Unequal: associated with poverty

–          Treatable: evidence shows violence can be reduced through effective intervention, e.g. homicide rate halved over 1 decade in Glasgow using a public health approach

Engagement – why does youth work make a difference?

–          Time to spend with young people focused on task of changing their lives, sit and wait with them, get food for them, talk to them in their “teachable” moment.

o   Honesty – if under 18, social services will need to be involved and we will need to break confidentiality to ensure their safety

–          Power

–          Psychological first aid – to support a young person processing the event, aiming to avoid PTSD

o   Contact and engagement at the earliest opportunity (in ED resus)

o   Safety and comfort – calling mum, food and safety plans

o   Stabilisation – grounding

o   Information Gathering – supporting to process

o   Practical assistance – calling probation, housing etc.

o   Connection with social supports – existing workers

o   Coping information – trauma first aid, aware of what might follow (e.g. arguments with parents, feeling anxious/sad/angry/PTSD symptoms) and what to do, when to see a GP

o   Linkage with services – e.g. social services

o   Note – they don’t force a discussion of the event, no a debrief

–          Safety planning

o   How safe do you feel right now?

o   Do you feel safe to leave the hospital?

o   How can you make yourself safer?

o   How can I help make you safer?

Who do we support? Careful not to assume anything:

–          Not all young people who have been stabbed are in a gang

–          Not all young people selling drugs are in a gang

–          Young people may not even consider themselves to be part of a gang, even if the adult network supporting them do

–          Everyone we work with is a victim of youth violence

–          Now that it’s more common for young people to be armed due to fear, conflicts escalate much more commonly due to their weapons

Child Criminal Exploitation

–          Exploitative situations, contexts and relationships where young people receive “something” (clothes, phone, tech, money, drugs) as a result of them completing a task on behalf of another individual or group of individuals; often of criminal nature. This happens without the child’s immediate recognition, with the child believing that they are in control of the situation.

–          In all cases, those exploiting the children have power over them by virtue of their age, gender, intellect etc. Child initially thinks their abuser is their friend, later can threaten child to maintain control of them.

The Drugs Industry

–          The illegal drugs industry is the 3rd largest business in the world (after oil and arms)

–          World $4 trillion market value

–          UK home office in 2007: illegal drugs market in UK £4-6.6 billion per year

–          £74 billion of this market goes through the financial systems in London

–          Dec 2009: UN drugs and crime executive director claimed illegal drug money saved the banking industry from collapse in 2008

County Lines

–          A way of drug distribution to localities outside a central urban hub (across counties)

–          The line is a phone number for local drug users to call

–          Deliveries made by the young and vulnerable (under 18’s) due to being more easily manipulated and different sentencing for young people

–          Not always about being in a gang, it’s more about the money, around £700 per week. But – often set up to owe huge debts à debt bondage, modern slavery.

–          Cuckooing (offer drug user a place to stay). Trap house (crack house). Bando – horrific conditions, young people might not be able to sleep

–          Signs for us to look out for:

o   Plugging (drugs in anus) – not wanting to eat or drink

o   Swallowing drugs

o   Wonders associated with torture

o   Sexual violence/sexual health

Contextual safeguarding

–          Child (centre)

–          Home

–          Peer group

–          School

–          Neighbourhood

–          Social media (peripheral)

–          Consider ACEs (Dr Burke Harris TED talk)

Redthread at St Mary’s

–          537 referrals: 77% male, 285 injured by knife, 16 gunshot injuries, 103 injured by other means, 41% under 18, 25 YP admitted to ICU each year

–          Feedback “You called me even when I pushed you away, thank you”

The Well Centre – opened in 2011 (Steph)

–          Integrated care, early intervention, one stop shop – youth work, primary care, CAMHS, nurse practitioner for holistic mental health, sexual health, general health

–          Drop in 3 sessions per week

–          Age 13-20

–          Everyone gets a biopsychosocial assessment based on HEADSSS, framed as a conversation (20 minute slots)

–          Always see YP on their own, even if they come with a parent

–          Social prescribing – personalised based on what will engage each young people, use knowledge of local charities and services

–          Youth workers – help write CVs, anxiety groups

–          70% from word of mouth, 30% referrals from schools, nurses, social services, GPs

–          Register as temporary resident, should have GPs elsewhere

–          Funded based on evidence for lack of young person access or engagement with GP, paediatrics and general healthcare