What does this project involve?
Hospital Navigators are trained individuals, based primarily in A&E departments, who talk to at-risk patients and provide support that aims to prevent their involvement in future violence. Using a short conversation, they aim to build rapport with patients and signpost to services (some of which may be provided by the Hospital Navigator’s organisation) that could support them after they leave hospital. If the patient consents, navigators will then follow-up with them via phone calls or in-person meetings to encourage take-up of support services. In this project, the Thames Valley Violence Reduction Unit (VRU) commissioned voluntary sector organisations to deliver Navigator interventions in five hospitals.
Why did YEF fund this project?
Hospital Navigators programmes are associated – on average – with a high level of impact on violent crime. However, we have a very low confidence in this estimate, which is based on only two US-based studies (one of which is of low quality). Previous evidence from a UK context is restricted only to analyses of implementation. Nevertheless, it is theorised by some that being admitted to hospital for a violence related injury could provide a ‘reachable moment’ in a person’s life – an opportunity to direct an individual away from future involvement in violence.
Given this theory and the sizeable evidence gap, the YEF and Thames Valley VRU funded a feasibility study of the Hospital Navigators programme.
The study had three objectives:
- To develop a theory of change, describing the programme’s intended activities and pathways to intended outcomes, both within each hospital site and across all five hospitals.
- To examine the implementation of the programmes and suggest refinement where necessary.
- To assess the feasibility of evaluating the impact of variations used in the programme, and of the overall programme itself.
These objectives were pursued using theory of change workshops, interviews with Navigators, site observations, a review of programme data and workshops with delivery partners. The study started in July 2021 and finished in April 2022.
|All five sites were able to articulate a Theory of Change (ToC). While there were some differences in the site-specific details of each ToC, the overall principles, target patients, activities, mechanisms and outputs had enough consistency to develop a coherent ToC for the overall Hospital Navigators programme.|
|The evaluator did not find significant deviations from the Theories of Change in the implementation of the programme in each site. They also observed a willingness from young people to engage in conversations. The initial engagement of young people was, therefore, not identified as a key barrier to implementation; a greater challenge was building and maintaining the adoption of the programme by all NHS staff involved in referral.|
|The length and intensity of Hospital Navigators’ support is short and light-touch compared to other interventions that tackle the complex challenges these patients face. In isolation, Hospital Navigator conversations are unlikely to be enough to improve outcomes. A key component of the programme is signposting to other services and groups that provide deeper support, which could drive long-term impact. The evaluator found mixed evidence regarding the take-up of this longer-term support, and the data to examine this were not available.|
|Hospital readmission data could be used as an outcome measure when evaluating Navigator programmes. These data can be collected for programme participants and those not involved, while it is also relevant to all recipients of Navigator support, regardless of their reasons for referral. Young people admitted to hospital when Navigators are not on site could provide a relatively strong comparison group that would allow for the comparison of an in-person, in-hospital Navigators intervention with an out-of-hours Navigators service.|
|The sample size used in this project is insufficient to conduct a fully powered trial. However, it could be sufficient to provide evidence of promise.|
What will YEF do next?
We have decided not to fund a further evaluation of this hospital navigators programme. This is in part due to the light touch nature of the initial intervention, which is unlikely to impact outcomes, and the limited evidence on how engaged young people were after being discharged.