A and E navigators

What is it?

A&E navigator programmes place a case worker, called a ‘navigator’, in hospital emergency rooms to support children and young people with a violence-related injury. Programmes can recruit navigators from a range of backgrounds including youth work, social work, nursing, probation, and medicine. Navigators try to develop trusting relationships with the injured children, provide informal mentoring, and help them access services. Some programmes have involved short interventions (up to 35 minutes) and take place solely in the emergency department. Other programmes involve a longer and more intensive phase of case management after the child is discharged.

Navigators often engage with children through a series of steps that can involve:

1. A holistic assessment of the victim’s needs, including a safety and risk assessment to safeguard them against immediate harm
2. Making an offer of support
3. Designing a tailored service plan to connect the child to services such as counselling, family support, mentoring, or help with conflict resolution, employment or substance misuse
4. Following up with the child and their family to continue support after the child has been discharged

There are several ways in which A&E navigator programmes might prevent children becoming involved in crime and violence. Being a victim of violence is strongly associated with future involvement in violence. Providing support in the aftermath of an incident could protect vulnerable children from this vicious cycle. Children may also trust navigators more than other agencies so be more open to engaging with services. The tailored service plans, which often include more than one service and extend support to families, could be more effective than engaging a young person in a single intervention.

Is it effective?

There are only two studies that have measured the impact of A&E Navigator interventions on preventing further violence . The available studies suggest that these interventions could have a high impact.

There are not currently enough studies to rigorously investigate whether A&E navigator programmes with different components have different impacts or explore the impact of programmes in different contexts.

The available studies suggest that A&E navigator interventions could have a high impact.

How secure is the evidence?

Our confidence in the headline crime reduction estimate is very low

There are only two studies that looked at the impact on violent offending. A systematic review suggested that one of these studies is moderate quality and the other study is low quality.

Both studies informing our headline impact rating were conducted in the USA. One study of a programme in Glasgow attempted to look at the impact on future emergency room visits but was not able to produce a rigorous estimate. It did not include an estimate of the impact on offending.

How can you implement it well?

Two evaluations of A&E navigator programmes in London and Glasgow provide evidence about effective implementation.

Forming a connection with the young person

These evaluations emphasized the importance of navigators developing strong relationships with the children involved.

In both studies about one-third of the children referred to the services did not participate. Some children may be distrustful of speaking to navigators, fear that it will lead to police involvement, and be reluctant to disclose the cause of their injury.

Recruiting relatable navigators who can build trusting relationships with young people could overcome this barrier. For example, the Glasgow programme recruited navigators with relevant lived experience.  

Building trusting relationships might be easier in longer-term interventions. One study found that the rapport between navigators and children increased with each encounter.

Combine immediate intervention with continuing support after discharge

It is likely beneficial to begin the intervention while the participant is still in hospital, rather than wait until they have been discharged. Some researchers argue that a violent injury could produce a ‘teachable moment’ – a time when a child or young person is especially receptive to offers of support. This ‘teachable moment’ might pass if the intervention does not start until the child has left the hospital. Researchers have also noted that children can be difficult to contact once they have been discharged.

Evaluations also emphasized the importance of providing after-care support and following up with young people after they are discharged. The navigator can continue to provide direct support, help the young person access services, and try to prevent any retaliation for the original violent incident.

Locating navigators in the A and E department

These studies suggested that the location of navigators’ offices could be an important consideration. When navigators’ offices were located outside of the A&E department, medical staff were sometimes unaware the programme existed. Stationing navigators in the A&E department could increase awareness of the programme and improve communication between navigators and other staff.

How much does it cost?

On average, the cost of A&E navigators is likely to be moderate. Costs are likely to include the salary of full-time navigators stationed in hospitals and additional time and resources spent coordinating services.

Topic summary

• A&E navigator programmes place a case worker, called a ‘navigator’, in hospital emergency rooms to support children and young people with a violence-related injury. 
• On average, programmes have led to large reductions in violence. However, we have very low confidence on our estimate as it is only based on two studies.  
• Research on the implementation of A&E navigators programmes emphasizes the importance of the relationship between navigators and victims, and combining immediate intervention with long-term follow up. 
• More UK-based evaluations are needed to increase the quality of the evidence. YEF is in the process of setting up several A&E navigator evaluations.

Take away messages

• Only place navigators in A&E departments that receive a high number of children with violence-related injuries.
• Review recruitment and attrition numbers regularly throughout the full programme of support, and adapt the programme to make best use of practitioners’ time.
• Implement strategies to maximise children’s consent to involvement in the programme.
• Make referrals to support services as quickly as possible, and ensure that children are supported for at least six months following initial engagement with the navigator.

YEF projects and evaluations

The YEF’s multi-site trial of A&E navigator programmes
The YEF has funded the Thames Valley Violence Reduction Unit, The Behavioural Insights Team and University of Hull to run a trial of A&E Navigator programmes across five hospitals.

External links

Glasgow navigator programme report.
A report summarising the findings of the A&E navigator programme in Glasgow Royal Infirmary in 2017.

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