Abstract
Historically dealt within the criminal justice systems, violence has become a pressing challenge to public health. Rates are rising globally, particularly among adolescents and young adults (Kane, 2025). Often emergency departments and trauma centres are the first point of contact for the victims of violence, placing nurses and other providers at a crucial junction between acute care and long-term prevention (Normandin, 2020). Crisis often creates an opportunity for engagement. These clinical encounters after a traumatic event offer a unique ‘reachable moment’, a period when youth are more receptive to reflection and change (McDaniel et al., 2024). Trauma-informed communication that is non-judgemental, empathetic and consistent with the young person’s developmental stage can help establish rapport at this point of heightened vulnerability. This may help young people feel heard and supported at their time of vulnerability. These interactions address the immediate consequences and paves the way for establishing broader support in the community. For these reasons, integrating violence intervention into healthcare settings holds real promise for disrupting cycles of retaliation and repeat offending. Within this context, nurses play a key role in violence intervention.
This paper (Cook et al., 2026) reports an evaluation of the Thames Valley Hospital Navigator Scheme (HNS), an Emergency Department (ED)-based violence reduction initiative operational in five hospitals across the United Kingdom. HNS covers children, adolescents and young adults to 24 years who attend ED with violence-related injuries, offering individual case management and referrals to community services following discharge. This study examined (i) who were referred into the scheme, (ii) how they engaged with it and (iii) whether they re-attended ED within 6 months.
The sample included 219 participants (6–24 years). The most common reasons for referral into the scheme were violence-related injuries, mental health concerns and substance misuse. Mental health difficulties including anxiety, self-harm, suicidal ideation or overdose were the most frequent cause of ED re-attendance highlighting the close relationship between violence exposure and psychological distress.
Just over half (54.8%) the participants maintained contact with navigators with engagement higher among older participants. Most engagement lasted less than 3 months, suggesting that brief and timely intervention can stabilise immediate risks. However, the data also show that engagement alone did not eliminate vulnerability: 11.4% re-attended the ED within six months, predominantly for mental health concerns, with most returning within 90 days of referral, suggesting the need for sustained and ongoing support for these young people. The preponderance of mental health issues show that violence-related injuries do not occur in isolation but are embedded in trauma, substance use and developmental changes. This pattern indicate that a subset of young people require more sustained support beyond an initial intervention episode.
Developmental theory also offers insight into the findings. Younger adolescents were found to be less likely to engage, possibly reflecting limited autonomy or reliance on family involvement in decision-making. Young adults (18–24) not only were more likely to engage but also presented with more complex, overlapping needs, illustrating how risks compound when early intervention has not occurred. For nurses, such findings underscore the importance of tailoring communication and intervention strategies to developmental stage. These differences have direct implications for nursing practice: younger presentations may call for safeguarding-focused conversations and family involvement, whereas older adolescents and young adults may respond better to collaborative, harm-reduction-oriented dialogue.
The pattern of re-attendance also warrants careful interpretation. Those who re-attended were older and they returned frequently to ED for mental health issues. Mental health recovery is rarely easy and repeated crisis reflect the ongoing struggle rather than disengagement. In some cases, returning to ED indicated trust in services as a safe and accessible source of help.
This study is relevant to emergency nurses, nurse leaders, educators and policymakers. It makes a case for including psychosocial assessment in routine ED care and for incorporating trauma-informed principles and developmental frameworks into nursing curricula. Findings also provide evidence that ED-based Navigator schemes are feasible, and young people will engage when support is available at the time of crisis (Brice and Boyle, 2020).
The preponderance of mental health concerns also points to wider systemic gaps in child and adolescent mental health provision, particularly at the transition to adult services, gaps that ED nurses are often first to observe. Their frontline position gives them an advocacy role that extends beyond individual patient encounters, enabling them to influence the design and implementation of services. Embedding nurses as coordinators in the HNS may enhance continuity of care while positioning them centrally in delivering the interventions.
In conclusion, this study (Cook et al., 2026) shows that EDs can function as early-intervention sites for young people experiencing violence-related harm and psychological distress. The study also reinforces that reachable moments can be leveraged, and nurses are not merely first-responders to injury but pivotal actors in prevention of future violence and crime. The HNS engaged a substantial proportion of a difficult-to-reach population, demonstrating that the scheme is feasible and young people will seek support when it is available at the moment of crisis. Rather than evaluating success primarily through reduced re-attendance, healthcare systems would do well to consider the broader developmental and psychosocial trajectories of the young people they serve. For adolescents and young adults at the crossroads of vulnerability and possibility, every clinical encounter can become more than a moment of treatment, the beginning of interruption in the cycle of violence.
