Communicating with Young People in Crisis

Authors: Trudie Kee / Editor: Charlotte Davies / Codes: CC6, PAP6, SaC1, SaC2, SaP1, SaP2, SLO5 / Published: 29/06/2021

Redthread is a charity that runs a number of hospital-based Youth Violence Intervention Programmes, Young Women’s and IDVA services in hospital EDs throughout London and the Midlands. This blog was prepared by Trudie Kee, Programme Coordinator for the Redthread team based in Queen Elizabeth Hospital ED in Woolwich, a busy local hospital in South East London.

Introduction

When young people attend ED, they sometimes have professionals who are already in their lives, for example teachers, social workers, or mental health professionals. In some cases, it could be that the trusted adults in their life have let them down, and that has created a barrier of scepticism when approached with support in the future. In this blog we will talk about how to overcome these barriers, which will help you build trust with and get the information you need from the patient to treat them and keep them safe, with some great insights from young people working with Redthread.

Picture the Scene

A young person is sitting on the bed, we know that they have been a victim of an assault and that their face is swollen and they are clearly in pain. They are refusing treatment and being verbally aggressive with staff. 

What do you do in this situation?

There are many ways this could go – some clinicians might give them time to calm down before attempting treatment and some may refuse treatment due to their behaviour. Whatever you do – Redthread advises every clinician to step back and think: what brought this young person here? Who is supporting them during their distress? In this situation it is clear that the young person needs treatment they are refusing, so the priority here is to get them to engage with you through de-escalation and emotional containment.

Use the tools you already have: 

 

 The familiar AIDET acronym is a great foundation to develop your interaction with young people. In a blog by Charlotte Davies in November last year on communicating with patients in the emergency department, she writes:

Patient communication in the ED serves several purposes. You want to get information from the patient, which needs rapport and skill, but you also want to give the patient information whilst maybe using your words to treat.  

AIDET” is one framework that might help. Many of you will complete components of this subconsciously and intuitively”

Using this familiar acronym as a foundation can help you develop your interaction. In the situation above, it is clear that the young person needs treatment but is refusing, so the priority here is to get them to engage with their medical treatment through de-escalation and emotional containment.

In addition to this, the HEEADSSS assessment offers a useful framework for exploring a young person’s circumstances and, though you may not want to undertake a full HEEADSSS assessment when a young person is in crisis, select parts of the assessment that can be used to talk with the young person, to build rapport and put them at ease. A guide to using the HEEADSSS assessment can be found here.

Consider childhood trauma or mental trauma:

It’s useful to understand here the mental state of a young person following a traumatic injury or crisis in a new environment. They may be fearful of the negative consequences of speaking to professionals, including doctors and nurses. These negative consequences could involve further physical or emotional violence, something that anyone would want to avoid. This fear can create conditions that activate the amygdala, the threat-response centre of the brain, causing young people to behave in ways that seem challenging or disruptive to professionals who are offering care. For more information on the trauma-informed approach Redthread use, check out this article in the RCPCH’s Milestone Magazine (page 18-19).

Communicate on a person to person, not clinician to patient level: 

Redthread sometimes see clinicians engaging firstly, or even exclusively interact with the older adult (i.e. a parent, or police officer, perhaps) in the room. Acknowledging the young person directly, can help in some way to build rapport, even if that leads to them directing you to the parent or guardian in the room.

Introduce yourself

Explain your role (avoiding hospital jargon if possible), make eye contact, be patient and aware that you may need to repeat yourself. Ask yourself: are their basic needs being adequately met? Is there more that can be (reasonably) done to make this young person feel as safe and comfortable as possible?

Be Inclusive

It’s also important that the young person is part of the discussion on their treatment plan, and is able to give consent to procedures. Alongside this, making sure that they understand what treatment they will be having and how long they are likely to be in the emergency department empowers the young person to take control of a stressful situation which, in this situation, could help rebuild their trust in professionals. Involving the patient by letting them ask questions of you is a simple yet effective way to give them space to process their ordeal.

Breaking down barriers can help to create an appropriate plan of care with a patient. At Redthread, safety planning is our immediate priority, and we often provide emotional containment for young people bedside, which helps support clinicians to build rapport and open up to both the YVIP service and further treatment.

Be curious and stay curious:

As humans, each of us have our unique experiences of the world. Young people are exactly the same, and it’s important not to assume an understanding of any one situation. Be curious, asking open-ended questions like “Tell me about being in school these days?” in, for example, the context of a school-based assault. Connecting over our differences can be just as important as finding common ground.

What young victims of violence told Redthread:

We asked our Youth Ambassadors, who have all previously been engaged with the Redthread service, about the experiences they have had in ED and the effect that it had on them. The same Youth Ambassadors shape how we run our services in hospitals through their valuable feedback, help us to employ our youth workers and generously offer their insights about their experiences both internally to Redthread and externally to other practitioners and even to politicians in Parliament!

It’s very important to listen to young people and their wishes. Where you have a legal obligation to report your concerns, being honest with the reasoning why could be communicated with them to show them that this is something that you must do in order to better safeguard them. In this case, as this young adult was 18 at the time, they had a choice to report to the police or not, a decision which should have been respected.

Multi-Agency Working

You can see from these statements that each case is completely different, which reinforces the importance of adaptability in any one presentation.

Communication and Multi-agency working in such complex situations is key. We can’t expect a busy emergency department to perform the same function as an inpatient ward, however, what clinicians should do is refer to your safeguarding team and make the appropriate referral to children’s social services or CAMHS. Where Redthread or another Hospital Youth Violence Intervention Programme is available, you can utilise our holistic support (if needed). In the cases above, referrals were made and the Redthread team were able to provide immediate emotional and practical support which helped progress these cases towards discharge and led to follow-up support in the community.

Want to know more about the work we do?

Website http://www.redthread.org.uk

Email: info@redthread.org.uk

Follow us on Twitter, Instagram and Facebook @redthreadyouth

 

For Further Links

  • Cappelli M, Gray C, Zemek R, et al., The HEADS-ED: A rapid mental health screening tool for pediatric patients in the emergency department. Pediatrics. 2012; 130(2):e321–7.
  • RCEMLearning, The Forgotten Tribe – adolescents in ED. 2021.
  • RCEMLearning, Communication in ED. 2020.

 

Leave a Reply