Health & wellbeing

Violence intervention through hospital A&E

Yael Ilan-Clarke Middlesex UniversityYael Ilan-Clarke is a Research Assistant at the Centre for Abuse and Trauma Studies (CATS) based at Middlesex University, which has been working with A&E patients to reduce cycles of violence.

An innovative approach to tackling interpersonal violence in the UK has been the move towards using hospital accident & emergency (A&E) departments as the setting for intervention efforts. Recently there has been such support for this approach that in 2015 over £600,000 has been invested in placing specialist youth work services in all the Major Trauma Centres (MTC) in Central London boroughs.

The first two such projects in the UK have been longstanding in the capital and have demonstrated sufficient effectiveness to encourage further investment in the same vein. The first was set up in King’s College Hospital in 2006 (one of the London MTCs) with the voluntary agency Red Thread pioneering the service. The second one launched in 2010 in St Thomas’ Hospital, delivered by the Oasis UK charity.

Both projects serve two inner-city London boroughs characterised by diversity and high levels of deprivation. Multidisciplinary teams form the backbone of the projects, whereby a youth-work service is embedded into the referral pathways of the hospital following clinical assessment/treatment at an A&E (or in the case of King’s, also later on the wards). Professionals from a range of services act as advisors to the projects’ steering, with specific contributions from paediatric clinical teams, public health, police and youth offending. The CATS research group became involved as evaluators of the intervention at St Thomas’ when it was launched as a pilot, and continues to assess its effectiveness and progress to this date.

Reducing risk

Photo by Phalinn Ool
Photo by Phalinn Ool (Creative Commons 2.0)

It is the nature of these interventions and their location which represents the unique vantage point for  violence reduction. Most important is the move towards support and care, and away from judgement and punishment. Rather than just patching up the wounds and sending young people back to the streets to face the same threats, the projects aim to identify those at risk and work with them to reduce the level of risk in their personal, social and emotional lives. Such projects facilitate access to a population which too often slips through the net in terms of help-seeking behaviour. The population are typically young people with multiple risk factors who are on a continuum of risk on the brink of, or already embroiled in, a cycle of violence.

So what can such projects contribute to violence reduction efforts?

  • Access – a large majority of violent incidents don’t reach the attention of services, are not reported to police and may go unattended, paving the way for further risk and potentially leaving vulnerability exposed and unattended. A&Es have unique access in that they are not stigmatised by society as being out of bounds in terms of help-seeking behaviour (unlike police and social services); therefore they see a large proportion of people who do not seek help elsewhere. In one seminal study, a team in Cardiff led by Professor Jonathan Shepperd (2007), found that up to 70 per cent of violent assaults reaching the hospital A&E were not reported to police. Conversely, the level of risk is apparent when you look at lifetime statutory service use. In the sample of young people in the St Thomas’ project (12-20 years old), approximately two-thirds had previously, or were currently involved with at least one of the following services: social services, mental health support or youth offending teams. This testifies to the complexity of circumstances surrounding these incidents and the vulnerabilities experienced by many young people along different facets of their lives.
  • Opportunity – the A&E visit presents itself as a window of opportunity, or what is known as a ‘teachable moment’ (McBride et al, 2003). The heightened emotion caused by the event, may give rise to scrutiny of the situation and the result is an opportunity in which the individual may be more amenable to changing attitudes and behaviours. This aspect is seized upon in A&E interventions, with a drive to reduce risky and dangerous behaviours. Research findings and qualitative data from the St Thomas’ project suggest that the period following the A&E visit is one of confusion, evaluation and openness to change. The youth worker’s presence and direction can make the difference between taking strides in a positive direction or at best, maintaining the status quo, and at worse, falling into more destructive and dangerous patterns of behaviour.
  • Scope – The relationship built between the youth worker and young person offers a unique opportunity to influence their choices and actions on issues that can have far-reaching effects. The youth worker can take on a role of companion to support the young person to act responsibly on matters that count, by undertaking tasks daunting or threatening to the young person, together. For example the St Thomas’ project has reported attending court hearings which otherwise would have been missed, supporting young people to attend appointments with mental health professionals, liaising with social and housing services on their behalf and encouraging the uptake of educational and employment opportunities. By devoting time and attention to the individuals, the youth worker is in a unique position to influence young people to make positive choices and to help them reach their potential.

These are just a few of the unique facets that hospital-based violence interventions for young people are able to contribute to the reduction in interpersonal injury. The CATS team will be holding a one day seminar in the summer for existing and emerging A&E-based violence interventions in the UK, with a view to forming a national network to facilitate sharing best practice between these innovative projects. It is hoped that by working with a shared agenda, more can be done to change the lives of individuals and communities in the effort to heal the wounds of violence.

Science & technology

The Dress: did genetics almost break the internet?

Dr Britta Stordal, Senior Lecturer in the School of Science and TechnologySenior Lecturer in Natural Sciences at Middlesex University Dr Britta Stordal examines which demographic factors could play a part in the colours we see ‘The Dress’.

When I first saw the photo of ‘The Dress’ (#TheDress, if you prefer), like most people I didn’t understand the fuss and figured it was some kind of trick. I see white/gold and nothing else. Then I showed it to my husband and he saw blue/black. At that moment a hypothesis was born: Maybe the way we interpret the colours has something to do with gender?

In the unlikely case you missed it, ‘The Dress’ is a photograph that started circulating on the internet in late February 2015.  Approximately 50 per cent of people see the dress with blue/black colouring and the other 50 per cent see white/gold or other colours.

In real life, the dress itself is blue and black. There is just something about the colour balance and brightness of this particular photo that leads to a different interpretation of colours by different people.

A quick search of the internet revealed that Kim Kardashian also sees white/gold like me, while Kanye West sees blue/black like my husband. Since this pattern of interpretation of colour is probably the only thing we have in common with the Kardashian-Wests I figured that I was on to something.

But four subjects is far from scientific proof; so I designed a survey to test my hypothesis.

The survey

I am a Senior Lecturer at Middlesex University in London, where I teach anatomy and physiology as well as statistics. I piloted the survey on my students and it generated a lot of excitement in class. In my class of 42 students we found no link between gender and seeing white/gold or blue/black.

A woman dresses manequins wearing the dress following the image going viral.
(Photo originally here:

However, the results from class suggested that there could be an association with age. Scientists are adaptable people; this finding just meant I needed a few more hypotheses and a way of collecting a lot of data. So I designed a new survey, and launched it online though the Middlesex University Facebook and Twitter pages. I asked participants their age, gender, ethnicity and if they were colour-blind.

Initial results

Thanks to the popularity of the white/gold vs blue/black debate on the internet I had 731 responses to the survey in the first week.

56.7 per cent of respondents saw blue/black and 43.2 per cent saw white/gold. So who is more likely to see white/gold?

I found that a person’s gender, age or being colour blind do not predict if they are more likely to see white/gold.

Ethnicity might have an impact but the difference between ethnic groups is very small. 40 per cent of people identifying as white in this survey saw white/gold compared 44 per cent of people identifying as non-white.

I received lots of suggestions from participants on how to improve the survey. There seems to be a few other groups of people who see blue/gold or blue/brown. Some who see the photo differently on different occasions and some who see it differently with and without wearing glasses.

Revised survey

The Dress image that circulated the internet
In case you missed it, here is the image of The Dress

A revised version of the survey is now available online. I now know that I am going to need at least 3,000 participants to prove any association with ethnicity so please let me know if you are a white/gold, blue/black or part of the new categories of blue/gold and blue/brown.

This photograph is going to be an exciting topic of research for years to come. I am sure that there could be a genetic factor in why different people see different colours in the image. The same way that people taste some foods differently, some people like coriander and some people say it tastes like soap.

I’ll leave those studies to the neuroscientists, but this study has given them a head start. Knowing what is not associated with something is an important step in finding out what is.

If you would like to contribute to this project by completing the survey please click here.

Business & economics

Orientation training: beyond boring manuals

Thomas Lange Middlesex UniversityProfessor of Economics and International Management at Middlesex University Thomas Lange discusses the positive impact that orientation training can have on employee satisfaction.

Think back to your first few weeks on the job. What were your challenges? More than likely, part of your time was taken up by your new employer’s orientation programme. Was it a helpful, productive, insightful and uplifting experience? Are you now clearer about the organisation’s corporate culture and what is expected of you in your new role?

Boring and irrelevant?

According to sources in the popular press, reality doesn’t always measure up to expectations. Allegedly, the most frequent complaints about new employee orientation are that it is overwhelmingly boring, or that the new employee is left to sink or swim. Organisations that have a structured orientation programme are frequently accused of focusing heavily on filling out forms, attending (yet again!) mandatory health and safety and diversity training courses, issuing ID cards, showing sorely out-of-date videos and PowerPoint presentations, and ensuring that new staff familiarise themselves with technical (read: boring) employee manuals.

Does this sound or feel familiar? How representative are these accusations? Does orientation training really make little difference to your working life?

Why orientation training matters

If you buy into the above story and are just about to give up on orientation training, then my advice would be: not so fast! Recently published research I co-authored with colleagues at the universities of Surrey and Kent has uncovered that orientation training has far-reaching implications: it affects employees’ job satisfaction. Our research was motivated by the importance of socialisation in developing task competence, developing work-role clarity, establishing realistic job expectations, and developing interpersonal relationships with work colleagues, all of which have an impact on work-related attitudes, such as job satisfaction.

“Ok, but why does this matter?” I hear you say. The answer comes in two equally important parts. First, a growing body of research has already explored the causal relationship between job satisfaction and important workplace attitudes and behaviours, including job performance, commitment, motivation, absenteeism and quitting intentions. These issues matter to both organisation and employee. Second, and this is where our research adds significant value, orientation training is indeed a strong predictor of job satisfaction and facilitates the workplace socialisation of new employees, specifically by reducing the uncertainty about aspects of the job that are not always contractible.

Bored - Fod Tzellos
Bored – Photo by Fod Tzellos (Creative Commons 2.0)

Key Findings

Our findings, published in leading HR journal, Human Resource Management, have important implications for human resource managers and practitioners, calling for a redirection of resources towards orientation training. This is especially important in a highly dynamic labour market environment where employee mobility and career changes have become the norm rather than the exception.

Orientation training evidently matters, and it arguably matters even more, given its predominance as a stronger predicator of job satisfaction than other type of training activity – another finding of our investigation. Redirection of resources towards orientation training could increase the effectiveness of human resource strategies for creating an engaged and motivated workforce.

What’s more, by delving a little deeper into our rich dataset, derived from the British Household Panel Survey (BHPS), we uncovered that orientation training exerts a significant positive effect on newcomer male employees’ overall job satisfaction in both the private and public sectors, but it increases overall job satisfaction of newcomer female employees only in the public sector. Building on findings in the work-life conflict research arena, we speculate that this finding may be reflective of women finding socialisation tactics in the so-called ‘model employer public sector’ more helpful where HR practices, such as orientation, encourage work-life integration.

Beyond overall job satisfaction, when we look at a number of job satisfaction domains, such as satisfaction with pay, satisfaction with job security or working hours, we find a positive relationship between orientation training and these satisfaction domains predominantly in the public sector. And we find that this is true for both, men and women. This reflects the view that, compared with the private sector, public-sector firms are indeed model employers who are more likely to exert effort and use tactics that ensure newcomers are competent with and socially accepted in various aspects of their work.

Impact and rigour of our research

Our insights are not simply based on anecdotal hear-say or derived from a handful of focus groups (however important focus group research may be). And, clearly, our findings are not mirror images of popular press chatter. Using briefly some technical jargon, our findings are ‘statistically robust’ and based on survey responses from nearly 7,000 male and female British employees in both public and private-sector organisations, using data from the BHPS.

Using this survey has allowed us to distinguish between different types of job training and domain satisfaction measures. Our work thus provides one of most disaggregated analyses of the relationship between job training and job satisfaction to date.