- Project offers therapeutic provision to support the psychological needs of young people in a range of secure accommodation in England
- High staff ratio means work with young people in secure settings can be more in-depth
- Enhanced training, supervision and support provided for staff working in secure settings
ACTION
Secure Stairs forms part of specialised health and justice work commissioned through NHS England’s Five Year Forward View for Mental Health launched in 2016 to improve mental healthcare provision across the UK.
With funding jointly awarded by the NHS, the Department for Education and the Ministry of Justice, this integrated care framework focuses on young people being accommodated in England’s secure children’s homes (SCHs), secure training centres (STCs) and young offender institutions (YOIs).
It recognises the unique needs of these young people many of whom will have experienced trauma or severe neglect and might not have previously accessed support to address their unmet needs.
The project also supports staff working with young people in these secure settings and aims to ensure they have the right skills and training to care for them appropriately.
The government’s decision to increase investment in this area of the youth justice system is also funding a large outcome evaluation to be carried out by the Anna Freud Centre.
“It’s a very ambitious project that has various forms of data collection across the sites so we can evidence the usefulness of what we are doing,” explains Dr Celia Sadie, a consultant clinical psychologist at Central and North West London NHS Foundation Trust and its clinical lead for Secure Stairs.
With little “definitive research” on successful methods to support a “niche” population of young people – numbers fluctuate around the 650-mark – a project such as Secure Stairs was long overdue, she says.
“It’s a set of ideas really, all entirely evidence-informed principles about what works with people and staff in extreme settings such as prisons and inpatient care but in this case really thinking specifically about the youth justice system.
“And then [producing] some recommendations from that set of principles about how to put them into practice in a practical way,” says Sadie, who works as part of an NHS team across two sites including Cookham Wood YOI.
Sadie says the project has only been in place for about two years. Funding rounds were allocated first to STCs and SCHs.
“We’re just getting people into post now and then we’ll only have one year left but I’m hoping it will be extended as it is completely necessary,” she says.
One of the main intended outcomes from the funding was to increase staffing levels across both the NHS and the secure setting workforce to deliver the principles of the model.
For Sadie, this has seen her NHS team double in capacity and up to 30 more officers employed at Cookham Wood.
However, she says the extra staffing has not just delivered an increase in therapeutic provision but also enabled more regular and direct contact with young people.
“We can now locate the staff principally on the wings where the boys live rather than being a kind of outpost that would hop in and see people.
“We are now there with them in their living areas and much more involved in their daily life,” she explains.
In terms of training for secure setting staff, having an enlarged workforce has also meant they can be released more easily to attend new and refresher sessions, she adds.
Sadie says programmes co-delivered with experienced YOI officers cover topics such as trauma, adolescent development, attachment, basic therapeutic skills and understanding the dynamics of working in “traumatised systems”.
“It has an impact on the people working in these places and they need to understand that’s happening and it’s not just normal in order to be able to manage it,” she says.
Supporting staff in this way also recognises their “parenting role” towards the young people and helps build more meaningful relationships over time.
Sadie says young people present with a range of different issues but trauma is “an almost universal factor” across the secure estate population.
For many of these young people, their needs may not have met the threshold for child and adolescent mental health services. In addition, chaotic family backgrounds mean appropriate support was not likely to be sought, she adds.
“Loads of them have witnessed domestic violence as well as parental losses,” she says. “They’ve missed out on lots of parental modelling on consistency and safety and play.”
The effects of such trauma on the young people presents itself through aggressive behaviour, disruptiveness and levels of anxiety that could be mistaken for conditions such as attention deficit hyperactivity disorder, says Sadie.
“Their sense of the world is that it’s a very hostile, dangerous place and they have to be violent and defend their physical integrity. So they are set to a hypervigilant state a lot of the time,” she adds.
Sadie says the expertise within her team means a wide range of therapies are offered including cognitive behavioural therapy and family work.
However, with increased resources she says practitioners are supporting more young people rather than those just those deemed “at risk or risky” and those most likely to respond to treatment.
“Those were the ones we would tend to look after the most but we always knew that if we had sufficient resources there’s work to be done with all of them,” she says.
IMPACT
The Anna Freud Centre’s evidence-based practice unit is evaluating how effective Secure Stairs is at identifying and meeting young people’s needs. Interim findings have been published (see box) but the evaluation will run until 2021.
Sadie says the project is being rolled out gradually within her settings – half of Cookham Wood is yet to benefit – but there is tangible evidence of its impact. A resettlement unit at the YOI, which has run the project for nearly a year, has seen an almost zero rate of violent episodes.
Moreover, feedback left by young people after release from the YOI is positive and encouraging about the project.
One young person said: “I felt like I was part of a family that I never would of imagined having.”
Another said: “You have helped me gain confidence. Any future careers I obtain are down to all the things you helped me do. Thank you for Secure Stairs and helping me help myself.”
GUIDE TO SECURE STAIRS
What is it?
The Framework for Integrated Care – known as Secure Stairs – is a project in the children and young people mental health transformation workstream, which is a priority programme within NHS England and NHS Improvement. The transformation programme derived from Future in Mind and the subsequent Five Year Forward View Implementation Plan.
What is the aim?
The workstream aims to improve the mental health and wellbeing of children and young people considered to be high risk, high harm or highly vulnerable. The vision of the framework for integrated care is to provide stable, integrated, therapeutic care for children and young people across the children and young people secure estate.
Why is it needed?
There were 811 children and young people aged 18 and under in custody in December 2019, the lowest total on record. There were 593 in young offender institutions (YOIs), 143 in secure training centres (STCs) and 72 living in secure children’s homes (SCHs). Children in custody are three times more likely to have mental health problems than those who do not, according to the Centre for Mental Health, while nearly one in five have a SEND education, health and care plan, according to the Council for Disabled Children.
How is it funded?
Funding of £37m has been provided for the entire project, £7.4m allocated each year from 2016 to 2021. After this, it is planned that funding will be included in baseline budgets.
Where is it being run?
All welfare and justice secure settings – SCHs, STCs and YOIs – across England are in the scope of the project, with the exception of Oakhill STC, totalling 19 sites.
What are the outcomes?
So far, 10 out of 19 sites have fully recruited staff to the project. More than 600 staff have received training as part of Secure Stairs. Feedback shows increased understanding from staff of the integrated care model, and an interim evaluation found increased understanding among officers of the importance of attachment and trauma in child development.
Source: NHS England & NHS Improvement
