“I’m not Just Some Criminal, I’m Actually a Person to Them Now”: The Importance of Child-Staff Therapeutic Relationships in the Children and Young People Secure Estate
We recently published a paper based on analysis of interviews / a focus group with 28 young people accommodated by the Children and Young People Secure Estate (CYPSE) in England, which includes Young Offender Institutions, Secure Training Centres and Secure Children’s Homes.
There are ethical reasons for systems to adapt to address the complex and pressing needs of this population of young people, who experience higher levels of mental health and wellbeing difficulties and learning disabilities than the general population, often alongside a history of exposure to multiple traumatic events. There is also increasing evidence to support the delivery of trauma-informed care and the provision of positive therapeutic relationships and role models for young people.
The interviews and focus group were conducted as part of the independent evaluation of the Framework for Integrated Care (SECURE STAIRS), commissioned by NHS England and NHS Improvement. You can see our full evaluation report here. The Framework for Integrated Care (SECURE STAIRS) is a trauma-informed approach to support, based on several principles including being understanding and reflective by co-producing formulations with young people. The aim of this research was to explore young people’s experiences of therapeutic relationships with staff in secure settings, which is a central component of the Framework.
The young people we heard from described good relationships as being contingent on staff having effective listening skills and being "caring". This aligns with previous research in mental health inpatient settings, where patients identified faciltative traits of staff as being understanding, accepting, trustworthy, friendly, and kind (see Moreno-Oyato et al., 2016, Sweeney et al, 2014).
While these factors might be personality attributes, they are also skills acquired through effective training, and in this case through the trauma-informed systems of support provided through the Framework for Integrated Care (SECURE STAIRS). The young people who had been involved in co-producing a formulation using the Framework, discussed the benefits of this as: allowing them to break things down into manageable chunks; having the opportunity to share their story; and the opportunity to feel understood by staff. Some participants described feeling understood as being a necessary basis for caring relationships. Most said that they felt that at least one member of staff understood them.
However the young people we interviewed also reported mixed experiences of their relationships with staff in the settings. While they generally discussed the importance of building good child-staff relationships, some said they had experienced relationships as transactional, particularly when talking about respect, e.g., you respect them, and they’ll respect you. Our interviews were conducted during the phased roll out of the Framework and so that might be in part an explanation for the differing experiences, although there is some suggestion from wider research that young people’s experiences have previously differed based on setting type (see, Gyateng et al., 2014). Potential barriers to good child-staff therapeutic relationships were suggested to be a general disconnect with staff, or high staff turnover affecting the ability to form good relationships. Participants expressed a need to be treated with respect and to be taken seriously by staff and for staff to be respectful and reliable, which wasn’t always their experience.
We highlight the cross learning between the secure estate and mental health inpatient and residential settings, and there is learning that can be applied more widely too. Finally, the availability of mental health support and promotion across secure settings has been demonstrated as variable and fragmented across Europe, often delivered by external agencies (MacDonald et al., 2013). Our findings are complex and warrant further exploration, but do also speak to the need for staff to develop and maintain meaningful therapeutic relationship with the young people in their care.
Jenna Jacob, CORC Research Lead
References
Gyateng, T., Moretti, A., May, T., & Turnbull, P. J. (2014). Young people and the secure estate: Needs and interventions [Online]. YJB. https://eprints.bbk.ac.uk/id/eprint/21769/1/young-people-secure-estate.2013%20pdf.pdf
Jacob, J., D’Souza, S., Lane, R., Cracknell, L., Singleton, R., & Edbrooke-Childs, J. (2023). “I’m not Just Some Criminal, I’m Actually a Person to Them Now”: The Importance of Child-Staff Therapeutic Relationships in the Children and Young People Secure Estate. International Journal of Forensic Mental Health, 1-13. https://doi.org/10.1080/14999013.2023.2167893
MacDonald, M., Rabiee, F., & Weilandt, C. (2013). Health promotion and young prisoners: A European perspective. International Journal of Prisoner Health, 9(3), 151–164. https://doi.org/10.1108/IJPH-03-2013-0014
Moreno-Poyato, A. R., Montesó-Curto, P., Delgado-Hito, P., Suárez-Pérez, R., Aceña-Domínguez, R., Carreras-Salvador, R., ... & Roldán-Merino, J. F. (2016). The therapeutic relationship in inpatient psychiatric care: A narrative review of the perspective of nurses and patients. Archives of Psychiatric Nursing, 30(6), 782-787. https://doi.org/10.1016/j.apnu.2016.03.001
Sweeney, A., Fahmy, S., Nolan, F., Morant, N., Fox, Z., Lloyd-Evans, B., Osborn, D., Burgess, E., Gilburt, H., McCabe, R., Slade, M., & Johnson, S. (2014). The relationship between therapeutic alliance and service user satisfaction in mental health inpatient wards and crisis house alternatives: A cross-sectional study. PLoS One, 9(7), e100153. https://doi.org/10.1371/journal.pone.0100153