PART 1 FINDINGS: PERSPECTIVES ON SECURE ACCOMMODATION
CHAPTER 2: PERSPECTIVES ON THE NATURE AND USE OF SECURE ACCOMMODATION
2.1.1 Findings reported in this chapter are drawn from a range of sources including interviews with secure unit heads, first line and senior social work managers, reporters, panel chairs and a range of other professionals working within the secure units, namely head teachers, psychologists, LAC nurses and children's rights officers. Respondents were drawn from all secure units and from eight local authorities. The local authorities were selected to give a geographical mix and reflect different patterns of use of secure accommodation, as indicated by the number of admissions in the previous year and whether the authority had its own secure provision. Respondents' views were inevitably shaped by their position within and knowledge of the system, but there were also marked variations within different groups of respondents. For that reason, and to avoid repetition, the findings are reported under topic headings, rather than respondent groupings. Connections between distinctive perceptions and expectations of secure accommodation and local authority ethos and practice are considered towards the end of the chapter.
2 EXPECTATIONS OF SECURE ACCOMMODATION
2.2.1 Asked to outline the main functions of secure accommodation for young people placed by a children's hearing, there was broad agreement that its primary role was to keep them safe and secure at a time of major crisis in their lives, while at the same time providing an opportunity for their emotional, educational and health needs to be assessed and help offered to reduce the difficulties which had resulted in the secure placement:
Mainly to protect the young people… but also at times the community. But also to try and make changes in the lives of these young people and their families ( S.W. manager 2)
Protecting the child, protecting the public from harm. I don't see it as a punishment (Reporter 1)
Keep a child safe and the public... just try to get something, just a stop in the child's life to get resources put in place (Panel Chair 1)
I suppose the obvious answer is to provide somewhere which provides safety, care and education for young people who need to have the kind of structure briefly around them to help them and sometimes stop and take stock and then be able to move on and move back into the community again ( S.W. manager 3)
2.2.2 Though brief, the above summary of responses about the function of secure accommodation encompasses all key elements. These were to:
- protect the young person and the public;
- assess needs and allow young people to take stock of their situation;
- engage with young people and effect change;
- equip young people to move back into the community.
2.2.3 A number of respondents gave a similar answer, but qualified it by saying that this was an ideal which had to be differentiated from the reality. One panel member expressed quite limited expectations of what might be achieved because of the short time scale:
There's a limit to what we can do in secure. A lot of it is just about keeping the children occupied, trying to talk to them about why they do what they do and, you know, it's more of a holding thing ( Panel Chair 2)
2.2.4 A social work manager said that though expectations were usually framed in terms of meeting young people's needs, the subtext was that secure accommodation catered for young people who had reached a point of non-engagement with any services:
The reality of when secure is used in my experience is when all the support mechanisms that could be used have been tried and someone is basically out of control and disengaged with any adults ( S.W. manager 2)
2.2.5 This latter comment is important because it highlights that the use of secure accommodation can be understood both in terms of what it offers young people and the function it serves within the child welfare system. As this research progressed it became evident that it would be necessary to understand the function of secure accommodation from both perspectives. Its relationship with other services is considered throughout the report, but primarily in chapters three, four and ten. This chapter reports on key stakeholders' views about the capacity of secure accommodation to fulfil its key functions. In chapters five-seven its effectiveness is assessed on the basis of young people's experiences and outcomes.
3. CAPACITY OF SECURE ACCOMMODATION TO FULFIL ITS KEY FUNCTIONS
2.3.1 Views about the capacity of secure accommodation were obtained in response to a specific question about whether the service was able to fulfil the key functions identified above. The majority of respondents identified gaps in capacity. A common explanation was that beds were not always available when necessary, so young people in crisis could not always be accommodated. A number of panel chairs thought that the remedy would be to increase the number of secure places, but more commonly respondents thought the answer lay in more flexible and targeted use of existing resources. Some expressed a preference for smaller, local secure units, whilst others focused on developing the capacity of open residential and community services to provide more intensive and structured care and support. Availability of places is considered in more detail in chapter four.
Capacity to protect the young person and the public
2.3.2 The predominant concern was that young people should be safe, with public safety viewed as an important consideration, but less frequently a major concern. In most instances secure accommodation was viewed as providing a safe environment. Some respondents thought one of the main values of secure accommodation was that it could allow young people who had grown accustomed to fear and uncertainty to feel safe and secure. However, a small number of respondents did raise concerns about the potential risk of bullying, with a few expressing particular concern about girls who had been abused being placed alongside boys or other girls who were intimidating.
2.3.3. A number of respondents, primarily social work managers, did identify some less tangible risks from the placement in secure accommodation, mainly to do with how the young person came to be perceived. There were concerns that resorting to secure accommodation implied to the young person that he or she could only be controlled and kept safe by being physically held, whilst others commented that the stigma of having been in secure accommodation could impede the young person's progress in the future. Some people expressed the view that peer influence could result in young people developing undesirable or unhelpful behaviours, but others argued that secure units were well enough resourced and structured to make sure that adult values and culture prevailed.
2.3.4 It was generally accepted that the public would be protected if young people were in a secure setting, though a few panel members pointed out that offences could be committed when the young person was home on leave or if young people ran away while on outings from the unit.
Capacity to assess needs and allow young people to take stock of their situation
2.3.5 Alongside keeping safe, the other key function of the units was to allow time for assessment and for young people to take stock of their situation. The ideal was that young people could take a step back from the behaviours which were putting themselves or others at risk, whilst staff could help them work out what would help prevent the same pattern of behaviour being repeated when they moved on.
2.3.6 There was widespread agreement that units did offer a degree of breathing space and could allow for full assessment of educational, health and emotional needs. In the three years during which the research was carried out, the capacity to offer multi-disciplinary assessment increased, with LAC nurses routinely offering a health assessment and a system operating in each unit for a mental health or psychological assessment to be offered to all or some of the young people admitted. Improvements were also reported in arrangements for educational assessment, for example quicker access to records from the young person's previous school. The importance of linking assessments together was also emphasised. Some professionals said that, as placements became shorter, on average 3-4 months, completing a detailed and holistic assessment could be an important element of what the secure placement offered.
2.3.7 Though each aspect of the multi-disciplinary assessment was valued, respondents often emphasised the need to better understand what emotional or mental health difficulties might be contributing to the young person's problematic behaviours and how these might be addressed. The psychologists or mental health professionals who were interviewed indicated that since most young people had multiple problems, assessment took some time. There was a strong emphasis on engaging with the young person, so that they became active participants in understanding the source of their difficulties and how these might be helped. Typically a range of difficulties were identified which needed attention, so a staged plan was developed to tackle them.
2.3.8 A number of the mental health staff pointed out that a lot of the young people's difficulties stretched back for many years. Though longstanding difficulties, for example in relation to attachment and loss, could not always be addressed within the secure placement, some suggested that secure unit staff should understand how these might impact on the young person's behaviour and response to the secure placement, and be able to draw on these insights when considering how an individual young person should be managed. It was suggested that unless staff had sufficient understanding and support to work in this way, the use of the time in secure placement would not be optimised. This kind of in-depth assessment and staff development was very time-consuming, so could not be routinely carried out within current resources and time-scales.
Capacity to engage with young people and effect change
2.3.9 Placement in secure accommodation was widely viewed as an opportunity to introduce services which had not been accessed by young people while in an open or community-based setting. From a rights perspective, several people pointed out that a secure placement should never be made or continued in order to access services, but it was seen as a great benefit that a range of services would be made available during the secure placement.
Health and Education
2.3.10 In terms of health , the most common needs were to visit a dentist or optician and have immunisations brought up to date. In addition, it was not uncommon for longstanding but untreated conditions, such as asthma or hearing difficulties to be identified and addressed. Drug-related problems could also be assessed and young people given appropriate advice. Young people were also given information on how to access services for sexually transmitted diseases and appropriate tests or treatments arranged. Some of the advice was given on a one-to-one basis, but in addition some LAC nurses provided sex education as part of the school curriculum, though the gender mix and range of sexual experience meant group teaching was not always considered appropriate. Capacity to offer education and advice on sexual health varied across units, so that in some the LAC nurse thought the service was as effective as it could be, whilst in another there were still plans for development.
2.3.11 Re-engaging with education was viewed as a major need to be addressed in secure accommodation, since many young people placed had missed out on a significant amount of schooling. Re-engagement was viewed as important, not simply in terms of learning but because reintroduction to a school or college placement would be important in sustaining any progress made while in secure accommodation.
2.3.12 Most respondents spoke positively about the educational provision in secure accommodation, though some gave examples of one unit taking several weeks to get information from a young person's previous school. A few questioned whether very small units could provide the breadth and flexibility of curriculum required. However those working in smaller units had given considerable thought to how the service could best meet such diversity of need and were evidently committed to ensuring that young people in their care did not miss out. In terms of certification, most units focused primarily on Vocational Qualifications and could offer a wide range of subjects. The modular format of these was well suited to the shorter term placements.
2.3.13 Across staff in units and respondent groups the main difficulty identified in relation to education was finding suitable provision for young people to move on to when they left. Education staff reported that the limited range of resources available meant there could be pressure to place young people in educational settings which did not correspond with their assessed ability. For example, it might be suggested that a young person who was capable of doing eight Standard Grades attend an educational unit which only offered two.
2.3.14 Much more positive developments were reported in relation to careers advice and planning. Through links with Careers Scotland, sessions could be provided on practical skills such as applying for jobs and more general preparation for work, whilst each young person was also offered an individual career planning interview. The range of vocational options in further education colleges was also cited as a positive option for young people in their last year of education, rather than returning to a school or specialist education project.
Emotional and Behavioural Difficulties
2.3.15 Within all respondent groups, the capacity to engage young people with services which would help address their emotional and behaviour difficulties was viewed as a key function of secure accommodation. Provision in this field was diffuse, varied and constantly being developed, so the interviews encompassed very different kinds of discussion about what should be provided in secure units, what was provided and whether current capacity was adequate to allow the units to engage with young people and effect change. Given their differing roles, stakeholders' understanding of what was entailed in introducing and providing services varied across respondent groups. Unit managers, social work managers and psychologists or other mental health staff provided the most informed and considered responses on these issues. A number of reporters acknowledged that this aspect was not directly relevant to their role, though some had formed a general view that current provision was not adequate. Several panel chairs pointed out that it was difficult for them to assess whether their expectations of secure accommodation in this respect were in fact met, because they did not usually see individual young people after the secure authorisation was made. However, from sitting on review panels, a few had formed the view that the service catered well for young people's needs, whilst others identified gaps, primarily for more specialised help to address mental health and addiction issues. Some panel chairs also emphasised the importance of the key worker forming a caring relationship with the young person and offering one- to-one contact rather than simply relating to them as part of the resident group.
2.3.16 Views expressed on this issue highlighted some of the ambiguities which permeate secure accommodation, so they are reported in some detail in the next two sections. Respondents' comments in this respect were closely connected to differing ideas of what was meant by a 'service'. Some respondents readily included the experience of living in secure accommodation, which we therefore cover first. Others only referred to specific programmes or services such as programmes to reduce offending or drug and alcohol use, so this is discussed afterwards. A number of respondents, primarily social work managers and mental health professionals, talked about the relationship between the residential experience and specific service provision.
The experience of living in secure accommodation
2.3.17 From some points of view the experience of living in secure accommodation made it more rather than less difficult to address the difficulties which had resulted in the placement being made. A number of respondents suggested that the very nature of institutional life meant that the priorities of the institution rather than the individual came to the fore, whilst residents became preoccupied with adapting to the regime and getting out, rather than the addressing of the difficulties which had resulted in their placement. Standard, rather than individually negotiated, arrangements for family visits and home leave entitlement were cited as examples of the needs of the institution taking precedence. At a more fundamental level, there was also a view that placing someone in secure accommodation conveyed a message to the young person that their problems could only be resolved by imposing external controls, rather than developing their own capacity to manage them. The enforced nature of the placement could also foster superficial rather than meaningful engagement on the part of the young person.
2.3.18 Doubts were commonly voiced about the effectiveness of addressing difficulties outwith the context in which they arose. Offending and drug and alcohol use were viewed as closely related to young people's peer and social relationships, so ideally work should be carried out in that setting. Correspondingly, it was difficult to address family issues without involving other family members. No one who expressed these reservations proposed that all work with young people whilst in secure accommodation was unproductive, but they took the view that it would be more effective to offer this in open or community-based services, so provision there should be boosted. They also suggested that service provision while in secure accommodation would have a more lasting impact if services and resources were available to allow a gradual, step-down approach from the structure and support offered in secure accommodation.
2.3.19 A final frequently made comment was that the multiplicity and complexity of many young people's problems meant they could not be addressed within a short-term secure placement. This lent support to the view that consideration should be given to what could be achieved within the time scale, and care taken to avoid embarking on programmes which would have to be cut short or relationships which would need to be broken and so constitute another rejection for the young person.
2.3.20 These comments provided a degree of balance to the widely expressed view that placement in secure accommodation provided a good opportunity to address young people's difficulties. The following comment was one of the most uncritical made by a panel chair, but several encapsulated similar sentiments:
'As far as the panels are concerned, they're delighted if a child manages to get a place in a secure unit and, you know, at the three- month review they're invariably positive because the child has been contained and isn't doing anything wrong'. (Panel Chair 1)
2.3.21 Turning to specialist services, most respondents took the view that capacity to help young people address serious difficulties was improving, but still inadequate. The growth of mental health or psychological assessment was very much welcomed because it enabled young people and staff to better understand the nature and causes of problem behaviour or emotions and so be better equipped to manage it. Arrangements for psychological and mental health provision were different across units, with one unit relying primarily on psychologists employed within its own service and others having access to a team of child mental health specialists, including psychologists, social workers, psychiatric nurse and occupational therapist employed by the local health authority. The latter was thought to be beneficial organisationally because staff could facilitate links to other health authority services. There was little support among mental health staff for the view that admission to a psychiatric unit would be a preferred option for many young people in secure accommodation, but in some situations it was helpful to be able to quickly access a psychiatric or neurological assessment.
2.3.22 Whatever the organisational arrangements, the general view was that capacity to identify evidence-based methods for addressing emotional and behavioural difficulties had greatly improved, but that insufficient resources were available to deliver appropriate programmes or therapeutic help. Three main models were described through which the units' capacity to cater for emotional and behavioural difficulties might be enhanced:
- providing consultation to staff to boost understanding and management of young people's difficulties;
- delivering group and/or individual programmes in collaboration with unit staff and/or monitoring the integrity of staff-run programmes;
- providing individual sessions with a psychologist or mental health worker for the young person.
2.3.23 The first two involved care staff. They worked wholly or in part through the young person's experience in the residential setting and had the advantage of developing the care staff's knowledge and skills. The third provided more intensive support to young people with individual difficulties. Different models predominated across different units, but all staff felt that there could be value in augmenting each. In terms of the issues to be addressed, faulty social learning, disrupted attachment, trauma and abuse were key. These were typically reflected in a range of behaviours including deliberate self -harm, violence, offending and sexual vulnerability or aggression. The ideal to be aimed for was that issues addressed in individual or group sessions would be actively reinforced through the young person's day to day experience, for example by care and teaching staff encouraging the development of pro-social behaviours or appropriate responses to negative experiences.
2.3.24 The use of evidence based programmes was more developed in some units than others. In at least one unit teaching and care staff worked together to deliver programmes. Programmes most commonly mentioned were for anger management, cognitive skills and violence reduction. One point emphasised by several respondents and all mental health specialists was that, in order to be effective, any approach had to be based on thorough understanding of the young person's needs and ways of responding to interventions. 'One size fits all' programmes were considered to be unhelpful and some specific concerns were raised about girls being asked to take part in programmes focusing on consequential thinking and offending, when most needed to learn how to value and nurture themselves and so enhance their self-esteem. In addition, a good fit between young people's needs and programmes offered was likely to boost young people's motivation and engagement. Thus the ideal was to combine appropriate programmes with individual work.
2.3.25 A second general point was that interventions should take account of the short time scales by providing a kind of survival kit that would help young people better understand their difficulties and develop a more positive view of themselves. Several evidence based approaches, such as pro-social modelling and dialectic behaviour therapy, were being introduced, but it took time and resources to train staff and introduce them, so the potential for effecting change was not yet being maximised.
2.3.26 Capacity to engage effectively with parents was viewed as limited, which was a matter of considerable concern, since a number of young people would return home. In the initial stages of the study the research team was not informed of any specialist staff working specifically with parents and young people. However in the final round of interviews with unit managers, some described more recent developments in outreach and family work. Sometimes this was viewed as the social worker's remit, but distance and shortage of social work time meant very little effective work could be undertaken.
Equipping young people to return to the community
2.3.27 It was not unusual for respondents to point out that it was unrealistic to expect that a period in secure accommodation would make significant changes to a young person's life since many of their difficulties were longstanding and severe and because they would be returning to an environment which had contributed to their difficulties.
'I think children in secure accommodation are not there long enough to have a benefit. …What they do come back to, well that's all pieced together, which is not ideal.' (Panel Chair 1)
2.3.28 Returning to their family could be particularly difficult if its way of life or relationships were likely to undermine progress. As noted above, there was little evidence of preparatory work being done with families. More often respondents emphasised the obstacles to family work. These included placements being some distance from home, lack of field social work time, parents' unwillingness to engage and a tendency for staff to frame the problems from the perspective of the professional services, rather than let parents say how they viewed the situation and what they would want to change.
2.3.29 Some respondents thought it was important to recognise when families lacked the capacity to offer more to the young person, in which case the focus should be on helping young people to acknowledge this and learn to parent or at least look after themselves. One psychologist emphasised the importance of this kind of work being based on an understanding of the cognitive and emotional processes through which young people develop, rather than expecting that simply getting older would equip them to cope.
2.3.30 Negative influences in the wider community were mentioned as equally important to the family environment. For some young people removal from the home community, either to residential school or foster care, was thought necessary if any change was to be sustained. For others the key was to strengthen positive influences and supports within their own communities. Developing the latter was easier if the secure placement had been in the young person's local area. The provision of appropriate education, in a school or college, was also mentioned as key to providing a focus for life after the secure placement. The view was that opportunities for college attendance and vocational training after school had greatly improved, but that finding appropriate education for younger pupils remained a weakness in the system.
2.3.31 In addition to considering the environment to which young people would return, a number of respondents, mainly psychologists and mental health professionals, emphasised the importance of considering what the transition from secure accommodation meant for the young person. A number of social work managers and mental health staff pointed out that the physical security and safety of the placement could promote attachment to staff. This was often viewed positively, but unless its significance was recognised and managed, leaving the placement could amount to another rejection and result in young people feeling bereft. Thus scope for continuing relationships with key workers or sensitively managing the transfer to new carers was an important ingredient in boosting the effectiveness of the placement. For some young people it was also important that therapeutic or medical services were continued after they had moved on. Not surprisingly there was recognition that it was more difficult to provide continuity when the placement had been some distance from the young person's home area.
2.3.32 There was a widespread view that current arrangements seldom allowed for this kind of needs-led planning. More usually young people had to fit into whatever resources were available and placement endings could be organised around maximising the use of resources rather than the emotional needs of the young person. Whilst individual planning was viewed as key, a step-down approach into a resource- like close support was considered suitable for many young people, but places were not always available. Managers in units which had close support provision on the same site found this much easier to arrange than others. Irrespective of how successful the placement had been, returning to the community was viewed as a highly risky stage when many of the benefits of the placement could be lost.
4. SUMMARY POINTS
2.4.1 The key expectation was that secure accommodation would keep young people safe and, if applicable, protect the community.
2.4.2 There was also an expectation that the time in secure accommodation would be used to assess young people's difficulties, introduce appropriate services and help them make changes.
2.4.3 There was a strong view that units' capacity for assessment and tackling difficulties had improved in recent years. The importance of developments in health care were frequently cited as particularly helpful. However, these improvements were seen as patchy and very few respondents thought that the service was able to fulfil the functions expected of it. There were requests for additional resources within secure units, but some respondents also took the view that comparable services should be available through open residential and community-based support, since they could be more effective in that kind of setting.
2.4.4 With increased input from psychologists and mental health professionals, there was increased awareness of the nature of young people's difficulties and how these might be most effectively addressed. However the capacity to offer appropriate interventions or support had yet to be developed.
2.4.5 In addition to specific programmes and interventions it was considered important that the experience of group care should facilitate changes in attitudes, perceptions of self and behaviour. This had implications for the respective roles of specialists and care staff.
2.4.6 A central issue was that many of the young people had entrenched difficulties, so would require skilled help and support in the long term, yet secure accommodation aimed to be short term. For this reason, it was widely held that the capacity to effect change depended as much on continuity and suitability of service provision as on what could be achieved within the placement itself. It was emphasised that appropriate after care support strongly influenced the service's capacity to influence young people's behaviour and sustain progress when they returned to the community or an open setting. This implies that any consideration of placement in secure accommodation (or indeed alternatives) should from the start be made on the basis of a long-term plan.