CHAPTER 6: THE SECURE ACCOMMODATION PLACEMENT
6.1.1 The decision whether or not to admit a young person to secure accommodation evidently had a significant impact on how each young person spent the following year. The admission itself constituted an abrupt shift in a young person's life, then, unless young people remained in secure accommodation for twelve months or more, the transfer back into the community had to be managed in the course of the same year.
6.1.2 In reviewing the year following admission to secure accommodation, the focus is on two dimensions: what the secure placements offered and the immediate impact of the placement, as assessed by the placing social workers. Within each of these dimensions, attention is paid to the extent to which expectations for the placements were met and protective factors boosted in the young person's life.
6.1.3 Young people were recruited for the study from each of Scotland's six secure units. Distribution in terms of gender is outlined in table 6:
Table 6: Location of Secure Placements by Gender
2. WHAT THE SECURE PLACEMENTS OFFERED
6.2.1 Insights into what the secure placement had offered young people were afforded through information from social workers and key workers, obtained from questionnaires and in interviews. Some young people were also interviewed and their perspectives are reported in the following section.
6.2.2 As people talked about what the secure placement offered, there were clearly two different processes which operated concurrently: 1) the young person adapting to the secure environment ; 2) identifying and addressing young people's needs and issues. In relation to both of these areas, this research only developed a broad indication of what each young person had actually been offered. For example the researchers might have been told that a pro-social modelling approach operated within the unit or that key workers were addressing specific issues such as family relationships. However from such descriptions alone it was difficult to know what the interactions with the young person had entailed. Even when young people were said to have taken part in programme work, it could be difficult to find out exactly what or how many sessions had been offered and how the young person had responded. It was not unusual to learn that social workers also had limited knowledge of what had been offered.
6.2.3 For these reasons and because the study is concerned with the overall impact of a secure placement, rather than trying to relate outcomes to particular kinds of interventions, no quantitative account of the service provision is provided, rather a brief overview of the key elements of the service.
Adapting to the secure environment
6.2.4 Each unit had its own procedures for introducing young people to the life of the unit. For most young people information about what life in the unit was provided by their key worker and fellow residents. A key worker was usually allocated very soon after admission and the main rules and routines of the unit were explained.
6.2.5 Each unit gave young people information about their rights and that they could ask to meet with a children's rights officer. Depending on the resources available to each local authority's Children's Rights Officer ( CRO) service, arrangements varied as to whether a children's rights officer would routinely make contact with a young person following admission. When they did visit, the initial focus was on making sure young people understood why they had come to be placed in secure accommodation and what they could expect from the children's rights service.
6.2.6 In the early days, it was usual for contacts with family and friends to be restricted in order to allow staff to make informed decisions about what contacts were safe. In at least one unit it was usual practice to only gradually allowed young people to have access to all their possessions, e.g.CD player, in their bedroom. These were set procedures which applied irrespective of the young person's individual circumstances, so they conveyed from the start that in certain respects young people would be required to conform to the unit's regime.
6.2.7 Within all of the units there was a commitment to staff modelling pro-social behaviour, alongside the operation of some kind of reward-based system through which young people could gain additional privileges, if their behaviour in the school and care unit merited this. This was partly because, as some unit staff pointed out, effective means of controlling behaviour were seen as crucial if the unit was to be made safe for all residents. Also developing pro-social behaviour and reducing aggressive or destructive behaviours were aims for most young people in the secure sample. Awards could also provide clear evidence of improvements in young people's behaviour.
6.2.8 However, though apparently necessary and helpful in the short term, the existence of reward-based systems lends support to the view that on entering the secure environment young people become preoccupied with adapting to it and securing privileges, rather than addressing the difficulties which had resulted in their admission. This point of view was expressed by several of the placing social workers.
Identifying and addressing young people's needs and issues
6.2.9 Plans for the placement were developed through both a system of formal reviews and planning meetings and individual discussions which took place between the young person and key worker or social worker. An assessment was carried out, though the form this took varied. Some units were beginning to use the YLS to identify issues related to risk of offending, whilst others relied primarily on psychological assessment or contacts with the key workers. In terms of how plans were recorded it was not usual for the files to contain a single document which identified key issues to emerge from the assessment process and how this would inform both the detailed work with the young person in the unit and plans for moving on. The various elements might well have been addressed in different documents, but at the time when the research was being carried out, they were not systematically recorded in a single, co-ordinated care plan.
6.2.10 Asked about the content of planning meetings and reviews, key workers, social workers and young people most often mentioned reviewing young people's progress or difficulties in the unit, arrangements for home leave and developing plans for moving on, including referral to outside agencies such as addiction or community support teams.
6.2.11 Opportunities to help young people address individual difficulties usually occurred in three contexts: planned individual sessions with the key worker or other member of staff; group programmes offered within the unit; contact with staff from agencies and projects based outwith the unit.
6.2.12 Issues mentioned frequently as being addressed with key workers or other member of staff were: life story work; self-esteem; keeping safe strategies; offending; temper management; relationships with peers; relationships with parents.
6.2.13 The importance attached to the key worker relationship varied across units. In two units from which the majority of the female sample had been recruited, developing positive relationships with staff was viewed as central. Each young person had two key workers and a key manager, so that there was usually someone available who knew the young person if a crisis arose. Staff used a range of tools and resources to explore relevant issues, but encouraging the young person to trust was viewed as key, if the roots of emotional difficulties were to be addressed. In a few cases there had also been some relationship-focussed work with a parent, but more usually key worker contacts with parents took place around practical issues such as leave arrangements.
6.2.14 In other units, more emphasis was placed on the use of structured programmes, delivered by care staff or staff specialising in developing this aspect of the service. At the time when the young people in the sample were in placement, the programme Offending is not the Only Choice was offered in three units. Other programmes offered to young people in the sample focused on cognitive skills to reduce impulsive behaviour and bullying. In a unit for girls some head massage and aromatherapy sessions had been organised. In addition, the girls had had group sessions on personal issues, sexualised behaviour, moral dilemmas, personal health and contraception.
6.2.15 Arrangements for bringing in outside agencies varied across units and could serve two different, though not mutually exclusive purposes. In some instances other agencies came in to help young people address specific issues during the placement, whilst with others the aim was to engage with the young person with a view to providing support when the young person moved on. Staff from specialist drug support projects sometimes set out to offer both. It was evidently more difficult to begin to engage during the secure placement if the young person had been placed some distance from home. There were also some examples of external mental health specialists offering advice to staff on the management of particularly difficult behaviours such as self-harming.
6.2.16 The kind of service young people received from their social worker varied, depending on the distance between the unit and home area, social work staffing levels in the employing authority and the kind of relationship the worker had been able to establish with the young person. Some units required that social workers attend a weekly meeting, whilst distance meant that others relied primarily on phone contact. In most instances the social worker's role was primarily to co-ordinate services and ensure appropriate resources were in place when the young person was ready to move on. Some also focused on encouraging parents to resume contact with the young person and/or offer him or her as much support as they were able to.
Education and health
6.2.17 Virtually every young person received an education while in secure accommodation, though one young woman had managed to refuse to attend classes throughout. Individual assessment and relatively small classes enabled most young people to re-engage with education and we were informed of six young people who had managed to obtain Standard Grades, despite considerable disruption to their schooling in the previous year. More usually the schools focused on vocational qualifications which could be offered in a wide range of subjects and completed in a short period.
6.2.18 Two- three years ago, the practice of routinely offering health assessments was not yet established in secure units. Nevertheless a range of health issues had been identified in relation to the young people in the sample and appropriate treatments arranged. Dental checks and eye tests were common. In addition a number of young women had had education and appropriate treatments in relation to sexual health.
6.2.19 In addition to more formal health interventions, young people's general health was boosted through receiving regular meals and sleep, which many had been missing out on prior to admission.
3 YOUNG PEOPLE'S PERSPECTIVES
6.3.1 Sixteen young people were interviewed across all the units in the study. The majority of young people were interviewed in secure accommodation, although two were interviewed in close support units and one young person was interviewed at home after leaving the unit. Young people who took part in the interviews had been in the unit where they were interviewed for between two and 24 months, with the most frequent length of time being three months.
Perceived reasons for being in secure accommodation
6.3.2 Nine young people believed that their current placement in secure accommodation was intended to keep them safe. For example: "Because I was putting myself at risk and smoking hash". One young person thought that their placement may have been necessary to keep other people safe, while two young people indicated that their behaviour had been so problematic, or they had been so 'out of control' that it warranted a secure placement. As one young person reasoned: "I wanted to come into secure accommodation to stop me running away. I couldn't stop myself. But I had to wait about six weeks for a placement". Four young people suggested that they were in a secure unit to access resources that they needed to help them address problems, or to enable appropriate resources to be put in place for them in the community.
Adapting to the secure environment
6.3.3. Most young people indicated that they had been very upset and distressed at the shock of finding themselves in secure accommodation. Some young people described being terrified and upset on arrival at the unit but noted that they were able to settle down in a short period of time. For one young person, arrival at the unit was a positive experience, which he remembered as: "warm, it was good to feel warm again because I had been outside a lot". A few young people did indicate that they knew, at the time, that it was necessary for them to be placed in a secure unit to keep them or others safe, while the majority said that it was only in hindsight they were able to see that their situation did require placement in a secure unit: "Now I think that I did need to be in secure, to stop me getting into trouble, but I didn't think that then".
6.3.4 Young people had many preconceptions about what secure accommodation would be like: "I thought you'd be locked in your room nearly all day and only get out for a wee while to the living room"; "Bars on the window. Bare rooms, like a cell". However several respondents knew someone who had previously been in a secure unit. While some young people indicated that they had felt afraid in the unit in the initial stage of their placement, they all said that in general they did feel safe and were confident in the ability of staff to deal with any tensions that arose in the unit.
6.3.5 All of the young people said they were provided with information about the unit on their arrival either verbally from staff, or in a written format - and generally both. They reported being given information about the unit, their rights and responsibilities, and about complaint procedures. All the young people interviewed were satisfied with the information they had received. Some units had a 'Who Cares?' worker who visited the unit, and almost all the young people were aware of the presence of a children's rights officer with many of the young people having some level of contact with the officer in their unit.
6.3.6 Young people considered that their key workers in particular, and unit staff in general, were aware of any problems they may be having as well as things they enjoyed doing. All young people interviewed described their relationship with unit staff and their key workers as being either: 'very good', 'quite good' or 'average'. The majority of young people described these relationships as 'very good'. One young person commented that the most important benefit in secure accommodation was the help they had received from their key worker and noted that: "if I had got that in a close support unit, it could have worked, but you don't get that in a YPC".
6.3.7 Being able to talk to staff was very important for the young people although the amount of communication surprised some of them. As one young person commented: "I didn't think you would have to talk to them as much as you do, I realised there would be some talking expected but not as much as there is". The skills that young people considered important in a staff member included the ability to listen, someone who was easy to talk to and who had a sense of humour. Some young people indicated that they wanted someone who could just 'be normal' with them.
6.3.8 While few of the young people were able to identify any specific assessment tools they had used, they did indicate that they were given worksheets to complete but were often vague about their purpose. A range of programmes were available including drug awareness and addiction, anger-management, offending and victim awareness and sex education. Programmes were often conducted in individual sessions and very few young people interviewed had experience of group work.
6.3.9 Young people gave examples of being able to participate in a range of activities which they enjoyed in the company of staff, however, school holidays were often seen as 'boring' when much of the time seemed to be spent watching television. Overall the routine of the unit was seen as acceptable and young people were generally satisfied with the way the unit operated, although a number of young people expressed a dislike for specified bedtimes.
6.3.10 Contact with social workers was generally 'very good' or 'good' and most young people saw their social worker once a week while in the unit, although this was not the case for all young people. All the young people interviewed stated that they had been involved in the development of their care plan. For many, the main emphasis of the plan was to help develop relationships with their family, or to support the move from secure accommodation to their family home or a residential school. Some young people's plans also included access to specialist services such as bereavement counselling or addiction support. Similarly, all respondents had attended review and planning meetings and predominantly felt included in decisions made about their care. Some young people clearly felt more able to participate in these discussions than others. In general, young people indicated that they were satisfied with the plans made to help them move on from the unit.
Things that young people found difficult
6.3.11 While some young people commented that they had not experienced any difficulties in the secure unit, others indicated that it was hard not being able to see friends or family when they wanted to, being watched on a continual basis, not being able to go outside when they felt like it, and experiencing boredom. Where young people had contact with their families, this contact was generally on a weekly basis while they were in the units, with several young people afforded home leave at weekends. Young people indicated that they were less likely to have contact with their friends however, particularly if their friends had not been approved by social workers: "I'm not allowed to have my best friend on my contact list because she smokes hash - this is daft because I'll see her the minute I go out". While relationships with staff were generally positive, relationships with other young people could be less predictable, although the mix of boys and girls (where this occurred) was seen as generally acceptable. Some of the girls interviewed indicated that it may be a good idea to have separate accommodation, however, the majority did comment that they thought it was a good idea to mix boys and girls. The hardest thing for most young people was the simple reality of being locked up: "It's hard not getting out".
How secure has helped
6.3.13 In general, young people were very positive about their key workers and staff in the secure units in general. Young people who had been in more than one secure unit did suggest that differences existed between units in access to support and resources. Most young people acknowledged that workers helped them address issues they were experiencing in their lives, often in relation to other family members, or due to risky behaviour such as drug-taking: "It's hard being in secure, but when you need secure you have to go there. It does help you. The staff do all they can". For most young people, unit staff were seen as the best thing about secure accommodation. One young person, when asked what had been most helpful in the unit replied: "Staff - they are what is helpful. Giving advice, talking to them. You get annoyed with the crabbit ones sometimes, but it is just for our own good". Young people indicated that in some cases, secure accommodation had kept them 'safe' and reduced the likelihood of future risk-taking behaviour. Several young people indicated that their placement in secure accommodation had helped get them back to school or into college.
4. PLACEMENT LENGTH
6.4.1 How long the secure placement lasted was evidently an important consideration in terms of its significance to the young people. Reflecting the legal requirements for renewing supervision requirements with a secure condition, placements had either lasted approximately three months, six months or over six months. Of the eight young people in the third category, four had remained for the entire year. Table 7 provides details of placement length
Table 7: Length of Placement by Gender
Length of initial secure placement
6.4.2 Length of placement was an important consideration because it related to the key issue of the purpose of placements and what they were expected to achieve. From the stakeholder interviews it emerged that the secure placement's primary role was to keep young people safe and stop a spiral of destructive behaviour. Though there were also expectations that the placement would provide an opportunity to start to address the young person's difficulties, it was also noted that some inherent characteristics of the placements, notably being enforced and cut off from the young person's usual environment, presented obstacles to effecting change. Thus length of placement was of interest not simply in terms of what it had meant to the young people, but also what it revealed about how the placements were being used in practice and their role in relation to other service provision.
6.4.3 Differences in local authority practice were clear in that 14 of the 19 young people who had spent less than 6 months in placement were from the city authority who were responsible for the majority of young people within pathway one, that is admitted from a residential unit. This is evidently a distinctive use of secure accommodation which was not mirrored in other areas. It is therefore accorded particularly close attention in c hapter eight when outcomes and benefits of the placement are considered.
6.4.4 The higher proportion of girls than boys spending under 6 months in secure accommodation (43% as opposed to 28%) also reflects the over representation of young people from this authority in the overall sample.
Identified Benefits of the secure placement at the point when the placement ended
6.4.5 Based on social workers' responses, an assessment was made of whether, at the point when the secure placement ended, young people had benefited from having been there. There had been clear benefits for all young people in that all were considered to have been kept safe and, with good personal care, to be healthier than they had been when admitted. All except one young woman who refused to attend school were also thought to have derived benefits from the education provided.
6.4.6 On other dimensions, signs of benefit were more ambiguous. Only in relation to 31 young people (58%) did social workers believe that there had been an improvement in the behaviour which had resulted in the secure placement. This was generally attributed to good relationships having been established with staff, the young person having appreciated the consequences of their problematic lifestyle and enough change in the young person's life circumstances to allow a less risky approach to life to be sustained.
6.4.7 For the remaining 22 young people, acknowledged improvements were qualified by doubts about whether these reflected real changes or were simply a result of having been contained. Some were felt to have adapted well to the secure environment, but not necessarily shown that changed behaviour would be sustained when they were back in the community. There were particular concerns that drug use had not been adequately addressed. Some social workers pointed out that it was difficult to address issues such as drug use outwith the environment in which it took place, whilst others thought that more specialised intervention would have been needed to make a sustainable impact on the young person's behaviour. With some young people, elements of the problematic behaviour had continued during the secure placement. A few had run away a few times or committed offence when on home leave, whilst others had sometimes been violent or destructive within the unit itself.
6.4.8 Some social workers were disappointed that the behaviours which resulted in the placement had not been more specifically addressed during the secure placement. Comments on lack of appropriate help with problematic drug use has already been mentioned. In addition, some felt that the fit had not been good enough between the young person's specific needs and the programmes. A number of social workers commented that, though the young person had appeared to participate in programmes, their learning difficulties meant that they lacked the capacity to really understand or benefit from what had been offered. Other social workers had not expected that the secure placement would effect a change in the young person's behaviour, because they recognised that these were rooted in deep seated difficulties, typically resulting from disrupted attachments and exposure to multiple traumatic events.
6.4.9 The latter point of view was reflected in assessments of whether the secure unit placement had had any positive effect on emotional difficulties which affected the young person. For just over half the young people ( n=31) some benefits were identified and in virtually every case where this applied, these were attributed to productive relationships with staff. These positive comments were made in relation to 18 of the 22 young people (84%) placed in the two units run by city authority A. The small number held there and the emphasis on the key worker relationship led some social workers to refer to it as a 'nurturing' environment. The view was that most young people had a good experience in that environment, but some social workers had concerns about how they would fare when they returned to a less protective setting.
6.4.10 Where there had not been any emotional benefits or even a detrimental effect, a common comment was that young people had remained detached from the whole process, doing enough to get through it and move on, but not really being touched by the experience. For some this was seen as a survival mechanism to get through a frightening and challenging experience.
6.4.11 Specific improvements in relation to family difficulties were noted in respect of only one young person. More usually social workers took the view that the placements had encouraged and supported contact with parents, but that little focused work had been carried out. In some instances, where the placement was some distance from the family home, it had been difficult for parents to visit regularly. Keeping parents informed and involved was often part of the social worker's own role and in some cases this work had been key to reducing the young person's anxiety.
6.4.12 Asked whether there had been any disadvantages from the young person having been in the secure placement, at least one was mentioned in relation to half of the young people. The most frequently mentioned drawback was distance from home which made family and social worker contact difficult and reduced opportunities for direct work with professionals from the home area who would provide support when the young person moved home. The disadvantage was essentially that the young person had been cut off from the support network in their home area.
6.4.13 Several comments referred to the time in security having been wasted because the work with the young person had not focused directly enough on the young person's difficulties. In a few cases aspects of how the young person had been treated were commented on, for example too many restraints or time spent in isolation in the early part of placements. However at the point when the placement ended, no social worker thought the experience itself had been harmful.
6.4.14 Taking this range of considerations into account, the overall rating of whether there had been identifiable benefits from the secure placement at the point when the young person was discharged were as follows:
Yes, clear benefits
Some benefits but also some drawbacks
6.4.15 In terms of how this rating applied to the main sub-groups within the sample, there was little difference across age groups, but a higher proportion of girls than boys were thought to have clearly benefited (75% compared with 48%). In addition clear benefits had been identified for a higher proportion of those who entered secure accommodation from a residential unit than for those coming from the other two pathways (77% compared with 40%).
6.4.16 These gender and pathway differences largely reflect the higher rate of benefits identified for young people in city authority A (90% compared with 39%). There are a number of reasons why ratings for young people in this authority might be expected to be higher. First the secure provision was local, so that disadvantages associated with distance from home did not apply. In addition, as pointed out in part 1 of this report, staff in this authority viewed the use of secure accommodation in a more positive light than was the case in other areas. The units did put considerable emphasis on developing supportive relationships with the young people, as commented on by both social workers and young people themselves. The positive use of secure accommodation in this authority may have resulted in social workers being more inclined to identify benefits, but there were other indications that because of location, smaller size and the central role of the key worker, most placements had provided reasonably positive experiences for the young people concerned. How they and the other young people in the sample fared in the longer term is the subject to which the report now turns.
5. SUMMARY POINTS
6.5.1 For each young person there were two key dimensions to the placement: adapting to life in the secure unit and addressing the issues which were causing trouble in their lives.
6.5.2 Units varied in terms of the services they offered, but key components were individual work with the key workers or other member of care staff, group work and programmes and services provided by staff from projects and agencies outwith the unit.
6.5.3 Young people interviewed generally thought they needed to be in secure accommodation and had benefited from the placement. They very much valued relationships with care staff. Young people said the worst aspects of being in secure accommodation were not being able to see family and friends, boredom and being locked up.
6.5.4 Social workers thought all young people had benefited from the secure placement in terms of being kept safe and for virtually all there were education and health benefits too. However at the time when the placements ended, over a third were not thought to have benefited in terms of the behaviour which resulted in the placement having been effectively addressed.
6.5.5. A higher than average proportion of young people from city authority A were thought to have derived clear benefits from the placement. This was thought to reflect that they were accommodated in provision which was local, small scale and placed a strong emphasis on relationship building with key staff. Social workers' ratings were also likely to be influenced by the fact that within this authority, secure placement was viewed as a potentially positive option.