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CHAPTER SEVEN Case studies

Introduction

Case study method and selection

7.1 Case studies were undertaken of 21 young people for this evaluation. Eleven of the young people selected were on ISMS, while the other ten young people were on intensive support service as a comparator group.

7.2 The case studies add depth to the other methods used in the study, focusing as they did on individual young people, their pathways through social services and the Children's Hearings System. Case studies allow for the consideration of contextual conditions, using multiple sources of evidence (Yin, 1994). In this way, the case studies provide qualitative depth to evaluate the effectiveness of ISMS.

7.3 Difficulties in identifying a comparator group, for young people on ISMS, were recognised from the study's inception (Scottish Executive, 2005). ISMS phase 1 areas had no intention of undertaking randomised controlled trials and allocate young people (all who met the criteria for ISMS) either to ISMS or secure accommodation or some alternative. Therefore, young people who did receive ISMS can be presumed to be different, in some way important for this study, than other young people who received secure accommodation or some alternative. It was decided that the most relevant comparator would be young people who only received intensive support services, as ISMS itself was tied to young people receiving an MRC as well as intensive support services. However, it is important to note that not all intensive support services cases meet section 70(10) conditions.

7.4 In practice, finding a comparator group was even more problematic than expected. Few young people were issued with ISMS in the first year of the programme, so that the potential to select was slim to nil. The position of young people could change, within or beyond the timeframe of the case studies: they could be on intensive support services only at one point but then be issued with ISMS subsequently, and vice versa. As detailed in Chapter 3, the use of intensive support service (as well as ISMS) differed substantially across local authorities. Intensive support service was often not used as an alternative to ISMS. Not only did this mean identifying a comparator group on intensive support service was difficult, but the LA effect has to be taken very seriously, and the 21 case studies are dispersed across six local authorities. While these factors were methodologically problematic, they also raise issues pertinent to the evaluation.

7.5 Some of the young people who fit the case study criteria were already involved in other research projects (e.g. Khan and Hill, 2007; Stradling and MacNeil, 2007; Vaswani, 2007). This evaluation sought to make this an advantage, as arrangements were made to co-ordinate data collection tools where possible and to share findings made by one research team with the other. This sharing sought to avoid over-researching a vulnerable group of young people and their families, and further burdening busy staff. There were disadvantages, however, in full coverage of fieldwork methods and following up issues particularly of interest to this evaluation.

7.6 Purposive sampling ⁵⁰ was used, in order to explore the various experiences of young people, depending on key background characteristics and/ or reasons for being considered for ISMS or intensive support services. The criteria were:

• A balance of young women and young men
• Cases that lasted for varying periods of time, including cases that ran through to completion (six to nine months) as well as short-term cases that lasted less than a month
• Cases that involved differing levels of offending behaviour
• Cases where the main reasons for being on the programme relate to child protection or reducing the risk of absconding or self harming
• Cases where the young person had issues related to their behaviour, e.g. mental health and substance misuse.

7.7 Cases were included from six out of the seven phase 1 areas: the exception was Moray, where there were too few cases while this part of the research was undertaken. Some LAs provided more case studies than others, due to their greater throughput of young people through ISMS in particular.

7.8 The resulting 21 case studies had the following characteristics:

• 13 of the young people were male and eight were female;
• 11 young people had been placed on ISMS (eight young men and three young women). Three of these young people had been on ISMS and then on intensive support services, and were interviewed at both stages. The average age of young people, on obtaining ISMS, was 14 years, with a range of between 13 and 18 years.
• 10 young people had been placed on intensive support services (five young men and five young women).
• Not all young people had completed their time on intensive support services or ISMS. There was a range of time periods reported, ranging from one week to two years.
• In 10 case studies, the young people were particularly identified to the research team because of their offending behaviour. In 11 case studies, the young people were particularly identified because of concerns of posing risk to themselves. It should be noted, however, that some young people were identified for posing risk to themselves, although their case files demonstrated that they had committed offences as well.
• Three young people were identified as having mental health issues, by both the ISMS/ intensive support services and in their case files, while other young people were reported to 'self-harm' and three were identified as having Attention Deficit Hyperactive Disorder ( ADHD). 17 young people were identified as having difficulties with substance misuse.

Methods within and analysis of case studies

7.9 Five sources of information, and associated methods, were sought for the case studies.

1. Interview(s) with the young person
2. Interviews(s) with the young person's carer(s)
3. Interview with the young person's current allocated social worker
4. A review of the LA case file on the young person
5. A review of the SCRA case file on the young person.

7.10 Interviews were semi-structured, following an agreed interview script with other research teams. Topics covered in the interview included:

• Background characteristics and involvement in the young person's assessment
• Views on secure accommodation for the young person and alternatives to ISMS/intensive support service
• Quality of communication and contact between the interviewee and other services
• Quality of services provided and whether they met the needs of the young person
• What young people needed help with, and whether or not ISMS/intensive support service had helped
• Ideas for improvement.

7.11 Ideally, both the young person and his/her carer were interviewed near the start of their time on ISMS/intensive support service and as they were due to complete. The interviews included structured, semi-structured and open questions. Notes were taken by interviewers, on proformas, as the interview progressed. Most interviews were also audio-recorded and transcribed.

7.12 A 10-page structured case file review was created for LA files (i.e. those held by social services). Broadly, the reviews sought to gather: background information on the young person and their previous involvement with services; information on the process and outcomes of their assessment for ISMS/intensive support services; the resulting services, outcomes and transition arrangements; and information on inter-agency working. Information from the case file was put against the case file review headings.

7.13 SCRA undertook the review of the case files that they held. A proforma was agreed with SCRA, which sought information about the young people's formal involvement with the Children's Hearings System, offending, their background and family characteristics. The information was made available to the research team in a SPSS spreadsheet.

7.14 There was some variation in methods included across the case studies. For example, not all carers were available or willing to be interviewed: 15 of the case studies include such interviews. Not all young people were identified before they began the ISMS/intensive support service intervention, so some case studies undertook interviews only at one point of time (nine case studies). While interview coverage worked well across research teams, LA case file reviews were considerably less complete. Thus, far more detailed information from local authority case files is available for some young people than for others. Includem files were included in some case studies, as well as LA files, to see if additional information was included (in fact, little additional information was found).

7.15 The case studies therefore used methodological triangulation, in using both interviews and case files. The interviews, in particular, had the advantage of gathering individuals' perceptions, in a confidential setting. Interviews frequently provided information not found in the case files (e.g. the precise start and end of the assessment period was clear only in some files). SCRA data provided an official account of referrals to the Children's Hearings System. The LA case files contained some informal notes, but largely represented a more formalised case history. These case files were particularly fruitful in providing background information on the young person and their families. As suggested by the Magenta Book, such triangulation provides, "a more rounded picture of what is being researched." (Cabinet Office, 2004: 36).

7.16 The case studies also used data triangulation, in combining data from more than one source. Because most questions were asked of all interviewees, it is possible to consider the responses of a young person, the parent/carer and/or the social worker across a single case.

7.17 In data analysis, consideration was given to analysis within each case study as well as comparing respondent type and data sources across the case study. Data were primarily analysed thematically, following the structure already provided by the fieldwork instruments but also attuned to new issues that emerged from consideration of the data itself. Furthermore, charts were produced on the combined information for each case study, to consider issues such as: history of offending and welfare concerns; the pathways for each young person before, during and after ISMS/intensive support service; concerns officially recognised for the young people's involvement in ISMS/intensive support service and the perceived outcomes. Care has been taken to test preliminary findings across case studies, to look for contrary evidence and alternative view points. No-one case study or participant is relied upon significantly more than any other.

Ethical considerations for case studies

7.18 A range of ethical issues applied to this evaluation, such as negotiation of informed consent (including the sharing of certain information across research teams) with all interviewees, and interviewing in a place comfortable and convenient to the interviewee.

7.19 Furthermore, the evaluation had to recognise the extremely sensitive nature of the research. For example, most of the young people had complex lives and were vulnerable in a range of ways; certain of the questions on the interview schedule asked about personal issues (e.g. were there concerns about the young person's misuse of alcohol or drugs and whether they were involved in prostitution). Professionals were being asked to participate in a service evaluation. Such concerns resulted in the following steps being taken.

• Interviewees were assured of confidentiality, when negotiating informed consent and within each interview. Interviewees were told when gaining informed consent, and at the start of each interview, that confidentiality would only be breached if there were concerns about significant harm to that interviewee or another person. In fact, no such concerns were raised during this research. This could potentially limit the information given to the researchers, but does inform the interviewee of the limits of confidentiality and meets good practice guidelines for ethical research with children and young people.
• Care was taken by the research team not to tell one interviewee what another interviewee had said. This was particularly important to uphold within a case study.
• Interviewees were assured that every effort would be made to protect anonymity.
• All data files were protected by a password, once on the research team's computers. Names were deleted, and a separate (password protected) file used to match data files with names.
• All print outs were held in locked office and protected files. All such identifying information will be deleted six months after the report has been accepted by the Scottish Government.
• The analysis has had to take account of anonymity. Many of the young people involved are very well known locally. Conventional (and illuminating) means of presenting case studies therefore were not used because they risked identifying the young people. For example, short holistic case studies (e.g. the young person's background, pathway through the system, perceived outcomes) take advantage of multiple data sources and perspectives, but were not presented here, nor were diagrams of young people's pathways to exemplify certain trends. Aliases have not been given to respondents, so that the reader cannot track a response from one section to another. The research team made these decisions as protecting anonymity was a paramount consideration.
• Care was taken, when interviews were undertaken by the research team, to ensure that the young person was in a safe and comfortable place before, during and after the interview(s) and had potential support through hotlines and support staff. Support staff knew when interviews would take place, so that they could be on hand should the young person require it.

Limitations of the evaluation

7.20 The qualitative interviews used within this report provide very useful 'thick descriptions' (Geertz, 1973) of the processes involved in ISMS and intensive support services. Yin (1994) advocates that the case study methodology is intended to produce findings that elaborate and develop a description of processes. Yin argues that the multiple case study design can be conceptualised as repeated examination of separate entities that allow the testing of theory that can be replicated through additional cases producing convergent findings. In this chapter the interview data should be regarded as representing the perceptions of the ISMS and intensive support service interventions and as such they provide very valuable information from those who are intimately engaged with these processes. However, the case study method does not allow do not allow hypotheses to be tested in a Popperian sense. As discussed by Renzema and Mayo-Wilson (2005), who conducted the largest evaluation of electronic monitoring to-date, in order to further understand the effectiveness of the processes in terms of 'does it work?', additional quantitative data would be required and a different methodology would be required (this area is discussed at the end of this chapter in recommendations for future research).

7.21 A further factor that limits the confidence in the findings is the small sample size within this study. A larger group of young people who received ISMS (and a closely matched control group) would allow more distinct conclusions on effectiveness to be argued. This issue is further compounded by: differences across LAs in the use of assessments (some using YLS/ CMI and others using ASSET); the perceptions of young people's suitability for the MRC; and in the variety of interventions and agencies employed to deliver work. Taken together, these differences mean that highly detailed and coherent conclusions about effectiveness cannot be drawn at the present time.

Organisation of this chapter

7.22 The following presentation of the case studies is divided into sections. First, it begins with giving an overview of the background characteristics of the young people involved in the case studies. Second, it takes the reader through the 'pathway' of the ISMS/intensive support services, from assessment, to service provision, to transition from the services (where applicable). Third, the match between perceived concerns for the young person, going into ISMS/intensive support service, and perceived outcomes is discussed. The chapter concludes with reflections on the case study findings.

Background characteristics of the young people

7.23 Research by SCRA (2007) demonstrated high levels of drug and alcohol use by their sample of cases on MRCs. About one-quarter of their sample had mental health issues and a quarter also had behavioural difficulties. For the vast majority, they had histories of persistent offending, non-attendance at school, absconding from residential establishments and there were concerns about their peer group. Just under one-third had suffered neglect and/or abuse. Similar results were found in Vaswani (2007) of ISMS cases in Glasgow. All of the young people on the ISMS programme were previously known to Social Work, and were first referred at an average age of 8 years 6 months. For cases where there was information on the reasons for referral, about half of these cases were initially referred for school issues, either non-attendance or behavioural problems in school, just over one-third were referred for solely welfare reasons, e.g. parental substance misuse or physical neglect. Out of the remaining young people, 10% were referred for behavioural issues and only 5% specifically for offending. However, 93% of the ISMS cases were classified as persistent offenders (five or more episodes of offending in a six month period). A look at family circumstances revealed a history of complex issues, most notably parental substance misuse, poor parenting skills, and financial problems. Deprivation was also a key issue.

7.24 In relation to specific cases incorporated in the present evaluation, the SCRA data available (for 9 ISMS cases, 6 boys and 3 girls) indicates that the young people who received ISMS had extensive histories of involvement with the Children's Hearings System prior to being to being placed on the MRC. These data are, however, limited due to the SCRA's Referrals Administrations Database ( RAD) being available nationally from December 2002 and, consequently, referrals made prior to its implementation are not reflected in these cases.

7.25 The average age of first referral recorded on RAD for this sample is 13 years, and the average number of referrals to the Reporter was 42.2. It would seem likely that had RAD been in operation nationally prior to 2002 that there would be more information available about the earlier years of this sample. However, even with this caveat, within this small sample of young people placed on ISMS there were 380 referrals to the Reporter. The largest category was for offence grounds with 317 (83%) referrals; the second largest group of offence grounds, with 10 (3%) referrals, was the child being the victim of a violent or sexual offence (schedule 1); the third largest offence grounds grouping for this sample, with 8 (2%) referrals, was the misuse of drugs or alcohol.

7.26 From the data available on offence grounds referrals, there was sufficient detail available for 272 of them that specified the offence types. The largest group of offences group was for Breach of the Peace, with 77 (28%) referrals. There were 56 (21%) offence referrals for violent offences, 4 (1%) for robbery, and 11 (4%) for carrying of weapons. There were 7 (3%) offence referrals for theft of motor vehicles, and 11 (4%) for attempted thefts of motor vehicles. Within this sample, there were also 6 thefts by housebreaking and 11 'other' thefts.

7.27 The SCRA data included a range of other information relating to the backgrounds of the young people referred. Alcohol use was noted in 8 of the 9 cases and reported as being a significant concern in 4 cases. Similarly, drug misuse was noted in 5 cases and regarded as a significant issue for 3 individuals. A family background where there was domestic violence was noted in 2 cases. Mental health issues were noted for 3 cases and anger management problems were recorded for 6 cases.

7.28 Despite the lack of early referral information (due to RAD data not being available), these data, overall, indicate that this small sample of young people placed on the MRC can be characterised by persistent and serious offending levels. The data also indicates that, within the backgrounds of this small sample, there were a number of care and protection concerns including histories of victimisation and substance abuse problems. In the following sections, findings from the qualitative data will be used to further define the sample of young people placed on the MRC and describe the decision making and allocation of resources to address their needs.

Assessment and decisions-making for intensive support service/ ISMS

7.29 Assessment reports were frequently found in the case files reviewed, which outlined the assessments' conclusions. LA files were rarely clear about the assessment methods used to reach these conclusions, so that the ASSET scores or their equivalents could not be compared across case studies. This chapter is therefore unable to comment substantially about assessment procedures, but can note that where it was systematically recorded the assessments were being done in the time required by the Scottish Government. The assessment reports seen did clearly outline the concerns for the young people and the recommended service provision.

7.30 The LA case files and social worker interviews demonstrated that there was, as required, inter-agency collaboration in assessment and particularly in decision-making for ISMS/intensive support service. Records of inter-agency meetings were frequently found in the case files, with clearly stated conclusions.

7.31 To receive ISMS, a Children's Hearing must set the MRC condition as part of a supervision requirement, therefore the decision-making of Hearings and of individual Panel Members is pivotal. The case studies primarily had two sources of information about the process of this decision-making: records within the LA case files and social workers' perceptions, gained from interviews. In most case studies, the decision-making appeared to be straightforward, with no particular concerns expressed or noted and, in one LA, there were particular comments about the good understanding between social services and the local Panel Members. In a few case studies, some concerns were evident, that impacted on the decision-making for individual young people. Such concerns divide into three, as expressed by social workers: initially, Panel Members being unsure about the MRC and requiring further training; Hearings being unduly focused on the MRC rather than the intensive support; and Panel Members failing to communicate well with young people by not recognising their complex and difficult situations.

7.32 Young people who were on ISMS were asked in the interviews why they had engaged with ISMS. Their answers all compared ISMS to more restrictive alternatives of secure placement or custodial disposals. Some young people also mentioned that the intensive support might meet some of their needs. When asked, 'How did you feel about receiving it?', all of the young people interviewed who were on ISMS, or had been on ISMS previously, regarded these options as preferable to a secure placement or custodial term. This is typified by the quotation below.

"To stop me getting a custodial sentence. […] You're locked up in jail with nothing to do. In secure, you get things to do so secure is nothing compared to jail; secure didn't bother me at all. With this [ ISMS], I have got freedom and I can do things, so it's a lot better than jail. […] I didn't like it cos of the curfew, but it's better staying in the house than getting put away."

Young woman interviewed when on ISMS

7.33 Two cases suggested disagreement with the (potential) application of ISMS to a young person, between professionals.

7.34 In one case study, there was recorded disagreement between professionals in reporting to, and as recorded by, the Hearing. This disagreement continued throughout the ISMS programme. The professionals who disagreed with the ISMS disposal had two reasons. Firstly, the young person was not seen as fitting the Section 70(10) criteria previously, but once the ISMS became available, the young person was seen as meeting these criteria. This was perceived as contradictory. Secondly, certain intensive support services were only being made available to the young person if s/he received ISMS; the services were seen as hugely beneficial, but the MRC unnecessary. The carer also shared these views. Attempts were clearly recorded (and, in some parts, it seemed successfully) to improve inter-professional communication and agreement.

7.35 In another case study, the Hearing had asked for the young person to be considered for secure accommodation, which the professionals did not think was appropriate. The young person was considered for secure accommodation, by the LA, and considered for ISMS/intensive support service. The young person's carer and social worker were clear that the young person did not meet the Section 70(10) criteria, but they clearly believed that the young person required intensive support (which the young person, in due course, received).

7.36 These two cases raise themes common across the case studies: the relationship between ISMS and secure accommodation criteria; and the popularity of intensive support services and their link or not to an MRC.

Experiences of the MRC

7.37 This section seeks to present the experience of being on the MRC itself, distinguishing it from receiving intensive support more generally (which is covered in the next section). Three themes arise from the case studies: views on the curfew conditions themselves; the implications for young people being with their peers; the implications for young people and their home life (whether in LA care or with a parent). The section concludes by considering recorded breaches of the MRC and perceptions of such breaches.

Views on curfew conditions

7.38 Young people frequently commented on the curfew conditions themselves. Not surprisingly, those young people who expressed negative views of ISMS tended to focus on the MRC as unduly restrictive. They wanted to stay out later or to have time-off at the weekends and on special occasions, as the quotations below exemplify.

"The curfew is very hard now, I want to go dancing with ma pals and I can't …"
Young woman interviewed when on ISMS

"If I was very hard, I would have broke it by now. Sometimes it's really hard though like when I'm out with my friends and then I need to go home early."
Young man interviewed when on ISMS

7.39 Many of the young people interviewed found meeting the curfew conditions to be difficult at times and reported breaching them. Technical issues with the electronic monitoring hardware were commented by some as being a problem, as detailed in these two quotations.

"They [Serco] come up at [mid-evening] to check the machine, it's really annoying, we've got five kids and it's really disruptive."
Carer of young man interviewed when on ISMS

"There were a couple of incidents, it didn't work sometimes and I had to talk to Serco. Once he was sitting in his house and it went off. Sometimes they'd turn up at inappropriate times."
Social worker for young man interviewed when on ISMS

Implications for young people being with their peers

7.40 Young people felt that they saw their friends less often and for shorter times as a consequence of the MRC. The majority of young people interviewed saw this as negative, although some recognised that less peer contact had reduced their offending and/or other concerns such as absconding or using alcohol or drugs. Generally, the increased amount of time spent at home was regarded by carers and professionals as having a protective affect on the young people's behaviour as it reduced contact with peers.

Implications for young people and their home life

7.41 Young people said they generally sat at home (again, whether this was in their LA unit or in a private home), when meeting their curfew conditions. They reported mainly watching television or listening to music, although some would have their friends over to visit. Two carers particularly comment on how this aided family relationships.

"He reads; plays with his sister; talks to his pals in the close; or he will watch TV; play computer games; and sometimes his friends will come in. He respects the house rules when he's in."
Carer of young man interviewed when on ISMS

"Before we never seen him and he wouldn't talk to any of us. Now we can sit with him and his girlfriend and have a chat. There's the odd argument but nothing gets out of hand now."
Carer of young man interviewed when on ISMS

7.42 In both these quotations, the increased communication between young people and family members is seen positively. Other carers also responded that they felt that the young people's increased amount of time within the home environment created the opportunity to re-establish their relationships with each other. As with the first quotation, the MRC and associated support was seen by some as having greatly assisted carers in being able to re-assert their rules. Such views are further supported by case file commentary, which notes improved family relationships as a successful outcome in several cases.

7.43 But one social worker commented on the potentially negative impact on family life, of the curfew conditions: the increased contact between carer and child might result in more interpersonal conflict. The additional support from the helpline was seen as useful in responding to stress that might result from a young person being in the home more often.

"I think if you bring troubled, young people in the home people have to deal with that. There are worries about other children in the home and they have to deal with the young person's problems too. So the support to the family is essential. This is given under ISMS, like from the Includem Helpline. The Helpline has been so good for mum as she can just pick up the phone at any time on any day."
Social worker for young man leaving ISMS

Compliance with curfew conditions

7.44 Some young people complied with the MRC, but breaches were common. Some 'technical' breaches were for a very short time (e.g. ten minutes late for the curfew), but others were extensive (e.g. overnight or for days) ⁵¹.

7.45 Several interviewees perceived a lack of consequences, should a young person not adhere to their curfew conditions (this was also raised by Reporters in research conducted by SCRA (2007)). Social workers particularly commented upon this in certain areas.

"We need more accountability from the young person, i.e. if they are not engaging. The Panel seems to hold the Social Work Department to account, but they also need to hold the young person to account too."
Social worker for young man placed on ISMS

"She does sometimes seem to wear the tag as a bit of a badge at times and there doesn't seem to be any consequences of not adhering to the MRC. […] Also, what options are there for non-compliance as secure is not always appropriate?"
Social worker for young woman placed on ISMS

7.46 In some cases, breaches were tolerated because there had, for example, been considerable reduction in absconding by the young women in question. In these cases, the MRC had been specifically given because the young women had been absconding. For some, the absconding had become less frequent, for shorter periods at a time and/or they were in safer homes rather on the street or with strangers. These case studies suggest that a breach requires interpretation in the young person's context, to see whether young people remain suitable for an MRC. They also suggest that numerically counting breaches as a performance indicator, for the success or not of MRCs, would not be useful in assessing their potential effectiveness for young people and reducing their risk to themselves.

Experiences of Intensive Support and services

7.47 Case files were reviewed for the intensive support and services provided to young people. Perceptions of what help young people received, and how much it helped the young people, were gathered from all those interviewed. Beyond the intensive support services themselves, the data does not distinguish between services that would have been involved with the young person and his/ her family without ISMS/intensive support services. In several cases, there was a deliberate decision to continue with past services and/ or professionals, as they had worked well with the young people, even though specific alternative services were available through intensive support.

General perceptions of intensive support

7.48 Two themes were nearly universal across sources for each case study: that intensive support brought increased resources; and that young people had increased contact with a larger number of professionals.

7.49 All carers and social workers interviewed for the 21 case studies, as well as most young people, were positive that intensive support and its accompanying resources were provided. A key element was the 'forced' engagement of young people with services and support. Such increased compliance is similar to those found in other studies (discussed in Chapter 2) of electronic monitoring when combined with some other intervention (Bonta, et al, 2000; Sugg et al, 2001). Consistency of support was also frequently reported as making a critical difference. The quotation below is a particularly succinct summary of this view.

"There has been improvement in [young person's] behaviour and attitude, which can be attributed to the management style of staff. The structure, firm boundaries, routine and consistent management of her behaviour and care has positively influenced [the young person's] self-worth and self-confidence, sense of security and emotional well-being."
Social work report on young woman on intensive support service

7.50 The one exception, in the case studies, was a young man who compared the level of intervention unfavourably with secure accommodation.

"I got more help when I was in secure. They helped me deal with ma anger management and I've not got that problem now and if I was in secure I'd be getting more help with training instead of getting offered things I don't want to do."
Young man interviewed when on intensive support service

7.51 This young man also indicated that he felt institutionalised and may have found managing his level of risk in the community to be more difficult.

7.52 Most young people were reported as engaging well with intensive support services, with considerable agreement among social workers, carers and the LA case file in each of the cases. However, for some young people, their engagement waxed and waned. The latter could be traced to the young people's personal circumstances, such as having a fight with someone or losing employment. Case files documented services' continual efforts to maintain this contact, which frequently did resume consistency. Some comments from young people related to issues of motivation and readiness to change, which have been argued as being key elements to the effective interventions (e.g. McMurran, 2002). These 'responsivity' issues have considerable implications for the outcomes of ISMS and intensive support services and it may be that young people who are motivated to change their behaviour will be more likely to comply with the ISMS/intensive support service conditions and benefit more from interventions.

7.53 Generally, young people had contact with more professionals once they went on to intensive support. Their contact time with professionals also increased, as intensive support workers made appointments on their behalf and went to some length to make sure that young people attended such appointments and other activities. These levels of support and professional contacts were regarded with mixed feelings by those interviewed. Such mixed feelings are captured by this young woman's response.

"It's millions every single day! I get different workers and it's a lot from going from nothing to having workers every day for hours. It means I can't go with ma pals and that I've got to stay in so it's a lot… It's okay. […] I get help now. I feel that things are moving now and that I'm making progress in a positive way. Before, I wasn't getting any help and I wasn't making progress."
Young woman interviewed when on ISMS

7.54 This quotation taps into themes found in other interviews (including some social workers and carers, as well as other young people) and LA files. For example, some young people were frustrated that they had less time with their friends or 'to themselves', due to the time taken up by the intensive support. Certain young people felt overwhelmed by the number of professionals they saw regularly. While some young people expressed these problems, overall, most young people felt that they were making progress due to the workers' intervention.

7.55 For one young person, however, the intensity of the ISMS led to him deliberately flouting his MRC conditions so that his involvement would end. He provides a narrative in his interview.

"They [Includem] were there too much. I never got time to ma self to do anything I wanted to do on my own. That's how I fucked up. I went out and all I had to do was offend and that would get rid of the tag and Includem and I knew that. I went on the run; I got the tag off. The police took it off me and I ran away .I tried to say to Includem and to ma social worker that I was getting too much time with Includem, but no one would listen to me. They did reduce the time, but then when the police took the tag off me, I said I wouldn't work with Includem cos I didn't need to."
Young man following ISMS conditions

7.56 This young man recognised that his actions got him into further trouble but he felt the extent of time with Includem was not needed. Other case studies showed a reduction in intensive support hours, when professionals felt this was in the young person's best interests.

7.57 Different views were expressed about the number of different workers, from any one service, with whom a young person might work. On one hand, one young woman was positive about having choice of whom to approach.

"A lot more people are working with me now under the ISMS, and if I fall out with one of them, I know that there are other ones I can go to for help."
Young woman interviewed when on ISMS

7.58 On the other hand, some social workers perceived the change in workers as negative, which led to either inconsistent approaches or lack of progress (as new workers had to build up a trust, for example). This quotation exemplifies such concerns.

"…there has been a lot of [Includem] worker changes and that's not been consistent. So there have been a lot of changes in staff working with him and sometimes areas of work they agreed to do have been done superficially, and other areas were not done at all."
Social worker for young man exiting ISMS

7.59 Overall, those interviewed valued the extent of contact, with a range of professionals, and the high level of resources, that accompanied intensive support. Certain negative views were raised about the confusion of having so many workers involved, the potential for an inconsistent approach to the young person, and the time intensity of the support.

General perceptions of Includem and NCH intensive support services

7.60 The main external intensive support provider in the phase 1 areas was Includem, with NCH providing such services in Highland. These services were regarded positively by the majority of the young people who were interviewed. Generally, the young people said they had established very good working relationships, as exemplified by this young person.

"They are pure nice people I've got good relationships with all of them. They never make me feel as though I'm too much bother."
Young woman interviewed when on ISMS

7.61 Young people commonly discussed the trust and respect they received from the Includem/ NCH workers, which they highly valued. Forming good working relationships has been identified as integral to effective practice (e.g. Trotter, 1993; see the discussion section). For example, this young person said about her worker.

"She is a good person, she tries to help us with everything I need help with. I trust her."
Young man interviewed when on intensive support service

7.62 Professionals and carers also generally reported a positive view of Includem/ NCH's interaction with the young people.

7.63 Of the carers interviewed, virtually all expressed very positive views of how Includem interacted and supported them in their capacity as families. It appears that the intervention is also impacting positively on the parenting styles within families. A large body of literature reflects the effectiveness of this type of 'multi-systemic' working (e.g. Henggeler and Borduin, 1995). The effectiveness of Includem's work in supporting parents is exemplified in the following two quotations from carers.

"… Includem has changed the whole family by helping our son and it's changed family life, we don't have to worry all the time and we don't have to argue with him all the time now; and we can spend time on the other kids. […] It's not just that they have helped him change, they have helped the whole family and he's now part of the family and see us as his family."
Carer of young man placed on ISMS

"She is really nice and she goes beyond her job to help us. She will give me time when she's got other work to do. She treats us like individuals and knows our problems, and like not a 'type' of family with problems that other people would just judge before they got to understand."
Carer of young man placed on intensive support service

7.64 Includem's ability to react to a crisis was appreciated by a number of carers and mentioned by certain social workers. One social worker noted that Includem was able to provide a quick response when social work could not.

"I think the young person would be a lot worse off if Includem had not been involved. He has gone through a lot of serious crises and, at one point in time, it was almost on a weekly basis. What's been crucial is the ability of Includem to respond to that. They respond out of hours and at weekends and the response, when he has been in that crisis, has been excellent. In terms of my other work commitments, I could not have done that at that time."
Social worker for young man placed on intensive support service and then ISMS.

7.65 Some concerns were expressed about Includem delivery. Concerns were raised in one social worker's interview regarding the experience of certain Includem workers, as well as consistency. This social worker explained.

"I think we agreed areas to work on with Includem so it wasn't in conflict. But I think some of the lack of experience from workers meant that the delivery of the work they did was not complimenting in the way it happened. […] I don't know if all the workers are experienced or not, but this may have been a factor. So this possibly led to work like anger management being done by one worker and then another leading them to not being able to challenge the young person because there wasn't a consistency in one worker doing that work with him."
Social worker for young man leaving ISMS

7.66 In another (intensive support only) case, a social worker felt that certain workers did not suitably confront the young person on her behaviour. 'What works' findings suggest that interventions are more likely to be effective when staff are skilled and experienced in that area of work and the interventions are consistent for the young people (e.g. Andrews, 1995).

7.67 While the above concerns are about the approaches and skills of particular workers, other concerns related to case management. Problems with communication and perceived accountability were the common themes, as exemplified by the following quotation.

"There could maybe have been a wee bit more on communication and other aspects. I've never really understood and never really received information of her worksheets, etc. to tell me exactly what type of work they are doing with young person on a daily/ weekly basis. … I've never received anything in writing. … Also, they don't inform me of crises or incidents that occur with young person."
Social worker for young woman placed on ISMS

7.68 Certain social workers interviewed discussed the tension between them managing the cases while another agency provided the majority of the interventions. One carer felt that Includem should have a stronger voice in the young person's case because of this.

" ISMS social work could listen more to Includem because you feel that Includem are the ones working with you and they know you and they know the family a lot better than social work does so they should listen to Includem more. Includem know my son and they know me, so ISMS should ask them and they should listen to what Includem says.
Carer of young man interviewed when on ISMS

7.69 Overall, the interviews presented very positive perceptions of the services out-sourced to Includem and NCH. Some criticisms were raised, such as the adequacy and consistency in certain workers' skills and approaches, communication between such services and social work, and tensions in accountability. These criticisms were mentioned in some local authority areas, but not others. This may be an artefact of the particular case studies selected, but it could also reflect the different ways that services are organised and used. These findings are resonant with those reported by Steele (2007) who conducted a number of qualitative interviews investigating young peoples' perceptions of the Includem service and to gather their views on .what worked for them in reducing their offending behaviour. Overall, the small sample of young people interviewed reported positive views of the service, including the relationship they had with their workers and the use of the Helpline in particular. However, some reported that they felt the service had little impact on their offending behaviour, regardless of the relationship they had with their workers. Further criticisms of the service related to the perception that work did not address criminogenic needs and was also lacking in 'programme integrity'.

Perceptions of other services

Social work.

7.70 Young people and carers were generally not positive about the relationships and levels of service from the young person's allocated social worker. Themes of inconsistent contact and lack of time appeared in many of the interviews, across phase 1 areas. Two out of several examples, from both carers and young people, are below.

"They never come to see me and they never even bother to phone. I've been home for three weeks and they've not even phoned once."
Young man interviewed when on ISMS

"He knows he's been out of hand, but he has felt his social worker has been no good. They were supposed to see him once a week and they only came once every 6 or 7 weeks and now that he's got Includem, she says she's only going to see him once every 3 months!"
Carer of young man placed on intensive support service

7.71 There were exceptions where young people and/or carers expressed positive views about their current social worker, including their receptiveness and contact availability.

Substance use services.

7.72 In addition to working with Includem/ NCH, some of the young people interviewed were referred to drugs and alcohol use services. In some cases, young people's views of these professionals were negative and they were not viewed as having had a positive impact. Accessing such external services could be difficult, as described by one social worker.

"The addiction work has been sporadic. The worker identified for [young person] was off sick and then left and the baseline assessment wasn't picked up by anyone for ages. Luckily, his use of substances decreased anyway so it wasn't a main priority, but it could have been an unmet need if that hadn't happened. Myself and Includem challenged him on his drug use"
Social worker for young man on ISMS

7.73 This social worker therefore saw the Includem worker and her own contribution as making a greater difference. In other case studies, improvements in young people's alcohol and drug use were frequently attributed to Includem interventions. The quotation below exemplifies this.

"Before I used to drink everyday … it was cider and vodka, but now it's about two times a week and it's a bottle of vodka or two bottles of cider. … They [the workers] tell you about drugs and it makes you think about why you are doing it. My drink is harder though even though they tell you that you're hurting your body. But I have cut down."
Young woman interviewed when on ISMS

7.74 This quotation also shows another common trend across the case studies. Improvements in substance misuse rarely meant a complete absence of alcohol or drug use, but often more awareness by young people that such behaviour (at least to adults) was problematic and a subsequent reduction.

Education and employment.

7.75 One direct consequence of being placed on intensive support is the planned access to education and employment agencies. Some young people and carers felt young people had increased contact with education professionals and support in maintaining and developing education provision. Two examples are given below.

"I've got courses to join in January for six months and then I get to college in August… before I was going to school, but not very often because I kept getting excluded because I'd get into fights."
Young man interviewed when on ISMS

"Before, he was excluded all the time from mainstream school. Since he's had [a local education service], he's been doing great. He's met new people there and he likes it. He gets lots of activities there and he likes that. […] He's not been excluded from there, so that's great. They haven't been on the phone to complain about him! In fact, they phoned once to ask if it was okay to do extra curricular activities with him!"
Carer of young man placed on ISMS

7.76 However, in one case, it was felt that the ISMS package had directly resulted in a disruption of the young person's mainstream schooling and the provision of a poorer education service.

"If you get ISMS here, they take your child out of ordinary school and put them in day care. Day care isn't an education that will help them move up in life, it's more like a lower level for not so bright kids. My son was fine in ordinary school and I wanted to keep him there. […] There is just no sense in making him go there when he could be building up to going full time in ordinary school"
Carer of young man interviewed while on ISMS

7.77 A large minority of case files and interviews, however, did not report on educational involvement at all, with a greater focus on young people's behaviour and welfare than education. From the case studies considered, there appear to be differences between LAs, in the attention given to education and employment.

Accommodation.

7.78 In particular LAs, housing appeared to be a problem for many of the young people interviewed, particularly those leaving secure accommodation and those not returning to their family home. Being subject to an MRC also appeared to have a direct negative effect, as it was reported that some residential options were taken away because the young person was being or had been electronically monitored.

"Somebody like this young person, who tends to continue to be difficult in terms of being a challenging young person. A lot of resources tend to want nicely behaved kids and not young people like him that continue to have difficulties. If you refer him to a project and he's there, they tend to throw him out very quickly and he very quickly gets to the end of the line in what's available because he presents challenging behaviour. And there doesn't seem to be anything set up for young people like him. And there are other people like him, he isn't unique. He's been in a whole series of supported accommodation places and been thrown out."
Social worker for young man placed on intensive support service and then ISMS.

7.79 In some LAs, housing services were not mentioned as relevant to the young people or moving on to independent accommodation was not as problematic.

Mental Health Services

7.80 In the interviews, contact with psychologists and psychiatrists were not frequently commented upon. When mentioned, comments related to problems accessing Child and Adolescent Mental Health Services ( CAMHS or, in some cases, Forensic Child and Adolescent Mental Health Services ( FCAMHS)). The quotation below suggests that the lead in time to access CAMHS did not match the timeframe for ISMS:

"He never really got his assessment, they did come on board near to the end of his time on ISMS but, by then, he had begun to disengage with ISMS, and if FCAMHS had been in at the beginning it would have been better. However, things have improved since then, I have not had that experience with FCAMHS in my other cases since."
Social worker for young person on ISMS

7.81 There was an exceptional (intensive support service) case, where a clinical psychologist was noted as pivotal (both in the LA case file and in interviews with the carer and social worker), in intensive support and recognising and meeting the young person's needs. The psychologist had longstanding involvement with the young person. In this case, the intensive support services did not need to make a referral but rather invited a mental health professional already involved with the young person into the inter-agency collaboration.

7.82 In general, services that were provided 'in-house' (e.g. intensive support teams within the LA) or 'out-sourced' to Includem or NCH, were generally accessible to young people and their families. Problems were more likely to occur when access was more arms-length, such as with accommodation services, educational services beyond intensive support services, addiction or mental health services.

Perceived outcomes for young people

7.83 The case studies provide a great deal of information on the perceived outcomes of ISMS/intensive support service for young people, from social workers, carers and the young people themselves. They do not provide conclusive information on the actual outcomes for the young people. Reviewed case files can track initial concerns for the young people (frequently listed in assessment reports) and perceived outcomes, as pieced together by the research team from different documentation. SCRA data is also limited because it only captures the time period when the child or young person is involved in the Children's Hearing System (for example, SCRA data do not include police referrals made only to the Procurator Fiscal and, particularly, do not pick up all charges once the young person is over 16 years-old). The remit of the research did not stretch to examining courts or police records.

7.84 Generally, those interviewed saw ISMS as having certain positive effects for young people. These effects can be divided into three types.

'Last chance' effect

7.85 The ISMS intervention was perceived symbolically as being a 'last chance' before institutionalisation (whether prison or secure accommodation). For one respondent, the young person's participation in ISMS helped prevent 'up-tariffing':

"It has kept her from custody, she had previously been in Young Offenders Institution and she probably would have been back there otherwise. It's also a programme that can be put forward to Sheriffs; it's kept her from custody on the last two occasions and she hasn't picked up any new charges since being on ISMS."
Social worker for young woman placed on ISMS

7.86 More often, ISMS was seen as helping to keep the young people out of secure accommodation. This quotation exemplifies such as view:

"Ma behaviour would have been even worse and I would have got into secure a lot earlier for much worse things. Cos even though I wasn't listening, I was listening sometimes."
Young man interviewed when on ISMS

7.87 Virtually all those interviewed did not want a young person to be in secure accommodation. But there were comments, within one case study, that the chance of secure accommodation was inappropriately used as a threat, so that the young person's 'choice' of the MRC was in fact coerced and the young person's negative view of secure accommodation was reinforced.

7.88 One social worker interviewed regarded ISMS having little positive impact on one young person's risk of harming others, due to the severity of his behaviour.

"I think that having an intensive support package that works is more effective than having a young person in secure in a general sense. But I accept that there are some young people whose life is that chaotic that they become a danger to themselves and others and that they require a period outwith that in a secure environment."
Social worker for young man interviewed when on ISMS.

7.89 This response highlights that, although a young person might meet the ISMS criteria, placement in a secure environment might be preferable in order to manage the young person's risk more appropriately.

Intensive support

7.90 Most of the positive outcomes attributed to ISMS were perceived to be a consequence of the range of interventions and access to resources that were the intensive support facet of the package, rather than the MRC itself. The quotations below exemplify this perception.

"If you have a good enough programme, there should be no need for the tagging element. Considering there are no consequences for non-compliance, then we should just focus on the programme… you have to look at the bigger picture, i.e. the tag is just a part of the whole programme; and it's better than being accommodated or in custody. I just don't see the tag as the major part."
Social worker for young man placed on ISMS.

"The tag isn't changing him. He doesn't care about the tag, he's listening to Includem and making changes. He'd be crazy again without Includem. With just the tag, it wouldn't work at all."
Carer for young man interviewed when on ISMS.

MRC

7.91 In direct contrast, carers in two case studies saw the MRC itself as the most effective part of the intervention. One carer explained why she felt this.

"…it's [the tag] being removed too soon. I know that when the tag came off, he'd stop meeting workers, and he doesn't seem to have a problem with knowing he's let me down. He seems to enjoy it when he knows he let me down. He likes to say I'm wrong and contradict me."
Carer of young man placed on ISMS

7.92 In a follow-up interview with this carer, after the young person was taken off ISMS and moved onto intensive support services only, the carer said:

"After the tag, he just doesn't take contacts [with professional staff] seriously and he thinks he can do what he likes."
Carer of young man placed on intensive support service following ISMS

7.93 The MRC created the 'forced' element of contact with workers and the carer's influence was insufficient to ensure such contact.

7.94 Similarly, another carer also regarded the MRC component to be the most effective element of the process, and felt the situation had deteriorated after its removal.

"The tag. He came in at [mid-evening] at his curfew and I knew he was not going to go out after that. Without the tag, he's not listening to me and I can see him going back to where he was before. […] He is in late now and he won't say when he will come in. I say to him to be in for [late evening] and he comes in later than that. I've no parental control. And he's not bothered going to [his training and employment project] now and it's hard to get him out of bed now. He's slowly going back to the way he was and he's only got Includem for another two weeks!"
Carer of young man placed on intensive support service following ISMS

7.95 The MRC itself, in its combined symbolic and practical meaning, was seen as helpful by some. Certain adult interviewees saw the MRC as allowing young people to develop a set of credible reasons for not engaging with offending peers. In one case, the young person's MRC had a similar effect with the housing agency in discouraging its use of an Antisocial Behaviour Order ( ASBO).

"It allowed him to walk away from his pals, without losing face, without losing their respect. It also allowed the family some respite; Housing were looking at an ASBO for [young person's name], but that got them off their back when they heard that [young person's name] was tagged."
Social worker for young man on ISMS

7.96 Finally, some carers saw the MRC as improving their relationships with the young people, and increasing their ability to exert control and boundaries.

Overall assessment on outcomes

7.97 Overall, ISMS and intensive support services were seen as keeping young people out of secure accommodation and/or custodial sentences and, for all but one of the case studies, this was positive for the young person. Overwhelmingly, respondents attributed, along with reports in case files, positive outcomes to the intensive support part in particular. A few interviewees, in contrast, attributed improvements to the MRC itself: its practical and symbolic presence. Some carers felt that the curfew conditions facilitated improved family relationships and their ability to exert control.

7.98 For most case studies, across multiple respondents, young people's misuse of alcohol and/or drugs was seen to have reduced, but not stopped, as had their risk activities (such as unprotected sex, absconding, inappropriate peer relationships and/or offending). The establishment of trusting relationships with professionals was reported as a substantial achievement in many case studies, as was the ensuing improvements in self-esteem and having a positive future. In several case studies, improvements for parents and families more generally were noted as a focus for services and a successful outcome.

7.99 While not a finding across all case studies, some participants argued for earlier intervention, that is, intensive support may be more beneficial if delivered to the young person at an earlier age. This view was not held solely by one group. Examples could be found across social workers, carers and young people, as described below.

"I would also like to say that I think there is a major gap in service provision and this intensive support service is not extensive enough. I really think there is a role for this service to become involved much earlier and I think we need community resources that work with young people in a preventative way rather than after the problems have occurred. […] There are a lot of people escaping that net. There's a lot of young people that we identify that's maybe going to graduate to that stage, if there's not something in place at that time. In terms of risk assessment, you can identify people who are going to end up there but, at that point in time, they will not get a service from Includem or ISMS. I think there is nothing for young people in a preventative sense to prevent them getting to that stage. It's almost reactive once they're there, as opposed to work being done to prevent people getting to that stage."
Social worker for young man placed on intensive support service and then ISMS.

"It would have been much better if he'd got ISMS a lot younger. If he'd got it between 12 and 14, it would have been a lot better for him rather than 15 and a half going on 16. It would have made a lot more difference because he would not have gone so far into getting into trouble when he was younger."
Carer of young man on ISMS

"Before I used to say I didn't need help. Now with Includem, I realise I need help and I wish I'd had them before. If I had them when I was first starting to get the jail that would really have helped me… I was 13 years old then."
Young woman interviewed when on ISMS

7.100 The last two quotations specify a particular age band (12-14 years-old), just below the more typical ages in this case study (14-16 years-old). At the latter ages, the young people are reaching key transition stages across service areas: for youth justice, but also for education, employment, potentially leaving LA care and seeking independent accommodation. In certain case studies, it would seem that ISMS/intensive support services was able to maintain young people, to manage their risk to themselves and to others, until they officially left the Children's Hearings System; the requests above suggest that the intensive support earlier might have resulted in more change for the young people and better outcomes in the longer run. This finding is consistent with the argument within the Kilbrandon Report (1964) and also with recent research into effective practice (Latimer et al., 2003). There was also some support for this concept among Reporters consulted by SCRA (2007).

Discussion

7.101 The case studies suggest issues for further discussion and investigation.

1. What is, and should be, the relationship between a) secure accommodation and ISMS, and b) between ISMS and intensive support service only?
2. What differences do the MRC themselves make with their curfew conditions? How might this differ by the particular risks and needs of the young people, their families and their communities?
3. What are the advantages and disadvantages of providing in-house, arms-length or out-sourced services, for ISMS/intensive support service?
4. How well do ISMS/intensive support service criteria, assessments and services meet the available literature on 'what works'?

Relationship between secure accommodation and ISMS

7.102 The case study interviews, along with certain case file information, suggest that the relationship between secure accommodation and ISMS may remain unclear for many respondents. Most of those interviewed saw ISMS as either an alternative to secure accommodation or one step below secure accommodation (or custodial institutions) on a hierarchical tariff. Secure accommodation, in all but one case, was seen as highly undesirable; for young people, this might mean they 'agreed' to ISMS, but this agreement was forced as they wished to avoid secure accommodation at all costs.

Relationship between ISMS and intensive support service

7.103 The fieldwork also found that the comparison between ISMS and intensive support service only cases did not work as planned, as LAs made different use of intensive support services. Some case studies found strict control of intensive support services, so that ISMS was favoured in order to access such services. Certain professionals were then supporting decisions because of service availability rather than feeling the MRC in particular would be of benefit the young people.

The impact of the MRC

7.104 Interviews in the case study were overwhelmingly positive about the availability of intensive support services and most of the perceived outcomes were attributed to these services. The most effective part of the ISMS provision was seen by almost all of those professionals interviewed as being the intensive support packages, rather than the MRC component. This perception is supported by the research by Bonta and colleagues (2000; discussed in Chapter 2) who report significantly lower recidivism for the high-risk offenders who received high quality cognitive behavioural programmes.

7.105 No one argued for the MRC to be available without the intensive support. Response to the MRC itself was mixed. Certain respondents saw clear benefits of the MRC, such as restricting young people's access to problematic peers, creating the opportunities for improved family communication and improving carers' control, and diminishing the extent of absconding for those with an extensive history. Young people frequently continued on their MRC, even when they had breached the curfew conditions: sometimes substantial and repeated breaches. However, for some young people the MRC was still seen as beneficial, e.g. it reduced and contained the absconding of young women who were perceived as highly vulnerable outside their homes. The case studies suggest that breaches do need to be seen within the young people's context and the usefulness of the MRC subsequently evaluated. This has implications for performance indicators.

Risks and needs

7.106 It seems likely that ISMS has been utilised with young people who presented as a higher risk of further offending than those who received intensive support services only. Consequently, a comparison of recidivism levels between these two groups is likely to reflect the underlying level of risk in conjunction with any effects of the interventions. The young people who accepted the ISMS disposals appeared to do so to avoid what they considered more serious recommendations being made (primarily the alternative choice for them was a secure placement). The ISMS disposal was seen positively by the young people interviewed in this light. Case file information, when available, indicated, generally, that young people on ISMS reduced their incidence and seriousness of offending behaviours. In addition, there appeared to be a similar reduction in levels of offending recorded in the files of young people placed on intensive support services only. This perception is consistent with findings from other research in the use of EM, which suggests that the monitoring component does not reduce re-offending (although it may be cheaper and more humane than custodial disposals). However if good quality interventions are also provided then these can be very significant in reducing re-offending (see Renzema and Mayo-Wilson, 2005).

7.107 Some of the young people interviewed appeared to reduce risky behaviours because of the potential consequences of not meeting the ISMS conditions. However, other young people also indicated that they did not always demonstrate this sort of consequential thinking, particularly in relation to offences committed while under the influence of drugs or alcohol, which appeared to be a contributing factor to risk behaviours for many of the young people interviewed. Overall, the MRC appeared to have, for some, a 'suppressive' effect on behaviours when in place. In addition, information within the interviews suggests that the MRC also provided a source of extraneous motivation for some young people to comply with the conditions of the ISMS disposal.

7.108 The case studies suggest that the ISMS disposal allowed access to protective factors in the community, such as college placements and relationships with family members and friends. In terms of community accessing resources and maximising social inclusion, the intensive support packages appeared to have increased young people's use of education, employment agencies and health agencies. Housing and accommodation, however, appeared to be a problem in some cases and was thought to exacerbate levels of risk. The phase 1 areas seemed to differ in the access and engagement of young people in substance use interventions: some areas had consistently positive responses across case study sources, while others did not.

7.109 Since ISMS and intensive support services have become available as disposals within the Children's Hearings System, the perception is that Panel Members' understanding seemed to have increased, in regards to what the disposals entail and issues regarding the complexity of some cases. Feedback from social workers suggests a continued training need for Panel Members in order to ensure appropriate and effective use of these disposals.

Different models of delivery

7.110 Variation in the LA areas makes comparison difficult between young people, but it does suggest considerations for how services are organised. Some LAs have chosen to keep services largely in-house or just at arms-length; for services like education or substance misuse workers, this may make them more accessible for young people. On the other hand, separating out education may separate out young people from mainstream provision or in-house services may have difficulty accessing the wider range of services externally.

7.111 External services have certain advantages. The intensity and extent of intensive support services provided by Includem and NCH was noted by numerous social worker respondents. The young people and carers, in particular, tended to note the trust they had with these workers and frequently contrasted that with the lack of trust they had felt previously, with other professionals.

What works?

7.112 In considering the effectiveness of the ISMS and intensive support services, it is appropriate to discuss briefly the contexts in which such an evaluation is situated. Following pessimistic data on the effectiveness of rehabilitation programmes (often referred to as 'nothing works'), there was an increase in positive findings, largely through meta-analytical studies, that tend to be grouped under the heading of "what works". Many of these "what works" principles of effective practice are also congruent with the recommendations made in the Kilbrandon Report (1964) and, more recently, within the objectives defined by the Youth Justice Improvement Programme (Scottish Executive, 2006). For example, the value of early intervention is supported in interviews with several of the social workers interviewed and by one of the carers. The theme running through these interviews was that the ISMS package could be more effective if used in a preventative and proactive manner in the future is consistent with Kilbrandon (1964). It has been found that 'what works' interventions with 12 to 15 year-olds are almost twice as effective than with 17 and 18 year-olds (Latimer et al., 2003).

7.113 Andrews (1995) discusses the principles of risk and needs (among 18 other principles that also include: individuality and diversity; offender engagement; high quality interpersonal relationships; and the use of personal discretion by staff), which are strongly related to effective practice in reducing re-offending. The 'risk principle' entails that the level of service provided should be matched to the level of risk assessed in the client and that a minimal level of intrusiveness is stressed. The Youth Justice Improvement Programme (Scottish Executive, 2006) and the recent document Getting it right for children and young people who present a risk of serious harm (Scottish Government, 2008) also stresses the need to ensure that high risk offenders' needs and risks are properly assessed in order to ensure that interventions such as ISMS are used effectively. Within the case files, there is little information available to indicate that young people receiving ISMS were actually at a high level of risk of re-offending (the available ASSET and YLS/ CMI scores would suggest scores around the mid-ranges of both tools suggesting approximately moderate risk of general recidivism). Given the criteria for use of the MRC, more detailed risk assessments would be recommended as tools such as ASSET and YLS/ CMI relate to general re-offending and do not specifically assess risk to other people through violent re-offending for example (although ISMS can appropriately be used for young people who are also placing themselves at risk). Bonta et al, (2000) found that programmes for high risk young people under electronic monitoring conditions could significantly reduce levels of re-offending, but could concurrently increase levels of re-offending in low risk offenders, when compared to a matched control group.

7.114 The 'needs principle' from the effective practice literature relates to a focus on criminogenic needs when intervening in order to reduce the risk of re-offending (although non-criminogenic welfare needs should still be regarded as important). This principle indicates that carefully designed interventions are used to target the specific characteristics and problems such as antisocial attitudes and behaviour, and anger responses (see also Latimer et al., 2003). The services delivered by Includem were singled out by the large majority of interviewees as being the most positive and effective aspect of the intensive service. Such commendation was also found in many case files and noted in some reports to the Hearings. There appear to be numerous similarities between what has been found in the case studies and what has been reported in the literature as being good practice in the supervision of people with complex needs and risk in the community. The Pro-social Modelling approach, researched by Trotter (1999), contains at its core the key elements of engaging with the client's motivation while simultaneously building on the relationship between the worker and the client. The quality of the relationships that developed appeared to involve themes of trust, empathy, a non-blaming approach, holding optimistic views, and being able to articulate the client's and family members' feelings and problems that are entirely congruent with the Pro-social Modelling approach. Rex (1999) similarly argues that a significant component to the client's engagement and motivation to change is created by the relationship between the client and the supervisor, effectively allowing the supervisor to become a role model (see also McMurran (2002) on the importance of motivation).

7.115 A further aspect of Includem's work which appears, on the basis of interviewees' perceptions, to be consistent with effective practice is their work with the young person and their family (see Farrington and Welsh (2003) for a review of parenting interventions). This approach has been generally very well supported in the research literature and appears to be most similar to "Multi-Systemic Therapy" ( MST), which draws on structural family therapy and cognitive behavioural therapy (Henggeler and Borduin, 1995; Henggeler, 2000). The MST approach is designed to address the needs of male and female persistent offenders aged from 12 to 17 years-old who are regarded as being at a high risk of out-of-home placement. The main goals of the MST approach are described as empowering the parents to address issues relating to raising their children and to empower the young people to cope better with problems related to their families, peers, schooling, and within their neighbourhood. In addition, the MST approach requires professionals to communicate with each other and co-ordinate services in a manner that address some of the issues raised particularly by social workers in relation to the ambiguities in who is holding the case and the direction of the work.

7.116 Negative views of Includem's service were not commonly expressed in the interview sample. Some of the negative views presented earlier relate to the principle of addressing criminogenic needs. It appears that, in some cases, interventions provided by Includem and other agencies, such as substance misuse services, did not adequately address areas of need that are specifically related to their risk of further offending. In addition, issues were raised about the number of changes in workers that some young people had and the level of experience in workers, both of which may have detrimental effects on the quality of the interventions. This point relates directly to the area of programme integrity, identified in the literature on effective practice as being a key factor in the delivery of effective interventions (e.g. Andrews, 1995). Similar criticisms of the integrity and focus of the interventions were reported by Steele (2007) in relation to a small sample of young people who had received a service from Includem. These findings are relevant to the recent work in relation to the risk management and quality assurance (Scottish Government, 2008) and it appears, in some cases, that the quality of interventions provided would not meet these standards.

7.117 The relationship between Includem and Social Work was also covered in the interviews. Due to Includem providing most of the work with the young people, themes of confusion over case management and accountability were raised in some phase 1 areas. Again, this would raise issues of programme integrity for the young people involved.

Recommendations for future research

7.118 While the case studies provide this evaluation with a number of questions, they do not allow hypotheses to be statistically 'tested'. In future, the Scottish Government could co-ordinate future research into the effectiveness of ISMS using processes that are standardised across LAs that allow the statistical analysis of this relatively small population. Should the diversity across LAs continue, a research design would need to capture sufficient numbers in each LA to make comparisons possible. A quasi-experimental method (which is not based on random assignment of people to interventions) would permit investigation into the effect of the MRC itself, when combined with multivariate statistical analyses that would control for confounding factors that may influence the outcomes (e.g. higher risk offenders may be more likely to be placed on ISMS than intensive support services only, consequently levels of re-offending might be based more on this level risk than the quality of interventions).

7.119 Future research could also usefully include a closely matched control group to allow the effect of the interventions to be assessed in comparison to another group of young people who did not receive these interventions. The use of a control group within research with this population is crucial due to the normal tendency for young people to desist from offending as the mature. The well established 'age-crime curve' (e.g. Smith, 2002) consistently shows an increase in levels of offending from early childhood that then declines in late adolescence and early adulthood. Similarly, Sampson and Laub (1993) examined patterns of offending over the life course of a cohort group and concluded by stating, "desistance from crime is the norm and most, if not all, serious delinquents desist from crime". This pattern of desistance, when taken in the context of the present study, would mean that it is likely that young people placed on ISMS and intensive support services may reduce their levels of offending independently from the interventions. In order to assess the contribution that the interventions may have had to desistance, a closely matched control group is required. A good example of the value of this methodology is the longitudinal study by McCord (1992), who followed up two groups of young offenders: one group receiving the intervention, the other served as a control group. McCord reports that, generally, there was no effect of the intervention when compared to the control group, despite the qualitative finding that many of those receiving the intervention reported that it had been very successful and beneficial. After several years, it was found in a small number of cases that the intervention group were more likely to have been convicted of 'serious street crimes' among other negative effects.

7.120 Future research could usefully include a longitudinal design, where repeated and consistent data from the same individuals are collected over a longer time period. This methodology allows findings to be disentangled through their temporal relationships and developmental sequences of events to be identified. In the present study, it might be the case that a young person in ISMS commences full-time employment. By collecting data repeatedly over short time scales it would be possible to investigate if any reduction in offending or welfare risk-taking can be attributed to ISMS intervention, employment, or other factors (see Farrington 2006, for a review).

Summary of findings from the case studies

• Where recorded, assessments were completed in the timeframe required by the Scottish Government. Further evaluation is required of assessment procedures themselves.
• Evidence of inter-agency collaboration can be found across the case studies. Some concerns were expressed about case management and accountability between social work and intensive services in certain LAs. Access to some external services (especially mental health services) was a problem.
• Young people on ISMS perceived it as better than the alternatives of secure accommodation or custody, but are not generally positive about the MRC itself.
• While some young people complied with their curfew conditions, breaches were common in other case studies. Some 'technical' breaches were for a very short time but other breaches were extensive. Social workers in some areas commented negatively on the lack of consequences for young people. But, in several case studies, it was recognised that the MRC had still significantly helped in managing young people's risk, resulting in a substantial reduction, even though breaches had occurred.
• ISMS was seen as providing young people with access to resources that could act as protective factors and to receive interventions that reduced risk. However, access to suitable housing and accommodation appeared to be a problem in certain LAs.
• Social workers and carers seemed supportive of ISMS in helping to manage the young person in the community rather than a secure setting. There is some support for the electronic monitoring component in terms of encouraging compliance with conditions, but there was also some dissent found within interviews.
• ISMS and intensive support services appeared to have some positive effects in reducing levels of further offending and other risk behaviours. It is not possible, however, to clarify the extent to which the MRC, rather than the intensive support interventions, contributed to this perception.
• The intensive support service itself (whether provided by Includem, NCH or in-house) received very strong commendations by virtually all respondents (young people, carers and social workers) and recorded in case files. Commonalities across case studies include the 'trust' relationship between workers and young people, young people's improvement in self-esteem and belief in a positive future, and the positive support for carers. Some concerns were expressed, relating to numbers and inconsistency of workers and case management.
• Early intervention used in a preventative and protective way does find support among social workers.

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