Background and Context
Future 4 Me (F4M), funded by the BIG Lottery, was a 7 year project, in 2 phases. The second phase (Jan 2017 – Dec 2019) had two core delivery strands:
- support for young people aged 16 to 21 who have experience of care and/or custody, and those at risk of entering custody, who have complex histories.
- development of a national toolkit offering resources, tools and models for organisations to improve and enhance services for young people who have experience of care and/or custody.
As part of the development of the Informing Futures Toolkit, supported by Jonny Matthew, we developed a pilot framework to use the Trauma Recovery Model (TRM) in our work with care and custody leavers.
However, partly due to the work of F4M, the South West Youth Justice Board (YJB) decided to undertake a wider pilot testing TRM as a tool for working with young people leaving custody and so the option to look specifically at using the TRM to support our work with care leavers presented itself. Part of the F4M project has seen close working with and support of the YJB for England and Wales ‘Enhanced Case Management Project’ in the West of England, building on learning and experience from the two pilots in Wales, the latest of which concluded in March 2020.
The pilot planning & preparation phase took place in late 2018, with the engagement and delivery phase between March and November 2019. The pilot covered a total of 7 cases, involving 20 external professionals, representing 11 different agencies across three local authority areas.
The pilot delivery was co-ordinated by 1625ip’s F4M Manager, the F4M Project Support Officer and 6 project workers from the F4M team.
Governance was provided by a project board which included 1625ip senior managers, Jonny Matthew (co-creator of the TRM), Dr Harriet Smith (project psychologist) and Colin Baker (University of Gloucestershire, who undertook the external evaluation of F4M).
Preparation and Staff Training
Effective implementation of the pilot required that colleagues involved have a broad foundational knowledge of:
- normative child development
- attachment theory
- impact of trauma on child development - including neurological functioning
- theoretical basis underlying the Trauma Recovery Model (TRM)
- the TRM itself and the implications for practice
- importance of and use of reflective practice and clinical supervision
In preparation for the pilot, 120 staff from 1625ip, Social Services leaving care teams and Youth Offending Teams completed 3-day TRM Academy training in the model and the knowledge and principles that underpin it. In addition, 1625ip’s Future 4 Me team (F4M) accessed clinical supervision to support continued learning and development throughout the pilot.
Potential cases for the project were considered with reference to:
- The inclusion guidance
- Is the young person engaging with support? Are they likely to consent?
- Are there issues related to other agencies that may exclude the case from involvement at this stage? (for example, staffing issues which mean colleagues are unlikely to be able to play a part in the formulation process)
Once case referrals were reviewed and confirmed by the project board and psychologist, dates were agreed for the team formulation meeting, convened by the F4M worker.
Relevant professionals were invited to the case formulation meeting in order to contribute their knowledge of the young person and/or of their family, both current and historical. In the event they were unable to attend, agencies were invited to submit a report summarising their knowledge of, and involvement with, the young person concerned.
Consent
F4M only worked with young people who consented to a referral to the service. There was then an added step to ensure young people consented to involvement in the TRM pilot. Each young person was provided with additional information regarding the involvement of the psychologist and had conversations with their project worker covering:
- brief description of service
- who else will have access to information e.g. psychologist
- how they will access information
- why (to inform practice of professionals)
- confirm any documentation created will only be saved within 1625ip systems
- that professionals and family / key supports (with YP permission) will be invited to be involved
Young people’s consent for this involvement was then determined. All of the young people approached to be involved in the pilot gave their consent.
Inclusion Guidance
All young people in the pilot had ‘Looked After’ status and evidence of complexity.
Young people selected for the pilot demonstrated at least three complexity factors in addition to ‘Looked After’ status. The complexity factors that were recorded as experienced by the young people who took part in the pilot are listed below:
- Child Protection Registration / Other Social Services Involvement
- Verbal Abuse
- Contact with CAMHS
- Physical Abuse
- Substance Misuse
- Sexual Abuse
- Emotional & Mental Health Issues
- Parental Separation
- Brain Injury & other Neurological Disabilities
- Domestic Abuse
- Learning & Educational Difficulties
- Mental Illness
- Speech, Language and Communication Needs
- Alcohol Abuse
- Emotional Abuse
- Drug Abuse
- Neglect
- Experience of Custody
Assessment and Review Procedures
Prior to the case formulation, the F4M project worker case lead, led an information-gathering exercise in order to ensure formulation was able to take account of all relevant information.
Examples of the types of documents and information gathered included:
- current legal status
- Looked After Child documents
- child protection status and history
- previous mental health reports (e.g. psychiatry, psychology, learning difficulties (cognitive) assessment, etc.)
- offending history and pre-sentence reports
- substance misuse assessment, history and intervention report/s
- known health history (e.g. diagnoses, difficult birth circumstances, any history of head injury & unconsciousness, mental health episodes, etc.) and
- education history (e.g. suspensions/exclusions, responses to different settings, education psychology reports, Special Educational Needs (SEN) statement/s, etc.)
View Key Learnings
Challenges were encountered with the information gathering process. Looked after children will often have been placed in different areas over time. Social services teams can provide a history of placements, but where children have moved on rapidly from one area to another it is not always possible to access information from health or education providers. Assessments may be started in one area and then not completed when a move is made. The lack of stability that some looked after children experience therefore results in an additional barrier to them receiving support. Where information does exist, there can be difficulties gaining access to it.
In spite of the challenges, the information gathering process was seen as key to the success of the pilot. The formulation process highlighted that gaps in a young person’s timeline are in themselves instructive and can act as a spur to further investigation.
A psychology-led team formulation of the case is a key feature of the enhanced case management approach.
The process involved:
- The F4M case lead convening a meeting which they attended along with all other relevant professionals, and the psychologist.
- The F4M case lead taking responsibility for ensuring that all available information is submitted to the meeting in the event professionals are unable to attend in person.
- The psychologist leading the discussion, creating the timeline, noting and categorising the information shared.
This process resulted in a team formulation for each young person which informed the intervention plan.
View Key Learnings
The process of setting up meetings and managing attendance requires some dedicated administrative support to run smoothly. The formulation meetings depend on the availability of the psychologist, and for us this dictated what days of the week they could be held. The more agencies are involved, the more complex it becomes to agree suitable locations and convenient times.
Some formulation meetings had to be rearranged multiple times. It was a benefit to our pilot that we had one administrator overseeing the meeting arrangements and ensuring that cancellations were communicated to the professional group and rebooked in a timely manner.
The Formulation Report
- A case formulation report was produced by the project psychologist and shared with the F4M case lead.
- F4M case lead circulated the formulation report to the contributing agencies at the discretion of the psychologist and in accordance with consents.
- The recommendations contained in the formulation report informed the intervention plan, as well as the clinical opinion of the psychologist.
View Key Learnings
It was found that the formulation report has impact as a tool in its own right. In one case, submission of the formulation report as part of pre-sentencing positively influenced the outcome for the young person. In another case it prompted a re-assessment of risk levels which had not been reviewed for some time, and were preventing a young person accessing housing.
The formulation report is essentially a clinical document, and uses clinical language. It was found that this made it highly effective in communicating with health agencies, who were able to recognise and respond to the clinical approach. For some professionals outside of health, the language used was a barrier to understanding. It may be useful to explore the possibility of creating a summary or lay report in future projects.
Reviewing the Case Formulation and Intervention Plan
The intervention plan formed the basis for planning case work and for subsequent review meetings. The pilot timeline allowed for two review meetings following the initial formulation, at 13 weeks and 18 weeks respectively.
View Key Learnings
In practice, it was noted that the review process was shaped by the professionals in the case group. Some cases were able to make quick progress and did not require a second review. At least one case required a third review meeting due to the number of professionals involved and the difficulty of getting all representatives to a meeting. In all cases, it was noted that the F4M case lead needed to be proactive in keeping the professional group in touch with one another between review meetings. In some cases it was noted that the F4M case lead also acted as a mentor and advisor to other professionals, particularly where those professionals had not received the TRM training ahead of the pilot. It was noted that cases where the most effective interagency communication was established tended to show quicker progress toward objectives and better outcomes for the young people involved.
Recording Systems
All case recording was carried out within Inform, the web based secure client database used by 1625ip. This was the responsibility of the F4M case lead.
Other professionals involved with the test cases maintained their own recording in line with their organisational policies.
View Key Learnings
Some challenges arose with the logistics of sending confidential data from one agency to another. A variety of secure email systems are in use across the four local authority areas participating in the pilot, and F4M case lead reported that difficulties with accessing secure email systems created a barrier to timely communication.
In one case it proved so difficult to send a formulation report electronically to an external agency that after many fruitless attempts the F4M case lead agreed to print the report and hand deliver it. Learning from this incident suggests that a single accessible and secure method of electronic data transfer would be an asset to future schemes.
Clinical Supervision
All key working F4M colleagues received group clinical supervision provided by the project psychologist monthly. These group sessions were in addition to existing line management supervision, reflective practice and team case reviews.
Where needed, F4M project workers were also able to arrange additional 1:1 clinical supervision with the psychologist, or to consult informally over the phone. These 1:1 sessions remained confidential between the worker and the psychologist (subject to safeguarding requirements).
View Key Learnings
Feedback from F4M project workers and from the project psychologist suggests that these additional support mechanisms were valued and well utilised. Clinical supervision assisted in removing blocks and barriers which arose in casework, and helped staff to process the stress and anxiety caused by dealing with the case. Some of this stress and anxiety arose from exposure to traumatised young people. Some of it arose from challenges presented by other professionals. In one case, the team formulation process uncovered some dangerous practice in an external agency. The F4M project worker was able to quickly access an ad hoc clinical supervision session in order to discuss her concerns, and, following input from the psychologist, the case was referred to the LADO (Local Authority Designated Officer).