Avon and Somerset: Resettlement and practice development enhanced case management project

Along with many Youth Justice Services (YJS), the four Youth Justice Services across Avon and Somerset (Bristol, North Somerset, South Gloucestershire and Bath and North East Somerset) had witnessed a shift in the cohort of young people they were supporting. Whilst the numbers of children coming through the Court system to the four YJS were declining, the areas had seen an increase in the complexity of the lives of those young people they were supporting, as well as a larger number of young people being supported for longer periods or repeatedly over time due to ongoing offending. YJS have successfully worked with increasing numbers of children through a range of diversionary and preventative services, thus avoiding many being escalated into the criminal justice system.

Simultaneously, the Youth Justice Board (YJB) wanted to explore new ways of working that responded to the increasing evidence base and knowledge around the impact of adverse childhood experiences and the link between childhood trauma and offending.

In 2019, the four YJS across Avon and Somerset (Bristol, North Somerset, South Gloucestershire, and Bath and North East Somerset) commenced a YJB trial project, following on from a successful pilot in South Wales. They implemented ‘Enhanced Case Management’ (ECM), a psychologically-informed service which is grounded in an understanding of child development and how the impact of early traumatic experiences in childhood and adolescence can result in offending and other behaviours.

The service is underpinned by the Trauma Recovery Model (TRM), a six-step model which builds layers of intervention that are sequenced according to the child’s developmental needs, with a focus on relational therapy to mediate the impact of trauma. The use of this model represented a seismic shift in practice, from a focus on risk management and offending behaviours to taking a longitudinal view of the child’s life and working with theories such as attachment theory, child development and neuroscience to progress towards recovery from trauma for the young person.

The service is run by two senior practitioners (one FTE post) with youth offending backgrounds, and two clinical psychologists (1 FTE post). Youth justice practitioners can refer young people who have experienced trauma and will be working with a YJS for at least six months. The intervention sits alongside their regular order and does not require any additional input from the young person, rather it provides practitioners with an alternative framework for thinking about engagement and intervention planning.

Once a young person (and their parent/carer) has consented to being part of ECM, the ECM team organises a case formulation meeting. This meeting gathers all of the professionals involved with the child, including staff from children’s social care, education, police, health, mentoring, youth clubs and any other relevant professionals. In this first meeting, the team creates a physical timeline of the child’s entire life, beginning at their mother’s pregnancy and charting their early life experiences through their childhood and to the current day. The team holds space for a focus on the child’s early life experiences, thinking about their experiences of pregnancy and pre-school years, given the research highlighting the importance of early life experiences on a child's brain development and patterns of attachment. They use insights from all of the practitioners present at the meeting as well as the relevant available data from agencies such as the police, social care and health. The team describe this as ‘putting together the jigsaw of the child’s life’ and have found that whilst many agencies hold sections of the ‘picture’, this meeting can often be the first time that all insights have been put together to create a full understanding of the child’s life. They also examine the child’s present day reality and assess where the child sits on the TRM according to their current needs and circumstances.

Following this meeting, the psychologist uses the timeline to create a full formulation report, which summarises the child’s life experience and develops a range of psychological hypotheses regarding the impact of those experiences in various areas of their life, for example behaviours, coping mechanisms, triggers and relationships. This report also recommends strategies and interventions to engage the young person which are matched with the child’s cognitive and developmental needs. These interventions are ‘sequenced’ and are often relationship-based to support the repair of some of the harm inflicted by their experiences of trauma.

Following the initial formulation, the multi-agency team comes back together every two-three months to review progress and re-plan, as well as to review any progress against the TRM. Sometimes, the team also creates a youth friendly version of their formulation to assist the young person in understanding the impact of their experiences on their present day self and to support psychoeducation around trauma.

54 young people have been supported by the project so far, many of whom have extremely traumatic backgrounds, unmet basic needs and have experienced a significant lack of stability in their lives. ECM is supporting the teams around the children to demonstrate consistency, predictability and reliability which are helping to both stabilise and engage children that other services have been unable to engage over long periods of time.

The focus on relationships is allowing practitioners to slowly build trust with children, who, once meaningfully engaged with professionals, can begin to receive the interventions they need in order to recover. Over time, teams are seeing children progress positively through the Trauma Recovery Model.

The team reports that the initial case formulation meeting often has the effect of pulling a very strong multi-agency team around the child together, where staff across a wide range of agencies are able to ‘see’ the whole child and form a sense of common understanding, responsibility and accountability for their recovery.

ECM has also brought about significant benefits for Youth Justice Service practitioners, who have reported that being involved in ECM has influenced their work with a wider cohort of young people. Their increased knowledge and confidence in understanding and addressing the impact of childhood trauma is leading Youth Justice practitioners across the area to think more broadly about children’s early life experiences and to take into account a wider range of information when intervention-planning.

For individual young people who are supported through ECM, the team focuses heavily on establishing safe and trusting relationships that can carry through after the young person’s involvement with Youth Justice Services. Where young people are transitioning from child to adult services, this can include involving adult probation practitioners, mentors and Personal Advisors in the case formulation process to ensure that there is a range of trusted professionals who understand the approach continuing to support the young person.

Initially funded by the Youth Justice Board and NHS England, the ECM pilot across Avon and Somerset ended in March 2022 and is now funded jointly by the NHS and each of the four YJS and local authorities, with the aim of embedding the model into business as usual.

The team are also spreading their impact by offering case consultations for young people who are not working with a YJS on a statutory order (for example young people on Out of Court Disposals or at the pre-court stage). The ECM team also provides a training package for their colleagues to upskill them in Trauma Informed approaches and its application to youth offending work.

The ECM pilot has been subject to formal evaluation. Guidance on implementing ECM can be accessed via the Youth Justice Board for local areas interested in learning more about the approach.

Having dedicated staff to implement ECM has been a key factor in the success of the approach across Avon and Somerset. Having dedicated and stable psychology provision in the form of clinical psychologists is an important consideration for local areas embarking on the journey of implementing ECM.

Training judges in the approach has also allowed the team to ensure that the judiciary understand the importance of relational work and are able to see that interventions carried out as part of an ECM plan are appropriate and necessary.