Cheshire Youth Justice Service have focussed on addressing young people’s unmet health needs to tackle reoffending. The creation of the Cheshire-wide youth justice partnership in 2017 highlighted inequalities in justice-involved children’s health provision, which they have worked to address, and are now taking an innovative social prescribing approach to meet the wider health needs of their youth justice cohort.
The challenge
Cheshire Youth Justice service covers the geographical areas of Cheshire West and Chester, Cheshire East, Halton and Warrington and has been operating as a pan-Cheshire partnership since 2017. The service identified that most children referred to them at the point of arrest have a range of previously unmet health needs, including comorbid health and neurodiversity needs. According to the recently published Cheshire Youth Justice Service Health Needs Assessment , 63.4 per cent of young people across the Cheshire Youth Justice Service had some form of special educational need, 63.7 per cent had some type of speech and language need and 12.5 per cent of young people had a traumatic brain injury.
Despite this, some of the children engaged with Cheshire Youth Justice Service have struggled to engage in clinical health or therapeutic services and their health needs remain unmet. Additionally, the creation of a youth justice service that spanned Cheshire in 2017 highlighted inequalities in health provision for these young people across Cheshire’s geographies. Many of those with unmet health needs appeared to be self-medicating; for statutory cases 79.0 per cent had ever used drugs, and 58.0 per cent were currently using drugs, whilst 30.3 per cent were currently using alcohol.
The service recognised that there was also work to be done on the equity of the health offer across the area and that they then needed to provide programmes that took a psychosocial approach to meeting unmet health needs, supporting children and young people to participate in programmes which they did not consider to be ‘therapeutic’ but which ultimately delivered the need for therapeutic intervention in different ways.
The solution
Across a four year period, Cheshire youth justice service worked with health commissioners and providers to remove the postcode ‘injustice’ to ensure an equitable health offer to children from the point of arrest to post-sentence across the entire county (all four LA’s). As a result of this work, Cheshire youth justice service now hosts or has co-located child and adolescent mental health specialists, speech and language therapists and substance misuse counsellors accessible by children across the four authorities.
Following this achievement, Cheshire youth justice service are piloting a social prescribing approach to addressing the unmet health needs of youth justice-involved children. The service felt that it was important for programmes to be delivered locally, by teams that the young people could relate to and feel a community connection with. In recognition of this, the service partners with local, community-rooted organisations that deliver health-related programmes from a lived-experience perspective.
The most fully-formed of these partnerships is with ‘Rage Fitness’. The Rage Fitness YJS Wellbeing Programme aims to improve justice-involved children’s mental and physical health through the delivery of an intensive 12-week programme of one-to-one and group sessions. These sessions focus on holistic fitness, self-defence, self-discipline, positive affirmations and accountability. Over the three month period, young people attend 72 support sessions, 82 fitness and wellbeing sessions and 16 group sessions, totalling 170 sessions, or 14 sessions per week.
Youth justice workers use motivational interviewing techniques to encourage a young person suitable for the programme to get involved. If they choose to sign up, Rage Fitness then matches them with a personal trainer who has some lived experiences which reflect their own, providing further motivation and an aspirational role-model that the young person may be better able to relate to.
Rage Fitness staff use WEMWBS, a validated scale for the measurement of mental wellbeing, to track young people’s progress across the intervention and further bespoke sessions to meet their needs.
The impact
Cheshire youth justice service have seen massive benefits to programmes being delivered by local adults with lived experience. The approach has improved engagement and participation while also supporting children’s compliance with their court orders but also provides the young people on the programme with much-needed positive role models. Cheshire youth justice service feel that the programmes give many young people the ability to step back and see themselves positively, sometimes for the first time, and in turn experience an identity shift which has the power to be transformative.
The Rage Fitness YJS wellbeing programme is still in pilot stage but so far has an impressive 100 per cent success rate for young people who have completed it across the following outcomes:
- Improvement in physical health.
- Improvement in mental health.
- Improvement in emotional wellbeing.
- Reduction in the use of class A drugs.
The impact of this pilot approach is demonstrated in Z, a young person arrested for a violent offence who agreed to being socially prescribed the Rage Fitness Wellbeing intervention. After the 12-week programme he remained offence free and his health and wellbeing has significantly improved. Following his successful journey through the programme, Z is no longer open to support services and has been successful in securing a place at college. 70 per cent of the young people on the original Rage Fitness programme have remained engaged with Rage Fitness in some way, some using the gym and others sharing and promoting the gym’s motivational content.
How the approach being sustained
The social prescribing approach is initially seed funded whilst Cheshire youth justice service works to prove the concept is successful. The first pilot has now been successfully completed with a cohort of young people displaying high level of complex need and risk and Cheshire now plans to scale the approach across the whole geographical area, delivering more programmes and further expanding their partnership and collaborations with VCS organisations.
The approach is currently funded by a ‘social prescribing pot’ of funding that the service has collated by pooling multiple funding sources. As the approach develops and further proof of its efficacy becomes available, Cheshire youth justice services hopes to seek sustainable funding to continue the model.
To sustain the impact in young people’s lives Rage Fitness plan to take on young people who have been through the programme successfully as ‘lived experience apprentices’, who will work to motivate and support the next cohort of young people on the programme. The hope is that this approach will provide future young people engaged in the programme with an even more relatable role model and a clear demonstration of the potential benefits, as they work alongside another young person who completed the programme just months before them. Cheshire youth justice service are also working with Rage Fitness to think about other ways to sustain the impact of the programme in young people’s lives, including increasing the number of sessions to allow for ‘tapered’ endings as young people transition back into their normal daily routine, and the use of a ‘lived experience champion’ who could be available for young people after the life of the programme as and when they require targeted advice or support.
Lessons learned
Where the approach relies on partnerships with small community organisations, the pan-Cheshire offer will depend on the availability of these organisations across the different geographies. This will also require significant time and attention from the Cheshire Youth Justice Service management team, who will need to source, assess the suitability of, commission and sustain partnerships with each individual organisation, of which there will be many if the approach is to be expanded across the region.
Whilst the programme delivery has been a success, there is an expected degree of attrition of those for which the programmes are not suited. A key learning however has been that this attrition is often down to unexpected structural issues external to the intervention which take away the young person’s energy and attention. Examples of these include changes in family and home circumstances or becoming homeless. Cheshire youth justice service are looking at how to ensure that young people have the opportunity to revisit the programme when circumstances allow.