The SECURE STAIRS Framework for Integrated Care was developed by NHS England as a way to promote a trauma-informed, evidence-based and whole system approach to children and young people accommodated in the Secure Estate. A pilot ‘Attachment and Developmental Trauma’ training module was developed by the Atkinson Secure Children’s Home in conjunction with members of the SECURE STAIRS Professional Collaboration Network (PCN). Fifty-six staff members working within a Secure Children’s Home in the North East of England completed the 2 day training. A pre and post evaluation method was utilised to analyse the results.The data indicated increased staff knowledge, understanding and confidence in attachment theory, developmental trauma, brain development and working with guilt and shame. The data also demonstrated the importance of safety and containment in the training environment in fostering opportunities to learn and grow. The need for ongoing training, supervision and reflective practice within the SECURE STAIRS Framework for Integrated Care is considered in order to consolidate knowledge and implement learning into practice.

The SECURE STAIRS Framework for Integrated Care (NHS England, 2016; Anna Freud National Centre for Children and Families, 2022) was developed by NHS England to promote a trauma-informed, evidence-based and whole system approach to children and young people accommodated in the Secure Estate. These settings accommodate children and young people presenting with high risk, high harm and high vulnerability presentations that cannot be kept safe in the community. Reflective practice sessions were facilitated over a twelve-month period for residential staff, physical health staff and management working within a Secure Children’s Home in the North of England. A pre and post questionnaire evaluation method was utilised to analyse the results. The evaluation indicated significant improvements in participant’s confidence in their practice and communication with colleagues and children and young people; ability to be reflective with others both during and after an interaction; levels of stress when interacting with children and young people; and uncertainty within their practice. However, decreases were observed in participants ability to appraise their practice and desire for improvement within their practice. The authors critically review the results of the evaluation and highlight the ongoing need for reflective spaces for staff caring for children and young people with complex needs within the Secure Estate.

Purpose The purpose of this paper is to evaluate pre- and post-formulation findings with multi-disciplinary staff within two secure children’s homes (SCHs) in the North East of England. Design/methodology/approach Multi-disciplinary staff teams involved in formulation across two SCHs were administered pre- and post-formulation questionnaires. The pre- and post-formulation questionnaires focused on five domains: knowledge; confidence; motivation; understanding; and satisfaction with treatment plan. Findings A total of 338 pre- and post-formulation questionnaires were administered across 43 formulation meetings. The highest proportion of formulation attendees were: residential staff (44%); mental health staff (17%); case managers (12%); and education staff (9%). Paired samples t-tests showed significant post-formulation improvements across all domains including: knowledge [t(337) = 22.65, p < 0.001]; confidence [t(337) = 15.12, p < 0.001]; motivation [t(337) = 8.27, p < 0.001]; understanding [t(337) = 19.13, p < 0.001]; and satisfaction [t(337) = 18.81, p < 0.001]. Research limitations/implications The SECURE STAIRS framework has supported formulation developments across the Children and Young People’s Secure Estate. Preliminary findings within two SCHs suggest multi-disciplinary staff teams find psychologically informed formulation beneficial. Future directions are considered including future evaluation of young person involvement in formulation meetings. Originality/value There is a notable lack of existing research within the child and young people secure estate evaluating the impact of SECURE STAIRS trauma-informed care developments including the impact of team formulation. This paper adds to the evidence base.

Psychology and psychotherapy have long been regarded as a Eurocentric and largely homogenous field primarily dominated by white, socioeconomically privileged/middle-class women. This lack of racial/ethnic diversity and inclusion within the field has become an area of increased focus of discussion within psychological professions due to its significant impact on the care, experience, and outcomes of service users. Individuals from racially minoritised backgrounds face multiple systemic barriers when accessing the profession during their training and as qualified psychological professionals. Extensive research indicates that clinical psychologists from racially minoritised backgrounds experience racism in clinical psychology and this has persisted over the years. Similarly, in the psychotherapy literature, there has been an emphasis on addressing the lack of acknowledgement of racial disparities in psychotherapy training. As a result, it feels imperative that there is a radical shift in psychology and psychotherapy which involves acknowledging its role in creating and perpetuating racism and discrimination, as well as an urgent need to adopt a decolonised, socio-constructionist approach. Despite this, there has been little focus or momentum on clinical psychology training programmes to actively address issues of racism and to develop anti-racist practice. The Newcastle University Clinical Psychology Doctorate Programme recently made an active stance to adopt anti-racist practice and implement an approach that supports collective responsibility and accountability. In this article, the authors engage in a critical, radical, and collective dialogue around their experiences, and share their reflections on developing a clinical psychology anti-racism strategy, attending to power, discomfort, and the role of systemic oppression. The diverse voices of trainers, trainees, and aspiring clinical psychologists presented suggest that collective action, solidarity, as well as attending to power and relationality, had a profound impact on the development of the anti-racism strategy, as well as on relationships, trust, and relational safety. The authors offer critical reflections on how these experiences can be helpful in further understanding the complexity and multi-faceted nature of anti-racist praxis in clinical psychology and psychotherapy.

Background:The Children and Young People Secure Estate consists of establishments that accommodate young people, either in a welfare capacity, under Section 25 of the Children’s Act 1989 or detention and sentencing by the criminal courts. There is evidence that Black, Asian and Minority Ethnic (BAME) adults and children are subject to disproportionate admission and detention in secure settings (Corrigall & Bhugra, 2013; Lammy, 2017).Aims:To explore whether similar trends around disproportionality are evidenced for BAME children and young people accommodated for welfare reasons under the Children’s Act 1989.Methods:All admissions to a Secure Children’s Home in the north of England over a five year period were analysed. Admissions were solely for welfare reasons. Data was extracted from Section 25 Referral Forms and analysed exploring ethnicity, rates of admission and length of stay.Results:164 young people were admitted to the Secure Children’s Home over five years. Black young people were 3.9 times more likely to be admitted to the Secure Children’s Home in comparison to their White counterparts. Those identified as Dual/Mixed Heritage were 6.2 times more likely to be admitted compared to children and young people who identified as White. No differences in length of stay were found.Conclusions:This study is one of the first to explore ethnicity and admission rates for children and young people detained for welfare reasons under the Children’s Act 1989 and found significant disproportionately similar to those that have been documented in other secure settings. Implications for practice and care are outlined.