The Fairy Tale Model: Secure Facility Therapist Perceptions

Abstract

The current exploratory qualitative study sought to investigate novice therapist experience of implementing a phased trauma recovery approach, the Fairy Tale Model (FTM), in secure accommodation in Scotland. Participants were ten therapists trained and supervised in FTM over a 6 month period. Therapists delivered FTM to 37 youth. Individual interviews with therapists were based on the objectives of FTM, and explored the benefits, challenges and facilitating factors for both youth and therapists. Perceived benefits for therapists included increases in trauma-informed knowledge, skills, and confidence. Youth were perceived by therapists, to be less emotionally dysregulated and more motivated, hopeful, and communicative. Challenges for therapists involved the complexity of youth difficulties, competing work demands, difficulties unlearning established approaches, and short duration placements. Prioritizing therapy, intensive sessions, and frequent communication with care staff were seen as facilitating factors. Recommendations are made for FTM delivery and more robust mixed methods evaluative research including therapist, youth and other stakeholder perspectives.

Unit manager perspectives of a trauma-specific programme across Scotland’s secure estate

“…Managers’ views both supported and contrasted with the results of a qualitative study of therapist perceptions of Progressive Counting, an individualised brief exposure approach, delivered in secure units in Scotland. Although this is a different trauma-specific programme, Barron and Mitchell (2017b) reported that therapists identified gains for themselves, young people and units as a whole. Therapists gained trauma-specific knowledge, skills and confidence and young people were described as more motivated, less emotionally dysregulated and more able to solve problem.…”

“…In comparison to managers, therapists who delivered a brief exposure therapy in secure units reported both similar and distinct barriers. Therapists, as with managers, reported limited therapy time and short duration placements but also reported feeling de-skilled by complex adolescent difficulties (Barron and Mitchell, 2017b). Therapists, as with young people, included their own internal experience as one of the barriers, albeit with a different trauma therapy.…”

“…Quasi-qualitative analysis of data facilitated: participant responses to be quantified and themed for meaning; responses to be compared across questions; a measure of inter-rater reliability to be conducted; and a comparison of findings to other studies of therapist and adolescent perceptions of trauma-specific programmes in Scotland where quasi-qualitative analysis had been used (Barron et al , 2017; Barron and Mitchell, 2017b). The analysis of interview data was by the principal researcher.…”

“…DTD refers to an extensive array of symptoms including posttraumatic stress disorder (PTSD), depression, anxiety, dissociation, relationship and behaviour difficulties, criminality, sexual promiscuity/dysfunction, educational difficulties, physical symptoms as well as a triggered pattern of emotional dysregulation. Within Scotland, 65 per cent of young people in secure accommodation report PTSD and depression and 18 per cent report dissociation (Barron and Mitchell, 2017b). An earlier large scale survey of children in England identified 8.8 per cent of children in residential (rather than specifically secure accommodation) presented with PTSD, 22 per cent presented with emotional difficulties and 56.2 per cent were identified as having a conduct disorder (Meltzer et al , 2003).…”

It really does depend: Towards an epistemology (and ontology) for everyday social pedagogical practice

“…For all the quest for evidence-based or scientific approaches to practice, it is hard to find consistent, replicable examples of their efficacy, certainly in child and youth care. There is no strong or consistent evidence of programmatic interventions being effective in promoting children's upbringing (Gharabaghi, 2012) even among its advocates (Whittaker et al, 2015;Hanson and Lang, 2016;Bath, 2017; Barron and Mitchell, 2019). Even in those rare instances where it might be argued to do so, the significance of such interventions is secondary or at the very least dependent upon the role of the helping relationship in this process (Smith, 2015).…”