Can trauma informed practice transform the criminal justice system?

Can trauma informed practice transform the criminal justice system?

In this blog, Dina Papamichael explores the relationship between experience of trauma and involvement in the criminal justice system; and outlines the emerging approaches from Scotland which have potential to transform justice outcomes across the UK. 

Links between childhood adversity, trauma and involvement in the criminal justice system are well evidenced. Those with four or more adverse childhood experiences (ACEs) are significantly more likely to be a victim of violence; perpetrator of violence; and be incarcerated during their lifetime. Experience of prolonged stress in childhood can disrupt healthy brain development and lead to risk-taking and offending in adulthood. Amongst those in prison in Scotland, just under half report personal experience of violence in their home as a child and 80% of those in prison in Wales report at least 1 ACE.

Links between adversity and offending can be broken

The association between childhood adversity and involvement in the criminal justice system informs two essential types of initiatives:

1. Recognising the impact of ACEs and trauma on individuals to prevent initial experience of the criminal justice system

2. Providing trauma informed interventions to those who already have experience of the criminal justice system to ensure risks of re-traumatisation are minimised.

In implementing these approaches, there is a need to ensure that those with ACEs are not stigmatised through implications that childhood adversity is inevitably associated with involvement with the criminal justice system.

There is a need to prevent initial involvement in the criminal justice system

Criminal justice processes such as being arrested, going to court and being imprisoned are often traumatising in themselves and should be avoided altogether wherever possible. Several innovative approaches which seek to understand the behaviours associated with adversity and reduce the likelihood of offending can be pursued:

Ensuring that at risk young people are not excluded from early crucial support: The Interventions for Vulnerable Youth (IVY) project is based at the Centre for Youth and Criminal Justice at Strathclyde University. It seeks to prevent offending amongst high risk youth by acknowledging and addressing traumatic experience, and providing risk assessment and treatment

• Extending support to the children of those with mental illness or problem alcohol or drug use: Having a parent with mental illness or problem alcohol

or drug use are types of childhood adversity. Health and care professionals can adopt holistic approaches which consider the whole family’s needs and extend support to children

Finding innovative ways to access those who may not be already linked in with support: Violence Reduction Unit Scotland’s Navigators reach out to those with traumatic injuries in accident and emergency departments to explore which support is needed to reduce the impact of violence on their lives.

Developing safe environments, promoting resilience and avoiding re-traumatisation are crucial for those with experience of the criminal justice system

When supporting those who have past or current involvement in the criminal justice system, services can be mindful of traumatic experience and take steps to build trust, reduce barriers to access and avoid re-traumatisation:

• Developing supportive, safe and trusting environments: Tomorrow’s Women Glasgow is a multi-agency centre which provides a wide variety of services to address the needs of women involved in the criminal justice system. The centre’s approach is trauma informed in that it prioritises safety, collaboration and trust for those accessing it. Services are offered in a low security environment which is important for supporting women to feel at ease and has not led to any increased risk for staff or other clients

• Equipping individuals with strategies to cope with the effects of trauma to support their resilience: Courses such as Survive and Thrive which explain the effects of complex trauma and provide coping strategies can be adapted for use in prison settings. This approach has been shown to lead to reductions in symptoms of anxiety and depression amongst clients

• Supporting staff to be mindful of trauma when interacting with clients: Staff working in criminal justice and related services can be provided with training on the behaviours associated with trauma, creating trauma informed environments and avoiding re-traumatisation.

Overall, the current climate of growing recognition around the impacts of adversity and trauma provides an opportune moment for innovation and collaboration in approaches to criminal justice. A growing body of evidence from trialled Scottish initiatives can be drawn on to inform trauma informed approaches across the UK.  

Dina is a Consultant in our London Office. For more information about our work in trauma informed practice and criminal justice, get in touch on 020 7253 6289

What makes a good outcomes framework?

What makes a good outcomes framework?

Cristiana Orlando and Clare Hammond reflect on what makes an outcomes framework work

A fundamental must do across public and third sector organisations is to be able to understand and evidence the change you are creating. Measuring outcomes is the bread and butter of organisations, and certainly the area of focus of a large portion of our work here at Rocket Science.

There is a huge range of complexities to bear in mind when measuring your outcomes for example:

  • Making sure you are measuring the right things – as you tend to do what you measure
  • Trying to articulate impact on soft and often intangible changes you are seeing in those you work with
  • Tracking long term impact so that you can report on impacts achieved after your work with an individual or community finishes.

However, the complexity we want to focus on in today’s blog is around how to coordinate impact measurement. For example, where Scotland-wide reporting is required, but activity and impact is occurring across 32 local organisations or partnerships. Scotland’s (and many other jurisdictions’) answer to this is to have a national outcomes’ framework. There are frameworks for community justice, mental health, alcohol and drug, social care etc – all seeking to build a comprehensive picture of impact at a national scale.

A framework has to let partners do their own thing but measure impact with consistency

The purpose of these frameworks is to enable a range of partners to do their own thing, but track progress, change and impact in a way that enables success to be aggregated, and in some situations compared.

An unused framework is a pointless framework

For a framework to be useful it has to be consistently applied and applicable for the vast majority of partners. More importantly a framework has to be used to be helpful.

We are all very good at creating amazing and theoretically perfect frameworks that are:

  • Impossible to lower onto delivery on the ground – if it doesn’t enable local partners to tell a story that makes sense to them it is difficult to use the framework in practice.
  • Not useful to those completing the data – if it isn’t useful to them then why divert already stretched staff time using it?

     

    In our experience of reviewing and developing outcomes framework across the social care, health, employability, community justice, and housing and homelessness we have learned that there are several good practice elements that make a framework work:

    • A good outcomes framework is concise, clear, and consistent in structure and content. Keep outcome titles short but with clear instructions on how to interpret and measure them. Keep the number of outcomes to the minimum needed. Be clear about the aim of the framework, how outcomes link together and be open about the strengths and challenges of the framework
    • Avoid obsolescence through being too vague. There is a tendency to keep outcomes very high level to ensure it is flexible and applicable for partners doing very different things. Being too vague runs the risk that the information becomes meaningless as it tries to be all things to all people
    • Create a framework that is easy to collect data Conducting feasibility testing beforehand, ensuring the framework is co-produced involving all partners, and providing guidance on the use of proxy data are three ways to mitigate the risk of including unfeasible outcomes or indicators.
    • When an outcomes framework is used across localities, it is important to balance national and local priorities. Create a clear link between national objectives and local needs by providing a breakdown of the framework’s aims at both levels. This helps partners have clarity around how they fit into the bigger picture and facilitates the collection of meaningful data locally.
    • Lastly, good frameworks are closely aligned to the way business is done already. The closer the alignment the easier it is to integrate into day to day activities and greater chance of staff buying into its value

    Outcomes frameworks are a powerful tool, but striking the balance between comprehensiveness, consistency and simplicity can be a tricky process.

     

    Clare Hammond is an Associate Director and Cristiana is a consultant in our Edinburgh Office. For more information on our outcomes frameworks and evaluation work please get in touch with the Edinburgh Office on 0131 226 4949 or [email protected]

    There is more to gain from employment than income

    There is more to gain from employment than income

    In the final of a three-part blog series on employability and mental health, Max Lohnert looks at what mental health services gain from integrating employability into their service provision

    Employment can have a positive impact on people’s mental health and wellbeing. A recent study has found that people’s wellbeing is higher if they have a job than not – even if controlled for their increased income. In the past two blogs, we have discussed mental health in the context of employability, now we explore employability in the context of mental health services.

    So, what can mental health services gain from integrating employability into their service provision? And what has been happening in this area?

    Many mental health services are now conceptualising their services using a recovery journey, similar to the concept that underpins many alcohol and drug services. Recognising the role that work can play in people’s recovery, Glasgow’s Health and Social Care Partnership funds a range of employability services for those with health and social care barriers to employment, including mental health. These services see employability as part of a recovery journey.

    During our evaluation of their employability services, we got to know Mental Health Employability Services across all stages of the employability pipeline. These started with pre-employability services providing clients who are not job-ready with the opportunity for “meaningful activity”.

    At the other end of the journey was the provision of Individual Placement and Support (IPS) schemes where people receive individualised support to gain competitive employment. IPS schemes challenge the assumption that competitive employment is too stressful for people with mental health problems. Instead, building on the insight that someone’s desire to work is a strong predictor of success in achieving and sustaining employment, they work with everyone that is motivated and committed to move into work. Access to IPS support is now available as part of the national Fair Start Scotland service.

     Bringing people into positive destinations, volunteering or employment, was also the goal of a recovery service of the Scottish Association for Mental Health which we evaluated recently.

    During our research, participants of the programme emphasised how important it was for their recovery, and for managing their mental health, to fill the void that their addiction has left behind. For many of these participants, working towards employment, no matter how far away employment was, played an important role in filling this void.

    While moving into employment can itself be stressful, there is more to gain from employment than income: a structure to their everyday life, meaningful activities as well as social connections and support. The extent to which this works of course depends on the quality of work that people move into.

    There is a considerable evidence of the negative effects of social isolation on people’s physical and mental health, for example, social isolation increasing the likelihood of depression. The importance for everyone to have meaningful connections is now high on the political agenda: in December last year Scotland published its first national strategy – “A Connected Scotland” – on tackling social isolation and loneliness and building stronger social connections. The Strategy outlines the importance of empowering communities, tackling stigma, and of supporting an infrastructure and providing opportunities for people to connect.

    Our work has shown that for people in recovery – for example previous drug users who had to leave their previous networks of active users – work or volunteering can be an opportunity to re-build their social networks. Employment can make a meaningful contribution to keeping people’s social isolation in check and can play a vital role in their recovery.

    While we have seen employability services integrating mental health support elements into their programmes and mental health services employability elements, there is still more scope for organisations to align their service offer, share resources, and provide coordinated care. We are excited to be working alongside our clients to help them ensure that both mental health and employability clients receive the right type of support at the right time.

     

     

    Max Lohnert is a Consultant in Rocket Science’s Edinburgh Office.

    This blog is part of a wider series of blogs on the intersection between employability and mental health.

    How employability providers are adapting to the mental health challenge

    How employability providers are adapting to the mental health challenge

    In this second of a three-part blog series on employability and mental health, Max Lohnert talks through four lessons of how employability providers are adapting to the mental health challenge 

    With a growing focus on mental health within employability services, how have providers adapted their service offer? What options do they have for developing their services, ensuring that they are sensitive and responsive to the needs of people experiencing mental health problems?

    We have identified four lessons from our recent work with employability programmes.

    Lesson One: Success comes when mental health and employability issues are addressed together

    The importance of people with (mental) health problems receiving additional support when moving into work is part and parcel of No One Left Behind, Scotland’s latest employability strategy. The Strategy emphasises how crucial an inter-agency approach is to enabling people with multiple barriers, including mental health, move into employment.

    EmployabiliTAY, one of the Scottish Government’s Employability Innovation and Integration Fund’s pilots which we have been evaluating, has done exactly that: integrating their employability service with housing, criminal justice, money advice and mental health services. One session of the three-week programme is led by an NHS Mental Health Nurse – here, the focus is not on treating clients’ mental health problems per se, but on making clients aware about how their lifestyle choices, such as their sleep or eating habits, affect their mental health and wellbeing. The programme also has Growth Mindset specialists delivering a session focusing on changing clients’ negative self-image and growing their confidence.

    Lesson Two: Staff roles and skills need to be broader than they were in the past 

    For services to support mental health and employability together, the traditional skills found in employability staff need to widen. Many services are addressing this by having mental health experts and employability experts work side by side. However, even where this is occurring, there is an increasing recognition of the need for all employability service staff (and their volunteers) to have a core set of skills in relation to mental health. This means that, while not all staff are treating mental health issues, they are all able to identify issues, signpost, and tailor their support to their particular needs.

    The importance of this was recognised by NHS Education Scotland who launched the National Trauma Training Framework in 2017. This recognised the need for all public services to be ‘trauma informed’: that is, recognising the impact of trauma on their service users and adapting their practices accordingly by establishing trusting relationships with clients and resist re-traumatisation.

     

    Our training needs assessment for NHS Greater Glasgow and Clyde showed that staff members across a range of services feel that they have a good understanding of what trauma is but would value more training to build their confidence in using trauma informed practice as a core part of their services.

    A youth employability programme we are currently evaluating recognised the high prevalence of mental health issues among their young participants. In response, mentors have received a one-day training on how to work with and support young people experiencing mental health problems. This ensures that they can identify mental health problems early on and engage with young people sensitively.

    Lesson Three: Supporting someone into employment is only part of the job – ongoing support to manage mental health is required to ensure retention and progression in work

    Our work has shown that moving into work is only a first step. Sustaining work can be at least as challenging as moving into employment. EmployabiliTAY ensures that mental health support continues when clients move into work. Participants are able to continue to meet with the NHS Mental Health Nurse if moving into work leads, for example, to increased stress and a resurgence in their anxiety.

    Lesson Four: Mental health is a key reason why individuals leave employment. They need quick access to support to prevent them from falling out of work in the first place

    Health problems, including mental health problems, are one of the major reasons for people dropping out of work. This has long been recognised through programmes such as Healthy Working Lives in Scotland. Recently steps have been taken to try to make it easier to know where to go for help for those struggling in work.

    The Scottish Government’s Health and Work Support Pilot is an example of this. It focuses on providing quick access to support for clients who are at risk of losing their job or have recently left their job due to ill health. The Pilot aims to streamline the service landscape by bringing together work- and health-related services and providing clients with a single-entry point to access the support that they need, preventing people from falling out of work and becoming long-term unemployed.

    There are a growing number of programmes across the UK working at this intersection between mental health and work, and it is exciting to see this spread and lessons being learnt and applied.

    Stay tuned for the next blog in this series where we explore how mental health services have sought to include employability as part of the recovery journey.

     

    Max Lohnert is a Consultant in Rocket Science’s Edinburgh Office.

    This blog is part of a wider series of blogs on the intersection between employability and mental health.

    When is a distance travelled tool a bad idea?

    When is a distance travelled tool a bad idea?

    When is a distance travelled tool a bad idea? Clare Hammond explores when and how to use distance travelled tools

    Distance travelled tools are a popular way of understanding the progression someone has made through a service. They are almost a standard part of any funder or commissioner’s monitoring ask and certainly feature heavily in evaluations and impact measurement.

    But when is using a distance travelled tool a really bad idea?

    The issue is that needs assessment and distance travelled tools can be seen as the same thing by funders, commissioners, service managers and others.

    So, what is the difference?

    • Distance travelled tools are ways of understanding the progress an individual has made. They are particularly useful when assessing the growth in an individual’s knowledge or tracking a single outcome
    • Needs assessment tools are used by practitioners to identify needs and target interventions as part of their case management role.

    Needs assessment tools are a vital part of providing holistic and person-centred support as they allow the practitioner to work through with the participant the various elements of their lives and identify the participant’s worries and needs. They tend to consider a wide variety of aspects of an individual’s life such as health, housing, relationships, employment and addiction.

    It is common for practitioners to use these tools regularly throughout their engagement with a participant in order to understand the changing priorities for support.

    For this reason, it can be easy to see how they could also be used to track an individual’s progression. If housing was scoring as a high area of concern and then after six weeks the concern level is significantly lower, then it could be reasonable to expect that this could be an impact of the programme.

    However, needs assessment tools make terrible measures of distance travelled. They can provide a distorted and confused picture of progression for two main reasons:

    1. Progression is not a linear pathway – particularly for participants with chaotic lives – and can be distorted by how individual’s feel on a particular day. Recovery or improvement is never linear and variations in scores can be misleading when considering overall progress

     

    2. Needs assessment tools can ask individuals how they feel (on a scale) on a wide range of broad issues such as employability, housing, and relationships. Practitioners quite rightly expect to see the figures on the scale to increase and decrease for reasons other than progress or regression. For example:

    • An individual may be focused on managing their addiction, so housing and relationship issues are likely to score low. Once the addiction is better managed, the focus of the individual may turn to their relationships and housing.
    • Initial scores may appear ok when individuals do not yet trust the practitioner they are working with. As the trust and relationship builds between the practitioner and participant, the individual may feel more comfortable expressing unhappiness with parts of their lives.
    • Not knowing what you don’t know can distort initial results. A participant may be happy with their housing situation initially, but as they build their self-esteem they can start to feel they deserve better. Or they can gain a better insight into  their rights when it comes to housing and they can recognise that their housing situation is unhealthy and not good enough.

    In all these situations, it would be reasonable to expect to see scores worsen over time as the individual has the space to think about these areas, the trust in the practitioner to open up about what is concerning them, and the knowledge and self-esteem to know they deserve better.

    There are two key differences between distance travelled tools and needs assessments to consider when working out how to measure impact:

    • Distance travelled tools should be used to test knowledge, understanding and confidence rather than feelings to avoid being distorted by a client’s feelings on a particular day
    • Distance travelled tools need to be focused and specific in what they are asking – broad questions like, ‘How are you feeling about your housing situation?’ should be reserved for needs assessment tools as they are useful questions to open up conversations about need.

    So, when working out how to measure progress – beware!  What can appear to be a distance travelled tool may not provide you want you are looking for.

     

    Until next time, Clare 

    Clare is an Associate Director at Rocket Science who specialises in health and social care with expertise in understanding impact and conducting evaluations. To discuss anything further please get in touch at [email protected] of 0131 226 4949

    Three Rocket Scientists talk about what it’s like to work at Rocket Science

    Three Rocket Scientists talk about what it’s like to work at Rocket Science

    Three Rocket Scientists give an insight into their day-to-day work 

    Cristiana Orlando, Research Intern

    Looking back to when I first started as an Research Intern in September 2018, it’s incredible how much I have learned in the span of six short months. I had just graduated from the University of Oxford with an MSc in Comparative Social Policy and I applied to the internship thinking it would be a great opportunity to dip my toes in the worlds of public policy and social justice. I can now say it’s been a lot more than that – from day one I have been working on tasks ranging from interviews with service managers and directors of health boards, to presenting to clients and writing our final reports. I have had the opportunity to work on a variety of projects including health and social care, criminal justice, and employability. During my time at Rocket Science, I have not only developed a wide set of skills, but I have also felt valued and that my work was having a genuine impact on both services and people.

    Max Lohnert, Consultant

    Much of what I do now as a Consultant was uncharted territory for me when I joined the Rocket Science team in Edinburgh as Research Intern in October 2017 after completing my MSc in the Psychology of Mental at the University of Edinburgh. Since then, every week has been filled with different activities for a range of projects across different sectors: ranging from doing fieldwork with vulnerable young people on employability programmes, large-scale survey analyses, all the way to conducting workshops with health service providers. Not only have I been supported through training and mentoring to develop a wide range skills, but our culturally flat structure means that there is much room for me bring my own ideas to the table and to develop my own areas of interest.

    Charlotte Wu, Senior Consultant

    I can honestly say that no day at Rocket Science is the same – we are always working on a revolving range of projects for a wide range of clients, which means we’re always getting to learn about new social issues and meet new people! There also isn’t a typical ‘Rocket Scientist’ – we have people from both humanities and sciences backgrounds (my BA was in English and MPhil in Gender Studies) and that variety helps us bring an interesting array of skills, interests and perspectives to any project. The thing that we all have in common is a commitment to supporting social change and fairness, and helping organisations to strengthen and demonstrate their impact.

    I also appreciate that while it’s a busy and fast-paced working environment, Rocket Science is encouraging of us pursuing development (both professionally and outside the company) and work-life balance. I actually started at the organisation back in 2013 as a Consultant and decided I wanted to go back to studying, so went away and did a PhD in Global Health Humanities, freelancing for Rocket Science part-time, and then joined again full time in November 2018 as a Senior Consultant. The different ways that I’ve worked for Rocket Science over the years, which have changed with my own circumstances, is an example of the willingness to be flexible around individual staff members’ needs that I really appreciate and value.

     

    See for more information about the open positions in Edinburgh or contact Clare Hammond for an informal chat on 0131 226 4949 or [email protected].