Background

Enhanced Case Management (ECM) is a relational psychosocial approach to working with children supervised by youth justice services (YJSs). ECM was first developed with YJSs in Wales in 2013, and is now being adopted by many services in England. It is based on the Trauma Recovery Model (TRM), which has links to Maslow’s hierarchy of needs, and comprises a series of intervention layers that are sequenced according to developmental and mental health need. For example, if the child is leading a chaotic lifestyle characterised by instability, an initial trauma-informed response would be to help them to develop a settled routine and to feel more secure. In terms of youth justice practice, this is likely to mean regular appointments with their worker (same time and same place) to help to build a routine and rapport, from which it will then be possible to start to address the problems they are experiencing. In essence, this is a form of relational work that aims to mitigate the impact of developmental trauma and focuses on the positive development of the child/young person.

Find out more about adversity and trauma

ECM is supported by a clinical psychologist who does not work directly with any children but supports YJS practitioners to develop trauma-informed responses arising from recommendations made in a multi-agency meeting and at further reviews of progress. Clinical supervision is offered to YJS practitioners to support them to manage cases and to provide the opportunity for reflection and discussion. More specifically, ECM includes the following six elements:

1. training for all YJS personnel in both the TRM and the underpinning knowledge base (e.g. attachment theory, child development, etc.)
2. a clinical psychology-led team case formulation meeting in which a physical timeline of key events in the child’s life is charted to inform interventions. The meeting involves as many agency staff as possible and gathers information provided by family members and the child. In line with a strengths-based approach, it identifies positive as well as adverse factors, and includes a key worker who represents the child’s voice and input to the process
3. a clinical psychology formulation report with a set of recommendations for both the type of interventions that match the child’s developmental and cognitive level but also the sequence in which they are best delivered
4. supervision for practitioners from a clinical psychologist
5. regular reviews (and, if required, revisions) of the formulation meeting report
6. guidance for YJS middle and senior management to facilitate trauma-informed organisational scaffolding to facilitate a more relational way of working within the organisation.

Summary of the evidence

Promising findings

There is not yet enough evidence that trauma-informed practices and adopting ECM-type approaches deliver reductions in offending or behaviour change. The approaches remain relatively new, and further research is required to build an evidence base on its use and effectiveness. Nevertheless, the process evaluations of ECM have been promising, with staff placing more emphasis on holistic, child-centred approaches that seek to build relationships. The following positive key findings have been identified:

• YJS practitioners found the case formulation improved multi-agency information sharing, and led to more accurate and detailed information on the child’s history
• the psychologist’s skills and experience were regarded as essential in the case formulation for highlighting more nuanced issues and making links between ACEs, trauma, and the child’s behaviour, leading to the coordination of developmentally-focused intervention plans
• the coordinated response allowed professionals to maximise interventions for the child, and reduced duplication across services
• developmental mapping helped YJS practitioners to better understand and respond to the fact that some children were functioning at an age much younger than their chronological age
• the TRM was found to be a useful tool to help YJS practitioners sequence interventions according to the child’s needs, and what children could realistically engage with. This was especially true of cognitive-behavioural therapy interventions, which require quite advanced functioning
• YJS practitioners found that consulting with the psychologist when a child missed appointments increased the flexibility around enforcement triggers. The greater scope improved the balancing of factors around public protection, vulnerability, and the ability to engage
• children reported that they greatly benefited from having ‘one person’ they could talk to
• children also reported improvements in coping skills and feeling more positive about themselves, with YJS practitioners looking beyond their offending, challenging any negative self-views, showing genuine care, and having more positive interactions.

Challenges

The evaluations have also highlighted areas for improvement and challenges:

• while the integrity of the psychologist’s support added validation to the YJS practitioner’s decision-making, YJS practitioners also felt that it reinforced pre-established perceptions of low credibility from managers and with other agencies in terms of their own professional abilities
• as part of the ECM, children could continue to engage with YJS practitioners on a voluntary basis when YJS contact would normally cease. However, practitioners described challenges in understanding how to manage risk and safeguarding concerns that arose during voluntary engagement
• there were some challenges in arranging incremental transitions to the probation service where there was less flexibility in the approach to missed appointments, for which children were not prepared
• staff reported that further work was needed across the criminal justice system to remove labelling language and prevent children from being treated as fully responsible adults
• there remained a need to build a community of common practice between different agencies working with the same children.

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Last updated: 27 October 2023