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. 2023 Feb 7:1–7. Online ahead of print. doi: 10.1007/s10597-023-01092-3

The SECURE STAIRS Framework: Preliminary Evaluation of Trauma Informed Training Developments Within the Children and Young People’s Secure Estate

S Atkinson 1,✉, A McKeown 1, D Caveney 1, E West 1, P J Kennedy 1, S Macinnes 2
PMCID: PMC9903271  PMID: 36749491

Abstract

The SECURE STAIRS framework promotes trauma informed understanding and training across the workforce to inform work with children and young people. A component of the framework is the ‘Trauma Informed Practice with Children and Young People in Secure Settings’ (TIPSS) training programme for multidisciplinary staff. Between November 2020 and May 2021, a total of 123 members of multidisciplinary staff from a Secure Children’s Home (SCH) in the North East of England attended five-day TIPSS training. A pre-post repeated measures design was adopted. Paired samples t-tests were used to analyse pre- and post- questionnaires regarding self-reported levels of (i) knowledge, (ii) understanding and (iii) confidence across Attachment and Developmental Trauma, Understanding Complex Behaviour and Trauma Informed Care training modules. Staff reported significant (p ≤ .001) post-training improvements in knowledge, understanding, and confidence across all three training modules. Implications of findings are discussed, and further developments outlined.

Keywords: Trauma informed care, Staff training, Evaluation, SECURE STAIRS, Children and young people secure estate

Introduction

Adverse Childhood Experiences and Developmental Trauma Within the Children and Young People’s Secure Estate

Adverse Childhood Experiences (ACEs) refer to “highly stressful, and potentially traumatic, events or situations that occur during childhood and/or adolescence that can be a single event, or prolonged threats to, and breaches of, the young person’s safety, security, trust and bodily integrity” (Bunting et al., 2019, p. 7). ACEs can include experiences of abuse and neglect, as well as indirectly harmful experiences such as parental conflict, substance misuse and mental health difficulties (e.g., Hughes et al., 2017). Exposure to higher number of ACEs can increase the trauma-response and risk of a wide range of social and health problems including cancer, heart disease, respiratory disease, mental health difficulties, and decreased life expectancy (Hughes et al., 2017; Walsh et al., 2019). The potential impact of ACEs has been found to be cumulative in nature (Chartier et al., 2010; Felitti et al., 1998).

ACEs directly affect the young person and their environment, requiring significant social, emotional, psychological and behavioural adaptation (Brennan et al., 2018; Bunting et al., 2019; Felitti et al., 1998). Adaptations can refer to children and young people’s attempts to survive their traumatic experience. In doing so, individuals develop a sense of safety or control to make sense of their experiences (Brennan et al., 2018; Bush, 2018). Given that these experiences can impact upon various elements of development, we can understand this within the term ‘developmental trauma’ (Gregorowski & Seedat, 2013; van der Kolk, 2005).

Almost a third of children and young people are reportedly exposed to trauma by the age of 18 years in the United Kingdom (UK; Lewis et al., 2019). Prevalence rates of childhood adversity and trauma within the Children and Young People’s Secure Estate (CYPSE) are known to be higher than within the general population (Baetz et al., 2019; D’Souza et al., 2021). The CYPSE in England and Wales includes Young Offender Institutions (YOIs), Secure Training Centres (STCs) and Secure Children’s Homes (SCHs). SCHs accommodate 10 to 17-year-olds who have been sentenced, or remanded to custody, or are residing in such environments under Secure Accommodation Orders (Gyateng et al., 2014). Young people within SCHs are among the most vulnerable within society, frequently presenting with significant experiences of trauma, complex mental health issues, disrupted patterns of attachment, neurodiversity and learning needs. Girls within the CYPSE have been described as a particularly highly vulnerable group, often with experiences of exposure to multiple traumatic events (Khan et al., 2021). Understandably, this can result in children and young people experiencing long standing emotional and psychological needs, sometimes contributing towards mental health difficulties (Robinson et al., 2019).

With the above in mind, it is important for professionals working within the CYPSE to ensure a trauma informed approach is used to understand the young person and their presenting needs. This has led to a call for children and young people’s services to acknowledge the impact of trauma and mitigate the effects of trauma through promotion of staff training and support (Taylor et al., 2018).

Trauma Informed Practice for Children and Young People

Trauma informed practice refers to a whole system organisational change process (Bunting et al., 2019; Taylor et al., 2018). Trauma informed practice aims to understand the traumatic life events that a young person has experienced and its impact on their current presentation (Chizimba, 2021). Intervention planning can then be explored by professionals to support the young person (Chizimba). Trauma informed practice also involves responding proactively by fully integrating knowledge of trauma within policies, procedures and practices to reduce the potential of re-traumatisation (Substance Abuse and Mental Health Services Administration, SAMHSA, 2020). Trauma informed practice values co-production, peer support and creating an environment in which individuals are able to feel safe; building on the individuals’ strengths and the support around them (Brenman et al., 2018; Chizimba). By adopting a trauma informed approach, staff can improve their understanding of young people’s traumatic experiences and improve therapeutic relationships (Maguire & Taylor, 2019). The Trauma Recovery Model (Skuse & Matthew, 2015) supports understanding the developmental needs of a young person during assessments and intervention planning.

There is a clear need for staff working with young people who have experienced developmental trauma to undergo training in trauma informed care (Robinson et al., 2019). A growing body of research suggests that trauma informed training can promote staff to gain confidence and knowledge to effectively assess and offer trauma informed interventions within a range of secure settings (Walters et al., 2015), and increase awareness of trauma informed care (Williams & Smith, 2017).

Despite some positive findings in the literature regarding trauma informed care and staff training (e.g., Dublin et al., 2021; Layne et al., 2014; Robinson et al., 2019), there remains limited research examining the efficacy of trauma informed training within SCHs in the UK.

The SECURE STAIRS Framework

The SECURE STAIRS framework is a whole system approach to integrated care within the Children and Young People’s Secure Estate (Taylor et al., 2018). The SECURE STAIRS framework is intended to ensure that children and young people receive the same care and support, irrespective of location in England, built on a consistent evidence-informed approach (Twitchett, 2016). The aim of the framework is to influence and support organisational culture change to better support trauma informed and formulation-driven, evidence-based approaches to create positive changes for children and young people (D’Souza et al., 2021). As part of this, the framework promotes trauma informed understanding and training across the workforce to inform work with children and young people and to support staff well-being.

The ‘Trauma Informed Practice with Children and Young People in Secure Settings’ (TIPSS) training is funded by NHS England and supported by the SECURE STAIRS project management team. The SECURE STAIRS project team identified the need for a more bespoke training package to help staff meet the complex and multiple needs of the children and young people they work with. The Atkinson SCH setting led on the development of the TIPSS training. The TIPSS training is currently in the process of being implemented across SCHs.

As part of this process, a pilot of the ‘Attachment and Developmental Trauma’ training module within the TIPSS training was delivered to 56 members of staff within Kyloe House SCH (Farooq et al., 2021). This evaluation indicated significant post-training increases in knowledge of child and adolescent brain development, attachment theory and styles, developmental trauma, understanding of the role of guilt and shame in young people’s presentation, and confidence in ability to work in a trauma and attachment-informed way. These findings are encouraging as the TIPSS training continues to be piloted within different establishments as part of the SECURE STAIRS framework.

The Current Study

The current study sought to undertake a preliminary evaluation of five-day TIPSS training for staff within an SCH in the North East of England. It was hypothesised that the training would improve (i) knowledge, (ii) understanding and (iii) confidence to support staff in helping young people work towards change in a psychologically safe environment. This evaluation was in line with the SECURE STAIRS framework developments that identified the importance of trauma informed practice in the care of young people.

Method

Participants

Between November 2020 and May 2021, a total of 123 members of staff from an SCH in the North East of England attended five-day TIPSS training. The training consisted of a total of 15 cohorts of training, with an average of eight attendees per cohort. The attendees included residential staff (68%), management (10%), education staff (9%), mental health provision (8%), interventions team (2%), substance misuse team (2%) and physical health team (1%).

Staff completed five modules including; (i) Introducing the SECURE STAIRS Framework; (ii) Attachment and Developmental Trauma; (iii) Understanding Complex Behaviour; (iv) Resiliency and Blocked Care; and (v) Trauma Informed Care.

Setting

The SCH within the current study supports young people between the ages of 10–17 years. SCHs provide a safe, supportive environment for vulnerable young people who frequently present with multiple and complex needs, including trauma, mental health difficulties, learning difficulties, and/or neurodevelopmental needs. Integrated mental health, education, and healthcare services are also provided within the settings. Young people may reside in an SCH under the provision of criminal sentencing legislation or due to a Secure Accommodation Order under a Sect. 25 Order of The Children’s Act (1989, 2004) due to heightened welfare concerns.

Measures

An adapted and extended version of the Consultation Questionnaire (Knauer et al., 2017) was identified as a measure for evaluation of staff responses to the TIPSS training. The Consultation Questionnaire was initially developed to explore the impact of probation staff’s self-rated knowledge, confidence, motivation, and understating (of adult offenders with personality difficulties), as well as their satisfaction with management plans at pre-consultation, post-consultation and after receiving a written formulation. The adapted and extended measure has been previously piloted and used in empirical research on team formulation (McKeown et al., 2020). Further research is required to assist with validation of this adapted tool.

Participants were administered three pre and post questionnaires in total to evaluate three of the training modules: (i) Attachment and Developmental Trauma, (ii) Understanding Complex Behaviour and (iii) Trauma Informed Care. The questionnaires measured staff views of the TIPSS training on four domains: (i) knowledge (ii) understanding (ii) confidence; and (iv) satisfaction with training. The items were measured on an 11-point Likert scale, ranging from 0 to 10.

Procedure

This study met criteria for service evaluation and therefore did not require NHS Research Ethics Committee (REC) approvals. The study received local approval from CNTW NHS Foundation Trust Research, Innovation & Clinical Effectiveness team (SER-19-046).

Due to COVID-19 restrictions being in place at the time of delivering the training, the training was remotely facilitated via Microsoft Teams Videoconferencing. The training was delivered by a psychologist, either independently or co-delivered alongside a Case Manager from the SCH.

Total population sampling was adopted and all staff members who attended the TIPSS training between November 2020 and May 2021, were asked to provide preliminary evaluation of the training. Staff members completed the pre-training questionnaire prior to commencing each training module. The post-training questionnaire was completed following completion of the relevant training module. The questionnaires were completed anonymously and sent electronically and securely to the team administrator.

Statistical Analyses and Results

Before data analysis began, all variables were screened for normality, missing data or outliers.

Participants were removed from further analysis if they had completed the pre but not post questionnaire, or vice versa. This was the case for ten participants in Attachment and Developmental Trauma, five participants in Understanding Complex Behaviour, and two participants in Trauma Informed Care. On average, 68% of evaluation forms were returned across the three modules.

Results of the Shapiro–Wilk test indicated that the data were not normally distributed and were positively skewed. Data from one participant was removed from the Attachment and Developmental Trauma data set as it was identified as an outlier. As the data was then normally distributed, parametric methods were utilised for data analysis. An alpha level of 0.05 was set for all statistical tests. Statistics were performed using IBM SPSS (V26, NY, USA).

Descriptive Statistics

In Table 1, the descriptive statistics for pre- and post-training in Attachment and Developmental Trauma domains for the sample are presented. In Table 2, the descriptive statistics for pre- and post-training in Understanding Complex Behaviour domains for the sample are presented. In Table 3, the descriptive statistics for pre- and post-training in Trauma Informed Care domains for the sample are presented.

Table 1.

Means and standard deviations for pre- and post- training in attachment and developmental trauma domains (n = 78)

Domain Pre-training Post-training
Mean (SD) Mean (SD)
Knowledge (child and adolescent brain development) 5.69 (1.69) 7.86 (1.10)**
Knowledge (attachment theory/styles of attachment) 5.78 (1.86) 7.99 (1.30)**
Understanding (role of guilt and shame) 5.45 (1.96) 7.95 (1.22)**
Knowledge (developmental trauma) 5.63 (1.82) 8.12 (1.13)**
Confidence (ability to work in a trauma and attachment-informed way)a 6.30 (1.78) 8.37 (1.10)**
Open in a new tab

**p = <.001

an = 77 due to missing data

Table 2.

Means and standard deviations for pre- and post- training in understanding complex behaviour domains (n = 83)

Domain Pre-training Post-training
Mean (SD) Mean (SD)
Knowledge (harmful sexual behaviour) 5.69 (1.66) 8.00 (1.00)**
Confidence (working with harmful sexual behaviour) 5.77 (1.94) 8.00 (1.17)**
Understanding (self-harm) 6.88 (1.64) 8.46 (0.88)**
Confidence (working with self-harm)a 6.81 (1.79) 8.33 (0.95)**
Understanding (lying) 6.25 (1.57) 8.16 (0.96)**
Understanding (false allegations)b 5.96 (1.73) 8.25 (1.00)**
Confidence (ability to apply formulation to complex behaviour) 6.12 (1.83) 8.22 (1.13)**
Open in a new tab

**p = <.001

an = 82 due to missing data

bn = 81 due to missing data

Table 3.

Means and standard deviations for pre- and post- training in trauma informed care domains (n = 75)

Domain Pre-training Post-training
Mean (SD) Mean (SD)
Knowledge (trauma informed care) 5.60 (1.97) 7.92 (1.06)**
Knowledge (key principles of trauma informed approaches) 5.27 (2.00) 7.88 (1.13)**
Understanding (trauma-informed environments) 5.47 (1.93) 7.95 (1.06)**
Knowledge (organisational change)a 5.51 (2.15) 7.77 (1.16)**
Confidence (group living dynamics) 6.15 (1.93) 8.17 (1.16)**
Open in a new tab

**p = <.001

an = 74 due to missing data

Paired Samples t-Tests

Attachment and Developmental Trauma

Paired samples t-tests were undertaken to examine pre- and post-training findings in domains of (i) knowledge, (ii) understanding, and (iii) confidence in the Attachment and Developmental Trauma domain. The findings indicated staff reported significant post-training improvements across all domains measured: (i) knowledge of child and adolescent brain development [t(77) =  − 12.62, p < 0.001]; (ii) knowledge of attachment theory/ styles of attachment [t(77) =  − 12.85, p < 0.001]; (iii) understanding of the role of guilt and shame [t(77) =  − 12.46, p < 0.001]; (iv) knowledge of developmental trauma [t(77) =  − 14.30, p ≤ 0.001]; and (v) confidence in ability to work in a trauma and attachment informed way [t(76) =  − 11.04, p ≤ 0.001].

Understanding Complex Behaviour

Paired samples t-tests were also conducted to examine pre- and post-training (i) knowledge, (ii) understanding, and (iii) confidence in the Understanding Complex Behaviour domain. The findings indicated staff reported significant post-training improvements across all domains measured: (i) knowledge of harmful sexual behaviour [t(82) =  − 5.98, p ≤ 0.001]; (ii) confidence in working with harmful sexual behaviour [t(82) =  − 12.98, p ≤ . 001]; (iii) understanding of self-harm [t(82) =  − 9.29, p ≤ 0.001]; (iv) confidence in working with self-harm [t(81) =  − 9.24, p ≤ 0.001]; (v) understanding of lying [t(82) =  − 11.93, p ≤ 0.001]; (vi) understanding of false allegations [t(80) =  − 12.27, p ≤ 0.001]; and (vii) confidence in ability to apply formulation to working with complex behaviour [t(82) =  − 11.32, p = 0.001].

Trauma Informed Care

Finally, paired samples t-tests were conducted to examine pre- and post-training (i) knowledge, (ii) understanding, and (iii) confidence in the Trauma Informed Care domain. The findings indicated staff reported significant post-training improvements across all domains measured: (i) knowledge of trauma informed care [t(74) =  − 11.86, p ≤ 0.001]; (ii) knowledge of key principles of trauma informed approaches [t(74) =  − 12.73, p = 0.001]; (iii) understanding of trauma informed environments [t(74) =  − 12.38, p ≤ 0.001]; (iv) knowledge of organisational change [t(73) =  − 10.41, p ≤ 0.001]; and (v) confidence in understanding of group living dynamics [t(74) =  − 10.89, p ≤ 0.001].

Discussion

The SECURE STAIRS framework highlights the importance of whole system approaches to integrated care within the Children and Young People’s Secure Estate (Taylor et al., 2018; D’Souza et al., 2021). The framework can be considered a fundamental component in promoting the development of trauma informed care among multidisciplinary staff within SCHs. The efficacy of trauma informed training, as underpinned by the SECURE STAIRS framework, within SCHs is a new and evolving area and to the authors’ knowledge, there is limited existing research evaluating this area (Farooq et al., 2021).

The current findings revealed that staff knowledge, understanding and confidence of Attachment and Developmental Trauma, Understanding Complex Behaviour, and Trauma Informed Care significantly improved following attendance at five-day TIPSS training. This echoes research identifying that trauma informed training can promote staff confidence and knowledge to effectively assess and offer trauma informed interventions within a range of secure settings (e.g., Layne et al., 2014; Walters et al., 2015). This also supports findings that trauma informed training can have a positive impact on trauma informed practice (e.g., Dublin et al., 2019, 2021; Perry & Daniels, 2016; Robinson et al., 2019).

The current study adds to previous findings and suggests that trauma informed training has a positive impact on the trauma informed knowledge, understanding and confidence in the multidisciplinary workforce within an SCH. The findings provide further evidence for staff working with children and young people who have experienced developmental trauma to undergo training in trauma informed care (Robinson et al., 2019). In doing so, staff can begin to understand the impact of young people’s experiences in bringing them to an SCH and ultimately work towards developing therapeutic relationships and mitigate the impact of adversity (Bunting et al., 2019; Maguire & Taylor, 2019).

Limitations

A limitation of this study is that a follow-up questionnaire was not used to assess the extent to which staff knowledge, understanding and confidence in trauma informed practice was sustained after a follow-up period of completion of the training. Furthermore, the current study did not use a direct measure of impact, such as changes to staff behaviour to ascertain whether improvements in staff knowledge, understanding and confidence changed practice. In not having the opportunity for independent measurement of behavioural change, it relied solely on self-report by participants, which can provide an inflated estimate of practice change (Miller & Mount, 2001; Williams & Smith, 2017).

This preliminary evaluation study was based on one SCH and therefore further research is required to explore whether the findings are generalisable to other settings.

It would be beneficial to collect data in relation to staff qualifications and length of time working in the setting to understand more about the potential for confounding variables impacting results. In relation to staff attending previous training in relation to ACEs, attachment and developmental trauma, 42% of staff noted that they had attended previous training in some capacity, however further specific details were not reported, including the length of training and period of time since completing the training. This information would also be helpful in relation to the data and any future research.

Future Research

Using a more direct measure of impact, such as changes to staff behaviour, may be beneficial to consider in future research. Research has shown that training itself is more effective in increasing knowledge than changing practice (e.g., Beidas & Kendall, 2010; Crowe et al., 2006). It would be beneficial to examine if improvements in staff knowledge, understanding and confidence are transferred into practice, and whether, if any, behavioural change is observed after receipt of trauma informed training.

Further research would be beneficial to examine staff perceptions of the extent to which the SCH in which they work is trauma informed. Measures including the Trauma Informed System Change Instrument (TISCI; Richardson et al., 2012), have been developed to assess staff understandings of trauma, as well as their views of broader policies and practices within the child welfare system with which they work in. It would also be beneficial to gain the views of the young people residing within the SCH regarding their understanding and experiences of living within a trauma informed environment. Further use of the Essen Climate Evaluation Schema (EssenCES, Schalast et al., 2008, 2016) may be helpful within such research. Implementation of the SECURE STAIRS framework and providing trauma informed care for vulnerable young people within an SCH has been found to coincide with improvements in the therapeutic climate (perception of safety, connectedness with others, and level of support within the environment) of staff and young people (McKeown et al., 2022).

Acknowledgements

The authors would like to acknowledge the young people, Cumbria, Northumberland Tyne and Wear (CNTW) NHS Foundation Trust, and Aycliffe Secure Centre for supporting the undertaking of this paper.

Funding

None.

Data availability

For queries regarding data, contact the ‘author for correspondence’.

Declarations

Conflict of interest

The authors declare that they have no conflict of interests.

Footnotes

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

S. Atkinson, Email: sarah.atkinson@cntw.nhs.uk

A. McKeown, Email: Annette.mckeown@cntw.nhs.uk

D. Caveney, Email: d.caveney@nhs.net

E. West, Email: ella.west@cntw.nhs.uk

P. J. Kennedy, Email: jack.kennedy@cntw.nhs.uk

S. Macinnes, Email: Sinead.MacInnes@durham.gov.uk

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