Talking Hope

Iriss.fm, Episode 215
Published on 27 Sep 2018

A roundtable discussion on Talking Hope, a project exploring to what extent creating safe conversational spaces among diverse stakeholders helps cultivate hope in the context of young people considered to be at high risk.

The conversation involved Katherine Baxter, Research Associate on the project; Natalie Connell, Unit Manager at the Good Shepherd Centre; Eileen Bray, Mental Health Nurse at CAMHS (Ayrshire and Arran); and Liam Slaven, a care experienced young person and member of Star Board which aims to transform secure care in Scotland.

Date of recording
Audio transcript

MD - Michelle Drumm
KB - Katherine Baxter
EB - Eileen Bray
LS - Liam Slaven
NC - Natalie Connell

MD - You're listening to Iriss.fm, Scotland's social services podcast. On the 28th of August 2018 we held a roundtable discussion on "Talking Hope", a project exploring to what extent to creating safe conversational spaces amongst diverse stakeholders helps cultivate hope in a context of young people considered to be at high risk. The conversation about Katherine Baxter, Research Associate on the project, Natalie Connell, Unit Manager of the Good Shepherd Centre, Eileen Bray, Mental Health Nurse at CAMHS Ayrshire and Arran, and Liam Slaven, a care-experienced young person and member of Star Board which aims to transform secure care in Scotland.

KB I'm Katherine. I'm the Research Associate for the "Talking Hope" project which is a project funded by the Scottish Government and European Social Innovation Fund, and it's based at the University of Strathclyde, and its primary partnership is with the Good Shepherd Centre in Bishopton, and we're here today to talk a little bit of hope with people who are involved in supporting in people or who have been and people who have had experiences of being in care. So I thought we'd just start off with some introductions, and so maybe all of you can go around and just tell me a little bit about your role and also what it is how you support young people?

EB My name's Eileen Bray. I'm a registered Mental Health Nurse and I work with Child and Adolescent Mental Health Services in Ayrshire and Arran.

NC I'm Natalie Connell. I'm a Unit Manager at Good Shepherd Secure Unit in Bishopton and I work in the assessment unit. So we carry out all assessments on young people when they first come in.

LS Liam Slaven, a member of the Star Board which is looking at transforming secure care and supporting young people to then get the best possible experience of care as possible.

KB Great, thanks very much for that. You gave kind of generic explanations of your role and what your title is, but maybe you could be a little bit more specific about the work that you do to support young people who have significant risk in their lives, or is it your experience as a young person in a care system? Something more about the everyday role that you play.

EB I'm actually the Service Manager now for CAMHS but I've been Charge Nurse in both the adolescent team and in a generic CAMHS team. So that was working with the ages of people of the age of five to eighteen. We do a lot of work around young person's mental health and emotional wellbeing and at the moment we're doing a lot of work with education, social work and voluntary agencies to try and make sure that young people are getting the right help at the right time rather than waiting to come into a CAMHS service, which is a specialist mental health service.

NC We get young people in from all kinds of different areas and as you can imagine when they first come into secure they're very traumatised, kind of different range of emotions, and our initial response to the young people is to trying and stabilise them, to build up relationships and then to allow a kind of therapeutic alliance between the staff and the young people where through that they've kind of got the nurturing and the kind of therapeutic environment, and we find that kind of really, really successful.

LS So from my own experience I was in residential and secure care, and from that sort of professional, not really professional, but my voluntary experience on the Star Board, it's about looking at good practice and about where we can see that good practice in different services, because my time in secure care was probably the best time of my life, and then it's about looking at how we can improve that and take that on the whole system approach so that, well, no one's getting a non-consistent approach in their care.

KB So I thought I'd start off just with a question for Natalie, and I was wondering if you could reflect on the importance of hope in some of the work that you do at the Good Shepherd Centre?

NC What we normally find is if a young person comes into secure care they've either got a very, very unrealistic kind of vision of hope or they've got no hope at all. So the unrealistic vision might be that they've been horrifically abused by their family and when they've got that loyalty that they'll want to return to the family. So we would kind of do a lot of work in relation to the kind of short-term, medium-term and long-term goals. What we find as well is young people that have got no hope when they come in and kind of self-harming really, really bad, they're in kind of regular safe homes being really, really violent. So we'll kind of stabilise them, build the relationships and look at short-term goals and kind of give young people incentives, and kind of to manage and through the kind of day to day kind of routine the relationships young people do normally kind of have a more realistic kind of idea of hope. So initially it might be to not be safely held on a day, not self-harm in a day, and then once we kind of get to that we'll then look at maybe them going to education. A lot of young people might be wanting to go out on mobility, so again we're constantly looking at the goals of hope, and once that young person achieves that they don't just stop there. We would then look at the next step and we always involve the young person as well, so it might be that they want to start playing a football team, so we would kind of support that and then through that they're continually building up their hope for the future.

KB So hope relative to them and where they're at is huge?

NC Yeah, and very, very much individualised to that young person. It might be something that we don't want for them, but if they want that for them we'll fully support that because it gives them a kind of ownership of their own individual care plan and building up their kind of levels of resilience, and also levels of hope for the future.

KB So despite the many challenges that we've spoken about previously I was wondering what you might see as opportunities and reasons for hope in your field at the moment?

EB I think for a lot of the young people that we work with they've come from other services already and it's very much, "Well if CAMHS can't fix you nobody can fix you", and that's unrealistic, and I think a lot of the young people come in and they think, you know, "This isn't going to work, this isn't going to help me", and very much like you were saying that sort of feeling of hopelessness. A lot of the work that we do with a young person is about helping them to wreak ownership of the difficulties that they're experiencing as well and taking ownership of the recovery, because there's only so much work that we'll do with a young person in an hour, you know? It's them taking that out with and sort of generalising that in everyday life. So it's about developing that bit of ownership as well, of actually we can do so much but together as a partnership we can do a lot more, and I think again it's that idea of building relationships and building that trust with young people to develop that hope as you go on, but it can be quite difficult at times with some young people can get to that point of they've gone through other services and people will say to them, "This is your last chance. This is your last hope", and I think they get the same message time and time again for secure care as well.

KB Liam, I was wondering what you think needs to happen to allow for more hopeful conversations to be had not only with but also about young people who might have been in secure care or who are currently in secure care? What do you think needs to happen?

LS Well I was also, I was one of those young people who used to self-harm a lot and be a risk to others and myself, so I think you need to start with talking. I mean, talking is a massive thing and especially CAMHS, I was involved with the CAMHS service as well in the Forth Valley area, and young people need to be listened to. They feel very isolated when they're in a secure care setting and they feel that they can't talk to anyone and they feel like they're just going to be shunned away, but I feel like there's a lot of focus on love within the care system as well. So you've got love, you've a nurtured and safe environment that'll support and help everyone, staff and young people, to get the best care possible.

KB And is there something specific that you remember that made a really good difference? Just you said that secure care was one of the best times of your life. Why was that?

LS In my unit there was quite a lot of supportive people in there. So like the staff were very supportive and even the young people were quite supportive because I mean, you know, anything could happen in a secure unit. So, and it was all about support and just listening to each other and sort of looking out for each other I think. So it's that trust within and relationships between different staff and young people.

KB So were there kind of key points where you might have been struggling but because of the work that someone did, a staff member or maybe someone with CAMHS or a Social Worker, that it made a really big difference to you and allowed you to kind of stay on track or reach the kind of goals that you had set for yourself?

LS There wasn't really any sort of processes but it was like they did quite a lot of, in Good Shepherd it's like the intensive support...

NC We've got interventions team, like the wellbeing team, yeah.

LS ...intervention, that thing. That one, yeah. So I had a worker from there and then I also had I think it was a Psychologist that specialised in criminal psychology. So I did a lot of assessments with them and work because well when I got put into the secure care setting I was quite violent, so I did a lot of training programmes called VINTOC, which is Violence Is Not the Only Choice, and I did a lot of work on so the empathy, and I think that just made me realise that my actions were wrong and made me sort of remorse.

KB Yeah, yeah. That's probably the word. And so when you were in secure care how did you maintain hope? Or were there times where you had no hope where you thought, "Why am I here?", or how did you hold on to that?

LS Well I kept getting put on three-week orders, so none of the work could actually start. So at that time at the start when I first got put in on an emergency order and then three days after you've got a hearing, and I got put on a three-week supervision order and then another three-week and another three-week, and I even had to go to court for an extension for like the last one cos you can only have so many before you have to apply, and at that point I felt like, "I'm going to be in here forever. I can't do anything", and then finally I got put on a three-month order and then that's when the work could actually start, and then I started sort of, "Well maybe this isn't so bad and I won't be here for that long". I mean, I think I was in for about seven months. So that's including the three-week orders and the two three-month orders.

KB And what's it like for you both maybe to hear Liam's experiences of this?

NC I think we can, although we're not the young person in secure you can certainly kind of share the frustrations in relation to the kind of Children's Hearing System with three-week orders. Obviously legislation, you can't argue with that, but feeling people are kind of getting three-week, three-week, three-week, three-week, but the Social Worker is very clear that they're going to be here for a long time. It is frustrating because a young person's not maybe able to invest in the staff because they think, "Well, do you know what? I could actually go to a hearing and I might leave at that hearing", and it also means as well that we can't start some of the kind of more focussed intervention work because we wouldn't be starting it if a young person was then going to leave. So it is very, very frustrating.

EB Yeah, but then thinking from a CAMHS point of view I agree with everything that you're saying, because a big part of our work is about building relationships and you're not going to build a relationship if you keep thinking, "Well, do you know what? In three-week's time I'm away", you know? 

LS Mmmhmm.

EB Because you don't allow yourself to open up in the same way, but if you think, "Oh, do you know what? I'm here. I'll maybe see you twice, three times, and then I won't see you again." So it's really, really hard to build those relationships.

KB Yeah. So what do you think can be done to address that, because that seems to be a challenge that all of you have identified?

NC We've noticed a difference, I mean it is very difficult cos if a young person goes to a children's hearing and if they understand the risks and they're wanting the help, if they say at a children's hearing, "I would prefer to spend here and spend three months rather than a three-week", the young person's voice is being listened to. So there is quite a high chance that that might happen, but a lot of other young people, although they understand the risks aren't at that stage of making the right choice for them. So it can kind of be prolonged, and also as well, Solicitors will argue the case for the young person not to be in secure care, and there is a kind of imbalance about whether a young person needs to be in secure care in the risks or just I suppose winning the case of getting a young person out of secure care. So that is something, a shift that maybe there needs to be some training around Solicitors and kind of legal representation about what's actually best for that young person.

LS Well I think that if they got rid of the three-week orders, of course that would mean legislative change which is sometimes quite difficult to do, but even if you were put on a three-month order, you know, a hearing can be called any time within those three months. So I don't see, I mean the young person can even call a hearing and a Social Worker can call a hearing. So I feel that if you were put on just a three-month order then well you can start the intervention work and then if you leave after the three months. At least you've done some of the intervention work and it can look got on like in your reports, so then you might get out a little bit sooner.

EB Thinking about the sort of three-week orders I think it's in the first instance to do that assessment of actually are you in the right place, you know? That's okay, but it's when it starts being just added onto and added onto it almost feels like there's a view around secure care that people aren't keen to use secure care, you know, and sometimes it feels like it's more that personal view as opposed to what's best for the young person, because yeah, I totally understand the first three weeks of actually, this is an assessment period - though I think the assessments take quite a bit longer at times - but yeah, you can see why that initial period might be in that case that actually just continuing to add onto it is not helpful.

KB Mmmhmm. So you've said that there's some reluctance to secure care. Why do you think that is and how pervasive do you think that is?

EB I think some people just have philosophical views around secure care and see it as we're just locking kids up and, you know, once you lock a kid up you throw away the key and there's no chance of sort of rehabilitation. I don't think they've actually spent any time within secure speaking to people, speaking to young people even, and finding out what it is that they're doing and actually finding out a lot of the success stories as well, because there's a lot of young people that have gone into secure that their life's been turned around. I've personally worked with a few that their lives have turned around and they've worked really, really hard and...

KB Natalie, do you want to say a little bit from the perspective of someone who's working in the secure care centre?

NC I mean, I think any young person coming into secure care it is a last resort, and we read backgrounds of young people and you maybe think, "We could have intervened two, three years ago." It can be quite difficult if say we get a referral for a seventeen-year-old young girl or boy and they have a lot of charges, their offending behaviour is really, really escalated, and they're coming in for a six-week period and the Social Worker's thinking, "Right, can you fix that young person?", cos what we need to then do is it's really, really difficult to unravel seventeen years of kind of problematic kind of troubled behaviour, and also depending on the kind of aid scores with young people, six weeks isn't going to be enough. So sometimes secure care - although I know everybody's not happy with it, the earlier intervention is going to be the kind of most beneficial for that young person. What we are finding right now is we're getting a lot of young people in much, much younger, and you are seeing your really kind of troubled behaviour. However, you are seeing them then settling very, very quickly, and we would then hope the younger that they are they're maybe not in for six, nine, twelve months because you're getting them at an age where you can make that kind of quick change, stabilise them, kind of give them a wee bit of nurturing and then they move out, but it really, really depends on the young people.

KB And how do you think all of the stigma and the misrepresentation of secure care affects the morale and the hope of staff and even, you know, potentially young people who are in secure care?

NC I think staff that work in secure care know that the work that's getting done they see the outcomes day in, day out. Like they might come in and have a really, really bad shift and then they come in the next day and they see that young person's turned things around, or they maybe go through a shift where a young person hasn't self-harmed for seven hours. So they're seeing the benefits day in, day out. So I think the stigma is out there but if you're in dealing with it they know how beneficial it is. So I think it is just a case of well we really need to show everybody else how beneficial and how good the work is that we're doing, but it can be difficult, and what we do as well with the staff is we've got a hope framework for the staff. So through the supervision, cos what we've kind of identified is how could we have been instilling hope in young people if the staff team don't have hope? So it's a kind of holistic approach where the staff have hope for the young people, and then they're kind of doing that through kind of key time supervision and that's really, really effective.

KB What would you say is the main source of hope, or what keeps people showing up every day despite the kind of thankless nature of some of that work?

NC Probably resilience, teamwork, and the relationships that they've got within the units, and the young people. I mean, I think you come into a care setting because you do care, you want to help young people. So although it might be a double shift, you're getting spat on, you're getting assaulted, you still come in the next day because you want to see that process through and you want to show the young person that you're caring for them, cos a lot of these young people have had rejection, abandonment, so we want to be that one that stops that cycle. I know it can be difficult. The team works around it and the majority of the time you do see the young person stabilising and them achieving and their kind of hope increasing.

KB And there's something about the challenge of holding hope for people who may not be able to hold onto it for themselves and the unique challenge of that. Maybe Eileen you could speak a little bit about that?

EB I think in the past, Mental Health Nurses that have probably, when you look at some of the reviews that actually the problem was to hold the least hope for some of the young people that they work with. So it's how you develop that within the staff team, and I think you're right, it's that bit about having stickability and I think that's something that the team that I work with are good at, you know? It's that case of, "Well you haven't turned up for your appointment? Right, well we're going to phone you because I know you're avoiding me because you don't want to talk about this." When young people feel uncared for, if there's family issues going on it's quite hard to expect someone else to care. So when you've got a member of staff that's - and I don't know about yourself but a lot of the time we get it thrown at us. "Well you're paid to do this. You're paid to care for me. You're not doing this because you actually care", but let me assure you we don't get enough money, you know, but it is. When you develop a relationship with a young person, you know, it is that, "No, I'm going to keep pushing. I'm going to keep pushing, and eventually you'll find out actually I'm not going away", you know? "You can hit out, you can spit out, you can avoid me all you want, but I'm still there", and I think that's something that I would say my CAMHS team's quite good at, but I think it's something that in supervision you talk about a lot as well because there are some cases that some of the young people that we work with that do really touch you and you do go away thinking, you know, "How have they got to that place?", and, "How have they managed to survive?", you know, and there's always that, you can always when you look at what's going on in the background you can always see that bit of strength and that bit of resilience even when the young person can't see it for themselves, because they couldn't have got to that bit without having that strength and without having that resilience.

LS Well I agree to be honest. I've heard like wee bits that actually coincide with a lot of the key messages of like the Star Board. So, I mean, I've got some up here. As you were saying about like the stigma. I mean Star's trying to change the attitudes towards young people in secure care and challenge the stigma so that, well, there's many people in society think they know secure care's, people in secure care are bad kids. When they're not, because, I mean, a lot of people will say that they have had traumatic backgrounds, but it's about finding that right support and about making it consistent throughout the whole sector and not just in secure care but also in residential and health, education, social work. That's what we need. More money! Anything - for the Government listening!

KB I think that's a really, really good point and I would just like to ask, not a closing question necessarily, but a question about what advice you would give to young people or maybe staff or adult professionals who might have lost hope, who are really struggling to kind of hold that hope at the moment?

NC I think rather than looking at next week, next year, you look at right now. Where we are right now. Focus on the here and now and if you can achieve something within that next ten minutes, hour, and then you take it very, very gradually, cos that's certainly how we work with the young people. Some people that are kind of in a very, very traumatised - they can't look at the future, it's too harmful, it's too damaging for them because of obviously what they've just came through. So it is just looking at the here and now, making them feel really, really safe, and letting them achieve something. It might be the tiniest wee bit that they achieve but if they achieve the tiny wee bit you then maybe build it up a wee bit more, and then before you know it you'd maybe went two or three days without self-harming, wanting to kill themselves, and then you can then take the young person back and reflect on that, and then you look at maybe medium-term goals. So I would always say to young people, "Let's just focus on the here and now. We're here, we'll keep you safe." 

EB I would agree with that, but I also think talk to someone, because even when you're feeling hopeless, you know, if there's somebody that you trust that you feel safe with, they'll help you just find that little chink cos I think sometimes it is quite easy to just, once you start thinking, and you can spiral quite quickly into that feeling hopelessness.

LS I'd probably say hold on. So you could be in that sort of the worst situation possible, but just hold on and it'll get better cos it usually does, and it can just be a wee blip and then next day it can be fine, and I think that with if you're in secure care or you're on the edges of secure care that support is always going to be there. So you're always going to be safe and nurtured.

KB That's like that, there's that quote, I think it's like a Star Wars quote or something! It's like, "Hope is like the sun. If you only believe in it when you can see it, you'll never make it through the night." So it's pretty cheesy but, you know?

EB Uh-huh.

KB I think it's true, and I was just wondering maybe if you could share a story providing as much detail or as little detail as you feel comfortable with, of something in your work or your experience that kind of reaffirmed your hope and the value of what you're doing?

EB A young girl that I worked with that had gone to the Good Shepherd that had, was out of education from the ages of twelve through to fourteen, fifteen, went to the Good Shepherd, left the Good Shepherd, started an access to nursing course and came out with student of the year for the whole college, and obviously she had really, the work that she had done really helped her turn things around, and there's times where she still struggles but she's really moved things on and it was that idea of one step at a time, one day at a time, rather than thinking of, you know, this time next year or, cos I think sometimes when we work with young people we say, "Oh, where do you want to be in five years?", when actually they can't think about what they're doing tomorrow, you know? So it's actually, I think it takes it back to what Natalie was saying right at the start, it's having that realistic hope and that realistic vision.

KB Mmmhmm.

NC So we got this young girl in, very, very distressed, who went through a couple of months of real kind of significant self-harming behaviour, but like what we were saying, we were taking it day in, day out. So there might have been a day where there was no self-harm that instilled hope in both the staff team that was working with her and also this young person. She then progressed onto moving to mobility, close support, and is now living out in a community doing volunteering work, but if you'd have said to that young person when she first came in, "You're going to be in the community in a year's time doing volunteering work", she would never have coped with that, any self-harming probably would have escalated to the point where she might have been detainable, but like it is, it's kind of achievable kind of goals, and you move along with the young person at the pace that they feel safe to do so.

LS Well, I think one of the most memorable times in secure was when my Social Worker came in. The council's got this, they have to come up every I think it's three weeks or something they come and visit you for like a review, and then I asked if I was getting out soon and then she was like, "Oh, I don't know", and I was like, "Well, you should know", and then I was like, "Well, so see when I do get out, am I allowed to go back to school?", and then she was like, "Well no. You're not allowed to go back to school", and I was like, "Well that's" - I started bursting out greeting because I actually quite liked school even though I wasn't the best behaved person in school, but I actually did enjoy the structure of school. So I started bursting out greeting and then after everyone came up from education, so I think it was lunchtime, then everybody came in, seen me greeting which was really embarrassing, and then, you know, they all just sort of kind of talked me through it and they were just like, "It'll be alright", and then they just supported me and, you know? Well I stopped crying cos it was really embarrassing and then, yeah. That was very much it, and then that sort of just made me accept the fact that I wasn't going back to school, but there's always going to be something there. So I went to like a behaviour or like an alternative school which is like a not a mainstream school, and well I did some tests and exams but I wasn't really good, and then now I'm starting with the NHS in Edinburgh, Modern Apprenticeship. So there's no wrong path to where you go really. I mean, I left school with chemistry National Five at a C pass which was I was surprised to get to be honest, but so no wrong path.

KB That's amazing!

EB Well done!

KB What are you going to be doing with the NHS?

LS Just business and admin but, you know, it's still a job.

KB Yeah, that's fantastic. So finally just I think I'm interested in the value of conversation and I'm wondering how often you all feel that you have the opportunity to just sit down in a room and maybe have conversations with people from different perspectives who are all doing different work, who have different experiences of the care system, and whether or not you think that's valuable or how you think that might make a difference in the work that you do?

EB I think I'm quite lucky in that we do sit down on a regular basis and think about what we're doing and how we do things differently. I mean CAMHS at the moment is going through massive changes and is very much in the spotlight. Yeah, so that, I mean there's lots of scrutiny around CAMHS at the moment, but I think that's a good thing and I think, you know, I've talked about ownership a lot today and I think unless we own what we're doing as well and actually then we make things difficult for young people at times, then we're not going to move forward, but yes, there's lots of very open conversations at the moment with lots of services involved and lots of professionals involved, and the one thing that I would say that we're probably not good at is involving young people in those discussions. We've got parents that are part of it, but young people, I don't know whether we think that we're protecting them or it's like, "Actually, you're not old enough to understand", but it's the one thing that we're not good at is bringing young people into those discussions. 

KB And so do you feel like as a member of the Star group that your perspective and your opinions and things are taken seriously and listened to?

LS I think they are to be honest. I mean, through my other voluntary work - so I do work with the Scottish Youth Parliament. I've done work in the past with the Children's Commissioner in the Scottish Government. So I think that just having conversations is massive because, I mean, if you're sitting down with someone that can actually, has all the power and can make those decisions and you give them the experience, they could be like, "Wow, I need to do something about that", but if you don't have the opportunity to do that then people in, I don't know, like the Civil Service, if there's policy changes that need to made, they're not ever going to know who you are if you don't stand up and voice your opinions on things.

KB And do you think it might be difficult for young people to feel comfortable voicing those opinions or to speak to adults and ...?

LS It is difficult for some young people, but I think that if there's a space for young people to communicate and then that could be taken forward by maybe some more confident young people that are, you know, like to voice their opinions, and then I think that young people in like if there's a sort of forum should also be supported to speak up. So like the more confident ones could start off and then there could be the less confident ones could be supported to speak up. So I think there should be like a national youth forum. I mean, I'm working with the NHS Forth Valley to look at an NHS youth forum. So it was going to be focussed on CAMHS services but now it's going to be more focused on all services. So kind of it's in the...

EB I will be in touch to see how you've developed it, get your advice!

LS It's in the workings hopefully.

KB And have you ever had an instance in which you had a conversation with a young person, maybe not one that you were working with directly, but that sort of opened your eyes or changed your mind on something or ...?

NC We obviously get background information in on all young people prior to them coming in, and part of the assessment process is to read all the background information and kind of analyse it and look at maybe why they're behaving in such a way, but the way the information can be written at times gives a young person a real kind of disservice. So what we find as well is speaking with the young people, finding out maybe why they behave in a certain way, and trying to understand how they think. You could then write their background completely different to how the Social Workers have written the background information. So our kind of main job is to do the assessment on the young person, yeah we've got the information there, but really get to know that individual to kind of how to kind of best intervene, cos it might be that you look at a background and you think they're just behaving like that because for example the mum has had a new baby so they're jealous, and that is the words that would be used in the kind of background reports, but then when you speak to a young person it could be, "Well I used to be my mums number one and when the baby came along and no longer had time for me I stopped going to youth clubs. I stopped going to this because he couldn't do it." So it's more about the kind of rejection. So it is really getting to know the young person and their understanding and views of their life, because if you don't have that you're not in the best position to support that young person through difficulties.

KB Mmm. So I guess just finally, so there are obviously a lot of tensions and ambiguities and uncertainties and challenges across the system, but there are still a lot of people who are doing absolutely amazing work who are holding hope for so many people who might not have it for themselves. What do you think is the key to that? What's the secret?

EB I think sometimes as much as anything else it's people's value base, and in terms of like working within services actually how that's developed from top to bottom and bottom up. That sort of ethos of this is what we believe and this is what we think, and I think to continually hold that line sometimes can be quite hard, but it does come down a lot of the time to individual's value bases.

NC I think we're getting better at partnership working and working kind of very, very closely with the CAMHS teams that we're got the relationship with, cos when we look at kind of trauma-informed care I think that's really, really kind of good to help the staff kind of understand the young people's behaviours, cos maybe years ago it'd just be, "They're just being naughty. They're just attention seeking." Whereas if you actually have got the trauma-informed care and you're understanding maybe like PTSD or kind of complex PTSD, you're able to look away from the behaviour and what's the kind of driver, and that seems to be kind of really, really kind of important to staff dealing with the kind of more complex young people.

LS I mean, I think the key and sort of the driver for people that work in the services is the young people themselves because, you know, you could have a really minor case and, you know, it's sorted within maybe three months, but then you could have a really severe case and like it's sort of like unravelling sort of like the inner workings of how their brain works and like the challenges that they face, and then as a worker you might also face challenges within that because, you know, anything could happen, like the young person could be taken to hospital and then that could have a really big effect on you as a worker. I mean I know I'm not a worker so I don't really know what they would feel, but I know from workers that have supported me that they do care and it's the young people that they care about, you know, and I think that should be recognised.

KB Yeah. So there's always hope cos there's always a difference that can be made, that needs to be made.

LS And I think it's about knowing that you're their help, maybe the only people that have ever supported that young person, and they're going to need you.

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