HMP Deerbolt Final Report by We Are Survivors

HMPFINAL DEERBOLT REPORT

The mission of We Are Survivors is:

To break the silence of the sexual abuse, rape and sexual exploitation of boys and men in order to empower those affected to defeat the legacy of abuse to move towards positive futures.

CONTENTS Welcome and foreword Being OUT Spoken We Are Survivors in Prison Inside OUT Spoken Introduction In Partnership Inside-OUT Spoken: A Personal Development Group Individual case study Clients feedback Staff feedback Data and outcomes Conclusion Recommendations References

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3 4 5 6

8 11 12 13 14 16 17 18

Since opening the doors in 2009, We Are Survivors (formerly Survivors Manchester) has developed some brilliant working relationships with both community-based services and with staff in the prison estate.

It hasn’t been easy, and it’s taken the grit and determination of many to build trust on all sides, not only to make this work for the individuals we aim to help, but to ensure that we stand with uniformed, healthcare, and civilian staff shoulder to shoulder, as they stand with us – this really is a true partnership in every sense! A partnership like this requires everyone to be open to learning so we are thankful to the Prison Officers, Senior Management, Governors, Healthcare, and allied professionals in the prisons for sharing their knowledge with us. Because of them we’ve been able to embed our service into regimes of the prisons. For anyone who has worked in the prison or secure estate, it will be of no surprise mental health is a key issue that people have to deal with. Many staff will also recognise the presence of trauma symptoms in many of the individuals in their care. When trauma is left unprocessed, it can manifest and present itself in a range of different ways, often thought of as PTSD (Post Traumatic Stress Disorder). However, unprocessed trauma doesn’t have to stay unprocessed and OUT Spoken aims to support individuals who present with difficulties, symptoms, or distress processing and integrating trauma so that it no longer causes difficulties and distress for the individual.

We know that the OUT Spoken Talking Therapy services as well as group work are having an impact; not only can we measure it with healthcare outcome scores and data, but we also use testimonials from staff and the men themselves who have used our service. It has been a privilege to be part of the HMP Deerbolt pilot and work alongside phenomenal and inspirational colleagues such as CM Anna Barclay who has supported and championed this project from the start. Letting little stand in her way and showing her deep commitment to the young men in her care. Kerri Brems and Michael Smith from Arch Teesside who despite new to the prison environments embraced everything they experienced and kept “the lads” at the heart of their cause, creating a trusting safe space to talk for those who attended. I am truly humbled by all your dedication, compassion and commitment in supporting these young people to develop and grow. Finally thank you to the young men who attended; your bravery and trust is something I will never forget.

ALISON LLOYD Criminal Justice Services Director We Are Survivors

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BEING OUT SPOKEN The OUT Spoken Talking Therapy service focuses on improving the mental health of individuals residing across the 15 North West prison estates dealing with trauma using talking therapy, mainly trauma-informed psychotherapy. The service is delivered by We Are Survivors (formerly known as Survivors Manchester), an organisation founded in 2009 to work specifically with men and boys affected by sexual abuse, rape and sexual exploitation across the Greater Manchester area. The OUT Spoken Talking Therapy service model is based on We Are Survivors’ years of experience of working with male victims/survivors of sexual abuse, rape and sexual exploitation in the community. It mirrors many of the services we already run, adapted to fit in the prison estate. All the services and activities delivered within the prison estates are trauma informed and victim/survivor focused; which means that we develop and deliver services where our actions and decisions are underpinned by our understanding of the evidence based on working with trauma, whilst also adapting our delivery to meet the specific and identified needs of male victims/survivors from the continual feedback cycle. There are many ways to understand the theory behind the

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world’s understanding of trauma, each of them with their own merit. The OUT Spoken Talking Therapy service uses an integrative model of therapy, using (based on) Judith Herman’s Trauma and Recovery (Herman, J. 1992) model set within the Skilled Helper model (Egan, G. 2007) as a framework for supporting clients to move through a process of Stabilisation > Processing > Integration. Alongside this we use Outcome measures PHQ9 (Patient Health Questionnaire), GAD7 (Generalised Anxiety Disorder) and PCL 5 (post-traumatic stress disorder checklist). All these outcome measures are validated for use with the Government and NHS IAPT National Mental Health Programmes. We hold a rich amount of data for OUT Spoken that helps us guide the service and show the strengths and weaknesses within. That said our success is that currently have 737 individuals engaged in our 15 North West prison estates, we have delivered 3012 interventions (these include therapy and contact with clients) within our last quarter (April – July 2023). Our most common most common reason for referral at 41.27% is RASSO – Rape and serious sexual offences (RASSO) that have happened to individuals, followed by 35.71% for PTSD.

IN PRISON We Are Survivors has a history of working within the Prison (prison) estate; it has been a journey that looks something like this:

2012 Working with HMP Manchester, We Are Survivors co-wrote a therapeutically facilitated 12 week group programme ‘Personal Growth and Education (PGE)’. 2013 - 14 Following a request for support for HMP Risley, We Are Survivors develop the first peer-led support group on the ‘Belief in Change’ Therapeutic Community programme, supported with 1:1 sessions. 2015 The success of the ‘Belief in Change’ group results in further investment and the evaluation and further development of ‘therapeutic’ facilitated peer-led support groups. 2015 - 17 A recommendation by a prisoner of We Are Survivors in helping trauma survivors to a Governor in HMP Preston leads to the development and installation of a monthly facilitated peer-led trauma group with 1:1 ‘top up’ sessions. 2015 - ongoing Recognition by Mental Health team and Safer Custody at HMP Buckley Hall of the impact of the Cyril Smith/Knoll View reporting on residents begins a 1:1 trauma therapy service in the estate.

2016 We Are Survivors is commissioned by NHS England and Ministry of Justice to support the acute impact for prisoners decanted through the prison estates as part of Operation Knightsbridge. 2017 - 18 HMP Altcourse commissions We Are Survivors to develop a group work programme to tackle significant self harm, and so ART Spoken is installed – an arts based 20 week therapy programme. 2018 HMP Buckley Hall supports the further development of OUT Spoken with the inclusion of the first ever UK prison engaged ISVA (Independent Sexual Violence Advisor) to support the ‘report to court’ process for current and non-current cases. 2020 Working with NHS England, We Are Survivors is commissioned to roll out the OUT Spoken Talking Therapy service in HMP Hindley, HMP Garth, HMP Lancaster Farms. 2021-ONWARDS Working with NHS England, We Are Survivors rolls out the OUT Spoken Talking Therapy service across 15 North West prisons, including HMP Styal in association with Greater Manchester Rape Crisis

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INSIDE OUT SPOKEN INTRODUCTION Following a number of conversations with HMP Deerbolt, Healthcare providers - Spectrum, and NHS England (NE), We Are Survivors suggested the following pilot project be undertaken. It was agreed that We Are Survivors would work alongside Spectrum (and associated Mental Health sub-contractor) to ensure that any provision commissioned to We Are Survivors is rooted in partnership working and focused on the needs of the primary beneficiaries.

The intervention best suited to the population described as those in the ‘Transition Unit’ at Deerbolt, was the Personal Growth and Education (PGE) course first developed for HMP Manchester, and since adapted to fit a number of other prison and community spaces.

THE PARTNERS The Inside Out project was made possible because of a multiagency partnership and approach of We Are Survivors, Arch Teesside, HMP Deerbolt and Spectrum.

IN PARTNERSHIP WE ARE SURVIVORS Owing to the location, We Are Survivors, as we have done in other establishments within the NW, worked with a local VCSE Sexual Violence provider in the Northeast, via our VCSE Sexual Violence network, through a secondment model that the organisation uses in the North West and in the female estate, to ensure local knowledge and transition ‘through the gate’ is pertinent. However, it was agreed that We Are Survivors would take full responsibility for all aspects of the delivery with their Criminal Justice Services Director attending every session, holding full responsibility for reporting and management and governance of project.

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We Are Survivors is a Greater Manchester based charity, with a UK reach, supporting male victims/survivors of sexual abuse, rape and sexual exploitation. Since the organisation opened the doors in 2009, it has grown to be one of the largest specific sexual violence organisations in the UK, engaging with over 2,300 males every year and receiving 3 new referrals every day of the year. The aim of the organisation is to promote and protect the good health of male survivors of sexual abuse by providing qualified counsellors, psychotherapists, and general support workers to support and advise survivors on how to cope with and move beyond their unwanted sexual experiences. These aims are achieved by delivering a three-

tiered service consisting of online, telephone and face-to-face support, in both 1-2-1 and group settings. We Are Survivors also run the trauma informed therapy service called OUT Spoken 1-2-1 therapy in all 15 North-west prison sites. Duncan Craig OBE Alison Lloyd

Chief Executive Officer Criminal Justice Services Director

Contact Details Unit 9 Brewery Yard, Deva City Office Park, Trinity Way, Salford, M3 7BB General/Referral enquiry: 0161 236 2182 E-mail: outspoken@wearesurvivors.org.uk

ARCH TEESIDE ARCH Teesside is a specialist sexual violence service offering free and confidential support, help and advocacy to people in the Teesside area who have experienced rape and sexual abuse, (no need for a comma) at any point in their lives. Based in Middlesbrough, it has over 25 years of experience in delivering services within the communities it serves. It originally evolved from a women’s domestic abuse project, specialising in providing trauma-informed rape and sexual abuse support. In 2007, it incorporated the then ‘Jigsaw’ project into its service, which extended support to men and boys. Nikki Harkin Kerri Brems Michael Smith

Chief Executive Officer Sexual Violence Counsellor Independent Sexual Violence advisor (ISVA)

Contact Details 22 Hoylake Road, Middlesborough, TS4 3JL General/Referral enquiry: 01642 822331 E-mail: admin@archteesside.org

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INSIDE OUT SPOKEN INTRODUCTION As previously mentioned after several conversations with HMP Deerbolt, Healthcare providers - Spectrum, and NHS England (NE), We Are Survivors suggested the following pilot project be undertaken. It was agreed that We Are Survivors would work alongside Spectrum (and associated Mental Health sub-contractor) to ensure that any provision commissioned to We Are Survivors is rooted in partnership working and focused on the needs of the primary beneficiaries.

4. 5. 6. 7. 8.

The Output of Trauma on the Individual (Anger) The Output of Trauma on the Individual (Relationships) Disclosure Healing from Trauma Health, Wellbeing and Resilience

TRANSITION UNIT AT HMP DEERBOLT Prior to our arrival no individual on the unit had been preselected by either prison staff or any healthcare provider. This meant that during the assessment process we were unaware of how many individuals were residing there, who would be involved, or what challenges, difficulties or support needs these individuals might have had.

A PERSONAL DEVELOPMENT GROUP (PDG) Inside-Out Spoken is an eight-week psycho-education course that provides individuals with the opportunity to express themselves and the impact of their trauma and develop a healthy resilience, all under the guise of learning without having to reveal too much about themselves. The course is broken down into the following two-hour weekly session: 1. 2. 3.

Introduction and Context What is Trauma, Abuse and PTSD? The Impact of Trauma on the Individual (Shame, Guilt and the ‘Victim’ Identity)

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Therefore, we assessed everyone on a 1:1 basis to find out more about demographics, physical and mental health issues; risk factors and historical trauma that may be identified; alongside this a consent to liaise form was also signed at this point. Every week, the session plan from the original booklet was revisited and where necessary was adapted to take into consideration the client’s emotional state as well as the wider prison context. Each week there were external factors that had to be taken into consideration when working with the group. Due to the volatile nature of the prison environment there was

always something that had happened. Issues ranged from the individuals’ cells being searched just before we arrived, individuals being physically searched and scanned, letters from solicitors or family containing bad news, relationship breakdowns or the removal of our clients to segregation or other wings after individual incidents occurring. Being in that environment was very much a juggling act, keeping an eye on the individuals who were in the room, the dynamics of outside, the prison environment whilst delivering a programme about trauma. PAPERWORK (GENERAL): Throughout the course a lot of paperwork was completed which some of the group struggled to complete due to issues with both reading and writing. Sometimes you could see a few of the group looked embarrassed about this. However other peers or staff running the course stepped in to support. However, it is to be noted if this course were to run again. Environment: The room is one normally used socially for other activities. Another room not connected to social activities would be preferable. Attendees took time out of their association, gym time or work time to attend – so there is/was a need to make their attendance worthwhile. Group: Some wanted 1:1 work, which may be something to think about, offering a mix of short one-to-one sessions and then an 8-week group programme. This might then assist in establishing therapeutic relationships and extra support for the lads to help offload or talk through things that come through the sessions. More activity-based work might be useful – drawing, exercise, practical activities. GROUP MEMBERSHIP The project assessed thirteen attendees; twelve started the group, and as expected there were people from different backgrounds, localities across the country, but it was noted there were 6 individuals who were local to the Northeast, and six were from the Northwest of England. It was obvious from the first session that there was a very strong split in the group, with some individuals who were presenting quite quiet, anxious, and tense others who presented as very loud, boisterous were clearly used to taking more of a leadership role within a group. The geographic differences seemed to create a split within the group – dependent on where the individual came from; from a North East V North West perspective and after two

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sessions we were left with six of the participants from the North West and the individuals from the North East opted out and gave various reasons such as “it is not for me”, “it is too much with them in”. It was disappointing that this happened as all attendees had a lot to offer. In future, an option for two groups to run alongside each other and look at how to assess that situation to help plan further smaller groups could be more feasible. The individuals that chose to opt out were offered a 1-1 debrief session afterwards; we checked in with these men each week whilst they continued to be on the unit. Around week 3 we started to notice a pattern when the clients left the room. They were put back in their cells; however, there would always be some form of disruption, shouting at the prison staff, banging things, and just “kicking off”. We thought it would be a good idea to consult with the Wing Custodial Manager as to how we could counteract this. It was agreed the following week to finish earlier and allow the clients some time to decompress before having to go back to the cells. We recognised that when the clients were leaving, they were probably still in a state of hyperarousal and had nowhere to release it, especially given the things we were discussing. This worked well and stopped the disruption and dysregulation we have seen previously. Towards the end of the course two of the group were moved onto another wing after a behavioural incident that had happened on the unit. Before the move one of these clients was put into the segregation and then moved onto a wing; he was not allowed to attend one week due to movement issues. On this occasion one of the therapists went to see him on the wing and facilitated a 1-1 session which he engaged in well. The following week both were then allowed to return to the sessions and were taken back to their wing. The impact of these moves affected the motivation of the other group members’ motivation’. However, despite this the group moved on but were quite disheartened by the change in

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dynamics for the couple of weeks they could not attend. Attendees were often happiest when they were just jotting, drawing or doodling where possible, especially in relation to the topic covered. This took the pressure off them and enabled them to feel more comfortable with silence, difficult topics and difficult disclosures. MENTAL HEALTH TEAMS WITHIN HMP DEERBOLT: After some challenges we met the lead psychologist of the Mental Health team and we agreed to keep in contact with all mental health staff every week after our group; this would have been where we would have relayed any concerns around care needs between sessions or concerns if we felt it was necessary. However, the group members were not aware of what mental health support was available to them generally and it would have been useful for us and the group members to recognize anyone they can utilize for support. This may have been useful and to ensure all clients were supported should they need it as we were only in Deerbolt for 2.5 hours a week. GRADUATION CELEBRATION Graduation was organised for six weeks post group and was held in the bistro where cakes and drinks had been laid on by the prison. A governor was in attendance and presented all the certificates and a poster created by We Are Survivors of all the collective word the clients had used; all individuals were photographed receiving their certificate of attendance from him. He validated their journey and encouraged them to talk about difficult issues surrounding trauma. One individual was in segregation and could not attend and so was visited to be congratulated and informed that he would be given his certificate when back on the wing. Another person did not want to attend for security reasons and again was given the certificate and photographed back on his wing.

CASE STUDY LIAM One Individual, in whom we noticed the most marked change was a man from a traveler community background. He, on our assessment, was noted to be of higher risk regarding his impulsivity and behavior; he had many risk markers on his NOMIS, his CSRA was high risk and had a lot of keep separate notices. He disclosed that he had basic literacy and numeracy skills in the first session.

However, it was noticed that week by week he would start to talk more in each session, disclosing little by little. He went from not saying anything to constantly asking questions and showing a massive interest as well as staunchly supporting others. Whilst sitting and talking one week, we spoke about why he couldn’t share a cell; responded with “coz I don’t do well with people do I”? In the past cell sharing had ended in violence for this individual. We explored this with him, that here he was, every week, with the group of clients, and us 3 practical strangers doing just fine, and to not dismiss himself and what he can do, that by exploring this further could be a trauma trigger. Unfortunately, this individual was put into segregation the following week due an altercation with an officer and then moved to a different wing; we were able to get him back for the last week of the programme which was a massive thing for him to be able to do and for us. It was clear from the feeling in the room on his return that the other group members had missed him, that it was beneficial – and he was more confident, more open, and engaged in the group.

“When I was in seg and then transferred to another wing I couldn’t attend the group sessions, I was gutted and disappointed as I was really enjoying it, the OUT spoken staff member however went the extra mile and came to find me on the wing and spent an hour with me, that meant a lot made me feel I was important to the group facilitators and group. I had never been given that kind of personal attention or thought before, I was always seen as the troublemaker.”

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GROUP MEMBERS FEEDBACK We like coming to this every week, you treat us with respect, we don’t get that anywhere else. You guys are sound. CLIENT

I have learned loads about what I have actually experienced in my life so far and how it has really impacted me and know that I can move forward. CLIENT

K said he felt he had gained knowledge about how some things that have happened has affected him. CLIENT

Thank you for coming to do this with us, it was good to do something like this, I really enjoyed it was a real pleasure. CLIENT

I really appreciate everything you have done for us all. I knew most of it already, but it was really helpful to go over stuff and remind myself of what I know, practice it and what I have in my own tool box to help me. CLIENT Once I am shipped out those pictures are going to help remind me of all sound work we did with lads in the group and in the sessions, I really appreciate all that, I have never had that feeling before. CLIENT

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STAFF FEEDBACK ON INSIDE-OUT TESTIMONY 1 “I have heard good things from the group”, Mr X had commented to me how positive his involvement in the group has been as he enjoys being part of it and he reports that he gets a lot from the group and engages well.” DEPUTY GOV (Came to visit the group) TESTIMONY 2 “I have nothing but positive reports from staff and the young men that have been involved which speaks volumes for what the OUT spoken/ARCH staff have delivered. Thank-you all so much and I really hope this can be developed and shared within the wider prison community in the near future” CM OF TRANSITION UNIT TESTIMONY 3 “This type of programme is what the prison estate needs and really should be rolled out across all our whole prison as there is such a need”. SAFER CUSTODY CM

TESTIMONY 3 “The lads really enjoy this and looked forward to their time with you, we have seen certain individuals who are quite boisterous have become calmer and more manageable following the sessions. It seems very beneficial, and it is also good that despite the other lads on the unit who opted out of the sessions, still get checked in with every week so they know they could come back if they wish which seems a very non-threatening way of getting their trust”. PO

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DATA AND OUTCOMES The 14 clients that started the supported in Deerbolt were in the age range 18-21 (the majority being either 18 or 19). All clients identified as heterosexual, and almost all as white 93% (7% as BME). Interestingly, in Deerbolt, the proportion of clients identifying as having no religion is much higher than the wider population of prison clients we support. 57% identify as having no religion in the 14 Deerbolt clients we supported, as opposed to 30% in the wider population. Age Count Percentage 18 6 42.9% 19 6 42.9% 20 1 7.1%

Count

Percentage

White British

78.6%

White Irish

7.1%

Other White Background Caribbean

1 7.1%

REFERRAL REASONINGS/SESSIONS In terms of reasons for referrals, this was split between PTSD and Adverse Childhood Experiences, with the majority being ACEs. Specifically, 86% ACEs and 14% PTSD. Referral Reason

21 1 7.1%

F44 - Post Traumatic Stress

Sexuality

Count

Percentage

F45 - Adverse Childhood

Heterosexual

100%

Age Count Percentage 18 6 42.9% 19 6 42.9% 20 1 7.1% 21 1 7.1%

Religion

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Disorder (PTSD) Experience (ACE)

Count %

14.3%

85.7%

A Total 94 sessions were completed at Deerbolt, 14 of which were assessments, and the remaining 80 being therapeutic input, contacts with health professional, prison staff. Due to literacy issues with a lot of the clients, the YP-Core questions were beginning to cause distress and frustration, so most switched to a simpler rating of 0-10 based on the question ‘how are you feeling’?

CLINICAL OUTCOMES 6 out of 14 clients at Deerbolt completed treatment. Of these 6, PCL-5 outcomes at assessment and end-of-treatment were gathered from 5 clients (one client was in segregation for a prolonged period to complete so unable to complete), which allowed us to determine caseness and corresponding recovery rates.

Of the 5 PCL-5s recorded at assessment, 2 clients scored higher than the clinical caseness threshold of 32. By the end of treatment, both of these clients scored below the threshold, giving a recovery rate of 100%. The remaining 3 who were not at caseness at assessment, remained below casenesss by the end of treatment. For the outstanding client, although outcome measures were unable to be gathered at assessment, a PCL-5 score of 10 was recorded at final session, again, putting them below the clinical-caseness threshold for trauma-related symptoms. The results of the outcome measures alone clearly evidence that positive change that had taken place for the majority of individuals involved in the “INSIDE OUT” project. Alongside the visible observations of the behaviour of individual members that was witnessed by staff with many reporting witnessing very positive change.

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CONCLUSION It is known that young people within the criminal justice system have experienced a higher level of adversity and trauma compared to the general population (HM Inspectorate of probation 2023). A 2021 study found links between serious youth violence and ACEs; in a survey of 200 individuals involved in the youth justice system - two-thirds had five or more ACEs, and over a fifth had eight or more ACEs. The reluctance to talk about traumatic experiences within young adult offenders (18 – 25) can leave these young people in a constant state of fight, flight, freeze - numbing their selfawareness, ability to determine their self-efficacy which can compromise their ability to engage and participate fully in beneficial interventions. We saw first-hand at the beginning of our group sessions how trauma had disinhibited some of the group, this continued into their prison life to exhibit reckless, self-destructive behaviours; created difficulties in tolerating and controlling negative emotions, causing maladaptive or self-endangering behaviour, and creating protective avoidance strategies, especially emotional avoidance, and an inability to safely self-regulate. Whilst we know that the stigma attached to discussing experiences of trauma makes it very difficult for individuals to disclose what may have happened to them, this did initially present us with a challenge mainly because of the group’s huge mistrust of strangers and new people; however, it also created a massive opportunity within this group to help them gain trust in us and explore these issues in a slow safe trauma informed manner that had a clear and consistent approach. This approach helped validate their experiences and be a place they could anchor themselves to reassure them and helped then discuss difficult feelings without ridicule or recourse. The data along with the feedback from prison staff and participants shows that the Inside Out project had a very

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positive impact that it not only had on group participants, but also helped staff have more insight about what had happened to individuals and how there were many layers within each individual group member that at times might have just been seen as anger, violence, and verbally abusive antisocial behaviour. The “on the hoof” successful ability of the INSIDE OUT team to tailor the course and interventions week by week and deliver in a way that not only acknowledged the external pressures within prison that they may face week by week and adapt around this, but also work with these young people’s traumatic experiences and supporting them to learn new coping skills, as well as a language that makes sense to them and they can use to articulate their experiences to other in an appropriate, non-threatening manner and helping them understand their responses and behaviour. The fact that course material was facilitated in a fluid way enabled the course to be responsive to the smaller size of the group and individual needs and responses. This enabled the delivery and course to be differentiated in such a way that it was accessible to all levels of ability and enabled all to participate and be acknowledged. The INSIDE OUT project at HMP Deerbolt project ultimately was a success was due to hard work, determination, and the transparency and support between the prison staff and Inside Out staff; this led the way for valuable knowledge exchange, shared risk management and intrinsic knowledge of trauma responses and reactions and boundaries within the group management. The dedication and consistency of the INSIDE OUT staff members who turned up no matter what and gave a safe and environment for these young men to express some of their innermost difficult of experiences that had happened in their lives so far without judgment and received with unconditional support paid dividends and created a strong and supportive band of trust within the group.

RECOMMENDATIONS We Are Survivors recommends the following: PRISON STAFF TRAINING : Prison staff involved with the care of these individuals - wing staff and personal officers should receive high quality trauma informed care training from the INSIDE OUT team prior to the course starting to promote partnership working and further understanding trauma informed care so they can develop clear and suitable responses. PRE SESSION MEETING AND DEBRIEF: Meetings before and after sessions to discuss any potential problems prior to each week and debrief with officer post session; however, we acknowledge the difficulty in facilitating this within the prison environment regime constraints and shift patterns of staff.

tallying up the questions and asking them to gauge how they felt out of 8; however, asking the participants in front of each other how they feel at times may have been difficult. PARTNERSHIP WORKING: It would be useful for the collaborative approach for the mental health team to introduce themselves to the group pre-group start date (rather than the end) and to be more visible if possible and not just there to crisis manage. Group participants should know what they can access post group as further disclosure may arise. OTHER CONSIDERATIONS: Being mindful of group dynamics for youth offenders. Group dynamics including geographic location individuals are from, alliances or relationships between co-accused youths.

OUTCOMES AND PAPERWORK: Outcome measures are a vital part of gathering evidence of the course impact. However, for the purpose of this group of clients, some measures may be more suitable to gauge where they are at.

We are Survivors and ARCH Teesside should promote HMP Deerbolt as a centre of excellence when working with trauma and male survivors.

For young people forms such as Young Person Core, CORE 10 (which we ended up using) or something simple like a smiley face outcomes measure may be more appropriate. To measure trauma, being able to design a trauma outcome that the individuals could relate to might also be something to consider. *Trauma forms can be a lot for individuals who are illiterate or have very limited emotional intelligence. We found that

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REFERENCES Glendinning, F., Rodriguez, G.R., Newbury, A. and Wilmot, R. (2021). Adverse childhood experiences (ACEs) and traumainformed approaches in youth justice services in Wales: An evaluation of the implementation of the enhanced case management (ECM) project. Bangor: Bangor University. Grey, P., Smithson, H. and Jump, D. (2021). Serious youth violence and its relationship with adverse childhood experiences, HM Inspectorate of Probation Academic Insights 2021/13. Manchester: HM Inspectorate of Probation. (PDF, 434 kB) https://www.justiceinspectorates.gov.uk/hmiprobation/ research/the-evidence-base-youth-offending-services/specificareas-of-delivery/adversity-and-trauma/ Stålner, O., Nordin, S. & Madison, G. Six-year prognosis of anxiety and depression caseness and their comorbidity in a prospective population-based adult sample. BMC Public Health 22, 1554 (2022). https://doi.org/10.1186/s12889-022-13966-4

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MAIN OFFICE Unit 9 Brewery Yard, Deva City Office Park, Trinity Way, Salford, M3 7BB Office: 0161 236 2182 E-mail: support@wearesurvivors.org.uk 24/7 Rape & Sexual Abuse Helpline: 0808 500 2222 OUR OPENING TIMES Mon/Wed/Fri: 9.00am - 6.00pm Tuesday: 9.00am - 8.00pm Thursday: 9.00am - 8.30pm

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