During the early period of the pandemic, there was a lack of detailed guidance for many groups, including the secure estate. For children in custodial settings, this meant staff often applied measures intended for adult prisons, in lieu of any other information. Here, Dr Charlotte Lennox shares her research showing children in such settings were an invisible group during COVID-19.

• During the pandemic, no single government department had responsibility for implementation of COVID-19 guidance for children in custodial settings.
• Children were confined for up to 23.5 hours a day, with a significant impact on their mental health and wellbeing.
• Clear lines of accountability, better future planning, and a review of current measures are needed to avoid this happening again.

Children in custodial settings have much higher rates of mental health and neurodevelopmental disorders than children in the general population. Prior to the COVID-19 pandemic, HM Inspectorate of Prisons  (HMIP) repeatedly expressed concerns about the safety of children in custodial settings. Now, evidence suggests that COVID-19 restrictions and limited social interactions had a significant impact on the general population, and a disproportionate impact on young peoples’ mental health. As children in custodial settings were an already vulnerable group, there were concerns about the impact of the COVID-19 restrictions.

Researchers led by Dr Lennox undertook a study aimed at understanding this impact, combining HMIP and Ofsted reports with analysis of policies, and the effect of these policies on children, staff, and settings. They also interviewed 41 participants, including NHS staff, policymakers, and children with experience of custody during COVID-19.

Findings

This research found that there were direct and indirect impacts of the COVID-19 pandemic, and the policies implemented.

Direct impacts

Children were not considered when COVID-19 guidance was being developed for custodial settings. There was no consistency of approach across the three site types – Secure Children’s Homes (SCH), Secure Training Centres (STC) and Young Offender Institutions (YOI) – and no single government department had oversight. This resulted in most sites adopting, to differing degrees, the COVID-19 guidelines for the adult prison estate.

However, this meant that children were locked in their rooms, in the worst cases for 23.5 hours a day for weeks at a time. The smaller SCH sites were able to offer more time out of their room, but during lockdowns, on admission, and periods where children needed to self- isolate, they did this time on their own, locked in their rooms. This isolation did result in a deterioration of children’s mental health, and within the NHS England Children and Young People Indicators of Performance (CYPIP) data, we saw increased referrals once restrictions were lifted with referrals higher than pre-COVID-19 rates.

‘Bubbles’ were one of the main ways sites managed children. Initially these were successful, as the smaller groups made it easier for staff to manage behaviour, keep good communication, and develop staff and child relationships. However, over time these bubbles led to rising tensions and inter-bubble conflict, as children within them formed gang-like relationships. These issues were more apparent in the larger sites than within the SCHs.

Data from our interviews showed that the rollout of the COVID-19 vaccination programme, and conflicting messaging and behaviours from residential staff around vaccine take-up, appeared to have an impact on childhood vaccinations more generally, with an increase in refusals for all vaccinations.

Indirect impacts

COVID-19 and policies implemented to minimise transmission affected staffing levels. These low staffing levels subsequently impacted many aspects of life, including how the children’s behaviour was managed, their ability to access facilities, services and professionals, and ultimately further restrictions and isolation. Staffing issues were more acute in the larger sites.

Prior to COVID-19, NHS England commissioned ‘The Framework for Integrated Care’, (SECURE STAIRS) to improve the quality of care for children. It aimed to do this through culture change, promoting trauma-informed, formulation-driven, and delivered within a whole-systems approach. In March 2020, sites were at varying stages of implementation. While the CYPIP showed that the number of children with a formulation had actually increased over time, our interview data suggested that in some sites staff had struggled to maintain momentum.  The Framework for Integrated Care (SECURE STAIRS) needs significant staff training and reflective practice, and these were the first things to be cut due to staffing shortages.

Policy recommendations

Future pandemic planning:

The lack of oversight of custodial settings by any single government department was central to the problem. To avoid repetition of these mistakes, a more coordinated strategy is needed between the Ministry of Justice, the Department for Health and Social Care, and the NHS. This includes having direct lines of accountability and advocacy for children in custodial settings when developing any policy.

There is a need for consistent infection control policies that are suitable for children in all custodial settings. In the future, if isolation periods are needed, this should be for the shortest amount of time, the needs of the child should be paramount, and there should be effective senior leadership in monitoring of isolation. There is a need to support the larger settings to encourage childhood vaccinations uptake given the increase in refusals.

Lessons learned from COVID-19:

The use of bubbles over time within the larger sites has been problematic. While the direction of travel is for smaller Secure Schools, this study highlights some important considerations, particularly around group dynamics. In the larger sites, there is also a need to address staffing issues in order to improve staff-child relationships and behaviour management.

Areas of practice to be refreshed:

The introduction of the Framework for Integrated Care (SECURE STAIRS) is likely to deliver improvements in children’s care. However, it requires sustained buy-in from all sectors, we would urge a drive to refresh uptake by the custodial settings. The use of the CYPIP data has the potential to be an effective research tool, but sites need to understand the value of reporting on this data to improve data quality.

Summary

While younger age groups so far seem to have endured a smaller physical toll from the pandemic, the same cannot be said for emotional and mental trauma – with children in the secure estate particularly affected. As with children more generally, it was assumed this group would help spread the virus, though this appears not to be the case.

This research demonstrates the necessity for clear and separate strategies for children living in the secure estate (particularly larger sites), alongside a single route of decision-making responsibility – and accountability.

The outcomes of the pandemic are still being explored and being used to strategically plan for future outbreak management. Children and young people must be a central part of this, including those on the secure estate.

This project is not supported by HM Prison & Probation Service or Youth Custody Services. The views expressed are those of the author and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.

This article was originally published as part of our collection on mental health and wellbeing, Open Minds. Read more evidence-led policy insight on this topic in the full online collection.