{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:36:11Z","timestamp":1787016971095,"version":"build-2736575974"},"reference-count":61,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"unspecified","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"NHS England and NHS Improvement, supported by UCL","award":["No grant number available"],"award-info":[{"award-number":["No grant number available"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,5,18]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Young people in contact with the youth justice system are more likely to present with complex ongoing needs than young people in the general population. To address this, the Framework for Integrated Care (SECURE STAIRS) is being implemented in the Children and Young People\"s Secure Estate: a \u2018whole systems\u2019 approach to support secure settings to develop trauma-informed and relationally based environments, supporting staff to provide consistent, therapeutic care. This paper aims to present the protocol for a national cohort study examining the impact and implementation of this cultural transformation programme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A mixed-methods realist evaluation will be conducted. Data collection will take place between August 2018 and December 2020. Eighteen sites will collect routine service activity data and questionnaires completed by young people, parents\/guardians and staff. Semi-structured interviews and non-participant observations will be conducted across five qualitative focus sites with young people and staff. An economic evaluation will examine value for money. The results will be triangulated at the analysis stage to gain an in-depth understanding of experiences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval was granted by the Health Research Authority, Her Majesty\u2019s Prison and Probation Service and UCL Ethics Committee. Findings will be disseminated via project reports, site feedback, peer-reviewed journal publications and conference presentations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-045680","type":"journal-article","created":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T14:16:02Z","timestamp":1622211362000},"page":"e045680","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Realist Process Evaluation of the implementation and impact of an organisational cultural transformation programme in the Children and Young People\"s Secure Estate (CYPSE) in England: study protocol"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1108-9392","authenticated-orcid":false,"given":"Sophie","family":"D\"Souza","sequence":"first","affiliation":[{"name":"Child Outcomes Research Consortium, Anna Freud Centre, London, UK"},{"name":"Department of Clinical, Educational and Health 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Available: https:\/\/www.ryantunnardbrown.com\/wp-content\/uploads\/2012\/11\/MH-Commissioning-Framework.pdf [Accessed 06 Oct 2020]."},{"key":"2025121411202395000_11.5.e045680.8","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.59.12.1133"},{"key":"2025121411202395000_11.5.e045680.9","doi-asserted-by":"publisher","DOI":"10.1097\/00004583-200401000-00019"},{"key":"2025121411202395000_11.5.e045680.10","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1080\/14789949.2011.564644","article-title":"Factors affecting the recognition of mental health problems among adolescent offenders in custody","volume":"22","author":"Mitchell","year":"2011","journal-title":"J Forens Psychiatry Psychol"},{"key":"2025121411202395000_11.5.e045680.11","doi-asserted-by":"publisher","DOI":"10.1080\/13682820601053977"},{"key":"2025121411202395000_11.5.e045680.12","unstructured":"Department of Health . Healthy children, safer communities: a strategy to promote the health and wellbeing of children and young people in contact with the youth justice system, 2009."},{"key":"2025121411202395000_11.5.e045680.13","unstructured":"Summerfield A . Hm Inspectorate of prisons, youth justice board: children and young people in custody 2010-11: an analysis of the experiences of 15-18 year olds in prison, 2011. Available: https:\/\/dera.ioe.ac.uk\/14598\/1\/children-young-people-2010-11.pdf [Accessed 06 Oct 2020]."},{"key":"2025121411202395000_11.5.e045680.14","unstructured":"Rutter M , Mercuro N , Rutter ML . Antisocial behavior by young people: a major new review. Cambridge University Press, 1998."},{"key":"2025121411202395000_11.5.e045680.15","unstructured":"Youth Justice Board . Housing needs and experiences, youth justice board, 2007. Available: https:\/\/www.gov.uk\/government\/publications\/housing-needs-and-experiences-youth-justice-report [Accessed 06 Oct 2020]."},{"key":"2025121411202395000_11.5.e045680.16","unstructured":"Youth Justice Board . Exploring the needs of young black and minority ethnic offenders and the provision of targeted interventions, 2010. Available: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/354686\/yjb-exploring-needs-young-black-minority-ethnic-offenders.pdf [Accessed 06 Oct 2020]."},{"key":"2025121411202395000_11.5.e045680.17","unstructured":"Lammy D . The Lammy review: an independent review into the treatment of, and outcomes for, black, Asian and minority ethnic individuals in the criminal justice system, 2017. Available: https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/643001\/lammy-review-final-report.pdf [Accessed 06 Oct 20]."},{"key":"2025121411202395000_11.5.e045680.18","doi-asserted-by":"crossref","unstructured":"Taylor J , Shostak L , Rogers A . Rethinking mental health provision in the secure estate for children and young people: a framework for integrated care (secure stairs). safer communities, 2018.","DOI":"10.1108\/SC-07-2018-0019"},{"key":"2025121411202395000_11.5.e045680.19","unstructured":"et al Jacobson J , Bhardwa B , Gyateng T . Punishing disadvantage-A profile of children in custody. project report. prison reform trust, 2010. 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Available: https:\/\/www.england.nhs.uk\/midlands\/wp-content\/uploads\/sites\/46\/2019\/05\/health-and-justice-camhs-transformation-workstream-report.pdf[Accessed 07 Oct 2020]."},{"key":"2025121411202395000_11.5.e045680.31","doi-asserted-by":"crossref","unstructured":"Rogers A , Budd M . Developing safe and strong foundations: The DART framework. In: Young people in forensic mental health settings. London: Palgrave Macmillan, 2015: 356\u201389.","DOI":"10.1057\/9781137359803_15"},{"key":"2025121411202395000_11.5.e045680.32","unstructured":"Saxe GN , Ellis BH , Kaplow JB . Collaborative treatment of traumatized children and teens: the trauma systems therapy approach. Guilford Press, 2007."},{"key":"2025121411202395000_11.5.e045680.33","unstructured":"NHS England . Future in mind: Promoting, protecting and improving our children and young people\u2019s mental health and wellbeing. London: Department of Health, 2015. 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