1 Introduction

Research consistently demonstrates the influence that speech, language and communication needs (SLCN) have on the criminal behaviour of young people, with a suggested overlap between behaviour and communication identified as a critical feature in the profile of many young offenders [1,2,3]. Indeed, within the criminal justice system young people with SLCN are considerably over-represented with estimates of 60–90% compared to 10% of the general population having SLCN [4].

Contact with the criminal justice system exposes young people to a range of experiences that draw heavily on language skills, including police interviews, court proceedings and therapeutic intervention programs for example, [5]. For young people in the criminal justice system SLCN may create barriers in terms of being able to fully comprehend what is happening to them, what is expected from them and how to successfully engage with Youth Offending Services (YOS) [6].

In England and Wales YOS’s (or Youth Offending Teams—YOTs—as they are also known) supervise 10–18 year olds who have been sentenced by a court or who have come to the attention of the police because of their offending behaviour but have not been charged (dealt with out of court). YOS involve multi-agency statutory partnerships situated in local authorities with the remit to deliver youth justice services at a local level. They are accountable to the Youth Justice Board (YJB), a non-departmental public body established through the Crime and Disorder Act 1998, with the statutory aim of preventing offending by children and young people [7].

A certain level of speech, language and communication skill is required by young people to successfully engage with YOS’s in order to maximise opportunities to bring about meaningful behaviour change through participation in all interventions set out within their engagement plan with the YOS [4, 6, 8]. However, a significant proportion (up to 90%) [4] of young people engaged with the criminal justice system may face many obstacles as a result of unmet SLCN’s. Obstacles can include for example, young people who offend with poor narrative skills being disadvantaged with respect to ‘information transfer’ demanded during police interview or a court-room cross-examination [2, 4]. The Youth Justice Board [9] also state many young people have difficulty understanding commonly used vocabulary within the justice system, including words such as ‘victim’ and ‘breach’. Consequently, interventions delivered by the criminal justice system to young people with unmet SLCN may fail to deliver change and reduction of subsequent offending behaviours. To address this need, many Youth Offending Services have incorporated some form of SLCN provision within their service. However, there is a lack of literature regarding how SLCN provision, through service delivery requirements should be addressed within a YOS context.

This research provides a contribution to the literature by developing theories pertaining to YOS service delivery requirements for young people who offend with speech, language and communication needs. Theories are developed using a realist approach whereby a framework is applied to understand the importance, impact and relationship between the context (conditions needed), mechanism (collective or individual reasoning and reactions of human agents) and outcome within situations, i.e. ‘what are the mechanisms for change triggered by a programme [involvement with SLCN related provision in a YOS] and how do they counteract the existing social processes?’.

By viewing SLCN provision within a YOS setting as an intervention, the new ideas and/or resources it provides into the existing social relationships of the YOS are explored. Taking a realist approach whilst acknowledging the context of the intervention has allowed for this research to ‘make sense’ of the complex processes within the systems where SLCN provision and the YOS reside, resulting in postulated theories pertaining the service delivery requirements/conditions felt necessary to endorse SLCN provision within the YOS setting [10].

1.1 Speech, language and communication need

It is important to understand what is meant by the term ‘Speech, language and communication needs’ (SLCN) in providing the contextual background to this research. SLCN is an overarching term used to describe the full range of speech, language and communication related difficulties a person may have. The terms ‘speech’, ‘language’ and ‘communication’ are often used interchangeably, however, subtle differences between these terms should be noted to effectively examine and interpret their impacts. The Royal College of Speech and Language Therapists [11] identify that ‘speech’ relates not only to words spoken, but also to expression in the voice. ‘Language’ includes both the spoken word and understanding spoken word by others. ‘Communication’ relates to the interaction with others and can include verbal and non-verbal elements. Providing a simple definition of SLCN is not straightforward. The term has developed multiple meanings across different professions which has caused issues with both interpretation and meaning between different disciplines [12]. Central to many of the interpretations of SLCN however is the notion of being able to understand others and being understood [8, 13]. This paper therefore uses the following adapted definition of SLCN: ‘a hindered ability in being able to understand others and/or make oneself understood’.

There is not one ‘type’ of SLCN. People vary in the pattern and severity of needs and difficulties they present with, some difficulties are transient and will resolve whilst others may be persistent having life-long impacts [14]. The actual types of difficulty a person experiences will determine the effect they have on everyday life. For example, communication is a central feature of society, directly impacting upon a person’s ability to learn, develop friendships, and increase life chances [15]. Without the ability to adequately communicate, a person is seen to be at risk of becoming isolated from society. Poor conversational skills, poor non-verbal skills and poor social perception can all hinder an ability to form, develop and maintain relationships with others [14, 15]. This social isolation also has consequential repercussions, including difficulties in developing coping strategies for conflict, problems accessing and engaging in education and negative peer and family relationships [16].

2 Methodology

2.1 Realist approach

Realism is a theory driven approach which seeks to understand not only whether an intervention works, but what it is about SLCN related provision within a YOS setting that works, for whom, in what circumstances and why [17].

Realism aids the collection of observations from the social world, but also assists in explaining these observations within a framework that takes account of the underlying mechanisms and contextual conditions which inform actions [18]. Context can be argued to be particularly important when looking at the application of speech, language and communication provision within a YOS setting as what is essentially a health led (specifically the NHS within England) provision is being delivered in a very different context to the norm (criminal justice rather than healthcare setting). Adaptations are therefore required as to how provision is both communicated and delivered. For example, an outreach model of engagement with a Speech and Language Therapist, using the same methodology as the YOS workers, rather than the less proactive method of engagement (that of sending out a letter and waiting for the applicant to accept a predefined appointment time) seen within NHS health settings.

The combination of context and mechanisms creates outcomes, which explains how and why SLCN related provision has impacted on and shaped service delivery within the YOS, in addition to its impact on engagement with the young people in the service. These context, mechanism, outcome (CMO) configurations are used as explanatory formulae (programme theories), which are refined as the project progresses. Empirical data is used to ‘test’ and refine the programme theories, providing a more nuanced account of how SLCN related provision (the intervention) works [18].

Programme theories are used within realist approaches to postulate ideas and assumptions as to how, why and in what circumstances complex social interventions work, they are the units of analysis used within realist approaches [19, 20]. Realist approaches support the collection of empirical data collection and involve an iterative process between evidence collection, programme theory development and conclusions. This continues until the research is viewed to reach such a point that there is a robust connection between the programme theories and the patterns of social activity observable in the empirical world with no new themes emerging, and then to appraise the ‘critical’ component (i.e. influence of the researcher) of the research [21]. This is often referred to as ‘theory consolidation’ [22].

Realist frameworks have had a rapid take-up for understanding innovation success and failures in health and social care contexts (e.g. [23, 24]). This is primarily due to its acknowledgement of the importance and subsequent impact of the contextual environment interventions are delivered within, alongside the impact(s) these contexts have on outcomes for individuals [18]. The use of this approach in respect to SLCN related provision within a YOS setting allows for a detailed focus on the generative mechanisms: an identification of what exactly it is about the intervention that is working, for whom and in what context.

2.2 Research context

Research was conducted within a case study YOS site in the North East of England situated in a large County Council. The county has a varied geography and population, with higher levels of deprivation and lower life expectancy than the England average [25]. At the time of the research, the YOS was part way through a three staged approach to incorporating SLCN provision within the service. Table 1 provides a broad overview of each stage.

Table 1 Staged approach to incorporation of SLCN provision within the local authority YOS
Full size table

The fieldwork began during stage three. By this point, much of the foundations for incorporation of SLCN related provision within the YOS had been made. The research therefore aimed to work with the YOS in understanding local need, focusing on the identification of mechanisms required to provide a service incorporating SLCN related provision to identify: what does an effective YOS service delivery model with SLCN provision look like; and what are the key components which make it ‘work’?

3 Methods

Initial theory gleaning consultations with senior staff at the case study YOS site were undertaken. Consultations took the form of meetings between Researcher and YOS to discuss and make sense of the original aims of the incorporation of SLCN related provision within the service by conceptualising, categorising, and ordering experiences and assumptions of the program designers and implementers [26]. These insights assisted in exposing the emerging themes underlying the incorporation of SLCN related provision before entering the field [22]. These consultations resulted in an overarching initial programme theory which was used to structure the interview topic guides and focus the research. The initial programme theory postulated that; If provisions are put in place (mechanism I) in the context of the YOS (context) to address SLCN through adapted provision (mechanism II) then young people with SLCN will be able to engage more effectively (mechanism III) with the YOS, and therefore receive greater benefit in participating in the interventions designed for them by the YOS (outcome I) and thus impact on the prevalence of re-offending rates (outcome II).

Following the initial consultations, thirteen qualitative interviews were conducted with fifteen key stakeholders connected to the YOS case study site building on the background information gleaned. Interviewees were categorised as follows: 10 YOS staff members (7 delivery team, 1 health related and 2 strategic management); and 5 key stakeholders including Police, Youth Justice Board (YJB) and community Speech and Language Therapists.

Interviews were conducted by the author who had no links, except through the research to the YOS. They took a semi-structured approach, using a topic guide to investigate propositions from the initial programme theories pertaining to how, where, when and why the incorporation of SLCN within the YOS is/is not effective [22]. Interviews lasted between 20 min to an hour. The focus of the interview was to gain an understanding of how speech, language, and communication services ‘fit’ with a young person’s journey through the youth justice system. They built on the initial programme theory by developing an understanding of what an effective YOS service delivery model with SLCN provision should look like in addition to identifying key components which make it ‘work’. The notion of a young person’s journey through the YOS was used to guide stakeholders thoughts as to what type of interventions were required by who at different points within the pathway; from pre-engagement, through initial-engagement, to continued engagement and resulting in disengagement from service. Questions focused on what specific support and resources are required for young people with speech, language and communication needs. The primary aim of the interviews was therefore to establish what provision related to SLCN should be incorporated within the YOS, or youth justice interventions more widely.

All interviews were transcribed prior to analysis. A thematic content analysis approach was taken, whereby extraction of meanings and concepts from the interview transcripts under broad headings of context, mechanism, outcome, was undertaken to examine and record emerging themes. Transcripts were first coded by the researcher. These codes were inductively developed to identify key elements in each area of context, mechanism, outcome within the text alongside relational themes, breaking the data down into manageable sections. Themes and codes were verified and confirmed by an iterative process of reviewing the data, and then repeating the process to identify further themes and codes. Judgement of the researcher and discussions with the research team was used to inform the development of themes and codes, and to interpret meanings within the data in the form of programme theories.

Participation in the research study was voluntary and recruitment was conducted via an introduction during a staff team meeting followed by an email about the research process sent out from the YOS to all staff (n = 56), including the Researcher’s email address for staff to opt-in to participate in the study. Informed consent was obtained from all individual participants included in the study. All staff that wished to participate were interviewed.

4 Results

Analysis identified seven key themes pertaining to delivery requirements within YOS settings to address needs of young people who offend with SLCN. Results are presented below under each of these themes, with key context, mechanism, and outcome components informing programme theory development identified.

4.1 Awareness of SLCN

Awareness here relates to an initial lack of awareness within the YOS about SLCN and it’s potential impact on young people, as well as awareness raising resources and training practices undertaken.

With regards to an initial lack of awareness of SLCN and their potential impacts, YOS management highlighted that historically they ‘…hadn’t been looking at things with a speech and language head on…’ (YOS Management A) and therefore training to increase understanding of SLCN (mechanism) was needed for the staff to start thinking about speech, language and communication embedded practices within the delivery of the service as it had not previously been considered. Training however had to be relevant. The Speech and Language Therapist who led the training had been embedded within the YOS (context) which allowed her to ‘…learn the language of youth justice…’ (Speech and Language Therapist A). This learning ensured that training could reflect and fit in with the context of the criminal justice processes thus supporting the translation of SLCN practices into a context of young people with very complex needs (outcome).

‘[SLT secondment] brought speech, language and communication to the forefront [within YOS], before that we weren’t very equipped to identify it.’ (YOS F).

The training delivered by the SLT within the YOS setting (context) clearly impacted on staff awareness (outcome). Staff stated that they had previously been unaware of SLCN and the impacts such needs could have a young person engaging with the YOS. The act of being made aware (mechanism) was identified by YOS staff as the key element which impacted on behaviour change in terms of their working practices (outcome) with one respondent stating that.

‘…if your eyes are open [referring to awareness of SLCN] your more likely to see, to identify and pick up [issues relating to SLCN].’ (YOS G)

There was a strong sense that training on SLCN awareness received (mechanism) within the YOS (context) complimented previous knowledge and facilitated the creation of new working practices based on the learning (outcome).

As well as general awareness it was stated by the YOS staff to be important to contextualise the differences between young people in core SLCN services and young people in the YOS (context). YOS staff generally felt that within core services, young people are typically in education and have a number of support networks including family around them. In contrast, the young people in YOS with SLCN typically have been excluded from school, or in alternative placements. Many parent/carers have also been identified by YOS staff to have their own SLCN related needs and young people often have mental health or substance misuse needs in addition to SLCN resulting in a more complex set of emerging needs (context).

Awareness training prompted reflection on engagement activities with young people and highlighted the importance of adapting YOS staff approaches to individual need (mechanism).

‘…sometimes you take for granted that they [young people in YOS] understand what you’re saying…sometimes [young people’s actions] taken as being obstructive…but actually they don’t understand what is going on…’ (YOS E).

YOS Case worker D stated that prior to undertaking the training, meeting with young people had been ‘…totally reliant on verbal communication…it’s all been told, nothing else.’ (YOS D). This realisation (mechanism) had subsequently led to a revision (outcome) of this particular type of meeting (context). Flash cards with pictorial explanations of complex language, which were developed by the Speech and Language Therapist, are now used by staff in meetings with young people (context) in order to help young people understand the more technical language used (mechanism).

The knowledge gained through the training was stated to be required to help equip staff with the tools to allow them to respond to situations they find themselves in (mechanism) within their work (context). Many of the YOS workers hinted at a need to be able to ‘read’ the situation, to know what is going on with the young person, to understand the environment and to appreciate how the young person may be feeling (mechanism). One of the YOS staff stated how they have to be aware of more than just what the young person is saying;

‘You go in and you see a lot, [you] read between the lines…you’re very sensitive to the nuances of what’s going on’ (YOS B).

A common issue facing YOS staff is the short time they have to work with young people (context). Within this context, staff reported the need to have the skills to engage with the young person and to build rapport (mechanism). The need for young people to ‘…feel comfortable with who they’re working with.’ (YOS A) was described as a key factor in being able to effectively engage with young people within the YOS (mechanism).

‘…build that relationship [between worker and young person], get a rapport going and if you haven’t got communication nowt’s gunner work.’ (YOS F)

It was apparent through the interviews that staff had adapted working styles, including additional skills to help ‘read situations’ and build relationships (outcome), as a result of the SLCN training (mechanism) when working with young people (context). Although the benefits of participating in awareness training were highlighted it was also suggested that there could be some resistance to participation in training. It was stated that staff already have large caseloads and therefore building-in attendance for additional training may not be seen as a priority in an already busy work schedule.

4.2 Communication

Communication here relates to the complex language and processes the young people are exposed to through the YOS. YOS workers reported having to act as an interpretation service when the young people they are working with are engaged with police or court settings with one YOS staff member referring to the need to ‘translate’ information provided in a court setting (context) into a more accessible format (mechanism);

‘…I go to court, I get it in the court language, I then translate it into English…and then I got to go and translate that for the young person’ (YOS C)

The need to be able to translate often technical terminology (mechanism) when working with young people (context) builds on the previously highlighted need for the YOS workers to build rapport with the young people they are working with if they are to be able to effectively communicate with them. The fact that, ‘If you can’t talk to that young person then the young person isn’t going to talk back…’ (YOS A).

The criminal justice system is a complex environment with complex terminology (context). Awareness of SLCN along with the relevant skills are needed by staff working with young people in this environment in order to ensure they can be effectively engaged (mechanism and outcome).

4.3 Resource

Resource here relates to physical, practical resources designed to be used by YOS staff such as.

‘word buster cards’ explaining technical terminology, with complex terms on one side and pictorial or simple language translation on the other), as well as personal abilities/resources (approaches developed by individuals based on skills and experience) and the resources provided (awareness raising, coaching, printed resources etc.) by the seconded Speech and Language Therapist in the team (mechanism) when working with the young people (context).

Overall, resources were viewed very favourably by staff internal and external to the YOS in relation to both their use and functionality. They were seen as important in prompting staff to think about and include reference to SLCN in work undertaken with young people (mechanism and context) with one YOS staff member stating that, ‘You’re not gunner forget to do something if is there in front of you…’ (YOS G).

Resources, such as word buster cards, helped in translating complex, often criminal justice related language into plain English (mechanism) for the young people (context). An example includes a card used to assist with explaining what ‘revoking the sentence’ meant to a young person. This phrase had previously been used on a regular basis with young people, with little or no explanation and it was not known if young people had previously fully comprehended what the phrase related to.

Although the resources developed to aid communication were well received, it was acknowledged that staff needed to apply their own judgement when engaging with the young people (context) to ensure their appropriate use, as it was commented that resources could appear ‘patronising’ in particular circumstances to some young people (mechanism).

In addition to printed resources, new approaches to working with young people (context) were highlighted to have contributed to the growing supply of informal resource development (mechanism). These resources included approaches such as visually drawing out complicated processes, ‘telling a story’ to highlight important components of for example, the ‘Howard caution’ (caution used by Police) and revising timetables given to the young people by simplifying language and including diagrams to be ‘…more speech and language friendly’ (YOS E). Within a health context in the YOS it was reported by staff that pictorial resources are often used to help the young people explain what has happened. For example, a YOS worker described how they used a picture as a prompt to explore with the young person was dealing with and thinking about (mechanism), i.e. what was going on inside their head;

‘I was with a young person and he had lots going on and I drew a picture on a bit of paper…of a skeleton, which he loved, and I pulled a hole out and said that’s what’s inside your head and I did all these arrows showing things like his dad and he got that…’ (YOS F).

The Speech and Language Therapist within the YOS was also identified as a ‘resource’. The fact that she was placed within the team (context) attracted a number of positive comments and facilitated informal information sharing practices within the team, allowing for continuous learning and awareness raising of SLCN (mechanism). Being physically based within the team (context), the Speech and Language Therapist was able to learn the nuances of the YOS including how interventions were delivered which was important to ensure that contextual influences were incorporated into SLCN provision (context and mechanism). The embedding of the Speech and Language Therapist (context) also had the benefit of allowing for informal frequent discussions with staff resulting in a reduced perceived requirement for formal training (mechanism).

‘…you can tackle problems from different angles within a brief conversation…unscheduled moments…I’ve got this kid I just can’t get…somebody else chips in and before you know it, you’ve got a different perspective on the issue…’ (YOS B)

4.4 Service delivery

Service delivery here is connected to understanding the core mechanisms underpinning and influencing how services within the YOS are delivered.

A strong culture of innovation and creativity was identified within the YOS (context). This was an important element in prompting and promoting service change (mechanism). Strong links within the team were highlighted as a facilitator to lead change within the service following the increased profile of SLCN (mechanism). It was suggested by several YOS workers that the team were able to feed ideas up to management to identify areas for improvement or areas where initiatives were working well. This strong staff cohesion promoted a sense of worth within the team to influence change (mechanism).

The seconded Speech and Language Therapist commented that the dynamic and supportive management structure within the YOS (context) has created the right service level environment to facilitate change (mechanism).

It was apparent through all the interviews with YOS staff that they were passionate about their work with young people (mechanism). It was highlighted by a YOS staff member that:

‘…the tenacity of many of our staff in terms of dealing with other agencies and in terms of doing all they can to force the issue one way or the other to get their kid the help that that person needs in my opinion, has been second to none. People will go and do great things to get what they think their young person needs.’ (YOS B).

In addition, the seconded Speech and Language Therapist stated that YOS staff are viewed as keen and want to do the right thing for the young people they work with (context) and therefore have adapted to changes and made the service more communication friendly as a result (mechanism and outcome).

Having the Speech and Language Therapist post within the YOS was commented to have made the referral process for specialist input ‘…a lot quicker’ and ‘…more straightforward’ (YOS A). It was reported that previously, ‘…we could be waiting weeks…’ (Health A).

4.5 Staff-mix

YOS is a multi-disciplinary team made up of professionals from a range of backgrounds (context). This was remarked on throughout the interviews and is referenced as ‘staff-mix’. References in relation to staff-mix were often very positive with respondents commenting about complimentary skill sets within the team as well as strong links between team members (mechanism). Staff remained a part of their specialist profession, even though they sit under the umbrella of the YOS (mechanism). One YOS staff member provided an anecdote of the differences observed:

‘…I was sitting next to …a CAMHS [Child and Adolescent Mental Health Service] nurse, …and a social work trained probation officer, just listening to how they conduct conversations. How they answer the phone was illuminating because their vocabulary, how they spoke about similar problems to other professionals on the phone just demonstrated that they were quite different. One was obviously from health, the other…social work…’ (YOS B).

‘Staff-mix’ reflects the broad range of disciplines evident within the team that help to ensure a holistic approach to working with young people (mechanism).

4.6 System

The system relates to the YOS in terms of approaches and interventions undertaken, often driven from a strategic management approach (mechanism) within the context of the criminal justice system (context). It is therefore directly linked to the awareness theme identified above.

Linked to awareness, YOS staff acknowledged that SLCN ‘…hasn’t come on overnight…’ (YOS A). Eighteen months ago staff acknowledged they were not aware of SLCN and therefore it wasn’t picked up. Staff argued that this probably mirrors other services who have previously engaged with the same young people and have ‘missed’ identifying SLC need (context). They went on to suggest that due to the structured approach to SLCN now seen across the YOS as a consequence of the seconded Speech and Language Therapist (mechanism), there are more young people with SLCN being picked up (outcome). YOS management reinforced these ideas stating that 53 young people had received a specialist SLCN assessment from the Speech and Language Therapist during their last reporting period (12 months), compared with only 5 during the previous 10 years. The explanation for the increase (outcome) was related to the fact that staff now knew what they were looking for (mechanism). As a result of the training received staff were now more aware of SLCN (mechanism) and could therefore identify if a young person had an SLCN (outcome) within their role (context).

During their secondment the Speech and Language Therapist also reported that they had worked with staff across several roles beyond the YOS as part of their case work with the young people. These roles included education, CAMHS, youth workers, social workers. These links are made on a case-by-case basis at present dependent on the individual young person’s needs. All links (context) were seen by the Speech and Language Therapist as opportunities to raise awareness of SLCN as well as improve outcomes for the young person (mechanism).

Although work in relation to raising awareness of and incorporating an SLCN related initiative is predominately happening within the YOS (context), effects of this work were far reaching. Information transfer at local and regional level meetings (mechanism) had reportedly started to inform practices in other organisations and departments, including wider children’s services directorate within the Council, other YOS’s, local police, court and healthcare providers (outcome). It was suggested that the impact of incorporating SLCN provision within the heart of YOS is creating a ‘Seismic shift in ways of thinking…’ (YOS management A) (outcome).

The structure of the criminal justice system was thought by some YOS staff respondents to hinder identification of SLCN (context). The system is complex which means that young people, especially those with SLCN, often do not know what is going on but they will agree to things so that they don’t ‘look stupid’ (YOS G). The system was described as ‘alien’ to many of the young people engaging in it (YOS A), which leads to uncertainty about how they should be interacting within it (context). In addition, young people are thought to be generally frightened, especially if it is their first encounter with criminal justice and this may affect their behaviour (mechanism). This uncertainty around young people’s place and engagement within the system was echoed by the Speech and Language Therapist core (universal community-based) service leads who highlighted a need for all professionals working with young people to have knowledge of SLCN in order to provide appropriate support (mechanism):

‘…there’s a role for anybody that’s involved with a child or young person to support them within the skill level that they have…a role for any professional to support their [young person’s] development’ (Speech and Language Therapist B)

Having an awareness of SLCN is thought to assist staff’s ability to ‘…interact and help that person access services and deal with whatever as part of that service’ (Speech and Language Therapist C) (mechanism).

It was commented that there is a different approach (context) between core SLCN services and those SLCN services seen to be provided within YOS in terms of operational procedures (mechanism). The tight timescales seen within YOS do not translate to core services. Within YOS there are opportunities to prioritise for early assessment in order that needs are identified before key dates, such as a court appearance for example. Whilst in core services this does not happen. It was felt by the Speech and Language Therapist core service leads that being embedded within the YOS environment (mechanism) will ensure that the Speech and Language Therapist is much more aware of the environment and the processes imposed on the young people and therefore better equipped to make contextually informed decisions (outcome).

The recent increase in referrals paints an inaccurate picture of the level of historic need of SLCN in YOS’s (context). It is argued that with increased awareness of SLCN has come the knowledge of what to look for (mechanism), and thus increased the number of referrals (outcome). The system as a result needs to change previous working practices in order to meet the newly identified SLCN needs of young people who offend.

4.7 Working practices in YOS

Within this theme working practices (context) focus on those practices which have been developed and evolved within YOS (mechanisms). Respondents argued that there should be more of a national steer on how SLCN is addressed not only within YOS’s but across children’s services in local authorities. AssetPlus is thought to be the first step towards the acknowledgement of the importance of considering SLCN within service delivery. It is a national tool used to screen all young people entering YOS (mechanism). However, the tool is ‘…only as good as the staff using it.’ (YOS management B). Respondents suggested that if there is insufficient training staff will not know what they are looking for (mechanism) and as such needs will be missed (outcome). In addition, there needs to be referral pathways developed for those young people identified as having need(s). In the case study site, there is a Speech and Language Therapist within the YOS, however not all YOS’s will have this provision as is it not mandatory and that pathways into community-based services often take too long.

Bringing in additional SLCN related resource into the YOS (context), namely that of the seconded Speech and Language Therapist post (mechanism), has meant that ‘pinch points’ (YOS management B) within the system could be identified (outcome). These were points at which interventions could be brought in to ensure the service was communication friendly.

The focus of SLCN provision (context), has been welcomed by staff, with a perception by management that staff ‘have owned it’ (YOS management B). Working practices have been changed with visible impacts on staff growth and development (outcome). Central to this has been the physical location or co-location of the Speech and Language Therapist within the YOS (mechanism).

There was only one YOS worker interviewed who questioned whether it should be the YOS that is responsible for providing SLCN related initiatives. They argued that although amendments to service delivery could be made within YOS to facilitate SLCN, ultimately, the YOS is not a panacea and appropriate professionals within health services need to be brought in to meet their needs. The YJB Advisor agreed that it should not be down to the YOS to have to undertake interventions and have a Speech and Language Therapist within the service to address SLCN. However:

‘…they’re [YOS] doing it [addressing SLCN issues] because nobody else has or because children have moved up and either it didn’t happen when they were young enough or they’ve learnt coping mechanisms to hide it.’ (YJB Advisor)

In contradiction to this, it was also noted by a YOS worker that perhaps, because the YOS is multi-disciplinary (context), it should be viewed as a catch-all for providing any services young people engaging in the service require (mechanism).

The role of the YOS worker is viewed to be adapting in relation to SLCN related provision with a Speech and Language Therapist stating that;

‘With AssetPlus they have to screen every young person for SLCN…so it’s a screening role then they need to be able to refer on to get specialist knowledge and help…then their role is about adapting their own practice to ensure that they make reasonable adjustments and link in partnership work with what I’m doing so that the two complement each other’ (Speech and Language Therapist A)

Working practices within YOS (context) have changed dramatically with the introduction of the seconded Speech and Language Therapist (outcome). Questions remain however with regards to the role for YOS’s in delivering SLCN related initiatives. There is a strong sense by the majority of respondents that it is within YOS’s remit to both acknowledge SLCN in young people and to provide relevant support in order to ensure effective engagement of young people within the service (mechanism).

5 Discussion: development of programme theories

Programme theories are often described as the unit of analysis for realist research and are used as explanatory formulae to postulate ideas and assumptions as to how, why and in what circumstances complex social interventions such as SLCN related provision within the YOS, work. The research explored the concepts of the initial programme theory postulated, identifying what provisions are required to be in place, how and what adaptations to practice should be made, which contexts will facilitate these changes and the outcomes these will have. As with the iterative nature of realist research, through this exploration, the initial programme theory was extrapolated and refined into four new programme theories which reflected the emerging findings as detailed above. These new programme theories were developed to provide further detail, replacing the initial programme theory, postulating how and why SLCN provision impacted on the YOS and the young people involved. The development of the programme theories included looking across the seven themes for commonalities and explanations within context, mechanism, outcome configurations to describe the impact of incorporating SLCN provision within the YOS. The four programme theories focus on an increased understanding of SLCN, unpicking terminology and becoming communication friendly, staff cohesion prompting learning together and co-construction approach to service delivery (Table 2).

Table 2 Overview of programme theories
Full size table

Programme theory 1 acknowledges and focuses on the importance of awareness of SLCN. It is postulated that if there is to be SLCN related provision within YOS’s there must first be awareness raising. Stakeholders connected to the service need to know what SLCN is and how it can impact on a young person’s engagement with the service in order to ensure any potential barriers to engagement are addressed. Through developing an understanding of how these practices may be different to pre-existing practices, understanding what tasks and responsibilities require ownership and how the work can be driven forward will assist in the actions stemming from this to become embedded in the ‘normal’ service delivery of the YOS.

Programme theory 2 highlights the requirement for the YOS to be ‘communication friendly’. Postulating that young people need to be able to understand what was going on to them and around them if they are to understand the consequences and implications of their actions and the subsequent legal restrictions that have or may be placed upon them. This increased understanding is thought to enable greater engagement with the YOS.

Programme theory 3 and 4 relate to the multi-disciplinary contextual considerations of the YOS. The importance of the multi-disciplinary context of the team within the YOS was a key feature in ensuring a cohesive holistic approach to service delivery. The seconded SLT alongside the forward thinking YOS management team was referenced as being instrumental in prompting service level changes. The SLT brought a wealth of knowledge regarding SLCN to the YOS and led on a number of initiatives to raise awareness within the team through working closely with delivery staff to understand and tailor the training to the current context of the YOS.

5.1 Contextual factors

The YOS is viewed as a ‘social system’ with internal (i.e. staff, structures, cultural values) and external (i.e. political environment, national directive) influences. The programme theories identified several contextual considerations pertinent to the endorsement of providing SLCN related provision. The majority of these considerations relate to internal influences, for example staff cohesion, staff awareness, and having strong purpose in service delivery and as such are reflected in programme theories one, three and four. This is not surprising as although the stimulus for inclusion of SLCN provision within the service came originally from a national government paper [8], it has been the local ownership and drive of the YOS to shape and include such provision within the service, which led to its success.

This notion of local drive has been central and was evidenced throughout the data collection. A strong desire from the majority of staff and connected stakeholders was evidenced in relation to wanting to be involved in promoting a communication friendly service, with the needs of the young people engaging in the service firmly at its heart. Involvement here was primarily achieved by improving one’s own awareness and understanding of SLCN related issues, and how these relate to the young people worked with. This was led by the YOS management, but there was significant buy-in and desire to learn and develop from all staff. This increase of knowledge facilitated, and brought about, changes in practices and behaviours within the service creating a shift in the contextual dynamic of the individual teams and overall service. Following increased awareness and training staff were more easily able to identify and engage with young people with SLCN. This desire to be involved, to learn more about SLCN and thus improve and adapt practices shaped the local service delivery context of the YOS. Therefore, the majority of the programme theories relate to internal rather than external, contextual influences.

The one exception to this is programme theory two, whereby the complex nature of the criminal justice system is the focus of the contextual consideration. This was viewed to be an important construct as it has a role to play in shaping the wider macro and meso level systems, and thus has significant impact on the YOS. Within this programme theory the complexity of the wider systems making up the criminal justice system are acknowledged to stimulate a context which can be difficult, especially for young people, to navigate.

One contextual element which was reinforced is that the YOS does not work in isolation. The YOS is part of a much bigger system and thus has a number of external contextual influences which shape service delivery mechanisms. Therefore, relationships within the YOS will be affected by, and impacted upon, by contingent relationships, that either the young person or the YOS has with other organisations and/or services involved with the young person. The impact of these relationships has not been explored in detail as the research has focused on the YOS and the service structure it has in order to include SLCN related provision. However, it is important to consider that these relationships will shape the context of the YOS and therefore influence the mechanisms generated in relation to how they are received by staff.

As systems within the YOS are developed and refined in relation to the incorporation of SLCN related provision, they establish properties and powers on their own, they are not static, they adapt. This was observed throughout the research whereby the refinement of the service delivery as the research progressed resulted in emergent properties which transformed the understanding of context. New understanding of the impacts of SLCN on the young people and their engagement with the YOS evolved, prompted by the accumulation of new knowledge about SLCN by staff. This resulted in ‘awareness of SLCN’ in some form featuring in most of the programme theories, due to its significant influence on responses to mechanisms, as well as forming the basis for emerging mechanisms.

5.2 Generative mechanisms

The contexts within the YOS system impact on ‘how’ mechanisms relating to incorporation of SLCN related provision are both ‘fired’ and ‘received’. Mechanisms identified through the programme theories connected to the incorporation of SLCN related provision produce ‘dynamic relationships’ whereby feedback between the component parts is seen to generate non-linear behaviour [27].

Programme theories one, two and three identified mechanisms which relate to the awareness of SLCN at an individual level and/or the associated behavioural impacts of this increased awareness. Staff awareness was the core theme running through the data collection and is identified as a core generative mechanism. The resource provided by having an increased awareness of SLCN is evidenced to influence behavioural changes, and thus stimulate the outcomes observed. This focus on individual behaviour relates to the concept of agency, whereby the power of people as actors within the social world is acknowledged [28]. Staff knowledge is the core generative mechanism illustrated throughout the research to impact on and facilitate the incorporation of SLCN related provision within the YOS.

Programme theory four identifies the individual specialisms of staff within YOS as a mechanism from which to see change in relation to meaningful service delivery made.

5.3 Associated outcomes

Non-linear systems, such as the YOS, interact to create behaviours which are more than the mere sum of their parts. Therefore, it is important to consider outcomes as a result of the mechanisms firing within the context described rather than being universal.

The outcomes for all the programme theories produced through this research relate to the effective engagement of young people within the YOS. In order for young people to get the most out of their experience with the YOS their engagement needs to be more than simply ‘passive involvement’, instead engagement relates to young people being committed to the objectives of the initiatives and/or programmes they are part of [29]. In addition, the formation of positive relationships between staff and young people, along with a motivation by the young person to want change, and awareness of the consequences of behaviour have been suggested to define engagement [7]. It is of no surprise therefore that engagement was viewed to be the outcome of all the programme theories. In acknowledging and incorporating SLCN related provision within the YOS setting, various mechanisms are fired, with the overall aim of promoting engagement with young people in the service, so that everyone has an equitable, regardless of SLCN experienced, opportunity to access services.

6 Strengths and limitations

The key strength of this paper is the identification and disaggregation of the mechanisms which assist our understanding of YOS service delivery requirements for young people who offend with speech, language and communication needs. In disaggregating the mechanisms, four central programme theories pertaining the service conditions felt necessary to endorse SLCN provision within the YOS setting are identified. This research has used a case study approach, looking in detail at how SLCN provision is incorporated in one particular YOS. A key limitation of the study is therefore that other services may have specific contextual factors which influence service delivery. Further research across multiple sites is required to ensure the findings are more generalisable. In addition, findings are reported from the perspective of key professional stakeholders, the voice of young people has not fed into the analysis presented. Further work to incorporate the perspectives of young people would strengthen findings. Further research is also required to ascertain the impact and explore levels of success associated with the identified mechanisms from this research.

7 Conclusion

If SLCN are not appropriately addressed and/or relevant provisions made for within the criminal justice system, the interventions delivered as part of a young person’s order, for example, may not be able to reach their full potential. This is in respect of changing and reducing subsequent offending behaviours of the young person due to a lack of being able to understand and/or fully engage with the intervention on the part of the young person. Engagement in this sense, not only relates to ensuring that all young people have access to criminal justice services, but that they are empowered through the notion of being able to effectively engage in changing their offending behaviours [30]. The notion of assisting with engagement through the delivery of SLCN related provision, has been threaded through this research with the core generative mechanisms contributing to the successful incorporation of SLCN provision within the YOS relating to an increased awareness of SLCN issues. The increased awareness of SLCN has been evidenced to lead to an adaptation of behaviours and practices by staff which are thought to increase engagement with young people.

This research has identified four central programme theories pertaining the service conditions felt necessary to endorse SLCN provision within the YOS setting. These include an increased understanding of SLCN, unpicking terminology and becoming communication friendly, staff cohesion prompting learning together and co-construction approach to service delivery were developed. Importantly, the programme theories developed within this study focused on explaining what it is within a YOS setting that is required in order for SLCN related services to be effective. This realist approach has explored contexts, and the mechanisms triggered as a result of SLCN provision within the YOS and at an abstract level, it can be concluded that:

If a YOS has staff which have an increased awareness of SLCN (context) this knowledge (mechanism I) will influence behaviours and practices (mechanism II) which will increase engagement with young people within the service (outcome).