In this paper we present the findings from the second of four Participatory Action Research (PAR) groups with men and women who have been diagnosed with type two diabetes. The findings of the men's group are reported here. People who have received a diagnosis of diabetes must immediately absorb a great deal of information about how to control their diabetes, care for themselves and make lifestyle changes. In this study, we have asked men about this transition and about what it is like to live with diabetes. We aimed to understand how people with type two diabetes incorporate chronic illness into their lives. Utilizing the processes of PAR, we created a conducive environment for the voices of people with diabetes to be clearly heard in relation to their health. Men who live with type two diabetes met with a researcher and two Clinical Nurse Consultants, for two hours, once a week, for four weeks, during November 1998. The men expressed that diabetes had made a positive impact on their lifestyle; they viewed diabetes as part of life and not as an illness. Men chose foods with confidence; their concern about potential complications meant they chose to take better care of themselves. They were confident in their knowledge of diabetes, and while they took responsibility for themselves, being supported by their partner was helpful in managing their diabetes. They managed their life with diabetes by minimizing the intrusiveness of the disease.
Purpose
The purpose of this paper is to outline the challenges to achieving positive outcomes for young people within the secure estate in England, and introduces a psychologically informed framework, SECURE STAIRS (SS), aimed at improving outcomes.
Design/methodology/approach
The paper argues that there is a need for a fundamental shift in the way care and intervention for young people within the secure estate is delivered. It gives an overview of current challenges and needs and summarises the theoretical concepts and evidence base which can guide practice and form the foundations of the SS framework.
Findings
The framework recommends that intervention shift from focussing primarily on individual assessment and treatment to a greater emphasis on supporting the work of the wider system of care. Recommendations include promoting trauma-informed care, a focus on the system dynamics within institutions and how these impact on the care young people receive, and on the collaborative development with residential staff and young people of formulation-led care plans that include a focus on issues of sustainability after leaving the secure estate.
Practical implications
These include the establishment of discrete residential groupings with truly integrated and trauma-informed work across residential, mental health, education and criminal justice agencies. This involves addressing governance issues around shared record keeping, and challenges to sustainability and the accompanying need for local implementation plans for each establishment alongside central support at a strategic level.
Originality/value
This paper describes a new and innovative way of working within secure settings to ensure children and young people’s needs are better met.
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