Exploring staff perspectives of working in secure care accommodation for young people: A systematic review of qualitative research

• Engaging staff in development improves motivation and quality of care. • Lack of psychological support for staff leads to stress and burnout. • Enhanced training is required to address complex youth needs. • Staff must maintain safety, often at the cost of therapeutic interventions. • Our findings offer crucial insights to enhance service design for professionals. Secure care accommodation is a constantly evolving, challenging work environment where staff must adapt quickly, often with limited training. High turnover and burnout are common, driven by poor working conditions, stigma, and the complex needs of residents. This review explores staff experiences, focusing on safety, wellbeing, and the challenges of caring for vulnerable young people. A systematic review was conducted following PRISMA guidelines. Studies were identified by searching five online databases in October 2024. Two authors independently assessed study quality and risk of bias using the Crowe Critical Appraisal Tool. Thirteen studies were identified, revealing four key themes: safety and wellbeing in a high-risk environment, young people in their care, interpersonal relationships and therapeutic approaches, and staff working environment. Staff faced difficulties balancing safety and therapeutic care, particularly when control measures limited effective interventions. The complex needs of youth, including trauma and self-harm, necessitated tailored care, though inadequate staff training was a barrier. Strong staff-youth relationships and a non-authoritarian approach were crucial for emotional growth, while emotional regulation was essential for staff in their everyday work. Structured training and a supportive environment improved staff wellbeing and care quality. Our findings emphasise the challenges staff encounter, including insufficient training and lack of support. The study highlights the need for enhanced training, greater emotional support, and a relational, empathetic approach. Creating a more supportive environment for staff could improve their wellbeing and enhance the quality of care, fostering a safer, more constructive atmosphere for both staff and residents.