Grantee Blog – Maria Kekus

Maria Kekus is a Child and Youth Nurse Practitioner working for Health Connections.

Maria has extensive experience in child and youth health through her work in the primary health care and NGO sectors both in England and New Zealand.

Maria was also the recipient of a Personal Development grant in 2018. Below is her account of her journey.

In New Zealand health care for young people in NZ secure or residential care systems is often competing for priority status against safety and security.  This is turn can result in missed opportunities for young people to receive health care. For this reason, I wanted to visit a service that seems to have juggled all the competing priorities and have been judged by OFSTED as Outstanding – the first secure care centre to be judged at this level.  So, thank you Vodafone Foundation for your support to visit Barton Moss, a 20 bed secure care centre for children and young people managed by Salford City Council Children’s Services.

In September 2018 I visited Barton Moss and had the opportunity not only to look around and meet young people but also key people in the residence team including the Residence Manager, the care staff (youth workers) and the health team.  I was also privileged to gain insight into other services such as the Hindley Youth Offending Institute, which I will cover later. 

Special thanks go to Rachel the lead nurse in the team who gave up so much of her time to answer my many questions, and continues to answer them via email since my visit!

There were two main findings that I think have contributed to better outcomes for young people in Barton Moss and that we can learn from in the New Zealand secure residential system:

  • Skilled staff
  • Enhancing the Healing Environment

Skilled Staff

SECURE STAIRS is a framework that aims to support trauma informed care and formulation driven, evidenced based, whole systems approaches to creating change for young people with Children and Young People’s Secure Estate (CYPSE).  One of the core principles of the framework is that the day to day staff are at the centre of the intervention, recognising that they have a pivotal role and as such the environment and the relationships within (rather than specialist in reach services) are proposed as the primary agents of change for young people within secure settings.

Barton Moss embodies this approach and creates shared learning across all staff consistently and in a sustainable way.  In addition, they have embedded the development of “within relationships” e.g mental health services form part of the core onsite team.  In New Zealand they are a visiting “guest” service.  The only visiting person in Barton Moss is a psychiatrist who is utilised as a resource for the health team and care staff to support the young person’s health plan.

Enhancing the Healing Environment   

Barton Moss has implemented change modelled on the Enhancing Healing Environment framework.  This framework was originally developed for dementia care homes with good effect and now has been rolled out to prisons and hospitals.

Barton Moss has created an environment that feels safe and secure for young people, including smaller family style units, more homely feeling to the young people’s rooms, personal belongings are encouraged.  The young people also participate in the food preparation and other activities that build life skills without being chores. The environment has indoor and outdoor activities including caring for animals, gardening, building and sporting activities; alongside creative opportunities.

Rachel not only provided me with the opportunity on site but has continued to support me with resources and links to key people that supported change in other residences like the Kings Fund Project which funded the Enhancing the Healing Environment Programme.  The Kings Fund Project also supported the changes in the health area at Hindley Youth Offender Institute. 

In Hindley young people were core to the consultation process, as they should be, and other stakeholders were included which resulted in the clinic area being transformed to a safe user-friendly space.

Young people in Hindley had high levels of non-attendance for their health appointments, however, since the change of environment this has improved by 67% with no incidents of vandalism/graffiti in the health area.  The space has been used for health promotion activities such as “beer goggles and remote-controlled cars”.

Below is a picture of the health waiting area from Hindley Youth Offenders Institute designed by the young people.  I felt I had to include this as it is so far from anything I have seen currently in New Zealand.  The lighting, colours and ambiance instantly promote a sense of warmth and comfort.

Health Waiting Area, Hindley Youth Offenders Institute, Wigan, UK


Health is a right for all young people in New Zealand wherever they may be placed.  We can learn much from these models in  the UK that are achieving improved outcomes for young people.  Many of the care facilities in New Zealand are not fit for purpose now and would benefit from applying the Enhancing Healing Environments framework to them. As NZ systems for children and young people are changing from large residential environments to smaller units the evidence still applies – create environments that promote healing.