Lessons from the Gateway programme, aimed at improving health and life chances for young people committing low-level offences: a qualitative evaluation.

BACKGROUND: Young people who commit criminal offences are often affected by mental health issues, including drug and alcohol misuse, with many leading chaotic lifestyles. Gateway was a pioneering court-diversion programme aimed to reduce reoffending and improve the health and wellbeing of people aged 18-24 years who had been questioned for a low-level offence. The Gateway Study consisted of a pragmatic, parallel-group, superiority randomised controlled trial (RCT) of the programme's effectiveness, and its qualitative evaluation. We aimed to determine barriers and enablers for implementation of Gateway and recruitment into the RCT.

METHODS: We evaluated the implementation of Gateway, a 16-week conditional caution designed by Hampshire Constabulary and delivered predominantly by third sector organisations. Following a needs assessment, young people received individual support from a Gateway navigator and attended self-development workshops. Recruitment into the RCT took place across four sites across Hampshire and Isle of Wight, UK. Semi-structured interviews were carried out with Gateway stakeholders over three time periods in 2018-22, with additional timepoints in the first time period. Purposive samples of Gateway clients and recruiters, as well as all of Gateway staff, were interviewed. Thematic analysis was applied, with an inductive and predominantly reflexive approach, for each group of participants in each time period.

FINDINGS: Between Dec 19, 2018, and May 3, 2022, qualitative interviews were held with 28 Gateway clients, 17 Gateway project staff, and 13 police officers and civilian staff who acted as recruiters into the programme and RCT. Various themes related to engagement were identified, with multiple subthemes and unique insights. The core themes can be classified as follows (with examples of factors influencing engagement): (1) setup for Gateway delivery and RCT recruitment (eg, multi-agency partnerships, physical locations, training); (2) young people's lifestyles and needs (eg, personal circumstances, pre-existing expectations, attitude towards Gateway); (3) priorities and culture in the organisations (eg, workload priorities, job satisfaction, inter-stakeholder relationships).

INTERPRETATION: The Gateway Study was a unique endeavour to gather evidence for a potentially life-changing intervention for an underserved population. Engaging vulnerable young people and the police in research comes with its own, specific challenges. The insights shared as a result of this evaluation can inform the design of interventions and studies that target similarly vulnerable people or are based in similar settings. Awareness of the potential barriers and facilitators can help public health researchers and practitioners plan accordingly and prevent or mitigate some of the low-engagement issues.

FUNDING: National Institute for Health and Care Research (NIHR).