Background

Young people with cognitive disability with previous contact with the statutory systemsFootnote 1 such as the child protection system (CPS) and/or youth justice system (YJS) are a group who have experienced significant social disadvantage. The term ‘cognitive disability’ is a non-diagnostic umbrella term used in this paper to denote ongoing challenges in intellectual functioning (including reasoning, problem solving and learning) and in adaptive skills (i.e. everyday social and practical abilities) (Schalock et al. 2021). Cognitive disability includes neurodevelopment disorders such as intellectual impairment (American Association on Intellectual and Developmental Disabilities 2022), autism spectrum disorder (American Psychiatric Association 2022) and acquired brain injury (including Foetal Alcohol Spectrum Disorder) (Gralton 2014).

While young people’s cognitive difficulties may considered ‘mild’ or ‘borderline’ by diagnostic standards (Baidawi & Sheehan 2019), their support needs may be far from ‘mild’. Many young people may have co-occurring mental illness, problematic substance and alcohol use, and in the case of Aboriginal and/or Torres Strait Islander young people, may experience entrenched racism and discrimination (Baldry et al. 2016). Compared with their same-aged peers, young people with cognitive disability are more likely to have poor health, be at greater risk of poverty, and have poor educational and future employment outcomes (Emerson and Spencer 2015; Young-Southward et al. 2016). They may be subject to greater stigmatisation and violence, and lack both formal and informal support systems (Ellem et al. 2020; Larkin et al. 2012).

Despite these clear indicators of individual and systemic harms facing young people with cognitive disability, there is little reliable evidence, at least within the Australian context, of how many of this group are exiting the CPS (Broadley 2015). Some authors both in Australia (e.g., Cheng et al. 2023) and internationally (e.g., Hill et al. 2017) contend that children and young people with disability are over-represented in CPS. Similarly, several Australian studies have indicated high proportions of young people with cognitive disability in the YJS (e.g., Baidawi & Sheehan 2019), but accurate estimates are thwarted by a lack of appropriate screening and identification of disability (McVilly et al. 2022). There is also a lack of documented practices for supporting disadvantaged young people (Moensted et al. 2020), particularly those with cognitive disability and histories of statutory system involvement (Macdonald et al. 2016), during the transition. This is despite growing recognition within the field of Youth Studies of the need to document ‘what works’ for supporting positive transitions for young people (Moensted et al 2020).

The Needs of Young People with Cognitive Disability and Histories of Statutory System Involvement

Many young people with cognitive disability with statutory systems involvement require highly skilled support to address their complex support needs. Young people with cognitive disability are likely to require assistance with planning and problem-solving, learning practical living skills, and individualised support for effective communication and social skills (Macdonald et al. 2016). The presence of mental ill-health, histories of trauma and exposure to negative family and peer influences may also increase their vulnerability (Westera et al. 2023). These young people can also be susceptible to problematic drug use and involvement in criminal activity (Mathur et al. 2020), live in unstable and unsafe living arrangements (Ellem et al. 2020) and be survivors of abuse and violence (Ringland et al. 2022).

The lack of accessible service structures are additional barriers which maintain and reinforce the individual difficulties of living with a cognitive disability (Malvaso et al. 2016). Young people with cognitive disability with statutory systems histories are likely to be well-versed as involuntary users of services and have a high level of distrust of professionals (Ellem 2019). They are likely to navigate multiple services in relation to disability, mental health, employment, drug and alcohol, domestic and family violence and education. Many of these services operate as siloes with a lack of specialised, wrap-around services for this group to support their successful reintegration (Mendes & Snow 2014). In addition, Aboriginal and/or Torres Strait Islander young people with cognitive disability are in critical need of culturally responsive and safe service provision (Fitts et al. 2023).

Group Work: An Under-Utilised Approach?

Group work is one method of practice for supporting young people with cognitive disability transitioning from statutory systems. ‘Group work’ in this paper refers to the practice of bringing together young people in an intentional and supportive way. Such an arrangement differs from historical practices within the disability sector which have often forced people with disabilities to come together with other people with disabilities, without considering the diversity of needs within such groupings or the compatibility of group members (Wolfensberger 2003). Service groupings, such as those found in group home arrangements and special schools are examples which run counter to intentional group work, as these groups are seldom initiated by people with disabilities themselves, and people with disabilities may be afforded very little say in how these arrangements operate (Björne 2020; Anderson & Boyle 2015).

Intentional group work involves processes of sharing power among group members (Toseland and Rivas 2022). It has the potential to provide a safe and supportive environment for group members to develop self-understanding and practice skills that can later be generalised to broader community contexts. The group setting is an opportunity to exchange ideas about shared problems, which may generate new perspectives on perceived challenges. Intentional group work can develop a social support network for group members with shared experiences which may decrease isolation and feelings of loneliness (Bauman & Shaw 2016); and provide opportunities to engage in advocacy (Anderson & Bigby 2017).

Group work with young people with cognitive disabilities in transition from statutory systems is likely to present both challenges and opportunities. Facilitators need to be highly skilled to manage complex dynamics that may arise due to the impact of disability and intersectional disadvantage, traumatic life histories and current crisis needs. Facilitators must manage these dynamics while maintaining a safe space for all group members (Bauman & Shaw 2016; Wayne and Gitterman 2004). However, sitting with this tension is crucial as skilled practitioners can enable young people with cognitive disability to access and participate in groups that they have been previously excluded from.

There is very limited literature which describes and reflects on group work practices with young people with cognitive disability. The current study seeks to address this gap and improve understandings of how to engage this cohort via group work, by addressing the research question, ‘what are the practices and resources that support the engagement of young people with cognitive disability in a group program designed to support their transition from statutory systems?’.

The Program Under Study

The program, targeted at young people (15–25 years) with cognitive disability who were homeless or at risk, and had an experience of statutory systems, was developed to address gaps in transition support for this cohort. It was delivered by a community organisation in Queensland (Australia) specialised in supporting young people with cognitive disability.

Method

Recruitment and Sample

A purposive sampling approach was used to recruit young people and practitioners engaged with the program.

Young people were eligible to participate if they were over 18 years old and involved in the program between January 2021 and April 2022. The researchers collaborated with the practitioners to ensure the recruitment process was ethically and practically appropriate for young people with cognitive disabilities. For example, the research team attended two group sessions to introduce themselves, build relationships, explain the project, and allow young people to ask questions about the study. Practitioners also discussed the recruitment materials with young people to help ensure understanding. Participant information sheets and consent forms were made accessible by using Easy English and visual cues to aid comprehension. While interested participants could contact the research team directly, most elected to complete a consent to contact form allowing the research team to liaise with a key support worker to arrange interview times. Prior to the interview, the researchers used a screening tool to ensure young people were providing informed consent. To accommodate communication preferences, young people were able to provide verbal consent rather than written.

In total, 4 young people were recruited—nearly half of all participants engaged in the program. They were born between 1997 and 2004. Two identified as female and two identified as male. Given the small number of participants, gender-neutral pseudonyms were allocated to protect their anonymity (see Table 1). Young people with histories of statutory system involvement are recognised as a hard-to-reach population and small sample sizes are also common in research involving young people with cognitive disability. This may reflect the complexity and adversity of young people’s daily lives and the systemic barriers to their participation in research.

Table 1 Young people’s pseudonyms
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Practitioners were eligible to participate if they were involved in the delivery or management of the program. The recruitment material was distributed by the service manager and interested practitioners contacted the research team directly. A total of 6 practitioners were recruited; most were female (n = 5), frontline workers (n = 4) and qualified social workers (n = 5). The participant characteristics are outlined below in Table 2.

Table 2 Participant characteristics—practitioners
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Data collection

Data collection occurred between November 2021 and June 2022, following clearance from the University of Queensland's Human Research Ethics Committee (2021/HE002144). This protracted recruitment period was due to COVID-19 lockdowns, end-of-year holidays and a natural disaster event. With the consent of participants, all interviews and focus groups were audio recorded.

Young people took part in a one-off, semi-structured interviews that explored their referral into and experiences of the program, including the extent to which it met their needs. The interview guide for the young people was co-designed with practitioners and was informed by interview guides used in previous research with young people transitioning from OOHC (Venables et al. 2017, 2019). To ensure that the communication needs of young people with cognitive disabilities were catered for, the interview: (a) asked questions in Easy English; (b) included visual prompts (e.g., photographs of the workers and a timeline to locate events; and (c) provided young people with cards (e.g., stop, rest, question) that they could use to control the pace of the interview.

Interviews ranged from 30 to 60 min in length and were conducted either face-to-face (n = 3) or via an online platform (n = 1) at a time and safe location that suited them. The researchers all have practice and/or research experience in working with vulnerable children and young people. Young people could elect to have a support person present.

Data collection with practitioners involved interviews and a focus group. Six practitioners took part in a semi-structured interview that explored: their role in program delivery; young people’s support needs; the extent to which the program met the needs of young people; and the strengths and weaknesses of the program model. Interviews were conducted face-to-face and lasted 40 to 50 min. Subsequently, one focus group, involving 4 of the practitioners and lasting 50 min, was held online. The purpose of the focus group was to use specific practice examples from case file reviews to help illuminate the practices used in delivering the program.

Data Analysis

All interview and focus group recordings were transcribed verbatim, de-identified and uploaded to NVivo12 (QSR International), a qualitative data program. Braun and Clarke’s (2013) widely accepted guidelines informed the thematic analysis, which included data familiarisation and the collaborative generation of an initial coding frame. One team member then coded all transcripts, meeting with the team regularly to discuss refinements. The team then identified patterns of meaning across the data. For example, the theme ‘conducive organisational context’ was produced when we grouped together the codes ‘transport’, ‘supervision’, ‘organisational culture’ and ‘staffing’. Throughout the analysis similarities and differences between themes were explored.

Findings were shared in accessible format with the young people, which used Easy English and visual supports. Although invited, the young people did not provide feedback on the findings. Practitioners were provided with a report of the findings, positive feedback regarding the principles identified within the analysis for supporting group work was received.

Findings

Five themes associated with facilitating the engagement of young people with cognitive disability in group work to support their transition from statutory systems were identified: (1) centrality of relationship-based practice; (2) more than just a cooking group; (3) iterative individual and group processes; (4) managing and learning from conflict and risk; (5) conducive organisational context.

Centrality of Relationship-Based Practice

Relationship-based practice was viewed by both young people and practitioners as essential to the establishment and ongoing functioning of the group. Young people reported that practitioners made efforts to get to know them individually, as this young person describes:

They made us Christmas cards… They wrote little blurbs specific to each of us… beautiful, tailored little messages… they definitely take what they do very seriously and with a lot of heart with what they do. (Dana)

As illustrated above, the practitioners’ relationship-driven approach was recognised by the young people who felt valued and appreciated by the practitioners. There were two sub-themes associated with relationship-based practice.

Proactive Engagement and Gentle Persistence

Practitioners described the process of building relationships with young people beginning with what they termed ‘proactive engagement’. This involved frequent contact, checking in via calls or texts and outreach work to build connection with each young person prior to the group to understand their individual needs and hopes for the group. This was recognised by young people, who valued that practitioners routinely ‘called me and asked if I needed any assistance or any help’ (Bailey).

Practitioners reported engaging in ‘gentle’ (Practitioner 2) and ‘respectful’ (Practitioner 3) persistence during outreach visits. This involved slowly introducing themselves to young people over several weeks by entering a safe space of the young person (e.g., flexi-school). The intention was to demonstrate that they were invested in building a relationship with them and would exercise patience in doing so. Young people stressed that this made them feel welcomed and included in the program:

I feel like [Program] is a place where everyone’s welcome, like everyone’s one. So I feel comfortable coming here. I feel like I’m invited … Just welcoming me, like asking me if I want to join something. (Bailey)

Practitioners explained how a relationship-based approach created this welcoming environment. They characterised the approach as demonstrating unconditional positive regard, meeting young people where they were at, walking alongside them with a non-judgmental attitude, and recognising their strengths and self-determination.

Personal and Professional Values

Practitioners perceived their personal qualities further influenced how they enacted relationship-based practices in the group. They highlighted the importance of needing to be: ‘fun, relaxed, very authentic and real’ (Practitioner 1 – individual interview). The young people confirmed this friendly approach, with Casey sharing, ‘They’re kind of like teachers…then you can still have a laugh with them, so you’re kind of like friends’.

Practitioners also reported their professional and personal values supported relationship-based practice with the young people in the program. For example:

I think part of my personal values is this sense of humanness… and that we all seek connection… And then in terms of what social work has taught me… person-centred practice and… understanding how systems disadvantage people… (Practitioner 2 – individual interview)

Notably, five of the six practitioners were social workers and explained their prioritisation of a relationship-based framework aligned with their social work values and was informed by theories of trauma, anti-oppressive practice and a strengths-based approach.

More than Just a Cooking Group

Each group session centred around a cooking activity. This provided structure and routine, whilst also creating opportunities for group decision-making, and socialisation by working together and sharing a meal. For one young person, coming to group was one of the few times they left their house and interacted with others. The focus on food preparation also had the practical impact of ensuring the young people were eating. This was a fundamental need often unmet in their day-to-day experiences and was particularly valued by the young people as Alex describes: ‘we can take all the leftovers home. So we make sure we eat’. Both practitioners and young people suggested the group was more than just a cooking group—it was also a space for building skills, confidence and connection, as well as an environment that enabled peer-to-peer support to occur.

Building Skills, Confidence and Connection

Young people and practitioners reported the sessions built young people’s confidence and aided their development of knowledge and skills related to nutrition, food preparation, time management, hygiene and home maintenance. As Alex shared:

what they [Program] do, is where Child Safety failed to finish off, is getting these… young adults, to a point where they’re comfortably able to sort of step out, and they’re ready, they’re not thrown out… they do it in a way where we do cooking groups… learn about nutrition and be able to eat and come together as a socialisation… encouraging each other to sort of uplift each other and to be more social, to not sort of isolate and get on drugs.

As illustrated in this excerpt, the group cooking sessions were a space for knowledge development, socialisation and support. Alex’s comments also highlight the need that young people, particularly those exiting statutory systems, require to develop important life skills.

Within the safety and structure of the group cooking task, young people felt able to raise issues that were impacting on them, as Casey described: ‘I can’t really read that much, so they help me with reading…with all my other stuff, like Centrelink [social security]’. Practitioners reported being attuned and responsive to these discussions—flagging when more individualised support was required. Young people acknowledged and valued this responsiveness:

They’re willing to be more flexible than any other organisation because they’re willing to try and step out of their comfort zone to try things, trial and error. Where other agencies are just clear cut, straight down line…You can still bend it and still be on the book. You know what I mean? Yeah, you’re not breaking the rules if you just do it a little bit more individually (Alex).

Alex differentiated the practice approach used within the program from that of other organisations they had worked with in the past, which they perceived to be rigid and less accommodating.

A Space for Peer-to-Peer Support

The shared cooking task also created opportunities for peer-to-peer support. For example, practitioners reported often witnessing young people sharing advice with others based on their own experiences, such as accessing support via Australia’s National Disability Insurance Scheme (NDIS):

… it was just so much more powerful than a worker explaining it. So, he was able to … speak to the impact that it [NDIS] had on his life… It was really helpful for the other young person to then think, ‘Okay, it’s worth going through this process.’ And it was helpful for the other young person to think, ‘My experience is benefiting others…’ (Practitioner 1 – individual interview)

As shown above, peer-to-peer support provided two-way benefits. Young people received advice based on the lived experience of others and could also experience increased self-esteem themselves when they shared knowledge based on their own experiences. Alex exemplified this when they shared, ‘it’s really good because I will be able to sort of pass on some recommendations’, and linked this positive experience to their future goal of ‘doing advocacy eventually’.

Iterative Individual and Group Processes

Another dominant theme across the dataset was the importance of an ongoing, iterative process of supporting individual needs and managing group dynamics. A practitioner described this dual process of individual and group work:

We’ve been having conversations around how to really enable the group work to happen. Lots of those conversations around expectations, safety within the group, that kind of thing actually happen on an individual basis outside of the group. …It’s very difficult to process that kind of thing within group space. So it’s almost like there’s this continuum… from individual to group, where it actually takes both processes to enable the group to happen. (Practitioner 4 – focus group).

There were two associated sub-themes: (a) establishing and reviewing the group agreement; and (b) supporting self-awareness, self-regulation and interpersonal skills.

Establishing Group Agreements

The establishment of group agreements is a fundamental principle of group work (Toseland and Rivas 2022). The young people described collaborating and negotiating with their peers and the practitioners on an ongoing basis to determine the evolving group agreement and focus:

We’re in the process of making a new group agreement…We’ve outlined what skills that we’re going to want to achieve by the end of the year. We’ve had a pretty good conversation about other stuff like, ‘If not cooking, what else can we do? What else are you guys interested in?’ (Dana)

The collaborative establishment of a group agreement was perceived as important for fostering young people’s acceptance and willingness to actively support and work towards the group’s collective goals. The practitioners highlighted the establishment of group agreements was particularly important to this cohort of young people, due to past experiences of being asked to leave groups. They shared:

We don’t want to have a line where we say, ‘If you do this, you will be excluded,’ because that defeats the whole purpose of this group. We’re trying to create a space where young people can engage in a group context where they won’t be faced with that sort of penalty (Practitioner 2 – focus group).

Recognising the powerful impact of a group agreement on young people, practitioners also acknowledged negotiating expectations within a group is a complex and dynamic process that would be challenging for this cohort of young people to undertake without support. As one practitioner commented:

…to get six young people to sit down and have a discussion, that kind of processing isn’t going to work for everyone and won’t allow everyone to contribute… It’s about having gentle conversations over a three-week period with individual young people, …And then actually bringing that stuff back to the group and seeing if they agree on all the individuals’ input. (Practitioner 4- individual interview)

As shown above, workers scaffolded the process by first providing young people with time and individual space to reflect on their expectations, before the workers brought all the ideas back to the group for discussion. This process attempted to account for each young person’s communication needs and ensure all young people’s voices were able to inform the group agreement.

Supporting Self-Awareness, Regulation and Interpersonal Skills

Practitioners discussed how they perceived the group environment as a rich learning environment for young people on how to interact with others, particularly when they hold different perspectives. However, they also recognised this was sometimes challenging for young people due to their history of trauma as one practitioner commented:

Nearly all of the young people in [Program] have pretty significant trauma, which impacts on their ability to self-regulate… and in a group space… there are challenges that come with that. So being able to find creative ways to respond. (Practitioner 4 – individual interview)

The data suggests practitioners had a deep understanding of the young people, the impact of trauma and their disabilities and used the iterative individual/group process as a helping mechanism. For example:

…we really try and focus on the young person’s reality and where they’re at… And they’re not trying to unpack that in the group, but, as I said, during that individual stuff so they’re not bringing all of that into a group and maybe triggering each other. (Practitioner 1 – individual interview)

This excerpt highlights the practitioner’s consideration of group dynamics. By providing young people with individualised support alongside the group work, practitioners were able to protect other group members whilst also supporting the young person to develop the self-regulation and interpersonal skills required to participate in the group.

Young people valued the practitioners’ responsiveness to their emotional needs and support in regulating their emotions, with Dana reflecting:

…if one of us is upset or had a bit of an incident or maybe if we’ve rocked up to [Program] upset, they’ll always check on you or let you know that, ‘We’re here. We’re happy to talk to you.’ Even if you might have to miss the first bit… there’s always little spots that are available for …breathers, having a drink, just sit down and cooling down (Dana).

While young people were being supported individually, the other practitioners in the group used the time to teach the other young people how they could support their peers when they were dysregulated:

…trying to support people to build a bit of understanding about how to support someone when they’re upset or support someone when they’re angry or give people space and not take things personally. (Practitioner 1 – individual interview)

This excerpt highlights how the practitioners sought to respond to the needs of individual young people, whilst also leveraging the group dynamics to create learning opportunities for the others about interpersonal skills and communication.

Managing and Learning from Conflict and Risk

Practitioners acknowledged group work with the young people required sitting with and managing risk. A key source of risk was conflict between group members. As one practitioner shared:

I think a big challenge for me was within the groups when there was conflict between young people… Often it was challenging when young people had a crisis going on… knowing they’re not going to feel safe in the group and they’re not going to come to the group if they’re not supported... (Practitioner 1 – individual interview)

Like this practitioner, the importance of group member safety during the group, as well as the need for individual group members to feel safe and able to attend, were key factors shaping their approach to risk management.

Proactive Safety Planning

The practitioners acknowledged the diversity of the young people in the group, their dynamic personal circumstances and the potential for this to contribute to conflict within the group. To address this, the practitioners reported needing to be ‘really mindful of what was going on for people, what they might be bringing into the space, who else was there. So, kind of proactive safety planning and exit strategies for people if something went wrong’ (Practitioner 1 – individual interview).

‘Proactive safety planning’ was described as practitioners using their knowledge of each young person and the dynamics between them to inform safety planning strategies ahead of the group. This approach also involved conversations with individual young people outside of the group environment, as this practitioner reports:

…that’s why I was always open to responding outside of the group to those things so that they had space to talk about that, process it, make a plan, before then coming to the group. We could say, ‘actually we had that conversation. Remember this, let’s try and focus.’ (Practitioner 1 – individual interview)

Having prior conversations seemingly allowed the practitioners and young people to pre-establish a plan for dealing with issues within the group—rather than expecting young people to perform the complex task of generating a plan in situ during the group session.

Maintaining Connection While Managing Risk

Young people appreciated the way in which practitioners managed incidents within the group without ostracising the young person. For example, Dana commented:

You’re just pulled aside for a little conversation about, ‘Hey, what was that? Are you okay? We know that we shouldn’t do that’, whatever else. And it’s to the point where we could pick our own consequence… For example, it’s like, ‘Okay, so what do you think we should do about this?’ There’s no, ‘You’re banned from [Program] for two weeks.’ (Dana)

Dana’s comments highlight the practitioners’ commitment to maintaining their relationship and connection, rather than having a rigid adherence to punitive rules and consequences that would impede their connection with group members. The excerpt also illustrates how young people are encouraged and supported to determine consequences and resolve issues, rather than this being a top-down decision.

In discussing how they responded to risk caused by conflict in the group, practitioners highlighted the importance of using a trauma-informed approach and recognising young people’s previous personal experiences of shame:

…a lot of responding to conflict is finding ways that are trauma-informed and supportive for young people and really trying to alleviate shame… a huge experience for them of previous groups, is being shamed for their behaviours… it was hearing what that young person, what their experience was, and then responding to it individually by going and speaking to the other young people individually, rather than coming back into a group and all being like, ‘Let’s talk about this,’ because that can feel really blamey and shameful for some young people… (Practitioner 2 – focus group).

This comment seeks to differentiate the Program’s approach to managing group dynamics from those of previous organisations young people had worked with. The key difference highlighted by practitioners was a trauma-informed approach that prioritised maintaining the young person’s sense of worth.

Another risk management strategy used by practitioners was drawing on the team leader, who was familiar with young people but not usually a group facilitator. The team leader explained:

I know all the young people that attend [Program]... Sometimes I’ll step in… The workers will use me as someone that’s a bit removed, and they talk about that team leader role as holding a bit of authority so they can use me to maybe set some boundaries that might need to be a bit firmer…It preserves the workers’ relationships with young people if they get me to step in and do that. (Practitioner 4 – individual interview).

This strategy reportedly enabled the conflict to be managed whilst allowing key worker relationships with young people to remain intact.

Risk as a Learning Opportunity

Whilst the practitioners highlighted the need to manage risk, they also saw the presence of risk as a normal part of life and something that could be an important learning opportunity for group members:

…often there’s risk stuff happening in young people’s lives that gets brought into the group space [substance use, violence, crime]… In other groups, young people have experiences of where they may have been banned from the group… [because] things like that shouldn’t be talked about in the group space. But acknowledging that actually this is part of these young people’s lives… it’s really useful for them to be talking about it, because then they can get that feedback from workers and having conversations with peers in a safe space… [it] opens up opportunities for individual work around some of the risk... (Practitioner 4 – focus group)

The practitioners reported using risk as an opportunity to respectfully challenge young people to think about the consequences of engaging in risky behaviours outside of the group context, such as justice consequences.

Conducive Organisational Context

Practitioners acknowledged the organisational context in which the program was delivered was conducive to delivering the group program in this manner. They highlighted how organisational culture facilitated the provision of practical resources that were essential to maintaining the relationship-based approach and for remaining responsive to the individual needs of young people. Their comments centred around three main sub-themes.

Organisational Support

All practitioners described the broader organisation’s support for, and emphasis on, relationship-based and trauma-informed practice, viewing it as ‘something that is valued so much in this organisation and is really fostered in workers’ (Practitioner 2 – individual interview). This organisation’s prioritisation of this practice approach was reportedly reiterated during individual and group supervision. It was also demonstrated via acknowledgement and endorsement of the protracted time frames required to undertake relationship-based, development work, as well as via the provision of transport resources.

Transport

The organisation recognised transport presented a potential barrier to the participation of young people. Thus, the organisation supported transport to and from the group being recognised as an essential element of the program’s structure. Beyond practical support, the provision of transport was perceived as integral for preparing young people to safely engage in the group and for further fostering peer connections and relationships with the practitioners. A practitioner illuminated the work that occurred during transport:

That transporting space is often an opportunity… we’ll pair up two young people that feel safe and comfortable to be in the car together and enable conversations between themselves and the worker. There are some people [who].. will transport individually because we know they need individual space to… come into the group space or to debrief afterwards. (Practitioner 4- focus group)

Further to this, transport, particularly post-group, was viewed as a mechanism for managing risk and being responsive to the emergent needs of young people. Practitioners reported checking-in with young people during the group session and then determining the best options for transporting the young people home. For example, one practitioner reflected how having a discussion with a young person about ‘mental health and suicidality’ would result in a decision to ‘take this person home one-on-one’ (Practitioner 2- focus group) so that more thorough risk assessment and support could be provided.

Staffing

Staff ratios also enabled practitioners to be responsive to individual needs within the group. Having multiple staff enabled one practitioner to be able to leave to respond individually to a young person while the group could continue running, as one shared, ‘If someone does escalate or just needs to remove themselves from the space… that’s usually supported for them’ (Practitioner 2 – focus group).

Having multiple practitioners facilitating the group had another impact—the young people perceived they had developed relationships with more than one practitioner and could ask for help from any of these: ‘If I need any help I could just call [Practitioner 1] or [Practitioner 2]’ (Bailey).

Adequate staffing was also reported to be a barrier. The 2 practitioners who were the ‘key workers’ acknowledged the group required their knowledge and connection with the young people to operate well, suggesting it could not be facilitated if they were absent:

… if [practitioner] and I are unable to do the group, we won’t have it in person… Having two people… that aren’t familiar with the group space. We’ve seen it not play out fantastically in the past … (Practitioner 3- focus group).

This suggests that both the number of staff and their experience level are crucial to consider to safely manage the inherent complexity of group work with this cohort.

Discussion

Using the example of a program delivered in Queensland (Australia), this paper has built knowledge of ‘what works’ in practice to foster the engagement of young people with cognitive disability and a history of statutory system involvement in group work to support their transition to adulthood. It contributes to the very limited literature on group work with young people with complex support needs (e.g., Kelly & Hunter 2016) and the skills practitioners require to effectively engage and support young people with cognitive disability transitioning from statutory systems (e.g., Ellem 2019; Moensted et al 2020). Our findings indicate that the delivering organisation leveraged their specialist understanding of the differentiated needs of young people with cognitive disability to design and deliver an intentional group work program (Toseland and Rivas 2022). Unlike historical practices within the disability sector (see Anderson & Boyle 2015; Björne 2020; Wolfensberger 2003), the group program under study was perceived by young people and practitioners alike to: (a) be attuned and responsive to the needs of and dynamics between group members; and (b) provide young people with power to determine the focus of the group and how it operated.

Central to this intentional group work approach was relationship-based practice, which is recognised in the literature as necessary and important for supporting disadvantaged young people in transition (Ellem et al. 2020; Moensted et al 2020) and those with histories of statutory system/s engagement (Ellem 2019; Purtell & Mendes 2019). Our findings build on this literature to show how relationship-based practice can be woven throughout the design and delivery of a group-based program (e.g., initial engagement, development of group rules, managing risk and conflict) to not only engage but sustain the participation of young people with cognitive disability.

Organisational literature highlights how ‘the social context of an organisation helps to determine what types of interventions will be chosen, how these interventions will be implemented, the ways decisions will be made and how problems will be solved’ (Hemmelgarn et al. 2006, p.74). Our findings suggest relationship-based practice was afforded its central position in the design of the program due to strong alignment with the delivery organisation’s practice culture. The approach the practitioners reported using was not only endorsed and resourced by their organisation, but also actively nurtured via supervision and expanded via staff training. The literature identifies these as deliberate strategies organisations can use to embed their desired practices and attitudes into local practice cultures (Schein & Schein 2016). Arguably, the commitment to relationship-based work was further reinforced by the employment of practitioners who espoused sharing a practice framework and commitment to social work values and theories (e.g., trauma-informed, anti-oppressive and strength-based). Such multi-layered commitment to relationship-based practice within an organisation has been identified as a mechanism for overcoming risk-averse practices in work with this cohort of young people (Ellem & Venables 2023).

Another key element of the program design was the iterative individual and group processes. This made three key contributions to the group. First, it was viewed as a mechanism for building safety for individuals and the group collectively. Safety is a key group facilitation task requiring management of individual needs and group dynamics (Bauman & Shaw 2016; Wayne and Gitterman 2004). Second, it allowed for individualism and sensitivity in the approach to skills training, which is recognised as best practice in work with young people with complex support needs (Malvaso et al. 2016). Thirdly, it was also perceived to create opportunities for developing young people’s emotional regulation and social skills. Practitioners reported that they viewed any behaviours that emerged in the groups as opportunities for individual and group learning. The literature indicates that such reframes can help to uncover the significant underlying issues they represent for the member and for the group (Wayne and Gitterman 2004). This suggests that iterative group and individual process can be used as a strategy to overcome difficulties that young people with cognitive disability may have regarding communication, social skills and concentration (Schalock et al. 2021)—all things needed when engaging in a group.

The shared and routine task of meal preparation also created structure and safety within the group. As well as supporting living skill development, this task also served to provide young people with nutritious meals—a need often not met in their daily lives. Comprehensive skill development is a recognised need for young people leaving care to achieve successful transitions and become self-supporting (Malvaso et al. 2016; Whyte 2011). It is also essential for young people with cognitive disability who require supports in reasoning, problem solving, learning, and adaptive skills (Schalock et al. 2021). Providing this skill development in a group context is more efficient for organisations in terms of resourcing. It also creates opportunities for young people to build peer-relationships and to learn with and from each other, helping to build self-esteem.

Active and meaningful participation of young people with cognitive disability in groups can be transformative by providing opportunities for young people to develop positive identities and demonstrate positive attributes, enabling greater ownership and perceived control over their lives (Purtell & Mendes 2019). In this research young people reported their participation in the group led to them feeling valued and experiencing an increased sense of agency and self-esteem. Peer-to-peer connections and mentoring also resulted from their engagement with the groups. These findings are promising as benchmarks for a successful transition from care include creating ‘an environment that supports the development of personal resilience factors such as the promotion of self-esteem, trusting relationships, personal achievement, community acceptance, an external support network and a capacity to exercise self-determination’ (Whyte 2011, p.40).

Whilst our findings give guidance on factors that support the engagement of young people with cognitive disability in group programs, our findings also reaffirm the existing gaps in transition planning for young people with cognitive disability exiting statutory systems (Malvaso et al. 2016). Programs such as the one under study can make valuable contributions to enhancing the lives of young people, but they alone are insufficient. This is because young people’s need for the program’s support arose from the inadequacy of support provided when transitioning from statutory systems.

Strengths and Limitations

Due to the lack of specialist services for this cohort of young people, it is possible that our purposive sample of young people and practitioners had a vested interest in the program being viewed positively. This limitation is compounded by the small sample size and reliance on self-report data. Future research also needs to include observational methods. However, our purposive sampling approach and use of semi-structured interviews have provided rich insights into the experience of being actively involved in the group program as a practitioner and participant, allowing for the research questions to be addressed. The findings, whilst not generalisable, provide guidance on the practitioner knowledge, skills and organisational resources required for supporting young people with cognitive disability to engage in a group program that supports their transition from statutory systems. We recommend future longitudinal research that explores the ongoing impacts of group approaches to providing transition support to young people with cognitive disability who are exiting statutory systems.

Conclusion

The findings of this research deepen understanding of factors that support the engagement of young people with cognitive disability transitioning from statutory systems in a group work context. It unearthed how, within the context of relationship-driven practice, the use of an iterative, dual process of individual and group work can provide a way of working that supports young people’s engagement and creates opportunities for building connection, self-confidence and skill development. Our findings suggest that with the right combination of practitioner qualities and skills, as well as broader organisational resources, young people with cognitive disability who have previously been labelled ‘disengaged’ can be supported in their transition to adulthood via group work.