Call for nurses to be central to a potential ‘Operation Paramount’ roll-out

A pioneering initiative in Oxfordshire has demonstrated the importance of doing more to supporting children affected by parental incarceration. With an extension of the scheme hoped for, Sarah Bekaert says that nurses and health visitors will be central to its future success

Thames Valley Police and the Thames Valley Violence Prevention Partnership launched the initiative ‘Operation Paramount’ in 2021, to routinely recognise and offer support to children and families affected by parental imprisonment – a historically hidden and under-served population.

Insights from interviews with mothers and family carers, conducted as part of the project evaluation, have implications for nurses; particularly health visitors and school nurses, as community-based universal health practitioners working at the frontline of child and family health.

Parental imprisonment: A hidden adverse childhood experience

Parental imprisonment is a recognised Adverse Childhood Experience. Children with an incarcerated parent are at higher risk of developing mental health issues, experiencing disrupted education, and exhibiting behavioural difficulties. Yet despite the impact, children affected remain largely invisible within health and social care systems.

Operation Paramount is a police-led pathway that addresses this gap by using prison reception data, cross-referenced with existing statutory systems, to identify familial links to children in the Thames Valley.

Once identified, families are offered tailored support through the charity Children Heard and Seen, which works with the remaining parent or caregiver and children.

Operation Paramount has received significant attention within UK Parliament. In December 2024, during a Westminster debate, MPs highlighted the pathway as an exemplar for identifying and supporting children of prisoners, with calls for its national rollout to ensure consistent support across the country.

The initiative’s recognition in Parliament reflects a growing commitment to addressing the needs of this vulnerable group and integrating such support into broader public policy. In the debate the Parliamentary Under-Secretary of State for Justice, Alex Davies-Jones stressed the role of all community services in supporting children affected:

‘We want to create an end-to-end system for support—from universal services, including family hubs, through to care—that is more responsive to different needs and how they might change over time.’ (Children of Prisoners, Hansard, 4/12/24).

For nurses working in community and education settings, this identification process offers a unique opportunity to deliver holistic, trauma-informed care, for the child and family.

Nurses as child and family specialists

Children impacted by parental imprisonment often experience a complex mix of emotions: confusion, guilt, anger, anxiety, and insecurity. The Operation Paramount evaluation found that while younger children are often shielded from the truth, older children and teenagers seek more direct and honest conversations. Caregivers frequently reported uncertainty about how to navigate these delicate discussions:

‘It’s quite hard to manage because he has become, on occasions, curious about his father, and it’s how I answer that, kind of pick up those pieces, and explain it… without him feeling rejected. It’s quite difficult to manage that.’

With expertise in child development and family-centred care, nurses are well-positioned to support families in developing age-appropriate communication strategies. They can also facilitate trauma-sensitive conversations, helping both children and carers process difficult emotions while maintaining stability and trust.

Nurses as advocates for joined-up school systems

The emotional and behavioural impact of parental imprisonment can play out in the classroom. While schools were viewed positively by families in the study, providing consistency and emotional support, there were instances of inconsistent responses, especially when behavioural issues led to exclusions.

‘It was fine at first and then it just really went downhill, his emotional regulation just went. It just wasn’t there. I managed to get an EHCP [Education and Health Care Plan]. He then got isolated through that school… He’s been excluded for 16.5 days, so he’s basically on the verge of permanent exclusion.’

School nurses can advocate for trauma-informed practices across the school environment. This could include helping staff to recognise and respond to the signs of trauma; and working collaboratively to develop non-punitive, supportive, strategies that recognise the root causes of certain behaviours.

The community nurse’s role in continuity of care

Families affected by parental incarceration often report feeling judged, unsupported, and abandoned after immediate risks have been addressed.

‘We had social services involved before he went to prison… and when he went to prison the social worker said, oh we’re going to close your case. The social worker was like, you’ve got this don’t worry…!’

One of the most critical gaps identified by Operation Paramount was the lack of ongoing therapeutic support for families. While some families accessed counselling or mentorship, support was often short-term and difficult to sustain, despite the presence of generational trauma and complex emotional needs.

Community-based nurses, particularly health visitors and school nurses, can have a crucial on-going support role, maintaining a presence beyond the initial crisis. They can identify emerging needs, provide emotional support, and liaise with specialist services as indicated.

Call for nurses to be central to a national ‘Operation Paramount’ roll-out

Operation Paramount has highlighted a long-neglected area of child and family health. Its data-driven, trauma-informed approach provides a model that is already being replicated in other areas in the UK and is likely to be rolled out nationally.

Community nurses, health visitors and school nurses in particular, must be central to this work. Nurses are uniquely equipped to support children and families affected by parental incarceration, through clinical expertise, advocacy, and their ability to offer continuity of care.

The report can be accessed here: https://www.tvvpp.co.uk/project/paramount/

Dr Sarah Bekaert is senior lecturer at the Oxford Institute of Applied Health Research, PhD, RN Child

Reference: Bekaert, S., Olphin, T., Massie, R. & Norris, J. (2025) What Works Series: Operation Paramount – Natural Experiment and descriptive multi-methods analysis of children affected by parental imprisonment and the people who care for them between 2021 and 2024, Thames Valley Violence Prevention Partnership: Kidlington, UK