Priority 8: Help Young People Influence Senior Managers

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Influencing senior managers occurs through a range of approaches and feeds into strategic decision making.

Senior managers on IAPT programmes should foster an organisational culture that recognises the value of the opinions of young service users, who can provide important insight into the effectiveness of services. Radical cultural change can only be achieved with a “just say yes” attitude, a commitment to challenge tokenism and the willingness to genuinely listen to feedback (rather than dismissing opinions as part of a mental health problem).

The following methods may prove useful:

  • Ensuring that young people have the means to comment on or complain about services in confidence
  • Providing a range of ways for young people to give their views, to meet a variety of needs and communication styles.
  • Recruiting a service user champion to sit on the management board
  • Ensuring senior management take feedback from service user groups “by default”
  • Building in direct two way links between young people and senior management that bypass the middle management
  • Hosting forums for young people (including service users) to input on the development and delivery of services.

To find out more about how YoungMinds is supporting these objectives, you can read our case studies:

Case Study 11: North East London Foundation Trust

The North East London NHS Foundation Trust has well-developed methods of involving service users in the monitoring of service performance in adult services. Service User Standards were developed in partnership with service users and have allowed the Trust Board to benchmark the performance of services over a number of years. There are also a number of service user and carer groups which are often called upon to sit on committees, input into planning and redesign, comment on policies and stand for election on the board of governors.

At the beginning of 2010 there was no infrastructure in place to support the involvement of young people accessing CAMHS . NELFT brought in a new participation worker, Sarah Bingham, who had a key goal of wanting to provide young people with the same opportunities that were offered to adult service users.

A small group of young people was established (called Young People’s Quality Action Team) that met every three weeks and fed directly into strategic decision-making within the Trust. The group reviewed the NELFT CAMHS standards (the set of expectations about the experience young people should have of NELFT services) and the questionnaires used within services. They also offered feedback and input to a new CAMHS website for NELFT, sat on interview panels for senior CAMHS practitioners and managers and fed back on their work to the senior executive interview panel.

This work has begun to put the voice of young people accessing CAMHS one step closer to the heart of the trust. Whilst it has only directly affected a small number of young people it has had a much wider influence on the experience of young people across the trust. For the young people involved, there seems to have been great benefit  the level of engagement is very high; and they have become more able to give open and honest feedback in a non-judgmental way. They feel empowered through the influence they have had and the change they have enabled. It has strengthened relationships between young people and the Trust.

Sarah felt that this type of work needs to be more embedded within the organisation. The structures for involvement need to be more defined otherwise the work can become tokenistic, open to manipulation or the results of which can be totally ignored. It does need to be well resourced if it is to be successful. The YQAT project has now ended but each of the boroughs within NELFT are in the process of setting up their own user groups, including one in Barking and Dagenham called ‘Listen!’ that is being led by young people.

Here are Sarah’s top tips for involving young people:

  • Participation must be rewarded
  • The specific reward should be interesting for the young person
  • Relationship is at the heart of participation for young people and CAMHS services
  • Establishing a space where young people can talk openly without being judged takes time
  • Developing teams of young people takes time and lots of energy
  • If you’re not having fun, they probably aren’t having fun
  • Do fun things together too; it can’t be all work, work, work – they will vote with their feet
  • Be clear, be open, be honest
  • Take care of yourself and ensure you have adequate supervision

Case Study 12: Northumberland, Tyne & Wear Foundation Trust

Susan Graham, Occupational Therapist, reports on young people’s involvement in service provision

Within Northumberland, Tyne and Wear Foundation Trust, yearly events celebrate the ‘involvement agenda’ and invite as many staff and users of services as possible to share examples of good practice inclusion in service provisions.

In November 2009 there was a Children, Young People and Specialist Services Directorate Event that invited examples to be shared of involving young people, clients/patients, parents/carers. This was an excellent event where presentations, workshops and stalls allowed all delegates to show how service users had been involved in the delivery, improvement and maintenance of the service provided by the Children, Young People and Specialist Services of Northumberland, Tyne and Wear Foundation Trust.

As a result of this event it was felt that a similar opportunity needed to be organised to support the participation of young people who found it hard to attend the day, either for issues relating to aspects of their Mental Health Act status, living in secure environments or indeed mixing with large crowds. The young people at both Prudhoe Hospital and St. Nicholas’ Hospital were asked if they would like to take part in organising such an experience, which led to two further ‘celebration events’ being held.

These were well-attended events where young people had a good opportunity to show how their involvements and participation had led to changes and
improvements in a wide scope of issues, such as: buildings and decorations, food, activities, staff training, service information, ward procedures, recruitment of staff, social and therapeutic availabilities, etc. The young people said they enjoyed this event and the opportunity to show others that their hard work had been recognised and listened to.

Top tip:

  • Remember to evaluate your event – we used a simple “question tree” to get quick feedback

Case Study 13: Engaging young people in strategic planning

South Essex Partnership Trust (SEPT) CAMH service is committed to understanding the needs, views and experience of the children, young people and their families/ carers, who use SEPT’s mental health services.

The CAMH service jointly funds (with Barnado’s) a Participation Development Officer who has carried out a number of engagement and involvement activities with children, young people and their families/carers. One such activity was a participation event that took place on in late 2010 and was part of the Trust’s ongoing commitment to engaging with and involving service users in shaping future service delivery. The purpose of the event was also aimed at contributing toward the Trust’s annual service planning process, as children and young people had not previously been involved at the level of strategic planning.

The event was held at a local theme park during the half-term school holiday. A “VIP” wristband enabling unlimited access to all of the theme park attractions after the event was provided to all service users, their siblings and main carer as an incentive to attend and participate in the event.

The event was aimed at young people between the ages of 12 and 18. Invitations were sent to all families currently using community CAMH services provided in south Essex and young people (between the ages of 12 and 18) who had previously been an inpatient. In addition, current inpatients had expressed an interest in attending the day and were supported to do so by the inpatient unit’s staff.

The young people who attended were offered the opportunity to either participate in a large group activity, facilitated by the Participation Development Officer, or to join in a number of smaller group discussions facilitated by service staff or the Trust’s planning leads. The smaller group discussions also involved siblings and parents/carers.

As well as coordinating the event, the Participation Development Officer also went to team meetings to talk to staff about the importance of participation in service delivery as well as in the children’s and young people’s recovery.

Feedback from young people:

“The chance to really have a say was not missed and we were given a good amount of time to say what we needed to say. It was empowering to say the least.”

“I have to say for the first time I actually felt on a level with commissioners and suchlike. I have often felt inferior and belittled by such people but the conference gave me a chance to feel equal and valued…I really felt like I had something important to share with them…if not even teach them.”

Case Study 14: Valuing young voices in Norfolk

Norfolk and Suffolk Foundation Trust are committed to increasing the participation of children and young people in strategic decision-making. A core part of working toward achieving this goal has been the establishment of a Youth Council that sits within the Trust’s governance structures. It is intended that the Council will have a central role in influencing decision-making and strategic planning with regards to the Trust’s children and young people’s mental health services.

The Council met for the first time in September 2011 with its members drawn from the Trust’s CAMH and Early Intervention in Psychosis (EIP) services, including current and former service users, with the young people being recruited from existing focus groups that had been established as part of work toward gaining ‘You’re Welcome’ accreditation. The initiative has been facilitated by a dedicated Children and Young People’s Participation Lead within the Trust, although it is intended that Council members will drive it forward as they grow in confidence and develop a sense of ownership. The Council is still in its early days, but the focus for the next year will be working to ensure the Council is properly embedded in the Trust’s governance structures. Specific pieces of work will include the Council leading the development of a Trust-wide participation strategy and charter for children and young people.

One of the key challenges has been ensuring children and young people are represented from all the CAMH and EI services across the Trust as some services are further ahead than others in terms of their participation work. However, the Council is supported by the Trust’s senior managers, including the Chief Executive who attended the Council’s first meeting to answer member’s questions. The real strength of the Council is the dedication, commitment and enthusiasm shown by the young people so far.

Case Study 15: Hull and East Riding

Michelle Watson, Clinical Service Manager, Hull CAMHS, was tasked by senior management, Humber NHS Foundation Trust, to write a participation strategy for the nine service areas that come under the umbrella of the CAMH Service across Hull and East Riding and she was assisted in this by YoungMinds.

The vision went quickly from simply writing a strategy as a management requirement to pushing for active participation and change through putting in place champions to drive service improvement and develop a programme of inspection involving young people.

The Hull and East Riding Services have now put in place a working group of champions, with representation from each area, to explore how to move participation forward in their teams. The champions meet regularly, receive training, contribute to the strategy so that it is realistic, and agree priorities for action.

The CAMH Service will be one of the sites involved in the VIK Inspector process, drawing on children and young people who have experience of CAMHS locally. This will include having open dialogue between children and young people and CAMHS senior managers about what can be improved and what is achievable in order to make services more responsive to their service users.

Case Study 16: CAMHS joint strategy, Leicestershire and Rutland

During the autumn of 2010 and the spring of 2011 a strategy for the future delivery of our Child and Adolescent Mental Health Services (CAMHS) across Leicester, Leicestershire and Rutland was developed.  The CAMHS Partnership feel that it is really important that this strategy is built on the views of children, young people, parents and carers.

To this end they aimed to gather the views of as many children and young people who were users and non-users of services as they could.  They wanted to know what children and young people thought of their principles, what type of services they wanted to see, where children and young people want services to be delivered as well as what skills and characteristics staff working in the  services should have.

They started by looking at what information was already available from national and local work in similar areas and went on to develop a questionnaire and posted it on several websites.  This resulted in over 50 people responding.  Then from this 24 young people were spoken to in more depth.

The children and young people felt that it was important for them to be involved in all decisions affecting them; services should be easy to use, fair and inclusive of all children and young people and more money should be spent on training a wide range of staff.

Here are a sample of qoutes from young people involved in the consultation:

“It is important that I have a say in my treatment.”

“Who is involved depends on the child or young person and what age they are.”

“I like this because it gives me the understanding that I will have more responsibility.”

“Especially good for older children who want more say and power.”

“I think the ultimate decision should be left to professionals.”

“At the end of the day it’s the person’s life and they should have options and choices.”

Case Study 17: Young people’s group, Wakefield

Gill Newey, Senior Practitioner, CAMHS Crisis Team, Wakefield, reports on how young people are involved with the steering of their service

The CAMHS Crisis Team is a small team with a specific remit; we offer an out-of-hours service and take referrals from the general locality teams for hard-to-engage, high-risk cases. The length of time we are involved and intensity of the intervention is very much led by the need of the young people. The team recently completed its annual report and we were very aware of the fact that young people’s views were not represented as fully as we would have wanted. The team was also aware of how potentially complex and time consuming this could be and also the ethical issues of seeking feedback when young people are still currently involved with the team. It would have been very easy to become overwhelmed by the potential issues but we decided that we would begin by inviting a small number of young people to what in essence would be a steering group. The focus was to begin to pull together the skeleton of a participation programme which would be led by young people.

We identified the young people we were going to approach from our existing caseload taking in to account their mental health status, ability to manage in a group and any other risk factors which could impact upon their wellbeing. The team put a date in the diary for when the first meeting would take place. I was allocated the task of sending a letter/invitation explaining the purpose of the meeting to the young people. The timescale was four weeks between the letter and the meeting taking place.

The replies were very positive and we had five young people who were willing to help us and become part of the group. The setting was difficult as we had no money to hire a less formal setting and the meeting had to be after office hours so we used the Team Meeting Room. The key workers prepared the young people before the meeting, transported the young people and remained for the meeting. We also provided drinks and pizza/cakes at end of meeting. The group mix was quite eclectic across gender, age and mental health issues including anorexia, self-harming, anxiety, OCD, and autism issues. We were not sure how or whether the group dynamics would work but  ensured there was a safety net for all the young people of leaving if they felt over whelmed. I’m pleased to say this was not needed and all the young people after a nervous start were fully engaged and said they enjoyed the meeting and would like to come again

For the first meeting I set the agenda and chaired the meeting. I feel for the first meeting having an organised structure and setting some parametera is useful. In the first meeting we covered a lot of ground discussing developing the young person’s leaflets, activities group, open day and future developments for the group.

The young people were very ambitious and enthusiastic but this has to be balanced against the reality of organisational bureaucracy and limitations of the service budgets. However, we did manage to organise and finance a trip to West Yorkshire Animal Park and we are planning a trip in December

We recently had a team open day to launch our annual report and to give stakeholders the opportunity to meet the team and understand the service we provide. The young people who attended this day talked with senior management who invited them to produce a wishlist of resources which was beyond our expectations.

The group is still in its infancy but in a very short time friendships have been made and the experience of being in the group has increased the confidence and self-esteem of the young people involved. These are young people who in many cases struggle with social interactions and who often feel stigmatised and they have really embraced the challenge.

In the future the young people’s group will involved in fully involved in service user feedback, future recruitment and hopefully will take over the running of the meeting.

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