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Are we listening and responding?

“Create Space” - hear and discuss different perspectives on

the mental health needs of looked after and accommodated children

Thursday 1 June 2017 Melting Pot Edinburgh

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Background As part of developing and implementing “A Sense of Belonging” there is a commitment to hear from people, practitioners, researchers and policy makers about experience, practice, evidence and new knowledge about important issues which affect communities of interest. Currently across Scotland there is a much welcomed focus on how we as a nation respond to and care for our looked after children (LAC). This “Create Space” event was an opportunity for stakeholders to hear from the experiences of a young person, a researcher, a policy maker and practitioner in how we should respond to this across Lothian. The event took place on Thursday 1 June 2017 at the Melting Pot, in Edinburgh. It was attended by approximately 45 people from across Lothian.

Welcome Rachel King, Mental Health and Wellbeing Team< NHS Lothian Rachel opened the event and welcomed everyone. Rachel at short notice helpfully stood in for Sally Egan, Child Health Commissioner, who unfortunately was unable to attend the event at the last moment. Rachel gave an overview of the localities involvement in work to support LAC, and some reflections on the importance of considering the mental health, wellbeing and resilience of young people in challenging circumstances and who face some of the issues common to care experienced young people. Rachel then gave an outline of the programme. The focus of today’s event was to hear from people with different perspectives and to consider how these perspectives will inform our work moving forwards.

Perspective 1: National working directions - An overview Marian Flynn, CELCIS Marian gave an overview of the work that she has been leading to consider the local and national picture for LAC in terms of mental health, health assessments and the provision available in different areas. Marian was very supportive of the need to consider health needs of young people, and to reflect on how we as key local organizations could work better together to make an impact on the day to day living and needs of young people. She cited Edinburgh Connect as an example of excellent practice for Scotland to learn from. Are we listening & responding?

Emotional and mental needs of looked after children is significant

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Current practice & system response is problematic • Considerable variability - segment children’s health need • Screen - SDQ • Diagnosis - DSM categories • Level of resource • Timing • One-off / annual event • Children’s sense of health assessment • Service driven • Expect children to articulate their problems

Organising frame of Child Development

• Understanding of the impact of early & cumulative adversity • Multi-disciplinary - Integration • Child-centred – GIRFEC - holistic • Repair & recovery in the day-to-day • Emphasis on relationships & attuned care • Child’s network supported by competent, skilled practitioners • Currently at the margins

Opportunities

• Review of care – step-back & think • Mental Health Strategy • Adverse Childhood Experience (ACE) studies • CELCIS – beginning to look at how we can bring people together to explore a

developmental approach • Good foundations in Lothian

Edinburgh Connect

Small scale use of Attachment, Regulation & Competency (ARC) framework in West Lothian

Perspective 2: Our evidence base, are we following it? Emily Taylor, University of Edinburgh Emily gave a high level overview of what the published and peer review evidence tells us is effective in relation to the delivery of formal psychological therapies for LAC.

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Sharing our perspectives: Discussion One The first two presentations were followed by small group discussion, where people were asked to reflect on what they had heard and how this impacted on their own local knowledge and practice. The discussion has been synthesized into three themes: Health and wellbeing, young people’s needs and perspectives and improving services. Some of the comments reflected the ideas prompted by hearing the presentations, some were reflections drawn from participants’ own experiences regarding about provision and support for young people who are care experienced.

Health Wellbeing and Mental Health

Young People’s Needs and Perspectives

Improving Services

Attachment Disorder and the usefulness or not of giving a diagnostic label Test of personal budget approach could help – e.g. can use other providers not just CAMHS if there is a wait Potential to learn from Family Nurse Partnership re Health assessment GP changing the bar: mental health sick line Timing of assessment very important Sometimes better / necessary to speak to the people around the child

Higher Education: Once kids are there, they don’t want to look back Supporting the Champions Board Life V’s Trust – Empowerment Sometimes need an outlet as much as an intervention SDS - young person can choose how they want to spend the money Trauma is very unlikely to be single, multiple and often long-term Young person may not be ready for help but professionals around could still be ready to help. ‘The right time for the young person’ Foster carers – everyday help is help LAC need same as all young people - a ‘sense of purpose’ and meaningfulness, allowing them time to connect with ‘their’ community

we know the evidence about the financial cost of LAC MH/Outcomes – we know early intervention makes it less costly over lifetime, but we haven’t applied this knowledge in our delivery of services for LAC Need to take cognisance of grey literature non-RCT, practice-led, build on what we know works and demonstrate impact A shared framework and formulation is very helpful, so can be with that child as their journey happens. GIRFEC could offer this, though it isn’t currently used in this way Need for continuity of care and social care, and engaging across professions especially social work Space for thought and reflective practice, and consolidating training, and proper supervision Need less formal, unstructured ways for young people to engage with services.

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Perspective 3: Our experiences Representatives from the East Lothian Champions Board A group of young people who are involved in East Lothian Champions Board, alongside four workers from the Board, gave both a presentation and a further input about the experiences of young people in care or leaving care in Scotland currently.

Looked After Children and Young People

15,404 people in care.

No more than 0.5% of Scotland’s population.

(Scottish Government, 2015)

This included information about the numbers and types of care young people were involved in, but more significantly, the sorts of challenges and ways in which the care system can be very difficult to navigate as a young person. This part of the programme was facilitated by Beth Agnew, who asked the participants of the event to reflect on their own experiences and how these are similar or different to those young people who have an experience of care. The participants of the event were very welcoming of this element of the programme, and the presentation generated a lot of further discussion.

Becoming Looked After in Scotland

90%Care &Protection

10% Offence

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Care happens where? Champions’ Priorities

Education

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Poetry from Representatives from the East Lothian Champions Board

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Perspective 4: Our practice

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Katie Hardie, Edinburgh Connect Katie led an interactive session focusing on the learning and experience that Edinburgh Connect have built up over the years. . This session gave participants the opportunity to consider the importance of being non judgmental, of understanding the perspective of the young person, of really listening and acknowledging the reality and priorities for each individual, and of supporting mental health, wellbeing and the future of the young people. It was striking how Edinburgh Connect staff’s experiences and value base mirrored that which the young pepel had said in the previous session what was important to them.

Sharing our perspectives: Discussion Two The second small group discussion gave everyone an opportunity to think about their own practice, the ways in which in their locality there are ways to work constructively to change practice and understandings of young people who have experience of care. There was a lot of focus in this discussion on the following elements:

• Acknowledging the need for real and authentic human contact between young people and those who are working with them

The positive role of arts and creativity, which may not have a strong traditional evidence base but does have a strong effect

Being able to use professional judgement and to work alongside a young person

Knowing that there are really high quality projects and workers who support young people

Acknowledging the care system and the hearing system is not young person friendly, nor does it always give the outcomes wished for by anyone involved in the care of young people

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Final Remarks Linda Irvine, Strategic Programme Manager, NHS Lothian Linda highlighted some key messages from wider social policy literature o what had proved to work well for young people who experience care. She emphasised the need for this evidence base to be utilised and to underpin our delivery of support and services. She also highlighted the strong correlations with the discussions of the evening form all perspective: Key Learning

• Critical moments understanding the transition experiences of young people whose life chances are constrained by social and economic circumstances.

• Vulnerable youth often reports that events appear to be beyond their control and they cope

with this by making the most of a least “bad option” • transitional points conventionally understood as passages to adulthood”

• Pay attention to diverse domains in YP lives - education, employment, family, peers, their

neighbourhoods and their life project.

• Bounded agency - ways to have their voice heard, ways to make their needs known ways to keep safe in harmful environments individuals who would provide them with “a sense of belonging despite their limited options.

• hidden resilience - limited opportunities to break out of the limitations and constructions

that define them as problematic, risky and needing to be managed

• Trust based relationships foundation of effective practice - Supportive relationships

provided opportunities for youth to be active partners • constraints can be reduced through policies that facilitate the provision of social and

material resources and programmes that directly respond to young people Linda concluded the evening by highlighting a number of key and current strategic divers which should really help mobilise and accelerate our work:

• Edinburgh emotional wellbeing and mental health services review • Edinburgh Connect Review • Corporate Parenting Strategies and actions • National focus on ACE findings • Community in Motion – Turn your life around • 2018 – year of the Child • Sense of belonging Arts Programme • Gamechanger Public Social Partnership • Young Adult Services - focus on North East •

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Linda reaffirmed the commitment from the Mental Health and Wellbeing Programme, as well as from NHS Lothian, and partner organisations, to supporting the mental health needs of those young people with an experience of care. Linda outlined the next steps following the event:

• Circulation of report from this evening’s event • Detailed work to be developed within the framework of the MH and WB Programme, and

across NHS Lothian within the next year. • A commitment to having a second event in one year to review and look at progress made.

Linda thanked all the presenters and participants for attending and being so engaging and generous with their time and energy. NHS Lothian Mental Health and Wellbeing Team, September 2017