Within this assignment I have chosen to explore whether therapeutic youth work which is informed by mental health and wellbeing principles can help build confidence and resilience in children and young people. I am writing this from my perspective as a Service Manager for Amicus Foster Care, an independent fostering provider. “Amicus supports families to care for children and young people who are looked after by Local Authorities. Our ethos is to remain small, friendly, and responsive while focusing on a personalised, ‘family-feeling’ approach to fostering.” (Amicus Foster Care, 2020)
I have worked within the fostering sector for over 15 years as a youth worker, foster carer, and service manager. Over the last few years, I have been developing a youth service which brings together the existing services on offer by Amicus under one umbrella whilst generating opportunities and services that prioritise mental health and wellbeing. In October 2020 I set up several youth groups and activities to work with a small group of children, this was in direct response to the COVID-19 pandemic. The focus was to maintain, and in some cases, create relationships with young people whom like all of us were experiencing huge changes to their lives and the way they lived them.
My aim within this assignment is to use the model of action research to explore the role of therapeutic youth work, what mental health and wellbeing informed practice means and whether this model of work can increase confidence and resilience within children and young people. I will use my reflective journal, recordings and feedback gathered both formally and informally throughout the groups. I will use pseudonyms for those involved so that they cannot be identified.
A focus on mental health and wellbeing came into a sharper focus in 2020 with the COVID-19 pandemic, we all struggled with the huge changes to our lives and the isolation this brought with national lockdowns and restriction around seeing people. I really felt it was crucial to find ways of connecting with our young people and helping them to explore some of the big feelings around the pandemic and the knock-on effects of not being with their birth families, including the reduction of face-to-face contact. This inspired me to set up the youth service with Amicus. I chose to focus on mental health and wellbeing because I have first-hand experience of the lack of understanding and support that is often found in this area, and in response to the growing number of young people who are placed in the care system experiencing poor mental health and wellbeing without any formal support in place for them. The main source of support is Childrens & Adolescent Mental Health Service (CAMHS), a service “that support young people with their mental health” (Mind, 2021), however they are notoriously underfunded, overstretched, and children and young people generally fall under the threshold for referral. Children and young people who are experiencing low-level disorders such as anxiety and depression for instance, may not even acknowledge they need support and should they choose to seek it out could find themselves on a long waiting list as priority is naturally given to more severe cases. I believe that by developing a service that works preventatively we could help reduce the number of young people that find themselves in distress and needing emergency response. By opening conversations about our mental health and wellbeing we can learn to recognise the early warning signs. It is through this process that we can begin to work with young people to develop appropriate coping mechanisms and create positive support networks.
“Recent research has revealed the pressure that CAMHS services are under: waiting-times for assessments vary from a few weeks to more than a year, while around a quarter of children who are assessed are turned down for treatment, often on the grounds that their problems are “not serious enough”. In total, around three-quarters of children and young people with mental health problems do not get the help they need.” (Young Minds, 2016)
Foster carers, like youth workers, are in a great position to fulfil this role of support however at present, mental health and wellbeing are not a core element of training within either sector unlike first aid, which further illustrates the lack of focus in the area. In the State Of The Nation Report compiled by The Fostering Network (Lawson and Cann, 2019) it highlighs that “as a direct result of previous traumas, children in care are far more likely to require mental health support” As part of a survey they asked 4037 foster carers whether they care for any children or young people who they felt should have access to mental health support (for example, CAMHS) but are not receiving this service. Nearly half of foster carers (48 per cent) state that they are looking after a child or young person in need of a mental health support service who is not receiving this support. The report goes on to say that “the true figure about mental health problems presenting in the foster home will be much higher than 48 per cent, because it does not take into account the foster carers who have successfully been able to access external mental health support for their fostered child. Therefore, we can say with confidence that at least 48 per cent of foster carers are caring for a child with mental health problems. For comparison with the general population, a recent report from the Public Accounts Committee stated that 13 per cent of five to 19-year-olds have a mental health disorder.” (Lawson and Cann, 2019)
As part of this service development, I undertook a 4-day Youth Mental Health First Aid course facilitated by Mental Health First Aid England (MHFA). The overall aim of the course is to provide practitioners with “skills and confidence to spot the signs of mental health issues in a young person, offer first aid and guide them towards the support they need. […] By giving you the tools to have these conversations, we hope to empower you to create a mentally healthy, supportive environment in your family, school, peer group or community.” (MHFA England, 2021)
The most significant aspect of the course for me was learning to normalise conversations surrounding our mental health and not being afraid to approach subjects of self-harm and or suicidal thoughts and idealisation. The case studies of young people were incredibly important to show what was lacking in the support they received. Particularly, what could have been done better and interventions that were in fact helpful. Ultimately, these young people responded positively to having someone actively listening to them and not providing judgement or minimising their feelings.
The course highlighted risk factors that may result in poor mental health, these were broken down into four categories: child characteristics, parents and their parenting style, family factors and social events and finally community and social factors. Examples include, noticing physical or behavioural changes in the child, whether the parents have suffered with their own mental health, have had family inconsistencies, or witnessed abuse or neglect, or even experience poor living conditions or poor healthcare. Additionally, there is further emphasis on a more specific areas of concern, cyberbullying. This is particularly relevant in a time where children are spending much more time online, further intensified by the pandemic. However, access to the arts, increased physical activity and social interaction were named as protective factors to promote good mental health and wellbeing. (MHFA England, 2021, pp. 25-29)
“Some examples of what schools and communities are doing – or could be doing – to support young people [include] Access to young people friendly services to ensure they have skills and information on where to get advice and help on issues surrounding abuse, drugs and mental health.” (MHFA England, 2021, p. 29)
What I am aiming to achieve by using these principles within youth work is to create spaces where mental health is talked about and given as much importance as our physical health. Stigma and discrimination around mental health is one of the highest risk factors which may exacerbate mental health issues and stop individuals from seeking help. (Kitchener and Jorm, 2017) My hope is that through increasing confidence and resilience, individuals will experience higher self-esteem and in turn improve their ability to talk about and challenge negatives thoughts. Mconville and Rae write “resilience is closely related to optimism. It is a cognitive skill that enables us to climb over life’s obstacles rather than be defeated by them” they go on to list the personal coping skills which enable a young person to be resilient which I aim to use as framework for the groups and activities. These include “being resourceful and having effective coping skills, a willingness to ask for help, the self-knowledge that they can do something that will enable them to manage their feelings and cope, trust in the social support that is available to them and strong connections to family and friends.” (2012, pp. 24-25)
I believe youth work has been seen by the public as a provision whose main purpose is providing fun and activities for young people. Within the fostering sector the use of support workers has traditionally been to deliver emergency response to children ‘kicking off’ or to offer a break for foster families without any real focus or outcome in place. In my opinion, a focus on creating, building, and sustaining relationships with individuals is at the heart of all good youth work, which is shared as an ambition by the mental health professionals and services that work with young people.
My aim is to promote the role of Therapeutic Youth Workers who work from a trauma informed approach, working closely with other professionals in the child’s life to provide a wrap-around support. This will be achieved developing relationships with the young people, their families and the agencies that support them by using understanding and application of attachment and developmental trauma. Ultimately, youth work is about helping young people overcome barriers and live their fullest potential.
By also integrating mental health and wellbeing principles a holistic approach to health and life can be achieved. During my research I came across a model of mental health and wellbeing approach to youth work called Right Here, “a five-year young people’s mental health and wellbeing programme developed and managed by both the Paul Hamlyn Foundation and the Mental Health Foundation, it ran from 2009 to 2014.” (Mental Health Foundation, 2021)
A quote that really resonated with me when I was researching this project came from a youth worker who fed back as part of the evaluation that “everything about youth work is fundamentally about having a positive relationship with the young person. You can’t do youth work without that really. It’s the core. If they don’t feel OK with that worker, if they don’t feel they can talk to them, that will be the thing that will break the effectiveness of anything you are doing more than everything else. It’s human, isn’t it? Sometimes I feel that people have got so service-focused that they have forgotten that all of this is about human interaction.” (Mental Health Foundation, 2021)
This drew further emphasis on the therapeutic elements of a youth workers role and how important it is to create relationships which are built on trust. These trusting relationships can only be achieved by also understanding our own triggers and responses to individuals and reflecting upon them. It is with this therapeutic approach that the weaving of mental health and wellbeing principles can take place. Otherwise, we are looking at ‘training’ young people in health and well-being.
I developed a series of activities between October 2020 and April 2021, which included a weekly online youth group held on Zoom. The initial focus within these groups was to promote confidence and resilience with the young people and allow a space to explore the feelings and emotions attached to the pandemic. The online youth group was open to all children and young people within Amicus, I chose the setting of a youth group because it is seen as a social space where children and young people can take ownership. Malekoff (2016, p.3) explains how “in the best groups, group workers and members are co-creators working from the same palette”. Therefore, I felt the youth group was a good way to start building relationships whilst creating an enjoyable experience.
For evaluative purposes, I have chosen to focus on the first, third and sixth session of a six week block of sessions. By choosing these three moments I am able to provide a summary of the start, middle and end of the journey. I will discuss the general outline of the sessions and present my observations alongside those of my colleague Erin (Therapeutic Life Story Worker/Youth Worker). The success of these groups is to be measured through qualitative and quantitative methods. The qualitative being through the gathering of anecdotal feedback from the group, foster families, and other professionals alongside my own reflections. The quantitative being through the record of numbers attending and through a formal evaluation process.
Our initial concerns when setting up the youth group was its accessibility. We wanted the group to be available and open for all young people regardless of their ages, abilities or if they were fostered or birth children. We were unsure if by doing this it would be hard to focus on activities which may promote confidence and resilience to a suitable standard for such a broad range of young people. The sessions drew a maximum of 10 young people ranging in ages from 9 to 17, 3 young people who identify as male and 7 who identify as female. 9 of the 10 young people are looked after and 1 birth child who is part of a fostering family. The plan for the first session was to create the ground rules of the group, ‘break the ice’ and provide an opportunity for the group to get now eachother and become more relaxed in taking part in activities. Additionally, we planned to ensure that the young people were aware of our wider purpose of increasing confidence and resilience and to have a space to open conversations about our mental health and wellbeing, thus ensuring that they were part of the reflective process and not something that was simply being done to them. It is hard to gauge if they understood fully what was meant but their response was accepting as long as they could have fun.
Session 1: “If I was…”
After our initial hellos, ground rules and purpose of the group. Our first activity was called “If I was..”, the aim of the activity is to introduce and share information about eachother. We chose this activity as it requires no additional resource from the group and would allow us to gauge the level of interest and engagement. We explained that this was an activity to get to know eachother, that we wanted everyone to start by saying their name and for them to think about what animal they think best represents them based on their personality or a characteristic.
Xanthe (10yr old female, birth child) immediately offered to go first and share with confidence her name, animal and why she felt this best suited her. There was a reluctance from the rest of the group to follow suit so myself and Erin shared ours and provided some encouragement. The response was varied with some young people really struggling to think how an animal could reflect them and a lack of confidence in wanting to speak to the group. We noticed lots of fidgeting and looking for their caregivers in the room for reassurance.
Sensing the differences in engagement and confidence levels we responded by moving on to a having a chat about television and what people were watching. The level of engagement changed immediately, most young people were able to express their views and engage. We harnessed the energy and shared a white board asking everyone to think about what they would like to get from the group and how they see it running. This resulted in lots of engagement through young people drawing and typing and provided us with a brief structure to the groups. The consensus being to feel good about themselves and to share music, jokes, funny videos.
We ended the session asking each young person to give a thumbs up or thumbs down for how they were feeling about the group. All 10 gave a thumbs up.
That evening we received an email from a foster parent, Guest (2021) “Hi both – thank you so much for your effort to engage all the kids this evening. My two really enjoyed it and can’t wait until next week. Keep up the good work.”
Erin and I reflected on how interesting it was to have a birth child as part of the group who almost inadvertently acted as our control subject, highlighting the level of confidence and resilience of a securely attached young person in contrast to the engagement of the other 9 children all of whom were looked after. This links to Schofield and Beek’s (2014, p.8) observation on the close relationships between attachment and resilience in which they highlight factors such as “trust in other people for support, positive self-esteem, self-efficacy and the capacity to reflect on your feelings and the feelings of others” as the attributes commonly found in securely attached children.
Session 3: “Smile and the world smiles with you”
By our third session we were down to 9 young people as one of the older boys had found it was not his cup of tea and fed back after the second session that it felt a bit young for him. By now a loose structure had been set, starting with sharing a joke and trying to make eachother laugh. I believe this had inadvertently set the tone for the sessions and increased feelings of happiness and connections to eachother. Stevenson (2012) really sums this up with her observation that “each time you smile at a person, their brain coaxes them to return the favour. You are creating a symbiotic relationship that allows both of you to release feel-good chemicals in your brain”.
We had also introduced “Three good things exercise” developed by MacConville and Rae (2012, pp. 38-39) which required the young people to write down three good things that had happened to them during the week, next to each of these they should answer one of the following;
- Why did this good thing happen?
- What does this mean to you?
- How can you have more of this in the future?
Seligman (2011) suggests by doing the three good things exercise regularly can make you measurably happier. The young people were asked to share these during the session, most young people were able to do this verbally but some preferred to share what they had written on screen. One of the young people, Charlie-May was struggling to talk about her three good things and without our prompt another member of the group supported her by offering to read them for her, others offered words of encouragement.
From my perspective the confidence of the group was growing, I was witnessing more engagement and energy from individuals and a sense of the group looking out for eachother and being respectful to eachother. After this session we received the following email from a foster parent, Taylor (2021) “thank you for doing these groups, Jordan is really enjoying it and its great for his confidence too”. We were glad to have received this feedback as Jordan was one of the young people we were really trying to encourage to share.
Session 6: “A blow to tissues of social life”
In session 6 we chose to focus on the changes that were causing us to be entering into another national lockdown, the activity encouraged us all to share our thoughts and feelings about lockdown. Using a shared whiteboard, we asked everyone to write or draw whatever they were feeling. “The good the bad and the ugly!” I was inspired by how Erikson (1976, p.154) described collective trauma as “a blow to the tissues of social life that damages the bonds linking people together, and impairs the prevailing sense of community”.
The whiteboard filled up in no time and an enthusiastic discussion took place about everything that was being written. Every member of the group shared something and were engaging with what others had written through the chat function or verbally. We explored the big feelings that were present by acknowledging and sitting with the lack of control we had over our lives whilst reframing the exercise to think about what we did have control over. We took the time to also look at some of the positive things that had emerged from the pandemic.
Malekoff (2016, p.304) stresses how “group work is indispensable in the aftermath of traumatic events and can serve as a counterforce to bleak outcomes that result from isolation”, he goes on to describe how it can empower individuals to find a voice and increase their skills to cope. I really believe this was reflected within this session.
The group were all willing to talk and share within this session and I think with the growing confidence we are experiencing as practitioners this is allowing us to work in a more spontaneous way. We can now respond to what is happening around us and are not trying to lead the group in a certain direction.
A round up: “what a great group”
The 6 sessions proved to be a real hit with the young people who attended, we lost two members during the 6 week period. Xander, age 17 and Wade age 11. Wade attended 4 of the 6 sessions, he was the young person whom we had the least relationship with, his foster family transferred to the agency in 2020. Whereas the rest of the young people had some knowledge or relationship with Erin and me. Wade was also the least confident in sharing his views, he would seek a lot of reassurance from Kate, his foster parent, when asked a question or would appear uncomfortable when talking. Although it was real shame that he did not continue to attend it was great to see that he took a much more confident role in a set of online cookery classes I led with a young people and their foster parent(s). It was in these sessions that I really saw his confidence growing, the activity was very much family-focused so him and Kate were cooking together. This seemed to really give him the ability to talk to us during the sessions and was happy to show off the meal they were preparing together. He took pride in doing this and the feedback from Hodgson (2021) via a text message was that he “couldn’t wait for the next cookery class and had started to help in the kitchen during the week”.
I was impressed that as the group developed, there was a real sense of support and membership. I feel this was because the young people really shaped how the sessions ran which provided us with the tools to cover our desired principles of mental health and wellbeing in a fluid and accessible way by using sharing, jokes, and music. They had given us the tools to work with, we just had to adapt to use them.
Over the 6 weeks I believe we witnessed the young people grow in confidence and finding their voice. By the last session everyone had shared their thoughts verbally to us and the others. There are of course some quieter members but even those have found a voice during these sessions and were no longer withdrawn into the perceived safety of sitting in the background.
It was through sharing of music that we were able to explore emotions with individuals and as a group, in one session Tam was unregulated, turning her video on and off and appearing at times distressed. When it came to sharing a music video, she immediately provided a suggestion which resonated with the feelings she was having that day. It was through this she was then able to explain to the group how she was missing being at home. The support from the others was quite overwhelming. My reflective journal recounts;
20.02.21 “Erin and I stayed on after this session and both had to say how powerful that was, the outpouring of emojis, messages and words to Tam was incredible! What a great group. We really didn’t expect to witness such a togetherness.”
Text surveys were sent to the foster parents of those that attended and completed with the young person prior to the first session and after the last. The results from these are shown in the chart below. Whilst it highlights that there has been an increase in confidence, sharing emotions and being with others, it is a simplistic view on this. I believe the most effective way to measure this has been through our own observations of the group as a whole and of individuals, it was through these observations that we were able to notice how the level of interaction grew over the weeks. The journey ranged from Week 1 where we only had a couple of young people wanting to talk to Week 6 where everyone had shared and engaged with the activities.
While having a set of structured activities which focused on mental health and wellbeing principles was useful to keep a focus on what we were trying to achieve, I found that it was the informality of sharing and the genuine connections that were made that had the biggest impact on us all. I am uncertain if I can determine whether youth work which is underpinned by therapeutic, mental health and wellbeing principles can increase confidence and resilience in young people solely through the service I have created. It is difficult to truly evidence this in a quantitative way because I feel there are so many variables, for instance I wonder if an individual’s confidence only plays out in the existing group setting due to the relationships and safety that has been created. There are larger organisations doing incredible work in this area of study which is having an impact on the sector. Referencing the report published by the European Sociological Reviews, Laurence (2021) suggests that “Young people’s increased confidence in their own social skills had the greatest impact on overall life satisfaction”. Therefore, the provision of a group setting which builds on the ability to connect socially and create relationships has a part to play in promoting good mental health and wellbeing.
This further supports the importance of youth work and therefore it is crucial that more attention and funding is provided to develop youth workers to be informed by therapeutic, mental health and wellbeing principles. I believe youth work should be given the value it deserves, if as much priority was given to equipping youth workers with a holistic approach as is the case with first aid for instance, then what is being offered could be hugely developed and elevated. With these skills, workers could bridge the gap with young people through meaningful and peer driven relationships that support young people to have the tools to promote their own mental health and wellbeing.
Moving forwards, I aim to continue to develop Amicus’ Youth Service by utilising aspects of the existing model used in Right Here, by encouraging further collaboration between specialised therapeutic and/or mental health professionals to ensure their expertise are integrated. A focus in these areas will also become engrained in core training. In terms of evaluating long-term progress, I would like to develop a way of gathering quantitative data to determine whether improving young people’s mental health and wellbeing is having any direct impact within the network. This could be through finding an increased engagement during Looked After Child Reviews, Personal Education Plan meetings or simply by foster families reporting that young people are more able to communicate their needs at home, school or with family members, peers and social workers. Further research could involve measuring how participants ability to engage in our session compares with their attitude in other scenarios.
As a result of this research in action project we have created Youth Ambassador roles within Amicus to ensure young voices are further engrained in the developing of policies, best practice, and the future of the service. Additionally, I am in the process of recruiting an apprentice who alongside being trained in a formal Level 3 Youth Work qualification will also be given the opportunity to study Youth Mental Health First Aid, Dyadic Developmental Psychotherapy Level 1 and be provided with individual and group supervision and reflective spaces.
“By supercharging existing youth work by adding a mental health focus, Right Here found that it was possible to help young people forge relationships with both adults and their peers. These relationships provided the springboard for these young people to begin to flourish in a way that other forms of support had not.” (Mental Health Foundation, 2021) I believe there can only be positive outcome for both practitioners and young people by bolstering the foundations of youth work with therapeutic, mental health and wellbeing principles. Especially at a time when young people face huge uncertainties and additional pressures casued by COVID-19. The re-emerging into the public world hold positives for all of us to live ‘normally’ but it will also shine a focus on the anxieties faced during the difficult times. Providing extra spaces to explore these feelings and create relationships will be crucial.
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