Primary care services and schools are seeing more children presenting with increasing mental health demands, in need of behavioural support, or mental health needs, which can manifest in different ways. In addition to this, local Child and Adolescent Mental Health Services (CAMHS) continue to have ever-increasing wait times, with young people reporting to ‘be at the mercy of the postcode lottery’ with waits to be seen of more than a year at times (STEM 4, 2019). There is persistent underfunding in resources for young people and although effective treatment for young people with mental health needs is available, less than half of them receive adequate care delivery as a result of poor engagement, or lack of early intervention (Dixon et al, 2016). Childhood adverse events lead to increased adult comorbid conditions with high-risk health-related behaviours.
Public Health England (2022) pointed out that people's health is determined primarily by a range of social, economic, and environmental factors. Social prescribing seeks to address people's needs in a holistic way, through one-to-one support or family support. It also aims to encourage individuals to take greater control of their own health and shape self-care and resilience to cope with the ever-evolving socioeconomic changes we face.
The COVID-19 pandemic crisis has put a huge strain on many young people who were already struggling with their mental health because of traumatic experiences, social isolation, a loss of routine and a breakdown in formal and informal support. A survey carried out by Young Minds in autumn 2020 highlighted positives for mental health in the initial return to school, such as seeing friends, having a routine, and seeing their teachers. However, many felt that the rapid return to academic pressure after 6 months away was having a negative impact, leading to poor relations between young people, teachers, parents (Young Minds, 2020). This is where the Young Person's Contact Service can offer support and help.
Rationale and vision
Key rationales for the contact service were:
- The need to support holistic care in children and young people; not seeing physical or psychological care in silos
- Improve prevention of adult comorbidities in physical and psychological health
- Support for young people is even more complex, in terms of balancing the primary focus on the young person with the input and needs of parents/carers, offering family formulations, family social prescribing
- Social return being an increased factor in outcomes
- The need to co-ordinate support and have liaison links across many providers, eg CAMHS, social care, social prescribing teams, GPs and schools
- Young people reported that link workers contributed to improving their sense of autonomy, reduced their sense of ‘stigma’ around mental health challenges, and filled a gap in mental health service provision by providing almost immediate access in non-clinically based emotional support within youth and community workers.
Since being established, the Young Persons Contact Service has provided an innovative and population-health focused service to patients within the Affinity Care primary care network (PCN) of 6 GP practices in Bradford. We have developed a service that offers a timely and comprehensive assessment of physical, mental, and social wellbeing delivered through a dedicated hub with drop-in clinics for young people. Our team consists of nursing, youth work, social prescribers, a trainee systemic practitioner, and sexual health workers focused on prevention and early intervention at the first point of contact. We have trialled our service with a combination of clinical and non-clinical support to provide holistic early help and prevention for the past 18 months and it has proved to be very successful, with further capacity being funded through integration with community health and social care partnerships.
The service identifies individual needs, and promotes a more personalised, planned and proactive approach to care. We aim to address the needs of those using the service and prevent the need for further care or intervention. The service also aims to identify young carers and provide them with timely signposting and identify the key stakeholders to ensure they can access the services they need and improve partnership working, particularly with schools and primary care mental health services.
We also offer colleagues a hub for advice and support. We have improved access in the wider community for children, young people, and their families through supporting emotional regulation and offering support while awaiting specialist and secondary care services.
The service was established in line with the Affinity Care PCN vision, which seeks to place communities at the heart of public health in order to:
- Create connected communities
- Engage those most at risk of poor health
- Empower/support the community voice
- Reduce health inequalities
- Offer relational personalised care.
Scope of the service
The Young Person's Contact Service is currently funded to support 120 young people each year with an integrated social and clinical support team aspiring to help with any unmet health needs, whether physical, social or psychological. This is an emotional wellbeing bespoke service that provides support to key target groups These include young people with a missed vaccination schedule, young people diagnosed with asthma who have not attended a review within 18 months, young carers and young people and their families following a neurodevelopmental diagnosis or while awaiting neurodevelopmental assessment.
We offer quarterly staff training and improved systemic connectiveness to target areas within schools in the community, encompassing adolescent development, anxiety management, behavioural support, adverse childhood events, and safeguarding, bespoke to the themes and demands of the particular community.
The team also looks to offer systemic approaches with family formulation support, bearing in mind the importance of personalised care planning. We offer staff supervision within the multiprofessional team and to the wider staff within general practice and the advisory support service.
The team offers an educational resource for young people, and this is delivered 4 times a year through 6 weekly group sessions across the differing areas of the PCN.
The type of referrals Affinity Care has received have involved support with improving mental wellbeing and emotional resilience, and offering help to parents of children with unmet psychosocial needs. They have led to improving engagement with school and children's services, helping families to connect with the right local support service, and encouraging the wellbeing of young carers and connecting to local services. Referrals have also supported health and lifestyle behaviour changes, seeking sexual health advice, and managing care needs, such as improving asthma care.
Young people have been supported in developing self-coping skills through group sessions and peer support, including coping strategies to improve low mood or anxiety, addressing low self-esteem, and helping those making transitions through difficult life-changing events.
Achievements
The Young Person's Contact Service has been able to identify achievements with case studies, pre- and post-evaluation of contact with the service and young people's feedback.
For example:
‘For me I still really struggle to express how I'm feeling because I don't understand any of it but art and music can be a big way to distract myself and so make it easier to deal with.’
‘This service has completely changed my life from being a person who suffers in silence and never opens to a person who would say when there is anything wrong.’
Parental suggestions and feedback are also sought, which have covered such areas as the importance of conversations with schools and other involved bodies ‘to close the loop on care’.
One young person who was referred to the service was socially isolated, having moved house to live with separated parents. There were challenges at home due to having to live between the two households. The young person was struggling with anxiety and low confidence, finding certain tasks very challenging such as catching a train or visiting a shop independently. The goals identified were to reduce her social isolation, and increase her self-esteem and confidence to tackle these challenges.
After 6 weeks of 2:1 phone calls the team built up a rapport with the young person, who has started attending and engaging in a weekly arts and crafts Zoom session, turning on her camera in the second week. Her feedback on the session was positive:
‘It was lovely honestly. My mood was just dropping so it was perfect timing too.’
She also started engaging in the WhatsApp group chat for arts and crafts, communicating with other girls in the group, slowly getting to know others and building up relations.
Other young people have also found the group a supportive resource:
‘There's no judging and it feels such a friendly group to be a part of. It makes me feel so much more comfortable knowing that the world isn't as bad as my mind keeps trying to tell me.’
Thoughts on the future
Innovation and development of this service has strengthened and enhanced accessibility along with prioritising our front door services in general practice for our young people. We have shown that this as an area of need to develop across all general practices, delivering on preventive care and improved health outcomes for our future generation. We are also looking to further enhance our approach to work within families, essentially piloting a form of ‘whole family social prescribing’ and sharing our model and approach with other PCNs to support equality of services.