Life Skills Coaching Project 12 Months On… Lee Kirwin Unit Manager

1. Life Skills Coaching Project 12 Months On… Lee Kirwin Unit Manager Kensington and Chelsea Whistler Walk Residential Unitin partnership withCNWL Foundation Trust Child and Adolescent Services

2. Outline • Project Team • Background • 3 Models • Intervention • Outcomes • Conclusions • Future Directions • References

3. Project Team Yasmin Mullick Life Coach / Child Clinical Psychologist CAMHS, Kensington and Chelsea Lee Kirwin Project Manager Unit Manager, Whistler Walk Clare Firth Project Consultant CAMHS, Kensington and Chelsea Andrew Rapley Project Clinical Supervisor CAMHS, Kensington and Chelsea

4. “Within all of us there are 2 dogs fighting – a good dog and a bad dog. The one that wins will be the one who is fed the most”

5. Background Gaps exists between: • Unmet Mental Needs (MH) of LAC • Poor uptake and engagement of CAMHS • Lack of MH Training for front line staff

6. Background • LAC Unmet Mental Health Needs • Prevalence rate of MH Disorder and LAC 4 – 5 x greater than general population (Ford, 2007) • 62% of LAC suffered abuse or neglect prior to being in care (Cocker and Scott, 2006)

7. Background • Poor Uptake of CAMHS • Little research into LAC Mental Health Service utilization • Anecdotal evidence from WW highlights: - prior negative experiences of specialist MH Services - low uptake of CAMHS Services - staff’s misconceptions of CAMHS

8. Background • Staff MH Training • RSW’s NVQs do not cover MH Training • LAC most commonly access front line services for MH support (Meltzer, 2003) • MH Training for front line staff, e.g. RSW’s, social workers, foster carers, teachers, is being prioritized (Cocker and Scott, 2006; Stanley, 2005; Kensington and Chelsea Residential Review, 2008.

9. 3 Models Model 1 – Life Skills • Cognitive skills (problem solving, understanding consequences, self evaluation) • Social / Interpersonal skills (communication, negotiation, assertiveness, co-operation, empathy) • Emotional Coping skills (managing feelings, managing stress, self- monitoring) World Health Organization

10. 3 Models Definition of life skills given to YP: “Life is like the ocean. Sometimes the waters are still and calm and at other times there are stormy waters. During these stormy waters we sometimes feel we are treading water, we sometimes feel like we are drowning and at other times we feel the thrill of riding huge waves. What skills are you already using, what do you think you could improve on and what new ones would you find useful?”

11. 3 Models Model 2 – Solution Focused 3 Assumptions: • There are always times when the problem behaviour is less apparent or even non existent • It is easy to imagine preferred futures for when the problem is gone • Resources and strengths exist in the here and now to get to these preferred futures

12. 3 Models Model 2 – Solution Focused Advantages of using this model with YP: • Problem free talk • Emphasis on solutions and current strengths • Ownership lies 100% with YP • YP is in the best position to know what is going to work and what isn’t going to work

13. 3 Models Model 3 – Social Pedagogy • Use of relationship between staff member and YP and shared lifespace as an opportunity to re-learn positive and healthy ways of relating and learning • 3 principles staff use 1. ‘the head’ (theories and reflective learning) 2. ‘the heart’ (trust, hope and empathy) 3. ‘the hands’ (shared activity)

14. Intervention Intervention with Staff: • Education and training • Shift Reviews • Group Supervision • Debriefing

15. Intervention - Staff • Education and Training • Active listening skills • Never using “Yes, but…” • Parental styles • Impact of depression and substance use on YP’s decision making • Identifying obstacles in putting learning into practice • Social pedagogy principles (private, personal, professional pedagogues) • Solution focused support plans • How to say ‘no’ to YP • Personal and professional boundaries

16. Intervention - Staff • Shift Reviews Use of rating scales (solution focused tool) to encourage reflective learning

17. Intervention - Staff • Group Supervision Use of systemic consultation model with reflecting team (Andersen, 1987)

18. Intervention - Staff • Debriefing One to one staff sessions when ‘the heart’ is validated and ‘the head’ is used to understand the way in which ‘the heart’ has been challenged.

19. Intervention Intervention with YP: • Life Skills Sessions • Activity Based Sessions • Crisis Intervention • Report Writing

20. Intervention - YP • Life Skills Sessions Sessions were one to one, took place on-site, lasted between 10 – 90 minutes. Life skills areas covered: • Dealing with loss • Rediscovering motivation • Identifying triggers for anger • Problem solving skills • Planning for setbacks • Being accountable………..continued

21. Intervention – YP • Self-belief • Identifying negative thinking errors (e.g. ‘all or nothing’ thinking) • Understanding anxiety and managing panic attacks • Coping skills • Assimilating mixed cultural identities • Coping with traumatic flashbacks

22. Intervention - YP 2. Activity Based Sessions YP reluctant to engage in life skills sessions were initially offered activity based sessions, e.g. board games, accompanying YP to appointments, shopping trips.

23. Intervention - YP • Crisis Intervention • Suicide risk assessment • Debrief after physical and verbal assaults with staff • Accountability and management of challenging behaviour after timed out placements • Management of panic attack

24. Intervention - YP • Report Writing • Reports to Home Office for unaccompanied minor asylum seeker • Report to tutor recommending learning styles • Summarizing Educational Psychologist reports and Social Worker case reports and making recommendations to staff.

25. Outcomes Outcomes for staff: 1. General 2. 12 month staff focus group evaluation

26. Outcomes - Staff • General: • Improved boundary keeping and saying ‘no’ to YP • Reduction of stigma of CAMHS by staff and YP • Distinction learnt between punishment based and learning based sanctions • Increased time spent in reflective learning • Increased knowledge of techniques and therapeutic tools for YP direct work • Managers accessibility to CAMHS resource

27. Outcomes - Staff 2. 12 month staff focus group evaluation: (5/8 staff attended the focus group) Themes: • Contextualizing challenging behaviour • Reflective practice • Ownership of practice • Cathartic debriefings • Project development ideas

28. Outcomes - YP Outcomes for YP: • General • Case Example • 6 Month Feedback Interviews

29. Outcomes - YP • General • 7/10 YP engaged in life skills sessions • 3-14 sessions were attended • 2 YP who engaged in the activity based sessions went on to engage in life skills sessions • 51 sessions were attended • Reduction in the number of physical /verbal threats • Increased amount of time spent with staff and YP in the evening

30. Outcomes - YP 2. Case Example 17 yr old female, semi-independent flat august ’07, excluded from college, L-T boyfriend Hopes: To get somewhere more in life; To keep my mouth shut when I need to; How do I control my emotions? Intervention: 6 sessions focused on: rediscovering motivation; examining pro’s and cons of ‘all or nothing’ thinking; predicting/planning setbacks; acknowledging the emotional impact of life events; understanding triggers for anger and sadness (continued…)

31. Outcomes - YP Outcome: On track to complete 1st term at college; successfully managed an ending of key family relationship; setting long term goals; improved communication skills, e.g. assertiveness; accessing help before a crisis 6 Month Feedback Interview: “I do like to get things off my chest a bit and I start to realize more, I start to just think, things I don’t really talk about or things that are hidden sort of thing…It sort of made me realize that I need to learn more about myself and just work on things and work on being a better me…”

32. Outcome - YP • 6 Month Feedback Interviews 3 YP participated in feedback interviews: • Sometimes I keep everything, I don’t say anything. When I talk to you it comes out. When I talk it comes out of my heart because I keep it all in there. • It’s nice to talk to someone who listens seriously. • You didn’t ask me something that was very, very difficult…If someone asks me a question and I don’t answer, I don’t like it…If I answer I go crazy. ….continued

33. Outcome - YP • I didn’t know whether the Life Coaching was for the staff or for the YP • Life Coaching makes no difference with staff. If Life Coaching was good, the staff would be cheerful, stop moaning and take time out for us.

34. Conclusions The project has successfully bridged the gap between LAC unmet mental health needs and supporting MH Training of front line staff: • Over ¾ YP engaged with life skills sessions • 51 life skills sessions attended • Reduced stigma of CAMHS with YP and staff • Staff valued ‘contextualizing challenging behaviour’ • Funding secured for full time Life Coach to include St. Marks Children’s Home

35. Conclusions Need for funding for continuation of Life Coach to be prioritized by CAMHS 7. Partnership between Residential Care and CAMHS central to improving service delivery and Every Child Matters Outcomes.

36. Future Directions • To help inform a new model of care based on psychological theories • To help develop assessment tools to assess need and measure progress • To link life skills sessions to supervision and keyworking sessions • To expand training /support to parents/families of WW residents, foster carers and social workers • To run joint education/training sessions with staff and YP in team meetings • To run effective groups

37. References • Andersen, T (1987) The reflecting team: Dialogue and meta-dialogue in clinical work. Family Process, 26, 415-428 • Cocker, C and Scott, S. Improving the mental and emotional well-being of looked after children: Connecting research, policy and practice. The Journal of the Royal Society for the Promotion of Health, 2006; 126;18 • Ford, T, Vastanis, P, Meltzer, H et al (2207) Psychiatric disorder among British children looked after by local authorities; a comparison with children living in private households. British Journal of Psychiatry, 190, 319-325 • Kensington and Chelsea Residential Review, 2008 • Meltzer et al (2003) The Mental Health of Young People Looked After by Local Authorities in England. Office for National Statistics • Stanley at al (2005) The Mental Health Needs of Looked After children: Matching Response to Need