Appendix A

ESCC_logos-TO-USE-90x64pxESCC Health and Wellbeing Project report

February 2023

Introduction

The ESCC Through Care Service created its Health and Wellbeing Project following its successful bid for Funding from NHS England in September 2021. The project aimed to target those identified young people with the service, who were experiencing difficulties with their Mental Health and Wellbeing and whose lives were impacted adversely from their own experiences in life as well as through the Covid-19 pandemic.  Funding was allocated in October 2021 to provide PHB’s for care experienced 16–25-year-olds as well as project support staff including a project Manager, part time Mental Health Specialist from within the local Health Trust and administrative support. We have projected 277 Personalised health budgets (PHB’s) by the end of March ’23.  This is around half of the current Care experienced cohort the team supports.

The primary driving hypothesis was that to reach and engage a marginalised group with predominantly poor health outcomes, it would be more effective to use the social prescribing model within an existing county wide social care provision, using existing social workers and personal advisors in a social prescribing/link worker role. 

A project plan was created with guidance from a Personalised Care Steering Group within the local NHS Trust - SPFT and with helpful oversight support from our South East NHS England delivery partner and the project began its work in early November 2021.

Project Overview and Summary

The project has been running for nearly 16 months and during that time has provided PHB’s to a broad range of care experienced young people and adults (see Appendix 1).  The project has very much succeeded in meetings its initial aims to:

·         Provide care experienced young people with opportunities to participate in activities that benefit their mental wellbeing by providing access to PHB’s and links to community assets.

·         Create a simple referral process and health and wellbeing plan alongside some care experienced young people that is accessible and responsive to young people and that records their identified need/s and wishes.

·         Identify and develop links with a range of community assets within East Sussex.

·         Ensure that Young People are involved in the co-production of their Health and Wellbeing Plans and decision making around what activities they would like to participate in to improve their wellbeing.

In addition to providing PHB’s for a range of activities/ equipment and health support our Mental Health Specialist has provided individual assessments of young people, staff consultations and training to workers within the team. (See Appendix 3)

It is difficult to predict the longer-term impact of the project for young people in terms of positive health outcomes and healthy lifestyles, but the feedback gained from both young people and professionals (see Appendix 2) has evidenced clear benefits to Mental Wellbeing and health in the short term.  Case study examples in Appendix 4 provide some anecdotal evidence of overcoming barriers to accessing services which bode well for improved engagement with health services in the future and individual Health and Wellbeing outcomes.

What has worked well?

·         Involvement of workers and young people in the project has improved engagement between workers and young people.  Co-production of the health and wellbeing plans (see Appendix 6) has meant young people have felt listened to and seen requests for support acted upon and realised.  Workers have fed back the positive impact of seeing their young people’s physical and mental wellbeing improve over time as a direct consequence of their engagement in their chosen activity.

·         There is self-report and third-party feedback that demonstrates clear improvements to the young people’s emotional health, reduced social isolation, self-confidence, and motivation in general life (see Appendix 2).

·         Some of our young people have started to engage in their health appointments for the first time.

·         The project has been able to meet most requests, find community artists, musicians as well as bespoke packages of support from community organisations (see Appendix 5).

·         The project team has been able to respond quickly to sourcing activities and setting up the finances to enable young people to engage quickly in their chosen activity.

·         The project has been able to reach a wide range of young people with diverse needs, ages across East Sussex and out of county (see Appendix 1).

·         Our Unaccompanied Asylum-seeking young people have benefited greatly from access to the PHB’s and also to individual support to develop an understanding of a western worldview around ‘mental health and wellbeing’.

·         We have been able to be flexible with the PHB’ expenditure to ensure we can meet differing complex individual needs of young people within the cohort. 

·         During the past 16 months we have built some excellent relationships with a range of community assets (see Appendix 5) and individuals, and the vast majority have been able to engage and build positive relationships with our young people resulting in them sustaining and benefitting fully from their chosen activity.

·         Our Specialist Mental Health lead has provided some very helpful targeted assessment and support to individuals in the team especially from our UAS cohort of young people (see Appendix 3 for details)

·         The Health and Wellbeing plans we developed in consultation with young people have proved accessible and simple enough for young people to engage with and represent their thoughts and wishes for how best to be supported. 

·         The gatekeeping role of project manager and Mental Health lead in the referral process has worked well overall in terms of checking clarity of information regarding the needs of young people and the support they may need to engage in a chosen activity.  Signposting to consultation sessions with the Mental Health lead worker have proved helpful to the staff team.

·         Team training sessions around anxiety and anxiety management have been well attended by Team workers and feedback has been positive in terms of knowledge and skills learning.

Challenges during the project

·         Some young people have been unable to engage in the project as fully as we would have hoped. Figure 3, Appendix 2 outlines a breakdown of reasons for this. 

·         Our financial processes within East Sussex have at times limited our ability to respond quickly to requests for funding. For example, certain Gyms prefer Direct Debit payments which we are unable to make; BACS payments set up with individual providers can take time when relying on having paperwork completed.  This did impact on some of the feedback we received about the project when there were delays to reimbursements.

·         The day to day demands of caseload management and working with trauma and complex needs have demanded flexibility and creative thinking around use of the PHB’s at times.  We have had to stop activities because of no shows; restart activities; change the activity or provide additional funding to individuals depending on need.

·         UAS limited understanding of ‘Mental Health as a concept’ and making connection between emotional states and physical responses in the body.

·         The Quality assurance of the community assets we have engaged with during the course of the project has been a challenge to us.  Fortunately, we have been able to use personal contacts; professional feedback from other county wide teams and in some cases trusted website reviews to try and ensure we are using experienced providers.

·         Having made some very positive contacts within other social prescribing services within East Sussex our hope to link in our post 18 group of young people to their local social prescribing service has not fully materialised.  In part we feel this is because young adults generally continue to use their Personal Advisors as their main source of support and signposting to community health services. 

·         Whilst the Health and Wellbeing Plans have proved helpful as a tool to highlight individual needs of young people, the review section and process for feedback on benefits or not, of the interventions has proved a challenge, both in terms of response rate and individual ability to reflect on impact.

·         The integration of the health and wellbeing plans into the pathway planning and review process is becoming more embedded but would benefit from a greater oversight and profile raising, by all professionals working around the care experienced child/adult.

 

Recommendations

·         Further training may be helpful for UAS whos cultural backgrounds may pose some difficulites when talking about/ accessing support around mental health concerns. Training may be delivered to the young individuals to help support normalise and bring some comfortability around these concerns. Personal Advisors can also be trained to deliver this support. We hope to include service user experience within this as part of the training package.

·         We hope to deliver training to Personal Advisors with regard to identifying and managing their own anxiety and concerns when working with complex or risky cases.

·         The health and wellbeing plans will be reviewed and adjusted, in particular the review section and process for feedback on benefits. Training can be provided to Personal Advisors around scaling questions and how best to support young people utilise this tool.

·         Look to develop more bespoke small group confidence building activity programmes alongside local providers for young people who are NEET and those experiencing low self worth and sturgling with their mental wellbeing.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendices

Appendix 1: Demographics of Young People with PHB

 

Appendix 1, Figure 1 - Referrals by Age Bracket

 

Appendix 1, Figure 2 - Referrals by Gender

Appendix 1, Figure 3 - Referrals by Ethnicity

 

 

Appendix 1, Figure 4 - Referrals by Accommodation Status

Appendix 1, Figure 5 - Referrals by Education/work status

 

 

 

 

 

Appendix 2: Feedback from Young People & Care Workers

 

 

Appendix 2, figure 1 - Impact on Mental Health as reported through HWP Feedback forms

 

 

 

 

 

 

 

 

APPENDIX 2, FIGURE 2- RATIO OF YP WHO BENEFIT FROM THEIR ACTIVITY/SUPPORT PROVIDED THROUGH HWP

Appendix 2, Figure 3 - Reasons for Non-Engagement within HWP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix 3: Specialist Mental Health Support

 

The project offers mental health support in the following areas:

 

5 consultation slots are offered per week. Social workers and personal advisors are able to book into consultation slots to discuss any mental health concerns for the young people they are supporting. The consultation slots may result in the following actions:

 

·         Signposting to appropriate support agencies

·         Advice regarding appropriate project activities to support YP mental wellbeing

·         Access to mental health assessment & reports

·         Support with enabling young people access project activities.

 

Below demonstrates the use of particular sections as a % of overall consultations.

 

Appendix 3, Figure 1 - Needs within Consultation

 

Training:

·         We have provided training on: 'Working with Stuckness'. This training is aimed to help support Personal Advisors work with young people who mght be difficult to engage. The training covers topics including impact of developmental Trauma and working through the Stages of Change.

·         In addition, we have provided 2 training sessions on 'Anxiety: An introduction to and Support strategies' for personal advisors. Personal Advisors are provided training on how to recognise anxiety, as well as provided a tool kit of strategies to share with individuals on their case load who struggle with anxiety.

 

 

Appendix 4 – Case Studies and Professional Feedback

All case studies anonymised, and names changed.

Case Study 1

Jane is a 16-year-old care experienced young person who has experienced complex trauma in her life and at the time of referral into the project in January 2022 was experiencing anxiety, very low mood, poor sleep, and appetite.  She along with her social worker asked for some financial help to buy a starter Nail Kit as she wanted to learn a new skill for herself.  Whilst providing some help in self-care and confidence Jane continued to struggle in other aspects of her life and relationships and her anxiety and experienced stress was having a detrimental impact on her physical health and sleep so further funding was agreed for some private Physiotherapy sessions.  Jane had always struggled to engage with Her health appointments but with support from her worker started physiotherapy and attended 3 out of 4 sessions provided which the social worker described as ‘incredible’.  She went on to feedback that the Physiotherapist has helped restore her faith in health professionals.  She went in believing she would be ‘fobbed off’ with being told to go home and do some exercises. Jane is very wary of health professionals, but her physio was kind and welcoming. It really helped she’s ‘home-based’ so it doesn’t feel clinical. Jane come out of each session feeling validated, that her pain has been real and not imagined and the actual physio in the sessions is starting to help.  From this, I’ve managed to get her to agree to see the optician today – massive step!

Case Study 2

Ahmed is a 17-year-old UASM from Sudan who has experienced much trauma in his life and on his journey fleeing his country of origin.  Waiting for a decision regarding his asylum claim has been very difficult for him and he has attended LACCAMHS counselling.  He has continued to experience much sadness, loneliness and flashbacks at night that disturb his sleep and have impacted his studies and mood.  He completed a health and wellbeing plan with his social worker and expressed a clear desire to become a plane pilot in the future.  Following discussion with him and his social worker about what might benefit him we found and funded a ‘glider experience’ for him in East Sussex.  The day was a great success for Ahmed and the project was able to fund a membership and further flights for him to sustain his mental wellbeing and allow him to develop his flying skills and knowledge to move towards his dream of becoming a pilot. He and his worker have feedback how his general mood, motivation and sleep have improved greatly which have had a very positive impact on his studies, friendships and ability to cope with the uncertainty of his future asylum claim.

Case Study 3

Adam has been diagnosed with ADHD and ASD. These diagnoses have an impact on his emotional and social development. His levels of aggression have been a real concern for some time which led to him being sec 20 accommodated.  Adam was going missing regularly and was at high risk of CSE as was fascinated with gang culture.  He has not wanted to engage in Therapeutic support but has been taking medication for his additional needs.

Adam was moved into a specialist 2-1 placement where he settled well over time.  The Placement have been able to provide support for Adam to follow his interests in Music and Boxing.  He was referred to the project in November 2021 and whilst at a boxing club was felt would benefit from one-to-one coaching as he wished to pursue his boxing and was benefitting greatly from the discipline and structure it gave him. He has only properly engaged in education in the last year and recently has achieved three grade 4's!!  His social worker states ‘he has totally turned his life around’.  He has engaged in his health appointments, no longer goes missing and is no longer a high safeguarding concern.

Case study 4

Sarah is a single parent of a 16-month-old young boy. Sarah really struggles with anxiety and has little support for herself from family or friends.  She has never engaged fully with health services for herself due to her anxiety.  Her resulting social isolation has been a real concern to both her Health visitor and personal advisor not only for her own Mental wellbeing but also for her son who does not get to socialise with other children or adults.  The project agreed to fund a nursery placement which was identified locally until he was 2 years old.  Sarah found it very difficult to attend an initial visit to the nursery but following a number of weeks encouragement from her PA she went to visit the nursery.  Support was provided to take her and her son to the first session.  The primary aim was to give her son time to meet and socialise with his peers as well as provide Sarah with some time to herself.  Whilst Sarah still struggles to talk to the nursery staff and other parents, she has been able to leave her son for several hours and use the time to shop and relax at home.   She is growing in confidence and now open to considering attend the dentist for much needed dental treatment.  Her early year worker feedback that Sarah has found it challenging at times leaving her son at nursery, but it has provided her with additional confidence in ways and a few hours breather which is needed for her wellbeing.  Her son appears to have come on well with his speech, which is likely due to nursery, I feel it has been a great support getting him into nursery and has allowed Sarah to overcome her initial fears of separation.

Case Study 5

Rowan has had substance misuse issues for a long time which has impacted her health, accommodation, and relationships.  Placing herself at high risk, not engaging with our service and leading a ‘hand to mouth’ existence has been of real concern.  At the start of the project, we had worked closely with Freedom leisure and secured an agreement for them to give our care leavers two months free membership with a 1 month free for a friend also. 

Rowans personal advisor met with her to discuss her specific needs, and both identified a gym membership as something she would find would give her structure to her day, health benefits and self-confidence.  We helped fund some sports clothing and trainers for her.  She is attending the gym regularly and we then bought her a year’s membership.  We have seen her self-confidence grow and the centre were talking to her and her worker about starting her on a training course at the centre.  However, her struggles with her heroin addiction led to a number of short relapses and a short-lived residential Rehabilitation placement.  Since then, Rowan has started back at the gym, has not relapsed for 9 months, and is now motivated to go back to college to train as a personal coach.

 

Personal Advisor Feedback 1.

I just wanted to highlight the significant positive impact the health and well being project is having on Chantelle. Chantelle has had to deal with a great deal of trauma from her past over the last three weeks. However the boxing has been a safe and positive constant for her and enabled her to remain focused and not move into destructive behaviours. So much so that I took her food shopping for the month yesterday and she bought healthy food as she wishes to remain in the best possible condition to maximise the benefit from attending boxing. This demonstrates how attending the boxing class has helped her make a significant shift in her decision making.

Personal Advisor Feedback 2.

The wellbeing project has made a positive impact on a few of my Young people. In all the 22 years I have worked for this team young people have had to miss out on activities especially when 18 or no longer in foster care, as money the government provide does not make it affordable to take part in activities in the community such as Riding lessons or Gym membership.  The project helped one young person complete his lifeguarding qualification. It been so nice to see the positive impact this has had and see young people grow in confidence.  It has been key in providing some structure to an otherwise chaotic life.

‘One of my young men has just been recovering from having had a mental health breakdown.  To start to see him building his life again, attending the local gym, swimming and start talking and thinking about a healthy body is amazing. ‘

I hope this is the start of something that can make a difference to life in care and leaving care.  It Feels good to open doors and not shut them.

UAS Social Workers feedback 3.

The project has been brilliant, allowing the young people I support to experience activities which have such a positive impact on their lives. Highlights have included kitting out one of our UASC with a football kit, boots and a bike to travel to training with – he has since been scouted for Hastings United and has played in their FA cup under 18s matches. Three of my young people have been given the opportunity to play and learn the guitar through the project, and it’s been a joy to hear them play their guitars and see their smiling faces when they show me what they’ve learnt. Our UASC often arrive not knowing anyone, being able to support them into a positive activity in their new community makes such a difference, helping them feel more settled in their new area after what is often a traumatic journey to the UK.

 

The fund has helped several of my UASC young people in different ways both directly and indirectly. I think the most valuable provision has been that of prevention or helping manage PTSD as so many of our young people come to the UK carrying trauma. Providing bikes has given the boys a real sense of freedom and shown how we trust them. They are united in their own company and passions as well as integrating and being very well accepted by the local players. They are all extremely thankful and relationships with workers has been fantastic.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix 5 – Community Assets

 

Printed below is a list of all community assets the Health & Wellbeing Project has engaged with. Number of YP allocated to these assets available on request.

 

Anytime Fitness (Eastbourne, Farnham)

High Tide Cycles

Leaps and Bounds Nursery

Little Skaters

Pup Station

The Meadows Nursery

Dorothy Thompsett – Counsellor

Eggtooth

Battle Road Dentist

Abbey Leisure Centre

BOX HIIT Gym

Breckland Leisure Centre

Energym, London

Freedom Leisure (Bexhill, Crowborough, Hastings)

GL Fitness

The Gym Group

Hasting’s College Gym/Station Plaza

Infinity Fitness

K2 Crawley

Lewes Leisure Centre

Peacehaven Leisure Centre

Platinum Gym

Pure Gym

Snap Fitness

Sovereign Centre

Team HIZO Boxing

The Dolphin

Underground Gym

Wave Leisure

Beauport Park Riding School

Hyfield Stables

Intuitive Horse

Oakhurst Farm

Polegate Equestrian Centre

Wellgrove Farm Equestrian

Wildwood Equestrian Centre

Merlin

National Trust

Art by Vicky Craggs

Darius Malkam – SuperDryve UK

DTA Residential

Flying Colours Eastbourne

Sussex Gliding Club

White Rock Theatre

AMR

Jane Reynolds & Associate

Margaret Blurton – Albany Physio

NEO Orthodontics

Specsavers

High 5

Bear Vocals Singing Tuition

Ben Taylor music

Donner

Eimear Collins – music tutor

Gear 4 Music

John Ash – music tutor

Nicki Gerrard – music tutor

Pete Prescott – music tutor

Replay Music Stores

Be Gymnastics

Blue Lagoon Pool

BOSS Gym

Brighton & Hove Football club

Crawley Karata Kyokushinkai

D&S Hastings football club

Eastbourne Boxing Club

Eastbourne Salsa

Eckington Leisure Centre

Guildford Spectrum ice rink

Hastings Running Club

Horntyre Park Cricket Club

Incognito Dance

King Alfred, Hove

Lovell Soccer

Ordinary Climbers

Phoenix Boxing – Eastbourne

Rumbles Gym – Sittingbourne

Skillz Sport Academy

Foot Asylum

JD Sports

Pro Direct Soccer

Wisdens

Tools & Tackle

Ellisons

 

Graphical user interface, text, application, email Description automatically generatedAppendix 6 – Health and Wellbeing Plan