Implementing the emotional evidence base into practice- lessons from Newham –EBPU Seminar Dr Simon Munk CYP Mental health and Resilience Strategic lead, London Borough of Newham CYP resilience programme lead, UCLPartners Simon.munk@newham.gov.uk Will cover 17:15-17:20- Who’s in the room 17:15-18:00-Interactive presentation • What is emotional resilience • Why it matters to us in Newham • Lessons from piloting three different resilience promoting interventions in Newham 18:05-18:20- Questions 18:20-18:35- Table discussion • What is the relevance to you locally? 18:35-19:00- Networking and further discussion if interested over tea What is resilience? “Positive adaptation to adversity despite serious threats to adaptation or development’ (Masten) Often best understood as a set of competencies- rather than one thing. These include: • • • • • • • • • Positive school connnectedness Positive connectedness with individuals and activities in community Positive peer connectedness Positive home and family connectedness Autonomy Positive self esteem Empathy Problem solving skills Aspiration Why does resilience matter? Competencies important in own right. Also Evidence that these resilience competencies lead to: – Reduction in mental health disorder (Schucksmith et al (2007)) – Improved behaviour and attendance at school (Adi, Y., Schrader McMillan, A., Killoran, A. and Stewart-Brown, S. (2007) – Reduction in Risky behaviours (Catalano, R., Berglund, M.L., Ryan, G.A.M., Lonczak, H.S. and Hawkins, J.D. (2002)) • Newham has high level of risk factors for development of mental health disorder and risky behaviour taking • Great political desire for prevention and early interventions which have been locally demonstrated to reduce level of specialist CAMHs interventions and social care interventions. Newham HeadStart Programme Intro • Big Lottery funded HeadStart Pilot Programme has been working across 16 primary and secondary schools and multiple community settings over last 12 months to pilot and evaluate different approaches to promoting emotional resilience in 10-16 year old pupils at risk of developing mental health difficulties • I describe today three of them focussing on why we chose the intervention, what we did, challenges, outcomes and wider learning for others seeking to do the same. 5 HeadStart Programme Objectives Delivery of evidence based approaches which promote emotional resilience in 10-16 year olds at risk of developing mental health difficulties which leads to: • • • • Reduction in Mental Health disorder Improved school attainment + attendance Reduction in risky behaviours (improved social care and YOT outcomes) Reduction in NEET In addition the programme is seeking to deliver: • Increased whole school staff competency to promote resilience • Increased parent/carer competency to promote resilience • Increased employment opportunities for parents as peer facilitators Ultimately aiming to make the case for ongoing local funding of programme 6 Newham HeadStart pilots Training and support for school staff to increase their capacity to promote the resilience of their pupils Peer led training and support for parents of young people to increase their capacity to promote resilience A supported volunteering programme to help young people engage in their local community A young-person led borough wide multi-channel resilience campaign Peer Mentors trained and supported to increase their capacity to promote the resilience of their mentees Why a Peer mentoring pilot • Evidence that 1:1 mentoring can promote resilience competencies in both mentors and mentees and that this can lead to improved mental health, educational and social outcomes • Specifically these resilience competencies are increased connectedness in school, the community and the family (Gordon et al., 2013; Randolph & Johnson, 2008) • Peer mentoring in particular shown to produce increased opportunities to reach higher-risk children. • Many different peer mentoring programs exist. It is apparent that a number of key elements distinguish programs with better outcomes from those with neutral or detrimental outcomes (Rhodes, 2005) (Gordon et al., 2013; Randolph & Johnson, 2008) • It was unclear to us that there was a best practice peer mentoring model available and we sought to develop our own. Development of local best practice model • • • • • • • A literature review conducted by UCL (Podmore, Munk, Fonagy, 2015) helped us to understand what the key components which made a peer mentoring programme effective were: These were categorised into how to recruit appropriate mentors and mentees, how to train and supervise the peer mentors and how to support and maintain the mentoring relationship. A expert development group of psychologists, youth practitioners and school staff worked with a group of trained peer researchers to understand these key components and crucially to understand how they could be implemented in a relevant way in the local context. Evidence that involvement of beneficiaries in the adapting of interventions leads to increased compliance. (Day, Carey, & Surgenor, 2006; Fotaki et al., 2005 Lessons from this peer review were then then used to develop a manualised peer mentoring model based on this co-design work. This included recruitment processes, mentor training and supervision materials and group based activities to support the 1:1 mentoring activities. The model is delivered by peer mentors who are trained and supervised by a local psychologist and youth practitioner. The next slide summarises this development process. Bringing together evidence and views of beneficiaries Example lessons from narrative review Mentors should be screened for engagement with purpose of the program. Individuals with an interest in joining “caring professions” are more likely to remain committed to the program (Bodin & Leifman, 2011) Some evidence that youth who present with more intermediate levels of challenge rather than youth for who such difficulties were either severe or relatively absent are more likely to benefit from mentoring programs (DuBois & Karcher, 2013; Schwartz, Rhodes, Chan, & Herrera, 2011) Mentors should be able to promote the mentee’s ability to develop positive natural mentoring relationships with surrounding peers and adults (DuBois & Silverthorn, 2005; Zimmerman et al., 2005) Mentoring programs need to consider how to develop positive youth development competencies in the mentees (Maslow & Chung, 2013; Theokas & Lerner, 2006a) Ongoing mentor training during program is vital to maintain quality but is not common (DuBois et al., 2002) Ongoing training is imperative to ensure good quality relationship. Experiential learninginvolving the mentor and mentee can be effective. This can start with small scale exercises and progress to larger exercises. Role Example implementation lessons from peer research Caring and trustworthy, honest, reliable, nonjudgmental and active listening are vital criteria Mentor should be friendly but professional and not a friend Practical reasons to be a mentor- good for CV, good for development of life skills Ex-mentees may be inspired to become mentors People with emotional difficulties feel isolated and want practical and want a mentor for emotional support Developed program component How to build trust even if little in common? Communication skills are a high priority Understanding of the change in the role of the mentor, from first few sessions building the relationship through activities to then starting support and challenge the mentee Mentor training Delivered by a positive psychology practitioner- provides mentors with toolkit to build positive relationship with mentee and support positive behavior change Want to be able to go to supervisor for support and advice Mentor wants to feel supported and safe, especially in first few sessions. If then goes out into community, want to be able to report back progress Mentor supervision Enables the mentors to review the mentoring and get ideas, advice and guidance from the supervisors and peers on areas the mentor and mentee are finding challenging Mentor and mentee recruitment Recruits peer mentors and mentees against specified criteria involving young people in recruitment process Piloting of model • The developed model was piloted with 36 students in two local schools (mentors 16-18; mentees 12-14). • Evaluation focused on: • Was there evidence that the intervention promoted resilience competencies in mentors and mentees • Qualitative indicators of the facilitators and barriers to delivery of the development of the intervention Results • • • • • On a validated measure of resilience competencies (student resilience survey) significant increase in mentees resilience was observed but not of mentors and high attendance and completion rate was observed in mentors and mentees Thematic analysis of structured interviews with participants and supporting individuals gave key clues to how the intervention could be refined to work more effectively in the local context. The role of the youth worker and psychologist in delivering the training and supervision was viewed positively by the young people, as was the role of group activities in supporting the mentoring activities. The role of young people in promoting the project as well as delivering the mentoring was deemed as important in engaging with the target population. The young people who took part in the acceptability study indicated a number of challenges that still need to be overcome if the intervention is really going to work in the local context. There needs to be clearer setting of expectations with the mentees about the role of the mentor. Thought also needs to be given to how the mentoring relationship can be made to feel more natural while still being contained in a safe environment. Key lessons More generally: • When different approaches to delivering an intervention are available- it is important to understand what are the key components which are linked to positive outcomes • In implementing any intervention locally it is important to work with local professionals and beneficiaries to understand how these key components can be most effectively delivered • When evaluating the effectiveness of an intervention vital to use metrics with validated psychometric properties • Important to use qualitative evaluation to understand the facilitators and barriers to delivery of an intervention and how delivery can be refined. • Importance of a manualised model which can then be evaluated and refined as a consequence. Why a Supported volunteering pilot • • Volunteering programmes or Service-learning interventions are defined as a teaching and learning strategy that attempts to integrate community service with an academic curriculum They have been shown to promote resilience competencies particularly self esteem, problem solving, community and school connectedness and empathy. (Celio, Durlak, Dymnicki (2011)) • • • • Whilst many schools encourage pupils to take part in school and community based community activities anecdotally schools told us that the more vulnerable young people (our target population) were not taking part. In addition it was not clear to us that these programmes were adhering to best practice from the literature . In particular the above mentioned metanalysis suggested that key components of successful programmes were those that linked learning back to the curriculum, provided students with a key voice in developing their own activities, actively involved the community and provided space for student reflection on the experience. We sought to work with a commissioned provider of community based youth volunteering opportunities to develop a manualised approach which incorporated these elements. Supported volunteering developed model • Typically the “wrong” (the most able) young people take part in such activities The volunteering model we co-developed locally focussed on youth practitioners working with young people in schools to promote the opportunity to more vulnerable young people. • The developed model supports recruited young people to as a group co-develop an initial school based volunteering activity which is followed by a community based activity over a term. • Time is built in for youth practitioner-pupil 1:1 reflection on the experience. • The model also focusses on developing and supporting sustainable links between the school and surrounding community volunteering placements. Pilot findings • Quantitative evaluation of young people taking part in volunteering pilot in four schools (age 10-14; 150 participants) showed average significant increase in resilience on survey (as above) • High 85% of young people taking part were within our target population (measured using RONI indicators) Qualitative evaluation demonstrated that the project was very well received by schools and anecdotally school staff noted marked improvements in behaviour of students who participated in the project. A positive impact on local communities who benefit was also observed. Evaluation of facilitators and barriers to delivery enabled us to refine manualised model We are now working with the provider to train and supervise locally based youth practitioners to deliver the manualised model. Supported volunteering-Key lessons • Working with the provider to ensure that the delivered model reflected key evidenced components was important • Flexibility is required regarding how the model is delivered with schools to ensure it fits around other priorities • Key role of beneficiary involvement in co-delivery helps to engage with vulnerable population • Key role of youth practitioners in engaging with vulnerable population. • Having a manualised approach will enable us to train and supervise local youth practitioners to deliver the model at scale. • Importance of ensuring that project is open to all student and promoted as a positive opportunity helps participation not to be experienced as a stigmatising process. This also ensures that groups are more balanced. • This has to be balanced with targeted promotion by school staff and youth practitioners to ensure that it reaches the target population. Why Whole school approach • Evidence that the whole school ethos, including behaviour policies, how vulnerable young people are identified and supported by the whole school staff can be significant in building resilience competencies and improving secondary outcomes. (Weare and Nind 2011) • Evidence that approaches which support schools to develop improvement plans, policies, systems and activities which are explicitly designed to promote social and emotional wellbeing do indeed promote resilience competencies. • However there are lack of robustly evaluated models for implementing such whole school training and organisational development approaches. • We sought to work with a provider to develop a model which: – Builds whole school staff competency to identify vulnerable pupils and support them to develop a number of resilience competencies including aspiration, self-esteem and school and community connection. – Support the school through a service improvement/organisational development approach to develop new policies, initiatives and ways of working Whole school staff training- pilot findings • • • • • • • We piloted this approach with a mix of ten primary and secondary schools supported by our provider. We trained a large number and variety of staff across the schools and it was very positively received. Staff consistently reported feeling more able to identify need and to promote resilience competencies following the training. However a lack of psychometrically validated measures to assess these staff competencies made it challenging to assess the effectiveness of the training. The whole school organisational development approach involved all levels of the school (including pupil involvement) auditing current practice and through this each school developed an action plan for change. The school SLT was then supported by an expert external facilitator to implement the action plan. The approach has been popular with schools who see the very clear links between this, behaviour management and improved attendance and attainment. It is as yet unclear whether these action plans are leading to measurable change in the school. Whole school staff training- key lessons • • • • • • • The evidence suggests the importance of changing the whole school ethos if targeted interventions such as mentoring and volunteering are going to work. The challenge however is that supporting a school to change its ethos places high demands on the school. It is also challenging to manualise such an approach as a bespoke approach is important dependent on where the school is at baseline. However it has still been important to define the key components of the intervention so that these can be evaluated and refined as well as for quality assurance. It has also been important to be able to clearly define to schools what the approach involves. The expertise of the external facilitator both in terms of their knowledge and ability/credibility to drive change in the school has been crucial. The role of pupils in contributing to the baseline audit process has also been vital in challenging the schools about current practice. The lack of validated measures of staff competency to promote resilience has made it difficult to assess the effectiveness of the training and thus to be able to refine the model. Discussion In small tables (15mins including tea) 1) What has been your experience of attempting to set up or deliver new interventions? Do reflections from Newham resonate? 2) What could you take home from the Newham experience? Newham roll out programme- if time/interest • • • • • • • Currently applying for funding from Big Lottery to establish a borough wide multifaceted programme which aims to promote resilience in 10-16 year olds with low emotional wellbeing Will be based on learning from the pilots both in terms of which interventions work locally but also the key implementation lessons (some described above) Key to success of this programme will be being able to demonstrate that the interventions not only promote resilience but that this leads to improved mental health and educational outcomes as well as a reduction in risky behaviours. We hope through doing this that we will be able to make a strong business case to education, health and social care commissioners for ongoing investment. To enable this impact to be demonstrated we will be regularly measuring resilience and mental health symptoms in all students taking part. This data will be matched with existing education and social care data sets. Analysis will enable us to refine the programme delivery as well as evaluate the impact of individual interventions. In addition it will enable us to assess whether the interventions are additive in value. Collecting, matching and analysing data to demonstrate impact