We provide additional and bespoke support to young people to help them in their recovery journey focusing on issues which may not be addressed adequately by mainstream child or adult services. Young people offered the Transitions Group often fall outside mainstream services. The Transition Group focuses on helping them better understand and self-manage their difficulties and assists them in seeking out additional help, opportunities and peer support outside statutory services.
What We Did
We provide additional and bespoke support to young people to help them in their recovery journey focusing on issues which may not be addressed adequately by mainstream child or adult services. Young people offered the Transitions Group often fall outside mainstream services. Some may be receiving additional help from adult mental health services, but many will be in a short term service from a community MH team and therefore will not have a care coordinator.
The Transition Group focuses on helping them better understand and self-manage their difficulties and assists them in seeking out additional help, opportunities and peer support outside statutory services. The Community Recovery Service Transitions Group has significantly improved the patient experience for this vulnerable and difficult to engage client group.
It is a course for young people aged 16-25 who struggle with the move from child and adolescent (CAMHS) to adult mental health services. Age is the only criteria for the group hence the mental health issues include anxiety, depression, ADHD to psychosis, obsessional compulsive disorder and personality disorder. Sometimes diagnosis is not clear. The 10 week course eclectically combines informative, class based sessions with external activities specifically chosen to boost a young person’s self-esteem and confidence. The Course is held in a non-health or statutory service building “The Circle” in the city centre. The venue is modern, well equipped with free refreshments and young people report that the surrounding add to the sense of value and care being provided to them.
The first session is an Introduction, not only to the course but to peers and facilitators (both staff and young volunteers). We have a variety of icebreaking activities, most of which use post-it notes as means of communication. This helps young people share their own thoughts and experiences in a much safer, less anxiety provoking way. This provides a platform to build on for group members to start sharing their thoughts in an open environment, with the intention that they feel less isolated. One of the activities asks young people to reflect on how they felt before coming to the first session and what they would like to get out of the course. This task, purposely put in place, gives participants a chance to see that everybody shares common fears and anxiety prior to the commencement of the course. The usual answers include: ‘anxious’, ‘nervous’, and ‘scared’. We then reflect on this and acknowledge the shared experience. Following this we introduce an activity which is repeated every session when we ask young people to reflect about their own mental health and one thing that has been going well, and one thing that has been a struggle. Asking these questions helps group members become familiar with the benefits of talking through issues with appropriate others, reducing the tendency to ‘bottle things up’. This activity uses post-it notes for the first two sessions of the course. For the remaining 8 sessions, all participants and facilitators are encouraged to answer these questions out loud, modelling an openness which we are introducing as therapeutic.
The second session focuses on Anxiety and Stress Management and presents a group with a variety of theories and skills derived from both Cognitive and Dialectical Behavioural Therapies (CBT and DBT). We discuss anxiety and fight or flight response. This gives young people a chance to recognise and understand what happens in the brain when stressed and what kind of physical side effects take place. Activities include Stress Bucket and recognising what sort of things cause distress to young people and how this can be overcome by using skills and coping mechanisms, doing activities and engaging with non- statutory services. We finish the session with a mindfulness with a twist practice which helps young people understand that being present in here and now can take different forms including games and physical activities.
Session three introduces the first of the two external activities which is facilitated by My Life Project community organisation which supports young people by engaging them in arts and music. The 2 ½ hour session gives participants a chance to create their own graffiti board and design original T-shirt. Most of the young people attending Transitions have never painted with spray graffiti before and although find this session challenging, come out with a sense of achievement.
Session 4 is a fairly new session focused on emotional sensitivity (ES). We have observed a rise in young people with a diagnosis or traits of Borderline Personality Disorder. As a team we believe that presenting the subject from a different angle and naming emotional difficulties as ‘sensitivity’ helps breaking the stigma and myths around personality disorder. Young people are able to focus and recognise positives of emotional sensitivity like compassion, loyalty, caring nature and empathy towards others and animals. We also introduce activities around a management of ES and ask group members to share their own ideas and skills they already use when feelings become overwhelming. Most young people feedback after the session includes comments around feeling less alone and seeing their sensitivity as a superpower rather than a vice.
Session five combines a Navigation of Services with Volunteering and Employment Opportunities. This includes discussions around young people’s experience of statutory and non-statutory services and exploring different pathways. Young people are given handouts and flyers of services in Sheffield, with details around referral pathways and how to seek help in the case of relapse or crisis.
Part of the session is facilitated by Occupational Therapists from Community Mental Health Teams and focuses on Volunteering, Employment and Education Opportunities as well as on the issues around disclosure about mental health problems and dealing with questions which refer to illness or disability.
Session six is Wall Climbing- the second external activity. As with the previous one, group members can meet facilitators at the regular venue and then travel together or meet everybody at the actual venue. The wall climbing is fairly new activity added to the Transitions repertoire. This activity encourages young people to work and support each other in pairs i.e. one person climbing, the other securely supporting them on the ground. Young people learn not only to trust one another but most of all gain confidence and sense of achievement from reaching the top of the wall.
Session seven looks at different mental health problems which affect young people as well as discussions around Social Media, Myths and Stigma. One of the activities includes dividing group members into two groups which are presented with variations of a similar task. Group one imagines an 18 year old young person and draws them and writes anything they can about their personality, family, education, friends, hobbies etc. The second group is asked to think about an 18 year old with mental health issues and again they draw and write about different aspects of the young person’s life. The results from both groups are usually completely different with group one presenting a ‘healthy’ young person, full of hobbies, friends and interest, and group two presenting a young person struggling with difficulties in all areas of their life. This task demonstrates the stigma around mental health still exists however the change has to start from within and each individual has a role to play in spreading the awareness. We also look at pros and cons of social media role in young people’s lives nowadays and provide information on ‘safe and tested’ apps and websites which focus on management of mood, negative emotions and reinforce skills learnt in the course.
Session eight is Meet the Mental Health Professional week. Participants prepare a range of questions for a psychiatrist or mental health nurse to answer. Previous subjects discussed have involved questions about medication, therapies, services, formulation versus diagnosis and specific mental health problems. Questions can be asked openly during the group, or prepared anonymously beforehand. This session provides the opportunity to speak face to face with a professional who is in the “hot seat”.
Session nine hosts the Marketplace event which has been developed over the last 18 months and is now a stand-alone session. The Marketplace invites representatives from different statutory and non-statutory services supporting young people in Sheffield. Each has their own table at which they display posters, leaflets and any other information or resources. The main activity is a ‘speed-dating’ session which means that the group members, individually or in pairs, go from one table to another, spending about 4-5 minutes at each station. Those invited have to try and ‘sell’ their services to young people, describing what they do and what they can offer.
The final session involves an external trip to a bowling alley. This session is a Farewell Session and provides the opportunity to reflect on the Transitions group as a whole. Group members are able to chat with their peers in a relaxed setting and are asked to provide feedback about the group, its facilitators and the activities. Group members are encouraged to keep in contact after the course and there are Facebook Groups for those who wish to keep in contact this way.
Wider Active Support
Sheffield Health and Social Care Foundation NHS Trust is an organisation with a strong history of partnership working with the Third Sector. The Transition Group has benefitted from collaboration with Chilipep – a local Children and Young People’s Empowerment Project who are commissioned by the CCG and work in collaboration with staff from SHSC to provide a strong User voice into service design and delivery.
The Community Recovery Service has the active participation of a number of Service User Volunteers and paid Experts by Experience.
The Transition Group has encouraged previous members to participate in facilitation of future groups. One of the sessions (No 3) is facilitated by the “My Life Project” community organisation which supports young people by engaging them in arts and music.
The Marketplace session is a community facing session showcasing opportunities within the non-statutory sector for seeking out help, support or social networks to support onward Recovery.
Organisations participating in this include: Sheffield Flourish, LGBT Sheffield, Sheffield Mind, Sheffield City Council Disability Service, Chilypep, Interchange, Autism Plus and Talent Match, Sheffield Young Carers, Sheffield Futures, MoveMore Sheffield amongst others. There is considerable enthusiasm from these organisations to “advertise” their services to a group who can be hard to access.
The Community Recovery Service has the active participation of a number of Service User Volunteers and paid Experts by Experience. The Transition Group has encouraged previous members to participate in facilitation of future groups.
All leaflets had always been standardised, we listened to service users who said the Transitions leaflet was not “youth-friendly” and did not reflect the format and spirit of the course. We supported some of the young volunteers in designing a brand new leaflet which now has been used for over a year. The leaflet has a different outlook and includes quotes from former group members as well as some of the graffiti art which previous groups did.
The activities in the group are kept under review and new ideas are always welcomed and tried out where possible. The external sessions and the artistic sessions are newer ideas which have been well received by young people.
Looking Back/ Challenges Faced
A powerful early change was the move from a health venue to a non-statutory venue in the town centre. Service users have commented on the additional value and sense of care they feel in this modern, non-institutional building. The funding for this was hard won by but well worth the effort.
In its very early stages the group was aimed predominantly at young people with neurodevelopmental disorders. The move to diversify offers groups with differing strengths more able to support one another and encourage empathy in “the other”.
A particular challenge was a safeguarding incident between a young volunteer and a participant. This needed a full investigation and has prompted a review of the position of volunteers and peer to peer support in the service. Whilst distressing and concerning, this has been dealt with sensitively and further processes have been put in place to ensure the safety of the group.
It is recognised that there is an inherent risk in encouraging the independence and recovery of young and potentially vulnerable people with mental health problems. This “positive risk taking” needs to and has been be acknowledged and supported at a senior level of the organisation.
The Service has the ongoing support of the Deputy Medical Director and the Service/Clinical Directors who recognise how popular it is not only with young people but also with primary care and CAMHS.
Evaluation (Peer or Academic)
Quantitative data. We are currently working on a report including data from 2016-2017 period. We identified 184 referrals for the Transitions group sent between January 2014 and January 2016. The majority of referrals were females although the difference was not significant Females 101; Males 83
However, when looking at attended vs did not attend, there appears to be a sex difference regarding attendence. Total: attended 81; DNA 103 Females: attended 49; DNA 52
Males: attended 32; DNA 51
The referrals come from four different CMHTs in the city N W SE SW 34 48 55 47
As the age is the only criteria for the course, young people present with a variety of mental health issues and quite often have more than one diagnosis or diagnostic uncertainty.
Depression (82); Anxiety (67); ADHD (52); BPD (27); Psychosis (17); Bipolar (10); Autistic Spectrum (9); Aspergers Syndrome (5); Tourettes Syndrome (3); Eating Disorder (2) Learning Disability (2); Dissociative Disorder (1); No diagnosis (38).
Single diagnosis (98); Dual diagnosis (46); More than 2 diagnoses (14); No diagnosis (24)
The Short Warwick Edinburgh Mental Wellbeing Scale is used as a measurement during the first and final week of the course. The Warwick-Edinburgh Mental Well-being scale was developed to enable the monitoring of mental wellbeing in the general population and the evaluation of projects, programmes and policies which aim to improve mental wellbeing. We gathered data on 43 participants who were able to provide both week 1 and 10 scores. Averages (N=43):
Week 1 Week 10 16.53488 18.18605
Averages after removing lowest scores (anomalous) (N=38): Week 1 Week 10 17.15789 19.31558
Qualitative feedback: In addition to the formal feedback which is undertaken by all of the groups within the Community Recovery Service, further evaluation was undertaken using Social media poll results:
What was the most helpful about the group?
Peer support 7 votes 63.6% Anxiety and Stress Management session 7 votes
63.6% External activities 6 votes 54.5% Facilitators 6 votes 54.5% Myths and stigma session 6 votes 54.5% Overview of mental health session 6 votes 54.5% Question and answer with a psychiatrist 5 votes 45.5% Service users/ volunteers 4 votes 36.4% The venue (city centre) 4 votes 36.4% Marketplace Event 2 votes 18.2% Getting to know you session 2 votes 18.2% Free tea and coffee 2 votes 18.2% Overview of services session 1 vote 9.1%
Volunteering and employment session 1 vote 9.1% Didn’t find anything helpful 1 vote 9.1% Other 1 vote 9.1%
If you found the group helpful how has it improved your life? Managing my mental health 6 votes 54.5%
Awareness of other people’s mental health 5 votes 45.5% Confidence 4 votes 36.4% My life hasn’t improved as a result of the Transitions 3 votes 27.3% Self-esteem 2 votes 18.2% Making new friends 2 votes 18.2% Learnt new skills and coping mechanisms 2 votes 18.2% Other 1 vote 9.1%
What do you remember the most about the Transitions course you attended?
“The great people that where in the group and the facilitators I met some wonderful people who I also miss dearly .” “Gave me more info on what I was going through and helped me find other ways of dealing with it”.
“The activity sessions, especially graffiti, the sessions on perceptions of others and ourselves .” “Knowing that my mental health problems didn’t define me”. ”Coming together and creating graffiti art”.
“I remember being terrified of going, but I had calmed down by the third or fourth week, I was still anxious being in groups but I felt more comfortable. I found it really helpful to know that there was other people going through the same things, I also found it helpful when I had to talk, this was because I struggle to speak when I’m in groups, but it made it a bit easier knowing that I wouldn’t be judged. All of the staff were lovely, that was part of the reason that i volunteered to do the ones afterwards.”
“The mutual support from each other.”
The external activities
Transitions group Post group Feedback:
- What did you find helpful about the course?
- External activities;
- Being able to talk to people;
- The information provided as it has been very educational,
Making friends has been good and the support has been great,
- Meeting other people in the same position,
- Regular time and schedule,
- Learning things I didn’t already know about myself,
- Meeting new people,
- Meeting new people with similar issues,
- Being able to discuss my problems without being judged and with people suffering the same issues. It also helped me learn more about my own mental health,
- Meeting other people with similar problems,
- Given loads of useful info on local services,
- Don’t feel like I’ve just been abandoned now that the course is finished,
- Agnes and Nic (facilitators) are lovely and made me feel welcome and relaxed,
- Learning about team work
- The routine factor,
- Did you find anything about the course unhelpful and if so what?
- Sometimes the other members of the group,
- I felt slightly isolated at times
- What suggestions do you have for improvements of the course?
- Not that I can think of!
- Don’t have any,
- Getting everyone to be more comfortable with each other
- More time with a psychiatrist so he can answer more questions
The work has been shared internally on a number of occasions within the Trust at Quality Improvement Events, the Trust AGM, a Joint Service event on Transitions alongside colleagues from CAMHs and Paediatrics and a Primary Care Development session organised by the CCG.
The Transitions team were nominated and successful recipients of the SHSC Trust Excellence Award for Best Team in 2013.
An early iteration of the Transition Group was cited as an example of good practice by the Social Care Institute of Excellence http://www.scie.org.uk/publications/guides/guide44/ practiceexamples/sheffield-adhd.asp and following this were commissioned to participate in the making of a film on best practice on transition by the Social Care Institute of Excellence http://www.scie.org.uk/socialcaretv/ topic.asp?t=mentalhealthtransitions which is regularly used to illustrate the principles of Transition.
The Transition Group were featured in the Joint Commissioning Panel for Mental Health Services for Young People in Transition. http://www.jcpmh.info/good-services/ young-people-in-transition/
Dr Crimlisk gave oral evidence to the NICE Guidelines Group on Transition published in 2016 and many of the principles embedded within the Transition Group were reflected in the Guideline on Transition https://www.nice.org.uk/guidance/ng43
SHSC collaborated with part of a Research Project on Transition led by Prof Colver: and in a workshop on Transition at the Royal College of Physicians of London Error! Hyperlink reference not valid. and Prof Singh’s Research Group in Birmingham on models of Transition.
Descriptions of the work of the Transition Group have been presented with posters at the Royal College of Psychiatrists, the Royal College of General Practitioners, and national Occupational Therapy conferences.
An abstract has been accepted this year for a workshop on the Transition Group by the Joint Annual Meeting of the Faculties of General Adult Psychiatry and Child and Adult Psychiatry at the Royal College of Psychiatrists Meeting in 2016 Error! Hyperlink reference not valid.
Is there any other information?
This service is seen locally and nationally as an innovative approach to supporting the mental health needs of a vulnerable and over looked group who can find it difficult to access help. Early intervention (defined broadly) is provided by an innovative and exciting bespoke psycho educational programme, part of a broader range of psycho educational courses which is inclusive and tailored to the needs of the individual. Participants are helped to move forward in their recovery journey developing skills around self-management, learning ways of addressing stigma, finding helpful and sustaining activities and occupation, addressing physical health, using creative arts as a means of therapeutic input and developing peer support networks to sustain ongoing support and growth.