Mind and Body – Addaction

‘Mind and Body’ (MAB) provides a structured intervention for young people aged 13 to 17 years inclusive who are involved in or deemed vulnerable to self-harming behaviours :-Primarily delivered in schools, the programme format is as follows; Initial assembly and screening process; Pre-programme one-to-one meetings; Six one hour groups sessions (held once or twice a week); Post-programme one-to-one meetings Following a gap of approximately two months …;Two additional group sessions; Exit-programme one-to-one meetings

http://www.addaction.org.uk/help-and-support/young-persons-services/mind-and-body-programme

WINNER - CYPMH AWARD - #MHAWARDS18

Co-Production

  • From start: No
  • During process: Yes
  • In evaluation: No

Evaluation

  • Peer: No
  • Academic: No
  • PP Collaborative: Yes

Find out more

 

Overview

‘Mind and Body’ (MAB) provides a structured intervention for young people aged 13 to 17 years inclusive who are involved in or deemed vulnerable to self-harming behaviours :-Primarily delivered in schools, the programme format is as follows; Initial assembly and screening process; Pre-programme one-to-one meetings; Six one hour groups sessions (held once or twice a week); Post-programme one-to-one meetings Following a gap of approximately two months …;Two additional group sessions; Exit-programme one-to-one meetings

The programme begins with an initial assembly to introduce the programme and explain how MAB works. To offer context, the facilitator highlights mental health as a growing issue of concern for many young people but something that is often still not spoken about due to fears around stigmatisation.

Young people are invited to take part in an online survey exploring aspects of their life and general wellbeing. Whilst they are not directly asked if they self harm, respondents may give information which identifies them as potentially vulnerable to self harming behaviours. These young people are then invited to a one-to-one meeting with a practitioner, at which their appropriateness for MAB can be assessed.

Risk assessments identify those in need of more specialist support. The process has identified a high number of individuals with suicidal ideation or intent for whom CAMHS referrals would be made instead. There are often first time disclosures elicited by MAB practitioners, uncovering risks that would otherwise have been unknown.

Young people accepted on to MAB are placed into small groups where they are able to explore the topics of mental health and self harm without being judged or stigmatised. Whilst not normalising self harm as a behaviour, we do seek to normalise talking honestly about mental health and as the programme develops, young people are able to realise they are not the only ones experiencing difficult thoughts and emotions.

Session content progresses from more broad discussions into exercises that look more at the specific behaviours employed by group members, allowing exploration of more positive distractions and diversions. Groups practise mindfulness and breathing strategies, they look at building more positive ways of communicating, they identify triggers and ways in which these can be managed, and they do all of this together, sharing ideas and empowering each other to make these changes.

At the post and exit meetings, young people complete the same paperwork as at the initial one-to-one, which act as both therapeutic tools and outcome measures. These include a timeline follow-back (TFB) which looks at participants’ behaviours (relating to self harm thoughts and actions, drug and alcohol use and sexual activity) in the past 28 days. The Short Warwick-Edinburgh Wellbeing Scale (SWEMWBS) is also completed at each interval. Participants are therefore able to identify areas of need but can also see where they are making positive progress as time goes on. As evidenced by the independent University of Bath evaluation released last year (https://www.addaction.org.uk/sites/default/files/public/attachments/mind_and_body_impact_report_2017.pdf), MAB has achieved excellent outcomes:

1. MAB results in an efficient identification, referral and support for young people engaging in self-harm and/or risk-taking behaviour.

2. MAB had a positive impact on young peoples’ awareness, thoughts, feelings and behaviours:

• 81% of the young people experienced a decrease over time in self-harm thoughts or did not think about self-harm at all whilst they engaged in the programme.

• 91% of the young people experienced a decrease over time in self-harm actions or did not engage in taking action at all whilst they engaged in the programme.

3. MAB had a positive impact on young peoples’ mental well-being. We are looking to extend MAB delivery across more areas in the future so more young people can benefit from this.

What makes your service stand out from others? 

MAB has been described by Dr Pooky Knightsmith (Vice Chair of the CYP Mental Health Coalition) as a “pretty revolutionary programme”. Whilst interventions around mental health and self harm are not new, using therapeutic group environments to address this issue at an early stage is innovative and has been very powerful for those involved.

Participant feedback clearly states this element was hugely beneficial as many had not felt able to speak openly before. Activities themselves are highly creative, with participants developing their own diversions and distraction techniques such as making self-soothe boxes or aromadough to aid their wellbeing. 

We believe the successes of MAB relate to the innovative group sessions and important roles played by the young people themselves, as the chance for participants to hear from others is invaluable in reducing feelings of stigma and isolation. The process, although initially challenging, empowers young people to build their confidence and collectively develop more positive coping strategies than those they may previously have employed. One element of the programme involves participants creating something that will inspire other young people to feel less isolated or stigmatised when it comes to mental health. Last year at the Turner Contemporary in Kent, MAB held an exhibition of pieces of art, sculpture, photography and animation to promote this message. There were over a thousand visitors across the August Bank Holiday weekend: https://www.youtube.com/watch?v=U9TKSvIDKRo 

Young people have also been involved in making films with this is mind, one of which (which focused on male mental health) was shortlisted for the 2017 Charity Film Awards. Examples of our films can be found here: 

https://www.youtube.com/watch?v=OIn-YfqUEvA

https://www.youtube.com/watch?v=Lg9aO-f81w8 Indeed, young people have played a key role in the development of MAB since its inception. Examples include:

    • Young people have consulted on programme length and content, and were pivotal in steering MAB from a four to an eight session programme.
    • • All interview processes feature at least two Mind and Body participants on panels.
    • • Participants spoke at our 2017 National Young Persons’ Conference at The Oval and ran workshops on mental health and adolescent self harm.
    • • Young people have co-chaired Public Health England takeover days.
    • • Participants have taken part in a number of interviews with journalists to promote the cause(BBC World, 5 Live, regional news), an example of which can be found here: https://www.addaction.org.uk/news/rick-and-will-mind-and-body-program-chatted-bbc 

MAB was the winner of Addaction’s co-production award last year.

Staffing

How do you ensure an effective, safe, compassionate and sustainable workforce?

This begins with our recruitment process. All shortlisted applicants go through a multi-faceted process where their skills and knowledge is assessed, especially in relation to safeguarding and relevant experience. Perhaps most importantly, candidates are required to deliver a session to young people who’ve previously been through MAB so that we can assess whether they have the necessary attributes to engage with young people on this topic. The young people’s feedback and scores are a vital part of the process and often determine who we go on to recruit.

Once in post, MAB practitioners go through an induction process where they are schooled in programme delivery, observing other practitioners and helping to co-facilitate groups once this is deemed to be appropriate. During this time they also undertake internal mandatory training, with a wide range of safeguarding modules as well as relevant therapeutic interventions (such as motivational interviewing and cognitive behavioural approaches) and specific courses on self harm and suicidality. Once we feel they are ready to begin delivery, their sessions will initially be supported by their line manager and other senior members of staff.

MAB practitioners are able to access a range of ongoing support to ensure that delivery is effective and safe. Line management meetings are held every four weeks where caseloads are discussed and safeguarding cases reviewed in conjunction with our clinical lead. Practitioners have individual clinical supervision every six weeks and attend group supervision sessions with colleagues every six weeks too. In addition, practice development sessions also run every six weeks where the whole team meet together for a day to review different elements of our delivery and training sessions are also booked on these afternoons. Team meetings are held on a monthly basis where we review any relevant issues appropriate to that forum and safeguarding is s standing agenda item to allow us to discuss any cases, policies or research that are pertinent to our work.

Monthly hub meetings are attended by managers to review all incidents that have been raised during that time. This is a forum in which managers and clinical leads meet to review cases to ensure that correct practices are being followed. Learning from these meetings is then cascaded down to the staff teams. 

Practice is also monitored through live observations with a minimum of two being undertaken by managers each year. (Peer shadowing and observations also take place frequently.) Audits are embedded into line management sessions and themed management and peer audits review clinical notes and practice on a quarterly basis. Feedback is also collected from participants, family members and partner agencies through anonymised surveys. 

A big focus for the management team is to ensure that the MAB teams are an enjoyable place to work. Some of the disclosures made to our practitioners can be challenging and we promote the importance of group check ins and peer support. We also ensure that time is booked out for team days where practitioners are away from the office and can strengthen bonds with colleagues over activities like cookery, pottery and zoo-keeping! It is written into practitioner manuals that they are not allowed to work beyond 18:00 to ensure that they practice self-care and so they can be boundaried in not taking work home with them.  The self care section of our handbook covers additional topics such as diary management, taking breaks, peer support, management support and the sharing of good news stories across the team.

We know that some of our staff team have lived experience of mental health difficulties, past and present. Practitioners are not obliged to talk to us about this but it is made clear that they can do if the so wish so that we can support them as best as possible. If they feel unable to speak with a manager or supervisor directly, Addaction has an Employee Assistance Programme which is free to access and allows them to chat to somebody independent if this is useful.

As well as the training, previously covered, some staff members are also undertaking additional courses or qualifications, such as counselling and through Anna Freud’s CYP IAPT initiative. We always look to offer flexibility for staff so that they can pursue such opportunities as we believe it benefits our team and the young people we work with.

In Addaction’s anonymous staff survey, carried out at the end of 2017, MAB achieved an employee engagement score of 98%, putting it in the top three of the nearly one hundred services across England and Scotland. Staff retention has also been good in spite of the short-term nature of contracts that we have been working under.

 

Who is in your team? 

I am the Operations Manager for MAB at a national level and we have Team Managers and Team Leaders who pick up line management of practitioners. In addition, we have two Senior Supervising Clinicians who oversee the clinical case management decisions for our young people.

Because MAB is an early intervention service, there is no requirement for us to employ clinical psychologists at all levels, although our Senior Supervising Clinicians are qualified as such. Our practitioners instead come from a range of backgrounds including pastoral care within schools and colleges, substance misuse practitioners, youth offending teams, family intervention workers, play therapists, occupational therapists, as well as those with other mental health qualifications and experience. What they all have in common is the ability to engage with young people who may be anxious to talk about their problems, whether linked to mental health or not. With the right support and training in place, they are able to help participants achieve great things and we are lucky to have a skilled and dedicated workforce across our MAB teams. 

As acknowledged in the recent Green Paper on CYP Mental Health, skilled staff teams are able to produce outcomes which are just as effective as practitioners who may be more qualified on paper. Our teams can be more cost effective because of the way we recruit and this allows us to see a greater number of young people as a consequence.

 

Working together

MAB promotes partnerships between participants, their families, schools, partner agencies and the wider local community, improving the wellbeing and resilience of young people. Programmes are set up to ensure coverage of all areas where MAB is commissioned.

The initial assemblies are clear to explain that mental health issues are nothing to be ashamed of and that it is important to talk openly about this. This message is extended to staff as well as students and information about useful organisations and support is disseminated to those attending. This same ethos is central to presentations made to partner agencies and at local community events. 

We have provided partner agency training on e-safety and self harm, including related first aid information.  We also run sessions on how best to support young people around self harm to groups including schools, family members (including a specific package in Kent for foster carers),  and other local community partners.

Support is available for parents and carers and in Kent there is a dedicated family worker offering telephone and face-to-face support, plus family group sessions similar to the young people’s programmes.

In both Kent and Cornwall, MAB operates a referral programme for community delivery. This programme operates in exactly the same way as the school-based programmes, the only difference being that rather than being identified through a screening tool, young people are referred in to us from agencies including CAMHS, Early Help, schools and GPs. 

It is not uncommon for young people referred to MAB from specialist CYP mental health services (because they are believed to be lower risk) to be referred back to CAMHS because we have been able to identify risks that did not come out during CAMHS assessments. We have found that CAMHS are receptive in accepting these referrals given that they know our programme and have a professional trust in the judgment or our practitioners.  

In each locality, we attend partnership group meetings and deliver presentations to relevant colleagues so that they know who we can work with and how young people and their families can access our services. In Kent, we hold professionals’ forums on a six monthly basis in conjunction with our colleagues in Addaction’s substance misuse services. These take the form of half day mini-conferences where we able to highlight the work we do and give a space for networking for both statutory and voluntary sector agencies. Our most recent events this month attracted nearly two hundred attendees.

 

Do you use co-production approaches?

Some of our co-production elements were covered in an earlier question and as mentioned we won Addaction’s award for this last year.

A good example of this is the workbook that has been developed to support young people going through MAB. We received feedback from attendees at our regular focus groups that they would like something that they could take away from groups, something they could work on in between sessions.

Last summer, we had a working group made up of MAB staff and participants who pulled together a 48-page workbook to guide people through the programme. Young people were able to guide us as to the look, size and feel of the book as well as the content. It is now something that every young person is given when they begin the MAB programme.

The workbooks link to the session content, giving summaries of some of the key messages that are given. There is space for young people to write or draw things that are most relevant to them, including goals or things they would like to work on. The book contains distractions and diversions that can steer people away from self harm and has guides to mindful activities. (The book also contains mandalas that the young people can colour in during or outside of sessions.

Feedback has been great and we feel it has been a very positive addition to the programme. 

We are conscious that co-production must be a live process and we continue to have Young Ambassador group meetings on a regular basis to explore new ideas. We are also keen to improve the co-production for our family work which has been funded more recently as we know there are opportunities to improve in this regard.

 

Do you share your work with others? 

We are very keen to promote the work that we do so that ideas of how young people can be supported around self harm are highlighted. Part of the reason for submissions such as this is to raise the profile and evidence the need for this type of work.

We have been able to promote our learning from MAB at a range of local and national events. Whilst we do not share the exact session plans and delivery guides for our work, we are very open in discussing the structure of the programme and over-arching session content. 

The films made with young people are one way in which we look to raise awareness of this work and I know these films have been useful resources for others, being used in schools for PSHE delivery and by other youth service organisations. 

We have tried to embrace online opportunities, not just through the films we mad but through blogs about our work and what we have been seeing. Examples include:

https://www.addaction.org.uk/blog/using-creative-interventions-support-young-peoples-mental-health

https://www.addaction.org.uk/blog/young-peoples-data-highlights-need-for-more-mental-health-support

We have used the survey results to present infographics (such as in the link above), highlighting the concerns raised by respondents.

The data can be used to promote open discussion with commissioners and specialist services, highlighting the need for improved funding and provision in these areas. Such conversations take part as part of regular meetings of the CAMHS Transformation Groups which we attend to ensure there is clear dialogue with partner agencies.

MAB feeds in to the local transformation plans and processes are in place to ensure data collected can feed into the NHS mental health dataset.

The publications linked to MAB are freely available on our website  https://www.addaction.org.uk/sites/default/files/public/attachments/mind_and_body_impact_report_2017.pdf and here: http://sheu.org.uk/sheux/EH/eh342rb.pdf 

 

Outcomes and evaluation

At the pre, post and exit one-to-one meetings, young people complete the same paperwork which act as both therapeutic tools and outcome measures. These include a timeline follow-back (TFB) which looks at participants’ behaviours (relating to self harm thoughts and actions, drug and alcohol use and sexual activity) in the past 28 days. We also use the Short Warwick-Edinburgh Wellbeing Scale at each interval. 

As evidenced by the independent University of Bath evaluation released last year (https://www.addaction.org.uk/sites/default/files/public/attachments/mind_and_body_impact_report_2017.pdf), MAB has achieved excellent outcomes:

1. MAB results in an efficient identification, referral and support for young people engaging in self-harm and/or risk-taking behaviour. The screening survey and the initial assessment session identified a number of young people who were “under the radar” of being at-risk. Focus groups reported enthusiastically about how the programme enabled young people’s individual needs to be identified and addressed once they engage in the Mind and Body programme.

2. MAB had a positive impact on young peoples’ awareness, thoughts, feelings and behaviours:

• 81% of the young people experienced a decrease over time in self-harm thoughts or did not think about self-harm at all whilst they engaged in the programme.

• 91% of the young people experienced a decrease over time in self-harm actions or did not engage in taking action at all whilst they engaged in the programme.

3. MAB had a positive impact on young peoples’ mental well-being with 73% of young people experiencing an increase in their mental wellbeing.

What has been most encouraging about our outcomes is that whilst we see improvements between pre and post intervals, exit outcomes are even stronger in spite of only two sessions being held between post and exit stages. This indicates that positive changes are being maintained by young people over several months and they are not reliant on interaction with their practitioner for this to be achieved.

We have more recently introduced a measure where participants rate whether they feel more able to manage risks relating to self harm since starting the programme. The most recent data for this has shown that more than 92% participants feel that this is the case.

We also look to capture qualitative data and young people complete a questionnaire at their post programme meetings in conjunction with their practitioner. We have found this a very valuable exercise to help summarise the improvements made by young people during their time on MAB.

Participants are also asked to complete an online evaluation tool at the end of the programme; this is anonymised and gives an opportunity for honest feedback which young people might not feel comfortable sharing with practitioners but may offer us learning opportunities.

 

Has your service been evaluated (by peer or academic review)? 

Yes. We believe it is important that interventions are based on what is known to be effective. Mind and Body developed out of the RiskKit programme, the evaluation for which can be found here: https://www.tandfonline.com/doi/abs/10.3109/09687637.2013.787526?journalCode=idep20 

As mentioned, MAB has been independently evaluated by a team of researchers at the University of Bath: https://www.addaction.org.uk/sites/default/files/public/attachments/mind_and_body_impact_report_2017.pdf 

We are now exploring future opportunities for a comparison group evaluation and our ultimate aim is to gain funding for a randomised control trial.

Whilst we are not CQC registered, Addaction has its own internal audit term who inspect services to ensure that they operate safely and effectively. Our last audit was held three months ago and received positive feedback.

 

Development and sustainability

MAB has been developed to be replicated and rolled out across a number of areas. The programme benefits from a practitioner manual featuring all session plans and resources. An online training induction package is also in place. Information packs for partner agencies are available along with summary reports that evidence MAB’s efficacy. A bespoke database is in operation which can be used across all services.

The prevention / early intervention nature of the programme, combined with participants’ roles in promoting mental health discussion across wider cohorts, should ensure longer term wellbeing-related benefits for communities where MAB is delivered.

In relation to ongoing funding, we have regular contact with commissioners in each area and are required to give quarterly updates about our outputs and outcomes. We always strive to deliver more than we are commissioned to and elements such as our films, workbook, exhibitions and media work with young people have been able to highlight the effectiveness of what we do. With a tricky funding landscape over the past few years, it is imperative that service providers can demonstrate that what they are doing is effective. 

We are liaising with commissioners to look at contracts being extended in length as we believe short-term contracts can create anxiety amongst staff teams and create uncertainty amongst local partners in terms of knowing which services will be around and for how long. The outcomes that we have achieved since MAB was commissioned have allowed us to demonstrate the effectiveness of what we do and four of the seven Kent CCGs have since confirmed funding for MAB through to 2021.

We have a broad management structure which ensures we are not overly reliant on any individuals in case of management changes. Whilst I head up the programme, we have Contracts Managers in both Kent and Cornwall who also have positive relationships with the local commissioners. With overarching clinical leads and local Team Managers and Team Leaders at a local level, we are in a strong position should we face any unforeseen circumstances.

 

What aspects of your service would you share with people who want to learn from you? 

We recently delivered a workshop around MAB at a self harm conference in Bournemouth. The theme was ‘Helping young people to help themselves’ and focused on why we must openly discuss adolescent mental health, and sharing information on strategies and resources for young people as well as how professionals can develop their own knowledge.

The key message was that we should encourage open discussion about mental health with young people. Too often, there is an anxiety with self harm in particular that speaking about this can trigger behaviours. Our experience is that if you can create a safe space for young people, hearing from others and starting dialogue can be hugely important. So many of the young people we work with have spoken about their fear of opening up but giving them the right environment and equipping them with the tools to engage with others has proven to be very empowering. In the words of one of our young people:

“It makes you realise that other people are similar to you when you think they’re not. It’s good to open up to people and share views and experiences.”

That said, discussions around these topics need to be managed carefully. Here is a link to a clip that highlights the key points which we feel are important to share: https://www.youtube.com/watch?v=g7L_h7YUJMk 

 

 

Access 

How many people do you see?

Over the past year, survey and screening information was collected from 8,440 young people, all of whom received information and advice about emotional wellbeing. 

622 young people participated in MAB programmes.

As well as those completing MAB, a further 612 young people received one-to-one information, support and guidance from our practitioners

Groups are generally comprised of five or six young people; we believe this allows them to have their voice heard in these settings but they have others who they can listen to and learn from as well.

Unfortunately, I have been unable to get information on our website visits and downloads. We currently have 663 Twitter followers (@_MindandBody) and thousands of people have seen our films by young people. Our film on adolescent male mental health has 1,615 views.

 

How do people access the service?

MAB works collaboratively with schools, Early Help and specialist mental health services to promote effectiveness of interventions. The use of a survey identifies young people who are often not known to be at risk and who aren’t engaged with support they may require. For school-based services, young people are invited to meet with our practitioner if their survey results indicate they may be relevant for our service. Questions are weighted so that those at potential risk are identified. Young people are also given the opportunity to request a meeting with the practitioner and school staff can suggest people for the programme if they think they would benefit from input.

Group work encourages sustainable support networks and reduces isolation. This is particularly evident for NEET participants accessing community groups. 

MAB is delivered where most needed (determined through PHE, CCG and CAMHS data) but as per the Marmot Review, does not solely target disadvantaged populations. MAB is open to all schools, including academies and grammar, where students may face different pressures. 

MAB can also be accessed via community groups in Kent. Community referrals are currently accepted from specialist mental health services, Early Help, schools and GPs. Young people contacting us directly would also be invited for an assessment.

Sessions are held in local community settings and young people are given options as to which location they would like to attend. They are not expected to travel to our service centres.

Those referred in to community programmes are seen within four weeks, meeting the guidance outlined in the recent Green Paper. 

There is no cost to access MAB.

 

How long do people wait to start receiving care? 

Initial one-to-one meetings in schools will be held in the fortnight after the screening takes place. Young people can indicate on their screening survey if they would like to be seen more urgently and this would be done within two working days.

Those referred in to community programmes are seen within four weeks, meeting the guidance outlined in the recent Green Paper. 

It is worth emphasising that MAB is an early intervention programme and it is made clear on all correspondence that we are not a crisis care service. All participants are given a prompt card at their first meeting which directs them to phone and online support as well as information on local services in case of emergencies. 

 

How do you ensure you provide timely access?

MAB delivery is planned several months in advance so we are able to stagger programmes accordingly. If a large number of young people are identified by a survey, we are able to draft support in from other local MAB practitioners so that the pre-programme assessments can take place within an appropriate time period. Those scoring highest on the surveys are prioritised and seen first.

In terms of community referrals, these are triaged by phone if there is uncertainty about whether a young person might be appropriate for the service. Those referred in to community programmes are seen within four weeks of the referral being received, meeting the guidance outlined in the recent Green Paper. 

We have managed to increase staffing levels in our Kent team in the past six months, with commissioners funding an extra community worker and a family worker to help us manage capacity.

 

Advancing mental health equalities

What is your service doing to identify mental health inequalities that exist in your local area?

MAB is delivered where most needed (determined through PHE, CCG and CAMHS data) but as per the Marmot Review, does not solely target disadvantaged populations. MAB is open to all schools, including academies and grammar, where students may face different pressures. MAB can also be accessed via community groups in Kent. There is no cost to access MAB.

We are working closely with data leads within the local CCGs to help identify which populations are most in need of support and look to tailor our offer to meet the demands of these cohorts. We link in with specialist services and Early Help hubs to ensure that young people identified as being most in need can access our service.

We are also now feeding in to the NHS Mental Health Data Set so that the young people with whom we work will now be contributing to learning through this avenue.

 

What inequalities have you identified regarding access to, and receipt and experience of, mental health care?

The main issue we continue to identify is that there are a number of young people who are falling in between the gaps of available services. Young people who present with needs too complex for our type of intervention are often still not meeting the thresholds of specialist services. (Examples have even included young people who have had recent suicide attempts within the past month.) We keep a log of such cases so that this can be fed back to our commissioners.

We have also found that our service is unable to best support young people on the autistic spectrum, primarily because they may not function well in the group settings in which MAB operates. Again, there seems to be a lack of appropriate support for these cohorts in the wider community.

 

What is your service doing to address and advance equality?

Addaction is an open and transparent organisation; our policies and practices are created and modified in close alignment with the Equality Act 2010, Human Rights Act 1998, Public Sector Single Equality Duty 2011. It is a core policy to ensure that staff, job applicants, volunteers and those that use our services are treated fairly, in an environment which is free from any form of discrimination. Everyone associated with Addaction has a responsibility for the promotion and advancement of this approach. 

Addaction integrates consideration of equality and diversity into the design and delivery of all of our services. As part of this work at a national level, Addaction has established an Equality and Diversity Group with the aim of providing support, training and tools to services to fully integrate equality and diversity considerations into their everyday work. 

The Equality and Diversity group assists in establishing routine monitoring across the organisation to review service outcomes and inform decision making. This monitoring is extended to service engagement, and demographic data is routinely reviewed to ensure all participating groups are accessing project opportunities. The data informs the creation of project outcomes, and any necessary alteration in delivery practice.

Addaction’s approach to equality analysis is in line with NICE. Our NICE incorporated approach embeds a systematic culture of using equality impact assessment principles in designing services or in decision making. Embedding this work demonstrates our compliance with the Equality Act 2010 including the Public Sector Equality Duty.

Addaction balances targeted services for key groups within a ‘whole person’ approach which does not assume that an individual’s personal characteristics define or limit them. Equality and diversity feature at induction and on-going development of the staff team, including:

● Equality and Diversity e-Learning/refresher courses

● Key skills for therapeutic alliance/engagement/motivation

● Volunteer specific Equality and Diversity training

We actively monitor our caseloads to identify under-represented-groups and groups whose outcomes are less favourable. MAB specifically targets key schools who have an evidenced need for the programme.  We also work with school staff in order to directly target those young people who would benefit from the intervention but may otherwise not engage. The use of a screening tool has also helped to identify those who may not have had the confidence to seek out support but who were very much in need of it.Our whole ethos is geared towards reducing stigma around mental health and raising awareness amongst young people that experiencing difficulties in this regard is not something to be embarrassed or ashamed about. Our media work and involvement in films, conferences and events are testament to this.

 

Assessing needs and providing care

How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?

Young people are asked to complete a short online survey which identifies any risks of self-harm. The survey acts as a screening tool, and has been developed in collaboration with The Training Effect. It focuses on five key areas of a young person’s life where their experiences or views can be indicators of current self-harm and of potential for self-harm in the future. The five areas are:

• Gender

• Wellbeing and personality

• Exposure to self-harm

• Social experiences and behaviours

• School experiences and views

Practitioners use evidence-based measurement tools to benchmark and measure progress of each young person attending the structured programme which includes: 

●The Timeline Followback (TFB): The main outcome tool used to track the behaviours undertaken by participants and provides data which can demonstrate reductions in the various risk behaviours which are measured against.  Areas covered include Substance Use, Self Harming Behaviours, Relationships and Sexual Activity, and the Ability to keep safe.●The Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS): The main outcome tool used to track the mental wellbeing of participants and provides complex data, beyond recording simply the behaviours being employed by young people on the programme.

 

How do you meet the needs of people using the service and how could you improve on this?

MAB is a fully evaluated and evidence based programme. In addition to our contribution to the evidence base, we apply latest research, national guidance and accepted good practice across all our delivery. Our staff operate with the help of version-controlled policies and standard operating procedures reflecting the wider national regulatory frameworks e.g. NICE, PHE, CQC. We use modules for best practice interventions and conduct outcome evaluations. As a learning organisation, Addaction ensures that every opportunity to drive improvement is captured and shared across the whole organisation. Lessons learned are used to maintain the organisation’s appetite for continuous improvement to be safer, more effective, responsive and well led. 

Commissioning, research such as our MAB research is one example of our commitment to developing, and working to, the evidence base. Addaction uses both formal research and good practice guidance as a bases for all approaches, but also collects feedback and monitors outcomes locally, ensuring services consistently meet set objectives. This is achieved through a comprehensive performance framework which outlines project outcomes, commissioner expectations and consultation feedback, facilitates effective performance management and allowing us to amend and adapt delivery according to need. 

MAB complements a range of NICE guidelines including; Social and Emotional Well-Being in Secondary Education (PH20); Self-harm in over 8s: short-term management and prevention of recurrence (CG16) and Antisocial behaviour and conduct disorders in children and young people: recognition and management (CG158); and also supports a range of national initiatives. The MAB programme is also featured within Public Health England’s ‘Measuring and monitoring children and young people’s mental wellbeing:
A toolkit for schools and colleges’. 

The foundations of Mind and Body has been based on a wide range of published research, as outlined within our 2017 Impact Report. On an ongoing basis, Addaction has a dedicated Knowledge Management Team who review changes in legislation, newly published guidance, and information on emerging trends, ensuring all policies, procedures and approaches are appropriate and up to date. This is filtered via monthly updates and communication through Regional Governance Hubs, ensuring any changes in legislation and practice are implemented operationally. 

Throughout delivery of the Mind and Body programme, our Knowledge Management Team will be on hand to ensure delivery meets best practice. Furthermore, local information gathering, outcome monitoring and feedback systems will ensure the programme is delivered in-line with local requirements. These will include:

●Regular meetings with commissioners before implementation and throughout delivery, ensuring the programme compliments local strategy and targets relevant populations●Regular communication with stakeholders, including participating schools, safeguarding teams, GPs and children’s service providers, ensuring the programme meets the holistic needs of local young people●Regular communication with parents and carers, ensuring the programme meets individual family needs●Feedback from individual young people and groups, allowing for the interventions to be tailored according to the specific needs of the young people involved ●A performance management framework which includes monthly monitoring ensuring anticipated levels of engagement and outcomes achieved●The use of the short Warwick and Edinburgh tool (SWEMWBS) and Timeline Follow-back tool (TFB) to assess distance travelled by the young people engaged on the programme●Ongoing evaluation of the programme

The ongoing evaluation of the programme allows us to ensure that we can build on what we achieve by making any changes that might benefit those taking part in the future.

 

What support do you offer families and carers?

MAB works directly with the young person. As part of the core programme, parents and care-givers of the participating year group are notified of a young person’s potential involvement. Should they require additional information, MAB workers are available to speak to parents and care-givers and offer links to further resources.

The programme encourages young people to develop positive communication strategies with parents and care-givers, to share their MAB workbook, and discuss progress. Where it is required that we share information with parents and carers (such as if safeguarding concerns arise), we work with the young person to manage these discussions in a way that they would feel most comfortable.

In Kent, we are commissioned to deliver family interventions as part of MAB. We have included the impact report conducted in relation to this work as an appendix.  

 

Further information

We are proud of what is being achieved through MAB in different parts of the country. It would be great if we could work with you to raise the profile of this intervention and the importance of addressing adolescent self harm at an earlier stage.

 

Hours the service operates: Monday to Friday 09:00 until 17:00

Brief description of population

Mind and Body is commissioned to support young people aged 13 to 17 who are involved in or deemed vulnerable to self harming behaviours.

We are able to work with any young person across Kent and Cornwall who meets the above eligibility criteria.

 

Commissioner and providers

Commissioned by (e.g. name of local authority, CCG, NHS England): Kernow CCG and all of the seven Kent CCGs

Provided by (e.g. name of NHS trust): Mind and Body is delivered by Addaction

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