Focusing on the positive difference local resources and people could make to improve mental health outcomes for children and young people, rather than deficiencies in the system, proved an invaluable experience and lead to system changes at a strategic and operational level in Hull.
Mental health services in Hull traditionally focused on mental illness and crisis intervention. This resulted in long waiting lists for clinical services and a large number of young people being referred to clinical services for low level mental health concerns, such as anxiety and low mood. A lack of early intervention and prevention services was stretching the system, and was not responding to the needs to children and young people.
Partners from across the system recognised that there needed to be a whole system, asset based approach at a universal and early help level; which focused on giving young people the skills and knowledge to cope with life’s challenges and look after their own mental wellbeing.
While this work was led by the council’s Early Help and Commissioning Team, there was exceptional partner commitment from the very beginning. Partners such as school (teachers and governors), youth services, voluntary and community sectors and health organisations were vital to the success of Headstart Hull.
Understanding the needs of young people was the number one priority, and they undertook consultation with over 1300 young people aged 10 to 19. The consultation helped professionals to understand the main issues impacting on their emotional health and wellbeing. Taking the asset approach further, the consultation also identified what young people thought ‘good’ support would look like, how they wanted to receive it and from whom.
To further build on the consultation, smaller focus groups of young people were held in schools and in youth centres to shape the initial findings. Consultation also took place with parents to understand their concerns.
In addition, through a series of events, a real understanding of the challenges facing partner agencies was developed, as well as the contribution that all could make to addressing issues. The response was overwhelmingly positive, especially from schools who understood that poor emotional wellbeing impacted on wider issues, such as school attendance and attainment.
Using the ‘Theory of Change’ transformational model, Hull used the insight they had gleaned from their engagement activity to refine the approach that they took to improving services. It was also used to create HeadStart Hull’s vision of ‘enabling children and young people to have positive mental health and wellbeing, thrive in ‘their Communities’ and to ‘bounce back’ from life’s challenges’.
The results of the consultation and subsequent service redesign informed a two-year pilot which ran across 10 primary schools and three secondary schools. The pilot involved testing out a range of interventions (universal and targeted); and included a new personal, social, health and economic (PSHE) package in primary schools. This provided training for school and community based staff to improve their confidence and skills to discuss mental health issues with the young people they worked with. The pilot also had several targeted interventions, including peer mentoring for young people and for parents, group work and counselling.
HeadStart Hull provides a scaffold of support based on the following five assets:
- a ‘Trio of Trusted Adults’ – in the school, community and at home
- aspirations for the future – children and young people and family
- confidence and self esteem
- positive peer networks – friends they can rely on and support each other
- stronger family networks.
The pilot was a success; and when evaluated showed an improvement in emotional health and wellbeing outcomes for the young people involved. Headstart Hull used the ‘Outcome Star’ model of evaluation, which enabled the young person or parent to set their own goals relating to improving emotional health, reducing risk factors, increasing protective factors and be able to measure the progress following the intervention. As well as improvement on the presenting issues, the evaluation also showed that the new way of working had led to some young people not now needing the clinical mental health services, that they had waited so long for.
The evaluation and findings from the pilot, together with further consultation with partner organisations and young people, informed the basis of the five-year HeadStart Hull model which after further development is now being rolled out across the city. The model builds on the universal approach of good personal, social, health and economic support, and good training for staff across the partnership. It provides a menu of targeted interventions for young people and for parents to reduce risk factors and improve protective factors. There is also an app for young people, designed by young people to help them access safe, reliable information and support online.
Demonstrating local leadership and accountability
The governance arrangements for HeadStart Hull are underpinned by Hull’s existing and well established multi-agency governance network. It forms a key part of the children, young people and families’ elements of Hull’s Health and Wellbeing Strategy (specifically the Best Start in Life outcome). This puts HeadStart Hull at the centre of local decision making about children, young people and families services.
The HeadStart Hull Partnership Group’s purpose is to deliver the HeadStart Hull vision by leading the implementation and delivery of HeadStart Hull, against the agreed model. It is also accountable for the monitoring of the programme’s financial plan. Working closely with the Children and Young People’s Mental Health and Wellbeing Transformation Plan Group and the Early Help Partnership enables a joined up approach, ensuring that HeadStart Hull is embedded within the Early Help offer and a key component of Hull’s transformation plan.
An Operational Delivery Group addresses operational issues and removes barriers to enable for effective and efficient delivery. It also provides a space to ensure effective communication and joined up working between HeadStart Hull partners and other key external partners, to maximise outcomes for children, young people and their families in receipt of HeadStart Hull services.
Headstart Hull was part of a national funded pilot (Big Lottery Fund) and as such had the capacity to lead in this. However, the key to its success was that from the beginning there was a commitment to ensuring HeadStart was an integral part of the overall early help delivery model for supporting children, young people and families, and not delivered or perceived as a separate and isolated programme.
In addition to this commitment it was also essential to build new capacity and skills across the early help delivery system so that the outcomes and activities become part of ‘the way we do things in Hull’ or ‘everybody’s business’.
Leadership planning for sustainability was based on three separate, but interlinked themes that will deliver change across the city:
- cultural: a real system change in delivering early help interventions and wellbeing support across all services
- financial: understanding the value in prevention services, making a real shift in where money is invested
- political: local leadership, leading the way.
Headstart Programme Manager, Hull City Council
This case study, written by Su Turner of Insight to Impact Consulting Ltd, is taken from the forthcoming LGA publication ‘Lessons in local leadership and accountability for children’s mental health services’.
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