Supporting the mental health and wellbeing of care leavers: Learning from good practice

[Intro] 

This is a Research in Practice podcast, supporting evidence-informed practice with children and families, young people and adults.

Fidelma: Hello, I'm Fidelma Hanrahan from Research in Practice. This podcast is part of a series exploring support for care leavers' mental health and wellbeing. In our other podcasts, we hear from care-experienced young people who tell us what they think is needed to improve support for care leavers' mental health. We also hear from a researcher about the national picture when it comes to mental health support for care leavers and, finally, we hear about good practice from people working with care-experienced young people to support their mental health and wellbeing. Good practice is the focus of this podcast where I'm speaking to Rachel Shaw and Clare Bayliss from Northamptonshire's Children's Trust, where Rachel is team manager for the Leaving Care team and Clare is advanced mental health practitioner for care leavers. We'll be hearing from Rachel and Clare about the service they run to support care leavers' mental health. Rachel, Clare, really lovely to have you with us.

Clare: Thanks very much.

Rachel: Thank you for having us.

[An overview of the Northamptonshire Leaving Care team] 

Fidelma: So, Rachel, I suppose I might start with you as team manager, can you tell us, I suppose, broadly about the service in Northamptonshire and how it came about?

Rachel: Yes, so, we did a bit of research looking around at what care leavers wanted and what kind of services we could put in place that might improve outcomes for them. It quickly became apparent, so bearing in mind this is 2020 and we've got lots of COVID and restrictions going on, that mental health was a key factor for them and trying to access the right support was very difficult. So, we managed to get a successful bid from public health and put together a team which involved a project manager, data collection, a mental health practitioner, a forensic psychologist and two of our care-experienced young people that we employed full-time onto the project as well, who did an apprenticeship with us. Yes, the team was formed and that project ran for two years. Public health saw the success at the end of December '22 and the project was extended until December 2023. Here we are, early '24, and Clare is still in post, so we are going forward bit by bit.

Fidelma: That's great to hear, because, of course, you mentioned there that in talking to care leavers you realised that mental health was really a big issue.

Rachel: That's right, yes.

Fidelma: Yes, and so, of course, that's mirrored in research that has highlighted that when in care, young people report lower life satisfaction and lower wellbeing compared to young people more generally. So, that's Coram's Bright Spots programme. They report 10,000 voices and, of course, there's no statutory duty for local authorities to provide emotional wellbeing services to care leavers.

Rachel: A strong reliance with universal services and increasingly they're finding that difficult to access.

[Barriers to accessing mental health services] 

Fidelma: Okay, yes, can you tell us a bit more about those barriers and why it was difficult to access for young people?

Rachel: So, we were finding perhaps people that might have been open to CAMHS or the LAC [Looked After Children] mental health team, to them going from children's services to adult services, the thresholds were different. So, perhaps they didn't quite meet criteria for adult services. Also, if they did, then they found that some of the criteria, even when they are there, trying to go to some of the rooms might be different to children's services. And they found it quite unwelcoming and perhaps didn't want to go again, or perhaps if they hadn't managed to get past the threshold and get in the door in the first instance, then you just have two, maybe three, did-not-attends and you would be taken off the service wait list, even though you would be very much in need. And actually, reaching some of our care-experienced young people, it needs to be done in different formats. It's not just go to adult mental health services and walk in the door and see a clinician. Perhaps some of that could be delivered in the community or done in different ways, and that's exactly what this project has managed to achieve.

Clare: Yes, and I'd, sort of, interject there as well. It's actually, as well, the appointments, even if they were lucky enough to get an appointment, were often, like, 9 o'clock in the morning. I've had a lot of young people that were given appointments at 9:00am or 10:00am, and obviously we know for our young people that sleep, historically, can be very tricky for them. So, often those sort of appointments, you know, they were never really going to be able to get there on time, which then caused the did-not-attend, which then made three did-not-attends pretty quick, to be fair. So, yes, there wasn't really a lot of scope for them to succeed, if I'm honest, because they were given really early appointments.

Fidelma: I suppose, Clare, it would be great to hear from you a bit more about your role, because some of those barriers that you've mentioned, you know, those really are highlighted as well in other reports, like Foundation's report on care leavers' mental health and Barnardo's report, as well, looking at exactly, which identified similar barriers. I'd be really interested to hear about how the work that you do, the service that you provide, offers something different and, I guess, something more accessible for young people. That would be really interesting to hear about.

[What the service does differently] 

Clare: My post is seconded from Northamptonshire Health Foundation Trust, so sometimes I had, when a young person was referred to me, and we can go on to the referral process later, if you'd like to know how that happened, but sometimes they were referred to me, I might have already known them through my other role. So, I might have already completed an initial assessment for health, say, six months ago or maybe in some cases, three or four years ago. So, I might have come in contact with that young person. Historically, as we know, as well, with our young people it takes a long time naturally for them to trust professionals. They've had to give their life story hundreds of thousands of times before and so therefore when sometimes you meet young people, they're not keen, understandably, to divulge exactly what they're feeling, because they don't know that I'm a safe person to do that with. So, if I've met them before, that was quite helpful, because then they would say, 'Oh, I saw you a few years ago,' so there was already an existing relationship. On top of that, I think, we've been able to offer, like, I was really given carte blanche as to how I wanted to run my appointments. So, usually most young people want to meet me after 12 o'clock and that's fine, I'm happy to meet at 12 o'clock, 1 o'clock, 2 o'clock, whatever it takes, and if they wouldn't feel comfortable coming to Russell House, I would meet them in the community for a coffee or in a local park or wherever they felt comfortable to meet for the first appointment.

Sometimes they would bring their personal adviser along with them. Sometimes they would just come on their own and then we would be flexible really within that. So, if they meet me once and then they say they'd like regular appointments, we'd set those up. Then, if on the day, I usually text them to say, 'Are we still okay for our appointment?' If someone came back and said, 'No, not really today. I don't want to talk,' that's also okay. You know, you can't prescriptively say, 'I want to talk to you at 4 o'clock on a Thursday afternoon.' You might actually not have anything to say at that point or not feel comfortable to talk. So, really, I was just led by what the young adults wanted. So, nothing to me was out of parameters. If they wanted appointments at certain times, that was fine. If they wanted to change from face-to-face to having an appointment on Teams or having an appointment by WhatsApp, which a lot of our young people use, that's also okay, as long as they felt safe in their surroundings to disclose the things that we will talk about, the things they wanted to talk about. So, I think we've been really flexible in our approach like that.

We have a sensory room here, as well, at Russell House. We're fortunate to have that. That's been quite helpful for young people. It's got some nice seating in it and some different lights. It's quite a calming environment, which is very different to adult services. So, adult services often don't have as nice a waiting-room. I can only speak for myself and the trust I work for. Children's services have got all-matching furniture and all-matching walls and they're quite welcoming. Within the adult services, it's not necessarily the same case. So, I think having that right environment, where someone feels safe and secure, is the most helpful thing to have.

Fidelma: That's really interesting. Can you tell me a bit about how your approach was shaped? Rachel, I know at the beginning you mentioned having a team which included young people with care experiences, is that right?

Rachel: Yes, that's correct.

Fidelma: Were they, kind of, part of informing what this service needed to look like or were there other examples of practice that you drew on from elsewhere? How did you, and Clare, I suppose, it will be interesting maybe to hear a bit about your background as well and just all the elements you used to shape a service that is so flexible and, as you say, working for the young people?

Rachel: So, right at the outset of the project, when we were still looking to try and get a successful bid in with public health to fund the project, I rang around local authorities that were already providing this service or had, yes, really got a handle basically on their mental health support offer for care-experienced adults. So, to try and not reinvent the wheel, you know, we'd simply rang around and spoke to others, which was, why not?

Clare: One of the care-experienced gentlemen was actually on the interview panel, as well, which was really helpful. So, obviously they were able to meet me before I was offered the post. My background is I've done-, this is my tenth year in working for Northampton Health Foundation Trust within the looked-after children's team for mental health. So, I've obviously completed ten years' service with them, and over those years have seen themes and patterns around the, sort of, support that our young people are offered or are not offered, should I say. So, we really based it on that. Plus, obviously working in the trust, I knew how the adult services part was run and therefore they would just really, like I say, I've been given carte blanche really to do what I want with appointments and when I want them. And we are not as rigid, as in, we've been able to support with things like, so, typically within the teams you would be offered, sort of, six, twelve, appointments. We haven't said that. We've said that they can have as many or as little appointments as they want.

So, some people might have an appointment, have one appointment one month and then dip out for six months, but then feel more confidence, come back after six months. And we've had quite a few people that have felt that. So, yes, there's no closed door. We've always tried to see everybody that has asked to be seen as and when they want to be seen, and be creative outside that. So, we had a young gentleman who had to appear in court. I was able to attend all week with that to support his emotional wellbeing. He had physical needs, as well, but we were able to support his emotional wellbeing. Ray and I also have been birthing partners for one of our young people, just before Christmas.

Fidelma: Wow, really?

Clare: That was the highlight, I think, for both of our years, where we both spent a few hours together while this young lady had her baby. Actually, we were her chosen people, which was really very emotional and very heart-warming for us, but also, you know, very sad in some respects that we were the people she chose to be with her.

[How young people access the service] 

Fidelma: Gosh, that's incredible. What an amazing honour that must have felt, but I can understand also what you're saying there that it is sad in a sense, too. It sounds like a service really grounded then in young people's needs with a really good awareness of what those care leaver needs would be. Can I ask a bit about how young people either find out about your service or are referred to your service, Clare?

Clare: Obviously, my strong links are with, the LAC mental health team are aware obviously that I sit in both teams. I'm part of their team and they were able to complete referrals, as well. We've done a lot of work with the Children in Care team, social work Children in Care teams. They know that I exist and they have been able to do referrals. The personal advisers here all knew obviously of my post and they've been able to mention it to their young people. It's promoted on our social media pages and people then get to meet me and by word of mouth. So, we have covered a lot of bases, I think, so the information was out there for our young people to access. I've also attended things like football matches sometimes or other events that people will get to see me. So, I think, some of that is-, part of the difficulty of mental health services is because people build up a picture or their previous experiences might have lead them to believe that all mental health practitioners practise in one way or look the same way, if that makes sense. So, when people get to see us they can see that we are maybe different people. I like to think I'm quite a warm, nurturing person and that comes across, I hope, when I get to meet people for the first time. That maybe gives them a different view of what they've experienced before and then often, as we all know, our care experience community talk to each other and probably know each other very well and then the word of mouth, 'Oh, I've seen Clare, she's alright, go see her,' and that has been helpful, in some respects.

[What kind of support is offered?] 

Fidelma: Clare, I'm really interested to hear more about what the work looks like. So, you've shared a bit about how flexible the service is and the different places that you can go to meet a young person, so the, kind of, structures around it. What about the work itself? How varied is it? What are the main needs that you see, I suppose? I know each individual case will be different, but are there common themes that you see in this group of young people?

Clare: Emotional regulation. So, that's a really big common theme, I think, for us, where people can go from zero to a hundred with their emotions and not necessarily understand where that comes from and how to try and manage that. That is a big one, I think, for me and that often then can result in self-injury. There are a lot of people we're sent with self-injury, and when we talk about self-injury, that's not just the cutting and the suicide ideation. It can be head-banging, picking, scratching, things like that. There's a whole range of different coping strategies our young people have. Sleep is another big difficulty for our young people. To me, those are the main core ones that I see.

Fidelma: Yes.

Clare: And probably a sense of, particularly around, as well, 'Who am I? Where do I belong and where do I fit in?'

Fidelma: Can you tell me a bit about what the work involves, Clare?

Clare: The work, primarily, that we do is relationship work, really, which is providing that safe, secure, attached figure, if that makes sense, which a lot of our young people have not been able to experience. Then, elements of other psychological interventions that I maybe have got some skills in that you drop in such as DBT and other psychological therapies alongside that. So, a lot of it is relationship work and it is delivered on a one-to-one basis with the young people. We have had some group work, but that comes with its challenges, as well. We did set a group up for young ladies, which was meant to be an empowerment group for girls. It's called the Voices programme. However, all of the young people we identified to join that group were actually open to me individually as young people and then when it came to sessions, it was a little bit difficult in the fact that a few of them have got a diagnosis already of a borderline personality disorder and therefore they weren't able in a lot of the sessions to share me as a clinician. So, it got a bit tricky having three people in the same room. Even though there were other clinicians there, they weren't able to share my time.

So, I very quickly realised that a group actually for young people that were all open to me probably wasn't helpful. So, we had to split that group up. I suppose you could say we were responding to those care leavers' needs, you know, immediately by saying, 'Okay, this is not going to work for anybody.' So, we split the group up. They see me as a secure, attached figure that they have in their life and the one person and they just weren't able to share, they just found that really difficult. We managed to run the groups again, but we ran them individually. We were running individual sessions for three adults with three clinicians each time. So, it was three professionals and one young person, to be able to deliver the training successfully, but also have that support when someone needed to maybe take a break, because it becomes quite all-encompassing, but we were able to do that and support them.

Rachel: So, year two, we did group work again, but delivered it in a different way. So, it was gardening for wellbeing. It was open to the whole service, not just people that were perhaps on the wellbeing programme, being supported by Clare already. There were other members of staff from the Leaving Care service that were on it as well and we're quite lucky for space round here. So, there was a project all summer, 2023, which made a sensory garden area, a fire pit, a hammock in the trees, grew their own vegetables. That was delivered with the forensic psychologist and Clare as advanced mental health practitioner, alongside other staff members. That was a regular group that came together for that. You didn't have to come every week, so it didn't matter if you'd missed a session. Yes, that was really successful and has then led on to the cooking group in the winter where you can cook the produce and we are going to go back into the gardening group again now the weather is getting better.

Clare: There's no criteria. We tended to get the same young people would attend every week. It was really, really nice to see and a lot of the feedback was that they didn't feel like it was typical mental health support, because we were working alongside and digging and using other sensory skills that would help with their emotional wellbeing as well.

[A multi-disciplinary approach] 

Fidelma: We've heard about the one-to-one work and group work offered by your service. I'm wondering are there other elements to this service also that you want to talk us through?

Clare: We set a complex case panel. So, we would have Ray as project manager and then we have myself and the forensic psychologist, if she was available, and maybe a personal adviser or somebody else in the social care aspect. Our PAs would submit a referral to us, which tell us what the different presenting difficulties were and then we would sit and have a 15-20 minute meeting. We would discuss where we felt maybe the next steps could be and what could be offered. That was a really nice way of different professionals giving their opinion and the PAs then being able to go off and action those plans. They were with the consent, obviously, with the young person.

Rachel: So, the formulations were led by the forensic psychologist, Clare, advanced professional, and the young person would attend as well, ideally, although if they didn't want to they didn't have to, and any other supporting professionals around the young person. So, always the Leaving Care member of staff, which will usually be the personal adviser, often a key worker, perhaps the police, any other health professionals involved. And the formulation would take one to two hours, where all the history, the current situation and next steps would be looked at in great detail. The forensic psychologist would then go and write this up by way of a, sort of, word document report, which is then, the young person's got a copy of that and that's really opened some doors for them to universal mental health services. In some instances, it's lead on to a diagnosis that the forensic psychologist thought might have been there, but it had been missed until that point. Recommendations could be made. You could just take it to your GP appointment. It was a really useful bit of paper. There's no other way a young person would be able to get that, you know, level of detail, really.

Clare: It's also quite helpful, I think, for other professionals, and not singling out, but the police. So, we had one, where we had a young person that was interacting with the police a lot. They were struggling to maybe understand why some of those interactions were coming about. So, we were able to sit with the police and actually say, you know, with the consent of the young person, being able to share some of their background. Not all the details, but some of the background and why they might be presenting in the way they were, which the police reported to be very helpful. They were saying they didn't get a lot of information sometimes and it was helpful for them to be able to take that to their teams to say, 'Okay, when X, this person, rings, this approach might be more helpful.' The police in particular were really keen to access the formulations when they could.

[The benefits of a joined-up approach to support] 

Fidelma: So, just thinking about work with multi-agency partners, I remember that you mentioned that Clare's role is co-located, can you tell me a bit about the advantages of that?

Rachel: The post was co-located between literally being able to access the computer systems at social care and health. It was really valuable for both sides, health and social care, because Clare had the oversight of both systems and went back to work at health once a fortnight for the duration of the whole project and still does. So, to share information with colleagues each way has really smoothed the path and given better, quicker outcomes for young people. So, that has been a really terrific part of the project.

Clare: Particularly, I think, that is pertinent around risk for our young people, because often, obviously systems don't talk. Some health systems don't even talk to each other. So, local hospitals sometimes don't talk to local NHS trusts, because they don't have the same technology. So, to be able to, particularly around risk, when a young person had been really struggling, we were able to share things very quickly, because I would mirror the information on both systems. So, then it has been able to be accessed by adult mental health services, but also if the GP was on the same system, it produced the whole complete cover for the services, because all the information was there ready for people to access.

Fidelma: Yes, so being able to, kind of, build a fuller picture so much more quickly.

Clare: What also goes along with that, I think, is that we've had incidents, one of my young people that I've been working with who have attended A&E and usually my other role, if someone is in Accident and Emergency, whoever is on duty on the day would go down to see the young person. Whereas, if one of my young people whilst I've been working, on the project was in Accident and Emergency, I've been able to go down myself, liaise with Accident and Emergency. Maybe complete their assessment support with them or help with them, because I've got an existing relationship. That's helped, I think, to speed up systems, as well. To get people in and out of A&E a lot quicker if they needed to be out and, or helped if they needed maybe to be admitted to a mental health hospital. I sometimes have other contacts that I might be able to contact.

Fidelma: Are there also times when you need to refer them into adult mental health services? Can you tell me a bit about that experience?

Clare: So, yes, the criteria was that a young person could be referred to me, providing they weren't open to another service, particularly adult mental health. In reality, that hasn't always happened, because, and I don't want to blow my own trumpet, but I think some of that is due to the approach. So, I do have some young people working with me that actually are open to adult mental health but have struggled to engage for lots of different reasons. If we then would help to refer back, I would offer to go and sit in on appointments with them. So, if they wanted me to attend their first appointment, I would go. Some of the challenges of that being is that we've noticed that some of the language that's used with our young adults is not necessarily helpful in some cases. I think this is a narrative not just from health, this is a narrative from lots of people, I think, when anyone hits the age of 18.

So, narratives such as, 'You should be able to do that, you're 18 years old. You should be able to do that,' which is not helpful and so some of that language that's used, particularly for our young people, can be quite triggering. So, to me to go in on an appointment was quite helpful, because I can reframe. My health colleagues didn't know I was from health, they just took me in as a support worker. So, I could just help to maybe guide the conversations a little bit for, one, to support my colleagues, but also to help the young person be able to get the best that they can from the appointment and maybe stay a bit more regulated. I think, we're really good, actually, as the whole Leaving Care team, on trying to reframe, particularly on to disciplinary meetings, because again a lot of the language and, you know, it comes from lots of different avenues. It's not one particular avenue, but the language is so important. Sometimes we hear things and we will respond but we will try and reframe it in that conversation to be be able to support a trauma-informed approach really so that our young people are maybe understood in a different context to how they might have been understood before.

[A systemic, trauma-informed, approach] 

Fidelma: Can you tell me a little bit more about the kinds of things that are going on in your service and maybe numbers of young people that you've reached with your service?

Rachel: So, we've got about 950 care leavers to Northamptonshire which is now the two unitaries, north and west Northamptonshire. Then, also aged 21-25, there are about 400 care leavers that might have been stepped down from a PA, but they're still able to access our service, which operates from age 16-25. So, Clare has been able to reach so many young people, which has been at tiered levels. We've had tiers one, two and three. We've told you a lot about tier three, which is one-to-one support. Some of the group work. Tier two might be just meeting people occasionally or at events or in larger groups, like the gardening group, and then tier one is offering advice to the support network around the young person. So, the complex case panels, offering advice to personal advisers. That also includes training so that this project can have a trickle down effect, so that it can potentially reach all care leavers that are open to our service, because the PAs themselves have been upskilled in trauma-informed practice, in language, in how to perhaps deal with some of the more difficult aspects around how to talk about self-injury or sleep, things like this.

So, we've had training in safety planning and developed a new safety plan, which was done in conjunction across health and Serendipity in the trust. Serendipity is the organisation where the forensic psychologist came from a day a week on the project. So, that training has been rolled out, is going to be rolled out again actually in a couple of weeks’ time. That's been quite far-reaching. Also, we've had a trauma-informed session with the managers, because trauma-informed practice is almost, sort of, halfway down the road. The beginning starts in the building you work from, the environment that you create for your staff. We literally walk around the building and said, 'Does this building look trauma-informed? How welcoming is the sign? Do we know where we're going when we arrive?' If I was a care leaver, could I find the duty staff that should be greeting you and they're redirecting you if needed. So, we've started right back at the beginning. Hopefully, the whole service can be much more trauma-informed and then lead on to trauma-informed practice.

Clare: The safety planning sessions also include one of the care experienced people. So, he was able to give his point of view as to how he might have managed all the things that he found tricky and what support was helpful for him. So, his presentation, which was really helpful and powerful, I think, for other people around to see how he managed the situation. I think, as well, what else we've offered from the project is an outcome, because of obviously all the young people that we work with, a lot of the conversations can become quite difficult for some staff to hold emotionally. They have a massive impact on our own emotional wellbeing. Yes, our staff have management supervision, absolutely, and their cases are managed and they're talked about and they will have a brief check-in possibly around how they're feeling, but I've been offering clinical supervision to all staff. So, anyone that wants to see me on a one-to-one basis so they can talk about how a case might have made them feel, how it's impacted on them.

[Measuring outcomes] 

I have regular slots every month for at least quarter of the Leaving Care team who are, sort of, monitoring data as well obviously, because at parts during the programme we've obviously been requested for data. So, we are managing that with the Edinburgh Wellbeing Scale and then the trust's Signs of Safety and doing that on a regular basis, so that we could look and see whether some months if that had improved or not and the overall journey for our young people. It's really tricky, I think, when we've been asked to provide data, the data is people often want statistical numbers, as in how many people have you kept out of A&E. How do we monitor that? So, we've been keeping very specific-, and we've had to learn quite quickly, I think, on keeping very different data to be able to highlight how much we feel that this project has met the needs of our young people, because it's not as easy as just saying, you kept 20 people out of hospital. That's not easy to document.

Rachel: We've developed our outcome measures throughout the whole duration of the project. We started off, as Clare said, with the Signs of Safety scaling questionnaire and Edinburgh Wellbeing Scales and then we've now got a spreadsheet, as you can imagine, with about 12 different tabs on that gathers the voice of the young adult. How many times somebody might have presented at A&E and Clare has narrowly averted that and how many people have now managed to move through to universal services or how many people we've managed to get onto adoption support fund monies, so that they can access therapy in their own right. We've also been fortunate that public health had funded some very limited number of therapies, which has been really terrific for those young people. So, it's just this access to therapy. I think, often when you've been offered it younger, it's perhaps not been the right moment or it's been too soon, things were too raw, but perhaps be aged 20, 21, 22, maybe the time is right and that will help you move forward with maintaining successful tenancy and getting into the work and training arena, which were two clear focuses of the project, because we knew being able to successfully hold down a tenancy and move towards or be in work, then that was going to in turn really positively impact your emotional wellbeing.

Fidelma: What impact do you see this individual and group work having on young people? Do you see them benefiting in terms of their wellbeing and their mental health?

Clare: Yes, I can think of a young gentlemen particularly, of mine, who came in to the gardening group, who turned up on the first meeting and he was wearing completely all black, had a hood up. He wouldn't turn to look at people when he talked to them, he wasn't able to do that, and he wouldn't have his photograph taken. Within three weeks, he'd started to wear, not have the hoodie on, not have a hat on, would have his photograph taken and was fully engaging. And you just saw a real change in their self-esteem and their self-belief, which was lovely to see. That, I think, for me, has been really apparent. You see people, you know, grow as individuals and it's really difficult to pinpoint exactly which bits they are sometimes, but you might see a reduction in self-injury or a different coping strategy. We set up an arts and crafts group, as well. I think we forgot to say that. So, we set an arts and crafts group up and people can come to that regularly, on a monthly basis, and just sit and chat to people but also, you know, you have a shared experience of a different art skill that they might not have had, which I think often helps with a bit of distraction. And, yes, just asking the young people where they feel, which can be really difficult for them, because sometimes they aren't able to see the growth, but it's about us continuing to promote that and say, 'Well, we can notice a real difference. Before, you'd only come in and sit at the door, but now look, you're coming in and you're quite happy to talk to a group of people.' Or, 'You seem to be smiling a lot more.' And just, sort of, pointing out things, really, that maybe they don't notice themselves.

Fidelma: Can you tell me a bit about how long you would normally see someone for?

Clare: Whilst I've been in post, actually, I've got two young people that I've seen two-and-a-half-years, one of those is open to adult services. So, doesn't meet the right criteria, but has engaged really well with me and continues to remain with me. And the other young lady has been with me for two years. I've also got another young gentleman, worked with him within my other role, and I'm now in my fourth year of working with him. But it's not a targeted piece of work, but you become that person they go to, because they maybe haven't had that in the rest of their lives. So, for me, there is a clinical rationale to stay with somebody being open and they want to stay open to coming to see me. I have no difficulty, but obviously we are at points, with funding and everything else, if people are paying for different bits, I then have to justify which bits of the work I'm doing and sometimes then, yes, people have had to-, I don't think up to date, up to this week, I've not had to close anybody because the trust has said, 'That's it, that's the maximum amount of services.' I've been able to see as many people for as long as I want or as little as they want to engage for. That's been brilliant, I have to say.

Fidelma: Thanks so much, Clare and Rachel, for joining us today and for being so generous in the insights and learning you've shared from this innovative work going on in Northamptonshire.

Clare: Thank you.

Rachel: Thank you for the opportunity.

[Outro] 

Thanks for listening to this Research in Practice podcast. We hope you've enjoyed it. Why not share with your colleagues and let us know your thoughts on X (formerly Twitter) @researchIP and LinkedIn.

[Intro] 

This is a Research in Practice podcast, supporting evidence informed practice with children and families, young people and adults.

Fidelma: Hello, I'm Fidelma Hanrahan from Research in Practice. This podcast is part of a series exploring support for care leavers' mental health and wellbeing. In our other episodes, we hear from care experienced young people, who share their views and reflections on what's needed to improve support for care leavers' mental health. We also hear from a researcher who has been involved in studies looking at the national picture when it comes to mental health support for care leavers. And finally, we explore good practice going on in this area by hearing from people working with care experienced young people to support their mental health and wellbeing. Good practice is the focus of this podcast, where I'm speaking to Carey-Ann Baisden who is the leaving care specialist nurse in the children in care service in Newham, East London. We'll be hearing from Carey-Ann about her role and how she supports care leavers' mental health. Carey-Ann, really lovely to have you with us. I wonder if you can start by telling us a little more about your role in Newham's leaving care team and how it came about. 

[The role of a leaving care specialist nurse] 

Carey-Ann: Yes, well thank you for having me. So, my name's Carey-Ann. So, the leaving care service was created in May 2021. So, I was employed as the first care leaving nurse within Newham for our care leavers between the ages of 18 and 25. So, the role was created really to think about the wellbeing needs for our care leavers, who originate from Newham but may be positioned or live in different areas within the UK. So, the role was originally created because there was a clear identified need within Newham. But we also know this isn't just Newham specific, this is nationwide, that our care leavers really would benefit from space to think about their lives, their experiences, not just previous traumas, but the general running of their lives. And sometimes, having missing elements of their support networks. The role of the leaving care nurse was originally created as there was known local need, but also we know on a national level for care leavers to have a support around their wellbeing. We know that when you're a child in care, there are lots of, sort of, statutory requirements in place and health provisions across the UK to help support our children in care around meeting their health needs. Unfortunately, when that young person turns eighteen and starts developing through to their adult years, some of those services vary. Now, there is known inequality around what's out there for care leavers in regards to meeting their health needs and particularly within our service, we were hearing directly from care leavers and also those who support them that additional support was needed. And the current, sort of, structures in place provided an element of transfer of care over to the leaving care pathway but there were gaps. So, my role was created really to focus specifically on care leavers full-time and to offer a service directly to them.

So, my service was then created for an opt-in approach for care leavers, if they wanted it. There are lots of changes, obviously, when somebody turns eighteen. Legally, they're deemed an adult, though we know we don't all immediately grow up overnight and mature very, very quickly. Though we could argue many of our care leavers may have to adult in many areas of their lives due to some of the experiences they've been through. But being left independently to navigate the health service was very tricky for many. And also, documented that very tricky for some of the health, the leaving care professionals who were trying to navigate on the behalf, or advocate for a care leaver, and finding it quite difficult to do so.

Fidelma: Yes, yes. Okay. So, this role it really sounds like was filling a real gap and meeting an identified need to address that, kind of, cliff edge it sounds like. You know, there was provision as you say, for children and young people while they were in care. But that dropped off. And obviously, there's no statutory requirement, is there, to provide emotional, kind of, wellbeing services to care leavers? Though there are guidelines.

Carey-Ann: Yes.

Fidelma: Yes, but as we know from research, you know, the difficulties a lot of young people in care face around their mental health and emotional wellbeing whilst in care doesn't suddenly stop when they leave care, so that's still there. Yes.

Carey-Ann: Exactly. And I think that what's very evident within the research is that care leavers are more likely to experience mental health problems and have lower wellbeing than their non-care experienced peers. And exactly what you've just mentioned around the cliff jump. You know, this is, sort of, demonstrated further because we know the criteria for children's mental health services and adult mental health services are very different. The thresholds change and there is a known gap. So, my role was really created to, sort of, bridge that gap. And it may not necessarily be around specific psychiatric disorders or people in acute state. We know the general wellbeing about how I'm feeling, how do I manage this situation? Or problem solving. Some advocacy role. It's a real blur of different positions in order to support somebody. Many of my care leavers have almost, sort of, described it as some of the conversations they would've had with a family member if they were able to provide that, or if they were in their lives or a very, like, a close support network, through keeping the professional boundaries and ensuring that the space is safe and, you know, protected. They can be fed with guidance, have time to be heard, and feel that they can talk about something that they may not want to have to share with other people in their lives. For example, they may have a brilliant relationship with their personal advisor or their social worker and work very well together. But some of these things that may be getting them down or may be on their mind a lot may seem quite small to some of our care experienced people, but it's impacting their life greatly. So, having that chance to speak to somebody who's not going to be involved in planning other areas or supporting other areas of your life, but have that space, offload it and be able to come away or access that space when you need it.

[A trauma-informed approach to accessing support] 

Fidelma: Thanks Carey-Ann. I wonder if you can take us through what the work looks like. So, how young people hear about your service and how you work with them?

Carey-Ann: So, the most important thing to start with is that because the service is opt-in, we don't want anybody to feel like they have to use this service. So, empowering a person to actively make their own decisions as an informed adult, there must be a need. So, if a person feels like, 'Actually, I would like that space,' whether they identify it themselves or whether it's following a conversation with their personal advisor or their social workers, that they recognise, 'Maybe I feel I would benefit from speaking to somebody.' It might not be at the level of needing therapy, it might not be at their level of needing a mental health service, it might be around other factors. So, as soon as there's a recognised need, the leaving care service are very well aware of what I can offer. I've done a lot of networking with them and know them personally. When they meet with their young person, they will inform them about my role. There are also other avenues where they can hear about me. So, for example, there are brochures and leaflets as part of the closure of the children in care review health assessments where there are bits about my role. So, they'll get reading material in the early stages. There are also posters up in the care leavers building. But word of mouth seems to be the biggest referral route. So, people who hear directly from their PAs or other care leavers within Newham. So, once they've recognised they'd like that space with me, I have a referral form that their personal advisor can complete on their behalf. There are reasons around that, because I use a trauma informed approach. I don't want anybody feel like they have to come to me and re-tell their stories. So, I have the consultation first to obtain just key information. Not to get someone else's perspective of their story, but just the key information that may affect how I best see that person, and the safest ways to see that person.

Fidelma: Yes.

Carey-Ann: Once that's been completed and there's full consent from the care leaver that they would like to utilise space with me, I will then offer them an introductory call where I'll explain what I can offer them. This has also proven to be very helpful because the intro isn't about that person feeling like they have to talk to a stranger. It's about me telling them what I can offer them and then they have choice, and empowered to make the right decision for them. 'Okay, I'd like to go further.' So, if they'd like to go further and meet with me, the interventions I offer are broken down into, sort of, three key sides. So, the first one really is one-to-one. So, I can offer one-to-one space. So, it can be in person, we have a really fantastic care leavers building in Newham called The Cove, which is not clinical. It's not been used as a building for other children in care services when they're younger, so we're taking out some of that risk of re-traumatising, because it's not somewhere they've necessarily been before, and if they have, it wouldn't have been related to their journey through the care system. It's a very open planned environment that's very welcoming, though there are protected rooms where I would see someone privately and respect their confidentiality. But the actual environment itself is very welcoming and relaxed. So, that provides a great space for me to meet with them personally on a face-to-face level.

Fidelma: Yes.

Carey-Ann: Though I recognise and hear from many people that sometimes they're not able to travel. It might be because they're working very hard or they've got independent arrangements for childcare or they've got, you know, studying or work employment issues. So, I try and be flexible and try to offer ways round it for everybody. So, the other options can be telephone and that's a good way of connecting with people and allowing people to feel comfortable in their own homes or in a place that they feel more comfortable in speaking to me. Or even sometimes if they're on the move and they want that space to try and fit in some protected time for themselves between a very busy life. And then the last one is virtual. So, using Teams and things like that. So, they can see me, but again, they have the flexibility of fitting it into their busy lives.

Fidelma: Yes.

Carey-Ann: So, that would be the first intervention for one-to-one.

[What kind of support is offered in one-to-one work?] 

Fidelma: Thanks Carey-Ann. I wonder if you can tell us a little more about some of the main needs you see from the young people who come to you for one-to-one work?

Carey-Ann: Yes, one of the biggest things that I would say, it's really individual to each person. Though there may be some common themes, it's really down to that person to use it how they want to. So, I'm very clear with them at the beginning, it's not therapy as such, but it may feel very therapeutic. I am a mental health nurse by background. I can offer a space where we can think openly together about experiences. We can also think about coping strategies. We can also think about how we make appropriate plans to help someone move forward in their lives. So, thinking about independence, confidence building, some sort of motivational, sort of, interviewing styles and speaking. For many, it's really a place just to offload and just being able to speak freely and not having somebody at the other end that may have their own perspectives on the situations. That's a common situation I do come across. There are many young people who are care experienced that may have very different memories in comparison to their siblings or family members and if they've ever tried to speak about certain things that bothered them, there are conflicting views back. Whereas I can just give them that free space to just tell their own story, if they want to.

Fidelma: Yes.

Carey-Ann: There are other people that come in who are very, very reflective, mature. They know what's maybe bothering them today and they might say, 'I really struggle with anxiety or being in social groups, can we think about that together?' And we talk openly about those things and think together around how do we make, you know, some changes that may impact you, or what do you find helpful? So, I let the person lead it themselves and I think that's a surprise for many, because most of the time, we all have the own answers to our own needs. It's just being able to think about it safely with somebody else. It comes back down to some of the simple things in my eyes, and in my experience, coming from an acute psychiatric background, where people are in crisis and there were lots of severe things going on. When I met many of the care leavers and we had this space, though they've had very tricky and unpleasant and traumatic experiences, what they really wanted to speak about is today and how they move forward. How do I deal with what I've been dealt with, what I've got now, and how do I confidently go through life? An example might be thinking about, you know, how do I tell somebody I have nobody coming to my graduation? That really hit home for me. That oh, that's a completely different problem and how do we think about that? And how do you want to share that information around respecting your own past and background? But also allowing people to understand you and understand what your support networks look like and how that may differ to some of your peers. So, it was those, kind of, questions that were coming to me at times. And in the early stages, it really made me think how I best support that person is around thinking about the general life experiences we have, the everyday stuff. How do we manage everyday stuff? Though they may be very successful and talented in multiple areas and very intelligent, and very lived, and they can cope with X, Y and Z and get lots of things done, some of these little things that you don't necessarily want to explain to people may be eating away at them.

Fidelma: Yes.

Carey-Ann: So, there's lots of stuff like that that comes through, which is more around having the space to be heard. Thinking about it with someone else, and then allowing them to think what they best do.

Fidelma: Yes.

Carey-Ann: Lead their own, you know, their own decisions. It's not for me to tell them what to do. But we think about it together. And some of these things they've not been able to speak or say to anybody else because they've been worried about what someone might think or if someone may judge them on what their understanding is, or whether there's any form of discrimination that they're worried about because of their past.

Fidelma: Yes, yes.

[The importance of talking about the ‘everyday stuff’] 

Carey-Ann: So, that is, that's something that I always feel is forgotten or maybe misunderstood and it sits within that gap of not necessarily needing adult mental health services. Yes, they might have been known to CAMHS in the past for other elements of their emotional needs, but right now it's the general stuff that they need to think through. So, the active listening, you know, advice, guidance, collaboration. It's massive and those little things that might seem small to somebody else can be huge in the future.

Fidelma: Yes, yes.

Carey-Ann: And actually, helping them make those decisions helps them move forward and make other decisions and that is what's very productive and seemed to have a very positive impact on their future decision making. There are many people, and some of our care experienced young people, who have still got very, very challenging lives and may be at risk of more acute illness or maybe already suffering with different acute illness and they need support accessing the right service. So, if they need a mental health service and they're not open to one, I will support them with the referrals and getting them to the appropriate team. And some of that might involve giving them a bit of education around what those services look like, because they may have blurred understandings, maybe because of some brief involvement in children's services when they were younger which they partially remember.

Fidelma: Yes.

Carey-Ann: Or no understanding, because they've not required it until, you know, later on in their lives, so giving them a bit of education around what great help can be offered to them and getting them to the right people. The same with if they need specialist therapists or they say, 'I'm now ready to do therapy.' Or, 'Can you help refer me? How do I do it?' You know, and again that varies. Some people are able to self-refer to local services that are available, other people might need more specialist services where it needs to have a professional-to-professional referral. So, I can be that person to help navigate that with them and give them the information that they need if they want to do it themselves, absolutely fantastic, but if they want a bit of help with it, I can help them.

[Supporting transitions to adult mental health services] 

Fidelma: Can you tell us a little about how you support care leavers with the transition to working with adult mental health services? Which must be quite difficult for some.

Carey-Ann: It is specific to each person. So, for many people, they may just need the first front door appointment and they may just want help getting the referral done that reflects their individual needs, and then I'll step back. They'll continue working with their mental health team, as designed. There are other people who understandably may struggle with trust because of some of their life experience in their earlier years, and they may want me to support them a little bit whilst they're building the rapport with their mental health teams or whatever specific team I've helped refer them to, which has been helpful. I've had many people who initially would've been quite avoidant of utilising those services for whatever reason it is for them and by having somebody that can just, sort of, reassure them along the way and also help advocate some of their communication styles to the other receiving team. So, if we've had people who have unfortunately missed school or missed education in different forms because of how their life has panned out for them, they may have also missed the opportunity to be assessed in different areas of their lives. So, if I've met someone that I suspect may have, whether some neuro differences or underlying mental health problems, that haven't been recognised yet, mainly because they've not been in environments enough or they've had lots of changes to be seen and to be assessed, I can help share what I've observed with that team. To give them a little bit of feedback from the perspective I may have seen them a little bit longer, but then of course allowing them to do their job as they're meant to and go down the correct assessment pathways if they feel it's deemed appropriate. But it has been very helpful in quite a few cases that I've supported.

It allows people to attend the session and get to that assessment because I might break it down to them, which unfortunately, is not available, really. As an informed adult, we have the right to refer ourselves or be referred, but the support that we would normally get, which usually comes from family or friends or people that may have used those services, and for many of our care experienced people, there's a gap there. So, they might need that extra, sort of, hand-held support just to let them know, 'This is what to expect, this is what it might look like, these are the questions they might ask you.' And that's proven to be very helpful.

[Working with other professionals] 

Fidelma: That's really interesting, thanks Carey-Ann. So, you sit within the leaving care team in Newham, I'm wondering how you work with colleagues and feed back to them about difficulties in a young person's life.

Carey-Ann: Yes, so where, you know, consent is given and that person's happy for me to provide feedback for them or with them, I will attend some of their professionals meetings to ensure that we are considering the impact of those other, sort of, biopsychosocial factors that impact us all. I can give feedback too, as well, if some of the suggestions made may not always be appropriate. So, if somebody may not require mental health services, but we need to think about how we best support them in other areas of their life, I'll give that feedback directly to their PAs or their social workers or the core team around them. So, that sits quite nicely with the second, sort of, intervention that I offer, which is direct to their worker.

Fidelma: Right.

Carey-Ann: So, if you've got somebody who may not be ready to utilise any service that I can provide, and that's absolutely fine, or they may not want it, but if there are some key risks around their health and wellbeing and there are concerns from their core team, and they might be a little bit lost in how to support them and want to support them in a productive way. I will offer the consultation directly to their worker first. So, we can think about what we know, what's out there that might also be something that could be of use to that person. Maybe not now, maybe later on down the line, and equipping their PA with knowledge around some of these services that they can then introduce when the moment's right, throughout the time they work with them. And that can also help their personal advisors, their PAs, feel more confident in what they're doing, specific to health. You know, they may be fantastic in what their actual job is, and how they provide, but when it comes to health, sometimes it can create gaps in knowledge for professionals in all fields.

Fidelma: Yes.

Carey-Ann: What we also need to think about as well is that our care leavers live all over the place, different localities, different boroughs, different counties. And the services slightly vary. So, you may feel confident in one borough and what their entry routes are and how I access this service, but then they move to a different area and the names are slightly different, the titles are different, so I feel very confident in understanding those differences and knowing how to navigate those systems, even though they vary and have slight changeability. So, I will take that duty away from that PA or that care leaver directly and find that out for myself and then deliver them with the information of what's current and correct for them and their situation.

[A flexible, trauma informed, approach to offering support] 

Fidelma: Okay, yes, okay. So, that's really interesting. So, working directly and closely with colleagues in your leaving care team to support them to support a young person as well. And is there another dimension of your offer.

Carey-Ann: Yes, so the third kind of intervention is what you'd probably consider more the early intervention as such. So, if there is somebody who's aware that they're finding certain elements of their life quite tricky and they may be struggling emotionally but it might not be as significant as, you know, they've suffered before, or they may not feel it's a significant issue themselves. But they recognise there's something there. If they agree and they would like for me to do, like, a one-off joint visit with their PA, I will go to see them and explain about what I can offer, and what services are out there within the National Health system. Charities, private sector, whatever they want to know about. And I will signpost them and give them that information, so when they're ready, if they're ready, and if it is something they want to do at some point in their lives, they know what's there. But also, as well, I feel it's been very helpful in preparing somebody to start thinking that way. So, by me going there and showing them who I am, talking to them, building up a slight rapport, again, leading them to make their own decisions, empowering them to lead on this so they're ready and able to do the work if they opt to at a later date. I give them that information and then I go away. They have the ability to access and contact me in different means that I would share with them, whether it's my work telephone number, whether it's my email details, whether they go via their personal advisors or the leaving care duty team, there are different ways around reaching me. Even being present at The Cove and they're there, that's another form of them able to connect to me.

What I found was in the first, sort of, two years of looking at my referrals and things like that, was that the younger age group, the eighteen, nineteen, almost the twenty-year-olds, were curious and the needs identified in regards to their emotional wellbeing. But they may not be quite ready yet. They're still going through a lot of change. Many of them are still moving properties or preparing for their independent homes. And there are lots of things they're working towards as well as other factors in their life around their social and their educational and their interpersonal wellbeing. So, when they are ready, I've found that the 21, 22s, 23s, they're the ones that really tend to come to me for the one-to-ones, because I think they're usually quite settled by this point, in regards to where they're living. They're navigating their lives around what they want to be doing or what their work looks like or their education or they may not know at this point. But they'll use that space to think about what they want to do or how they want help. And that's been a very noticeable age group that have been very productively working.

Fidelma: Can you tell us about how many sessions you offer for your one-to-ones with care leavers?

Carey-Ann: I haven't put strict boundaries on that. I'm clear and boundaried in regards to how you book a session, you know, it's not an open telephone line for calling whenever you want. I'm teaching that actually, we have to have, like, some professional means and that we book an appointment and then that's our space. So, we'll book that space and they can use it. But obviously, if they can't attend, for whatever reason, I'm not using an approach that's, you know, two DNAs (Did Not Attend) or three DNAs and you're out. I'm very aware that our cohort of young people may take a bit longer to build trust and may have multiple other factors in their life that they're not getting support with, so it might affect how they engage. So, I'm very understanding with them that it's okay if you can't come, I'll keep the doors open, we can re-book. But I do encourage them to, you know, make the right decisions and be responsible for their actions and update me where they can and let me know, 'I can't come.' To help with what may be-, which may sabotage future healthcare appointments if they're not taught now that actually, other services won't allow you not to just turn up. So, being open about what's expected within the mainstream healthcare. But how I will help adapt them whilst they're going through different things. So, that's been very helpful to them because it does take people a while to maybe feel confident to come and see me.

Fidelma: Yes, so actually, it sounds quite, it's quite flexible and open ended to give them space and to really appreciate, kind of, what stage they're at.

Carey-Ann: Something that I advocate and really drive throughout my practice is the trauma informed approach. So, from the beginning, thinking around what space we invite people to.

Fidelma: Yes.

Carey-Ann: What does it look like? Have they been there before? Are there memories there? All of these factors impact how we make decisions, how we opt to engage, not engage, turn up, no. Even just the title of the building. There are so many factors that we, as professionals, can forget and I've tried very hard within this service to be flexible and accommodating and adapting, to help with some of the foundation setting, the work which will then help them go on, if they choose to. If they need to. They may never need to, but if they do need to go on and work therapeutically with a specialist service, they've got the groundwork there. They've been able to sit with somebody and talk about whatever they want to talk about. They've been able to attend, turn up and work through those uncomfortable feelings of first meeting a stranger. Especially if you have difficulty trusting or experiences where, you know, adults have been unkind to you.

Fidelma: Yes.

Carey-Ann: It's those things that might seem small to other people, but are life changing to that person that's had a traumatic time. And I don't think you can underplay it, you know, that flexibility, adapting, thinking around how do I do things better to help that person? Not focusing, 'Oh, they've not attended, they've not turned up.' What do I need to be doing to make that more approachable for them?

[The benefits of increasing confidence] 

Fidelma: Yes, yes, yes. Oh, that's really good to hear. And I'm wondering if you can tell us a bit about the benefits you see from the work that you do? Do you see, you know, changes? 

Carey-Ann: Yes, and I know I've said this a few times, everybody's different, they are. But what I have seen, and again, in the earlier years of starting this service, what was significant in my mind, when I'd met people who really just wanted to think about confidence building, for whatever reason, they may lack in confidence. That confidence has held them back from education as an adult, employment, socialising, meeting new people. So, meeting with somebody and thinking about how do we manage conflict with somebody? You know, if you're worried about going for a job interview or you're worried about working in an environment where someone may be verbally abusive to you, which may re-traumatise you or take you back to other memories, so instead you avoid it. And then avoiding it leaves people very stuck. Thinking through those things with somebody has proved to see real positive outcomes. For example, it's all anonymous, but one person was struggling with confidence, and this is just one example of many. We thought about emotions, how people share emotions, what to expect, for example, working in a shop and somebody comes in and is very unnecessarily rude to you. Nothing to do with you but you felt it. You've received it. You're lacking confidence, you don't know how to manage it. We set different examples. There was even some role play thinking about it's not something that may happen, working in retail and with the general public, it will happen. So, let's prepare ourselves for that. And doing that, kind of, sort of, interviewing style role play thinking together, then led onto the person feeling confident to go for an interview.

To go working in an environment where the general public will be. And when those scenarios arise, instead of feeling like I need to run, guess what, we'd already prepared for it. And it did bring a bit of humour within that person's mind because they knew we'd had this discussion, and now I just have to think about how I am supported. You know, thinking about their team leaders, thinking about advice from their colleagues, thinking about staying calm, thinking about it's not your emotion, it's theirs. How do we deal with our response to them? That then led on to the person then going back into education, doing extremely well, a career. The whole life and the aspects of life have improved over something that started with confidence.

Fidelma: Yes.

Carey-Ann: It was like a domino effect.

Fidelma: Yes. That's really powerful.

Carey-Ann: It's those kind of things that we could stop and go, 'Oh, that person's shy.' Actually no, you know, let's go a bit deeper, that person actually does want help feeling able to share their views, be heard and how to do it safely.

[Thinking about endings] 

Fidelma: Yes. We've talked about that it's open-ended work that you do, but is there a cut off? Is there an age limit?

Carey-Ann: Yes. So-,

Fidelma: Upper age, yes.

Carey-Ann: The service is an opt-in service for eighteen to 25 year old new care leavers.

Fidelma: Yes.

Carey-Ann: Now, it does end. So, what I tend to find is, it's not like I'm an additional PA, a nurse slash thing that's throughout your whole care. People opt in to speak to me. Some may only have one session and then I may not hear from them for another year, because they speak about a lot of things and they think about, right, how they want to do stuff and they go off. Other people may need a bit more than that and they may speak with me, you know, every other week for a few weeks and then they go off. There are some people that'll come to me when there are big decisions to be made. So, they'll book an appointment with me. So, one of the things that I've had to be in order to keep the therapeutic relationship and to be boundaried but also not to cause harm, I didn't want to be too present in anybody's life because then I'll be missing when they leave and that's another loss. The space is for them, I'm there, and then I step away. I don't follow up with them to see if they want to speak with me, they reach out and ask to book something. So, they know the rest of their, sort of, support and care sticks with their leaving care PA, social workers, their core team. I am an additional which they can access as and when required. And that has helped for when people do move on and they are approaching 25 or turning 25. I will do a close-, if there's somebody that I've worked with for quite, you know, quite a few times or quite a significant period of time, a closing end with them. And then again, equip them with what's out there if they want to use it. Many of the times what I find is, people say, 'I already know.' You know, 'This person in my life's been very good and they're always there for me.'

Fidelma: Yes.

Carey-Ann: 'I can speak to that one.' So, it's about thinking about who do we go to? So, they know who their network is at that point in their lives.

Fidelma: Thank you so much Carey-Ann, it's been so valuable to hear about the service in Newham and your leaving care team and your role specifically as well and how you work with young people. Thank you so much for joining today and for sharing that with us.

Carey-Ann: Thank you for having me.

[Outro] 

Thanks for listening to this Research in Practice podcast. We hope you've enjoyed it. Why not share with your colleagues and let us know your thoughts on X (formerly Twitter) @researchIP and LinkedIn.

[Intro] 

This is a Research in Practice podcast supporting evidence-informed practice with children and families, young people and adults.

Fidelma: Hello, I'm Fidelma Hanrahan from Research in Practice. This podcast is part of a series exploring support for care leavers' mental health and wellbeing. In our other episodes, we hear from care-experienced young people who tell us what's needed to support for care leavers' mental health. We also hear from a researcher looking at the national picture when it comes to mental health support for care leavers. And finally, we hear about good practice from people working with care-experienced young people to support their mental health and wellbeing. In this podcast, we take a closer look at innovative practice when it comes to support for care leavers' mental health and wellbeing by speaking to Sarah Sturmey who is the founder and CEO of Pure Insight. An organisation which works with care leavers across a range of needs including mental health. Sarah, lovely to have you with us. I wonder if you could start by telling us a little bit about Pure Insight, its aims and how it came about.

[What does Pure Insight do?] 

Sarah: Pure Insight's overarching aim is to support care-experienced young people to thrive. We're a relationship-based organisation so our core values are integrity, courage and belonging. But our aims are to provide connection, belonging and purpose for care-experienced young people through a full wrap-around offer. We collaborate with local authorities in the Northwest to provide, yes, like I say quite a unique wrap-around offer to care-experienced young people. Pure Insight was founded in 2013. So, my background is in transformational change within the social care sector. And I was working for another charity, leading their employment division called Pure Innovations. And we had a contract with Stockport Council to support care-experienced young people into education, employment and training. And we were fairly good at that. And when I say, 'Fairly,' we were really good at it but what we were seeing was lots of other unmet needs getting in the way of young people being able to sustain employment. So, because Pure Innovations is a not-for-profit, they allowed us as a leadership team to identify an underserved group. And because of obviously my experience of managing a contract that supports care-experienced young people into employment and some of my personal experience as well. I had an idea that actually we could create something new for young people based on what they'd been telling us. So, I happened to win that. And we got three years start-up funding from Pure Innovations.

And the first thing we did was employ two care-experienced people to work alongside the young people that we were already in contact with to discover what were the main needs and challenges that they were facing, that didn't have solutions at that time. We very quickly identified loneliness and isolation and poor mental health as two of the top scoring areas of need.

Fidelma: I'm just thinking that very much mirrors some of the other research out there doesn't it? I was just looking at, you know, there's the 2022 government report Ready or Not. I'm sure you're familiar with care leavers' views of preparing to leave care and isolation, feelings of loneliness. And not knowing where to get help around mental health and emotional wellbeing was something really big that came up there. So, that's really interesting that that also tallies. Can you tell us about the programmes that you developed to support young people experiencing loneliness and isolation?

Sarah: The first projects that we supported young people to set up with us, because we collaborate when we're designing and delivering services, was a mentoring scheme and a peer support drop-in café. So, our mentoring programme was born that year. We designed it, again, very much around what young people were telling us. And, again, some research that we'd done nationally around mentoring programmes and what was successful, what hadn't worked, who it hadn't worked for? And we heard a lot of feedback around some of the more targetted programmes around education, employment and training weren't successful for a lot of care leavers. So, we wanted our programme to be a really broad offer that was about, 'Which bits of your life would you like to make some changes or thrive in? Whether that's being the most amazing parent you can be. Whether that is getting a job or, you know, whatever it is. You know, just being happy.' Whatever that was was going to be classed as a successful outcome. Because what it was about was about relationships and connection rather than very focused on specific outcomes. Because the outcomes actually come all by themselves if you can create connection, belonging and a bit of purpose.

Fidelma: It sounds like really listening to what was important for those young people in their lives.

[Expanding the scope of the programme] 

Sarah: Absolutely. So, they were an integral part of the design of our mentoring programme. Which we, like I say, we developed in Stockport. At that time as well we became part of a national programme called New Belongings. And that was a national approach to look at best practice for care leavers across the country. Which started to bring into our awareness, actually that what we were doing in Stockport was quite unique and needed to be scaled. You know, lots of people were starting to talk about it. So, we started to look at what other funding we could get. And we were really lucky to get some Children in Need funding, which allowed us to expand our offer in Stockport more fully before we then wanted to look at replicating that wrap-around support. So, the next programme we developed was our parent support project which is for care-experienced young parents. It's volunteers that are involved in part of that wrap-around offer. But that's for care-experienced young parents who become new parents. It might be parents who had children on plans with the local authority. Or they may have had children already removed from their care. So, it was a full wrap-around offer, again, to support that little family to thrive. And we were very aware that we also needed to develop something around mental health. Because our mentoring programme was working really well. Young people were saying how much it was changing their lives. But there were certain groups which were young parents, those that were really struggling, really, sort of, crisis presentations around mental health. And then another group of young people who were quite high risk due to exploitation, or it might be that they were still stuck in cycles of behaviour that was quite difficult or quite damaging to their lives at that time.

So, since then we got extra funding that we've managed to scale into, well it'll soon be, later on this year, seven authorities that we'll be working alongside. We were able to pilot a mental health project in one of those local authorities. Again, with some funding. We have to get a lot of funding from grants and foundations. So, only a proportion of our wrap-around offer is actually funded by the local authority or the ICB or whatever set-up they've got in each area. And we have to secure quite a lot of grants and foundation funding. So, it was one of those funders that supported us to develop our mental health programme. And again, it was a huge success in the area that we piloted it. So, we very quickly found funding to replicate that again across the board into the local authorities that we're working alongside.

Fidelma: Well, it would be great to hear about that service then in particular. As we're talking about supporting mental health with care leavers.

Sarah: So, our cycles or wellbeing service is an offer that sits as part of our bigger wrap-around offer. We have outreach psychological wellbeing workers who, similar to your IAPT-type service, they've got that training and qualifications around a range of therapeutic interventions that can be delivered to young people. But because of the nature of the young people that we support, we also require our outreach workers to be quite skilled in dealing with some of the environmental circumstances, if you like, that our young people may be facing. Because again, you can have great therapeutic input but if your housing is still unstable or your relationships are falling, or you've got other things going on that aren't being addressed, it might not be as helpful as it could be. So, again, we want them to be really holistically looking at a young person's needs. So, it's all delivered, all of our services are delivered on an outreach basis. So, they're delivered in the community. Either in the young person's home, in local green spaces or community spaces. Whatever's most accessible for that young person. So, immediately, again we're removing barriers around access. Because a lot of young people struggle to access services because of transport, because of finances. Because they are quite transient sometimes.

[A relational approach to support] 

Fidelma: It sounds like quite a flexible service and quite informal too.

Sarah: We're a lanyards-off, human-first organisation. So, again, the programme's developed, all of them are, designed in a way that the young person's got a chance to really get to know that person first, feel comfortable with them before starting any assessment tools. Or talking about quite deep things. Some young people want to do that straight away and that's great, we can do that. For others that need that softer, gentler relationship-building approach first. You know, time to tell their story and not just focus on what challenges and things are getting in the way. But, you know, 'What's happened and how's that impacting on your physical and emotional wellbeing right now? How's that presenting itself?' It's a weekly offer but again it can be quite flexible. So, what young people tell us really works is that they don't just get a letter saying, 'Your appointment is at Tuesday on a-, at 3:00.' It's a collaborative approach around, 'Right, this is our first meeting. Then from here what does this look like? When do you want to meet?' Again, looking at trauma-informed principles around giving as much choice and control to a young person is a massive power shifter. So, we try and do that as much as we can. And then the psychological wellbeing workers deliver a range of psychoeducation, looking at emotional regulation, problem-solving, skill development. Again, if a young person needs some support around healthy, unhealthy relationships, again, we do a lot of that. Risky behaviours, again, interpersonal skills, life navigation skills. It's a really really broad offer.

And it's done in real-time as well. So, if a young person's really struggling to access their GP or other types of mental health support that they could be receiving, or would be eligible for, but there are barriers getting in the way of them being able to access it. A lot of the support we provide is in real-time as well so we're not a signposting service. We're a, 'We will help you to access,' service. So, a lot of time is spent going into different environments with young people and helping them to actually regulate in that real-time as well.

Fidelma: So, does that mean attending a GP appointment with someone or picking up the phone to help them make an appointment with a service?

Sarah: Absolutely. Yes. It's all delivered with the design that, you know, we can, it's about incremental steps forward isn't it sometimes? So, it's not doing things for or to somebody, we're doing with. But encouraging that, those slow, because actually some of the young people, if you think about your own children, you know, some can achieve and be shown something once and do it. Others need quite a few times to be shown how to do something.

Fidelma: To gain confidence.

Sarah: Absolutely, yes. It's the know-how, isn't it? But it's the confidence that goes with that as well. So, we do a lot around ensuring that young people are accessing GPs and dentists. Anything around their health. And if they are eligible for other mental health provision, because again as a provider we, again, what's quite different about Pure Insight is that every care leaver is eligible for support from us. And we just need to find a way of delivering that, whatever it is that that young person needs. So, there are young people who've got quite high-level mental health needs that we're supporting. Which again, when we first developed the programme what young people were telling us was that some of them were deemed too high risk for the other provision that was out there in the third sector usually. Which might be counselling or, you know, or even IAPT services. But then they were really struggling to fit with the offer from adult mental health services. Because again, due to the nature of their services being very oversubscribed the access arrangements, again, lack of engagement was seen as a lack of willingness to accept help. When actually there were bigger things going on there. So, for example, if we are supporting a young person that is struggling with psychosis or does have other, what would be classed as secondary mental health types of difficulties. We are very much linking into those services, again, to try and work together to provide a package for a young person. So, the support really ranges from that, sort of, early intervention, lower-level help to quite high risk, defined as probably complex needs presentation. But, yes, there are a lot of young people with a lot of stuff going on in their lives.

So, we wanted to make sure that we didn't exclude anybody from our support. Because actually, those were the young people that had the greatest need that were telling us that they weren't getting their needs met. So, it just needed a bit of a different approach. And again to work in collaborations and make sure that young people are getting access to what they could or should be getting. Quite specialist support sometimes.

Fidelma: Does it also mean that a young person could have an outreach person from Pure Insight with them at some of those appointments again?

Sarah: Absolutely, yes. You know, care-experienced young people face a lot of barriers in regard to accessing services. And services as we know are very oversubscribed. And again, I think that the rigidity sometimes of the offer can feel very very difficult for a young person who has been in systems a lot of their life. It can feel a very very difficult experience. So, young people will possibly drop out fairly quickly. Or, again, their lack of engagement can be seen as a lack of willingness. And it's, kind of, a three strikes and you're out type experience. So, yes we will support in the background where we can. But yes, just making sure again that we are working really effectively with those local offers that are around and working together to get the best possible outcome for a young person.

Fidelma: How do young people find out about your service? How are they referred to your service? And I suppose I'm also wondering is there a cut-off point? Is there a limitation, you know, it's up to 25? Or what are the parameters that you have?

Sarah: Okay. Again, in any area that we're providing services we will already have, or will be negotiating a contract with that local authority to cover some of our core work. We will not provide services in areas where that offer isn't there. Because it's very important to us, well, a) it has to be sustainable because care-experienced young people have had a lot of things popping up, disappearing, changes in this, changes in that. So, we have to have a sustainable offer. But part of that offer is around being really effectively being able to work in collaboration with the local authority. So, we work really closely with leaving care teams. It varies in every different local authority that we're in. But we try and co-locate with them some of the week. We attend their team meetings. They attend our mentoring training as part of session too. So, we're very, very closely linked. So, the majority of our introductions, we call them, will come via leaving care teams. But we also have a route where young people can actually self-introduce to Pure Insight. Again, what we would have to do is go back and just get some information from them about who their leaving care team is, who their leaving care worker is. Just to ensure that, again, we have got a full, rounded set of information. And then usually an introduction form that gives us the information that we need around what their needs might be and risk, in addition to what the young person's saying. Because we do a lot on social media, again, young people will quite often say, 'My friend needs a bit of help. Can they receive an offer as well?' So, again, we're quite often introduced to other young people via our existing cohort of young people.

We work, again, closely with colleagues in health. So, part of any service that we provide, especially when we're going into a new area, is about making all those connections and links so that, you know, the looked-after children's nurse knows about us, and can make referrals in. We connect with local GP surgeries. So, again if they come across which, again, it's becoming more actually that they are being identified within GP surgeries. But just other health partners as well. So, that, for example, family nurse partnership teams who might be supporting care-experienced young parents. Perinatal teams, again, we've worked alongside them. So, any professional can make an introduction to Pure Insight. And then we will touch base with the leaving care team just to, again-, yes.

[The scope of the service] 

Fidelma: Okay, super. Thank you. And what about the parameters then? So, is there an age limit? And is there also a limit as to how long you'll work with the young person?

Sarah: Yes. So, our service can start from the age of sixteen. And we go up to 28. However, we do support some care leavers who may be older than 28 in quite distinct circumstances. So, it might be that, I'll give you an example, so a young person that we'd known, gosh, probably from about being fifteen. Had been in really destructive cycles, he hadn't managed to make the changes that he needed to. And at the age of 27, he'd come out of prison and he was really ready for change and came to us. Came back to us and asked, 'Can you help and support me now?' He was just about to be 28. But, again, it's stage not age isn't it? So, we have to have a cut-off point because otherwise, we would be completely oversubscribed. But we will make individual decisions. Again, we'll go back to the local authority and the majority are very keen to look at an over-25 offer. And, certainly, we support a lot of the local authorities that we work alongside with their over-21 offer because, again, leaving care teams are becoming very oversubscribed with the volume of young people that they're supporting.

Fidelma: That's really fascinating, yes, thank you, and there's a lot of research out there about often the later ages that care leavers are going to reach particular stages of readiness. Whether it's personal therapy or education or whatever it is, those stages might come later, that's good to hear.

Sarah: I think, we're just moving the cliff edge, aren't we? When we move the age range, we're just moving it to another age and, yes, like you say, again your brain development, when you look at how your brain keeps developing. They say 25, it could actually be older than that now, couldn't it, so sometimes people can't or aren't able to make the changes that they'd like to make until a bit later on in life. And, yes, then you've not got that support available to you, it must be incredibly difficult.

Fidelma: Yes, and when there has been so much instability, absolutely. Thank you. Obviously, it's going to be different for every young person that you see. But, can you talk in terms of what are the main needs that you see of young people coming into your service?

Sarah: Again, it is really varied because we work with such a wide range of young people. Sometimes we can be working with or supporting nearly over 50% of our local authority's care-exposed cohort within a year. Which is a real varied group of young people. But, again, the needs are very similar to the needs that we identified back over 10 years, which are loneliness and isolation, lack of support networks, real struggles around mental health and the complexities of difficulties that young people are struggling with. We see lots of young people that are just really struggling to manage that adult lifestyle. You know, adulting's hard, isn't it? All the things that you're expected to do as an eighteen-year-old, to manage your tenancy, your finances, what you're going to do in the daytime, your emotional, physical health, it's huge, isn't it? Housing, again, is a massive challenge, isn't it. So, the local authorities that we partner with are doing their very best to make sure that they are getting secure, stable housing but that's not always the case. Poor housing and the areas sometimes that young people are living in, again, when you're already vulnerable to exploitation or to other factors that can be tricky as a young person trying to manage life are there in those communities.

That can be really difficult. Young parents, again, we see a lot of need around some of our young people who are also young parents, parenting's difficult, it's complex, isn't it, and without those support structures around you it's incredibly difficult. We see, as well, quite a large number of young people that do have additional needs. Some of those may be already labelled or diagnosed, but we see quite a large population of young people who don't have those labels or diagnoses or they can't remember if they have, and that can be a huge challenge. Because, again, learning disability, being on the spectrum or neurodiversity, there are a lot of young people who are struggling with neurodiversity that are really, emotional regulation is apart of that. And, in addition to that, you've got your former history as well, so managing relationships, managing tenancies, holding down jobs, all of these things require a level of emotional regulation and inter-personal skills. And, again, that's really tricky when you are struggling across all those areas. We particularly see the older range, actually, of young men that are approaching 26, 26, upwards, that are really struggling in that area, that we're trying to get in adult services for learning disability or adult social care package, if you like.

It's really tough. So, you've got young people that are living independently but who don't have the skills to perhaps do that, that can be really hard. But, yes, and just going back, loneliness and isolation and mental health are always the two top topics. So, young people might tell us they're struggling with a number of different things but those tend to be two very common themes still. Cost of living, as well, has had a huge impact of young people, huge impact, yes. Finances, again, it's another area that's tricky until you get the hang of it, but it can be devastating, it can have a devastating impact, can't it, on being able to stay in your housing if you've got yourself in debt. This stuff follows you around for a long time.

[Reducing loneliness and isolation] 

Fidelma: Yes, and the strain that that puts on mental health, again, is huge. So, you've mentioned loneliness a few times, so for those young people for whom that's one of the key parts of why they need support, you've talked earlier about having a mentoring service. Are there also opportunities for young people to meet each other?

Sarah: Absolutely, yes. So, young people will usually enter our provision with their most pressing need. So, it might be that, actually, support around their mental health has been what they felt was most important. Mentoring is quite an abstract idea for a young person, 'What do you mean, there's going to be a volunteer, a stranger, that's introduced to me?' And, some young people get the concept straight away, others are a little bit more suspicious of it. So, it doesn't matter how a young person arrives with us, they can have their most pressing need met first. So, it might be through the psychological wellbeing service, it might be if there's a young parent, it could be that, actually, they've seen our projects and activities. So, we do a lot of outdoor challenge-type activities in groups of young people, so, again, it's about peer support but it's just being able to get out of the environment that you're in. Have new experiences, you know, for some young people who are coming away from quite high-risk situations, you need a bit of excitement in your life, don't you. So, we climb up mountains, we go kayaking, we've just done some Alton Towers trips. So, it might be the young person's come thinking, 'Well, that's what I would like to get from Pure Insight.' But then, by getting to know some of the team, some of the volunteers, because whenever we deliver anything like that there are usually volunteers that are supporting it as well. So, they get to meet mentors and suddenly it's, 'Oh, actually, they're quite nice and I perhaps would quite like to have somebody like that in my life.' I mean, the other thing that we do as well is we have a drop-in cafe in the areas that we work in. Again, we work with local community spaces to take over a space in an evening. Sometimes it is a real cafe, sometimes it's a community space, and, again, it's a space where young people can come in an evening, so it's once a fortnight. We cook together, we do have fun activities, again, it's heavily supported by volunteers, mentors will bring their young people if they're not as confident to come by themselves. But, again, it's a real sense of community and belonging and it's a space that the young people very much feel a sense of ownership over as well. So, if we are trying to introduce, again, we will ask the young people, 'Who would you like to introduce?' We might have somebody from the local debt advice service, we might have somebody from the local substance abuse service that comes in to talk to young people. The local authority sometimes asks, 'Could we come in and talk to young people and ask some questions about our service provision?' I think, we've even had Ofsted inspectors in there as well, on occasion. And, sometimes funders will want to come and speak to young people as well, but it's all got to be by young person invite only. So, it's not for everybody, but there is a significant number of young people that really enjoy having that space. And, that's why it's really nice to hear of some of these hubs that are cropping up across the country. Again, we've seen it, having that space where you can just be yourself, you don't have to be anything else. You can just come, you know you've got shared experiences, and, again, young people, because we do champion lived experience within our organisation as well, can come across older care-exposed people. And, again, it's about that role modelling and connection.

Fidelma: That sounds really valuable, thanks Sarah. Can you tell me about how long you generally work with young people? Is there a limit, is it a two-year thing or?

Sarah: It is really bespoke. So, again, how we've deliberately our programmes, with local authorities and some of the other funders that support our work, is that we're not excluding people. So, there's no set agenda. The mentoring support, so once a young person has been matched to a volunteer, the programme will support that relationship for two years. And, that means that we're around in the background, we support the relationship to flourish and thrive until it has got legs of its own, which can happen quite quickly. And, at the end of those two years, if all parties agree, it would progress, then there's a mentoring friendship. So, again, it's up to the two people involved to make their own arrangements after that. So, we've got mentoring relationships that are ten years old.

Fidelma: Oh, wow.

Sarah: So, they can be a lifelong connection.

Fidelma: Yes.

Sarah: Again, we don't have, and we've worked really closely with local authorities, because KPIs are always part of conversations, aren't they, to not say, 'You have to match within a certain amount of time.' Because, some young people, especially those young people who have had the most disrupted experiences already, won't be ready to be matched to a volunteer. There's too much chaos or there's too much risk going on. So, they can sit with a coordinator, again, we have to really carefully manage this because we've got to have enough young people coming through so that we can support as many young people as possible. But then, we need to also make sure that that group who are the furthest away from everybody else has a fair chance as well. So, we've had young people who have sat with the mentoring coordinator for three years before it has been appropriate to introduce a volunteer into their life. And then, obviously, they've got the two year offer after that. Young people can, sort of, move around our wraparound offer. Again, we try not to dual-work too much, but it might be that having some support around mental health through a psychological wellbeing worker will enable that mentoring relationship to flourish.

Because, the young person is learning the skills and coping strategies to be able to sustain that relationship in the longer term. So, there's no definitive setup. For some young people, it can be a much longer offer, the idea is that every young person, like with your own children, will leave us, we call it the Pure Insight family, they can always be connected. Young people come back and help us, I've not really talked about our experts by experience and influencing work yet, but, again, there are lots of other ways for young people to stay connected to us, to help us to deliver what we do. And, influence services, commissioners, policy makers, whatever. So, yes, sorry I can't answer that with a definitive. But, for some young people it can be a shorter offer, for others it can be much longer.

Fidelma: Fantastic, thank you. What, kind of, difference do you see this making, your service making to young people that you work with?

Sarah: Yes, so, again, the benefits are really broad and specific to a young person. But, what we try to do, because we want to report on progress and show the outcomes that we're achieving, in our mentoring programme, a young person picks three areas of their life that they would like to focus on. Loneliness and isolation is added onto that, and we use a mentoring progress wheel. It's a bit like an outcome star type assessment tool, but it's one that we've developed ourselves with care-experienced young people to be delivered in a way that they feel comfortable is and isn't re-traumatising. So, they pick the areas and, again, we're able to track progress. So, we assess that every six months, so we can see the areas. So, examples of areas, apart from loneliness and isolation, would be finances, physical health, mental health, confidence and self-esteem, positive things to do in the daytime, education, employment and training. Belonging and relationships, parenting, reducing unhealthy coping strategies, housing. The psychological wellbeing service, again, we've worked really hard to evolve this because what young people told us when we set up the service was that they really struggled with some of those questionnaires that were about feelings.

And, actually, they were really skewed, the answers, because they were telling us sometimes, 'We just say three for everything.' Or, if they're worried about losing the service, they will underscore themselves as well. So, the data can be skewed in lots and lots of different ways. So, again, we've worked really closely with care-experienced young people to design assessment and monitoring tools that aren't re-traumatising, that do feel helpful and useful. But, they're not an absolute. So, again, if you've got a young person that feels they've been processed so much, they're just so resistant, and it would ruin the relationship, it would ruin the work, we do it as an observational tool in the background. We'll check in with the PA, 'What changes can you see,' so we're not just putting a finger in the air. But, they don't have to fill in, lots of young people want to because we've designed them in a way that they've been involved in, so it does feel different. But, again, we've got eight questions that are around, 'How well do you understand the way your emotions affect you, how in control do you feel?' You know, various different things for our psychological wellbeing service. But, again, a young person also picks three areas that they would like to focus on to develop.

So, it might be understanding a diagnosis or their identity or labels that they may have had or symptoms they might be having. Emotional regulation is usually on everybody's list as well. But, it might be building social support networks, it might be improving inter-personal or life navigation skills. So, again, the team will pick those three areas and we will monitor progress against those areas as well, so that we have got a way of tracking. But, again, it's not always linear, is it, somebody's journey. So, we use a lot of storytelling and case studies to describe the complexities that a young person is facing when we initially meet them, the range of therapeutic or other types of support that we've introduced or walked alongside them with throughout that journey. And then, where they're at at the end of that journey. Again, usually with a quote from the young person or from somebody that knows them really well, and some quite tangible things in there, as well. So, again, it's a relational based approach but if somebody has managed to maintain a tenancy when previously they were struggling to do that, or they have gone into education, employment or training, some of those harder outcomes that people want to see as well. We're able to track all of that, really, in a live way so that local authorities, funders, they're able to see that our service is making a difference to a young person.

Fidelma: Thanks so much, Sarah, that sounds like an incredibly valuable service and I wonder, can you describe what it is that's really unique about Pure Insight from your perspective?

Sarah: Yes, I think, it's a number of things. I think, it is that flexible outreach wraparound offer that is all-encompassing. So, it doesn't matter what you're struggling with, you can have that immediate need met and then move seamlessly around to get other. Because, again, a lot of young people tell us that they feel overwhelmed with the number of services and professionals that they need to engage with to get their various needs met. It's that we don't exclude young people, we find ways to provide and, again, if we come across an area that we don't have as much knowledge, like, unaccompanied, separated young people has been a new area of work for us. We partner, we collaborate to increase our knowledge and increase our offer, but it's all about being embedded. So, our growth has happened, it's been very organic, we've tumbled into, let's not make it sound like it's, we've strategically looked at the next local authority. Because, again, we're very aware that if it's about care-experienced young people feeling part of their communities, belonging in their communities, you can only achieve that with the community.

So, we employ local people, our volunteer networks are local people, we connect everybody, we create, if you like, that network and family for young people that don't have that. And, that not only works really well for the young people, it works really well for the volunteers, it works well for our team. Because, actually, we're all human beings, having an experience, and we've got to look after each other to be able to do this work really effectively. But, one thing I didn't mention, actually, about the psychological wellbeing service was that clinical supervision is a really important component of that as well. As is that reflective practice space for all of the other provision that we've got. Because, again, if we don't look after our workforce, whether that's our paid or volunteer workforce, we're supporting young people who have experienced a lot of pain. And, that can be quite difficult at times, can't it, it's the most rewarding experience but it can also be quite difficult because it's really important to look after people. And, like I say, have that real embedded community response to pull in as many other services as you possibly can just to, together, achieve better outcomes for care-experienced young people.

Fidelma: Thank you so much, that sounds like a really rich and valuable service. I really appreciate you coming to talk to us today and sharing with us what Pure Insight is all about and how you support care leavers around mental health and wellbeing. Thanks so much.

Sarah: It's a pleasure.

[Outro] 

Thanks for listening to this Research in Practice podcast. We hope you've enjoyed it. Why not share with your colleagues and let us know your thoughts on X (formerly Twitter) @researchIP and LinkedIn.