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Social and Behavioural Challenges in Adolescence - Chaired by Ann Sutton
Paul Griffiths - ‘Needs of young people - the role of voluntary agencies’ Dr Leon Polnay - ‘Needs of Young People in Residential Care’ Laura Gamble - Recreational Drug Use Christine Ferron - School Drop Outs Dr Aggrey Burke - ‘The challenge of race - the outcome of teenage pregnancies’ Keith Drinkwater - Young People Running Away.
Paul Griffiths - ‘Needs of young people - the role of voluntary agencies’ First I would like to congratulate Youth Support - .. happy 10th birthday to you. I think you started, on the same year as Childline, it’s Childlines’ 10th birthday too this year; so … happy birthday Youth Support. Now, in letters to Judy Blume, who was an American agony aunt, who wrote a book called ‘what kids wish they could tell you’, amongst the examples of correspondence, one stands out:- ‘Dear Judy, my mum’s so scared to tell me anything, so could you write a book called “How to tell my daughter” so I can give it to her, yours Karen, aged 12’ One call I remember taking in Childline all those years ago, was a young women who said:- ‘Please help, my mum says she is going to leave my dad, and I am going to stay with him. My daddy says mummy is going to run off with another man, and I am going to go with her. What can I do?’ Think about it. Why do young people need voluntary agencies, and what can they do to achieve and reach out and begin to work with young people, who come to them for help? Some of you may remember a children’s society campaign a few years ago which featured a boy against a yellow background and it said ‘I need a good listening to’. Well that is our motto, that is what we should all work from. I am going to talk a bit about what the Children’s Society has done in recent years, to listen to listen to the needs to young people, and structure it’s work and activities in such a way that they are child involving, child friendly, child empowering, and while it is very depressing to hear of adult’s criticism of, say, the recent NSPCC commission of an inquiry report into child abuse, had anyone actually asked the children about what their experience was of being a child was in the UK today. At least the NSPCC did that, and if their projection of 1 million children who are unhappy, were listened to in some way, rather than the adult view, which I heard predominately on the radio, may be we would actually learn from that. I think that rather like Youth Support, when I launched Childline, this was against Department of Health advice and almost every director of social services in the country. It was irresponsible, we were giving children analgesics, the social service departments were going to be overwhelmed, and well, you know, ‘please don’t do it’, to the point that my own professional credibility was questioned and threatened on many, many occasions. Well, it was launched and in the first ten minutes of it’s work it was swamped with over 50,000 calls, we know that from the figures BT actually gave us. Calls that did get through were disembodied voices, rather like the young women I have just talked about, and which we as adults never really stop to listen to. Now, why is that? And what have we at the Children’s Society done as a voluntary agency, to attempt to address this balance, and become what I would term a Real Children’s Society? So, what do we know about young people’s needs already? Well, in asking them, we find that their only certainty is change. That the proportion of children living outside the two parent family is almost the same today, as it was in 1851, that there are decreases in family sizes, postponement of parenthood, increase in child-baring outside marriage, and there is a frailty and discontinuity in relationships. The proportion of children under 16 living with both natural parents was 83% in 1979 and in 1991 it was just 68%. Nearly one in five of households in London has just one adult. Children are less likely to share the companionship as they used to with siblings or wider kinship, and in London in 1991 43% or households with children had only one child. In 1979 10% of all children were living in poverty - that’s defined as people living below 50% of the average income after housing costs. In 1992/93 33% of all children were living in poverty. And 14 of the most deprived local authorities (of the first 20) were here in London, whereas within 20 of the 40 postal districts within London there is the highest income in the country. So hence this huge contrast twixt poverty and affluence. In 1971 80% of 7 and 8 year olds went to school unaccompanied by an adult - you probably remember going to school without anyone coming with you, we now know that only 9% are allowed to go to school on their own (1995). So we have this contract between what I call the free-range environment that many of us grew up in, and the battery reared conditions that most of today’s children grow up with. When we turn to special schools, we find that an decreasing proportion of children were placed in special schools in the 80s but between 1991 and 1992 this trend was reversed, and between 1991 and 1994 there has been a threefold increase in the number of pupils who have been permanently excluded from school. 1985 37% 16 and 17 year olds were in full time education and 29% had a full time job. In 1995, 69% of 16 and 17 year olds were in full time education and only 8% had a full time job. And so it goes on, 90% of all young people leaving care are unemployed. Benefit rates, we know about the removal of benefits from 16 and 17 year olds. And the removal of benefit entitlement for asylum seekers. Housing stocks have reduced very considerably, in 1994 345 households applied for re-housing under homelessness legislation and were refused assistance on the basis that they were asylum seekers. So it is against that backdrop, and there many more statistics which you could take which would demonstrate the considerable pressures upon children and young people today. There are a few upon which we actually based, what we call, our justice objectives, and ways of working within London, and helped resource some of our new projects which I am briefly going to talk to you about. We were largely lead by the UN convention on Rights of the Child, to which this Government, fully signed up member, ascribed to at the summit in New York just a few years ago. Yet we have a justice system that still locks up children. And 8 times as many black children as white children. I was in Feltham the other day and that was very, very clearly demonstrated. The Governor told me he had to resist three judges that this 14 year old should come to prison, should come to Feltham Young Offenders Institution. It is illegal, but the judges were insisting on that, but he successfully resisted. Yet, we still have 15 and 16 year olds locked up in this country. So, we determined to organise our work in to six justice objectives upon which we would actually carry out our work, and we called them our action plans. 1) We felt that all children, and we had to be idealistic and envisualising about this, all children should have a good start and have access to positive childcare experiences in their homes and communities - this concerns children under the age of 8. 2) We felt that all children should be protected from all forms of violence and abuse. 3) All children should experience just processess and retain their liberty, unless containment is necessary to protect themselves or others from serious harm. We also wanted in that context to adopt an object that anyone under the age of 18 should not be in prison custody. 4) We felt all children should have access to sufficient income, and the number of households with children and young people where income was below half the average should be reduced. 5) All children and young people should have somewhere to live, and no-one under the age of 21 should be homeless. This is not the case in London today. 6) And finally that all children should be listened to, and be able to participate in their neighbourhood, and in services which effect their lives. And also that their thoughts and wishes were taken into account and they were able to make informed decisions about their lives. So on the basis of those justice objectives, what I want to do now is to talk to you very briefly about the process as we, at the Children’s Society have made here in London in the last three years. Well, we are setting up two new projects under the object of ‘have a good start’. One is a project in Dagenham and that is about listening to children under the age of 5 and asking them what services, what play groups, what facilities they would actually like. If you listen to them, carefully, they have a lot to say, particularly at that age, I can remember that just about - and being a grandfather now I am living all that again. They have a lot to say about the places that they go to and what’s good and what isn’t good. We need to listen to them and value them. The setting of a project where we are helping parents learn how to play. I was looking at the swiggle diagrams on display, and that is particularly going back to my childhood too, and I was very much a follower of Winnicott. And in terms of looking of parents who were themselves as children were deprived of play, or don’t know how to play and they now have children of their own. The setting of a project will help them play, to help them in what understanding play needs actually are. We did this by talking to children under the age of 5 and watching them and looking at their degree of depravation and withdrawal, and how we are going to get that turned around so that they become healthy young people. We are going to set up a project under our objective which reaches out to homeless young people. There are about 400 homeless young people under the age of 21 in Central London with a number of serious mental health problems in some cases, it is really touch and go as to whether they get into the justice system or the criminal system. Their life expectations may not be any longer in some cases than 24 years. We really have to start to work with them, however resistant and angry they may be, and that is often based on past experiences of abuse in care and so on. Under our treated fairly objective we are having a rights and participation project which looks at young people who are in local authority care and how they are actually going to change that for themselves, in Hackney, Lewisham, Newham and Southwark. We have a project which is called ‘Schools Inclusion’ (not exclusion but inclusion) where children are actually earmarked, or identified as being for their behaviour excluded from school, we want to turn that round to a positive way and call it schools inclusion, and that project is now taking off, and is very valued by the schools concerned, in Lambeth and Wandsworth. We are setting up a project which is also about rescuing, I had to use that word even though I don’t actually like it, rescuing those young people inappropriately committed to prison. Like the children I was just talking about. We are working very closely with the prison in Feltham on that. Under sufficient income, we are setting up a project which is about helping young people tackle their poverty, the fact of their poverty within the anti-poverty strategy which exists in the London borough of Greenwich. We are involving them in that, and a way of involving industry and business to take an interest in young people and their special skills and talents, and how they can develop and feel more valuable and not unemployed, and lacking any value We have a project in East London which is looking at the social exclusion of young Bangladeshi women. Also about young people with disabilities. This is tied up with poverty as well within Tower Hamlets. We have another project which is going to look particularly at asylum seekers, who are particularly discriminated against in UK today. There is a lot going on about that at the moment. And refugees in Newham and very possibly in Hillingdon. We are working with young tenants who are largely excluded from housing associations and so on. We are setting up a project to support young homeless in gaining tenancies in housing associations. We have already secured a very large contract with a very large housing association in Brixton and we are going to back them up and support them and demonstrate that they can be reliable and vulnerable, and not stereotyped as unreliable and noisy and rowdy as people often do. We believe, we trust in young people, and that project is going to demonstrate that very conclusively. We also want to develop with those young people the concept or notion of self build. They have talents, they have skills, there are modern apprenticeships and so on. Why can’t the build their own houses? And we want to try and help them do that. A lot of that is visualising, which is what we are doing. And if we have that belief we can work with young people, because this is what they want, we have consulted them, and we want to take them along with us. We have a project with in Battersea and in Wandsworth which is about preparing young people for independence - that is those young people leaving care. We have another project under our listen to objective which is about looking to children in neighbourhoods, about how children at all ages, can influence the development their own neighbourhood and turn it around from being not the safe place that we parents think it is at the moment but into the safe place, which is it clean, where they can go out and play football in the street, where they can feel as free as perhaps we did - although perhaps I have a rosy memory as a child growing up in Liverpool. So that is about involving children in community decision making processes, it is about influencing counsellors - in my other life I am a counsellor in Bedfordshire and I would welcome young people coming to see me and persuading me that the village green should be used for something else, or that a youth club ought to be build. We have problems too, not only in London, but also in the so called leafy places, in terms of the intolerance which there is of young people and where they can go and play and feel valued and wanted. That is working across the London Boroughs of Hammersmith and Fulham, Hackney, Enfield, Camden, Bexley and Lewisham. So a pretty wide spread cutting across London. And finally we have two projects, one is called ‘Baseline’ (not too far from Wimbledon hence the name I think), working in Mitcham, London Borough of Merton, which is about providing information and advice of all kinds based on what young people want - if you like a kind of walk in child line can listen to young people on the phone, but in some cases children need to work face to face. Now in Mitcham particularly what we actually did was that the young people actually designed the centre themselves, and with us they demonstrated where they would like it to be, they were involved in the appointment of the staff and the also involved in the appointment of the management committee. Now, that is not patronising, that is what is actually happening, if you were to go to our Mitcham project you would actually see the young people running it, with us and the London Borough of Merton, and they are involved in making management decisions about the running of an agency in collaboration, as partners, genuine partners, with us. I think that is one of the few projects in the country where I think that that has actually happened. We have another project on similar lines set up, called Genesis, which works inside a school in South East London, two thirds of the young people there are black and our whole team is black working with these young people and facing some of the problems of growing up in Peckham with them. There are some of the examples of the projects which the Children’s Society have, in the last two or three years, developed. So, I think that when you can see, as a voluntary agency in London, where you actually get a group of people working with young people, as partners and so on, that is a very powerful mechanism. We have certainly found that. Children are very demanding, they want something done like yesterday, and we try to do it like yesterday, because that is the way it works and what we want to do with them. We can look at the social policy issues which are around, their therapeutic needs, their health needs, their family problems, but we look at that very much from a young person’s perspective - with them as partners. So, looking ahead - yes, we want to work with young asylum seekers. 53% of all young people looked after in the London Borough of Hillingdon are children who have on their own, not with adults, have fled from oppression and very possibly torture in other countries. We also want to work with young people who abuse other young people, who may well themselves have a history of discontinuity in care, poor bonding in early childhood and so on. Now, I know that list can actually go on, but I think voluntary agencies like ours, and we are not the only one, Youth Support certainly and many, many of the others, could stand here where I am and really claim that we are in the forefront really of developing young people centred services today, and this is against the backcloth of declining resources from statutory agencies, wide spread public disaffection and often anger and apathy towards young people, increasing needs, highly competitive market place which we are in which makes young people much more vulnerable and at risk. Tallulah Bankhead once said ‘I wish I had children, beautiful children, well, I wouldn’t care for the other kind’. Well, we have to trust (that is a word which I have picked up today), and care for every child beautiful or otherwise.
Dr Leon Polnay - ‘Needs of Young People in Residential Care’ I have amended a few of these notes as I have gone along, as I have seen there has been quite a bit of repetition of various themes and points during the day. And I think that this is good, it indicates that there is a high level of agreement among the speakers at this meeting, but I think also, when you look at who comes to a meeting, perhaps the people who we most need to influence are not here and we agree amongst ourselves but we perhaps need to get our hands on other people. First of all some statistics. Currently about 50,000 children are looked after altogether, with about 20,000 in residential care. The numbers in residential care are dropping and now mainly represent those children and young people with the most severe difficulties (about 20%). The routes into residential care are generally neglect, abuse, offending, ‘difficult to place’ and behaviour problems. But in general we are talking about combinations and thinking about many of the young people I am working for or with nearly all of these apply - so it is multiple difficulties rather than single problems we are dealing with. In terms of a policy that we are supposed to be pursuing in health, in terms of the ‘Health of a Nation’ targets, I think I would challenge anyone to identify any group of young people where the ‘Health of a Nation’ targets are perhaps least met. So, if we look at teenage pregnancy, or smoking - certainly with the first group of twelve we worked with, we found one non smoker amongst the 12. In terms of sexually transmitted diseases and in terms of self harm these are a group of young people who we should really strongly targeting, that is if we believe in ‘Health of the Nation’ targets. But it is not just the health service which ought to be targeting these children, because clearly there are major problems in other areas. Many have learning difficulties, some simply because they have not attended school, and certainly over all may be 60% or 70% are not attending school, or certainly in the past have missed large amounts of school, or where there has been incredible discontinuity in their education. I would have brought some notes along, but I have trouble carrying heavy weights at the moment, but you read a huge pile of notes, and you read the changes in school. Enormous number of schools, 6 or 8 primary schools, or more secondary schools, with very large gaps. So, no wonder there are learning difficulties, which I think is perhaps to some extent an understatement. Many are excluded from school, or when they are in school they have problems or behaviour in school, and if we turn to behaviour, prostitution is certainly in our district a major problem. Boys and girls as young as 12 are involved in child prostitution, and many of those children were abused in the home before coming into care. We see that community homes are targeted by people who wish to recruit them into prostitution, and certainly the offer of drugs and other substances may well be a factor in that as well. But prostitution is a major factor, and actually trying to prevent children going into prostitution is also an important area. In our district we have prostitute outreach workers, who are ex-prostitutes, who are involved with the community homes talking with the young people. In terms of substance abuse, we actually think that perhaps there is a great deal of knowledge about that, but we also see another side of it, that people will experiment with almost any substance, to see what would happen. And we are regularly seeing children being admitted to hospital - we had a group who broke into an elderly couple’s house, found some pills, took them away, and the pills were ‘frusemide’ a powerful diuretic, and ‘digoxin’, but they were sick kids, they had to be monitored, it could have been potential lethal, and some children will actually try virtually any substance that may or may not give them some pleasant effect, and certainly there are major concerns about that. We have had one or two children in intensive care recently, but no fatalities. What about health, what problems do we have there? Well, start with diet, because when we looked at what children in residential care were eating, not what they were offered, I may add, none of the children were eating fruit and vegetables. Well you might say does it matter, they have bigger problems than whether they eat their greens or not! But having said that, they were following very unhealthy and restricted diets. Continence was a problem. Problems of wetting, or soiling, smearing faeces, common problems which we encounter. Discontinuity, I think is one of the areas which make work so difficult. The children move from one area to another, and to build up a programme of health care which can actually be delivered is very difficult. What happens is that we are frequently going back to the beginning and starting again, and not really delivering a proper continuous programme of health care. Lack of information, is very much a problem. What happens to the children’s medical records, do they follow them, do we have the information we should have? Do we have proper information about family history, do we know what treatment the children have been on or should be on? And very often we have to be a fairly good detective at milking records and other systems to get this information. There might be poor compliance. We may get there, we have the medical records, we know what treatment the child should have, how well, how effectively is that treatment being complied with? And what level of organisation do you actually need, to ensure that children get repeat prescriptions, that they attend appointments, that they actually get connected with the service. Fear and mistrust was one of our major problems. When we asked the children what it was like, what they felt like, when they had their routine health check examinations and reports, we found that there was one person who felt it was a good idea, everyone else was very critical about it. Imagine what it is like to be taken to see a doctor who you have never met, to not know what is going to happen, and to be in fact the object of that consultation, rather than a person who is centrally involved, who’s views, who’s worries about their health are being looked at. And I think many young people feel very negative, they don’t want to go, and there is a great deal of fear and mistrust about that whole process And I think we should be doing something to address that. Choice - who do you want to go with you? And major issue, was whether they were accompanied by a male or female person, and also whether they saw a male or female doctor. It is a major issue for most young people, but again, we found that most were not asked and didn’t get a choice. And often were reassured that ‘yes it will be a lady doctor’ or ‘yes it will be a male doctor’, would actually make a big difference about how the children would feel about the medical consultations. And when we think of what is involved in those reports, I think that too many are confined to physical health, height and weight, and not very much if anything about health promotion or mental health. So I think we can do a lot to improve the quality of health interviews for this group of young people. What do we need? We certainly need a better access to existing programmes of care. If children are not in school, they probably don’t have access to the school health care service, and to health promotion in schools. What access do they have to primary health care teams? How easy is it to get an appointment? What are the problems with access? Do we need on top of that a separate tailor made programme, which is actually made to meet these young people’s needs? We often talk about ‘comprehensive’ or ‘seamless’, but quite often it seems to me that rather than seamless it is a whole pile of rags. We do need to provide continuity within that service, and I hope that one of the messages that we are putting forward in our programme is that we are here to stay. I think now, we are two years into our programme for young people in residential care, I think the fact that the same people keep coming to community homes is beginning to be realised, that we are providing continuity. Not only over time, but in the various places where they might be seen. We need proper information and records which not only we have, but the young person has, not us being the only custodians of that. And above all we need collaboration - we need to be working together. Aims - What are the aims of the service? in fact, that’s probably the aims of service for any children in the community. All we are doing is restating it and saying that we have the same aims as any service which is dealing with children. What are the objectives of the service? We do want to have an overview of children in residential care, their health needs. Identify gaps and attempt to meet those. We need to provide a source of advice to staff in community homes on health care. And for individuals we need to provide health care advice - to young children who are looked after. So we are really working at three levels, at the population, at the level of the community home, and knowledge about child health, and at the individual. In our approach these are the various levels we are trying to work at:- * Health Promotion programme which is taking place in community homes. * Individual assessment of health needs. * The young person is actually in control of the process - which is very important - rather than the object of it. * Provision of support and training for residential social workers. So, who is in our team? * The most important person, the only full time member, a research school nurse. * An administrator to keep records and to provide information about where children are coming from and going to. * Paediatricians, three part-time people who are seeing individual children - I am the only one which is permanent, but we can give children the option of seeing either a male or female doctor. * A part-time clinical psychologist who is part of the core team, who will see individual young people * And a child and adolescent psychiatrist who is part time. We have a broader range of people, and the extended team is just as important:- * Social services policy officer, without whom none of the work in community homes could actually happen. * We have the involvement of training officers from both health and social services in supporting the educational programme for residential social workers. * We have a named educational psychologist working with us in order to try and look at the educational needs of each individual young person. * And we have a dietician because we are obsessed with what people eat! Interestingly we are hoping to get funding to run a programme where we will try to improve diets and also self knowledge about food and independence. One of those lovely things which happen by chance - the cook left from one of the community homes and an unemployed chef applied for the post to work on a temporary basis, and people were sampling mushroom and oregano soup and all sorts of lovely things and because the meals were absolutely super, restaurant food, rather than sitting down to the minimum time to eat the meal, everyone sat down and talked, communicated and it was absolutely wonderful. It was orderly, and it made a very big difference. And we are now trying to see if we can actually extend that, recognising that a good meal and actually sitting down and eating together is very important process. How do we assess the needs of individual children? We have a questionnaire pack, which they in fact complete themselves. It consists of a number of different questionnaires. There is the Trent lifestyle questionnaire which looks at areas such as food, injuries, out of school activities, feelings, drugs, alcohol and sexual health - we have added an extra couple of pages to cover sexual health and self-harm. And we have other questionnaires which cover depression, fears which children may have in ordinary situations, and a locus of control questionnaire, and a quality of life questionnaire. And the children can complete them in one go or in several steps. The next stage, we have actually got these questionnaires now onto the computer and having done that we provide feed back to the young person themselves on the results of the questionnaire and we produce an agreed health care plan on the areas which they actually want to work on which arise from the questionnaire and that is actually agreed. But what we think is very important is that the recommendations are actually implemented. So the core team have a monthly meeting at which we have a review of every young person and the progress of implementing their recommendations. We have to deliver. We can’t just make assessments, raise hopes and then not deliver. And I think that the implementation is very important and must be seen to be successful. The health promotion work in community homes is done is six-week blocks by two team members. It usually consists of an introductory session, and then chosen topics by the young people and sexual health and drug miss-use are the most often chosen topics by the young people. There are also individual health promotion and staff support as well within that element of the programme. We started at the beginning by establishing a one week course on health for residential social workers. We have ten or twelve people on each course and these are the areas which we cover:- * Growth * Development * Child health surveillance programme * Common illness and their management * Mental health * Substance miss-use and drugs * Sexual health * Child protection And we have a follow-up day in six weeks time. And we have had very positive feedback from that and we would want to in the future extend that and do some advanced training related to health. Where might we be going for the future? I hope that the project for children in community homes is permanent, it’s got secure funding so what is it’s future? * I think developing the trust of individual young people is very important * Communication of health information which has been very poor, to young person and to others about the young person. * Continuity within the programme, with who is seeing an individual. * Choice for them in terms as where they are seen - in the community home, in school, we also meet in Macdonalds which is quite popular (back to food). The young person is actually in control of the programme rather than being the object of it and we would like to end up with meaningful medical appointments - which the young person is taking a full part in and which actually achieves some objective, because I think currently we have poor attendances, and we are not really achieving what is required. And by medical appointments I mean with the paediatrician, with the clinical psychologist, or with the child psychiatrist or with the school nurse who are involved in the project.
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