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Evaluating group work for supporting the emotional wellbeing of young people in care

06 June 2018

Una Foye, Emily Satinsky, Camilla Rosan and Josefien Breedvelt examine the My Life, My Future programme that was set up to boost the emotional wellbeing and resilience of looked-after young people.

Web conversation

Authors 

Dr Una Foye, research officer
Emily Satinsky, public mental health research assistant 
Dr Camilla Rosan, programme lead for families, children and young people
*Josefien Breedvelt, research manager 
*Correspondence JBreedvelt@mentalhealth.org.uk

Acknowledgement

The authors would like to thank all programme participants, Natasha Rego who developed and led the My Life My Future project, and the funders BBC Children in Need, the Constance Travis Trust and Big Lottery Awards for All.

Declaration: The authors declare that there are no conflicts of interest

Abstract

Purpose: The purpose of this evaluation is to explore the acceptability and impact of using group work to support the emotional wellbeing and mental health of young people in care.

Method: Using a topic guide, young people completed semi-structured interviews about their experiences taking part in the group-based programme. Interviews were recorded, transcribed and analysed using thematic analysis.

Findings: The analysis found that engagement in group work positively impacted young people’s confidence, wellbeing, feelings of connectedness, and aspirations for their future. Secondary outcomes were observed in participants’ engagement with education and school activities, as well as within their home lives.

Implications: The findings of this project have implications for how youth services may approach design and engagement when working with young people in care. The relationship-based group activities had a considerably positive impact on participants, providing early evidence that this approach is valuable in a youth work setting. It is important to note the small sample size and potential selection bias. Thus, future programmes should follow more rigorous research methods to provide evidence for positive outcomes and to validate the model.  

Value: This paper provides original value to the field as a primary focus was placed on understanding the experiences of young people in care in such groups, as well as exploring the impact on the foster home and school. This innovative project and approach to evaluation provides valuable insight that can help shape future work in this area.

Keywords young people, care, wellbeing, mental health, resilience, looked-after children

 


Introduction

In 2017, 72,670 young people were in care in England, with 74% living in foster care (Department for Education (DfE), 2017). Inequalities are evident in both the educational attainment and emotional wellbeing of this population: DfE and the Office of National Statistics found that young people in care had considerably lower educational attainment than young people not in care with reading, writing and maths (48% reached the expected level against 79%), and significantly lower rates of achieving five A* to C grades at GCSE (12% against 52.1%) (DfE and ONS, 2014). Levels of exclusion were also twice as high as those of the general population.

Young people in care are more vulnerable to mental health problems (Hannon et al, 2010; Blower et al, 2004) with between 45% to 50% of five to 17-year-olds assessed as having at least one psychiatric disorder. Levels of poor mental health rise too, to over 60% for those in residential care (Meltzer et al, 2003; Richardson and Joughin, 2000). Thus, emotional wellbeing is a key objective for young people in care (Department of Health (DH), 2016). This evidence is not limited to England – research demonstrates poor mental health among young people in care throughout the UK and globally (Bazalgette et al, 2015; Polihronakis, 2008). The US, for instance, has documented that up to 80% of young people in care live with mental illness (Polihronakis, 2008).

Similarly, risk taking behaviours, such as substance misuse, unsafe sexual activity, and offending, are significantly higher in young people in and leaving care – 23% of the adult prison population was previously in care and almost 40% of prisoners under 21 were in care as children (vs 2% in the general population) (Centre for Social Justice, 2008).

A review of child and adolescent mental health services identified unmet mental health needs of young people in care (DH, 2008). In response, NICE set targets to promote aspirations and ensure emotional wellbeing of looked-after children and young people (NICE, 2013). These guidelines recognise the need to improve outcomes for young people in care so they are:

  • Supported in fulfilling their potential 

  • Supported in trying activities that promote wellbeing and provide opportunities to improve social skills and self-esteem

  • Provided with opportunities to make sense of their identity and relationships.

Other governmental bodies in the UK have enacted programmes to better meet the educational and emotional needs of young people in care. For example, the Social Services and Wellbeing Act 2014 in Wales stressed the importance of giving young people in care voice and control, improving their wellbeing, preventing and providing early intervention to minimise critical needs, and co-producing services with young people (Welsh Government, 2014). Similar regulations and guidance are regularly published in both Scotland and Northern Ireland (Scottish Executive, 2014; The Department of Health, Social Services and Public Safety, 2005).

In a study from 2003, young people in care identified areas to promote and maintain their mental health: the need to feel physically and emotionally safe and supported; the need to talk to a trusted adult in confidence; the need to access meaningful activities (sports centres and youth clubs); and the need for positive self-image (Ryan et al, 2003).

Purpose

‘My Life, My Future’ was developed in response to the lack of co-produced, evidence-based interventions engaging young people in care. The programme began in 2015 and involved young people in care in the Sutton area. The 18-month programme aimed to:

  1. Increase young people’s confidence in themselves and their abilities

  2. Maintain emotional wellbeing and resilience

  3. Promote development of aspirations.

Development of the My Life, My Future programme

This paper follows the Medical Research Council’s (NICE, 2013) framework for developing and evaluating complex interventions (Craig et al, 2008). It describes the evidence-base and theory behind the defined intervention components, and the formative process evaluation focusing on acceptability and feasibility.

Theoretical frameworks for programme development were identified through the DfE (2017; 2014) reports, NICE (2013) guidance, and a literature search on MEDLINE and PsychINFO. Synthesis of the evidence and co-production with young people resulted in the identification of key topics:

  • Plans/aspirations

  • Social networks

  • Identity

  • Stereotyping/prejudice

  • Respect

  • Emotions – happiness, stress, anger

  • Self-esteem

  • Peer pressure

  • Relationships

  • Bullying/cyberbullying 

  • Grooming/child sexual exploitation 

  • Sleep/dreams.

This evidence guided programme structure, dosage, facilitator attributes, and general implementation. The programme targeted young people in care between 11 and 15 years old, as children in this age range share several developmental transitions (Erikson, 1993) and since it allowed a focus on educational and personal development. The My Life, My Future group accepted both self-referrals and referrals from healthcare professionals.

Sessions were held weekly over 18 months, and were designed to be interactive, engaging, and creative; exercises included painting, baking, craftwork, and activities that the participants had not done before, such as ice skating, go-karting and trampolining.

The developed intervention manual laid out exercises and activities concerning the programme’s core topics. While topics changed throughout the programme, sessions followed a predictable structure: Check-in (20 minutes); icebreaker (10 minutes); topic for discussion (45 minutes); lunch and informal catch-up (30 minutes); and check out (10 minutes).

Sessions were co-facilitated by two trained youth workers who modelled responsive relationships using a partnership approach (Davis et al, 2002) and mentalisation principles (Bateman and Fonagy, 2013). Facilitators built rapport and enabled participants to gain confidence by modelling reflective listening.

Method

Participants

Of the 12 young people who took part in the intervention, only individuals who attended more than three sessions were invited to take part in data collection. The evaluation included six young people (four (66.6%) females and two (33.3%) males aged 13 to 15) consented to participating in the evaluation, all of whom attended the group from baseline to the 12-month point when the evaluation was conducted. Attendance was over 85%.

Two foster carers also took part in the evaluation: one was a foster carer for two of the female participants, and the other was a foster carer for the two male participants.

Design

An evaluation team researcher conducted semi-structured interviews with all participants and carers. Questions regarded their experiences of the group, what they liked and disliked, and the project aims.

Ethical issues

Participants provided informed consent prior to data collection and verbal consent at the time of data collection. To ensure confidentiality and blind evaluation, My Life, My Future staff were not involved in data collection. All participants were assigned individual participant codes to protect their anonymity. All data was stored in accordance with the Data Protection Act 1998. No formal ethical approval was required as the project was a service evaluation.

Data analysis

Qualitative data were transcribed and analysed using thematic analyses (Joffe and Yardley, 2004). Interviews were assessed by a member of the evaluation team and topics were organised into meaningful themes. Coding was reviewed and refined, similar themes were merged, and sub-themes were created where appropriate.

Results

Group Enjoyment

Young people responded positively, consistently referring to sessions as ‘good’ and ‘cool’.  Participants reported:

‘I really enjoy it and the others, I seem to get the impression that they really enjoy it too!’

‘We have had a blast!’

When asked what they enjoyed or liked about the group, young people replied that they liked everything; two participants said there was nothing they didn’t like:

‘You can meet new friends and, like, the activities we do are fun… like, do art activities sometimes or listen to music.’

Most of the young people felt that the group size of six was just right and shouldn’t be extended.

Similarly, carers observed that participants enjoyed attending the group. Even on a ‘bad day’ participants still wanted to attend the group, as attending improved negative moods:

‘Even on the bad days when they might not want to go, you have just got to give them a nudge … mine have actually had a choice of going out with their friends or going to My Life, My Future and they always choose My Life, My Future.’

All participants and carers asserted that they would recommend the group to others. As one carer commented:

‘I do [recommend the group] to all of the foster carers. I always say to them you should send them there, it is really good. It gives them a positive, it is something that is very positive in a negative life.’

Connectedness

Participants found the increased positive relationships and connectedness with other group members to be particularly salient. Young people noted that the friendships formed within the group were more personal than that with their school friends. As one participant said:

‘I just feel I am a bit of a ghost at school, but here I am always included in everything. I feel like part of the group!’

When discussing this connectedness, two of the young people referred to the group as a family. These relationships positively influenced participants’ lives and self-assurance.

Both carers reflected young people’s positive perceptions of these relationships, commenting that the group increased participants’ ability to connect with others:

‘It helps them to mix with other peers and have a better relationship with others.’

The group structure, which focused on treating participants as individuals rather than as young people in care, enhanced connectedness:

‘It doesn’t matter that all the children are looked after, it is still a fun group whereas everybody else [whom] they see in their lives is all connected with social services, psychologists, me, the social workers, they are all against them whereas they don’t actually see My Life, My Future being against them… I think they just look at their self as being part of the group.’

One carer described how the group helped young people better understand relationships and develop relationship skills:

‘I think it has probably helped him in the social setting a little bit more… because you know you have got a child there that has had to go to a special school for behavioural and emotional difficulties, so it has helped him in that respect. Being able to sort of, you know, liaise with the staff and to form friendships and interact with other people.’

Emotional wellbeing

A few participants discussed the safe space created by the group, which allowed them to talk openly about their emotions. Furthermore, the group increased perceptions of trust: 

‘I am trusting people a bit more. Like before as I said I was really anti-social but then since I came here… they listen to everything you say… I know they won’t spread it around everywhere, like if I go and tell my mates at school they are going to like spread it.’

Coping skills and resilience

When discussing how the group affected their emotional wellbeing, participants noted that the group helped them understand how to deal with challenges in life:

‘Yes, I think it has [helped] because we have discussed some life problems which we have encountered and stuff.’

By teaching skills to navigate these challenges, the programme improved participants’ resilience. A carer noticed improvements in wellbeing:

‘They can be like really grumpy and then they go to the group… and you think oh god they are going to have a really bad time because they are really miserable… they come back and they are not; they are quite happy actually.’

For one participant, their carer noticed a positive change in his behaviour:

‘[He] has had his emotional and behavioural problems but I definitely think there has been an improvement… My Life, My Future has been a big contributory factor in that process.’

Confidence

Young people were asked to score their confidence on a zero to 10 scale – with zero representing no confidence and 10 representing high confidence – before and after attending the group. Only one young person said they were always very confident, while the remaining five young people indicated increased levels of confidence following a year of attending the group (Figure 1). The findings show that on average, young people had a minimum increase in confidence of 30%, with two of the young people reporting a 70% increase in confidence levels.

This increase in confidence was one of the main outcomes participants noticed:

‘[In] 2014, I completely lost my confidence because of what happened and then I started to build it up again, and then when I came here I feel like it has built up more.’

‘I feel a bit more confident because when I first came I didn’t really speak to everyone but now I can, like, speak to everyone.’

Emotional wellbeing was also observed as an important outcome that impacted participants’ lives. Carers observed changes in participants’ ability to communicate openly and in their confidence in themselves and their identity:

‘They have become more confident! They do change after they have been there. They do see things slightly different.’

Aspirations

Participants noted that attending the group helped make them think about their future; they all reported feeling positive about the future. While the participants noted that they were still young and weren’t sure what they wanted to do with their lives, they spoke about how the group helped them develop aspirations and dreams:

‘I didn’t know what I wanted to do but then I kind of realised… I am not going to stay 13 forever… They kind of got me thinking about what I could do… I think I can’t do anything. But they said ‘well, you can’. They are kind of inspiring.’

Three young people noted definitive aspirations, while the other three formed vague ideas of where they wanted to be in the future. These ideas changed as individuals learned more about themselves. One participant noted that the increased future-thinking kept her from getting kicked out of school.

Carers similarly noticed increased future aspirations:

‘After they have been they will come home saying, do you know I could actually do this or I could do that… so it does give them a bit of a clearer insight into what they could possibly achieve… it does help them realise their potential.’

Barriers and challenges

While all participants and carers reported positive experiences in the group, and most of the group reported that they would change nothing, a few of the participants noted potential areas for improvement. Young people reported a lack of interest in bullying as a topic as theyhad no related experiences:

‘I have never been bullied so I didn’t see the point… it just bores everyone.’

The personal and in-depth nature of some of the sessions was noted by a couple of the young people as a positive reason to attend the group, as it allowed them to share experiences. However, one young person pointed this out as a negative, as some in-depth issues were potentially too raw for peer discussion. Some issues could bring up memories of young people’s history, which may have been too fresh to discuss openly. For example, one participant reported that they felt the topics were too close to their own experiences of domestic violence and bullying. This reflects the need to be mindful of subjective experiences and empathetic about sensitive issues within the group. Carers discussed practical concerns regarding timing and location.

Young people and foster carer recommendations

When asked what changes they would make to the programme, three participants provided recommendations.

Topics covered and activities

Participants recommended including topics more applicable to real life, such as a focus on crime, alcohol, and drugs. Furthermore, participants suggested more variety in activities and locations, for example rock climbing trips or workshops on fire. Others suggested the use of technology to make topics more interactive:

‘Make it all linked to games… if it was something like cyber bullying then you could have a computer programme.’

One young person suggested incorporating trips with similar youth groups in a ‘meet-up’ style. Another participant thought it would be good to mix age groups to help younger members learn from older or past members and care leavers.

Discussion

Without doubt, My Life, My Future had a positive impact on participants’ wellbeing. All participants enjoyed their experiences and the outcomes supported programme objectives. Participants and carers experienced and observed increased confidence, aspirations, positive family relationships, personal development, and emotional wellbeing following participation. Participants unanimously agreed that they would recommend My Life, My Future to other young people in care.

By employing supportive staff, the programme created a peer-based environment with reflective mentors. Mentors are instrumental in keeping young people in care on track and in helping youth towards positive development (Hass and Graydon, 2009). In fact, research has demonstrated that adult mentors during adolescence increase positive adjustment and other developmental outcomes in adulthood (Ahrens et al, 2008). My Life, My Future participants benefited from the peer-focused model. One of the central themes identified through the evaluation was around social connectedness. Participants felt increased connectedness with their peers, reduced isolation, and increased feelings of support, which in turn resulted in better emotional wellbeing. These findings reflect those of a randomised control trial conducted with 67 adolescents with mental health challenges in foster care (Geenen et al, 2015). Through interactions with their programme mentor and peers, participants experienced increases in levels of self-determination, mental health, hopefulness, and empowerment (Geenen et al, 2015).

The most widely cited benefit of group participation was an increased sense of confidence, with five of the six young people reporting considerable increases in confidence. Past mentorship programmes have similarly demonstrated increased confidence among young people in care (Scannapieco and Painter, 2013; Rhodes et al, 1999). By improving self-belief, My Life, My Future consequently encouraged aspirations. As a result of the group work, participants started thinking about their futures and developing goals. One young person remained in education because of the project, further indicating the group’s positive impact on confidence, self-belief, and subsequent educational attainment.

While young people did not specifically use the term ‘resilience’, associated sub-themes were identified by both participants and their carers. Notably, My Life, My Future helped participants build coping skills by encouraging engagement in open, supportive, and trusting relationships.

While the initial proposal suggested a group size of 20 to 25, the findings suggest a small sized group works well as participants found that it further encouraged connectedness.

In addition to the mentorship component, peer-based structure, and intimate group size, My Life, My Future benefited from the use of co-production. By including young people in the formative work, the programme team successfully developed a group-based programme relevant to the interests and needs of the population.

Although the My Life, My Future group took place in England, findings are generalisable to the rest of the UK and the global landscape. As young people in care face obstacles in educational attainment and positive mental health throughout the world, comparable groups in other settings would produce similar improvements in confidence, resilience, aspirations, behaviour, and educational attainment.

As evidenced by Fisher et al (2009), there is a paucity of evidence-based group interventions for young people in care. Past trials have successfully introduced group programming to improve educational attainment of young people in care (Harper and Schmidt, 2012). However, limited programmes have specifically focused on social and emotional outcomes. The My Life, My Future programme and evaluation contribute to this gap.

Limitations

While the qualitative methodology provided rich experiential data and insight into participants’ experiences, quantitative analyses to assess changes in confidence, wellbeing, and aspirations would have added rigour. Also, the small sample size limited validity and generalisability. Results provide initial insight into the effectiveness of My Life, My Future but an evaluation with larger and more diverse samples, such as in rural areas or with different age groups, could better assess generalisability.  

Finally, the sample only included young people engaged with the programme. Attempts at recruiting young people who disengaged from the service or had poor attendance were unsuccessful and, as a result, findings may not accurately reflect service effectiveness.

Conclusion

My Life, My Future was developed to help young people in care develop emotional resilience and aspirations. This evaluation explores experiences of carers and young people, and highlights developmental improvements. Despite methodological limitations, findings demonstrate increases in subjective confidence, aspirations, and coping skills.

Future research should include larger sample sizes and reliable quantitative measures to assess validity and generalisability. Furthermore, longitudinal measures can better evaluate long-term effectiveness on the lives and futures of these young people.

 


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