I realise I am leaving myself wide open here – but April Fools Day has been a very significant date throughout my career for one reason or another. The 1st of April was when myself and my job share partner Rachel Williams first came into post as Joint Heads of Child Psychology for Gwent in 2002. Twelve months ago, exactly 18 years later, I took up the role of chairing the Early Help and Enhanced Support Workstream of the Together for Children and Young People Programme for one day a week. Just about every other year in between ‘month 12’ has been marked by the frenetic transition from the end of the last financial year to the start of a new one and all the angst/relief/hope/fear wrapped up in that. Unusually this year it falls during the Easter holidays and so I find myself in a reflective space, looking back on what has been an extraordinary 12 months in so many ways.
Unlike just about every other aspect of life Covid has not hindered, and may even have helped this particular role. Firstly, we were already knee deep in a pandemic when I started so any plans had to be made with that in mind. Believe me it is much easier working out how to do a new job virtually than trying to work out how to do an old job – especially one that is dependent on relationships and connection. Suddenly I had access to people from all across Wales – youth groups, parents, carers, and front line professionals working in every sector – and all from my ( and often their) kitchen worktop. I could drop into established meetings and present for 15 mins or set up our own meetings and talk for hours! We could hold focus groups that teachers could join from their caravans in August and parents could join in their lunch breaks from work. We could film video logs on phones to explain the journey we were on, and narrate power point presentations that anyone could watch at their leisure. As a psychologist I am the first to say there is no substitute for human connection, and it would have been fantastic to meet up in person. However what we lost in depth of relationship we gained in spread of view and that is so important for a Framework that aims to include everyone.
The Early Help and Enhanced Support Work Stream’s task is to develop a planning tool to help Regional Partnership Boards to address the ‘missing middle’ – the gaps in knowledge, services and structures to support the mental health and well-being of babies, children, young people, parents, carers and their wider families across our communities. Co production is one of the five pillars of the T4CYP Programme, alongside Evidence Informed, Values Driven, Digitally Enhanced and Needs Led. Over the course of the journey so far towards developing the framework more than 220 hours of co-production have taken place; and the process is ongoing with continuous improvement built in. Every person we have spoken to has helped shape the direction; and the gems of insight, reflections, ideas and challenges from across such a broad range of stakeholders has been, and continues to be, inspirational.
We started with the views of our National Youth Stakeholder Group, a diverse forum made up of young people from across Wales, all of whom have experience of mental health services. Building on the Hafal Report ‘Making Sense’, the landmark document ‘Mind Over Matter’ and a stakeholder event focused on the ‘Missing Middle’ in June 2019 we weren’t starting from scratch. The guiding principles were ‘don’t medicalise growing up’ and ‘help those who are closest to us, like our teachers to understand how to support us with our mental health’. The ideas from the group about how to operationalise this were phenomenal, and a penny drop moment came when one young person said ‘its a bit like Maslow’s hierarchy of need, we need to focus on the basics first’. Here is one of the early the vlogs we shared to start the conversations:
It was absolutely brilliant, and more than a little nerve wracking, to return to the Youth Stake Holder Group recently and share how far we have come since that first meeting nearly a year ago. There is now a finished Framework, and accompanying documentation about to be translated into Welsh; and the early concept for a digitalised and interactive tool due to be launched in a few weeks time. I won’t give away too many spoilers but we were delighted with the feedback the young people gave on how it looks so far, and their hopes for what it will achieve in practice. They were especially pleased with the co-production journey, and hearing the very tangible differences their ideas have made. The concept of the ‘full circle of co-production’ has been really important to them. It seem obvious of course, that they should want to know the impact they have had but unfortunately it doesn’t always happen in reality.
Indeed, the energy and enthusiasm for this piece of work from across all stakeholders is really exciting to be a part of. It has been an absolute privilege too, especially at a time when hope and a vision for the future feels difficult to focus on. In addition to the Youth Stakeholder Group, there are so many people to thank for the contributions they have made, starting with the very proactive Parents Voices in Wales who have been alongside the developments every step of the way. Teachers, Youth Workers, GPs, School Health Nurses, Youth Justice, Police, Ambulance, Therapists, Social Workers, Housing, Third Sector Organisations – if they had an interest in mental health and well-being they were invited to share their views. We have been careful not to reinvent the wheel, drawing heavily on the inspiring work of leaders in the field – from the amazing Karen Treisman who has helped us significantly with her insights, to Kim Golding, Bruce Perry, and the work of the Anna Freud Centre to name but a few. Having lived and breathed it for 12 months it feels very strange to be pressing pause whilst the finishing touches are pulled together by people with a very different skill set to my own. But I will leave you with a taster…..
The framework is called NEST (NYTH in Welsh) because everyone needs a NEST to support us to grow strong, aim high and be the best that we can be. A NEST is there to come back to if we need to as well. Our NESTS are unique, made up of layers and layers of connections and experiences with the people who are closest to us, the things that we enjoy and the places we go. If our NESTs are to support our mental health and well being they need to be filled with experiences that are Nurturing, Empowering, Safe and Trusted. These happen in our day to day interactions at home and in our schools and work places, with our friends and in our communities. They create a sense of belonging and provide the ‘every day magic’ that give us hope, help us feel valued and taken care of, and lift and encourage us when life gets hard. Every baby, child, young person, parent and carer needs access to these experiences across their lives, and those going through the most difficult times need it most of all. The framework aims to build it into every environment and every context, supporting front line professionals to understand why it is so important, and why it can sometimes feel difficult to provide. When people are really struggling they may even reject it, leaving us feeling like we are failing and someone else would know what to do. Indeed, these are often the times it is needed more than ever, and persevering can make the difference. Quick and easy access to expertise to support this, alongside ‘no wrong door’ if and when extra help is needed is essential if we are to create NESTs that are truly Nurturing, Empowering, Safe and Trusted for everyone.
The NEST/NYTH logo above was co-produced to capture the concept of the Framework. Young people were clear they wanted something that was inclusive regardless of age, gender identity, sexual orientation, race, culture, disability, neurodiversity or indeed any other difference. I love how everyone sees something different in it – from the layers of support we all have a responsibility to provide to help everyone be the best that we can be, to the sun rising above the rolling hills of Wales! I am really excited about sharing this work in more detail at the launch in a few weeks but in the meantime we would love to hear your thoughts on the journey so far.