Mapping out the future

Home to real EastEnders, the London borough of Tower Hamlets is
rich in character, history and culture but is somewhat less
well-off economically.

Almost half (48 per cent) of the borough’s population is from
ethnic minority groups. The Bangladeshi community – comprising 34
per cent – is the largest single ethnic minority population in
London. And it has been a community difficult for social services
to reach

However, the highly-regarded Multi Agency Preventative (MAP)
project was set up following the findings of a local audit on the
effectiveness of services. “We were not proactive in working with
Bangladeshi boys, with outreach work in particular. And child and
adolescent mental health services were significantly under-used,”
says MAP team manager, Maswood Ahmed.

For the Bangladeshi community there is a stigma attached to mental
health. “It is still a very taboo subject. If someone in your
family has mental illness you don’t mention it to anybody. And many
parents find it difficult to understand the behaviour their
children may be exerting. There is confusion about who to turn to:
sometimes people will even turn to spiritual healers,” says Ahmed.
So, in 1999 the MAP project was drawn up to provide a confidential
information, counselling and support service for, at first,
Bangladeshi boys attending three (of 15) schools in the borough.
The team includes three social workers, practice manager, clinical
psychologist and four youth workers. “We decided to use youth
workers as the first point of contact – they operate at a level
young people can understand and in a non-stigmatising way,” says
Ahmed.

MAP youth worker Katie Burwood agrees: “Although working with young
people is challenging they respond to us because our relationship
with them is voluntary. We have the time and patience to listen to
what’s going on in their lives.”

The multi-agency approach has been the foundation of the project’s
success. “Working with a multitude of professionals has its
challenges. But the rewards are so stupendous for the boys and the
professionals. Everybody works on their differences and get on with
the task in hand,” says MAP social worker, Abdul Baki.

Schools became ideal partners. “We felt that teachers, with some
guidance on mental health issues, would be able to pick up the
ideas and make referrals to the project,” says Ahmed. Originally
the schools identified year 9 pupils (13-14 year olds) as the
preferred target group as their behaviour was reportedly the most
challenging, loudest and disruptive.

However, this proved problematic, as Ahmed says: “We thought we
could move in to provide a quick intervention and solution and then
move onto the next batch of young people. But things were actually
taking a lot longer. Some young people had already developed
complex behaviours and problems and these needed more in-depth
interventions.”

The team felt it would be better if they could intervene earlier.
“I made a conscious decision to take referrals from year 7 – the
first year at secondary school. We have been very effective since
then. By engaging earlier we have been able to effect more solid
changes in behaviour and attitudes,” says Ahmed.

Despite its successes the project from birth has battled against
funding uncertainties, as Ahmed recalls: “Funding has only ever
been certain year-on-year. This spelt big problems with
recruitment. At the set-up, we had a lot of interest but when
people read the small print that we could only offer a year-long
contract and they knew that by the time they got into post we would
be half-way into the year, it wasn’t a great incentive for them to
leave permanent and more secure posts.”

Nonetheless, the project has expanded this year, with significant
Children’s Fund backing, and now works with Bangladeshi girls and
has extended its reach into six schools. Emerging patterns show
that while boys tend to exhibit emotional difficulties in a
physical, visible way, girls tend to turn into themselves and
self-harm. “While we need to work in a significantly different way
we still have the focus on improving their self-esteem,” says
Ahmed.

The project’s big selling point to young people is the leisure
activities it provides through its options programme. And building
self-esteem is the name of these games. “Young people come from a
background where they don’t get many positive reinforcements. Those
who complete an options programme successfully are given
certificates or trophies as if they were champions. We have a bit
of a celebration at the end and that really lifts them. On
returning to school they feel important and positive about
themselves,” says Ahmed.

The project also works closely with parents. Says Ahmed:”Parents
become anxious when outside agencies get involved. But they can get
in touch with me to talk through what we do. I speak to them in
their first language – that reassures them.”

Speaking in Bangla also simplifies explanations, taking away the
fears of psychological terms and jargon that may often be used to
describe things. “It is quite a skill to win the confidence of
parents – you need to show empathy and understanding. They fear
their parenting skills will be scrutinised and they will have their
children taken away from them – all this raises anxiety,” says
Ahmed.

The project has worked with more than 200 young people and all,
says Ahmed, have left the project in a healthier state.

There is scope to widen the target group, but no current plans.
“While there are good reasons to work with a specific ethnic group,
I’ve no doubt that if we expanded the service to all communities it
would be of great benefit because of the outreach approach and the
way we have been working flexibly by moving all specialist services
to the young people,” he says.

Learning power

Lessons from the MAP project…

• By having specialist projects mainstream service providers may
  find it an excuse not to gear their services towards ethnic
  minority groups. Projects should enhance not replace their
  services.
• With a multi-agency approach the management structure needs
  sorting out from the start. All partnership arrangements and
  protocols need to be in place.
• Don’t expect quick results from preventive services – the first
  year should be set aside for getting a service off the ground.
  There needs to be more thinking about making schemes more
  long-term. Trust projects for longer than a year.
• Expect difficulties coping with different operational
  management issues. Staff from different agencies may need dual and
  separate supervision. Clinical support and professional development
  need to be negotiated.
• A multi-agency team should be based together.
• Part-time posts may be attractive but bear in mind – given
  supervision and development needs – how substantially they are able
  engage with the clients they are working with.

Case study

Abdul Malik is a 14-year-old male Bangladeshi. Faced with permanent
exclusion through repeated disruptive and aggressive behaviour,
bullying and gang involvement, he was referred to the MAP project.
Abdul lives in an area where gang violence and conflicts are
common. He shares a room with his two brothers, one 16 and the
other six. Abdul’s mother is a homemaker and father (in poor
health) is unemployed receiving jobseekers allowance. Project
workers worked with Abdul and over nine months using methods from
motivational interviewing to cognitive behavioural therapy and
through social work values such as partnership and user
self-determination achieved positive changes in his behaviour.
However, Abdul occasionally disappointed the MAP workers by getting
fixed-term exclusion for disruptive behaviour and gang involvement.
Through one-to-one counselling, the social worker worked closely
with the school and Abdul’s family to ensure that everyone involved
in his life took some responsibility for his rehabilitation.
Positive changes in behaviour were rewarded by recreational
activities. During these Abdul took responsibilities for younger
participants as a peer leader and mentor, developing leadership
skills. Currently Abdul is attending school without much
difficulty. He is no longer a gang member and avoids fights. He
continues to receive support from the MAP project.

Map project funding

Department of Health: £50k

Primary care trust: £56k

Children’s Fund: £106K

Youth support services: £16k

Social services (Quality Protects): £35k

Youth Action UK: £12k