See beyond the label

Being a city there is nothing unusual in Southampton having numbers of children and young people with severe and complex emotional and behavioural difficulties. Sex working, burglary, absconding, violence, self-harm, drug dependency, risky lifestyles – all are well known in the city.

But what is unusual is the resource set up to work with these young people. The Behaviour Resource Service (BRS) is a child and adolescent mental health innovations project originally funded by the Department of Health with matched local funding. With staff from social services, health and education it is a truly integrated service.

The four-bed residential unit with its intensive one-to-one staffing 24 hours a day provides support for and assessment of young people aged 13-18, usually through a six-week programme. Many young people may progress from the unit to the community team, who work with children from five to 18 and their families, usually over many months, after an eight-week assessment.

BRS, a beacon service, aims each year to work with the 50 children with the most complex needs in the city, a high proportion of whom, unsurprisingly, are looked-after children. “Part of our criteria,” says residential team manager Jamie Schofield, “is to be outside all three mainstream services – health, social services and education. So, one can imagine risk is pretty high on the agenda for all the young people. Every child we take is referred to us because of the high level of anxiety of the risk to themselves or others in terms of their mental health state and their behaviour.”

BRS has been subjected to a rigorous evaluation report on its first three years by a team of researchers from the University of Southampton. “Service users have in the main expressed positive views about BRS and their experience of using the service,” says one of the report’s authors, senior research fellow Julia Waldham. Indications also suggested that the single, seamless service was welcomed by young people and their parents or carers. The service was also praised for its “good attachments” to young people.

“Engagement is the name of the game with us really,” says Schofield. “Sometimes we will hang out with a young person and their friends at bowling, just so as we can get half an hour with that person.” It is an example Waldham refers to as “a form of assertive outreach with disaffected young people in the community”.

Schofield says: “Most people come to us and are labelled one thing or another. But sometimes you can look back and there’s nothing at all.”

He cites the case of Mark Kingsley (not his real name), a young person with learning difficulties. “He came to us labelled as an arsonist and as such was proving difficult to place. But when we scoured through the 10 years of files we discovered that while at residential school he was up at night making toast and he burnt it,” he says. The school did not have night-waking staff so concluded that he was in “an inappropriate environment” – and a few years later that became “arson”.

“He displayed bits of aggression – which was nothing compared to what we deal with,” adds Schofield. “From us, he went straight out into the community again. We worked with him and he’s now living semi-independently. He should never, ever have been labelled that way at all.”

Although some of the young people will never progress into the community, without BRS it seems likely that the young people under the auspices of the project would either be in psychiatric hospital or being picked up as difficult-to-manage children and placed in care.

“It’s an interesting and forward-looking development, although building innovation on top of locally under-resourced foundations is clearly problematic,” says Waldham. “But one of the clear messages to emerge is the value of working with children and young people in a respectful, individualised and non-judgmental way.”

And Mark Kingsley could well attest to that.

Background

Staffing: Two team managers.

Residential team: Unit leader, 12 residential care staff, seven nursing staff, 0.5 child and adolescent psychiatrist.

Community team: Special education teacher, two social workers, community nurse therapist, two community support workers, 0.5 child and adolescent psychiatrist, 0.5 education psychologist, 0.2 community paediatrician, learning disability nurse, community therapist, two clinical psychologists (0.5 for looked-after children).