A novel multi-component intervention for Unaccompanied Asylum-Seeking Young People: The Well Being Project- London Borough of Hillingdon.

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The Well Being Project (WBP) is a pilot mental health service for unaccompanied asylum seeking young people (UASC). The project is funded by a 2-year grant from the Department of Health (12) and delivered through Central and North West London Mental Health Foundation Trust Child and Adolescent Mental Health Service (CAMHS) in Hillingdon.  It provides an outreach mental health service for UASC within the London Borough of Hillingdon.  Hillingdon has one of the highest numbers of unaccompanied asylum seeking children in the UK due to the location of Heathrow Airport within its boundaries.  As a result, Hillingdon also has a dedicated Asylum Service staffed by over 100 social workers, care staff, and administration, which makes it one of the biggest in the UK. 

Under the provisions of the Children Act 1989 (8), UASC are cared for by social services as ‘Looked After Children’ under Section 20 of the Children 1989 (13). This places a duty on the local authority to provide them with accommodation, health access, education and social work support.  In a number of areas this is complemented by voluntary agencies largely in the form of Youth Centres and ESOL courses.  In 2007, HM Government produced a number of aims with regard to improving emotional health and well-being (9) of children and young people.  These are the early identification of need to an identified vulnerable Black and Minority Ethnicity (BME) group of children through working with and through Tier one provision, both in social services and education, early intervention with these children, and more specifically, offering a service to 16 to 17 year olds.  Hillingdon has taken a lead in this and the project described below is a novel response to try and achieve these aims.

The Well Being Project

AIMS

The Well Being Project is located in the same building as the Hillingdon Asylum Service.  It provides a range of service interventions for staff and young people, which are delivered in groups or individually. The overall aims of the project are:

• Early identification and intervention for UASC mental health needs;
• To promote service access through interventions delivered from a range of venues and agencies;
• To develop specific interventions for UASC in relation to past trauma, transitions, and self-care;
• Dissemination by way of papers and conferences.

More specifically, the objectives are to work closely with practitioners who have primary contact with UASC (predominantly social services, health, and education), to provide immediate consultation to front-line duty staff and reduce referral to the Children, Family, & Adolescent Consultation Service (CFACS), by providing individual and group psychological sessions.  

Staff

The Well Being Project is comprised of a coordinator and systemic psychotherapist (.40 fte), psychiatrist (.20fte), full time administrator, primary mental health care workers (1.4 fte), and a youth worker (.50 fte)

Components of the Project

Staff Training and Consultation

Mental health training is offered to Tier 1 professionals to help them identify the specific mental health needs of the UASC presenting at Hillingdon.  This includes individual consultations concerning particular clients.  The consultation is broadly systemic in theory, where the problem is not prejudged and existing strengths are recognised through collaboration between practitioner and WBP staff.  The aim is to review the mental health concerns and risks as identified by the worker, and the issues that underpin these concerns, and what action, if any, can be taken and by whom.

Individual Psychotherapy

Young people received one-to-one sessions, rooted in systemic or psychoanalytic psychotherapy or cognitive behavioural therapy, addressing issues of trauma, loss, attachment, coping strategies and social relationships. The intervention is offered when the young people are struggling to cope with daily life.

Art Space

These are weekly drop in art therapy workshops, in local voluntary sector education and support service for UASC known as Asphaleia. The aim is to enable a client to effect change and growth on a personal level through the use of art materials in a safe and facilitating environment. This form of expression and communication can be particularly helpful to people who find it hard to express themselves verbally.

Orientation and Memory Box (OMB)

The OMB is a short-term, psycho educational group intervention designed for 16 and 17 year old UASC.  It seeks to improve their emotional well-being by way of decreasing social isolation, increasing knowledge about the care system, and providing a therapeutic space for reflection.  It is eight sessions long, each being approximately two hours in length, and involves interpreters for all the languages participating in the group.

Life Skills Programme

The life skills programme is an addition class of six sessions delivered by Well Being staff to UASC through local English access courses.  It aims to enhance emotional literacy and resilience, to promote self-care, to equip them with practical information about local services, and to identify and communicate needs to professionals.  The classes are delivered in English, adapted to the wide range of language abilities.

Cultural healthy cooking group

This cooking group is a series of 11 sessions run in an open group format.  The aim is to use food and cooking as a tool to improve health and physical well-being, as well as social networking by helping the young people develop new cooking skills, and facilitate sharing.  The process of adjusting to a new cultural, social and familial environment also requires the ability to cook for oneself.  In an effort to retain aspects of their culture, some young people mainly cook traditional foods associated with comforting relationships and memories.  This may limit experimentation with local foods, therefore having a detrimental impact on their eating habits and balancing a budget.

Becoming-18 Transitions Group

The Becoming-18 Transitions Group is a question and answer drop in service for UASC conducted at the local YMCA club.  The service was run by both WBP and YMCA staff.  The aim was to allow young people an informal atmosphere so that they may ask any questions they have about leaving the care of social services or becoming an adult.

FINDINGS

The Well Being Project met a number of the targets identified in the public service agreement (PSA) and is consistent with Every Child Matters (10) with regards to improving emotional health and well-being of children and young people.  More specifically, in the early identification of need, the development of specific interventions, and joint working across health, social services and education.

Figure 1 (right) displays the total number of staff and young people serviced by the Well Being Project. Overall, there were a total of 376 young people who accessed project over the course of 27 months from August 2005 to December 2007.  WBP staff provided psychotherapy in several venues including  GP practices, young people’s accommodation, and youth outreach centres.  More than 90% of referrals came from the Asylum Service at Hillingdon, with a further 10% coming from CAMHS and the voluntary sector.  Two thirds of the sample were males between the ages of 16 and 18.  Approximately half of them came from Afghanistan, Somalia, China, Ethiopia, Eritrea and Iran.  The remainder were from East and West Africa and the Middle East, with Guinea and the Democratic Republic of the Congo strongly represented.  All young people were living independently or in supported living settings provided by the local authority.

Outcomes were considered by analysis of the self-report Strengths and Difficulties Questionnaire (11).  Outcomes seemed to show that those young people who had some form of leave to remain scored better than those who were still awaiting a decision about their asylum status.  When compared with normative values, SDQ results in this sample showed a mixed pattern.  Their main difficulties were shown on the emotional problems and peer problems subscales where they were approaching levels nearly twice as high as the norm.  Furthermore, some of the young people arrived in a state of acute distress, including several young women who experienced sexual trauma.  These cases were medically and psychiatrically or psychologically assessed, involving the WBP. Staff feedback reported that the Well Being Project was useful educational.  They reported that the project improved upon their existing assessment skills.  Furthermore, staff said that it gave them prompt support, enabling a faster and easier way to access mental health services.  The young people’s feedback included that they believed the interventions helped them make optimal use of the existing educational, social care and health services.

Implications for Practice

This research suggests that the Well Being Project can integrate a mental health service into a specialist asylum service and that there are considerable advantages in doing so.  The presence of this project allowed for greater consultation and assessment of the young people by social work staff.  Furthermore, staff were able to gain greater knowledge about the mental health of UASC, thereby extending their professional knowledge base.

 

This pilot study seems to indicate promising findings for early intervention with UASC from a social services platform working together in partnership with a range of agencies.  All stakeholders and research tools utilised in the project seem to warrant further investigation based on the positive findings described here.  The Department of Health provided additional funds to continue the WBP to February 2008 from the original end date of September 2007, suggestive of stakeholder satisfaction.  At present it is seeking funds from both statutory and voluntary sectors in order to continue its service, but it is unclear how much of the work will be maintained.

 

In future work and research with UASC requires close cooperation between the various agencies involved and inevitably further funding which is pooled under a single umbrella agency that is rooted in the project will make it more coherent and easier to manage.  Further collaboration between Hillingdon and Oxford University will undertake further rigorous evaluations of this important and under researched and marginalised group of children.

 REFERENCES
1. Every Child Matters, Department for Education and Skills, 2003, Department for Education and Skills
2. A School-based Mental Health Service for Refugee Children, B. O’Shea, M. Hodes, G. Down and J. Bramley, 2000, Clinical Child Psychology and Psychiatry
3. Different perspectives on emotional and behavioural problems in unaccompanied refugee children and adolescents, I. Derluyn and E. Broekaert, 2007 Ethnicity and Health
4. ‘I was running away from death’- the pre-flight experiences of unaccompanied asylum seeking children in the UK, S. Thomas, S. Thomas, B. Nafees and D. Bhugra, 2004, Child: Care, Health and Development
5. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review, M. Fazel, J. Wheeler and J. Danesh, 2005 The Lancet
6. Social work with unaccompanied asylum seeking children. R. Kohli, 2007, Palgrave Macmillan
7. Working with unaccompanied asylum seeking children: issues for policy and practice, Kohli, R and Mitchell, F (eds.), 2007, Palgrave Macmillan
8. Children Act, 1989, Stationery Office
9. PSA Delivery Agreement 12: Improve the health and wellbeing of children and young people, (2007) HM Government, The Stationery Office
10. Care Matters: Transforming the Lives of Children and Young People in Care, Department for Education and Skills, 2006, Department for Education and Skills
11. The strengths and difficulties questionnaire: A research note, R.Goodman, 1997, Journal of Child Psychology and Psychiatry
12. Child and Adolescent Mental Health Care Services (CAMHS) Health National Service Framework Development Initiatives Fund
13. For further information see Local Authority Circular (13) 2003 (DoH, 2003) and the Hillingdon Judgment

AUTHORS

Amanda Austen, Coordinator/systemic psychotherapist Well-Being Project, Hillingdon.   

Raeli Bronstein and Paul Montgomery, Centre for Evidence Based Intervention, University of Oxford.