Case Study Four: Walk and Talk, Right Here Sheffield/Counselling on the Move

Relationship-based therapeutic and exercise programme for young people with complex needs

http://www.right-here.org.uk/projects/sheffield/

LEAD AGENCY:

Sheffield YMCA

PARTNERS:

YMCA White Rose, the Children and Young People’s Empowerment Project and Interchange Sheffield CIC. Also Sheffield Futures, PCT Community Development Team, NHS Sheffield, CAMHS, NSPCC, Sheffield Futures, YASY, Sheffield City Council, Sheffield Health and Social Care.

ADDITIONAL FUNDING AND RESOURCES:

• Change4Life funding

AIMS AND OBJECTIVES OF ACTIVITY

• To improve young people’s confidence, emotional wellbeing and physical health and work to overcome harmful ways of thinking and behaving around food and exercise
• To embed new life-enhancing habits around food and exercise which can be sustained after the programme end
• To support those young people who wish to lose weight, helping them to increase their awareness of 1) healthy eating and exercise, and 2) the ways in which emotional problems can interfere with efforts to control what we eat
• To increase young people’s understanding of the value of exercise in maintaining good mental health – psychological (the sense of accomplishment) and biochemical (increases in the levels of neurotransmitters associated with the mood)
• To help improve the understanding of workers in the Change4Life programme of mental health issues for young people in transition to adulthood and how to signpost their service users towards appropriate support when needed

RELEVANCE TO RIGHT HERE’S NATIONAL AIMS AND OBJECTIVES

This activity allies itself with the following Right Here ambitions:

• To increase the capacity and support available to young people to look after their own mental health
• To develop new approaches / structures which are participatory and able to engage with and be sensitive to the needs of young people

WHAT LED TO THE ACTIVITY BEING SET UP

Several groups of vulnerable young people aged 16-25 in the area served by Right Here had been identified as being hard to reach: those from ethnic minorities, with mental health problems, with learning difficulties, engagement with the criminal justice system, NEET, homeless, LGBT, and young carers. They were often socially isolated and lacking appropriate support to maintain good mental health in difficult circumstances. Interchange also identified that some clients struggle with traditional mental health support sitting still in a room with an adult for the therapeutic hour. Consultation with service users and with the STAMP panel suggested that counselling support ‘on the move’ and combined with peer group support may be more accessible for some.

DESCRIPTION OF ACTIVITIES

Walk and Talk is a therapeutic programme providing vulnerable young people aged 16–25 with on-going support through counselling, along with physical activity sessions, with the aim of embedding new life-changing habits and providing social support. The activity began as six 50-minute weekly sessions of one-to-one counselling with three (one per month) sessions offering group exercise and social support. However, in recognition of the complex needs of the young participants, an open ended approach was later adopted, which allowed young people to participate on an on-going basis. Whilst walking remained a feature of the group physical activity programme, over time the group also incorporated massage, yoga, cooking and day excursions in the local area, to  reflect participants’ interests and requests.Following the completion of Walk and Talk, a therapy-only group was established by Interchange counsellors and made available to all Walk and Talk participants who wished to take it up.

TARGET GROUP

Young people from North East Sheffield: not in education, employment or training; long-term unemployed young adults; teenage/young parents; BME young people who would benefit from improving their physical health as well as their emotional wellbeing. A total of 40 potential service users were referred to the activity – 14 male and 26 female, the majority aged between 16 and 19. Of these, 23 attended some or all of the sessions.

TARGET GROUP INVOLVEMENT

“We worked from the basis that the young person knows themselves the best… and we wanted that to permeate through to other aspects of the project… The whole ethos, the holistic ethos, was one of being person centred”

– Walk and Talk counsellor

“We worked very sensitively with clients individually…the activities we offered came from the young people themselves and we developed it from there”

– Walk and Talk counsellor

The project was inclusive and responsive to the needs of its participants in the following ways:

• Modifying the programme away from time limited counselling to allow for on-going support
• Providing counselling in a person-centred way, which went at each individual’s own pace
• Consulting participants on their choice of group activities
• Offering a choice of venues for counselling and group activities
• Obtaining written and verbal feedback about individual experiences of the project
• Sharing and disseminating the learning from Walk and Talk through a training package developed for delivery at ZEST.

TIMESCALES

August 2010 to March 2012

Evaluation

Impact evaluation for each young person

OUTCOMES TO DATE

“Everyone knocks you down out there but coming here builds you up again”

– Young person

“We just connected like I wouldn’t think anyone would connect…we just all became friends”

– Young person

As a results of their participation, Walk and Talk participants reported increased levels of:

• general wellbeing
• social connectedness and friendships amongst and between group members
• self confidence, resulting in taking up new opportunities such as volunteering and undertaking activities which were previously difficult, such as catching the bus
• healthier lifestyles with regards to exercise, diet or weight management
• trust in other young people and professionals who support young people
• coping skills

Participants also described experiencing reduced levels of:

• anger
• anxiety
• fear
• social isolation
• self harm and suicidal ideation

Learning Points

“If we were just sat there in a circle…I think it would be a bit awkward. Doing an activity helped…it became a regular thing… That’s what made the project I think – walking and talking”

– Young person

“It were like a peer mentoring type group as well – even if we didn’t realise we were doing it…”

– Young person

“I was going through depression and anxiety but everyone has been really supportive and everyone has known…and I have felt really accepted by everyone”

– Young person

Success factors of the project include the following aspects:

• The person-centred approach of the project enabled Walk and Talk to be flexible to the needs of participants, both in terms of the structure of the project and the content of activity sessions
• The combination of one-to-one counselling and group activities worked well for young people with complex needs, giving them the opportunity to talk through their issues with trained counsellors alongside having the opportunity to build relationships with other young people
• Offering physical activities enabled the project to reach some young people who may well not have been engaged by traditional models of therapy
• The physical activities may have been more engaging for some young people  than typical discussion groups. The physical element of the programme also seemed to provide non-verbal ways for the group to bond, for example by walking together at the same pace
• The counsellors were present for all group activities, taking a back seat unless specifically needed. This meant that issues arising from group discussions could be incorporated within the 1-2-1 sessions

The self-referral route led to a number of young people joining the programme who may not have accessed services  otherwise.Some of the challengesthe group experienced over the years included:

• Because participants were often friends in real life, this meant that on each occasion the staff had to repeat and reinforce ethical and confidentiality issues
• The project was time limited because of funding restrictions, and for some young people no other service had quite replaced it in terms of the support it provided
• Some young people felt that although contact had been maintained between the young people since, the closeness of the friendships developed through the group had not been sustained after the project had finished.

“It’s really sad that’s it’s had to end – there was a lot that came good out of it…we all bonded so well…now everyone is just doing their own thing…You kind of miss the group situation”

– Young Person

What we know

The complex and multiple risk factors experienced by the young people participating in Walk and Talk placed them at higher risk of poor mental health¹. However, evidence suggests that young people experience a range of perceived and actual service barriers, including a paucity of young person specific mental health services, which can prevent them from getting the support they need². It has been recommended that an approach which places mental health support within a wider context of health and welfare expertise should be adopted to better address the mental health needs of young people[45. Patel V, Flisher AJ, Hetrick S, McGorry P ( 2007) Mental health of young people: a global public-health challenge, The Lancet, 369,9569, 1302-1313].

Mental health and physical health are closely inter-related and both impact on the other³. Regular physical activity is associated with a greater sense of wellbeing and lower rates of depression and anxiety across allage groups⁴. Physical activity that takes place out of doors has been found to be particularly beneficial for wellbeing, with some evidence that outdoor walking groups may have a greater impact on participants’ self esteem and mood than the equivalent activity indoors⁵. The New Economics Foundation  also suggest that slower-paced activities, like walking, can have the benefit of encouraging social interactions at the same time as providing physical exercise[49. Aked J et al (DATE) Five Ways to Wellbeing, New Economics Foundation].

Social connectedness is another key determinant of mental wellbeing, both in terms of having access to supportive individual relationships and involvement in group and community activities⁶. The peer support which was clearly demonstrated amongst Walk and Talk participant members, built on and extended existing friendships with support from trained facilitators.

What this project adds

Through offering self referral routes and a variety of young person-centred 1-to-1 and group activities Walk and Talk has worked to engage and maintain supportive relationships with a traditionally underserved cohort of young people. The teams’ reflections on the flexibility required to enable young people to engage and benefit from the support available provides useful practical learning for other organisations wishing to engage with young people with complex needs.

Areas for future research

Qualitative research exploring methods for maintaining the social benefits of groups like Walk and Talk in the longer term would be  useful, in light of the feedback from some young participants about the difficulties in sustaining the close relationships after the group finished.

Examples of similar Right Here activities

A similar Walk and Talk project has recently started in Brighton & Hove. http://www.right-here.org.uk/projects/brighton-and-hove/ Other projects provide a range of physical activities such as rock climbing (Brighton & Hove) and Boxing (Newham)

The combination of group work, one-to-one counselling and referrals to other counselling as necessary is one of the hallmarks of Right Here Sheffield’s approach.