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December 2015 Quarterly Meeting notes

Date: 2nd December 2015 (Wednesday)
Time: 10:00 - 13:00
Venue: Paddington Arts (Pyramid Room)32 Woodfield Road, London, W9 2BE [MAP]
Theme: Children adn Young People's Health and Wellvbeing
AGENDA: Download HERE docx 

INFO: This meeting was about the health and wellbeing of young people. It was a great meeting to attend hear about projects in the voluntary sector and ask NHS commissioners and providers some searching questions. Presentations included Early intervention in Psychosis services, Westminster Mind, Spectra, Al Badja and the Westminster council staff who are currently preparing the Joint Strategic Needs Assessment on the 18-25s.

DOWNLOAD POWER POINT SLIDES HERE:

Childhood Obesity JSNA and 18 - 25's pptx
Spectra LGBT presentation pptx
FGM and mandatory reporting presentation pptx

Nafsika Thalassis, BME Health Forum Director, welcomed all to the meeting and introduced the first item.

Item 1:
Public Health – Three boroughs Jessica Nyman will present the childhood obesity JSNA and the JSNA about the needs of 18-30 yr olds

The JSNA – Joint Strategic Needs Assessment reviews health & wellbeing needs across the 3 boroughs (Westminster, Kensington & Chelsea and Hammersmith & Fulham).

Findings of JSNA on Childhood obesity and New Project on 18 – 25 year olds.
  • What the picture is
  • What we can do to tackle the issues
  • And what are the recommendations for the future
Rates of childhood obesity
Compared to the national rate, rate in Tri borough is not that far off. However 1 in 4 children are still overweight and this is a high rate of childhood obesity – which then leads on to obesity in later life.

We try and focus on childhood obesity as it is much easier to tackle obesity in children than people who have been obese for 30 or 40 years.
Tackling obesity is complex [Slide image taken from power point presentation attached]:

 

Predictors of childhood obesity
  • 1 parent at least is obese
  • deprivation
It is important to work with whole family.

Ethnicity ould somewhat also be a factor for risk of obesity because of:
  • Less access to healthy food
  • Less access to health services
However it is difficult to tell though – the truth is, obesity affects all groups.

This is a whole systems problem – Tackling Childhood obesity programme needs a whole council approach.

  • Community approach – Go Golborne
  • Working in RBKC – joint working with schools

AIM
  • Whole system pilot to test community-level intervention model.
  • Focused on small, highly deprived area.
  • Targeted at children, young people, families and community settings.
KEY FEATURES
  • Political support.
  • Multi-level and multi-stakeholder participation.
  • Large scale social marketing campaigns.
  • Sound evidence base.
  • Robust evaluation.
KEY ACTIVITIES
  • Themed social marketing campaign.
  • Training and development.
  • Consistent messages.
  • Environmental improvements.
  • Community development.
Question to forum: What can you do to tackle childhood obesity in your day to day work
with children and young people?

[Download power point slides for this presentation here pptx]

Q&A
Question/ comment: obesity can be a very sensitive issue e.g when you are told that your child is overweight can feel very criticising about the way you are bringing up/ feeding your children.
Also in some cultures having weight is a sign of a healthy child and something to be proud of.

Question: In terms of the strategy to tackling childhood obesity can you tell us a bit about how you are getting schools involved?
Answer: The Healthy schools partnership works with schools to offer healthier meals. In K&C Go Golborne includes work with schools in this way.

Question: Do we know if additives in food have an effect on weight gain
Answer: Yes

Young Adults (18-25s) and Students JSNA

Purpose: investigate the needs for students and young people, in order to provide early interventions on issues which could develop into long term conditions

Came about on recommendation of GPs who were seeing trends in health issues for this age group cmoprising of the following:
  • Eating disorders
  • Sexual health
  • Unplanned care
  • Depression, anxiety and stree
  • Community safety – sexual assault, muggings
Jessica asked Forum to please speak to her if anyone has any input on habits of 18 – 25 year olds.

[Download power point slides for this presentation here pptx]

Item 2:
Spectra Kelly Imathiu from Spectra will talk about his work with BME LGBT people

Spectra is formerly known as North London Gay Men’s Project
BME/LGBT vulnerability– the duality of vulnerability - being both BME and LGBT.

How does ‘oppression’ affect our approach?
E.g In HIV testing week we set up a drop in HIV testing clinic in a Church in Wandsworth and it initially had a queue of 10 or so people when they thought it was about a test for glucose levels.

When it was made clear the blood tests were about testing for HIV the queue was reduced to only 1 person.

What is oppression?
Oppression is the prolonged unjust treatment and control of people.  When people are oppressed they often feel weighed down, either physically or emotionally.
Oppression leads to increased health risks - it affects how we access health services.
Feelings of worthlessness and powerlessness – people don’t know where they can get help.
Different narratives that exist in media specifically for black men/ BME do not help.

What does Spectra do?
A community interest company
—  Community Interest Company  
—  Offering services to:
  • MSM (as GMP)
  • BME (as ACE) – BME and sexual health including HIV testing and counseling.         Our programme is also highly incentivized with health checks, condom       distribution and lube
  • Trans* (as Spectrum)
  • All Wandsworth residents (as Brighter Partnership)
  • MSM pan-London (as GMI Partnership)
Focus:
—To improve the health and well-being of diverse and often marginalised communities by empowering individuals to make positive, informed choices about their health and overall wellbeing. We provide supportive, knowledgeable, non-judgemental and peer-based services.
—
Addresses the following health promoting behaviours:
  • Reducing late diagnosis
  • Reducing HIV stigma
  • Increasing HIV status disclosure
  • Reducing sexual risk behaviours
  • Reducing substance miss-use behaviours
  • Reducing health inequalities
Challenges
Myths –
—  HIV is only passed on by sex.
—  HIV only affects gay men.
—  Immoralising of HIV basing the condition on having multiple sexual partners or sex work.
—  Multiple sub cultures in London among sexual diverse communities
—  Shame and/or fear and anxiety of the unknown

Conclusion – It is important that we have evidence based research and interventions.
[Download power point slides for this presentation here pptx]

Q&A
Question: Do you offer emotional support?
Answer: Yes – we offer counselling before and after HIV testing
Further question: But do you general offer ongoing counselling?
Answer: Well not specifically.

Question: Do you have clients from Arabic and Asian communities?
Answer: Yes we do, but not that many. More from Black – African communities.

Question: Do you have issue with people not coming forward as MSM (men who have sex with men)  - is it still a taboo?
Answer: Yes – it is still largely a taboo.

Question: Should groups refer clients to you specifically for HIV testing or for other issues related to BME LGBTs as well.
Answer: Yes for HIV testing but also for issues around identity. We have many support groups.

Item 3:
Al Badja -  Hasna Kahlalech from Al Badja talking about her work with young people to sustain positive healthy behaviours

Al-Badja means ‘happiness’

Al Badja have been in Westbourne ward for past 15 years and we run a Step up to Fitness programme for women (in general) but also for young people, especially on our Friday and Saturday sessions.

Ethnicity in the groups are broad and reflects the area. The majority of the women are from Muslim faith but all women are welcome. The project has been very successful and is in fact oversubscribed.

Friday evenings have been particularly successful in attracting young people with their mums.
One of the things we have found helps is team work and rewarding committed members. Entering 10 K run.

Also we have found that BMI does not always give an accurate or effective analysis of your improvement. We find that body fat analysis is better – by measuring.

Q&A
Question: Good point about BMI – how do we get this message across to authorities?
Answer: Well, it is difficult but there is already a change in terms of talking about sugar being the enemy rather than fat.

Question: Can you tell us a bit more about why you find working with mothers and daughters works particularly well?
Answer: Creates a bond and they motivate each other to come. Also young people seeing older women at the sessions as well gives them the motivation/ idea to invite their own mums along.

Item 4:
Wandsworth & Westminster Mind – Eva Papadopoulou from Westminster and Wandsworth Mind will talk about her work with schools

Art therapy – two pilot projects that took place in one schools

Westminster academy – this is a very diverse school

We had 2 Art therapy groups and we accepted 10 students into each group.

We had many issues around how art therapy works and the administration of school e.g. the schools wanted to know everything that happens in the group but we needed the group to be a safe confidential space.

Topics covered:
—  Self regulation
—  Awareness of self and other

We had a 68% positive outcome and 40% had a positive response to self regulation.
Response to conflict:
—  Relationships – 75% felt they built closer and more safe relationships with peers.
—  Better self awareness – of how their behaviour affects others

These were the outcomes of the 1st pilot. The second pilot looks even better after having made some adjustments.

We have seen there is a need for preventative work. We need to remove stigma – to educate young people in a way that is more approachable.

There is a high level of anxiety about external events in world/ news etc.
In WW Mind we are putting groups together to tackle this kind of anxiety.
Also social media influence  and online bullying was flagged up.

Q&A
Question: What was the make up of the 1st group
Answer: Very mixed in terms of ethnicities and gender.

 

Question: In the group did you find that Black/ African boys were more troublesome as more often portrayed to us in the media?
Answer: Actually in our group, no. There was more troublesome incidents happening between the girls. The boys in this group tended to be more withdrawn. However this is such a small sample that it is not a qualifiable indicator in any way.

 

Question: How did you identify the group?
Answer: We worked with the school. We chose those who were not meeting the criteria of CAMHS but obviously still needed support. Support assistants played a big part in making referrals to the group.

 

Question/ comment: I find it interesting that it was so well received in terms of stigma.
Answer: Yes – it became something to be proud of to be part of the ‘Art psychotherapy’ group – it was seen as ‘cool’ to be in this class.

 

Question: What are the next steps in this project?
Answer: We will finish the 2nd pilot, put all our stats together and then seek funding.

 

Question: What happens in art psychotherapy?
Answer: It is a therapeutic intervention that uses no verbal communication to start with. It is good for those who do not have the vocabulary to express their emotions.
e.g I did a group around the time of the Paris attacks. We don’t talk about the Paris attacks but focus on adding details to an object and then speaking about why we did it. When people starting describing why they added certain things it came to express emotions around Paris attacks but came at it from an indirect way.
 
Item 5:
North Westminster Drug & Alcohol Service - Nyalah Asantewa will speak about the support available for young people at North Westminster Drug and Alcohol Service
 
I (Nyalah) am a recovery Substance misuse outreach worker. We do work with 18 – 25 year olds but anyone under 18 we refer to Turning Point.

We work with clients who have problematic substance misuse. We offer a confidential service to help them reduce their use OR have a safer practice.

We work alongside a clinical team including nurses in conjunction with Woodfield Rd practice.

Needle exchange – working with clients who inject – make sure they have safe paraphernalia.
We also work with sex workers.

We also offer one to one key working – trying to work with motivation of their clients. They don’t always see how their substance misuse impacts on their wider family and also on their community.

We do group work and also Peer work – sitting in a group to share experiences and learn from each other how to better manage.

Legal advice – Helping people who have debt issues, rent arrears or eviction notices due to anti – social behaviour.

Specialist Women service – Open group for women
Also more structured group for women available – for helping women with issues around the impact on their lives of their misuse, perhaps loss of children etc.

My role – I work out in the community - in hostels in the local area. A lot of the clients I work with do not want to do something about their substance misuse – they feel that they are in control even though they e.g regularly drink well over the recommended amount.

I run satellite drop-ins which are more group based and informal. My role is about building a rapport with clients from more hard to reach groups.

Referrals
—  Hostels
—  GP surgeries
—  Drop-in (self referral)

Q&A
Question: Do you have relationships/ or contact with dealers who sell drugs to clients?
Answer: We do not contact dealers at all – we often can identify who dealers are - sometimes they are previous clients – we would never intervene directly with dealers though. But if a crime was being committed I would have to share that information.

 

Question: How would your organization describe a successful story – from substance misuse to no substance misuse?
Answer: A successful outcome is from using to not using but we do also need to look at things step by step. 1st initial step may just be them considering the impact of their substance misuse on their family OR initially drinking 36 units a week and bringing it down to 16 units a week is also a success.

 

Question: What age groups do you work with?
Answer: 18 – 50/60/

 

Question: How do you attract young people to the programme?
Answer: Outreach team link in with other groups happening with younger people. Offering satellite workshops in other groups, working informally.

 

Question: Do you offer presentations to other organizations to raise awareness about alcohol misuse and help available?
Answer: Yes – we offer presentations to staff and also to residents in a more informal way.

 

Question: Have you seen an increase I the numbers of people with drug and alcohol misuse in the last 5 years?
Answer: In North Westminster in the last 5 years the numbers have been roughly the same. In South Westminster there may be a difference but not hugely.

 

Question: Do you work in Kensington & Chelsea?
Answer: It is a Tri- borough service
 
Item 6:
CNWL NHS Foundation Trust Richard Gordon from CNWL mental health trust will talk about his work with young people who are experiencing a first episode of psychosis

Early intervention in Psychosis – how we get involved with young people.

With 14 – 35 year olds who go through their 1st episode of psychosis, research shows that the 1st 3 years is a critical period – This is why we have a programme that has been set up to engage with people at this critical period.

Therapy at early point of diagnosis will be much more effective. Therapies include Cognitive Behavioural therapy (CBT) and Family therapy.

The difficulty is the stigma and so getting people involved and saying it needs to be treated as if after 3 years of showing signs it is not treated it is much more difficult to help them.

If someone has psychosis for more than 7 days we would get involved and try and help.
Family work is very important – we need to educate the family as well as the person who is diagnosed. E.g Hallucinations at home – we can help the family understand what these episodes are.

The stigma affects social activity and employment. Clients want to be involved in a normal life – they don’t want to separate themselves from normality. Our team can support employers and colleges to help clients stay in regular jobs and schools.

Referrals: GPs used to be first point of referral but now this has changes with CNWL’s Single Point of Access which allows CNWL to assess clients themselves for referral into the service.

Comment: if you we're accessing the service via your GP you would most likely see the mental health practitioner at your GP in Westminster via the primary care plus service.

 

Q&A
Question: Do you work across Tri-borough?
Answer: We are in Westminster and Kensington & Chelsea.

Question: If you are worried about someone with possible psychosis who would we need to go to?
Answer: Firstly your GP.

Question: Could you tell us a bit about what psychosis is?
Answer: Psychosis is a change in a person’s thought process – this might manifest itself in hearing voices, seeing things that are not there, experiencing things that didn’t happen. We would look at negative symptoms in a person such as them being particularly withdrawn.

Question: What percentage of your client group go on to secondary mental health services.
Answer: Not sure exactly – possibly 30% – 40%. We do have a quite good success rate though.
Question: What do you think about other services such as spiritual support groups etc.?
Answer: We do in fact have a worker who deals with that side of things.

Question: Do you work with BME communities and have you come across that parents try to hide it in these communities?
Answer: Parents sometimes will insist that their children do not have a problem at all until the point when there is a crisis episode. This is why family work is so very important. Parents often don’t want to accept that there is a problem because of the stigma attached.
Question: How do you differ from CAMHS (Children and Adolescent Mental Health Services)?
Answer: We just deal with first episodes of psychosis. We do work alongside CAMHS but our service is specifically about first episodes of psychosis.
Question: What about referrals?
Answer: We now get referrals through CNWL’s Single Point of Access but before this was in place referrals were mainly through GPs.

Question: Do GPs know where to refer children? Sometimes children have been referred to adult services.
Answer: GPs should know.

Question: Is there a waiting list for your service?
Answer: No, we must see people who are referred within 2 weeks.

Question: What is the background/ ethnicity of your referrals?
Answer: Completely mixed.

 

Item 7:
London Tigers - Sulthana Begum from London Tigers will talk about her work with young people.
 
We work across London.
We have a vision where every individual has the opportunity to fulfil their dreams.
We work to support socially deprived communities.

We have been running for 30 years and are originally based in Westminster but have other bases across London.

Health issues of those we work with include inactivity and isolation.
Beneficiaries have poor socio-economic backgrounds with barriers to access mainstream services.
We are not a Bangladeshi organisation – we work with a very mixed group.

Our work runs along several themes:

Community cohesion (events and international holiday gatherings)
Football clubs  (Football, badminton, cricket)
Employment – training programmes – in fact many of our staff have started off as volunteers and gone on to become staff.
International development

Work with Children and Young People include:
  • Health & Wellbeing groups
  • Women only groups
  • Men over 40’s group
  • Healthy eating workshops
We are a user led organisation.

[Download power point slides for this presentation here pptx - Not available at present - please enquire.]
 
Q&A
Question: You are doing a lot - may I ask what your annual turnover is?
Answer: £500,000 (Key funders are Children in Need and Home Office)

Question: Have you ever done FGM workshops with young people?
Answer: No – but would be happy to work with you on that.

Item 8:
Public Health Tri Borough - Andrea Goddard will present ‘FGM in Children and Adolescents – how it can affect their health’ and Debbie Raymond will talk about Mandatory Reporting

Andrea Goddard: I’m a paediatrician and I work in St Mary’s Hospital. Young people in the Tri-borough did not have their own FGM service so we have set up a service for young people in Hammersmith Hospital. Referrals can be through MH services or through self referral. We operate once a month where there is a paediatrician, health advocate from the community, and a gynaecologist present. All issues can be addressed here in an age appropriate safe setting in a holistic fashion.

If anyone has any concerns about FGM or needs to know about referrals to services they should be in touch with Shruti Clayton (Shared Services FGM Lead Practitioner -  Shruti.Clayton@rbkc.gov.uk)
Mandatory Reporting of FGM
There have been very few referrals for FGM from children’s services and there have been no criminal prosecutions.
Mandatory reporting, introduced by Central government signals an impatience to bring forward referrals.

Teachers, health workers and community workers must report actual cases to the police. All professionals have that duty but we are not seeing referrals being made.
With this new mandatory duty the individual must make the referral themselves – the responsibility is theirs and not to be passed on to manager or organisation.

When we talk about healthcare professionals it is far reaching to include such as dentists and osteopaths.

Guidance says that the time scale for referrals must be within 1 day of discovery. This can be delayed to 1 month under specific conditions –the process of consultation is always safe practice in cases of safeguarding.

Guidance sets out that the reporting has to be made directly to the police. Guidance allows for making the referral through 101 – which will then be passed on to Child Protection team at the police. If you have trouble with making a referral or have any worries about it do ask Children’s Services first as we can help with reporting.

On reporting there will be a MASH (Multi agency team meeting) to assess and make a plan of action.
If FGM is suspected it is highly likely that there will be an inspection. The health emphasis is that the person affected will receive long term healthcare and mental health care.
Consequences of not reporting
  • Revert back to their professional regulatory body
  • Disciplinary action
But what weighs more heavily is the responsibility for what happens to girls and also that then other children may be at risk.

FGM is a traditional practice

If you just suspect a case of FGM you still have a duty to report but it is covered by the protocol of mainstream safeguarding.

KEY CONTACT INFORMATION
If in doubt please pick up a phone and speak to:
  • Shruti Clayton - Shared Services FGM Lead Practitioner, 0207 641 1610 - shruti.clayton@rbkc.gov.uk  
  • Hilary Shaw - Safeguarding in Schools Lead, 0781 736 5519  hilary.shaw@rbkc.gov.uk
  • Debbie Raymond - Joint Head of Safeguarding, 0773 931 5970
debbie.raymond@rbkc.gov.uk

 

[Download power point slides for this presentation here pptx]