Service users as the key to service change? The development of an innovative intervention for excluded young people

Young people affected by street gangs and those at risk of offending often have high levels of unmet mental health needs.

  • By Sally Zlotowitz, Chris Barker, Olive Moloney and Charlotte Howard
  • Child and Adolescent Mental Health, Vol 21, (2015)

Young people affected by street gangs and those at risk of offending often have high levels of unmet mental health needs. Multi-agency and multi-component interventions seem most promising for meeting those needs according to research by Hodgkinson et al, 2009 and McMahon, 2013, but provision by local authorities and third sector organisations can be inconsistent and time-limited due to variable funding, and mental health components can be missing.

Evidence has found that there is a gap between statutory mental health services offered in the community and their take-up by these "hard-to-reach" young people. This may be partly explained by the use of an appointment-led approach to mental health provision, which creates barriers for excluded young people - from geographical barriers such as neighbourhood territories to psychological barriers, such as mistrust of professionals.

The Music and Change Project

The two-year Music and Change (M&C) project aimed to bridge the service gap for this group, focusing on building a trusted relationship between a keyworker and a young person. Attachment and mentalisation-based theory informed practice and understanding of young people's behaviours and mental health issues. Project development was "bottom-up" rather than "top-down", based on principles of strengths-based co-production with "little predetermined content, structure and processes".

The project took place in an inner-city, high-density housing estate, targeted at young people aged 14-25 not engaged in education, employment, training or youth services (other than the youth/criminal justice system) and at a high risk of offending or reoffending. Young people were identified through informal outreach and participatory methods - spending time where young people gathered (eg the local takeaway), building relationships with the local youth centre and by being identified as gang-affiliated through a relevant multi-agency panel and self-reporting by young people.

Mental health concerns were not in the inclusion criteria; staff informally assessed young people's needs throughout the intervention. Young people were able to self-refer by attending activities and often brought their peers along with them, which was actively encouraged. Exact demographic data was not known for all young people because they reported that such data collection was a barrier to coming.

Young people wanted the sessions to focus on music skills (DJ-ing and lyric-writing) as a vehicle for building relationships with staff and receiving support with a range of needs. Other professionals, such as a housing adviser, were invited to come and provide support around music sessions. Over time, as relationships with practitioners grew, young people became willing to explore their emotional experiences more deeply, especially if they could see a link to achieving their occupational and financial goals. Young people then met practitioners individually outside of music sessions.

The authors opted to use an ethnographic approach to understand young people's experiences of the project and to work with the fluidity of the population involved. Interviews and conversation with young people, stakeholders and staff were drawn on, with some of the young people acting as research consultants.


Young people viewed the following features of the project as being key to encouraging them to respond effectively, mirroring other findings by Hodgkinson et al (2009) and Pitts (2008):

  • Trusted relationships
  • Responsive, flexible and relevant
  • Local and safe
  • Peer- and youth-led
  • Holistic in approach
  • Creating contextual change

One young person attributed the success of the project to receiving support from a trusted adult: "I've known Lisa for over a year now and I'd prefer to speak to her if I've got any problems than go to someone I don't know in some weird building."

Implications for practice

The co-production process and the peer-and youth-led nature of the project were of paramount importance. Practitioners quickly learned that once young people trusted the project, their appetite for bringing their friends along, gaining experience and utilising their skills and knowledge was huge. Practitioners coined the term "street therapy" for the practice of taking any opportunity to explore young people's internal experience and build reflective and empathic capacity, while drawing on clinical formulations and practice. In addition to these therapeutic benefits, young people valued having leadership roles (as volunteers or employees) within the project and having control of their own and their peers' inclusion in the sessions, resisting professional referrals or requirements. This seemed to enable young people to engage with the project in a non-stigmatising way, helping keep them safe in terms of gang affiliations, allowing them to feel more ownership of neighbourhood issues and gain self-efficacy.

The research section for this special report is based on a selection of academic studies which have been explored and summarised by Research in Practice part of the Dartington Hall Trust.

See also: Tackling offender mental health
A Mac-UK scheme could point the way for supporting young offenders with mental health problems.

Further reading

Related resources:

  • SCIE resources on co-production in social care: What is it and how to do it
  • Children's participation in decision-making: a children's views report by the Office of the Children's Commissioner
  • Participation work by the Office of the Children's Commissioner with young children and their families aimed at reducing the impact of low income
  • Children and young people giving feedback on services for children in need: ideas from a participation programme by the Office for the Children's Commissioner
  • Achieving emotional wellbeing for looked after children: a whole system approach by the NSPCC
  • Learning from the Relationships Matter project, challenging and promoting continued relationships between practitioners and care leavers
  • The Department for Education has recently published the user journey mapping research report and website.
  • An evaluation of the impact of children's participation on The Children's Society and its stakeholders
  • Emerging learning from the Council for Disabled Children Learning and innovation programme including promising practice around co-production

Related resources by Research in Practice:

  • Voice of the child: Evidence review
  • Attachment: Frontline briefing
  • Adolescent mental health: Frontline briefing
  • That Difficult Age: Developing a more effective response to risks in adolescence: Evidence scope
  • Communicating effectively with children under 5: Frontline briefing
  • Communicating effectively with Children Under 5: Webinar recording
  • Communicating effectively with children: In-house workshop
  • June 2016 Communicating with children and young people with developmental delay, communication difficulties and disabilities: Frontline briefing
  • June 2016 Young person-centred approaches in Child Sexual Exploitation (CSE): Building self-efficacy and promoting participation: Frontline briefing
  • July 2016 Young person-centred approaches in Child Sexual Exploitation (CSE): Building self-efficacy and promoting participation: Webinar
  • System redesign with young people's voices centre stage: Blog by Louise Bazalgette from NSPCC and Jake Garber from DfE's Innovation Unit
  • Evaluation tools and guides including:
  • Embedding the Voice of Children and Young People in Service Evaluation: Evaluation Tool
  • Ethics for research with children, young people and vulnerable adults

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