Developing life story work to improve the mental health of adolescents
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"I hope that this work and the entire programme helps children and young people with care experience to recognise they are not limited by their reasons for entering care, or by their experiences in care, but that they are limitless. I want all young people with care experience to be able to flourish. They deserve to thrive, not just survive"
In the LIMITLESS programme’s new realist review, 'Improving the mental health and mental health support available to adolescents in out-of-home care via Adolescent-Focused Low-Intensity Life Story Work: a realist review', published in BMJ Open, Dr Simon P Hammond continues to strive towards improving the mental health and well-being of young people with care experience. With this paper, published on World Mental Health Day, Dr Hammond and his co-authors ultimately hope to improve the quality, accessibility and consistency of life story work offered to young people with care experience; a vulnerable group which is six times more likely to experience mental illness than the general population.
Life story work is an intervention “that seeks to promote the well-being of children living in care by building a sense of identity and belonging,” explains Hammond. This involves children living in care and their carers recording and reflecting on positive everyday memories in order to make sense of their past. Disappointingly, teenagers are often overlooked in the delivery of life story work in favour of more specialist and intensive work with younger children.
"Teenagers are often overlooked in the delivery of life story work in favour of more specialist and intensive work with younger children"
The paper is the latest work from the LIMITLESS programme, “a set of studies which aims to improve the mental health and well-being of teens living in social care by improving the guidance available to support them,” says Hammond. “Children and young people can often find themselves listening to self-limiting narratives. The LIMITLESS programme aims to help children and young people with care experience flourish by utilising their every-day experiences and relationships to support positive future expectations.”
Having worked in social care since 2005 and researched the area since 2008, Hammond observes that conventional ‘high-intensity’ life story work “remains poorly evidenced, lacks standardised guidance, is expensive, inconsistently implemented and remains inaccessible for many teens due to a lack of resources and teen specific guidance." The National Institute for Health and Care Excellence (NICE) advise that life story work be offered to all children and young people in care; however, there is, unfortunately, a dearth of high-quality evidence-based guidance on how ‘low-intensity’ approaches to life story work should be delivered.
The project, which is funded by the National Institute for Health and Care Research (NIHR) and led by the University of East Anglia (UEA) and Norfolk and Suffolk NHS Foundation Trust (NSFT), is attempting to “improve the accessibility and consistency of pre-existing lower-intensity life story work practices for teens by creating evidence-based guidance and recommendations.”
A key cornerstone of the LIMITLESS programme, and indeed the BMJ Open paper, is ensuring the expertise of young people with care experience and those supporting them is central to the work.
Katie Martinez-Thompson, an expert from the Care Leavers National Movement (CLNM) who contributed and advocated for her community alongside others throughout the project, adds that LIMITLESS “gives young people a real achievable opportunity to take part in life story work when and how it suits them. Many young people don’t get the opportunity to undertake life story work in its traditional form [high intensity], as it’s time consuming and there’s a huge waiting list.”
What is the LIMITLESS project?
In 2021, the LIMITLESS programme published 'Life story work for children and young people with care experience: A scoping review' which identified and analysed life story work approaches. For the new paper, the authors collaborated with Context Expert Groups (consisting of professionals and young people with care experience) to produce guidance which would aid care providers in the delivery of low-intensity life story work. Hammond explains how “current life story work practices are high-intensity, poorly evidenced, lack consistency and focus on younger children. Ultimately teens, the most in need, often miss out. Our research begins to understand if life story work can be delivered in a lower-intensity way (e.g., by foster carers) to teens, and how and if this helps.”
The realist review finds that best practice low-intensity life story work: is flexible and person-centred; should begin at the earliest opportunity (there is no need to wait!); utilises co-construction of narratives (between carer and the teen living in care); and includes the recording of positive everyday experiences, amongst other suggestions.
"I’m sure you’d agree this work is essential as opposed to desirable. Better evidence allows for the creation of better guidance"
Hammond hopes that the LIMITLESS programme changes social care policy: “If you speak to any person with care experience who doesn’t have everyday memories from their time in social care, I’m sure you’d agree this work is essential as opposed to desirable. Better evidence allows for the creation of better guidance, better guidance and recommendations allow for better practice. And better practice should lead to more confident and supported carers and, ultimately, improved mental health and well-being support for teens with experience of living in social care.”
The positive futures and mental health of children and young people with care experience are the goals of the LIMITLESS programme’s impressive and admirable outputs. “I hope that this work and the entire programme helps children and young people with care experience to recognise they are not limited by their reasons for entering care, or by their experiences in care, but that they are limitless,” says Hammond. “I want all young people with care experience to be able to flourish. They deserve to thrive, not just survive.”
'Improving the mental health and mental health support available to adolescents in out-of-home care via Adolescent-Focused Low-Intensity Life Story Work: a realist review' is published in BMJ Open on 10 October 2023.
'Life story work for children and young people with care experience: A scoping review' was published on 12 February 2021 in Developmental Child Welfare.
This project was funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (Grant Reference Number NIHR 201963).