ANNUAL REPORT 2016/2017

Transcription

1 ANNUAL REPORT 2016/2017

2 THE BRANDON CENTRE Background Brandon Centre for Counselling and Psychotherapy for Young People is a charitable organisation that has existed for over 49 years. It began as a contraceptive service for young women aged 12 to 25 years and was called the London Youth Advisory Centre. The founder, Dr Faith Spicer, recognised the need of young women to access a service, which allowed them to talk through emotional issues associated with requests for contraception. Shortly after the founding of the contraceptive service, an information service and a psychotherapy service were created to meet the emotional needs of both young women and men in the local community and beyond. These services were easily accessible through self-referral and ensuring confidentiality. They provided comfortable, welcoming and non-institutional premises in the heart of the local community, with receptionists being friendly but not intrusive. The contraceptive service quickly gained a reputation for working effectively with young women from dysfunctional backgrounds that put them at risk of unwanted pregnancy and sexually transmitted diseases. The Centre acquired a reputation for its imaginative application of psychotherapeutic principles in creating innovative services for young people, particularly high-priority groups of young people, and for combining service delivery with audit and research, including the rigorous evaluation of mental health outcomes. Objectives The principal objective of the Brandon Centre is to maintain and develop an accessible and flexible professional service in response to the psychological, medical, sexual and social problems of young people aged 12 to 25 years. The Centre aims to relieve distress, mobilise personal resources and facilitate growth in adolescents by working towards responsibility and self-fulfilment. The Centre particularly aims to prevent or alleviate suffering caused by unwanted pregnancy, ill mental health, psychological disturbance and maladaptation in adult and future family relationships. Our service extends to a wide range of adolescent problems and is based on a psychoanalytic understanding of adolescent development. There are also particular medical provisions for contraceptive, pregnancy and psychosexual difficulties. Activities The Brandon Centre s services cover the following activities: contraception and sexual health psychotherapy multisystemic therapy parent training. The Centre also provides information on contraception, sexual health, mental health and other health issues. Our services are free of charge. There is no geographical restriction for users of the contraceptive and sexual health service, and the parenttraining service. The psychotherapy service is confined to young people that live in Camden or Islington. The Centre s evaluation activities include routine monitoring of outputs and outcomes, and a randomised-controlled trial. We report and disseminate the findings from evaluation activities in peer-reviewed, professional journals. The Centre is registered with the Care Quality Commission (CQC) and is assessed annually for compliance with the CQC s regulations and standards governing the delivery of healthcare. We are also subject to external assessment. New Philanthropy Capital, an independent charity that analyses charity performance in social welfare, reported its analysis of the Centre in 2008, which it updated and revised in Introduction from the Chair I am delighted to present the 2016/17 Brandon Centre annual report. The Centre has had an extremely busy year with excellent uptake of all appointments, as well as drop-in services, and many outreach activities provided in schools, in the local accommodation pathway and in other sites where young people can be reached. All services continue to operate according to the Centre s policies and procedures and key principles of being accessible (including an emphasis on selfreferral where possible and appropriate), evidence-based and outcome- focused. This requires innovation alongside constant measurement and improvement. The psychotherapy service and the contraception and sexual health service form part of a local network of services for young people and have continued to develop their services. The Centre engages service users, their parents and carers in its feedback and this continues to be used to improve our services. The Centre has also continued to conduct research of the highest quality, including a unique study of MST for problem sexual behaviour. Last year the Council of Management met for five ordinary meetings and the Annual General Meeting (AGM). We have spent time reviewing our strengths and weaknesses as a Council, as well as the risk to and strengths of the Centre using guidance from the Charity Commission. This is to ensure that going forward we fulfil our duties as trustees and build a healthy future for the Centre. I would like to thank all members of the management committee who give their time, experience and knowledge to help the Centre, including Richard Taffler, Honorary Treasurer, who oversees our finances. Danielle Mercey, who has been Chair of the Council of Management since 2005, retired at the AGM. I would like to thank her for her invaluable contribution to the growth and development of the Centre. The successes highlighted in this report were made possible due to the hard work and loyalty of our staff. On behalf of the Council of Management, I thank them for their work and in particular for the dedication of the Director, Geoffrey Baruch. We are very appreciative of the continued financial support from a number of clinical commissioning groups (CCGs) and local authorities, and for the generosity of charitable trusts and corporations. Their support allows the Centre to continue to respond to the mental health needs and contraceptive and sexual health requirements of young people seeking help. Dolores Currie Chair, Council of Management June

3 ANNUAL REPORT 2016/2017 Introduction from the Director The Centre offered 10,952 appointments in 2016/17 of which 82% were attended by young people and parents. In total, 6,080 young people, parents and families used the Centre s services. With the support of our participation lead and two trainee clinical psychologists, five youth ambassadors participated in a project, which included collaborating with an animator to produce a video showing a young person s experience of psychotherapy at the Brandon Centre. This project was among a number of participation activities in our sexual health and psychotherapy services. The Centre continued to offer a range of contraceptive and sexual health services, including an appointment clinic staffed by doctors and a nurse, and drop-in services offering free condoms, sexual health advice and information, and basic screening for sexually transmitted infections (STI) run by trained front-office staff. The Centre s C-card coordinator and sexual health programmes facilitator also continued to run and promote the C-card scheme in Camden and, in partnership with Brook, in Islington at outreach sites. Our facilitator ran interactive information sessions in schools, colleges, pupil referral units, youth centres, and hostels. A total of 5,084 young people used the contraceptive and sexual health service, dropped in for condoms and chlamydia and STI testing, were newly registered for the C-card scheme, and attended sex and relationships education (SRE) lessons. Brandon Reach, a service to provide emotional support to young parents who have had a child removed into care, continued its multi-faceted programme in Camden. The Centre continued its participation in the Child and Young People s Improved Access to Psychological Therapies programme (CYP IAPT) of routine patient-reported outcome-measurement. It was also involved in Camden s Minding the Gap initiative. Minding the Gap aims to provide a seamless transition for young people transferring from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS), additional treatment capacity for Camden 16- to 24-year-olds and access to holistic mental health provision for hard-to-reach young people through the Axis service based at the Hive, a youth-focused venue. 283 Camden young people were seen in the psychotherapy service. An expanded Islington psychotherapy service and a new project for Islington 16- to 24-year-olds, classified as being not in education, employment or training (NEET) due to moderate to severe social anxiety, were used by 89 young people aged 14 to 24 years. They attended sessions at Drum, Lift, Platform or in the community. The Centre s activities continued to see high levels of participation with 427 students in year 11 from three local secondary schools taking part in an exam stress workshop run by our clinical psychologists. The Centre was also commissioned by Harrow to run a 12-month pilot of a psychology service of secondary and primary schools as part of the Future in Mind initiative aimed at transforming CAMHS in Harrow. One Brandon Centre team provided MST in Camden, Enfield, Haringey, and Lambeth. We also completed the final year of the first clinical trial in the UK, in partnership with MST UK and the Research Department of Clinical, Educational and Health Psychology University College London (UCL), to investigate the effectiveness of MST for problem sexual behaviour (MST PSB) in young people. We ran six well-attended and well-received parent-management training groups for parents of teenagers with challenging behaviour and further established the Brandon Prevent programme, providing eight sessions of individualised support for parents of teenagers with moderate to severe challenging behaviour in addition to attending the group. We also ran three successful eight-session group programmes for Camden parents of five- to 12-year-olds with a diagnosis of attention deficit hyperactivity disorder (ADHD). These achievements are consistent with our aspiration to provide services that are: Accessible: don t have long waiting times, are designed with young people in mind, are open at times that are convenient for young people, are safe and confidential, and have friendly and professional staff. Evidence-based: the staff use their knowledge of what works (the evidence base) and their experience of working with young people (practice-based evidence) to decide with young people the best way to help them. Outcome-focused: helping young people achieve the outcomes they want and using outcomes measures and feedback from young people to find out whether we are meeting their goals. Geoffrey Baruch Director 3

4 THE BRANDON CENTRE Contraceptive and sexual health services Since April 2015, the contraceptive and sexual health service at the Brandon Centre has been commissioned by Camden and Islington Public Health to work in partnership with Brook Euston and Homerton NHS trust at Pulse in Islington to deliver a network of young people s community sexual health services across the two boroughs. This innovative model of joint care includes three contraception and sexual health clinics (one being the Brandon Centre), supported C-card sites (providing access to free condoms in community youth services), SRE in schools, clinical and targeted outreach with more vulnerable young people, and children s workforce training and development across the boroughs of Camden and Islington. The focus of our activities in Strengthening the Camden and Islington Young People s Sexual Health network Ongoing collaborative partnership working with Brook and Homerton NHS trust to ensure services meet the sexual health needs of young people, and are accessible, consistent and standardised across Camden and Islington. 2. Further developing the contraception and sexual health clinic services based at the Brandon Centre Improve access for more young people to a wider range of services and reducing the need for onward referral to larger genitourinary medicine (GUM) and contraceptive clinics. Throughout 2016/17 we have: established Monday to Saturday opening times, offering a mix of appointment clinics and drop-in services continued to offer a comprehensive range of STI testing and treatment, and contraceptive methods, either on site or through established referral pathways into other services (within and outside of the network) further developed our drop-in services, appreciating that these services are particularly successful in attracting young men, and other harder-to-reach clients, who want immediate access to a quick, simple, informal and discreet service provided advice, information and condoms via our frontline support workers who are now trained to offer full STI testing, pregnancy testing and assistance with self referral to abortion services; they also have the experience to recognise young people who may be especially vulnerable or have more complex sexual health needs, who should be assessed by a clinician continued to provide a well-managed appointment clinic that allows doctors and nurses adequate time to deal comprehensively and holistically with sexual health concerns and difficult issues, such as managing an unplanned pregnancy, an infection, or sexual and relationship difficulties. 3. Developing the C-card and workforce development (WFD) programme. The Brandon Centre has responsibility for coordinating the C-card scheme provision and WFD training across both Camden and Islington. The C-card scheme provides 13- to 24-year-olds with easy access to free condoms from C-card sites (youth clubs, colleges and other community youth services), both in Camden and Islington, and in any other London borough that participates in a London-wide Come Correct C-card scheme. At certain sites, young people may be offered a self-test on site for chlamydia and gonorrhoea. Our Brandon Centre C-card coordinator is responsible for supporting existing C-card sites, identifying new sites, providing hands-on training and support to youth workers, and assisting with engagement to increase the number of young people signing up to the scheme. Our coordinator always prioritises sites that work with young people who are considered especially vulnerable. WFD training targets staff who work with young people in various statutory and non-statutory organisations across Camden and Islington. Training aims to increase staff s knowledge about the sexual and reproductive health issues that affect young people, so they feel more confident to address these issues with their service users and support their access into sexual health services if needed. In some cases, organisations will be motivated to become a C-card provider and/or an outreach site where young people can access chlamydia/gonorrhoea screening. 4. Sexual and relationships education (SRE) The sexual health network providers (Brandon Centre, Brook and Homerton NHS Trust) work collaboratively to deliver a core offer of sexual health and healthy relationship education in mainstream secondary schools and academies across Camden and Islington, and to support teachers in the planning and delivery of Personal Social Health and Education (PSHE) lesson plans. We provide outreach SRE workers who contribute to this network provision and who meet other providers on a quarterly basis to develop the core resources, link delivery to schools, and develop other initiatives. 4

5 ANNUAL REPORT 2016/ Brandon Reach programme We continue to work in close association with the psychologists managing the Brandon Reach programme, to address the contraceptive and sexual health needs of young women who have had, or who are in the process of having their children taken into care. What we achieved during 2016/17: Camden and Islington s Young People s Sexual Health network Our contribution to collaborative network activities included: service user involvement with young people, developing young people-led methods of feedback to help inform how the network can make services more accessible, especially for those harder-to-reach young people participation in audit and reporting to ensure that all network partners achieve a high-quality, consistent, standardised approach to safeguarding and risk assessment, management of young women with an unplanned pregnancy, partner notification, and referral pathways into level three services developing and sharing clinic resources to ensure that young people can access information about wider health issues, eg smoking cessation, drugs and alcohol, mental health, and be signposted to organisations providing support and intervention in these areas members of our Brandon Centre counselling team delivered training to frontline staff across the sexual health network, around the basic assessment and management of mental health risk in young people. Contraceptive and sexual health clinic services at the Brandon Centre Service activity: more young people than ever before (2,020 individuals) used the contraceptive and sexual health clinic services during 2016/17, recording 4,046 attendances. This represents a 15% increase in activity compared to last year. A quarter of the young people using the centre were young men. User feedback (see below) indicates that most young people appreciate the ease of access, the range of services provided, and the respectful and confidential manner with which they are treated. Chlamydia and gonorrhea screening: 1,635 chlamydia and gonorrhoea screening tests were carried out in 2016/17: our highest number to date and a 12% increase on last year. Almost a quarter of these tests were done in young men, who appreciate the ease of access to the dropin service. As a result, 140 young people (8.5% of those who took a test) were diagnosed and treated for chlamydia, gonorrhoea or both infections. HIV/syphilis testing: young people can now easily access full STI testing through our drop-in service. As a result, 210 young people were tested for HIV and syphilis with a point of care finger prick test (40% increase on last year). Provision of contraception: almost 70% of young women attending our sexual health service were provided with effective hormonal contraception, including long acting reversible contraception (LARC) methods (11 14%). Promotion and uptake of LARC methods continues to increase: 100 contraceptive implants were fitted at the Centre during 2016/17 (10% increase on the past year). Seamless referral pathways have been developed within the network for emergency and routine intrauterine device (IUD) or coil fittings. Brandon Reach: we continue to provide contraception and sexual health services to several of the young women engaged in this programme, ensuring flexibility wherever possible to ensure accessibilty for this hard-to-reach group. Sex and relationships education (SRE) Brandon Centre SRE workers delivered 28 sessions in local schools and colleges as part of the network provision. C-card and workforce development (WFD): In 2016/2017 we saw a significant increase in the number of young people using the C-card scheme across Camden and Islington C-card sites: there were 2,333 new registrations with a total of 4,493 encounters with young people on the scheme. Feedback from young people confirms they appreciate the easy access to a wide range of free condoms from youth services which are local and familiar to them. During the year, we facilitated training for the children s workforce across Camden and Islington: 69 staff members received basic core training, 53 attended Introduction to talking to young people about sexual health training, and 19 took Come-Correct C-card training to operate as practitioners for their community s C-card scheme. We responded to requests for bespoke training on emerging themes such as puberty, sex and relationships, young people and pornography and young people and relationships; a total of 54 staff attended bespoke training. 5

6 THE BRANDON CENTRE We delivered training on chlamydia and gonorrhoea self-testing to 34 members of staff, enabling them to offer screening to young service users. What we aim to achieve next year during 2017/18: Camden and Islington s Young People s Sexual Health network continue to work collaboratively with the network to ensure consistent, high-quality services for young people throughout Camden and Islington make services more cost effective by sharing training and resources, and ensuring better coordination and coverage of outreach activities work with commisioners to respond to local needs and funding opportunities eg specific services for older young people, looked after children and those leaving care review opportunites for more online services, eg for STI testing. Contraceptive and sexual health clinic services at the Brandon Centre: continue to provide high quality sexual health services for young people, which are readily accessible, with minimal waiting time review the staffing structure with the CaSH service to make the best use of our trained staff, increasing the use of drop-in services for young people who do not need to see a clinician, and allowing our doctors and nurses more time with those who are higher risk and with most need continue the implementation of an electronic notes system, which will reduce paper-based administration, improve monitoring and reporting. SRE provision: continue to work collaboratively with the network to ensure that young people across Camden and Islington have an increased understanding of healthy relationships and sexual health and adequate information to access services. C-card and WFD: increase the number of young people who use the C-card scheme by 10% in both new registrations and repeat attendances across 75% of C-card sites identify new community settings as potential C-card sites, supporting their staff with necessary training and resources work with commissioners on a pilot scheme for expanding C-card services into local pharmacies deliver a stakeholders event for C-card practitioners which will involve training and networking opportunities continue to respond to training needs identified by the Camden and Islington children s workforce in order to develop relevant training around young people and sexual health. How we deliver public benefit We work collaboratively with Camden and Islington public health commissioners and other sexual healthcare providers, to meet the sexual and reproductive healthcare needs of young people across both boroughs. We provide core clinic-based services, outreach activities and SRE delivery in schools and colleges. With our partner organisations, we aim to meet the targets set by local and national strategies, especially those which aspire to reduce teenage pregnancy rates and improve STI and HIV screening coverage, and increased awareness and knowledge of relationships and sexual health among young people The Brandon Centre s specific strength and contribution, lies in its ability to provide welcoming, accessible and flexible services, which are successful in engaging the more vulnerable and harder-to-reach young people. These include young men, black and minority ethnic young people, young offenders, young people in care, those not in mainstream school or living with a learning disability, and those who may struggle to access more mainstream health services. 6

7 ANNUAL REPORT 2016/2017 How a sample of young people who used the contraceptive and sexual health service at the Brandon Centre felt about their experience Definitely true Partly true Not true Don t know The people who saw me listened to me It was easy to talk to the people who saw me I was treated with respect and dignity by the people who saw me I feel the people here know how to help me I felt involved as much as I wanted to be with decisions about my care and treatment The facilities (eg waiting room, other waiting areas, clinic rooms) at the Brandon Centre are comfortable It is easy to travel to and find the Brandon Centre Appointments are usually easy to get and at a time that suits me When I talk with the staff here, it always feels private and confidential Young people who are under 16 years old would feel safe coming here If a friend needed this sort of help, I would recommend that they came here Overall I feel the care I have received here is very good Young people tell us what they like about our service: I m 16 now, but have been coming here since I was 14 I have always felt safe coming here. Have been going here for years! Great place for young people, to be able to talk to someone or get the right contraception they need! Collecting the quit smoking leaflets helped me quit! Very happy about the centre, very warm and welcoming. Only centre that makes me feel comfortable. It s helpful and quick. All staff are welcoming and make you feel very comfortable. Very welcoming place! It s really easy to book an appointment and get seen for what you need. The staff are all really helpful and easy to approach. A sense of trust, no shame and a level of confidentiality...appointments can be available same day. They don t judge you or make you feel uncomfortable. I feel as if I can tell them anything I needed to. The people here are really easy to talk to and know the best ways to help. Also it doesn t feel like I m being judged for coming here. The leaflets are very useful; the sexual health service is fantastic. I received the best help and was offered many options that suited me. I can trust the people here and I feel comfortable. Very professional and comfortable centre with excellent service. They made me feel very welcome and looked after. I love this place. I would be so stuck without the amazing workers and service provided here. 7

8 THE BRANDON CENTRE Psychotherapy service Providing a psychotherapy service for 12- to 25-year-olds with mental health problems has been at the heart of the Brandon Centre s work for over 48 years, alongside our contraceptive and sexual health service. The remit of the service is, in particular, to reach out to 16- to 24-year-olds with mental health problems who don t fit into a child and adolescent mental health service or an adult mental health service. There have been few changes in the characteristics of the Centre s service: responsiveness to the mental health needs of young people accessibility by encouraging self-referral to make it as easy as possible for young people to get help confidentiality so that young people feel able to reveal their worries and concerns professional clinicians experienced in working with young people therapeutically and therefore able to adapt their therapeutic model for the needs of young people. The Centre, with a number of NHS and voluntary sector providers, is a member of Camden Open Minded joint-intake team. Joint intake is a central point for child and adolescent mental health referrals in Camden, for example from GPs and schools. The Centre is also a founding partner with Open Minded and Camden and Islington Health NHS Foundation Trust of Minding the Gap Transition service. This is new service to bridge the gap between adolescent and adult mental health services for vulnerable young people with a complex presentation. Brandon Reach provides emotional and psychological support for Camden young parents who have had a child removed into care. With the support of Islington and Cripplegate Foundation, the Centre provides counselling and psychotherapy services for Islington s 16- to 21-year-olds at the Drum youth centre in Whitecross Street EC1 and at Lift and Platform youth hubs. In October 2016, we started a new project aimed at Islington 16- to 25-year-olds who, due to social anxiety and other mental health problems, are unable to access education, employment or training. This is supported by an 18-month grant from Islington Giving. The Centre was also commissioned by Harrow to test a 12-month pilot of a psychology service to secondary and primary schools as part of the Future in Mind initiative aimed at transforming CAMHS in Harrow. The Centre is part of a consortium led by Catch 22, which includes The Tavistock and Portman NHS Trust, Camden and Islington NHS Foundation Trust, The Anna Freud Centre, The Winch, and The Integrate Movement; the latter successfully tendered for Camden s Minding the Gap Multidisciplinary Team, which is now named Axis. Axis supports young people with multiple social and health problems who don t access traditional services. Young people take a leading role in shaping this new, predominantly outreach service, which is situated in a renovated youth space at the old post office on Harben Parade, Finchley Road NW3. An innovative feature of Axis is the staff composition comprising Young People s Workers with skills in engaging a hard-to-reach population. What we planned to do: Provide individual long-term and short-term psychotherapy, cognitive behavioural therapy (CBT), dynamic interpersonal psychotherapy, interpersonal psychotherapy, narrative therapy, dialectical behaviour therapy at the Brandon Centre, at the Drum, and at the Lift and Platform. Aim to help 300 Camden 12- to 24-year-olds and reduce average waiting time from 9.4 weeks to six weeks. Aim to help 80 Islington 16- to 21-year-olds and reduce waiting time from 16 to eight weeks. Provide a psychotherapy service for 12- to 18-year-olds who have suffered a bereavement. Continue to develop the Brandon Reach model of service delivery for young parents whose child has been permanently removed from their care. Provide an exam stress workshop run by the Centre s clinical psychologists to 300 year 11 students in three Camden secondary schools. Pilot an outreach mental health service for 24 Islington young men disengaged from education, employment and training in partnership with Jobs in Mind. Pilot a new school-based counselling and psychotherapy service to a cluster of primary and secondary schools in Harrow. Continue embedding outcome-monitoring to improve the quality and experience of the psychotherapy service. Extend the involvement of young people who have had therapy at the Centre by continuing to develop the service through the pioneering youth ambassador scheme. Continue to be active partners in Camden joint intake and Minding the Gap transitions service. Support the Axis service in collaboration with our Camden partners. 8

9 ANNUAL REPORT 2016/2017 Analyse findings from user feedback and from outcomemonitoring, and consider service developments. Offer a placement for two third-year doctoral clinical psychology trainees and one child and adolescent psychotherapy trainee. What we achieved: The psychotherapy service team (staffed by two child and adolescent psychotherapists, six clinical psychologists and two psychodynamic therapists) provided individual child and adolescent psychotherapy, psychodynamic psychotherapy, CBT, dynamic interpersonal psychotherapy, interpersonal psychotherapy, narrative therapy, dialectical behaviour therapy, mindfulness and group psychodynamic psychotherapy. In total, 283 Camden 12- to 24-year-olds were referred or selfreferred, and 86 Islington 16- to 21-year-olds were referred or self-referred in 2016/17. Average waiting times in 2016/17 for Camden young people was 6.9 weeks, and 11 weeks for Islington young people seen at the Drum and Islington young people seen at Lift and Platform youth hubs. 284 Camden and 82 Islington young people attended psychotherapy sessions of whom 143 and 53 were referred during the year. 14 young parents engaged in the Brandon Reach service staffed by two clinical psychologists. 46 Harrow students attended sessions in three primary schools and one secondary school. Seven 16- to 25-year-olds engaged in Brandon Connect. 427 year 11 students from three local secondary schools attended an exam stress workshop provided by the Centre s clinical psychologists. 63 bereaved young people enagaged in counselling or psychotherapy, of which 31 were 12- to 18-year-olds. Identified four most frequent current problems presented by young people as emotional problems (391:99%), family problems (285:72%), problems related to school and higher education (212:53%) and social isolation (157:40%). Support provided to 92 (23%) young people suffering from deliberate self-harm, 69 (17%) who had attempted suicide and 153 (39%) reported being at risk from deliberate self-harm. 107 Commission for Health Improvement Experience of Service Questionnaires (CHI ESQ) were completed by young people: 106 rated the statement I felt the people who saw me listened to me as certainly true and 102 rated the statement Overall the help I received here is good as certainly true ; 83 rated the statement I feel the people know how to help me as certainly true ; 106 rated the statement I was treated well by the people who saw me as certainly true ; 96 rated the statement If a friend needed this sort of help, I would suggest to them to come here as certainly true. 170 young people new to the service completed a youth selfreport form (YSR) or a young adult self-report form (YASR) before starting treatment; 138 completed a follow-up YSR or YASR to monitor treatment outcome. 116 young people who completed the goal-based outcome measure also completed a follow-up on at least one of their goals. 81.9% of young people achieved a reliable change (ie a change greater than 2.45 points) with at least one of their goals. Provided a four-year placement for one trainee child and adolescent psychotherapist. Provided a third-year placement for two doctoral clinical psychology trainees from UCL. Clinicians working in the counselling and psychotherapy service were participating in the Children and Young People s Improved Access to Psychological Therapies programme (CYP IAPT) of routine, patient-reported outcome measurement. With the support of our participation lead and two final year trainee clinical psychologists, five youth ambassadors participated in a project which included collaborating with an animator to produce a video showing a young person s experience of psychotherapy at the Brandon Centre. What we will achieve next year: Provide individual long-term and short-term psychotherapy, CBT, dynamic interpersonal psychotherapy, interpersonal psychotherapy, narrative therapy, dialectical behaviour therapy at the Brandon Centre, at the Drum, and at the Lift and Platform. Support 300 Camden 12- to 24-year-olds and reduce average waiting time from 6.9 weeks to six weeks. Support 90 Islington 16- to 21-year-olds and reduce waiting time from 11 to seven weeks. Provide outreach psychological intervention to enable Islington 16- to 25-year-olds struggling to access education, employment or training due to mental health problems. Continue to develop the Brandon Reach model of service delivery for young parents whose child has been permanently removed from their care. Provide an exam stress workshop run by the Centre s clinical psychologists to over 300 year 11 students in three Camden secondary schools. Complete a school-based psychology service to a cluster of Harrrow primary and secondary schools. 9

10 THE BRANDON CENTRE What was really good about your care? Work with other providers to provide psychology input in developing a Tier 3 weight management service for children and young people. Continue embedding outcome-monitoring to improve the quality and experience of the psychotherapy service for young people. Extend the involvement of young people who have had therapy at the Centre by further developing the service through the pioneering youth ambassador scheme. Continue to be active partners in Camden joint intake and Minding the Gap transitions service. Support the Axis service in collaboration with our Camden partners. Analyse findings from user feedback and from outcomemonitoring and consider service developments. Offer a placement for two third-year doctoral clinical psychology trainees and one child and adolescent psychotherapy trainee. How we deliver public benefit: Our psychotherapy service targets high-priority groups of young people aged 12- to 24-years who have had great difficulty in accessing statutory services, which often seem to them remote and unavailable. These young people have mental health problems that are currently harmful to them and risk harming their future prospects. Our role is to help them overcome these problems to allow them to function independently and fulfil their potential. The weekly sessions for an hour, someone taking the time to listen and follow your progress not just once a month where so much time has passed you don t see the point in mentioning all the little things in day-to-day life you need help with. My therapist is always open to listen about how my week has been progressing and the challenges I have faced within it: flexibility which allows a diverse range of topics to be discussed. In short, I do not feel constrained or pressured to talk about any one particular thing. Genuine compassion and care from my therapist, I felt valued and that my problems were important From the moment I walked through the door I felt like people wanted to help and saw you as a whole person and not simply as what you had come to the Centre for. After visiting three different services before the Brandon Centre the main difference was that I didn t feel patronised and it felt like genuine care and help was at hand. I felt I was really well listened to. The CBT programme I undertook was comprehensive and was explained very clearly. I felt really comfortable discussing any issues. It is an incredibly comfortable place. I feel safe and very comfortable. I enjoy coming here and feel like everyone cares. I have never spoken to any members of staff who were mean or even just unhappy. Ten out of ten. 10

11 ANNUAL REPORT 2016/2017 Feedback from 107 young people on their experience of the Centre s psychotherapy services in 2016/17: findings from Experience of Service Questionnaire Certainly true Partly true Not true Don t know 15/16 16/17 14/15 16/17 14/15 16/17 14/15 16/17 I felt that the people who saw me listened to me. 91% 99% 9% 1% It was easy to talk to the people who saw me. 77% 79% 22% 19% 1% 1% 0 1% I was treated well by the people who saw me. 93% 99% 7% 1% My views and worries were taken seriously. 90% 93% 10% 7% I feel the people know how to help me. 73% 78% 23% 21% 0 0 4% 1% I have been given enough explanation about the help here. 73% 73% 25% 26% 0 1% 0 0 The facilities are comfortable. 81% 76% 16% 22% 3% 1% 0 1% My appointments are usually at a convenient time. 82% 82% 14% 16% 4% 1% 0 1% It is quite easy to get to the place where I have my appointments. 89% 86% 10% 13% 1% 1% 0 0 If a friend needed this sort of help, I would suggest to them to come here. 89% 90% 11% 2% % Overall the help I received here is good. 87% 95% 12% 4% 0 1% 1% 0 Was there anything you didn t like or anything that needs improving? My one concern was that my sessions were governed by my mood at the time of the session. Sometimes during my week, I would vary a lot and have attacks of anxiety or depression, but then somewhat forget about these when my sessions came around. It would be good to have some way of talking in the moment, even just to an answering machine. I don t like assessing myself with numbers but I know that is compulsory. The six-month waiting time is long, but I know that s not really your fault. I can t really think of anything, but the waiting time was quite long. This was/is not in your control though. The limit of a year s therapy here the time restriction caused a lot of anxiety, although I appreciate as a free charity service this is a long time in the first place. 11

12 THE BRANDON CENTRE 12

13 ANNUAL REPORT 2016/2017 Multisystemic therapy (MST) In 2003, the Brandon Centre was the third organisation in the UK to offer MST standard, in 2009 the first to pilot MST for young people with problem sexual behaviour (MST PSB), and in 2010 one of the first organisations to offer multisystemic therapy substance abuse (MST SA). There are now 36 teams in England, Scotland and Northern Ireland providing MST. MST was developed in the late 1970s by two psychologists, Scott Henggeler and Chuck Borduin, from the Medical University of South Carolina, because existing services for young offenders and antisocial young people were costly and showed limited effectiveness. MST is a pragmatic goal-oriented treatment that targets factors in the young person s social network, which contribute to antisocial behaviour and other clinical problems. Typically, MST interventions aim to improve parental discipline practices, enhance the emotional bond between parent and child, decrease the young person s association with peers who are antisocial, increase their association with peers that are not involved in antisocial activities, and to help parents seek support from relatives, friends and neighbours in achieving these changes. The specific treatment techniques used, such as cognitive behaviour therapy, behaviour therapy and pragmatic family therapies, have strong evidence supporting their effectiveness in tackling antisocial behaviour and other clinical problems. MST is delivered in the community, eg in the family home and school. The treatment plan is formulated in collaboration with family members. The ultimate goal is to empower the family to build an environment that promotes healthy development without over-reliance on professional support. MST lasts between three and five months and is intensive: the MST therapist is likely to visit the family three times a week and have regular telephone contact. An MST team usually includes three or four therapists, a supervisor and a coordinator. The teams hallmark is their availability for families to contact them 24 hours a day, seven days a week. Visits to families are arranged to suit the family and frequently take place outside traditional office hours. MST has been evaluated in several randomised controlled trials run by the developers that show: reduced long-term rates of criminal offending in serious young offenders decreased recidivism and re-arrests reduced rates of out-of-home placements for serious young offenders extensive improvements in family functioning decreased behaviour and mental health problems for serious young offenders favourable outcomes at cost savings in comparison with usual mental health and youth offending services. The success of MST with young offenders and antisocial behaviour has led to adaptations of MST standard being piloted and evaluated with other clinical problems including young people with problem sexual behaviour, child abuse and neglect, substance misuse, diabetes management and acute psychiatric hospital admission. In 2003, the Brandon Centre ran the first clinical trial of MST in the UK, in partnership with Camden and Haringey Youth Offending Services (YOS) and UCL. The aim of the trial was to evaluate the effectiveness of MST in reducing youth offending compared with YOS management as usual. The quantitative findings were published in the Journal of the American Academy of Child and Adolescent Psychiatry in December Although young people receiving both MST and YOS interventions showed improvement in terms of reduced offending, the MST model of service-delivery was shown to significantly reduce the likelihood of further non-violent offending during an 18-month follow-up period. Consistent with offending data, the results of youth-reported delinquency and parental reports of aggressive and delinquent behaviours show significantly greater reductions from pre-treatment to posttreatment levels in the MST group. The trial was accompanied by an economic evaluation by the Centre for the Economics of Mental Health at the Institute of Psychiatry. These results support the finding that MST and YOS management can save costs compared with YOS management alone. Findings from a qualitative study of the experiences of families participating in the trial support the MST theory of change, although suggest some adaptations are needed such as ongoing support for families struggling to maintain strategies beyond the prescribed treatment period. These two studies were respectively published in PLOS ONE in 2013 and in the Journal of Family Psychology in What we planned to do: Treat 13 Camden families, 10 Enfield families and 10 Lambeth families. Continue to recruit cases for the MST PSB randomisedcontrolled trial with the aim of treating a minimum of six cases. Continue to follow up families that had MST at one year and two years, collecting MST outcome data on whether the young person is in education, employment or training and is living at home. 13

14 THE BRANDON CENTRE What we achieved: 36 families received MST, 27 cases were successfully completed, nine were ongoing. Treated 11 cases referred by Camden; three were ongoing from 2015/16 and were completed in 2016/17. In 2016/17, six were successfully completed and two were ongoing at the end of the financial year of 31 March Treated 11 cases referred by Enfield; three were ongoing from 2015/16 and were completed in 2016/17. Of eight new cases referred and started in 2016/17, three were successfully completed and five were ongoing at the end of the financial year. Treated 5 MST PSB cases; four cases including one commissioned case were ongoing from 2015/16 and were successfully completed in 2016/17. Four cases were treated as part of the MST PSB randomised-controlled trial. One MST PSB trial case was ongoing when the trial stopped taking new referrals on 31 March Treated four Haringey cases that were ongoing from 2015/16 and were successfully completed in 2016/17. Treated five Lambeth families; three ended prematurely, one was successfully completed and one was ongoing. What we will achieve next year: Treat 13 Camden families, 10 Enfield families and four Lambeth families. Develop a new intensive family treatment model, systemic integrative treatment (SIT) that applies interventions compliant with the National Institute for Health and Care Excellence (NICE) guidelines for the treatment of behaviour and conduct problems, and incorporates learning from our experience of working with families with an adolescent child on the edge of care. Obtain up to seven referrals in addition to referrals from Camden and Enfield for the new SIT intervention programme. How we deliver public benefit Although youth offending has declined, it remains a significant social problem. Policy makers and commissioners of services are seeking alternatives to the use of custody, which is expensive and largely ineffective in preventing re-offending. Commissioners are also looking for effective, community-based interventions as an alternative to placing young people with complex clinical and family problems in medium-stay hospitals, foster care, children s homes and boarding school. The Centre s promotion of MST is making a significant contribution to this agenda. What was really good about your care? Everything! Very supportive, clear, balanced, understanding, fair and informative. Knew exactly how to go about helping and fully supported my ability to take control. I had all the pieces of the puzzle, but MST has helped me to put it into one whole picture. MST were able to listen and help me to plan ways of coming up with ideas to help with my son, I found the sessions beneficial as it helped to put structure, rules and rewards in place to get a positive result. I was never pressured into doing anything that was not agreed on first. Allowed time for me and my son to speak and to try and move forward from the place we were struggling. The level of care and intensity of treatment, feeling very much understood and supported, the thoroughness in thinking of everything that was troubling us as parents or that was anticipated to be difficult, the warmth and containment of the therapist was very holding for us all. I liked that they listened to your points and discuss the issues or problems that you all have and try to resolve them using techniques that can be used for the future. Also that you get regular contact via phone or to see how things are going during the periods where you are not having sessions; you are given copies of what you ve planned to help guide you to continue with the actions you ve set out as a family. 14

15 ANNUAL REPORT 2016/2017 Feedback from 14 families on their experience of MST in 2016/17: findings from Experience of Service Questionnaire Certainly true Partly true Not true Don t know 16/17 16/17 16/17 16/17 I felt that the people who saw me listened to me It was easy to talk to the people who saw me I was treated well by the people who saw me My views and worries were taken seriously I feel the people know how to help me I have been given enough explanation about the help here I feel the people here are working together to help with the problems My appointments are usually at a convenient time If a friend needed this sort of help, I would suggest to them to come here Overall the help I received here is good

16 THE BRANDON CENTRE Parent management training (PMT) Parent management training (PMT) is a proven and effective intervention that is recommended for managing and reducing behaviour problems and behaviour associated with attention deficit hyperactivity disorder (ADHD) in young people and children. Group-based PMT programmes have become a common way of delivering this intervention. PMT uses behaviour management principles taken from social learning theory. The training shows parents how to track and monitor behaviour, and teaches parents how to use positive reinforcements and mild punishment in an immediate and predictable manner. This year the Centre ran Parenting with Love and Limits, a group-based PMT programme run over six weeks for parents and carers who are having difficulty controlling the behaviour of their teenage child (ages 12 17). We also ran a group-based programme for parents of 5- to 12-year-old children with a diagnosis of ADHD, incorporating the principles of Magic Parenting. Both of these programmes give practical guidance to parents who are trying to change and improve their child s behaviour. Parents who attend the programmes find their child s behaviour at home difficult to manage, while some are concerned about how their child behaves at school, and others are worried about their teenager being involved in antisocial behaviour, taking drugs and drinking alcohol. We also continued to implement Brandon Prevent, for parents of teenagers with behaviour problems of sufficient severity to require additional support. This, in addition to the Parenting with Love and Limits group, provides a weekly session with an assistant psychologist who works with the parents to reinforce the lessons taught in the group programme. The aim is to increase the probability of parents achieving the goals of the programme with regard to problem teenage behaviour and to generalise the strategies to other children in the family. What we planned to do: Offer six Parenting with Love and Limits groups. Offer two groups per week; one group for parents who prefer to attend while their child is at school and another group for parents who prefer to attend after work. Support parents from 16 families attending the groups in the Brandon Prevent programme. Offer three groups for parents of 5- to 12-year-old children with a diagnosis of ADHD incorporating the principles of Magic Parenting. What we achieved: Held six Parenting with Love and Limits groups and three groups for parents of 5- to 12- year-old children with a diagnosis of ADHD. 100 parents attended a group with an average of 11 parents per group. 650 sessions were offered (including sessions offered to parents on the Brandon Prevent programme) and 558 (86%) were attended. 18 parents were supported by the Brandon Prevent programme. Using the goal-based outcome measure, of 49 goals set and re-rated by 17 parents attending the Brandon Prevent programme, 32 (65%) showed a reliable improvement and 14 parents scored at least one goal as improving reliably. Parents reported a high degree of satisfaction with our programmes. What we will achieve next year: Offer six Parenting with Love and Limits groups. Offer two groups per week; one group for parents who prefer to attend while their child is at school and another group for parents who prefer to attend after work. Support parents from at least 20 families attending the groups in the Brandon Prevent programme. Offer training to professionals working with parents in the principles of the Brandon Prevent programme. Offer three groups for parents of 5- to 12-year-old children with a diagnosis of ADHD incorporating the principles of Magic Parenting. How we deliver public benefit Conduct disorder and oppositional defiant disorder affect 8.1% of boys and 2.8% of girls between ages 11 and 16, and are the most common reason for referral to Child and Adolescent Mental Health Services. Conduct disorder is associated with severe functional impairment and often presents with disorders such as depression, anxiety and ADHD. Young people with conduct disorder are likely to have worse mental health, less successful family lives and poorer social and economic prospects in adulthood. Left untreated, conduct disorders are also economically costly. By offering PMT, the Brandon Centre makes a significant contribution to preventing and treating these problems. 16

17 ANNUAL REPORT 2016/2017 Feedback from 55 parents on their experience of the parent training programmes in 2016/17: findings from Experience of Service Questionnaire Certainly true Partly true Not true Don t know 16/17 16/17 16/17 16/17 I felt that the people who saw me listened to me It was easy to talk to the people who saw me I was treated well by the people who saw me My views and worries were taken seriously I feel the people know how to help me I have been given enough explanation about the help here The facilities are comfortable My appointments are usually at a convenient time It is quite easy to get to the place where I have my appointments If a friend needed this sort of help, I would suggest to them to come here Overall the help I received here is good What was really good about your care? Extremely grateful to receive the knowledge and support and advice from the ADHD group and the services. I really feel empowered to make decisions and choices to help my child and put boundaries in place and I would recommend to every parent or carer. It really is magic. Thank you so much I have found the ADHA programme very helpful and after starting the Magic Parenting course our son has improved in his behaviour and seems much happier within his own limits. He enjoys the reward charts and understands timings much better since using a timer that he can watch and hear. It (Parenting with Love and Limits) feels really comprehensive covers all angles and is very practical. Particularly useful in understanding button-pushing, techniques of exit-and-wait, button busters and reclaiming love. It s really helped me step back and look at my situation and understand it better and then have the techniques to make a difference. The content (Parenting with Love and Limits) was relevant to my predicament and so I found the material useful and practical and most of it easy to put into practice, the most useful part was Sara s weekly visit to tweak the programme content to my situation. A big thank you to you BOTH for your time and valuable advice. Helped me to reassess my parenting styles; helped me to identify our weaknesses and strengths; confirmed some issues I have been trying to tell my husband. It gave us tools to work with; that our challenges are not the end of the world but an opportunity to work on positive things. I learnt about how a teenager looks at issues/thinks. Also, how as a parent you don t get pulled into problems emotionally. It set limits for myself and my teenager and looked at problems separately, and also the needs of my child. Everything was helpful. I think the parts on button pushing, giving love/reclaiming love in the last session all the aspects of that. It was a good opportunity to be reminded of what I can do to improve my relations with my sons now and in the future. It was good to share with others so it reduces the feeling of isolation. The handouts were good and I will keep looking at these to remind me of what I can do to help my situation 17

18 THE BRANDON CENTRE Audit and evaluation Audit has become a fundamental requirement in clinical practice. The purpose of clinical audit is to improve services to patients by a formal process of setting standards, gathering data to find out how the service is performing in relation to them, and changing practice as a result. The Brandon Centre applies three different approaches in auditing the contraceptive service and psychotherapy service. First, we collect data on the characteristics of our users that help us to understand whether our services are reaching our target population, particularly young people who are hard to reach and difficult to treat. Second, we find out how well psychotherapy is working by evaluating mental health outcome. We use reliable and valid methods of measuring the functioning of young people and use different sources of information on the young person s functioning, including information from the young person, their therapist and a significant other in their life, eg a parent, friend, teacher or partner. This evaluation of mental health outcome involves making these assessments at the beginning of treatment, during treatment, at the end of treatment, and at repeated follow-ups after treatment has ended. Finally, we interview young people to find out their views about the service and their ideas for improvements. 6,080 young people, parents and families used the Centre s services 2,333 young people were newly registered for the C-card scheme 427 year 11 students from three local secondary schools participated in an exam stress workshop run by Centre clinical psychologists. 2,020 used the contraceptive and sexual health service, dropped in for condoms and chlamydia and STI testing 433 young people used the psychotherapy services 100 parents attended the Centre s PMT programmes 36 families received MST 731 young people attended SRE lessons 18

19 ANNUAL REPORT 2016/ % 40% Self-referred counselling and psychotherapy service Referred counselling and psychotherapy service Monitoring statistics Service data 11% GPs 42% Mental health services 19% Schools and higher education 28% Other In 2016/17, 6,080 young people, parents and families used the Centre s services: 2,020 used the contraceptive and sexual health service, dropped in for condoms and chlamydia and STI testing 2,333 young people were newly registered for the C-card scheme 731 young people attended SRE lessons 433 young people used the psychotherapy services 100 parents attended the Centre s PMT programmes 36 families received MST 427 year 11 students from three local secondary schools participated in an exam stress workshop run by Centre clinical psychologists. In addition, 40% of young people self-referred to the counselling and psychotherapy service. The main referrers were child, adolescent and adult mental health services and student counselling services (42%), schools and higher education (19%) and GPs (11%). Demographics The ages of the young people were: Age (years) Contraception Psychotherapy Parenting and MST Total (%) (%) (%) (%) (N=2,020) (N=433) (N=124) (N=2,576) Not recorded Total Gender of young people was: Contraception Psychotherapy Parenting and MST Total (%) (%) (%) (%) (N=2,030) (N=433) (N=124) (N=2,576) Female Male Total Ethnic background: Contraception Psychotherapy Parenting and MST Total (%) (%) (%) (%) White 1,181 (58.5) 211 (48.7) 63 (50.8) 1,454 (56.4) Mixed 279 (13.8) 67 (15.5) 18 (14.5) 364 (14.1) Sessions offered Sessions attended Contraceptive services 4,411 4,046 (92%) Therapy 4,849 3,514 (72%) MST 1, (82%) Parenting (86%) Total 10,952 8,970 (82%) Asian and Asian British 97 (4.8) 41 (9.5) 3 (2.4) 141 (5.5) Black or Black British 282 (14.0) 50 (11.5) 16 (12.9) 348 (13.5) Chinese 16 (0.8) 5 (1.2) 0 (0.00) 21 (0.8) Other ethnic group 96 (4.8) 9 (2.1) 0 (0.00) 105 (4.1) Not known or recorded 69 (3.3) 50 (11.5) 24 (19.4) 143 (5.6) Total 2,020 (100) 433 (100) 124 (100) 2,576 (100) 19

20 THE BRANDON CENTRE Problems presented by young people The average number of problems for young people using the psychotherapy service was five. They presented the following problems: Psychotherapy Parenting MST % (n:349) % (n=74) % (n=33) Family problems Depression/anxiety Problems related to school and higher education Sexual/relationship problems Conduct/behaviour problems or ADHD Social isolation Sleep problems Separation anxiety and developmental problems Somatic symptoms Drug abuse and alcohol abuse At risk of deliberate self-harm Sexual and physical abuse Bereavement Eating problems Deliberate self-harm Attempted suicide Employment problems Significant illness involving hospital Use of contraceptive and sexual health service interventions with young people Number of clinic consultations where young people were issued with the following methods of contraception: C-card/ Clinic Drop-in Total Oral/transdermal hormonal contraception 1,300 Condoms supplied ,820 Injectable contraception 211 Implant supplied 100 Number of emergency contraception supplied 404 Number of STI screening tests (CT/GC) performed 1, ,635 Number of pregnancy tests performed Number of positive pregnancy tests: Number referred for termination 46 Number planning to continue with pregnancy 4 Number unsure of their decision/outcome unknown 5 Number who miscarried 0 Details of chlamydia and gonorrhoea screening Female Male Total Chlamydia/gonorrhoea screening tests done in appointment clinic ,070 Chlamydia/gonorrhoea screening tests done in drop-in/self-managed care Total number of tests performed 1, ,635 Overall number of positive tests for one or both infections Number of positive tests diagnosed in appointment clinic Number of positive tests diagnosed in drop-in/self-managed care % of young people who used the counselling and psychotherapy service were from an intact family. 22% were at school, 40% were at college, university or engaged in vocational training, 7% were unemployed and 9% were employed. 20