Why Participation matters at Anna Freud: A Q&A with our leaders

[03:07]

Vicky: So we'll start with our first question. This is from one of our parent champions who said, I have seen participation growing in importance at Anna Freud over the last couple of years, and this is great to see. How do we keep the momentum going?

Eamon: That's a really good question. If we are on a journey, we need to continue to feel motivated and inspired and we need to have a sense of direction. And for me, in this role, part of that is embedding participation in everything we do, in the clinical work, in the training, and in the education that we do and in the clinical offers that we have. So how do we do that? Well, I think there's sort of three things.

First, especially over this year, will be building a new strategy for Anna Freud and that sort of sets the longer term vision. So participation really needs to be embedded in that undertaking what it means. But then kind of more practically, we need to embed participation in the policies that we develop. So as we develop and renew our policies, then participation needs to be in there. And clarified how it actually works in practice. And then there's just the nuts and bolts, how do people work every day. Do people have the resources they need? Do we have enough funding to ensure that participation work can happen?

Namrata: I think for me, a lot of it is about two things. One, culture, which Eamon talked about it's about, bringing that culture shift. And two, it's about accountability, at senior levels of management, with the board and with people who are decision makers in the organisation.

So there has to be authenticity behind the momentum on participation. Participation isn’t a tick box where we say, okay, we've done this, we've done that, we have these scorecards. It's really how the organisation will define itself, the culture we have, the way management takes decisions, embedding that at every layer of the organisation.

And I see that's something very important. We have incredible clinicians and so much expertise. And that there's a lot of knowledge there. But I think it's also really important to recognise that it's a youth led organisation and that children have the right to express their ideas. And I think it's really bringing that voice into all the amazing clinical work we do and research we do, bringing that everyday lived experience, voice of children and youth into the organisation and then embedding that at every level.

And then the second part is about accountability. How are we measuring that. So over time we're saying we're starting certain initiatives around participation. Well what does that really mean. How are we going to measure that impact over time and actually share with management how that's impacting the products, their usage, the popularity of the products, and in fact, understanding from young people how is that making a real difference in how they're feeling at the school gate, or how parents are feeling about how they're working with other, clinicians or education teams.

[06:17]

Eamon: So we need to be humble. Yes, we have made real strides. And I think the public launch of our participation strategy was really helpful in sharing with the external world what we've achieved. And the Lundy model network that we've set up has been really helpful.

But I suppose I would reflect that we are still learning. And part of that learning that we could share with others is that you need to have an openness to listen to parents and young people and maybe not agree – you know, to find oneself challenged, to be able to change your opinion, to be open, to be persuaded, to be open to do things differently and think differently.

And these things aren't always comfortable and aren’t always easy. So I think it's really important for leaders to be able to sit with things being a bit uncomfortable and not always as they have been in the past. And just to be patient with that, because I think what can happen through participation is that creativity brings to light new ways of working.

You discover new things. You can actually propel your organisation further and in a more positive direction through the incredible input that young people and parents can provide.

Namrata: We're not maybe the experts today, but we're working with experts and we're bringing that resource into the organisation. I think transparency is really important. We need to share back with the senior leadership team what we're doing, how we're doing it.

That's going to be really a cornerstone of what we do. And I think in terms of advising other organisations, I think Anna Freud has always been a pioneering organisation. And certainly when I started working here, I always thought about Anna herself and the work she did for her time. She really had a different voice for that time.

And I think there is that aspect of Anna Freud – like it's a pioneering organisation. It does things differently to really go into areas that perhaps aren't seen as areas that have been explored before. But I think, yes, we are at the beginning of the journey. So for me it's about, you know, transparency, sharing learnings, taking risks and, you know, having an open mind.

[08:42]

Vicky: We use the Lundy model here at Anna Freud as a framework to help ensure that service users are given the opportunity to express their voice and given the safe, accessible space so that they are heard and their views influence services and the support that they receive. Have you ever used such a model in previous roles, and are you seeing the evidence of Lundy across Anna Freud now?

Eamon: So it's really helpful to spend a few minutes to focus on the Lundy model. I mean, I have in my previous roles used approaches to participation and bringing young people in. So what I didn't use at that time was the Lundy model, which would have been so helpful because we were trying to work it all out. We were trying to think about best practice in participation. And what's been so helpful about the Lundy model is how explicit it is, how it focuses so clearly on all those different dimensions that allow both young people and professionals to have a shared understanding of what participation means. And I find that really helpful as we brought that into Anna Freud and what we do in terms of our clinical offer, I really see it in our research where we're bringing young people and parents in to advise on our research applications, how we conduct research and how we disseminate research, and also in the training we provide.

But because we do those different things – clinical work and we do education and research – it's becoming really clear that it's not a one-size-fits-all. The Lundy model is really helpful – it's just the principles – but they need to be applied in different contexts and different ways. And that's something we're still really working through.

[10:27]

Evie: Your role as trustee sponsor is a new thing for our participation work. We’re really excited to have you champion participation in spaces with Anna Freud senior leaders. What do you see as your first RC model?

Namrata: I think for me it's the external orientation piece. It's really understanding broadly the area of participation and how it can begin to impact us. And I'm obviously at the beginning of that journey. So it's working with external experts. It's understanding what established principles we have in that area, how that's perhaps been applied to other similar organisations, and then taking some of the learnings from that and seeing how we can amplify and build that within Anna Freud again through, you know, accountability, transparency and really also fighting for resources behind.

And you look at the mental health space and you look at how participation works and the philosophy behind participation – there's so many obvious links that, you know, children have the right to impact how mental health services are being shaped up. And I think it's helping everyone in the organisation make that same learning and just really shine the light on that and make sure that we are coming back to that in key meetings that we have. Also ensuring that you have the right resources at your disposal to continue to champion that in your organisation.

[11:45]

Vicky: As you know, participation is only as effective as those voices that we support to be heard and have influence. Do you have any thoughts on how we broaden diversity in our participation activity?

Eamon: That's a really great question. And it chimes with the organisation's focus on EDI, which is a priority for the organisation alongside participation. We've grown as an organisation but we're still not huge. So how do we ensure a diversity of voices that captures the range of people we want to support and help, through our work. Part of that is defining what we mean by diversity – being very clear about what kind of diverse backgrounds and experiences and identities we need to capture if we're going to serve those communities well, and being very mindful of the obstacles people might have in engaging with us. Do they have the time and the resources in order to work with us?

So part of it is how we make ourselves accessible, how we are mindful of the systemic and practical barriers people can face. And sometimes they’re psychological or cultural, and sometimes they’re financial and logistical. We can think about how we overcome those internally through our processes, through our communications, through our resources. But we can't do everything. And I think we also need to be mindful of when we need to partner with others, partner with other organisations. We then can work together and ensure we're bringing those voices – many of whom have been silenced in the past – to their discussions through the development and strategy that we have at Anna Freud.

Namrata: I think it's an interesting question around diversity and participation, because I suspect that at the core of participation work there is addressing a lack of diversity or lack of diversity in thinking – the preconceived notion that if somebody has lived a certain number of years or been through a certain professional degree, sat in a boardroom, or created products before, that they have all the answers, when actually lived experience and the child's experience of something can be equally important in creating an amazing product or something that works.

I also think that when someone has lived experience or has been through perhaps some sort of trauma around this, it's hard to talk about it. And I think it's an understanding that we need to create a safe space.

It's not just the voices that want to be heard or shout the loudest, it's people who perhaps may not be able to talk about it, but giving them a way to talk about it in a way that feels, sensitive and right. But I think the two things are so interlinked – participation and diversity of thinking. They should be mentioned more often together.

Eamon: We really need to make those efforts and be sensitive and mindful of the different places people and parents are coming from and how they can be supported.

Namrata: Yeah, I think it's all about privacy and sensitivity, because sometimes the most meaningful insights can come from someone who's perhaps worried about sharing it or worrying about how it's going to reflect back on them. And I think that it's really important to bear that in mind.

Vicky: The courage it takes to speak.

Namrata: Absolutely, absolutely. And that's diversity as well – it doesn’t always mean one thing, it can mean just diversity of experiences or age.

[15:06]

Evie: I'd like to ask a question on why you think robust participation at Anna Freud is helping to make mental health services better for children, young people and families.

Namrata: One of the things that I've learned throughout, you know, my own lived experiences and things like that is the relationship between control and mental health. So typically, this feeling of powerlessness or lack of control that comes – that you don't have your own agency, you don't have a choice to express how you want your future to be – can lead to a huge impact on your mental health.

When you feel you don't have a choice and you're not being listened to and you don't have that agency, I think that exacerbates this whole cycle of powerlessness and mental health. So I think it's essential to everything we do – giving children and young people agency and control over their choices, but also just leaning forward to really listen to them.

Even if you are a clinician, even if you do have that expertise, even if you are a parent and you’re a parent to ten children, you might have the eleventh child that is slightly different or reacts to the same situation in a different way. So it's a little bit about listening to that and keeping an open mind to shape winning mental health services.

Eamon: By giving young people and parents agency they can play a really meaningful and active role in how services are developed, which services are developed, how they're developed, and how they provide help and support to young people and families.

Because traditionally, in the past, those services were developed by professionals, and they worked really well for professionals because it fitted in with how they worked. But it didn't always reach the people who needed them. And the people who came often felt disempowered by the experience and how they were treated. So participation is really helping us think: how do we develop accessible services? Services that people trust? Services where people receive the help that they need and in the way that they need and understand?

When we think about adolescence, we have a big problem of engagement. And how do we not just bring someone into a service to provide support or help, but how do we maintain that relationship over time so we avoid them dropping out and not continuing with that help? And I think with young people's voices, we can begin to think: how do we support those adolescents? How do we build trust with them? And how do we make sure the services are really meeting their needs? And we can do that in the direct services we're helping to shape, but more broadly at Anna Freud we train a lot of therapists and clinicians through our education programmes, and all of them are going back to their own services in different parts of the country.

And if we can help inform them and help them think about the role of participation and bring young people into their training, then that's having a much broader impact in services across the UK because they can begin to think: how are we using participation to shape our services? So for us, that's one way we can amplify the impact of participation and how we develop services.

Namrata: I think it's about the what of how we create these services, but it's also very much about the how – how people are accessing mental health services today. And that's shifted a lot. There are concerns around privacy, around data, around how young people want to be served and access these services, and also what is engaging for them – how do they want to talk about these sorts of issues? And I think, you know, that whole how piece has changed so much in the last 20 years that it's a real open opportunity.

[18:43]

Vicky: What are you most proud of when you look back, and looking forward, what would you like to see us achieve over the next 12 months?

Eamon: So, there's so many achievements I think that the participation team have delivered. And we see that, for example, in the staff training, which is now something that all staff have on their level one trainings. There are new spaces for managers to come together and reflect. And the Lundy Model Network has been an incredible initiative. It's really beginning to share practice across the UK as well as internationally. So all of those things I think are really fantastic achievements that we can be very, very proud of.

Looking forward, I think what's coming up in my mind is the importance of embedding participation in our future strategy – really thinking about where next and making this just embedded in everything that we do. We can think about accreditation for young people and parents. How do we help formalise and support those people who help us? How do we ensure that you're receiving the kind of training, the support, the recognition for the expertise and the input that you provide?

We can do some brilliant work and we can feel very good about it. But how can we measure whether we're making a difference? Not just for the group of young people we're working with, but for the services, for example, that we're seeking to change or for the training programme that we're helping or the research projects that we're developing. So we need to be better at finding ways to measure that impact and then celebrate that success – or learn from it if it hasn't worked so well.

Namrata: I think it's incredible to see all the work that's been done and the things that we've achieved. And I think for me, it's really about taking the whole principle of participation and applying it back to Anna Freud. So if we feel we're doing work in the area of participation, it would be good to understand from younger voices at Anna Freud where they see our ability to implement that better.

So it's really having those open conversations and talking to people about the things that we've done. Where do you think, as a young champion, or where do you think, as a young person receiving these services, we can do better as an organisation?

So it's almost continuously holding ourselves accountable – but not just having a conversation as management or as Execs. It's really constantly checking that with people who are accessing our services and are in the organisation that work on participation. Because I do think it has to feel authentic. It has to feel like the organisation has embedded it in its culture. And we're taking bold decisions to move the organisation forward, bearing the idea of a participation-centric model in mind. And we have to be able to sense check that within the organisation.