Dissertation Example-An Investigation of Youth Participation in an Irish Youth Mental Health Service: Staff and Young People’s Perspectives.

James Barry

 

 

 

Supervisor: Dr. Sinead Freeman

 

 

 

 

Submitted to the Department of Social Sciences, Dublin Institute of Technology in
partial fulfillment of the requirement leading to the award of the Masters of Arts in
Child, Family and Community Studies.

 

 

Word Count: 14,871

Dublin Institute of Technology                                                                                                         October 2014

 

 

DECLARATION

 

I hereby declare that the material which is submitted in this thesis toward the award of the Masters (M.A.) in Child, Family and Community Studies is entirely my own work and has not been submitted for any other academic assessment other than part fulfillment of the award named above.

 

Signed: ____________________________

 

Date: ________________

 

 

ABSTRACT

Youth participation is widely recognised as essential to the design and delivery of youth mental health services (Coates & Howe, 2014). Despite this there is limited literature available on youth participation in these services (Monson & Thurley, 2011). This study aimed to develop an enhanced understanding about youth participation in Headstrong, The National Centre for Youth Mental Health and it’s programme of service delivery Jigsaw. A mixed methods approach, using focus groups and questionnaires, gathered the opinions of 160 staff and young people involved in the organisation, on their experiences of youth participation. The factors that supported youth participation were noted as; allocated resources to facilitate youth participation, a staff member with responsibility for working with young people, a progressive organisational culture, and positive staff attitudes towards youth participation. Young people expressed beliefs that they had benefited in many ways from being involved in Headstrong/Jigsaw, these included; increased confidence working with staff, better understanding of mental health, increased confidence working in a professional environment, increased feelings of belongingness, and improved help seeking skills. Involving young people had also been beneficial to staff and the organisation in numerous ways including; the promotion of the service, to the young people availing of the service and decision-making. Youth participation in Headstrong/Jigsaw has helped create a service that is youth friendly, credible and accountable. However, the organisation experienced challenges in involving young people, including; a lack of time and resources to adequately involve young people, an absence of training to support young people and staff to work in a participatory way, and a lack of clarity about youth participation within the organisation. To achieve meaningful youth participation within a youth mental health service it takes time, energy and resources to support staff and young people to work together for the betterment of services.

 

 

DEDICATION

 

This research is dedicated to all the members of the Youth Advisory Panel, past and present. Your passion, energy, and dedication to ensuring Ireland is a better place for young people is inspiring to witness.

 

 

ACKNOWLEDGEMENTS

Thank you Dr. Sinead Freeman. Your advice, guidance and support was invaluable throughout this research.

Thank you to all the participants who gave their time to take part. I hope I can translate your thoughts into actions.

To my wonderful grandmother, I wish you could see me now, but I know you have been here every step of the way. Guess we are still proving them wrong.

To my colleagues past and present for showing me the very real difference a group of dedicated people can make.

Much gratitude to all my friends, you know who you are (this way I can’t get in trouble if I miss anyone). But seriously thanks for the many many laughs along the way.

Aileen O’ Reilly, this research would not have been possible without your guidance and patience. I owe you big time.

J. T. thanks for getting me over the final hurdle. You getting closer to that best man spot.

Pat C, thanks for all your help throughout this masters. Your friendship while doing this has meant the world.

 

 

TABLE OF CONTENTS

 

Declaration

Abstract

Dedication

Acknowledgements

List of Tables and Figures

Glossary of Terms

Abbreviations

List of Appendices

Chapter 1: Introduction 
1.1 Introduction
1.2 Aim of the Study
1.3 Research Questions
1.4 Research Focus and Context
1.5 Research Rationale
1.6 Methodological Overview
1.7 Delimitations
1.8 Chapter Outlines

Chapter 2: Literature Review
2.1 Introduction
2.2 Youth Participation
2.2.1 Youth Participation in Mental Health Services
2.3 Models of Youth Participation
2.4 The Factors that Support Youth Participation
2.4.1 Resources
2.4.2 Staff
2.4.3 The Culture within an Organization
2.4.4 Training for Staff and Young People
2.5 The Challenges of Youth Participation
2.5.1 Lack of Time
2.5.2 Lack of Clarity                                                                                                                                                      2.5.3 Lack of Diversity
2.6 The Benefits of Youth Participation
2.6.1 To Young People
2.6.2 To services
2.7 Conclusion

Chapter 3 Methodology
3.1 Introduction
3.2 Research Design
3.3 Research Methods
3.3.1 Qualitative Methods
3.3.2 Quantitative Methods
3.4 Questionnaire Design
3.5 Sampling of Participants
3.6 Participants
3.7 Ethics
3.8 Data Collection: Quantitative
3.9 Data collection: Qualitative
3.10 Data Analysis
3.10.1 Quantitative
3.10.2 Qualitative
3.11 Researcher Bias
3.12 Reflexivity

Chapter 4:Findings
4.1 Introduction
4.2 Youth Participation in Headstrong/Jigsaw
4.2.1 Why Involve Young people in Headstrong/Jigsaw
4.2.2 Activities and Depth of Involvement
4.3 Factors that Promote Youth Participation
4.3.1 A Member of Staff
4.3.2 Budget
4.3.3 Organizational Culture
4.4 Benefits of Youth Participation
4.4.1 To the Jigsaw Service
4.4.2 To the Young People
4.5 Challenges to Youth Participation
4.5.1 Lack of Time
4.5.2 Lack of Resources
4.5.3 Lack of Diversity
4.5.4 Lack of Training and Skillset
4.5.6 Lack of Clarity

Chapter 5: Discussion
5.1 Introduction
5.2 Youth Participation in Headstrong/Jigsaw
5.3 The Factors that Support Youth Participation in Headstrong/Jigsaw
5.3.1 Resources
5.3.2 A Member of Staff
5.3.3 The Organizational Culture
5.4 The Benefits of Youth Participation
5.4.1 To the Young People Involved
5.4.2 To the Jigsaw Service
5.5 The Challenges of Youth Participation
5.5.1 Lack of Time
5.5.2 Lack of Diversity
5.5.3 Lack of Training and Skillset
5.5.4 Lack of Clarity
5.6 Limitations and Strengths of the Study

Chapter 6: Conclusion
6.1 Introduction
6.2 What Form does Youth Participation take in Headstrong/Jigsaw?
6.3 What are the Factors that Promotes Youth Participation?
6.4 What are the Benefits of Youth Participation to Young people and the Jigsaw Service?
6.5 What are the Challenges of Youth Participation?
6.6 Recommendations
6.7 Conclusion

References

Appendices

 

 

LIST OF TABLES AND FIGURES

 

Table 1: Questionnaire Demographics

Table 2: Focus Groups Demographics

Table 3: Focus Group Schedule

Table 4: Activities YAP members were involved in

Table 5: Perceived Changes as a Result of Involvement with  Headstrong/Jigsaw

Figure 1: How involved are you in Headstrong/Jigsaw?

Figure 2: What do you do most of the time?

 

 

GLOSSARY OF TERMS

 

Headstrong –  Headstrong is the National Centre forcYouth Mental Health.

Jigsaw Project  – Jigsaw is Headstrong’s programme of mental health service delivery for young people betweethe ages of 12-25.

Young Person –  For the purposes of this research anyone between the ages of 16-25.

Early and Brief Intervention – The Jigsaw model aims to intervene early in the development of mental health difficulties to prevent them becoming more complex and/or entrenched. Early interventions also facilitate the building of resilience in young people so that they are better equipped to cope with life’s stressors. The model is brief in nature and adopts a solutions focused approach.

 

 

ABBREVIATIONS

 

AICAFMHA         Australian Infant, Child and Adolescent Mental Health Association.

YAP                     Youth Advisory Panel.

UNCRC               United Nations Convention on the Rights of the Child.

YEO                    Youth Engagement Officer.

YECW                 Youth and Community Engagement Worker

 

 

LIST OF APPENDICES

 

Appendix A: Better Outcomes, Brighter Futures Overview

Appendix B: Hart’s Ladder of Participation

Appendix C: Jigsaw Staff Questionnaire

Appendix D: Headstrong Staff Questionnaire

Appendix E: Jigsaw YAP Questionnaire

Appendix F: Headstrong YAP Questionnaire

Appendix G: Focus Group Consent (Staff and Youth)

Appendix H: Parental Consent Questionnaire

Appendix I: Under 18 Consent Form

Appendix J: Staff Information Sheet

Appendix K: Youth Information Sheet

Appendix L: Focus Group Protocol

Appendix M: Youth Focus Group Questions

Appendix N: Staff Focus Group Questions

Appendix O: Sample Transcription

Appendix P: Sample Coding

 

 

CHAPTER 1: INTRODUCTION

 

1.1 Introduction

Chapter one begins by illustrating the aims of the study and the research questions. The research context, focus and rationale will be examined alongside a brief overview of the methodological approach taken. The chapter will conclude by detailing the delimitations of this study and outlining the chapters that will follow.

1.2 Aim of the study

The overall aim of this study was to explore staff and young people’s perspectives of youth participation in an Irish youth mental health organisation and its programme of service delivery. More specifically the study addressed the following research questions.

1.3 Research Questions

•  What form does youth participation take in Headstrong/Jigsaw?
•  What are the factors that support youth participation?
•  What are the challenges of youth participation?
• What are the benefits of youth participation to the young people and the Jigsaw service?

1.4 Research Focus and Context

At present the researcher is employed as the Youth Engagement Officer in Headstrong, The National Centre for Youth Mental Health. Headstrong is a charity, which aims to change how Ireland thinks about young people’s mental health through research, engagement and its programme of service delivery, Jigsaw. Jigsaw is a network of projects across Ireland that provides an early and brief intervention, youth mental health service to young people aged 12-25. Jigsaw is currently in ten communities across Ireland including; Clondalkin, Donegal, Dublin15, Galway, Kerry, Meath, North Fingal, Roscommon, Offaly, and Tallaght. Headstrong/Jigsaw have ensured young people are involved in the organisation by setting up a youth advisory panel (YAP) for the Headstrong office and for each of the Jigsaw projects. Each panel is comprised of between 12-20 members between the ages of 16-25. These young people give their time and meet monthly to advise and guide Headstrong/Jigsaw in its work. The researcher’s role in the organisation is to support and promote youth participation both in the main Headstrong office, and within the Jigsaw projects.

 

1.5 Research rationale

The researcher is acutely aware of the lack of research that has been undertaken on the topic of youth participation within the organisation. It is important moving forward that youth participation has an evidence base as there is a lack of existing research on youth participation in youth mental health services (Howe, Batchelor, & Bochynska, 2011). This evidence base is necessary to develop the field of youth participation, and to gather support and resources for this developing area.

 

1.6 Methodological Overview

A mixed methods approach was taken through the use of questionnaires and focus groups. The participants involved in this study were staff and YAP members in Headstrong and all Jigsaw projects. The data was analaysed for dominant themes that provided answers to the research questions.

 

1.7 Delimitations

The study asked participants their thought’s, views and experiences about youth participation. The research did not use any measurements that directly assessed the impact of youth participation other than the participants’ thoughts; therefore the findings of the study are subjective. The study was undertaken at a particular point in time therefore requiring participants to think retrospectively which may introduce potential errors as it relied on their memory and their beliefs.

 

1.8 Chapter Outlines

Chapter two reviews the current and past literature on youth participation. It will focus on defining youth participation with a specific focus on youth participation in mental health services. Also examined will be models of participation that provide a theoretical framework for youth participation. The literature on factors that promote participation, the benefits to services and young people, and the challenges of youth participation will also be explored.

Chapter three outlines the methods that were employed in this study. Why mixed methods were chosen will be justified, with emphasis on rationalising the use of online questionnaires and focus groups. Participant information will be shared along with ethical considerations pertinent to this research.

Chapter four presents the key findings gathered from the data collection. Information will be merged from both the questionnaire and focus groups to provide answers to the research questions.

Chapter five discusses the findings while comparing and contrasting these to the literature examined in chapter two. These findings will be explored to ascertain how they answer the research questions and how they fit into the wider landscape of youth participation.

Chapter six concludes the study by summarising the answers to each of the research questions while providing recommendations for youth mental health organisations who may wish to develop a youth participation strategy.

 

 

CHAPTER 2: LITERATURE REVIEW

 

2.1 Introduction

This chapter opens by reviewing literature that is available on youth participation. This will be followed by an exploration of models of youth participation and the factors that support youth participaton. Finally the benefits achieved from youth participation by young people and services will be shared along with the challenges involved. As there is limited literature on the topic of youth participation in youth mental health services available, this review will concentrate on the literature that exists on youth participation in general while incorporating any relevant literature that focuses on youth mental health services.

 

2.2 Youth Participation

Youth participation is a right protected by the United Nations Convention on the Rights of the Child (UNCRC) 1989, ratified by Ireland in 1992, which gives young people an opportunity to exercise their rights as citizens (Seebach, 2008). It allows the adult world to work with young people to draw on their expertise as young people for the betterment of society (Checkoway, 2011). Youth participation is a process within institutions that involves young people making decisions that affect their lives (Hart, 1992; Checkoway, 2011). The National Policy Framework for Children and Young People; Better Outcomes, Brighter Futures sets out the Irish Government’s agenda and priorities in relation to children and young people aged under 25 years from 2014-2020. It has five national outcomes and six transformational goals (See Appendix A). Goal three outlines the government’s commitment to listen to and involve children and young people. The government has committed to a range of activities to ensure young people are consulted and involved in decision making in policies and issues that affect their lives including strengthening participation in decision making for health and wellbeing at community level (Department of Children and Youth Affairs, 2013).

Young people are commonly seen through their deficiencies and their burden on society and are viewed as a group who have disengaged from civil society (Checkoway, 2011) but conversely, young people should be seen as resources, not just victims or problems (Howe et al., 2011). Young people are experts of their own time and they are in the best position to make a decision about what is youth friendly, welcoming and accessible for young people (Howe et al., 2011) which explains the growing movement of mental health organisations developing youth participation strategies (Monson & Thurley, 2011).

2.2.1 Youth Participation in Mental Health Services

The primary health issue for young people is their mental health (Dooley & Fitzgerald, 2012) but young peoples’ experience of mental illness and their treatment needs can be very different to those of adults. Young people can experience mental health difficulties in an episode and therefore may only require brief and early intervention (James, 2007). The majority of young people do not have any experience of mental health services, and some find the symptoms of mental illness as issues they need to hide as it disturbs them and can lead to embarrassment and shame. Consequently, it can be hard for a young person to access a traditional mental health service that is designed by, and for, adults (James, 2007). Despite policies outlining the need for young people to be involved in the development of services there is limited literature available on youth participation in mental health services (Inspire Foundation, 2009; Monson & Thurley, 2011; Howe et al., 2011).

Internationally, there have been calls for children and young people to actively participate in service planning and the development of mental health services. In the UK the National Service Framework (NSF) for Children, Young People and Maternity Services calls for the views of young people to be taken into account in the planning, improvement and evaluation of services (Howe et al., 2011). The Australian National Mental Health Plan 2003-2008 identified that consumer and carer participation and partnership at all levels of policy, planning and treatment should be a hallmark of a quality mental health system (James, 2007). ‘A Vision for Change’ was developed to detail a comprehensive model of mental health provision for Ireland (Department of Health and Children, 2006). It described a framework for building and fostering positive mental health across the entire community and for providing accessible, community based, specialist services for people with mental illness. A Vision for Change recommended that the involvement of service users and their carers should be a feature of every aspect of service development and delivery within mental health services in Ireland (Department of Health and Children, 2006).

 

2.3 Models of Youth Participation

Models of youth participation can be traced back to Roger Hart’s ladder of participatory forms (Hart, 1992, 1997; Head, 2011). This model has been identified as being the most influential typology of youth participation (Seebach, 2008). Hart outlines an eight rung ladder (see Appendix B). Rungs one to three are; manipulation, decoration and tokenism, where projects and decisions are adult led with very little input from young people and are viewed as non-participation (Hart, 1992). Rungs four to eight see an increase in the level of input young people have until ultimately young people and adults share decision-making. Hart’s ladder of participation is often interpreted as a framework for encouraging stakeholders to extend youth participation towards the higher rungs of the ladder (Hart, 1992). Hart however would caution anyone using it as a definitive interpretation of where youth participation needs to be and there has been criticisms of the model for implying that all participation of children and young people should be at the highest rung (Barber, 2007). Full participation whilst aspirational is dependent on situations, culture and the setting in which youth participation is taking place (Head, 2011). The image of youth participation on a continuum from higher to lower is a common feature of many models of youth participation (Howe et al., 2011). Full participatory roles and responsibly are not feasible or necessary for every task or project and therefore caution is advised when using hierarchial models for guidance (Kirby, Lanyon, Cronin, & Sinclair, 2003). While there is a significant amount of literature relating to models of youth participation, there is a paucity of literature relating to models of youth participation in mental health services (AICAFMHA, 2008).

 

2.4 The Factors that Support Youth Participation

2.4.1 Resources

The resourcing of youth participation is required to maximise its contribution (James, 2007; Day, 2008). Young people should be appropriately recognised and remunerated for their participation and the payment of young people ensures their input is seen as valued and equal (Howe et al., 2011). In order to achieve effective outcomes organisations must allocate appropriate time and resources to youth participation (AICAFMHA 2008). A specific budget is required for the participation of young people as this may incur extra costs that would not be present when consulting adults, such as transport and food (The National Childrens Office, 2005). Young people at risk may require special attention when it comes to developing their capacity to participate, therefore resourcing allocations should be mindful of this (AICAFMHA 2008). When resources are not available to implement and evaluate participation, it results in an an inability of organisations to accommodate young people in their decision making structures and therefore becomes a barrier to effective participation (Revans, 2009).

2.4.2 Staff

A key staff member whose role it is promote and support youth participation within an organization is needed for youth participation to develop (AICAFMHA, 2008). Adults play various roles in the process to reaching out to young people, supporting their ideas, and building support for their work (Checkoway, 2011). One person must be identified with the skills and influence to lead the participation strategy but they should not be the only person who works in a participatory manner (The National Children’s Office, 2005). When this resource is not made available youth participation is affected negatively (Howe et al., 2011). Supportive staff relationships have been found to be beneficial in youth mental health settings and promote youth participation (Collin, Stephens-Reicher, Blanchard, Herrman, & Burns, 2011).

2.4.3 The Culture within an Organization

Hart (1992) emphasises that some environments are more conducive to the development of youth participation. A top down, bottom up approach is needed for meaningful youth participation to develop (Davies, 2008). A supportive workplace and organisational culture can have a significant impact on the success of youth participation strategies (The National Childrens Office, 2005). Organisations must allow time for trusting and respectful relationships to develop between staff and young people. Undertaking meaningful and sustainable participation is about the entire ethos and culture of the organisation and needs to be practiced by senior management, as well as frontline staff, and across policy and practice (Kirby et al., 2003). It is about developing new ways of working with children and young people. Developing the infrastructure and building organisational capacity needs dedicated commitment, sufficient staff support and an undertaking to adopt an organisational learning approach: all of which are more likely where there are champions of children’s participation present (Kirby et al., 2003). A fast turnover of staff and volunteers can affect the continuity and capacity to follow up with young people to become more involved (AICAFMHA, 2008). A positive youth participation culture is beneficial for both staff and young people within a youth mental health service (Collin et al., 2011). While the culture of an organisation can positively support the participation of young people, an organisation’s attitude where it recognises participation in theory but not in practice can be a challenge (AICAFMHA, 2008).

2.4.4 Training for Staff and Young People

Young people may lack the skills, information, support and training that is required to enable them to participate fully (Young Minds 2005). Skill development is necessary to develop the abilities for staff to incorporate young people into their work, and for young people to be able to work in the professional world (O’ Donoghue, Kirshner, & McLaughlin, 2002) Participation is more likely to be experienced as positive and worthwhile where individuals possess basic skills and confidence and where social learning occurs for broad groups of participants (Head, 2011). Young people and adults need to be given the time and space they need to develop skills and expertise to participate effectively (O’ Donoghue et al, 2002).

 

2.5 The Challenges of Youth Participation

Whilst all the factors outlined above support youth participation it must be acknowledged the potential for these factors to become challenges. The general challenges of youth participation include; lack of transport, lack of access to effective communication tools such as SMS, emails and the Internet, which are integral for young people to participate effectively (AICAFMHA, 2008). The level of wellness of the young person within a mental health system can present difficulties especially when young people have used mental health services (AICAFMHA, 2008). The primary challenges detailed in the literature include time, lack of diversity and the lack of clarity about youth participation.

2.5.1 Time

Time is a critical challenge for young people especially when they have competing interests of school, college, sports and work (The National Childrens Office, 2005). These other important areas in their lives can block their capacity for getting involved (AICAFMHA, 2008). Time is a barrier for staff and young people in youth mental health services as this time is needed to meaningfully engage young people in a way that works for both parties (Inspire Foundation, 2009). Working with more marginalised young people takes more time as they require additional support (Kelleher, Seymour & Halpenny, 2014). As outlined earlier organisations who are committed to youth participation must dedicate time to ensure young people are supported to participate. There is no literature available that outlines what time commitment is required for organisations and young people to give to ensure youth participation is effective.

2.5.2 Lack of Clarity

Repeatedly asking children and young people for their views, and not actioning them will disillusion them and other stakeholders, result in consultation fatigue and compromises the ability to work with them again (Davies, 2008). To consult implies action will be taken and to consult without any intention to act on the recommendations is ethically unsound (Neill, 2005). Being clear with young people from the start about what is possible and what is not prevents ethical and moral difficulties that will arise when young people expect more than is possible to provide (Neill, 2005). Clarity about aims, purposes, methods and processes should ensure that the benefits and limitations of participation in each case are explicit: and sometimes this improved clarity emerges only after a robust exchange of views (Head, 2011). When young people are dissatisfied with levels of consultation, participation and feedback provided, this can result in disillusionment and disengagement with the process (Kendall & Merrill, 2008). Review, evaluation and dissemination should be built into participation initiatives so that the elements of effective practice can be identified (McAuley & Brattman, 2002). Adequate feedback mechanisms from staff to young people on decisions should be developed so that young people know where their opinions has gone, what has been actioned and what has been the final outcome (The National Childrens Office, 2005). These markers of effective participation should be developed by young people and adults who work with them (Lansdown, 2010). This lack of clarity regarding youth participation can potentially be explained by the distinctive lack of evaluation in the area.

2.5.3 Lack of Diversity

In Ireland, young people who become involved in participatory activities are generally middle class, well educated, articulate young people and these young people are generally not representative of young people that are most in need of the services they are representing (Roe & McEvoy, 2011). This viewpoint is echoed by Head (2011) who claims that generally the more confident young people are involved in consultation, while the vulnerable and seldom heard young people’s voices are often overlooked (Head, 2011). The term seldom heard refers to groups of people who together do not have a voice, and are generally under represented in activities around participation (Kelleher et al., 2014). Traditional models of youth participation such as youth councils and youth board are elite models of participation where only the voices of some young people are heard (Collin et al, 2011). Young people who engage in participatory structures in mental health organisations can also be a homogenous group (Inspire Foundation, 2009). Caution must be added to these interpretations though as no young person is the same as the next therefore a young person cannot represent the views of all young people. It is important to consider the absence of evaluation with regards youth participation, so it is not known if having a representative group makes decisions better or worse.

 

2.6 The Benefits of Youth Participation

Although the aforementioned challenges can make youth participation difficult the process has numerous benefits for all involved and should be promoted.

2.6.1 To Young People

The benefits of youth participation for individuals include; the development of particular skills, self-esteem and self-development outcomes (Sabo, 2003; Checkoway, 2011). In general young people learn new skills such as teamwork, negotiating, problem solving and influencing, while learning more about policy and how organisations work (The National Childrens Office, 2005). Youth participation can improve education and employment opportunities, while heightening aspirations and plans for the future. It allows the young person a chance to increase opportunities to have fun and meet new people, while giving them the chance to help their communities (Kirby et al., 2003).

Motivations behind becoming involved in a youth mental health service include, wanting to build confidence, social skills and make new friends (Coates & Howe, 2014). Youth participation fosters resilience in young people, including a sense of connectedness, belonging and valued participation which ultimately has a positive impact on mental health and well being (Laws, 1998; Oliver, Collin, Burns, & Nicholas, 2006). Young people involved in participatory structures have reported increased skills, confidence and participation in a range of ways as a result of their involvement (Inspire Foundation, 2009). They described an increase in their confidence working with staff and external stakeholders, confidence working in a professional environment and their ability to work as part of a team. On a social level participation had a positive impact on young people’s sense of social connectedness, an increased sense of belonging and a significant positive relationship between increased social connectedness and decreased levels of psychological distress(Inspire Foundation, 2009). Youth participation increases the sense of value and connectedness young people feel to services especially where there are positive relationships between staff and young people (Inspire Foundation, 2009).

2.6.2 To Services

Youth participation improves services in both the statutory and voluntary sector (Oldfield & Fowler, 2004). Consumer participation within a youth mental health service can improve service quality, health outcomes for those involved and creates a service that responds to the needs of its clients (Monson & Thurley, 2011). Youth participation assists organisations in developing services that respond to, and are accessible to young people by challenging adult presumptions about what the needs of young people are (Revans, 2009). Youth participation plays a key role in the success of service development and delivery as it allows a service to use the most relevant platforms to reach young people and to focus on issues relevant to them. It leads to increased accessibility of the service therefore creating a more engaging service (Inspire Foundation, 2009).

Involving young people also benefits staff morale as it supports understanding and appreciation for the strengths and capabilities of young people (Inspire Foundation, 2009). Involving young people improves service accountability and brings about new perspective while influencing outcomes in new and unexpected ways (Kirby et al., 2003). It gives a chance for programmes to become more responsive, understanding and considerate of young people’s needs while also improving the efficiency and effectiveness of policies and programmes through the incorporation of young people’s views. It improves the development and delivery of programs through the provision of more reliable information that when adults speak on behalf of young people (Sinclair, 2004, AICAFMHA, 2008).

 

2.7 Conclusion

Youth participation is about giving young people a voice in matters that affect them. Youth mental health concerns young people and they are the experts on what it is like to be young in modern day Ireland. They are the most appropriate people to help guide and advise a youth mental health service to ensure it is youth friendly and accessible for the people using it. It is clear that factors such as resourcing, adult support, the culture within an organization, and skill development for all involved can further enhance youth participation. When these are missing or limited they have the potential to become challenges. Challenges of youth participation include lack of time, the homogenous nature of young people who become involved in participatory activities, and the lack of clarity organizations have regarding youth participation. Youth participation provides many benefits for young people while ensuring services are responsive to the needs of young people. Considering the potential benefits of youth participation and the inherent challenges involved this study aims to gain a deeper understanding about youth participation in an Irish youth mental health service.

 

 

CHAPTER 3 METHODOLOGY

 

3.1 Introduction

This chapter provides information on the research design and methods used within this study. Descriptions will be given for both qualitative and quantitative data collection methods and how they were employed in this research. The population sample will be explored including some demographics on the participants. Ethical considerations will be outlined and further information on how the data was analysed will be specified. Finally a reflective piece from the researcher will be shared.

 

3.2 Research Design

A mixed method was chosen for this research study and this refers to the use of two or more methods in research that results in both quantitative and qualitative data being generated (Bogdan & Biklen, 1992). Every data collection method carries its own limitations and therefore it was decided to combine quantitative and qualitative data collection methods for this research to ensure the reliability of the findings (Flick, 2011). A mixed method was most suited to the research aims and the participants of the research. The qualitative methods allowed for a narrative to be told around youth participation while the quantitative methods ensured an array of data from which to analyse.

In order to understand the world around us social scientists can adopt a number of different approaches (Bryman, 2012). The paradigm, which informed this design, was pragmatism as it assumes that the usefulness of any particular mixed methods design can be known in advance of it being used (Hall, 2013). A pragmatic rationale also related to the resources that were available to the researcher. A pragmatic approach allowed the researcher to open up the world to social enquiry and be less purist in terms of methods and preconceptions (Brannen, 2005).

 

3.3 Research Methods

3.3.1 Qualitative Methods

Qualitative methods generate ‘soft data’ words, images, sounds, feelings and or images (Burnett, 2009). These methods aim to develop understanding of meanings, which rely on interpretation, a methodological act which in turn requires theorizations and which can be conducted in different ways with different outcomes (Burnett, 2009; Bryman, 2012). Focus groups were the qualitative method chosen for this study. A focus group typically is viewed as qualitative research, which involves a group discussion with around 6-12 people. It usually lasts between one and three hours and it capitalises on the interaction between participants. It is useful for gathering sensitive data and it requires careful and unbiased analyses (Burnett, 2009; Sarantakos, 2013). Participants in a focus group are likely to provide more information than one-to-one interviews (Flick, 2011). Focus groups were appropriate for this study as they were low on cost and rich in data, helped participants remember specific events and were particularly useful to study opinions (Flick, 2011).

3.3.2 Quantitative Methods

Quantitative methods aim to identify and make sense of patterns in data, using measurement and exploring connections by attempting to establish cause and effect between different variables (Burnett, 2009). These methods generate data such as numbers and their connections are mapped using statistical analyses (Burnett, 2009). Questionnaires were the chosen quantitative method for this study. Questionnaires are a common approach to quantitative research (Burnett, 2009). They allow a researcher an opportunity to ask the same questions across a sample and their answers can be easily compared while also ensuring anonymity if needed (Bryman, 2012). The data generated can reveal patterns and acts as a good source of information. Benefits of questionnaires include: flexibility, the ability to show which variables is at work in specific inter-relationships, the speed of and the quantity of data that can be collected (Sarantakos, 2013). Using questionnaires benefited this study as young people lead busy lives and it gave them the flexibility to complete it when they had time. It was useful for staff as they could choose to do it in their own time. This method gave staff and young people around the country an opportunity to be involved in the study, as it would not have been feasible to conduct focus groups with a large sample.

A disadvantage of questionnaires is that they can be very poor at providing reasons behind answers (Burnett, 2009; Bryman, 2012). To combat this open ended questions, which required more in depth responses, were added to the questionanire. Similar questions were also asked in the focus group, which allowed for more depth of themes. An online questionnaire was administered via survey monkey. It saved time and money as it meant that participants did not have to fill in paper versions and return them. All staff are provided with a work laptop and access to Internet therefore the online questionnaire was suitable for this cohort. The choice of being posted a printed version was also offered to all participants however none of the participants requested this option.

 

3.4 Questionnaire Design

The questionnaire was adapted from a similar questionnaire used for staff and young people involved in an Australian youth mental health service (Inspire Foundation, 2009). This Australian study asked youth participants questions about their own mental health or social connectedness which were not required for this research therefore these area’s were omitted. Sections which were useful for this research and were adapted to fit an Irish context were the retrospective self-assessment questioning on benefits of youth participation, the activities young people had been involved in, the participant’s views of the impact of youth participation on the service, and how it had impacted on them as individuals. To answer the research questions this study also incorporated questions on factors that promote youth participation, how much they felt listened to and the benefits and challenges of youth participation. This study’s staff questionnaire contained more similarities with the Inspire Foundation (2009) questionnaire. Similar topics were covered including; how often the organisation considers young people’s opinions, the reasons for involving young people, benefits and challenges, and the involvement of young people in staff member’s roles. Added to this study’s staff questionnaire were questions concerning impact on service, impact on young people, and the staff member’s experience of working with the YAP.

Four versions of the questionnaire were developed; Questionnaire 1: Jigsaw Staff (See Appendix C), Questionnaire: 2 Headstrong Staff (See Appendix D), Questionnaire 3: Jigsaw YAP (See Appendix E), Questionnaire 4: Headstrong YAP (See Appendix F). Jigsaw YAP and staff filled in questions primarily related to Jigsaw, while Headstrong staff and YAP filled in questions primarily related to Headstrong. There were some sections that required the participants to answer in relation to both Headstrong and Jigsaw. The reason for the seperation of the words Headstrong and Jigsaw was the young people who piloted the questionnaire felt they were confused when asked questions about Headstrong and Jigsaw together and felt clarity would be brought by naming one or the other. Young people and staff who worked with Jigsaw generally gave their answers in relation to their Jigsaw project unless asked otherwise. This was the same for the Headstrong YAP and staff.

 

3.5 Sampling of Participants

A sample is a segment of the population that is selected for investigation as it saves time and money (Gratton & Jones, 2010). The participants in this study was staff members from Headstrong and Jigsaw projects and members of the YAPs from Headstrong and Jigsaw projects. The focus groups were chosen by means of purposive sampling, as the goal of these sampling methods is to sample those who can answer and have a relationship and relevance to the research question being posed (Bryman, 2012). It was important for this research to ascertain the views and opinions of the people who are directly involved in youth participation in Headstrong and Jigsaw. Participant’s inclusion in the questionnaire sample was determined by the following criteria:

•  They must work in a Jigsaw project or the Headstrong office.
•  They must be a member of the Headstrong YAP or a Jigsaw YAP.

Staff invited to take part in the focus group was comprised of various disciplines across the organisation including; senior management, clinical staff, and administration staff therefore the researcher needed to ensure that there was an even mix of these disciplines in the focus groups as recommended by Burnett (2009). Focus group one was mixed with various disciplines whereas focus group two was comprised of all staff members in the Jigsaw projects who had a responsibility for youth participation. Members of Headstrong’s YAP, which also contained members of Jigsaw YAPs, formed the youth focus group. This was decided as being the most appropriate route as it allowed for ease of access to participants and the focus group was scheduled one hour before a meeting that the group were already attending. Participant’s inclusion in the focus group was determined by the following criteria:

•  They must work in a Jigsaw project or the Headstrong office for at least a year.
• They must be a member of the Headstrong YAP or a Jigsaw YAP for at least a year.

The researcher was able to access the samples through the Jigsaw projects and through Headstrong the National Centre for Youth Mental Health.

 

3.6 Participants

In total 160 participants took part in this study. 138 participants completed the online questionnaire. This represented a response rate of 73% for staff and 54% for young people. 22 questionnaires were deemed incomplete; as participants had not answered enough questions and a further eight were disqualified from the questionnaire, as they had not returned their parental consent. 22 participants took part in focus groups.

 

 

3.7 Ethics

Researchers need to consider the ethical issues associated with the research whilst ensuring the design is socially and morally acceptable (Gratton & Jones , 2010). The Dublin Institute of Technology ethical committee approved the study proposal and methodology which were also reviewed and approved by the Headstrong research team.

Many ethical procedures were used during the research including; voluntary participation which extended to participants only choosing to answer questions they were comfortable with, informed consent, the right to withdraw, secure storage of data, and the participants having access to the findings (Bryman, 2012). (Denschombe, 2007) highlighted 3 ethical issues which guided the research ethically. Ethical Issue 1: Researchers have a duty to consider in advance the likely consequences of participation and to take measures to safeguard the participant’s interests. With respect to this the researcher ensured that the questionnaires were anonymous so that staff and young people would feel free to answer honestly, without worry of identification. Anonymity was important for the young people in case there was a concern that how they responded may affect their membership of the YAP or their working relationship with Headstrong/Jigsaw. It is acknowledged that 100% anonymity cannot be guaranteed due to the tracking of IP addresses, however this is not something the researcher or Headstrong/Jigsaw would have ever been in a position to do. It is understood that all participants should be informed as to who will have access to research data and ideally this should be limited to only those who need to know (Gratton & Jones , 2010). All participants were informed that all information within the focus group was going to be confidential and the only time that this confidentially would be broken would be if a risk to a participant or to someone else and/or if a child protection issues arose. Additionally, it has been recommended that the identity of the participants be kept confidential (Bogdan & Biklen, 1992) and with this in mind all participants in the focus groups were assigned pseudonyms for the presentation of findings.

Ethical Issue 2: The avoidance of deception or misinterpretation by the researcher being open, honest and explicit with the participant. The researcher was mindful that all participants were aware that their inclusion was not part of their work with Headstrong/Jigsaw and therefore it was voluntary to take part. It is acknowledged that only those who are participating voluntarily and have been informed about the study should be involved in the data collection (Flick, 2011). Consequently, all participants in this research voluntarily agreed to participate in the data collection methods.

Ethical Issue 3: It is important that participants are given as much information to make an informed decision about whether or not they wish to take part in the study (Bryman, 2012). Written consent was sought from participants of the focus groups to ensure appropriate ethical practice (Creswell, 2007) (See Appendix G). Informed consent must be given by someone competent to do so (Flick, 2011); consequently parental consent (See appendix H) was requested for all participants under 18 years of age. These participants were also required to give their consent (See Appendix I) Once participants had returned their consent form they were then sent the link to the questionnaire. If a young person accessed the link, and revealed they had not received parental consent they were brought to a disqualification page .

 

3.8 Data Collection: Quantitative

The youth questionnaire was piloted with two past YAP members and the YAP intern who works during the Summer months in the Headstrong office to ascertain their views. The main suggestions for change were to make the language much clearer and accessible, and to be more direct when asking questions, for example use either Headstrong or Jigsaw but not both. They also suggesting attaching a picture as they felt it put a face to the research. Two staff members were also sent the staff questionnaire to ascertain their thoughts. Similar to the youth pilot group they felt that questions needed to be asked directly about Headstrong or Jigsaw.

An information letter outlining the purpose of the study (See Appendix J) was developed and sent to each Jigsaw project via their staff email. A similar letter (See Appendix K) was also sent to all the YEO’s to forward onto their YAP’s and to post to their Facebook YAP group pages of the YAP’s to increase the likelihood of a higher response (Sarantakos, 2013). The link to the questionnaire was then emailed to all staff, and placed on the Facebook pages of all the YAP’s two weeks after this email on the first week of August. A follow up phone call was made to all the staff members who were employed to support the YAP’s to encourage staff and young people to complete the questionnaire two weeks prior to the final date. The questionnaire was kept online for three weeks to ensure maximum uptake whilst also taking into account that staff take annual leave at this time of the year.

 

3.9 Data collection: Qualitative

An email was sent to staff from a range of disciplines to ask them if they would be willing to participate in a focus group for the study. As recommended an interview protocol (See Appendix L) was used to guide the focus groups and interview questions (Creswell, 2007). The average length of the focus groups was 72 minutes. Questions had similar themes for all focus groups but some were phrased differently in the youth focus group (See Appendix M) and the staff focus groups (See Appendix O). The questions were ordered to allow a natural flow through the research questions. Each focus group finished off on a question looking at the future so it would end on a positive note. As the focus groups developed if someone said something that required more analysis the researcher asked them to elaborate on the point further. At times specific participants were asked to give their response if it was felt they had not had the opportunity to speak especially if there were stronger participants in that group. The focus groups were recorded on a dictaphone and transcribed verbatim afterwards (See Appendix O)

The focus groups were spread apart to give time for transcriptions to be completed whilst also being conscious that the online questionnaire was live simultaneously.

 

3.10 Data Analysis

3.10.1 Quantitative

The questionnaires were transferred into Microsoft Excel, which allowed for ease of analysis for all the closed questions. Microsoft excel was a practical tool to translate the findings into clear tables and charts which in turn provided answers for several of the research questions. Coding as a data analysis technique was used for the openended questions of the questionnaire and for the focus groups. Coding involves exploring the collected data and assigning it codes, which may be names, concepts, categories, theoretical ideas or classes therefore enabling the researcher to understand a text better (O’ Reilly, 2009; Flick, 2009). The open-ended questions, which produced a qualitative response, were coded into themes, with the predominant themes being shared in the findings section. An example of a theme coding is the this research is provided in Appendix Q.

3.10.2 Qualitative

The data analysis phase is the core of qualitative research (Flick, 2009). Data analysis in qualitative research consists of preparing and organising data for the purpose of analysis. This data must then be reduced into themes by a process of coding, condensing the codes, allowing the research to represent the data in figures, tables or a discussion (Creswell, 2007). Data analysis can be pursued concurrently with the data collection or after the data has been collected. It is suggested that researchers do some analysis concurrently with the data collection in order to provide structure and direction to future data collection. However, the majority of the analysis should be left until after all the data has been gathered (Bogdan & Biklen, 1992).

Six steps of data analysis, as identified by Creswell (2009), were carried out on the data gathered in this study:

(i) The data from the focus groups was organized and transcribed.
(ii) All the transcriptions were read several times to get a sense of it.
(iii) The coding process began.
(iv) The use of codes was used to identify a number of themes.
(v) Consideration was given to how the themes would be presented in the results. The use of quotes supported theme’s that were discovered
(vi) Interpretations were made from the data that was given.

 

3.11 Researcher Bias

It was important to realise that people start on a research topic due to their own biography (Bogdan & Biklen, 1992). It was therefore crucial that the researcher’s position was made explicit to participants. Acknowledging the researchers positioning and the potential bias that may occur increases the validity of the research (Creswell, 2009). As the researcher is employed as the YEO within Headstrong, who’s primary role is to develop and support youth participation the potential for researcher bias was explored and a clear explanation was given in each focus group that all information was confidential. While analaysing the data the researcher needed to be mindful to separate out information gathered from the research and information that was gathered as part of their role.

 

3.12 Reflexivity

This study was difficult at times to undertake. As it was research that concerned my own role, and a topic I am incredibly passionate about, it was difficult to create boundaries between my working world and this research. It was challenging at times to hear or read negative comments regarding youth participation. I sometimes took them as personal comments against my work.

As I was still working while doing this research piece, I became hyper vigilant to youth participation which I feel had a negative impact on my role within the organisation, as it didn’t allow for rationale thinking at times as my sole focus was on youth participation. I would recommend researchers choosing a topic that is associated with their employment to develop strategies to allow for a separation of the working and research world.

I feel my role had potential to impact on the focus groups. While there was an atmosphere of honesty, and the participants were assured confidentiality I was still concerned that they may not be 100% open as they may have been concerned about offending me. To counteract this, similar questions were asked in the questionnaire that gave all participants an opportunity to share their thoughts anonymously.

 

 

CHAPTER 4: FINDINGS

 

4.1 Introduction

This chapter will present findings from the data gathered in the focus groups and questionnaires. Results will be merged together to indicate the participants’ views on youth participation. Subsections will be used to highlight findings in the following themes; youth participation in Headstrong/Jigsaw; activities and depth of involvement; factors which support youth participation; benefits of youth participation to young people and the service; and finally the challenges of youth participation.

 

4.2 Youth Participation in Headstrong/Jigsaw

“Youth Participation for me means that young people participate throughout an organisation. That their views and opinions are equally valued as any other persons, not more or less, but equal. That their time is appreciated but that it is of mutual benefit for both the adult and young person. In theory it should be a win win situation, one that makes the organisation better no matter how difficult it is to achieve this” Youth Questionnaire.

Youth and staff participants from the questionnaire and focus groups held common beliefs that youth participation was about involving young people, listening to them and giving them a voice in how the organisation is planned, designed, implemented, and evaluated. It meant involving them in decisions in an appropriate, mutually respectful and meaningful manner at every level. Staff and young people within the focus groups believed that young people do not want power in Headstrong/Jigsaw but rather wanted to be involved and consulted in the appropriate areas. Young people in the focus group expressed views that young people should not have a dominant voice in discussions or be given a veto, they wanted to be an equal voice. For example one youth in the focus group stated: “young people don’t expect everything to revolve around their decision” Youth Focus Group.

4.2.1 Why Involve Young People in Headstrong/Jigsaw

93% (n = 50) of staff that completed questionnaires revealed that a significant or very significant reason for including young people in the development of services is that young people have insights and perspectives to offer that are different from adults. One staff member felt: “the Yap has acted as our compass for when we are unsure about how we can deliver, design and communicate about the service” – Staff Questionnaire. (94%; n = 50) of staff believed that young people have a right to be consulted with respect to policies/issues affecting them, (83%: n = 45) felt young people engage more with services when they are consulted, (66%: n = 35) were of the opinion that involving young people leads to better decision making including decision making that does not directly involve young people. These points were supported in the open ended responses of the questionnaire with staff asserting that involving young people made the services more credible and real, and that young people are more likely to approach the service if they knew young people had been involved in designing it. The young people in both the questionnaire and focus group articulated that Headstrong/Jigsaw are taking the right approach by involving young people. For example one YAP member responded:“if you actually want to fix something around the issue of young people, the best sort of person to go to is actually a young person” Youth Focus Group.

4.2.2 Activities and Depth of Involvement

Findings revealed that young people dedicate a large amount of time to Headstrong/Jigsaw, with the majority of young people in the questionnaire stating that they were “heavily or quite involved” with the organisation. Participants in the youth focus group were clear that Headstrong/Jigsaw created a space where you could dedicate as much time as you had available, and that the time they gave changed according to different things that would occur in their lives. As one young person indicated: “like for me, it’s a major part, well I do like, uh my school work, my family, my sports, and my Headstrong like it becomes part of your identity” Youth Focus Group.

Findings from the youth questionnaire indicate the top five activities YAP were most involved in were: fundraising, planning in Headstrong/Jigsaw, attending Headstrong/Jigsaw team meetings, media work and sitting on sub groups of Headstrong/Jigsaw (See Table 4). The selection and design of buildings, promotion of, and fundraising for the service were acknowledged in both the qualitative responses of the questionnaire and all focus groups as being practical areas of involvement. Young people sitting on management groups and sitting with the board of directors of Headstrong were viewed as positive areas of involvement that made a difference at a management level. However, it was highlighted that not all Jigsaw projects have young people on the management groups and that their lack of presence was evident. One staff member revealed: “there is a clear difference between the way an OMG work’s, when there are young people on… around the table, and where there are not young people” Staff Focus Group.

Participants from the youth and staff focus groups consistently observed that the strongest example of youth participation within the organisation was involving young people in interviewing staff. Young people had an equal voice in the decision-making process here. Interestingly the participants in the youth focus group relayed that if they ever felt unequal, it was when candidates spoke to them or treated them differently from the rest of the panel. As one young person stated:

“I will ask the question and they will answer my question but not to me, they’ll answer to the other members of the panel. They wouldn’t make eye contact with me or they wouldn’t mention my name or anything like that. They will just talk to everyone else” Youth Focus Group

 

4.3 Factors that Promote Youth Participation

4.3.1 A Member of Staff

Within all focus groups and of questionnaires, a staff member whose role it was to support youth participation resource was consistently highlighted as being a vital factor in promoting and supporting youth participation. This person usually with title Youth Engagement Officer or Youth and Community Engagement Worker was a crucial link between the young people and the staff and was essential for the development of youth participation. One member of staff commented: “Seriously I believe the appointment of a full time youth participation person is by far the most important and effective step we’ve taken to facilitate youth engagement” Staff questionnaire. The staff focus groups particularly felt that having different resource allocations from one day to five days for this worker meant that not all Jigsaw projects could be at the same level of youth participation and this created difficulties, especially if the worker was not based in Jigsaw. While the dedicated staff member was seen as a factor to promote participation, when a Jigsaw project had limited time allocation of this staff member, it then became a challenge to include young people adequately.

4.3.2 Budget

Staff and young people within the questionnaire and focus groups reported that having a budget was an important factor to support youth participation. This budget was useful as it allowed for transport and food costs to be taken care, which was important for young people who do not have access to disposable income. Within the staff focus group, when asked where they would like to see youth participation going forward many felt that it needed to be budgeted for. This budget would support the costs associated with the youth engagement staff member mentioned in the previous sub section, and costs incurred by the young people.

4.3.3 Organizational Culture

Staff and young people within the focus groups observed that Headstrong/Jigsaw created a positive open culture towards youth participation the minute a member of staff and young person walked in the door, which was strongly seen, from a top down level with young people being involved in the management structures. Many participants from the questionnaire’s and focus groups highlighted the importance of staff and young people physically seeing and interacting with each other for youth participation to develop and felt that the more opportunities there was for this, the greater the degree of youth participation. In addition, an open door policy in Headstrong/Jigsaw, where there was adequate space to meet the YAP, strongly contributed to youth participation. One participant remarked:

“Probably the open door sort of policy, your kind of welcome in anytime because there is always something to work on and if you actually want to come in and work on something you’re more than welcome and there will be a desk waiting there for you” Youth Focus Group

Positive staff attitudes towards youth participation within the organisation were evident throughout the questionnaires and focus groups. Young people from the questionnaire and the focus groups reported that staff that listen to them, respect them and work in a friendly welcoming environment contributed towards youth participation. The young people from the focus group commented that doing something well and proving to staff that they can be trusted, built on youth participation. Staff within the focus group conveyed how they receive the opinions of the YAP created a sense of whether or not they will continue to give feedback.

As one staff member described:

“I think how you receive a young person’s opinion is, something that promotes youth participation in the sense of how you respond, particularly initially will determine whether they’ll open their mouth again or how they’ll open their mouth again, and I think that’s, that’s really important” Staff Focus Group

While there was very positive attitudes from staff towards youth participation 45% of staff rarely or never involved young people in the various aspects of their work.

 

4.4 Benefits of Youth Participation

4.4.1 To the Jigsaw Service

“ if you want to encourage self referrals, and that’s what we want to do, we want to change how young people think about and how they access services. They are the most powerful tool. They are the most powerful resource to do that and we need to invest in them” Staff Focus Group.

96% (n = 59) of staff participants in questionnaire agreed or strongly agreed that involving young people has been most beneficial to promoting Jigsaw, while 88% (n = 56) agreed or strongly agreed that it has been beneficial to the young people who use Jigsaw. This was further supported in the staff focus groups that commented on the very strong role that young people play in the promotion of the service. In addition, 89% of staff (n = 54) agreed or strongly agreed that there were benefits in involving young people in developing projects, programmes and initiatives while 87% (n = 54) agreed or strongly agreed that involving young people benefitted decision-making within Jigsaw. Findings indicate that involving young people made the service more credible, transparent and accountable. As one staff member indicated:

“it means that you can’t let yourself off the hook and just do what suits staff or the service! You need to explain decisions and involve young people in decision making… if you can’t justify it to the Youth Advisory Panel, or you just can’t explain it, simply, to the Youth Advisory panel, then you need to ask yourself about your decision-making method and conclusions” Staff Questionnaire

The young people in the questionnaire also felt it stopped the service from being intimidating and clinical and set it apart from other mental health services. Staff and young people in the questionnaire and in the focus groups believed that involving young people had a crucial impact on making the service more accessible, youth friendly and responsive to the needs of young people while breaking down stigma. For example one staff member reported: “impact is directly felt by the young people who attend in terms of the youth friendly “feel” of the service” Staff Questionnaire. While the majority of participants were positive about the impact a minority of staff had negative experiences of youth participation with one staff member commenting on youth participation: “very little and at times has seemed tokenistic” Staff Questionnaire.

4.4.2 To the Young People

There were many references throughout the youth questionnaire about the positive benefits young people had experienced during their time on the YAP. 94% (n=64) of young people in the questionnaire reported their confidence working with staff increased somewhat or a lot. 90% (n=63) believed their understanding of youth mental health had increased somewhat or a lot. 89% (n=62) reported that their confidence working in a professional environment had increased somewhat or a lot. 81% (n=56) stated how likely they were to seek help if that had a personal problem had increased somewhat or a lot. 75% (n=52) said how much they felt they belonged had increased somewhat or a lot. Other areas that the young people believed had changed included; their ability to work in a team, oral communication skills, confidence working with external partners, initiative to take personal actions about issues they care about, ability to solve work related problems, their own ability to cope when things got tough, personal planning and organisation, levels of involvement with other organisations (e. g. online community group, human rights organisations, local sporting groups), understanding of political and social issues and written communication skills (See Table 5). One YAP member stated that their experience was: “Hugely beneficial. I developed many skills as part of working with Jigsaw (communications, public speaking, team-work). I have been given many opportunities too (writing articles, participation in talks and presentations. ” Youth Questionnaire.

 

4.5 Challenges to Youth Participation

4.5.1 Lack of Time

A lack of time was a dominant theme in the qualitative responses of the questionnaire and in the staff focus groups. 64% (n=36) of staff that completed the questionnaire described a lack of time to devise, implement and evaluate work with young people as being a significant or very significant barrier to involving young people in their work. Likewise, young people within the focus groups and questionnaires reported time being an issue for them when they had competing demands of school, college and their outside lives. This lack of time resulted in young people not being involved in ways they should be, with only 3% – 5% of staff indicating that they always involved young people in their area of work. The young people within the focus group recognised that sometimes due to time constraints and deadlines that staff are under pressure and that limits the involvement of the YAP. Staff both in the questionnaire and the focus groups supported this belief for example:

“I don’t mean to make excuses but the nature of our work is often quite reactive and it’s hard to find time to complete a project never mind consult/collaborate with young people Staff Questionnaire

4.5.2 Lack of Resources

While resources were highlighted in the factors that promote participation section, 60% (n=32) of staff within the questionnaire reported a lack of resources (e. g. funding, personnel etc. ) to devise, implement and evaluate work with young people as being a significant or very significant barrier to involving young people. This lack of resources was highlighted in the staff focus groups in relation to staff allocation for youth participation. This lack of resources impacted on the ability of staff to include young people in their work even though it was something they were open to.

4.5.3 Lack of Diversity

Both the young people and staff within the focus groups commented on the homogenous nature of the YAP’s and that this can be problematic as the YAP wasn’t necessarily a representative group. The young people in the focus group felt that while there was diversity of regions a lot of the YAP were in secondary school or colleges. One Jigsaw project did highlight that they had the opposite experience and had successfully engaged seldom-heard groups but the voices of others were missing. The average age of participants to the questionnaire was 20 years of age with only 11% being under the age of 18. No one under the age of sixteen is a member of a YAP in Headstrong/Jigsaw.

4.5.4 Lack of Training and Skillset

Young people in the focus group highlighted the lack of training given to young people to carry out their role. They felt that they needed certain skills to be put in certain situations and at times they did not have these skills and that Headstrong/Jigsaw did not provide enough training. Staff reported the importance of young people having skill sets and training with a participant commenting:“you have to equip young people to be able to participate, in such a way that they’re not feeling like a spare part” Staff Questionnaire. 45% (n=24) of staff that completed the questionnaire felt that a significant or very significant barrier to involving young people in their work was the limited training courses and resource materials to enable them to consult or work directly with young people effectively. Clinical staff in particular, frequently commented both in the questionnaire and in the focus group that it is much harder for young people to play a role in their clinical work due to the lack of a skillset on the part of the young person. One member of staff stated:

There are barriers to involving young people in clinical decisions, such as the remit of the service, the interventions provided, appropriate responses to risk etc. because these decisions involve a level of qualification and professional experience and need to be based on evidence and best practice Staff Questionnaire.

4.5.6 Lack of Clarity

According to staff and young people within the focus groups there were varying levels of youth participation throughout the organisation and between Headstrong and Jigsaw projects. Hart’s ladder of participation was referenced in one staff focus group with staff acknowledging that Headstrong and Jigsaw projects can be on different rungs of the ladder mainly due to lack of resources. Both groups expressed concerns that there was a lack of clarity in relation to what youth participation meant in Headstrong and Jigsaw. There is no organisational definition for youth participation or model of youth participation that the organisation uses. As one staff member identified: “maybe Jigsaw/Headstrong needs to define what level of participation they’re at, so that makes it clearer for us” Staff Focus Group This caused difficulties for staff, as they did not know what they were aspiring to, and created frustrations for the young people who were unsure what their involvement was at times. The youth focus group expressed a desire to be told what role they were playing in a process and for this to be communicated clearly from the outset. They wanted to be more aware of how decisions were made. Staff supported this viewpoint with one staff member stating: “I think at times we probably thought they were in a consulting role when they might have thought they were in a decision making role” Staff Focus Group.

Young people were heavily involved in the initial planning and set up of Jigsaw. All focus groups acknowledged that this activity dies down for Jigsaw YAP’s and that there was a lack of clarity in relation to their role in the actual implementation/ service and delivery/ evaluation elements and that young people’s involvement was limited in this area, but that there was potential there. One staff member provided an insight: “It’s harder to find where the group necessarily fit in terms of implementation and evaluation” Staff Focus Group.

This brings this findings chapter to a conclusion.

 

 

CHAPTER 5: DISCUSSION

 

5.1 Introduction

This chapter will discuss the main themes that emerged from the findings and examine these in relation to the literature reviewed in chapter two. The implications of this study will be addressed throughout, concluding with a description of the limitations of this study.

 

5.2 Youth Participation in Headstrong/Jigsaw

Youth participation in Headstrong/Jigsaw is a process that involves young people in the organization taking part in a variety of roles as outlined by Checkoway (2011). This study supports the assertion by Howe et al. (2011) that young people are experts of their own time and they are in the best position to make a decision about what is youth friendly, welcoming and accessible for young people. For this reason, Headstrong/Jigsaw has created YAPs as the organizations participatory structure to involve young people. The organization is consistently following best practice both on a national and international level concerning young people’s rights to participate by adhering to Article 12 of the UNCRC, giving children and young people a say in decisions that affect their lives although it must be acknowledged that Headstrong’s participatory structures do not include the voices of children under 16, even though it is a service for young people aged 12-25. As proposed in ‘Better Outcomes, Brighter Futures’ Headstrong/Jigsaw ensures that young people are consulted in decision making for health and well-being at community level with a particular emphasis on youth mental health services (Department of Children and Youth Affairs, 2013). The organisation has taken a slight divergence from a ‘Vision for Change’ recommendation to ensure service user consultation and feedback in designing mental health services by also involving young people who have not been services users. This can be viewed as a positive step as it ensures that all young people can have an opportunity to shape services.

The young people are centrally involved in the physical design and promotion of Headstrong/Jigsaw, however, there is a lack of clarity where they fit in relation to implementation and evaluation within the organization. The most successful examples of the young people’s involvement is interviewing of staff and supports Michel & Hart’s (2002) study which found that this level of involvement yields excellent results for organisations. From the initial set up phase there has been a natural evolution of the role to take in fundraising for the sustainability of the service and promotion to increase referrals and reduce stigma. Similar to the Inspire Foundation’s (2009) evaluation Headstrong/Jigsaw offer a broad range of activities, which allows youn people to committ when and how they choose to. Young people are represented on the board of directors of Headstrong and on some of the operational management groups of Jigsaw, highlighting a lack of consistency of young people being present at this decision making level throughout the organization. Headstrong/Jigsaw do not have an organizational definition for youth participation and therefore need to define what youth participation is and what role young people and staff play. There is no evident model of youth participation present in Headstrong/Jigsaw. While Hart’s ladder of participation was discussed in the staff focus group there was a distinctive lack of clarity about what the organization is aiming for in relation to youth participation. Staff and young people both expressed opinions that young people didn’t want ultimate power and decision-making but wanted to be part of the process in how decisions were made. This study would support cautions applied to traditional hierarchical models of participation put forward by Barber (2007) and Hart (1992). This study reinforces Head’s (2011) belief that full participation, while being aspirational, is dependent on situations, cultures and settings. In a youth mental health setting, while young peoples’ opinions are important, due to the clinical nature of the service, adults with professional experience should hold the final decision. The development of a linear, and organisational specific model of youth participation may be more useful for Headstrong/Jigsaw, which would allow a more flexible, situational approach to youth participation.

 

5.3 The Factors that Support Youth Participation in Headstrong/Jigsaw

5.3.1 Resources

The findings of this study are in line with the views of James (2007) and Day (2008) that the resourcing of youth participation is required to promote and support participation. In accordance with recommendations from The National Children’s Office (2005) food and travel costs are provided for young people to ensure they are able to participate without any financial burden. While there has been some allocation of funding towards youth participation to cover food and transport costs, the findings would indicate that the resource allocation for youth participation is not adequate. This has resulted in staff not being able to work with the young people as much as they would like. This corresponds to Revan’s (2009) research which also found a lack of resources results in an inability of organizations to accommodate young people in their decision making structures and therefore becomes a barrier to effective participation. This is evident in some Jigsaw projects who have not included young people on their management structures and through the numerous staff who commented on the limited interactions they have with the YAP. While it is acknowledged that resources help youth participation in Headstrong/Jigsaw, it is also a challenge when these resources are limited which is the case in some of the Jigsaw
projects.

5.3.2 A Member of Staff

This study supports the assertion of the AICAFMHA (2008) that a key staff member whose responsibility it is for the promotion and support of youth participation is a crucial factor for youth participation to thrive. The role of the youth engagment officer/youth and community engagment worker was seen as a commitment on the part of Headstrong/Jigsaw to support young people’s participation. This role was resourced differently between Jigsaw projects and Headstrong with a time allocation of between one to five days. When there was limited resources this had a detrimental effect on youth participation and impacted on the level at which staff could incorporate young people into their work. This supports Howe et al., (2011) view that when this resource is not present, participation is affected negatively. While Headstrong/Jigsaw are enthusiastic about youth participation this is not necessarily resorced adequately throughout the organisation. This study would support Head’s (2011) caution that youth participation should not fall solely on one staff member’s shoulders as it should be a part of everyone’s role. It would benefit the research base of youth participation if a comparison was done between Jigsaw projects to ascertain what differences are present between the different projects, and what impact having a staff member has on these differences.

5.3.3 The Organisational Culture

Hart (1992) emphasised that some environments are more conducive to the development of youth participation and the environment in Headstrong/Jigsaw is one of these. Headstrong/Jigsaw has a positive culture of youth participation and it is reinforced in a top down and bottom up approach, which is vital according to Davies (2008). The importance of physically seeing and interacting with one another should not be underestimated in the organisation and there is a real desire from participants to see this increase. This positivity must be translated into action, and supports Kirby et al.’s (2003) findings that youth participation requires time and effort, on behalf of the staff and young people, to succeed. Staff have created a welcoming space where young people in Headstrong/Jigsaw feel safe and secure to give their opinions. This is in line with the view of Collin et al., (2011) who claim that a positive youth participation culture is beneficial for both staff and young people within a youth mental health service. As the organisation grows it is important for this positive culture to remain. While there are positive views towards youth participation, 45% of staff reported never or rarely involving young people in their work. This should be a concern to the organisation as youth participaton should be about young people being actively involved working alongside staff. The organisational culture needs to develop so that working alongside young people becomes a normal part of staff’s work as opposed to once off activities.

 

5.4 The Benefits of Youth Participation

5.4.1 To the Young People Involved

The findings from this study correspond with Kirby et al.’s (2003) research which found that youth participation gives young people an opportunity to have fun and meet new people, while giving them the chance to help their communities. Being on a YAP has been an overwhelming positive experience for the majority of the YAP. The findings of this research mirrored results found in the Inspire Foundation (2009) evaluation which also found young people reported an increase in their confidence working with staff, their confidence working in a professional environment, their ability to work as part of a team, and their oral communication skills. Also showing increases in this present study, was the young person’s understanding of youth mental health, their own ability to seek help if they needed it and a sense of belonging. This would reinforce findings from Law (1998) and Oliver et al. (2006) which also believed that being involved in a participatory activity can have a positive impact on help seeking and mental health awareness. The findings from this research were primarily based upon a retrospective self-assessment, and would be strengthed by a longitutdinal study with young people that measured changes pre and post their involvement in youth participation structures. It is also important to consider that it is possible that young people who had positive experiences were the ones who took part in the study, and possibly some of the 44% who didn’t take part may have had other experiences.

5.4.2 To the Jigsaw Service

Young people and staff believed that involving young people in Headstrong/Jigsaw has created helped create a service that is responsive to the needs of the young people using it, which supports Monson & Thurley’s (2011) and Revan’s (2009) argument for the importance of youth participation in youth mental health settings. Young people are viewed as useful resources to the Jigsaw service. Findings from this study mirror the Inspire Foundation’s (2009) evaluation where young people and staff also held strong beliefs that involving young people was a key factor in effective service design and promotion. This research also adds further weight to Kirby et al.’s (2003) finding that involving young people makes the service more credible, real and accountable. This study supports Oldfield and Folwers (2004) and Sinclairs (2004) claims that involving young people is the right thing to do as it contributes to improved services. Ultimately, staff and young people feel there have been many benefits to the service in terms of design and promotion of the service Further examination is needed on the services users experience of Jigsaw and how youth participaton has impacted on their journey through the service. It would benefit this field of study to compare Headstrong/Jigsaw to a similar organisation that does not have youth participation to ascertain any differences.

 

5.5 The Challenges of Youth Participation

5.5.1 A Lack of Time

A lack of time to engage with young people was a dominant barrier found, and time was also a challenge for involving young people in the Inspire Foundation (2009) evaluation. When time was ‘protected’ in a diary, this ensured the staff members were able to meet with the young people. This lack of time, combined with lack of resources has resulted in staff not being able to work with young people as much as they would like. Staff must also work to deadlines that limit the opportunity for young people to get involved. Young people understand that deadlines need to be met, and that their involvement is not always possible, but not being involved leads to frustration. The progressive organisation culture of youth participation is challenged when this happens. This research would support the recommendation of the National Children’s Office (2005) which state that time is a critical challenge for young people as well. They have competeing interests and sometimes they are not able to committ the time they need to Headstrong/Jigsaw. This lack of time for staff to involve young people may contradict the findings of the strong organisational culture towards youth participation. If the organisation is truly committed to youth participation, staff should be supported to involve young people in a meaningful way.

5.5.2 Lack of Diversity

From the participant demographic given there would appear to be limited representation from young parents, unemployed, working, or young people who have not taken a traditional educational route. These are groups of the population who Kelleher et al. (2014) would describe as seldom heard and underrepresented. Both staff and young people commented on the homogenous nature of the YAP’s and expressed a desire for more diversity. While the research did not examine social class, it agrees with Roe and McEvoy’s (2011) findings that those who become involved in participatory activities are usually well educated and articulate young people. It is clear the majority of participants who took part in this study are from college and school and similarity a homogenous group was found to be present in the Inspire Foundation’s (2009) evaluation. It must be considered that 44% of young people did not reply, therefore it would be preemptive to presume that all of these young people who did not participate are in college or school. It is also important to caution that engaging seldom-heard groups is not easy. As The National Children’s Office, (2005) correctly points out, working with seldom-heard groups takes time, skills and new understandings and with the limited resources dedicated towards youth participation this may not be possible. Therefore, while it has been highlighted that diversity is a challenge within Headstrong/Jigsaw, time and resources have also been highlighted, therefore these challenges would need to be overcome first before the issue of diversity can be addressed. The age profile of the participants was also surprising, as only 11% were under 18, and no one was under 16. For an organization who caters for 12-25 to not have structure in place to ensure the voices of 12-16 year olds are heard perhaps goes against the principles of youth participation.

5.5.3 Lack of Training and Skillset

A lack of skill set is evident for both staff and young people and has presented as a challenge as these skills are needed to support youth participation as highlighted by O’ Dongohue et al. (2002). Certain decisions especially around clinical services may require a skill set, training and qualifications that a young person just may not have to equip to participate fully as claimed by Young Minds (2005). While young people have been involved in a large amount of activites with Jigsaw/Headstrong their lack of skills set was a concern especially for clinical staff members. This group of staff found it harder to incorporate young people into their work. This was a problem for staff as they also needed a skill set from which to work with the young people in a participatory way. This mirrored findings in the Inspire Foundation’s (2009) evaluation which also found that staff identified a lack of training for staff to be a challenge. The young people felt that they needed certain skills in certain situations and that at times they did not have these. This research supports guidelines by The National Children’s Office (2005) that successful participation requires training and support for both adults and child/young people involved as both groups need new information, knowledge and skills. O’ Dongohue et al. (2002) stated that young people and adults need to be given the time and space they need to develop skills and expertise to participate effectively. This will present a further difficulty when promoting youth participation within the organisation as time constraints have already been highlighted as a challenge.

5.5.4 Lack of Clarity

The AICAFFHMA (2008) highlighted a lack of knowledge and clarity about participation acts as a barrier to youth participation. There is a distinctive lack of clarity in Headstrong/Jigsaw regarding youth participation and where young people fit into processes and decision making. This lack of clarity led to frustrations for young people when they did not feel part of decisions within the organisation or when they feel pressured into supporting projects. Young people needed to know at the start of a process what their role was going to be, and to be kept informed about how decisions were made. This does not appear to happen in Headstrong/Jigsaw, and there was dissatisfaction expressed about the lack of clarity as to how decisions had been made. This study supports Neill’s (2005) finding that when organisations are not clear with young people from the start this can create difficulties. The study supports research by Davies (2008) and Kendall and Merrill (2008) who believed that when young people feel their voice has not been listened to they can become disillusioned and disengaged from the process. While young people as a group feel listened to within Headstrong/Jigsaw there was a minority who expressed feelings of dissatisfaction with levels of consultation, participation and feedback provided. Headstrong/Jigsaw needs to ensure that these feelings of dissatisfaction do not increase and therefore as Head, (2011) declares, clarity about aims, purposes, methods and processes are needed to ensure that the benefits and limitations of participation in each case are made explicit to the young people and staff involved. Staff also lacked clarity on youth participation. There was a very real sense that they were meant to work in a way that facilitated this approach but had not been given the information, skills, training and time to allow them to do it.

Headstrong/Jigsaw needs to view this challenges, not in isolation but how they are interconnected. A lack of clarity and knowledge about youth participation within the organisation, will not aid planning in the area of resource allocations, which are needed to support staff in involving young people. Youth participation is proving itself to be benefical, but more research is needed to ascertain what resources are needed to implement an effective youth engagment strategy. It is this study’s assertion that a comprehensive youth participation strategy must be developed first and foremost in an organisation to identify what form youth participation will take, what are the markers of success, and what resource allocation is feasible to progress this strategy.

 

5.6 Limitations and Strengths of the Study

The study was conducted on a national organisation and it’s programme of service delivery. This approach did not allow for individual Jigsaw projects to identify themselves, which would have given an opportunity to compare and contrast differences between Jigsaw projects and also the Headstrong National Office. Due to the limited number of staff in employment in the organisation it was not possible for staff to identify their role within the organisation, which would have allowed for a comparison across disciplines.

This study was only able to draw on staff and YAP member’s thoughts on youth participation. While the staff response rate was positive, 46% of young people on YAP’s did not respond. The views of the service user, who is a key stakeholder in a youth mental health service was not explored due to ethical concerns. There was no measure used, nor did the researcher find one, that was able to identify the impact youth participation on youth mental health services. This is a potential area for future research.

Despite its limitations the study addresses a gap in knowledge about youth participation in an Irish youth mental health context. The study also obtained views from young people and staff giving a good insight into youth participation from a variety of viewpoints and experiences. A further strength was the flexibility of a mixed methods approach, with two different samples which meant more people could have their voice heard within this study.

 

 

CHAPTER 6: CONCLUSION

 

6.1 Introduction

The aim of this study was to explore staff and young people’s perspectives of youth participation in an Irish youth mental health service. Information was obtained as to the depth and type of involvement of young people in Headstrong/Jigsaw. Key factors that support youth participation, benefits to young people and services, and the challenges that are faced were all examined to provide understanding to the complicated nature of youth participation. It is clear that factors, which promote youth participation, can also become challenges.

 

6.2 What Form does Youth Participation take in Headstrong/Jigsaw?

Headstrong/Jigsaw have a positive and progressive ethos and organisation culture towards youth participation.. Their commitment to youth participation is evidenced through their forming of youth advisory panels and the resourcing of workers to support these panels. Young people give a considerable amount of time and are heavily involved in the design and set up of Jigsaw, but their role becomes somewhat unclear and ambiguous in relation to the implementation and evaluation aspects of the organisation. Young people and staff believe that young people should be consulted and involved in decision-making, as partners in the process, but they should not be the ultimate decision makers as it is a youth mental health service, and therefore some decisions may require expertise and skills sets that young people may not have. The strongest example within the organisation of young people sharing decisions with staff is their involvement interviewing new staff and the most frequent example is promoting the service and fundraising for it. While young people sit with the board of directors of Headstrong there are inconsistencies in how young people are represented in management structures in Jigsaw projects which needs to be addressed. While the organisation has a positive progressive culture towards youth participation this is not matched evenly in the resourcing directed towards youth participation. Considering the economic climate Ireland has emerged from it is a credit to the organisation that every Jigsaw project has a at least one day a week allocation for this work.

 

6.3 What are the Factors that Promotes Youth Participation?

The positive progressive organisation culture and staff attitudes towards youth participation are a dominant factor in promoting youth participation in Headstrong/Jigsaw. A top down bottom up approach, and a welcoming staff attitude have ensured young people feel safe and comfortable to give their opinions. Staff appreciate the benefits of working with young people, and both staff and young people feel that seeing each other and interacting with one another contributes to the enhancement of youth participation.

Resources proved to be a factor that both promotes and challenges youth participation in Headstrong/Jigsaw. An allocated budget that allows for young people’s expenses to be covered reduces barriers to young people’s participation. Resources have also been allocated for the employment of a member of staff whose specific role it is to support and promote youth participation. The allocated time for each worker varies between the Jigsaw projects but where this resource allocation has been limited, youth participation has suffered as a result.

 

6.4 What are the Benefits of Youth Participation to Young people and the Jigsaw Service?

It is clear that young people experience many benefits as a result of their involvement with Headstrong/Jigsaw. Their confidence working with staff, understanding of youth mental health, confidence working in a professional environment, sense of belonging, and how likely they were to seek help if they had a problem all increased. It has created positive experiences , allowed them to have an impact on their communities and contributed to their growth as individuals.

Involving young people has particularly been beneficial in promoting Jigsaw, to the young people who use Jigsaw, to the development of programme/projects and initiatives, it has lead to better decision-making, and has supported staff in their work. Involving young people has also benefited the Jigsaw service as it has helped it become more youth friendly, credible and accountable.

 

6.5 What are the Challenges of Youth Participation?

A lack of time and resources are evident challenges in Headstrong/Jigsaw and impact on how meaningful young people can be involved. The lack of training for both staff and young people to enable them to work in a participatory way is a difficulty for staff and young people. The homogenous nature of the young people involved has been called into question. These barriers are intrinsically linked, as adequate resources would support training, which would also allow for the engagement of harder to reach young people. More resources would also allow staff to allocate time in their schedule to ensure they can work with young people.

Headstrong/Jigsaw does not have a definition for youth participation and a model which they base it on. Staff often do not know what they are aspiring to, and young people can also be confused about their role. This has led to frustrations for both young people and staff, where young people have not been involved in areas they felt they should have been. There also appears to be inconsistencies in participation throughout the organisation, with Jigsaw projects being at very different stages to one another, with some Jigsaw projects still do not have young people on their management structures. Feedback structures are not present to show young people where their feedback has been involved and this needs to be prioritised going forward.

 

6.6 Recommendations

•  Organisations must have clarity about youth participation before they embark upon it. An organisation should have a definition of youth participation and an appropriate model from which they work. This model should be linear and create a range of participatory activities in which a young person can get involved.
• Adequate resourcing, including a role specifically designed for youth participation should be a key consideration of any organisation that is hoping to develop a youth participation strategy. A budget should be set aside for the support of the young people. This adequate resourcing should also support the participation of seldome heard young people on participatory structures.
• Training for staff and young people in youth participation is essential for young people to be meaningfully involved.
• Organisations must ensure effective feedback mechanisms for young people so they are aware of where their inputs have or have not been taken on board and if not, why. This will stop young people from disengaging by feeling their voice has not been heard and reduce consultation fatigue.
• The development of evaluation tools for youth participation is vital for the furthering of an evidence base on this area. Much more research on youth participation in a youth mental health service is required.

 

6.7 Conclusion

Headstrong/Jigsaw are breaking new ground in their quest to ensure young people’s voices are heard in the design, implementation and evaluation of youth mental health services. Youth participation is a process and a journey that the organization is on. It is a journey that has no road map, infact staff and the YAP are creating their own, each learning to trust one another along the way. The numerous benefits youth participation has brought are considerable and should be celebrated. Working with young people in a participatory way will provide challenges, but if young people and staff navigate these obstacles together the final destination of meaningful youth participation can be reached.

 

 

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APPENDICES

 

Appendix A: Better Outcomes, Brighter Futures Overview

 

 

Appendix B: Hart’s Ladder of Participation

 

 

Appendix C: Jigsaw Staff Questionnaire

 

 

Appendix D: Headstrong Staff Questionnaire

 

 

Appendix E: Jigsaw YAP Questionnaire

 

 

Appendix F: Headstrong YAP Questionnaire

 

 

Appendix G: Focus Group Consent (Staff and Youth)

 

Hey there,

My name is James and I am the youth engagement officer with Headstrong, the National Centre for Youth Mental Health. I am writing to invite you to a focus group at ……………………………………………… on ………………………… from ………… to ………….

A focus group is when people meet to talk about a topic that a person called a researcher wants to know more about. The topic here is youth participation and as you are a youth advisory panel member it is really important that we get your opinions on youth participation in Jigsaw/Headstrong. The information received from this focus will give further understanding to youth participation in Headstrong and Jigsaw from both a YAP and staff view point. It will examine the benefits and challenges regarding youth participation in the design, implementation and evaluation of a mental health service.

This is a voluntary study. It is up to you to decide whether you are going to take part or not. You are in no way under pressure to attend the focus and are free to leave the group at any time.

The focus group will last about an hour, and will be recorded on a voice recorder. The results of the focus group may be published in the future or may be presented at conferences. However, as you do not put your name on the surveys, no information identifying you or your Jigsaw project will be included in these reports.

If you do decide to take part, please complete the consent form enclosed with this letter, showing on the form whether or not you would like to participate in the focus group. Please return your signed consent forms to the drop off box in the reception of your Jigsaw project.

If you have any further questions about this research please contact James Barry at:

 

Thank you for your time.
Yours sincerely,
James Barry

 

CONSENT FORM FOR YOUTH PARTICIPANTS OF FOCUS GROUPS (OVER 18)

 

Please complete this consent form and ensure that you drop it back into Jigsaw or posts it to the address below. THANK YOU

I …………………………………. . consent / do not consent (delete as appropriate) to participate in the focus group “Youth Participation in the design, implementation and evaluation of a mental health service at ………………on …………………… from …… to ……….

 

Name: ……………………………………………………………………….

Signature: ……………………………………………………………………….

Date: ……………………………………………………………………….

 

 

Dear Staff member,

I am writing to you invite you to participate in a focus group to be held at …………………………. on …………………from …………. . to …………….

The purpose of this focus group is to give staff a voice to allow us gain a deeper understanding about youth participation within Jigsaw/Headstrong. The information received from this focus group will allow us to examine the benefits and challenges regarding youth participation in the design, implementation and evaluation of a mental health service. Other participants in the focus group will be members of staff from Jigsaw projects and Headstrong and will be facilitated by me, James Barry, Youth Engagement Officer with Headstrong, the National Centre for Youth Mental Health.

This is a voluntary study. You are free to withdraw from the study at any time and without giving a reason.

The results of the focus group will be analyzed and a report of the findings will be given to Jigsaw projects. The results may be published in the future or may be presented at conferences. However, as the surveys are anonymous, no information to identify your child will be included.

I would be most grateful if you could complete the consent form enclosed with this letter, indicating whether or not you would like to participate in the study.

If you have any queries or would like further information about the focus group and the research project, please feel free to contact me on the details below:

 

Thank you for your time.
Yours sincerely,
James Barry

 

 

CONSENT FORM FOR STAFF PARTICIPANTS OF FOCUS GROUPS

 

Please complete this consent form and ensure that you drop it back into Jigsaw/Headstrong or post it to the address below. THANK YOU

I …………………………………. . consent / do not consent (delete as appropriate) to participate in the focus group “Youth Participation in the design, implementation and evaluation of a mental health service at ………………on …………………… from …… to ……….

 

Name: ……………………………………………………………………….

Signature: ……………………………………………………………………….

Date: ……………………………………………………………………….

 

 

Appendix H: Parental Consent Questionnaire

Dear Parent / Guardian,

I am writing to invite your child to take part in a survey being carried out to explore youth participation in the design, implementation and evaluation of a mental health service. The research is being carried out by myself, James Barry, Youth Engagement Officer with Headstrong, The National Centre for Youth Mental Health as a requirement of studies for an MA in Child, Family and Community Studies in Dublin Institute of Technology. My supervisor is Dr. Sinead Freeman, 01-4024210, [email protected]. I am inviting your child to take part, as I am keen to hear their opinions about youth participation through the work they do as a youth advisory panel member. I am confident that the information I find from this research will allow us to strengthen youth participation in Ireland.

About the project: Youth Advisory Panel members and staff are completing the survey across the Jigsaw projects and Headstrong with a view to gaining a deeper understanding about youth participation.

Aim of the research: The information received from this survey will give further understanding to youth participation in Headstrong and Jigsaw from both a YAP and staff view point. It will examine the benefits and challenges regarding youth participation in the design, implementation and evaluation of a mental health service.

What your child needs to do if they take part: If you give permission for your child to take part in this study, your child will be asked to complete a survey which will take about 10-15 minutes to complete and will be completed in a setting of their choice. The information given in the survey will be anonymous, as your child will not be asked to put their name on the survey. However, because your child’s name will not be on the survey, you will not be able to take your son/daughter’s survey out of the research once your child has completed it.

Voluntary participation: This is a voluntary study. This means that it is up to both you and your son/daughter to decide if they wish to take part or not. If you or your child decides not to take part, this will not in any way affect your child’s rights. Your child is free to withdraw from the study at any time up to the point of submitting their questionnaire without giving a reason.

Support: If taking part in this survey raises any concerns or difficulties for the young person, it is important that they let someone know. Jigsaw in your area provides a free and confidential service if you wish to access support.

Use of the data: The results of the survey will be analysed and a report of the findings will be given to your local Jigsaw project. The results may be published in the future or may be presented at conferences. However, as the surveys are anonymous, no information to identify your child will be included.

Consent: As your child is under 18 years of age, your consent is needed before your child can participate in this research. If you could complete the consent form enclosed with this letter, indicating whether or not you would like your son/daughter to participate in the study. Please ask your child to return the consent forms to Jigsaw where there is a drop off box, or please return with the stamped addressed envelope attached.

Questions: If you have any questions regarding this project please do not hesitate to contact James Barry (contact details provided below).

 

Thank you for your time.
Yours sincerely
James Barry

 

PARENTAL/GUARDIAN CONSENT FORM

 

Research Topic: “Youth Participation in the design, implementation and evaluation of a mental health service”

Researcher: James Barry, Youth Engagement Officer, Headstrong, The National Centre for Youth Mental Health, MA Student, Child Family and Community Studies, Dublin Institute of Technology.

•  I understand the purpose of this research and what my son/daughters participation involves.
•  I have had time to consider whether I want my child to take part in this research and any questions that I had were answered satisfactorily.
•  I understand that my child’s participation is VOLUNTARY and that my child and I have a choice as to whether she/he participates. I also understand that they are free to stop their participation in the study at any time if she/he chooses to do so.
•  I understand that the information collected may be presented and/or published in reports and at conferences, but that my son/daughter will be identifiable from the information.
•  I agree to my child’s data being anonymized and securely archived at Headstrong, the National Centre for Youth Mental Health to be reused for research purposes.

Please tick as appropriate:

 

Name of your child (in block letters): …………………………………………………

Name of Parent/Guardian (in block letters): …………………………………………. .

Parent / Guardian signature:…. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date: ……………………………………………………………………………………

 

Appendix I: Under 18 Consent Form

 

Research Topic: “Youth Participation in the design, implementation and evaluation of a mental health service”

Dear Youth Advisory Panel Member,

I would like to invite you to take part in an online survey which is looking at youth participation in the way a youth mental health service is designed, run and reviewed. The research is being carried out by myself, James Barry, Youth Engagement Officer with Headstrong, The National Centre for Youth Mental Health as a requirement of studies for an MA in Child, Family and Community Studies in Dublin Institute of Technology. My supervisor is Dr Sinead Freeman, 01-4024210, [email protected]. I am inviting you to take part, as I am keen to hear your opinions about youth participation.

About the project: Youth Advisory Panel (YAP) members and staff are completing the survey across the Jigsaw projects and Headstrong with a view to gaining a deeper understanding about youth participation.

Aim of the research: The information gathered from this survey will give further understanding to youth participation in Headstrong and Jigsaw from both a YAP and staff view point. It will examine the benefits and challenges regarding youth participation in how a youth mental health service is designed, run and reviewed.

What you need to do if you take part: Participation in this study involves completing an online survey. The survey asks questions about your thoughts and experiences on youth participation, and your own attitudes to mental health and help seeking. This survey will take about 15 minutes to complete and can be completed anywhere you are comfortable to do it. A link will be sent to you once consent has been received.

Voluntary participation: This is a voluntary study. It is up to you to decide whether you are going to take part or not. You are in no way under pressure to complete the survey and are free to withdraw from the study at any time up to the point your submit your survey.

Support: If you feel upset while filling out the survey in this study, or afterwards, it is important to talk to an adult you trust. Jigsaw in your area also provides a free and confidential service if you wish to access support.

Use of the information: The results of the survey will be included in a dissertation and may be published in the future or may be presented at conferences. However, as you are not asked to put your name on the surveys, no information identifying you or your Jigsaw project will be included in these reports. All information will be confidential and stored securely.

Consent: As you are under 18 years of age, both you and your parent/guardian’s consent are needed before you can take part in this research. I would be most grateful if you could discuss participating in the study with your parent/guardian. If you wish to take part, please return your parent/guardian’s consent form to Jigsaw or return them with the stamped addressed envelope attached.

If however, you would prefer to complete the survey in a paper format, please contact me (details provided below) and I can send you a copy in the post.

Questions: If you have any further questions about this research please contact James Barry at:

 

Thank you for your time.
Yours sincerely
James Barry

 

 

YOUNG PERSON CONSENT FORM (UNDER 18)

 

Research Topic: “Youth Participation in the design, implementation and evaluation of a mental health service”

Researcher: James Barry, Youth Engagement Officer, Headstrong, The National Centre for Youth Mental Health, MA Student, Child Family and Community Studies, Dublin Institute of Technology

•  I have read the information sheet describing the above study and the consent form, and know what taking part involves.
• I have had time to consider whether to take part in the study and any questions I have asked about the study have been answered.
•  I understand that my participation is VOLUNTARY and that I can stop taking part in the research at any time.
•  I understand that findings from the research may be published in the future, but that no names will be included in any reports.
•  I agree to my data being anonymised and securely archived at Headstrong the National Centre for Youth Mental Health to be reused for research purposes.

Please tick as appropriate:

 

 

 

 

Your name (in block letters): …………………………………………………………

Your signature: ……………………………………………………………………….

Your contact email to which the survey link will be sent: ……………………………

Date: ………………………………………………………………………………….

 

 

Appendix J: Staff Information Sheet

 

Dear Jigsaw/Headstrong member of staff,

I would like to invite you to take part in an online survey exploring youth participation in the design, implementation and evaluation of a youth mental health service. The research is being carried out by myself James Barry, Youth Engagement Officer with Headstrong, The National Centre for Youth Mental Health as a requirement of studies for an MA in Child, Family and Community Studies. My supervisor is Dr Sinead Freeman, 01-4024210, [email protected] I am inviting you to take part, as I am keen to hear your opinions as a member of staff about youth participation within the organization.

About the project: Youth Advisory Panel members and staff are completing the survey across the Jigsaw projects and Headstrong with a view to gaining a deeper understanding about youth participation.

Aim of the research: The information received from this survey will give a further understanding of youth participation in Headstrong and Jigsaw from the perspectives of both YAP members and staff. It will examine the benefits and challenges regarding youth participation in the design, implementation and evaluation of a mental health service.

What you need to do if you take part: Participation in this study involves completing an anonymous online survey. The survey asks questions about your thoughts on youth participation. This survey will take about 15 minutes to complete and can be completed anywhere you are comfortable to do it. A link will be sent to your work email account.

Voluntary participation: This is a voluntary study. It is up to you to decide whether you are going to take part or not. You are in no way under pressure to complete the survey and are free to withdraw from the study at any time up until the point where you submit the survey. As you have not given your name on the survey there is no way to take it out after the point of submission.

Support: If you feel upset while filling out the survey in this study, or afterwards, it is important to seek appropriate supports through either your supervision or line management structures.

Use of the data: The results of the survey may be published in the future or may be presented at conferences. However, as I have not asked you to put your name on the surveys, no information identifying you or your Jigsaw project will be included in these reports.

Consent: If you do decide to take part you will be asked to tick the consent box on the online survey. If however, you would prefer to complete the survey in a paper format, please contact me (details provided below) and I can send you a copy in the post.

Questions: If you have any further questions about this research please contact James Barry at:

 

Thank you for your time.
Yours sincerely,
James Barry

 

 

Appendix K: Youth Information Sheet

 

Research Topic: “Youth Participation in the design, implementation and evaluation of a mental health service”

Dear Youth Advisory Panel Member,

I would like to invite you to take part in an online survey which is looking at youth participation in the way a youth mental health service is designed, run and reviewed. The research is being carried out by myself, James Barry, Youth Engagement Officer with Headstrong, The National Centre for Youth Mental Health as a requirement of studies for an MA in Child, Family and Community Studies in Dublin Institute of Technology. My supervisor is Dr Sinead Freeman, 01-4024210, [email protected]. I am inviting you to take part, as I am keen to hear your opinions about youth participation.

About the project: Youth Advisory Panel (YAP) members and staff are completing the survey across the Jigsaw projects and Headstrong with a view to gaining a deeper understanding about youth participation.

Aim of the research: The information gathered from this survey will give further understanding to youth participation in Headstrong and Jigsaw from both a YAP and staff view point. It will examine the benefits and challenges regarding youth participation in how a youth mental health service is designed, run and reviewed.

What you need to do if you take part: Participation in this study involves completing an online survey. The survey asks questions about your thoughts and experiences of youth participation, and your own attitudes to mental health and help seeking. This survey will take about 15 minutes to complete and can be completed anywhere you are comfortable to do it. A link will be sent to you through the staff member in your Jigsaw project who works with the YAP.

Voluntary participation: This is a voluntary study. It is up to you to decide whether you are going to take part or not. You are in no way under pressure to complete the survey and are free to withdraw from the study at any time up to the point your submit your survey.

Support: If you feel upset while filling out the survey in this study, or afterwards, it is important to talk to an adult you trust. Jigsaw in your area also provides a free and confidential service if you wish to access support.

Use of the information: The results of the survey will be included in a dissertation and may be published in the future or may be presented at conferences. However, as you are not asked to put your name on the surveys, no information identifying you or your Jigsaw project will be included in these reports. All information will be confidential and stored securely.

Consent: When you log into the survey there will be a section that asks you to confirm that you are over 18 and that you consent to take part in this survey. If however, you would prefer to complete the survey in a paper format, please contact me (details provided below) and I can send you a copy in the post.

Questions: If you have any further questions about this research please contact James Barry at:

 

Thank you for your time.
Yours sincerely
James Barry

 

 

Appendix L: Focus Group Protocol

This focus group protocol was designed to support the research in the carrying out of the focus groups to make sure all relevant areas were thought through to ensure each focus group would be beneficial for the research and also the participants. The protocol was divided into phases:

Phase One: Before the focus group

Phase Two: The focus groups themselves

Phase Three: After the focus group

PHASE 1: BEFORE THE FOCUS GROUP

1. Get approval for this method of data collection:

a. A proposal, methodology and ethical approval is required to be submitted and approved about the methods of data collection. Once this is approved the following steps must be undertaken.

2. Decide on the number of focus groups:

a. It was determined that 3 focus groups would be suitable. As it was a mixed methods approach these focus groups will hopefully give more depth to the quantitative responses It was decided to do an extra staff focus group as they were an easier sample to recruit as they were able to participate during their working hours. As there were much more young people involved in the organisation the numbers would also balance out.

3. Identification of participants:

a. No more than 8 and no less than 6 people will be invited to participate.

b. Criteria is that they must be a member of staff full time for at least a year or be a member of a youth advisory panel for a year.

c. Staff to be emailed an invite to attend, while making sure there is a diversity of staff roles.

d. Young people to be invited to attend through their Facebook group and email.

4. Generate questions:

a. Questions were developed to answer the research questions and to allow flow.

b. Additional questions may be added to allow for more depth of information or to seek clarification.

c. Questions started off general and then developed into specific, all with a clear purpose to answer the research questions.

5. Development of script

a. Part one: participants to be welcomed with a clear explanation of the research aims and general instructions. A clear explanation about confidentiality must be give and the important of not using names. A clear explanation of the recording as well.

b. Part two: Ask the main questions, but be conscious to probe and ask follow up questions if the need arises.

c. Part three: Close the focus group by thanking the participants and explaining where the information will be going and when they should hope to hear back from.

6. Choose the location

a. Headstrong offices in Dublin were chosen for ease of access and familiarity for participants.

b. Basic tea/coffee/water and scones were provided for participants.

PHASE 2: The focus group itself

1. Materials needed:

a. Notepad
b. 2 Dictaphone’s (1 for back up)
c. List of participants
d. List of questions
e. Name tags
f. Clock on wall

2. Room to be set up 30 minutes in advance, including heating on as it is a cold room. .

3. Introduce yourself in your role of the researcher. Important to reference that you are not here in your role as youth engagement officer.

4. Start the focus group while being mindful of:

a. Ensuring an atmosphere of honesty and respect
b. Tone of voice
c. Make sure that everyone is projecting their voice towards the dictaphone and can hear one another
d. If the group are talking over one another ensure it is only one voice at a time
e. Do not let it go off topic – ensure a list of research questions are there throughout
f. If someone is quieter make sure to involve them in the conversation
g. Keep an eye on time
h. Make sure you do not provide any information/ agree or disagree with any participants. You are there as the researcher first and foremost

PHASE 3: After the focus group

1. Data

a. Immediately after the focus group, download the audio recordings and back up each copy.
b. Make quick notes about main points that came across.
c. Follow up with a thank you email to all participants.
d. Transcribe interviews
e. Analyze data.

 

Appendix M: Youth Focus Group Questions

 

1. Can you all please say your name and age please?

2. How long have you all been involved in your youth advisory panel?

3. What motivated you to get involved in the Youth Advisory Panel?

4. If an alien came into the room how would you explain youth participation to them?

5. Do you think there is a difference sitting on the Headstrong YAP compared to sitting on a Jigsaw YAP?

6. How involved do you feel young people have been in the design, implementation and evaluation of Jigsaw/Headstrong

7. Can you give practical examples of how young people have /haven’t been involved in particular areas?

8. Do staff treat you like you are on the same level as them or do they speak to you differently because you are a young person?

9. What do you think are the factors that promote youth participations?

10. What do you think are the barriers to youth participation?

11. How can these barriers be overcome?

12. If we had a time machine and we went forward five years, where would you like to see youth participation in Jigsaw/Headstrong

 

Appendix N: Staff Focus Group Questions

 

1. Can everyone please say their names and what their position is?

2. So if an alien was to walk into the room can you explain what youth participation is?

3. Do you feel that young people want to lead Headstrong/Jigsaw or be involved?

4. Do you feel there is clarity in your own YAP’s about where young people are invovled?

5. Is this a new way of working for you? Involving young people?

6. How involved do you feel young people have been in the design, – implementation and evaluation of Jigsaw/Headstrong

7. Can you give practical examples of how young people have /haven’t been involved in particular areas?

8. What do you think are the factors that promote youth participations?

9. What are the resource allocations for youth engagement in your project?

10. What do you think are the barriers to youth participation?

11. How can these barriers be overcome?

12. If we had a time machine and we went forward five years, where would you like to see youth participation in Jigsaw/Headstrong.

 

Appendix P: Sample Coding

 

QUESTION: What are the factors that promote youth participation?

CODE: A member of staff

Having John Smyth as a youth engagement officer

I think of one: John Smyth

The Youth Engagement Officer is very good at making sure that YP are thought about in all aspects of our work.

A dedicated YEO

YEO plays a huge role in promoting youth participation and ensuring that they remain involved

However, without the dedicated youth engagement resource I would not be able to work with the YAP

There is also a dedicated worker to facilitate YAP activities.

Hiring of a Youth Engagement Officer

Staff whose role is more specific to working with the YAP members, relay information I seek or the YAP member’s provide, regarding my role on my behalf.

Strong youth engagement officers appear to really promote youth participation.

A real presence of YEOs on-site and at team meetings.

Fun and engaging YCEW.

Having a person designated to work specifically with YAP.

Having a Youth Engagement Officer – full time if feasible

The youth and community role in Jigsaw Kerry

A Youth Engagement Officer on site who would facilitate regular meetings with young people

Having a Youth Engagement Officer who constantly and consistently consults the YAP on most changes and updates in Jigsaw.

A Youth engagement officer has made a massive effort to get everyone involved at
every stage.

I think the youth engagement officer has played a huge part as. She has involved young people at every stage.

Friendly approachable staff that are over the yap

Dedication of the staff, in particular our youth engagement officer

Active facilitator/Youth Engagement Officer who can speak to YP in a genuine way and who is supported by other staff.

Having a designated YAP person has been key.

An active youth engagement officer

John Smiths enthusiasm and interest in every young person’s opinion.