The Initial Problem and its Impact

Through speaking with RCPCH members, child health workers and reviewing existing resources, it was identified that there was a lack of practical “how to” materials to support professionals in delivering face to face sessions with children, young people and families.

The impact was twofold, professionals that felt they didn’t have the confidence or skills to involve children, young people or families to routinely involve them in strategic voice (shaping service design, supporting policy and strategy development). In addition this meant that young patients and their families were not consistently involved in providing feedback on services, in identifying gaps, reviewing service deliverables and being involved collaboratively with professionals to develop and test solutions.

Ultimately this provides a missed opportunity to provide a service user centred service that meets their needs as well as the potential for reducing long term disengagement with treatment plans. By having a service that actively listens and involves the service users strategically,  is fit for purpose, meets the needs of the patient, family and professional and has shared ownership in developing the best service possible, services can become more effective and efficient.

Causes of the Problem

The early stages of the project identified the following causes of the problem:

• Lack of confidence in delivering strategic level discussions with children and young people in an engaging and interesting way
• Perceived lack of budget, time or resources to “do it well”
• Lack of easy to understand information about the why this is important to do, how it makes a difference and what needs to be done operationally
• A perception that it is a “nice to have” and “an add on to the day job” rather than a statutory requirement within legislation

Aim

To develop with children, young people and families, a resource that is for healthcare professionals full of games and activities to support interactive and meaningful participation and engagement in service level decision making.

Outputs

1. a resource booklet with games and activities that can easily be picked, up, understood and delivered without the need for expensive materials or resources
2. learning opportunities for workers that includes information about the why, how and what for Recipes for Engagement
3. development of additional materials as required
4. provision of 1:1 information, advice and guidance through the Engagement Collaborative

Outcomes

• a workforce that is knowledgeable, confident and able to actively and meaningfully involve service users (Article 12 of the UNCRC)
• the best healthcare services possible for children and young people (Article 24 of the UNCRC)

Stakeholders

The RCPCH project team included

• • RCPCH Registrar
  • RCPCH Children and Young People’s Engagement Manager
  • RCPCH Children and Young People’s Participation and Advocacy Coordinator
  • RCPCH &Us Children, Young People and Family members

Stakeholders included:

• • Children, young people and families – involved in helping to design the games and activities within the Recipes for Engagement games booklet, and designing the workshop content and supporting delivery
  • RCPCH Members, child health workers, voluntary sector workers – involved in testing and providing feedback on the resources, identifying gaps and making recommendations

PDSA Cycles / Solution(s) Tested

2016 PDSA

Plan:

• • Identification of the challenge
  • Desk based research into available resources
  • Sessions with RCPCH &Us members (children, young people and families) to develop an approach

Do:

• • Resource development – Recipes for Engagement booklet and workshop
  • Delivery at RCPCH Annual Conference to 100 professionals

Study:

• • Feedback from professionals, what is missing, what needs to be improved, what difference it is making (soft and hard outcomes)

Act:

• • Include additional resources e.g. the standalone legislation briefing, how to write and engagement plan, examples and case studies of how people are “doing” engagement

Cycles:

1. 2016 Recipes for Engagement edition 1, workshop materials
2. 2017 Recipes for Engagement edition 2 (11 new activities), Legislation Briefing, How to write and engagement plan guide, refreshed workshop materials
3. 2018 RCPCH ICYP Engagement Committee review into what support do the paediatric workforce need to actively engage and involve children and young people in shaping services, The Art and Science of Effective Engagement CPD approved one day training programme launched, Recipes for Engagement edition 3 (merged the two separate previous editions as was causing confusion!)

Data Results

Due to the qualitative nature of this study, outcome measures link to our initial output markers:

Outputs:

1. 2 editions of the resource booklet were published with 22 tried and tested activities to use with children and young people.
2. Over 2400 healthcare workers have been in sessions exploring the RCPCH model for engagement.
3. Additional resources have been developed such as the legislation briefing, engagement 101 spark, how to write and an engagement plan, edition 2 of Recipes for Engagement, CPD approved engagement training.
4. 1000 workers have joined the Engagement Collaborative supporting workers on how to involve children and young people in shaping services with an average of 20 individual coaching and support sessions provided each quarter.

Outcomes:

• 2400 workers have now taken part in sessions that include information on the why, how and what for engagement including the Rights of the Child
• 1000 workers have joined the Engagement Collaborative and regularly receive information on how to create the best healthcare services possible through meaningful engagement. over 300 young people and family members have signed up to join the &Us Network and over 3500 children, young people and family members have shared their voices, views, needs and wishes and health topics through the RCPCH &Us Network, supporting development of the best healthcare services possible since 2016.

How This Improvement Will Be Sustained

The RCPCH Children and Young People’s Engagement team is a core function of the RCPCH strategic plan and offer to members and the wider child health workforce. As such, the ability for workers to access engagement expertise, information, advice and guidance, resources and materials remains a sustainable offer. Through oversight by the RCPCH Registrar who holds the portfolio for children and young people’s voice within the College and the Infants, Children and Young People’s Engagement Committee at RCPCH, there remains active scrutiny and a drive for further development.

Within the RCPCH 2018-2021 vision, a key performance indicator has been established to provide stretch targets around the active involvement of children and young people in shaping services. A robust operations plan ensures the programme remains centred on providing good quality opportunities for children and young people alongside workforce development and support. This includes embedding engagement through all RCPCH programmes such as providing Recipes for Engagement workforce training within the Diabetes QI Collaborative programme, supporting youth advocates to ensure audit programmes are reflective and reactive to both data needs and those of service users, as well as work to develop voice programmes within paediatric training and exams.

For local settings, information, support and advice can been accessed through the Engagement Collaborative which also provides links to local experts and organisations. Through increased awareness of the legislative frameworks across the UK and publications such as the NHS Long Term Plan in England (Jan 2019) where there are requirements for patient voice, local sustainability is growing.

As part of daily practice, there is a role for managers and practice supervisors to ensure the United Nations Convention on the Rights of the Child is part of training, supervisions, reflective practice, commissioning specifications and service monitoring and review processes. This will continue to raise the need for dialogue on engagement and to bring an outcomes based accountability approach (what would the service user say, feel, do) to child health work.

Challenges and Learnings

Whilst starting with the practical toolkit of games and activities, based on the review of existing materials that were incredibly theoretical, it became apparent that there was still an appetite for exploring the why and the how, rather than just focusing on the what.

How professionals access information has shifted from detailed publications such as “Not Just a Phase (2010) which explores the theory of participation and engagement with case studies, to a need for responsive and bite size chunks of information. This led the Recipes for Engagement programme to develop a range of short, easy to read publications, using mixed methods such as videos, booklets, bulletins, awareness sessions through to full day training courses, 2 page downloads to individual case studies and short reports.

Having the ability to continue to have access to face to face support and sessions remains important to the topic in being able to unpack concepts, explore challenges and test activities and practice in person.  Developing skills for the workforce in community profiling and stakeholder analysis, plus deepening understanding of specific areas of theory was also identified, leading to other programmes of work being established such as joint work with Picker to look at the impact of strategic voice and with NHS England on involvement in specialised commissioning.

Suggestions for Further Implementation

There is still a need to do more across all areas of an organisation to shift understanding around meaningful engagement of children and young people in service decision making, and in moving it from a “nice to have” to roles with clear job descriptions, targets, outputs and outcomes.

Engagement and participation training and awareness session with senior managers through to healthcare assistants is needed to embed learning at all decision making levels. By providing good quality support to people developing funding bids or service specifications to accurately cost and support meaningful engagement is also important, to address resource issues currently faced.

Accessing the existing workshop and training materials, and published resources already allows the Recipes for Engagement programme to be picked up and replicated anywhere across the UK. We have anecdotal feedback that this is being done in team meetings and training programmes.  We have also seen an increase in direct requests for the RCPCH Children and Young People’s Engagement team to deliver bespoke support.

Developing a Recipes for Engagement Module within paediatric training that builds in its complexity through the training pathway would also ensure there is an accumulation of skills, knowledge and confidence. This would see changes from when you first come into the paediatric workforce where you are focused on individual voice through to increasing competency in strategic voice. This would also have a parallel programme in paediatric training through the clinical exams and consultant assessment process – sending out a clear message as to the why, how and what.