Facilitating health behaviour change in looked after young people Lorna Watson, NHS Fife Hannah Dale, Health Psychologist, NHS Fife Pauline Adair, University of Strathclyde Gerry Humphris, University of St Andrews

Looked after young people (LAYP) have poorer health outcomes No reported interventions on LAYP evaluate on outcomes ‘Hard-to-reach’ Risk behaviours have been linked (Aicken et al, 2010) Factors such as feelings of safety and belonging (neighbourhood, school, family) may protect against multiple risk behaviours (Brooks et al, 2012) Physical activity associated with reduced risk for all substances and sexual risk behaviour (Nelson et al, 2006) Background

Objectives were to develop and evaluate a health behaviour change intervention for LAYP to improve their lifestyle around multiple risk behaviours

Social and environmental determinants of health & wellbeing Looked after children & young people Physical, sexual & emotional abuse Living with parents abusing alcohol or drugs Neglect Absences & gaps in schooling & low attainment Attachment issues Disruptive nature of placements Socio- ecomonic status No consistent positive adult support Being a child of a teenage mother

Psychological determinants of health & wellbeing Looked after children & young people InformationSocial norms Risk perception Attitude towards behaviour Self esteem & confidence MotivationReinforcement of behaviour Behavioural skill Plans to help support positive behaviour

3 main sources guided development: Methods Qualitative – focused on sexual health initially. Needs assessment Behaviour and behaviour change theories Theory 33 Effective interventions for young people around lifestyle. Evidence 1.Needs assessment revealed gap between knowledge and behaviour, need for flexible services and interventions spanning all lifestyle issues 2.Theories include Social Cognitive Theory, Theory of Planned Behaviour and Health Action Process Approach 3.Evidence mixed for some areas, especially for vulnerable populations 2 1

Research, theory and evidence around health behaviour change Behaviour change interventions Consultancy Teaching and training What did we do?

Delivered by a health psychologist in a personally tailored way to individuals Aimed to motivate and provide LAYP with the skills for change and is very flexible to needs, targeting: –Sexual health –Smoking –Activity –Healthy eating –Alcohol and drugs 2 phases – motivational and volitional Young people involved in design of materials Behaviour change interventions

With thanks to Jilly Martin

39% self referral, social work team, NHS staff 942 appointments attended (average 5 per person) 75% seen at home Sexual Health, Smoking most frequent issues Detailed evaluation undertaken: Opinion; quantitative Summary of Service

BehaviourN in analysesPre-score Mean (median) Post-score Mean (median) Significance value and effect size Smoking (number/week)3826 (0) 16 (0) p=0.01 r=-.30 Exercise (hours/week)253 (2.5) 6 (5) P=0.000 r=-.52 Fruit and vegetable intake (number/day) (1) 2.58 (2) p=.001 r=-.48 NN Intention to use condoms Do not intend to Unsure Intend to Strongly intend to p=0.003 r=-.44 Condom use Never Not very often About half the time Most of the time Always P=0.026 r=-.53 Pregnancy contraceptive Yes No McNemar’s test p=0.006 Undertaken STI test Yes No McNemar’s test P=0.219 Alcohol (units per week)24.52 (.000).333 (.000) p=.715 Cannabis use (number/month) (.000) 0.00 (.000) p=.180 Wellbeing19Mean= Median= 39 SD=11.28 Mean= Median= 53 SD=10.68 p=.002 r=-.49

47 techniques (33 from 40 item taxonomy of BCTs) used across sessions, most commonly (25+ sessions): Audit of behaviour change techniques Goal setting (behaviour) Action planning Barrier identification/problem solving Set graded tasks Review behavioural goals Plan social support/social change Building confidence to say ‘no’ to sex Provide general encouragement VolitionalTechniques Motivational interviewing Provide information on consequences of behaviour in general Provide information on consequences of behaviour to the individual Discrepancy assessment (between own standard and actual behaviour) Provide normative information about others’ behaviour Promoting positive values and attitudes towards sexual health and relationships Elicit aspirations about the future Motivational Techniques

Discussion points Multiple health issues, whole person approach Due to the sometimes complex backgrounds of LAYP, many may require intensive tailored interventions to assist in behaviour change and include motivational elements Flexibility is also key in initiation and maintenance of engagement Consultancy and Training for staff well received Links created across NHS and other agencies

Conclusions The development of a tailored one-to-one service for LAYP around healthy lifestyle issues is, however, possible and can result in behaviour change Due to the difficult nature of engaging young people, training for staff and carers in behaviour change techniques important to embed learning from the project