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The Considerations of Working with Very Poorly Young People and Any Specific Learning or Tips I’d Give to Others Wanting to Work in Similar Settings by Paul Carroll (Lead Artist on Quench Arts’ Plugin Project)

Over the past 7 months, Quench Arts’ Plugin project has aimed to engage and benefit the most isolated young people across the city of Birmingham. My Young Music Leader colleagues, Megan and Dan and I have worked in two of the project settings, one locked psychiatric hospital ward and one multi-intervention community setting. I write here what I have learnt from working in sometimes challenging circumstances with young mental health service users.


We have had some great results where, for example, a young person has not been engaging in any education in hospital but then started to do so after a session or two of creative, fun and positive music-making. One young person went on to start a Performing Arts course in college after leaving hospital. Another, after not attending school for some time was back in education but struggling as GCSEs approached. Through completing the practical Arts Award at Bronze level during the Plugin project, they are now motivated to achieve more in education and are considering music for further study.


However, there are challenges nonetheless. Because sessions have been in the daytime, we have young people who are not well enough to go to school. Some young people we have met would rather not leave their homes due to anxiety or depression-related low motivation and some, we are told, rarely leave their bedrooms. Some have come to sessions and not spoken at all; some will not give an opinion; some are reluctant to try. One attended two full-length sessions with their hood pulled over their face, offering nothing to the session, just observing!


Given the nature of the job, I believe it is good to try and make working relationships as positive an experience as possible for both the young people and the staff involved. The first thing that I have found is that it is the Occupational Therapists (OTs), teaching staff and healthcare assistants who have an existing trusting relationship with the young people can be key in the first step of effective engagement: signposting the young person to the sessions; if there is reluctance then explaining why the project could be beneficial to them; in some cases staff have to help practically by liaising with parents for further support and with transport. Yes, some young people are brought to the sessions by the OTs. This all takes a lot of work, which takes a lot of motivation, so staff need to understand the benefits of the project from the outset. Therefore, I have also taken time to feed back to staff so that they can see the actual, real-life benefits and that it is worth all the hard work.


The other good thing about keeping in touch with staff is that it is a two-way relationship and I can benefit from their perspective. After all, it is they who know where the young person was before we met them and that can really demonstrate more effective change than I realise. For example, I should say that in the case of the young person with the hood pulled over their face: after talking to their OT I discovered that it was in fact amazing that they came to two whole sessions that they’d never been to before, with adults they’d never met before. That is a great observation to demonstrate the effectiveness of the project that despite it feeling to us that it had been largely unsuccessful, the young person had not wanted to leave the room and willingly came to another session, so was getting something out of it.


At Quench Arts, artists write a report for each session, highlighting the achievements that day. This way, practical concerns can be addressed and a plan can be made for next time but also the motivational aspects of sharing can extend to the very hard-working staff at Quench Arts and the Young Music Leader support staff.


I’ve spent a lot of this blog talking about keeping everyone positive about sessions because I do believe it’s really important for getting a young person to the session in the first place. They might not know exactly what to expect but at the least the setting staff with which they have an established relationship has told them positive things about Plugin. That’s a good start to the young person’s own positivity about a new and possibly daunting experience.


Another skill I have been developing on Plugin is how to measure the pace of a session; how to tread that balance between not boring and not overwhelming. I attended the excellent two-day Core Autism Awareness training at Forward Thinking Birmingham (Birmingham Children’s Hospital) and the most practical thing I Iearnt was not to be tempted to fill silence with continual rephrasing of a question but to wait and allow time for the answer to come. Repeating a question over and over in different ways can just be too much information for some people on the autistic spectrum. I had a question about this at the training: what do I do while I’m waiting for a response? Just look? The answer was not to look because too much eye contact could be intimidating. The trainer said some staff just do a quick bit of reading, typing or writing to make the moment less pressured. So, on Plugin I may do that now or look at something in an iPad music app. I have found that this helps create a relaxed creative environment, for me and everyone else.


I’ll finish with a list of points which are helpful to remind myself and my colleagues at Plugin:

Sessions are accessible therefore we use music technology, often GarageBand on the iPad as a unintimidating starting point which is fun to explore with good-sounding results.

Some young people prefer to work with a friend and don’t want the pressure of creativity all on them. In the absence of a friend, the artists present can share the decision-making.

Some young people prefer to work without other participants. Through observation I think this is because they don’t want to appear unable, vulnerable or even playful in front of another young person, even one they know. At Plugin we have two musicians in each session but I feel that in some cases, more progress has been made in the more balanced situation with just one music leader.

Some young people like to sing. I love to let that happen even if it’s commercial songs. We have had many cases when singing cover versions has led to making more rewarding original music.

Some young people don’t like to sing. That’s what the music technology and instruments are for.

Some people want to sing but are too shy. We have had cases where we’ve made an energetic Hip Hop instrumental using music technology and once the young person has achieved that and trust us a little more, they admit that actually they’d like to sing a ballad.

Session lengths are flexible for the young person so they always have the option to finish if they wish. This way they don’t feel the pressure to continue working on something they don’t have the energy to, perhaps because of their medication. If a young person feels the session is dragged out, then they’re less likely to come back next time.

Session lengths are not flexible for the artists! Some young people can become anxious if the session starts late or isn’t as long as they were expecting.


What I am trying to illustrate, as is often the point whenever working with people with additional needs, is that the content and pace of the sessions is measured in real time for each individual I work with. And what can help with this is a positive working environment through regular reflection with the participant and all other staff involved.