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Dr Clare Bingham – London Vanguards progress

When I joined the Violence Reduction Programme, the three London Vanguards were in their early stages of mobilisation, and they are now delivering a community multi-system model for children and young people impacted by violence.

The Vanguards are based on a service model developed by an Expert Advisory Group and underpinned by the national Health and Justice Framework for Integrated Care – Community.

As well as an emphasis on early intervention and prevention, this model highlights the need for continuity and an integrated approach into early adulthood, removing the unhelpful hard boundary between children’s services and adult services at the age of eighteen. It also centres around collaboration with young people, families, and local voluntary, community, faith and social enterprise (VCFSE) partners.

Reflecting on achievements so far

Recently, I have been fortunate to visit each of the Vanguards. I was struck by the passion and energy of the people offering the services – from the service managers to the clinical teams to the VCFSE partners. It is clear that a huge amount has been accomplished in a very short period of time.

There has historically been a gap in service provision for the children and young people that the Vanguards have been set up to support. One of my main reflections from the visits has been a new understanding of everything that the VCFSE partners have been holding in that gap, specifically in relation to mental health.

It has been positive to hear VCFSE partners talk about the benefits of having access to clinical expertise. One of the VCFSE leads that I met spoke about how the option to refer to clinicians in the Vanguard for mental health support for children and young people has been a huge positive shift.

The Vanguard services each have their own distinct, local identities. However, the ethos of the model runs through each one. There was clear evidence of positive engagement with the families of children and young people. The introduction of options for peer and self-referral at some sites will help to remove barriers to accessing support. Young people described how the Vanguard services felt like safe spaces where they could start to recover from difficulties and explore possibilities for their future. Vanguard staff shared examples of advocating for young people and being able to influence the wider system to work more successfully with their support.

Evaluating the new model of care

We have now received a report from the first phase of an evaluation of the Vanguards, carried out by the Child Outcomes and Research Consortium (CORC) at the Anna Freud Centre. This first phase focused on the learning and experiences of staff. It highlighted ways that staff feel the Vanguards are working well, as well as some useful learning and areas for development.

It demonstrates how essential it is to create a workforce that centres cultural humility and sensitivity when supporting young people, families and communities who have been impacted by multiple inequalities.

The report also contains some learning about the investment needed, both in terms of time and effort, to develop partnerships between NHS and VCFSE services and having appropriate funding to embed the model of care. It also highlighted how important it is to have senior level commitment from the outset.

Looking to the future

We are looking forward to the next phases of the evaluation, which will look at the experiences of children and young people using Vanguard services, followed by an analysis of the quantitative service delivery data.

Ultimately, the hope is that the Vanguards will not only show us successful new ways of working, but that through the evaluation and other feedback, we can start to understand what really works for children and young people impacted by violence, and how we can influence and support the wider system to offer that more routinely.

Dr Clare Bingham
Clinical Lead for Mental Health, London Violence Reduction Programme, NHS England

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