Rough, and not ready

A new guide reveals health services for young people are not as accessible as the providers believe. Wendy Wallace reports on an unusual consumer survey. The United Nations commentators who recently condemned Britain's poor record on children's rights would probably have approved of a project initiated by the North Birmingham Community Health NHS Trust.

Concerned by the low take-up of services by young people, health promotion staff have produced the Rough Guide to Help, Advice and Information for Young People in the area. But what distinguishes this guide from countless other similar publications is that the assessment of the services on offer come straight from the mouths of young people. Some are highly critical.

The Rough Guide was researched by more than 100 young people, aged from 14 to 25. Youth workers recruited people through local schools, hostels, teenage mothers' groups, and lesbian and gay groups. "We went through a process of working with them to identify the issues that affect their health and lifestyle," says Dawn Shufflebotham, senior health promotion officer at the trust. "We weren't just looking at medical illness but at a whole range of things from stress to abuse."

Having identified a spectrum of issues, youth workers helped the young people research the range of places locally where they could go for help. Before approaching agencies, the young people wrote down their feelings about seeking help. They then visited agencies, or telephoned them, presenting either their actual problem or an assumed one. On their return, says Dawn Shufflebotham, "a worker would support them in recording their experiences, what happened, what they felt about the service and any recommendations they had to the service provider about improving that service".

The results have been published in a neat, card-backed ringbinder, not much bigger than a Filofax. Meant to be attractive to teenagers, and portable, the guide has 14 sections ranging from abuse and alcohol through death, drugs and homelessness to racism and rape. Over 30 agencies are reviewed, usually by a number of young people. Feelings "before" and "after" are represented in easy-to-read thought or speech bubbles.

Thus one can learn that an 18-year-old Asian man worried before visiting the AIDS Lifeline that "I want to speak to someone who speaks Bengali". And afterwards commented that "It was OK. He could understand me." And that "I felt shy but he made me feel good about myself. He said I had been sensible. "

Some agencies, such as "Drugline" a telephone and face-to-face counselling for drug-users and their friends and families - got a unanimously positive verdict. "A bit nervous," commented one young man before making contact. "I didn't want to go in," said a young woman. "I felt she helped and was very kind to me," was one of the comments afterwards. "They are helpful and friendly," said another.

But many of the comments were not flattering to the agencies involved. So what, for instance, did the Brook Advisory Centre feel about reading "The place was miserable and cold". Or, worse, "the woman on reception acted like she had heard it all before. I felt like leaving straight away." Jenny Smith, director of client services for Brook in Birmingham, is sanguine about the remarks. "We think feedback is a positive thing," she says, "and the guide flagged up issues for a lot of agencies. For us it's a reminder that while you might be on your toes 95 per cent of the time, we need to maintain the high standard at all times, even when we're very busy. There has been a lot of discussion in the organisation about it." The comments made about Brook were not all negative. One 18-year-old man said "Brook are very caring and keep everything confidential. I'd recommend them to everyone."

So what are young people reading the guide meant to make of these sometimes conflicting reviews? "Perhaps," says Dawn Shufflebotham, "we should have put more emphasis in the guide on the fact that this is an individual young person's experience. Another could go along and have a totally different experience."

The trust organised a seminar for agencies reviewed in the rough guide after the launch. Although some were unhappy about their write-ups, on balance the "service providers" were well-disposed towards the project. "A lot of energy and emphasis is put in all the time into how to improve services for young people," says Dawn Shufflebotham. "But very little feedback comes out on what young people think of these services. There was overwhelming support from the agencies about what an excellent resource it is, and a feeling that they needn't be too defensive about the comments that young people have made. Here is some feedback to work on and improve services from."

The high-quality guide was not cheap, and Pounds 8,000-worth of City Challenge money only paid for 1,000 copies. These were distributed to all school leavers in the area last summer; limited numbers have been given out in local youth groups. Demand outstrips supply, and a second, bigger-scale edition of the guide is likely to follow, with a larger print run.

Project manager Alice Cruttwell has produced a guide to producing a rough guide, and hopes the idea of giving young people will be taken up elsewhere.

Copies of the Rough Guide, and information on how to produce one, cost Pounds 15, from Dawn Shufflebotham, HINT Project Health Promotion, Carnegie Centre, Hunters Road, Hockley, Birmingham B19 1DR. Tel: 021-554 3899

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