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Is it safe to go outside?”

Young person, Wales

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We started this work in May 2020 and we'll continue through this year. We'll be sharing��findings and resources on this page, so look out for updates.��

The insights from the young people we're working with will inform a number of our own programmes and the wider sector - including our��Paediatrics 2040 programme, our quality improvement sharing hub����and our��workforce impact tracking of COVID-19.

They'll support recovery and surge planning as we move through to reset, restore and recover child health services - particularly for our programmes such as RCPCH Ambassadors (where members acting as local advocates for children and young people), the NHS Long Term Plan's children’s transformation board and health and social care trust boards across the UK.

Virtual health services

[We need] clear information, no waffle, more support for families and children and be able to choose how to see your doctor.

Young person, Wales

Sixty young people from all four UK nations��participated in focus groups led by RCPCH &Us in May and June 2020 - exploring healthcare experiences during lockdown. We were also lucky enough to observe other sessions in June with 20 additional young people, also sharing their virtual health experiences.

Young people shared their experiences from lockdown:

• "CAMHS phone calls happening but not to everyone, also problems about having everyone listen in at home so not telling them what is going on” - young person, Northern Ireland
• "Children and young people matter during COVID-19 and should be part of the solution and should consult with them" - young person, England
• "I’ve not spoke to anyone about it [shielding], not my friends it’s a bit odd to talk about it, so I’ve just become withdrawn with it all" - young person, England
• "When lockdown was announced I went home [from university], luckily I had kept my home GP and was able to get prescriptions for long term condition" - young person, Scotland

They also shared their experiences on virtual health appointments:

• “They should have a range of options as some get anxious on a phone and some get anxious meeting the professional in person so they need both options.” young person, Wales
• “Remember that for some YP it is becoming too much with everything happening in their bedroom: school, friend socials, mental health appointments/health consultations. You can't get away from it space wise” - young person, England
• “Offering online appointments issue is that sometimes at home with the family there is no safe space to have confidential call and feel safe that no one is listening in.” - young person, Scotland
• “Phone doctors' appointments are good because they get back to you quick but they can’t see you like if you need to show them your eczema,” - young person, Northern Ireland

What do doctors need to think about to help make virtual health appointments work? They identified six areas:

1. Reassure us about how it will work
2. Give us choice of how to talk with you
3. Help us to keep it private when we are at home
4. Help us to prepare for our virtual appointment
5. Make it easy for people without good WiFi access
6. Make it clear and simple about how we get help when we need it

When we looked at all the results of our consultations, we noticed these common themes about accessing virtual health services:

• Burden: A sense of having to make tough choices about accessing healthcare services, protecting their family or concerns relating to their future due to COVID-19. There is also a sense of the weight of COVID-19 in relation to space; for some young people it is becoming too much with everything happening in their bedroom: school, friend socials, mental health appointments/health consultations. Lots of comments about increasing anxiety due to the pandemic.
• Choice: Young people shared their appreciation of being able to access health services in person, on the phone or online, and would like this choice to be carried forward post COVID-19.
• Confidentiality: Accessing health services from home has resulted in privacy issues for some young people who did not want to access mental health support in earshot of their families or talk through health concerns in fear someone could hear, create a code word for children and young people to share with health care professionals and have jointly developed expectations to support virtual conversations.

You can read more about what children and young people said in our Paediatrics 2040 post-pandemic��report. We have also helped provide links to resources about or with children and young people on QI Central.��

Supporting mental health in a national crisis

Remember that for some young people it is becoming too much with everything happening in their bedroom: school, friend socials, mental health appointments/health consultations. You can't get away from it space wise

Young person, England

RCPCH were kindly given a legacy donation from Dr Michael Williams, to do a project looking at children and young people’s mental health. RCPCH &Us set up a six month project which ran in 2020 bringing together 30+ young people and five RCPCH members/health professionals to share reflections on experiences during the pandemic, gaps and solutions for the future.��

In part one,��young people shared ideas and experiences of tools, resources and strategies that they used - or felt were missing - when they needed mental health support during lockdown.��We had a big list of apps, websites and information to look through. They came up with great ideas: where there are gaps in the information, or problems with what's already out there. They also shared their personal experiences of the changes in mental health support they have had through lockdown and the impact this has had.��Paediatricians also shared their ideas of where there have been good resources or gaps for their patients.

In part two, young people reviewed the findings and prioritised. The main themes were:��

• That there was too much information from too many places about mental health that could be overwhelming
• Information too generic and needed to be more personalised��
• Mental health services were not effectively providing information through the online channels that young people used (Instagram, Tiktok, YouTube)
• Peer support was a preferred option for young people, but there were questions about whether there was enough available, if young people felt confident to provide peer support and had their own support channels if needed��
• Online therapy and support was not geared up for a crisis, with issues such as having to speak with different therapists each time, having a 1 hour time limit then have to start process again, it being short term support or there being no private space to speak when at home accessing online support��
• Workers did not always know where to signpost young people to
• University and school wellbeing services were offering inconsistent support between areas

During part three in October, the youth steering group facilitated an online workshop��that they had planned with young people from other groups and organisations, to explore three priority areas below and to help develop solutions for services to consider.����

1. Mental health services do not use the online channels effectively to reach young people
2. Peer support is the preferred option for young people, but they can't always access it
3. Online therapeutic support not geared up for a crisis like COVID-19

You can read more about the ideas and tips��from young people in the downloadable report below, RCPCH &Us - Mental health resources in a national crisis,

Across all three parts of the project, there were clear actions for all services to consider:

• to increase��training opportunities for children, young people, families and professionals in mental health first aid
• to have up to date sign posting information that is clear to understand and not overwhelming
• to think about how they will be ready to deliver online mental health support that is private, confidential, consistent and provides choice for children and young people in how they access it.��

We were really lucky to receive the legacy donation from Dr Michael Williams for this project and would like to say a big thank you to him and his family for thinking of RCPCH &Us.

Download our report below, RCPCH &Us - Mental health resources in a national crisis

Services and us - voices from specialist experience groups

I’ve not spoke to anyone about it [shielding], not my friends it’s a bit odd to talk about it, so I’ve just become withdrawn with it all

Young person, England

We're supporting workshops with children, young people and young adults from a range of backgrounds, including those with long term conditions, from vulnerable groups or with specific health care experiences such as LGBT+ young patients. We looked at specific experiences, expectations and perceptions on services.��

In summer 2020 we hosted one workshop with young people and young adults who have been shielding. We've shared our report from this with NHS England & Improvement to help inform guidance and planning for life after lockdown.

Some key themes from the workshop on shielding included:

• Support the mental health of young people who have been shielding as they integrate back into not-shielding
• Improve communication and messages shared about how to shield and what needs to happen when
• Make sure support services recognise under 25s are shielding too, so might need extra support. For example,��online shopping slots were available for over 70s at the start of lockdown, but under 16s were being able to get prescription deliveries

The Association of Young People’s Health (AYPH) with support from RCPCH &Us, worked with three organisations to find out what young people from different backgrounds thought about their pandemic experience. Key themes from young carers, Gypsy and Traveller young people and those from LGBT+ backgrounds were:

• Accessing health services: it needs to be clearer how young people can do this, what they are entitled to and how their rights and confidentiality will be managed
• A range of ways to engage: there need��to be digital options and other ways to get health support as not everyone has access to devices or data
• Clear communication: those shielding or supporting family members or where shielding really felt that communication wasn’t clear or supported them in managing complex conditions
• Importance of social support: online social support groups like youth groups and school clubs really helped support mental health, accessing information and having something else to do that was positive
• Understanding the impact of inequalities and stigma: for those that were from different groups and backgrounds, the effect of COVID-19 went beyond physical health and included housing, safety, mental health, and the stigma towards different groups creating a barrier to accessing health support
• Being at home means different things for different people: for some it was protective, for others it was challenging, and this needed to be more understood and planned for by services.��

Thank you to the young people from the York Travellers Trust, Richmond Carers Centre and Free2B Alliance for sharing your views with AYPH and RCPCH &Us.

Download below the full AYPH report on the experiences of young people facing inequalities

Sharing experiences with our members

In the chaos I'm thankful to a team of NHS heroes who step into a mess that others step away from. You are truly appreciated.

Nadia, a teenage student from Northampton

Young people from RCPCH &Us have been sharing their experiences about life in lockdown in our members magazine, Milestones. Every member gets this in the post four times a year, and can read it online on our website.

You can read Nadia and Emma’s experiences in the summer 2020 edition.��Demi and Sashank shared why it matters to them to be heard during the pandemic in the autumn 2020 issue.

Find out more

If you would like to be involved or to find out more about our approach, contact us��and_us@rcpch.ac.uk.