Developing and piloting a peer mentoring intervention to reduce teenage pregnancy in looked-after children and care leavers: an exploratory randomised controlled trial

Teenage pregnancy

In the UK, policy discourses around the prevention of teenage pregnancy have changed in recent years. The Teenage Pregnancy Strategy71 resulted in various positive outcomes, such as an increased number of school- and college-based contraception and sexual health (CaSH) services and support for teenage parents through, for example, Care to Learn, which helps towards childcare costs for young people aged < 20 years who wish to study, and the Family Nurse Partnerships, which aim to improve pregnancy outcomes for first-time mothers. In some areas where there was effective implementation of the strategy the rate of under-18 conceptions fell by up to 45% from the 1998 baseline1 (under-18 conceptions in England as a whole fell by 13% from the 1998 baseline to 2008). Immediate challenges to maintaining the achievements of the Teenage Pregnancy Strategy were identified as public spending cuts, a lack of young person-friendly CaSH services and variation in provision and quality as well as unequal provision of SRE. 1

Since the change of government in 2010, the aim of reducing teenage pregnancy has come to be positioned within the remit of improving health inequalities. In 2012, the TPU was disbanded and responsibility for improving the quality of SRE in schools and colleges and integrating it within personal, social, health and economic education (PSHE) was taken over by the Department for Education. Subsequent initiatives included increasing the availability of young person-friendly CaSH services and targeted SRE advice for groups of young people at risk of teenage pregnancy. From April 2013, local authority (LA) health and well-being boards have had a statutory duty to improve the health and well-being of the local population and reduce health inequalities, through joint strategic needs assessments, as well as to support young people to prevent unhealthy lifestyle choices, which include risky sexual behaviour. 72 Reducing the rates of teenage pregnancy and STIs now forms a key part of the work of local areas to tackle child poverty and address health inequalities. 72 This reflects research evidence that illustrates the impact of socioeconomic disadvantage on rates of teenage pregnancy.

Looked-after children

In March 2012 there were just over 67,000 children and young people in England and Wales under the care of local authorities, designated as ‘looked after’. This is an increase of 13% compared with 31 March 2008. 24 The increase in care applications in recent years can, in part, be attributed to a number of high-profile cases involving the deaths of young children, which it was judged could have been prevented if they had been removed from their homes at an earlier stage. 73,74 In 2012 the Children and Family Court Advisory and Support Service (Cafcass), which safeguards the welfare of children involved in family court proceedings, received a record amount of care applications and they are expected to rise further as a result of changes to the benefits system. 75 Recent amendments to the Children and Families Bill76 have increased the age at which children in England can remain with their foster parents, from 18 years to 21 years, which it is hoped will encourage LAC to remain in education for longer.

Child protection policy in the UK is based on the Children Acts 198923 and 200477 and in the past decade a raft of major initiatives has been introduced to promote the rights and health and welfare of children and young people. In the wake of the enquiry into the death of Victoria Climbie in 2000, the government published the Keeping Children Safe report,73 the Every Child Matters programme78 and the Children Act 2004. 77 The 2010 Working Together to Safeguard Children guidance79 outlines statutory and non-statutory guidance on how organisations and individuals should ensure that services are ‘joined up’ and the National Healthy Care Standard [see www.ncb.org.uk/media/173813/healthy_care_standard_entitlements_and_outcomes.pdf (accessed 21 July 2015)] is intended to help LAC and young people achieve the five outcomes described in Every Child Matters. 78 In recent years, the Care Matters White Paper80 and the Children and Young Persons Act 200881 created independent reviewing officers to oversee the process of placement moves of young people in care and brought in higher education bursaries and other changes designed to encourage them to remain in education for longer.

Statutory and other guidance on promoting the health and well-being of LAC82,83 were brought in to improve collaborative working between local authorities, primary care trusts (PCTs) and strategic health authorities (SHAs) and to collect, monitor and share information more effectively. Following successful piloting of virtual school heads to promote the educational achievement of LAC,84 and in response to the latest statistics on educational GCSE outcomes for LAC,49 the government intends to enshrine in law a virtual head teacher for LAC in every council. 85 However, there is still a lack of consistent support and advocacy for LAC and care leavers. Various barriers to participation for LAC have been documented, including a lack of an advocate to take proactive action on their behalf, lack of meaningful and sensitive involvement in their education plans, lack of an effective voice at reviews and lack of confidentiality. 86–89

Positive youth development and peer support

Although the TPU considered that the decline in the under-18 conception rate in some LA areas had occurred as a result of targeted work with LAC and care leavers,90 there has been no independent evaluation of the effectiveness of the various measures put in place to address this issue and none using an experimental design.

Positive youth development (PYD) programmes, focusing on the development of strong bonds with appropriate adults and maintaining regular involvement in positive activities, appear to be more successful at preventing young people from engaging in risky behaviours than programmes that focus on the ‘problem’ that has to be solved. 91 A systematic review including a statistical meta-analysis of controlled trials of early childhood interventions and youth development programmes showed that the teenage pregnancy rate was 39% lower amongst individuals receiving an intervention than amongst those receiving standard practice or no intervention [relative risk 0.61; 95% confidence interval (CI) 0.48 to 0.77]. 22 The interventions aimed to promote engagement with school and counter the effects of early adverse experiences through learning support, guidance and social support and to raise aspirations through career development and work experience.

One systematic review of PYD programmes in the USA, using experimental or quasi-experimental evaluation design,92 found 15 programmes that had led to an improvement in at least one sexual and reproductive health outcome for young people. However, a non-randomised UK study to evaluate the effectiveness of development programmes for young people at reducing teenage pregnancy, substance use and other outcomes93 found no evidence of effectiveness and some suggestion of an adverse effect. Methodological limitations of this study may have affected outcomes and it was recommended that any further implementation of PYD programmes in the UK should be randomised trials.

A number of studies have focused on peer support, which includes mentoring, befriending, counselling and other types of support provided by someone who has knowledge, or experience, relevant to their mentee. 94–97 The Randomised Intervention trial of PuPil-Led sex Education in schools (RIPPLE) project, which employed peer educators to provide sex education within schools, appeared to be effective in reducing self-reported pregnancies by the age of 18 years. 95 An informal, peer-led approach to adolescent smoking prevention has also been shown to be effective. 96 However, the only comprehensive systematic review of the effectiveness of peer-led health promotion interventions for young people, half of which were concerned with sexual health, concluded that, although a peer-led approach was promising, there were too few studies to be able to identify what constituted an effective model. 97

Mentoring and peer mentoring

‘Mentoring’ is a somewhat ambiguous concept that has been used as a broad term to describe a variety of interventions and practices. 98,99 A common thread linking all mentoring schemes is the development of a trusting relationship between an older, more experienced person and a younger, less experienced person over an extended period of time, with the aim of providing social support. 98 The UK-based Mentoring and Befriending Foundation (MBF) advises that mentoring usually involves some form of goal-oriented work in addition to building a relationship, which is the cornerstone of befriending. 98 Mentoring can take place in a formal or an ‘artificial’ context, in which the mentor is acting in a voluntary or paid capacity, involving an external organisation, or it can be naturally occurring, usually involving a non-familial adult who is already present in the young person’s life. 99,100

There has been an increase in ‘peer mentoring’ programmes in recent years101 and particularly in schools. 102 However, the definition of ‘peer mentoring’ varies widely across programmes. Over one-third of schools in England operate some form of peer mentoring/peer support scheme to reduce bullying and promote self-confidence and self-esteem, some of which have been effective. 102 The MBF review102 of peer mentoring programmes in schools demonstrated the interchangeable use of the terms ‘peer education’, ‘peer support’, ‘peer befriending’, ‘peer buddying’ and others. Most programmes characterise the ‘peer’ element in relation to mentors being slightly older than, or having had similar life experiences to, the young people who they are supporting. In relation to LAC, the Scottish Government’s report Peer Mentoring Opportunities for Looked After Children and Care Leavers103 identified the most important criterion for being a peer as having a shared experience of being in care.

Impacts of peer mentoring schemes have been variable. In 2006, the MBF conducted a national pilot of formalised peer mentoring schemes in 180 secondary schools in England. Self-report and qualitative data demonstrated some benefits; however, there was no clear impact on pupils’ behaviour, school attendance or educational attainment. 104 A study of year 10 students supporting year 7 pupils with the transition from primary to secondary school found that, following the mentoring, year 7 pupils reported increased self-esteem and confidence and less anxiety. 105

A US meta-analysis of 55 evaluations of mentoring programmes found small benefits in general from mentoring but greater benefits for disadvantaged youth. 106 Very few controlled evaluations of mentoring have been carried out in the UK. However, an evaluation of the Mentoring Plus programme found that mentoring had positive impacts on training, education and work engagement in disaffected young people. 107,108 There were no clear impacts on offending, which was a general aim of the programme rather than a goal set as part of the programme.

Peer mentoring and policy

The concept of peer mentoring for LAC is consistent with the coalition government’s key factors for success, particularly ‘aspirational personal and social development programmes, targeted SRE and sexual health advice for at risk groups of young people’ (p. 49) and the requirement on local areas to address child poverty and health inequalities. 73 There is little evidence for the effectiveness of using peer mentors, as opposed to adult mentors, for LAC and care leavers; however, non-peer mentoring for care leavers has been shown to increase confidence, self-esteem and aspirations. 109 One large-scale study, supported by the Department for Children, Schools and Families (DCSF), evaluated one-to-one mentoring relationships to increase educational engagement and performance for 449 LAC aged 10–15 years. 110 The programmes were managed mainly by voluntary organisations and the majority of mentors were adults, although some providers included peer mentors. The evaluation found marked improvements in school work, attendance and participation in hobbies and social activities, as well as in young people’s feelings about themselves, the future and relationships with others. Providers that were located within a LA were found to be the most successful at delivery.

Potential pitfalls

We were aware of the potential challenges involved in accessing and engaging LAC,124 of finding positive role models125,126 and of sustaining such an intervention. We nevertheless considered that a peer mentoring approach would benefit from research, geared towards intervention refinement and experimental evaluation. In particular, we hoped to be able to explore the acceptability and feasibility of such an intervention; the need for and nature of rewards for the mentor; the training and support needs of the mentors; the means by which sustainability can be ensured; and the management of the post-intervention transition in a way that supports both mentor and mentee. From the available evidence we were convinced that not only was this a promising avenue to pursue given the aims of the project, but also the systematic and rigorous exploration of peer mentoring in this context would be generalisable and of benefit to a broader field.

Scoping exercise

Information was sought regarding local or national voluntary or statutory sector projects as well as published or unpublished reports, papers and web links relating to the following three types of intervention:

1. peer mentoring interventions for LAC

2. peer mentoring interventions to reduce teenage pregnancy

3. other interventions to reduce teenage pregnancy in LAC.

Directors of Children’s Services for England and Wales and virtual head teachers, teenage pregnancy co-ordinators, children’s and young people’s charities, mentoring organisations and members of the study Advisory Group were contacted (n = 457) between April and May 2012 to see if they were able to provide relevant information. Reminder e-mails were sent throughout the 2-month period. Initial responses were followed up by telephone or e-mail to explore professionals’ views on the components of existing interventions. Particular attention was paid to questions around the selection, training and support of mentors, the specification of the mentoring relationship (e.g. amount and types of contact and duration of relationships), exit strategies and views on contextual factors affecting the effectiveness of these interventions.

Targeted literature review

A targeted literature review was conducted at the same time as the scoping exercise. The following databases were searched between March and April 2011 for published and unpublished literature on peer mentoring for LAC with the aim of reducing teenage pregnancy: PsycINFO, Social Sciences Citation Index, MEDLINE, Database of Abstracts of Reviews of Effects, Education Resources Information Center (ERIC), System for Information on Grey Literature in Europe (SIGLE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Studies pre-1992 were excluded. An initial search of these databases revealed only limited available literature and so the search strategy was broadened to include studies that used more traditional (i.e. adult to youth) mentoring methods. The literature review encompassed the following types of mentoring:

• mentoring and peer mentoring for young people

• mentoring and peer mentoring for LAC

• mentoring and peer mentoring to increase positive sexual behaviours and/or reduce teenage pregnancy

• mentoring and peer mentoring for pregnant and parenting adolescents.

For a detailed description of the search strategy used in the review, see Appendix 3.

A further database search was conducted in December 2012 to incorporate more recent literature into the review.

Intervention logic model

The behaviour–determinants–intervention (BDI) logic model63 is a standardised approach to theorising and informing the development of social interventions for community health problems, including sexual health and teenage pregnancy. Drawing on the literature review and scoping exercise, a BDI logic model was designed to describe and explain the intended causal mechanism of the intervention. The BDI logic model is presented in Chapter 3 of this report.

Piloting the peer mentoring intervention

A 3-month pilot of the methods for recruiting participants and the delivery of the intervention was undertaken in LA1. The recruitment target was six mentors and six mentees. The findings were used to refine the mentor training programme and other intervention components and to test the research methods and instruments to be used in the exploratory trial.

Methods used included observation of the training programme, a focus group with mentors on the last day of training and individual semistructured interviews with participants at the end of the 3-month period. Semistructured interviews were also held at the end of the 12-month intervention to explore the mentoring relationships and any impacts on mentors and mentees. These interviews were not included in the original protocol but were added because of the lower than planned level of recruitment in the exploratory trial.

Mentor training and support

A 3.5-day training programme was designed by the research team in collaboration with the National Children’s Bureau (NCB) and Straight Talking, a teenage pregnancy organisation (see Chapter 6 for details). All potential mentors were offered the training, after which they were asked whether they were still willing to act as mentors and were consented. Only those who completed the training programme were permitted to work as peer mentors. We anticipated that pilot training would be delivered to 8–10 young people from LA1 and that the exploratory trial training would be delivered to 10–12 young people from each of LA1, LA2 and LA3. Training was delivered locally, in each of the LAs, to make attendance easier for participants, generally at a location arranged through the LA. Participants were paid £30 in shopping vouchers for attendance at training. The pilot training took place between 31 August 2011 and 5 September 2011. Exploratory trial training ran from 13 to 16 February 2012 in LA3, from 22 to 25 February 2012 in LA2 and from 20 to 23 March 2012 in LA1.

A booster training day, delivered by the NCB and Straight Talking, was held approximately 4 months into the intervention. This focused on discussing issues that had arisen for mentors within the mentoring relationship and problem solving.

Mentors were provided with ongoing support from the PC in each LA for the duration of the intervention, through monthly support groups and ad hoc troubleshooting and the provision of advice in-between these meetings on an individual basis. The PC role was refined during the pilot stage and is described later in this report (see Chapter 3).

Mentor role

It was agreed at the outset that each mentor should be required to take on only one mentee at a time, for a period of up to 1 year. Contact between the mentor and the mentee was by a variety of means (face-to-face meetings, e-mail, telephone conversations and texts). Mentors were provided with a mobile phone to facilitate communication with their mentee. Mentors received a monthly stipend in recognition of their work and contribution to the study, as well as money for activities with their mentees (described later in this chapter). They were also offered the opportunity to gain an accreditation for their peer mentoring through the Award Scheme Development and Accreditation Network (ASDAN). Mentors signed a mentoring ‘contract’ that outlined the responsibilities expected of them in terms of maintaining contact with their mentee, attending support group meetings and using the money and mobile phone appropriately. The mentor role was refined during the pilot phase and then further refined before commencement of the exploratory trial (see Chapter 3).

Inclusion criteria

Exclusion criteria

Young women (both mentors and mentees) were originally to be excluded if they were pregnant at the time they were approached to give consent, but they were not necessarily excluded if they already had a child (see Chapter 5 for details on exceptions to these criteria because of recruitment difficulties).

Recruitment

Pilot study recruitment was scheduled over a 2-month period between July and August 2011. Recruitment for Phase II was scheduled over a 3-month period between December 2011 and February 2012, although in practice we were unable to keep to these recruitment windows (see Chapter 5).

Recruitment leaflets and posters were designed by the research team in collaboration with a service user representative to ensure that they were appropriate. The leaflets summarised information about the study, explained confidentiality and anonymity procedures and included researcher contact details. To make the study accessible to young people and other stakeholders and for easy referral it was named ‘the Carmen study’ (derived from the words ‘care’ and ‘mentoring’). These materials were given to PCs to distribute to professionals and young people within their LA (see Appendix 4 for the written information included in the recruitment leaflets).

When a potential mentee indicated that they might be interested in participating, the researcher made an introductory telephone call and arranged to meet. The initial meeting with one or both of the researchers (DM and FC) was held on LA premises or at the participant’s home address if the participant preferred. At the meeting the researchers checked that the participant understood the nature of their involvement, details about the mentoring programme and the randomised nature of the trial (Phase II only). If the potential mentee was happy to enter the trial the researcher completed the consent procedures and baseline interview. Participants were given a £15 shopping voucher for completing this.

When a potential mentor indicated a willingness to participate, the researcher made an introductory telephone call and checked that potential mentor could attend the training. The potential mentor was then sent a letter with details of the training times and venue. If they were still interested in participating after completing the training course, a meeting was arranged with the researchers to complete the consent procedures and baseline interview. These meetings were held in the same locations as meetings with potential mentees. Participants were given a £10 shopping voucher for completing this.

Informed consent and safeguarding

Verbal and written consent was obtained from participants before completing the baseline interview (see Appendix 5 for consent forms). Baseline interviews were completed before randomisation. Young people aged < 16 years were invited to have their social worker or other LA individual present when obtaining consent. If they preferred to attend alone, the researchers spoke to their social worker to confirm their capacity to consent. Young people aged between 16 and 18 years could also elect to have a third person present if they wished. Fraser guidelines,129 which set out criteria for determining if a child is mature enough to make decisions around contraception and sexual matters, were followed. Participants were advised to direct initial queries about the research to the researchers and any other queries or concerns to the PC. A copy of the mentee consent form was sent to the mentee’s social worker, together with details of the PC.

We developed protocols for dealing with a disclosure of significant risk or ongoing harm involving a mentor or menteed young person. Before giving consent, all participants were informed of the limits of confidentiality in research interviews and that their social worker or another member of their care network would be informed if any such disclosures were made. Mentors were also advised to inform the PC if their mentee made any disclosures to them.

Randomisation

Mentees participating in the exploratory trial were individually randomised. Randomisation was stratified by LA using blocking and was undertaken using the BRTC automated randomisation service. After obtaining consent from the mentee, the researcher contacted the randomisation service to obtain the allocation. This information was then communicated to the mentee, their social worker and the PC.

Mentees were randomised to either the intervention arm of the trial or the usual support arm. Those in the intervention arm received a peer mentor in addition to their usual services.

Usual support condition

Those in the usual support arm received the services already available to them because of their status as a looked-after young person. These services aim to promote their educational achievement, physical health and social and emotional well-being. 83

Sample size

The sample size in the exploratory trial was not intended to have sufficient power to detect a significant difference in the primary outcome measure. However, the target sample size, 48, was sufficient to test whether the trial methods were robust and to provide sufficient data to check the reliability of the psychometric measures being used as secondary outcome measures.

Baseline measures

The following data were collected from LAC aged 14–18 years (see Appendix 6 for the baseline questionnaire):

1. sociodemographic data (age, ethnicity, etc.)

2. care history (current and previous)

3. forensic history and alcohol and drug use

4. educational attainment and achievement – attainment, school attendance, history of exclusions, truancy and suspensions, future educational/vocational intentions

5. sexual activity, contraception use, condom use to prevent STIs, history of pregnancy and STIs (some questions were adapted from the second NatSAL, a large UK study of sexual behaviour130)

6. physical and psychological health (see Explanatory variables for list of standardised measures used)

7. interpersonal and social functioning including number of confidants/close friends and engagement in leisure/sporting activities.

Additional information (including care history, sexual health and contact with other agencies) was collected from mentees’ social workers using a questionnaire (see Appendix 7). Consent for obtaining this information was obtained from mentees.

Outcome measures for mentees

Follow-up data collection took place when the peer mentoring intervention ended; this was scheduled at 12 months after the baseline interview. Follow-up interviews with Phase II mentors and mentees took place in June and July 2013. Participants were given a £20 shopping voucher for this.

Outcome measures for mentors

Mentors completed a baseline questionnaire prior to the commencement of the intervention (see Appendix 8). The questionnaire recorded:

• sociodemographic data (age, ethnicity, etc.)

• care history

• education and employment status

• physical health, alcohol use and pregnancy history

• interpersonal and social functioning including number of confidants/close friends and engagement in leisure/sporting activities.

Mentors also completed three psychological measures – the Self-Esteem Scale, the GHQ and the locus of control – pre intervention and following completion of the intervention to assess change.

Follow-up semistructured interviews

At the end of the Phase II mentoring intervention (June 2013), follow-up semistructured interviews were conducted with mentors, mentees and PCs (see Appendix 9 for qualitative interview schedules). We originally intended to qualitatively interview a sample of mentors and mentees; however, low recruitment numbers resulted in us attempting to interview all participants at follow-up. The interviews explored their experiences of the mentoring relationship in terms of its acceptability, appropriateness and impact, their views of whether mentoring is effective, their views of how it effects change and their suggestions for how mentoring could be enhanced. With regard to the research, views were examined on the consent and randomisation procedures. Interviews were also sought with mentors or mentees who left the programme early, to understand their reasons for exiting the study. Interviews were conducted by the researchers (DM and FC) on LA premises or at participants’ home address, depending on their preference.

Assessing the feasibility of a Phase III trial

To assess the feasibility of delivering the peer mentoring intervention in a Phase III trial, the following domains were explored:

• availability of eligible participants for a Phase III trial

• feasibility of recruiting mentors and mentees

• acceptability of the consent and randomisation procedures

• participant retention

• evidence of harm to participants

• characteristics and appropriateness of proposed outcome measures

• costs for a full trial

• ability to manualise the intervention.

Training evaluation

The training sessions were observed to assess whether the specific components were being delivered and the appropriateness of the approaches used and the level of the mentors’ engagement with the training material presented/discussed. A semistructured checklist was used to guide the researchers’ observations and the observations were recoded qualitatively. Participants completed a questionnaire at the beginning of training and at the end of each day and participated in a focus group on the last day (see Appendix 10 for schedules), giving feedback to the researchers on the training provided. Further feedback regarding training delivery and the training process was provided by the trainers to the researchers.

Mentor diaries

Mentors were asked to keep a structured diary logging the frequency, nature and content of their communication with mentees, as well as their reflections about their mentoring experiences (see Appendix 11 for schedule). A mobile phone-based application known as Magpi [see www.magpi.com (accessed 21 April 2015)] was downloaded onto the mobile phones and used to capture the information. Mentors were also given an option of completing the diary online. Diary entries were sent electronically to the researchers and were held on a secure, confidential server. The researchers provided guidance on completing the diary at the mentor training. Mentors were asked to complete the diary after each contact with their mentee, as well as weekly, even if no contact had taken place that week.

During the Phase II exploratory trial, researchers collected information from mentors and mentees over the telephone, taking the form of a ‘snapshot’ diary at three time points – 3, 6 and 9 months into the intervention – asking about contact in the previous week (see Appendix 12 for schedules). The diaries were digitally recorded and transcribed verbatim.

Amendments introduced to the study

A number of additional elements (not originally included in the study protocol) were introduced to the study in May 2012. This was in response to recruitment difficulties that had resulted in target participant numbers not being met (see Chapter 5) to enable us to further explore the barriers to recruitment and assess the feasibility and acceptability of undertaking a Phase III definitive trial. These additional elements are described in Table 2.

Semistructured interviews with professionals

In June and July 2012, 13 semistructured interviews were conducted with PCs, senior managers (referred to as SM in quotations) and social workers (referred to as SW in quotations) from LA1, LA2 and LA3 (see Appendix 13 for schedules). We interviewed all PCs and senior managers involved in the study and a sample of social workers, who were chosen because of their involvement in recruitment. A senior manager was defined as a person who had management responsibility within the field of LAC/care leavers and who did not have a caseload. The purpose of these interviews was to understand individual experiences of participant identification and referral to the study and also barriers to recruitment. Interviews were conducted either in person on LA premises (in a private office) or on the telephone and lasted from 30 minutes to 1 hour. All interviews were digitally recorded and transcribed verbatim.

Qualitative data analysis

For the purpose of this report we adopted a pragmatic thematic approach to the analysis of qualitative data, seeking to provide a largely descriptive account137 of the peer mentoring process that would complement the analysis of quantitative data and enable further refinement of the intervention and research procedures. Although we borrowed analytical techniques of coding and comparing data from grounded theory,138 we used these tools to organise our data, rather than seeking to build theory about the processes underpinning the peer mentoring relationship (this approach will inform additional, in-depth qualitative outputs from the study).

Transcripts from the process evaluation interviews were read a number of times by researchers (DM and FC) to familiarise themselves with the data. Participant and LA area attributes were assigned to each transcript to allow analytical themes to be explored in relation to the experiences of different groups and to compare processes across areas.

An initial ‘open coding’ was undertaken of a selection of transcripts from different participant types and LAs. Coding involved assigning labels to data (passages of text) – where possible retaining language used in the transcripts – that indicated the relevance of that data to the research questions being addressed. In this study, the coding process was guided by the team’s key questions about the processes of mentoring and relationship building and the progress of the relationships between dyads, what made a relationship work and what did not. Questions asked of the data included how the mentor and mentee experienced the relationship; the expectations of mentors and mentees about the workings/dynamic of the relationship; what mentors and mentees thought was a safe and appropriate relationship; and the impact of this supportive relationship on their relationships.

Following open coding, researchers adopted an iterative process139 whereby they looked for patterns, similarities and differences, as well as silences, in the coded data. This process was used to coalesce codes into categories or themes that constructed our descriptive account of the mentoring process. The iteration was a reflexive process and was key to sparking insight and developing meaning. The researchers visited and revisited the data and connected them with emerging insights, progressively refining the themes. The themes emerging from the data were driven by the inquiries above but also by the researchers’ interpretations of what the data were telling them based on their experiences of having undertaken the interviews and of the fieldwork environment. The researchers undertaking the coding (DM and FC) presented the emerging analysis to members of the research team through regular meetings and to members of the Advisory Group on two occasions to validate themes from the wider team perspective.

Through the iterative process we developed an analytical framework – a comprehensive set of themes – that was applied to all semistructured interview and focus group data. Themes that made up the framework were created as ‘nodes’ in the NVivo qualitative analysis software package (version 10; QSR International, Warrington, UK) and all transcripts were coded to those nodes, that is, sections of text were assigned, using the software, to the themes to which they were relevant.

The resulting coded NVivo database was used to facilitate the management of the large qualitative data set. In undertaking the process evaluation ‘query’ functions within NVivo were used to collate data relating to particular themes that described the mentoring process and to enable comparisons between data from different types of participant (see Chapter 8).

As well as the process evaluation, qualitative data also explored the structure and components of the intervention (examined through follow-up interviews and mentors’ diaries). NVivo software was used to collate qualitative data from all sources to support and make comparisons with the quantitative data collected through baseline and follow-up interviews and survey data, that is, data sources were triangulated139 (see Chapter 7).

Quantitative data analysis

Because of the small sample size in this study no hypothesis testing has been conducted comparing the outcomes of the intervention and usual support groups. Baseline data have been presented for all participants (by randomised allocation) using descriptive statistics (see Chapter 5), frequencies and percentages for categorical variables, means, SDs and minimum and maximum values for continuous normally distributed variables and medians with minimum and maximum values for discrete count variables. The pilot study sample has been added to the Phase II sample for reporting of quantitative data in Chapters 5 and 7. For the follow-up data (see Chapter 7) descriptive statistics are again used to report the primary and secondary outcomes by randomised allocation. Individual data are presented for the pregnancy and sexual behaviour outcomes given their importance and paucity. Frequencies and percentages are reported for categorical variables and medians and minimum and maximum values for all quantitative variables (given the smaller sample size at follow-up). For the three psychological measures (GHQ, Self-Esteem Scale and locus of control) mean changes from baseline to follow-up with 95% CIs are presented. All analysis was conducted using IBM SPSS Statistics version 20 (IBM Corporation, Armonk, NY, USA).

Initiatives to prevent teenage pregnancy

The scoping review did not identify any peer mentoring interventions for preventing teenage pregnancy; however, effective peer-led sexual health interventions do exist in England. 140 Several interventions were identified that aimed to support pregnant teenagers or teenage parents and increase their engagement in health and education services. Mentors were often teenage parents themselves, although they did not have to have been in care. We identified one scheme in North Lincolnshire that was in the process of being set up to support LAC who were already pregnant, using peer mentors who had experience of the care system and who were teenage parents.

Other interventions focused on equipping young people, including vulnerable groups such as LAC, with the knowledge and skills to negotiate safe sexual relationships. In areas with high teenage conception rates, teenage pregnancy was addressed by condom distribution services and fast-track access to CaSH services; sexual health outreach teams providing advice and support to young people; allowing young people to interact with toddlers in a nursery environment; and teaching parents skills to discuss sex and relationships with their children. Examples of peer education initiatives to reduce teenage pregnancy were peer-led SRE and teenage parents going into schools to discuss their experiences and the realities of being a teenage parent.

Based on these findings it would appear that peer-led education on sexual health and pregnancy is commonly used but peer mentoring has not been widely used as an approach to preventing teenage pregnancy either generally or in LAC specifically.

Recommendations from peer mentoring providers

At the time of scoping, some peer mentoring schemes had been running and expanding over a number of years, others no longer existed because of the various problems that they had encountered and a few were still in the development stage. Only a limited number of programmes had conducted any type of formal evaluation, although some had carried out internal audits. The dearth of independent, external evaluations meant that reports of benefits tended to be anecdotal or based solely on the individual practitioner’s experience, making it difficult to compare effectiveness across programmes. However, the problems encountered and the recommendations made by the providers were broadly consistent with those identified in the research literature.

Some of the key problems encountered by providers included:

• Lack of funding for staff time and inadequate administrative and mentoring resource, which made it difficult for providers to carry out work effectively. Some programmes did not have their funding renewed to allow them to continue.

• Concern over the ability of mentors and mentees to sustain appropriate boundaries in their relationship when mentoring is unsupervised. Providers advised caution over the exchange of personal mobile phone numbers.

• Infrequent and inconsistent meetings between mentors and mentees, which therefore need to be carefully monitored.

• Transport issues, especially in LAs that cover a large area. Some programmes had to fund taxis to transport mentors and mentees to sessions.

All established programmes offered some form of training and support for mentors. Providers considered that adequate training for mentors was essential and emphasised that a substantial amount of support may be needed for peer mentors who have left care to enable them to meet the demands of the role and cope with issues in their own lives.

Different approaches and criteria were adopted for matching mentors and mentees. Some providers reported matching on the basis of their professional knowledge of the young people, whereas others used specific criteria such as location, ethnicity or shared interests. A number of providers also based their matching on preferences expressed by the young people themselves.

The most common format for mentoring was weekly sessions, either one-to-one or in a group. Anecdotal evidence was provided for the benefits of mentoring for young people’s aspirations, education, self-esteem and confidence, but no formal evaluations had been carried out.

Building a successful framework for mentoring

Research has shown that a crucial element in the success of mentoring programmes is a strong infrastructure,141–144 including adequate resources, staffing and management of programmes and also appropriate selection, training and ongoing support for mentors.

The role of the mentoring PC is to co-ordinate and manage the screening, training, matching, support and supervision of mentors, as well as to effectively integrate the mentoring into the organisational context and establish appropriate links with other services. 141 Co-ordinators need to be adequately inducted into the role and have the relevant skills and experiences and sufficient time to commit to the task. 145 Evaluation of the MBF peer mentoring scheme in 180 secondary schools in England104 found significant workload pressures – almost one-quarter of PCs had experienced a ‘major problem’ with managing their time, which impacted on their ability to perform this role effectively, and only a small percentage (6%) said that they had ‘no problems’ with managing their time.

Recruitment and selection of mentors and mentees

The literature also provides guidelines on risk management, to guide the recruitment of volunteer mentors. The MBF’s guide to risk management146 suggests that providers of mentoring schemes should ensure that all potential hazards and risks relating to mentors are identified, assessed and managed. The guide recommends that PCs should keep records relating to DBS checks for mentors, training attendance, supervision and contact with mentors and mentees and any incidents.

Most peer mentoring programmes employ a mentor recruitment and selection strategy, often involving a job description, a person specification and an application and interview process. 147 Careful selection of mentors is key, as mentors who cannot commit to the task or act as appropriate role models may undermine the effectiveness of the intervention. 148 For example, an effective mentor should be able to prioritise the young person’s emotional well-being. 149 An evaluation of 10 UK mentoring programmes working with hard-to-reach young people recommended ascertaining whether mentors’ motivations were primarily ‘instrumental’, namely a means to financial or other rewards, or ‘normative’ and primarily driven by the desire to help someone. 107

When mentoring is based within LAs it is also important for there to be a selection and referral process that is understood by all relevant social services teams. 141 Mentees need to fully understand the aims and purpose of the mentoring scheme to reduce the risk of misunderstandings or unrealistic expectations,145 and an orientation session for mentees, before they commit to the programme, could be beneficial. 150,151

Mentor training and support

Some form of initial training, ongoing support and supervision for mentors is essential. 106,144 The length of training varied across the mentoring programmes identified. The initial training among the 28 delivery partners for the DCSF mentoring and LAC pilot scheme141 ranged from 1 to 5 days, although most had a minimum 2-day training package and ongoing training. The Centre for Excellence for Looked After Children in Scotland’s (CELCIS) review of LA-led peer mentoring interventions in Scotland concluded that a minimum of 20 hours of training was necessary for peer mentors to feel fully equipped to undertake the role103 and, overall, it would appear that longer training times are associated with longer-lasting mentoring relationships. 152

The DCSF-funded mentoring and LAC pilot scheme141 recommended that mentor training should include introducing the role of the mentor, stages of the mentoring relationship, dealing with conflict, maintaining boundaries, confidentiality, child protection and health and safety. Mentors who are going to work with LAC should also receive training in relevant legislation, goal setting and action planning, communication skills and attachment and loss issues. It is important for programme providers and trainers to monitor mentors’ suitability on a continuing basis. Unsuitable mentors may need to be identified and deselected during the training. Evaluation of 20 Prince’s Trust mentoring projects for care leavers found that only 50–90% of volunteers completed the training and selection processes successfully. 109

The provision of ongoing support and supervision for mentors following initial training is important both to maximise the benefits for mentees and to reduce the risk of inappropriate or harmful contacts. 153 The National Children’s Home Cornwall pilot mentoring project (now known as Action for Children) found that, without proper supervision and support, unresolved issues in the mentors’ lives could impact on their commitment to mentoring. 141 There is some evidence the most failed matches are reported by programmes in which co-ordinators do not regularly contact mentors. 154 Rainer141 recommended that programmes offer group support for mentors every 4–6 weeks, as well as ad hoc or one-to-one-support every 2–3 months. Supervision serves a number of purposes for mentors: to record their contacts, reflect on their relationship and feedback concerns, submit work for accreditation if the programme offers this and identify additional training needs. Although it can be difficult to get mentors to attend group supervision, attendance may be increased by providing an advance schedule of meetings to mentors, ringing or texting mentors before each meeting to remind them, providing refreshments and adding a social element to the sessions. 141

Building the mentoring relationship

A great deal of the success of mentoring programmes depends on the quality of the relationship between mentor and mentee. 106,152,155

There is no consistent evidence on the benefits of matching mentors and mentees143,144,156 or on what attributes, if any, they should be matched on. 144,157 In practice, matching is most frequently based on geographical location, gender, race/ethnicity or shared interests. 106

Regular contact and clear expectations

It is important to provide mentors with some guidelines and expectations regarding their roles and responsibilities and some structure with regard to mentoring sessions. The DCSF-funded mentoring and LAC pilot scheme141 found that most providers delivered an introductory session facilitated by the mentoring co-ordinator. With regard to timing, content, frequency, etc., there is also evidence that mentees value the opportunity for regular but also flexible contact and the mentor being available on an impromptu basis.

Characteristics of the mentor

Mentors who have high relational qualities such as empathy, engagement, authenticity and empowerment appear to be the most effective in bringing about positive change in their mentees,158 including the formation of constructive relationships with others in the future. 159,160 Focusing on the mentee’s preferences and interests is also important for establishing and maintaining a good mentoring relationship. 161

Building rapport and trust and maintaining a strong emotional connection may be particularly difficult for LAC, many of whom will have experienced relationship breakdowns in the past,111 and this in turn may affect the motivations of the mentors. 162

Frequency of contact and length of the mentoring relationship

Different mentoring programmes adopt different arrangements for the frequency and length of contact between mentors and mentees. A Canadian review of the literature144 recommended that adult mentors and young people spend between 2 and 5 hours together every week over a minimum of 12 months. There is strong evidence to suggest that the most positive improvements for young people occur among those whose mentoring relationships last for a year or longer. 152,155,163–165 However, mentoring providers in the DCSF-funded mentoring and LAC pilot scheme141 found that 12 months of mentoring may not be sufficient for LAC and young people with multiple and complex needs. However, LAC are at risk of becoming overdependent on their mentors, which means that care has to be taken to encourage them to move gradually from a state of dependency to growing autonomy and agency. 155,163

Sustaining the mentoring relationship

When mentoring programmes are goal focused, establishing mutually agreed short- and long-term goals can be helpful, as can providing mentees with opportunities to reflect on their goals and progress within the mentoring relationship. 166

Some estimates suggest that around 50% of mentoring relationships will fail in the initial months167 and failure rates may be even higher for young people with complex problems such as LAC. 168 In a RCT of a peer mentoring programme for first-time mothers aged 16–30 years, 22 of the 32 mothers who acted as mentors resigned during the intervention and 33% of their mentees declined the offer of a new mentor. 169 The reasons given for attrition by mentors included new employment, disillusionment and insufficient time. In the DCSF-funded mentoring and LAC pilot scheme,141 the most common reason cited for relationship termination was that the mentee no longer wished to engage.

Sometimes the mentor and mentee perceive their relationship differently. Philip and colleagues170 found that, although adult mentors tended to describe their relationship with their mentee as a ‘working’ one, their mentees largely viewed their mentor as being more like a confidant or a friend. It is therefore important for mentors to be clear about their role and to be able set this out at the start of the relationship.

Ending the relationship

Research emphasises the importance of ensuring that mentoring relationships end in a carefully planned and managed way. Premature or unplanned endings may have a detrimental impact on mentees,171 especially for at-risk youth such as LAC. 144,152,155,168 Philip and colleagues170 argue that an over-reliance on the mentor may undermine the positive outcomes achieved through the intervention and lead to feelings of loss, abandonment and rejection by the mentee if endings are not managed sensitively. Conversations about ending the relationship should therefore form an integral part of the mentoring relationship from the outset. 141 This may be particularly relevant for LAC, who have often already experienced repeated rejections and losses in their lives.

Mentor selection process

Individual qualities most likely to be associated with being a successful mentor were being non-judgemental, empathetic and a good listener, being able to act as an appropriate and positive role model, being committed and able to meet the demands of the role. LA staff were asked to select young people who they felt were appropriate based on these criteria and professional knowledge. PCs were asked to ensure that there was enough time for DBS checks to be completed on potential mentors.

Mentor training

In spring/summer 2011 the research team met with NCB training staff and managers to discuss and finalise the content of the 3.5-day mentor training course. Following discussion with the research team it was agreed that the NCB would produce the training material. Key aspects to be covered during training were the expectations of the mentoring role, confidentiality and safeguarding, maintaining boundaries, facilitating help-seeking behaviour and dealing with difficulties (see Chapter 4 for further details).

Matching

Because of the lack of consistent evidence on attributes that mentors and mentees should be matched on, PCs were advised, as a minimum, to match mentors and mentees on the basis of geographical proximity. A 5-year age differential between mentor and mentee was specified, on the basis that mentors might experience more difficulty in maintaining an appropriate emotional distance in the relationship if they were too close in age to their mentee.

Managing the mentoring relationships

The PCs were given responsibility for recruiting mentors and mentees, managing the contacts and providing support to mentors through monthly group meetings. PCs were asked to commit a minimum of 3 hours a week to the role. It was felt that one-to-one support for mentors, in addition to monthly support groups, would be too much of a burden for PCs. The monthly support group meetings with the mentors were created for the purposes of monitoring relationships, identifying concerns, signing off work for ASDAN accreditation, giving out monies for activities and identifying additional training needs. PCs were asked to facilitate a three-way meeting with the mentor and mentee at the start of the intervention, to ensure that the aims, roles, responsibilities, length and boundaries of the relationship were clearly understood. A detailed PC role description can be found in Appendix 17, which was provided to all PCs when they commenced the role.

Mentor–mentee contact

Mentors were asked to spend at least 1 hour of face-to-face contact time per week with their mentee over a 12-month period. They were also encouraged to contact their mentee on an ad hoc basis, by telephone, e-mail or text message. Mentors were advised to give mentees the number of the mobile phone provided to them by the research team, rather than their personal contact details. They received a monthly stipend from the PC of up to £40 a month to pay for any leisure, social or other activities with their mentee and to cover travel expenses.

In relation to the intervention’s primary outcome, reducing teenage pregnancy, mentors were asked to discuss issues relating to sexual health and relationships when they felt that this was appropriate or if raised by the mentee. Mentors were advised to encourage their mentees to seek help for troubling issues (e.g. sexual health, substance use, criminal activity, mental health) using knowledge of local services or by asking professionals and, if required, to accompany their mentee to any subsequent appointments (see Appendix 17 for a detailed description of the mentor role).

Exit strategy

Mentors were asked to end the relationship in a carefully planned and managed way, to ensure that the mentee was clear about the length of the relationship from the outset and to ensure that the mentee was able to identify a support network post mentoring relationship. Towards the end of the mentoring period, mentors were asked to identify any additional or unmet support needs for their mentee and to discuss these with the PC.

Allocation of project co-ordinator roles

Allocation of the LA1 PC role was described as part of the pilot process (see Chapter 4). The same individual continued to act as PC in LA1 for Phase II.

In LA2, the PC role was divided between a sexual health outreach worker from the primary care trust (referred to as LA2 PC1) and an assistant team manager from the Leaving Care Team (referred to as LA2 PC2). Senior management identified a worker with sexual health knowledge to deliver the intervention and facilitate support groups for mentors. However, the fact that she was employed outside the LA limited her access to social workers and LAC. This resulted in a second PC being identified from social services, whose role was to assist with recruitment and deal with internal organisational issues, such as mentor DBS checks.

In LA3, the PC role was given to a manager within the LAC service, who volunteered for the role, supported by a team manager from the Leaving Care Service (referred to as LA3 PC1), who was chosen because of her background in research. However, in January 2012, following an organisational restructure, her post was relocated to a different service. The LA3 PC role was then split between two individuals: LA3 PC1 and a mental health co-ordinator in the Leaving Care Team (LA3 PC2). They divided the tasks so that LA3 PC1 focused on recruitment and LA3 PC2 assisted with supporting the mentors.

Promotion of the study within the local authorities

The recruitment strategy was modified after the pilot phase. The research team met with the PCs in August 2011 to explain the recruitment process, the numbers required and the milestones we were working to. Recruitment guidelines were then distributed to all PCs in September 2011 (see Appendix 19). PCs were requested to make contact with LA professionals to provide preliminary information about the study and to meet with social workers to explain the study and ask them to identify participants. Senior managers were encouraged to disseminate information to staff. Social workers were asked to pass on the details of potential mentees and mentors to the researchers. Mentors were then invited to attend the training and mentees were contacted by the research team and consent procedures were completed.

By October 2011, very few participants had been identified by social workers, despite regular prompts from the PCs and LA senior managers. To try and encourage recruitment, in LA1 and LA2 the researchers started attending social work team meetings, together with the PCs, to promote the study. However, because of an imminent reorganisation, LA3 did not accept the researchers’ offer to attend one of their meetings. Following advice received from a CiCC Participation Officer in LA3, the team distributed new social worker recruitment guidelines and information about the study, aimed at alleviating concerns related to the use of randomisation in the study and the safety of mentor–mentee relationships (see Appendix 20).

In February 2012, the research team had another meeting with the PCs to discuss progress in recruitment. Despite being requested to complete mentor and mentee recruitment concurrently, the PCs had mainly been focusing on ensuring that there were enough mentors to attend the training, which was due to commence imminently. Even so, only 15 potential mentors (as opposed to the hoped-for 30) attended the training, which took place throughout February and March 2012 (LA1: n = 5; LA2: n = 6; LA3: n = 4).

Mentee recruitment failed to progress, even after mentor training had taken place, largely because of competing time pressures and work constraints on the PCs. PCs felt that active and visible support and back-up for the study by senior managers would have improved the response of social workers to their requests for participants (also found in the pilot study). In LA2 and LA3, senior management had been active in sending out e-mails asking social workers to identify participants. However, in LA1, there was relatively little input or visible support for the study from senior management:

I think if [name of senior manager] had sent an e-mail out saying to all the social workers that, you know, they must do their best, I think that would have went a long way . . . there’s a lot more different teams out there that we don’t work with but we could’ve got young people from them.

LA1 PC2

As a result of the delay in recruiting mentees, the researchers had to become much more actively involved in recruitment than was originally planned or anticipated. We presented the study at social worker team meetings, followed up on leads and completed a ‘floor walk’ of offices with the PCs in LA2 and LA3, which involved approaching social workers at their desks and providing them with information about the study. However, team managers often turned down, or failed to respond to, our requests to attend team meetings and so this strategy met with only partial success. The researchers then resorted to publicising the study more widely to other professionals working with LAC within the LAs. A one-page flyer, advertising the study to LAC, was developed in response to the PCs’ observations that the recruitment leaflets were too wordy to appeal to young people. These were distributed at social worker meetings. In LA3, regular e-mails from senior management to social workers produced a list of potential mentees and the researchers then asked the relevant social workers in LA3 to discuss the study with the individuals identified. Finally, following advice from a Corporate Parenting Manager, LA1 and LA3 sent a letter to all eligible young women within the boroughs (see Table 12 for numbers of eligible women), inviting them to participate.

By June 2012, LA1 and LA3 had recruited sufficient numbers of potential mentees to be randomised to the intervention and control arms. By contrast, LA2, having recruited the largest number of mentors, completed mentee recruitment only in September 2012.

Young people aged 14–18 years (mentees)

In total, 26 LAC aged 14–18 years were recruited to the Phase II trial as potential mentees (10 from LA1, 12 from LA2 and four from LA3). Thirteen were allocated to the intervention arm and 13 to the usual support arm. In LA1, the majority of participants were recruited through the mail-out letter to eligible young women in the borough. The number recruited through social worker referrals was much lower in LA1, consistent with PC1’s perception that she did not have much senior management support when pushing for referral. This is highlighted in Table 6.

In LA2, the majority of participants were identified by a combination of referrals from social workers and the PCs. PC1’s role as a sexual health outreach worker also enabled her to recruit LAC who were accessing sexual health services through her clinic. Two mentees were recruited by other professionals (youth offending team and clinical psychology services). In LA3, referrals increased following a direct request from senior managers.

These results show that different approaches were used to recruit mentees. In LA1 and LA2 the PCs used the existing contacts that they had with young people to identify potential participants. Although the mail-out approach in LA1 identified more potential participants than referrals from PC1, the fact that she was well known to young people and fellow social workers within the LA made the process of identification and communication more straightforward:

In LA1 we have a sort of you know quite good relationship with young people. So, it wasn’t because of the Carmen project, I knew them anyway and I had the relationships already established.

LA1 PC1

Young people aged 19–25 years (mentors)

Fourteen mentors were recruited to the Phase II trial (five from LA1, six from LA2 and three from LA3). One additional young woman who was pregnant attended the LA3 training. However, she gave birth shortly after this and did not proceed to mentoring. In all LAs, referrals were received from social workers, PCs and other professionals. In LA2, most mentors were recruited by the PC through a LA event for care leavers. Fewer mentors than mentees were recruited through social workers. This may be because of the decreased direct involvement of social workers with young people who have been in care after they reach the age of 18 years, unless they are still in full-time education. The recruitment method for mentors is illustrated in Table 7.

The most effective strategy for recruiting young people aged 19–25 years to act as mentors was through existing networks of care leavers. Some were identified by social workers who already had some professional knowledge of the young person concerned:

I did the [name of other mentoring programme run in LA1] mentoring programme . . . I think they must have heard about it and then they need mentors for their research and you know, to reduce the teenage pregnancy, to see how it goes and I think they just chose people from the [name of other mentoring programme].

LA1 mentor 4

Selection criteria for mentors

Project co-ordinators and social workers targeted individuals who they thought would be good role models for young women in care – those who had engaged in education or work and who had aspirations and a sense of direction in life. They also considered individuals’ personality, level of maturity, reliability, commitment to taking on a mentoring role, level of self-awareness and communication and interpersonal skills:

You might have so-called successful university graduate . . . but they might not be as suitable as somebody . . . who’s just steady, calm and cheerful. In fact, sometimes if you’ve got that, that person that’s up there it’s going to be quite far away from that person . . . it’s almost like they’re in a different stratosphere from me.

LA2 SW

I would be looking for somebody that has a certain level of maturity, not necessarily that they haven’t got their issues but they’re aware of what their issues are and they’re working on them. That’s stable at the moment, making quite good life choices.

LA1 PC2

Personal or psychological problems, such as a history of substance misuse or past abuse, were not necessarily regarded as exclusion factors, provided that the young woman had overcome them:

Someone who has got life experiences, so I’m not saying they couldn’t have had issues with the police or issues with substance misuse in the past, I think in some ways that’s quite useful. But more that they are more settled in where they were. In the sense of ‘I’ve had that experience, this is what I’ve done and I’ve been stable for a period of time’. I think that was for me, just that they are emotionally in the right place to be able to offer someone else support.

LA3 PC1

Pregnancy, or having a young child, did not necessarily exclude a young person from acting as a mentor, although these had been exclusion criteria in the pilot study. The appropriateness and adequacy of the mentor selection criteria are explored in Chapter 8.

Baseline characteristics of mentees/usual support group participants

Table 8 shows the baseline characteristics of the 30 participants aged 14–18 years. The participants in the pilot study (n = 4) are included in addition to the 26 Phase II participants. This is because the outcome analyses (see Chapter 7) include the pilot study data because of the small number of participants recruited in Phase II. The data presented in Table 8 are based on participants’ self-reported history and current circumstances. To corroborate these baseline data we sought information from each participant’s social worker; however, only 12 out of 26 social workers returned the baseline questionnaire.

Participants often gave more than one reason for having entered the care system. The main reasons cited for being taken into care were emotional abuse (n = 6 intervention group, n = 6 usual support group), breakdown of relationship with family carer (n = 3 intervention group, n = 5 usual support group), sexual abuse (n = 3 intervention group, n = 1 usual support group), neglect (n = 2 intervention group, n = 1 usual support group), unaccompanied minor (n = 1 participant in each group) and physical abuse (n = 1 intervention group). Four participants (n = 3 intervention group, n = 1 usual support group ) stated that they did not know why they had been taken into care.

Participants reported high rates of self-harm (50%), truancy (76%), suspension/expulsion from school (50%), contact with the police (60%) and episodes of going missing from home (40%). Over half of participants had already engaged in sexual intercourse (63%), with a mean age of first intercourse of 14.3 years.

With regard to the primary outcome variable, one-fifth of participants (n = 3 in each group) had been pregnant. Four participants had been pregnant once (n = 2 in each group), one participant (in the intervention group) had been pregnant twice and one participant (in the usual support group) had had three previous pregnancies. No participants were pregnant at baseline. Out of the total of nine pregnancies, three had resulted in a live birth (n = 2 intervention group, n = 1 usual support group), four had ended in spontaneous miscarriage/stillbirth (n = 2 in each group) and two had resulted in a termination (n = 1 in each group). Only one of the nine pregnancies had been intended. Of the eight unintended pregnancies, contraception had been used on only two occasions.

Before the start of the intervention, participants were asked to state the youngest age at which they thought it would be acceptable to have a baby. The mean age reported was 17.2 (SD 3.4) years, ranging from 11 to 29 years. In total, 22 participants (73%) reported that they would feel scared/nervous if they found out that they were pregnant now, with only 2 (7%) participants stating that they would feel happy/excited. Sixteen (53%) would give birth and keep the baby, six (20%) would have a termination and two (7%) would give birth and have the baby adopted or fostered.

At baseline, seven of the intervention group (41%) and five of the usual support group (42%) scored ≥ 4 on the 12-item General Health Questionnaire (GHQ-12) (Table 9).

A similar distribution of attachment styles was reported across the two groups, with 10 out of 29 participants (34%) indicating a secure attachment style. Eleven (38%), two (7%) and six (21%) participants indicated a fearful, preoccupied and dismissing attachment style respectively. Participants were asked to rate the likelihood that they would seek help from a variety of sources, first, if they had a personal or emotional problem and, second, if they were feeling desperate and having thoughts about suicide. The most popular source of help for a personal or emotional problem was a friend, from whom 17 (57%) participants reported that they would be extremely or very likely to seek help. The least popular sources of help were religious leaders, helplines and doctors, from whom 24 (80%), 22 (73%) and 19 (63%) participants, respectively, reported that they would be extremely or very unlikely to seek help. Only four (13%) participants reported that they were likely or more than likely to seek help from no one for personal or emotional problems. A similar pattern occurred in the second scenario. However, nine (30%) participants reported that they were likely or more than likely to seek help from no one when feeling desperate and having thoughts about suicide.

Baseline characteristics of mentors

Table 10 shows the baseline characteristics of mentors, including the pilot participants, based on self-reported history and current circumstances. All of the mentors in the study had educational qualifications. At baseline, three had already received a degree and a further four were studying at university. Of the remaining 11, six had a level 3 qualification (equivalent to A level) and five had level 1 or level 2 qualifications. Ten of the mentors had been pregnant at least once and eight were already mothers at baseline. One additional participant was pregnant at baseline.

Data were missing for all psychological measures for one pilot participant. Two out of 17 mentors (12%) scored ≥ 4 on the GHQ-12 (Table 11).

Mentors’ motivations to participate

Mentors mostly gave altruistic reasons for becoming a mentor. These included wanting to ‘make a difference’ to another young person’s life and help them to achieve their aspirations, wanting to help them to make more informed choices about relationships and using their shared care experience to act as a positive role model.

Personal development, such as the acquisition of new skills and increasing future employability by being able to add this experience to their curriculum vitae (CV), was also cited as a reason to become a mentor:

I’d like to become a peer mentor to help young women who have been in a similar situation to myself and because I’d like to help young people in my future career and this project will give me some experience [of that].

LA3 mentor 12

A number of mentors said that they would have valued the support of a peer mentor themselves when they were younger.

Several mentors from LA1 had already been involved in an established group peer mentoring scheme run within the borough and therefore had experience of mentoring young people in care:

The first thing that came to my mind was that it would be good for me anyway ‘cos I wanted something that could be hands on, like properly get into the actual work . . . of mentoring, not being supervised all the time . . . having that free time to just, you know, talk . . . so I was interested in that.

Pilot mentor 2

The national survey similarly found that wanting to help a young person in care (28/37 responses; 76%) and being able to share their own experiences (24/37 responses; 65%) were the most frequent reasons given for wanting to be a mentor amongst care leavers aged 19–25 years.

In return for their participation, mentors were offered a £40 voucher per month and the option of completing a level 1 ASDAN qualification. At follow-up interviews, mentors were asked for their views on the adequacy of these incentives. Most said that they would have taken part in the study even without a financial reward; however, they agreed that the vouchers added an extra incentive to participate. This particularly resonated with mentors who were mothers:

Having it there is handy . . . especially like being a single mum it’s like okay, I can go and buy the nappies with this if I’m kind of short on money that week or something. So it is a bit like . . . it is quite a big incentive.

LA1 mentor 15

The mentors were undecided on the adequacy of the £40 voucher. One mentor commented: ‘I think that was reasonable . . . ‘cos it’s a volunteer position I wasn’t really expecting anything – that’s a lot – so I’m quite happy with that £40’ (pilot mentor 3).

Another mentor thought that more money should have been offered, given the amount of effort needed. She was not in education or employment and therefore financial remuneration may have been more important to her. Others, who recognised that their commitment had not been as much as expected, felt that £40 was more than sufficient (see Chapter 7 for an analysis of the reasons why mentors did not fulfil their responsibilities). Three mentors said that they may have been more committed to the role if they had been paid more, with one commenting that ‘if it was a job, I think yeah, maybe the focus would have been there a bit more’ (LA1 mentor 18).

Twenty-five out of 29 (86%) respondents in the national survey of care leavers aged 19–25 years said that they would take part in the study even if they were not paid and 21 out of 33 (63%) rated the incentives offered as 4 or 5 on a satisfaction scale (1 being ‘unsatisfactory’ and 5 being ‘satisfactory’). Only two respondents rated the incentives as ‘unsatisfactory’.

In terms of the ASDAN qualification on offer, mentors had initially valued the opportunity to pursue this. However, those mentors who already had, or who were pursuing, a university degree felt that a level 1 qualification was quite low. Some with lower-level or no qualifications welcomed the chance to obtain the ASDAN qualification whereas others said that they were too busy to complete the paperwork. By the end of the study, however, none of the mentors had obtained this qualification (see Chapter 7 for reasons why).

These findings suggest that a future trial could offer the option of a qualification for mentors; however, it would need to be managed effectively with consideration given to ensuring that the qualification being offered reflected the educational and vocational needs of the participants.

Mentees’ motivations to participate

Having the opportunity to be in a mentoring intervention, to meet new people with similar experiences to their own and to form a network were the main reasons given by mentees for participating. Several young people also expressed the desire to talk to someone who they could relate to, someone similar in age, whose role was separate and distinct from that of their social worker, who ‘didn’t know my situation, and wasn’t involved in it basically’ (LA1 mentee 1009).

I thought . . . well if I had got a mentor then I thought that would really be like really good, ‘cos I didn’t really have someone my age that I could tell completely everything to. So, it was nice to have someone like old enough to understand and relate rather than someone like my age that hasn’t been through the same things.

LA2 mentee 2008

Because I wanted someone that I could see like every week or something. Seeing the social worker’s two different things. Seeing a mentor is like, someone you bond with. And might have some kind of connection with like, for example, past experiences and stuff like that.

LA2 mentee 2002

Participants often found it difficult to differentiate between their participation in the research and the mentoring intervention; however, some did express positive views about the research, including the opportunity to be involved in a project aimed at helping young people in care and also being able to express their opinions in a research interview:

Being able to speak out about more things . . . and express the way I feel and, yeah, so if someone could get an understanding of how I am as well . . . ‘Cos most of the time I wasn’t really asked questions, like these kind of questions [referring to research interview] that I will be asked from my social worker.

LA2 mentee 2002

Local authority structural barriers

Lack of time to commit to this research was the most common reason given by social workers preventing their effective participation in this study. Despite the fact that most social workers saw the value in what the study was trying to achieve, they were unable to prioritise it because of competing work commitments and deadlines. LA1 PC2 commented that social workers’ large caseloads and time pressures meant that they often prioritised ‘reactive knee-jerking stuff’ rather than preventative work. This had a detrimental impact on recruitment to this study. Furthermore, during the recruitment period, all three LAs were subject to a number of reorganisations, inspections and cutbacks, which tended to push the requirements of this project further down the agenda:

I think on some level the team managers is maybe where there’s been a bit of a . . . blockage. Yeah, they’ve not really followed it up. And I say that, bearing in mind the environment, the climate we are all in. Consultations, inspections, Ofsted, health. These are massive things not to be considered lightly. So . . . the information may have gone out but it then slips very quickly through the list of priorities, which is understandable.

LA2 PC1

I think you get people who think well that person may or may not be interested, but it’s about trying to continue to get social workers to prioritise it. Because they are constantly getting other needs, other issues, child protection . . . I think the general concept has been received well and most people think it’s a good idea but it’s then the effort it needs to actually translate that into something active and meaningful.

LA2 SM

In LA1, PC1’s role was integrated into her existing workload. However, in other LAs, the PC role was in addition to the PCs’ existing role, which meant that they constantly had to juggle a number of competing priorities. All PCs felt that the role required a greater time commitment than originally anticipated, especially during the busy recruitment period: ‘Somebody’s got to have the time to devote that . . . I think the downside has been the consistency and you know it hasn’t been there’ (LA2 PC1).

Within all three LAs there was a lack of clear communication about the study from the PCs to social workers, despite the standardised recruitment guidelines designed for this purpose. Of the 19 social workers who responded to our survey of social workers across the three LAs, only eight said that they had been informed about the study. The focus group discussions also highlighted some confusion amongst social workers over the purpose of the study; not all social workers realised that this was a study aimed at reducing teenage pregnancy.

Given the problems encountered with recruitment, we conducted interviews with LA professionals towards the end of the recruitment period, exploring their suggestions for management in a future trial. Most suggestions complemented those from the pilot study. These included PCs adopting a face-to-face approach with social workers (rather than e-mail exchanges); having consistent support from senior management, who can use their authority to filter information down through the organisational structure; and wide advertising of the study across the borough with clear communication amongst professionals:

[It] means everybody working together consistently, sort of singing from the same hymn sheet basically. So that if you’ve got the IROs [Independent Reviewing Officers] chairing reviews that it’s featured there. If you go to a stat medical where, you know, things like sexual health, all the things that the project is trying to promote is actually discussed so it’s featured there. In schools they also have a curriculum so it’s featured there. So it’s in everybody’s face.

LA2 PC2

Professionals were united in expressing the view that a dedicated PC role should be built into a future project. This would allow PCs to persist with encouraging social workers to recruit without the constraints of competing priorities:

If you seriously wanted to take peer mentoring forward then I think you’d need to have someone who is dedicated to doing it even if it’s a 0.5 of a post, but that would be what they do. They actually support, they actually recruit because it is a process where I think you’ve got to keep on going at it, you’ve got to follow up the leads . . . it’s about that follow-up and I think the project’s shown that, that as soon as you begin to lose that focus, lose that emphasis on it, things begin to slide back and stuff doesn’t get followed up. It’s competing with other priorities and you need someone who’s really focused on it.

LA3 SM

Based on this suggestion we explored further the characteristics of the PC role, including the amount of time needed to deliver the intervention and the professional role best placed to co-ordinate it. This is discussed in Chapters 8 and 9.

Availability of eligible participants

In our national surveys of DCSs (n = 39) and social workers (n = 103), the DCSs reported that on average, LAs had 31 young women who fitted the mentee recruitment criteria and were placed in the borough (SD 26.6, range 0–160) and social workers reported an average of six young women fitting the mentee recruitment criteria per social worker’s caseload (SD 9.4, range 0–75). In theory, therefore, the pool of young people who would meet the criteria for inclusion in this and any future study is large enough to support a Phase III trial.

However, it was not considered feasible, or reasonable, to expect mentors to travel long distances to see a mentee and this placed a geographical limitation on the numbers of eligible participants, which impacted on recruitment rates. In LA3, which covered a very large mainly rural area, the professionals had to limit their recruitment to only one region, further reducing the number of potential participants (Table 12).

Social workers in the local and national surveys were asked for suggestions for increasing the pool of potential participants. Nearly one-third of respondents (31/91) thought that the minimum age for mentees should be younger than 14 years, to encourage them to engage in safe behaviours and to make better choices around their sexuality and relationships before they became sexually active. The suggested minimum age was around 12–13 years, although some thought that the intervention could start even earlier, at age 10–11 years:

What my belief is it needs to start at a much younger age group. I think if there is anything, it’s a process . . . in terms of positive sexual health you need to educate before they are sexually active. Sometimes by the time they are sexually active, the horse has kind of bolted.

LA2 PC1

With regard to recruiting mentors, PCs experienced a great deal of difficulty in accessing them, because looked-after young people mostly leave care at 18 years of age. LAs remain in contact with young people until the age of 25 years only if they are in education. This meant that recruitment of mentors had to be focused on care leavers who were currently in education or who had kept in contact with the LA:

I don’t know whether or not that’s just about young people moving on and disengaging with social services ‘cos they don’t want the stigma of us being involved in their lives you know, some young people simply move on and don’t stay in touch with anyone . . . perhaps they feel they’ve had so much kind of social services involvement that that’s sort of enough for them.

LA1 PC1

After we were alerted to this issue we endeavoured to explore the possibility of recruiting care leavers directly from universities, by conducting a focus group with students from universities in south-west London. However, as discussed in Chapter 2, on speaking to the head of the Student Centre it was apparent that there were very few students across the two universities in the right age range and who had self-identified as being a care leaver (and it was unclear what proportion of these were female). This suggests that recruiting care leavers directly from universities may not prove to be any more successful than recruiting them from LAs.

Randomisation

From the interviews and survey data there were mixed views about, and understandings of, the need for randomisation. In the DCS survey, over two-thirds of respondents (34/48 responses) stated that they would not have concerns about randomisation in a study of this kind and most respondents recognised the need for randomisation as a method of measuring effectiveness:

I think randomisation is a vital part of research and is a must. It is an excellent way to possibly rule out any confounding factors early on in the study that could potentially impact the study.

DCS survey respondent

Similarly, some social workers said that randomisation would not, in itself, deter them from approaching young people to participate, ‘as long as they fully understood what they were making a decision about’ (LA3 SW).

However, several senior professionals and social workers were uneasy about failing to offer a service that might be beneficial to all young people and thought that the randomisation process potentially conflicted with their role as a service provider. Many of them felt that it was unethical to raise expectations in vulnerable young people that could not be met and thought that the young people should automatically receive the mentoring if they showed any interest in the study. Concerns were expressed that young people who had agreed to participate would feel let down and disappointed if they were allocated to the usual support group and that this could affect their willingness to engage in services more generally. These concerns may have deterred some social workers from approaching young people to participate in the study or from passing on their names to the PC:

If they are going through this and then they feel that they are going to have a mentor how do they respond to that, being told well you haven’t been allocated one after they’ve gone through that process. And sometimes it’s really hard for them to accept or say to themselves that you know, I do need a mentor and once they’ve made that step, how crushing is that to then to say they haven’t got one?

LA2 health and education professionals focus group

I think for some social workers they may have identified a young woman who definitely needed a mentor . . . and the idea that they may be put forward a name and then they may not get a mentor, this may have stopped them.

LA2 PC1

The national survey of social workers came up with similar findings to the interviews: 40 out of 80 social workers said that only young people who could ‘manage rejection’, who needed less specialist support and who did not have learning difficulties could be considered for a study involving randomisation.

Finally, the interview and survey data highlighted some confusion over what exactly was meant by randomisation. Research equipoise was an alien concept to many and, for some, this extended to a deep-rooted mistrust of academic research. One social worker in particular was vocal about this:

To me it’s blatantly obvious that having a mentor is going to be a positive beneficial effect, so it’s almost like saying, well how many people think that letterbox is red? Yes everybody’s going to nearly think it’s red because it’s blatantly obvious . . . so I actually think it’s an incredible waste of money and resources.

LA2 SW

And then usually what’ll happen after all that wasted money and resource [spent on academic research], they’ll bring out some paper or form for us to do something else, which’ll just clog up 85, 95% of our work doing something that’s not necessary. So I find it . . . it’s just a waste of time, waste of money. I understand the need for a little bit of research, because that’s how things come out, but I think we’ve gone research bureaucracy mad at the moment.

LA2 SW

By contrast, evidence from the national LAC survey suggested that randomisation is not a deterrent for the young people concerned. Over three-quarters of respondents (16/21) stated that they would take part in the study knowing that they had only a 50% chance of receiving a mentor. Only one of the five respondents who said that they would not take part cited randomisation as the reason. The other reasons were all related to not wanting support from a mentor at that time in their life.

The study participants themselves had mixed understandings of randomisation, even though this was explained to them when they were consented. Data from the follow-up interviews confirmed that, although some of them were able to recall the purpose of randomisation, others could not remember or had misconceptions about it. For example, some believed that they had been allocated on the basis of their personal characteristics or behaviours, or that it was a resource issue, that is, there were not enough mentors available, or that receiving a mentor was based on ‘luck’. One mentee thought that the study was a ‘competition . . . to win a mentor’ (LA1 mentee 1007).

Of the 13 young people interviewed directly after they were allocated to the usual support group, 10 reported that they were ‘OK’ with not having a mentor or ‘didn’t mind’ and three said that they were ‘disappointed’. However, it was clear that the majority had gone into the study hoping to receive a mentor, as expressed in the following quote:

I was hoping that I did get one and I was thinking that I hope I do actually get one. I think I hoped too much though. So it was, I was fine about it afterwards, ‘cos I understood, but it was just like that fact I really wanted one.

LA2 mentee 2002

Ten out of 26 participants aged 14–18 years (n = 6 intervention group, n = 4 usual support group) did not complete follow-up interviews. For those participants in the usual support group, we do not know whether their decision to disengage from the research was influenced by the fact that they were not allocated a mentor.

Lack of understanding about recruitment criteria

Despite being given clear recruitment guidelines, social workers remained unclear about the inclusion/exclusion criteria: whether males could be included, whether potential mentees had to be sexually active and whether potential mentees could be children ‘in need’ (Section 17 of the Children Act 198923), a lower threshold than those under LA care:

‘Cos initially we didn’t know whether it was male and, we did think it was male and female and that came up in the team meeting and it’s just been, obviously with it being teenage pregnancy it didn’t filter through straight away.

LA3 SW

This lack of clarity led to social workers adopting opposing recruitment strategies: LA1 approached ‘at-risk’ young women (for further details see Chapter 4) whereas LA2 PCs approached less chaotic individuals. Although they felt that the mentoring would be particularly beneficial for the most troubled, isolated young people, they also wanted to protect them from harm or potential risk:

I think probably the ones who possibly are completely off the rails and maybe have so much issues going on . . . even though I must say you would consider all young people, because it may be even somebody in that remit would benefit from a mentor – but it would have to come at possibly at a different stage . . . it’s about is it the right time to introduce a mentor? Or would you wait until that person is a little bit more settled?

LA2 PC2

Many professionals acknowledged that it was easier to select young people who they knew would engage with services, although they also felt that hard-to-reach young people would benefit the most from the intervention:

Two of the young people that you’ve been working with . . . those two were selected because they’re here [attending the Education and Achievement Centre]. Because they’re here, they come to everything, and you can engage them. And because they’re known to us, it’s almost like ‘right well we’ll use them then for this’ whereas actually there are a lot needier young people who are incredibly hard to reach and it’s them that need it.

LA1 health and education professionals focus group

Within LA3, social workers still seemed to be adopting a targeted approach, with one social worker reporting that she chose young women who she felt would ‘potentially be vulnerable to, you know, to pregnancy in itself’.

Engaging looked-after children in this study

It was very difficult for the researchers to set up the consent meetings with the mentees; numerous contacts were usually necessary before a date and place could be agreed. In many instances these then had to be rearranged because the young person concerned did not turn up to the meeting.

Our experiences were consistent with those of the LA professionals, who reported that it can be extremely difficult to engage this group of young people in services. Some social workers wondered whether the young people’s reluctance could be related to the negative connotations of being singled out for a pregnancy prevention intervention, or the fact that this was perceived as ‘just another process that they have to go through that makes them feel different’ (LA3 SW):

I think by that stage some young people are really suffering from professional burnout, so, they just don’t want to . . . ‘I don’t want to hear . . . don’t tell me about another person that you’re going to refer me to. I’ve already got a youth offending officer, a probation officer, a social worker, a keyworker, I’ve got somebody from children looked after health . . . my teacher, my school nurse’. You start potentially going into double figures.

LA2 PC1

The LAC population often have difficulty in establishing trusting relationships because of early experiences of rejection, neglect and abuse by adults. Professionals reported that it can take a long time for LAC to build positive relationships and this was supported by some young people, who expressed suspicion that the research was being run by social services and was yet another service they were being forced to engage with:

I thought it was gonna be like time wasted and like, like how the social workers do it; like ask a load of things – I just thought it was the random things that the social workers just have to do.

LA1 mentee 1003

Although there were difficulties with accessing and engaging the young people, it was also apparent that the opportunity to participate appealed to some. Seventeen out of 22 respondents to the survey of mentee-aged LAC reported that they would want a peer mentor if they were offered one.

For care leavers aged 19–25 years, the main barrier to participation was fitting the mentoring around existing commitments. Many were in education or work and some had decided against participation because they were concerned about their ability to do the mentoring role justice. There was also a problem in making the time to attend the 3-day training event. One PC commented:

Because these guys are at school or colleges and stuff like that, it’s about trying to find an appropriate time for the training which suits everybody . . . I think you would have, you would’ve been inundated . . . you would’ve had more than 10 if we did it, the training, at a time when they all could attend.

LA1 PC1

The young people’s survey supported this. In total, 30 out of 34 (88%) young people said that they would be interested in becoming a mentor for young people in care. Of the four respondents who said that they would not consider becoming a mentor, the most cited reason was education/work commitments (four responses), as well as issues in their own lives (three responses) and family commitments (two responses).

Given these barriers, we again explored professionals’ and young people’s suggestions for promoting the study to young people in the future. Most professionals felt that a direct approach, contacting young people face-to-face, would be the best method of recruitment. They suggested accessing networks of young people in care, such as CiCCs or youth centres, as well as promoting the study at events where they would be present.

Data from the survey of young people aged 14–18 years indicated that many young people would prefer e-mail contact to other means of communication (12/18 responses). Several participants in the study also recommended wider advertising through posters and leaflet distribution, possibly because this would feel less pressurised than a face-to-face approach. As discussed in Chapter 4, however, it is not clear whether young people would have the confidence to actively put themselves forward; the survey results showed that only 30% of the 14–18 years age group felt able to call the PC after seeing a poster compared with 65% of the 19–25 years age group.

Most professionals felt that the initial approach regarding the study should be made by a professional known to the young person (i.e. a member of their care network). However, the young people who were surveyed did not have a preference as to who they received the initial information from (Table 13). Most participants in the trial had no problems with the way that they were recruited to the study. However, their willingness to engage was clearly influenced by whether or not they had a good relationship with the professional who made the initial approach:

I think sometimes with young people they may not want to listen to what their social worker says. Because social workers they really drive people mad. What I thought it could be . . . if you contacting them, contact them yourself, and say that we’d like to meet you.

LA2 mentee 2011

So I think maybe next time, as well as using the social worker . . . maybe trying to go through . . . we have like a Foster Carer’s Forum where a big percentage of our LA2 carers go – and if you tell them ‘cos they direct[ly], they know the children better than social workers, better than anybody. And I think carers have a better way of being able to talk to and persuade young people as well.

LA2 mentor 11

It was also suggested that a mentoring scheme that was run by an organisation external to social services, such as a voluntary sector organisation, might increase young people’s engagement with the service:

If it was sort of independent from CYPS [Children and Young People’s Services] the response may actually be sort of different. So, for example, if it was a service we had to buy into or we had to sort of refer young people to ourselves, rather than be directly from CYPS, that may be a better option and young people would probably be more welcoming to it as opposed to a bit more dubious about it.

LA2 PC2

These suggestions are considered in further detail in the discussion chapter of this report and are used as a basis for making recommendations for future recruitment (see Chapter 10).

Adaptations to the pilot training

Based on the feedback from the pilot, the Phase II training programme was adapted as follows:

• more discussion about how to approach the first meeting with the mentee, including consideration of mentees’ feelings and how to respond to these

• emphasis on the need to persevere with contacting the mentee during the initial stages of the relationship

• an additional module on risk awareness and management, with examples and advice on what mentors should do if there were concerns about the mentee and ensuring that meetings take place in a safe setting and that the PC is made aware when meetings are set up and are taking place

• increased use of role play, including potential scenarios that could occur in mentoring relationships

• the need to identify and draw on outside sources of advice and support, including from professionals within their mentee’s and their own care network.

The Phase II training agenda can be found in Appendix 22.

Phase II training took place in all three LAs between January and March 2012. Five mentors attended in LA1, six in LA2 and four in LA3. All participants completed the training course, although there were varying degrees of attendance throughout the 4 days, with some participants arriving late and others leaving early because of other commitments. A minimum of 80% attendance was required to commence mentoring. The same data collection methods were used as in the pilot study.

Overall, the training was received well by participants across the three delivery sites. Feedback forms, completed at the end of each day and using a rating scale from 1 (‘very poor’) to 5 (‘excellent’), showed that the overwhelming majority of modules (16/18) were rated as 4 or 5 by participants who completed them. Participants described the training as a useful learning experience – all either agreed or strongly agreed that they had gained additional knowledge as a result of the training.

Preferred learning modules

Participants preferred the modules that allowed them to reflect on their own lives and experiences, as well as those that provided them with new knowledge. Across all sites, participants most enjoyed the modules on sex education, contraception and STIs, both because of the content and because of the interactive learning methods used. Participants were also generally positive about being given the opportunity to learn about risk factors for teenage pregnancy. One young woman in LA3 valued listening to the perspectives of other participants in the group who had become teenage parents. With regard to the module on healthy and unhealthy relationships, one participant said:

I didn’t really think of sex as in a very major thing, but obviously it opens your eyes up to a lot of things . . . because you could get yourself into a lot of trouble with that like herpes and stuff I didn’t realise you can’t get rid of it . . . and I’m thinking oh my God.

Pilot mentor 1

Other popular modules included those about child rights and building trust among the peer mentor group and a module entitled the ‘three P’s’, in which participants were asked to consider professional, personal and private boundaries in relationships and what they would be willing to share with a mentee. Mainly these modules were valued because of the combination of practical and reflective elements:

And I really enjoyed . . . the trust thing, with the eyes closed . . . I’m used to doing things all by myself and taking control of things. And what I really enjoyed was that I had to trust her to take control of, not my actions, but my steps and get me to the right place. And I think that helps in terms of trust.

LA2 mentor 19

Was it the ‘three P’s’ . . . there should be boundaries . . . on what you talk to your mentee about, plus to some extent you have to be very professional. And there will be some certain situations where you have to talk about your personal experience. So it’s about balancing everything.

LA2 mentor 10

Information relating to safeguarding and confidentiality was less positively received, largely because a few participants felt that, because of their ‘lived experiences’ as a child in care, they already knew about, or had learnt about, these issues:

Sometimes I drift off ‘cos it was a bit slow for me personally. Sometimes we go over the same thing a few times and I’ve either done it before in other training stuff or . . . not that I’m saying I know everything, I don’t know everything but sometimes I’d be like ‘come on’.

LA3 mentor 12

However, most participants were able to recognise that the reiteration of safeguarding procedures was important within the context of mentoring relationships and tried to view it as a ‘refresher’ of their existing knowledge.

Delivery methods

The emphasis of training was on discussion and reflection coupled with practical activity sessions:

The reason why I liked case studies, because you’re given a situation and then you’re asked questions which make your brain think a bit and it’s asking like what are your concerns and what would you say and what else might you do, so it’s getting you to be like placing you in the mentoring role . . . so it’s kinda like equipping you with the skills that you’re gonna need.

Pilot mentor 3

Group learning was viewed as important as participants valued the opportunity to share their experiences and opinions with their peers and the trainers:

When we split up into groups and we had our pieces of paper and pens on the floor and we were all putting in our ideas. I enjoyed that. And then coming together afterwards and both saying and sharing and putting it all together.

LA1 mentor 11

Pilot study participants suggested that role-play of potential scenarios in mentoring relationships would be a helpful tool for future training. In Phase II, role-play was implemented only in LA1 because in LA2 the participants were more reserved and in LA3 there were too few participants for role-play to be effective. When role-play was used in Phase II, participants were generally positive because it ‘gives you the experience of being in the situation and how you’re feeling’ (LA1 mentor 11).

PowerPoint slides were used infrequently by trainers and only to deliver factual information. However, this mode of delivery was the least preferred by participants. One mentor commented, ‘when you sit and listen it’s really hard to focus’ (LA2 mentor 7).

The dynamics of the group also impacted on the way that the participants engaged with the training. LA2 mentors were very different to those in LA1 and LA3. They were initially very quiet and reluctant to engage in discussion or to share personal experiences, unlike LA1 and LA3 mentors, who had been more open and cohesive as a group. The different group dynamics required the trainers to be flexible in their approach and to be willing to adapt delivery methods to the needs of each group.

Across all sites, participants expressed appreciation for the fact that the trainers were non-judgemental and encouraged them to express their views, as well as making time to speak to them individually outside the session if they needed additional support or input. Many of them referred to the importance of a safe and supportive environment, which helped their learning and also gave them the confidence to ask questions: ‘because of the environment that we’re in there’s like no one’s judging you, no one’s laughing at you or anything like that, I feel more comfortable speaking out’ (pilot mentor 3).

Delayed age at first intercourse

At the baseline interview, 19 out of 30 participants reported that they had previously had sexual intercourse. Of the remaining 11, follow-up data were available for seven (n = 4 intervention group, n = 3 usual support group). None of the four from the intervention group reported first intercourse during the study year whereas one out of the three in the usual support group reported first intercourse during this time.

Contraceptive use

Of 19 participants followed up, 12 had sexual intercourse during the study year. They were asked to report the number of sexual partners they had had and to distinguish between contraceptive use to prevent pregnancy and use of condoms (as the only method to prevent against STIs).

Table 14 illustrates that, at follow-up, 10 out of 12 were using contraceptives to prevent against pregnancy. One-third (n = 4) were using condoms as an additional form of contraception. In the 3 months prior to follow-up, although six young women had sex without using a condom, only two of them were not using any other form of contraception against pregnancy. Three young women who were not using contraception at baseline were using it at follow-up. Interestingly, the contraceptive implant was the most popular choice of contraceptive (n = 4) followed by the injection (n = 2). Others used the patch, the contraceptive pill and the coil.

Attitudes to pregnancy

At follow-up, participants were asked to state the youngest age at which they thought it would be all right to have a baby. The mean age reported by the intervention group was 17.0 (SD 2.8) years, ranging from 14 to 24 years, whereas the usual support group gave a mean of 17.8 (SD 1.8) years, ranging from 15 to 20 years.

At follow-up, three (27%) in the intervention group reported that they would feel happy/excited if they found out they were pregnant now whereas none of the usual support group said that they would feel happy or excited. Seven (64%) in the intervention group reported that they would have negative feelings (scared/nervous/sad/depressed) if they found out that they were pregnant now compared with eight (100%) in the usual support group. In the intervention group, six (55%) said that they would give birth and keep the baby, one (9%) would give birth and have the baby adopted/fostered, two (18%) would have a termination and two (18%) would make some ‘other’ choice. In the usual support group, five (63%) said that they would give birth and keep the baby and one (13%) said that she would have a termination (two participants did not respond).

Health and well-being

At follow-up, five of the 11 (45%) in the intervention group scored ≥ 4 on the GHQ-12 compared with three out of six (50%) in the usual support group. The vast majority of participants self-rated their emotional and physical health as ‘OK’ or better. Four participants in the intervention group reported self-harming during the study year and one reported a suicide attempt, whereas none of the usual support group reported these behaviours. Over one-third of the participants reported using at least one substance. Seven reported using cannabis and one a hallucinogen. Five of the 19 (26%) participants reported drinking at least fortnightly in the last year. Nearly half of the participants (47%) reported episodes of drinking six or more units on at least one occasion during the study year (Table 15).

Eleven young women had attended an appointment with a sexual health practitioner during the study year. Two of them had not had sex during this period. As shown in Table 14, 10 out of 12 young women who had had sex during the study year also had a STI test. Fewer participants in the intervention group than in the usual support group had seen their doctor more than six times in the last year.

Educational engagement and criminal justice involvement

At follow-up, the majority of the sample was still in full-time education; however, over one-third in both groups had truanted in the previous year. More participants in the intervention group than in the usual support group reported police involvement, had been cautioned/convicted or had had contact with a youth offending team, with none in the usual support group reporting these outcomes (Table 16).

Interpersonal and social functioning

There was an increase in self-esteem of three points between baseline and follow-up in the intervention group (Table 17). There was no change in the locus of control measure. About one-third of the participants reported a secure relationship style. Six of the 11 young women (55%) in the intervention group had made a significant new friendship in the past year compared with five (63%) in the usual support group. Five of 11 (45%) in the intervention group reported feeling unable to trust anyone compared with three (38%) in the usual support group. At follow-up, 14 (82%) were unlikely, or more than unlikely, to seek help from no one for a personal or emotional problem (82% in the intervention group vs. 83% in the usual support group). The most popular source of help was friends [three (27%) in the intervention group and five (83%) in the usual support group responded that they were very or extremely likely to seek help from friends]. The corresponding numbers for seeking help when feeling desperate or thinking about suicide were 10 (59%) overall, six (55%) in the intervention group and four (67%) in the usual support group; 11 (65%) reported being unlikely or very unlikely to seek help from no one when feeling desperate or thinking about suicide, seven (63%) in the intervention group, four (67%) in usual support.

Mentoring and increased mentee confidence

Several of the mentees felt that having a mentor amounted to gaining a ‘friend’:

I feel a bit more confident about deciding – like making decisions . . . as a mentor, they don’t really see you as a teacher to student thing, they see you as a friend, so somebody you can relate with, have just a talk, or just hang out with.

Pilot mentee 2

One mentee had entered the care system as an unaccompanied minor 6 months previously. She spoke very little English and she had been nervous about meeting her mentor because of this. However, she reported that her mentor had encouraged her and helped her to feel more confident about speaking: ‘When I want to say something and, you know, she could understand [my English] and she say to me “say it” . . . so yeah, I can say anything to her’ (LA2 mentee 2001).

One mentee reported that she had felt confident about discussing her sexual orientation because of her mentor’s empathic and non-judgemental approach when they had first started to discuss sex and relationships:

She kind of taught me don’t let people judge me like, just be who I want to be. If they don’t like it then obviously they are not my true friends . . . I’ve gossiped about my sexuality with her, because I think . . . when I was younger . . . at the time I had a group of friends which was proper anti-gay and anti-lesbian, so I couldn’t really play on it. But now I’ve got older and I don’t really care what people say. I’m just me, if you like me, you like me. I’ve learned to open it and I’ve spoken to her about it. I think that’s the first time I actually spoke about it properly and actually decided like d’you know what? Actually I do like girls, and if you don’t like the fact that I like girls then you don’t have to be my friend.

Pilot mentee 3

Another mentee described feeling more confident about asserting herself appropriately with boys, rather than just becoming angry, as a result of her conversations with her mentor:

Well she used to say to me, ‘you can’t always beat your boy up, you have to like let them look but they’re not allowed to like come to you, because obviously if you don’t want to be talking to them and you don’t like them, you don’t have to’ . . . I still hit them [boys], but I’m a bit kinder.

LA1 mentee 1007

Another mentee felt that spending time with her mentor had broadened her mind and encouraged her to be more open, which had reduced her stress levels. At follow-up she believed that she was less likely to get angry with people:

I don’t know whether it’s just me growing up, or in a way . . . while she was there I think maybe I was like opening up myself . . . opening up did kind of release certain stress. Because I’m used to just bottling everything up, and then one day I’ll just have a meltdown and that’s when I’ll overdose myself. And that’s when I’ll go out and then I’ll sleep with like 10 different men or do something stupid, to harm myself.

Pilot mentee 3

Nowadays people could step on my foot and I’ll just blow it off, like literally because I think just life’s too short. And this time last year I would have probably got arrested for someone stepping on my foot because I would just turn around and get mad.

Pilot mentee 3

Mentoring and improved mentee decision-making

Mentees reported benefits from being able to engage in positive leisure pursuits with their mentor, including being able to make more positive decisions and ‘good choices’. For example, one mentee said that her mentor had helped her to realise that that she tended to be somewhat judgemental of other people, which had limited her social interactions and engagement. She had learnt that it was important ‘not to judge a book by its cover’ and to try to be a bit less judgemental, which had in turn begun to open up her social network:

It’s like if you see my set of friends . . . it’s like I need to stop – what’s it called? Not stereotyping . . . I need to stop having a type basically. Like because, to be honest, like my next-door neighbour she’s more into her jobs and stuff so I wouldn’t really be her friend because she’s . . . like they say a ‘nerd’ init? She’s more of a nerd and I’m more of I dunno, a problem, because it’s me that’s bad. So I wouldn’t really be her friend . . . so I think now I’m gonna start like making friends no matter what they are like . . . I should just be friends with everyone.

Pilot mentee 3

Another mentee reported that her mentor had helped her to realise that she needed to broaden her horizons, which had previously largely been focused on impressing the opposite sex:

I think that it should be for most girls now in care, living by themselves – I think this would be good for them . . . because I know a lot of depressed people and I think they just need someone, not from the area, to take them out, to show them that, look, you don’t have to get ready, put on make-up and go meet a boy, it’s not all about that. ‘Cos that’s what I used to do. You don’t have to do that.

Pilot mentee 3

Mentees also reported feeling more confident in being able to make the right choices in other important areas, including education and family life:

When I was younger, thinking I don’t care about my future, I’ve still got a long time to go, but then it comes quite quick and you’ve got to think about what you’re gonna do; so you should know from a long-off . . .’cos before I was choosing my GCSEs and like she was saying, ‘go for what you enjoy for’ and stuff so I went for that, I enjoyed what I was going to, like I hopefully want to go into . . . like when I leave school and get a job.

Pilot mentee 4

She tried encouraging me to see my family more and everything like that . . . it was just general encouragement to be honest. But there was a time where she said you need to take a step back because like my family problem was getting to like an extent that I couldn’t handle.

LA1 mentee 1006

Impact of mentoring: quantitative findings

Twelve mentors (63%) completed follow-up interviews at 1 year. Table 18 indicates that there was little change in their general health (GHQ-12), locus of control and self-esteem between baseline and follow-up. Four of 12 (33%) mentors at follow-up scored ≥ 4 on the GHQ-12.

Impact of mentoring: qualitative findings

Although there were no significant changes in quantitative outcomes for mentors, the qualitative data suggest that some mentors experienced benefits in terms of increased confidence and self-efficacy. Our logic model did not attempt to theorise change for mentors, but these findings do suggest that mentors’ experience of the intervention might impact on implementation. This is discussed further in the following sections.

Duration and frequency of contacts

The original timetable for the duration of mentor relationships was September 2011 to August 2012 in the pilot study and May 2012 to April 2013 for the exploratory phase. However, because of the over-running of recruitment, the relationships began later and some ended later than planned. Exploratory trial pairs had until the end of June 2013 to complete their relationships.

Tables 19 and 20 show the approximate length of each mentoring relationship calculated using mentor diary entries and self-report interview data. The tables show the approximate number of face-to-face contacts that occurred by month. All four relationships in the pilot phase (see Table 19) lasted between 5 and 11 months, although not all relationships were consistent in their level of contact. The maximum number of contacts per month was two (i.e. fortnightly contact).

Table 20 shows the length of relationships during the exploratory phase. In four cases no face-to-face contact took place because the mentees were unresponsive to the mentors’ calls or were non-contactable or the mentor did not put in enough effort to ensure contact. Seven relationships lasted for ≥ 3 months, with the longest three relationships lasting for 9, 10 and 11 months. Weekly contact was not feasible. Mentors and mentees were more likely to meet once or twice a month because they were busy with education, work or childcare commitments; although mentees were more likely than mentors to desire a weekly meeting, a couple of them said that they were also too busy.

Two-thirds of survey respondents aged 14–18 years (14/21) said that meeting once a week would be ‘just right’ whereas over one-quarter (6/21) said that it would be too much. Participants aged 14–18 years in the usual support group also thought that weekly meetings would be feasible.

Tables 19 and 20 show that contact tended to be fairly consistent over the first 3–4 months of relationships but it then became less regular. Following their initial meeting in December 2011, pair 1 did not have any face-to-face contact until 2 months later. Initially, the mentee had been somewhat shy and unforthcoming, which the mentor had found difficult. However, they had maintained their relationship over 7 months, only ending then because of commitments in the mentor’s life and difficulties in finding suitable times to meet. The mentor in pair 2 found it difficult to make contact with her mentee and she often requested support from professionals in the mentee’s network. In spring 2012, the mentee in pair 3 was tagged and had a curfew imposed by the courts as a result of an offence she had committed, which impacted on her availability to see her mentor. Pair 5 began by seeing each other once a month and the relationship seemed strong, but it tailed off to no contact by April 2012.

During the exploratory trial, the mentor in pair 5 maintained a relationship with her mentee for > 11 months, with monthly contact for around 6 months supplemented by telephone conversations. Despite living furthest from her mentee, the mentor in pair 6 had one of the longest and most consistent relationships with her mentee. She was the only mentor to see her mentee at least once a month for the duration of her relationship, occasionally arranging two or three meetings a month.

In addition to face-to-face contact, pair 14 held long conversations over the telephone (usually around 30 minutes), particularly as the mentor said that she felt that she needed to save up activity money to participate in activities with her mentee. In general, however, the mentors’ research telephones were just used for the purpose of setting up meetings with their mentee, rather than providing the intervention.

Initial meetings between the mentor and the mentee

In LA1, the majority of mentors and mentees met up for their initial meeting without anyone else being present, although two pairs had meetings facilitated by the PC. Three pairs held their initial meeting in the education centre, which meant that the PC or other staff were available if needed. In general, mentors and mentees appreciated the presence of the PC at the initial meeting:

‘Cos it was the first like additional meeting with anyone it was kind of like, it was a bit nice to have that support, like from [PC1], so like, you know like every now and again I could just give that look like ‘am I saying everything right, am I doing?’ . . . and just get that little reassurance like okay you’re doing alright.

LA1 mentor 15

In LA2, the PC organised a group meeting for the mentors and mentees to get acquainted with each other in an informal atmosphere. All of the mentors attended, but none of the mentees turned up, despite being reminded several times about the day and location. As a result, the introductory meetings between mentors and mentees had to be arranged on an individual basis over the following weeks. It was clear that both mentors and mentees were somewhat nervous about the initial encounter:

I was a bit worried that we wouldn’t get on. Or if we just didn’t like each other . . . so I was worried that I wouldn’t be able to even talk to her . . . it was . . . like when we first talking to each other it was just a bit like getting to know each other, but we got comfortable with each other, like over time.

LA2 mentee 2008

Her mentor was somewhat more positive about their first meeting: ‘My first meeting was excellent, me and my mentee got on like we’d met before’ (LA2 mentor 8).

Contact during the mentoring period

Relationship endings

Four pairs, one during the pilot and three during the exploratory phase, participated in a planned final meeting. One mentor said that her mentee had ‘seemed shocked’ by the ending, despite the fact that she had been expecting it. Mentor 18 had not reminded her mentee about the ending, as she had not seen her for 2 months, but she did arrange a final meeting to say goodbye. She felt that it would have been better to have had this last meeting as a group meeting, involving all of the mentors and mentees:

End it how it kind of started with everybody, like you know? Bring it all back to one again, like and not just everyone finish separately . . . I think maybe a little gathering at the end.

LA1 mentor 18

Some of the mentors arranged shopping or restaurant trips with their mentee for their final meeting. Mentor 4 used the last meeting as an opportunity to reminisce about the things that they had done together and clearly found the experience valuable and rewarding:

It was lovely, it was so nice. We did . . . her favourite, which is restaurant and cinema in one . . . and we were reminiscing all the like highlights and what happened and [when] we was out and about, like little situations we got into . . . we just talked about the good times, the bad times and she let me know how she felt . . . she said she was gonna miss me, she really loved working with me, she thinks I’m a really lovely person and she goes if you go on to be a social worker or whatever you will be so good at it . . . oh and I go shocking you are saying all this after how many times I had a go at you. And then she just went like ‘even though you had a go at me . . . it’s not like you was like being horrible’, she goes at least you cared or whatever.

LA1 mentor 4

Two of the four mentees were openly disappointed when the relationship ended:

I wouldn’t mind talking to her again actually yeah . . . I wouldn’t mind her being my tutor for college actually – that’d be really helpful ‘cos I’m going to do animal care.

LA1 mentee 1007

I’m sad. I thought it would have lasted longer so I could see her a bit more. But hopefully I’ll see her again anyway.

LA2 mentee 2008

However, another mentee said that she was ‘okay’ about the mentoring ending, as her mentor had informed her she could keep in touch with her by phone if she wanted to talk. One of the mentors expressed disappointment at ending the relationship, which she thought had been ‘strong’, and worried about the impact of ending on her mentee: ‘I kept saying all the way through that it’s ending now. So I think she was ready. She mentioned that every time she gets close to someone they go away’ (LA2 mentor 8).

A number of pairs had no definite ending because their contact tailed off. Some of the mentees expressed disappointment that the relationship had ended prematurely, even though they had often failed to respond to their mentor’s calls/texts and requests to meet up: ‘It’s like knitting a scarf and not completed it, you just feel like why did you start it . . . I don’t know me personally I didn’t want it to end’ (pilot mentee 3).

Following concerns raised by professionals that ending the relationships after 12 months could leave mentees feeling disappointed, mentors were asked to ensure that their mentee was aware of the official month of the relationship ending from the outset and to identify any follow-up needs for their mentee before ending the relationship.

Focus group participants aged 14–18 years in the other London borough (LA4) were concerned that if a mentee remained in need of support but was unable to continue seeing her mentor, any benefits from the mentoring could be cancelled out:

Because I’ve been so used to that support, if I was happy and was willing, I don’t need no more support. But if I felt like I needed support and they just dropped it then it’d be I’d just gone back to square one again . . . I wouldn’t wanna to do that support for a year and then I’ve achieved everything and then I’ve just gone back downhill again.

LA4 age 14–18 years focus group

The national survey of young women aged 14–18 years and 19–25 years also provided examples of young people who had felt let down and disappointed following the end of a mentoring relationship:

I was gutted because it was really helpful and made a difference for the right reasons.

Age 14–18 years national survey respondent

I felt fortunate to of even had a mentor who helped me so much, however I was a little sad because I had no one to go to for advice when difficulties arose.

Age 19–25 years national survey respondent

Non-judgemental attitude

Because many of these young people were very used to being judged or criticised by others, the idea of having someone to talk to from outside their friendship or social network who would not judge them was very appealing:

I would have them [friends], but then I wouldn’t talk to them as much . . . because they’re close to me, so I wouldn’t really talk to them . . . because I’m scared in case they judge me. I thought if I had a mentor they wouldn’t really judge me ‘cos they don’t really know me.

LA1 mentee 1006

Mentee 1006 valued the fact that her mentor did not simply tell her off or panic after she disclosed that she might be pregnant, but offered her help and practical advice to deal with the situation:

She tried helping me out saying do you want me to come [to a clinic] and everything. I was like okay. And then like I found out I wasn’t [pregnant] anyway . . . it was really calm. Like if I told my friends, my friends would panic; they would be like ‘oh my God, you’re pregnant’ da-da-da, they wouldn’t, they wouldn’t stop and kind of go you might not be.

LA1 mentee 1006

Active listening and advising

Mentees in the study said that they appreciated being able to ‘offload’ to a mentor and to feel that they were being listened to. They also appreciated that a mentor would only offer advice after listening to them and taking their views and concerns seriously: ‘When I see her I get things off my chest and that. So it helps, a lot. Because I’m the type to not really say a lot’ (LA1 mentee 1006).

Mentees appeared to differentiate between talking to their mentor and talking to their friends or to an adult in a position of authority:

‘Cos she’s really down to earth and she just says it how it is, like, she says it straight. Like, she don’t use these big political words and stuff like that . . . She just makes me feel really comfortable, like I’m talking to one of my home girls. But at the same time she’s not ‘cos you know she has that professional side to her . . . it feels good.

Pilot mentee 3

Sharing personal experiences

During the training, mentors were encouraged to think about the aspects of themselves that they would like to keep private and those that they would be happy to discuss. Limited self-disclosure by mentors of personal information was often quite useful in facilitating difficult conversations:

I’ll be like ‘So tell me about your love life?’ and then I just like mention something minor about mine or whatever, or ‘mine’s dead boring’ and then I realise it makes her talk a bit more.

LA1 mentor 4

Because it wasn’t just me opening up, it’s not like someone’s asking questions and I’m answering, it was both – like she’ll tell me stuff about her current life and I’ll tell her something about mine, so it’s like we are both really trusting each other, and I saw that she trusted me, when like she told me stuff about her and her boyfriend and I think her son . . . so I thought okay, then I’ll tell her stuff about me.

Pilot mentee 3

Advocacy and signposting to support

An important part of the mentor role was the mentors using their knowledge and experience of the care system to support mentees with their issues in care:

And then we were talking about getting my passport done and she got in contact with my social worker and pushed him to do it – that got done.

Pilot mentee 2

I even said to her . . . advised her like did she know places like Children Right‘s Officer, things like that . . . ‘Cos, honestly, myself, I never knew about all that, until, you know . . . when I start learning about all those services it was a bit too late really . . . I was trying a little bit just to put her into that, and say to her ‘We can meet those kind of people, they can explain things to you if you don’t understand’.

LA2 mentor 9

Maintaining confidentiality

Mentees appeared to appreciate the fact that whatever they told their mentor would be kept confidential, but they also understood the limits of that confidentiality. It was also important that the mentor was located outside their usual social network in terms of facilitating disclosure of sensitive information:

It’s good . . . because I know . . . things that I told her and if I told like my other friends – I’m not trying to say they will tell other people – but somehow it always ends up coming out – but I know for a fact ‘cos she don’t know no one that I know, no one that I know would come back to me and be like ‘Well I heard she said this’ because it can’t happen . . . So that’s why I liked her.

Pilot mentee 3

Offering new opportunities

Some mentees felt that having a mentor had given them opportunities to do new and exciting things or to have new experiences:

She’s just so different. And like, you know whereas I’ll wake up and I’ll ping [call/text] my friend and be like, ‘So what’s the motive?’ and she’ll be like, ’Can we go link [hook up with] a boy’ – she’ll [my mentor] be like, ‘Can we go shopping?’ . . . I mean my usual group of friends it will be like a special occasion. Like for us [friends] to go ice skating it would be like ‘oh my God we’re going ice skating’ but for me and her it will just be like ‘Yeah, it’s just ice skating’.

Pilot mentee 3

Persistence

It was difficult to assess why some mentor–mentee pairs were able to sustain a relationship over a period of time whereas others fell by the wayside at a relatively early stage. Some mentors withdrew from the intervention when faced with a difficult or reluctant mentee; however, others remained enthusiastic and adopted various strategies to engage their mentee and persevered with the relationship:

I say let’s do something different, but she keeps on wanting to go cinema . . . I said we can do other things you know? I go if you wanna go to a show or do you wanna do something that’s involved with sexual health? Sometimes you can go [to a] clinic and book an activity . . . I said to her we could do ice skating. I go we can do anything; it can be sport – to get fit or whatever . . . It helps you find her a little hobby. But, no, she seems to just like cinema.

LA1 mentor 4

It would appear that the personal qualities of the mentors, in particular openness, dedication, persistence and good problem-solving skills, were important determinants of a sustainable mentoring relationship, as illustrated by the following case study examples:

Shared experience of care

The majority of mentees said that they would rather speak to a mentor than to their social worker about personal issues, as social workers were often too busy fulfilling statutory requirements to listen to them or to support them with emotional issues. At the end of the mentoring period, when the mentees were asked if there was any more support that they required, one said:

Having someone like her . . . a mentor that isn’t a social worker, who I can talk to about problems, and then yeah, just to get a bit of space away – like with someone that’s older . . . so she could give me advice.

LA2 mentee 2008

Social workers also felt that they would be less effective than peers at engaging the young people in conversations around intimate issues, both because of the age gap and because they tend to be viewed rather negatively and mistrusted by the young people they work with:

I think it’s really difficult for looked-after young people to talk to social workers. I think that although social workers are skilled in communication, I think they know that if they share too much information that social workers might have to act on that if they feel it’s a child protection issue.

LA1 SM

This view was echoed by the mentors:

This is what I thought, ‘Anyone who’s working with me, they’re going to report back to my social worker ‘cos that’s their job’ . . . when I speak to a lot of young people they said the exact same thing.

LA1 mentor 4

The majority of those aged 14–18 years (seven of the 11 who spoke about it) considered that it was important that their mentor had some experience of care, as it made it easier to relate to them:

Someone was actually in your situation so they knew what they’ve also been through and what you had been through, instead of saying ‘Ah, I know how you feel’ when actually they don’t know nothing how you feel . . . it’s like teachers say ‘Yeah, I know what you’re going through’ and it’s like, no you don’t, shut up [laughs].

Pilot mentee 4

One of the mentors also considered that her experience of care had helped her to empathise with and build up a relationship with her mentee:

There was one girl that come up to me, and she was like ‘I just miss my mum, I don’t understand’ . . . and she just broke down crying. One of the other members of staff she come over and she was like ‘Oh it’s alright, it’s alright’ and the girl flipped out. And then I went over and I was like ‘Look, I’ve been there, I’ve come through now, like look at me’ . . . and I kind of explained a little bit of my story without trying to traumatise her and by the end she was like ‘Oh’, she was like ‘You went through that?’ and I was like ‘Yeah’. And she was like, ‘And you’re like this now?’ and I was like ‘Yeah’ and she was like ‘Oh’. And then she kind of went off and toddled and carried on.

LA2 mentor 11

However, mentees also considered that it was important for their mentor to have a genuine interest in them and to support them, regardless of whether they had been through the care system themselves:

You’re more likely to open up to someone who has been through what you’ve been through, but at the same time, she [a previous mentor] was the one who invested in my life the most, and you know, she came from like a really good background . . . and she had a lot to offer me.

LA1 mentee 1009

With regard to the survey findings, 10 out of 22 (45%) LAC aged 14–18 years said that they would prefer a mentor aged 19–25 years and a further six (27%) said that they should be aged 26–30 years. Only one person said that they would like a mentor aged ≥ 40 years, whereas four (18%) said that they would not mind what age they were.

More than half of respondents (12/22) stated that they would like their mentor to have had experience of care. Just under one-quarter said that they would like to be mentored by a professional who already worked with LAC, such as a participation worker or advocate, and the same number said that it would not matter whether the mentor had any experience of working with LAC. No one felt that it would be appropriate to have a mentor who had no experience of the care system, as either provider or recipient.

Matching

Mentors and mentees tended to value having some common background or interests. Three pairs with a shared Caribbean background and one pair from Central Africa commented about the importance of this:

It’s like when I was talking about my mentor having certain traits ‘cos we’re both from the Caribbean, like, it’s like one simple thing. People might think, ok, so what? You’re both from the Caribbean but it’s just that certain factor, that, certain things we’ve both been through together. It just makes it easier.

Pilot mentee 3

She’s just really good; she understands me . . . she’s like Caribbean as well. And obviously I’m half Caribbean as well so we are like get on very well.

LA1 mentee 1007

One of the mentors had attended the same college as her mentee, which they had been able to discuss. Another pair discovered a shared interest in fashion.

Professionals also identified location as an important matching consideration, although one of the most successful relationships involved the mentor having to travel across London, from her university, to meet up with her mentee:

You think if people have got a gym, if the gym is right by your house 10 minutes away, you’re going to go. If the gym means that you have to get a bus or train, you’re not going to go.

LA2 SW

Survey findings of young people aged 14–18 years indicated that it was more important for mentors and mentees to have some shared interests than shared ethnicity.

Information sharing

Of the 76 social workers who responded to the national survey, 65 (86%) thought that a mentor should have some information about a mentee before they start mentoring whereas 11 (14%) felt that they should not have any information.

When this issue was discussed at a focus group, social workers were concerned about historical information about a mentee being disclosed, as the situation for the mentee may have changed. However, they also agreed that sometimes it would be in the best interests of the young person to share certain sensitive information with a mentor:

When you read some of our young people’s files there could be something that happened, what 6–7 years ago, and you look at them and you just judge them sometimes before you’ve even met them. So sometimes it’s better to not know anything.

LA3 SW

I suppose, I was just thinking about one of my young people and I was thinking she’s been sexually abused, and I just . . . wonder if somebody goes bowling in there talking about pregnancy and sex and all thoughts of things, they’re not aware of some of the issues of the young people. How it might cause more harm than good.

LA3 SW

Overall, there was a consensus amongst professionals that mentors should be given any relevant information about a mentee that might impact on their ability to mentor that they should be alerted to issues that could potentially arise during mentoring.

Format of meetings

Mentors and mentees were asked for their views on the format of the mentoring sessions. Eight out of 12 mentors, as well as three mentees, expressed a preference for group mentoring in addition to one-to-one meetings. Mentors and mentees felt that group mentoring would accelerate the bonding process between pairs, encourage a more relaxed atmosphere and open dialogue, increase confidence, widen their social networks and encourage additional one-to-one meetings to take place:

I think what we can do once a month at least . . . have a meeting where both mentees and mentors come together; like you know at the [LA1 mentoring project] they come every single . . . you know Monday 5 pm – all of them in one place . . . once a month you all come in, you know and do an activity together . . . at least then you can guarantee that once a month they’ve actually met . . . and then from then onwards see whether it’s actually going on, you know after that meeting . . . and if that doesn’t work I think you should just make it to be that every single week they all come in – like you know how the [LA1 mentoring project] does? ‘Cos they all come in, every single week.

LA1 mentor 6

One of the mentors in LA2 recalled group meetings that she had participated in on the CiCC, which she felt would be a helpful model to adopt in the mentoring project:

In [CiCC] we used to have meetings once a month . . . when we meet we just sit around the table talking about everything concerning young people in care, law, everything. But when we speak about that we get to know each . . . even when we meet each other on the street, it’s like . . . that’s your family . . . we know each other for other things than the world outside, because we all come from the same background . . . so it’s kind of our secret you see?

LA2 mentor 9

One of the mentors thought that a group setting would be useful for SRE and another felt that it would encourage mentees to engage with other LAC of a similar age, thereby increasing their social network:

I would like to do a group thing like and teaching them like sexual health . . . but they can talk about other stuff that’s on their mind as well, ‘cos er, a lot of teenagers do need that – as they tell me.

LA1 mentor 4

In a situation where she [mentee] is really happy and things are settled for her so she’s not seeing you, so she’s only using you for like crisis points, could we not all do something where we all met and then we all sort of know that we’re all in a similar boat.

Pilot mentor 1

Barriers to engagement

Mentees would often agree to attend a meeting with their mentor but then would alter the time or place of the meeting, without notice, or simply fail to turn up. Reasons given for not turning up included too much school work, seeing friends and ‘bad weather’. This led to some mentors themselves feeling let down and demoralised:

I initiated contact and I spoke to her, everything seems fine, she was willing to meet me and everything. But when it comes to meeting up it’s . . . either she cancels or she never shows.

LA1 mentor 20

You do get young people that will be like yeah yeah and that meeting would be their number one priority and then someone else, like a friend will come round oh let’s go here so, it will always just change.

Pilot mentor 5

One mentor said that she ended up feeling ‘like a teacher trying to find a, you know a primary school kid, chasing them around the playground’ (pilot mentor 2).

Even when mentees were not required to travel far to meet their mentor, they were often unmotivated to make the effort:

‘Cos sometimes like I’ll have one of them lazy days when I’ll just . . . don’t want to go nowhere and I just want to stay in my house and . . . It’s like if she came to get me – I know it sounds lazy, but if she came to get me then obviously I wouldn’t mind going, but I don’t really . . . I like travelling but sometimes I don’t.

Pilot mentee 3

To address the issues of non-attendance, mentors usually had to go to where their mentee was, rather than expect the mentee to come to them.

As some young people said that they did not like having to engage with social workers, it is perhaps unsurprising that one of the barriers to engagement was the mistaken belief by mentees that the mentors were part of social services provision:

That made me feel like oh maybe, they don’t want to meet us, because for myself I know like sometime[s] you don’t really want to talk to someone . . . they were all scared . . . maybe they thought like we were part of social services.

LA2 mentor 9

It is perhaps not surprising that mentees find it difficult to build up trusting relationships and are likely to regard any new people introduced into their social orbit with a degree of suspicion, particularly if they themselves have not chosen them: ‘It takes me a while to get close to someone and become friends with someone or, until I trust someone. I thought it’d be hard for me to do that’ (LA1 mentee 1001).

Pilot mentee 3 started off from a position of mistrust and suspicion; however, her position later started to shift, particularly in response to her mentor disclosing information about herself: ‘I will never fully trust someone innit, but I do trust them to a certain point – but you can never really give anyone your full trust can you?’ (pilot mentee 3).

It may be that the mentees in those relationships that did not last long, or that were inconsistent, never got to the point of trusting their mentor enough to be able to talk about things that were important to them.

Even when a mentee appeared to have engaged well with a mentor at one meeting, this did not mean that they would necessarily turn up for the next one, which often left the mentors questioning their judgement and whether they might have done or said something wrong:

I mean on the first day she was quite open . . . ‘cos we did have some sort of similarity in terms of education ‘cos she went to the same college as I did. So I mean from the word first go I mean we was chatting from start to end. That’s why I think she felt comfortable . . . but I think, the problem is . . . It’s just about getting her here . . . I mean I’ve told her many times I don’t mind going to obviously where she [lives] . . . it’s just about obviously getting that time. ‘Cos when we did get that time it was quite nice.

Pilot mentor 2

Overall, non-engagement of mentees appeared to reflect their ambivalence about the intervention. The researchers also encountered a lack of motivation and ‘mixed messages’ regarding engagement and often had to rearrange meetings with mentees after they failed to show up, without providing an explanation or an excuse. One PC expressed the view that LAC may find it hard to express their opinion about whether or not they want to participate, possibly because they feel so disempowered, and so they end up voting with their feet, by not turning up or not responding to phone calls. Some mentees may have found the mentoring encounters too anxiety provoking and therefore withdrew, or they may not have appreciated the importance of not letting other people down. Professionals also considered that these young people may experience difficulties in planning ahead and organising, or taking control over their lives, so that if something better comes along they will simply go with whatever seems easiest.

Personal lives and communication

Some mentors acknowledged that, despite their best intentions, personal and work-related issues impacted on their ability to fulfil commitments. Mentees reported that mentors did not always communicate with them when other commitments made it difficult for them to keep up with their mentoring role:

She said she is busy in Christmas and everything and I was like ok, just contact me like when do we want to meet and stuff, and then after there was no contact for . . . a couple of months and then yeah we got back in contact again and then she was, she just kept saying oh it’s busy and everything . . . and then afterwards, yeah, we was in contact and then it just fell back again.

LA1 mentee 1006

One mentor failed to inform her mentee that she had a job interview and could no longer make the arranged meeting. This frustrated her mentee who, when asked for her views on what an ideal mentor should do, responded ‘just turn up’.

Many LA professionals expressed concerns about the vulnerability of the mentors and the extent to which they would be able to separate their own issues from the mentees’ issues. Some of them also had to deal with family issues, domestic violence and/or mental health issues. Moreover, a number of the mentors were juggling other commitments during the mentoring period, including college, work and childcare responsibilities:

With any study that you do, when you’re working with looked-after young people, it’s whatever’s going on for them is gonna always take precedent because that’s how they’ve been growing up; you know because they are in the care system.

LA1 PC1

There was evidence from the national survey that competing commitments and life stresses would prevent some care leavers from volunteering as mentors in the first place. Four young women aged 19–25 years (12%) indicated that this was the case.

Managing money and mentor diary entries

Although there were several examples of mentors who fulfilled the responsibilities of the mentoring role, there were a greater number who, in some form, breached the terms in the mentor contract (see Appendix 23). Issues included not collecting receipts for money spent, running up large phone bills on calls not related to the project and keeping money for their own use:

I know that she wasn’t spending all that money on that ’cos I was getting the receipts and like I’m thinking look at this baby stuff on it . . . I was like ‘did you actually go out with your young person?’ [she said] yeah, and then she was like but I forgot the receipt, so I just gave you one that I had.

LA1 PC1

In one case a mentor confided in her mentee that she felt irritated that other mentors were spending money on themselves and not spending it on the mentees. The mentee believed that this was ‘out of order’ but was also content in the knowledge that her mentor ‘would never do that’.

In relation to excessive phone usage, the PCs felt that it was difficult for them to challenge the mentors about what had occurred and, without proof of any wrongdoing, they were reluctant to take action:

And if it turns out that actually I get the bill and it’s like ‘hang on’– right? . . . there’s a mismatch here right? Then that’s a different conversation yeah? . . . but without evidence . . . I’ll ask the question and I’ll challenge and I’ll look at you hard – but if you’re sticking to your guns what . . . where’s my proof?

LA2 PC1

Anecdotal evidence suggested that one or two mentors were attending the support group meeting solely for the purpose of collecting vouchers as a reward for their role, even if they were no longer making attempts to meet regularly with their mentees:

Some of the mentors – I think they know the loopholes of the whole mentoring programme . . . they know that every single month PC1 is going to send a text saying, ‘Ladies, let’s meet up soon’, as long as they say ‘oh I’ve been trying to call, they haven’t picked up’, PC1 will say – you know, she’ll say why haven’t you done this, why haven’t you done . . . but after that they’ll still get their payment, and that’s all they want – really and truly.

LA1 mentor 6

There was a clear indication from social work professionals that, when mentors were not fulfilling their role, they should not receive the full £40 voucher payment. Yet, in LA1, the PC took a more lenient approach:

I never did tell them they couldn’t have their money . . .‘cos I do think there’s a conflict of interest. Because they will, no matter what they’ll take it out on you. You know, and I’ve got to continue working with them after the study has finished. So I just gave it to them, but for me it’s about working with them to empower them to do their role . . . it would be different if I was running it. If it was my project . . . I would tell ‘em straight, you know, ‘you’re not getting paid if you’re not doing your work’. But you know, it isn’t my project.

LA1 PC1

This PC acknowledged that ‘they all knew what they were doing wrong . . . and all said what they had to do, and they all did nothing’.

Only two of the mentors made regular diary entries, despite weekly text message reminders from the researchers. LA1 PC1 noted that, apart from the monthly support group meetings (which some mentors did not attend), she lacked information about how often mentors were seeing their mentees and this made it difficult to impose penalties. The PCs and one mentor thought that it would have been helpful for data from the diaries on the frequency of contacts to be made available to the PCs and that they should give the full voucher payment only to mentors who had completed the diary.

Undertaking a dual role: motherhood and peer mentoring

Five out of 10 mentors who met with their mentee had a child and most of them were single mothers. For the majority of mentors, childcaring responsibilities had a negative impact on their ability to give time to a mentee:

I wouldn’t have minded to see her continuously ‘til it finished, but it was literally just that I had so many things to do, for myself, being a single mum which was a bit difficult. Yeah, I think that was the most difficult thing.

LA1 mentor 18

She had a child and she had her job to do as well, so it kind of depended on both of us, and it’s like most of the times she’ll be busy when I’m free and then when I’m free, she’ll be busy . . . and even in phone calls I will hear how busy she is with her child, so it’s like sometimes I’ll have to be like, ‘D’you know what, deal with your family and then ring after or call tomorrow or something’.

Pilot mentee 3

Clearly, in any future study, there would need to be proper thought given to whether it is appropriate to recruit peer mentors who are pregnant or who have young children unless they are sure that they will have the time to give to the task.

Prerequisites for the peer mentor role

In LA3, where professionals experienced difficulties recruiting mentors to the study and retaining them, professionals believed that care leavers needed to have sufficiently ‘left the system‘ to be effective mentors:

It’s far too early and life events are still happening for these 18-, 19-, 20-year-olds you know? And I think, you know, even beyond 25 we’re still asking quite a lot for somebody who needs to establish themselves. Chronologically they’re not the age we think we [they] are, you know, with our teams. I don’t think those young people are where they should be yet and I think it takes a lot of life and a lot of sorting out to get to a place where you do feel comfortable about a 13 – or whatever age – coming at you and asking very difficult questions.

LA3 PC2

The PCs in LA1 and LA2 believed that care leavers should be given an opportunity to mentor, despite the difficulties highlighted earlier. However, they were clear that, in a future study, PCs would require additional time to work one-to-one with each mentor to ensure that they had the required skills to fulfil the mentor role and to explore their ability to manage their time and emotions over the mentoring period:

At the entry point, we need to really be firm in terms of their availability and getting them to think about even looking forward, about the possibility that may have certain things, like courses starting, movement – they might be going through a transition stage, ‘cos of moving, etc. Looking forward, there’s a number of things that maybe, I think we need to consider in terms of what could possibly change that mentor’s circumstances.

LA2 PC1

Similarly, nearly three-quarters (65/88) of survey respondents from the national and local social workers survey thought that care leavers aged 19–25 years were capable of acting as mentors, provided that they were mature enough and were given sufficient training and support. However, nearly one-fifth of respondents (16/88) thought that the mentors should be older (e.g. in their early to mid-20s) and that the upper age limit should be extended to around 30 years.

Boundaries

Local authority professionals believed that there was a potential for boundaries between mentor and mentee to become blurred, unless they were well defined by the project and monitored by the PC:

I was in a meeting and they were setting up a meeting of her and her mentor and swapping telephone numbers. And I sort of asked well are there any sort of boundaries around the relationship and it didn’t seem as if there . . . they had talked about boundaries, but it didn’t seem as if there was any clear kind of guidelines around that.

LA2 SW

Concerns revealed in the national surveys mirrored this:

Young people in distress could contact their mentor relentlessly if appropriate boundaries are not established . . . what if the YP [young person] is texting/calling constantly or disclosing issues of a safeguarding nature? Mentors will need considerable training/support to manage these sorts of difficulties.

SW survey respondent

Although some professionals had expressed concerns about mentees becoming over-reliant on their mentor, there was no evidence of this or indeed of any inappropriate or excessive contact. However, because of the rather chaotic nature of some of the mentees’ lives and their difficulty with time management, some mentees appeared to expect their mentor to be able to drop everything and see them at a moment’s notice, rather as a friend would do:

You know she doesn’t plan. She keeps on calling me up last minute, like ‘Hey girl how are you? Yeah, d’you wanna come and meet up?’. . . ‘I’m busy’ I said to her and I go, ‘I have a very busy schedule’ and everything has to be planned with you I’m sad to say.

LA1 mentor 4

Disclosures

Mentors were told during their training that, if they had any concerns about the health or welfare or safety of their mentee, they should immediately pass on the information to the PC, after first informing their mentee. Some professionals thought that mentors would find it difficult to make decisions in relation to sharing information, because of the potentially damaging effect that it could have on their relationship, and that they would need a lot of guidance and support around responsible information sharing to ensure that the best interests of the child are met. However, within this study, a number of mentors were able to report concerns to the PC without this impacting negatively on their relationship with their mentee.

Unsupervised meetings

Many professionals expressed some concerns about meetings being set up between vulnerable young women, without supervision or without sufficient communication between professionals in the mentee’s network. In one focus group it was suggested that allegations of misconduct could be made against a mentor by a mentee. However, the main risk identified in the exploratory trial was of mentors failing to inform the PC where and when they were meeting with their mentee, which was in clear breach of the mentor contract. LA1 PC1 admitted that only one of her mentors regularly informed her of when and where she was meeting her mentee.

Individual support

Following training, mentors in both LAs faced a long wait whilst the mentees were recruited and matched to mentors, which tended to decrease their motivation. In LA1 there was little pre-emptive communication from the PC to the mentors about this, but in LA2 the PC’s communicative approach was particularly appreciated by the mentors: ‘She’d be saying, ‘okay, we haven’t forgotten about you’ like just to remind us that she hasn’t like forgotten about us but she was doing whatever she needed to do at the time’ (LA2 mentor 11).

In general, mentors felt able to contact the PC in their LA to discuss issues that were preventing them from seeing their mentee, concerns about their mentee’s welfare and difficulties with making contact. Mentors said that the advice that they received was helpful. However, in LA1, mentors said that the PC was difficult to contact and too busy to support them:

To be honest I could have had more support. And um, but whenever I did manage to get hold of her, ‘cos she’s a very difficult person to get hold of, when I did manage to get hold of her, and um, I did like contact her to let her know anything that’s going on, she will give advice, I’ll give her tops for that. But I still think I could have had a bit more support.

LA1 mentor 4

Regarding the direction of communication, several mentors believed that the PC should have been more proactive in contacting them:

I would like somebody to just chase because there are so many other things going on in my life, if somebody was on my case sort of thing, like ringing up to find out . . . how did your thing go you are more likely to think oh . . . I need to go and meet her . . . there is not any of that support going on. So I know that PC1 is really busy so I can’t blame her for that.

Pilot mentor 1

I think they need to be more active towards the role in a weekly sense of basis, because all the communications I’ve had with PC1, it was me making the communication – all the calling up instead of actually her calling me up and giving me some information.

Pilot mentor 2

As she was often in the education centre, it was easy for one of the mentors to make face-to-face contact with LA1 PC1 on an informal basis, outside the support meetings. She reiterated, however, that it was often difficult to get through to the PC by telephone.

In LA2 there was less evidence from the mentors about how supported they felt. However, the PC often contacted her mentees by text message. One mentor said:

I do feel like she was quite supportive, yeah. Because, every time that I called her, apart from when her phone had a problem, yeah, I was able to get through to her. Yeah. And she always motivated us as well. Sometimes . . . it’s not even a call, she will text and stuff like that, you know to let us know that we are doing a great job and stuff like that. And if we do need to speak to her about anything, we shouldn’t waste time; we should just call her.

LA2 mentor 10

However, LA2 PC1 described feeling guilty that she had been unable to give as much attention to the mentors as she felt they required:

They’d be like oh I know you’re busy and I’d be like ‘ahh’ and I felt really bad that I’d given that impression that they were taking up my time. But in a way they were . . . but I owed them a duty of care . . . it was conflicting for me . . . I’m out on the street and I can’t speak properly so [I said] can I call you back? And sometimes I didn’t call them back until maybe 7 o’clock in the evening or the following day . . . and it would just be nice to know that that’s who I’m committed to.

LA2 PC2

In both LAs, the consensus amongst the mentors was that a weekly phone call from the PC to motivate them would have been helpful in keeping them focused and motivated. LA1 PC1 recognised the importance of calling mentors every week and admitted that she had not done enough of this, although she thought that mentors could have contacted her when they experienced problems. The extent to which this is true is unclear. One of the mentors in the pilot said that she was ‘put off’ calling the PC because she seemed too busy.

The national social worker survey asked respondents about the type of support they believe mentors require. As well as telephone calls and monthly support group meetings, 67 out of 118 (57%) social workers said that there should be individual, face-to-face support with a PC and 37 of them (56%) believed this should be provided monthly. A further 17 (26%) said this should be every two weeks and the rest (18%) every week. One of the mentors in the study thought one-to-one meetings with a PC should occur every two months, or quarterly, because group meetings had been poorly attended.

Monthly support meetings

In both LAs the PCs struggled to deliver a support group every month, and even when they did occur few mentors attended. The main difficulty in arranging meetings appeared to be around scheduling a date and time that suited all of the mentors:

It was something to do with the mentor availability. The dates, time, so some agree with the dates, some don’t agree with the time, some agree with the time, some don’t agree with the dates, so that’s why everything was just being pushed. Okay let’s, let’s find another date for next month and so on.

LA2 mentor 9

One of the mentors in the pilot believed that LA1 PC1 was simply too overworked to be expected to deliver a monthly meeting and suggested that someone with dedicated time should deliver the support. She commented:

She’s got so many other things that she’s doing. And then she knackered by the end of the day. She’s been here since 9 o’clock and then [at] 6–7 [pm] we’re expecting her to do a support session. Come off of it, she must be physically and emotionally knackered. So I think somebody else should be employed and that person works specifically with the mentors and mentees. I think that person will be able to relate better to the mentors and mentee because they have that specific knowledge about this project in itself.

Pilot mentor 1

During the pilot, the PC role in LA1 was formally integrated into her existing role by management, meaning that she had slightly more time to devote to the role during Phase II. One of the mentors involved in both the pilot and the exploratory trial said that she felt better supported by the PC during the exploratory trial. However, the data suggest that only two or three mentors regularly attended the support meetings and problems persisted. For those mentors who attended regularly and saw their mentee, it was frustrating and demoralising to be let down by their fellow mentors:

I don’t think they was monthly or an appointment to the month. And, um, I think like that more of the girls could turn up, like the girls didn’t turn up as well, so sometimes we’d be sitting there and there’s about three girls that’s actually turned up to the support groups and things like that, so yeah.

LA1 mentor 18

Despite the low turnout, in both LAs mentors who attended felt that the meetings were useful for talking about their experiences and comparing these and getting support from both the PC and other mentors to deal with issues:

We’d talk about our experiences that we’d had so far with young people . . . say for instance one of them was like ‘ah my young person’s really shy’, we’d all work and like talk about things that we . . . like come up with ideas just off the top of our head, like ooh try this and – maybe if you’d start with this and start with an ice-breaker.

LA2 mentor 11

It was quite good actually because you start to realise that actually I’m not the only one that’s having issues, like other people are having issues too; even if they’re not the same issues that you are suffering with, it’s still nice to know that . . . you don’t feel as bad, like you don’t feel as guilty or like oh my gosh. Like, so it, it is nice so that everyone can kind of share their views and experiences.

LA1 mentor 15

Support group meetings were also designed to enable PCs to sign off ASDAN award paperwork for accreditation. However, it became clear that most of the mentors were not prepared or perhaps simply did not understand that they were expected to do the work in their own time to achieve accreditation:

I couldn’t even get the ASDAN qualification – because not everybody was here and then if I wanted to answer a question I have to be on my self-initiative, it wouldn’t be like oh PC1 will sit down and then she’ll help me go through it – none of that. But I think if it would have been other people then people could have helped each other, but nobody came.

Pilot mentor 1

I even came a couple of times for the ASDAN, like there hasn’t really been much focus and really sit down and make, like help, and get on with this ASDAN.

LA1 mentor 18

The PCs admitted that they felt ill equipped in terms of having information from the training partners and researchers about how to implement and sign off work for the ASDAN qualification and believed that additional training would be required in a future intervention.

Overall, the PCs felt that they had been unable to commit sufficient resources or emotional support to the mentors and considered that to deliver the work effectively a dedicated PC would be required. In LA1, the PC believed that mentor support groups could have been delivered more effectively by going back over training material and that delivery of group mentoring sessions would ensure that the PCs have a better grasp of communication and knowledge of the status of the mentoring relationships. PCs in LA2 and LA3 thought that the support package should also include one-to-one support meetings.

Alternative support for mentors

Support for mentees

The research team had assumed that, during the mentoring, mentees would be well linked in with their social workers and would raise any issues with regard to the mentoring with them or with the PC. PCs were not expected to routinely contact the mentees. This was a mistaken assumption because many of the mentees were left for periods of time without contact from their mentors and not all of them asked for support. Those who had an existing relationship with their PC did ask for help or advice: ‘She did try and get in contact with her but if [mentor 15] didn’t pick up her phone or answer to any of the letters or anything’ (LA1 mentee 1001).

However, one or two mentees said that they would not have known who to contact in the event of difficulties. One mentee said that she wanted to speak to someone about the fact that she was not seeing her mentor, but she would not speak to her social worker as she did not want the social worker involved in her life. Another mentee said that, when she lost her phone and lost contact with her mentor, she thought about asking her social worker but did not as she ‘was enrolling for colleges and thinking about my birthday’.

Allocation of support

The DCS and national social workers survey asked professionals to consider who would be best placed to take on a PC role.

There was a clear indication that the PC role should be separate from the social care role, with many stating that the responsibility should be shared between someone able to offer therapeutic input to mentors and someone with experience of teaching PSHE/sexual health, to drive the prevention of teenage pregnancy agenda:

I think sexual health expertise is critical to the project and so the person must first and foremost be an expert, from medical perspective. I think the other roles can be provided to support the medical expert or be learnt.

DCS survey respondent

I think the programme will be best placed to carry out by two project coordinators, a child and adolescent mental health clinician as well as a sexual health worker. The clinician will be able to address and offer knowledge on the emotional and developmental support while the sexual health worker could offer advice on the sexual health impact.

DCS survey respondent

Responses from the DCS survey highlighted the importance of health professionals and youth workers rather than social workers offering emotional support (Table 21). One-quarter of national social worker respondents also felt that graduate mentors could work alongside a health practitioner to deliver the role, or that ‘lead’ mentors could assist with the recruitment of new mentors, encouraging mentors to attend meetings and lead some of the group sessions. A social worker in LA2 said:

I run a group for care leavers, and I have a care leaver co-facilitator that runs the group with me. And I find that the young people will ask him questions quite often and I’ll just kind of stand back and listen . . . it works really well having young people guiding young people ‘cos they are more likely to listen to the young person.

LA2 SW

The existing educational mentoring model in LA1 involves mentors in leading the sessions. In addition, one mentor from LA2 described a system of ‘lead’ mentors, which, from her experience on the CiCC, is an effective way to drive attendance:

A lot of people never used to come [to CiCC], sometime only five, six people come in the meeting and we are meant to be 12 of us – no more motivation and everything. So [the PC would] nominate a chair, within the group, yeah and maybe a co-chair within the group. Because it’s a group of mentors, you should have a chair. And that chair will nominate herself within the group, like okay I want to be the chair. Her role would be more like to contact the others to motivate them. So it needs to be someone who is more motivated.

LA2 mentor 9

Role of the researchers

From the outset, the researchers offered to assist mentors with research-related issues. However, some mentors seemed to regard the researchers as a source of emotional support. This was in part because of a misunderstanding of the role of the researchers, but in LA1 it was also because of the perceived lack of capacity of the PC to provide this support. For example, one of the mentors telephoned the research team after discovering that her mentee had a diagnosis on the autistic spectrum. She had assumed that both the researchers and the PC knew about it but had simply failed to inform her. The researchers advised her to discuss her concerns with the PC, who was also unaware of the mentee’s diagnosis; the PC said to the mentor that ‘if anything I would have thought the Carmen study would know about it’. Having promised to look into the mentee’s situation, the mentor reported that the PC then failed to get back to her. She subsequently stated that, in relation to the research team, ‘Me personally it just felt like we were just being used for research and they didn’t really care – as long as you guys got your data that’s all you care about’ (LA1 mentor 4).

She felt that the research team should have been more directly involved in supporting her and troubleshooting difficulties as and when they arose:

Yeah, come down and see us more, I think talk to us more as well and if . . . the concerns we have or whatever, like proper take it on board and just like help us out and stuff. I know that it’s [PC1]’s job to do that, but it would be nice if like the people above did it as well, yeah.

LA1 mentor 4

The researchers (DM and FC) were constantly being required to overstep the boundaries of their research and to take on a more active management and even counselling role, which was difficult to resist and not always appreciated by participants or social work professionals.

Inception and preparation

This element of the project was one of the most opaque in terms of what went on and the resources consumed, but it is also one of the most critical elements to its success. Accordingly, the model envisages a formal approach to consideration of the project by senior management, including preparation of a detailed, costed plan that is submitted for approval and backing to an assistant director. This process assumes the creation of a steering group, which nominates a working group to develop the project. The steering group is considered necessary to ensure the direct involvement of senior management.

The final output of this stage is a package containing a list of things to be done; who is expected to do those things; and materials to make these tasks easier, including standard draft letters, explanatory leaflets, posters and training provision already negotiated with providers. The list is based on experience with the present exercise.

An important part of the preparation is the recognition that problems may arise during the course of the project that require intervention from management. To allow for this, the management group will meet twice during the year and once after the trial is over. Of course, these meetings may be cancelled if there are no problems requiring intervention. The burden of ‘ongoing management’ is likely to be lighter beyond the first year.

Awareness raising

The model envisages that the project being launched has the strong backing of senior management, but there will still be a need to repeat the message on a more personal basis. This is seen as the responsibility of the PC, who will arrange presentations to various groups of staff. The most important of these groups includes the social workers dealing with looked-after girls, not least because the model assumes that they will bear the main responsibility for recruitment.

Recruitment of mentors and mentees

Experience in the pilot and the exploratory trial found that recruitment was a particular problem. It took a lot of time and progress chasing by the PC and the researchers to identify potential mentors and mentees.

The solution envisaged in this model was to require social workers to write to all of the young women on their caseload, through their carers, to outline the project and ask anyone who was interested to contact them to discuss the project further. The social workers would then pass any likely candidates to the PC, along with a summary of their case file.

A similar procedure would be followed for the mentors. Social workers would write to the last known address of women who met the inclusion criteria and who they considered would be appropriate mentors. Anyone expressing an interest would speak to the social worker in the first instance and then, if they were still interested and considered appropriate, their names would be passed on to the PC.

The model assumes that social workers and the PC have some administrative support for sending letters and extracting case file summaries, etc.

Training of mentors

This section of the model also includes the DBS checks for potential mentors. As it is a relatively simple section of the model, the detailed list of actions and assumptions about staff time required to perform them is presented in Table 22 as an illustration of the nature of the whole approach.

The activities required are listed in an intermediate level of detail. For the DBS check, the basic requirements would have been communicated to the potential mentors in the recruitment letter sent by the social worker seeking expressions of interest, but it is assumed here that this would need repeating probably in a telephone conversation. The material required for the DBS check would be sent to the PC, who would assemble it for the set of mentor applicants and then hand it over to the administrator who handles DBS checks for the LA. The DBS results, when received, would be passed on to the PC, who would send the appropriate standard letter back to each mentor applicant.

At this point the PC would have a list of cleared potential mentors and some idea of how many mentees to expect. To allow for contingencies, the PC would arrange training for 20% more mentors than there are mentees.

Matching mentors and mentees

At this point the PC has a pool of trained mentors and a pool of mentees. The aim is to match a mentor to each mentee. Once this is achieved, the PC has to organise and attend a meeting between the members of each pair. This could be a lengthy process, with the potential for more than one attempt being necessary, and there is a possibility that the relationship will fail at this first meeting. A judgemental allowance is made for these possibilities.

Support/maintain relationships

Over the course of the next 12 months the PC will remain in contact with the mentors through regular group meetings, as well as dealing with expenses, payments and any contingencies arising, including a mentor or mentee dropping out.

Normal terminations

Towards the end of the 12 months, the PC will take steps to smooth the termination of the relationship. This entails finding someone to take responsibility for supporting the mentee through the withdrawal process and arranging a three-way meeting with that person, the mentor and the mentee. The model also assumes that there will be a standard end of relationship debrief of the mentor by the PC and of the mentee by her social worker.

Review

After running for 12 months the model assumes that there will be a review of procedures and outputs. This will take the form of a report compiled by the PC with the support of the management group and delivered to the steering group. The report will cover the whole process, with particular emphasis on the views of the mentors and mentees as expressed during the debrief sessions on ending the intervention and the views of the social workers on the effect of the process on the girls and young women.

Critique

There are few data available to reality check these results. However, one observation that was made by a PC with some certainty was that the demand on her time during the support/maintenance stage was 3 hours per week, which squares quite well with the last row of Table 23.

The same person also estimated that recruiting mentors and mentees each took 56 hours of her time (112 hours in total). These figures were recalled during an interview some time later and cover only the PC’s own time. The model results give an estimate of 80 hours of total staff time for recruitment and DBS checks combined. As both the PC’s estimate and the model’s estimate are subject to some uncertainty we are assuming that the model gives a better estimate of the time required by the recruitment phase in a tightly managed project.

Analysis of the research team data

Figure 7 shows the aggregate effort expended on the whole project by the researchers. In total, over the duration of the project, just under 7600 hours were logged under the five headings shown. The first Phase I mentor–mentee pair met in November 2011 (week 52 in Figure 7).

FIGURE 7.

Cumulative cost of the evaluation in hours.

Other activities (non-project related) are basically staff development. Research on the intervention and design and set-up of the intervention take up 1925 and 3080 hours of researcher time respectively. Project management, which takes up 876 hours, largely consists of management meetings within the team and communication with outside interested parties. It also includes a relatively small amount of time spent carrying out actions that in a strictly ‘hands-off’ exercise would be left to the LA staff.

Each of the three main components in Figure 7 are examined in greater detail in Figures 8–10.

FIGURE 8.

Analysis of the researcher time put into the design and development of the project.

FIGURE 9.

Analysis of the researcher time put into the management of the project. HTA, Health Technology Assessment.

FIGURE 10.

Analysis of the researcher time put into the research activities of the project. HTA, Health Technology Assessment.

Figure 8 shows an analysis of the time spent on design and set-up of the intervention. The items concerned with recruitment materials and mentor training might fairly be considered as work that would have to be carried out by the LAs if the research team had not been available and these items could therefore be excluded from any research effort on a completely hands-off basis. In addition, examination of the researchers’ comments (attached to their data returns) suggests that some 104 hours logged under ‘other’ could similarly be considered work that the LAs could do for themselves.

Figure 9 shows an analysis of the time spent on management of the intervention. Three blocks of time contain tasks that are properly for the LAs. The block marked ‘troubleshooting’ is almost entirely concerned with chasing up recruitment of mentors and mentees and accounts for 200 hours. Examination of the free-text comments under ‘other’ shows that this block contains a number of similar activities, adding up to 29 hours. Also, examination of the element labelled ‘liaising with mentees and mentors’ shows another 40 hours dealing with problems that could be considered work that the LAs could do for themselves.

Figure 10 shows an analysis of the time spent on research activity. As an aid to costing the evaluation of a larger project, each element of the analysis is expected to be either independent of the project size or proportional to the number of one or other of the mentees, mentors or LA staff.

Using the data to estimate research costs for a Phase III evaluation

The figures in the previous section show the finest level of analysis of the researchers’ logged time that is possible given the nature of the data. Table 25 shows each component and the total associated hours recorded.

As discussed earlier, the researchers spent some time actually helping to manage the intervention. Corrections have been made to the figures shown in the table to remove this element of work. The table also shows how each remaining element of time is to be scaled to estimate the cost of a Phase III exercise. A spreadsheet has been constructed to carry out the scaling, including the calculation of an overhead for the research managers and steering group. It is available for use by any interested party.

Proposal

Suppose that we have a group of young women leaving care, approximately half of whom have been mentored. The first question is whether the pregnancy rate in each group is different. If yes, we need to assess the benefits in the short and long term; if no, do we expect that there will be any delayed effects of mentoring that will prove beneficial in the longer term? If yes, we need to follow the intervention group further to discover what they are; if no, we can stop at this point. Assuming that we have a case for assessing the benefits, how do we go about this?

The study population can be divided into six groups:

• group 1 – mentored and not pregnant

• group 2 – mentored and became pregnant and miscarried or terminated the pregnancy

• group 3 – mentored and became pregnant and carried the pregnancy through

• group 4 – not mentored and not pregnant

• group 5 – not mentored and became pregnant and miscarried or terminated the pregnancy

• group 6 – not mentored and became pregnant and carried the pregnancy through.

A full evaluation of the mentoring requires a comparison of the future life course of girls in group 1 with those in group 4, those in group 2 with those in group 5 and those in group 3 with those in group 6. The comparison could be made in a range of ways but here we are interested primarily in the costs incurred by the six groups and the economic contribution that they make to society.

It would be possible to construct a probabilistic model of the kind used in other evaluations, but these rapidly become mired in conditional probabilities and have to be simplified. A better course would be a longitudinal study of a cohort of treated and untreated girls. However, that is not practicable.

An intermediate approach is to draw on existing cohort studies and use them to fill out a likely future for each of the young women in the Phase III trial. One would do this by selecting a longitudinal study (e.g. the 1970 birth cohort study179) and looking at how the girls in that study were categorised at age 16 years. 13 One would ensure that data were collected from the subjects in Phase III that would allow them to be matched to young women in the longitudinal study (ideally but not exclusively to girls who were in care).

One would then construct a range of futures for each young woman, based on the experience of her matched group. That experience may need to be modified using other data pertaining to broad social change, for example changes in relationship patterns, social security and treatment for health conditions. The aim would be to estimate the costs incurred by any family unit that the young women find themselves in during every future year and the share of those costs incurred by the young women and their children.

The cohort study would, in effect, provide a framework onto which one could map data from other studies in a disciplined and progressive manner and thus accumulate knowledge of the impact of ‘care’ policies on children. Cohort studies have previously been used to study long-term effects of teenage pregnancy and it would be very useful to draw on those studies; however, none, as far as we are aware, has attempted to build a general economic evaluation tool as envisaged here.

Availability of eligible participants for a Phase III trial

As has been found in a number of RCTs based in social care181 and trials of peer mentoring,162 we experienced considerable difficulties in achieving the target recruitment, which delayed the start of the intervention. Determining the reasons for non-participation amongst young women aged 14–18 years was difficult as social workers provided only the names of the young women who they felt were suitable and who had agreed to be contacted by the researchers. We were unable to obtain detailed information from the social workers or the PCs on how many approaches had been made to the young women or how many of the young women had then declined to be referred on. There would appear to be a sufficient number of eligible young people at a national level for a future Phase III trial. Our survey of young people in care elicited a positive response with regard to participating in a mentoring intervention in the future, either as a mentor or as a mentee. Given adequate information, participants were generally willing to take part in the study and none of the young women who we approached subsequently declined to give consent once the study had been explained to them. There is some evidence that, when recruitment can be carried out directly by researchers, recruitment rates appear to be higher; however, this also carries considerable ethical challenges in such a vulnerable population. 182

Oakley and colleagues183 have suggested that, to successfully implement randomisation in social care settings, the issue being addressed should be considered a priority issue by the participants. One of the problems that we encountered in this study was the fact that, although teenage pregnancy in LAC was, at the time of developing this programme, a priority issue for government and arguably for health and social care providers, it was not viewed as such by the young people themselves, in contrast, for example, to educational outcomes.

A second prerequisite for mounting a RCT in a social care setting is that there needs to be a clear scientific and policy rationale for using random allocation and sufficient consideration given to ensuring that stakeholder groups are fully signed up to, and understand, this approach. 183 We found that stakeholders were not entirely in agreement with, nor fully understanding of the need for, randomisation. Indeed, many social workers were extremely uneasy about the principle of randomisation on the basis that they considered it unethical to deprive the care as usual group from an intervention that they considered would benefit them.

Project co-ordinator and social worker understandings and expectations of the trial, its methodological approach and effective intra- and interagency communication were crucial for its success. However, many social workers in the participating LAs viewed the study as an additional burden that had been imposed on them by their managers and external researchers, which meant that they lacked a sense of ownership of or commitment to the project. PCs were also frustrated by the lack of recognition and support of their role by senior management or by social worker colleagues.

If this trial had taken place within a health-care setting, payment would have been made for PCs on the basis that they constituted an excess treatment cost. In health-care settings there is a culture of NHS trusts supporting the cost of providing an experimental intervention and, under the terms of the new clinical commissioning groups’ mandate, commissioners are committed to providing the funding to support National Institute for Health Research-funded research (updating and strengthening previous similar agreements). No such culture or provision exists in social care, resulting in a situation in which senior management in the LAs agreed to participate in the study but could not commit additional resources to the teams implementing the intervention.

Had the trial taken place in a health-care setting, mechanisms would have been in place to cost for health-care professionals’ time to recruit participants (research support costs), enabling the host trust to backfill that time. No equivalent system is in place in social care settings, which meant that PCs were required to support the trial in addition to their other duties, which, more often than not, had to take priority.

To improve recruitment and retention rates in any future trial, additional research support costs would need to be provided to participating LAs to cover the costs of recruitment and retention and any additional research-related tasks. In addition, social workers would need to be fully informed about the need for the research and the specific research approach being taken, with additional input and support from senior managers, to encourage internal management and ownership of a future trial.

The process cannot be successful without adequate backing from senior management to disseminate information about the trial, throughout the organisation and borough wide, to the teams and groups that work with LAC: children’s social work teams, leaving care teams, fostering teams, virtual school teams, independent reviewing officers, LAC nurses and foster carers.

Recruitment of mentees and peer mentors

The vulnerability of children and young people in the care system is well recognised. Participants in this study exhibited emotional and behavioural problems, consistent with the literature,49 including self-harm (52%), truancy (82%), suspension or expulsion from school (50%), contact with the police (62%) and running away (40%). Over half of participants had already engaged in sexual intercourse (63%), the mean age of first intercourse was 14.3 years and one-fifth of participants (n = 3 in each group) had been pregnant. A recent national survey of sexual behaviours and attitudes in the UK found that the average age reported by young people for first sexual intercourse was 16 years. 25 The same survey also reported that 29% of women had had sexual intercourse before the age of 16 years. This group would therefore appear to be more sexually active and at a younger age than the national average. Several professionals in the study suggested that any future intervention to reduce the rate of teenage pregnancy in LAC should target a younger age group, those aged 12–16 years, before they become sexually active. They also recommended ‘front loading’ data on eligible young people in a future trial, in which senior management, working with their data management officers, would identify eligible young people, who would be approached in the first instance by the professional who has the closest relationship with them regarding their interest in participating. Networks of young people in care could be accessed in alternative ways, for example through CiCCs or youth centres, events for young people in care and specialist publications such as the Who Cares? Trust newsletters.

When obtaining consent, LAC aged 14–18 years were told by researchers that they wanted to look at the effects of peer mentoring on general well-being, as well as work, social life relationships, attitudes to sex and thoughts about early pregnancy. We found no evidence that being informed of the aims of the programme deterred anyone from taking part, although young people may have been more engaged and motivated had the approach been to focus on developing positive behaviours skills and opportunities rather than avoiding the ‘problem’ of teenage pregnancy, as advocated in the PYD model (see Chapter 1).

Because of the difficulties that we encountered in recruiting sufficient numbers of young women to act as mentors, we ended up essentially accepting onto the training all those who met the age criterion. This included young women who were pregnant or who had young children, none of whom were able to complete, or in some cases even commence, mentoring. Social workers were simply given the following as inclusion criteria: young people aged 19–25 years who were currently, or who had recently been, in care and who they considered would be suitable as a mentor. There was otherwise no independent assessment of a mentor’s motivation, capability or commitment to the role or any exploration of personal issues that might affect a mentor’s ability to perform this role. Any future trial would need to adopt a more formalised approach to mentor recruitment whereby social workers ensure that relevant information about potential participants is passed on to the PC and that mentors are subjected to a rigorous selection and screening procedure, both before and post training. It would also be important to use the training process to screen, and if necessary exclude, individuals who may not be suitable as a mentor.

Despite the qualities identified by social workers as desirable for good mentoring, we were unable to predict from the training who out of the young people who participated would go on to form a successful mentoring relationship and who would drop out, simply based on their personal qualities or characteristics. However, one of the factors that did appear to predict failure to take up mentoring, or early discontinuation, was the mentor being pregnant; therefore, in any future trial this should be added to the exclusion criteria.

Although some of the mentors were conscientious and assiduous in fulfilling all of the components of their role and took their responsibilities towards their mentee very seriously, a large number did not commit themselves to the task, with high rates of dropout and disappearing from contact without warning, misuse of the mobile phone, failure to attend support sessions, failure to record contacts and non-contact with their mentee. We underestimated the vulnerability of our mentor group; there was evidence of significant psychological, emotional and social problems in this group, despite the fact that over two-thirds of them were in further education. Based on our findings, we consider that only the most resilient of young people should be recruited to act as a mentor in any future trial. Raising the lower and upper age limits for mentors from 19–25 years to 21–28 years may help to ensure that applicants are sufficiently mature and emotionally stable to take on this work. However, it might also make it more difficult to identify potential candidates, as most of them will no longer have any formal contact with social services.

Training and matching

The 3-day training course for mentors was judged to be acceptable and relevant by the young people who participated. Both trainers had experience of working with young people in care, skills in group work and a willingness to be open, were non-judgemental and flexible in their approach and adopted a range of non-didactic training methods including role play. A high trainer to participant ratio was important to enable trainers to provide individual support to mentors if required.

Post-training interviews with the participants would help to assess the commitment and ability of would-be mentors to deliver the intervention and any personal or structural barriers that might get in the way of their effective participation or lead to early dropout. Effective communication between the referrer and the PC would ensure that mentors are provided with any information about their mentee in advance that might impact on their ability to build a relationship and provide support. No clear evidence was found to support the need for matching, apart from the tactical consideration of geographical location.

The delay between training mentors and recruitment of sufficient numbers of young women aged 14–18 years to act as mentees meant that the momentum and motivation of mentors waned, again highlighting the importance of a more stringent recruitment process in the future to ensure that recruitment of mentors and mentees takes place concurrently.

Randomisation

Amongst the young women we consented to be randomised to the intervention arm or the control arm, and from our national survey of young people in care, we found no evidence that randomisation, that is, the prospect of having only a 50% chance of receiving the intervention, was a deterrent to participation.

Participants randomised to the control arm reported minimal levels of distress, despite having hoped for a mentor. By contrast, there was considerable unease expressed by social workers about the harmful and even unethical aspects of randomisation when dealing with such a vulnerable population and some evidence that these concerns deterred some from approaching or referring eligible young people. Similar findings have been reported by other researchers in relation to research in social care settings. 181,184

Content of mentoring sessions

In this study, weekly face-to-face contact between mentors and mentees was not feasible; fortnightly contact would appear to be more realistic, in terms of what actually happened but also based on feedback from the participants, social work professionals and young people in the national survey. Many young people expressed a preference for group meetings held at monthly intervals, which they felt would be less intimidating and would encourage mentees to be more open, both within and outside the group setting. The mentors rarely used the mobile phones provided except for the purpose of arranging appointments with their mentee. However, some mentors did abuse the privilege by using the phone for unrelated calls and texts and running up large phone bills.

The content of the mentoring sessions was left to the mentor and the mentee to decide on. Many of the mentors lacked confidence to structure the sessions and similarly many of the mentees were unwilling, or unable, to express a preference as to how they wanted to use this time together. The findings illustrate the importance of creating some structure to the mentoring whilst not being overly prescriptive. There is an abundance of materials that charities give to mentors to use to address healthy relationships, which were discussed with mentors during the training but not provided or used during the sessions. In a future study such materials could be provided as an alternative way for mentors to address these issues on an individual basis. A goal-oriented approach, providing mentees with a clear sense of purpose for mentoring as a whole and for each meeting, might encourage more regular attendance. In a future trial, mentoring sessions would need more of a focus on the issues that are of relevance to these young women – education, transitions from care and future aspirations – to try to ensure that they remain engaged with the programme.

Although the intervention was designed with the aim of reducing rates of teenage pregnancy, it is unclear to what extent this aim was fully understood, or endorsed, by participants. We found from our interviews that, although a reduction in teenage pregnancy may have been a desired outcome for policy-makers, professionals and the research team, it was not necessarily an aspiration that was fully embraced by the young people themselves. This clearly contrasts with the education mentoring scheme, which young people chose to attend because they wanted to perform better educationally (see Chapter 8). Despite the training, many mentors felt somewhat reticent about discussing sex and relationships with their mentee and felt that they lacked the personal resources, or confidence, to be able to do this effectively. SRE could be delivered by a trained practitioner, as part of group mentoring sessions, to ensure that mentees and their mentors receive sufficient and accurate information. It is likely that delivery of this material in a group setting would increase mentors’ confidence to discuss these issues further during individual sessions with their mentee.

Retention

Thirteen out of 20 mentors (65%) and 19 out of 30 participants aged 14–18 years (63%) were retained for the research. We overestimated the resilience and independence of the young women who were recruited as mentors, which meant that many of them struggled to deliver the intervention as specified. Perhaps not surprisingly, given the fact that they were drawn from the same pool as the mentees and shared many of their characteristics, they were a vulnerable group with limited problem-solving skills, which meant that some of them were overwhelmed by the emotional as well as practical demands of the role. The 3.5-day training was not in itself sufficient to sustain the mentors, or keep them motivated, particularly when problems arose in the mentoring relationship. Providing additional support in a future trial would be expected to improve retention rates of mentors.

The role of the PC is crucial in terms of running the monthly support groups and offering ad hoc advice and support to mentors for the duration of the intervention, as well as monitoring their contacts, facilitating communication with other involved social care professionals and providing crisis management. However, this requires a significant investment of time and energy and without additional resources for a dedicated PC is not realistically achievable.

If funding could be made available in a future trial, PCs would need to be contacting mentors with weekly phone calls as well as providing monthly group support meetings. Mentors would benefit from a one-to-one review with a PC on a quarterly basis, allowing mentors the opportunity to reflect on the mentoring relationship and PCs to assess progress and consider whether the work carried out warrants payment for input and activities. It remains to be seen whether the level of support that would be required from LA professionals to make a future peer mentoring intervention feasible would be economically viable.

Although mentors and the PCs said that the monthly group support meetings had helped them to reflect on the progress of their mentoring and discuss problems that they might be having, the mentors did not attend these meetings on a regular basis or they sometimes turned up only to collect their activity money and shopping vouchers. It is therefore unclear whether simply offering more support would fully address issues around mentor compliance and retention.

In a future trial, an alternative model to address problems around mentor recruitment and retention would be to recruit mentors from outside the care system altogether, for example through universities. This would certainly increase the potential pool of applicants; however, it would also mean losing one aspect of the ‘peer’ support, that is, the shared experience of care, which appeared to help mentors to empathise with mentees, act as advocates and raise concerns with social workers, which mentees appeared to value (see Chapter 8).

Evidence of harm to participants

Beyond the fact that there were no examples brought to our attention of inappropriate or risky contacts between mentors and mentees, it is difficult to determine the extent of any harm associated with participation in the study. The research team was very aware of the highly vulnerable population involved in the study. We were particularly aware of the potential for harm to the mentors, possibly as a result of being asked to deal with situations that they were poorly equipped to deal with, feeling out of their depth and becoming emotionally overwhelmed. We were also concerned about the potential for excessively dependent relationships to develop and the risk of personal versus professional roles becoming blurred, particularly given the synergy between the mentee and the mentor in terms of age and life experience. We attempted to address these issues through the training and the ongoing support meetings and by emphasising the need for clear lines of responsibility and accountability and channels of communication within the mentees’ care networks. In spite of this, however, some of the contacts between mentors and mentees took place without PCs or social workers being informed.

All participants had given informed consent to participate in the trial knowing that they had a 50% chance of not being allocated a mentor and all were deemed Gillick competent. 129 Although those participants who were randomised to the care as usual arm of the trial expressed some disappointment at not being allocated a mentor, there was no evidence of any lasting harm, or damage, to these individuals. Equally, a number of mentees expressed feelings of rejection or disappointment if their mentor dropped out prematurely or failed to match up to their expectations. It is not clear to what extent these feelings were severe or persistent or to what extent they might impact on the mentees’ willingness to engage with carers or seek help in the future. However, any future trial would need to mention mentor dropout as a possibility when obtaining informed consent from would-be mentees, particularly when working with such a vulnerable group whose past experiences may have made them particularly sensitive to rejection and loss.

Characteristics and appropriateness of the proposed outcome measures

The outcome measures were acceptable to the young people and appropriate; however, given the low numbers recruited to the study, there was necessarily more emphasis on the qualitative data than on the quantitative data. Measuring pregnancy as a primary outcome was not possible given the low numbers recruited and retained. Equally, the proxy measure, initiation of sexual activity, was not particularly illustrative given the high baseline levels of sexual contact and pregnancy (one-fifth of the young people had been pregnant on at least one occasion at baseline). The low numbers of mentees recruited prevented us from being able to interpret any changes in the quantitative measures around psychological health, attachment and help seeking. This is not to say that these measures would not provide a useful insight into the mechanism of action of any future intervention. The logic model (see Chapter 3) supports the relevance of self-esteem, self-efficacy and decision-making capacity in teenage pregnancy in this group, which our qualitative data would appear to support.

There was some qualitative evidence for an increase in self-esteem and sense of control in the mentees. Similarly, mentors reported feeling more confident and competent as a result of their mentoring experience. Therefore, in a future trial, there is sufficient qualitative evidence to support the continuing use of the locus of control measure and a self-esteem measure for mentees and a measure of self-efficacy for mentors. Similarly, although there was no evidence in this trial for a reduction in feelings of general anxiety and depression, the GHQ is a sensitive measure of clinical distress and of change over time and was acceptable to this population.

Strengths and limitations

Although we recruited only around half the target group for both mentors and mentees, this is similar to findings of other RCTs with vulnerable groups. 182 The reasons for this reflected difficulties with engaging young people in care as well as working with LAs:

• LA staff lack time to prioritise recruitment and awareness of the study was patchy

• informal gatekeeping by social workers

• lack of exposure to and experience in research and research concepts such as equipoise and lack of research infrastructure to support this project within LAs

• concerns about the project aims and variable interpretations about the recruitment criteria

• the overall aim of the research project may not have been fully shared with or accepted by the young people concerned or viewed by them as a priority.

The non-London site that we recruited (LA3) had to withdraw from the intervention because of problems recruiting and retaining mentors. This limits the generalisability of our findings somewhat as LA1 and LA2 were both based within London, although it is not entirely clear how this may have affected our results.

One of the strengths of this trial is the fact that the intervention has been embedded within the LAs that would be required to deliver the intervention in the real world. However, this strength has also proved to be one of its limitations. Many of the problems that we encountered are representative of a fundamental clash of professional philosophies and values as well as divergent professional cultures that make cross-agency research collaboration so difficult. 185

Some have suggested that there is a fundamental incompatibility between social work practices and the science of evidence-based practice,183,185–190 which has resulted in an evidence base that lags behind current social work policy and practice. 191 Opposition to RCTs by social scientists has been based around feasibility, science and ethics, particularly in relation to the use of randomisation. 183 As a result of this, research evidence in social care often falls short of what is considered to be the gold standard for health and clinical research – the RCT. 188

In social work, research and development runs at about 0.3% of total spend compared with 5.4% in health. 189 Within social work there is considerable disagreement as to what constitutes current best practice and, although there may be a lot of support for the idea of research, in practice social workers lack training compared with health workers, as well as skills in critical appraisal, and tend instead to follow a type of practice wisdom or intuition. 185,186 It has been noted that the fact that a study may receive approval from official gatekeepers will not necessarily guarantee the co-operation of the informal gatekeepers and participants or professional commitment to the study. 181,190 This observation certainly replicates the experiences of the researchers in this trial.

The difficulties that we have encountered in this trial are similar to those described in many other studies of hard-to-reach and hard-to-engage populations. 181,182,187,191 The staging of a RCT within, and in collaboration with, LAs was undermined by different understandings of research methodology; the lack of a research infrastructure within the LAs; our inability to provide LA research support costs; the absence of a dedicated in-house project manager, which meant that competing generic commitments took priority; frequent LA reorganisations, economic cutbacks and demoralisation amongst social workers; and a tendency of social workers to act as informal gatekeepers.

External

Professor Geraldine Macdonald (Queens University) (Chairperson).

Dr Kristin Liabo (Institute of Education).

Professor Janet Peacock (King’s College London).

Internal

Professor Gillian Mezey (Principal Investigator SGUL).

Khatija Hafesji (user representative).

Professor Rona Campbell (Bristol University).

Relevance to the primary research question

Publication type

• 3 = journal articles

• 2 = published reports, books or chapters

• 1 = dissertations, internal reports, classroom guides

• Publication date – exclude studies pre 1992.

• Language – exclude studies that are not written in the English language.

• Type of participants:

  • Care history – include studies involving young people who are currently in care or who have left care.

  • Age – between 13 and 25 years.

  • At risk – include studies involving young people aged 13–25 years who are ‘at risk’ or showing behaviour that would constitute risk. ‘At risk’ is defined as the presence of individual or ecological characteristics that increase the probability of teenage pregnancy. Ecological characteristics include family and parenting influences on behaviour, residence in a neighbourhood with high levels of poverty or crime or exposure to gangs. For the mentoring and teenage pregnancy search, include studies focusing on at-risk and pregnant young women and teenage mothers only, and mentoring that aims to improve sexual health/behaviour generally.

Scoring

As well as taking into account publication date, language and participant type, inclusion/exclusion was based on the following scoring system.

Selection of mentors

1. How will you select mentors? (How might you access them?)

2. What characteristics would they have? What knowledge/skills would they need?

3. Do you think there would be any issues with mentors being aged 19–25 years and having been in care? How old should they be and why?

Training

The training would last for a minimum of 2–3 days.

1. What days of the week and at what times would your training be held? (What might you have to consider in your decision?)

2. What difficulties might you have in attending training? How could these be overcome?

Contact

1. Based on the aims of your programme, will you be meeting your mentee in the community (e.g. café) or in a young person’s centre? Why?

2. How often would you have time to meet with your mentee? Would you like it to be the same day/time each week or would you like it to be flexible?

3. What are your other commitments? How would you manage your time around them?

4. What will you do during your meetings with your mentee (based on the aims of your mentoring programme)?

5. What difficulties might you have with meeting your mentee? How would you overcome the difficulties?

   • Probe:

     • Travel – car/public transport.

     • Other commitments – childcare expenses.

6. What would you think about when it was nearing the end of the relationship? (How would you end the relationship?)

Support

1. What support do you think you would need to be an effective mentor? (Who would provide it? How often? In what location?)

Incentives

1. Do you think mentors should receive anything in return for mentoring? (What would that be?)

Carmen study

The Carmen peer mentoring intervention is managed and run by a project co-ordinator within the local authority. The role of the project co-ordinator is to recruit mentors and mentees and to provide support to mentors.

Recruiting mentors

1. Mentors in the Carmen study are aged 19–25 years. When you were aged 19–25 years what contact did you have with social services? What other organisations/services did you have contact with?

2. Based on the above, what do you think is the best organisational context for recruiting mentors aged 19–25 years who have left care?

   • Probe:

     • Social services, universities, other organisation mentioned above.

Contact with mentee

1. Mentors in the Carmen study were asked to meet with their mentee once a week, face-to-face, for 1 year. What do you think about this?

   • Probe:

     • Is it too much, too little, just right?

2. Mentors were asked to complete a diary of their contact for the researchers. They are able to complete the diary using an application on their mobile phone or by completing it online, through a confidential server. What do you think about completing a diary on a phone/online? The mentors have not completed the diary consistently – what do you think would be a better system for them to feed back their contacts to a project co-ordinator?

3. What do you think about 1 year as the amount of time for the mentoring relationship?

Support

1. What do you think of the idea of a monthly support group? This would be to discuss how things are going with other mentors and the project co-ordinator and to try and resolve any issues.

2. What kind of professional do you think should provide the support?

   • Probe:

   • Attributes and role, i.e. a social worker?

Incentives

1. Mentors in the Carmen study receive a £40 voucher per month and can gain a level 1 ASDAN qualification. What is your view on these incentives?

2. Mentors receive £60 per month for paying for activities with their mentee and for travel for both of them. What do you think about this amount of money for activities (£15 per week)?

Any other questions/comments? (recruitment, difficulties we’ve experienced).