Guidance

'You're Welcome': establishing youth-friendly health and care services

Published 27 June 2023

Foreword: World Health Organization

Adolescent-responsive health services: an imperative to achieve universal health coverage

Adolescence is one of the most rapid and formative phases of human development. The distinctive physical, cognitive, social, emotional and sexual development that takes place during adolescence demands special attention in national development policies, programmes and plans. The goal of universal health coverage with essential services and interventions - a goal central to the work of the World Health Organization - cannot therefore be achieved without investing in adolescent-responsive health systems and services.

Global initiatives are urging countries to prioritise quality of care as a way of reinforcing rights-based approaches to health and achieving universal health coverage. However, evidence from high, middle and low-income countries shows that adolescents experience many barriers to receiving information and quality healthcare, and that services for adolescents are often fragmented, poorly co-ordinated and uneven in quality.

Recognising the problems, many countries have moved towards a standards-driven approach to improve quality of care for adolescents, adapting and adopting the global standards for quality healthcare services for adolescents developed by the World Health Organization and other stakeholders.

We are pleased to see that the Office for Health Improvement and Disparities (OHID) is supporting improvements in the experiences of young people in relation to both the quality and access to the health and wellbeing services by publishing the revised quality standards. By placing young people’s voices at the heart of services and the care they provide, by guiding support services to help young people develop their health literacy and self-care for the future, and by encouraging community and primary and referral cares services to implement self-assessment assurance processes, the guidance will benefit 10 million young people aged 10 to 24 in England.

The World Health Organization strongly advocates that young people’ expectations and perspectives are included in national programming processes, and that their leadership and participation is institutionalised and actively supported during the design, implementation, monitoring and evaluation of adolescent health programmes and services. We are confident that the revised standards will make a difference because they have been developed through engagement with young people and because they are sensitive to the changing needs and influences on young people’s lives.

We believe that the consistent application of the 8 standards, enhanced by developing digital approaches and investing in an adolescent-competent workforce across health and social services, will improving young people’s access to services and reduce inequalities.

Anshu Banerjee, Director of the Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization

Introduction

It is important young people feel confident in accessing services and being part of their own health. This can be achieved by making young people feel welcome and services being youth friendly. This guidance sets out 8 standards and associated quality criteria for youth-friendly services that have been developed in partnership with young people. The standards are intended to improve the experiences of young people in relation to both the quality and access to the health and wellbeing services.

The original standards were published in 2007 and subsequently in 2011. These revised standards have been refreshed through engagement with young people in recognition of the changing service landscape and influences on young people’s lives. Feedback from young people suggests the standards are relevant and could make a difference across a wide range of service providers, and beyond health and social care.

Young people are experts in their own health, and they have been involved in designing and prioritising the revised standards. The standards are voluntary and provide one way to benchmark provision and give young people confidence that the services being delivered account for their needs. A voluntary approach to self-assessment has also been devised by young people and is detailed below.

Understanding and responding effectively to young people’s health and wellbeing needs

There are 10 million young people aged 10 to 24 in England, forming 17.7% of the population who will now, or in the future, need to use health or care services. It is important to make their experiences positive to support appropriate use of services. Improving young people’s access to services will facilitate earlier support, resulting in improved use of services and interventions, potentially reducing the burden on health and social care. Investing in young people’s health can have a significant impact on young people, including:

• improving access to services for young people
• improving health and wellbeing, and supporting behaviour change
• reducing health inequalities
• reducing financial costs for the future

Improving access to services for young people

Outcomes for young people are improved when services engage young people in decisions about their care.

Young people may not always have access to the information they need, for example in primary care and mental health.

Recognition of the diversity of young people’s experiences can support service delivery and reduce health inequalities.

Improving health and wellbeing, and supporting behaviour change

Adolescence is a time of rapid brain development, presenting opportunities to provide positive experiences to support young people adopt healthy behaviours and lifestyle choices to improve outcomes.^{[footnote 1]}

Many long-term conditions emerge during adolescence, including the majority of life-time mental health problems. Early intervention is critical for young people and has huge potential impact on future health and wellbeing.^{[footnote 1]}

Many long-term health behaviours such as tobacco and alcohol use, and lifestyle issues including obesity and physical inactivity, are established during adolescence. Strategies to support young people are an opportunity to promote positive health and improve lifestyle behaviours. Getting it right at this age supports improved health outcomes now, in adulthood and for the next generation. Adolescence is a time to develop health literacy and to foster autonomy in decision-making to support self-care. The introduction of statutory Relationships, Sex and Health Education supports health literacy and may result in more young people actively seeking to engage with health and care services

Reducing health inequalities

The health and wellbeing of young people in the UK are much worse than in other similar income countries in key areas such as obesity, type 1 diabetes and asthma, limited exercise or teenage pregnancies.

Disparities are exacerbated for some young people, including ethnic minority groups, young carers, LGBT people, looked-after children or those with a learning disability.

Reducing financial costs for the future

Improving access to healthcare and supporting healthy behaviours and lifestyle choices in adolescence, such as for healthy weight or smoking, can have long-term positive impacts to the NHS or social care.

Early diagnosis and intervention for long-term health needs in adolescence supports improved self-management and can reduce emergency hospital admissions.

Investing in the health and wellbeing of young people, particularly around substance misuse, can have a positive impact on antisocial behaviour and crime as well as health.

Investing in adolescent health brings economic and larger societal benefits through greater productivity, reduced health costs and enhanced social capital.

Using the standards to improve young people’s outcomes and experiences of services

The standards:

• place young people’s voices at the heart of services and the care they provide
• support services to improve approaches to help young people develop their health literacy and self-care for the future
• encourage community and primary care, secondary care, social care and voluntary sector to develop youth-friendly services, while also improving quality through self-assessment assurance processes

Benefits include:

• services that give young people the confidence and trust to access the help and support they need when they need it
• non-judgemental services delivered by approachable professionals, who understand and can respond to young people’s unique needs and challenges
• a focus on self-care as knowledgeable professionals who empower young people to manage their own health, care and treatment
• improved health literacy, resulting in improved understanding of service aims, expected outcomes and referral methods
• local ownership: opportunities for local communities to review services, resulting in a sense of ownership through involvement and participation
• improved community cohesion as young people are recognised as important members of the community, with their involvement and voice valued
• improved local information about young people’s perspectives, good practice and opportunities for innovation
• more inclusive and accessible services, which will be able to to engage with young people to improve services and commission outcomes

The standards and criteria

Each standard includes 3 essential criteria and some additional considerations. In addition, the service must consider relevant legal requirements and organisation policies, which include:

• ensuring that appropriate confidentiality, consent and safeguarding policies and procedures are in place. Local policies should include a protocol for when it may be necessary to breach confidentiality

• promoting equity in accordance with:

  • the Equality Act 2010
  • Human Rights Act 1998
  • UN Convention on the Rights of the Child
  • UN Convention on the Rights of Persons with Disabilities

• protecting health and safety, including online safety of young people and their families in line with relevant legislation and statutory guidance. This includes:

  • Children Act 1989
  • Children Act 2004
  • Working together to safeguard children
  • data protection and GDPR regulations

The links to other relevant quality frameworks are also highlighted for each standard. Services that have successfully completed a Care Quality Commission (CQC) inspection, Ofsted inspection or other quality or regulatory inspections should have policy and practice in place which can demonstrate meeting the standards.

Standard 1: involving young people in their care and in the design, delivery and review of services

Essential criteria

Essential criteria for standard 1 are:

• staff actively encourage young people to be involved in their care. Plans are developed with young people, considering all aspects of their life and how they would like their parent or carer to be involved in their care. Where appropriate, young people are supported by an independent advocate

• there are processes in place to ensure that young people’s views are included in care planning, governance, service design and development. Consideration is given to ensuring the views of marginalised or seldom-heard groups of young people are heard. Feedback is reviewed and acted upon. Staff listen and are responsive to the voices of young people

• there are clear processes to safeguard young people including those involved in youth participation

Additional criteria

Additional criteria for standard 1 are:

• the service has a nominated young people’s liaison who is responsible for linking with young people, supporting their participation and making sure others hear what they say

• information about how young people can have a voice within the service is available and has been developed with young people

• young people are routinely included in feedback or patient experience surveys, for example the Friends and Family Test

• the service works with other organisations who already support young people’s engagement, such as a local youth council or school councils

Other quality frameworks

CQC key lines of enquiry for healthcare services

CQC: the fundamental standards

NHS England: patient and public participation in commissioning health and care

NHS England: involving people in their own health and care

Ofsted and CQC: Area SEND framework and handbook

Further resources

Council for Disabled Children

Get Your Rights: information for children and young people about rights in the NHS

NHS England guidance on working in partnership with people and communities

Social Care Institute for Excellence: involving children and young people in developing social care

Young Minds: participation toolkits for schools, NHS staff, commissioners and local authorities

Standard 2: explaining confidentiality and consent

Essential criteria

Essential criteria for standard 2 are:

• information about young people’s right to confidentiality, what they can and cannot give consent to, and their right to make complaints, is freely available in an accessible format

• confidentiality and consent policies are made explicit to young people and parents or carers. The information makes clear young people’s entitlement to confidentiality and any limitations to confidentiality about safeguarding and managing risk

• young people are made aware of who holds information about them, and when and how it may be shared

Additional criteria

Additional criteria for standard 2 are:

• young people are routinely offered the opportunity to attend appointments on their own, with impartial chaperones or a trusted friend, instead of parents or carers if they wish. This is made clear in information about the service

• all staff are trained and skilled to inform young people of their rights around confidentiality, consent and the right to complain

• a confidentiality policy sets out how staff will work with parents and carers where appropriate while respecting the confidentiality of the young person

• all staff know when and how to routinely explain the confidentiality policy to young people and to their parents or carers

• where digital health records exist, all staff are clear at what age young people can access these records and when parents may no longer access them. This is explained to young people and parents

• staff signpost young people to alternative services or professionals they can talk to, for example the school nurse, teachers, a trusted adult, or Childline or other helplines

Other quality frameworks

CQC key lines of enquiry for healthcare services

CQC: the fundamental standards

Further resources

British Medical Association: ethics guidance - see section on confidentiality and health records

NSPCC: Gillick competence and Fraser guidelines

Royal College of General Practitioners: Adolescent Health Group - see the ‘Confidentiality and young people’ toolkit

Standard 3: making young people welcome

Essential criteria

Essential criteria for standard 3 are:

• young people are greeted with professionalism and compassion. All staff, including reception staff and volunteers, treat young people with respect. Where young people are accompanied by a carer, both are acknowledged and made welcome

• consideration is given to whether access is convenient for young people, including choice about service location, which may offer better transport links to support independent access. Staff recognise some young people may need longer appointment or meeting times, for example if they have complex needs, a long-term condition or disability. Services make it clear how young people can rearrange or cancel appointments when necessary

• staff ensure that young people’s preferences about the consultation, appointment or meeting are considered. This includes who they prefer to be seen by, whether they can bring a friend, and how many people will be present. Staff work with young people to manage their expectations and provide explanations in an open and honest manner when their wishes cannot be granted

Additional criteria

Additional criteria for standard 3 are:

• the service provides information and communicates in an inclusive way, explaining things such as how to access different parts of the service, how information is shared, and how to make complaints, compliments and comments. This may include providing information in a variety of formats (such as large print or easy read, British Sign Language or Braille) and in languages other than English where needed via provision of interpreters or translation of documents

• care and interventions are delivered in a safe, accessible and youth-friendly environment. Young people are treated with sensitivity, and any potentially sensitive questions are asked in private where they cannot be overheard - for example, away from the reception, waiting areas or clinical environment

• the reception, waiting area and care or treatment areas are accessible and youth-friendly, comfortable and welcoming. Any resources that are provided are appropriate for young people and these are refreshed regularly

Other quality frameworks

CQC key lines of enquiry for healthcare services

CQC: the fundamental standards

Further resources

Association for Young People’s Health: GP champions for youth health toolkit

Royal College of General Practitioners: Adolescent Health Group

World Health Organization: increasing the quality and coverage of youth-friendly services

Standard 4: providing high-quality health, wellbeing and care services

This includes essential criteria for all and specific criteria relevant to 5 specialist areas of young people’s services.

All health, wellbeing and care services

Essential criteria

Essential criteria for all health, wellbeing and care services are:

• there is clear communication about the support and services being offered to young people. Communication may be face to face, in publicity materials such as leaflets or posters, social media platforms or websites and includes provision of materials that are accessible for everyone such as in different languages or for young people with or without disabilities. This information includes feedback from young people about the service and the outcomes the service achieves as evidenced by robust evaluation processes

• all staff use a holistic approach to provision of evidence-based care, with consideration given to social, educational, emotional, spiritual and physical wellbeing. Staff providing care for physical and complex conditions are aware of the importance of mental health and wellbeing, can identify early signs of need and provide information about, or referral to, prevention services. Staff listen to and support young people disclosing violence, exploitation or abuse, and take appropriate action

• all staff routinely introduce themselves and provide information about the provision available to support young people. Young people’s privacy and dignity are always maintained, including during discussions, provision of advice, physical examination, and during treatment, personal care and support

Additional criteria

Additional criteria for all health, wellbeing and care services are:

• staff discuss choice of management and interventions with young people and, where appropriate, their parents or carers

• staff working with young people have received training in adolescent development such as the Adolescent Health Programme. This includes communication skills when talking to young people, knowledge of interventions, treatments and likely outcomes, responding to diversity issues such as gender identity, ethnicity or culture, and a clear understanding of informed consent

• the service has clear mechanisms in place to support young people’s transition to adult services where appropriate. Staff are aware of the processes and young people are supported in a timely way to ensure continuity of care

• young people, parents and carers are provided with information about how to access local and national support and useful resources via social media, apps or other digital support tools

• staff promote healthy lifestyles in a non-judgemental way by Making Every Contact Count including issues such as: keeping healthy and well, positive mental health and emotional wellbeing, healthy eating and physical activity, avoiding online harms, stopping smoking, avoiding alcohol and substance misuse, supporting long-term health and care needs, staying safe and positive relationships and sexual health

• staff connect young people with social prescribing schemes to enable them to identify local sources of support, for example volunteering, arts activities, sports and a range of other activities

Other quality frameworks

CQC key lines of enquiry for healthcare services

CQC: the fundamental standards

Further resources

All Our Health: personalised care and population health

NHS: Every Mind Matters - children’s mental health and self-care tips and videos for young people

StreetGames: resources for children and young people’s social prescribing

Specialist young people’s services

The following criteria are relevant to services that specialise or offer services in one of the following areas:

• healthy weight and physical activity
• alcohol and drugs
• managing long-term and complex health needs and disabilities
• mental health and wellbeing
• sexual and reproductive health

4a: specialist services for healthy weight and physical activity

Essential criteria for standard 4a are:

• young people receive easy-to-understand advice and interventions on eating a balanced diet, healthy food choices and portion size, including advice on how to choose, cook and prepare healthy food

• staff are familiar with physical activity guidelines, are aware of services and activities locally, and can provide support to young people to help them increase their physical activity and reduce sedentary behaviour

• easy-to-understand information is available for young people and their families about healthy weight, obesity, physical activity, healthy eating and local support services

Additional criteria for standard 4a are:

• staff are trained and follow National Institute for Health and Care Excellence (NICE) guidelines when assessing weight, lifestyle issues and potential co-morbidities

• services link with local public health teams; they refer young people living with overweight or obesity to other services that help manage their weight

• staff are trained in nutrition and actively encourage young people to take opportunities to support healthy lifestyle activities

• staff are trained and confident in raising and discussing healthy weight with young people and their families sensitively and know about the local services where they can get further support

• the food and drink at the service venue for young people is healthy and supports them to make healthy choices and reduce their intake of high fat and high sugar foods

Further resources

Childhood obesity: applying All Our Health

Healthier weight conversations: support for professionals

National Child Measurement Programme: a conversation framework for talking to parents

NHS: Better Health - easy ways to eat well and move more

4b: specialist services for alcohol and drugs

Essential criteria for standard 4b are:

• staff who work with young people at risk of alcohol and drug misuse problems can screen for substance misuse. They ask young people about other related risks and concerns such as mental health or sexual vulnerability

• staff working with young people are trained to deliver interventions and know how and when to refer to other services for young people with complex needs including child sexual exploitation, gang involvement, domestic violence, crime and anti-social behaviour

• specialist alcohol and drug assessments are carried out by a trained professional in a sensitive non-judgemental approach to identify factors influencing and maintaining alcohol or drug use. Specialist alcohol and drug service staff can engage with young people, parents and carers, and other professionals who are working with young people as required

Additional criteria for standard 4b are:

• staff ensure that other agencies working with young people know how to refer to the drug and alcohol service, and that young people are aware of how they can self-refer

• a range of psychosocial interventions are offered and delivered according to need by competent and qualified staff in line with NICE guidance on using psychosocial interventions to treat drug misuse in over 16s

• a range of age-appropriate pharmacological (drug) interventions are offered and delivered by a qualified professional according to need

• staff can recognise, intervene appropriately and refer on young people affected by different trends in drug use including new psychoactive substances

Further resources

Talk to Frank

WithYou: confidential support with alcohol, drugs or mental health

4c: specialist services for managing long-term and complex health needs and disabilities

Essential criteria for standard 4c are:

• staff work holistically with the young person and engage other agencies to support ongoing health needs. Staff are familiar with the multi-agency assessment process for an education, health and care plan (EHCP), where the young person has one. Services are commissioned, funded and delivered in line with provision specified in a young person’s EHCP, where applicable, and staff liaise with other professionals involved in the young person’s education and care as necessary. This approach is shared by all staff and made clear in information about the service

• the service has systems and facilities in place to identify and respond to young people’s additional requirements and access needs. A flagging system identifies young people with learning disabilities or autism in case they have additional requirements, for example, double appointments. Specific communication needs are identified and accommodated. Mobility issues are provided for, and in all cases, young people can maintain privacy and dignity regardless of level of need

• young people are supported and empowered to understand their long-term condition or disability. Staff offer information and advice to help young people and their families make informed decisions regarding their care, support needs and treatment choices

Additional criteria for standard 4c are:

• staff understand that young people with a long-term health need or disability can face social isolation and loneliness and help them come together in person or virtually, linking to local and national projects, school, college or care settings

• staff recognise that young people may have different needs depending on their age and developmental stage. Advice and information are appropriate for their level of understanding and development including easy read, visual and other formats suitable for young people with communication needs or learning disabilities. Services provide age-appropriate space and resources within the health or care setting

• staff within the service make every effort to reduce education or employment absences and support continuity of care. Staff offer engagement where the young person feels most comfortable, such as appointments at school, college or in the community, after school or during holidays, supported by online access where feasible. A plan is in place to keep everyone up to date with communication (including, if appropriate, use of a passport of care). Appointments are as streamlined and co-ordinated as possible

• each young person has a key worker to help them navigate the services they need and be a main point of contact. The key worker provides guidance on information received by the young person, offers practical support and advice, liaises with other agencies including education, and promotes self-management skills

• staff receive training in adolescent development, managing long-term conditions and transitional care, such as the Adolescent Health Programme e-learning, as a context for understanding the impact of complex and long-term health needs

• staff recognise and act upon the link between physical and mental health especially if it is having a daily impact, for example pain or fatigue, which can often be more likely with patients with chronic long-term conditions

Other quality frameworks

CQC key lines of enquiry for healthcare services

CQC: the fundamental standards

Further resources

Council for Disabled Children

Royal College of Speech and Language Therapists: inclusive communication resources

Young Lives vs Cancer

4d: specialist services for children and young people’s mental health and wellbeing

Essential criteria for standard 4d are:

• young people, their parents and carers receive easy-to-understand information and advice on the roles of staff they might encounter in mental health services making it easier to share decision-making. Young people’s preferences for involving other people for support during the assessment, and when making treatment decisions, are considered

• young people and their families receive clear information and advice about the intervention, treatment options and likely outcomes

• young people are offered appropriate information and advice on whether to involve other people - such as parents - in their assessment and treatment process. Refusal of consent to family or carer involvement is accepted unless they do not have capacity or there is serious risk to the young person’s welfare. Shared decision-making underpins all actions, including in cases where the overriding serious risks lead to compulsory treatment. Young people are always offered appropriate information and advice to make treatment choices based on informed consent

Additional criteria for standard 4d are:

• staff are aware of current evidence-based practice and treatments and use these to support young people

• young people and their families are made aware of the legal procedures in place to ensure safety where appropriate and given the opportunity to ask questions

• staff are aware of local pathways, referral mechanisms and the roles and responsibilities of other services

• the service has clear protocols for sharing of information and communication to support effective partnerships with young people and families and other services such as social care, schools, colleges, school nurses and mental health support teams

Further resources

Childline

Find a local NHS urgent mental health helpline in England

Kooth: online mental wellbeing community

NHS England: supporting children and young people with mental health needs - a joined-up approach

Papyrus: prevention of young suicide

SHOUT: text messaging support service

Young Minds crisis messenger

4e: specialist services for sexual and reproductive health

Essential criteria for standard 4e are:

• provision of routine, intermediate or specialist sexual and reproductive health services is offered. This includes contraception, emergency contraception, screening for and treatment of sexually transmitted infections (STIs), pregnancy testing, referral for NHS-funded abortion services and antenatal care

• where STI services are not available on site, there are clear methods for referral to other services or clinicians. Where the full range of contraception methods is not available, there are clear methods for seamless referral to other services where these can be accessed

• young people are offered appropriate information and advice to help them develop their ability to make safe, informed choices. This includes advice on healthy relationships and to help them develop the confidence and skills to make positive choices about sexual activity

Additional criteria for standard 4e are:

• appropriate, easy-to-understand information is available on a range of sexual health issues, including all methods of contraception, STIs, use of condoms, relationships and sexuality. The information makes it clear that contraception, testing and treatment for STIs are free

• staff receive training and support in communication skills, the latest evidence base for best management options, how to recognise and respond to diversity including culture and religion, how to obtain informed consent, and how to recognise signs of sexual coercion, abuse, exploitation, female genital mutilation and substance misuse, including chemsex. Staff know how and where to refer young people for additional support when needed

• the service will see young people who are not ordinarily registered with them in order to provide sexual health advice and contraception, including emergency contraception

• the service is committed to addressing the needs of young people from diverse communities including black and minority ethnic, LGBT or disabled people. Diversity is integrated into service design and publicity

• the service has strong links with relationships and sex education programmes in schools and colleges and with other services and practitioners in touch with young people, including school nurses

Further resources

The British Association for Sexual Health and HIV (BASHH) guidelines

Brook: healthy lives for young people

Children’s HIV Association (CHIVA)

Faculty of Sexual and Reproductive Healthcare (FSRH): standards, guidance and resource centre for SRH professionals

Sexwise: advice about contraception, pregnancy, STIs and pleasure

Terrence Higgins Trust

Standard 5: developing digital approaches

Essential criteria

Essential criteria for standard 5 are:

• staff make use of technology to increase accessibility for young people, for example text messaging, virtual consultations, online prescriptions and online appointment booking. Digital approaches do not replace face-to-face appointments - they are used to enhance the experience and improve accessibility

• staff are aware of digital limitations that restrict a young person’s access to phone, online or video consultation. Limitations include:
  • poor wifi
  • sharing devices or not having devices
  • sharing space, which reduces confidentiality
  • ability to use digital resources
• staff are appropriately trained in using the technology adopted by the service, and patients are provided with clear and accessible instructions for use in a timely manner before their appointment

Additional criteria

Additional criteria for standard 5 are:

• a range of technology is used to gather young people’s feedback, for example through text surveys, online surveys or website comments

• staff are mindful of digital fatigue and the impact this can have for young people with complex health needs and disabilities when using online services

• young people are routinely provided with advance details about when their phone or online consultation or appointment will take place so they can make arrangements to be in a safe space to ensure confidentiality. This is important to help reduce anxiety and worry about the appointment

Further resources

European guidelines for digital youth work

RCPCH: principles for conducting virtual consultations with children and young people

RCPCH: COVID-19 summaries of key findings on children and young people’s views

World Health Organization: youth-centred digital health interventions - a framework for planning, developing and implementing solutions with and for young people

Standard 6: staff skills and training

Essential criteria

Essential criteria for standard 6 are:

• all staff who meet with young people receive appropriate training on cultural competence, confidentiality and consent, and engaging and communicating, including strength-based approaches to interventions. Staff adopt an inclusive approach to service provision for young people including isolated and marginalised groups. Staff adjust their approach depending on a young person’s age and ability, culture and religious practices

• all staff who meet with young people receive appropriate training, supervision and appraisal on understanding young people and the issues that they face which can impact on their health and wellbeing

• staff routinely receive training appropriate to their level of responsibility on safeguarding, confidentiality and consent including contextual safeguarding, trauma-informed practice, supporting disclosure and strength-based approaches to interventions

Additional criteria

Additional criteria for standard 6 are:

• staff receive regular training, supervision and appraisal to ensure that they can manage sensitive and difficult consultations and support young people in making their own informed choices

• staff use young people’s feedback and views to inform their reflections and make improvements to practice. These are included in revalidation processes for those with professional registration, for example the Nursing and Midwifery Council

• inter-disciplinary training is undertaken in line with local safeguarding arrangements to ensure that approaches to safeguarding are in line with national guidance:
  • Working together to safeguard children
  • Child sexual exploitation: definition and guide for practitioners
  • Multi-agency statutory guidance on female genital mutilation
  • Preventing serious violence: a multi-agency approach
  • Domestic abuse: statutory guidance
  • Tackling child sexual abuse strategy
  • Criminal exploitation of children and vulnerable adults

• training complies with the intercollegiate competencies and training standards for child safeguarding

• staff are trained to complete psychosocial assessments in consultations and reviews to help discussions about all aspects of young people’s lives

• staff receive routine induction to the organisation, local area and local services including training about working with young people. Staff feel comfortable asking for additional training if they identify a gap in their knowledge or skills

Other quality frameworks

CQC key lines of enquiry for healthcare services

CQC: the fundamental standards

Ofsted education inspection framework 2019

Further resources

Centre of expertise on child sexual abuse: e-learning

Me First: children and young people centred communication

NSPCC: safeguarding and child protection standards for the voluntary and community sector

Royal College of Nursing: safeguarding children and young people - roles and competencies for healthcare staff

Youth mental health first aider training

Standard 7: linking with other services

Essential criteria

Essential criteria for standard 7 are:

• the service is part of local networks with good links and active partnerships to a range of other projects, organisations and services working with young people, including integrated care systems

• the service supports young people’s access to education, training and employment, for example, through flexible appointment times, which are longer where needed, and scheduled to fit with young people’s school, college or university timetables where possible

• the service provides information about other local services for young people. All staff are familiar with local service provision and arrangements for referral

Additional criteria

Additional criteria for standard 7 are:

• the service is co-located with other relevant services for young people where possible. Where this is not possible, there are regular collaborative working sessions and meetings

• information about the service, including the criteria and process for referral, is provided to other relevant organisations and to key professionals working with young people. This information is kept up to date, is freely available and accessible to young people

• staff are aware of the emotional and psychological needs of young people with clear and appropriate referral pathways or signposting to provide support as early as possible

• young people are made aware of opportunities to support and influence development or change to services or policies in their local area or wider policies and practices in their educational setting, such as whole school and college approaches

Other quality frameworks

CQC key lines of enquiry for healthcare services

CQC: the fundamental standards

Further resources

Association for Young People’s Health

NHS England: What are integrated care systems?

RCPCH : young people’s special interest group

Royal College of General Practitioners: Adolescent Health Group

Royal College of Nursing: Adolescent Health Community

Royal College of Physicians: Young Adult and Adolescent Steering Group

Standard 8: supporting young people’s changing needs

Essential criteria

Essential criteria for standard 8 are:

• the service provides healthcare and support based on a young person’s needs and competency

• referral systems foster a positive approach to healthy transitions with established systems for communication between relevant health professionals, departments and services

• staff have a working knowledge of guidance on assessing a young person’s ability to consent based on age, maturity and mental capacity. This information is shared with young people, parents and carers, and other relevant professionals

Additional criteria

Additional criteria are:

• the service has a clear procedure to prepare young people for the transition from health and care services designed for children and young people to adult health services, consistent with current NICE guidance. Specific attention is given to the needs of young people with long-term health needs

• staff members are trained to help young people, and their parents or carers, with the transition to adult services from the age of 12 onwards, where appropriate. All young people with ongoing needs have an individual transition plan including a named key worker to provide continuity during the transition process

• the service provides publicity material specifically on transition to adult services that is accessible for everyone such as in different languages or for young people with or without disabilities. This is youth-friendly, and uses age-appropriate language and images for the age and ability of the young person

• parents and carers are provided with relevant information and support, in ways that are sensitive to different cultures and religions

Other quality frameworks

CQC key lines of enquiry for healthcare services

CQC: the fundamental standards

Self-assessment and verification

The process of self-assessment and verification is completed in 4 stages.

Stage 1: getting started

To get started, consider how youth-friendly your service is now.

Use the following steps to review what you have in place now and determine your baseline.

1. A liaison for young people

Identify one person to act as a young people’s liaison within the service. This person will lead on the review, explaining what’s happening and why. They will not be responsible for all the changes, as this needs to be a whole team or service approach.

2. Get some feedback

Put out a suggestion or feedback box, simple online survey or feedback text for young people. Invite them to give anonymous feedback about the service, for example:

• what they like
• what they don’t like
• how they’d like things to change
• how they’d like to get involved in developing changes

3. Feel comfortable around confidentiality

Check the confidentiality policy is up to date and circulate to all staff including reception and ancillary staff. It should be displayed or published online.

4. A welcoming place to be

Refresh the waiting area. Consider if there are ways to make the space more inviting and relaxing.

Consider getting some games, resources or magazines that are more appropriate to young people across a variety of ages. Make sure resources are appropriate and sensitive to the range of people attending.

5. What we are doing for young people

Think through the various aspects of your provision and identify different services that are relevant to young people. Create a ‘Did you know’ poster for the waiting area listing all these services. Consult young people in this process and involve them in the design process of any visual aids.

6. Experience of working with young people

Talk with all staff about working with young people. Find out what previous experience staff have working with young people. Are there any positive or negative stories that can be learnt from? What do staff feel are the barriers to engaging positively and productively with young people?

7. Find out who is out there

Do some initial research into other projects and services in the area that support young people’s health and wellbeing. Consider:

• third sector organisations
• small community projects and events
• healthcare professionals, such as school nurses

8. How young people access services on their own

Make sure all staff are clear about when young people can access services on their own. Make this information available to young people and their families.

Stage 2: self-assessment

Collate evidence that the service meets each of the essential criteria and 2 additional criteria for the 8 standards. A template for self-assessment is available. This can help identify areas for development to make services youth-friendly. If you offer a specialist service to young people, you should also use the specific specialist service criteria.

You should provide clearly presented evidence for each of the criteria you have selected. This may include detail about policy, structure or staff training with clear explanations. You should consider the evidence from the perspective of young people who may not have any existing knowledge about your service.

You can support your evidence by using existing information gathered for other quality frameworks, or from key performance indicators and evaluation of outcomes for your service.

Stage 3: review by young people

Services should identify a youth group or project to evaluate self-assessments or recommend further work. Ideally, the group or project will encompass young people from a variety of backgrounds and with different needs and experiences of health and care services.

You may need to pay a fee to the youth group to provide youth worker support for the process and to support the young people to complete your review. There should be communication on what to expect during the review, explaining:

• their roles
• how they will be supported
• parental or young people’s consent forms
• essential safeguarding during their review

The youth group will need to see your self-assessment in order to plan and prioritise their review and to give them context and background about the service. Once this is done, a visit can be arranged and this should make provision for any adjustments the young people or youth workers need, as well as identifying a member of your staff to act as liaison on the day.

Your member of staff should be on hand during the review to answer questions, act as a guide, respond to any needs the young people may have and collect any feedback the young people may want to offer.

You will need to liaise with the youth workers to give them the context for the standards so they can properly prepare the young people who will carry out the review and verification visit.

Youth organisations

You can contact the following national and regional youth organisations:

• British Youth Council has a nationwide network of youth voice groups and of young inspector groups
• the Young People’s Heath Partnership is a consortium of 6 national charities with members from across the country
• UK Youth
• some local Healthwatch organisations have young people’s groups
• Young Person’s Advisory Service
• Youth Focus North West has contacts in all 23 local authority areas in the North West and a regional youth forum
• Youth Focus North East works across the North East of England
• Youth Focus West Midlands
• Off the Record Bristol
• Partnership for Young London

You should keep a record of the self-assessment. If the reviewers need more information, or recommend additional measures be put in place, a SMART action plan should be developed (specific, measurable, achievable, relevant and time-bound). A follow-up review can be agreed with reviewers to demonstrate standards have been achieved.

Stage 4: service review

Local arrangements for service development and quality improvement can use a continuous cycle of evaluation and review. This should include a plan for how young people will be involved in ongoing evaluation and improvements. Where possible, services can benchmark against each other to identify opportunities for improvement, learn from each other and to share best practice and innovation. This may be with other locally commissioned services, with collaborative networks or with other similar services regionally or nationally. These assessments can support your CQC inspections.

Other general resources

British Youth Council

Explain guides: information for young people about various conditions

The Makaton Charity

National Children’s Bureau

National Institute for Health and Care Research: involving young people in research

NICE guidance on babies, children and young people’s experience of healthcare

SALTO: support for youth participation from European perspective

RCPCH: resources for working with children, young people and families

UNICEF: how we protect children’s rights with the UN Convention on the Rights of the Child

Young Minds: what is participation in children and young people’s mental health?

1. The Association for Young People’s Health, Public health outcomes: key data 2021 ↩ ↩²