What Works - Gloucestershire Boys & Young Men Network

Boys’ and Young Men’s Health
What works?
Trefor Lloyd
Working With Men
on behalf of the
Health Development Agency

Acknowledgements
This report was commissioned by the Health Development Agency (Young People’s Health Network), funded by the
Department of Health, and carried out by Trefor Lloyd of Working With Men.
We would like to thank all those projects who gave up their time to help us put the best descriptions of their work on
paper, and those projects we approached who accepted but did not fit our criteria for inclusion. Also, we would like to
thank Richard Fletcher (Boys’ and Men’s Program, University of Newcastle, Australia) and Neil Davidson (Working With
Men) for reading and commenting on the first draft of this report, and Anne Sweetmore for sub-editing this publication.
For further copies of this publication please contact:
Health Development Agency
Holborn Gate
330 High Holborn
London
WC1V 7BA
Email: communications@hda-online.org.uk
Website: www.hda-online.org.uk
© Health Development Agency 2002
ISBN 1-84279-106-0
Trefor Lloyd
Working With Men

Contents
Summary 1
Introduction 4
Examples of practice 5
Alive and Kicking (CEDC) 5
Barnardo's Young Men's Project 7
CALM 10
Dorset Suicide Prevention Strategy 13
ENIGMA 16
42nd Street 19
Hospital Youth Work Team 22
Leap 24
Loud Mouth Theatre Company 27
New Bridge 30
Running the Risk 33
Strides 36
Emerging themes 39
Accessing, targeting and engaging 39
Understanding young men and masculinity 41
Methods 42
Staffing issues 43
Clarity of purpose 44
A questioning environment 44
Gender and/or what works 44
Evaluation 45
Funding 45
Conclusion 45
References 45

Summary
This report is a follow-up to the Health Development
Agency’s literature review and mapping of projects that
address boys’ and young men’s health. Twelve of the most
established projects were visited between October and
December 2001. This report contains detailed descriptions
of these projects and an analysis of the themes that
consistently emerged.
The purpose of this report is to help practitioners learn
from the experience of established projects working with
boys and young men in the health sector.
Main findings
Projects were able to describe clear strategies that enable
them to target and engage with young men. While these
strategies varied enormously, most were based on a
significant understanding of boys’ and young men’s
attitudes towards their health and towards services.
Projects had carried out investigations, research, needs
assessments and other mechanisms that enabled them to
understand not only young men generally, but the
particular group of young men they were targeting.
Projects had identified and used a broad range of methods
that worked with young men. While these varied
enormously, they were underpinned by an approach that
was positive about young men; practical and direct; took
into account the ways young men dealt with their
emotions; targeted young men when they were receptive;
and were solution-based rather than problem-based.
Project staff were able to engage with young men because
of the approach they used, rather than their gender. There
was little to suggest that projects worked because they
employed men to carry out the work. This brings into
Summary
question the increasingly popular view that young men
seek role models that are male.
Projects worked well if they had a substantial awareness of
gender and masculinity, but they also required an
approach that regularly reviewed the effectiveness of their
methods, and they needed to recognise what worked with
young men.
Accessing, targeting and engaging
All 12 examples of practice were confident and able to
target and engage young men, despite young men (as a
group) being poor users of services. Some of their
strategies included the following.
• Taking more traditional routes (sports, clubs, music and
bars) – particularly useful for those agencies that
wanted to convey small amounts of information for
short periods.
• Agencies working in settings such as Young Offenders’
Institutions (YOIs) and hospitals found young men more
receptive and reflective than they would have been on
the street. This was particularly the case for agencies
that wanted to work at a more emotional level with
young men, trying to impact on both their attitudes and
behaviour.
• Offering incentives such as footballs and football kits
worked in the case of one project; another mounted an
advertising strategy that presented the workshops
offered as exclusive (rather than boring and undesirable,
which is how they had been perceived by the men
being targeted). Another project integrated its services
within the bar and music culture, so their mental health
message was seen as ‘cool’ because of its affiliation
and endorsement.
• Agencies also found that offering services when young
1

men were desperate worked well. Young men were
much less concerned about whether they appeared
weak, or whether the agency was welcoming.
However, agencies found that young men often had
multiple problems which they were unable to ignore
any longer.
• Some agencies made it clear to young men that they
saw at least some of the problem as societal rather than
personal. For those young men who believe that they
should not have problems, this process of externalizing
them seemed to have enabled them to address their
difficulties without appearing less of a man.
• The perceptions that young men had about what was
and what was not ‘manly’ had a significant bearing on
both the targeting strategies they responded to, and the
ways agencies thought about targeting and engaging.
Agencies found that they had to be gender- and
masculinity-aware.
Understanding young men and masculinity
All the projects visited showed an understanding of boys
and young men. Most had carried out some kind of
investigation as a basis for their project. Research, detailed
interviews, and looking at the world from a boys’
perspective were all important aspects of agencies’ work.
While all the projects had a view about what was specific
to boys and young men, this understanding had different
degrees of impact on their practice. One agency used an
understanding of boys and young men to only develop
their targeting strategy. They integrated a marketing
approach to clubs and bars, where young men felt more
comfortable than with more traditional mental health
services. Most projects had a view about what beliefs and
attributes many young men had that would inhibit their
engagement with professional services. Most projects also
found that a number of themes and understandings came
out of an ongoing engagement with young men. Agencies
found that an understanding of what does and does not
work with boys and young men developed and emerged,
if they reflected on their work.
Methods
A variety of methods and ways of working with boys and
young men emerged from their practice. Common themes
included the following.
• Be positive about boys and young men – while this is an
obvious element of working with anyone, many workers
seem to have a particular difficulty in approaching
young men in this way.
• Be practical and direct, and engage – many projects
said that methods that were direct, practical and
engaging were the most successful. Projects reported
that young men were less able to see the value of
‘talk’, and found it harder to identify the learning
involved.
• Feelings take longer – some said that the more
reflective and feelings-based sessions were more
difficult to deliver to young men, and usually took
longer to have an impact. Most of the projects accepted
that, if they wanted to work at an emotional level, this
took time.
• Gender and emotions – those agencies that worked
with young men and women usually commented on the
differences they saw in their work – interestingly, not
with individual young men and women but when group
work was involved. Young women were thought to be
closer to their emotions, more willing to sit and discuss
them, more reflective about emotions and ideas and, as
a result, they were often seen as easier to work with. In
contrast, some of the same issues were seen as major
barriers in working with boys and young men. Much of
the thought given to methods was related to ways that
these barriers could be surmounted.
• Make the work stimulating and interesting – while any
work with young people needs to be stimulating and
interesting, workers were particularly concerned about
this when trying to engage groups of boys and young
men.
• Young men like to be challenged and given situations
where they are required to take risks – while most
would quickly recognise this in terms of physical activity,
projects also found this to be the case within discussion
work.
• Use an adaptable approach – projects stressed that their
approach had to vary with different groups of young
men. This varied depending on young men’s willingness
to reflect on and discuss issues.
• Solution-based, not problem-based – projects found
young men reluctant to discuss problems, and some
found that a more solution-based approach engaged
young men and enabled them to become involved in
discussions.
• Humour helps – humour was an important part of their
work for many of the agencies.
2 Boys’ and Young Men’s Health: What Works?

Staffing issues
None of the projects suggested that male staff were an
essential component of developing work. This is in sharp
contrast with much of the debate around male role models
and the need for a male presence, and even a male
culture, within primary and secondary education and the
family.
While projects were able to identify a number of specific
skills and attributes, none was exclusively a male attribute,
quality, characteristic or experience. Most could be taught
or developed through practice. However, most projects did
suggest that skilled staff were essential, and that these
skills had to be developed over and above workers’ basic
professional training.
While not just a problem for work with boys and young
men, many suggested that there was a significant skills
shortage. Workers who have experience of working with
boys and young men in these innovative ways appear to
be few and far between.
Clarity of purpose
All of the 12 projects had clear aims – although many of
the agencies had been in existence for some years and
confessed that this clarity of purpose had not always been
there.
A questioning environment
Many of the 12 projects were developmental in nature,
working in areas where there were very few initiatives, let
alone good examples of practice. They were often seen as
being at the forefront of the sector they were in. In some
cases this was not just in terms of work with boys and
young men.
Gender and/or what works
Some projects were established within a gendered
perspective. They started from the assumption that gender
had an impact on targeting strategies, methods, and
achievable outcomes and outputs. Gender and masculinity
therefore underpinned their developing practice. In
contrast, some agencies developed out of an
understanding of the issues being addressed (parenting
and suicide, for example), and developed according to
Summary
what worked in practice. This willingness continually to
review whether the methods applied achieved the desired
outcomes meant that a gendered approach developed out
of a careful focus on the impact of the work itself, not
necessarily out of an initial understanding of young men.
Evaluation
Even within these well established agencies, external
evaluation was not the norm. Interestingly, the smaller the
initiative, the more likely it was that an external evaluation
had taken place.
Funding
Project funding came from a very broad range of sources,
which included Department of Health, local HIV funds,
health action zones, health and education authorities, and
the larger charitable foundations. On the whole, these
projects were relatively well funded – well enough to
attract experienced and qualified staff, and to know that
projects were secure for at least a year and that important
indirect aspects of the work (supervision, management,
staff training) could be offered and delivered.
Conclusion
Projects were diverse in their approach, methods, aims and
conditions, even in the groups of young men targeted and,
above all else, in the broad range of approaches that
worked with boys and young men. It is much too early to
say that any of these approaches can be rolled out in any
environment, by any agency. Even the most experienced
of these projects were still finding their way to being most
effective in their work with boys and young men.
However, their collective experience has a lot to say to
practitioners about how they might approach their work.
Trefor Lloyd
Working With Men
3

Introduction
Background
In March 2000 the Young People’s Health Network (YPHN)
held a conference on young men’s health. As a result of
this conference the Minister for Public Health, Yvette
Cooper, asked the YPHN to find out what works, and why,
in relation to young men’s health activities. The YPHN
commissioned Working With Men to undertake this work.
In 2001, the HDA published the results of a literature
review and project mapping that addressed boys’ and
young men’s health. This covered 45 projects, and some
basic analysis was carried out identifying common themes
such as funding sources and common approaches or target
groups (most work with boys and young men aged 14–16
years).
Having identified so many examples of developing
practice, we have taken our initial analysis much further.
This report contains a more detailed account of 12 of these
projects, followed by an analysis of why they worked. We
have aimed to draw out the elements common to most, to
provide a series of themes for consideration to assist those
wanting to develop work with boys and young men. This is
not seen as a template to be followed rigidly, rather as a
series of considerations to help avoid projects finding
themselves reinventing the wheel.
Method
To arrive at the 12 examples of practice, projects had to be
selected from the initial mapping of 45 initiatives. To
whittle this down to 15, projects were included only if they
had been in existence for at least four years; had worked
with a substantial number of boys and young men; and
had got over the initial recruitment barriers that virtually
everyone experiences.
Projects were then contacted to see whether they were
interested in being involved. Those that replied positively
were then looked at in terms of geography, type of setting
and style of work, to ensure that the broadest variety of
projects were included.
Projects were visited between October and December
2001. The reports are generally a combination of
interviews and other materials related to the work. Once a
draft had been written this was returned to the project,
and what you will read is an agreed version of the work.
These are detailed descriptions rather than evaluations,
although two of the examples do draw heavily from more
formal project evaluations.
4 Boys’ and Young Men’s Health: What Works?

Alive and Kicking
Alive and Kicking aimed to raise awareness about
health and healthy lifestyles among young men
through Sunday league football teams in the
Midlands.
This description has been written from a careful reading
of the Community Education Development Centre
(CEDC) publication ‘Alive and Kicking’ – a guide to
working with local football teams to improve men’s
health.
This project arose out of the concerns raised by the local
director of public health’s annual report that highlighted
‘the significant number of unnecessary male deaths
associated with risk-taking behaviour; men’s lack of
understanding of the body and its functions; men’s delay in
seeking intervention for primary and secondary health
problems and poverty.’
In 1994 CEDC carried out its own small-scale survey of
young men’s health, funded by Coventry Health Authority.
The survey concluded that ‘most men regarded their body
as a machine needing regular servicing. There was much
interest in exercise and diet, but almost none in general
wellbeing, mental health and feeling happy about life.
Visiting a GP was seen as a weakness – attendance was
avoided for as long as possible – and advisory services,
such as family planning clinics, were thought to be
embarrassing and for women.’ The survey found that there
was a mismatch between how ‘these men behaved and
how they felt’ and it was thought that, if approached in
the right way, men would be receptive to health
information. The survey concluded that gaining access is
the primary barrier, and that ‘intervention was likely to be
more effective, if carried out in the context of the young
Alive and Kicking
men’s own interests and pastimes and involving young
men themselves.’
A successful application was made to the Department of
Health (through Section 64) to set up a project in the West
Midlands targeting Sunday morning footballers. The
project estimated that 35,000 young men played football
in the West Midlands alone, and while it was difficult to
describe the average Sunday footballer, it was thought that
he was aged 16–35 years, left school at 16, worked in
skilled or semi-skilled employment (or was unemployed)
and, despite playing football, ‘he may smoke and
drink, engage in risk-taking behaviour and be slow to
attend a GP’.
The method was simple and involved inviting each team in
two divisions (initially of a Coventry and Leamington
league, followed by Warrington and Nuneaton) to
complete and return seven questionnaires and reflection
sheets, sent out every few weeks throughout the season,
covering diet, sex, cancer, physical exercise and stress.
Once returned, points were given for the answers and
these contributed towards a team total, with prizes given
for every 150 points (including first aid kits and match
balls). After each return a league table was updated and
sent out to clubs, and a full team kit (worth £300) was
given to the team that came top of the Alive and Kicking
health league. Each team was also offered a health check
carried out by a local nurse.
Contact was made through the football leagues, club
secretaries were involved, and the project’s outreach
worker visited clubs, watched games and helped teams
complete the tasks. They also organised and gave out
prizes. CEDC found that both the leagues and club
5

secretaries were very interested in the scheme, and teams
became involved relatively easily.
Local health promotion departments, district nurses and
health visitors were all invited to be involved, and one of
the services in each area was identified as the lead
agency. This was thought important, to ensure both that
the initiative sat within the locality and that a local agency
could continue the work if the project was a success.
Once the project partners were established, 16 copies of
the tasks were sent to each club secretary every few
weeks, with a stamped addressed envelope for return of
the task and a deadline date. With the first task some
registration documents were sent out, asking for basic
information about the club such as training and match
times, as well as a list of the participating players. Tasks,
wherever possible, were written in language and ideas
related to football (such as healthy diet being called
‘performance diet’), and some thought was given to the
appropriate level of the tasks (how much writing, length of
time taken to complete).
One of the tasks was for players to undertake a health
check-up carried out by local nurses (district, community
and school nurses as well as health visitors were involved).
These were sometimes at the football clubs themselves, or
at school changing rooms or sometimes pubs. These health
checks identified a number of men with high blood
pressure, and some evidence of diabetes. Where
appropriate, men’s results were passed on to their GPs.
Nurses and players consistently reported that this was a
worthwhile task.
The project evaluation (questionnaires were completed by
168 players in Warrington and Nuneaton) suggested that
almost two-thirds felt a lot better informed about a healthy
lifestyle as a result of the project, and one-third reported
that the project had a significant impact on their behaviour
(through information on cancer and eating habits, and
from the health check-up). Almost all would recommend
participation by other football teams.
A series of in-depth interviews (ten players and six
managers) put more flesh on the questionnaire evaluation.
These suggested that most men found the information
both informative and easy to read, and also that after a
game or training participants didn’t want to be ‘studying’.
Comments suggested that the tasks often led to a light-
hearted discussion, not only between the players but
involving others in the pub or club bar (which was where
many completed their tasks). This highlighted both the
enthusiasm, but also the limitations of this approach.
Some players were very pleased to have been included in
a process they felt was only usually available to
professional and semi-professional clubs, and thought that
‘more encouragement was needed for the cynical and/or
indifferent types’. The project identified a number of
lessons learnt about men’s involvement, including the
following.
• While football games were played at the weekend, the
tasks were mostly completed on the training night and
often in the pub afterwards. It was assumed that players
would complete the tasks alone, but this was not the
case.
• Many of the tasks were questionnaire-based, and the
project found that players were willing to reflect and
think, and even to discuss, more than had been
expected.
• Partnerships with the leagues and club secretaries, as
well as local health agencies, were seen as essential for
the project to succeed.
• Prizes played an important part in motivating the teams
– many of the players said that they valued the project
in its own right.
Because of the success of the project, CEDC is keen to
encourage others to use this approach to target men. The
Alive and Kicking publication was published in June 2001.
Alive and Kicking can be contacted at CEDC, Unit 1,
Grovelands Court, Grovelands Estate, Longford Road,
Coventry CV1 9NE, tel: 024 76 588449, info@cedc.org.uk,
www.cedc.org.uk
6 Boys’ and Young Men’s Health: What Works?

Barnardo’s Young Men’s Project
Barnardo’s Young Men’s Project was founded in
1989 as the Streets of London project, and aimed
to identify and engage with boys and young men
on the ‘rent scene’.
This project has changed substantially in its 13 years,
but still works with boys and young men. The aim now
is to protect young men from serious abuse (emotional,
physical and sexual), and also to prevent and reduce the
sexual exploitation of boys and young men.
This report is based on an interview with Mark Lee (the
project leader) and the project’s annual report for
2000–01.
This project was established at a time when there were at
least ten rent boy ‘hotspots’ in the Central London area,
and Barnardo’s was keen to develop a street-based project
for vulnerable young men involved in prostitution and
selling sex. Mark Lee is of the view that, initially, the
project was unclear about what it would do after
identifying and contacting young men, and this made it
less effective than it might have been.
The 1990s saw the ‘scene’ pushed underground. Mark
says this was as a result of police policy changing to a
more reactive stance; the gay sex scene was becoming
more respectable and therefore unlikely to employ
children, contributing to the ‘rent scene’ going further
underground. This made the work of the Streets of London
project harder, as the hotspots disappeared and street
work became less effective. Having six workers delivering
street-based work, in an environment where the sex scene
had disappeared from the streets, contributed to serious
project difficulties in the late 1990s.
In an area where research evidence is slim, the project
Barnardo’s Young Men’s Project
aimed to reposition itself within the changing sex scene of
Central London. Because of the lack of research evidence,
extensive consultation with a range of stakeholders (those
with experience of the client group and agencies working
in related areas) were carried out. These raised a series of
decisions for the new project workers, which included:
• They would position themselves within a child
protection framework ‘aiming to protect young men
from serious abuse (i.e. emotional, physical and sexual)’
• They would focus on boys and young men under the
age of 18 (following on from the child protection
position)
• They would work closely with a number of significant
agencies in the West End of London (including agencies
working with homeless young people; those with drug
and alcohol problems; and others dealing with sexual
health, the sex industry and the police).
Stakeholders were divided on a number of important
questions. Some thought the project should concentrate
primarily on the gay scene, but the project itself felt that
‘consumers’ of under-age sex could not be corralled into
the gay scene, and there was no evidence to support the
view that predatory gay men were preying on boys.
Another issue was whether the project should maintain its
focus on young men, or become a young people’s project.
Concerns that the service would find it difficult to deal
with both, and that it would be a severe loss to an already
limited service to young men, convinced them to continue
to focus only on young men.
While the project has a strong protection element, the aim
of the service is also ‘to empower boys and young men to
have greater control over, and make more positive choices
about, their (sexual) lives and relationships.’
7

While Mark is understandably reluctant to generalise about
the young men, the project has identified at least four sets
of circumstances and identities. The first are young gay
male prostitutes, who identify openly as being gay and
acknowledge and ‘own’ their sex-selling behaviour. The
second are gay for pay, who are usually homeless, and do
not acknowledge their sex-selling behaviour – for them,
selling sex is a coping and survival strategy. The third type
are thought to be sexual explorers, who are involved in
sexual exploitation as a method of exploring their sexuality.
The last group are thought to be those vulnerable to sexual
exploitation, in the rent boy scene or involved in some
other risky behaviours. Mark is quick to point out that
many of the young men do not fit neatly into these types,
and they may move from one group to another.
Ages range from 12–17 years, but those involved tend to
be at the upper end of this range. About 60% are white
European (with most of the others being African
Caribbean), most originate from London boroughs, most
are non-attenders at school, and significant numbers use
crack cocaine (especially those in the West End).
The project carries out street work (mainly in Central
London) with other local projects once (sometimes twice) a
week. Mark says that this serves a number of functions. It
ensures that the project monitors what is happening on the
streets (who is arriving and who might be at risk), and that
young men on the streets know about the project if they
should wish to use the services on offer. The project’s child
protection function also comes into play – if it is known,
for example, that a man has been asking about under-age
boys, the project will contact and help the police identify
and arrest him.
Mark says that all the young men have a street facade.
They present as being confident and tough enough to
survive. Workers recognise this as a front, and the young
men’s machismo. This inevitably plays an important part in
the interaction between young men and the project. Tough
talk is taken as just that. Mark says they hope that they
are ‘in the right place at the right time’ to enable young
men to make a different set of choices for themselves.
Getting off crack cocaine is often the starting point for
these conversations, although sexual and cultural identity
often play a part as well.
The core of the project’s work is with individual young
men, usually referred by social services (a total of 42 in the
year 2001). Mark explains that since 1990 (with the
government’s guidance Safeguarding Children Involved in
Prostitution), young people at risk of sexual exploitation
have not be seen as criminals, and the guidance indicates
that services need to be offered to them. The project’s
experience of social workers is that they are often not
skilled, trained or aware enough in this area (and often
see sexual exploitation as an issue for girls, not boys), and
referrals are often made on the basis of a gut feeling that
some exploitation is going on (which the project accepts as
a good enough basis for referral). Disclosures and even
basic information about the young men’s lives often take
time to emerge. Sometimes the project could be seeing a
young man once a week for six months before issues of
abuse and exploitation emerge. Shame, Mark believes, is
at the core of the barriers to young men disclosing, and he
also sees this as one of the primary gender differences.
This, combined with young men putting up a front of
competence and control, often leaves young men unable
and unwilling to acknowledge and talk about their lives.
Mark also believes that there are a number of pulls
towards the streets for these young men. He gives an
example: ‘there was one young man who became
involved in amateur pornography, and his self-esteem
seemed to go up. He received positive feedback from
those involved and felt good about himself.’ Many of the
young men become popular, receive good money, and
enjoy the buzz that crack and risk-taking offers them.
While Mark says that these young men are of course
exploited, feel ashamed, are often confused and
generally have very low self-esteem, they do not
always present in this way and do not describe their
lives in this form.
Project workers concentrate on those areas where they
believe young men would like to change, and where they
have choices. They discuss having better places to have
sex; the ways in which they can reduce the risks they take;
that relationships are more than a physical act; and their
choice to give up crack cocaine. These young men are
often very isolated. Mark is quick to make a distinction
between young men being distant from society (which he
thinks is part of the stereotype), and isolated (in part
because of the shame they experience). The project
concentrates on individual work, because they have found
young men very reluctant to work together, showing no
interest in meeting with one another. However, through
the individual work young men are supported to develop a
8 Boys’ and Young Men’s Health: What Works?

social network of people of their own age, and often
referred to the ‘gay youth service’. For those young men
who are still exploring their sexuality, these and other
groups can be problematic as they tend to be structured
for those who are looking for confirmation of their
sexuality, rather than an exploration.
Gender plays a significant part in the one-to-one work.
Young men often put on a very well developed front, both
on the street and within the one-to-one sessions. They
often find it difficult to talk and express themselves, are
often in denial, and are difficult to engage. They
frequently do not show for appointments and are very
reluctant to be referred, often seeing referral as
punishment. While some of these issues are not gender-
specific, and the client group usually has a multitude of
issues and too often a chaotic lifestyle, many of these
problems appear to be compounded by their gender (being
exploited inevitably makes it difficult for anyone to discuss
their experience).
The project sees itself as a social work agency that uses
youth work methods. While Barnardo’s is traditionally a
social work organisation, Mark says that there is very little
known about, and very little experience of working with,
this client group, so managers give the project a lot of
encouragement and licence to develop appropriate
responses. This has led to a focus on engaging young men
and empowering them to have greater control over, and
make more positive choices about, their (sexual) lives and
relationships.
All four of the full-time workers are male. This has not
been by design. Adverts have stressed the agency’s
interest in receiving applications from female workers, but
as yet none has been received. Mark is not sure of the
reasons, but thinks that only a few workers have the skills
required, and the experience and interest in such a project.
Mark is of the view that having only male workers limits
the choices they can offer young men, who occasionally
ask to talk to a woman. The project ensures that all
workers have a substantial understanding of sex and
sexuality and are sensitive to the fact that the young men
have usually been exploited by other men. A substantial
training plan for staff is in place, ranging from child
protection issues through to holistic approaches to their
work. Career development is seen as an important project
ethos.
Barnardo’s Young Men’s Project
Inevitably, an innovative project such as this is asked to
deliver training to other professional workers and to offer
preventive educational work with boys and young men.
While this is seen as important work, it is secondary to the
one-to-one work of the project.
Barnardo’s Young Men’s Project can be contacted at
52 Weston Street, London SE1 3QJ, tel: 020 7378 8797.
9

CALM: Campaign Against Living Miserably
CALM aims to raise awareness of depression
among young men, and to destigmatise help-
seeking. CALM currently has local campaigns in
Manchester, Merseyside, Cumbria and
Bedfordshire, which all link into a national
freephone helpline that operates from 5pm to 3am
every day.
This report is based on a conversation with Pippa
Sargent (National Campaign Coordinator), an article
that Pippa wrote for the journal wym – working with
young men, and various evaluations and newsletters
produced by CALM.
Unusually, CALM originated in the Communications
Directorate of the Department of Health in 1997, out of
concerns about the high numbers of young men taking
their own lives through suicide, and that young men were
not accessing services or being touched by media
campaigns.
Initial research concentrated on young men’s use of
helplines, and a strategy emerged that targeted young
men through music and the development of a ‘CALM
brand’ (based on themes from music press, CD covers and
club promotions). This advertising-speak reflects CALM’s
innovative approach to the destigmatising of depression.
Pippa Sargent says:
‘traditional methods to encourage positive health
choices have often been limited in their success at
reaching young men, so a completely new angle was
needed to do just this. Research into young men’s
perceptions of existing helplines helped shape CALM’s
initial development, and two key findings were
significant. Firstly, doubts existed as to whether
established services would be useful or relevant to the
young men interviewed. Secondly, and more important,
these young men considered the use of existing helpline
services to be necessary “only as a last resort”. It was
clear that destigmatising the issue of depression and
attempting to remove the barriers towards asking for
support, as well as encouraging young men to do so
earlier in order to increase the opportunity for young
men to access services that may help, were appropriate
goals for the campaign.’
Pippa continues: ‘the campaign’s key messages are to
“open up”, “don’t bottle it up” and “sort it out” – about
anything defined by the young man as a problem. So,
although it developed in response to the high suicide rates,
the campaign is aimed at young men at the onset of
depression when feeling low or down for any reason, and
to encourage them to talk about problems to anyone –
family, mates or support services. The task for CALM is to
encourage young men to take that difficult first step and
open up.’
The campaign was launched in Manchester in December
1997, in part because of the high rates of suicide. Pippa
says that ‘sponsors were recruited from the music and
club/bar industries who would give credibility to the
campaign’s messages in the eyes of young men’. The
campaign was led by graphics and branding, which the
local radio stations, clubs and independent record shops
and companies responded to with enthusiasm. Pippa is of
the view that many of the sponsors had had direct
experience of depression and suicide, and the ‘right look’
of the graphics brought support and a willingness to put
the CALM message on bags, cards, CD covers, teeshirts
and water bottles. This, in turn, made it easier for the
young men to respond to the messages, because they
10 Boys’ and Young Men’s Health: What Works?

were part of ‘what was cool in Manchester’. Sponsors
were willing to contribute in kind, handing out cards,
attending events, and talking with the media. All these
mechanisms were also supported by a billboard campaign,
and even the backs of bus tickets were used to
communicate the message.
At this stage the success of the campaign was measured in
traditional marketing terms – was there product
recognition? Were the messages reaching the target
audience? There were enough positive signs for the
Department of Health both to continue the campaign, and
also to develop a helpline, on a three-month pilot. The
service contract was given to The Essentia Group, a
Glasgow-based call centre with experience of health and
social welfare telephone services. The helpline service
complemented the campaign messages and was set up
with a focus on young men, and a database of local
services offering more specialist or ongoing support would
enable ‘referrals’ (via self-referral) to be given to callers.
Counsellors from a variety of backgrounds – mental health
nursing, social work, other helplines and counselling
practice – were recruited, some of whom also worked on
The Essentia Group’s other helplines such as the national
Drugs Helpline and Sexwise. Counsellors are trained in a
range of issues through an intensive two-week training
course and 40 hours of supervised calls, followed by
assessment. Random ‘listen-ins’ by a training supervisor
and ongoing training help to both monitor the quality of
service and develop it in line with changing needs. With
the development of ‘calmzones’, local issues and needs
have determined some of the training that counsellors
have received. So, for example, training about Asian
culture and religion has been delivered as a result of calls
from Luton-based Asian young people.
CALM aimed to capture the attention of young men. As
Pippa points out, ‘persuading young men to do, think or
believe anything is big business. Giants of industry in drinks
brands, clothing labels and audio-visual equipment spend
millions every year trying to do just that. But young men
are no easy target – even for the multinationals – as they
don’t follow easily predictable patterns of behaviour. Our
challenge is to capture the attention of young men with a
fraction of the budget of the multinationals and a far less
sexy “product”; in essence, positive mental health.’ Pippa
believes this happens at two levels, what she calls the
traditional means of targeting young men, such as through
CALM: Campaign Against Living Miserably
late-night radio, and ‘the “ambient” media CALM uses to
communicate the message, which takes many forms – the
backs of bus tickets, urinal posters asking their captive
audience if they are “pissed off?” and promotional flyers
which mimic those of club tickets, but hold self-help
information. The two methods – traditional and ambient –
work together to spread the message directly through
mainstream advertising while maintaining a subliminal
presence in the right places.’
While most services do not have the budgets that CALM
has to drive their campaign, some of the essential
elements are certainly transferable. They talked to young
men. They wanted to understand what images meant to
young men, and what messages they would and would
not respond to. They tried to wriggle themselves into
young men’s lives and outlook. They integrated their
campaign into a part of the world that the targeted young
men inhabit and, while most services will not want to
make this their primary purpose, maybe too often services
are surprised when young men do not respond to a service
that is so clearly outside their lives.
With local funding came a coordinator whose role was
firstly promotional – to manage the advertising and
promotion of CALM and to build on and develop the
relationships made with sponsors; and secondly
developmental – to liaise with both local service/support
agencies and the helpline in Glasgow, and to feed caller
information back to local health planners and
commissioners.
This model of a local campaign coordinator has been
rolled out in Cumbria, Merseyside and Bedfordshire, where
local networks, approaches and services have varied
enormously. Pippa is of the view that the basic form still
holds up well, and inevitably new calmzones will need to
take account of local differences. To help this process,
steering groups have been established with their own
funding, monitoring procedures and research helping to
ensure that local conditions are always taken into account.
So, for example, Pippa says that ‘research among 200
young men in Bedfordshire told us that music was by far
the biggest way in which young men coped when they felt
down, which links in nicely with the musical basis of
CALM’s communication strategy. Most recently, research
in Cumbria to consider CALM’s approach in a rural setting
has produced encouraging results.’
11

The campaign and helpline have never been exclusively
targeted at young men, but they have always reflected the
majority of callers to the helpline (on average, two-thirds
since its establishment). However, while CALM’s primary
target group is young men aged 15–35, by far the majority
of callers are over 25 (with a substantial number older than
35). Interestingly, this reflects previous studies that have
found a willingness in older men to use helpline services,
while younger men are more reluctant, often resistant, and
not trusting of the help being offered. This remains a
challenge for CALM, and Pippa believes they may need to
develop the campaign base to target young men under 25
more effectively. She thinks this may need to involve more
hands-on, schools-based work with young men and more
college-based contact, as well as including bars and leisure
centres.
Since its inception, the helpline has offered counselling,
advice, information and referrals, through signposting to
local services and encouraging callers to get in touch for
more specialist or ongoing help. It is free, anonymous and
confidential, and while the helpline is available from 5pm
to 3am, by far the majority of calls are made between
11pm and 1am. An estimated half of all callers have not
been in touch with other services, and calls can be 30–40
minutes long. Radio and ‘word of mouth’ are most
commonly cited as the way that callers found out about
CALM.
Initially, most calls from young men were about
loneliness, relationship difficulties with partners,
families and friends, or violence and sexual abuse.
However, with over 25,000 calls (in the first three
years) having been made, problems presented also
include drugs and alcohol use, suicide or depression, illness
(their own or in their family), bereavement, exam
worries, unemployment, issues relating to sexuality,
divorce and occupational stress. Relationships still
constitute more than a quarter of all calls.
In reviewing 20 recent calls to the helpline, a number of
themes emerge. Men presented current dilemmas (debt,
recent arguments, feelings of depression, thinking about
suicide, and recent events pushing them over the edge)
with agitation, anger, anxiety, loneliness and desperation
often being their presenting moods and feelings. Many
presented either complex or multi-dimensional problems
(such as falling out with a girlfriend, as well as alcohol
abuse and depression).
Helpline counsellors were encouraging and reassuring,
they listened, supported, explored options, and reflected
back what the caller had been saying. Callers talked,
calmed down and felt better, and referral to agencies and
counselling was common. Most responses (from the
counsellors) were basic in technique, and the practical
overshadowed the reflective. Indeed, male callers were
often looking for relief and solutions, not reflection.
More information about the CALM Campaign can be
found at www.thecalmzone.net The CALM helpline on
0800 58 58 58 is open 5pm to 3am, 365 days a year.
Pippa Sargent, National CALM Coordinator, can be
contacted on 0161 237 2720.
12 Boys’ and Young Men’s Health: What Works?

Dorset Suicide Prevention Strategy
While many of the reports in this publication are
within specialist agencies or very specific
initiatives, this one describes Dorset’s suicide
prevention strategy, developed as a response to
both the national and local increase in young male
suicides.
This report is based on a conversation with Sue Bennett
(Consultant in Public Health and Acting Consultant in
Communicable Disease Control), and reading of a
broad range of publications related to the Dorset suicide
strategy.
Dorset has a population of about 670,000, with half living
in Poole and Bournemouth and the other half living in rural
areas, centred on market towns and small villages. The
west of the county is predominantly rural, with Weymouth
being the only urban area.
Dorset has seen an increase in young male suicides, and a
number of factors are thought to be significant. These
include a decline in job opportunities for men (with only
one vacancy for every six job seekers). This is particularly
the case in increasingly isolated rural communities, where
there are very high rates of suicide among farmers and
other agricultural workers.
During 1994 a health promotion campaign was targeted at
men over the pre-Christmas period. Posters, beer mats and
radio advertising carried the strapline ‘You’ve got to be
tough to tell someone what’s up. Talk about your problems
– that way they’ll get sorted’. While the impact of this
campaign is difficult to assess, local media coverage was
very good, and it was felt that general awareness of the
campaign was high.
Dorset Suicide Prevention Strategy
This was followed up with a conference in 1995, reflecting
both national and local perspectives and a range of
workshops such as ‘promoting self-esteem in young men’
and ‘promoting the mental health of young men in rural
areas’. The organisers were surprised by the level of
interest and had to stop bookings at 200. The material
generated from the conference and the broad range of
agencies enthusiastic about developing this work further
led to the drafting of an action plan.
The story so far is nothing unusual. Concern, leading to a
one-off campaign, to a conference and to a draft strategy
is a fairly traditional developmental route. However, while
Dorset may not strike us as a radical area, and certainly
(apart from a small number of local estates) may not be
thought of as particularly deprived, the way Dorset
approached suicide prevention certainly was radical.
A number of factors created a context where suicide
prevention could be approached as the complex area it
obviously is. Those factors are thought to include the
following.
• Significant individuals within health promotion, public
health, primary healthcare and other related services,
who had a shared vision of what services could be
offered. Also, a lively combination of practitioners,
academics/researchers and strategic planners.
• A process of a strong evidence base, leading to clear
action plans had already been tried and tested in other
areas of work. A strong link between needs assessment,
the evidence, action plans and evaluation had also been
well established.
• A willingness to ask ‘does it work?’ and, if it doesn’t, an
acknowledgement that it doesn’t and a willingness to
replan.
13

• A coordinated approach through a range of agencies,
with relatively little professional ‘defending of territory’.
• Strong links between health promotion and public
health have encouraged a broader community approach
to health promotion, rather than a more individualistic
one.
• Experience of working in and for communities was very
strong among the significant individuals above.
It was this context that encouraged an exploration of
gender and its impact on suicide and broader mental
health issues. This willingness to ask ‘why young men?’
enabled further questions – ‘why don’t they use services?’
and ‘what can we do about it?’ – to be posed.
Whereas a significant number of health authorities either
failed to produce a suicide prevention strategy, or tended
to produce one that hinged on traditional approaches (such
as heightening GPs’ awareness and strengthening mental
health services), Dorset accepted a broadly based strategy
that incorporated 28 interrelated initiatives. These cut
across a range of related issues (such as parenthood, the
media, and bullying in prisons) in a range of settings (such
as casualty, helplines, primary healthcare, voluntary sector
agencies, schools and prisons).
While the broad range of initiatives have been important,
Sue Bennett believes it has also brought gender into
mainstream thinking. When there is a disproportionate
imbalance between boys and girls (such as in eating
disorders and schizophrenia), then gender becomes a
significant part of the strategy, planning and monitoring.
So, for instance, the suicide prevention strategy was a
contributing factor in the review of Child and Adult Mental
Health Services (CAMH). When other services were asked
about CAMH, they wanted a service that was prepared to
work with violence and conduct disorder (seen as
predominantly male conditions), which CAMH did not.
They heard that some GPs had stopped referring young
people, and were buying in psychologists and counselling-
trained community practice nurses to do the work that
CAMH was there to do.
This review (and research) led to a pilot project with two
psychologists working with schools and parents, taking
referrals from health visitors (who were identifying
problems at a very early stage), and working with 80%
boys. The review of CAMH also led to them moving out
into the community (rather than being a clinic-based
service), and again this was weighted towards boys at risk.
Aggression, drugs and schizophrenia have become their
core issues.
Awareness and monitoring of gender have also led to
other services being established or adapted. West Haven
Counselling Project (funded by education, health and
social services) offers two sessions a week within primary
schools to disruptive pupils (mainly boys), referred by the
school itself. Nurses in schools have been funded through
the teenage pregnancy initiative to work with those
showing signs of mental health problems. Most of these
have been boys, and a substantial number have been self-
referred.
Much has been learned about boys and their preferences
for service delivery, and professionals have been
encouraged to look at young men in new ways. A review
of The Samaritans’ publicity material has seen the
development of boy-focused leaflets. Research looking at
the mental health needs of men in the Dorset cluster of
prisons has led to some surprises about the very high levels
of mental illness and bullying in particular, resulting in the
introduction of new services and improved training for
14 Boys’ and Young Men’s Health: What Works?
staff.
Staff training programmes have also been a significant part
of the strategy, with ‘suicide myths’ and gender training
being important components. The strategy has also seen a
trickle-down of awareness about young men. One school
noticed that some boys were very hyped up in the
mornings, and introduced a group work programme to
help settle them down.
While many of the initiatives have highlighted the
problem-based nature of young men’s behaviour, this has
not necessarily led to services approaching young men as
problems. An awareness of the need to approach young
men with a positive outlook has underpinned the strategy.
For some, the bottom line is whether these initiatives have
had any impact on suicide rates? The answer is yes: Dorset
has seen a reduction of the rate that has gone against the
national trend. However, Sue is much more reflective –
‘we must be doing something right, but we can’t be sure
what. Our view is that the broad range of services are
valuable in their own right, we want best practice in all

areas.’ Sue is of the view that the approach has shown
signs of success for three main reasons.
• There has been a willingness to work together and (if
necessary) fundamentally to reshape services; this has
happened to other services as well as CAMH.
• There has been a broad focus (not just on acute
services) and a linking of agendas, partnership, statistics
and performance, with the lead agencies clearly
identified.
• An approach has been adopted that says ‘don’t do
research unless you are going to act on it’.
While it is hard to encapsulate such a broad-ranging
development in such a short report, the suicide strategy
has not only reduced suicide levels, but has also helped to
bring boys and young men into the mainstream, and has
had a very positive impact on general thinking about
them. This has developed out of a best practice approach,
rather than a gender-led analysis.
The Directorate of Public Health can be contacted by
writing to Dorset Health Authority, Victoria House,
Princes Road, Ferndown, Dorset BH22 9JR, tel:
01202 893000.
Dorset Suicide Prevention Strategy
15

ENIGMA Project
ENIGMA is a programme-based sexual health
intervention for gay and bisexual men with a
focus on those under the age of 25. Conceived and
developed by Southampton Gay Community
Health Service (formally Gay Men’s Health Project),
the first ENIGMA pilot was delivered and evaluated
in 1999, with the project currently on its fourth
programme.
Funded through local HIV prevention money, a total of
58 men have attended the programme to date. This
report is based on an interview with Mark Heywood,
and reading of two evaluation reports.
The evidence base for this project is that 58.2% of HIV
infections in Southampton and south-west Hampshire were
through sexual intercourse between men. There has been
a decline in safer sex practices and a drop in condom use
despite free and easy access to condoms. A local survey of
100 gay and bisexual men found that half had had
unprotected anal intercourse in the previous year.
This project was initiated on the basis of these worrying
trends, coupled with a needs assessment survey of 277 gay
and bisexual men carried out in 1998. When asked if they
had engaged in sex without condoms, almost half the men
had, for reasons such as ‘heat of the moment’, ‘drunk’,
‘took a risk’ and ‘dislike condoms’. These results
suggested that some men had no strategy for risk
reduction, but instead either lapsed or made mistakes. The
needs assessment recommended that risk-taking was
addressed by ‘providing workshops, training and support
for members of the gay community’.
However, the project also believed that a ‘deeper’ rather
than ‘shallow’ intervention was required; and that gay and
bisexual men were reluctant to attend workshops,
particularly those who were high risk-takers. A marketing
strategy was therefore developed that would ‘arouse
interest and curiosity’. The name ENIGMA aimed to add a
sense of mystery, and publicity was displayed with
messages such as ‘Can you keep a secret?’, ‘Is it time you
found out?’ and ‘Some people know some things about
it’. Posters and beer mats were displayed and placed in all
the gay venues in Southampton. This provoked discussion
about what ENIGMA might be. This was followed up with
full page advertisements in Boyz (a national weekly free
magazine for gay men), and then with a further set of
posters carrying messages such as ‘Will you get an invite?’
and ‘Will you be able to find out the secret?’. To the last
weekend of April 1999, project workers invited men to an
interview for the programme. Only four men who were
approached refused the invite. The interview was ‘a cross
between a tarot reading and an interview and utilised a
series of cards’, and was entitled the ENIGMA Journey,
with men who were interviewed asked to keep the
process a secret.
The interview involved two parts. The first was a series of
statements on cards which men were asked to place in
three categories: TRUE, NOT TRUE or UNSURE. The
statements (such as ‘I sometimes have sex with people
and regret it later’ or ‘I am usually happy with the
decisions I make’) aimed to indicate levels of
assertiveness, confidence or risk-taking. The second set of
statements (such as ‘I would like to develop more
confidence’ or ‘I want to be able to take the lead in sex’)
aimed to identify what skills and attributes men wanted to
change and develop. Both sets of answers were given
points indicating how appropriate men would be for the
programme and how motivated they were to attend.
‘Sometimes participants emerged as scoring high on some
16 Boys’ and Young Men’s Health: What Works?

attributes, but low on others. For example, some
participants seemed to have high levels of assertiveness,
but low levels of confidence.’
Men were asked what type of activities they were
interested in, what would put them off, and what would
engage them. This helped in planning the workshop
sessions. Those who were invited to the workshop sessions
were given two time options (Tuesday evening and Sunday
afternoon), and were given an ENIGMA card that offered
them free entry to the Magnum night club for the rest of
the month.
In all, 57 men were approached, of whom 53 agreed to
attend the ENIGMA Journey. Of the 32 men who attended
the interview, 30 were offered the workshop sessions and
26 agreed to attend (14 on the Sunday and 12 on the
Tuesday).
In evaluating this marketing stage, the strategy was seen
as ‘highly successful’. ‘Moreover, the interview process had
proved an important stage in its own right. It enabled the
project to ensure that the sessions were targeted at those
most likely to benefit, it helped to establish commitment
from participants and it enabled the planning of the
sessions to take account of the varied needs and wishes of
those attending … the exercise seemed very effective in
moving candidates from pre-contemplation to thinking
about change.’
The ENIGMA Journey consisted of four weekly sessions,
lasting two-and-a-half hours each, and a residential
weekend. Each of the four sessions started with a buffet
and refreshments (which ensured that those arriving late
did not miss the main elements), and used a variety of
methods such as quizzes, games, group/team games, case
studies, continuum activities, role-play, story-telling, whole
group discussions and presentations. This variation of
technique was intended to maintain interest and maximise
the learning and enjoyment of all the participants. The
main aims of these four sessions were to develop
participants’ skills; encourage active participation; offer a
challenge; and have a bit of fun. In addition to the
sessions, the ENIGMA Booklet (designed to enable
participants to analyse, monitor and record their behaviour
and to assist them in using the skills that had been covered
in the sessions) was introduced.
To encourage involvement, participants were telephoned a
couple of hours before the start of the session as a
ENIGMA Project
reminder; the ENIGMA card was extended week by week
if sessions were attended; invitations to the residential
weekend went out only to those who had attended all four
sessions; and participants were asked their views about the
sessions so that changes could be made in the ones that
followed.
The residential was held at a gay-friendly hotel in Brighton
(one of the few within a reasonable distance). Sessions
included some that were purely skill-based and others that
were knowledge-based, and all activities aimed to include
an element of fun. The ENIGMA Booklet provided the
content for a number of the residential sessions.
Another of the underpinning themes of the residential
weekend was team-building. Participants were from both
Tuesday and Sunday groups so they did not all know one
another. At the beginning of the weekend men were
placed in teams of three or four, and a number of activities
were carried out in these groups and points and prizes won
by the teams. These activities included ‘identifying sexually
transmitted infections from photographs’, ‘designing a gay
men’s health promotion poster’, and visiting local gay pubs
and a cruising area to collect information. These activities
required participants to practise a number of skills and to
test their confidence and assertiveness.
Evaluation of the workshop sessions and residential
weekend was taken very seriously. Pre- and post-
evaluations, checklists and graffiti sheets were all used to
collect opinions and views of the ENIGMA Journey. The
evaluation report of the first course concludes that:
‘the first achievement is that ENIGMA included a
successful marketing strategy. It was effective in selling
the idea of workshops to those gay men who were
perceived to be most at risk and most difficult to
persuade to address their risk-taking behaviour. The
posters and other publicity materials were attractive,
culturally relevant and succeeded in arousing curiosity
about the project. The marketing strategy resulted in 32
gay men turning up to the first stage of the ENIGMA
process, more than enough to fill the sessions.’
‘The initial interview (the ENIGMA Journey) seemed to
be effective as a means of moving men to a stage of
pre-contemplation of the need for change.’
‘The workshop sessions appear to have been successful
in enabling participants to develop their negotiating
skills and increase their knowledge of safer sex.
17

Changes in attitudes also resulted. A further aspect,
enhanced by the residential element, was team-building
and social development. Most of those taking part had
changed their views about other gay men and the gay
‘scene’ in general. Some participants noted
improvements in their ability to understand and get on
with men from different backgrounds to themselves.’
There have been four ENIGMA Journeys to date. While no-
one was aged under 18, the average age of course
participants has been 21 years. The programme itself has
changed very little since the first pilot, and although there
have been slight adjustments, Mark Heywood is of the
view that the model has worked consistently well. Similar
programmes are now being adapted to the African
Caribbean Community and for those in rural areas.
This report draws heavily on A Report on the ENIGMA Pilot
(an in-depth intervention addressing sexual risk-taking with
gay and bisexual men) and an evaluation of the second
pilot with the same title.
ENIGMA can be contacted at 82a Northam Road,
Southampton, Hampshire SO14 OSN, tel: 023 80 235111.
18 Boys’ and Young Men’s Health: What Works?

42nd Street
42nd Street was established in 1981 as a
community mental health service for young people
in Manchester. Funded by social services, health
authorities, health action zone and a broad range
of charitable trusts, this is a body of work with
boys and young men, rather than one initiative.
This report is a result of conversations with Simon
Hepburn, Saira Hussein, Richard Moosbally, Mark
Needham, Ian O’Donnell, Donovan Powell and Ian
Trafford, and reading of a number of documents related
to their work.
42nd Street is no ordinary youth work organisation. With
37 workers and 19 volunteers (in October 2001), it is the
size of an average County Youth Service. Its main office is
in central Manchester (where some counselling and group
work programmes take place), and it also has Salford and
Trafford teams, and office bases. Teams operate within
themes as well as geography, with suicide/self-harm;
lesbian, gay, bisexual; African-Caribbean; participation;
and children’s and young people’s project workers.
42nd Street describes its aim as ‘to provide creative,
innovative and accessible forms of therapeutic support that
reduce young people’s experiences of stigma when
receiving support for their mental health needs.’ It provides
a helpline, one-to-one support, befriending, counselling,
group work and workshops to young people, and carries
out research and offers training for other professional
workers. As well as their specific themes, all workers have
stints on the helpline, which is seen as a very important
point of contact with the project for young people.
’42nd Street has a history of identity-based practice,
including specific work around gender, race and
sexuality. Over the past seven years 42nd Street has had
42nd Street
a specific post working with young men and in more
recent years this has been augmented by other posts
focusing on work with gay men and men from the black
communities. Group work has always formed a core
element of the services provided’
[Green, K. and Trafford, I. (2002) The men’s group –
words in action. wym 1(1): 19–22].
Having been established for so long, 42nd Street does not
have the difficulties many organisations face in promoting
and developing a new initiative. The project is very well
known throughout the north west, and is held in high
regard by many. Most agencies are happy to refer work in
collaboration with 42nd Street, which prides itself on
producing consistently high quality work. Gender is not a
new issue for the organisation, and the management
encourages cross-fertilization between teams and themes.
Here selected initiatives are described, and a series of
themes are picked up at the end. This is a growing body of
work integrated within a dynamic organisation that goes
beyond reliance on individual workers.
Donovan Powell is the African-Caribbean male project
worker, and part of his role has been to work with
individual African-Caribbean young men making the
transition back into the community from two wards of a
psychiatric hospital. Most have been sectioned (into
hospital via the courts or the police, or on the
recommendation of two doctors) because of either
violence or a diagnosis of schizophrenia. The African-
Caribbean community has campaigned for some time
against the high proportion of young black men diagnosed
as schizophrenic, and Donovan finds there are some
tensions in the expectations of him held by the men he
sees and the hospital itself. The men engage with
Donovan as another black man, and want to talk about
19

their experiences of the mental health system and
particularly about racism and culture. He says ‘some black
males are perceived by some professionals as big, bad and
dangerous. If they are religious and speak in tongues, for
example, this can be seen as a mental health issue rather
that a religious Christian practice.’ On the other hand, the
hospital expects Donovan to accept their diagnosis and to
help with the practical transition out of the hospital, and
certainly not to act as advocate for the individual men
involved. Donovan sees his role as offering support and
befriending the men, helping them clarify what they want
for themselves. He attends case conferences to ‘put a
different perspective’, and this is usually quite challenging
for the medical staff, who often find race and culture more
difficult to incorporate within their individualistic and
illness-based approach. Donovan also says masculinity
tends to be secondary to race for most of the young men
he sees. This work is still in its infancy.
Simon Hepburn is also employed by the project to work
with black young men. His post is funded through the
Innovative Projects Fund of the National Youth Agency. His
work is a mixture of individual informal support for young
black men at serious risk of exclusion from school, and
group work focusing on self-esteem, confidence and
communication.
The individual work takes place one afternoon a week,
and usually involves taking year 10 young men out of
school (often to the local university) to provide time and
space to reflect on what happens in school. Young men
often focus on the trouble they have with individual
teachers, and Simon believes this approach will provide
the release and support they need to maintain their
involvement in school. He also thinks there is an important
role model function. He has been introduced by the young
men as ‘my counsellor’ with no apparent stigma or
embarrassment. This work is in its infancy, and Simon is
optimistic that the role and quantity of work will increase
as the project develops.
Both Donovan and Simon highlighted the tensions and
frustrations they experience between individual counselling
and support work within 42nd Street, and the wider issues
that often emerge from their work. Young black men’s
experiences of the criminal and mental health systems, of
school exclusions, and of the care system all have
implications for these institutions themselves, but they are
much more reluctant to explore their own behaviours
and policies.
Richard Moosbally is employed as the gay and bisexual
project worker. This work is well established at 42nd
Street, and Richard currently runs three groups in central
Manchester. Cityboys has been running for three years (on
a 12-week cycle) and attracts as many as 19 or 20
predominantly white young men in their early 20s. A high
proportion of members are homeless, and because of this
there is a steady turnover. This is a discussion-based group
that tackles themes determined by the young men
themselves. These have included health, self-esteem,
personal safety (including self-defence), assertiveness and
identity, as well as more community-based issues such as
the age of consent or Section 28, and relationships are a
recurrent theme. Richard says that his role has changed
significantly: initially it was to create safety and introduce
themes, but now he takes a much more challenging role –
generalisations such as ‘that’s just het. men’ would go by
unless he challenged them, and groups become too
comfortable if he doesn’t take that role.
Inside Out targets gay and bisexual men aged 15–25 years
who have more significant mental health problems than
Cityboys. There is a much stronger support content and
isolation is a major theme, as are ‘coming out’ and a
whole host of negative questions about identity. This group
has recently moved to a drop-in format in response to
users, and in an attempt to make the group more
accessible to young men.
Richard says he is trying to identify what skills and
attributes make young men resilient to the pressures of
being gay or bisexual. He believes that if these can be
identified and taught as skills this will be a valuable part of
the support work they can offer young men.
Ian Trafford and Keith Green have been offering young
men with mental health issues a regular group for some
seven years (with a break after five years). While there
was some diversity in terms of ethnicity and sexuality, in
the main the six to eight participants were straight, white,
working-class young men. Initially this group was started as
a discussion-based group for young men to talk about their
experience of psychiatric services, panic attacks,
depressions, suicidal feelings and attempts, violence,
pornography and sexuality. ‘This experience helped the
young men to take their difficulties seriously and feel
listened to and valued. During this phase a number of
young men did move on from the group to enter work
or college, feeling stronger and more confident in their
abilities.’
20 Boys’ and Young Men’s Health: What Works?

As this approach became less effective, a ‘social action’
model was introduced to help the young men move from a
reflective to a solution-based approach, where they were
encouraged both to take responsibility for themselves and
to identify solutions to the problems they faced. Workers
were concerned that the more reflective approach (where
young men talked about their lives and problems), while
helpful did not enable young men to make changes. While
this group has now ceased, attempts continue to identify
methods that support young men in making changes in
their lives.
Ian O’Donnell is currently a ‘participation’ worker, but until
recently his role was to work with male survivors of sexual
abuse at 42nd Street. While presenting for counselling
having been sexually abused is difficult for anyone, Ian
believes there are some significant gender differences. The
project sees almost twice as many young women as young
men. Ian says that the few young men are also the ones
more likely to drop out of counselling, and that most of
those that stick have to ‘learn an emotional language’. He
believes this inhibits the young men’s progress. He has to
‘work at a reflective, and more gentle level, before they
are able to get deeper’. This may take five or six sessions,
where young men learn to link their feelings with their
expression of them. Ian finds himself saying such phrases
as ‘you sound angry, but seem sad’, which he says help
young men identify what they feel.
He also says that because the majority of young men have
been abused by other males, they are sometimes reluctant
to trust and open up to another man. Some are unaware
of this, while others will ask to talk to a female counsellor.
Unusually, almost half the young people seen at 42nd
Street during 2001 were male and aged 14–20 years
(within counselling agencies the usual ratio is 20–25%
males to 75–80% females). Many have experienced
depression, family problems and isolation, and almost half
have self-harmed or attempted suicide. On this basis
alone, 42nd Street must be doing something right for
young men.
The underpinning approach is person-centred (with respect
and listening at its core), mixed with a pro-young people
stance (no blame or seeing them as the problem) and an
understanding of the impacts that gender, race and
sexuality will have on young men and women.
42nd Street
Without doubt, this and the established nature of 42nd
Street’s services have made them approachable for a
broad range of issues. Other projects have found young
men more willing and able to use services that approach
them around their identity (especially gay and bisexual
young men and African-Caribbean young men). This may
also play a part in 42nd Street’s success in engaging young
men, which has been particularly difficult with regard to
mental health issues [MHF (2002) SOLDIER IT! Young Men
and Suicide. An audit of local service provision and young
men’s uptake of services. Men’s Health Forum, London.]
Workers are generally very experienced. They have
confidence in their own skills and the organisation as a
whole. The turnover of staff is relatively low, and quite
often staff move within 42nd Street rather than leaving.
The project as a whole is committed to developing work
around the themes of gender, race and sexuality, and
therefore debates start from what constitutes effective
practice, rather than whether gender-focused work is a
good idea. This does not mean that 42nd Street is a
seamless, coherent, tension-free organisation, but critical
debate is seen as part of project development.
Interestingly, because 42nd Street has confidence and
experience in contacting and engaging young men, much
of its work has moved on to other challenges. While many
projects have been delighted when they have established
a discussion group for young men, 42nd Street is more
reflective on the effectiveness of the approach. For
example, while many projects have been pleased to
engage young African-Caribbean men in reflective
counselling, 42nd Street is looking to tackle institutional
causes of the difficulties that young black men face, and
looking for strategies that enable young men to advocate
on their own behalf.
While many of these issues are still being explored by the
organisation, and ways forward may remain elusive, 42nd
Street is some steps forward compared with many projects
that are still looking for ways to contact and engage young
men in more reflective and engaging relationships.
42nd Street can be contacted by writing to Second Floor,
Swan Building, 20 Swan Street, Manchester M4 5JW, tel:
0161 832 0169. The project helpline is 0161 832 0170,
and the e-mail address is forty_second.street1@virgin.net
21

Hospital Youth Work Team, Wolverhampton
The Hospital Youth Work Team is a three-year
project, started in April 2000, and funded from the
innovative fund of the local health action zone.
While this is a relatively new project, and does not have
a specific boys’ and young men’s focus, it has been
included for two reasons: young peoples’ projects within
a hospital setting are very unusual; and the initiative
side-steps some of the accessing difficulties that many
projects targeting boys and young men experience.
This report is based on an interview with Sean Cullen,
and reading of some of the monitoring sheets related to
the project.
The purpose of this service, based in New Cross Hospital,
is to offer young people within the hospital environment
support that will enhance their general health. Three youth
workers (seconded from the youth service) make contact,
assess needs and provide (mainly) individual support to 13–
17-year-olds. Hospitals are in operation 24 hours a day, so
the project workers cover 9am to 9pm Monday to Friday,
and four hours on Saturday.
The rationale is that young people find any hospital stay
difficult, especially if they have a long-term illness; also
that there are children’s and adults’ wards so 17-year-olds
may well find themselves in a children’s ward (with 7-year-
olds), or in an adult ward (with 77-year-olds). While any
hospital stay is primarily about treatment, boredom,
understimulation, isolation and frustration can all hinder
recovery, and there is a recognition that young people too
often experience these while in hospital.
One of the biggest barriers has been convincing medical
staff that youth workers in hospital could be a valuable
addition to treatment. With no social work team within the
hospital, Sean Cullen is of the view that it is harder for
medical staff to see support services as valuable. While the
Youth Work Team has some important advocates (such as
doctors in the paediatric team), presentations, often to
small groups of medical staff, have been essential to
ensure that medical staff know, understand and use the
service appropriately. Sean believes their services need to
become integrated within the hospital, rather than being
seen as a support service. This would also involve a
change of view, with patients seen as people with medical
conditions, rather than just as medical conditions that need
to be treated. The rapid turnover of staff, shift systems,
and an atmosphere where workers can be very territorial
(and feel as though their toes are being trodden on) all
mitigate against the Youth Work Team being seen as
integrated.
The first few weeks of the project were spent interviewing
young people on the wards, asking them about their
opinions and feelings regarding their hospital experience.
Boredom, having nothing to do, and being confined to bed
were regularly reported as the worst aspects of being in
hospital, and many thought that ‘a room for teens’, more
contact with teenagers, and access to computers, TV/video
and CD/stereo would make their stay easier. There was a
strong view that they had to forget they were young
people while in hospital, and that that their illnesses should
not mean a complete lack of stimulation and contact with
people of their own age.
Written material has been prepared by the project for
young people in the hospital. All young people in the
children’s ward are told about what is on offer, and they
can access the service at any time.
Sean felt that gender has a significant bearing on the
project’s work. For example, staff might contact them if a
22 Boys’ and Young Men’s Health: What Works?

young man was being abusive to nursing staff, as the
Youth Work Team was more likely to find out why he was
being abusive and engage with that. They often become
go-betweens, and Sean says that conflict resolution is a
significant part of their work. He also says that it is young
men who are more likely to resist treatment, especially in
Accident and Emergency (A&E), with lads saying ‘there is
nothing wrong with me’. With so many young men coming
into A&E with injuries related to high levels of risk-taking
and alcohol excesses, this is another setting they are often
called to. Sean is of the view that a significant number of
young men who come into A&E are also excluded from
school, and staff often find these lads particularly difficult
to relate to.
Sean suggests that when many young men are in hospital,
they are also more receptive to support and help. They are
often bored, feeling low, and their defences are down, and
this can lead them to be more reflective and willing to
engage. However, this is not always the case. Sean is
quick to say that ‘young women engage much more
readily, value meeting and talking about problems, while
the lads want to know why you want to meet them and
want to know what you are going to do’.
This view, that ‘help’ comes in very practical forms,
determines to some extent what is offered to young men,
even if the problem is emotionally based. Sean illustrates
this when he says of one young man on his caseload who
has leukemia and is also diabetic: ‘He can be aggressive
and the initial referral came from a doctor who was
concerned that if he carried on the way he was, then he
would end up in prison’. While he was in hospital, Sean
concentrated on building a relationship with him. On his
discharge (although because of his condition he is a
regular in-patient), Sean encouraged him to become
involved in youth achievement. He had a strong interest in
vehicles, and got involved in mountain bike maintenance.
Sean says that ‘his medical condition is the backdrop,
always there, but he wants to, and has to get on with his
life’. Helping young men adapt to their medical conditions
again makes up a significant part of the team’s caseload.
Self-harm or failed suicide attempts, eating disorders, and
other conditions where doctors recognise that the medical
issues are the symptoms rather than the problem, are all
issues that the Youth Work Team is asked to become
involved in. There are some similarities between the
hospital Youth Work Team and a detached team, the
hospital wards being the equivalent to the streets where
Hospital Youth Work Team
young people are made contact and engaged with.
However, a substantial amount of the Youth Work Team’s
work is involved in post-discharge contact, supporting
young people in accessing services (Connexions and youth
service in particular), advocating on their behalf (with
schools and even the criminal justice services), and
working with parents.
While by far the majority of the work is one-to-one, where
appropriate, young people are encouraged to have contact
with one another, and events and activities are arranged.
A residential session for 12 young people who were self-
harmers was arranged, which was a mix of activities and
discussions hinging on the themes of self-esteem,
confidence and consequences.
With three workers, Sean says that their caseload is a
maximum of 30 at any one time. However, one-off
difficulties and crisis intervention are dealt with over and
above this caseload. Sean says that, on average, 60
adolescents come through the hospital wards at any one
time. As well as the children’s wards and the A&E
department, they have regular input to the cystic fibrosis
clinic, the renal dialysis unit and the hospital’s dietitians.
During their contact with young people, they are often told
important information that has implications for their
treatment. Confidentiality has been an important issue to
clarify with both young people and medical staff, but Sean
now feels that medical staff are beginning to see the
benefits of the project’s involvement, and this has helped
to increase the team’s status in some parts of the hospital.
With such a rapid turnover of patients and staff within the
hospital, it is crucial that the Team continues to publicise
its services. In addition, they also have to maintain their
links and contacts with services and activities operating
within the hospital’s catchment area and, as this is
substantial, this takes time as well.
While the project was originally funded for two years, this
has now been extended to three. This is partly as a result
of the difficulties the Team has had establishing itself
within the hospital structures, but also because the
potential is beginning to be recognised. Sean is optimistic
that they can develop a significant young people’s service
within New Cross Hospital.
The Hospital Youth Work Team can be contacted c/o
Children’s Out Patients Department, New Cross Hospital,
Wolverhampton, WV10 0QP, tel: 01902 642887.
23

Leap Confronting Conflict
Leap was founded in 1987 by The Leaveners
(Quaker Community Arts Project) to explore the
causes and consequences of conflict and violence
in young people’s lives. A three-year grant (from
the Department of Education and Science’s Youth
Service Unit) in 1988, and resulting publications
(Playing with Fire and Fireworks) established Leap
as an innovatory project, working in a relatively
unexplored area of the youth curriculum. Steady
growth has led to Leap becoming an independent
national voluntary youth organisation, currently
employing 10 staff members and 15 trainers.
This report results from a conversation with Helen
Carmichael (Executive Director), and reading of various
publications, evaluations and articles, in particular:
Report on the Leap Leadership Programme in particular
with HMP Rochester (September 1998–September
1999), by Jo Broadwood; An Evaluation of Feltham
Approaches to Conflict Training (FACT) Leadership
Workshops (May–November 1995), by Claire Russ; and
Leap’s Annual Review 2000.
Leap’s origins are in the Quaker movement, but it works as
a national youth organisation open to everyone interested
in conflict. Conflict resolution and mediation lie at the
heart of the approach, as well as interactive learning,
drama, and a variety of other art forms. Leap’s youth work
origins continue to shine through, with empowerment and
development of skills and confidence continuing to
underpin the educationally based work. While Leap rarely
offers gender-based training opportunities, an
understanding of gender can be seen throughout its
approach and, because of the focus on violence and
conflict resolution, it often works in criminal justice or
school settings where boys and young men are either the
primary target or the primary concern.
Through initial grants from central government and large
charitable trusts, Leap has developed a number of related
initiatives. These include The Quarrel Shop (accredited
youth training in conflict skills and mediation), which has
led to the recently established Young Mediators Network
in July 2000. Gangs and Territorialism (funded through a
grant from the Diana, Princess of Wales Memorial Fund)
will initially map approaches to working with street gangs
and intergroup conflicts, then ‘develop and trial innovative,
practical approaches to reintegration of young people
involved in street gangs’. Another element of Leap’s work
is its Confronting Conflicts in Schools programmes, which
usually involve a ‘conflict audit’ to explore how conflict is
expressed in the school; an intensive student training
phase with all year 9 or year 10 pupils; and a residential
training experience with year 10 pupils and staff. This is
usually followed by peer training, when trained students
deliver conflict resolution workshops to younger pupils.
Staff training sessions are then followed by an evaluation
of the whole programme. Leap undertakes a substantial
training programme of short courses and consultancies
open to all adults working with young people.
Leap works with both males and females but, particularly
in criminal justice settings, the participants are primarily
boys and young men. To highlight the programme content,
a basic description is given below of the three-day Conflict
Training Programme, delivered in young offenders’
institutions.
‘Day one is focused on the present; participants are
encouraged to examine their triggers and explore their
habitual reactions to difficult situations. Day two focuses
on the past; participants share significant events in their
lives with each other. This is often a moving and painful
day with personal stories being told; of parents leaving,
bereavements, divorces, and beatings. The young men
24 Boys’ and Young Men’s Health: What Works?

egin to acknowledge the pain behind the masks they
show to each other in the world. They also look at their
reactions to these events and others and see how their
reactions have put them on a vicious cycle of behaviour,
which is also sometimes referred to as the “in and out
of prison” cycle. Day three focuses on the future;
participants consider what will happen if they stay on
the path they are on, what they must do to create a
different future for themselves, and what the first
obstacles are that they need to overcome in order to
stay on their chosen path.’
For some this may be walking away from fights; for others
it might be staying away from peers (who tempt them into
committing crimes with promises of easy gains and no
risk). Others need to be able to resist the lure of drugs and/
or alcohol. For yet others, it is weaning themselves off the
adrenaline rush of excitement that crime gives them.
Helen Carmichael says that day one aims to establish
contact with the young men. They are often reluctant,
don’t really know what to expect, and often are not used
to a workshop environment. The day is very active, with
lots of games and exercises, and the training team shows
great interest in what the young men have to say. In many
respects, day one is preparation for the role-plays of day
two. Often young men comment at the end of the day
that it is the first time they have felt listened to, and that
others had expressed so much interest in them.
Day two is often a much more emotional day, where
young men often ‘drop their mask’. The training team
aims to both engage the young men in their past cycles of
behaviour which they may have adopted, and recognise
what provokes them now. The training team also wants to
encourage the notion of ‘choice and change’, so that
young men are able to recognise that cycles of behaviour
can be broken.
Day three continues the theme of choice and change with
a series of exercises that aim to help young men see
alternatives and even rehearse them. One of these
exercises is the ‘boxing ring’. The following description
(taken from a report of work carried out in HMP Rochester
in 1999) highlights both the process, and the emotional
level at which this process operates.
‘Carlos has taken his challenge into the ring. Another
participant who was a friend of Carlos and knew him
well was playing the challenger. In each round he had
known precisely the things to say which would needle
Leap Confronting Conflict
and provoke Carlos into a violent reaction. Each time
Carlos had turned to me, the referee, and said that by
now, if it had been real, he would have hit the guy, and
each time he was sent back to get some more coaching
from his supporters. The challenger had supporters too,
to keep him in role and to keep him playing the role
sensitively.
In the first three rounds Carlos was defeated. We put
some more coaches into his corner. In the fourth round
Carlos did manage to walk away. But he sat in his
corner with his head down and his arms crossed, his fists
clenched and tucked in to his sides. I had asked him
how he felt and he shook his head miserably in
response. So for the final round I told his supporters that
they had to coach Carlos so that he would walk away
and walk away proud. They redoubled their efforts.
Using the learning they had gained from the previous
two days of the workshop they reminded Carlos of what
his goals were now, and of what violence had cost him
so far in his life. They also told him he did not need to
prove himself by fighting, he was better than that.
Carlos had walked into the ring uncertainly. His
challenger faced him, issuing taunts and threats and
jeers. Carlos said nothing, he just watched him. The
challenger grew anxious at the lack of response from
Carlos and increased the provocation. Carlos just carried
on looking at him very calmly, saying nothing. Then he
turned and walked slowly back towards his corner. Just
before he reached his coaches he looked back at the
challenger. “I don’t need to fight you.” He stated it as
fact and as a realization rather than as a taunt to the
other side.
Everyone in the room went wild. Afterwards in the de-
roling of the exercise there was a discussion about it
being a role-play and whether Carlos could do the same
in real life. All the young men agreed that the role-play
had felt very real indeed. Carlos talked about what a
struggle it had been to walk away the first time. Even
the participants who had been initially sceptical said
that they could see how real it had been for both Carlos
and the challenger.’
While this cathartic level is not maintained throughout the
three days, young men know they have been through an
experience. This requires a very skilled team of trainers.
Leap operates with three trainers for 12 participants, and
each member of the team has a specific role throughout
the three days. One monitors how the programme is
unfolding (are young men responding?); the second
monitors what impact the programme is having on each
25

individual; and the third leads on content. Leap has found
that investing in its staff has brought longer-term rewards.
Staff are regularly supervised and given substantial
planning time. During a given year there are also two
‘creative project days’ and two trainers’ forums, where
both the mechanics of courses and the methods and
beliefs that underpin the approach can be discussed.
However, before trainers are allowed to run a course, they
are themselves put through a rigorous selection and
training process. Only those with a broad range of skills
and abilities (confronting conflict and group work in
particular) are selected, and then a ten-day basic course,
followed by a further five days of training the trainers, are
completed before they are made part of a training team.
To identify any gender differences, Helen was asked to
contrast the three-day course described above with a
similar course delivered to young women within a young
offending environment. Helen suggests that, while young
women are often initially more cooperative, they are also
more guarded. There is often more denial, and they are
less open to learning and to alternatives. However, this is
in sharp contrast with Leap’s work in other settings, where
Helen suggests that the young women are often quicker to
participate, and usually more active, willing and reflective.
In Leap’s adult training programme, two of the most
popular courses are labelled by gender – ‘Young men and
anger’ and ‘Young women and self-esteem’. Although
both courses explore similar material, they have different
starting places, which seem to be what adults working
with young people want.
While Leap evaluates much of its work, some of the
host agencies carry out their own detailed evaluations.
An evaluation of work carried out in Feltham in 1995
(by Claire Russ of their psychology department)
concluded that:
‘overall, the leadership workshop appeared to be an
enjoyable experience for those who completed it. For
many, it was the first time they had worked in groups
and talked openly about themselves. They felt that
doing so in the “safe” environment provided by the
leadership workshop had benefited them in numerous
ways. In particular, those who were interviewed
following the workshop appeared more tolerant of their
peers and claimed to be less egocentric. They stated
that they now thought about themselves, their future
and how they handled difficult situations. Although
there were some negative comments about the
groupwork experience, these appeared to be due to
lack of experience in this area. On the whole, these
participants stated that once they got used to working in
a group, they enjoyed and benefited from it.’
While workshops such as the one described are at the core
of Leap’s work, they are often placed within a broader
framework. So, for example, within the work Leap delivers
to schools there are a number of commonly found
components, which include the following.
• A conflict audit – where methods of dealing with
conflict are explored, as are the sources of conflict,
what impact this has on both pupils and teaching staff,
and solutions that pupils and teachers may adopt to
resolve this conflict. This audit provides the basis for any
future training programme.
• Training programmes – for both pupils and staff. Leap is
reluctant to accept that conflict arises only from young
people, and believes that awareness, skills development
and raised self-esteem are often as relevant for staff as
they are pupils.
• Peer mediator training – this is also seen as a useful
element for a school to develop in dealing with conflict.
• Building support for teachers – also seen as essential.
These components illustrate key features of Leap’s
approach to programme design. The features are: a
detailed assessment of needs at the outset; an active
training programme; an opportunity for participants to
practice new skills in a supported way; and building a
community of support around the programme.
While Leap is often asked to carry out crisis intervention
work, this is declined as its work focuses on long-term as
well as short-term gains, and effective rather than quick
solutions. Helen estimates that (especially in relation to
schools work) at least 25% of their time is taken up in
negotiating with staff and governors, giving briefings and
communicating with the school. However, Leap has also
found that unless it gives this aspect of its work this
significant amount of time, misunderstanding and
problems inevitably occur. Within any training team, one
member will have the specific responsibility of liaison with
the host institution.
Leap Confronting Conflict can be contacted at The Leap
Centre, 8 Lennex Road, London N4 3NW, tel:
020 7272 5630, website www.leaplinx.com
26 Boys’ and Young Men’s Health: What Works?

Loud Mouth Educational Theatre Company
Loud Mouth was founded in 1994. Eleanor Vale
and Chris Cowan were both drama students at the
University of Kent in Canterbury, and wanted to
develop theatre that moved beyond entertainment
to look at issues that affect young people. Loud
Mouth tours nationally, and currently offers ten
different programmes for young people and
professional workers. They aim to use theatre to
explore young people’s issues and views. While
none of the programmes solely targets boys and
young men, they do have a very strong gender
perspective.
Loud Mouth is now based in Birmingham, but works
country-wide. This report is based on a conversation
with Chris Cowan, and various reports and evaluations
of Loud Mouth’s programmes.
Loud Mouth’s first programmes (in Canterbury) were about
bullying, litter and puberty. These early pieces of drama
(and monologues) helped Chris Cowan and Eleanor Vale
to develop an educational style and approach that is
resonant in all their current programmes. A research phase
leads to the development of the drama, and to workshop
ideas and materials for the discussion that follows the
performance.
All the programmes are researched with professionals and
young people, which helps to ensure that they are ‘honest
and relevant and provide a way to feed young people’s
views on the issues into the work.’ The programmes are
also very supportive of young people’s lives and dilemmas,
and use humour to address common worries,
embarrassments and concerns. The characters disagree,
fall out and have different views on most issues, but blame
is rarely directed at the young men. Chris sees the drama
Loud Mouth Educational Theatre Company
element as a tool to enable young people (and
professionals) to reflect on and discuss the themes within
the interactive workshops.
While Loud Mouth tackles a range of issues that many
professionals find it difficult to engage young men in, there
are some issues that they have found more difficult to deal
with. Chris believes that some issues are difficult to discuss
openly, without polarisation. Drugs, for example, has
proved hard to cover, Chris says that ‘objectivity is difficult,
extremes predominate, people are too often for or against.
Most of the discussion is somewhere in the middle and
that has proved difficult to capture.’
Loud Mouth currently works with small groups in schools,
youth work environments, young offenders’ institutions and
pupil referral units, working with up to 35 young people for
one-and-a-half hours. These sessions use drama,
monologues, discussion and interactive theatre techniques
to work with the group on an issue. The group size is
thought to be very important, ‘as it builds a safe, intimate
environment for the groups to work in’.
Schools will usually book a number of sessions so that they
can reach all the pupils in a particular year group. Loud
Mouth is often asked to perform to larger audiences such
as year groups, or to perform without the workshops as
part of schools’ health days. They regularly decline both
kinds of work as they see the drama and discussion as
integral to the programme, not separate elements.
Chris says that gender plays a part in both the themes the
programmes raise and the methods Loud Mouth uses.
Seventy per cent of bookings are for ‘Trust me’, originally
developed in 1997, which is based around the story of
April (15) and her boyfriend Dave (19). The drama ‘follows
27

their relationship from their first meeting through the
developing sexual relationship to the difficult decisions they
face as a result of an unplanned pregnancy’. The play lasts
for 35 minutes and is followed with a 55-minute interactive
workshop which ‘includes discussions in both mixed and
single sex groups as well as opportunities to question the
characters from the drama and offer them advice and
suggestions for the future’. Issues addressed include
contraception (negotiating the use of), communication
within relationships, awareness and information about
local services, as well as sexually transmitted infections
and pregnancy. Loud Mouth is particularly keen for schools
(and other settings) to use the programme as a catalyst for
further themed work, and some thought goes into ensuring
that Loud Mouth’s input provokes a number of themes
within the Sex Education and Relationships curriculum.
A recent programme, ‘Ben, Nat and baby Jack’, which
focuses on parenting and relationships, emerged out a
piece of research commissioned by the Theatre in Health
Education Trust to look at young fathers. This research has
since developed into a half-day training programme for
professionals, looking at the needs of young fathers. This
detailed report reflects the thorough approach that Loud
Mouth uses when investigating a new programme, with
careful observations and comments about young fathers
and their attitudes, and views of agencies that may be
there to help them.
What is significant in ‘Ben, Nat and baby Jack’ is that Ben
(like most of the male characters) is multi-dimensional. He
has a bit of ‘lad’ in him, he usually knows what is right
and wrong, and he sometimes has a more concealed,
sensitive side to his nature. His problems often stem from
not always knowing which part of him to show at any
given time, which makes him very likeable (to both young
men and young women), and able to change and develop
as the drama unfolds. Hearing the public voice as well as
the private thought is a technique often used by Loud
Mouth to ensure that characters are not one-dimensional.
Chris says that quite often boys and young men respond to
some aspects of the programme and methods more
enthusiastically than others. A technique called ‘hot
seating’, which Chris says has developed from political
theatre, involves the characters in the drama being
questioned by the audience about their attitudes. Chris
says that the boys respond really well to the opportunity to
ask questions to challenge the characters. He thinks that
they may see their own behaviour and attitudes in this,
and that they like the active problem-solving format. There
is usually a lot of laughter and engagement in hot seating.
Dave, of all the characters in any programme, appears to
be the most able to reflect young men’s lives, stimulate a
response and engage them.
Another technique the boys often respond to is when the
audience gets to direct the way the drama unfolds. Chris
says that this has been taken from forum theatre, and
again allows members of the audience to put their own
ideas, attitudes and perspectives into the developing
drama.
Interestingly, Chris says that when they are developing
scripts for programmes they often think ‘will the boys be
getting bored?’ and may include more humour or change
the pace of the drama. Because most of the dramas only
have two characters, and are performed in such a small
area, action is minimal and dialogue is everything, so
humour is one of the few releases.
In contrast, Loud Mouth has found that girls and young
women tend to come into their own in the small group
and discussion aspects of the workshop, especially where it
gets more personal. If boys and young men are going to
mess around, they will apparently do it in the workshop.
The characters seem to provide a distance that allows the
young men to talk more freely and openly. Chris says that
they are constantly surprised at how thoughtful and
sensitive many of the boys are, and how willing they are to
engage and give their opinions if the setting is right.
While the programmes have consistently engaged young
people, when they have returned for follow-up sessions
they have found the issues much harder to pick up again.
It has also been difficult to fund or arrange follow-up
sessions. It is therefore difficult to assess the impact weeks,
months or years after the sessions. Chris believes that this
ongoing evaluation is one of the challenges for the future.
Because of the nature of Loud Mouth’s work (in schools
and other settings for one-off sessions), we did not talk
directly to young men. However, Loud Mouth carries out
evaluations of each tour, and we looked at the evaluation
report of the Solihull tour of ‘Trust me’ (from September
1998 to March 1999). Ninety-one sessions were held in 17
schools and colleges, with 2,156 pupils, with almost a
50% split between males and females, 91.79% of whom
were white.
28 Boys’ and Young Men’s Health: What Works?

The evaluation concentrates on pupils’ enjoyment and
learning. Enjoyment levels were very high – many talked
about how funny and realistic the performance was, and
how well it was acted. Comments suggest that it was easy
to engage with, many found themselves drawn in by the
drama, and because of this they were prepared to talk and
take part. Some commented on the opportunities to ask
the characters questions and to give them advice. Having
a sense of their opinions being valid helped pupils to
reflect, think and learn.
When asked about what they had learned from the
session, many pupils indicated some strong messages:
‘always use contraception’, ‘keep sex safe’, ‘talk to your
partner about contraception’, ‘don’t be shy or embarrassed
to talk to your partner’ and ‘don’t be pressured’. But how
these were translated into practice is impossible to
determine, and whether these messages were what they
thought they ought to have learned, is also difficult to
know. Pupils also said that they had learned ‘where to get
advice’, ‘about different types of contraception’ and
‘where to get contraception’. Some pupils said that they
had learned not to make the mistakes that the drama
characters had, which suggests that pupils were as active
about what not to do, as about what to do.
Chris is of the view that there are gender differences in the
ways that young men and women receive and react to the
programmes. He says that young men are ‘active problem-
solvers, they like facts about contraception (such as about
the 72-hour pill, or where to get advice), while the young
women focus more on identifying with the character’s
feelings and drama messages such as “don’t be
pressured” or “wait until you are ready”.’
In the written evaluations from teachers, many
commented on the interaction between pupils and the
programme. Some commented on the high level of
participation, the transformation of some into ‘human
beings with opinions and ideas’, and a heightened level of
confidence.
Loud Mouth Educational Theatre Company can be
contacted at The Friends’ Institute, 220 Moseley Road,
Highgate, Birmingham B12 0DG, tel: 0121 446 4880,
fax: 0121 440 3940, e-mail info@loudmouth.co.uk
Loud Mouth Educational Theatre Company
29

What Works? – New Bridge
New Bridge was founded in 1956 with the purpose
of ‘creating a link between offenders and the
community’. It has over 200 volunteers (supported
by professional staff), working in over 100 prisons
and special hospitals in England and Wales. It
supports, advises and befriends people in prison;
runs parenting courses; helps find jobs and places
on training and education courses; and encourages
the integration of ex-offenders into the
community.
This report was based on a conversation with Ann
Renton (part-time coordinator of Family Matters) and
various documentation, course descriptions and session
plans.
In 1991, New Bridge (through its befriending work) found
that men were increasingly raising issues related to their
children and to their role as fathers. A course was
designed and trialled at Portland Young Offenders’
Institution (in Dorset), and at nearby HMP The Verne. The
course had a very practical edge, concentrating on
antenatal care, but also touching on the positive role that
fathers can provide for their children.
The Family Matters course has now developed into six
weekly, two-hourly sessions, with 22 courses (for 209
prisoners) held in the year 2000 alone. Fifty-three per cent
of participants were already fathers.
The courses are inevitably affected by the limitations and
narrow opportunities provided by prisons and young
offenders’ institutions (YOIs). Negotiations (with the prison
or YOI) usually take some time, with obvious security
issues slowing the delivery process.
Officers sit in but are expected to participate, and first
names are insisted upon. Ann Renton says that this is
rarely a problem, and usually encourages and enables
understanding for both officers and the young men
themselves.
Courses are voluntary, with posters placed on the wings
advertising them. Prison officers are crucial in the
recruitment process. Where officers are enthusiastic and
willing to ‘sell’ the course they tend to go ahead; where
they are not, they are less likely to happen. Men have
been ridiculed for attending – ‘off to your mummies’ class’
can be heard from both other prisoners and officers. Only
one course has been compulsory; Ann says that while
there was some reluctance initially, young men became
involved quickly.
New Bridge believes that the attitudes of those running the
courses are very important. They say: ‘we never go in as
teachers, we are on first name terms, and aim to
encourage discussion and keep things moving. We treat
them as human beings, and show respect for them’.
Ann says that they have found the courses have been as
much about gender as about parenting. Violence and
discipline are recurrent themes, and while men often
speak very openly, those running the courses do not dig
too deeply. Ann says ‘we are not counsellors’, and the
project is very realistic about the limitations of the course
format.
While courses are offered in both YOIs and male prisons
(and more recently in a women’s prison), it is recognised
that there are some significant differences, especially
between males and females. Anne says ‘many of the
30 Boys’ and Young Men’s Health: What Works?

young men keep up a front, and are more reluctant to
show their vulnerability. We need to build up their trust
and their confidence’. In contrast, the women want to talk
about their ‘relationships, but all participants need to talk.
The women also like to talk a lot about “myths” of good
and bad motherhood’. The only significant difference in
the course content is that the practical sessions (that the
young men take to so enthusiastically) are not offered to
the women, most of whom tend to have been socialised to
perform childrearing tasks. The only difference that Ann
could recognise in the prison and young offender institute
(YOI) courses were that the age of the children, not
surprisingly, tended to be older for the adult prisoners.
The courses seek to develop awareness and understanding
of family life and of the role and responsibilities of
parenthood, and to create an atmosphere of trust and
confidentiality.
Course content includes issues of separation; child
development; safety and first aid; parenting skills
(speaking and listening, consistency, follow-through,
patience and behaviour management); difficult behaviour
and discipline; sexually transmitted diseases and
contraception. All sessions involve video material and/or
very practical exercises (such as bathing, changing and
feeding). Quizes, reflective questionnaires and other
materials are given at the end of a session for young men
to complete before the next. Ann says that men are very
keen to reflect between sessions. Sessions intentionally
move very quickly, often dealing with up to eight themes
over the two hours. This can be best illustrated with a brief
description. Within week three (which covers domestic
accidents), men report back on their ‘egg babies’ (they are
given an unboiled egg to care for); are asked to recount
childhood accidents; watch a video, Babysafe (covering
first aid relating to babies); change a nappy (practical);
bathe a baby (practical); discuss breast and bottle feeding
(questions and tips); and finish with a quiz focusing on
safety in the home.
Ann says that this fast-moving and practical format has
been found to stimulate young men, and keeps the level
of interest and involvement high during the two-hour
sessions. She believes that the courses work so
consistently, in part, because of the practical and
structured nature of the course, and also because of the
course leaders’ attitudes towards young men. The value
they place on the young men’s role with their children,
What Works? New Bridge
Ann says, comes as a surprise to the young men
themselves, and the respect they receive is too often in
sharp contrast to their experience in the YOI and
sometimes in their lives generally.
Ann also believes that most of the young men have not
experienced a positive father figure in their own lives and,
as a result, have little understanding of their importance in
their children’s lives. ‘These young men are too often
caught in a cycle of offending and uninvolved parenting’,
says Ann.
No formal evaluation has been carried out on the Family
Matters courses, although two reports have concluded that
parenting training in YOIs have been well received and
have had an impact on young men’s attitudes towards
fatherhood (Caddle, 1991; Lyon, 1997). Course
participants are asked to complete a Lugard-style
(satisfied/dissatisfied) questionnaire about aspects such as
whether the course meets their needs, the course pace,
presentations, and practical aspects of the sessions.
Because of the difficulties of follow-up (some participants
have even been moved in the middle of a course), only
initial impact evaluation is thought to be possible.
New Bridge is a volunteer-based project, so training is
essential for those volunteers delivering the Family Matters
courses. There is a pool of 50 or so volunteers nationally,
with only two men (in contrast to the befriending
volunteers, who have an approximately equal ratio). The
problem appears to be that, when men do volunteer, they
do not stay for very long, often saying that their paid work
has to come first, or that the commitment to six two-hour
sessions is difficult to see through.
All volunteers attend the two-day New Bridge basic
training, followed by a further Family Matters day, then
have the opportunity to shadow a more experienced
course leader, and finally to deliver a course (with support).
Volunteers know that the materials have been well
tested and that they work. The highly structured and
detailed course materials help ensure consistent
delivery of the sessions.
While the courses were initiated in Dorset, most of the
more recent delivery and development has been in
the north east and north west of England, where the
course was accredited through the Open College
Network in December 2000. The national accreditation
31

process is currently under way, and Ann hopes this will
help particularly in negotiating with both the prisons
and YOIs.
Family Matters courses are expected to be offered to more
prisons more regularly in the future. To meet the expected
demand, New Bridge has started to move towards a paid
project-worker base supported by sessional outreach
workers, which Ann believes will enable them to keep
course leaders for longer, particularly male workers. They
have also recently applied for grants to fund four regional
project workers (20 hours a week) to deliver courses, carry
out administration, and support and supervise the other
sessional workers.
What the young men said:
‘I never really thought about any other ways of getting
my kids to do what I wanted apart from belting them,
and that’s what I hated about my dad.’
‘Learning about how to bring up a baby and how hard it
really is was the most useful part of the course. Also
learning that violence towards a troublesome child
would only make matters worse, the child will not learn
from this. Also learning about how important it is to love
and care for a child.’
‘Learning about how babies are supposed to be brought
up and of course how sweet and cute they are made
me want to be a dad.’
‘The hardest part of the course, I think, was when we
had to give the baby a bath and change its dirty nappy,
because it’s kind of hard treating a dolly like a real
baby, but it was a good experience.’
References
Caddle, D. (1991) Parenthood Training for Young Offenders: an
evaluation of courses in young offender institutions, Home
Office Research and Planning Unit Paper 63, HMSO, London.
Lyon, J. (1997) Parenthood Training for Young Offenders: does
it work?, TSA, Brighton.
Family Matters can be contracted by writing to New Bridge,
27a Medway Street, London SW1P 2BD, tel: 020 7976 0779.
32 Boys’ and Young Men’s Health: What Works?

Running the Risk Project, Birmingham
Running the Risk Project is funded through and
managed by the Sexual Health Promotion Service,
which is part of the Heart of Birmingham Teaching
Primary Care Trust. Running the Risk aims to
improve the sexual health of socially excluded and
disadvantaged young men who are also high risk-
takers.
This report results from conversations with Steven
Richards (project worker from 1999 to May 2001), Liz
Morris (project manager), and reading a variety of
documents related to the project’s development.
In 1997, Working With Men was commissioned by
Birmingham Health Authority to investigate ‘the risk-taking
behaviour and decision-making processes of young men,
their interactions with local services and to develop a
strategic framework for the advancement of HIV
prevention work with young men in Birmingham’. The final
report outlined 21 recommendations, including one for the
development of projects specifically targeting boys and
young men, and also a training capacity within the health
authority to train a broad range of professionals in
targeting and engaging with boys and young men.
In 1999 the Running the Risk project was commissioned
through Birmingham Health Authority and funded via the
HIV prevention allocation. The project, once established,
employed a full-time health promotion worker to target
disaffected and socially excluded young men aged 14–25
years, and African-Caribbean young men in particular, to:
• Promote their sexual health through providing
appropriate information related to HIV prevention and
sexually transmitted infections (STIs)
Running the Risk Project
• Focus on self-esteem and assertiveness, attitudes to
parenting, and communications skills in relationships.
As well as direct work with boys and young men, Running
the Risk also aimed to offer training to professional and
community members who work with the project’s target
group.
Since the project’s inception, the primary focus has moved
from boys and young men themselves to professionals
working with boys and young men. However, this
description concentrates on the earlier stages of
development. A range of sexual health initiatives have
relied heavily on the ‘type’ of person delivering the work
as much as the content itself. Peer education has
suggested that barriers and resistance (to sexual health
education) can be removed, at least in part, by
ensuring the transmitter of the information is similar to
those it is being offered to. Most peer education
initiatives have emphasised age as one of the most
significant barriers.
The Running the Risk Project has found (in the same way
as many one-worker initiatives) that the worker employed
determines the way the project develops. Stephen Richards
is a relatively young black man with great skills in
engagement and communication, and the charm needed
to make contact with people effectively. This is well
balanced with professionalism (strong on understanding
personal boundaries, clarity of roles, and an ability to
deliver on promises).
When talking about his work, Stephen stressed the need
to ‘do the research’ and ‘know the score’ about the young
men he is working with. He talks about ‘holding up the
33

mirror’ to young men, and of being ‘hard-hitting, no
bullshit’ and how he ‘sits down and reasons’ with young
men.
Steven also brought with him to the job contacts with local
pirate radio and garage scenes, and locates himself within
the black community, seeing his work, at least in part, as
an ‘obligation’. He shows the unusual ability to move from
groups of young men, to professional workers, to the
health authority structures, and within the black (and
other) communities, as well as anyone. He says there are
tensions between the approach he uses and the more
traditional behaviour-change approaches used within
health promotion. Steven suggests that professionals are
too often over-cautious in their work with young men. He
believes there is a need to be more direct, more
confrontational at times, and to operate more within the
context of young men’s lives. ‘Reasoning’ might sound to
others like arguing; he uses the identity he seems to have
as a ‘big brother’. In this approach, engagement is
everything. He thinks this approach works, in part,
because of the significant gender differences. While he
finds that young women are much more able to reflect on
their health and are interested in learning, young men
have to be reminded of (and sometimes confronted with)
the consequences of risk-taking.
Steven does not put this down to ethnicity, but to youth
culture. He believes that there is substantial overlap in
terms of economic and social patterns for young black and
white men. Most of the young men he works with are
white (he has a pan-city brief), and he is as likely to be
found in outer as inner Birmingham. He says that he is
flexible in the methods he uses, and chooses his methods
according to the young men he is working with. He tends
to work with groups of eight to ten young men: sometimes
the session is an intense conversation, while at other times
he may use structured exercises. He talks about ‘which hat
fits’ the young men he is trying to engage. At the
beginning of sessions he stresses the importance of both
responsibility and being informed. He encourages young
men to ‘pass it on’ (the information) and believes that he
‘gives permission’ to young men to ask questions and take
the sessions seriously.
With Steven leaving in May 2001, Liz Morris (project
manager) was of the view that the project needed to
employ someone with a similar approach and set of
personal attributes and skills to Steven’s. Liz believes they
were lucky to employ Richard Daley in the post, who was
also able to ‘hit the floor running’, with as good local
contacts and profile as Steven. The combination of
attributes and skills that are equally attractive to both the
young men and professionals being targeted have proved
to be essential elements for this project’s success and
development.
Requests come from young offenders’ institutions, pupil
referral units, colleges and youth work settings. Those
young men who are thought to be high risk-takers are
specifically targeted through these settings. The project is
usually asked to deliver a one-off or a short series of
sessions, usually with content including assertiveness,
negotiation and communications skills. With the recent
national emphasis on teenage pregnancy, issues related to
young fatherhood have also become part of the
project’s work. A fatherhood forum is planned, and
joint work expected to lead to funding applications is
also envisaged.
Running the Risk also arranges events that are expected to
attract young men. A Sexual Health Dance event is
planned. A website, www.runningtherisk.co.uk has a
number of games (such as a moving condom which ‘zaps’
a range of STIs attacking you), as well as information
pages. This is currently being evaluated by young men.
Training is offered to other professionals and
community groups, where a number of themes are
developed, such as:
• Know the young men you are trying to target
• Assess what they will and will not respond to
• Involve them in content planning (ask them what will
work)
• Engage on their terms
• Be prepared to adapt methods to fit the group’s needs.
While many of these are fairly basic elements within youth
work (and other professional) approaches, the project finds
that professionals do not always use them with boys and
young men. Basics, such as communication and
engagement, too often do not happen between
professionals and young men.
The broad-based approach of the project has enabled
Running the Risk to become an important component in
more strategic development of work with boys and
young men. The project has recently presented an HIV
Prevention Strategy for Birmingham’s young African-
34 Boys’ and Young Men’s Health: What Works?

Caribbean community, and has been able to present its
model of practice to local forums, conferences and
events.
While the worker’s attributes and skills are always going to
be a crucial component of the project’s success, Running
the Risk has found this to be central to its approach. To
employ a worker with a substantial understanding of
young men’s lives, lifestyles and thinking processes, as well
as a clarity of boundaries and project purpose, can lead to
sexual health issues being integrated in young men’s lives,
rather than alien to them.
The project can be contacted through Richard Daley
(Health Promotion Specialist – Sexual Health and Young
Men), Sexual Health Promotion Service, Heart of
Birmingham Teaching Primary Care Trust, Primary Care
Services Directorate, St Patrick’s Centre, Frank Street,
Highgate, Birmingham B12 0YA, tel: 0121 446 1094.
Running the Risk Project
35

Strides, South Wales
The Strides project is an initiative of the fpa Cymru
(formally the Family Planning Association in
Wales), and was established in 1996 to work with
boys and young men in the South Wales Valleys.
The Valleys were chosen because they are an area
of considerable social and economic deprivation,
with the highest incidence of teenage pregnancy
in Western Europe and an increasing incidence of
sexually transmitted infections.
This report is a result of a conversation with Socrates
Siskos (project worker) and an evaluation carried out by
Elaine Mullan (senior researcher in the Health
Promotion Division of the National Assembly for Wales),
and other reports related to the project.
Strides is funded by Bro Taf Health Authority, and employs
a full-time worker based at fpa Cymru in Cardiff to work in
the Rhondda, Cynon, Taff and Merthyr Tydfil areas. The
overall aim of Strides is to improve the emotional literacy
and sexual health of boys and young men aged 11–20. In
practice, the project mainly works with young men aged
13–15 years. The worker is managed from within the fpa,
and the project advised by a steering group which
comprises representatives from health, education, youth
service, probation, further education and social services, as
well as the National Assembly.
The three main objectives for work with boys and young
men are:
• To increase knowledge concerning all aspects of sex,
sexuality and sexual health
• To explore attitudes, emotions and beliefs concerning
sex, sexuality and sexual health
• To equip young men with the skills and self-confidence
required to address matters of sex, sexuality and sexual
health.
The funders expect to see young men’s increased use of
condoms and of family planning services; a reduction in
sexually transmitted infections (STIs) among young men;
and a fall in the number of pregnancies for girls aged 12–
18 years. However, there is also a recognition that these
are difficult measures by which to gauge the project’s
effectiveness.
Courses are offered mainly within a youth club and
community settings in villages and towns across the project
area. Occasionally Strides is asked to work within pupil
referral units, young offenders’ institutions and colleges of
further education, and to demonstrate practice in schools.
As the project has been in existence for six years, this is a
substantial body of work. An estimated 2,700 young men
have been reached, and 400 sessions delivered. The
project has had two workers, Simon Blake (until October
1998), and Socrates Siskos since April 1999, so there has
been substantial continuity. Simon ended his time with
Strides with a publication (Blake and Laxton, 1999) which
outlined many of the exercises that he had used within his
youth club work.
Currently, Socrates does an average of 6 to 12 sessions of
two hours at each site (each two-hour session usually has a
break in the middle). The work is so well established that
most workers know of Strides’ existence. Clubs are often
only operating on one or two nights a week, usually with a
strong activity base (snooker and football) and are very
informal. One of the problems of this work is the small,
36 Boys’ and Young Men’s Health: What Works?

adly ventilated rooms Socrates has to work in, with
numbers limited to how many can be squeezed in, as well
as noise from other activities going on nearby.
Socrates says that he spends the first two weeks getting
the programme established and creating a relaxed
atmosphere. He is often seen as a ‘city boy’, and says that
young men in the Valleys are not really used to meeting
people from outside. This has its advantages – he is seen
as more likely to keep confidentiality (a big issue in many
of the villages). These first two sessions help get over some
of the barriers: many of the young men have not really
been involved in discussions about sex before, and often
say afterwards that no-one has really asked their opinions.
The programme has a strong core content:
• Condoms (attitudes to and beliefs), how to use them
properly (demonstrations and practice), and where to
obtain them
• STIs, attitudes and beliefs, incidence, types and
symptoms, and where to get help
• ‘Being a man’, which covers attitudes and beliefs about
masculinity and sexuality, homophobia, the media, sex
and language, roles in friendships and relationships,
feelings and emotions about sex, friends and family.
Around this core, other sessions might include testicular
cancer, other types of contraception, menstruation,
conception, pregnancy and abortion, teenage fatherhood,
and attitudes towards local family planning and genital
urinary medicine services.
Socrates’s approach varies depending on how the groups
of young men react. Some programmes become very
knowledge-orientated (lots of facts, figures and myths),
while others are much more discussion-based, with more
personal experience and feelings, and yet other sessions
are geared towards skills development. This is particularly
the case for condom use and assertiveness, but some
other themes, such as service use, can become an
opportunity to practise and develop skills. While there
are written exercises, they are kept to a minimum –
Socrates says that many of the young men have poor
literacy skills.
The evaluation report (written by Elaine Mullan) suggests
that ‘the project is based on a rationale that by improving
self-esteem we improve empowerment and the availability
of choices, and the feeling of control over exercising those
Strides
choices. The project operates from a humanist perspective
by engendering feelings of trust and openness, by
encouraging catharsis, by providing support and
understanding.’
Socrates says that young men, on the whole, respond very
positively, partly because they haven’t had opportunities to
be listened to, and partly because they are genuinely
interested in the subject matter. Some themes catch the
imagination more than others. Socrates says that
‘discussions about relationships could go on and on’ while,
in contrast, ‘sexuality baffles them’. Interestingly, he says
that delivering these programmes in Cardiff is much
harder, with the young men in the Valleys genuinely
appreciative of the time he gives them.
The project evaluation interviewed both young men and
host organisation workers about the programmes. The
evaluation states that:
‘Both tutors and centre managers reported seeing much
change in the knowledge base, particularly with regard
to the need to use condoms and the types and
symptoms of STIs. Interviews with the participants
confirmed this. Project involvement has also reportedly
led participants to challenge and sometimes change
beliefs about sexual practices, responsibilities, sexuality
and their roles in friendships and relationships. Centre
managers also noted overall positive changes in
demeanour and self-confidence.’
‘Many (young men) said that they enjoyed everything,
but most cited the condom session (where they practise
putting a condom on a rubber demonstrator) ... when
asked what they’d learnt about STIs, the majority of
participants know about the different types, their
symptoms, how to avoid catching them and where to
go for help if they suspected they or another might need
help ... many said that Strides had made them think
differently’ [about both their attitudes and behaviour].
The project evaluator concluded that ‘overall, the Strides
project has achieved its aims of increasing knowledge
concerning all aspects of sex, sexuality and sexual health;
exploring attitudes, emotions and beliefs concerning sex,
sexuality and sexual health; and equipping young men
with the skills and self-confidence required to address
matters of sex, sexuality and sexual health.’
Strides has been asked by many of the youth clubs (and
the young men) to return and deliver follow-up
37

programmes, sometimes on sexual health, or related
themes such as emotional intelligence and anger
management. The project has tended to resist this, instead
ensuring that the very large geographical area is offered a
basic sexual health service. As a means of building on the
limited resources of one full-time worker, an accredited
course (by the fpa and the University of Greenwich) has
been offered to eight potential volunteers. Run by Socrates
and Joanna Laxton (fpa Cymru Development Officer)
over three residential weekends during October and
December 1999, four participants completed the
course. Unfortunately, only one has sustained regular
involvement (the other three have pulled out for family
and health reasons). This has restricted the number of sites
and courses Strides can offer. Development of Strides will
depend on further training of volunteers, which will free up
Socrates to broaden the courses and themes that he can
offer to clubs in South Wales.
Reference
Blake, S. and Laxton, J. (1999) Strides: a practical guide to sex
and relationships education with young men, fpa, 2–12
Pentonville Road, London N1 9FP.
Strides can be contacted by writing to Socrates Siskos, fpa
Cymru, Canton House, 435–451 Cowbridge Road East,
Canton, Cardiff CF5 1JH, tel: 02920 644034.
38 Boys’ and Young Men’s Health: What Works?

Emerging themes
The purpose of this publication is to learn from the
experience of established projects working with boys and
young men in the health sector. This final chapter pulls out
some of the common themes and offers them as important
considerations for those wanting to develop work with
boys and young men. Inevitably, within such a diverse
range of projects, a very broad range of issues are
identified as significant, and sometimes learning from one
contradicts learning from another. Some workers offer
issues as being fundamental which we believe are of local
importance.
At the outset, it was always envisaged that we would
concentrate on ‘the most important aspects of practice’,
believing that any more breadth would begin to defeat the
object of helping workers reflect on other practice. Our
most important aspects of practice may, after reading the
practice examples, turn out not to be yours, but we have
provided evidence for each, and feel they are important to
developing practice. However, our experience in
supporting work with different groups of men is that
workers reflecting on their practice will often lead to
increased confidence and the identification of significant
issues, so if that is the outcome, this report has achieved at
least part of its aim.
Accessing, targeting and engaging
The most commonly recurring theme within these 12
examples is how to access and target boys and young
men, then, once we have managed that, how do we
engage them? This is understandable – young men (as a
group) are poor users of services. Our review of literature
on boys’ and young men’s health concluded that:
• There are significant differences in the ways that many
men and women seek help
Emerging themes
• We know relatively little about what conditions
encourage young men to use services
• We know relatively little about the extent to which
young men perceive barriers to their use of services, or
the level of their reluctance to use existing services
• There may be value in focusing within the personal,
social and health education (PSHE) curriculum on help-
seeking for a substantial number of young men
• How much embarrassment, and feeling they have to
appear ‘tough men’, affects young men’s use of services
and help-seeking behaviour is worthy of exploration
(Health Development Agency, 2001).
The literature tells us very little, apart from confirming
what many practitioners already know – that young men
approach most services and agencies with some
reluctance. Previous reviews have suggested that men will
use services under certain conditions: when they are
desperate; when agencies have a strong positive view of
them; and when projects do not stigmatise them. There
also appears to be an unfortunate combination of young
men thinking that illness, vulnerability and asking for help
are inappropriate, and agencies (generally) not having the
experience or the inclination to target young men
specifically.
In their lives – many of the 12 projects developed a
targeting strategy, and this was seen by some as the most
important challenge or barrier. Alive and Kicking and
CALM were the most explicit in targeting young men
‘within their own lives’. Alive and Kicking adding its
information-based service onto football, and CALM to the
music and club scene. This willingness of services to go out
(rather than expecting young men to come in), while
involving extra effort and sometimes more thought from
the project workers, has enabled services to engage with
men. However, because workers are going out to these
39

activities, the amount of time they have and the
receptiveness of the young men involved is usually limited.
Not surprisingly, many of the more successful projects using
this approach have concentrated on putting over relatively
little information, or engaged with young men in a short
time slot. CALM aims to ‘advertise’ its phoneline service in
a non-stigmatising way, and Alive and Kicking encourages
young men to reflect and discuss with each other their
general health and wellbeing.
When receptive – another approach, which also usually
involved ‘going out’ to young men, can be described as
engaging with young men when they are receptive.
Because the issues we want to raise are often a little more
serious, which often means that we have to make it fun or
‘a bit of a laugh’, this may also require us to dilute the
message or the importance of what we want to say.
Alternatively, agencies such as Hospital Youth Work Team,
Running the Risk, New Bridge and Leap engage with
young men when they are more receptive and reflective
(and therefore they do not have to dilute the approach).
The Hospital Youth Work Team finds that, as well as young
men being restless, they are also more reflective when
they have a week or two in bed with a serious injury or
disease. Running the Risk, Leap and New Bridge all
operate within the criminal justice system, and all report
that young men within YOIs are often much more
reflective than they would be on the street. This suggests
that, when agencies have thought about accessing and
engaging young men, both the setting and the level of
reflection will have a significant bearing on the
effectiveness of the work. Interestingly, these projects were
also some of those wanting to work at a deeper level with
young men, trying to affect both their attitudes and
behaviour.
Incentives – another prominent theme was that of offering
young men an incentive to become involved. This
operated on a number of different levels. Alive and
Kicking provided prizes (such as footballs, first aid and
football kits), while ENIGMA offered club cards if men
attended the workshops and residential, but also less
tangible incentives, including exclusivity – men could only
be involved if they were invited, and then they had to go
through a selection process and agree not to tell anyone
else about ENIGMA. This advertising strategy was devised
because the ‘product’ of workshops was thought to be
perceived as boring and undesirable to the men targeted.
Therefore, through an advertising campaign, the product
was made more desirable.
CALM used some of the same rationale. Through its
research, it found that phonelines and helplines were seen
by young men as undesirable, too much of a turn-off, and
not services that they wanted to be seen using. In part, this
was seen as related to the message-bringers (health
professionals). However, if the bars and clubs were seen to
endorse the view that mental health problems are
widespread and that seeking help was the smart thing to
do, then this would de-stigmatise the product and enable
young men to use services that were an extension of what
they saw as ‘cool’. In this instance, the professionals get
out of the way on the basis that their presence will
devalue the product.
Running the Risk works on a similar basis, but by changing
the face of the service so that it appears to be less
professional than it actually is. The worker presents as
someone near enough to the young men’s lives, not like a
school nurse (or the stereotype of one: middle-class,
middle-aged, white and female).
When desperate – interestingly, there are also agencies,
such as 42nd Street, that target young men in crisis and
have little difficulty engaging them in the service. This was
also a finding of a review of agencies working with fathers
(Lloyd, 2001). Those who were desperate (especially
regarding court-related contact with their child/ren) were
much less bothered about whether they presented as
weak, or whether the agency was welcoming. 42nd Street
and Barnardo’s have found that many of the young men
they see are in this category – they have often left
contacting agencies until they have multiple problems and
are unable to ignore them any further.
Someone else is the ‘problem’ – a number of the
initiatives also take an advocacy approach. This often
takes the form of seeing (and communicating) the
problem/s as outside the young men’s control. 42nd Street
has a strong focus on gender, race and sexuality, and
quickly identifies the source of some of the young men’s
difficulties as being as a result of societal attitudes towards
them as young, male, black or gay (or a combination of
these). For those young men who believe that they should
not have problems, this process of externalizing them
enables them to address the difficulties they have without
appearing less of a man.
40 Boys’ and Young Men’s Health: What Works?

Gendered approach? – another issue was whether projects
were specifically focused on young men, or whether they
were ‘condition’-focused. Leap, while it concentrated on
conflict resolution, found itself working with significant
numbers of young men, mainly because others identified
this as a particularly male issue. Leap itself would probably
suggest that there are gender differences in the ways that
young men and women are violent and act towards each
other in conflict, and not that it is male issue. Loud Mouth
works predominantly around themes with a strong gender
element (sexual health, prostitution and parenthood), and
while it rarely works exclusively with single-gender groups,
it does often divide into gender-based workshops for
discussion. The issues identified have a significant gender
content, and single-gender groups often work more
effectively. Loud Mouth also finds that young men and
women reflect, discuss and focus on different elements. So
they see the gender elements much more in the process of
what they do, as well as the issues they are dealing with.
Running the Risk specifically targets high risk-taking young
men, as a result of pre-project research into risk-taking
which concludes that there are groups of young men
where very high levels of risk-taking are identifiable, and
these groups can be targeted. Settings were identified
where these young men could be engaged. Strides has a
sexual health focus, and targets young men because of the
view that they are not informed enough to be sexually
responsible, and to challenge attitudes that make them
risk-takers.
Some projects are less interested in boys and young men
than in the conditions they are targeting. They find that
the issue itself has unavoidable gender elements (such as
violence and conflict), or that the absence of young men is
unavoidable if they are to address the issue (suicide).
Counselling agencies often have a disproportionate
number of females to males (usually 80 to 20%), and
some agencies choose to ignore this (on the basis that ‘we
will work with anyone who comes through the door’), or
see this as an agency problem that needs to be addressed.
However, they may see it only as a targeting problem, and
offer the same service to males or females without
acknowledging gender differences in need or process.
Understanding young men and masculinity
All the projects interviewed showed an understanding of
boys and young men. Most had carried out some kind of
investigation as a basis for the project. Loud Mouth and
Emerging themes
ENIGMA carried out focused research; the Hospital Youth
Work Team carried out detailed interviews; and Dorset
offered training for professional workers involved in
initiatives, to ‘raise their awareness of boys and young
men’, and tried to look at the world from a ‘boys’
perspective’. Alive and Kicking based its projects on
perceived views of men’s attitudes towards their health
and help-seeking behaviours. Running the Risk was based
on a previous piece of research and the project workers’
experience of the world of young men. Some of the
projects’ understandings came from their previous
experience of working with boys and young men. 42nd
Street has developed single-gender work for a number of
years, which informs their methods. New Bridge has an
understanding of young men that has developed through
noticing what has worked in the past; while Leap and
Strides have developed out of a close association between
gendered understanding and their emerging practice.
Barnardo’s Young Men’s Project has found that its
understanding of boys and young men has become more
complex as practice developed.
While all the projects have a view about what is specific to
boys and young men, this understanding has had different
degrees of impact on their developing practice.
Targeting – CALM used an understanding of boys and
young men to develop a targeting strategy. It integrated a
marketing approach to clubs and bars where young men
felt more comfortable than with mental health services.
CALM aimed to tack on mental health issues to young
men’s lives, rather than the other way around.
What young men do – most projects had a view about
what beliefs and attributes many young men have that
would inhibit their engagement with professional services.
They ‘see their bodies as machines’ (Alive and Kicking);
they ‘often resist treatment and get into conflict with
hospital staff’ (Hospital Youth Work Team).
What emerges out of practice – a number of themes and
understandings emerged out of projects’ ongoing
engagement with young men. While many of these are
discussed in more detail in the following Methods section,
they show a developing understanding of what does and
does not work with boys and young men. ‘Young men are
often reluctant to reflect, they are not used to it’ (Leap) –
a belief that young men present a front when in public
places (especially with their mates), while they will be
much more open and straightforward when they are on
41

their own. This was mentioned by Barnardo’s, New Bridge
and Leap, in particular, and informed the way they worked
with young men.
These three levels (targeting, young men’s experience of
gender, and the impact of masculinity on developing
practice) were taken on in varying degrees. Most projects
used an understanding of masculinity to inform their
targeting strategy, with a smaller number developing
engagement methods out of the same understanding. Still
fewer felt there was a need to also use this understanding
to change ‘clinical practice’.
Methods
Not surprisingly, the projects had a lot to say about
methods and ways of working with boys and young men.
While some were working with individual young men, the
majority were working with groups. There has been an
acknowledgement that working with individual young men
can be difficult, but that groups of young men consistently
raise a series of control and containment issues for workers
(Lloyd, 1997), and projects had much to say about this. We
have translated these themes into a series of considerations
or approaches that other workers will find of interest.
Be positive about boys and young men – while this is an
obvious element of working with anyone, many workers
do seem to have particular difficulty in approaching young
men in this way. Projects such as 42nd Street stressed the
importance of a positive, pro-young men approach as an
essential component of their work. Interestingly, New
Bridge said that showing respect for young men was
important in its work, and that young men had said that
they liked the course because they had been treated ‘like
human beings’. It is a bizarre thought – and a very
worrying one – to think that many people find it too
difficult to have positive attitudes towards young men.
Be practical, direct and engage – many projects talked
about methods that were direct, practical and engaging as
the ones that worked best. Running the Risk found that
young men responded when the worker was ‘more direct
and even confrontational’, while CALM said that young
men were usually looking for ‘relief and solutions’. New
Bridge makes sure that sessions are ‘practical, move
quickly and have lots of content’. Strides, found that the
more practical the session (condoms, for example), the
more young men enjoyed them and were able to
recognise the learning. Other projects reported that young
men were less able to see the value of ‘talk’ and found it
harder to identify the learning involved.
Feelings take longer – some said that the more reflective
and feeling-based sessions were more difficult to deliver to
young men, and these usually took much longer. Most of
the projects accepted that if they wanted to work at an
emotional level they had to give this time. Barnardo’s and
42nd Street both mentioned barriers for young men and
high levels of isolation, and even that some young men
needed to ‘develop a language’ to talk about their
emotions. Some projects (such as Alive and Kicking) were
reluctant to be too ambitious in their aims, in part because
they were not sure how much attention their activities
would be given.
Gender and emotions – those agencies that work with
young men and women usually commented on the gender
differences they see in their work. Young women were
thought to be closer to their emotions, more willing to sit
and discuss them, more reflective about both their
emotions and their ideas, and as a result they were often
seen as ‘easier to work with’. In contrast, some of these
issues were seen as major barriers to working with boys
and young men. Much of the thought given to methods
was related to ways these barriers could be surmounted.
Make the work stimulating and interesting – while any
work with people needs to be stimulating and interesting,
workers were particularly concerned about this when trying
to engage groups of boys and young men.
Young men like to be challenged and given situations
where they need to take risks – while most would quickly
agree with this statement about physical activity and
young men, projects also found this to be the case in
discussion work. Loud Mouth, using its ‘hot seating’
technique, found young men very willing to ask questions
of characters in the drama and help develop the plot. They
often showed willingness to take risks in this type of
activity, while they were reluctant to open up in more
reflective and personal discussions. Running the Risk found
that young men invited the worker to confront them about
their risk-taking behaviours, and liked this approach.
Use an adaptable approach – Running the Risk and Strides
both stressed that their approach varied with different
groups of young men, depending on the young men’s
42 Boys’ and Young Men’s Health: What Works?

willingness to reflect on and discuss their sexual health. If
they were willing to talk, they went with that approach; if
they were more reluctant, they used exercises that
engaged young men and got them involved with the
materials and subject matter. The same projects stressed
the importance of engaging young men before they were
able to use more reflective methods.
Solution-based, not problem-based – projects found young
men reluctant to ‘discuss problems’, and some found that
a more solution-based approach engaged young men and
enabled them to value the discussions more. 42nd Street
(within its mental health work) explored solution-based
approaches, and while there were some difficulties, they
found themselves a step on from more reflective
approaches.
Humour helps – both New Bridge and Loud Mouth said
that humour was an important part of their work. Loud
Mouth wrote performance material with young men’s
attention span in mind, and used humour to stimulate
them.
Approach young men when they are receptive – the
Hospital Youth Work Team stressed this as a crucial
element of their approach. Other projects highlighted that
‘timing’ made a difference to their work with young men.
‘When they were receptive’, may have been about
settings (YOIs for New Bridge and Leap); about the worker
(Running the Risk, where the worker presented as nearer
to them than other sexual health professionals); or about
desperation (CALM, 42nd Street, and even the Hospital
Youth Work Team).
Staffing issues
None of the projects suggested that male staff were an
essential component of developing work. This is in sharp
contrast with much of the debate around male role models
and the need for a male presence, and even a male
culture, within primary and secondary education and the
family. While these discussions rarely highlight the skills
and attributes that these males are supposed to bring,
there was surprisingly little mention of this within project
interviews.
There was more discussion about male presence being a
barrier, for example within the two projects that worked
with young men around sexual abuse. Both 42nd Street
Emerging themes
and Barnardo’s said they would have liked to have been
able to give young men the option of talking to a female
worker.
A study looking at What Works with Fathers? (Lloyd, 2001)
found that being male was a secondary issue to being
competent, informed, able and willing to engage with
fathers. Within a series of interviews with boys and young
men who were asked ‘what makes a good teacher?’, the
young men consistently said that attributes such as being
firm but fun were ahead of the teacher’s gender (Working
With Men, 1998).
While projects were operating at a broad range of levels,
from information and reflection (Alive and Kicking),
through to longer-term counselling (42nd Street and
Barnardo’s), there were recognisable skills and attributes
that workers needed to work effectively with boys and
young men. These included:
• Significant understanding of boys and young men
• Significant knowledge of the lives of boys and young men
• A positive approach that enabled them to engage with
boys and young men
• Willingness to acknowledge their own difficulties in
engaging young men, as well as young men’s difficulties
in engaging with services
• Motivation and patience to persist with engaging with
young men (despite their reluctance and, sometimes,
resistance)
• Confidence that has developed out of the experience of
working with boys and young men
• Ability to integrate an understanding and knowledge of
boys and young men into developing practice
• Significant knowledge and experience of the conditions
or issues that the project is focusing on (suicide,
violence, sexual health, fatherhood, mental health,
sexuality and general health).
Interestingly, none of these is an exclusively male-specific
attribute, quality, characteristic or experience. Most can be
taught or developed through practice. However, most
projects also suggested that skilled staff were essential,
and that these skills needed to be developed over and
above workers’ basic professional training.
Another staffing issue was, in part, determined by the size
and focus of the organisation initiating the project. At one
extreme were the very well established, large agencies
43

such as Leap and 42nd Street; and at the other, Running
the Risk and Strides, with one dedicated worker. Leap and
42nd Street had substantial experience and a well tested
approach that any new worker would be absorbed into.
Within these organisations there was an established way of
working, based on previous (and existing) workers’
practices.
Within one-worker initiatives this was much harder to
sustain and, by definition, the quality – and often success –
was based primarily on the worker’s skills and abilities. Too
many one-worker initiatives with boys and young men
have developed and then collapsed because a worker has
left and the agency has been unable to replace them with
another worker possessing the same level of skill and
commitment (see back issues of the journal Working With
Men). We have already seen with Running the Risk how
important this can be. Indeed, one very well established
project that was to be included in this review has been left
out because the work died in between a worker leaving
and another being appointed.
While this is not an exclusive problem to work with boys
and young men, many have suggested that there is a skills
shortage. Workers who have experience of working with
boys and young men in these innovative ways appear to
be few and far between.
Clarity of purpose
Common among these 12 projects is clarity about what
they were trying to do. Of course, many of the agencies
had been in existence for some years, and confessed that
this clarity of purpose had not always been there.
Barnardo’s, for example, told us that at the beginning of
the project the aim was to make contact with young men!
Contact to do what was never really clear – an approach
had replaced a purpose. When the service was reviewed,
the agency dealt with the more fundamental question of
purpose, which has enabled it to clarify what it is trying to
do (child protection agency).
Too often, projects say their aim is to ‘set up a young
men’s group’, which is a method rather than a purpose or
aim. The 12 projects here were able to articulate their
purpose, aims, methods and benefits for the young men.
Clarity of purpose is the cornerstone of most of these
projects.
A questioning environment
Many of the 12 projects were developmental in nature.
They were working in areas where there are very few
initiatives, let alone many that are seen as good examples
of practice. They were often seen as at the forefront of the
sector they were in – in some cases not just in terms of
work with boys and young men, but in the context of
broader developments. This is certainly the case for 42nd
Street, Leap, Loud Mouth Theatre Company and New
Bridge. However, common to most projects was an
approach that suggested they were still mulling over the
question, rather than that they had found the answer. This
willingness to continue the pursuit of good practice,
appears to be an important element of their approach.
Seen in Dorset’s being prepared to overhaul substantial
sectors of provision (in the case of Child and Adult Mental
Health Services), and in Loud Mouth’s continuing to
rewrite programmes that others thought worked perfectly
well, is the questioning, ever-improving and learning
environment that most agencies chose to operate within.
Gender and/or what works
Projects such as Strides and Running the Risk were
established within a gendered perspective. They started
from the assumption that gender affected targeting
strategies, methods and achievable outcomes and outputs.
Gender and masculinity therefore underpinned their
developing practice.
In contrast, New Bridge and Dorset’s suicide strategy, for
example, developed out of an understanding of the issues
being addressed (parenting and suicide), and then by what
worked in practice. This willingness continually to review
whether the methods being used achieved the desired
outcomes meant that a gendered approach developed out
of a careful focus on the impact of the work, not
necessarily out of a detailed understanding of young men
themselves (which often developed later).
The only conclusion to be drawn from this is that either
can work. However, the approach of New Bridge and
Dorset has a lot to say to projects that are within the
mainstream of services. The reality is, that most projects
have a brief to work with both males and females, and
specialist single-gender agencies will always (and quite
appropriately) be a minority of agencies whose function is
to break new ground and inform others.
44 Boys’ and Young Men’s Health: What Works?

Evaluation
Even within these well established agencies, evaluation
has been very limited. Interestingly, the smaller the
initiative, the more likely it is that an external evaluation
has taken place. ENIGMA and Alive and Kicking stand
out, but they are also the smallest, most focused initiatives
of the 12. Strides has also been formally evaluated, and
again, the nature of its courses makes its impact
measurable. CALM has an ongoing monitoring and
evaluation component, but the nature of the service
(campaign and confidential helpline) makes the evaluation
criteria much less solid (relying on aspects such as ‘service
recognition’). Leap has had components of its work
evaluated (usually when organisations using their services
carry out an evaluation themselves), as have Loud Mouth
and Dorset.
Most of the other organisations reviewed here have had
no formal evaluation of their services, surprisingly including
the Hospital Youth Work Team, which is health action
zone-funded.
Funding
Project funding came from a very broad range of sources,
including Department of Health, local HIV funds, health
action zones, health and education authorities, and the
larger charitable foundations. On the whole, these projects
were relatively well funded – well enough to attract
experienced and qualified staff; to know that projects were
secure for at least a year; and so that important indirect
aspects of the work (supervision, management, staff
training) could be offered and delivered. This is probably
no coincidence. Projects will need substantial funding if
they are to develop quality work with boys and young
men.
Conclusion
This publication aims to give other professionals an insight
into 12 well established examples of practice with boys
and young men. They are diverse in approach, methods,
aims and conditions, and even in the groups of young men
targeted, and they indicate above all else that a broad
range of approaches work with boys and young men. It is
much too early to say that any approach can be rolled out
in any environment, by any agency. Even the most
experienced of these projects are still finding their way to
Emerging themes
be effective in their work. However, their collective
experience has a lot to say to others about how they might
approach their work. If this can contribute to helping other
professionals reflect on and develop their work with boys
and young men, then it has served an important purpose.
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Development Agency, London.
Lloyd T. (1997) Let’s Get Changed Lads (development work with
boys and young men). Working With Men, London.
Lloyd T. (2001) What Works with Fathers? Working With Men,
London.
Working With Men was a practice-based quarterly journal
produced from 1990–2001. Working With Men, London.
wym (working with young men). (2002). Working With Men,
London.
45