Children and Young People’s Mental Health and Wellbeing Local Transformation Plan for Sandwell 2019-21
A system partnership committed to transforming access and support to give the best start in life
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List of Contents
1. Foreword ………………………………………………………………….... 2 2. Introduction ………………………………………………………………… 3 3. Transparency & Governance ……………………………………………. 4 4. Understanding Local Need ………………………………………………. 31 5. LTP Ambitions 2018 – 2020, Our Priorities ……………………………. 54 6. Workforce ………………………………………………………………….. 78 7. Health & Justice …………………………………………………………… 89 8. Eating Disorders …………………………………………………………... 95 9. Data - Access & Outcomes ………………………………………………. 98 10. Urgent & Emergency Care (Crisis) MH for Health Care CYP ………... 103 11. Early Intervention in Psychosis ………………………………………….. 104 12. CYP Mental Health Services …………………………………………….. 106 13. Abbreviations ……………………………………………………………… 113
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1. FOREWORD
The national survey report ‘Mental Health of children and young people in England’ (2017) highlighted some worrying statistics. One in eight children, aged 5-19 years had at least one mental disorder with emotional disorders being the most prevalent. Rates of mental disorders increased with age and show a slight increase since 1999 from 9.7% to 11.2% in 2017. So, it is only right that children and young people are placed front and centre of the NHS Long Term Plan (2019). The Plan outlines how NHS children and young people’s services will move to a 0- 25 years’ service and towards service models for young people that offer person-centred and age appropriate care for mental and physical health needs, rather than an arbitrary transition to adult services based on age not need.
We are working with our partners to design and implement models of care across the Black Country that meet these needs, that are closer to home and that bring t ogether physical and mental health services. These models will support health development by providing holistic care across local authority and NHS services, including primary care, community services, speech and language therapy, school nursing, oral health, acute and specialised services. We continue to focus on the development of the Thrive model which moves away from tier-based services with artificial boundaries and towards integrated agencies working together to deliver prevention and advice, early support, help and more help. This model will enable the 90,000 children and young people in the area to access age- appropriate, family orientated child-focused services delivered using the framework of prevention before mental health problems develop, treatment ranging from low level support to specialist medical intervention, based on multi-agency integrated care and then support for recovery and discharge from services; the child and family always receiving the right level and type of support for their needs.
To achieve this we must continue to invest further, with other agencies to ensure our workforce is prepared to deliver early years support for children provided by third sector services, school nursing and health visitors, for older children access to mental health promotion and prevention services in schools to prevent the development of more established problems, improved student welfare and advice services for those young people in colleges and at university, transitions that mean children do not fall between the gaps and the aim that when services are fully established then 100% should receive a wrap-around, recovery-focused, holistic offer of care and support to the young person and their family.
Although much work has already taken place, we must continue to develop services fit for our children and young people in the future. Our Transformation plan is a living document which must develop, adapt and grow to meet the needs of our children, now and in the future.
Dr Liz England
SWB CCG Mental Health and Learning Disabilities Clinical Lead RCGP Mental Health Clinical and Commissioning Lead 2
2. INTRODUCTION
Sandwell and West Birmingham CCG is committed to work with our partners to build effective, evidence-based outcome-focused Children and Young people’s Mental Health Services (CYPMHS). Through system wide leadership and working in collaboration with children, young people and families, this plan confirms our continued commitment to transforming access and support for children and young people and their families.
Future in Mind outlined recommendations to improve the quality of provision of mental health and wellbeing services for children and young people. In addition, it established the key principles to make it easier for children and young people to access high quality mental health when they need it.
The Five Year Forward View for Mental Health (February 2016, NHS England) identified children and young people as a priority group for mental health promotion and prevention and endorsed the vision set out in Future in Mind. It is clear that:
• early intervention and quick access to good quality care is vital • waiting times must be significantly reduced • inequalities in access should be addressed, and • support needs to be available whilst people are waiting for care • the workforce across health, social care and education needs the right mix of skills, competencies and experience i.e. is fit for purpose.
To deliver the national ambition, Future in Mind suggested the development and agreement of Transformation Plans for Children and Young People’s Mental Health and Wellbeing. The plans should clearly articulate the local service offer, covering the whole spectrum of services i.e. health promotion and prevention work, support and interventions for children and young people who have existing or emerging mental health problems, as well as transitions between services. The plans were to be drawn up by the lead commissioner, typically Clinical Commissioning Groups, working closely with Health and Wellbeing Board partners and underpinned by additional investment from NHS England.
Since 2015 priority has been placed on the Sandwell and West Birmingham local health and care system to work together with greater synergy, accountability and simplicity to improve CAMHS. Our partners include:
• Sandwell Children’s Trust • Sandwell Metropolitan Borough Council • Sandwell Health and Wellbeing Board • The Children’s Society and other voluntary sector organisations • Black Country Partnership Foundation NHS Trust • Sandwell and West Birmingham Hospitals NHS Trust • Sandwell and West Birmingham CCG (SWB CCG) • Children, young people and their families living in Sandwell and West Birmingham
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• Birmingham and Solihull CCG • Healthwatch • NHS England
SWB CCG recognises its accountability for ensuring people registered with GPs in Sandwell and West Birmingham requiring health services have equitable access to effective interventions, experiences and benefit from improved health outcomes. It maintains a close working relationship with Birmingham and Solihull CCG who is responsible for commissioning services for our West Birmingham population, including children and young people. The West Birmingham Joint Commissioning Committee has been established for the purpose of ensuring strategic alignment, consistency of provision and assurance purposes.
Each partner recognises the value in bringing our NHS, Local Authority, voluntary sector and digital experts together, working alongside parents and children and young people to improve the local service offer. We agree it is time for continued and sustained change.
We are delivering an ambitious, transformational programme of work to significantly re- shape the way services for children and young people with mental health needs are commissioned and delivered across all agencies, and in line with proposals put forward in Future in Mind. To this end, the Sandwell and West Birmingham Children and Young People’s Mental Health and Wellbeing Local Transformation Plan (CYP LTP) has been refreshed. Its implementation will enable our local children and young people to get support more quickly, easily and locally. Its delivery will ensure that the current, and future, generations of children and young people are fully supported to succeed.
Whilst progress has been made in many areas identified in the original plan, there is still much further partnership work to do to ensure that children and young people in Sandwell and West Birmingham are able to access the mental health and wellbeing services as well as specialist CAMHS that they require in the right place and at the appropriate time.
The Transformation Plan has been refreshed and updated each year in order to report on its implementation and impact and to provide assurance that our aims are being delivered through appropriate investment, service redesign and system change. This is the 2019 refresh of the Sandwell plan.
3. TRANSPARENCY AND GOVERNANCE
In this section we describe: • How local people and partners can access the Local Transformation Plan (LTP) • Alignment of the of our LTP with the Sustainability and Transformation Plans for the Black Country, and also Birmingham and Solihull • The work of the Local Transformation Board in responding to the voice of CYP and their parents/carers that reflects the diversity of the local population • Local Transformation Plan baseline information including finance and activity 4
• Our processes for tracking and reporting progress • Engagement with Children and Young People in the transformation and commissioning of services
The Sandwell and West Birmingham Children and Young People’s Mental Health and Wellbeing Local Transformation Plan will be accessible on the Sandwell and West Birmingham CCG webpage. It will be available on our partner’s websites in Sandwell and West Birmingham including Black Country Partnership NHS Trust, Sandwell Metropolitan Borough Council, Sandwell and West Birmingham Hospitals NHS Trust, Healthwatch (both Sandwell and Birmingham) and Sandwell/Birmingham Voluntary Sector Organisations.
CYP LTP and Black Country and West Birmingham Sustainability and Transformation Plan
The Black Country and West Birmingham Sustainability and Transformation Partnership (BCWB STP) for Mental Health and Learning Disability services focuses on the collaboration between providers and commissioners to improve care and outcomes for service users, including CYP and their families/carers. The ambition is for patients to have access to universal and specialist mental health and emotional wellbeing initiatives, with an increased focus on prevention and early intervention at key moments in life that integrates physical and mental health as well as improving their quality of life chances and opportunities. Furthermore, we want people with learning disabilities and/or autism to be seen as citizens with rights who should expect to lead active lives in the community.
One Mental Health Commissioner A key priority for the BCWB STP is to work as ‘one NHS commissioner’ across the geography, ‘leading to a substantial reduction in the current unwarranted variations in the quality of care, standardised services, and the creation of an environment in which our providers can maximise resources and workforce through better skill mix utilisation’.
During 2018/19 SWB CCG worked with the other 3 Black Country CCGs (Dudley, Walsall and Wolverhampton) to align service specifications for the following services:
• CAMHS Core • CAMHS Crisis • Eating Disorders • Early Intervention in Psychosis (all age pathway) • Criminal Justice.
Following governance approval across the four CCGs, the financial case for commissioning these services ‘as one’ is being progressed during this year. The ambition is that these shared service specifications will be incorporated into 2020/21 provider contracts to ensure patients access and receive care in a consistent manner to meet their needs, regardless of the borough in which their General Practitioner (GP) is located.
Services delivered to meet the ‘one commissioner’ requirements will create equity of provision
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for CYP, which in turn is expected to reduce unwarranted variation and improve the quality of care provided. Our approach will result in core components of services being delivered across all our providers within the STP footprint. This enables us as a system to work together more productively, efficiently and effectively and where possible join up delivery of key services.
SWB CCG is as committed as our partner CCGs in both the BCWB and Birmingham and Solihull Sustainability and Transformation Partnerships to achieve ‘parity of esteem’ i.e. valuing mental health equally with physical health across the footprint. Achieving this would see our patients benefitting from equal access to the most effective and safest care and treatment, equally high aspirations for service users, equal status in the measurement of health outcomes and equity in the allocation of funding and resources on a basis commensurate with need i.e. meeting the Mental Health Investment Standard.
The BCWB Sustainability and Transformation Plan refers to sharing of best practice and aligning to the work of other agencies to reduce variation; improve access, choice, quality and efficiency; and collaboration to develop new highly specialised services in the Black Country and West Birmingham e.g. Children’s Tier 4. Furthermore, the Black Country CCGs are working together to co-design, agree and establish a pathway-based suite of designed and specified services for CAMHS Learning Disabilities common to all 4 areas of the STP footprint.
Transforming Care
SWB CCG is part of the Transforming Care Partnership (TCP) in BCWB and as an associate to Birmingham and Solihull BSOL). The Partnership in each area is committed to improving the lives of children, young people (as well as adults) with a learning disability and/or autism who display behaviours that challenge, including those with a co-morbid mental health condition. In 2019/20 (to date), there is only 1 Sandwell and West Birmingham CYP admitted to a Tier 4 bed, with an intended discharge before 31st March 2020.
Delivering the TCP programme requires continuous planning, information exchange and cooperation with colleagues in the NHS England (NHSE) Specialised Commissioning team about children and young people hospital admissions and discharge arrangements. Alongside health we work very closely with special education need (SEN) officers and social care.
We know that through more coordinated approaches to commissioning of services will support better care planning for those CYP in the most need. We continue to work with colleagues in NHSE to prevent admissions where possible but also where admission is required to ensure our local providers provide in-reach support that will aid discharge processes. We have examples of where this has worked very well specifically for children and young people with Learning Disabilities and/or Autistic Spectrum Disorder (ASD) and/or behaviours that challenge.
SWB CCG is actively involved in the work programme of the TCP children and young people’s
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sub-group, the priories being:
• Ensuring the availability of services for children and young people with ASD only, and a model of care that improves the infra-structure to provide more community options for when a child or young person enters a crisis;
• Actively monitoring the dynamic risk register, identifying children and young people who are at risk from admission and taking proactive action to reduce the likelihood of requiring hospital care;
• Acting as a support network, ensuring all community service options are pursued to avoid unnecessary hospital admissions.
• Undertaking Care and Education Treatment Reviews (CETRs) to: − reduce hospital admissions and unnecessary lengthy stays in hospital − facilitate a person-centred approach to ensure the treatment and support − needs of the child or adult with a learning disability and or autism and their families are met, and − challenge and overcome any barriers to progress.
• Auditing inpatient admissions to learn what action might have been to prevent the need for admission and ensure future application of that learning
• Working closely in partnership with NHSE to ensure children and young people who are admitted to hospital receive the appropriate care and treatment. This includes ensuring a clear multi-agency discharge plan is developed to support the child/young person and family to come back home.
As part of TCP, the Children and Young Peoples’ Pathway project seeks to develop a service model for CYP with ASD and/or Learning Disabilities to receive the most appropriate care within the community including home-based interventions. The project will ensure we have a clear understanding of the population we commission services for, who are at risk of admission and the type of services required to prevent admission (if possible) with a view to looking to develop services at prevention and early intervention level working with colleagues across the patch in the Local authorities/Children’s Trust.
Our model is premised on reducing admissions and proactively supporting discharge where repatriation CYP into appropriate services and to their own communities is a key objective. Outcomes for community support are to:
• reduce the usage of Tier 4 hospital beds (and for shorter lengths of stay) • provide 52-week residential care • establish ‘home-based’ interventions/services with Key Performance Indicators (KPIs) in each of the 4 Black Country local areas, and • develop criteria and establish local and regional ‘At-Risk’ Register.
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The outcomes for inpatient services are to:
• develop tool to evidence post- Care and Education Treatment Reviews (CETRs) provider planning; and • understand child admission and re-admission cases through case reviews using completed Root Cause Analysis to build up themes and learn lessons.
The Birmingham and Solihull Transforming Care programme is responsible for our west Birmingham registered population. The CCG has a seat on the Transforming Care Advisory Board and contributes to delivering the agenda as appropriate.
CYP LTP and the Birmingham and Solihull Sustainability and Transformation Plan
Birmingham and Solihull CCG (BSoL CCG) is responsible for planning and commissioning health services for people living in Birmingham and Solihull. As such, SWB CCG works with BSoL CCG to commission health services for people living in West Birmingham to ensure parity and equity of provision across the Sandwell and West Birmingham footprint.
Given SWB CCG’s commissioning responsibility for the west Birmingham population, we work as an ‘associate’ member with all the Birmingham and Solihull (BSoL) Sustainability and Transformation Partnership members:
• Birmingham and Solihull Mental Health NHS Foundation Trust • Birmingham Children’s Hospital NHS Foundation Trust • Forward Thinking Birmingham • Birmingham and Solihull CCG • Sandwell and West Birmingham CCG • Birmingham Health and Wellbeing Board • Birmingham City Council • National Probation Service • Staffordshire and West Midlands Community Rehabilitation Company • West Midlands Police, and • Solihull Metropolitan Borough Council. Our patients in west Birmingham access the 0 – 25 years model that incorporates the Future in Mind recommendations and benefit from the investment already made in Eating Disorders, Early Intervention into Psychosis and children’s Improving Access to Psychological Therapies. Birmingham commissioners have sought to provide seamless support at the earliest point of need and remove barriers to access by working with partners including the voluntary community sector, education and children’s services. The Birmingham LTP provides an overview of what has been achieved so far and outlines the plans to deliver Future in Mind ambitions by 2020/21. It can be accessed via https://www.birminghamandsolihullccg.nhs.uk/about-us/publications/strategic/2181- birmingham-children-and-young-peoples-mental-health-and-wellbeing-local- transformation- plan-201920/file
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Specialised Commissioning
CAMHS Tier 4 are specialised services that provide assessment and treatment for children and young people with emotional, behavioural or mental health difficulties i.e. those with more complex needs usually requiring inpatient treatment. These are commissioned by NHSE.
Since 2017/18 specialised commissioning nationally has been working to shift Tier 4 into localities. Established steady state commissioning is the approach being taken to develop and implement new care models by April 2020. We are engaged in this programme, considering local models of care being established nationally.
Specialised commissioning is involved in supporting development of the New Care Models which is now called Establishing Steady State Commissioning (ESSC) and the favoured provider for community provision as part of the Provider Collaborative. Establishing a new care model for the Black Country is another key strand of the ‘One Commissioner’ programme in which we are fully engaged and supporting delivery. Our Mental Health STP Lead at Wolverhampton CCG is providing strategic oversight and leadership for new care model development. Sandwell is part of the One Commissioner meetings and are tasked within ensuring local connectivity to Black country STP. Sandwell embraces new care models design features and will work with partners to redesign local services to support triple integration across primary and specialist care, physical and mental health.
Furthermore, as part of the review of inpatient services our provider, Black Country Partnership Foundation Trust, is working with other mental health providers to explore place-based commissioning of inpatient provision to support children and young people within our STP footprint. We know that through more coordinated approaches to commissioning of services will support better care planning for those CYP in the most need. BCPFT’s involvement has been through the clinical pathways development groups for both CAMHS and ED and at Board level for CAMHS and at a strategic level for both developments.
NHSE – Midlands and East Regional Team have been party to the development of our transformation plan. We routinely work closely with NHSE when any of our children or young people have been admitted to an inpatient facility to ensure that connectivity with local CAMHS services are made to support discharge planning.
We will continue to support implementation of new care models with a focus to ensure children and young people receive the most appropriate care where possible in the community, and locally.
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Sandwell Health and Wellbeing Board
Leaders across health and care, including the voluntary and community sectors, through the Health and Wellbeing Board (HWB) have signed up to Sandwell’s Vision 2030 and its ambition to deliver 10 ambitions that will ensure Sandwell is a thriving, optimistic and resilient community by the end of the next decade. Partners on the HWB include the:
• Director of Children’s Services, Sandwell Metropolitan Borough Council • Chief Executive, Sandwell Children’s Trust • Cabinet Member for Children’s and Young People • Chief Executive - Black Country Partnership Foundation Trust • Chief Executive - Sandwell and West Birmingham Hospitals NHS Trust • Chief Executive - Sandwell Community Voluntary and Community Sector • Accountable Officer – SWB CCG • General Practitioner (GP) Director – SWB CCG
Ambitions 3 and 4 are particularly pertinent to the children and young people’s agenda:
• Ambition 3: Our workforce and young people are skilled and talented, geared up to respond to changing business needs and to win rewarding jobs in a growing economy
• Ambition 4: Our children benefit from the best start in life and a high-quality education throughout their school careers with outstanding support from their teachers and families
Strategic Commissioning Partnership for Children, Young People and Families Board
The Partnership has been created this year in response to comments and recommendations within the Ofsted report (January 2018). The Partnership aims to evidence a more robust commissioning process, fully informed by comprehensive plans and processes including client and public involvement. It is the responsibility of the partnership to establish the needs of children, young people and families within the Borough, to identify:
• what we know about these needs • what currently works well • what could be done differently, and • to use this information to identify gaps and future commissioning opportunities.
Membership of the partnership will be open to those working with children, young people and families within the Borough. The partnership will operate as an ‘alliance’ of commissioners and providers and will initially include representatives from:
• Sandwell Metropolitan Borough Council • Sandwell Children’s Trust
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• Sandwell and West Birmingham Clinical Commissioning Group • Sandwell and West Birmingham Hospitals NHS Trust • Black Country Partnership NHS Foundation Trust • West Midlands Police • Sandwell Council of Voluntary Organisations.
After one year, the partnership seeks to evidence its successes in measurable outcomes and outwardly show where its presence has had positive impacts for children, young people and families in Sandwell.
Sandwell’s Thrive (CAMHS) Board
The Thrive Board, previously the CAMHS Board, is an Executive Director Level forum that continues to oversee the delivery of the local transformation plan. The Thrive Board reports into the Health and Wellbeing Board via the newly established Strategic Commissioning Partnership for Children, Young People and Families Board (see governance landscape in Figure 1 below). The programme of work to deliver the plan is undertaken through active multi-partner operational work groups.
The revised governance provides for continued multi-agency system leadership and collaboration intent upon shaping and driving a partnership approach to service planning, commissioning and delivery that improves local services. It facilitates the continual review and refresh of this CYP LTP by health and care leaders and frontline professionals across the Sandwell place and system.
The Thrive Board is chaired by the CCG clinical lead. Its membership comprises a combination of executive level, and other senior managers from Sandwell Metropolitan Borough Council, Sandwell and West Birmingham CCG and BSoL CCG, Public Health, Education and a range of voluntary and community sector (VCS) organisations.
The Thrive Board oversees the delivery of the plan and ensures that risks are managed appropriately. Sandwell’s governance arrangements reflect individual’s accountabilities whilst also creating a basis for collective action. They are inclusive, and as such ensure that those involved in delivering and receiving services are meaningfully involved in decision-making and able to co-ordinate the range of activities necessary to meet the plans ambitious objectives.
The combined effort has resulted in year on year improvements in how services are delivered. Partners continue to work together, refining their approaches and the extent of integration to ensure that the best outcomes can be achieved for children, young people and their families.
The governance arrangements include Executive Sponsorship. This allows leaders to work collaboratively, using a system leadership approach, based on negotiation and influence. Importantly this is underpinned by clinical leadership and the engagement of frontline clinical staff. Ensuring that Sandwell can deliver on changes needed.
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The Thrive Board has a strong commitment from all partner/member organisations. It is characterised by an atmosphere of constructive challenge and the freely expressed views of all board members which are reconciled in the interests of improving services for local children and young people. There is a sense of collective responsibility for delivery of the programme, whilst individual partners are held to account for improvement in their constituent elements of the plan.
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Figure 1: Children and Young Peoples Governance Landscape
STP TCP Board West Midlands Commissioning Board MH STP One Commissioner Programme
Regional Adoption Agency School Improvement Group
Early Years Transformation Police and Schools Panel Academy
Adverse Childhood Early Help Partnership Experiences Steering Group
Co-operative Working Board SEND Partnership Board (School nursing & Health Visiting)
Corporate Parenting Board
Thriving Getting Advice Getting More Help and Partnership Help Group Risk Support Group
Safer Sandwell Sandwell Safeguarding Sandwell Children’s Sandwell Improvement Partnership Adult’s Board Safeguarding Partnership Board
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Sandwell and West Birmingham Outcomes Framework
SWB CCG is leading the development of two separate outcomes frameworks for each of the places within the local area; Sandwell and West Birmingham. They will operate as single frameworks in response to the individually agreed priorities of multiple health and social care organisations operating in each place.
The agreed Outcomes Framework for Sandwell was developed in conjunction with local authority colleagues, based upon a thematic approach covering all population ages, that provides for a clear and strong focus on the best start in life for local people. The coproduction nature of this work across both health and social care sees real progression in moving towards working together on a whole population basis, and all children and young people therein.
The structure of the Sandwell framework is that of thematic areas which are underpinned by high level outcomes which are, in turn, underpinned by metrics to ensure that collectively we can evidence real change for people. These range from infant mortality to school readiness to life aspirations/ambitions in the teenage years.
There were three priority areas selected, one of which was the ‘Best Start in Life’. The outcomes frameworks will cover multiple health and social care organisations, both statutory and non-statutory, with the initial term intended to be for five years. The longer term will allow organisations to move away from annual round of contracting and cyclical lurches in service provision and organisational assurance to allow real investment into what matters to people over the longer term.
Public Health The Public Health Directorate within Sandwell Local Authority is represented at all levels of decision-making in the Thrive Governance arrangements. The Public Health team provide leadership and support at both strategic and operational levels including:
• Collating and analysing data to inform the Joint Strategic Needs Assessment (JSNA) • Providing information and the evidence base to inform commissioning decisions • Supporting evaluation design • Providing wider public health information and connectivity with wider upstream prevention work, for example social prescribing for wellbeing, community-led resilience projects, Early Years Transformation • Co-ordinating the ‘Thriving’ workstream via a multi-agency meeting - this group will continue the work of the previous Emotional Health and Wellbeing Steering Group and focus on the Whole School Approach to Wellbeing, contribution of the universal/non-specialist workforce and Voluntary Care Sector (VCS), universal training, awareness campaigns/communications and Personal Social and Health Education (PSHE) • Feeing in the voice of CYP coming through the SHAPE Programme and other engagement and insight work.
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Sandwell Children’s Trust
Following a statutory direction, Sandwell Local Authority has delegated its duties to deliver children’s social care services to Sandwell Children’s Trust under section 479A of the Education Act 1996. Its creation creates new opportunities for health and social care to integrate and really make a difference for the most vulnerable children in the borough.
Sandwell Children’s Trust established in 2018 and aims to move the rating for provision of children’s services from “inadequate” to “good”. In addition to this, Sandwell Local Authority has identified 8 key priority areas which it expects the Children’s Trust to achieve, including:
• Children looked after • Vulnerable groups (Child Exploitation including sexual, missing, and trafficked) • Partnership • Voice of the Child
The services delivered by the Children’s Trust have direct and indirect impacts upon demand and how emotional wellbeing and mental health services work together.
Sandwell Children’s Safeguarding Board
The safety and welfare of children is of paramount importance to SWB CCG and the partners in our local systems. We are a key contributor within the Sandwell Children’s Safeguarding Partnership (SCSP), the governance structure for which is shown in Figure 2 below. Figure 2: Sandwell Children’s Safeguarding Partnership Governance Structure
“Working together to keep children”
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SCSP is a partnership of all the different organisations working to protect children and young people across the borough, including the VCS. We bring together information for children, young people and their families and the professionals who work with them. The SCSP ensures that all organisations that work with children work together to keep children and young people safe from harm, abuse or neglect. Partners collaborate to make safeguarding everyone’s responsibility and promote the welfare of children, providing training, development of policies and procedures and raising awareness.
Sandwell is seeing an increasing number of children and their families being referred to statutory services. Given the increased demand and children entering care it is likely that many of these children and young people will have been exposed to one or more Adverse Childhood Experiences (ACEs). ACEs is the term used to describe all types of abuse, neglect, and other potentially traumatic experiences that occur to people under the age of 18, and have been linked to risky health behaviours, chronic health conditions, low life potential, and early death. Early adversity has lasting impacts and as the number of ACEs a child or young person increases, so does the risk for these outcomes.
We need to work together to ensure professionals, parents and carers are equipped to provide low level support during emotionally challenging times for some children and young people who are entering care or deemed a Child in Need.
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Special Educational Needs and Disability (SEND)
Special educational needs and disabilities (SEND) can affect a child or young person’s ability to learn. We know that SEND can affect a young person’s:
• behaviour or ability to socialise, for example they struggle to make friends • reading and writing, for example because they have dyslexia • ability to understand things • concentration levels, for example because they have Attention Deficit Hyperactivity Disorder (ADHD) • physical ability.
Percentages of pupils with Moderate Learning Difficulties (MLD) in Sandwell primary schools are reducing following targeted work on over-identification (at SEN Support level). The national average for 2019 has reduced in the last year and therefore Sandwell is 2.4% above national despite continues reductions. Pupils with Severe Learning Difficulties (SLD) in Primary schools in 2019 was 0.3% compared to national 0.6%.
This work will include understanding of the activity being undertaken for the cohort aged 18 - 25 which appears to be unclear. Targeted work on the over-identification of MLD (at SEN Support) has had an impact in secondary school percentages but there is still a lot more development work to do in order to bring percentages more in line with national levels.
A Gap Analysis will be undertaken around pre and post diagnostic support for CYP with SEND who have mental health needs.
Aligned to Sandwell Councils Vision 2030 ambition 4, children will benefit from high quality education throughout their school careers with outstanding support from teachers, partners are working to continually the way they collaborate and contribute to supporting the Local Authority in the development of education, health and care (EHCP) plans. In 2019, there were 1,675 Education and Health Care Plans (EHCP) in place which equates to 2.8% of the school population. Sandwell have a well-established partnership approach to ensuring children and young people with SEND have the care and support they need. The SEND Strategic Partnership Board is responsible for the strategic co-ordination of the work of partners to ensure the SEND reforms and requirements are implemented and delivered effectively in Sandwell. The Board has a SEND Development Plan that requires full compliance with the SEND code of practice by members. Board membership includes representation from the People’s Parliament (mental health service users), VCS, health providers, education and commissioners Education, Adult Social Care, Children’s Social Care, Parent Carer Forum and CCG.
Through local partners being represented on both the Thrive Board and SEND Accountability Strategic Partnership Board facilitates the alignment of the strategic priorities and enables integrated planning, co-design and delivery. Examples include the work we are doing to jointly scope the roll-out of personal budgets for young people with SEND and how for those at risk of inpatient admission can have services wrapped
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around so they are clinically safe yet can remain within their home and or placed within the least restrictive environment. The outcome of the Office for Standards in Education, Children’s Services and Skills (Ofsted)/Care Quality Commission SEND inspection in March 2019 is evidence of the success of the joint way we work as partners. The inspectors complimented the partnership, recognising the collaborative approach taken to address concerns previously raised and have confirmed that they are fully assured with the progress made.
Early Help Partnership This new partnership initiative aimed at improving access to support for local children, young people and families launched in February 2019. It is the culmination of many months of discussions between schools, health agencies, Sandwell Council, the police, fire and the voluntary sector, the focus being on how to ensure families can find the support the ‘early help’ they need to improve their health, happiness and wellbeing and to address at the earliest stages challenges that growing up and family life can bring. Partners are committed to a joined-up approach where agencies work together more efficiently to provide a range of different support activities to meet children’s and families’ needs at the earliest point. SCVO has launched an online portal which providers of family support can use to advertise their services. Membership of the Early Help Partnership is open to any local public or voluntary sector organisation that commits to the principles of good partnership working and safeguarding of children and young people. Members receive regular communications including case studies of good practice and information on training opportunities, and the Partnership will be finding ways to come together to build local networks across all sectors and to strengthen relationships between key agencies.
Early Years Transformation Academy
The Early Intervention Foundation is supporting Sandwell in its systems-wide reform agenda through the Early Years Transformation Academy (EYTA). The Foundation encourages early intervention to problems, identifying and providing effective early support to children and young people who are at risk of poor outcomes (see Figure 3 below).
The Academy is designed to bring local partners together, with time and space to understand the evidence on what works to improve outcomes for children, explore new approaches and consolidate their existing provision. Improving the health of children is fundamental to the Sandwell 2030 Vision, premised on good child health leads to better education and employment prospects.
All relevant partners are engaged in re-designing the service pathway from conception to the end of the school Reception year. With a refreshed population needs assessment and agreed outcomes framework, three priority areas have been identified: • Healthy Pregnancy • Family Engagement, and
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• School Readiness.
Figure 3: Early Years Transformation Academy Outcomes Framework
Service mapping has been completed and engagement with local children, young people, families and carers underway. A Theory of Change model has been used to inform potential re-commissioning and links to maternal mental health, family support services for children 0-4, and specialist support to children under 5. The EYTA programme is due to complete in March 2020.
Local Transformation Plan baseline information including finance and activity
The CCG is split across the two main localities of Sandwell and West Birmingham. The West Birmingham programme is managed by the Birmingham Children & Young People's Mental Health and Wellbeing Board. The Sandwell programme is managed by the Sandwell Children & Young People's Mental Health and Wellbeing Board. The financial arrangements are structured in accordance with this arrangement. A detailed analysis of funding and expenditure is contained later in this document. 19
Financial Summary
The Mental Health Investment standard requires the CCG to increase investment in services to a level of programme growth allocation. Excluding Learning Disabilities and Dementia Sandwell and West Birmingham CCG have a plan to invest £94.5m in Mental Health (compared to an 18/19 investment of £85.5m). This represents growth of 10.6% which exceeds the national requirement (7.7% in 2019/20 for Sandwell and West Birmingham CCG).
The planned investments within specific service lines related to Children and Young People have increased by 10.4% in 2019/20. In comparison to the Local STP (>6%), Regional (>18%) and National (>15%) picture Sandwell and West Birmingham CCG investment more in Mental Health services when looking at spend per head based on registered population.
Table 1 2018/19:
The funding and expenditure for the CCG in respect of the Children & Young People's Mental Health and Wellbeing programme can be summarised as follows.
Table 2
The allocated funding will rise from £1,012K in 2015/16 to £2,593K in 2020/21. However, the CCG has invested in excess of these mandated levels with investment increasing from £1,490K in 2015/16 to £3,424k in 2020/21. This represents an additional investment of £831K over the nationally expected levels in 2020/21. The detail of this investment is shown in Table 3.
The investment in Children & Young People has been made within the NHS sector, local authority and 3rd sector. The table below summarises the areas the CCG has invested to help achieve the MHFYFV. Other row relates to investment reserves that the investments CCG are in the process of approving.
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Table 3
2 0 15 - 16 2 0 16 - 17 2 0 17 - 18 2 0 18 - 19 2 0 19 - 2 0 2 0 2 0 - 2 1 Source of Funding £000 £000 £000 £000 £000 £000 NHS 1,270 1,831 2,186 2,409 2,452 2,496 Local Authority 201 251 276 526 624 641 3rd Secto r 20 47 42 51 41 42 Other - - - - 84 245 Total Funding 1,4 9 1 2 ,13 0 2 ,5 0 4 2 ,9 8 5 3 ,2 0 1 3 ,4 2 4
Financial Detail
The detail of the increased investment is shown below. The investments are split between the Sandwell and West Birmingham programmes. The plan shows how funding has been allocated and used in previous years and plans for 2019-20, this can be seen in Table 4 below:
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Governance
The spending plans in respect of the above are developed and agreed at the respective Children & Young People's Mental Health and Wellbeing Local Transformation Boards and formally ratified and routinely monitored within the governance structure of the CCG. The funding and expenditure flows contained within this paper are incorporated within the financial plans of the CCG. These financial plans have been approved by the CCG’s Governing Body and assured by NHSE.
Mental Health Investment Standard
The CCG has achieved the mental health investment standard in previous years and is planning to meet the standard in future years. Again, these plans in respect of the CCG’s mental health spend (circa £100m) have been approved by the CCG’s Governing Body and assured by NHSE.
CCG Financial Position
The CCG has a robust financial position and achieves all its financial metrics each year. This includes the maintenance of a cumulative surplus forecasted (£23.9m) at the end of 2019/20. The CCG will further increase this surplus by £10.19m in 2020/21. The CCG’s plans are fully assured by NHSE.
Workforce
Sandwell’s ambition is to support 100% of children and young people to access emotional wellbeing and mental health services at the appropriate time to meet their needs. To achieve this ambition, we need to expand the workforce to provide the right skills in the right place, based on triangulating demand, capacity and skills of the workforce. We need the right number of staff across the different disciplines to be confident that we have the capacity to meet demands in services for each of THRIVE category of services.
Mapping the number of sessions across THRIVE has identified that we need to change the way we work to maximise efficiency and maximise recovery. We have used the THRIVE framework to benchmark whether our workforce can adequately support demand across the care-based categories between now and 2023/24. Please see Section 6 - Workforce for a comprehensive outline of our plans to achieve this, however in summary:
BCWB STP has been successful in its application to become a trailblazer for Mental Health Support teams in Schools. 100% of CYP in BCWB STP will have access to emotional wellbeing and mental health services by 2024. We will achieve this by developing mental health support teams in schools and colleges (MHSTs) across all localities. By 2024 we will have expanded our teams moving from 4 to at least 8 with an expected reach of approximately 8,000 CYP per team. Our teams will provide whole school/education setting types of approaches to ensure that CYP have knowledge of how to access services when they most
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need it. The BCWB STP Mental Health Trailblazer is innovative where we will develop a virtual targeted team that will work across the footprint to support CYP who are placed outside of local authority boundaries.
The expansion of community mental health services for Children and Young People aged 0- 25
By 2024 we will have a comprehensive BCWB STP 0 to 25 offer that ensures that CYP up to age 25 can access the right support to meet their cognitive needs with a focus on the most vulnerable and most likely to be impacted by health inequalities such as CYP with protected characteristics or those known to Children’s Social Care.
A service specification has been developed to provide a CAMH Crisis and Intensive Community Support Service which will align the service available for children and young people across the Black Country. This will ensure that the CYP model is now more in line with the offer for adult mental health crisis team which is available for the 18 – 25 cohort. This will provide a blended model response to crisis and is to be signed off and written into the relevant contracts for 2019 – 20.
The vision and models for the Specialist Community Mental Health Service and Enhanced Community Mental Health Team are to provide truly transformative services that will support people across the lifespan in a more dynamic and engaging community model with improved access and responsiveness. Through business plans they will increase capacity and capability of Transition staff, and they will provide an additional focus upon transition for those aged 18- 25 (with particular support for those with emerging or suspected personality disorder and neurodevelopmental conditions such as Autism and / or ADHD – this will be part of the core offer but also part of the specialist support provided as part of a PD Hub).
Under 5s in the city are supported by the Emotional Mental Health and Wellbeing service through systemic family therapy as well as specialist services available through the specialist CAMHS services. The specialist CAMHS service also provides support to the ASD diagnostic service to ensure that the mental health needs of the children are considered when confirming or not the ASD diagnosis. The 18 – 25 cohort activity will be unbundled and ensure that the knowledge and data gap is closed.
Alignment of LTP with other key strategic reforms
The Local Transformation Plan refresh is aligned to the transforming care agenda with work being undertaken to ensure that CYP in crisis are better supported by staff who have skills in managing CYP with LD and/or ASD and prevent hospital admission. As part of this agenda, the development of the risk register supports this group of young people and those who are at risk of entering the criminal justice This work is also supported by Kaleidoscope who are commissioned to provide Tier 2 services for targeted groups of CYP via their Primary Mental Health Workers. (PMHW). Each of Sandwell’s six Town Community Operating Groups (COGs) have a named PMHW co-located in a COG. The work focuses on referrals from Looked After Children’s (LAC) Team, Child Sexual Exploitation (CSE) Team and the Youth Offending Team.
Our processes for tracking and reporting progress
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The CAMHS Programme Delivery Plan 2019/20 with has been developed to drive coordinated joint actions and monitor/report progress. The Strategic Commissioning Partnership Board for Children and Young People (SCPB CYP) will provide strategic oversight and hold system leaders to account for their organisation’s contribution to delivery of this LTP. Using the routine reports of the operational challenges being experienced across partners in the system the Board will hold the operational groups charged with making the changes to account and require assurance that issues and risks are being mitigated.
SWB CCG continue to ensure CAMHS transformation projects are recorded on the Programme Management Office’s PM3 database, enabling performance to be routinely reported to the Strategic Commissioning and Redesign Committee which is accountable to the Governing Body. Reports will be available to the Thrive Board for monitoring and assurance purposes, and thereby feed up to the SCPB CYP.
Project management discipline will be required by all operational groups that support delivery of this Plan. Furthermore, we have developed a Children and Young People’s Performance Dashboard comprising the priority areas for delivery and monthly monitoring data to give assurance, inform actions and enable effective risk and issues management. This is a key tool to ensure partners work together to keep on track and deliver to standards. SWB CCG will continue to monitor performance against the local quality requirements included in contracts with our providers. Reports are reviewed on a monthly basis, and in the event of continuing declining performance remedial plans agreed with providers in accordance with NHS contract terms. As part of the contract review monitoring/performance monitoring meetings, activity is tracked to ensure that services are meeting targets set as well as ensuring outcomes are being achieved for the CYP. Tracking also demonstrates that the CYP are in receipt of appropriate support. Given that the services now use outcome measures to measure the service the children and young people are in receipt of, this also ensures that the children and young people are in receipt of appropriate support.
Engagement, Participation and Co-production – Involving Children and Young people in Transforming Services
The United Nations Convention on the Rights of the Child, Article 12 states children and young people have a right to have their views heard in all matters affecting them and for these to be taken seriously. In February 2013, the UK Government pledged that ‘Children, Young People and their families would be at the heart of decision- making, with the health outcomes that matter most to them taking priority’. Furthermore, adults in a position to help young people have a duty to provide them with support. SWB CCG is committed to ensuring children and young people’s participation in the development of plans, their delivery (where appropriate) and in evaluating whether practice matches their needs and aspirations. The Local Transformation Board in Sandwell, and Birmingham, understands and respects the valuable contribution that children, young people and their families and carers can make where given the opportunity to shape health and care services.
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In Sandwell and West Birmingham, we continue to engage and co-produce our local services by listening to the voices of local children and young people and using them to achieve tangible service improvements. Both Local Transformation Boards pro- actively identifies and creates opportunities for joint working between professionals and children and young people and has an established partnership approach that uses the intelligence gleaned in all stages of the commissioning cycle. One example of this has been the development of additional group support offered to parents of children receiving services from Early Years Inclusion Support for ASD in response to feedback from parents. We have consulted widely to create our transformation plan and continue to engage with a number of colleagues including the voluntary and community sector, Education including Inclusion Support Services, Sandwell Local Authority – Youth Services, Youth Justice, Sandwell Children’s Trust – social care, the Multi-Agency Safeguarding Hub (MASH) and others. Together, partners and agencies explored priorities and actions to improve the emotional wellbeing of Children and Young People to meet needs. We ensured the voice of our local children and young people influenced our ambitions, problem solving and planning for 2019 onwards. Aligned to the ambition set out in Every Child Matters (ECM), the SHAPE programme in Sandwell has been operating over the past 5 years, governed by the SHAPE Strategic Board that links into the Sandwell Health and Wellbeing Board. The SHAPE Board is chaired by the Director of Public Health and has multi-agency representation that includes Sandwell Children’s Trust, Youth Services, Voluntary and Community sector providers, Education, Work and Employment, Fire and Police services and SWB CCG. The Programme is funded via a number of funding sources that includes Sandwell Council and SWB CCG. Partners have combined and committed through the SHAPE programme to continue to build a more collaborative approach to consultation and engagement with children and young people across partner organisations to enable us to better understand their changing needs and aspirations. This approach will enable the partnership to be more effective when planning, delivering and commissioning services year on year. This collaborative approach aims to address gaps in local intelligence with regards to service planning by increasing ongoing involvement opportunities for a wider range of service users and potential service users of all partners The SHAPE Strategic Board is linked through governance to the Health and Wellbeing Board, Police Crime Commissioners Office and the CCG’s Strategic Commissioning and Redesign and Primary Care Commissioning Committee’s amongst others. The primary purpose of the SHAPE Board is to listen to the voice of children and young people in Sandwell, whatever their background or circumstances, using the 5 ECM themes:
• Staying Safe • Being Healthy • Enjoying and Achieving • Making a Positive Contribution • Economic Wellbeing.
The SHAPE Youth Forum (meets bi-weekly) has been established with children and young people aged between 12 and 23 years actively participating. The Forum act as
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a consultation and co-design group for Sandwell agencies and provides the opportunity for young people to meet other young people from across the Borough and organise SHAPE Events. SHAPE engages with children and young people from a range of diverse backgrounds and holds specific events and forums with those from local community schools (Pupil Referral Units) and those in alternative education. SHAPE also work with voluntary sector groups who support CYP with mental health and emotional difficulties. They also act as a link into school councils at many of our schools. The forum also has 2 elected Youth Commissioners who sit on the UK Youth Parliament who are working to tackle issues important to them including knife crime, loneliness and traffic issues on the school run. As part of National Take Over day this year mental health was raised as a major concern for local young people when they “took” over the SHAPE Board in October this year. All partners on the board made the pledge to continue and strengthen their engagement with children and young people and look at how we can improve the mental health and wellbeing of our children and young people. The SHAPE Board have developed a multi-agency Children and Young People’s Engagement Strategy, and its work is underpinned by an annual action plan. In addition to delivering the overarching ambition, the strategy seeks to identify all existing engagement, understand gaps and duplication and opportunities for joint consultation and engagement. Projects included in the action plan are derived from national and local emerging issues, using the intelligence gathered through engagement with children and young people on what matters most to them. The focus is on identifying underlying causes, often associated with the wider determinants of health and wellbeing and generating ideas and possible solutions for partners to consider and agree how best to respond.
The action plan comprises annual events e.g. Your Talent, Youth Festival, national initiatives such as National Youth Takeover Challenge in addition to roadshows, learning initiatives e.g. online safety and other ad hoc events and activities. In Birmingham young people have already told partners that homelessness, drugs, bullying, transport and leisure provision are some of the things they’d like to discuss and make improvements to. Birmingham’s Children and Young People’s Parliament is a citywide forum for young people and has representation on the UK Youth Parliament.
We will continue to work as part of the SHAPE Board in Sandwell and co-produce an accessible version of the recently agreed Children and Young People’s Engagement Plan. We know that we need to do a lot more in West Birmingham to engage Children and Young People and build and strengthen links with partner organisations to do this. The CCG will be starting this in November with a “What Matters to You” roadshow aimed at Children and Young People in the West Birmingham area. We will be taking this opportunity to ask about Young people’s mental health and wellbeing. We also want to strengthen our relationship with the Youth Service in Birmingham to put it on a par with our connection with the SHAPE Board in Sandwell. We have good relationships with the local VCS across Sandwell and West Birmingham, and we will be building on these relationships to increase our work listening to the views of children and local people in the future.
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SWB CCG have built on our Enterprise Advisor and partnership role with Health Futures University Technical College, the first UTC in the UK with healthcare and health sciences as its specialism, our partnership has given us the opportunity to jointly work on a number of health based projects with the college and local young people.
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Children and Young People’s Improving Access to Psychological Therapies Programme (CYP-IAPT)
The CYP-IAPT is a transformational change programme for children and young people’s mental health services. Sandwell CAMHS and Sandwell partners have been part of the CYP- IAPT Midlands Collaborative since it commenced in 2015. By following the CYP-IAPT principles we are improving outcomes, increasing access for all groups and enhancing the experience of children and young people attending these provisions through the delivery of evidence -based interventions and system-wide changes.
The programme works with services that deliver mental health care for children and young people across the system and aims to create, within teams, a culture of full collaboration between child, young person and/or their parents or carers by embedding the following principles:
• Accountability: Our services are migrating across to electronic health records and we have undertaken a large-scale piece of work to ensure that we have all the correct documents and processes on this new system. We have undertaken this work on a STP footprint to ensure that our service users get the same processes irrespective of where they access services across the Black Country. We have also introduced the use of the national SNOMED codes to ensure that reason for accessing specialist mental health provisions can be captured nationally. We also contribute to the national data collection around access.
• Accessibility: We strive to make our services as accessible as possible in the least timely manner. We work with the online provision Kooth to ensure that C&YP have access out of normal working hours. Many of our specialist CAMHS offer flexible appointments out of normal working hours and our staff have offered weekend initial assessments to measure the impact of this provision. We are working with our participation groups to offer self- referral but currently C&YP can self-refer via drop in clinics.
• Evidence Based Interventions: The transformation of our service has included the development of 4 core care constellations across the service with 23 care National Institute for Health and Care Excellence (NICE) compliant pathways sitting under the care constellations. We have developed an emotional and behavioural, neurodevelopmental, learning disability and STEP (suicidality, trauma, eating disorder and personality). Our participation group contributed to these developments. We have invested in our workforce training to give assurance that our clinicians have the skills and competencies to deliver the compliant pathways and some have attended the CYP-IAPT core modules training. We are in the process of setting up the electronic routine outcome measures but have piloted these since January 2019 to give us assurance that our provisions are delivery the required outcomes.
• Awareness: Our participation group have developed our CAMHS web site which supports the de-stigmatisation of CYP mental health provision. We have attended many local forums to promote our services alongside other CCG commissioned emotional well-being services.
• Participation: changing the culture of a service so that children and young people clearly participate in their care planning and the interventions they engage in are a key part of how participation has improved across the service. Care plans are co-produced with CYP and their parents/carers. They are asked to reflect on each of their interventions and report
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back to the clinician whether this has met their need. This process is reported on during clinician’s clinical supervision and assurance must be given that this process is upheld.
CYP also participate in service developments, in recruitment of the workforce and in the model of delivery. We currently have one participation group for across our CAMHS provision within the Black Country Partnership NHS Foundation Trust (BCPFT), but this group will be further developing more community-based participation groups.
The contribution of the core participation groups this year has included establishing the CAMHS Council, setting out the terms of reference and the vision document. This Council meets 3-weekly and is run by young people who have direct experience of accessing mental health services and is proving to be an effective participation mechanism for the service. The Council attends the CAMHS team meeting on a regular basis and participation is discussed at every team meeting. Areas of development and change initiated and led by the CAMHS Council include:
• Employment of service improvement CAMHS volunteer • Waiting area modernisation • Recycling suggestions • Information about staff group – boards to be changed to reflect participation recommendations • Editing and update of website • Supporting and developing the use of social media within service • Development of self-referral forms • Specific areas of development around lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) inclusivity • Mental health awareness information • Polling booth in waiting area that is utilised as either participation survey’s or mental health promotion to gain views or give information to wider service users • Recruitment involvement – panel and questions • Changing the culture of team • Participation individuals/group to support their own continued journey of recovery • Attendance at participation conferences or workshops.
Plans for 2019/2020 include:
• Twitter account – social media • Further recruitment of CAMHS volunteer • Self-assessment tools – participation and engagement • Establishing self-referral • Co-production of business and development plans • Determining quality and outcome measures.
ACES Steering Group
Our ACEs Steering Group has is established to deliver an 18-month task and finish programme, attended by all statutory agencies plus schools and voluntary sector partners. It is chaired by the Executive Director of Children’s Services and reports through the Strategic Commissioning Partnership for Children and Young People to the Health and
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Wellbeing Board. The ACEs work underpins the work of the Thrive Board and its 3 operational groups. Three objectives have been agreed:
• Sandwell has a good understanding of the distribution of ACEs across the borough; professional curiosity is used in a systematic way to identify those at risk and their support needs (Priority A)
• People can access support and advice from a range of trauma informed interventions and services (Priority B)
• Professionals are ACE aware, and trauma informed, communities across Sandwell have a better understanding of Adverse Childhood Experiences and its impacts (Priority C).
An action plan sets out key deliverables and those achieved to date include:
• Understanding the local position (delivering Priority A), with JSNA in development
• Service commissioning (delivering Priority B): mapping completed, engagement with CYP in progress, review of the multi-agency Teamwork and One Nurture programmes started
• Workforce development (delivering Priority C):
• development and delivery of an e-learning programme ‘ACES Aware’;
• development and testing of a face-to-face training programme ‘Trauma-Informed Practice’; roll-out starting end of October;
• development of Trusted Adult training; delivery starting in November;
• Chartermark for Schools
• development of tools and resources for mental health curriculum in primary and secondary.
4. UNDERSTANDING LOCAL NEED
Understanding our communities is vital to understand the health and care needs of our children and young people. In Sandwell and West Birmingham partners have agreed that analysis of service use and need must be a priority for planning and commissioning services, and used to identify gaps, inform decision making, undertake evaluations and importantly to develop this plan. This plan has been developed using data and evidence: on what matters most to children and young people; considering feedback from engagement with professionals across health and care agencies and Joint Strategic Needs Assessments
The Sandwell Joint Strategic Needs Assessment (JSNA) identifies that the social, economic and physical environments in which people live have a strong influence on their mental health and wellbeing; these are the social determinants of health. Poor mental health and wellbeing in childhood is negatively associated with many adult health outcomes, including poor adult mental health, higher rates of alcohol and substance misuse and an increased risk of suicide.
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We know that half of those with lifetime mental health difficulties experience symptoms by the age of 14, that one in ten children under 16 years have a mental health difficulty, and that self-harming in young people is becoming more common, occurring for example in 10- 13% of all 15-16-year olds. (Mental Health Foundation, 2006)
4.1 Young Populations Sandwell has a relatively young age profile compared with the population of England & Wales as a whole. There are particularly high proportions of young people and lower proportions of older people.
34.6% (N4354) of Sandwell’s population are aged 0-25 years (See Table 4.1). This is higher than the average for England (29.9%). Splitting this into 5-year age band, we can see the proportions are similar in all age bands with slightly lower number of 15 - 19 year olds.
Table 4.1. Sandwell's young population breakdown (2018) Age Group 0-4 5-9 10-14 15-19 20-25 0-16 0-18 0-25 Number 23,772 24,367 21,918 19,205 23,947 77,935 85,723 113,209 % of 0-25 Population 21.0% 21.5% 19.4% 17.0% 21.2% 68.8% 75.7% 100.0% % of Total Population 7.3% 7.4% 6.7% 5.9% 7.3% 23.8% 26.2% 34.6%
Source: 2018 ONS Estimates
4.2 Population Projections
Chart 4.1 below, shows the population changes that are projection for Sandwell’s young people. Whilst overall, the population aged 0-25 is likely to increase, the numbers in the youngest (0-4) and oldest (20-25) age bands are forecasted to fall. There will be a fall in these age bands of 1,472 and 1,579 respectively. The overall increase in the numbers of young people will influence the planning for future demand for Child and Adolescent Mental Health Services (CAMHS) over the next five years.
Chart 4.1 Young Person Population Projections 2016-2025. ONS 2016 based Projections
Projected number of People by Age Band: Sandwell 2016-2025 25,000 24,000 23,000 22,000 0-4 21,000 5-9 10-14 20,000
Number of People of Number 15-19 19,000 20-25 18,000 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Source: ONS Subnational Population Projections, 2016-based projections
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4.3 Ethnicity
Sandwell has a higher proportion of 0 - 24year olds from the black and minority ethnic (BME) community (39.1%) than both the West Midlands region (25.3%) and England (20.8%). In the 0-24 age group in the 2011 census in Sandwell there were: -
• 24,417- Asian/Asian British • 6,898 - Black/African/Caribbean/Black British • 7,233 - Mixed/multiple ethnic group • 1,843 - Other ethnic group
There is considerable variation by area within Sandwell. Within the towns of Sandwell Smethwick has the highest proportion of young people from BME backgrounds (43% Asian; 33% white; 12% black; 5% mixed; 3% other) collectively they make up the majority of the population in this town and nearly half of the population in West Bromwich Central.
4.4 School Provisions in Sandwell
In Sandwell there are 113 state funded schools (including 35 academies and 78 maintained schools and independent nurseries) for approximately 56,450 pupils and around 734 pupils attend 7 state funded special and alternative schools. There is one primary free school which has a capacity for 420 pupils.
The January 2019 School Census shows that: 28,619 pupils are classified as “minority ethnic pupil” which is 50.35% compared with 24% for England (Note: this does not include nursery pupils, Pupil referral units and alternative provision academies)
• 12,034 pupils attending a Sandwell school are eligible for a free school meal which is 21.17% compared to 14.7% for England. • 1,605 pupils have a statement of Special Educational Needs (SEN) or an Education, Health and Care (EHCP) Plan which is 2.82% compared with 2.9% for England. • 7,148 pupils receive Special Educational Needs support which is 12.5% compared with 11.7% for England 4.5 Protective Factors School Readiness: This is a key measure of early years development across a wide range of developmental areas which includes personal, social and emotional development. A lower proportion of Sandwell children are school ready compared to than other parts of the West Midlands region and England. For 2017/18, 66.4% of Sandwell children achieved a good level of development. This is statistically lower than England (71.5%) and the West Midlands region (69.8%). Similarly, to the national and regional rates, for the past 5 years, the percentage of children in Sandwell achieving a good level has been increasing, however in comparison to the regional and national figures, the inequality gap is still large. Ranking the levels of good development across the West Midlands Metropolitan Councils,
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Sandwell’s rank is the lowest.
Educational Attainment: relatively poor levels of educational attainment in Sandwell are also a cause for concern. For example, in 2018 the Attainment 8 score in Sandwell (which measures pupil’s attainment across 8 qualifications) was 40.6 compared to 46.5 for England1.
20.3% of the Sandwell working age (16-64) population have no formal qualifications compared to 7.8% in England. 21.1% of the Sandwell working age (16-64) population have NVQ4+ (which includes degrees) compared to 39.3% in England.
Other factors: Burstow et al (2018)2 in their policy report highlight close personal and a family relationship that offer trust, acceptance, mutuality and financial resources, positive social and personal identities as protective factors too. 4.6 Risk Factors
Deprivation: Sandwell is an area with high levels of deprivation. The English Indices of Deprivation (2019) ranked Sandwell the 12th most deprived Local Authority. There was some relative improvement in deprivation levels with the proportion of LSOA in the worst 40% in England falling from 81.8% in 2007 and 2010 to 78.5% in 2015, there has been an increase again to 80.7% in 2019. Evidence suggests that those from deprived backgrounds are more likely to experience poor emotional health. In addition, Sandwell Children and Young People have an increased likelihood to be exposed to risk factors associated to mental disorders including:
• 25.6% of all children aged 0-15 in Sandwell are living in low income families compared to 17% across England and 20 % in the West Midlands (HMRC 2016 data).
Unemployment & Families out of work: as identified from the 2011 census, 7% of households in Sandwell with dependent children, do not have an adult in employment. Sandwell has the 13th highest percentage in England.
The ONS annual population survey, estimated between April 2017 and March 2018, in Sandwell 26% of 16 - 64 year olds who were economically inactive where inactive due to long term conditions. Long term unemployment is associated with an increased likelihood of developing and living with mental and physical ill-health. Sandwell and West Birmingham have higher levels of unemployment than national and regional rates.
Family Homelessness: The UN Convention on the Rights of the Child highlights the right of every child to an adequate standard of living. Children from homeless households are often the most vulnerable in society. Homelessness is associated with severe poverty and is a social determinant of health3, For Sandwell, according to the number of applicant households with dependent children or pregnant woman accepted as unintentionally homeless and eligible for assistance, 3.0 per 1000 households in Sandwell were homeless in 2017/18. This compares statistically worse than England
1 Department for Education (2018) 2 Burstow, P., Newbigging, K., Tew, J., and Costello, B., 2018. Investing in a Resilient Generation: Keys to a Mentally Prosperous Nation. Birmingham: University of Birmingham.
3 Public Health England Fingertips- https://fingertips.phe.org.uk/profile-group/mental- health/profile/cypmh/data#page/6/gid/1938133095/pat/6/par/E12000005/ati/102/are/E08000028/iid/90819/age/-1/sex/4 34
(1.7 per 1000) and regionally (2.6 per 1000).
The number of accepted applicants is only a fraction of the level of homelessness in Sandwell as it does not take into consideration the hidden homelessness.
Teenage pregnancy: is a risk factor for poor mental health outcomes. Teenage mothers are less likely to finish their education, are more likely to bring up their child alone, live in poverty and have a higher risk of poor mental health than older mothers:
Although the national and local trend for teenage conceptions are declining, Sandwell’s latest data (2017) shows that the rate of teenage conceptions at 28.2 per 1000 15-17-year olds is still statistically higher than the England rate at 17.8 per 1000. Sandwell has the highest rate of teenage conceptions in the West Midlands region.
Family conflict and breakdown is a risk factor for poor mental health and wellbeing:
For Sandwell, the proportion of people who are separated or divorced, at 11.2%, is comparable with similar areas (12% in statistical neighbour areas), Census 2011
Single parent families with dependent children make up 33% of Sandwell’s families with dependent children, compared to 29% nationally and 30% regionally, Census 2011
Parental mental health: Parental mental illness is a risk factor for childhood mental illness, with children of mothers with mental ill health being five times more likely to have a mental disorder:
Not in Education Employment Training (NEETs): According to the results from the Macquarie Youth Index, 2017, employment status has a significant impact on the happiness and confidence of young people. Young people who are in education, training or work have a score of 71. This compares to a score of 61 compared to those who are NEET (a score of 100 denotes participants being entirely happy or confident).
However, for Sandwell the proportion of NEETs (4.8%, N370) is lower than the regional (6.4%) and national (6%) proportions.
Racism: Racism can impact negatively on the health and wellbeing of all communities. Racist attitudes, behaviour, and attacks can have profoundly enduring and damaging effects on the mental health of BME communities. Racial discrimination can also be a cause of ill health and poor educational and employment prospects among ethnic minority people. Those reporting some form of racial attack are almost three times more likely to have depression, and almost five times more likely to have psychosis than people reporting no harassment4
The available scientific evidence suggests that racism can adversely affect mental health status in at least three ways: (i) racism in societal institutions can lead to truncated socioeconomic mobility, differential access to desirable resources, and poor living conditions which adversely affect mental health, (ii) experiences of discrimination can induce physiological and psychological reactions that can lead to adverse changes in mental health status, and (iii) in race-conscious societies, the acceptance of negative cultural stereotypes can lead to unfavourable self-evaluations that have
4 Karlsen, S, Nazroo, J Y., McKenzie, K, Bhui, K and Weich, S. (2005) Racism, psychosis and common mental disorder among ethnic minority groups in England. Psychological Medicine, 2005, 35, 12: 1795-1803.
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deleterious effects on psychological well-being567.
4.7 Vulnerable Groups
For children and young people, vulnerable groups who may require additional support include unaccompanied asylum seekers, children whose parent have mental health problems or have a history of alcohol or substance misuse, young carers, those at risk of Child Sexual Exploitation (CSE) and looked after children.
Unaccompanied asylum seekers: As identified by the Hadley Centre for Adoption and Foster Care Studies, Coram Voice, refugee and asylum seeking young people can have concerns about their mental health, especially anxieties about the past, rights and entitlements to education, housing and leaving care services, as well as the status of their asylum claims and its impact on their future8.
Local authority data shows that as at May 2018 Sandwell had 397 CYP who were asylum seekers. 8 children and young people were looked after asylum seeking children which is relatively low compared to 145 in Birmingham. On a national level, Sandwell has one of the lowest numbers in England.
Migration & Language: Virupaksha et al (2014) 9 concluded that migration is a vulnerability factor for developing psychological stress and/or mental health complications. Due to feelings of insecurity and non-availability of their own community members, the distress would turn into mental health consequences or other forms of health complications.
According to the Census 2011, 4.3 % of Sandwell residents over 3 years of age, cannot speak English well or at all. This is higher than the national rate of 1.7%.
The Dept for Education reported for January 2018 that 32.8% (N12,30) primary school children do not have English as their first language and 28.2% (N6,124) in secondary school.
Parental Alcohol and Substance Misuse: Parental substance misuse can have a negative impact on children at each stage of their development.
Women who misuse substances during pregnancy may put their babies at risk of impaired brain development, congenital malformations, premature delivery, low birth weight and withdrawal symptoms after birth.
In later stages, impacts to children can be:
• physical and emotional abuse or neglect as a result of inadequate supervision, poor role models and inappropriate parenting • behavioural, emotional or cognitive problems and relationship difficulties • taking on the role of carer for parents and siblings • preoccupation with, or blaming themselves for, their parents’ substance misuse
5 McKenzie, K On racism and mental illness. Psychiatric Bulletin, 23, 1999: 136–137. 6 Chakraborty A & McKenzie K Does racial discrimination cause mental illness? Br J Psych, 2002 , 180:475 -477. 7Chakraborty A & McKenzie K Does racial discrimination cause mental illness? Br J Psych, 2002 , 180:475 -477. 8 Children and Young People's Voice on Being in Care A Literature Review, Hadley Centre for Adoption and Foster Care Studies Coram Voice 9 Migration and mental health: An interface H. G. Virupaksha, Ashok Kumar, and Bergai Parthsarathy Nirmala
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• infrequent attendance at school and poor educational attainment • experiencing poverty and inadequate and unsafe accommodation • exposure to toxic substances and criminal activities • separation from parents due to intervention from children’s services, imprisonment or hospitalisation • increased risk of developing drug or alcohol problems or offending behaviour themselves.10
According to the figures produced by Public Health England – Health & Wellbeing, for 2011/12, there were 108.3 parents attending treatment for substance misuse for every 100,000 children in Sandwell. This is on par with the national rate of 110.4.
There are 63.2 parents attending treatment for alcohol misuse for every 100,000 children in Sandwell. This is significantly lower than the national rate of 147.2
Perinatal Mental Health: The mental health of children and young people in England, 2017 survey, identified that children of parents who had poor mental health were three and a half times more likely to be identified with a mental disorder than children whose parents showed little to no evidence of a mental disorder. Research has shown that 3.9 per cent of new or expectant mothers in 201711 were in contact with secondary mental health services, with young mothers (particularly those aged 16 or under) most likely to be in contact with these services (NHS Digital, 2018)
Public Health England produce estimated numbers of women that might be expected to have certain mental health problems in pregnancy. These estimates are produced by applying national estimates, for these conditions, to local delivery figures for Sandwell. Public Health England recognise that there are concerns about the quality of this data, but they do provide an indication of prevalence for these conditions within the borough. Mild-moderate depressive illness and anxiety, and adjustment disorders and distress indicators are presented as a range of figures, with upper and lower estimates. These have been calculated by applying the national estimate ranges to local delivery numbers. These estimates are presented in the table 4.2 below.
10 (Altobelli & Payne, 2014; Cleaver et al, 2011; Cornwallis, 2013; Home Office, 2003; Templeton, 2014) 11 For further information on the definition of perinatal period, see https://digital.nhs.uk/data-and- information/publications/statistical/mental-health-services-monthly-statistics/mental-health-services-monthly-statistics- final-march-2018
Table 4.2 Estimated number of women affected by perinatal mental illnesses (2017/18)
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Table 4.2 above shows:
Women experiencing postpartum psychosis and chronic serious mental illness (SMI) are rare occurrences during or after childbirth, with only an estimated 7 women experiencing each of these conditions, 0.2% of the 4,597 deliveries in Sandwell, in 2017/18.
It is calculated that an estimated 107 mothers experienced post-traumatic stress disorder (PTSD) and that the same number may have experienced severe depressive illness in Sandwell, in 2017/18.
It is estimated that between 355 and 533 women experienced mild to moderate depression and anxiety in Sandwell, 7.7% to 11.6% of the 4,597 childbirth deliveries in Sandwell, in 2017/18.
It was estimated that between 553 and 1,066 women may have experienced this type of mental illness during or after childbirth in Sandwell. This is between 11.6% and 23.2% of the women who have given birth in 2017/18.
It is possible that some women may experience more than one of these perinatal mental health conditions. Public Health England comment that between 10% and 20% of women are affected by mental health issues at some point during pregnancy or in the first year after childbirth (Public Health, Fingertips)
Child Sexual Exploitation: 122 children and young people in Sandwell have been identified as being at risk of CSE
Social Care Referrals: In 2018, Sandwell had a referral rate of 775.80 per 10,000 for children’s social services (N 6290). The referral rate for West Midland is lower at 649.30 per 10,000 and England at 552.50 per 10,000. Sandwell has had an increasing rate since 2015. Between 2017 and 2018 there has been an increase of 194.90 referrals per 10,000 children aged under 18. Sandwell’s changes are particularly high compared to the West Midlands region where there was a decrease of 4.70 referrals, Sandwell’s statistical neighbours with a decrease of 93.28 and England with a small increase of 4.30.
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The data indicates that Sandwell has a growing population of children who are known to Children’s Social Care. We must understand the reasons for identification and use information gathered from the framework of assessments to target services to build protective factors within the community to reduce risk of development of emotional wellbeing and mental health problems.
Children in Need: In 2018, Sandwell’s rate for children in need was 451.50 per 10,000 children. As comparators; the West Midland’s rate (360.20) and England’s (341.0) is lower than Sandwell. With the increase in referrals, there has also been an increase in the rate of children in need. Between 2017 and 2018 Sandwell has had an increase of 138.80 per 10,000 children, whereas the region has had a substantially smaller increase of 8.0, statistical neighbours decrease of 21.13 and England an increase of 10.90.
Sandwell’s change between 2017 and 2018 is 17 times higher than the West Midlands change and 13 times higher than England’s year on change.
Looked After Children: Being in care when young is a determinant of adult mental health, such as levels of antisocial behaviour, emotional instability and psychosis. Sandwell has a substantially higher rate of looked after children than its comparators.
There rate of looked after children for 2018 is 92.0 per 10,000 children (N 749), this is higher than the West Midlands region at 78.0, Statistical neighbours at 89.50 and England at 64.0. Between 2017 and 2018 Sandwell has had an increase of 16.0 per 10,000 children, the West Midlands region an increase of 3.0, statistical neighbours 2.8 and England 2.0. Although the changes are smaller than those seen for referrals to social care and children in need, Sandwell’s increase is still 5 times higher than the West Midlands and 8 times higher than England.
Local Sandwell Children Trust data shows further increases since 2018 and as of 15th October 2019, there were 899 children in care and from period 1st April 2019-30 Sept 2019 – 138 missing episodes of children in care.
Children Living with Connected Carers: Sandwell Children’s Trust has 107 connected foster carer households looking after 196 children and young people in the care of the Trust.
Connected or Kinship Care is an arrangement where a child who cannot be cared for by their parents or other person with Parental Responsibility, goes to live with a relative, friend or connected Foster Carer. The arrangement can be a private arrangement directly between the parents and the relative, friend or connected person or it can arise through Children’s Services involvement.
As children and young people grow and develop, they need support from those responsible for protecting them during this journey. When going through the various stages in this developmental process their experience of attachment plays a crucial role. This continues throughout the young person’s development, from absolute dependence, to independence and autonomy as an adult. All children and young people who become looked after need professionals help and support to manage living with new families and situations. However, those living in connected placements often face more challenges about their attachments as they are still living in their families but not with their birth family.
Care Leavers: Sandwell Children’s Trust has responsibility for 291 care leavers (October 2019). As numbers of children in the care of the Trust has risen over the last 2 years, so does the number of
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care leaves with a further 100 young people classed as eligible for this service in the coming year.
The number of current care leavers as at 30th September 2019 was 215, of those above 27 of these turned 18 between 1st April to 30th September 2019. A further 41 will turn 18 by March 2020.
All care leavers were entitled to receive support from a Personal Adviser (PA).
Children and Young People affected by Adverse Childhood Experiences (ACEs) and Complex Needs
Children who are exposed to negative parenting, relationships and other early-life adversities are at risk of mental health problems in later life (HM Government, 2011), highlighting the importance of good parent-child relationships in promoting positive outcomes in children.
Adverse childhood experiences (ACEs) are situations which lead to an elevated risk of children and young people experiencing damaging impacts on health, or other social outcomes, across the life course. In many cases multiple ACEs (living in a household where domestic violence, abuses, neglect, drug and alcohol misuse, mental ill health, criminality or separation are present) are experienced simultaneously.
Those who experience four or more adversities are at a significantly increased risk of poor health outcomes across the life course compared to those with no ACEs. Prolonged exposure to stress in childhood disrupts healthy brain development. This can manifest as emotional and conduct problems in childhood, mental health problems and risk-taking and criminal behaviours in adulthood. (Levenson et al, 2016). One England study involved 4,000 people being asked about abuse, drug and alcohol misuse, mental ill-health, domestic violence and being involved with the criminal justice system. The study showed where a young person had experienced four ‘ACEs’ or more, they were eleven times more likely to use illegal drugs, be the victim or perpetrator of violence and to be imprisoned
Sandwell is seeing an increasing number of children and their families being referred to statutory services. Given the increased demand and children entering care it is likely that many of these children and young people will have been exposed to one or more Adverse Childhood Experiences (ACEs).
Estimates of the numbers of children and young people affected by ACEs is not available as the impact is cumulative over time and the research that the national estimates are based on was carried out with adults. However, identifying ACEs through care and support for all levels of need and tailoring interventions as part of the universal service offer will enhance emotional health and wellbeing as well as life chances for our local people.
LGBTQ +
We do not know the exact numbers of young people in Sandwell who identify as LGBTQ+. However within the Mental Health of Children and Young People in England 2017 survey of the 14 -19 year olds one in ten (10.2%) described themselves as lesbian or gay (1.7%), bisexual (6.3%), or other (2.2%). Girls were more likely to identify with a non-heterosexual identity (13.2%) than boys (7.1%).
There are no reliable national estimates about the numbers of trans young people but there is evidence that the number of trans people becoming visible is growing rapidly. These young people
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are vulnerable to psychosocial stressors including gender non-conformity, victimisation, homophobia, lack of support, family problems; placing the at greater risk of homelessness, substance misuse, mental health problems, self-harm and suicide.
Special Educational Needs and Disability (SEND) Children with Learning Disabilities: Special educational needs and disabilities (SEND) can affect a child or young person’s ability to learn. We know that SEND can affect a young person’s:
• behaviour or ability to socialise, for example they struggle to make friends • reading and writing, for example because they have dyslexia • ability to understand things • concentration levels, for example because they have Attention Deficit Hyperactivity Disorder (ADHD) • physical ability.
Children with learning difficulties known to schools is a summation of three different categories (Children with Moderate Learning Difficulties, Children with Profound & Multiple Learning Difficulty and Children with Severe Learning Difficulties. Every term the schools report the type of need children with special educational need have.
4.6% (N2784) of children in schools are identified as having learning difficulties known to schools in 2018. 4.1% (N2473) of these children have been identified as having moderate learning difficulties; 0.4% (N237) with severe and 0.1% (N74) with profound learning difficulties.
Percentages of pupils with Moderate Learning Difficulties (MLD) in Sandwell primary schools are reducing following targeted work on over-identification (at SEN Support level). The national average for 2019 has reduced in the last year and therefore Sandwell is 2.4% above national despite continues reductions. Pupils with Severe Learning Difficulties (SLD) in Primary schools in 2019 was 0.3% compared to national 0.6%.
Since 2017, Sandwell has had a significant drop in the number of children with learning difficulties – a decrease of 1235 children.
Autism Spectrum: for 2018, Sandwell had 6.7 per 1000 children known to schools with autism spectrum disorders. Similarly to the national movements, Sandwell has seen small increases in the number of children being identified. Sandwell’s rate is significantly lower than the national rate at 13.7 per 1000.
4.8 Local Concerns identified by 11-16 year olds – Young People’s Voice
The annual 2017 SHAPE survey which was conducted with Sandwell schools is completed by 939 children. 84% (N793) were aged 11-13 and 14% (N133) were aged 14+. Although the survey is completed by 939 children, it is not representative for the whole of Sandwell: 57% of responses were from a particular school in Wednesbury and 36% from a particular school in Oldbury. Caution should be taken when using the results and should not be generalised to all children in Sandwell.
Top concerns about living in today’s society, included exams and schoolwork, bullying, gangs and
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youth violence.
In response to ‘Are you treated badly at school because of….’ the reasons with the highest responses included matters relating to appearance (22%), lifestyle and relationships, and ethnicity were cited by 60 (6%) young people. 35.5% (122) of 9 to 13-year olds and 20.2%(118) year 7.
The life skills the children indicated they would most like to cover in PSHE included:
• How to stay mentally and emotionally healthy (including managing stress) • How to recognise and deal with risky situations • How to plan for the future, decide which career to choose and get job-ready* • How to apply for college and apprenticeships* • How to manage money*
*higher interest for Years 9-13
• In 2018, 2223 11-18 Year olds in Sandwell voted on the issues that they wanted to be debated by the UK Youth Parliament in the House of Commons. Mental Health was the second most popular response (15%) after knife crime.
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4.9 Mental Health Related Disorders
There is no validated method of calculating mental health disorders, emotional disorders, conduct disorders or hyperkinetic disorders prevalence in children, however, as a guide, NHS conduct a national survey12 with parents and young people and this is the best source of data for child mental health. 9,117 children and young people responses are collected from parents, children (age 2-19) and teachers and the results are weighted to be representative of 2 – 19year olds in England.
The figures below show the results from the national survey applied to Sandwell’s populations in the respective age groups to determine the number of children in Sandwell likely to have a disorder. It should be noted that the estimates do not consider differences in other factors which may influence the rate such as socio-economic status. Due to Sandwell’s high level of deprivations the proportions are likely to be higher for Sandwell than other areas of England.
In summary:
Mental health disorders: 12.8% of children aged 5-19 are estimated to have mental health disorders. This equates to 8,376 children in Sandwell. Significantly a higher rate for girls than boys.
Emotional disorders: 8.1% of children aged 5-19 are estimated to have emotional disorders. This equates to 5,278 children in Sandwell. Significantly a higher rate for girls than boys.
Anxiety disorders: 7.2% of children aged 5-19 are estimated to have anxiety disorders. This equates to 4,729 children in Sandwell. Significantly a higher rate for girls than boys.
Depressive disorders: 2.1% of children aged 5-19 are estimated to have depressive disorders. This equates to 1,376 children in Sandwell. Significantly a higher rate for girls than boys.
Behaviour disorders: 4.6% of children aged 5-19 are estimated to have behaviour disorders. This equates to 3037 children in Sandwell. Significantly a higher rate for boys than girls.
Hyperactivity disorders: 1.6% of children aged 5-19 are estimated to have hyperactivity disorders. This equates to 1,074 children in Sandwell. Statistically a higher rate for boys than girls.
Other less common disorders: 2.1% of children aged 5-19 are estimated to have fewer common disorders. This equates to 1,383 children in Sandwell. Statistically a higher rate for boys than girls. This grouping includes autism spectrum disorder, eating disorders and others. Eating disorders has the smallest percentage (0.4%) within this grouping, equating to 552 children.
12 NHS Digital - Mental Health of Children and Young People in England, 2017
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Table 4.3 Mental Health of Children and Young People
5 to 10 year olds 11 to 16 year olds 17 to 19 year olds All Mental disorders Boys Girls All ALL Boys Girls All ALL Boys Girls All ALL Boys Girls All ALL % % % No % % % No % % % No % % % No Any disorder 12.2 6.6 9.5 2753 14.3 14.4 14.4 3613 10.3 23.9 16.9 1916 12.6 12.9 12.8 8376 Emotionaldisorders 4.6 3.6 4.1 1192 7.1 10.9 9.0 2252 7.9 22.4 14.9 1690 6.2 10.0 8.1 5278 Anxietydisorders 4.4 3.4 3.9 1135 6.2 9.7 7.9 1991 6.3 20.3 13.1 1480 5.4 9.1 7.2 4729 Separation anxiety disorder 1.0 1.1 1.0 301 0.8 0.4 0.6 144 - - - 0.7 0.6 0.7 431 Generalised anxiety disorder 1.2 0.2 0.7 213 1.0 2.2 1.6 402 1.9 4.6 3.2 362 1.3 1.8 1.5 1011 Obsessive compulsive disorder 0.1 0.1 0.1 37 0.7 0.6 0.7 164 0.7 0.7 0.7 77 0.5 0.4 0.4 284 Specific phobia 0.6 0.9 0.8 230 0.8 1.0 0.9 222 0.4 0.9 0.6 72 0.7 0.9 0.8 522 Social phobia 0.2 0.2 0.2 49 0.8 1.3 1.0 260 1.0 2.6 1.8 203 0.5 1.1 0.8 533 Agoraphobia 0.0 - 0.0 7 0.2 0.7 0.5 121 0.6 2.8 1.7 191 0.2 0.8 0.5 343 Panic disorder 0.0 - 0.0 7 0.6 1.6 1.1 284 1.4 5.6 3.4 390 0.5 1.7 1.1 728 Post-traumatic stress disorder 0.2 0.2 0.2 58 0.3 0.8 0.6 147 0.3 2.4 1.3 150 0.3 0.9 0.6 372 Body dysmorphic disorder (BDD) 0.1 0.1 0.1 22 0.2 1.9 1.0 249 0.8 5.6 3.1 355 0.3 1.8 1.0 669 Other anxiety disorder 1.5 0.9 1.2 349 1.2 2.2 1.7 424 1.2 3.4 2.3 256 1.3 1.9 1.6 1042 Depressive disorders 0.4 0.2 0.3 87 1.6 3.8 2.7 684 3.2 6.5 4.8 546 1.4 2.8 2.1 1376 Major depressive episode 0.2 0.1 0.2 56 1.0 2.8 1.9 475 2.4 4.7 3.5 399 1.0 2.0 1.5 973 Other depressive episode 0.1 0.1 0.1 32 0.6 1.1 0.8 209 0.8 1.8 1.3 147 0.4 0.8 0.6 403 Behavioural disorders 6.7 3.2 5.0 1448 7.4 5.0 6.2 1568 1.0 0.5 0.8 90 5.8 3.4 4.6 3037 Oppositional defiant disorder 4.7 2.5 3.6 1054 3.9 3.0 3.4 867 0.7 - 0.4 40 3.6 2.2 2.9 1913 Conduct disorder confined to family 0.2 0.1 0.2 45 - 0.2 0.1 23 - - - 0.1 0.1 0.1 65 Unsocialised conduct disorder 0.4 0.2 0.3 86 0.7 0.5 0.6 153 - - - 0.4 0.3 0.4 234 Socialised conduct disorder 0.6 0.1 0.3 91 1.9 1.0 1.5 367 0.3 0.1 0.2 24 1.0 0.4 0.7 476 Other conduct disorder 0.9 0.3 0.6 171 0.9 0.3 0.6 159 - 0.5 0.2 25 0.7 0.3 0.5 349 Hyperactivity disorders 2.6 0.8 1.7 498 3.2 0.7 2.0 501 1.5 - 0.8 90 2.6 0.6 1.6 1074 Hyperkinesis 2.4 0.7 1.6 462 2.6 0.7 1.7 415 0.8 - 0.4 49 2.2 0.6 1.4 908 Other hyperactivity disorder 0.2 0.1 0.1 36 0.6 0.1 0.3 86 0.7 - 0.4 41 0.4 0.0 0.3 166 Other less common disorders 3.4 1.0 2.2 637 2.4 2.0 2.2 551 1.4 2.2 1.8 202 2.6 1.6 2.1 1383 Pervasive Developmental Disorder (PDD)/Autism Spectrum Disorder (ASD) 2.5 0.4 1.5 427 1.8 0.7 1.2 307 1.0 0.0 0.5 55 1.9 0.4 1.2 776 Eating disorders 0.1 0.1 0.1 16 0.2 1.0 0.6 148 0.0 1.6 0.8 88 0.1 0.7 0.4 261 Tics/other less common disorders 1.6 0.6 1.1 330 0.8 0.4 0.6 158 0.4 0.8 0.6 70 1.1 0.6 0.8 552
Pre-School Mental Health (2-4 years): The NHS Mental health of children and young people in England, 2017 survey also identified that one in eighteen (5.5%, CI 4.3% – 6.8%) preschool children were experiencing a mental disorder around the time of the interview in England in 2017. Boys (6.8%) were more likely than girls (4.2%) to have a mental disorder.
Less common disorders and behavioural disorders were the most common disorder types in preschool children (2.8% and 2.5% respectively)
Overall, preschool children are less likely to have a disorder than older children
Self-harm: Hospital admissions (not persons) for self-harm in children nationally has increased in recent years, with admissions for young women being much higher than admissions for young men. However, for Sandwell the rate has been declining since 2015/16.
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In 2017/18 – There were 188.6 hospital admissions per 100,000 classified as self-harm for ages 10-14 years. This is similar to the national rate.
In 2017/18 – There were 483.6 hospital admissions per 100,000 classified as self-harm for ages 15-19 years. This is better than the national rate
School pupils with social, emotional and mental health needs: This is children with special education needs who have been identified as having social, emotional and mental health needs as their primary need classification
Sandwell Primary School children: In 2018, 2.3% had been identified as having social, emotional and mental health needs. Although this proportion is on par to England’s proportion of 2.2%, there still remains an inequality gap for children from Sandwell and the rest of the West Midlands. This proportion is statistically higher than the West Midland region which is at 1.9%.
Sandwell Secondary School children: In 2018, 3.3% had had been identified as having social, emotional and mental health needs. This proportion is statistically higher than the West Midlands (2.2%) and England (2.3%).
Sandwell is amongst the 20 local authorities with the highest proportion of secondary school children with social, emotional and mental health needs. It is also the highest proportion in the West Midlands.
4.10 Determining Service Need in Sandwell Service Need
Based on wider mental health promotion evidence, the Centre of Mental Health’s methodology for assessing emotional and mental health needs across the spectrum has been applied to the children and young people population of Sandwell (based on 2017/18 activity). The formula aims to provide the potential numbers for those children and young people who may require the different levels of service across the system and give assurance to commissioners whether sufficient services are commissioned or planned to be commissioned. It will also identify areas of unmet need and suggest where and how the gaps can be filled.
Our estimation of the level of support required across the Sandwell system by THRIVE category of need is set out in Table 4.4.
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Table 4.4 Children and Young People Emotional and Mental Health Need in Sandwell
Potential CYP’s Description of CYP % of Numbers Responsible Thrive Mental Health Needing Help CYP of CYP Organisations Category of Needs (0-25) Need 2018 Estimate Universal All CYP and families need 100% 113,209 Whole service Thriving – needs resources and assistance system Prevention to build strong Mental and Health in children. Promotion
Targeted or Some CYP need extra help 15% 16,981 Voluntary sector, Getting early help to build resilience because evidence-based Help needs they face greater exposure counselling, drop to risk. Some CYP also in’s, online access have deteriorating Mental Health and need early help to de-escalate and restore good wellbeing.
Children with Some CYP will have less 7% 7,925 School counselling, Getting less complex complex and risky voluntary sector, Help diagnosable diagnosable level needs evidence-based needs counselling, primary Mental Health support
Children with Very complex or high risk 1.85% 2,094 Specialist CAMHS & Getting complex and diagnosable Mental Health services to avoid More Help more risky needs further escalation needs
Children with Some CYP will have highly 0.075% 85 Inpatient settings, Getting highly risky, complex, concerning and broader service Risk complex or specialist diagnosable system Support specialist Mental Health needs. needs
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Table 4.5 Level of Need in Sandwell by Thrive Category (see narrative below for explanation)
THRIVE Level of Need Expected Sandwell Sandwell Number of Category (Tier) No. of POA Data Activity Sessions Sessions Data
Getting More help / Getting Specialist 493 800 946 2,239
Getting Help Targeted 1,160 1,582 1,409 4,151
G etting Universal Advice /Help Plus 279 120 130 529
Getting Advice Universal 206 170 162 538
Not 95 178 408 681 Recorded
Total 2,233 2,850 3,055 4,138
The Thrive Framework identifies five categories of need based on NICE groupings of care pathways and has developed the predicted resource use for each needs-based grouping. Table 4.5 attempts to map the levels of care outlined by Thrive against the types of services commissioned in Sandwell. It aims to identify if our service activity reflects that of the evidence- based modelling. Our activity does not neatly align to THRIVE domains due to the service composition, however, core components of the Thrive model are comparable to provision in Sandwell. Table 4.5 shows that 3,055 referrals were received for children and young people’s emotional and mental health services. The population prevalence provides an indicator of what types of services are likely to be required to effectively meet the needs of our children and young people... The 946 referrals into CAMHS specialist services (Getting Help/More Help) in 2017/18 are higher than expected yet referrals to universal and universal plus services Getting Advice/Help) is approximately 30% under the estimations. The level of need identified within referrals to services during 2017/18 has been collated. It indicates that there is a year on year increase for Getting Help and Getting More Help services and less children and young people requiring Getting Advice.
Over the next two years we will work with services to use NICE pathways as recommended by THRIVE to establish a thorough understanding about the levels of need. We will use this intelligence in service redesign to inform the commissioning cycle going forward.
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SWBCCG and Wolverhampton CCG jointly commission local CAMHS provision and commissioned Niche Consulting earlier this year to undertake event simulation modelling working closely with local service providers. The purpose of this work was to
• undertake historic analysis of patterns of activity and utilisation with the services in scope, and
• develop forecast models of future service structures and systems.
The findings are based on the construction of a statistical model of the current operation of services, based on a three-year census of historic data; and then forward projection of a wide range of scenarios.
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Figure 4: Prevalence of need in Sandwell based upon 2017 data
5 to 10 year 11 to 16 year 17 to 19 year old’s old’s old’s Total Boys Girls Boys Girls Boys Girls Boys Girls PREVALENCE THRIVE Model Constellation n n n n n n n n Any disorder 1,770 911 1,814 1,717 632 1,257 4,217 3,885
Emotional disorders 664 499 897 1,298 483 1,176 2,052 3,119 emotional and Anxiety disorders Getting Help behavioural 634 473 786 1,154 383 1,066 1,809 2,824 Separation anxiety disorder 142 152 95 45 0 0 234 189 Generalised anxiety disorder 178 29 131 260 116 241 428 564 Obsessive compulsive disorder 17 19 92 68 44 34 154 125 Specific phobia 93 131 98 118 27 45 217 294 Social phobia 22 25 97 156 60 139 182 340 Agoraphobia 7 0 29 89 38 148 76 259 Panic disorder 7 0 80 196 88 293 179 532 Post-traumatic stress disorder Getting Help STEPP - PTSD 28 29 43 100 21 125 92 271 Body dysmorphic disorder (BDD) 14 7 20 220 50 294 87 565 Other anxiety disorder 214 125 154 259 73 179 440 582 emotional and Depressive disorders Getting Help behavioural 52 33 207 458 196 343 465 882 Major depressive episode 36 19 130 331 148 246 321 631 Other depressive episode 17 14 77 127 48 97 143 251 Bipolar affective disorder Getting Help STEPP - Bipolar 0 0 7 0 0 14 7 16
emotional and Behavioural disorders Getting Help behavioural 964 445 940 596 63 28 1,943 1,047 Oppositional defiant disorder 676 351 493 356 42 0 1,197 686 Conduct disorder confined to family 25 19 0 22 0 0 25 39 Unsocialised conduct disorder 53 31 88 62 0 0 139 91 Socialised conduct disorder 81 7 241 119 21 4 339 130 Other conduct disorder 129 38 118 38 0 24 243 101
Hyperactivity disorders Getting Help neurodevelopmental 377 107 406 88 95 0 872 189 Hyperkinesis 350 99 329 80 51 0 723 173 Other hyperactivity disorder 28 7 77 8 43 0 149 15
Getting Advice Other less common disorders (Assessment) neurodevelopmental 486 132 303 236 83 117 867 495 Pervasive Developmental Disorder (PDD)/Autism Spectrum Disorder (ASD) Getting Help 361 53 224 78 58 0 638 128 STEPP - Less Eating disorders Getting More Help Common 8 7 29 114 0 84 37 218 STEPP - Less Tics/other less common disorders Getting More Help Common 233 88 105 50 25 44 360 184
Source of prevalence rates: Mental Health of Children and Young People in England, 2017 [PAS] Source of populations: Office for National Statistics
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The 5-year prevalence up to 2025 by ‘Constellation’ and Thrive level of need based upon work undertaken by Niche consultancy is detailed below in Figure 5. Figure 5: Constellation THRIVE Model emotional and behavioral Getting Help neurodevelopmental Getting Help
neurodevelopmental Getting Advice (Assessment) STEPP - Bipolar Getting Help STEPP - Less Common Getting More Help
STEPP - PTSD Getting Help
Figure 6: Estimated Prevalence
Estimated prevalence over time Emotional and Neuro- LD (Severe / Behavioural developmental STEPP Profound) Grand Total Sandwell 2019 8,478 1,654 1,155 316 11,602 2020 8,634 1,676 1,177 321 11,808 2021 8,740 1,695 1,192 326 11,952 2022 8,876 1,704 1,209 329 12,119 2023 8,996 1,717 1,224 334 12,270 2024 9,037 1,715 1,232 336 12,320
Assuming the prevalence above, we can see that Sandwell CMHT alone are able to deliver Thrive to the “elaborated” model – Figure 7
Figure 7: Prevalence Getting Help 7,314 Getting More Help 788
Target 35% target of total prevalence 2836
Episodes per year to meet target Getting Help 2,048 Getting More Help prioritised over getting help 788
Mean expected episode length Getting Help from THRIVE (elaborated) 6.2 Getting More Help 10.4
Calculations Contacts PA 20,892 Offered contacts per annum (10% cancellation/DNA) 23,214 (14 contacts / week / WTE CMHT WTE assumption) 28.7 Getting advice (24% predicted resource usage) 9.6
Total (Clinical) - WTE 38.3 Total (Non-clinical) - WTE 20% 9.6
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Total WTE 47.8 Current WTE 48.3
Expansion Plan
The aspirational plans for the specialist CAMHS workforce is that they will both continue to increase the workforce numbers via the C&YP IAPT recruit to train and well-being practitioner programmes and continue to upskill current workforce. These additional numbers will also be available for the Non-NHS Commissioned services. BCPFT has continued to access C&YP SFP and PWP programmes for 4 trainees this year. As part of the MHST trailblazer project for 2020 this will increase the capacity of the team to support the required increase in access and ensure that children and young people are seen by the right people and the right service. As part of this project 4 EMHP’s will undertake a year’s training and upon qualifying increase to band 5. BCPFT also have a requirement to ensure that they have sufficiently upskilled their current clinicians to ensure they can deliver the new evidence-based interventions required for some of the most complex children and young people. Within specialist CAMHS greater skills around trauma informed care is required and therefore 8 clinicians have been offered further EMDR training.
To ensure children and young people with depression, mood disorders and suicidality are adequately supported, BCPFT have offered a large cohort of staff across both specialist CAMHS and the voluntary sector training opportunities for CBT. It is anticipated that this will support he reduction in suicide numbers and ensuring recovery of those presenting with severe depressive disorders. Upskilling the workforce for C&YP with mental health and learning disabilities BCPFT have continued investment in the PBS coaching programme. They have also introduced further opportunities for shared learning, supervision, secondments and shadowing within local communities and across the Trust as part of their continued professional development programmes. BCPFT also invest in the C&YP leadership programme and clinical supervision opportunities at Universities.
As part of the increase in funding to Crisis, Home Treatment and Intervention team there is currently a drive to stop children and young people being admitted to the acute trust unnecessarily. Following a review of Crisis services across Wolverhampton and Sandwell & West Birmingham, the crisis team in Sandwell tend to see the CYP prior to their attendance at A and E. Work will be done in conjunction with the review of services across the Black Country to ensure that it meets the Black Country’s needs for the future. Currently there does not appear to be a need for 24 hours, 7 days a week coverage for the Crisis, Intervention and Home Treatment Team given the number of children and young people who appear to go into crisis out of hours.
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4.11 Inequalities of Access
Ethnicity
National research over the last 50 years has repeatedly shown that Black, Asian, Minority and Ethnic (BAME) communities have more adverse experiences and negative outcomes within mental health care compared to the majority population in relation to:
• inequalities
• access
• experience of care
• within BAME group differences
• between BAME group differences.
This manifests in under and over representation of different ethnicities in services.
Ethnic minorities appear to be disadvantaged even before they reach specialist mental health care. Problems with access to primary care and mental health promotion have been reported, and it has been contended that people from BAME backgrounds do not get the mental health services they want or needs. Psychological services such as Improving Access to Psychological Therapies (IAPT) also appear to be more inaccessible for people from minority communities. Black people are also reported to be more likely to be turned away from mental health services when they seek help. Furthermore, BAME groups tend to report more dissatisfaction with mainstream services compared to community sector or voluntary organisations providing mental health care, and mainstream services are often perceived as more likely to misunderstand their situation and experience.
Our locally collected data from POA during 2017/18 shows that 67% of CYP who have been referred to services are White, 18% BAME and 13% had no ethnicity data is available. Public Health data shows that as at May 2018 Sandwell had 397 CYP who were asylum seekers. 8 children and young people were looked after asylum seeking children which is relatively low compared to 145 in Birmingham.
Gender and Sexual Orientation
In Sandwell, all referrers access a range of Emotional Wellbeing and Mental Health Services through the Point of Access (POA). POA referral data shows that more boys are referred into services. It is recognised from national surveys (Mental health of Children and Young People in England 201) that a significantly higher proportion of girls are affected by mental health disorders, whereas boys are significantly higher for behaviour disorders. Further analysis of Sandwell’s access data is required to understand whether this proportionally represents the locality. We need to assure ourselves that there are no unintended barriers to girls being referred or accessing services.
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Whilst there are data gaps for children and young people related to sexual orientation, available data from POA 2017/18 indicates that less than 5 children and young people in Sandwell were referred to services for support around sexual orientation. The numbers of referrals are relatively low and may indicate that there are gaps in our understanding regarding children and young people who identify themselves as Lesbian, Gay, Bisexual or Transsexual (LGBT).
4.12 Implications of our Needs Analysis
• The forecast growth in all age groups in the 5-19 years range is likely to impact on demand for CAMHS over the next 5 years. We must plan for this increase across the wider system and ensure age-appropriate care and support is available. Our reliance on drop-in services may not be as accessible for primary school age children. We need to explore developing School-based teams with the capability to respond to the diverse age specific needs of our children and young people.
• We need to plan and commission services that have the capacity to meet increased demand indicated by the forecast population growth and predictive indicators of future demand. Given half of mental illness begins by the time a young person reaches 14 years, we need to start earlier to build resilience with children and young people to manage emotionally challenging situations.
• The forecast growth in demand requires the local system to expand upstream wellbeing and mental health support to prevent the advancement of emotional wellbeing concerns manifesting into mental health conditions. Professionals routinely encountering children and young people across education, health, and care are ideally placed to enable increased emphasis on prevention and early intervention given they are appropriately trained and skilled.
• The variation in the numbers of children and young people diagnosed with Autism Spectrum Disorder identified warrants further work to ascertain the actual numbers with the condition and work across partners to ensure appropriate provision is commissioned in accordance with the NHS 10 Year Plan.
• Over the next year we will be consulting on developing intensive community support as well as exploring alternative support that is required to help families to stay together. We need to analyse our local needs data to shape our future commissioning intentions.
• We need to understand what ‘support to cope’ looks like in relation to children and young people with learning disabilities and ASD. We need to work in partnership, with children, young people and their carer’s, using the intelligence gathered, to co-design provision and ensure it is commissioned to meet this unmet need. In addition, we will be reviewing our Learning Disabilities nursing service to ensure that we have appropriate skills to support this patient cohort. • We will ensure that all service planning, co- production and commissioning of services for
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children and young people everyone with, or are at risk of, emotional wellbeing or mental health needs (or cares for someone who does) provides for equitable access to effective interventions, and equitable experiences and outcomes, regardless of ethnicity. Additional investment in mental health will be made that benefits all communities and BME groups
• Further work is required to understand service access by geography within Sandwell and whether there are barriers to access for specific groups.
• Moving forward Sandwell will need to consider how girls present with emotional wellbeing concerns and raise awareness with partners to support earlier identification of mental health difficulties in girls.
• As part of our programme of work with schools we will work towards ensuring that they are offering a safe environment for young people to express diverse sexual and gender identities. This will be embedded in universal training, curriculum development and parent support. Recent press reports of parental opposition to LGBTQ+ inclusive practice has created anxiety in local schools, who will need to receive support and advice in preparation for meeting the new statutory requirements for Relationships and Sex Education.
• We have already started to support Early Years to support emerging emotional wellbeing and mental health needs through commissioning an Early Years Psychologist to work within our Child Development Centres to identify needs earlier. In addition, as a system we have agreed to work on the Early Years agenda over the next few years.
• More analysis is required to understand the local prevalence and effectiveness of local interventions to address perinatal mental health issues. We to ensure that the promotion of maternal mental health remains a key priority for our Maternity Local Transformation Plan and Early Years Transformation Academy Programmes.
5. LTP AMBITION 2018-2020 – OUR PRIORITIES
Our vision in Sandwell is:
“To create a culture where Children and Young People’s emotional wellbeing and mental health matters to all; knitting universal to targeted and specialist services together”
We want our children and young people to be optimistic, resilient and living in communities where they can thrive. We want CYP in Sandwell to Start Well and have the best life chances and outcomes possible, recognising the challenging environment in which some are growing.
Our ambition is premised on a systematic approach to delivering and commissioning emotional wellbeing and mental health services for children and young people. We aim to work with current and new providers to ensure good quality integrated person- centred approach to support CYP to thrive. Our ethos has been and still is to remove the barriers that have previously hindered access to emotional wellbeing and mental health care and support, with the aim to reduce the numbers of children and young people who unintentionally fall through
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service gaps owing to the limitations in access criteria.
This plan starts from the premise that the needs and wants of our children and young people must be central to how the CCG and its partners work together to plan, commission and deliver services. It seeks to set out the system wide breadth of transformation required across partners to achieve our vision. It outlines how we will link universal services to targeted and specialist services by:
• Embedding good emotional health and wellbeing as foundational principles within the main touchpoints of access to services for CYP • Providing training, advice and support for universal services to manage low level wellbeing concerns • Promoting resilience through self-management • Creating opportunities for children and young people to gain timely access to a choice of services • Developing holistic provision where all services are connected and ensure children and young people access the right pathway of support and care • Expanding community services in particular education settings to support early identification and intervention • Developing workforce capacity to support a full range of bio-psycho-social therapeutic interventions based on children and young people’s needs, and • Supporting the most vulnerable such as children and young people with Learning Disabilities, Autistic Spectrum Disorder or both, and Looked After Children.
Children and Young People’s Local Transformation Plan (CYP LTP) is connected to multiple partners and joint working arrangements across different work programmes and organisations, as described fully in Chapter 3: Transparency and Governance. Recognising that our partnership is multi-layered and multi-faceted we aim to connect our diversity to provide an asset-based approach to CAMHS transformation. We will achieve this by following national guidance, using local intelligence and developing place-based solutions that build a culture that mental health is everyone’s business where provision is integrated to support Sandwell’s children and young people to be optimistic, resilient and in turn Thrive.
Our commitment to delivering this plan is underpinned by robust programme management and a plan (see Appendix 2) that enables partners to track progress and ensure delivery resources are in place to ensure all deliverables are achieved. We are actively working to ensure that by March 2021 we will have:
• reliable and comprehensive data flows to enable routine performance monitoring against access targets and financial investments across partners • key performance indicators (KPI’s) and outcome measures to inform, track and improve performance, aligned to our locally agreed Outcomes Framework.
Our vision aligned with the national vision. The Five Year Forward View for Mental Health (2016), the CCG Improvement and Assessment Framework (2016/17) and Implementing the Five Year Forward View for Mental Health (2017) describe NHSE’s detailed improvement blueprint for mental health to 2020 and beyond which has been developed in partnership with patient groups, clinicians and NHS organisations. In addition, the NHS 10 Year Plan further extends ambitions for children and young people’s emotional wellbeing and mental health. For
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local delivery, we have incorporated the work we need to do with our partners into this plan.
Sandwell’s CYP LTP embeds ambitions of the MHFYFV and aims to make them a reality by changing the way services are delivered. Our approach is to move from medicalised models of mental health support to bio-psychosocial models that are based on increasing holistic provision that is accessible early to prevent deterioration in mental health presentation.
This LTP represents the delivery plan for Sandwell emotional wellbeing and mental health services. Partners all participate in the annual revisions of the plan which along with the ambitions of the 10-year Long Term Plan (2019) aim to achieve the following:
• Increased investment in children and young people’s mental health services • An additional 345,000 more children and young people will have access to NHS-funded mental health support services through CAMHS, community mental health services, as well as through support in schools and colleges by 2022/23. Further analysis is currently underway to understand what this means from a local perspective. • Creating a comprehensive mental and physical health model for 0-25 year olds to avoid difficult transition into adult services at 18 years old • New services for children with complex needs which are not being met, including children who have been subject to sexual assault • The 95% children and young people’s Eating Disorder referral to treatment time standards achieved in 2020/21 will be maintained • There will be 100% coverage of 24/7 mental health crisis care provision for children and young people, including those with ASD and/or LD which combines crisis assessment, brief response and intensive home treatment functions • Children and young people’s mental health plans will align with those for children and young people with learning disability, autism, special educational needs and disability (SEND), children and young people’s services and health and justice.
We have further work to do and this plan sets out the actions and initiatives we will undertake from 2019/20 onwards to achieve the ambition of MHFYFV and the 10 Year Long Term Plan in Sandwell, and the STP. We are committed to:
• Meeting the access and waiting time standard for children and young people with an eating disorder - by March 2021, at least 95% of children and young people with an eating disorder should be seen within one week of an urgent referral • Achieving the access and waiting time standards for first episode of psychosis for children and young people to commence a NICE-concordant package of care within two weeks of referral – at least 56% of people aged 14-65 experiencing their first episode of psychosis should start treatment within two weeks • Ensuring adequate crisis and liaison services for CYP embedded within all age services • At least 34% of children and young people with a diagnosable mental health condition should receive treatment from an NHS-funded community mental health service by March 2020 (and at least 35% by March 2021), and increasing access to 100% local population prevalence in the long term • Continued reduction in out of area placements • Undertaking continued workforce needs analysis and planning, linked with activity demand and capacity modelling, so that we have the workforce we need with the right skill set in the places we need them,
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• Developing and monitoring local quality requirements to support performance management of delivery of this CYP LTP • Taking action to expand the emotional wellbeing and mental health workforce, including specifically the role of primary care to support children and young people • Creating more opportunities for children and young people to access services through connectivity and embedding school based mental health team, and providing training for schools to better equip staff to support young people at higher risk e.g. LGBT, CIC • Reducing waiting times, with new referrals being seen within 4 weeks and the second appointment within 6 weeks • Facilitating the transfer of budgets to local providers to incentivise reductions in avoidable admissions, shorter lengths of stay and cease out of area placements. • Maximising digital opportunities to increase access and the offer to children and young people e.g. on-line support • Improving access and quality of care and support for children and young people, and their families/carers, with learning disabilities/ASD, who are looked after or who have been adopted e.g. annual health checks, Supporting Treatment and Medication in Paediatrics (STAMP) • Working with primary care to increase awareness of Young carers • Developing personal health budgets for CYP with LD/ASD • Working to establish a comprehensive service offer for 0 to 25-year olds that seeks remove the current inadequacies in transition to adult services • Creating an optimal urgent response and recovery in the local system, supported flexibly across primary care and community services • Ensuring access to perinatal mental health services for mums-to-be to give infants the best start in life, and • Reducing inequalities in access and provision for all.
Key enablers include:
• Ensuring all providers, including third and independent sector providers, submit comprehensive data to the Mental Health Services Dataset (MHSDS)/Improving Access to Psychological Therapies (IAPT) dataset • Ensuring a comprehensive understanding of data and information on local health inequalities and their impact on service delivery and transformation • Ensuring a clearly defined mental health digital strategy is in place, supported by a service transformation programme and board-level sign off that includes processes to achieve future digital record sharing across health and care communities, and the integration of digital tools and digitally enabled therapies into routine clinical practice.
Whole System of Care – Using the THRIVE framework
Sandwell has moved away from the traditional tiered system for CAMHS and is now utilising the THRIVE framework for transforming mental health. This approach allows representatives from formal organisations to talk about emotional wellbeing and mental health with each other, and with local children and young people (and their families/carers) in a common language that everyone understands. Its value lies in being a needs-led approach to planning and organising the local service offer that we choose to commission; this means that mental health needs are
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defined by children, young people and families alongside professionals through shared decision making. It allows the future model of provision to not be limited by traditional organisation based on severity, diagnosis, or health care pathways.
Partners are committed to moving towards utilising the THRIVE model to develop and deliver emotional wellbeing and mental health services going forward. This CYP LTP is based on the five THRIVE model categories of need: Thriving, Getting Help, Getting More Help and Getting Risk Support. This approach underpins our 2019-20 work underway to develop a refreshed engagement strategy and on-going activities that will enable the local system to demonstrate inclusivity in service planning, commissioning, delivery and evaluation.
Our ambitions 2019/20 are outlined against each of the THRIVE need categories. It provides evidence that our plans have been built on a whole system of care approach and will describe how Early Help provision with local authorities, Public Health and Children’s Services are working together to support CYP to Thrive. In summary our ambitions are to:
• Support prevention and early intervention within universal settings, schools, colleges • Work collaboratively to provide Early Help • Continue to provide evidence-based care and how Reported Outcome Measures (ROMS) will be included in monitoring arrangements • Continue to provide crisis and intensive interventions • Identify needs and care and support for groups who may require alternative interventions. Work with NHSE to develop new models of care for Black Country and West Birmingham STP • Provide specialist care for CYP with learning disabilities or forensic CAMHS.
In terms of organisation for delivery of our CYP LTP, the THRIVE Board has produced a high- level map of services that are aligned to the 5 THRIVE need categories (see Figure 8 below). It details commissioner responsibility for services by THRIVE category with overlaps and depicts how a joint approach across partners is necessary to make CAMHS transformation happen. The map identifies the 3 operational delivery groups who report to the CAMHS Transformation Board, otherwise known as the THRIVE Board, to deliver the work. The scope and work focus for each delivery group has been determined by the assigned THRIVE need categories:
• Group 1 - Thriving Partnership • Group 2 - Getting Advice and Help • Group 3 – Getting More Help and Risk Support
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Figure 8 – Operational Groups by THRIVE category, THRIVE Board (previously CAMHS transformation board) showing Commissioner Responsibility Thrive Operational Group Group 1 - Group 2- Group 3- Thriving partnership Getting advice and help Getting more help and risk support Public Health chair Multi-agency chair (CCG/ PH/ SCT) CAMHS provider chair (BCPFT)
Thriving Getting Advice Getting Help Getting More Help Getting Risk Support
Prevention & promotion Signposting, self-management and Goals focused, evidence Extensive treatment Risk management and one-off contact informed and outcome crisis response focused intervention Those whose current need is Those who need advice and signposting Those who need focused goals- Those who need more Those who have not benefitted support to maintain mental based input extensive and specialised from or are unable to use help, wellbeing through effective goals based help but are of such a risk that prevention and promotion they strategies are still in contact with Public Health and VCS services
SMBC Inclusion support ▪ Universal services Sandwell Children’s Trust ▪ Parenting Programmes ▪ Early Help SWB (changes, Solihull ▪ Best start CCG approach, Triple P) ▪ Child development centres ▪ Child development ▪ CAMHS (11 care ▪ Urgent Care and ▪ Best Start (CDC) centres (CDC) pathways); Crisis Services ▪ School nursing ▪ EHWB Charter Mark (inc ▪ Inclusion support ▪ Eating Disorders ▪ Crisis services ▪ Early Intervention Intervention & home Treatment team ▪ Health visiting curriculum & tool) ▪ Beam into Psychosis ▪ Crisis Care Police ▪ EHWB Charter Mark ▪ Inclusion Support service ▪ PMHW ▪ Liaison & Diversion Custom (inc curriculum & tool) ▪ Kooth ▪ CAMHS (11 care services ▪ Inpatient Care ▪ CYP workforce ▪ Beam pathways) ▪ SEND team post training ▪ EP’s and Inclusion support ▪ Dedicated LAC team ▪ Well-Net ▪ ACES strategy within CAMHS ▪ ACES strategy ▪ Primary Care – social prescribing
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Our Ambitions - ‘Thriving’ (Promotion and Prevention)
The THRIVE model defines ‘thriving’ as services to support children and young people ‘whose current need is supported in maintaining mental wellbeing through effective prevention and promotion strategies’ (THRIVE framework 2019). Vulnerabilities and risk factors such as poverty, protected characteristics, social and environmental factors all impact on a child or young person’s ability to thrive. Meeting ‘thriving’ needs requires health and care systems to deliver prevention and promotion activities that raise awareness and to recognise their own emotional wellbeing and know children and young people know where they can access support.
Thriving services and interventions that promote emotional and mental wellbeing and prevent emotional and mental ill-health include activities that raise awareness, develop resilient communities, promote self-help, create health-promoting environments and provide the front door to further help. Much of this work is commissioned or led by the Local Authority Children’s Services, Education and Public Health, and delivered or embedded in a wide range of services, including those delivered by the Voluntary and Community Sector.
During 2018/19 our ‘Thriving’ service included:
• Infant Mental Health Promotion Information on wellbeing in pregnancy delivered by midwives, health visitors, Best Start practitioners and Children’s Centres, delivered through: − routine contacts − community group-based activities such as Aqua Natal classes, and breastfeeding support groups − parenting classes that provides opportunities for expectant and new parents to develop social connections − co-produced Sandwell focused magazine given to all pregnant women − our ‘Changes’ Antenatal Education Programme.
• Supporting Parenting − use the evidence-based Solihull Approach in working with families through health visitors’ services - this includes promotion of early childhood attachment and is a high priority for our universal services − parenting education and support that focusses on positive behaviour management and building strong and healthy relationships (e.g. Changes Parenting Courses, Triple P)
• Supporting Children and Young People’s Emotional Wellbeing and Mental Health − Access to School Nurses for confidential advice and support via Drop-In Sessions and a confidential texting service available to all young people − Implementing our Whole-School Approach − Training of the universal workforce, including short courses on building resilience and understanding self-harm − Mapping of emotional wellbeing and mental health services − Local awareness campaign based on 5 Ways to Wellbeing 60
− Co-designed a ‘toilet door’ poster campaign with young people highlighting a range of agencies they can access for someone to talk to by text, online, or by drop-in.
Early Help
Early Help is provided as part of a continuum of need; from universal services through to targeted support where families experiencing more complex and multiple difficulties are supported. An early help assessment is completed that assesses a child within the context of their family and community and depending upon where this is undertaken along the continuum determines the level of support required.
The current Early Help service offer provides opportunities to support professionals to identify vulnerable children and families. Training funded by Public Health and the Inclusion Support Service supports the wider workforce to recognise some of the vulnerabilities of these families.
Sandwell’s Early Help strategy identifies several challenges:
• The family experience of transformed services: knowledge of services and engagement to empower children and young people, and families to define and create a life worth living • Culture: commitment by professionals to work across organisational boundaries and extent of shared vision and ambition across local organisations • Workforce: differing understanding of the principles of family working • Leadership: rhetoric commitment for partnership actions, absence of one common purpose across key partners and associated commitment to commission outcome-based services
Child Development Centres
Sandwell Early Years Services has Child Development Centres (CDCs) for children identified as not meeting their developmental milestones. The CDC provide an integrated approach to support children who have been The Early Years provision includes professionals from Early Years, Health and Education to work together to provide specialist advice, support and guidance to families and settings.
The opportunity was taken when our 0.6 Whole Time Equivalents (WTE) Early Years worker in CDC post became vacant to evaluate the impact of this role. This review led to increased investment to enable a full-time post to be recruited. In 2018/19 we recruited to this post and secured a dedicated Psychologist to support professionals in all Early Years settings, funded by CAMHS transformation funding. The role has been commissioned to: • Provide staff supervision and direct observation of children in community-based settings to determine if the child requires ongoing support of 0-5 CAMHS intervention in line with the Transition Plus Pathway. • Support multi-agency assessment • Provide post diagnostic sessions to parents. • Provide workshops on Sleep, ASD Awareness, Feeding issues, Sensory issues, Toileting for both pre- and post-diagnosis to parents/carers • Undertake personalised planning providing conclusions and further 61
recommendations to support children referred to the service • Develop a multiagency pathway with the Educational and Child Psychologists within Inclusion Support to support the successful transition into school • Work with the Counselling Psychologist 0-5 CAMHS ISEY service and Area SENCO for the CLASS Strategy to ensure children with Complex Communication Difficulties needs are met in a timely way i.e. within 4-6 weeks of referral. • Develop links with organisations such as Autism West Midlands particularly at the post diagnostic stage for additional ongoing support.
In 2019/20 we will continue to invest in the role as well as work with the Early Years settings to capture activity and can report the Mental Health Minimum Dataset.
Children with Disabilities Team
Sandwell Local Authority has a social care team dedicated to supporting children and young people with severe and profound disabilities up to the age of 18, and their families through providing:
• Information on the impact of a disability on a child or young person and their family • Support at home for parent or carers in caring for a child with a disability • Short breaks during the day in a family's home and in the community or overnight in foster care and residential units • Play and leisure opportunities • Direct payments to enable families to buy in their own care • Signposting to other agencies that may be able to help • Counselling to talk through worries and problems.
The team includes social workers and community support workers who are available Monday- Thursday 9am-5.30pm and 9am-5pm on Fridays.
Sandwell Inclusion Support
This Local Authority service works across Sandwell to improve the education, learning, development and mental health and wellbeing of all children and young people (ages 0 - 25) with a focus on those who are vulnerable and/or have special educational needs.
The service has experienced and well qualified staff who have a high degree of specialist expertise within the field of education, school improvement, early years, special educational needs, and mental health and wellbeing. This expertise and experience are subject to external audit on a six-monthly basis. The service has achieved the British Standards Institution (BSI) ISO 9001 award that focuses heavily on customer service and has a requirement for continuous improvement.
It is a multi-disciplinary service that provides assessment and intervention, specialist teaching, advice, consultation, information and support for parents, carers, schools and other educational settings regarding children and young people who have a wide range of needs. These needs can range from severe physical disabilities to mild learning difficulties and serious social, emotional or behavioural difficulties. The services provided include:
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• Education and Child Psychology • Support for CYP with learning difficulties, including Dyslexia • Support for CYP with behavioural, emotional or social difficulties (including the Preventing Primary Exclusion Team) • Support for CYP with complex communication disorders, including Autism • Sensory Support team for hearing/visual impairment • Support for people with special educational needs or disability in Early Years • Fair Access and Exclusions Team support for young people, their families, Headteachers, governing bodies and other professionals around exclusions and ‘hard to place’ children to ensure the right school place secured • Training programmes for Sandwell schools including behaviour recovery, ADHD in primary/secondary schools (awareness, strategies and management), counselling skills for staff, anger management, Dyslexia (awareness, strategies and management), introduction to Dyscalculia, ASD (sensory integration and managing behaviours that challenge) and bullying including e-safety, ‘Facing the Facts’ and homophobic bullying.
During 2019/20 we are analysing the data of any changes to the 3rd version and 4th of the Well-net audit to gain information on the demand and levels of access to training and gaps to inform future commissioning of training.
ACES
During 2019/20 our wider ACEs Strategy with action plan intent on establishing an ACE informed approach across Sandwell that provides inter-generational support for parents, families and children seeks to reduce the potential negative impacts for children and young people in later life. We will continue with the implementation of the ACEs plan, involving raising awareness of the impact of adverse childhood experiences and focussing and delivering the following priorities:
• (Priority A) - Sandwell has a good understanding of the distribution of ACEs across the borough; professional curiosity is used in a systematic way to identify those at risk and their support needs.
• (Priority B) - People can access support and advice from a range of trauma informed interventions and services.
• (Priority C) - Professionals are ACE aware and trauma informed, communities across Sandwell have a better understanding of Adverse Childhood Experiences and its impacts. Primary Care
The GP Five Year Forward View outlines transformational changes required to meet the needs of the population. By reforming the workforce provides opportunities to explore new roles such as Social Prescribing, Physician Associates and how they can provide new ways to support people to achieve positive outcomes holistically considering both physical and mental health.
SWB CCG is supporting the establishment of 15 Primary Care Networks that will be
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responsible for between 30-50K registered patients. This is an ideal opportunity to review how wider children and young people’s mental health and emotional wellbeing services work alongside primary care in an integrated way. Starting in 2019/20 we will seek to work with health and care partners to answer 4 key questions to inform future commissioning decisions:
• What role primary care plays in supporting children and young people’s mental health?
• How primary care workforce development plans that include therapists that can support children and young people up to 25 years old where appropriate?
• How primary care can access and promote healthy emotional wellbeing through up to date knowledge of local services available?
• How Primary Care can be informed identifying CYP who have had an ACE and quickly signpost or refer families for support to reduce the severity of exposure to such experiences or to recognise unexplained medical symptoms in adults and signpost them for psychiatric liaison services
• Develop ACE-aware and trauma-informed practice within Primary Care settings, including an understanding of the link to medical symptoms in adults and the further development of support pathways.
Getting Advice
The THRIVE model describes ‘Getting Advice’ as children, young people, parents and families whose needs are described as adjusting to life circumstances. It recognises that some of these circumstances can be mild or temporary difficulties where interventions should be accessible within the community and complimented by self- support (where this is possible). This cohort may include children and young people with chronic, fluctuating or ongoing severe difficulties for which they are choosing to manage their own health and or are on the road to recovery. Within Sandwell there are several services that support Getting Help within the THRIVE model, with the framework suggesting that children and young people with this need are likely to access services up to 6 times. The current services are provided by BEAM and Sandwell Inclusion Support Service, which are described below.
BEAM
SWB CCG jointly commission Sandwell BEAM with Sandwell Children’s Trust. BEAM provides children and young people between the ages of 5-18 years old, or up to 25 for care leavers, with advice, signposting and support with any low-level concerns relating to emotional health and wellbeing. The ethos of the service is that anyone can access the service to get information, support regarding emotional wellbeing and mental health concerns.
BEAM Sandwell provides a safe space for young people who may need support with their emotional and mental health and delivered in partnership with several statutory and voluntary sector organisations. The service provides:
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• Online information, learning, advice and guidance support 24/7 (via Kooth) • Online counselling support (via Kooth) • Specialist support for young people who have experienced some form of violence • Structured one-to-one support for CYP who do not meet CAMHS criteria • Therapeutic and wellbeing groups for CYP, parents and carers
BEAM has located services within areas where there are under-represented groups, as well as high deprivation. Regular drop in sessions at open access provision is available at three locations in Sandwell (West Bromwich, Rowley Regis, Oldbury and Smethwick). Young people can simply drop in and converse with volunteers and staff.
The team of Youth Workers, Therapists and trained Wellbeing Volunteers offer young people with guidance on a variety of topics. Specialist staff members provide caring advice and guidance areas including anxiety, anger, family difficulties, mood management and self-esteem. These areas of support have been tailored according to the presenting referral data identified over the last three years.
A recent survey showed that almost all young people accessing BEAM travel by car and this may indicate that children and young people living in families without a car may not be accessing the service. Feedback from various professionals indicated that afternoon opening times make the service inaccessible for some young people and families. During 2018/19, we reviewed the drop-in locations and established an additional location in Sandwell College which is very accessible by rail, bus and car. In addition, the opening times for the drop-in sessions were changed to 3-5pm to increase the opportunity for access to young people travelling by public transport into West Bromwich.
Sandwell Children’s Trust Personal Advisors for Care Leavers
As a statutory requirement, the Local Authority providers Personal Advisors (PA) to care leavers.
The PA acts as a focal point for the young person, ensuring that they are provided with the practical and emotional support they need to make a successful transition to adulthood, either directly or through helping the young person to build a positive social network around them. All care leavers are advised who their PA is and how to contact them. Throughout their transition to adulthood and independent life, care leavers have access to consistent support from their PA, who is the designated professional responsible for providing and/or co-ordinating the support that the young person needs. This includes taking responsibility for monitoring, reviewing and implementing the young person’s pathway plan.
The level of support that each care leaver will need will differ depending on their circumstances. Some care leavers may face many continuing challenges and require support across different aspects of their lives. Support for young people around their emotional and mental health is crucial for them to transition towards adulthood in a safe and appropriate way.
Sandwell has a NICE concordat multi-agency Autism assessment and diagnosis pathway in place provided by Inclusion Support, SLT, CAMHS and Community Paediatrician. Whilst our current pathway provides an excellent diagnosis service, there are limitations in relation to follow up support. In 2017/18 children and young people waited on average 32 weeks for an autism diagnosis. During 2018/19 SWB CCG agreed recurrent funding for the 0.5WTE Educational Psychologist to support Multi-
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agency Autism Assessments (MAA).
The NHS 10 Year Plan set targets to reduce waiting times for ASD and requires provision of packages of care and support during and post ASD diagnosis. Starting in 2019/20 have started working with the MAA Steering Group to ensure that the service has the capacity and capability across organisations to support the forecasted increase of prevalence of ASD in children and young people, in addition to reducing the waiting times and providing packages of support.
Family Action in Sandwell has recently been awarded funding to support children and young people, and their families, who are on the ADHD and/or ASD diagnosis pathway. During 2019/20 we are working with Family Action to co-design and commission assessment and post diagnosis support consistent with the NHS Long Term ambition.
During 2018/19 we identified that BAME children and young people access online support more than other ethnic groups. During 2019/20 we are continuing to work with target groups and media which we anticipate will increase access by our children and young people.
Our plans for Getting Advice 2019-2021
In collaboration with partners, we will:
• Utilise feedback gained through 2018/19 engagement exercises to develop strategic and operational commissioning plans for investment including:
− School-based support − Drop-in’s in locations that are accessible by public transport and opening on evenings and weekends − Undertake an audit and service evaluation of Beam − Targeted work with BAME community to raise awareness of mental health and understand barriers to access − Working alongside non-funded NHS commissioned VCS partners to explore how we work together to increase the resource envelope of supporting CYP needs in a coordinated way
• Develop workforce development plans to support children and young people’s access to Getting Help Support
• Develop structured support programmes for children and young people referred to BEAM services
• Undertake outreach work with BAME’s to increase engagement through BEAM
• Develop data quality improvement plan with providers to support MHSDS data collection
• Develop local access targets to increase access
It should be noted that our providers of emotional wellbeing and mental health services straddle both Getting Advice and Getting Help services.
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Getting Help
Getting help is defined by THRIVE as children and young people and families who would benefit from focused evidence-based treatments, with clear aims and criteria for assessing whether the aims have been achieved. This group includes children and young people that fall within the remit of NICE guidance but also those where it is less clear which NICE guidance is applicable to guide practice. This section describes our current Getting Help service offer.
The Safeguarding Children’s Partnership has set up a priority working group to improve the identification and response to childhood neglect (including emotional) through the implementation of the Graded Care Profile 2 across the multi-agency workforce. The Graded Care Profile 2 is an assessment tool which helps practitioners measure the quality of care a child is receiving. Training will be rolled out during 2019/20.
Our Best Start Service (previously known as the Family Nurse Partnership) provides intensive support for our most vulnerable families for the first two years of their child’s life. There is a strong focus on promoting attachment and supporting parental wellbeing.
The Primary Mental Health Service (PMHS) is been jointly funded between Sandwell Children’s Trust and Sandwell and West Birmingham CCG. Sandwell Children’s Trust is the lead for the contract with Kaleidoscope Plus Group. The service aims to align services across health, social care, the multi-agency safeguarding hub and community operating groups (COG’s).
The PMHS has been commissioned to March 2020 in line with the national directive to shift the focus of services from crisis intervention to early intervention and prevention. The service provides nine Primary Mental Health Workers (PMHWs) pre co-located with Sandwell Children’s Trust:
• 6 - each Sandwell ‘town’ COG • 1 - CIC Team • 1 – Horizon Child Exploitation • 1 - Youth Offending Team.
Co-location within specific teams provides for an integrated approach that adds value to each to the teams within which they operate, considered a key strength of our service delivery model.
PMHWs offer an outreach service of 1:1 and group therapeutic goal-based interventions for children aged 5 to 18 years (25 years if care leavers). They provide bridging support to children and young people awaiting intervention by CAMHS and other specialist in order to prevent escalation of need; and work collaboratively with CAMHS and other professionals to deliver a joined-up service of support for complex cases.
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The PMHW service also delivers therapeutic and mental health awareness training for professionals and foster carers to support the emotional health and well-being of children and young people; and has been part of the Children and Young People’s Increasing Access to Psychological Therapies (IAPT) learning collaborative.
Public Health colleagues have undertaken an evaluation, the results of which will inform future commissioning of the service. The evaluation found that:
• The average age of a service user is 12, with the youngest recorded aged 0 (usually the child of a service user) up to 19 years old. • For 176 cases where the waiting time for assessment is recorded, the average time to an assessment being completed from the time of allocation is 31 days.
This is in addition to the ten-day standard for allocating a patient from referral. This means a patient can wait up to 41 days on average from referral to assessment with sessions commencing within two weeks of assessment.
• For 83 patients where their Strengths and Difficulties Questionnaires (SDQs) were completed (22% of 381 patients, the results showed an average 3-point reduction in the SDQ Scores from start to finish, reflecting improvement in the patients’ conditions concerned.
Finance and activity data analysis in relation to this service has identified that our average cost per patient and per contact compared the CAMHS Benchmarking Report in 2013 undertaken by the Royal College of Psychiatrists is lower. This demonstrates significant value for money.
We need to consider how the PMHW service or similar models of care can be developed further and increase access to meet the MHFYV and NHS 10 Year Plan ambition.
Appendix 1 provides details of future expenditure aligned to the model.
Child and Adolescent Mental Health Service
The Sandwell Child and Adolescent Mental Health Service (CAMHS) is commissioned by SWB CCG from BCPFT. It sits as one of the mental health services provided by their Children’s Division that also delivers services for Early Intervention in Psychosis for 14-25-year olds and our Eating Disorders service.
The CAMHS service assesses and treats severe behaviour and moderate/severe mental health disorders in children and young people aged from 5–17 years (up to 18th birthday). The CAMHS offers support and guidance to families and stakeholders. The workforce is multi-disciplinary and provides evidence-based interventions and assessments including and not exclusive to:
• Cognitive Behavioural Therapy (CBT) for a range of emotional wellbeing challenges • Systemic and Functional family therapy • CAT, CBT and Systemic Family Therapy • Dialectical Behaviour Therapy (DBT) for emotional dysregulation 68
• Mental health assessments (diagnostic) • Structured behavioural assessments (cognitive, functional and developmental) • Pharmacological interventions and prescribing (as per NICE guidance) • Counselling and psychotherapy for a range of presentations.
The CAMHS report against all national indicators and quality requirements as part of schedule 6 of the NHS contract. In addition, local quality requirements (LQRs) have been agreed, for which BCPFT provide performance monitoring information that includes:
• response times for children and young people who present as needing urgent or crisis support • length of time in service • LAC specific reporting.
Getting Help services in Sandwell provides a range of evidence and routine based care. Partners across the system have both shared and unique skills, assets, systems and processes which result in cost-effective and timely provision being provided to children and young people who require some Help. This year we are embarking upon our two- year plan to reduce the gaps in inequality of access through reducing waiting times and monitor the impact of our interventions more fully. A summary of our actions to support children and young people to Get Help are outlined below.
Getting More Help
THRIVE describes Getting More Help as support for those children and young people, and their families, that would benefit from extensive long-term treatment which may include inpatient care but also extensive outpatient provision. Within our CAMHS provision we have dedicated teams that work with specific vulnerable groups including CYP with Eating Disorders, Learning Disabilities, Psychosis and Children in Care.
This section will outline our Getting More Help offer to children and young people in Sandwell as well as outline our plans for the forthcoming years. We seek to ensure that Getting More Help services are holistic, coordinated and person centred, and delivered by skilled and experienced workforce across all domains of support, which include:
● Eating Disorder Services ● Early Intervention into Psychosis Service ● Urgent Care and Crisis service ● CAMHS Crisis Intervention Home Treatment Team ● Liaison and Diversion Services
Regarding specialist care, Sandwell has and will continue to support delivery towards regional implementation plans to reduce length of stays, provide care closer to home and avoid inappropriate out of area placements by 2020/21. SWB CCG recognises that supporting patients to receive treatment and care closer to home helps them to maintain a better connection with their families and friends and improve how they interact with local services. SWB CCG supports the national initiative
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‘establishing steady state commissioning’, the approach being taken to develop and implement new care models in tertiary mental health services by April 2020. The programme aims to reduce length of stay and the number of patients who are out-of- area in a number of specialised mental health services. It seeks to delegate responsibility for the budget for in-patient services to local provider partnerships so they can ensure funding is spent as effectively as possible. Partners can work together to reduce costs and reinvest in improving patient pathways, including in the community.
We want to establish specialist care locally that:
• uses a multi-disciplinary team approach, with providers taking ownership of their patient population • develops a wide range of therapeutic interventions across a whole pathway • focusses on recovery through accommodation, community activities, social networks and employment advice • works proactively with the criminal justice system, local authorities and secondary care providers • expands both liaison support and community follow-up provision • develops local capacity and capability to manage all types of patients.
SWB CCG is actively contributing to the new care model development as part of the STP Mental One Commissioner programme, demonstrating our commitment to redesign local services to achieve triple integration across primary and specialist care with our fellow Black Country CCGs.
The NHS 10-year plan sets the ambition to ensure that any child or young person admitted to an inpatient facility with a LD, ASD or both will have a designated keyworker by 2023/24. SWB CCG is working with the other 3 Black Country CCGs to develop our future key worker model of care. Within Sandwell we already have a dedicated health key worker who in-reaches to inpatient facilities and supports Care Education and Treatment Reviews. We envisage that this role will work alongside other key workers in the future.
Sandwell Community Children’s Services
These services are provided by Sandwell and West Birmingham Hospitals NHS Trust (SWBH) and include:
• Health Visiting Service • School Health Nursing • Community Nursing - which includes our community children’s nursing team, our school paediatric nursing team, our complex care team and our palliative care team • Children’s Community Therapy (CCT) teams - which include our physiotherapy, occupational therapy and speech and language therapy • Best Start Practitioners, and • Community Paediatricians.
These services seek to provide seamless care and are provided across homes, schools, children’s centres and, acute and community hospital settings as required.
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At the last CQC assessment every part of the service provided achieved a rating of either good or outstanding, with caring and leadership rated as outstanding.
The services are innovative using new technology to deliver care that has a positive impact on young people, one example being that one of the Speech and Language therapists has designed a ‘tactile cue’ for children with complex needs. This is a system which uses touch to promote effective communication with children who have profound and complex learning disabilities. Another innovation is a computer app used as a teaching programme. Children were more engaged using the app than when playing with a toy. Across the whole service our staff are empowered to be creative which ensures they continually strive to improve care and treatment for our young patients and their families.
Community therapy services (CTS) align with CAMHS service around the ASD pathway. Both in Sandwell and nationally there is increasing demand for Occupational Therapy and Sensory Integration Therapy and the service is currently working alongside the CAMHS service to address this.
SWBH has invested in a dedicated resource to support CYP through the process of transitioning to adult services in line with NICE guidance. As part of the transition process CYP’s emotional wellbeing will be assessed and appropriate measure put in place to ensure the transition process is smooth and children and young people feel supported. 16 medical specialities have been identified within the initial plans including chronic illness such as Asthma and Diabetes.
The Sandwell School Nursing service are introducing the provision of target website resource for young children and teenagers to enable them to access information around health and mental health.
SWBH manage the 0-19 pathways in the Sandwell borough from maternity care to transition of care where required, which promotes seamless care provision for children, young people, parents and carers.
Our Vulnerable Groups
Across all organisations within Sandwell there is a focus to reduce inequalities for those at risk of marginalisation. Policy directives from Department of Health and Social Care, Department of Education, Department for Housing, Communities and Local Government all have priorities that support improving children’s emotional health and wellbeing. Across all departments recognition that support for the most vulnerable CYP and families are a priority to improve the social, economic and health outcomes of people living in England. This section sets out how SWB CCG is seeking to increase care and support for the most vulnerable children and young people in partnership.
Children in Care
Sandwell has a growing population of CYP who are known to Children’s Services, with the numbers rising from 610 children in care in March 2017 rising to 749 12 months later and with a total of 901 children in care in March 2019. This represents an increase of 291 CYP in care, 32%.
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To understand the level of associated need we have prioritised support by appointing a Dedicated Primary Mental Health Worker (PMHW) for Children in Care (CIC) and providing additional commissioner input for CIC/CAMHS. The PMHW-CIC is currently working with the Local Authority (Sandwell Children’s Trust) to develop clear processes for children and young people who are placed out of area and require CAMHS support. We also have additional PMHW capacity for unaccompanied asylum-seeking children and young people.
Within the CAMHS team we have dedicated Children in Care team. The PMHW for CIC works collaboratively with the CAMHS CIC team to provide a CIC/CAMHS drop-in for informal consultations with SCT social workers. The number of children and young people accessing our Children in Care team represents approximately 20% of CIC population placed in Sandwell. Further data analysis is required to understand the true activity for CIC within our emotional wellbeing and mental health providers.
Within Sandwell CAMHS our targeted CAMHS Children in Care team work across the system to offer support to professionals caring for children in care and in addition practitioners within core CAMHS offer evidence based specific treatments, such as the Cognitive Behavioural Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), and Dialectical Behaviour Therapy (DBT) interventions with CYP in care with more complex and enduing mental health needs, such as long- standing depression and more enduring trauma, attachment or anxiety disorders. The CAMHS CIC team also offer:
• Drop in consultation clinics for social workers to support them in the understanding of emotional well-being and mental health issues presenting in children in care cases
• Child development and attachment evidence-based training for foster parents within Sandwell
• Support to educational establishments and training around children in care
• Attendance at the child sexual exploitation (CSE) panel meetings to ensure a joined-up approach to recognition of vulnerable groups and interventions
• Therapeutic work for unaccompanied asylum-seeking children and young people who present with mental health presentations
• Work undertaken by this team either directly or indirectly with children and young people in care empowers the child to determine what they think will genuinely improve their mental health outcomes given the often complex situations where children in care find themselves. Each direct or indirect contact with the CYP is personalised and allows the young person to have choice and control over the mental health support they wish to uptake.
Sandwell places approximately 50% CYP out of borough and a key challenge is that a child or young person placed in another locality may not have access to Getting Advice services. It is a barrier to access which we have recognised and our PMHW team only provides support up to 30-mile radius. We need to identify how we can support Getting Advice and other needs for children placed out of area and on repatriation back to Sandwell CAMHS to ensure the pathway prevents a young person falling into gaps between services. The manager of the PMHW team is a member of the subgroup that 72
feeds into the Corporate Parenting Board and provides updates about the service.
CIC Health assessments are completed on an annual basis. In 2014 a review of health services for CIC in Sandwell was completed. The review found that information to adequately inform health assessments was patchy and inconsistent. We have improved our connectivity for CIC health needs a subgroup to Corporate Parenting Board focused on Health has been developed. In addition, we have a Safeguarding Health Partnership Board as part of the Safeguarding arrangements.
For CIC we will continue to work alongside Sandwell Children’s services to identify how we can commission joint/tri-partite placements that meet the holistic needs of children and young people. Where appropriate we will continue to work with NHSE Specialised commissioning to prevent admission and develop bespoke solutions for our most vulnerable children, in particular those with ASD/LD with challenging behaviour that are looked after.
During 2019-21 we will be working with our providers to identify opportunities for earlier support and stablish sustainable deliver mechanisms to achieve this. CIC will have access to additional support via the future development of the new MHST provision which will include some dedicated capacity for the Virtual Schools in Sandwell and should benefit from a trauma informed workforce in Universal settings.
Child Sexual Exploitation
Sandwell Children’s Safeguarding Partnership has prioritised interventions aimed at reducing and eliminating child sexual exploitation (CSE) across the borough. This is reinforced in the Sandwell CSE strategy (2017-2019) agreed across partners that outlines our ambition to increase community resilience to prevent, protect, pursue and prosecute people who have committed crimes related to CSE.
SWB CCG’s Safeguarding Team has supported achievement against the Prevent workstream of the CSE strategy through its superhero campaign. The CSE Sexual Exploitation (CSE) Superhero campaign is an innovative project developed in partnership with The Children’s Society, and fully endorsed by NHSE. The CSE Superhero theme was developed in response to a challenge at a National Safeguarding Conference by the mother and brother of a young woman who was murdered trying to help a friend who was a victim of CSE. The call from the victim’s family was for health professionals to become Superheroes and help tackle CSE.
To raise awareness amongst healthcare professionals about CSE and the associated signs, SWB CCG funded and commissioned the ‘Know the Signs’ film. The film starring Josie Lawrence, was produced by ‘Chat back’, who are a group of looked-after or birth children of foster carers.
Resources and training material were developed and delivered to over 220 professionals including GP’s, Nurses, Midwives, Practice Managers and Paediatricians.
We have a dedicated PMHW embedded within the CSE team, ensuring exposed children and young people are identified and experience timely access to mental health services.
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Our work is consistent with the NHS 10-year plan that prioritises increasing awareness across agencies and institutions of CSE and requires the development of specific training for schools on exploitation and knowing the signs.
Young Carers
Proportionally the young carer population in Sandwell is higher than the England average. We know that young carers face extra pressures and at times may struggle to look after themselves. In Sandwell we have jointly commissioned a young carers service for 5 -18year olds that has developed a dedicated website that signposts children and young people, parents and professionals to providers that can offer them guidance and support. We also have a Young Carers GP leads.
During 2018/19 the Young Carers service has:
• Delivered learning events for health and education professionals to raise awareness that will support identification and assessment • Undertaken specific work with primary schools using a ‘whole school’ approach and distributed ‘Is your child a young carer?’ poster to children and families to identify ‘hidden’ carers and raise awareness of the available support • Worked with primary care to increase awareness of young carers including training, providing and displaying information about Young Carers, providing information on how to register young carers on GP clinical systems and sharing information to facilitate referral to the young carers services.
In April 2019 our revised co-produced Carers Service specification was incorporated into BCPFT’s contract. The service now provides support to children and young people who are caring for an adult with mental health conditions and learning disabilities.
During this year we will continue to invest in the Young Carers service. We will also be developing a ‘Top Tips’ brief for GPs to support them in ensuring any young carers registered with them are appropriately supported. Out GP Leads for young carers will help promote the importance of identifying young carers and ensuring they access services to meet their needs.
Black, Asian and Minority Ethnic Children and Young People
Black, Asian and Minority Ethnic (BAME) groups are under-represented in CAMHS yet over-represented in adult Mental Health services. BAME children and young people diagnosed with autism have been highly associated with forming a large proportion of the prison population and/or at increased risk of exposure to CSE.
Health and care partners recognise that whilst the indicators of poor emotional health in BAME children and young people are readily identifiable and that understanding the specific cultural sensitivities applicable in proving any necessary care and support requires a person and family centric approach by frontline professionals.
During this year and next SWB CCG will work with BAME groups to increase understanding about how they access services. This will allow us to consider changes in the current service offer that will encourage greater engagement with and access to children and young people’s emotional wellbeing and mental health services.
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Special Educational Needs and Disabilities
Sandwell have a well-established Special Educational Needs and Disabilities (SEND) Partnership board that oversees the commissioning and effectiveness of the joint requirements. The Board has a detailed delivery plan to ensure all partners take assigned actions to fully comply with the SEND code of practice.
During 2018/19 we also revised the requirements of the Education Health Care Planning (EHCP) Officer role to better align with the role and responsibilities of the Designated Medical Officer.
Children and Young People with Autism or Learning Disability (Transforming Care Partnerships)
We are working with our STP partners to develop and establish models of service that will better support the needs of children and young people with Learning Disabilities and/or Autism who present with behaviours that challenge.
As part of the BC TCP, the focal areas for developing the model for care are to: • Increase personalisation • Establish the dynamic risk register to facilitate person-centred planning to reduce avoidable admissions, and • Improve pathways into adult services.
The BC TCP is currently mapping pathways for Autism only diagnosis and interventions and identifying opportunities to improve the treatment and care of this cohort. To support the STP TCP, our Sandwell focussed children and young people’s steering group has been established where partners come together to review Sandwell specific infrastructure and resources and agree plans for improvements. This group is focussing upon:
• improving transition into adult social care • embedding the EHCP process within local processes • identifying and seeking to work with partners to avoid 52-week placements • upskilling the workforce particularly in relation to vulnerable children and young people in 36/52-week placements • managing the dynamic risk and ensuring system processes are in place to minimise demand for more intensive interventions, and • embedding Black Country TCP developments locally in Sandwell.
In 2019/20 SWB CCG continues to invest in 0.5 WTE Learning Disabilities Psychiatrist for children and young people, the other 0.5 WTE is funded by Wolverhampton CCG, employed by BCPFT.
During 2019/20 we are reviewing our Learning Disabilities Nursing Service to develop a service model that supports children and young people to remain in the community where possible, aligned to Transforming Care requirements.
Through the Transforming Care Programme, we are implementing Supporting Treatment and Appropriate Medication in Paediatrics (STAMP) in Sandwell and also in West Birmingham where this work is referred to as Stopping Over Medication of People 75
with a learning disability, autism or both (STOMP). Through this work we want to:
• make the lives of CYP with a learning disability, autism or both who are prescribed psychotropic medications better • make sure that CYP who need medication can get it for the right reason, in the right amount for as short a time as possible • help people to understand more about these medications and have the confidence to ask why they are needed • make more non-medication treatments and support available • make sure the person with their family and paid carers are involved in any decisions to start, stop, reduce or continue taking them, and • get more children and young people with a learning disability, autism or both to have an annual health check starting from the age of 14.
In conclusion, within the Getting More Help – vulnerable groups section we have provided an overview of the support that is available to the most vulnerable. Getting More Help services provide multi-organisational approaches to tackle moderate to severe mental health. Our aim by providing Getting More Help is to ensure that CYP grow well with recovery-based approaches that build resilience to reduce the impact of periods of severe mental ill health. Our focus on the most vulnerable groups and using evidence-based approaches is our offer to support CYP to get back to Thriving.
Palliative Care for Children and Young People with Life Limiting Conditions
Children’s palliative and end of life care is an important priority nationally, but locally NHS funding has not kept pace with growth in clinical care costs or inflation. Over the next five years NHSE will increase its contribution by match-funding clinical commissioning groups (CCGs) who commit to increase their investment in local children’s palliative and end of life care services including children’s hospices, with the ambition to significantly increase the investment by 2023/24.
During 2019/20, along with the other three Black Country CCGs, additional investment was made to support palliative care provision by Acorns Children’s hospice. We are actively participating in the STP working group focussing on reviewing and redesigning the end of life mode of care/pathways for children and young people, the outcomes of which will inform future commissioning of services and the associated level of investment.
BCWB STP C&YP commissioners and providers are involved in the development of the CAMHS Tier 4 new care models, which from a project perspective is led by Birmingham and Solihull Mental Health Trust. The expression of interest business case has been presented and accepted and the group are working towards the full business case. Further work is required around participation and merging the new clinical model with the bed management element. Governance is overseen across the STP’s via the Merit partnership. The project group feel that the developmental track is the most feasible for them. Each locality across the STP is working on integrated care alliance/system which is both locally led and should bring about one of the most fundamental and far reaching changes in how the NHS works across different services with external partners. The systems across the Black Country STP vary widely in their size, complexity and developmental stage but the fundamental principles are to work more collaboratively to manage both finance and performance and integrated care.
The LTP also recognises the important role that whole-school approaches play in supporting children and young people’s mental health and attainment, which will also be seen in the 76
Mental Health Support Teams in schools. This is also in line with the FYFV for mental health. Work is underway with mental health services to link with liaison psychiatry or mental health teams. Currently although there is no gap in provision, work is required to identify clearly the activity undertaken with the 18–25 cohort. The liaison psychiatry service manages any adults who come into the acute trust in crisis.
The initial transition CQUIN supported children and young people as they moved into adult services and ensured they are properly prepared. For those CYP who are transitioning into adult hood, there are clear pathways for transfer from CAMHS to AMHS. The ambition of services post 2020 is that young people will be fully aware of their plan going forward into adulthood and that services will be available to meet their needs. As part of their transition process, young people will have had contact with their new adult team and be aware of how they can receive support going forward. This has been built into service specifications as they are developed. This has formed the discussions with AMHS commissioners as part of the ‘One commissioner’ across the STP.
Improvement in access figures
Demand and Capacity work has been undertaken across BCPFT, jointly commissioned by Wolverhampton CCG and Sandwell and West Birmingham CCG by Niche Consultancy. This will result in achievable targets being set for each provider to reach to ensure access standards are reached across the services. There are some concerns following this piece of work that not all interventions are being entered on the system in a consistent manner by staff and as a result one of the outcomes is likely to be ensuring that staff members in each of the commissioned services enter data and outcomes in a consistent manner. This work will support development of an action plan to reach the access targets for each NHS commissioned service.
Work already undertaken to increase activity includes:
• Group work as an alternative method of delivering interventions. • Pathways & length of stay to be standardized across services that are similar. • Data o Both entry and reporting/understanding o Switch to RIO for BCPFT commencing April 2020 with importance of understanding need to record accurately. • Review of learning disability services • Waiting list initiative to be developed • Work with partner agencies in Sandwell to improve activity and ensuring all relevant data recording is recorded on MHSDS appropriately. Work still to be undertaken to increase access targets include:
• Care Constellations • Learning Disability model to be aligned with the Transforming Care Programme agenda
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• Confirmation of what can be included in contracting reports – i.e. possibility to include therapeutic telephone calls • Self-referrals • Electronic records • Mental health support teams in schools and their development and ensuring effective data recording on the MHSDS. • Outcome measures which are currently manually recorded but to become electronically recorded when the new electronic system is in place.
Comprehensive 0 – 25 support offer in the STPs by 2023/24
In Sandwell we recognise that there will be a menu of evidence-based approaches that are to be made available in 2020 for us to deliver the long-term plan. We recognise the need to ensure comprehensive support is available for this cohort and are committed to this end. Sandwell is in the process of identifying the baseline of current activity for 18 – 25-year olds in this financial year to support the gap in knowledge for this cohort. However, currently planned activities and partners agencies that will support delivery, is outlined in chapter above.
CYP going through transition in to Adult Services
The initial transition CQUIN supported children and young people as they moved into adult services and ensured they are properly prepared. The ambition of services post 2020 is that young people will be fully aware of their plan going forward into adulthood and that services will be available to meet their needs. As part of their transition process, young people will have had contact with their new adult team and be aware of how they can receive support going forward. This has been built into service specifications as they are developed.
In addition to this, the wider Mental Health programme is now moving towards delivering services at regional scale and will be including the 0-25 age range whilst addressing the wider breadth of services. Although this does not yet cover all areas, there are good examples already in place, with services for Early Intervention for Psychosis (EIP) and Eating Disorder being provided as an ‘all age’ model, removing ages and limitations and eradicating the need for transition from these services due to age limitation. It is the intention that these examples of good practice will be extended across a wider number of services.
Transition is a key priority for all, as getting this right can lead to better lives for our service users and potentially mean young people are less likely to go into crisis.
6. WORKFORCE
In this section we describe: • Our progress and plans for workforce development across all THRIVE levels of care • The workforce challenges we face in Sandwell • Organisational development, delivered and planned • Our plans to undertake further modelling to inform workforce plans.
The current refresh demonstrates the increase in workforce across the commissioned services since the original Local Transformation Plan (LTP) was developed. It gives a view of further training that will be commissioned across the system to ensure services are CYP IAPT compliant. Sandwell and West Birmingham was successful in the
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recent ‘Trailblazer’ bid to provide Mental Health Support teams, equipped with trainee Education Mental Health Practitioners to not only grow the local workforce but create greater resilience in Children’s workforce across the area in being able to support Children and Young People’s Emotional Mental Health and Wellbeing.
Sandwell’s ambition is to support 100% of children and young people to access emotional wellbeing and mental health services at the appropriate time to meet their needs. To achieve this ambition, we need to expand the workforce to provide the right skills in the right place, based on triangulating demand, capacity and skills of the workforce. We need the right number of staff across the different disciplines to be confident that we have the capacity to meet demands in services for each of THRIVE category of services.
Mapping the number of sessions across THRIVE has identified that we need to change the way we work to maximise efficiency and maximise recovery. We have used the THRIVE framework to benchmark whether our workforce can adequately support demand across the care-based categories between now and 2023/24.
In order to understand the current position for workforce activity and inform the manner in which services need to be changed in order to deliver maximum efficiency, Niche Consulting were commissioned, in conjunction with Wolverhampton CCG to undertake simulation modelling of mental health services for children and young people. Assessment of current activity of all CAMHS services across all levels of provision within both areas of Sandwell and Wolverhampton, and modelling this to identify required staffing in order to meet access standards based on anticipated activity for 2023 and beyond was undertaken collectively in light of the shared Mental Health provider organisation covering this wider area, Black Country Partnership Foundation Trust.
Following significant analysis of current activity need, prevalence rates and provider capacity (as detailed in the Access chapter of this document), the key findings of the outturn report have been identified as:
● The baseline “do nothing” model risks a significant rise in waiting times to access many services, and no realistic prospect of achieving prevalence targets ● There are striking differences in practice between Sandwell and Wolverhampton: episode length, referral arrangements, caseloads, repeated assessments, staff utilisation. ● The local CAMHS may be offering a larger volume of short-term work than comparable services elsewhere ● Early indications are that there may already be enough staffing resource in Sandwell to implement the Thrive model with some changes to existing models of provision ● There is an opportunity to increase group activities in service provision which would have both clinical and capacity/demand benefits, and ● It is likely that some additional investment will be required for local prevalence targets to be met.
SWB CCG is currently considering the recommendations made in order agree joint 79
actions. These include:
• The uplifted prevalence estimates are adopted as actual targets by the CCG as best estimates of local need and the level of response for which we should be planning • The current CAMHS provider, Black Country Partnership Foundation Trust (BCPFT), should lead work alongside local partners to review opportunities to improve the productivity of local services. This will focus on: 1) Ensuring clinical staff meet utilisation targets 2) Ensuring there are planned episode lengths for each case, and that patients are moved to discharge consistent with that plan 3) Reducing or eliminating repeated assessments which offer insufficient additional clinical value to the patient and family 4) Ensuring caseload targets are maintained 5) Introducing and evaluating the impact of additional groupwork options across children and young people’s services • Agreed investment plans which relate to the achievement of identified targets i.e. additional investment which is released in response to demonstrated levels of productivity. These investment plans should permit services to work towards the 35% access of anticipated prevalence target by 2023.
It has been identified that if SWB CCG implement the recommended actions outlined above, based on the modelling activity as outlined in the Access chapter of this document, the forward profiling of required workforce to deliver this increased capacity identifies that we already have sufficient workforce in the Sandwell area to meet this demand, provided that the workforce is utilised efficiently.
The table below identifies where staff need to be located according to the THRIVE model, using prevalence figures, presented by Niche. In Sandwell, as stated above, we have sufficient workforce to meet our prevalence demands:
Prevalence Getting Help 7,314 Getting More Help 788
Target 35% target of total prevalence 2836
Episodes per year to meet target Getting Help 2,048 Getting More Help prioritised over getting help 788
Mean expected episode length Getting Help from THRIVE (elaborated) 6.2 Getting More Help 10.4
Calculations Contacts PA 20,892 Offered contacts per annum (10% cancellation/DNA) 23,214 CMHT WTE (14 contacts / week / WTE 28.7 assumption) Getting advice (24% predicted resource 9.6 usage)
Total (Clinical) - WTE 38.3 Total (Non-clinical) - WTE 20% 9.6 Total WTE 47.8 Current WTE 48.3
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The workforce numbers for Tier 2 services in Sandwell were not available at the time of the demand and capacity work undertaken by Niche due to the problems with the operationalising of the service.
Notwithstanding the suggested workforce actions as outlined above, the MHFYFV sets the target that by 2020/21 at least 1,700 more therapist and supervisors are in post nationally. Sandwell has supported this agenda through the expansion of our staff establishment in the following services:
• all-age eating disorder service • crisis and home treatment service • core CAMHS • Early Years • Primary Mental Health Workers.
Within four years, our workforce has doubled as shown in Table 5 below. The largest growth in our workforce has been achieved in ‘Getting Advice’ and ‘Getting Help’. Even though current analysis identifies that there is already sufficient workforce within Sandwell to manage increased activity within forthcoming years, the efforts to continue to recruit additional staff to offset standardised turnover are ongoing.
Table 5: Workforce Expansion from 2014/15 – 2020/21
Thrive Service Area 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 Domains Service Design and Commissioning (CCG) 1 1 1 1 Development Service Design and Commissioning (panel 0 0.1 0.1 0.1 0.1 Development representative) Getting Help Management CAMHS 2 2 3 3 3 3
Getting Advice Point of Access 0 2 2 2 4 4
Getting Advice Early Years (0- 5) 0 0.6 0.6 0.6 1 1
Getting Advice EHWB Services 5
Getting Advice KOOTH 2
Getting Help Core CAMHS 21.5 21.5 22.67 22.67 23.17 23.17
Getting Help Primary Mental Health 0 10 10 11 11 11 Workers Getting More Help Crisis/Home treatment 5 9.1 9.1 9.1 10.1 10.1
Getting More Help Eating Disorders 4.64 4.64 14.35 14.35 14.35 14.35
Getting Support CAMHS waiting list initiative 0 0 2 2
Getting More Help 136 suite 0 1 1 1 1 1
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Service Design and TOTAL 34 52 66 74 68 68 Development
Sandwell has 10.6 WTE Education and Child Psychologists within our Inclusion Support Services. In addition, Sandwell has dedicated specialist provision for children and young with social emotional and behaviour difficulties offering approximately 90 education placements in schools. We have identified opportunities to work closer with Inclusion Support Services to increase access and will be exploring over the next year how we can develop an integrated offer to schools where we can provide direct-clinical evidenced based interventions to children and young people based within education settings. We envisage this to be a partnership arrangement, blending the skills of all professionals supporting the most vulnerable children and young people to access the right support, at the appropriate time. It should also be noted that Sandwell are party to the ‘Trailblazer project’, providing additional Trainee Education Mental Health Practitioners in up to 15 schools in Sandwell. Further information on this pilot project is available within the ‘CYP MH services working with educational settings (incl. MHST)’ chapter of this plan.
The Royal College of Psychology recommends 19.3 WTE per 100,000 population should be recruited to provide CAMHS specialist services for children and young people up to their 18th birthday. The Sandwell population of children and young people is approximately 86,000. As we have 53.94 WTE clinical staff within CAMHS, our workforce significantly exceeds the recommended level of staffing, by 36.64 WTE (including specialist staff) or 3.87WTE (Core staff only). Additional work is required but this provides a useful baseline position upon which to undertake further workforce modelling. Our children and young people population is rising, and we need to increase our skills within the workforce so that as a system we will be able to meet demand on a sustainable basis in the years ahead.
Across all partners delivering emotional wellbeing and mental health services we have enough capacity to meet current demand and meet the access targets up until 2020/21 (subject to demand forecasts remaining the same). We have made assumptions based on caseloads, complexity and number of sessions to be supported to provide a high- level indication of our future potential workforce requirements.
Workforce and Activity
The summary of our workforce analysis indicates the need to re- distribute and reconsider the workforce by skill mix across the domains going forward. This belief
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has been reinforced by the findings of the Niche Consulting report. We need to work with providers to ensure they can use their workforce flexibly across services to ensure needs are met in future years. Our early modelling is the start of a more detailed workforce development programme that we will be undertaking in collaboration with Black Country STP CCG partners. Sandwell services provide significantly more capacity i.e. time provided in Getting Help services than the THRIVE model suggests. We need to review why our children and young people remain in services for longer compared to the THRIVE evidence- based model. Early indications are that this is partly due to longer time spent on pathways between appointments. The reconfiguration of services in line with the Thrive model will go some significant way to redressing this issue. There is also variation in the number of sessions provided than requirements indicated in the THRIVE framework. Whereas the average number of sessions (2.7 per individual) by BEAM for Getting Advice matches THRIVE the average number of sessions for Getting Help services (13 per individual) is significantly higher than the THRIVE level of 6 or less sessions. We need to understand if our children and young people are remaining in services longer than is appropriate and based on our findings feed the results into our longer- term workforce planning. The THRIVE model shows that Sandwell has a lower than expected percentage of children and young people accessing Getting Advice and Getting Help support, but a higher level accessing Getting More Help. This supports anecdotal evidence from clinicians that the complexity of emerging mental health issues in our children and young people has increased. However, another explanation might be that too many children and young people are re-directed to Getting Advice support via Point of Access (POA) when they may have greater levels of need. In order to strategically plan our workforce requirements for the future we need to understand on a micro-level the flows into CAMHS and where bottlenecks arise such as internal waiting lists for specialist staff which may result in care being extended for children and young people waiting for specific interventions.
Within any system we need to support activity to flow. We know that lower level support earlier is required to increase flow and reduce the risk of need escalating. In addition, we need to bolster lower level support to have the skills to wrap around and support children and young people.
Our focus for our universal workforce for 2019-29 is to increase the breadth of the wider children and young people workforce to have the skills of supporting those with emerging emotional wellbeing concerns. This is aligned to multi- agency training undertaking for safeguarding which we believe will raise awareness and possibly raise demand. Where specialist services are required, we will be increasing the breadth of the clinicians’ skills to offer a variety of interventions to ensure that children and young people have choices in the type of interventions they engage in. Sandwell services provide up to 47% more capacity i.e. time provided in Getting Help services than the THRIVE model suggests. We need to review why our children and young people remain in services for longer compared to the THRIVE evidence-based
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model. There is also variation in the number of sessions provided than requirements indicated in the THRIVE framework. Whereas the average number of sessions (2.7 per individual) by BEAM for Getting Advice matches THRIVE the average number of sessions for Getting Help services (13 per individual) is significantly higher than the THRIVE level of 6 or less sessions. We need to understand if our children and young people are remaining in services longer than is appropriate and based on our findings feed the results into our longer-term workforce planning.
To ensure children and young people with depression, mood disorders and suicidality are adequately supported, BCPFT have offered a large cohort of staff, across both specialist CAMHS and the voluntary sector, training opportunities for CBT following investment from the CCG. It is anticipated that this will support the reduction in suicide numbers and ensuring recovery of those presenting with severe depressive disorders. These services are commissioned to provide the emotional mental health and wellbeing and will be able to be CYP IAPT compliant as a result of the training.
The plan is to increase the workforce numbers via the C&YP IAPT recruit to train and well- being practitioner programmes and continue to upskill the current workforce as demonstrated. BCPFT has continued to access C&YP SFP and PWP programmes for 4 trainees this year. As part of the MHST trailblazer project for 2020 this will increase the capacity of the team to support the required increase in access and ensure that children and young people are seen by the right people and the right service. As part of this project 4 EMHP’s will undertake a year’s training and upon qualifying increase to band 5.
Further development of staffing levels in the services will be seen with the development of the MHSTs in schools. These will be embedded by 2020- 21 with recruitment starting in the next month:
Role per MHST Band SANDWELL
Admin 4 0.5
EMHP 5 4
HLTA 6 1 CAMHS
HLTA 6 1 Education Psychology
Team Leader 7 1 CAMHS
Supervisor 8 0.25 Education Psychology
Supervisor 8 0.25 CAMHS
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Modelling our activity from POA and those who have accessed services against the THRIVE model shows that Sandwell has a lower than expected percentage of children and young people accessing Getting Advice and Getting Help support, but a higher level accessing Getting More Help. The implementation of the above will support early intervention and promoting more partnership working against the Thrive model.
Strategically Planning our Workforce
Our workforce profile has changed incrementally, one example being that 97% of the workforce was providing Getting Help and Getting More Help support in 2014/15 compared to 82% in 2017/18. We have also increased the Getting Advice workforce by 16% since 2015/16. This shows that we are starting to redistribute investment upstream towards prevention and early intervention. In addition, we have significantly increased and sustained staff levels within Getting More Help services, supporting the national ambition to increase access to IAPT, provide early access to Psychosis and Eating Disorder pathways and support during urgent/crisis situations.
We do not perceive our current providers of emotional wellbeing and mental health services as our only workforce as we consider the wider network of organisations that have regular contact with Sandwell supporting our children and young people, as illustrated by the Trailblazer project as one example. To this end we are committed to training both specialist and the wider universal workforce to meet the needs of Children and Young People of Sandwell.
Although a multi-agency single workforce plan for the wider CYP agenda across the Black Country STP has not been developed, all four Black Country CCGs are working collectively on a number of workstreams, many of which are identified within this plan. From the common specifications and shared service delivery across a wider footprint, more streamlined workforce plans in discreet areas are currently in development.
For training staff in schools to work with specific needs, there will be a need to consider the specialist Mental Health needs of some of our changing population and the need for additional specialist training for staff to ensure these young peoples’ needs are met. Some of this training will at universal level as well as specialist levels.
Anecdotally, the specialist CAMHS team have reported an increase in the number of referrals for Young People who are questioning their sexual orientation and transgender issues and there is also a correlation between transgender issues and autism. This is likely to become a training gap within specialist and universal services. Mermaids UK had provided some training for the CAMHS team.
Work has been undertaken around the gap in provision for Children and Young People who have been identified as engaging in Harmful Sexualised Behaviour (HSB). This gap includes awareness, assessment and intervention. Three levels of training have been developed for whole system training depending on levels of need, similar to the levels as in safeguarding training.
Upskilling the workforce for C&YP with mental health and learning disabilities, BCPFT have continued investment in the PBS coaching programme. As part of the Transforming Care 85
programme it has been identified that staff across the system need to have an increase awareness in how to support ASD and LD and also how to recognise those who are at risk of entering either a tier 4 bed or entry into the criminal justice system.
Organisational Development
In 2018/19, the Sandwell Inclusion Support Service alongside Sandwell Public Health was commissioned to develop and deliver training to the wider workforce. The training was aimed at two audiences:
1) Education Workforce (inclusive of Sandwell Primary, Secondary, 6th form, Colleges, Independent schools and education support services)
2) Wider Workforce (inclusive of independent alternative education providers such as Impact/ Krunch, the voluntary and community sector, youth services and external providers of SMBC commissioned universal services such as GoPlay)
The training offer to the Education Workforce will take a ‘train the trainer’ approach on a learning community locality basis, consisting of 5 days broken down as follows:
1. Day 1; Awareness raising of Mental Health as ‘everybody’s business’ and normalizing the experiences and mental health challenges children and young people are likely to face in everyday home and school life.
2. Days 2 & 3 will take a skills-based approach, developing relationships of those ‘trusted adults’ who work within schools with pupils who might be experiencing mental health difficulties, such as pastoral roles.
3. Day 4 will focus on early interventions taking a topic-based approach, based on existing feedback from the Charter Mark process and consultation with children and young people.
4. Day5 will embed learning from days 1 to 4 via in school coaching and follow up support. The training offer to the Wider Workforce will a take a ‘train the trainer’ approach and will be delivered via a rolling programme of twilight sessions, which will reflect an appropriately reduced content of the education training package. The delivery model will be aligned with Sandwell Safeguarding Children’s Board structure of Levels 1, 2 and 3. Following training development we expect 360 people within Sandwell who support children and young people to be trained across the levels 1 to 3:
• Level 1: Initial awareness raising of Mental Health being everyone’s business, including levels of support and current services.
• Level 2: A skills-based approach to understand and develop trusted adult relationships.
• Level 3: Specific topic-based interventions highlighted through need and demand of the target audience. 86
During 2019/20 we are continuously evaluating the course to ensure that it is aligned to best practice.
The upskilling and development of current workforce, including those working with children with specific needs e.g. children and young people with learning disabilities, autism or both, ADHD, and communication impairments, is a key element of the realigning of the CAMHS workforce plan. It is also explored during the continued recruitment process, explored earlier in this chapter, to ensure the support and help received by Children and Young People in Sandwell is always the most appropriate for them.
Furthermore, the Continuous Professional Development (CPD) needs of all CAMHS delivery workforce are addressed in line with General Condition 5 (GC5) of the standard NHS contract, most specifically section 5.6. which articulates the requirement for ‘details of its analysis of Staff training needs and a summary of Staff training provided and appraisals undertaken’ to ensure oversight of maintenance of appropriate training standards.
Evidence Based Support
We have supported the MHFYFV ambition relating to increasing access to IAPT by enabling 13 clinicians to access CYP IAPT across our partnership, details provided in Table 6 below.
Table 6: CYP IAPT Training Delivered 2018/19
Organisation Courses Completed Numbers Trained
Kaleidoscope Post Dip in Evidence-based Psychological approaches 2 for Children & Young People (CYP IAPT) Post Graduate Certificate in Transformational Leadership 1 (CYP IAPT/CAMHS) Black Country Transformation Leadership 1 Partnership CBT 2 Trust Systemic Family Practice Eating Disorders/Clinical SV 3/1 EEBP 1 Clinical Supervision CBT 1 Clinical Supervisor PWP 1 TOTAL 13
Our workforce in Sandwell has the capability to provide a number of evidence- based interventions to children and young people. Our providers can offer a range of therapeutic interventions including and not exclusive to:
• Counselling • Cognitive Behaviour Therapy (CBT) • Play Therapy • Art Therapy • Transactional Analysis • Solution Focussed • Humanistic Approaches
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• Trauma and Attachment • Systemic Family Therapy including Eating Disorder specific • Family Based Treatment (FBT) • Psychological Psychotherapy • Dialectical Behaviour Therapy (DBT) • Nutritional Counselling • Medical/Psychiatric Intervention • Evidence-based Psychological approaches for Children & Young People (CYP IAPT) • Enhanced Evidence Based Programme (EEBP) for Children and Young People • Positive Behaviour Support.
During 2018/19, we joined Wolverhampton CCG in supporting our providers to apply for 4 training places on the Wellbeing Practitioner Supervisor course, and 4 places on the Wellbeing Practitioner course. We have learnt that distance to training provider location impacts on our staff completing courses.
We have embraced whole system approaches to training our dedicated Eating Disorder services where 10 clinical staff attended national training for Eating Disorders. In addition, we had a gap in providing DBT and commissioned an organisation focused DBT training course which 30 staff has now completed.
During 2018/19 funding to train staff within Getting Help services was invested in upskilling clinicians with the tools to provide wider choice of evidence-based interventions, listed below:
• Eye Movement Desensitisation and Reprocessing (EDMR) • Positive Behaviour Support • Lego Therapy training • Positive Behaviour Support • Autism Diagnostic Observation Schedule (ADOS) • Sensory Integration.
Training identified has been targeted to support the most vulnerable in particular those with neurodevelopmental difficulties and children and young people who are undergoing autism assessment. There has been an increase in requests for sensory needs….Recent Novak review presents that SI has weak evidence; there are challenges to this as strong evidence about a Sensory Processing Approach is beneficial; therefore the training chosen has been to train staff with specific skills to support children and young people with communication difficulties, ADHD, ASD and Learning Disabilities.
As part of the STP Mental Health One Commissioner we have submitted workforce plans. Further work is required to assess what define what workforce is required to meet the NHS 10yr plan. An STP task group has been set up to support children and young people and adult mental health commissioners to scope the workforce requirements for the future, including consideration of a future 0-25 years model of care. This work is expected to be completed by October 2019. 88
Our partnership is keen to ensure that children and young people move on when they have maximised the outcomes that they can achieve within a service. We are currently working together to explore an integrated approach to supporting children and young people who straddle across services that offer Getting Advice and Getting Help support. We anticipate that by integrating disciplines and services across our partnership we will support flow and reduce time to access services, where joint working will reduce time for assessment which in turn will free up time to create capacity elsewhere to ensure children and young people access services at the most appropriate point.
In 2019/20 we will be piloting an integrated approach to providing Getting Help support. We have provisionally committed to increasing the workforce by approximately 4 WTE staff. The emerging model will be undertaking joint assessments for a child or young person who does not present as needing specialist services but needs exceed the risk levels associated to lower level support.
Through joint working we believe that the 19% of referrals that go to CAMHS who only receive one appointment could be supported by alternative services. In addition, our POA data shows that on average there is a 19% re-referral rate to both targeted support and specialist services within Getting Help. We anticipate that through joint working our workforce will develop the skills required to straddle targeted and specialist support within Getting Help domain of THRIVE.
7. HEALTH AND JUSTICE
In this section we describe:
• How we support children and young people transitioning to and from secure and detained settings (includes police and court Liaison and Diversion, Sexual Assault Referral Centres and other secure facilities for children and young people) • How specialist or forensic CAMHS collaborates alongside community services • Interaction between Liaison and Diversion services • Crisis care police custody
Liaison and diversion services have been shown to identify people who have a mental health, learning disability, substance misuse or other vulnerabilities when they first come into the criminal justice system. The government committed to having at least 68% coverage of Liaison and Diversion (L&D) services by 2018 and 75% by 2018. NHSE commissions L&D services for children and young people in the Black Country. The wider Black Country has a dedicated L&D pathway/service for under 18’s. This service undertakes assessments to identify with the aim of diverting those most at risk away from the criminal justice system and into relevant services, which are identified as determined via a thorough assessment of needs and vulnerabilities.
Extensive work has been undertaken with the Health and Justice services to ensure that the pathways from Liaison and Diversion (L & D) are both robust and clear and that services are aware so that referrals can be accepted. This includes pathways from Liaison & Diversion into the Youth Offending Team (YOT) and into and out of the new Emotional Mental Health and Wellbeing service (Beam), with L&D acting as a lynchpin in the system between these pathways. The resettlement officer for the Youth Offending Team works closely with the CAMHS worker for YOT to ensure that the
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mental health needs of the young people coming out of the secure state are addressed. This partnership working operates successfully and the alignment of dedicated Youth Offending staff ensures effective communication, clear pathways and transition of children and young people from the secure estate to specialist local community support. Furthermore, we are seeking to increase dedicated clinical capacity to support Youth Offending Service (YOS) so that children and young people will access support wrapped around wider interventions that they have been ordered to complete by the youth judicial processes.
Sandwell and West Birmingham CCG supported Kaleidoscope Plus Group in applying for funding from the Health & Justice Children & Young People’s Mental Health Transformation Workstream. We were successful and awarded £110k over a 2½ year period to increase the capacity in mental health services for children and young people who have been in contact with NHSE Health & Justice directly commissioned services.
The aim is to improve their journey through full clinical pathway connectivity from being custody to release. The funding has been used to develop better links into mainstream/community services and ultimately achieving improved outcomes for children and young people, and their families and carers who access the service. The aim of the programme is to improve the outcomes for children and young people held within, transitioning into or out of, the Children and Young People’s Secure Estate (CYPSE) either on youth justice or welfare grounds.
Liaison and diversion teams are pivotal in supporting both mental health identification and connection into local services. L&D in Sandwell act as a lynchpin, referring to POA if an emotional wellbeing or mental health condition has been identified to ensure that children and young people receive the right care at the right time. Furthermore, the Youth Liaison and Diversion scheme in the Black Country provides a health professional to sit on Out of Court disposal panels, to screen and assist health access for young people accessing that process. In Sandwell we have developed a pathway which provides the opportunity of an assessment for those receiving a first community resolution, and a health representative on the weekly Out of Court Disposal panels, which is added value to an already effective process.
There is a growing recognition within the criminal justice community that understanding trauma and how it affects people is essential to changing how we respond in the criminal justice system.
To improve outcomes for children and young people who have been involved in the youth justice system 1.0 WTE Primary Mental Health Worker (PMHW) has been employed and works alongside the existing PMHW Team and co-located within Sandwell’s Youth Offending Service (YOS) and the community, providing services both in and out of Children and Young People’s Secure Estates (CYPSE) including Secure Children’s Homes (SCH), Secure Training Centres (STC) and Youth Offending Institutions (YOI), ensuring seamless delivery. Referrals come via the CYPSE, the Black Country Liaison and Diversion Service, POA and Sexual Assault Referral Centres (SARCs).
Interventions are provided to children and young people, families and carers where the child or young person is pending release or discharge to Sandwell. Referrals are received from staff engaging with children and young people, and their families and carers, both in a general capacity or those who specifically wish to refer to a transitional service into the community.
The focus of the provision has been on supporting good emotional and mental health and wellbeing, the prevention of escalation of poor emotional or mental health and 90
wellbeing, ensuring seamless access of services pre and during the transition from custody to community. This is achieved by the PMHW being able to connect with secure settings pre-release/discharge and in the community with the same clients (this would not involve direct delivery whilst the child or young person was in the secure estate placement).
The Health and Justice Primary Mental Health Worker service has been operational since July 2018. PMHWs from this service have worked closely with colleagues in the Youth Offending Service to screen and identify those with, or at risk of developing, mental health issues. The service has received a significant number of referrals to date and is working to support young people, professionals and families.
Over the last year we have recognised that the model needs to diversify. The numbers of CYP detained remains low and therefore we will extend the model to support CYP who are known to the YOS as well as consider our response to complex trauma, exploitation, speech and language/communication needs in the YOS cohort. The over- representation and particular needs and experience of black and minority ethnic young people (including those born abroad) in the criminal justice system may require bespoke consideration.
However, over the last year it has been recognised that the model needs to diversify. The numbers of CYP detained remains low and therefore the model will be extended to support CYP who are known to the YOS or within education at risk of exclusion and the potential of entering a criminal justice pathway as well as consider our response to complex trauma, exploitation, speech and wider language/communication needs in the YOS cohort.
Furthermore, the Lammy report (2017) identifies that the over-representation of black and minority ethnic young people (including those born abroad) in the criminal justice system is not an anomaly in our system, but rather more likely indicative of unidentified needs which have not been met. In order to address this imbalance, bespoke consideration will also be given to the particular needs and experience of these CYP; how we identify these currently unknown needs, move to address them and reduce the disproportionate representation.
Sexual Assault Referral Centres
From 1st January 2020, the Sexual Assault Referral Centre (SARC) Service has been provided by Mountain Healthcare, working with the previous provider during the mobilisation period in order to ensure seamless handover between organisations. Specialist counsellors are available who are trained in talking to and supporting children and young people who have been sexually abused and understand how difficult it can be to talk about it. The service works with children and young people aged 5 – 17 years old and parents and carers of children aged below 5 years old. The service is also available to adults 18-25 who present with complex needs. 6 -10 sessions of psychological therapy are currently offered to survivors, after which time the expectation is that the patient is referred onto other local services if ongoing support is required.
The survivor must have been through the SARC to access this either as a historic or acute case and this pathway is open for 3 weeks post assault. If a child is under 13 years old, access to the service must be via the West Midlands Police or childrens social care. Children and young people 13 and over can use either of these routes to access the provision, although self referral is also acceptable to access the service. Also, this is a time limited offer and if the survivor does not want to access the service at the time of the assault, they are not able to access it for an indefinite period. However, pathways
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available state that if the child or young person is at risk of self-harm or have suicidal thoughts then they should be urgently referred to the local CAMHS crisis team for these issues to be addressed as a matter of urgency. Once intervention is complete and if ongoing counselling is required as a result of their assault the child/young person can be referred to those services that specialise in this area.
There is a National Sexual Assault and Abuse Strategy for which there will be an expectation of how local areas can support the expected outcomes. These include how appropriate care pathways can be developed in the Sexual Assault Referral Centres for children and young people who are displaying Harmful sexualised behaviour (HSB) either towards themselves or others. Our risk of admission register meetings include our local police and we currently work with them for all CYP who are identified as displaying HSB with diagnosis of either ASD and or LD and the plan will be to look to extend this work for all CYP. Work needs to ensure that if children and young people with additional needs e.g. learning disabilities are referred to these services following a sexual assault that the services are appropriate to meet their needs. It will also be necessary to give consideration as to how the current commissioning arrangements for GUM clinics can be extended to include children and young people under 13.
During 2016/2017 the volume of crimes recorded against children and young people with coding that included sexual assault or rape in Sandwell for under 18’s was 166. In addition, 122 children and young people have been identified as at risk of Child Sexual Exploitation (CSE) during 2017/18.
Sandwell Children’s Safeguarding Partnership (SCSB) has prioritised CSE and have developed Sandwell CSE strategy (2017-2019). The strategy outlines our ambition to increase community resilience to prevent, protect, pursue and prosecute people who have committed crimes related to CSE. In Sandwell we are committed to raising the awareness of CSE by developing CSE superhero campaign. The project was developed in partnership with The Children’s Society designed to raise awareness amongst healthcare professionals of the signs of CSE. Part of the project involved Chatback, a group of CIC CYP and CYP of foster carers who developed a film called ‘know the signs’. Resources and training material were developed and delivered to over 220 professionals including: GP’s, Nurses, Midwives, Practice Managers and Paediatricians.
Sandwell and West Birmingham CCG are supportive of collaborative arrangements to support CYP who present or are referred to a sexual assault referral centre. The Sexual Assault Referral Centre (SARC) provides a 24/7 ‘one-stop’ open service to anyone between up to the age of 17 who has been the victim of rape, sexual violence and/or sexual abuse, or up to the age of 25 if the individual has complex needs. The service offers a holistic health assessment for any child or young person (CYP) who may have been sexually assaulted. The on-call team is available 24 hours a day, seven days a week and aims to be available within 90 minutes of referral. It has specialist counsellors, who are trained in talking to and supporting children and young people who have been sexually abused and understand how difficult it can be to talk about it, as outlined in the national sexual assault and abuse services strategy.
Furthermore, alongside its urgent response service, the SARC also operates week-day clinics which offer planned appointments at six venues across the West Midlands region and a paediatrician is available on call 24 hours a day for case discussion. Any child or young person aged 5-17 years’ old who undertakes a medical examination and/or has been sexually abused or exploited will be offered specialist counselling. Onward referral takes place wherever this is required to ensure effective support for the young person
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Crisis Care Police Custody
Sandwell has access to a dedicated ‘place of safety’ (136 suite) which has been in operation since November 2015. The place of safety is provided for children and young people who have been detained under sections 135 or 136 of the Mental Health Act. The purpose of the place of safety is to ensure that CYP are cared for in safe and appropriate environment. When a young person is detained under section 136 of the mental health act the police will contact Penn Hospital to notify them that they will be bringing a young person to the facility. If the call received from the police is during core hours of Crisis Home Intervention and Treatment Team (CHITT) delivery Penn Hospital contacts CHITT team who will liaise with the referring officer and complete the section 135/136 proforma. Out of Hours Penn Hospital will work with the DSN
Partners are working collaboratively to agree plans, and offer assurance to NHSE, that when the regulations change the provision is compliant with the legislation, regarding the detention of adults and Under 18s under section 136 of the Mental Health Act.
The custody pathway is managed locally with police contacting the CAMHS Crisis Intervention Home Treatment Team directly. Response is immediate.
Specialist or Forensic
NHSE specialised services commission community forensic CAMH services. The service supports transitions into and out of secure inpatient care. BCPFT work with NHSE commissioners to agree the optimal care management plan for all children and young people who present with forensic behaviours which can be seen clearly in Figure 9 below, which illustrates the BCPFT CAMHS Specialist Mental Health Escalation Process. It identifies the appropriate pathway following by the young person in crisis, dependent upon the day and time of referral, illustrating a 24-hour service provision.
Figure 9:
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Following agreement, referrals are submitted to Arden Leigh Youth First Service. The Youth First Team arranges a local assessment with specialist CAMHS.
If young person requires admission then CAMHS clinicians monitor progress via the Care Programme Approach (CPA’s) or Care, Education and Treatment Reviews (CETR’s) process, where discharge planning takes place. Young people are discharged back to CAMHS, CHITT and core CAMHS where work is continued within the community.
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Youth Justice – Safe Centre
West Midlands Children’s Services as part of the West Midlands Combined Authority have recently been awarded some funding from the Department for Education to undertake a feasibility study for a Safe Centre, which would be a campus-based resource that covers 14 Local Authorities including Sandwell. The aim of the proposal is to explore the needs of a Safe Centre, with the target group being those children and young people who offend. The Safe Centre feasibility study will explore:
• Secure children’s unit for those requiring Tier 4 admission • Those CYP who have offended but do not meet the threshold of Tier 4 CAMHS provision • What therapeutic interventions are required? • Outreach and interoperability with local services
Design is at a very preliminary stage. Our work is concentrated on understanding levels of demand and need in the wider West Midlands and evidence regarding ‘what works’. However, we currently believe there is a need for a holistic, resilient service that provides:
• A more local (regional) therapeutic secure facility for those currently sent to secure children’s homes (and potentially other secure settings) elsewhere • A non-secure ‘safe haven’ to support children in crisis, whilst preparing for appropriate long-term specialist provision • A ‘step-down’ service for those young people leaving secure settings, enabling supported transitions to bespoke community care and support • Linked intensive fostering and/or supported lodgings services in communities, to support prevention/ step-down (possibly in a ‘hub and spoke’ model) • Early intervention services to prevent escalation to specialist/ secure settings.
Sandwell will support connectivity with the West Midlands Children’s Services proposals to ensure that local pathways are in place to enable safe transition for both their welfare and youth justice.
8. EATING DISORDERS
In this section we describe: • An overview of our Eating Disorders service and model of care • The influence of service users and their impact on current service design • Service activity and performance • User feedback.
Local transformation funding has enabled investment in an expanding all age Eating Disorders service, commissioned in partnership with Wolverhampton CCG. The Black Country joint service specification supports the collaborative working between the two mental health trusts who operate in the Black Country. We remain committed to developing services to enable all CYP for urgent cases to be seen within 7 days and for routine cases within 28 days.
Our comprehensive all aged specialist eating disorder service delivers evidence-based eating disorder interventions provided by a multi-disciplinary workforce. The development of the service specification for this service has been informed by the commissioning and policy guidance within the ‘National Service Framework for Mental Health’ (Department of Health (DH), 1999), National service framework: children, young 95
people and maternity services (DH 2004), ‘New Horizons’ (DH, 2009), ‘No health without mental health’ (HM Government, 2011). NICE Guidance has been used to design the service, of which some are: (National Clinical Guideline 9, 2004), ‘Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care’ (NCG 16, 2004), ‘Self-harm: longer-term management’ (NCG133, 2011). The service works in collaboration across Universal Primary, Secondary and Tertiary services to provide multi-disciplinary team approaches to the Eating Disorders Care Pathway.
Providers across the STP ensured that clinicians both in dedicated eating disorder services and wider CAMHS team attended the National NHSE training programme to ensure that services were in line with NICE guidance and a decrease in place-based health inequalities. Alongside developments to be fully compliant with the recommended model, all CEDS are working towards being members of National Quality Improvement Programme. Sandwell hope to be able to have joined the network and have full accreditation by the end of 2019.
The Eating Disorder service has improved outcomes and service quality for children and young people particularly in relation to:
• Waiting times (helped by prioritising referrals in line with Management of Really Sick Patients with Anorexia Nervosa - MARSIPAN Guidelines) • Increased access to services (as seen in increased referral rates for eating disorders), and • Helping preventing admission to Tier 4 (as there have been no CAMHS admissions over the past 18 months).
Service users are at the centre of the continued evolution of the service and continue to be asked for feedback using the services Service Evaluation Questionnaire, the ‘Tell Us How We Are Doing’ Questionnaire and Session Rating Scales. This has led to: • changes in the therapeutic environments • greater collaboration between the CAMHS eating disorder elements and the CHITT to help prevent admission • the adoption of a Systemic based Assessment at the start of treatment (to improve access and experience of the service on entering the service), and • the seamless progression for Young People with Eating Disorders in the context of an all age service, thereby eliminating the need to transition from CAMHS to Adult Mental Health eating disorders services.
The Eating Disorder Service adheres to set standards that drive and monitor the performance that include:
• working in partnership with primary and secondary services to ensure that care team can identify, assess and when appropriate treat people with Eating Disorders and are fully coherent with the referral pathway to the specialist provision
• providing a range of acute and general medical treatments and services to ensure that physical health needs are addressed, and information is shared on treatment and diagnosis
• coordinating care with inpatient providers to ensure timely access and discharge, with adequate follow up as recommended by NICE guidance
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• continuous improvement to ensure a high quality, safe and therapeutic continuum of assessment, treatment and care for all ages across all tiers of service.
Interventions currently offered include:
• Cognitive Behaviour Therapy (CBT) • Systemic Family Therapy • Family Based Treatment (FBT) • Psychological Psychotherapy • Dialectical Behaviour Therapy (DBT) • Nutritional Counselling • Medical/Psychiatric Intervention
We are benefitting from the investment in a dynamic Service Manager and workforce changes that are enabling us to intensify our efforts with those young people who require more intensive support. As an example, we have increased our capacity to deliver CBT to this core group.
As per the MHFYFV the CCG has invested in eating disorders, table 7 below demonstrates the level of investments. The CCG has invested in BCPFT for Sandwell and in West Birmingham has invested in FBT to further develop and increase capacity within the existing services.
Table 7:
2 0 15 - 16 2 0 16 - 17 2 0 17 - 18 2 0 18 - 19 2 0 19 - 2 0 2 0 2 0 - 2 1 Source of Funding - Eating Disorder £000 £000 £000 £000 £000 £000 CCG Funding per National Allocation (incorporated within CCG baseline) Sandwell 170 176 176 176 176 176 West Birmingham 119 124 124 124 124 124 Total Funding 289 300 300 300 300 300
Application of Funding Sandwell 81 390 390 391 406 417 West Birmingham 119 124 124 124 124 124 Total Expenditure 200 5 14 5 14 5 15 530 541 Underspend/(Overspend) Against Hypothecated Allocation 89 - 2 14 - 2 14 - 2 15 - 2 3 0 - 2 4 1
During 2019/20 we will:
• Enhance our governance in relation to NICE compliant interventions such as FBT • Build capacity for a Parent Group Program (based upon Surry Early Intervention Program by Nicholls & Yi 2015), and • Develop provision for Binge Eating Disorders using Self Help Models as a further resource. • Complete the application to join the Quality Network Community CAMHS – Eating Disorders (QNCC-ED)
Our referrals between 2014/15 to 2017/18 are below, we also hope to be in a position to offer Self-Referral, a year earlier than the National Strategy/Plan, and we are internally benchmarking against the Royal College of Psychiatry Quality Network for Community Eating Disorder Services for Children and Young People (QNCC-ED) and have started the application to join QNCC-ED. National training had to be completed prior to this.
Table 8: Eating Disorders Referrals under 19 – Sandwell CCG
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Age at Referral 12 13 14 15 16 17-18 Total (Years)
2014-15 0 0 0 0 0 17 17
2015-16 2 0 1 0 0 6 9
2016-17 0 1 1 5 4 16 27
2017-18 1 1 9 6 5 6 28
Total 3 2 11 11 9 45 81
For urgent referrals we are achieving 66.67% patients being seen within 1 week. However, we are only achieving 94% of patients being seen within 4 weeks for a routine referral.
9. DATA – ACCESS AND OUTCOMES
Sandwell’s ambition is to support 100% of children and young people to access emotional wellbeing and mental health services at the appropriate time to meet their needs. The MHFYFV outlines access as one of the transformation changes required. It challenges local systems to increase access incrementally 34% by March 2020 and 35% by March 2021. Aligned to the NHS Long term plan expansion ambition by 2023/24, based on local prevalence targets our ambition is to support 13,475 children and young people per year accessing services.
Demand and Capacity work has been undertaken across BCPFT, jointly commissioned by Wolverhampton CCG and Sandwell and West Birmingham CCG by Niche Consultancy. This will result in achievable targets being set for each provider to reach to ensure access standards are reached across the services. There are some concerns following this piece of work that not all interventions are being entered on the system in a consistent manner by staff and as a result one of the outcomes is likely to be ensuring that staff members in each of the commissioned services enter data and outcomes in a consistent manner. This work will support development of an action plan to reach the access targets for each NHS commissioned service.
Work already undertaken to increase activity includes:
• Group work as an alternative method of delivering interventions. • Pathways & length of stay to be standardized across services that are similar. • Data o Both entry and reporting/understanding o Switch to RIO for BCPFT commencing April 2020 with importance of understanding need to record accurately.
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• Review of learning disability services • Waiting list initiative to be developed • Work with partner agencies in Sandwell to improve activity and ensuring all relevant data recording is recorded on MHSDS appropriately.
In order to assess our level of delivery, we recognise that all NHS commissioned and jointly commissioned services, including non-NHS providers should be flowing data for key national metrics in the Mental Health Services Data Set (MHSDS). SWBCCG has worked with NHS, NHS Improvement and NHS Digital to enable all NHS commissioned, jointly commissioned services, including non -NHS providers, to input data into the MHSDS. This improvement in the flow of data via the national data set has allowed us to monitor current access data and have clear visibility against outcomes. The requirements for data inputting have been established by highlighting and monitoring of regularity of data inputting directly with all providers. This also provides us with the assurance that providers are flowing data into the dataset, as stipulated.
The CCG is working closely with internal performance monitoring reporting team to identify gaps in reporting and potential rationale. This is being fed back to all providers as part of performance monitoring with providers and seen as an aspect supporting improvements in quality of data submission
As part of national reporting, Sandwell submits data against access standards for: • Access to CYP IAPT • Eating Disorders services • Early Intervention into Psychosis
Current Reporting against national indicators
Local and regional data reporting
The following KPIs are captured on a regular basis from the specialist CAMHS services provided by BCPFT and this data supports commissioners to discuss the needs of the CYP in the city:
• The number of new children and young people aged 0-18 receiving treatment from NHS funded community services in the reporting period. • Number of CYP with ED (routine cases) referred with a suspected ED that start treatment within 4 weeks of referral (0-19 year olds) • Number of CYP with ED (urgent cases) referred with suspected ED that start treatment within 1 week of referral (0-19 year olds) • Number of patients with ED (routine cases) referred with a suspected ED that start treatment within 4 weeks of referral (19 year olds and above) • Number of patients with ED (urgent cases) referred with suspected ED that start treatment within 1 week of referral (19 year olds and above) • Percentage of children referred (from all sources) who have had initial assessment and treatment appointments within 18 weeks. (Breakdown of DNAs to be included in Exception 99
Reports) • Total number of referrals received and source. (Total numbers, plus LAC) • Number and reasons for discharge for referrals received and not taken on • Number of patients seen by Crisis Team on acute wards (excluding self harm) • Every person presenting at A&E with crisis seen within 4 working hours (i.e. referrals received between 08:00 and 18:00). The clock starts when A&E make the referral to crisis. • 95% of children and young people (and parents or carers) wait no more than 18 weeks between Assessment and Treatment [or Choice to Partnership] - Target not applicable (and subject to change) until Demand and Capacity work has been completed • Average time between first and second appointment (Median Average) • Longest wait between first and second appointment • Shortest wait between first and second appointment • "Every type of contact with CYP is recorded, according to CYP Access target and Outcome Data requirements. • Audit of sample of notes, which asks: 1) Have at least 3 outcome measures are used per episode of care? 2) Has progress been made? 3) Is there a breakdown into the care constellations or interventions?" • Number of LAC DNAs/cancellations/reasons and follow up • Number of out of area LAC patients that are seen in Sandwell • Unaccompanied Asylum Seeking Children: Number of holistic needs assessments undertaken specifically to identify MH needs with negotiated Action Plan with CYP completed. • Unaccompanied Asylum Seeking Children: Number of young people referred to service requiring emotional health and wellbeing support. • Unaccompanied Asylum Seeking Children: Number of young people identified who required specialist support with need to refer on to specialist services • Unaccompanied Asylum Seeking Children: Number of awareness raising sessions jointly delivered with RMC for up to 10 professionals from each of the services (social care, health and education.) across agencies in Sandwell • Unaccompanied Asylum Seeking Children: Number of young people referred to service, who are engaging with therapeutic sessions • Unaccompanied Asylum Seeking Children: Outcome monitoring systems being used with clear articulation of journey travelled as a result of intervention provided. • Unaccompanied Asylum Seeking Children: Provision of data from Outcome measuring tools which demonstrates the progress made by the young person around their emotional health and wellbeing.
A local CYPMH dashboard has been developed to ensure that all activity captured can be analysed to ensure that Sandwell and West Birmingham CCG is meeting our targets and is used by commissioners to feedback directly to providers
Reporting
As part of the Black Country and West Birmingham STP reporting, SWB CCG submits our local performance against the access targets which is collated and submitted in collective reports to NHSE. Our combined prevalence as an STP is 33,147 across all 4 CCGs. Our population access targets are outlined in Table 9.
As a system we have set out clear expectations to all commissioned providers to flow data directly or via a lead information provider. Ongoing data quality refinements have been implemented to support accurate data capture.
Table 9: Trajectory to Support Increasing Access
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2019/20 2020/21 2021/22 2022/23 2023/24 CYP Access Target 34% 35% 50% 75% 100% SWB CCG Access Target Activity 4582 4716 6737.5 10106 13475
Sandwell Population 2749 2830 4043 6064 8085 West Birmingham Population 1832 1887 2695 4042.5 5390
During 2018/19 we had reported low levels of activity for SWB CCG. Possible reasons for this was that Forward-Thinking Birmingham (FTB) had not started to flow data. BSOL CCG and FTB have worked with North East Lancashire Commissioning Support Unit to interrogate how FTB can flow data. It is expected that data for Birmingham will flow from April 2019.
Table 10: Published Data – MHSDS 2018/19
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Receiving Treatment 230 190 155 175 110 140 165 160 100 170 180 185 SWBCCG In-Month Performance 20.48% 16.92% 13.80% 15.58% 9.80% 12.47% 14.69% 14.25% 8.91% 15.14% 16.03% 16.47% BSMHT Receiving Treatment 5 0 0 5 0 0 0 0 0 0 0 5 BWC Receiving Treatment 55 45 35 15 20 5 0 15 15 25 20 15 BCPFT Receiving Treatment 155 120 95 110 55 90 100 95 60 75 70 85 Dudley and Walsall MH Receiving Treatment 5 20 15 5 15 20 25 15 5 10 15 5 The Childrens Society Receiving Treatment 0 0 0 35 20 15 30 30 15 35 35 35 Kaleidoscope Receiving Treatment 0 0 0 0 0 0 0 0 0 0 5 10 FTB Receiving Treatment 0 0 0 0 0 0 0 0 0 20 25 20 Opening Doors Receiving Treatment 0 0 0 0 0 0 0 0 0 0 0 5 Other Receiving Treatment 0 0 0 0 0 0 0 0 0 0 0 0
Increasing Access
As a system we are ambitious and want to support 100% of CYP access emotional wellbeing and mental health services within 4 weeks, although achieving 100% access will take a number of years to reach. Triangulating access and waiting times data suggests that Sandwell as a system has several challenges, these are:
• Identification of Children and Young People
The access standards could not be met based upon current referral levels. Given estimated prevalence this suggests we may not be identifying children and young people with needs who would benefit from emotional health and wellbeing services. We are committed to ensuring all statutory agencies and VCS organisations work together to ensure we identify CYP as early as possible to enable them to access care to meet their needs and increase their life chances.
In addition, we are working to improve data capture in several areas to ensure we do not underreport the level of access we are realising e.g. Early Years Psychology, Crisis and Home Treatment and MAA. Our Point of Access (POA), a collaborative venture between Sandwell Children’s Trust, SWB CCG, BCPFT and the EHWB collaborative BEAM, allows us to monitor referrals and access across the whole of the EHWB/CAMHS provision except for PMHW service. As the PMHW service currently has its own referral system, this year we are working with Kaleidoscope to submit referral data via the POA 101
so that we can capture all information according to need category.
We continue to work closely with Kaleidoscope and have commenced discussions to review current process of referrals that Kaleidoscope receive directly. They currently receive referrals directly however we have identified these need to come via POA to enable correct capturing of data but also ensure referral is directed to correct provision and relevant to CYP needs. The Primary Mental Health Worker model (Kaleidoscope) aims to reduce unnecessary referral to more specialist services however this ideology has taken away from an accurate recognition of number of overall number of referrals data and ensuring provision is delivered by most suitable provision based on need. Kaleidoscope timescales for referral to allocation are 10days. We feel going forward this needs to align with POA decision making of 5 days. We are also mindful that we need to monitor capacity of Kaleidoscope against number of referrals they may receive.
We continue to take action to ensure that professionals and children and young people are aware of what services are available to encourage them to access support in a timely way.
• Capacity within services to meet waiting time standards
PMHW’s see children and young people within 8 weeks compared to 18 weeks for CAMHS. PMHWs have the skills to support some children and young people on the Getting Help pathways. We will work collaboratively with CAMHS and the PMHW service to provide community sessions by Kaleidoscope where clinically appropriate rather than CAMHS and/or with support and supervision to Sandwell BEAM - May 2019.
• Right place right time
Point of Access (POA) has been live since May 2019. Quarter 1 2019/20 data shows 492 referrals to POA with 555 referrals for Quarter 2 2019/20. Main source of referrals has come in from Health- GP & other primary care & schools. Of these, 47% of these referrals have targeted levels of need, with 26% needing specialist intervention. Both these numbers however are lower than last quarter. Discussions regarding a review of POA however have commenced with, with particular focus on a more integrated and diverse mix of professionals within POA, including those from community and voluntary sectors organisations. The vision is increased appropriate signposting to relevant services, as the rate of decisions made with 5 working days has declined from 29% to 7%. The positive impact to date has been the single route of referrals, and particularly swift referral to service when specialist and targeted intervention is needed.
• Increasing access
Providing pop-up drop in’s at schools will encourage children and young people to access services in a convenient place, removing barriers to access such as limited access via public transport.
• Managing future demand
Sandwell population projections predict that there will be an increase of 24.5% of 10 - 14year olds, 11.6% 15-19yr olds and 10.6% for 5-9 years over the next 8 years. Given this projected increase, capacity and capability will need to be considered strategically as part of an integrated care system
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10. URGENT & EMERGENCY (CRISIS) MENTAL HEALTH CARE FOR CHILDREN AND YOUNG PEOPLE
Supporting young people experiencing mental health crisis remains a top priority. Our CAMHS Crisis Intervention/Home Treatment Team continue to operate an 08.00-20.00 model every day of the week and is provided to young people in mental health crisis. It delivers; intensive home treatment to those young people deteriorating into crisis, crisis assessments provided in both the community and acute hospital settings and in-reach support to acute hospitals and inpatient mental health settings.
Clearly the model for provision to establish comprehensive support for the children and young people of the local areas needs to be much wider than just crisis intervention and admission avoidance. We have ensured that paediatric liaison is in place to support all young people attending emergency departments in emotional or mental health crisis. The CAMHS paediatric liaison function delivers provisions at two local hospitals; Sandwell General Hospital and City Hospital, with the aim of reducing admissions where safe, and ensuring an appropriate, joined up follow-up support in the community. This service is accessible to all by making reasonable adjustments to ensure high quality crisis care is just as readily available for CYP with learning disabilities, autism and ADHD.
We know that young people and their families only attend A&E when there is a real crisis and admission is not always the best place to support the young person. There is an early intervention and liaison within the local emergency departments as this helps support young people to be seen in a timely manner. Although CYP aged 16 and under who have self-harmed are admitted in line with national recommendations, for all other presentations, we work with the young person and their family to avoid admission where it is safe to do so. Following this, there is a 7 day follow up following contact with the CAMHS provider, BCPFT.
Additional investment in Mental Health Liaison services at Sandwell Hospital, which has been operational since September 2019 has resulted in Core 24 compliance for the whole of our CCG population.
One of our key priorities is to ensure that no young person detained under Section 136 of the Mental Health Act is taken to a police cell as a place of safety. Our CAMHS Crisis Intervention/Home Treatment Team (CHITT) operate a 24/7 on call rota to ensure that CYP placed on a Section 136 Mental Health Act (MHA) can access a place of safety at the 136 suite and can be cared for by dedicated CAMHS clinicians during their mental health act assessment. This ensures that no child/young person is inappropriately detained in a police cell. The police and our street triage work closely with our CIHTT to ensure mental health assessments are undertaken for those detained in police custody for criminal matters.
The model of support is designed to ensure that children and young people receive care in the most appropriate setting to facilitate their recovery and improve associated outcomes. The service interfaces with Tier 4 inpatient provision and community CAMHS ensuring that children and young people are provided with care closer to home that seeks to reduce admissions, reduce lengths of stay and decrease presentations at A&E. This is achieved by routinely delivering step up and step-down support in to and out of inpatient services (Tier 4) and monitoring children and young people via a Care Programme Approach (CPA) or Care and Education Treatment Review (CETR) attendance. 103
As part of the Transforming Care Programme, it has been agreed to enhance the CIHTT, employing staff with Learning Disability qualifications as well as CYP MH nurses, and with experience within an ASD service to support CYP with these co-morbid conditions, as well as ADHD. This has helped the CIHTT to better support this cohort of young people and prevent admissions to hospital as staff have competencies to support managing this cohort.
In addition to the paediatric liaison and ED service provision the CAMHS CHITT also operate a home treatment element to the service. CYP who have presented in mental health crisis and require more than the standard two weeks mental health crisis support will commence on an intensive home treatment programme. This allows for a further period of assessment and brief crisis intervention during the acute phase of the crisis presentation. This support includes interventions taking place in the home, school or the best location for the young person. This also includes telephone support for the family and YP and liaison with appropriate other services. These interventions frequently keep the young person within their home and community.
As with all of the CAMHS provisions children and young people are involved in goal setting their sessions with the CAMHS CHITT and evaluation of their sessions via the session by session rating scales – this ensures that C&YP remain in not only their care planning but also the outcomes they wish to achieve through the interventions offered.
18 to 25 Years
Sandwell CAMHS and adult mental health provisions are in discussion around developing young adult provisions. These provisions will be funded through the Long-Term plan funds and ensure that there is flexibility in where this cohort of young adults 18 to 25 years has their mental health issues addressed. This would allow for CYP already know and engaged in CAMHS to remain within CAMHS post their 18th birthday and would allow for dedicated young adults provisions to be developed in keeping with the philosophy of a CAMHS provision which is family centred. We will ensure dedicated transition workers are employed across both services to ensure that timely and secure transitions can take place for the young person involved.
Triage Car The availability of the triage car further enhances the crisis provision locally. It is mostly called by 999 to assist in an emergency. Data demonstrates that there are a number of younger adults and children accessing this service which aims to prevent hospital admissions (unless the child requires inpatient care). A number of case studies shared have evidenced that this type of support has and will continue to save lives given the fast response (mostly under one hour, the police powers to access property, the paramedic with the skills to provide essential first aid and the Community Psychiatric Nurse providing the psychiatric support.
11. EARLY INTERVENTION IN PSYCHOSIS
In this section we describe:
• The early intervention in psychosis (EIP) service model in Sandwell • Local delivery of national targets for EIP
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• Next steps
It is well known that early intervention can reduce the exacerbation of life-long mental ill health. Commitments nationally have been set where areas are required to provide at least 60% of people with first episode psychosis starting treatment with a NICE recommended package of care with a specialist EIP service within two weeks of referral by 2020/21.
Sandwell Early Intervention in Psychosis (EIP) is a discreet service provided by BCPFT. It is available from 14+ with no upper age limit and currently operates from 8am to 8pm Monday to Friday. The service is distinct from CAMHS and is managed internally by the provider in the same directorate, aligning both services closely in.
There is a clear pathway to EIP from CAMHS where Psychosis is suspected and there are no barriers to a young person entering the service by virtue of their presenting in CAMHS. It may be that the initial assessment is undertaken by the CAMHS service with some intervention provided before it is passed to the EIP service. If the individual is allocated a care coordinator within the Early Intervention Service, medical responsibility will be held in the Early Intervention Service rather than CAMHS. However, liaison will continue with professionals in CAMHS as appropriate. This will ensure that the holistic needs of the individual and family are met. Crisis and out of hours support will be requested from the CAMHS crisis service as needed. In order to ensure continuity of care, all outpatient appointment letters, care plans and risk assessments will be routinely forwarded to the appropriate CAMHS Consultant so that information regarding treatment and risk can be accessed as needed.
EIP has historically performed well in enabling access to treatment pathways with 2 weeks of referral to service. Exception have exclusively been around patient choice and the service is committed to reviewing how it engages from the point of referral.
This is a wider collaboration with NHS England to review the Sandwell Service, in parallel with Wolverhampton and has seen an increased focus on delivering NICE concordant treatment pathways in line with the 6 care processes/interventions defined in the NCAP self-assessment tool for services. As a result of this focus, more users are receiving physical health checks, more staff can deliver family-based interventions and access to CBT for Psychosis will increase as more training becomes available for practitioners.
EIP is now aligned with other EIP teams across the Black Country in working towards the delivery of revised specification on the larger footprint that will release greater capacity through scale to allow delivery of more effective treatment pathways. The service does and will continue to operate in accordance with the national guidelines which broadly prescribe the following:
• NICE concordant treatments • Specialist ongoing assessments of the young person’s needs • A care co-ordinator • Assessment of relapse signs and a relapse plan • Medication advice and monitoring • Advice to the individual and their family about managing and maintaining recovery • Advice on training, employment, and education
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• Youth-friendly help such as confidence building activities and social interaction.
The EIP service involves are a broad range of professionals to provide a young person with the support they need, including psychologists, social workers, vocational workers, occupational therapists, fitness and lifestyle workers, BAME workers, support workers, psychiatrists and nurses.
The EIP is a recovery model that seeks to reduce relapses and hospital admissions. In 2017/18 75% of referrals to the EIP service were seen within 2 weeks against the 50% national target. The target increased to 53% for 2018/19 against which 51.61% of patients were seen within 2 weeks of referral.
A pathway is in place between CAMHS and the EIP where 51 CYP accessed NICE recommended packages of care during 2017/18.
The EIP service has seen an increase of 46% of referrals into the service.
12. CYP MENTAL HEALTH SERVICES WORKING WITH EDUCATIONAL SETTINGS – SCHOOLS AND COLLEGES (INCLUDING MENTAL HEALTH SUPPORT TEAMS) The Mental Health Support Teams (MHSTs) will be a joint model between CAMHS and Educational Psychology. This enables a combined knowledge base of mental health and educational need which will enable young people identified as requiring support to be provided with a seamless service. Joint supervision can also be offered to the MHST which will enable staff to feel contained and supported. VCS are pivotal in supporting delivery of MHST across Sandwell, Walsall, Dudley and Wolverhampton and an integrated model with local agreements with delivery partners of education, health and VCS will be applied, where the MHST will be conduits to connect CYPF with other local community services that can promote positive emotional health and wellbeing such as physical activities.
Figure 10 below outlines the MHST team makeup and how it will connect to education-based settings and the wider system to provide evidence-based interventions.
Figure 10
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The model celebrates the diversity within our four places and aims to reduce variation in practice across the system. We will achieve this through demonstrating fidelity and integrity towards the national MHST model. We are committed to a partnership approach to service planning, commissioning, delivery and continuous improvement, involving Education Providers, Local Authorities, Voluntary & Community Sector (VCS) Organisations collaborating alongside Children and Young People and their families (CYPF). We will use funds exclusively for the intended purpose of developing dedicated MHSTs. As part of the MHSTs in Schools, the model below illustrates a dynamic relationship across commissioned service providers offering emotional wellbeing and mental health support to education and CYPF. It capitalises on the strengths of each sector (education, health and the voluntary community) and where CYPF will be initially supported within MHSTs.
Delivery:
Joint assessment of need in the education setting, will be carried out in conjunction with school/college leadership. This will direct how we target our engagement with schools and education settings. This assessment will identify the need in the education setting with the planned work of the MHSTs commensurate to the training and resources of the setting. We have opportunities to explore how MHST can reduce the impact of risk factors associated with poor mental health e.g. holistic family-based support which can be provided to Children in Need, those who have been impacted by adverse childhood experiences (ACES) etc. In addition, we will work with CYP from vulnerable groups to identify what are the best ways to engage with them to increase access and reduce health inequalities.
As part of the MHST we will triangulate and analyse data across the system to ensure that we increase access to the most vulnerable groups. The virtual MHST provides opportunities to share best practice in order to encourage access for those who are systematically under/overrepresented in current services in other group settings such as pupils known to the criminal justice system and connections with PRU/alternative education provision. The virtual team will provide the opportunity to address border issues and ensure continuity and consistent approaches across the Black Country and West Birmingham.
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The MHST’s will be a joint model between CAMHS and Educational Psychology and as a result NHS CYP mental health services will be integrated with MHSTs. There is also an understanding that school nursing services will also be able to receive support via the MHSTs. This enables a combined knowledge base of mental health and educational need which will enable young people identified as requiring support to be provided with a seamless service. Joint supervision can also be offered to the MHST which will enable staff to feel contained and supported.
Our trailblazer sites will provide an integrated model offering direct and indirect interventions including: • Behaviour support programmes for mild conduct problems • Cognitive behaviour approaches for low mood, emotional distress and self- regulation • Problem focussed group sessions • Parenting group sessions (stand alone or in parallel with a CYP group) • Whole school or class approaches that work with educational staff to ensure that our schools offer the psychologically informed environment to support children and young people in developing good mental health needed to build resilience, • Ensuring educational workforce are trained and supported when supporting young people’s Emotional Wellbeing and Mental Health Service (EWMH) • Targeted/selective interventions that are aimed at groups whose risk of developing MH problems are significantly higher, such as CYP in youth offending services YOS and Pupil Referral Units (PRUs).
Governance
Across the Black Country and West Birmingham CCG’s we have system wide partnership boards that focus on improving emotional wellbeing and mental health of CYP. Figure 12 illustrates the governance structures for the Black Country MHST trailblazer programme.
Place based boards in The Black Country have different names such as: CYP Mental Health Strategy and Transformation Group in Walsall, Emotional Health and Wellbeing Partnership in Wolverhampton, Emotional Health and Wellbeing Steering Group in Dudley and Thrive Board in Sandwell.
The reporting arrangements for the delivery of specific teams located within place will be reported to these partnership boards. The overarching reporting across the whole system will be responsible to the One Commissioner Work Programme to ensure system assurance against programme deliverables.
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Figure 11: Governance Structure – MHST Trailblazer Programme
The BC STP has a dedicated workstream that support mental health, and SWB CCG is the lead organisation for the MHST project for the BC. The project manager will be overseeing local submissions and reporting against overall progress of the MHST and will compile an overall system view of the MHST implementation in Black Country and West Birmingham.
Place and System Need The Black Country has a good understanding of local need. CYP in the Black Country, based on our population demographics, are at risk of poor emotional wellbeing and mental health outcomes, see Table 11.
Table 11: Black Country population benchmarked against prevalence of forecasted need:
Level of Needs Percentage Education/ of Social Care Population Total Tier Thrive Thresholds Dudley Sandwell Walsall W’hampton Population Universal 100% 72,460 86,000 67211 66,018 295478 1 Thriving Needs Getting Targeted Advice/ and Early 15% 10,869 12,900 10650 9,903 44322 2 Help Help Children with less Getting complex 7% 5,072 6,020 4970 4,261 20323.2 More diagnosable 3 Help needs
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Very complex high risk diagnosable 1.85% 1,341 1,591 1314 1,221 5466.01 Getting mental More health 3 Help needs
Across the BC STP, funding for MHST’s will be in addition to the current investments made in emotional, behavioural and psychological wellbeing interventions. The model will operate:
• with newly created MDT teams led by the VCS, CAMHS and Education Psychology working as matrix teams – all organisations will host teams to maximise opportunities to provide blended leadership and support across the wider system (see table 1 and Appendix 4: example process map).
• within Local Authority placed based teams working in a co-ordinated and integrated way across the BC
• with use of systems and processes to monitor outcomes, performance and impact including, amongst others, ROMS
• in a matrix style of working with shared governance arrangements
• to ensure CYP are supported to access education, clinical support and/or community services appropriate to needs, at the right time
• on the principles of sharing of data/knowledge and expertise ensuring consistency in practice across the BC MHSTs. Recruitment to the additional posts is underway with the plan for new staff to start training in January 2020. Mental Health Support in Schools and Colleges
Further to the Green Paper in 2017, one of NHSE with the Department of Education is leading the delivery of establishing new Mental Health Support Teams (MHSTs). MHSTs will develop models of early intervention on mild to moderate mental health and emotional wellbeing issues, such as anxiety, behavioural difficulties or friendship issues, as well as providing help to staff within a school and college setting. The MHSTs will be a joint model between CAMHS and Educational Psychology. This enables a combined knowledge base of mental health and educational need which will enable young people identified as requiring support to be provided with a seamless service. The teams will act as a link with local children and young people’s mental health services and be supervised by NHS staff.
We were successful in being awarded funding as a wave 2 trailblazer site to establish MHSTs across the BCWB STP by March 2020
MHST schools have been selected on the basis that there is an established and engaged Mental Health Lead that the Universal groundwork is in place, pupil needs are well understood, and they are using the survey mechanisms to identify vulnerable pupils. This will ensure that the scarce resources can be targeted at the right level of need within each school and maximise the chance of the success of the programme. 110
Whole-School Approach to Wellbeing
Sandwell has a well-established and nationally recognised a universal programme designed to promote emotional and mental health through a whole-school approach, currently in its 4th year of delivery. This programme is commissioned and funded by Public Health and developed and delivered by the Educational Psychology Service in conjunction with schools. The programme provides a strong foundation for all our school- based prevention and support work. It is an action research process, where educational psychologists support schools to gather information, reflect and develop a bespoke action plan to enhance practice across key areas known to improve wellbeing. It includes a:
• Charter Mark - awarded following completion of the school action plan/learning cycle • survey, to assess levels of wellbeing, identify pupils who need extra support and measure change. • wellbeing curriculum co-designed with children, specialists and teachers.
The Charter Mark for Schools is a universal programme designed to promote emotional and mental health through a whole-school approach which has been running for 3 years. It is a key element of delivering Thrive Getting Early Help category of need to our CYP.
During 2019-20 we have been exploring how we connect the School Charter Mark to the wider emotional wellbeing digital offer to ensure that schools and education professionals can access online resources to create emotionally healthy classroom environments. The Schools Charter Mark will continue to create awareness in schools which will enable specific targeted support those CYP who are experiencing emotional wellbeing and mental health concerns.
We will use the School Charter Mark as a tool to embed emotional wellbeing and mental health across the workforce to become more psychologically informed as well as utilise findings to commission services. The Charter Mark aims to promote pupil resilience by creating a school environment where they can thrive socially, emotionally and mentally. This is achieved by developing the following areas: • Leadership – Every school has someone with lead responsibility for social, emotional and mental health and a development plan agreed by the senior leadership team. • Ethos and Environment – Children feel emotionally safe, policies promote wellbeing and the school is a pleasant place to be. • Curriculum, Teaching and Learning – Children are learning and developing the awareness and skills to keep themselves and others emotionally and mentally well. • Student Voice – Children’s views are heard, and they are actively engaged in the life of the school. • Staff Development – Staff have the skills they need to promote pupil resilience, support those needing extra help. Every school is working to promote staff wellbeing. • Identifying Needs and Monitoring Impact – Schools use data and feedback to find out about the impact of the school environment on wellbeing, including identifying children needing extra help. They use data and feedback to see if their plan is making a difference to the school community. • Working with parents/carers – Parents have a good relationship with the school and their voices are heard.
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• Targeted support and appropriate referral – Extra help is available for children who need it (e.g. mentors, emotion coaching, nurture groups) and the staff know how and when to refer someone for specialist help.
69 schools have completed their Charter Mark and a further 27 are actively engaged in the process. This includes all our specialist provision, pupil referral units and residential sites. Each school provides evidence of improvements examples include staff training, physical activity, creative play, access to green spaces, social mealtimes, pupil-led social action projects, nurture groups, staff wellbeing initiatives etc.
For every school that is involved there is a very detailed baseline assessment, that looks and hard data (e.g. exclusion, staff absence, pupil survey findings) as well as feedback from children, parents and staff. This detailed intelligence gathering has informed both the content of the universal training programme (see workforce section) and the model/targeting for the implementation of the Mental Health Support Teams (see below). Given the high levels of deprivation across all areas of the Borough,
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13. ABBREVIATIONS
A&E Accident & Emergency ACEs Adverse Childhood Experiences ADHD Attention Deficit Hyperactivity Disorder ADOS Autism Diagnostic Observation Schedule AMHP Approved Mental Health Professional ASD Autistic Spectrum Disorder BAME Black, Asian, Minority and Ethnic Communities BC Black Country BC TCP Black Country Transforming Care Partnership BCPFT Black Country Partnership Foundation Trust BCWB Black Country and West Birmingham BCWB STP Black Country and West Birmingham Sustainability and Transformation Plan BME Black and Minority Ethnic BSI British Standards Institution BSoL Birmingham and Solihull BSoL CCG Birmingham and Solihull Clinical Commissioning Group C&YP Children and Young People CAMHS Children and Adolescent Mental Health Services CAT CBT Cognitive Behavioural Therapy CCG Clinical Commissioning Group CCT Children’s Community Therapy CDC Child Development Centres CETRs Care, Education and Treatment Reviews CGAS Global Assessment Scale CHI ESQ Commission for Health Improvement, Experience of Service Questionnaire CHITT Crisis Home Intervention and Treatment Team CIC Children in Care CLASS Communication, Language, Autism & Social Skills COGs Community Operating Groups CORE Clinical Outcomes in Routine Evaluation CPA’s Care Programme Approach CPD Continuous Professional Development CQC Care Quality Commission CQUIN Commissioning for Quality and Innovation CSE Child Sexual Exploitation CSU Commissioning Support Unit CTS Community Therapy Services CYP Children and Young People
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CYP LTP Children and Young People’s Local Transformation Plan CYPF Children and Young People and their families CYP-IAPT Children and Young People’s Improving Access to Psychological Therapies Programme CYPMHS Children and Young People’s Mental Health Services CYPSE Children and Young People’s Secure Estates DBT Dialectical Behaviour Therapy ECM Every Child Matters ED Eating Disorders EDMR Eye Movement Desensitisation and Reprocessing EDQ Eating Disorder Questionnaire EEBP Enhanced Evidence Based Programme EHCP Education, Health and Care Plan EHWB Emotional Health & Well Being EIP early intervention in psychosis EIS Early Intervention Service EMDR Eye Movement Desensitization and Reprocessing EWMH Emotional Wellbeing and Mental Health Service EYFSP Early Years Foundation Stage Profile EYTA Early Years Transformation Academy FBT Family Based Treatment FTB Forward-Thinking Birmingham FYFVMH Five Year Forward View Mental Health GC5 General Condition 5 GCSE General Certificate Secondary Education GP General Practitioner HMRC Her Majesty Revenue & Customs HONOSCA Health of the National Outcome Scales of Children and Adolescents HWB Health & Well Being IAPT Improving Access to Psychological Therapies ISEY Inclusion Support, Early Years JSNA Joint Strategic Needs Assessment KPIs Key Performance Indicators L&D Liaison and Diversion LA Local Authority LAC Looked After Children LD Learning Disabilities LGBT Lesbian, Gay, Bisexual, Transgender LGBTQ+ Lesbian, Gay, Bisexual, Transgender, and Queer LQRs Local Quality Requirements LSOA Lower Super Output Area LTP Local Transformation Plan
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MAA Multi-Agency Autism Assessment MARSIPAN Management of Really Sick Patients with Anorexia Nervosa MASH Multi-Agency Safeguarding Hub MDT Multi-Disciplinary Team MHA Mental Health Act MHFYFV Mental Health Five Year Forward View MHFYV Mental Health Five Year View MHSDS Mental Health Services Data Set MHST Mental Health Support Teams MLD Moderate Learning Difficulties MST Multi Systemic Therapy NCAP (Self-Assessment) NEET Not in Employment, Education or Training NHS National Health Service NHSE National Health Service England NICE National Institute for Health and Care Excellence NSPCC National Society for the Prevention of Cruelty to Children NVQ National Vocational Qualification OFSTED Office for Standards in Education, Children’s Services and Skills ONS ORS Outcome Rating Scales PA Personal Adviser PMHS Primary Mental Health Service POA Point of Access PRUs Pupil Referral Units PSAS PSHE Personal, Social & Health Education PTSD Post-Traumatic Stress Disorder PWP QNCC-ED Quality Network Community CAMHS – Eating Disorders RCADS Revised Children’s and Anxiety and Depression Scale RCGP Royal College of General Practitioners ROMS Reported Outcome Measures SARCs Sexual Assault Referral Centres SCH Secure Children’s Homes SCPB CYP Strategic Commissioning Partnership Board for Children and Young People SCSB Sandwell Children’s Safeguarding Partnership SCSP Sandwell Children’s Safeguarding Partnership SCVO Sandwell Community Voluntary Organisation SDQs Strengths and Difficulties Questionnaires SEN Special Educational Needs
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SENCO Special Educational Needs Co- Ordinator SEND Special Educational Needs and Disabilities SHAPE Staying Safe, Being Healthy, Enjoying & Achieving, Making a Positive Contribution, Economic Wellbeing SLD Specific Learning Disability SLDOM Sheffield Learning Disabilities Outcome Measure SLT Speech & Language Therapy SMBC Sandwell Metropolitan Borough Council SNOMED Clinical language that facilitates electronic communication between Healthcare Professionals in clear and unambiguous terms SPA Single Point of Access STAMP Supporting Treatment and Medication in Paediatrics STC Secure Training Centres STEP Suicidality, Trauma, Eating Disorder and Personality STEPP STICK Screening Training Intervention Consultation Knowledge STOMP Stopping Over Medication of People STP Sustainability Transformation Plan SWB CCG Sandwell & West Birmingham Clinical Commissioning Group SWBH Sandwell West Birmingham Hospital TCP Transforming Care Partnership UTC Universal Technical College VCS Voluntary & Community Sector WEMWBS Warwick Edinburgh Emotional Wellbeing Scale WMAS West Midlands Ambulance Service WTE Whole Time Equivalents YOI Youth Offending Institutions YOS Youth Offending Service YOT Youth Offending Team
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Appendix 1: CYP LTP 2019/20 Investment Monitoring Plan & Risks/Mitigations
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Appendix 1
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Appendix 2: CYP LTP 2019/20 ACTION PLAN
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List of Contributors to this version refresh
Sandwell and West Birmingham – List of Contributors
NAME ROLE ORGANISATION Amanda Geary Group Director of Operations Sandwell & West Birmingham NHS Trust Amarjit Ballagan Principal Research and Intelligence Specialist Sandwell Local Authority Angel Lakha Early Help Partnership Coordinator Early Help Partnership Angela Poulton Deputy Chief Officer SWB CCG Carol McCauley Commissioner 0-25 Children, Young People BSoL CCG and Young Adults Mental Health Cheryl Newton Group Director of Nursing, Women & Sandwell & West Birmingham NHS Trust Children’s Health Chris Yates Business Improvement and Change Manager Sandwell Children’s Trust Craig Rollinson Performance Lead Sandwell Children’s Trust Dean Robinson Senior Case Manager Transforming Care NHS England & Improvement Diane Osborne Commissioning Manager SWB CCG Eileen Welch Head of Service, Child Safeguarding Service SWB CCG Dr Elizabeth England Clinical Lead for Mental Health SWB CCG Emily Jane Morgan Advisory Teacher for PHSE Sandwell Council Gene Kelly Designated Nurse / Head of Service SWB CCG Harjinder Sangha Commissioning Manager SWB CCG Jade Osborne Directorate General Manager Sandwell & West Birmingham NHS Trust James Cole Senior Commissioning Manager SWB CCG Jane O’Reilly Designated Lead for Looked After Children SWB CCG – Safeguarding Team Jenna Phillips Senior Operations Manager SWB CCG Julian Povey Contracts Manager SWB CCG Juliet Ridgeway Designated Clinical Officer - SEND Sandwell & West Birmingham NHS Trust Karen Woodfield Area Manager BEAM Children’s Society Katie Weston Business Support Officer SWB CCG Kulbinder Thandi Senior Commissioning Manager SWB CCG Lee Wilkins Performance Manager Sandwell Children’s Trust Leona Bird Strategic Engagement Officer Sandwell Council – Voluntary Organisations Lesley Hagger Executive Director of Children’s Services Sandwell Local Authority Lisa McNally Director of Public Health, Sandwell Local Authority
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Lorraine Atwood Area Team Manager – SEND Services Sandwell Local Authority Dr Madhava Rao Consultant Child Psychiatrist Black Country Partnership NHS Foundation Trust Margaret Courts Children’s Commissioning Manager Wolverhampton CCG Mark Davis Chief Executive Officer Sandwell Council – Voluntary Organisations Matthew Plant Senior Information Manager SWB CCG Melanie Barnett Group Head- Inclusive Learning Sandwell Local Authority Michelle Mincher Business Support Officer SWB CCG Mike Botham Youth Offending Service Manager Sandwell Children’s Trust Moira Tallents Principal Education Psychiatrist Sandwell Local Authority Neesha Patel SHAPE Sandwell Local Authority Niten Makwana Consultant Sandwell & West Birmingham NHS Trust Pauline Turner Director of Operations Sandwell Children’s Trust Dr Rajesh Pandey Designated Medical Officer - SEND Sandwell & West Birmingham NHS Trust Sarah Farmer Public Health Programme Manager 0-19 Sandwell Local Authority Sarah Hogan Nurse Consultant/Transformation Lead Black Country Partnership NHS Foundation Trust CAMHS Scott Humphries Director of Learning Disabilities, CYPF & Black Country Partnership NHS Foundation Trust CAMHS Sobia Bi Senior Finance Manager SWB CCG William Kidd Head of Service, Children in Care & Fostering Sandwell Children’s Trust Zulkifl Ahmed Operations Manager – SEND Services Sandwell Local Authority
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