Multi-Agency Comprehensive Child

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Multi-Agency Comprehensive Child Adolescent
Mental Health Services How Far Have We Come
and Where to Now?
Dr Alex Hassett Senior Consultant (CAMHS) Manager
CAMHS Practice Improvement Programme
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Aim of todays session

• Explore the CAMHS Review
• Background to the review
• What do we mean by CAMHS?
• What has been achieved?
• What do we still need to do?

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Purpose of the CAMHS Review

• to investigate
• recent progress (since 2004) in delivering
  services to meet the educational, health and
  social care needs of children and young people at
  risk of and experiencing mental health problems,
  including those with complex, severe and
  persistent needs
• practical solutions to address current challenges
  and deliver better outcomes for children and
  young people with mental health problems
• methods for monitoring these solutions.

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Vision of the Review

• Improving the mental health and psychological
  well-being of all children and young people can
  help realise the ambition set out in the
  Childrens Plan to make England the best place
  in the world to grow up in.

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Outcome of the Review

• The Review made twenty recommendations that have
  been accepted in principle by government, and
  will be considered in more detail by the new
  National Advisory Council, whose remit is to
  ensure implementation of the Reviews findings.

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Defining our discussions

• What is mental health?
• What do we mean by CAMHS?

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What do we mean by mental health?
Young People are saying .
Feeling in control
Feeling balance
It doesnt mean being happy all the time but it
does mean being able to cope with things.
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Mental Health Definition

• A state of well-being in which the individual
  realises his or her own abilities, can cope with
  the normal stresses of life, can work
  productively and fruitfully, and is able to make
  a contribution to his or her community.

World Health Organization, 2004
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The 4-tier model for CAMHS
Very specialist services, incl. children away
from home
Tier 4
Specialist Multi-disciplinary Teams
Tier 3
Individual Professionals Trained in Children and
Young Peoples Mental Health e.g. Psychiatrists,
Psychologists, Therapists etc
Primary Mental Health Workers etc
Tier 2
GPs, Paediatricians, Teachers, School Nurses,
Youth Justice Workers, Health Visitors, Social
Workers, Voluntary Agencies etc
Tier 1
Health Advisory Service, 1995. Together We Stand
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Every Child Matter
Specialist
Targeted
Universal
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Continuum of needs and services
ContactPoint
Single practitioner
Relevant practitioner takes on Lead Professional
functions
Multi-Agency Integrated Support
Lead Professional not required
Children with additional needs
Lead Professional not required
Practitioner required by statute or best practice
to take on Lead Professional functions
Children with no identified additional needs
Children with complex needs
Resource Directory
Information Sharing between practitioners
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Background
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Key Concerns of Victoria Climbié Report
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Every Child Matters Change for Children
Programme
Childcare Bill and National Childcare Strategy
Children Act 2004
Every Parent Matters
Youth Matters
Respect Agenda
The National Service Framework for Children,
Young People and Maternity Services
The National Healthy Schools Standard on
emotional health and well-being
Choosing Health Public Health White Paper
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Every Child Matters Change for ChildrenFive Key
Outcomes
Children want to.
Enjoy and Achieve
Make a Positive Contribution
Stay Safe
Be Healthy
Achieve Economic Wellbeing
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National Service Framework for Children, Young
People and Maternity Services
NSF Standard 9 The Mental Health and
Psychological Well-being of Children and Young
People
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National Service Framework for Children, Young
People and Maternity Services
A major part of the Change for Children programme

• Multi-agency working
• Appropriate Services
• Seamless Service

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NSF Standard 9 The Mental Health and
Psychological Well-being of Children and Young
People

• All children and young people, from birth to
  their eighteenth birthday, who have mental health
  problems and disorders have access to timely,
  integrated, high quality multidisciplinary mental
  health services to ensure effective assessment,
  treatment and support, for them, and their
  families.

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A common theme through out the new policy is on
the emotional well-being of children and young
people and on meeting their mental health needs
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To meet the mental health needs of children and
young people the NSF calls for the development of
multi-agency comprehensive CAMH services
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Everybodys Business
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Summary of components of comprehensive CAMHS

• Multi-agency
• Diverse range of services
• Located in a range of settings
• Inclusive
• Age appropriate
• Universal service providers for children and
  young people (e.g. teachers, primary health care
  teams, Connexions personal advisors) have
  sufficient knowledge of childrens mental health
  to be able to identify those who need help, offer
  advice and support to those with minor problems,
  and refer appropriately when necessary.

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Mental health and psychological wellbeing are
fundamental to broader health and wellbeing.
Unless a person is feeling mentally healthy, it
is difficult for them to have optimum physical
health and wellbeing.
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Emotional wellbeing and good mental health are
crucial for every aspect of a childs life, now
and in the future. Strong social and emotional
skills are essential to success in life and work
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Why is children and young peoples mental health
and emotional well-being important?

• 1 in 5 children has a mental health problem in
  any one year
• Child mental health problems are a strong
  predictor of adult mental health problems
• Mental health problems in young people are
  associated with educational failure, family
  disruption, disability, offending and anti-social
  behaviour
• May continue into adult life and affect the next
  generation

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Relevant to all children
All children have mental health needs and will
benefit from a greater focus on emotional
well-being in families, schools and the wider
community
Lifetime Impacts, Mental Health Foundation, 2004
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What is the current picture?The mental health of
children andyoung people

• 10 of children and young people aged between 5
  and 15 had a clinically diagnosable mental
  disorder that is associated with considerable
  distress and substantial interference with
  personal functions
• Gender and age
• emotional, conduct or hyperkinetic disorder

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What is the current picture?The mental health of
children andyoung people

• Nearly one third of children diagnosed as having
  emotional disorders in 2004 still had them in
  2007
• Around 43 of children and young people who had
  been assessed with behavioural disorders in 2004
  still had them in 2007
• Vulnerable groups e.g. Looked After Children,
  Young Offenders, Learning Difficulties or
  Disability
• Risk and resilience factors

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What factors contribute to our mental health
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So what has improved?
?
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Progress within CAMHS

• Many areas now have multi-agency CAMHS
  partnerships, which have provided a more
  strategic focus on service developments.
• an increase in the number of local authorities
  reporting fully comprehensive provision for
  children and young people with complex needs
  (from 23 to 53)

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Progress within CAMHS

• a 14 fall in the number of children and young
  people waiting to be seen, with shorter waiting
  times as well
• a 20 increase in the number of targeted and
  dedicated worker teams with a focus on
  looked-after children and social care
• an increase in the provision of 24/7 on-call
  services with a CAMHS response (from 44 to 56)

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Progress within CAMHS

• an increase in the number of CAMHS reporting
  appropriate care for young people aged 1617
  (from 56 to 90)
• an increase in CAMHS for children and young
  people with learning disabilities and mental
  health problems (with 87 of services now having
  this provision)

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Progress within CAMHS

• overall increases in the size of the workforce
• mental health being identified as a focus of work
  by a broad range of universal and targeted
  services
• more Tier 4 services providing alternatives to
  inpatient care, and more units providing secure
  inpatient mental health

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Issues within CAMHS

• Unacceptable variations and gaps still need to be
  addressed.
• Still waiting too long for interventions from
  more specialised childrens services, including
  CAMHS.
• Difficulties in monitoring improvements in
  outcomes

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Recommendations
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Leadership

• 3 recommendations
• Local Childrens Trusts required to
• set out how it will ensure the delivery
• set up local multiagency boards

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Leadership

• Regional GOs and SHAs to deliver a coherent
• performance management
• support and challenge role which promotes a
  consistent approach to service improvement and
  delivery across all areas.

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Leadership

• National DH and DCSF
• clarify and publicise their roles and
  responsibilities
• communicate consistently to stakeholders
• secure effective commissioning and performance
  management frameworks

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Promotion, prevention and early intervention

• 2 recommendations
• Promoting a positive understanding of mental
  health and psychological well-being should have a
  focus on children and young people as well as
  adults.
• A clear description of the services that are
  available locally

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Specialist Help for Children, Young People and
Families

• 2 recommendations
• High quality assessment, action plan, lead
  person, signposted routes and what to do if
  things dont go to plan
• Reduce waiting times

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Services Working Together

• Recommendation To improve consistency and
  promote greater cooperation and co-ordination,
  there should be a shared development of the
  language used to describe services, so that all
  services can understand that they are part of the
  comprehensive range of provision to address
  mental health and psychological well-being.

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A needs led system

• 5 Recommendations
• Children's Trusts to develop commissioning
  framework
• Government clarity on use of funding
• Review of use and effectiveness of CAF in
  identifying mental health needs
• Access for vulnerable young people
• Support for those approaching 18 years of age and
  in CAMHS

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Measuring outcomes

• 3 recommendations
• Develop outcome measures
• Strengthen the Governments national support
  programme
• A clear strategic approach to monitoring,
  evaluation, service improvement, knowledge
  management and inspection

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Developing the workforce

• 3 recommendations
• Basic knowledge of child development and mental
  health and psychological well-being
• Support for universal services
• Focus on training in evidenced based therapeutic
  interventions

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Recommendations

• Where are we in Kent?

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Leadership

• Local Childrens Trusts

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KENT CHILDRENS TRUST
CAMHS Strategy Steering Group
CAMHS Practice Improvement Programme
YOS Expert Group
Clinical Network Group
LAC Expert Group
LD Expert Group
CAMHS Strategy Manager
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Services Working Together
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JOINT WORKING
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There are examples of good practice

• Multi-agency projects and team across the county
• Childrens Centres
• Single Points of Access
• Integrated Teams
• CAMHS LIGS
• Local Children's Services Partnerships

Gaps and Inconsistencies
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This was one fathers plea when he heard about
this Review.
If you do one thing, just get people who know
what they are doing to work together better.
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But it is not easy
Professional barriers different professional
cultures leading to different perceptions of role
and priority and disagreement about assessment
and intervention with young person Communication
barriers - often different professions and
different organisations approach the same issue
from a different perspective and use different
terms Organisational barriers - different
organisations may have different goals,
priorities and structures Resource barriers -
there may not always be sufficient money or time
to support joint working.

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Developmentally delayed
Mental health problems Psychiatric disorders
Challenging behaviour Emotional and behavioural
problems Special Educational Needs
Children at Risk Children in Need Suffering
Significant Harm
WHO IS RIGHT?
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No one and everyone
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• Sexually abused young person
• can develop serious conduct disorders
• conduct problems often present with serious
  depressive disorder in adolescents

There needs to be close collaboration between
agencies to ensure that young people with such
problems have their social, educational and
health needs met.
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Learning Disabled
Young Offender
Substance Misuser
WHO AM I ?
Looked After Young Person
Conduct Disorder
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Young person with complex needs!!!
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Sometimes we are so busy with our bit that we
forget the bits belongs to a young person!!
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Developing the workforce
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• CAMHS Practice Improvement Programme
• Solihull Approach
• Pilot of National Everybodys Business mental
  health awareness training
• Undergraduate and Postgraduate training in CAMHS
  related areas
• Social and Emotional Aspects of Learning
• Leuven Box Full of Feelings
• Written into Children and Young Peoples
  Workforce Strategy

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So what are users saying they want?

• What children, young people and their families
  and carers want is often quite simple.
• They want consistent relationships with people
  who can help and to be treated with dignity and
  respect.

CAMHS Review 2008
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Features of effective services as defined by
children, youngpeople and their parents and
carers

• Awareness
• Of mental health and how to deal with it
• Trust
• Build a trusting relationship
• Regular contact with the same staff
• Clarity over confidentiality arrangements

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Features of effective services

• Accessibility
• Convenience
• Accessible information and advice available
• Single point of entry to specialist mental health
  services
• Age-appropriate services
• Communication
• Being listened to, given individual attention
• Straightforward, no technical jargon

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Features of effective services

• Involvement
• Being valued
• Opportunity to discuss what services and
  interventions are available
• Support when its needed
• Available when the need first arises, not when
  things reach crisis point
• Support and follow up

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Features of effective services

• Holistic approach
• services that think about you as an individual
  for example, providing help with practical issues
  and addressing your physical health as well as
  your mental health

Summary of key findings from Focus groups and
interviews with children, young people, parents
and carers, conducted specifically for the
Independent CAMHS Review Expert Group.
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So what can we do?
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Key question

• What can I do to improve the mental health and
  well-being of this child?

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See your role in promoting mental health
Being clear that the emotional well-being and
mental health of children and young people are
all our responsibility
We need to mainstream it into all our services
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We all play a part in helping children and young
people grow up. Mental health and psychological
well-being are not the preserve of one profession
or another, or of one government department or
another. Children and young people need to be
supported by professionals who help each other
out and by a truly joint approach, that is child-
and family-centred, from the Government at
national level as well. Anyone in contact with a
child has an impact on that childs mental health
and psychological well-being. The challenge for
all of us is to remember that and to be able to
respond if things start to go wrong.
Jo Davidson Chair, National CAMHS Review
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Agencies seeing their role in promoting emotional
well-being and mental health
Educational Achievement
Schools
EMOTIONAL WELL-BEING MENTAL HEALTH
Agencies seeing how emotional well-being and
mental health underlie their reaching their goals
and target
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Work more jointly

• If things go wrong, families need advice, help
  and support quickly.
• They need this from people who know what works or
  what can help, and who work as part of a united
  local effort to address problems early on.

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Work more jointly

• Underpinning this approach is a need for all
  practitioners to understand and respect each
  others role and responsibilities and be able to
  rely on each other.
• There is also a need for the whole community to
  understand mental health issues, and to know they
  can be discussed without reinforcing stigma.

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The language that we use

• Mental Health and Psychological Well-being

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Suggestions for consistency ofterminology

• The term childrens services is used to refer
  to the whole family of services that have a role
  to play in supporting mental health and
  psychological well-being from universal to
  specialist services.
• The term CAMHS is used to refer to those
  services that have a specific remit to assess and
  provide specialist mental health support and care
  for children and young people and their families,
  and which also are part of the comprehensive
  range of childrens services.
• The terms universal, targeted and
  specialist need to be consistently defined and
  used at national, regional and local level to
  improve understanding, increase flexibility and
  reduce confusion within childrens mental health
  and psychological well-being services.

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Identify your training and support needs
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We have to acknowledge this work has an
emotional impact on us
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Your job can be stressful
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You can feel overburdened by the demands
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Admitting that at times being a frontline
practitioner is hard, tiring, stressful,
demanding does not mean you are a
failure.
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Acknowledgment leads to THE RIGHT QUESTIONS
ABOUT WHAT KIND OF SUPPORT WE NEED BEING ASKED
AND HOPEFULLY BETTER SOLUTIONS BEING FOUND!
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Caring for the mental health needs of young
people has to go hand in hand with caring for the
mental health needs of staff
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Summary What is needed?

• Not a substantial shift in policy
• Full implementation of policy
• Shift in thinking and behaviour within services

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Key questions we need to ask ourselves
What are the needs of all the young people in my
local area?
What is my contribution?
What skills and / or training do I need to meet
those needs?
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www.camhs.org