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Jackie Powell, Senior Lecturer and Julia Waldman, Senior Research Fellow, Department of Social Work Studies

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Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service. Jackie Powell, Senior Lecturer and Julia Waldman, Senior Research Fellow, Department of Social Work Studies.

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slide1

Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service

Jackie Powell, Senior Lecturer and Julia Waldman, Senior Research Fellow, Department of Social Work Studies

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Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service

What is the Behaviour Resource Service?

  • A Multi Agency approach to meeting the Health, Education and Social care needs of children and young people with complex needs
  • The service is shared between :-
      • Education
      • Health
      • Social Services
  • An integrated service comprising two teams:
    • 4 bedded residential unit for 13 - 16 year olds
    • Community Team for children 5 - 18 years:
    • Psychiatry, clinical psychology, educational psychology, teaching, social work, occupational therapy, community support and nursing.
    • Managed together in one service
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Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service

Who receives the service?

  • Children and young people ages 5 - 18 years
    • Extreme behaviour related to mental health /severe emotional difficulties
    • Difficulties with education placement related to mental health/severe emotional problems
    • Risk of self harm or harm to others
    • Home circumstances vulnerable to breakdown

How is the Behaviour Resource Service different from other services?

    • Government Grant (Part) funded project for innovative mental health services for children
    • Three year project
    • Project fills a gap in previous provision
    • Set up as an additional service for a small group (approximately 50 per year) not as a substitute for existing service
    • Service addresses the needs of the children with extreme complex needs
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Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service

National Context

  • The BRS is one of 24 projects in England funded through Department of Health CAMHS grant see Young Minds website http://www.youngminds.org.uk
  • a requirement of the funding was for external evaluation
  • Department of Social Work Studies commissioned to evaluate 2 of the projects
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Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service

The evaluation has four aims:

  • to describe the organisation and operation of the BRS as it evolves over the three-year period
  • to identify and analyse outcomes for Service users (children, young people, kin and other carers) both in terms of behavioural and social changes and Service satisfaction levels
  • to examine the nature of inter-agency relationships and collaborative working arrangements established within the BRS
  • to understand the impact of the BRS on Services and agencies associated with children and young people presenting challenging behaviour
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Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service

The BRS as a complex and diverse social experiment

"Rather than treating such diversity as problematic, pluralistic evaluation acknowledges, even gives central place to, the varying perspectives proffered by different parties within a particular initiative” Fuller and Petch

  • The pluralism of the Service required that these perspectives be gathered whilst the complexity indicates that outcomes need to be understood alongside process issues influencing progress.
  • The evaluation team also had a commitment to the principles of partnership and participation that demanded a negotiating approach to the design of the study, the methods of data collection and presentation and use of findings (Guber & Lincoln).
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Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service

Presentation is mainly concerned with the 1st and 3rd research aims

  • to describe the organisation and operation of the BRS as it evolves over the three-year period
  • to examine the nature of inter-agency relationships and collaborative working arrangements established within the BRS

paying particular attention to the overall management systems and structures of the service, using a framework of 4 overlapping sets of activities to understand the processes involved

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Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service

Building on collaborative activity, which

  • Established shared concerns and interests
  • Mapped needs and gaps in resources
  • Situated these within wider policy context, including shifting locality boundaries
  • Leading to recognition of inter-dependency
  • Facilitating service planning in a collaborative way
  • Collaboration opened doors for central government grant aid
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Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service

Building Structures and processes

from vision to preparing for a new service involved

  • Funding issues
  • Shared space - geographical and conceptual
  • Human resource issues
  • Development of policies and procedures
  • Information systems

All led to the need for agencies to act and think differently

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Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service

Collaborative management of the operational service

  • Evolution from steering groups to Management Board, who’s challenges include
    • Balancing tensions operational tasks and the continuing of development of structures and processes
    • Interface between senior and front line management
    • Managing service and organisational diversity alongside nurturing a new inter-agency service culture

Achieved by the well-established working relations between individuals which are strong enough to cope with degrees of conflict, risk-taking and uncertainty

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Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service

Creating a learning organisation

  • Monitoring and review activities
  • Shifting identities
  • Contribution of external evaluation
  • Endorsements
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Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service

Key factors in developing and managing integrated CAMHS

  • Building on established collaborative initiative and its associated relationships
  • Senior manager sustaining the strategic vision and supporting operational management
  • Problem-solving in the integrated service context
  • Managing diversity within a new inter-agency service culture
  • Using risk, trust and negotiations skills within context of shifting power relations
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