Multi-Agency Comprehensive Child Adolescent Mental Health Services: How Far Have We Come and Where to Now

1. Multi-Agency Comprehensive Child & Adolescent Mental Health Services: How Far Have We Come and Where to Now?

2. Aim of today�s 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?

3. 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.

4. 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 Children�s Plan �to make England the best place in the world to grow up in�.

5. 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 Review�s findings.

6. Defining our discussions What is mental health? What do we mean by CAMHS?

7. What do we mean by mental health?

8. 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.�

11. Continuum of needs. Children are not static on the continuum but move back and forth at different times. Points on spectrum also be known as universal/targeted/specialist services or by tiers. CAF aimed at low level needs at first sign of difficulty to support early intervention and stop problems escalating ICS and other specialist assessments are aimed at when a child has more complex needs. If a child has already has a CAF, this may inform more specialist assessments Some children�s needs can be met by one service. Others require multi-agency support Lead Professional has a co-ordinating role where one or more services involved so is only needed for children with additional or complex needs receiving multi-agency support Identification of appropriate statutory and non-statutory services during CAF and by Lead Professionals will be supported by the local resource directory ContactPoint and information sharing underpins the other processes by enabling practitioners to identify each other and get in touch quickly and effectively and enabling appropriate sharing of information when they are in touchContinuum of needs. Children are not static on the continuum but move back and forth at different times. Points on spectrum also be known as universal/targeted/specialist services or by tiers. CAF aimed at low level needs at first sign of difficulty to support early intervention and stop problems escalating ICS and other specialist assessments are aimed at when a child has more complex needs. If a child has already has a CAF, this may inform more specialist assessments Some children�s needs can be met by one service. Others require multi-agency support Lead Professional has a co-ordinating role where one or more services involved so is only needed for children with additional or complex needs receiving multi-agency support Identification of appropriate statutory and non-statutory services during CAF and by Lead Professionals will be supported by the local resource directory ContactPoint and information sharing underpins the other processes by enabling practitioners to identify each other and get in touch quickly and effectively and enabling appropriate sharing of information when they are in touch

12. Background

13. Key Concerns of Victoria Climbi� Report

15. Every Child Matters: Change for ChildrenFive Key Outcomes

16. National Service Framework for Children, Young People and Maternity Services

17. Multi-agency working Appropriate Services Seamless Service National Service Framework for Children, Young People and Maternity Services

21. Everybody�s Business

25. Why is children and young people�s 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

27. 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

28. 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

29. What factors contribute to our mental health

31. So what has improved?

32. 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%)

33. 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%)

34. Progress within CAMHS an increase in the number of CAMHS reporting appropriate care for young people aged 16�17 (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)

35. 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

36. Issues within CAMHS Unacceptable variations and gaps still need to be addressed. Still waiting too long for interventions from more specialised children�s services, including CAMHS. Difficulties in monitoring improvements in outcomes

37. Recommendations

38. Leadership 3 recommendations: Local: Children�s Trusts required to: set out how it will ensure the delivery set up local multiagency boards

39. 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.

40. Leadership National: DH and DCSF: clarify and publicise their roles and responsibilities communicate consistently to stakeholders secure effective commissioning and performance management frameworks

41. 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

42. 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 don�t go to plan Reduce waiting times

43. 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.

44. 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

45. Measuring outcomes 3 recommendations: Develop outcome measures Strengthen the Government�s national support programme A clear strategic approach to monitoring, evaluation, service improvement, knowledge management and inspection

46. 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

47. Recommendations Where are we in Kent?

48. Leadership Local: Children�s Trusts

50. Services Working Together

52. There are examples of good practice Multi-agency projects and team across the county Children�s Centres Single Points of Access Integrated Teams CAMHS LIGS Local Children's Services Partnerships

61. Developing the workforce

64. 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.

65. 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

66. 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

67. Involvement Being valued Opportunity to discuss what services and interventions are available Support when it�s needed Available when the need first arises, not when things reach crisis point Support and follow up Features of effective services

68. 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

69. So what can we do?

70. Key question What can I do to improve the mental health and well-being of this child?

76. 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.

77. Work more jointly Underpinning this approach is a need for all practitioners to understand and respect each other�s 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.

78. The language that we use Mental Health and Psychological Well-being

79. Suggestions for consistency ofterminology The term �children�s 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 children�s 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 children�s mental health and psychological well-being services.

80. Identify your training and support needs

88. Summary: What is needed? Not a substantial shift in policy Full implementation of policy Shift in thinking and behaviour within services

89. Key questions we need to ask ourselves