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Oxfordshire & Buckinghamshire Mental Health Partnership NHS Trust. Community Forensic Adolescent Services: A Comprehensive Integrated Regional Service. Forensic Adolescent Network Meeting, St Andrews Hospital, 3 rd October 2008 DR NICK HINDLEY Child and Adolescent Forensic Psychiatrist

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community forensic adolescent services a comprehensive integrated regional service

Oxfordshire & Buckinghamshire

Mental Health Partnership NHS Trust

Community Forensic Adolescent Services: A Comprehensive Integrated Regional Service.

Forensic Adolescent Network Meeting, St Andrews Hospital, 3rd October 2008

DR NICK HINDLEY

Child and Adolescent Forensic Psychiatrist

Child and Adolescent Forensic Mental Health Service, Warneford Hospital, Headington, Oxford OX3 7JX

Email: nick.hindley@obmh.nhs.uk

introduction

Oxfordshire & Buckinghamshire

Mental Health Partnership NHS Trust

Introduction
  • Context for development
  • Philosophy and remit of service
  • Components of service
  • Successes
  • What can be expected
  • Continuing concerns
the context of caf team development

Oxfordshire & Buckinghamshire

Mental Health Partnership NHS Trust

The Context of CAF Team Development
  • development of YOTs
  • prison in-reach to NHS
  • ‘comprehensive’ CAMH services
  • ‘creative commissioning’
  • children’s NSF
          • early intervention
          • complex needs
          • transition
          • learning disability
          • CJS and mental disorder
philosophy

Oxfordshire & Buckinghamshire

Mental Health Partnership NHS Trust

Philosophy
  • comprehensive service to a given area
    • Oxon, Bucks, Berks and MK (2.1m)
  • flexible use of experienced and qualified team to deliver Tier 4 specialist service
  • based in mental health but committed to multi-agency working
  • equivalence of service across institutions
  • clinical and institutional role
  • promotion of continuity and attachment
  • team active, accessible and approachable
  • broad interpretation of ‘forensic’
slide5

Oxfordshire & Buckinghamshire

Mental Health Partnership NHS Trust

Integrated Liaison Model for a Forensic CAMH Service

Substance Misuse Services

Young sex offenders

Youth Offending Teams (YOTs)

Child &

Adolescent Forensic Mental Health Team

“Looked after” sector and secure accommodation

Courts

National Adolescent Forensic Inpatient Services

Prison In-reach

Locality Specialist CAMHS

Education

scope of overall regional service

Oxfordshire & Buckinghamshire

Mental Health Partnership NHS Trust

Scope of Overall Regional Service
  • Prison in-reach: HMYOI Huntercombe
  • Specialist regional resource
      • advice
      • formal consultation
      • assessment, liaison and clinical intervention
      • service development and training
      • other prison/institutional liaison
      • other strategic functions
funding location and structure

Oxfordshire & Buckinghamshire

Mental Health Partnership NHS Trust

Funding, Location and Structure
  • funded jointly by prison in-reach monies and initially DH development grant
  • prison in-reach monies via local pct (SLA)
  • regional community service funded by DH (SLA) until April 2008
  • regional community service funded by regional specialist commissioning from April 2008
  • team managed within mental health NHS trust (Oxon and Bucks Foundation MHT)
  • located within CAMHS but strong links with adult forensic service and multi-agency environment
what team

Oxfordshire & Buckinghamshire

Mental Health Partnership NHS Trust

What Team?
  • child and adolescent forensic psychiatrist
  • child and adolescent clinical and forensic psychologist
  • clinical nurse specialist
  • forensic team practitioner
  • administrator
overall service clinical issues
Overall Service: Clinical issues

Wide-ranging; differ in emphasis

  • Core child and adolescent work in prisons and other settings
  • ‘Forensic’ (risk-related) work in community settings
  • Identifying needs and risks in all contexts
slide10

Oxfordshire & Buckinghamshire

Mental Health Partnership NHS Trust

Prison In-reach: Interaction between CAF Team and YOI

Y.O.I.

Casework, Officers, Child Protection, Suicide Prevention, Family Liaison, Movements, Substance Misuse, Forensic Psychology, Education, Healthcare and Primary Mental Health Workers

  • C.A.F. Team
  • Consultation
  • Joint working
  • Assessment
  • Interventions
  • Multi-agency liaison
  • Facilitation of access to

CAMHS (incl. transfers)

  • Education
prison working successes

Oxfordshire & Buckinghamshire

Mental Health Partnership NHS Trust

Prison Working: Successes
  • multi-disciplinary working in the prison
  • multi-agency liaison with outside agencies
  • a variety of interventions (tier 3 and 4)
  • continuity of support for boys from region (in- or outward)
  • focus on mental disorder and health
  • support of senior figures in prison, PCT, YOT, DoH, Home Office, HM Inspectorate
  • out of hours mental health cover via mental health trust
slide12

National Inpatient Services

  • NHS
  • independent sector
  • Wider Criminal Justice System
    • courts
    • prison
    • secure accommodation

Oxfordshire & Buckinghamshire

Mental Health Partnership NHS Trust

Regional Community Child and Adolescent Forensic Service: Clinical Network

  • Regional Child and Adolescent Forensic Service
      • advice
      • consultation
      • specialist assessment and management
      • strategic development and professional support
  • CAMHS/YOT Linkworker
    • appropriate CAMH background
    • interested in this group of young people
    • ‘belongs’ to both agencies
    • wide range of liaison functions

Local YOT

Other Local

Agencies

Local Specialist

CAMHS Service

regional community service how it works
Regional Community Service: How it Works
  • advice
  • formal consultation
  • assessment and intervention
      • wide-ranging access if clear need
      • joint working with local CAMHS
  • strategic development
      • CAMHS/YOT linkworker network
  • training
      • complex needs
      • structured risk
  • varied liaison functions
      • local, regional, national
community working successes

Oxfordshire & Buckinghamshire

Mental Health Partnership NHS Trust

Community Working: Successes
  • establishment of stronger links between children’s mental health services (CAMHS) and criminal justice system
  • development of a regional mental health network focussing on support for local services but with availability of specialist input as needed
  • local multi-agency solutions to complex and worrying problems
  • provision of service to young people across a variety of settings
interface issues what local camh services should be doing themselves
Interface Issues: What Local CAMH Services Should be Doing Themselves
  • gaining preliminary oversight and developing formulation of a case
  • considering issues of risk
  • developing short-term risk management
  • evaluating need for further (joint) evaluation
  • liaising further if needed
  • ? identifying team member for further training in structured assessment
interface issues what local camh services should expect from a regional caf team
Interface Issues: What Local CAMH Services Should Expect From a Regional CAF Team
  • accessibility
  • good communication
  • clarity relating to function and responsibilities
  • specialist knowledge of
    • relevant institutions
      • custody, community agencies, courts
    • practice
      • Mental Health Act, information sharing etc
      • risk management
  • good collaborative relationships
continuing concerns
Continuing Concerns
  • young people with sexually harmful behaviours
  • pervasive developmental disorders and learning disability post 16
  • transitions to adult services
  • commissioning vulnerability and maintaining strategic support from senior managers for CAMHS/YOS working