Enhancing Child Mental Health Services: BRS Evaluation Study

1. Behaviour Resource Service Dr. Ciaran Kelly, Child and Adolescent Psychiatrist, BRS Julia Waldman, Principal Researcher, BRS Evaluation Study, Dept. Social Work Studies, University of Southampton

2. Outline of Presentation • Brief Overview of BRS • Characteristics of the service users • Multi – professional issues • Inter-agency issues • Influencing individual and systems changes • General comments

3. Behaviour Resource Service • Multi agency service: Health, Education & Social Services, major investment (over 1 million pa to run). • Jointly planned, funded, staffed. • Residential and community teams. • Children and Young People with complex needs, causing greatest concern to society (Tier 4 service). • CAMHS Beacon Site.

4. Assessment & Interventions • Undertake comprehensive assessment addressing: mental & physical health, ‘health’ of personal, professional and social support systems – within residential or community context • Develop individualised intervention plans, which focus upon: • Assertive outreach to support engagement • Co-ordinating Networks

5. The characteristics of the service users • In first 2 years worked with 93 young people (& 38 in discrete LAC service) • 37% were boys aged 11-13 years and overall 70% boys • high prevalence of known risk factors including parental mental ill health, lone parent and reconstituted families, difficulties with school disaffected with professional intervention, ½ of research sample have convictions, low in protective factors, • Approximately half LAC at referral

6. The Multi-profession team(s) – benefits and challenges • Establishment of a new multi-agency team • Working together for holistic case perspectives • Developing the cross-boundary worker • Balancing assessment and intervention • Recruitment and retention of nursing and clinical psychology staff • Differing priorities of residential and community teams • Provision of appropriate supervision

7. Inter-agency working – strengths and issues • Sustained involvement of problem-solving management group of senior managers from all 3 agencies • Influencing new working arrangements within local services • Management of non co-terminus agency boundaries • Development of pooled budgets • User involvement –level of energy on statutory partnerships should leave room for voluntary sector and user involvement

8. Influencing change • Engagement –res. unit via staff ratios, unit size and behaviour management approach, community via form of assertive outreach • Improvements for some children in placement stability, education inclusion and reconviction rates • High levels of service satisfaction amongst parents and young people • Some children with severe mental illness require specialist provision and assessments support funding decisions • Difficulties of attribution • Intractable difficulties of boys with anti-social behaviours and experiencing disaffection • Placement availability impacts on transition and needs-led choices • Case closure and re-referrals– long-term support needs

9. General comments • Information management – within service and across agencies • What happens to the leadership role within an inter-agency democracy (as distinct from management and firefighting functions) • Mainstreaming – situating innovation within a context of services experiencing change and facing resourcing issues