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Promoting,protectingandimprovingourchildrenandyoungpeople’semotionalwellbeingand
mentalhealth
Doncaster’sLocalTransformationPlan
2016-2020
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Contents
OpenLettertochildrenandyoungpeople
Doncaster’svisionfortransformation
Introduction
CurrentCommissioningArrangements
LocalInvestment
EngagementwithStakeholders
UnderstandingDoncaster’sNeed
SelfAssessmentToolkitFindings
Workforce
KeyObjectives
Outcomes
TransformationPlanandUpdates
RiskstoImplementation
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1.OpenLettertochildrenandyoungpeopleIamwritingtoyoutoexplainwhatchangeswehavemadeinthisnewplanandwhatthecontinuedofferwillbe.LastyearwedevelopedaLocalTransformationPlanthatoutlinedhowweweregoingtochangethesystemsandservicesforthebetter.Iamdelightedtoupdatethatthingsareimprovingandwewillcontinuetobuildonthisinthenewplan,weremaincommittedtochangingthingsforthebetter.Westrivetoensurethatyougetthesupportyouneed,attheearliestopportunity,providedbytherightpersonorpeopleattherighttime.Wearenowstartingtoseesomeofthesebigchangestakingplaceandthisisagoodthing.Stafffromdifferentserviceswillworktogetherbettertosupportthosewhomayneeditaroundtheiremotionalwellbeingand/ormentalhealthsothatyougetthebestsupportpossibleandnotbeingreferredtolotsofdifferentservices.Thecommunityeatingdisorderandintensivehometreatmentservicesarenewandsomethingwehaven’thadinDoncasterpreviously.Bothwillhelpsupportyoungpeoplethatneedthiskindofhelpandalsootherprofessionalsthatneedsomeadviceandguidance.Abigpartofthetransformationishowservicesbettersupportschools.Whathasbeenamazingishowschoolshaverespondedtothis.Therearenowover80%ofschoolsinDoncasterwithanamedemotionalwellbeingandmentalhealthchampionwhowillactastheleadwithintheschool.TheywillbewelltrainedandlinkedintothecommunityCAMHsworkers,eachschoolnowhasanamedCAMHsworker.WehavebeenworkingwithanorganisationcalledYoungMindstodevelopawaytoincludethevoiceandopinionsofchildrenandyoungpeople,inallareas.Thismeanswearelookingatwaysyoucanhelpustocommissionandthenoverseetheimplementationofservices.Ifyouareinterestedinhelpinguspleaseletusknow.Sowhatarethebigplansforthisyear?Wellthereareafew……….
1. ContinuetoworkwithYoungMindstogetthevoiceandopinionsofchildrenandyoungpeople.
2. Developtheexpertiseofstaffbytrainingallstaffthatmayhaveanopportunitytosupportchildrenandyoungpeople.
3. Makesurethenewservicesworkbycontinuouslycheckingthem.4. WearegoingtohavealookathowwecurrentlyprovidesupporttoLookedafter
Children,thosewithLearningDifficultiesandthosethatmayenterYouthJusticeservicesandimprovethem.
5. Checkthattheoutcomeswewanttoseeactuallyhappen.ItisanexcitingtimeandwewantyoutoknowthatTeamDoncasterisabsolutelycommittedtothisplan.Yourssincerely
DamianAllenDirectorofLearningOpportunities&Skills
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2.Doncaster’svisionfortransformationOurvisionsetsouttheambition;ourmissionstatementisourstatementofpurposeaspartnerorganisations.Ourvaluesdrivethecultureofthepartnerorganisationsandprovideananchorforeveryoneagainstwhichtotestbehaviouranddelivery.VisionTeamDoncasterwillworktosecuresustainableimprovementsinchildrenandyoungpeople’semotionalwellbeingandandmentalhealth.MissionToprovidearesponsibleandtransparentpartnershipinordertobringaboutwholesystemtransformation,bydevelopingandimplementingtheLocalTransformationPlan.Values- Theneedsofourpopulationareparamount- Thepartnershipwilldriveforwardcontinuousimprovement- Relationshipsbasedonintegrityandtrust- Childrenandyoungpeople’sviewswillbeconsistentlysought,understoodandbecomepartoftheservicedeliverymodel
2.1Wearenowayearintotheplananditispleasingtoreportthatpartnersareadheringtothemissionandvalues.TheprofileoftheLTPishighandremainsapriorityforTeamDoncaster.ItwasagreedthatitwouldbehelpfultoexpandonthevisiontogivegreaterclarityanddetailaboutwhatisitTeamDoncasterwantstoachievethroughthisplan.2.2WewanttoimprovesecuresustainableimprovementsthatmeanschildrenandyoungpeopleinDoncasterhavegoodmentalhealthandemotionalwellbeing.2.3Wewantallchildrenandyoungpeopletobeemotionallyresilient,happy,andconfidentandtohavethebestchancespossibletosucceedinwhattheywanttodo.2.4Forthosechildrenandyoungpeoplethatneedsupport,wewanttoprovidethisattheearliestpossibleopportunity,withaclearfocusonearlyinterventionandprevention.2.5Encourageamoresystemicapproachwheresupportaroundemotionalwellbeingandmentalhealthwillbeanaddontowhatsupportisalreadyinplaceand/orbeingputinplace,ratherthanahand-offreferral.2.6Theremovalofreferralthresholds,criteriaandwrittenreferrals.Supportwillbepartofasystemicapproach.2.7Todevelopaparticipationapproachwithchildren,youngpeopleandtheirfamiliesinthecommissioningandimplementingallfacetsoftheplan.Theaimistoputchildren,youngpeopleandtheirfamiliesattheheartofthesystemtransformation.2.8Toremovethestigmaofemotionalwellbeingandmentalhealththrougheducationandawarenessraising.2.9Toimprovetheunderstandingofemotionalwellbeingandmentalhealththroughaclearworkforcestrategy,thatwilloffertrainingandeducationtoeveryprofessionalworkingwithchildren,youngpeopleandtheirfamilies.Thismeansthateveryonewill
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understandtheimportanceofgoodmentalhealthandhowtohelp,orknowhowtoaccesshelpwhenit’sneeded.2.10Wewantaspecialistservicethatoffersevidencebasedinterventionsaspartofasystemicapproach,withhighlyqualifiedstaff.2.11Howwillweknowthatthisvisionisachieved?
Morechildren,youngpeopleandtheirfamilieswillberesilient,happyandconfident,withbetterchancesofsuccessevidence–feedbackfromchildren,youngpeopleandtheirfamiliesthroughquestionnaires,i.e.healthrelatedbehaviourquestionnaire,reduceddemandonservicesandgreatereducationalattainment.
Childrenandyoungpeoplewillhavegoodmentalhealthandemotionalwellbeingevidence–routineoutcomemeasures,goalsetting,numbersintreatment.
Childrenandyoungpeoplewhoneedsupportwillgetthisattheearliestopportunityevidence–reductioninnumbersseeninspecialistCAMHs,numbersseenbyconsultationandadviceworkers.
Morechildrenandyoungpeoplewithmentalhealthproblemswillrecoverevidence–individualgoalsetting(whereCYPmeettheirgoals).
Supportforchildrenandyoungpeopleisprovidedbytherightpersonattherighttimeevidence–numbersseenbyconsultationandadviceworkers.
Theremovalofreferralthresholds,criteriaandwrittenreferrals.Supportwillbepartofasystemicapproachevidence–numberreceivingsystemicsupport,numberofwrittenreferrals.
Fewerchildrenandyoungpeoplewilldevelopseriousmentalhealthproblemsandthosethatdoaregiventhebestsupportpossibleinthecommunityevidence–inpatientadmissions,numbersseenbyintensivehometreatmentservice.
Aqualityworkforcethatisexcellentinpracticeandabletodeliverthebestevidencedcareevidence–numbersaccessingtrainingcourses,numberofreferralsintospecialistCAMHs,posttrainingfindings.
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3.Introduction3.1ThisdocumentisarefreshoftheoriginalLocalTransformationPlan(2015-20)submittedinOctober2015whichoutlinedTeamDoncaster’sfiveyearvision.Theessenceofthatplanverymuchremains;withakeyfocusonEarlyInterventionandPrevention,whilststrengtheningchildren,youngpeopleandtheirfamiliesinvolvementinalldecisions.3.2ThefirstplanwassignedoffbyNHSEnglandashavingmetthecriteriainfullwithidentifiedstrengths.Astrongneedsassessmentandgoodengagementwithstakeholders.Theycommendedthattheplanwasveryaccessible,transparentandeasytoread,clearlydescribingtheservicesforchildrenandyoungpeople,recognisingthechallengesinDoncasteranddirectingeffortstowardsmanagingthesechallenges.Therewerealsosomerecommendationsincluding;baselinedataforLocalAuthorityservicestobeadded,strongergovernancearrangementsandfurtherdevelopedoutcomes.3.3Lotsofgoodthingshappenedinthefirstyearoftheplan,namelythedevelopmentofatierlessservice,newintensivehometreatmentandcommunityeatingdisorderteamsandtheengagementwitheducation.Itisimportanttonotethoughthatthetransformationofservicesandultimatelythesystemisstillinitsearlystagesandthereisstillmuchtobedone.Thisplanwillfocusonhowwebestachievethat,withagreateremphasisonthechangemodelneededtodrivechange.3.4TheplaniswrittentositalongsidetheFiveYearForwardViewforMentalHealth(NHSE2016),theSouthYorkshireandBassetlawSustainabilityandTransformationPlan(STP),TransformingCarePartnership(TCP)andDoncaster’sPlaceBasedPlan.3.5ForthepurposesofthisLocalTransformationPlanthepartnerserviceswillbereferredtoasTeamDoncaster,whichisthelocalpartnershipnameforthefollowingservices;DoncasterClinicalCommissioningGroup,DoncasterMetropolitanBoroughCouncil,DoncasterChildren’sServicesTrustandThirdSectorpartners.
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4.CurrentCommissioningArrangements4.1DoncasterClinicalCommissioningGroup,TheLocalAuthorityandChildren’sTrustmovedtoaJointExecutiveCommissioning(JCEG)arrangementinJune2015andagreedontwopriorityareas;oneofthesebeingemotionalandmentalhealth.4.2TheJCEGacknowledgedthattherearemanycontributingfactorsthataffectemotionalandmentalhealth,andaimstoevolvethejointcommissioningarrangementstoawholesystemintegratedapproachtoensurebetteroutcomes.Thiswillspanthelifeofachild,withaclearfocusonthe0-1001daysagendaandtransitionintoadultservices.4.3Theaspirationofthisplanisthatchildrenandyoungpeoplewillbeinvolvedincommissioningatalllevelsandalsotobeinvolvedintheimplementationofservices.TheworkwithYoungMindsisthefirststeptodoingthisfromanemotionalandmentalhealthperspective.4.4.Doncastercommissionsanumberofproviderstodeliverarangeofcommunityandacuteservices.Rotherham,DoncasterandSouthHumberNHSFoundationTrust(RDaSH)RDaSHisaspecialistmentalhealthtrustofferingmentalhealthandcommunityservicesinDoncaster,Rotherham,NorthLincolnshire,NorthEastLincolnshireandManchester.AsDoncaster’sleadCAMHsprovider,RDaSHprovidesalltheelementsoftheCAMHsprovision.ThisincludesspecialistCAMHs(includingtheoutofhoursservice),LookedafterChildren,LearningDisabilityandYouthOffendingspecialistservicesandthenewprovision;consultationandadvice,intensivehometreatment,paediatricliaisonandworkforceeducator.RDaSHactastheleadproviderforthenewcommunityeatingdisorderserviceandtheleadforDoncasterforChildrenandYoungPeople–IncreasingAccesstoPsychologicalTherapies(CYP-IAPT).RDaSHhosttheADHDteamandprovideclinicalpsychologyinputintotheautismpathwayanddiabetesbestpracticetariff.DoncasterandBassetlawFoundationHospital(DBHFT)DBHFTareahospitalTrustthatprovidearangeacuteservices,includingaccidentandemergencyandacuteandcommunitypaediatrics(incADHDandASD).DBHFTaretheleadorganisationforautismassessmentsandtherapyservicesandhostthe24/7crisissupportandmentalhealthliaisonservices.DoncasterChildren’sServicesTrust(DCST)DCSTisanindependentorganisationsetuptodeliversocialcareandsupportservicestochildren,youngpeopleandfamiliesinDonncaster.ItwasthefirstTrustofitskindwhenestablishedinOctober2014andoffersarangeofservices.TheseincludetheYouthOffendingservicewhichhasitsowndedicatedCAMHsworkerandaforensicpsychologist.DCSTisleadingonanumberofinnovativedevelopmentprogrammes,includingGrowingFutures,PauseProjectandMockingbird.CollaborativesEarlyHelpCollaborativegroupsarelocalstrategicpartnershipgroupsandwereconceivedasakeyelementofDoncaster'sEarlyHelpStrategy.Collaborativesarefundamentallydecisionmakingbodieswiththepowertomakedecisionsonprovisionandcommissioningofservicessoastosecureimprovedoutcomesforchildrenandyoungpeopleaged0-19years.Insodoing,Collaborativesreceiveneedsbasedassessmentoflocalchildrenandfamilies,performanceinformationofexistingserviceprovisionandtobeabletoplan,
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sourceandsecurefunding,redirectresourcesandprioritiesofkeyagenciesinordertoachieveimprovedoutcomes.TheCollaborativesareempoweredtoproducealocalplanwithafocusonreducinginequalities,prioritisingpreventionandearlyintervention.4.5Doncasteralsocommissionsarangeofservicesthatcontributetowideremotionalwellbeingandmentalhealth,physicalhealthandcareneedsforvulnerableand/orhardtoreachchildrenandyoungpeople.JASPJASPisapart-time,interimeducationalprovisionforkeystages3and4pupilsreferredbyCAMHswhoare:
- experiencingsevereandenduringmentalhealthdifficulties- havingdifficultyaccessingamainstreameducationfull-time- activelyinvolvedwithCAMHs.
Theaimsoftheservicearetokeepthiscohortofchildrenandyoungpeopleengagedineducation.YoungMindsYoungMindsistheUK’sleadingcharitycommittedtoimprovingtheemotionalwellbeingandmentalhealthofchildrenandyoungpeople.DoncasterhascommissionedYoungMindsoverthenextfiveyearstobuildasustainableparticipationmodelwithchildren,youngpeopleandfamiliestogivethemarealvoiceinhowservicesarecommissionedandprovided.SouthYorkshireEatingDisorderService(SYEDA)SYEDAareanindependentcharitythatsupportsawiderangeofpeoplefrommanydifferentbackgroundswitharangeofeatingdisorders.Theyprovidetherapeuticsupport,facilitatesupportgroups,offerabefriendingserviceandoffereducationandtrainingsessionsinschools,colleges,toprofessionalsandthewidercommunity.OpenMindsOpenMindsisalocalcharitythatprovidesacounsellingservicetochildrenandyoungpeople.Theyofferarangeofserviceswhichinclude;counselling,CBTandNLP.
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5.LocalInvestment5.1ThereisaclearlyidentifiablebudgetforCAMHswhichcomprisesoffundingfromDoncasterClinicalCommissioningGroupandtheLocalAuthorityandismanagedbytheStrategyandDeliveryManagerforChildrenandMaternity,withCAMHssittingwithinthisportfolio.DoncasterClinicalCommissioningGroupandtheLocalAuthorityhavemaintainedasignificantfinancialcommitmenttoCAMHsandwillcontinuetodoso.TheLocalTransformationPlanfundingenhancesthisbaseleveloffundingandishelpingtosupportsystemtransformation.5.2Doncasteriscommittedtoinvestinginemotionalwellbeingandmentalhealthandtheestimatedspendin2016/17isasfollows:
SpecialistCAMHs: £1,655,338SinglePointofAccessCAMHs: £120,000Consultation&AdviceCAMHs: £80,000IntensiveHomeTreatmentService: £220,000PaediatricLiaison: £50,000LookedafterChildrenCAMHs: £80,000LearningDisabilityCAMHs: £80,000YouthOffendingServiceCAMHs: £35,000CYP-IAPT: £35,000WorkforceEducator: £50,000WorkforceStrategy £100,000AutismPathway: £516,825ADHD: £200,000JASP: £372,814Thrive: £72,398YouthOffendingServiceAssistantForensicPsychologist: £35,000WaitingListNHSEFunding*: £90,000
Total*: £3,792,375
*thisexcludesthepotentialfundinglistedin5.9.
43%
3%2%
6%
1%2%
2%1%
1%
1%3%
13%
5%2%
10%
2%2%
DoncasterSpendSpecialistCAMHs:
SinglePointofAccessCAMHs:
Consultation&AdviceCAMHs:
IntensiveHomeTreatmentService:
PaediatricLiaison:
LookedafterChildrenCAMHs:
LearningDisabilityCAMHs:
YouthOffendingServiceCAMHs:
CYP-IAPT:
WorkforceEducator:
WorkforceStrategy
AutismPathway:
ADHD:
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5.3Abreakdownofhowthisspendwillbemadeagainstthelocalpriorityschemeindicatorsisbelow:
LocalPriorityScheme Q1 Q2 Q3 Q4Establishnamedemotionalwellbeingandmentalhealthleadsinschools(internal)
£12,500
Continuousconsultationandengagementwithchildren,youngpeopleandfamilies
Appointmentofworkforcedevelopmentlead
£10,000
£10,000 £10,000 £10,000
Auditandrollingtrainingprogramme
£35,000 £35,000 £30,000
CAMHsworkertobeembeddedintheEarlyHelpHub
£10,000
£10,000 £10,000 £10,000
NamedCAMHsleadsinschools&PrimaryCare
£20,000
£20,000 £20,000 £20,000
Supportingselfcare Developmentofsinglepointofaccess
Furtherdevelopevidencebase
£18,275
Implementallareasofthecrisiscareconcordat
£12,500 £12,500 £12,500 £12,500
Intensivehometreatmentservicetobeprovided
£55,000 £55,000 £55,000 £55,000
Expansionofpeermentoringservice
Enhancethecurrentassessmentprocesstoincludesensitiveenquiries
Enhancethecurrentdonotattendpolicy
Enhancethecurrentdonotattendpolicy
Developmulti-agencyteams Improvedcommunitypaediatricservices(incASDandADHD)
£129,206.25 £129,206.25 £129,206.25 £129,206.25
Developmentofdomesticviolencemulti-agencyteams
Provisionofeatingdisordercommunityservices
£177,966
Thedifferencebetweenthefiguresin5.2and5.3isthespendonotherareasnotincludedinthelocalpriorityschemeindicators,i.e.specialistCAMHs.Anyindicatorswithnoallocatedspendwillhavespendin2015/16.
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5.4Theprimaryfundingsourcesare:
ClinicalCommissioning
Group
LocalAuthority
NHSEngland*
Children’sServicesTrust
Collaboratives
£2,385,338
£508,340
£685,000
£35,000
£57,398
*thisexcludesthepotentialfundinglistedin5.8.5.5Itshouldbenotedthattheaboveestimatesincludethemajorityoffundingspentonemotionalwellbeingandmentalhealth,howevertheremaybeadditionalfundingwheredetailedinformationisn’tavailable.However,thiswouldbelimitedaswehaveunpickedseveralchildrenserviceblockcontractsandhaveagoodunderstandinglocallyonspend.5.6Theremaybechangestofundingthatoccurinyearthatweareunabletopredictatthisstage.Therearenoreductionstofinancesplannedinyear.5.7ImplementingtheFiveYearForwardViewforMentalHealthservicessetsatrajectoryforincreasedaccess,whichisbasedonexistingprevalencedataandallocatesfundingtothisonanationallevel.Thisfundingwillthenbeallocatedlocallytosupporttheincreaseincapacityandsystemtransformation.
5.8Thefundingprofileforchildrenandyoungpeopleisasfollows:Thereforeitisanticipatedthattherewillbeincreasedlevelsoffundingeachyearuntil2020/21.Weareunsureatthepointofwritingthisplanhowthiswilltranslatelocallyandwhatthefuturelevelsoffundingwillbe,and/orifcommissioningresponsibilitieswillflowdowntoCCG’swithanyadditionalfunding.5.9Inadditiontothis,aletterdated26thSeptemberfromtheNationalMentalHealthDirector(NHSEngland)wassenttoCCGaccountableofficers.Thisletterannouncedthatanadditional£25millionnationallyhasbeenidentifiedwhichcanbemadeavailableforCCG’sin2016/17.ThisfundingisinadditiontothemoniesalreadyallocatedtoCCG’sandbrings
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forwardtheexpecteduplifttobaselinefundingtomeetthepublishedlevelssetfor2017/18(£170millionnationally),whilstalsoprovidingnon-recurrentfunding.Aswithallallocationsofnewmoney,itiscriticalthatweareabletodemonstratetheimpactofthisinvestment.ItisexpectedthatthesefundswillsupportCCGstoachievethefollowing:
• Acceleratetheirplansandundertakeadditionalactivitiesthisyeartodrivedownaveragewaitingtimesfortreatment,andreducebothbacklogsofchildrenandyoungpeopleonwaitinglistsandlengthofstayforthoseininpatientcare.
• SupportCCGstocontinuetoinvestintrainingexistingstaffthroughtheCYP-IAPTtrainingprogramme,includingsendingnewstaffthroughthetrainingcourses.CYP-IAPTcollaborativesarerecruitingtotrainingplacesnow,soCCGsshouldbeidentifyingwiththeirpartnersthestafftosendonthetrainingcourseandanyadditionalresourcesrequiredtoreleasestaff;and
• Accelerateplanstopump-primecrisis,liaisonandhometreatmentinterventionssuitableforunder18s,withthegoalofminimisinginappropriateadmissionstoinpatient,paediatricoradultmentalhealthwards.ThisshouldincludeworkingwithNHSEnglandspecialisedcommissioningteamstodevelopintegratedpathways.
5.10Inordertosecurereleaseofthefulladditionalfunding,CCGswillbeaskedtoprovidedetailsofhowtheyintendtoimproveaveragewaitingtimesfortreatmentbyMarch2017.Thisfundingwillcomedownintotwopayments;thefirstwillbeallocatedinOctober2016onafairsharesbasis,thesecondpaymentwillbemadeinJanuary2017subjecttoCCG’sdemonstratingprogresstowardstheirimprovementstargets.
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LocalPriorityStream ExpectedOutcome Q3Oct-Dec15/16 Q4Jan-Mar16 Q3Oct-Dec15/16 Q4Jan-Mar16
Localprioritystream1Establishnamedmentalhealthandwellbeingleadsinschools(internal) £5,000
Localprioritystream2
Continiousconsultationandengagementwithchildren,youngpeopleandfamilies
£90,000 £90,000
Localprioritystream3Appointmentofworkforcedevelopmentlead £10,000 £10,000
Localprioritystream4 Auditandrollingtrainingprogramme £100,000 £100,000
Localprioritystream5
Developan'innovationpartnership'approachwithalocaluniversitytodeliveranacreditedtrainingprogrammewithnationallyrecognisedmodules
Localprioritystream6CAMHsworkertobeembeddedintheEarlyHelpHub £10,000 £10,000
Localprioritystream7NamedCAMHsleadsinschools&PrimaryCare £20,000 £20,000
Localprioritystream8 Supportingselfcare £40,000 £40,000Localprioritystream9 Developmentofsinglepointofacess £50,000 £50,000Localprioritystream10 Furtherdevelopevidencebase £45,000 £45,000
Localprioritystream11Implementallareasofthecrisiscareconcordat £76,306 £131,280 £76,306 £131,280
Localprioritystream12Intensivehometreatmentservicetobeprovided £55,000 £50,000
Localprioritystream13 Expansionofpeermentoringservice £10,541 £10,541
Localprioritystream14Enhancethecurrentassessmentprocesstoincludesensitiveenquiries £5,000 £5,000
Localprioritystream15Enhancethecurrentdonotattendpolicy
Localprioritystream16 Developmulti-agencyteams
Localprioritystream17Improvedcommunitypaediatricservices(incASDandADHD) £25,000 £25,000 £25,000 £25,000
Localprioritystream18Developmentofdomesticviolancemulti-agencyteams £35,000 £35,000 £35,000 £35,000
Localprioritystream19Provisionofeatingdisordercommunityservices 177,966 177,966
Localprioritystream20
RedeploygenericstaffcurrentlyseeingEDcasesnowseenbycommunityteamtoimproveaccesstoselfharmandcrisisandinvestunderspendfromEDfunds
Total £136,306 £804,787 £136,306 £804,787
PlannedSpend ActualSpend
5.11Alltransformationmoniesreceivedin2015/16werespentonareasidentifiedwithintheoriginalLTP.Abreakdownisasfollows:
5.12CommunityEatingDisorderServiceFundingFundingforacommunityeatingdisorderservicesitswithinDoncasterCCG’sbaselinefundingandisasfollows:
BaselineAllocation TotalSpend
£177,966
£177,966
5.13Commissionersandprovidersareconfidentthatthefullfundingallocationswillbespentin2016/17asperthetermsoftheLocalTransformationPlan.
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5.14PerinatalMentalHealthAnotherobjectivewithintheFiveYearForwardViewistoincreaseaccesstospecialistperinatalmentalhealthsupport.Thetablebelowshowstotaladditionalfundingandhowthiswillbeallocated.Doncasterwon’treceiveanydirectlocalfundinguntil2019/20,insteadadditionalfundingisallocatednationallytosupportnationalprogrammes.However,DoncasterhassubmittedtwobidsforSTFmoniesthatwouldbringextrafundingintoDoncasteruntil2019/20.
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6.EngagementwithStakeholders6.1In2014Doncasterconsultedwithlotsofitschildrenandyoungpeopleinpreparingthechildrenandyoungpeoples’plan.TheconsultationwaswiderangingandpulledtogetherbytheYouthCouncilwithseveralkeythemesemerging.Oneofthetoppriorityareaswasemotionalhealth.Doncasterhasacollaborativemodelofprimaryschoolsandchildrencentresbeingalignedintermsofgeographyandthesegroupshaveconsultedwithchildren,youngpeopleandfamiliesintheirareastounderstandlocalneed.Againemotionalhealthandwellbeingcameoutasakeypriority.Primarilyaroundthelackofprovisionforlowerlevelemotionalhealthneedsandwellbeing,especiallytheidentificationofgapsinmentalhealthprovision.6.2Buildingonthisarethefindingsfromachildrenandyoungpeople’sdemocracyeventheldthisyear.Acollaborationofyoungpeoplefromavarietyofsettingsheldaneventwherefourpriorityareaswerediscussed;oneofthesewasemotionalwellbeingandmentalhealth.Theeventwasagreatsuccessandthekeyfindingsareasfollows:
Notenoughisdeliveredinschoolsonmentalhealthissues,someschoolsonlyofferaone-offlesson.YoungpeoplestatedthatMentalHealthis‘Likeasecret’notseen,itsinvisible.WhenaMentalHealthissueisraisedteachers/schoolscanmakeitworseandunsafe,lackoftrainingandexperience.
YoungPeoplefeelnotenoughadvertising,publicityandawarenessisdeliveredoravailableonmentalhealth.YoungpeoplefeelthereisarealstigmaaroundmentalhealthandCAMHSsMoreneedstobedonetoaddressthis.YoungpeoplestatedtherearestilllotsofissuesarondPeerPressureandthatmoreneedstobedone.
Youngpeoplefeelthereisareallackoffundingforchildrenandyoungpeople'smentalhealthservice.Moreworkneedstobedoneonpathwaysintomentalhealthservices,theyarenotclear.CurrentspendingonchildrensMentalHealthdoesn’tmakesense,moreisspentonadults.
Havetotalktomorepeoplethannecessary,unlikesmokingwelladvertised,clearpathwayinplace.Lotsofissuesregardingtransitionfromchildtoadultservices.Moreneedstobedoneonearlyinterventionandwaitingtimes.MoresupportforyoungpeoplewhoarelivingwithMentalHealthwitinthefamily.e.g.youngcarers,managingtheirattendanceatschool.
MentalHealth
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6.3Solutions6.4DoncasterPublicHealthco-commissionedapupilHealth-RelatedBehaviourQuestionnaire(HRBQ)incollaborationwithEducation,atDoncasterCouncil.ThequestionnairewascompletedbySchoolsHealthEducationUnit.ThisprovidesusefuldatatoshowtheimpactofstrategiesinplaceandinformsusaboutthephysicalandemotionalhealthandwellbeingofschoolchildreninDoncaster,inordertoplanforthefuture.Topicsofthequestionnairewereasfollows,althoughthecontentdiffereddependingonage:-EmotionalHealthandWellbeing-HealthyEating-PhysicalActivity-Dentalhealth-Safety-Bullying-Substanceuse-RelationshipsandSexualHealth.6.5Allschools(includingthoseforchildrenwithSpecialEducationalNeeds)wereinvitedandencouragedtoparticipateduringthelasttermoftheacademicyear14/15.Initially,63primaryschoolsandall18secondaryschoolsagreedtotakepart.However,duringthedatacollectionphase,twelveschools(2secondaryand10primary)withdrewfromthesurveyorfailedtocompletebeforethedeadlinedateforcompletion.NoSENschoolsagreedtoparticipate.6.6SchoolswereaskedtosurveyYear4andYear8pupilsasessentialandYear6andYear10pupilsasoptional,eitherusinganonlineversionofthequestionnaireoronpaper.SomeschoolsalsosurveyedYear3pupils.6.7Intotalthisequatesto2,607boysand2,576girls,atotalof5,183.Thepertinentonesforthisplanaretheonesundertheemotionalhealthandwellbeingsection.Thekeyfindingswereasfollows:
Education–Schoolsneedtodomore,currentlyonlyofferedinPSHE/Citizenshipbutshouldweaveintoothersubjectse.g.Drama.Moretrainingforteachers/mentorstoreduceneedonCAMHs.Publicity–MorepositivepublicityneedstobedonetostopstigmaaroundMentalHealthandCAMHs.Youngpeoplesuggestrunninga'TimetoChange'campaign.GoodPractice-OthergoodpracticeservicesneedtobefollowedsuchasEClinic,Pyramid(BalbyCarr).Support-Youngpeoplewouldprefersupportfromapersontheyhavearelationshipwith,someonetheytrust,notnecessarilysomeonefromschool.Importantthatthepersonhastheskills&experienceinMentalHealth.Youngpeoplealsowelcomehomeservicesworkingwithallthefamilyandcarers.
YoungMinds-Youngpeoplewelcomedthe'YoungMind'programmethathasbeencommissionedinDoncasteroverthenext5years.
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6.8Compositeself-esteemscoresforPrimarySchools
Onthewholethecompositeresponsesarequitegood,howeverthereare28%ofchildrenaskedwhohavelowtomediumlevelsofself-esteem.Thereisafairlyevensplitbetweenmalesandfemalesandacrossthetwoyeargroups.6.9CompositeresiliencescoreforPrimarySchools
Againonthewholethecompositeresponsesaregenerallygood,howeverthereareoverathirdofthechildrenaskedwithalowtomediumlevelsofresilience.Againthereisafairlyevensplitacrossmaleandfemaleandyeargroups.6.10Compositeself-esteemscoresforSecondarySchools
Onthewholethecompositeresponsesarequitegood,howeverthereare22%ofchildrenaskedwhohavemediumlevelsofself-esteem.Howevertherearestillapproximatelyathirdofchildrenaskedwithlowtomediumlevelsofself-esteem.
6.11CompositeresiliencescoreforSecondarySchools
Year4 Year6 All Male Female Male Female
Values0-4(low) 5% 6% 4% 5% 5%Values5-9(medium) 21% 26% 19% 22% 23%Values10-14(med-high)
42% 42% 39% 37% 40%
Values15-18(high) 32% 26% 38% 36% 32%ValidResponses 656 678 433 419 2208
Year4 Year6 All Male Female Male Female
Low(upto19) 18% 14% 16% 15% 16%Med-Low(20-22) 19% 19% 21% 18% 19%Med-High(23-25) 22% 26% 25% 28% 25%High(26+) 41% 41% 38% 40% 40%ValidResponses 576 607 404 396 2002
Year8 Year10 All Male Female Male Female
Values0-4(low) 5% 9% 5% 8% 7%Values5-9(medium) 15% 27% 18% 27% 22%Values10-14(med-high)
35% 38% 36% 39% 37%
Values15-18(high) 44% 26% 42% 25% 34%ValidResponses 623 652 313 314 1956
Year8 Year10 All Male Female Male Female
Low(upto19) 18% 42% 34% 54% 38%Med-Low(20-22) 21% 20% 24% 21% 21%Med-High(23-25) 22% 22% 22% 15% 21%High(26+) 29% 16% 20% 9% 20%ValidResponses 554 600 274 279 1752
18
Therearesomebigdifferencesbetweengendertypes,withalmosthalfthefemalesaskedhavingalowlevelofresilienceinyear8andoverhalfinyear10.Thisisworryingandsomethingthatclearlyneedstobeaddressed.Thisquestionnairesuggeststhatmalesaremoreresilientthanfemales.6.12Theplanistorecommissionthisquestionnairein2017andthisisthemeasurementtooltoseeifthingsareimprovinglocally.6.13CAMHsaskedserviceuserstocompleteanexperienceofserviceandsessionfeedbackquestionnaire(seeappendix7).Thekeypointswereasfollows:
• Reportingthroughexperienceofservicequestionnaire(ESQ)formsshowedthat74%ofparents/carersfelttheywerewelltreatedbythepeoplewhosawtheirchild.
• Thesessionfeedbackquestionnaire(SFQ)thatbothserviceusersandparents/carersfeltlistenedtoo,talkedaboutwhattheywantedtotalkabout,understoodthemeetingandfeltthemeetinggavethemideasonwhattodo,sooverallpositivefeedback.
• Therewasageneralthemeofdissatisfactionwiththefacilitiesintermsofthewaitingareaandappointmenttimes.
• Therewasareoccurringthemerelatingtochangesinkeypersonnel.6.14Throughout2015/16therehasbeenasignificantamountofengagementwithstakeholderstoensurethattheLTPwasverymuchapartnershipplan,andthatitwasonevery-one’sagenda.Thisincludedpresentationsatalltherelevantboards,groupsandmeetingsincludingthoseforchildren,youngpeopleandtheirfamilies.Thishasbeenareallyhelpfulexerciseasitashelpedshapetheimplementationprocessthroughabetterunderstandingofindividualserviceneedswithinthewidersystemtransformation,inparticularwithschools.6.15Thefeedbackfromthevastmajorityofstakeholdershasbeenpositive,whichhasreallyhelpedembedtheplanacrossallareaswithinthesystem.Weareinapositionwherethereisgoodownershipandthereisasolidbasetokeepmovingforward.6.16Thisisfeltparticularlystronglyinschoolsasevidencedin77%ofschoolsnominatingaemotionalwellbeingandmentalhealthnamedleadwithintheirschool.Thenamedleadactsasthechampionandpointofreferencebetweenschoolsandotherservices,i.e.CAMHslocalityworkers.Theresponsefromschoolshasbeenextremelypositive.Thereisaclearplantosupportthoseschoolsyettonominatewiththeaimofhaving100%nominationbyMarch2017.6.17Aseriesoflocalityworkshopswereheldwithschoolrepresentativestodevelopandagreerolesandresponsibilities,andwhattheinterfacewiththenewCAMHslocalityworkerswouldbe,inparticularconsideringthemoveawayfromtiersandreferralthresholds.Allfindingswerecollatedandjointlyanalysedwithrepresentativesfromschoolsandagreementshavebeenmadeonrespectiveroles,responsibilitiesandtheinterface.Thishasbeensensecheckedwithchildren,youngpeopleandtheirfamilies.6.18TherehasbeenlotsofengagementwiththeCAMHsstafftogettheirthoughtsonhowbesttosupportthetransformation,whichhasbeenreallyvaluable.Thisworkison-going.
19
7.UnderstandingDoncaster’sNeed7.1Thechildrenandyoungpeople’semotionalwellbeingandmentalhealthneedassessmentforDoncaster(2015)wasdeemedtobeastrongneedsassessmentbyNHSEnglandandwasthefoundationfortheoriginalLTP.Thisneedsassessmentandinformationinthefollowingsectionssetsoutthecaseforchange.InformationSources
- Emotionalwellbeingandmentalhealthneedsassessment- EastMidlandsStrategicClinicalNetworkself-assessmenttoolkit- DoncasterSafeguardingChildren’sBoardmulti-agencyauditofchildren’s
mentalhealth7.2PrevalenceofkeyriskfactorsformentalhealthMentalhealthproblemsaffectabout1in10childrenandyoungpeople.Theyincludedepression,anxietyandconductdisorder,andareoftenadirectresponsetowhatishappeningintheirlives.Alarmingly,however,70%ofchildrenandyoungpeoplewhoexperienceamentalhealthproblemhavenothadappropriateinterventionsatasufficientlyearlyage.Theemotionalwellbeingofchildrenisjustasimportantastheirphysicalhealth.Goodmentalhealthallowschildrenandyoungpeopletodeveloptheresiliencetocopewithwhateverlifethrowsatthemandgrowintowell-rounded,healthyadults.Thingsthatcanhelpkeepchildrenandyoungpeoplementallywellinclude:
• beingingoodphysicalhealth,eatingabalanceddietandgettingregularexercise• havingtimeandthefreedomtoplay,indoorsandoutdoors• beingpartofafamilythatgetsalongwellmostofthetime• goingtoaschoolthatlooksafterthewellbeingofallitspupils• takingpartinlocalactivitiesforyoungpeople
Otherfactorsarealsoimportant,including:
• feelingloved,trusted,understood,valuedandsafe• beinginterestedinlifeandhavingopportunitiestoenjoythemselves• beinghopefulandoptimistic• beingabletolearnandhavingopportunitiestosucceed• acceptingwhotheyareandrecognisingwhattheyaregoodat• havingasenseofbelongingintheirfamily,schoolandcommunity• feelingtheyhavesomecontrolovertheirownlife• havingthestrengthtocopewhensomethingiswrong(resilience)andtheabilityto
solveproblems.
Mostchildrengrowupmentallyhealthy,butsurveyssuggestthatmorechildrenandyoungpeoplehaveproblemswiththeirmentalhealthtodaythan30yearsago.That’sprobablybecauseofchangesinthewaywelivenowandhowthataffectstheexperienceofgrowingup.(MentalHealthFoundation).7.3PopulationanddeprivationprofileDoncasteristhelargestgeographicmetropolitanboroughinthecountrywithanareaofmorethan225squaremiles.Doncasterhasapopulationof302,400,ofwhich72,100are
20
childrenandyoungpeople(0-19years).Childrenandyoungpeopleundertheageof20makeup23.7%ofthepopulationofDoncaster,whichissimilartothenationalaverage(23.8%).Thenumberofchildrenaged0to4yearshasslightlydeclinedin2015(19,200);thischangeisdifferenttotheregionalornationaldata,whichshowsanincrease.Twelvepercentofschoolchildrenarefromminorityethnicgroups,whichisanincreaseofoveronepercentwhencomparedwith2014(10.9%).(Childhealthprofile(CHP),2015).7.4Doncasterhasanequalproportionofmaleandfemalechildrenandyoungpeopleandahomogenousdistributionofchildrencanbeobservedthroughoutalltheagegroups(Figure2).7.5Figure2:Numberofchildren&youngpeopleinDoncasterdividedbygenderandagegroupsSourcemid2013estimate.
9806
9382
1079
9
1063
8
1045
3
1014
8
3744
3776
0
2,000
4,000
6,000
8,000
10,000
12,000
Males Females
Noofchildrenandyoung
people
Ages 0-4
Ages 5- 10
Ages 11- 16
Ages 17- 18
21
7.6ChildpopulationinDoncaster(2015)
Doncaster
YorkshireandtheHumber
England
Children(age0to4years)2013
19,200(6.3%) 334,100(6.3%) 3,414,100(6.3%)
Children(age0-19years)2013
72,100(23.7%) 1,278,600(24.0%) 12,833,200(23.8%)
Children(age0-19years)in2020(projected)
71,400(23.2%) 1,305,700(23.6%) 13,325,100(23.6%)
Schoolchildrenfromminorityethnicgroups,2014
4,782(12.0%) 150,330(22.3%) 1,832,995(27.8%)
Childrenlivinginpoverty(ageunder16years)2012
23.8% 20.8% 19.2%
Lifeexpectancyatbirth,2012
Boys77.5Girls81.7
78.582.2
79.483.1
Source:CHP20157.7Doncasterisrankedthe39thmostdeprivedofthe362LocalAuthoritiesinEnglandwithconsiderablevariationbetweenthemostaffluentwardsandthemostdeprivedwhichnumberamongstthemostdeprivedneighbourhoodsintheUnitedKingdom.7.8ChildrenandAdolescentMentalHealthServiceDataBasedonnationalprevalencedata(ONSmentalhealthofchildrenandyoungpeople),thefollowinghighlevelassumptionscanbemadeabouttheemotionalwellbeingandmentalhealthofchildrenandyoungpeopleinDoncasteraged5to16yrs.
AllMentalDisorders DoncasterPopulationofchildrenandyoungpeople
5to105,040
5to1610,800
11to165,260
7.7%ofchildrenagedbetween5to10yearshaveamentaldisorder
388
9.6%ofchildrenandyoungpeopleagedbetween5to16yearshaveamentaldisorder
1,037
11.5%ofyoungpeopleagedbetween11to16yearshaveamentaldisorder
605
22
7.9.ThefollowingdatashowsthekeyperformanceareasforCAMHsagainstkeyperformanceindicators.ItisusefultonotethatCAMHsisanintegratedservicesodataisnotshownintermsoftiers.Thedatarelatesto2015/16unlessotherwisestated.7.10ReferralDataAtotalof1,451referralswerereceived.
7.11NumberofUrgentReferralsTherewereatotalof13urgentreferralsreceived.Thechartbelowshowsthenumberofthosedeemedurgentassessedwithin24hours.
7.12NumberonNon-UrgentReferralsTherewereatotalof752referralsthatweredeemedtobenon-urgent.Thechartbelowshowsthenumberthatwereassessedwithin4weeks.
0
50
100
150
200
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
NumberofReferrals
100%
0%
%ofurgentreferralsassessedwithin24hours
92%
8%
%ofnon-urgentreferralsassessedwithin4weeks
23
7.13Numberofassessedchildrenandyoungpeoplestartingtreatmentwithacareplanwithin8weeksofreferralTherewereatotalof626assessmentscompletedandthechartbelowshowsthenumberstartingwithin8weeksofreferral.
7.14NumberofpatientsleavingtheserviceinaplannedwayAtotalof913patientslefttheservicein2015/16.Thechartbelowshowshowmanyleftinaplannedway.
7.15Numberofpatientsreturningtoservicewithin30daysofaplanneddischarge16patientsreturnedintotheservicewithin30days,thisequatesto1.75%.7.16AccessandWaitingTimesDoncasteronthewholehaspositiveaccessandwaitingtimes,thatcomparefavourablywiththeCAMHsbenchmarkingreport(2013).
88%
12%
Numberassessedstargngtreatmentwithacareplanwithin8weeks
98%
2%
Numberofpatientsleavinginaplannedway
24
25
7.17GeneralServiceTheaveragewaitingtimeforanassessment(non-urgent)isapproximately21dayswhichiswithinthe28daytarget,andtheaveragelengthoftimefortreatmenttostartis22daysafterassessment,thisgivesatotalof43dayswhichequatesto6weeks.Thenationalbenchmarkisonaverage15weeks(105days),withaveragewaitingtimesincreasingconsistentlysinceJanuary2011.Thiselementoftheserviceintermsofaccesstimesisperformingreallywell.
26
7.18LearningDifficultiesTheaveragewaitingtimeforassessmentis23daysforthiselementandthenafurther36daysfortreatmenttostart.Thisequatesto59daysand/or8.4weeks.Thisisjustoverthe56daytarget.7.19LookedafterChildrenTheaveragewaitingtimeforassessmentis28daysforthiselementandthenafurther51daysfortreatmenttostart.Thisequatesto79daysand/or11weeks.Thisissignificantlyoverthe56daytarget.Thiswillbethepathwaywherewewillfocustheadditionalfundingwiththeaimofimprovingcapacitytodrivedownthewaitingtimestoaccessingtreatment.7.20YouthOffendingServiceThereisadedicatedCAMHsworkerbasedwithintheYouthOffendingService(YOS)thatoffersfasttracksupporttoyoungpeoplewithintheYouthJusticesystem.
Descriptor ActivityNumberofYPassessedwithamentalhealthneed(ASSET)
30
NumberofYPoncaseload 86NumberofYPstartingtreatmentwithin8weeks 13 43%NumberofconsultationswithYP 25
7.21Inpatient(tier4)admissions&beddays
Numberofadmissions PCT CCG
Service 2012/13 2013/14 2014/15 2015/16 GrandTotal
AcuteCAMHS 9 9
Adolescent 13 16 16 45
AutisticSpectrumDisorder 1 1
Child 7 12 5 24
EatingDisorders 5 2 2 9
LearningDisability 4 9 6 19
ComplexLearningDisability 1 1
LowSecure 2 1 1 4
PICU 1 1 2 4
MediumSecure 1 1
Notknown/Notstated 2 2
Totalpatients 33 38 31 17 119
27
AnalysisTherewasaslightreductioninthenumberofadmissionsin2014/15comparedtothepreviousyearandverysimilarnumberto2012/13.Thenumber(31)isstillahighnumberregionallyandbasedonadditionaldatafromNHSEngland,Doncasteristhesecondhighestreferrerintheregionforinpatientservicesatarateof52per100,000.Thishastobelinkedtonolocalhomeintensivetreatmentservice.Whencomparingourdatatoareasthathaveahometreatmentservicethenumberofadmissionsintheseareasissignificantlyless.Thenumbersfor2015/16areforthefirstthreemonthsofthefinancialyear(Apr–Jun)andiftheratesweretostayconsistentfortherestoftheyear,theforecastedannualtotalwouldshowasignificantincrease.Thebreakdownofdatamaybedoesn’tgiveadetailedpicture,forexampleweareawarelocallythattherewereactuallysixinpatientsforeatingdisorder,howeverfourofthesepatientswillhavebeeninanon-specialisteatingdisorderservice.Thenumbersacrosstheservicesareprettyconsistentoverthethreeyears,withthefollowingexceptions:
• IncreaseinacuteCAMHsin2015/16.• Reductioninadmissionsforchildservices.
Occupiedbeddays PCT CCG
Service 2012/13 2013/14 2014/15 2015/16 GrandTotal
AcuteCAMHS 617 617
Adolescent 1187 1263 1320 3770
AutisticSpectrumDisorder 47 47
Child 900 1147 745 2792
EatingDisorders 12 12
LearningDisability 381 181 218 780
ComplexLearningDisability 320 632 683 1635
LowSecure 347 364 142 853
PICU 24 67 160 251
MediumSecure 243 243
Notknown/Notstated 56 56
GrandTotal 3402 3406 3138 1110 11056
28
AnalysisAgainthenumbersareprettyconsistentacrossthethreeyears,withaforecastedsignificantincreasein2015/16.Theaveragelengthofstayisapproximately101daysandagainthishasn’treallyvariedoverthethreeyears.Therehavebeenchangesinthenumberofdaysthoughacrossservices:
• Yearonyearincreasesforadolescentservices• Yearonyearincreasesforlearningdisability,particularlyfrom2012/13to2013/14• Nodaysinmediumsecure.
7.22Tier4Spend
Tier4Spend 2014-15 2015-16 £2,668,815 £1,581,674Therehasbeenasignificantreductioninspendin2015-16duetoareductioninadmissions.7.23SecureChildren’sHomeThenumberofDoncasteryoungpeopleinasecurechildren’shomewastwo.Thenumberinasecuretreatmentcentrewastwo.Thisdataisprovisionaland2014/15and2015/16figureswillbefinalisedintheretrospectiveannualYouthJusticestatisticspublications.Notethesefiguresareamonthlysnapshotofthecustodialpopulation,takenonthelastFridayofthemonthorfirstFridayofthefollowingmonthdependingonwhichisnearertoactualmonth.7.24CYP-IAPTDoncasterChildrenandYoungPeople’sMentalHealthService(CAMHs)teambecamepartoftheChildrenandYoungPeople’sImprovingAccesstoPsychologicalTherapies(CYP-IAPT)inOctober2012.ForthepurposesoftheapplicationtobeapartofCYP-IAPT,thepartnershipforDoncasterincludesNorthLincolnshireCAMHs-thiswasdecidedduetothesmallerteaminNorthLincolnshireandmadethebidding/applicationprocessmoreachievableforbothservices.DoncasterispartoftheNorthEastCollaborativeandisawave2site,joiningoneyearaftertheinitialpilotbegan,thiswasalongsideseveralservicesfromTees,EskandWearValleyNHSTrust(TEWV).TheNorthEastcollaborativeislinkedtoNorthumbriaUniversity,anytrainingrequirementsarefacilitated/providedthroughNorthumbriaUniversity,withanagreementthatsomeofthetrainingwouldbeprovidedinYorkratherthanNewcastletoreducetheimpactoftravel(timeforstudentsandcostforthepartnerships).Thetwokeyareasoftransformationanddevelopmentwereasfollows:
1. Training2. Transformationofservice.
7.25TrainingThetrainingisdeliveredatlevelseven,postgraduatediplomalevelandbelowisasummaryofthetrainingopportunitieswhichDoncasterCAMHshasaccessed,alongwithanupdateonthetrainees:
29
7.26ParentingInterventions• (2012/13)-twoplacesforDoncaster,staffcompletedthetraininganddelivered
WebsterStrattonparentingcourses• Bothparentingtraineeshavesincelefttheservice,onetopursueprivatework,the
othertoworkinanotherCAMHsservice• Nofurthertrainingplacesrequestedfromtheareaasthisworkisalready
predominantlyprovidedbyotherservicesinDoncaster.7.27CognitiveBehaviouralTherapy(CBT)
• FourtraineeshaveundertakentheCBTtraining,twoin2012/13,twointhefollowingyear(2013/14).TheCBTtrainingfocusesoninterventionsforanxietyanddepression
• Fromthefourtrainees,onepersonfailedanelementofthecourse,onepersondidnotcompleteduetoillness.Onepersonhasrecentlylefttheservice.
• DoncasterCAMHshasidentifiedafurtherneedforanotherplaceonthe2015/16training,giventheneedandlossoftrainedworkforce.Thisplacewasgranted.
7.28ServiceLead• ThreestaffthathadinvolvementwithintheDoncasterCAMHsteamundertookthe
serviceleadstraininginwavetwo;notallcompletedthecoursework,butundertookprojectstoaddresstransformationofservices
• NosubsequentserviceleadshavebeenidentifiedfromDoncastertocompletetheserviceleadscourse.
7.29Supervisortraining
• SeveralclinicianshaveaccessedCYP-IAPTsupervisiontrainingfromDoncaster,therewerenostaffwhohadappropriateexperiencetoundertaketheformalsupervisorstraininginCBTorInterpersonalPsychotherapyforAdolescents
• Afamilytherapistprovidedsupervisionforthesystemicfamilypracticecourse,theyhaverecentlylefttoworkwithinaCAMHstier4unit
• ItwashopedtosendaCBTtherapisttocompletethesupervisorstrainingthisyear,buttheyareonmaternityleave.
7.30SystemicFamilyPractice(SFP)
• Introducedin2013/14,branchedbetweensystemicpracticeforeatingdisordersandsystemicpracticeforself-harm
• TwotraineescompletedtheSFPtraining,oneineachoftheareas-eatingdisorderandself-harm.
7.31InterpersonalPsychotherapyforAdolescents(IPT-A)
• Introducedtotheprogrammein2014/15• Oneclinicianiscurrentlyundertakingthetraining,expectedtocompletein
November2015.7.32EnhancedEvidenceBasedPractice(EEBP)
• Thiswasintroducedin2014/15,atGraduateCertificate/AdvancedDiploma• OnecliniciancommencedtheEEBPcourse,butwithdrewduetopersonalandwork
circumstances.
30
7.33TransformationThefollowing,detailstheaspectsofservicedevelopmentwhichDoncasterCAMHshadagreedtodevelopaspartoftheCYP-IAPTapplicationprocess,alongsideabriefsummaryoftheprogresstodate:Ensureaccessandwaitingtimestotreatmentdonotdeteriorateduringthetrainingperiodasaresultofthisproject-therehasbeennodeteriorationinwaitingtimesforaccesstoservice,remainingconstantat25to28daysforaroutinereferral.Ensurethatthetransformationtakesaccountofthediversityandculturalneedsofthecommunityyousupport-on-goingdevelopmentofservicestakesintoconsiderationtheneedsoftheyoungpeoplefromtheDoncasterareaandhowthischanges. CommittoallTier3CAMHs,andTier2CAMHswhoarepartoftheproject,undertakingsessionbysession/frequentoutcomemonitoringusingtheCYP-IAPTdatasetwhichisusedtoguidetherapeuticinterventionsandsupervision-theabilitytocaptureroutineoutcomemeasureshasbeendevelopedwithinthepatientrecordssystem,thereisinformationavailablethroughbothrawdataandtabulatedviewsforusewithinsupervision.Theinformationgatheredalsosupportsclinicaldecisionmakingprocesses.Furtherworkisrequiredwithintheservicetofullyembedtheuseandmonitoringofroutineoutcomemeasures. Moveoverthelifeoftheprojecttoacceptself-referrals–self-referralhasbeenavailableforyoungpeopletoaccessviatheTalkingShopinDoncasterasadrop-inonedayaweek.Childrenandyoungpeoplecanalsocontacttheservicedirectlytodiscussreferrals.
Createalocalsteeringgrouptosteertheprojectlocallytoincludehealthandlocalauthoritycommissioners,NHSandvoluntarysectorproviders-alocalsteeringgroupwassetupinitially,astheprojecthasdevelopedandmainaspectshavebeenfocussedontrainingplacesandthedevelopmentoflocalpathways.Thishasnowbeenabsorbedintolocalbusinessdivisionmeetingsandmeetingswithcommissioners. Supportnewpartnershipsworkingwithyourcollaborativesastheycomeonlineinfutureyears-wearepartofthecollaborativesteeringgroup,whichprovidesanopportunityforlearningandsupportfornewandexistingmembersofthecollaborative. WorkwiththeHEIstoselectappropriatelyskilledtraineesandsupervisors-recruitmenttopostgraduatecoursesarefullyestablishedandembeddedintopracticewiththeNorthumbriaUniversity. Ensurethattrainees,supervisorsandservicemanagersselectedtoundergothetrainingcanattendtrainingandcanundertaketheassignmentsnecessarytopassthetraining-traineeshavebeensupportedtoattendtrainingasrequired,postgraduatetraineeshavebeenfullyback-filledwithinservicetoallowfortheappropriatetimeandresourcetobeavailableforthem. EnsurethattheinfrastructureanddatasystemsaresufficientlyrobusttoallowdatacollectionoftheIAPTdatasetandensuredataissentasrequired-therewasfinancialsupporttoemployadataanalystwithinthefirstyearoftheproject,whichsupportedthedatacaptureforthenationalreportingrequirement.Theremovalofthiscontinuestobechallengingfortheinformationdepartmentasreportingstructuresandparameterschange
31
frequently.Thisshouldbecomeeasierinthenearfutureasreportingwillbedeliveredthroughthementalhealthdataset. AgreethatdatasenttotheprojectofficebecomesthepropertyoftheChildrenandYoungPeople'sIAPTProject-agreedlocally. Receiveandtransferallfundsinaccordanceoftheobjectivesoftheproject,andensurethat,asNHSbodiesevolve,thatorganisationswhichmayfollowoninthecommissioningroleareawareof,understandandacceptthecommitmenttotheIAPTproject–fundinghasbeenmadeavailabletotheserviceasperrequirement. AgreetoparticipateinserviceaccreditationtoIAPTstandards-thisisongoing,serviceaccreditationwillbeconsideredthroughthe‘DeliveringWith,DeliveringWell’criteria.7.34DatacollectionandanalysisThechildrenandyoungpeople’sIAPTdatacollationandanalysisdocumentproducedbytheCORCcentralteam(July15)providesasummaryofdemographicdataandservicelevelcompleteness.Doncasterhasmixedresultsacrosstheboard,scoringwellincertainareas,i.e.Sourceofreferralrecordatassessmentandcompletedgoalatassessment,andnotsowellinotherareas,i.e.pairedgoalinformationandpatientsatisfaction.Thismeansthereisstillworktodo.7.35PerinatalMentalHealthIn 2014, the Review of Health services for Looked after Children and Safeguarding inDoncaster,highlightedthat:Perinatalmentalhealthservicesworkwellforthoseexpectantwomenwhorequiresupportformildtomoderatementalhealthneeds.TheyareprioritisedwithintheIncreasedAccesstoPsychologicalTreatmentservice(IAPT)andtheadultmentalhealthaccessteamareabletoofferrapidassessment.Thepathwayislessclearforthoseexpectantwomenorwomenwhorequireurgentcrisisinterventionpost-delivery,andthereisongoingdiscussionacrosshealthprovidersonhowbesttorespondtotheirneeds.There are collective national and local recommendations that highlighted the need for aspecialistcarepathwaytosupportthisclientgroup.Doncaster CCG commissioned a piece of work to review Mental Health Services inDoncaster that resulted in a report highlighting 26 recommendations. One of therecommendations focused on the requirement to develop specialist care pathways, forexample,thecurrentmentalhealthservicesdidnotprovidecareinaco-ordinatedwayforpregnantwomen.Thismeantthattheircarewasfragmentedatbest.Moreconcerningisthat there are notmany choices open to womenwho are experiencing amental healthcrisis pre/post birth. This results in either mothers being sent out of area to high costplacementstoMother&BabyUnits,orchoosingtostaylocallyandbeingseparatedfromtheirbabies.Theneedforaspecialistperinatalmentalhealthserviceisundisputed.InDoncasteralonewehave4000 livebirthsannuallyand figuresquoted in theGuidance forCommissioners,PerinatalMentalHealthServicessuggestthatfor4000maternitiesatleast1,256willsuffersomedegreeofmental illnessduringpregnancyorwithinoneyearofgivingbirthandof
32
those136willneedintensesupportfromsecondarymentalhealthservicesoradmissiontohospital.For4000maternities:
• 8womenwillexperiencepostpartumpsychosis• 8womenwillexperiencechronicseriousmentalillness• 120womenwillexperienceseveredepressiveillness• 400-600 women will experience mild-moderate depressive illness and anxiety
states• 120womenwillexperiencePostTraumaticStressDisorder• 600-1200womenwillexperienceadjustmentdisordersanddistress.
PracticalMentalHealthCommissioningNov2012TherewastheestablishmentofaworkinggrouptolookatmodifyingthePerinatalMentalHealth service pathway and as a result, a pilot knownas theDoncaster PerinatalMentalHealthAdvisoryPilotwassetuptorunforthethreemonthsfromMarchtoMay2014.Theobjective of this pilot was to establish the demand for such a service. It was promotedalmostexclusivelytothematernitydepartmentalthoughwedidnotrefusereferralsfromothersourcessuchasGPsorotherpsychiatrists.ThepurposeoftheAdvisoryServicePilotwasto:
• Determine and evidence the level of need – previously the community mentalhealthteamandtheirmidwifeappointmentssawtheseladiesseparately
• To test a joint pathway developed through the work of the Doncaster PerinatalMentalHealthGroup.
7.36PerinatalAdvisoryServicePilotDuring the three month pilot there were 99 referrals for consideration; each of thesereferrals was discussed at amultidisciplinary teammeeting. Of the 99 referrals 28wereconsidered tobe inappropriate, 36were felt to requireaprimary care levelof inputandwereeitherdivertedtotheirGPortotheIAPTservice.SixclinicswererunatAnte-natalClinicswiththreewomenbeinginvitedtoeachclinic.Theaimoftheclinicwastoconductathoroughpsychiatrichistory,establishthecontextofthepregnancyandanycurrentorpastpsychiatrictreatment.Thenextstephasbeentocommissionafurtherpilot;apsychiatryliaisonservice.Thekeyfindingswereinclusive:
• Atotalof388referralsweremadetotheclinic.
33
Reasonforreferral. Number
Pasthistoryofpostnataldepression 13Previoushistoryofdepression 10Currentdepressiveepisode 7Previoushistoryoflowmood 6Generalisedstress/anxiety 6Currentpresentationoflowmood. 4Medicationreview 3Thoughtsofself-harm. 2Obsessivecompulsivedisorderwithassociatedanxiety 2Historyofpsychosis 1Phobiainrelationtomedicalprocedures 1Historyofmentalhealthproblems 1PersonalityDisorder 1TOTAL 57OutcomeforthepatientsseeninclinicItneedstobenotedthatduetotheirpresentingneedssomepatientshadmorethanoneoutcomefollowingtheirassessmentinclinic.
Outcomes NumberReferredbacktoGeneralPractitionerwithadviceinrelationtomedicinesmanagement
18
ReferredbacktoGeneralPractitionerwithnofurtheradviceorfollow-up
15
ReferredbacktoGeneralPractitionerwithsupportplaninplace 4Tocontinuewithinput/supportfromsecondarymentalhealthservices 4ReferredtoIAPT 14Referredforcounselling 1Referredtosocialservices 1Referredtoaccessforsecondarymentalhealthservices 5Safeguardingreferralmade 1Referraltosecondarymentalhealthservicesdeclined 1TOTAL 64Findings
• Ofthe57patientsseen,only5werealreadyknowntoandinreceiptofsecondarymental health services, and 2 reported to havemadeprevious suicide attempts,butnocurrentriskwasidentified
• However,33(58%)wereeithercurrentlyorhadpreviouslybeentreatedinprimarycareformentalhealthproblems
• 10reportedtohavingpreviouslybeenunderthecareofsecondarymentalhealthservices
• 12wereassessedashavingpreviouslyexperiencedthoughtsofself-harmbutwithno current risk.Most identified their children or the fact theywere pregnant asprotectivefactors
• 3 reported to regular use of cannabis. 2 stated that they had not used itwhilstpregnant,1reportedtostillbearegularuser.Asafeguardingreferralwasmadeinrelationtotheseparticularwomen
34
• 3 of thewomen reported to regularly drinking alcohol above the recommendedlimits,butallstatedthattheyhadstoppedduetotheirpregnancy
• 1reportedtostillbesmokingduringherpregnancy• 1womanreportedthatshehadbeenviolenttowardherpartner• 1womanreportedtohaveexperienceddomesticviolencebutthiswaswhilstwith
apreviouspartner.7.37EatingDisordersEstimatedincidenceforDoncasterhasbeencalculatedusingdatafromMicalietal.(2013):AnorexiaNervosa
• Femalesaged10-49years=13.6casesper100,000population=11newcasesperyear
• Malesaged10-49years=1.3casesper100,000population=1newcaseperyear.BulimiaNervosa
• Femalesaged10-49years=20.7casesper100,000population=16newcasesperyear
• Malesaged10-49years=1.6casesper100,000population=1.2newcaseperyear.EDNOS
• Femalesaged10-49years=28.4casesper100,000population=22newcasesperyear
• Malesaged10-49years=4.2casesper100,000population=3.3newcaseperyear.ThefollowingdatareflectsCAMHsreferralstotheeatingdisorderpathway.The2014dataisYTD(asof16.04.14).
ThedatasuggestsanincreaseintotalreferralstotheEDpathwaysince2011.In2014,therehavebeen19referralsintotalinlessthanfourmonths-thesamenumberofreferralsasforthewholeoftheprevious12months.Thetablebelowoutlinestheagebreakdown.
02468
101214161820
2009 2010 2011 2012 2013 2014
N re
ferr
als
Referrals to pathway
Total
Male
Female
35
Confirmed2014/15dataacrosstheregion(forthoseCCGareaswhowillbepartofthecollaborativeisasfollows:DoncasterTotalnumberofnewcasesunder18years: 34Totalnumberofnewcasesover18years: 6RotherhamTotalnumberofnewcasesunder18years: 19Totalnumberofnewcasesover18years: 10NorthLincolnshireTotalnumberofnewcasesunder18years: 23Totalnumberofnewcasesover18years: 20Totalnumberofreferrals: Under18years: 76Totalreferrals: 1127.38CommunityEatingDisorderServiceThenewcommunityeatingdisorderservicebeganinApril2016andtheserviceisevolvingtohaveallfacetsofthehubandspokemodel.TheserviceisprovidedacrossDoncaster,RotherhamandNorthLincolnshire.ThedatabelowrelatestoDoncasteronly.
Descriptor Apr May Jun JulNumberofemergencycasesreceived 0 0 0 0Numberofurgentcasesreceived 1 1 2 0Numberofnon-urgentcasesreceived 3 1 0 1NumberofcasesadmittedintoT4 0 0 1 0Seenwithinaccesstarget 100% 100% 100% 100%
0
1
2
3
4
5
6
7
8
4 8 9 10 11 12 13 14 15 16 17
N re
ferr
als
Age at Referral
2011
2012
2013
2014
36
SouthYorkshireEatingDisorderAssociationhavebeencommissionedtoprovidethefollowing:
• Raiseawarenessaroundeatingdisordersandhowtobestsupportthese;and• Provideeducationandawarenessraisingsessionsforyoungpeople,theirparents
andprofessionals.
Descriptor Apr May Jun JulAwarenessRaising-Numberofprofessionalattendingtraining
0 14 0 0
EducationSessions-Numberofprofessionalattendingtraining
0 0 0 0
TrainingSessions-Numberofprofessionalattendingtraining
0 0 0 1
7.39OutofHoursServiceCAMHsoperateanoutofhoursservice24/7.Therewere50call-outstotheOOHworkerduringDec14andJune15,whichisthehighestacrosstheproviderpatchofDoncaster,RotherhamandScunthorpe.
7.40Section136Thefollowingdatarelatestothenumberofunder18yearoldsonasection136whowerebroughttothe136suiteasaplaceofsafety:2013–2014: 2YP2014–2015: 5YP2015–2016: 3YP7.41PoliceCellsThefollowingdatarelatestothenumberofyoungpeoplewheretheuseofcustodyasaplaceofsafety.Detailsasfollows:2012–2013: 0YP2013–2014: 2YP2014–2015: 1YP2015–2016: 0YP
2
7
5
10
7
109
32
3
8 87
9
23 3
2 2
5 5
0
5
10
Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15
CalloutbyBaseLocalityDec2014-June2015
Doncaster Rotherham Scunthorpe
37
7.42AdultAccessTeamTheaccessteamarebasedwithanacutesettingandseeyoungpeopleandadultsaged16yearsoldandabovewithamentalhealthissue.Theysaw15sixteenyearolds,16seventeenyearoldsand15eighteenyearolds,givinganannualtotalof46youngpeople.7.43PerinatalMentalHealthIn 2014, the Review of Health services for Looked after Children and Safeguarding inDoncaster,highlightedthat:Perinatalmentalhealthservicesworkwellforthoseexpectantwomenwhorequiresupportformildtomoderatementalhealthneeds.Theyareprioritisedwithintheincreasedaccesstopsychologicaltreatmentservice(IAPT)andtheadultmentalhealthaccessteamareabletoofferrapidassessment.Thepathwayislessclearforthoseexpectantwomenorwomenwhorequireurgentcrisisinterventionpost-delivery,andthereisongoingdiscussionacrosshealthprovidersonhowbesttorespondtotheirneeds.There are collective national and local recommendations that highlighted the need for aspecialistcarepathwaytosupportthisclientgroup.Doncaster CCG commissioned a piece of work to review Mental Health Services inDoncaster that resulted in a report highlighting 26 recommendations. One of therecommendations focused on the requirement to develop specialist care pathways, forexample,thecurrentmentalhealthservicesdidnotprovidecareinaco-ordinatedwayforpregnantwomen.Thismeantthattheircarewasfragmentedatbest.Moreconcerningisthat there are notmany choices open to womenwho are experiencing amental healthcrisis pre/post birth. This results in either mothers being sent out of area to high costplacementstoMother&BabyUnits,orchoosingtostaylocallyandbeingseparatedfromtheirbabies.Theneedforaspecialistperinatalmentalhealthserviceisundisputed.InDoncasteralonewehave4000 livebirthsannuallyand figuresquoted in theGuidance forCommissioners,PerinatalMentalHealthServicessuggestthatfor4000maternitiesatleast1,256willsuffersomedegreeofmental illnessduringpregnancyorwithinoneyearofgivingbirthandofthose136willneedintensesupportfromsecondarymentalhealthservicesoradmissiontohospital.For4000maternities:
• 8womenwillexperiencepostpartumpsychosis• 8womenwillexperiencechronicseriousmentalillness• 120womenwillexperienceseveredepressiveillness• 400-600 women will experience mild-moderate depressive illness and anxiety
states• 120womenwillexperiencePostTraumaticStressDisorder• 600-1200womenwillexperienceadjustmentdisordersanddistress.
PracticalMentalHealthCommissioningNov2012TherewastheestablishmentofaworkinggrouptolookatmodifyingthePerinatalMentalHealth service pathway and as a result, a pilot knownas theDoncaster PerinatalMentalHealthAdvisoryPilotwassetuptorunforthethreemonthsfromMarchtoMay2014.Theobjective of this pilot was to establish the demand for such a service. It was promotedalmostexclusivelytothematernitydepartmentalthoughwedidnotrefusereferralsfrom
38
othersourcessuchasGPsorotherpsychiatrists.ThepurposeoftheAdvisoryServicePilotwasto:
• Determineandevidencethelevelofneed–previouslythecommunitymentalhealthteamandtheirmidwifeappointmentssawtheseladiesseparately
• TotestajointpathwaydevelopedthroughtheworkoftheDoncasterPerinatalMentalHealthGroup.
7.44ChildhoodDevelopmentThepercentageofchildrenachievingagoodlevelofdevelopmentattheendofreceptioninDoncaster(53.1%)islowerthanthenationallevel(60.4%).During2013/14,1,981childrenachievedgoodlevelsofdevelopment(CHP2015).Table3:Percentageofchildrenachievinggoodlevelofdevelopmentattheendofreception(2011-14)
Year
Noofchildrenachievinggood
levelofdevelopmentat
theendofreception
Percentageofchildrenachieving
goodlevelofdevelopmentattheendofreceptionin
Doncaster(%)
PercentageofchildrenachievinggoodlevelofdevelopmentattheendofreceptioninEngland
(%)
2011 1,997 57.0 59.0
2012 2,177 62.0 63.5
2012/13 1,623 43.3 51.7
2013/14 1,981 53.1 60.4
Source:CHP2012-157.45SpecialEducationNeedsDoncasterhasabout6,386childrenwhorequirespecialeducationalneeds(withorwithoutstatement)andthisequatesto13.2%ofschoolchildren(DfE.2015).ThehighestpercentageofchildrenwithSENinacommunityfromDoncasterwas36.4%whilethelowestwas8.6%.Atotalof1278pupilswereidentifiedaspupilswithSENduring2014-15;theyeitherhadastatementofSENoranEducation,HealthorCarePlan.
39
PupilswithSENwhohadastatementweredividedinto:
7.46SchoolsSchoolsareincludedintheuniversaloffertochildrenandyoungpeopleandprovideawiderangeofservicestosupportchildrenandyoungpeople.Thesupportofferedtochildrenandyoung people around emotional health and wellbeing is varied. A recent audit ofcounsellingprovisionwithinschoolsshowedthereisvarianceacrossschools(samplesizeof50%ofallschools).ForfulldetailsseeAppendix5.However,themainpointswere:
• Overhalfofschoolsdon’tprovideface-to-facecounsellingforarangeofemotionalhealthandwellbeingissues
• Approximately 70% didn’t have an external organisation provide face-to-facesupport
• Trainingassistantsdoprovidesupportinsomeschools,butinthemajorityofcaseswheretheydoprovidesupport,theyhavehadnoformaltraining
• Insomeschoolsthereisanominatedleadforemotionalhealthandwellbeing• Schools and CAMHs are not closely configured and don’t have robust systems to
enableeffective jointworking. Thismeans there is very little consultation, adviceandguidanceprovidedintoschoolsfromCAMHs.
7.47Anemerging theme fromrecentengagementwith schools so far is the requirementfor more targeted support for children and young people who seem to be strugglingemotionally,andaneedforstafftrainingonemotionalhealthincludingkeyissuessuchasself-harm.7.48EarlyHelpOfferMostchildren,youngpeopleandfamilieshaveanumberofbasicneedsthatcanbesupportedthrougharangeofuniversalservices.Theseservicesincludeeducation,earlyyears,health,housing,youthservices,leisurefacilitiesandservicesprovidedbyvoluntaryorganisations.However,somefamilieshaveneedswhichwillrequireadditionalsupporttoenablethemtoreachtheirfullpotential.InDoncastertheearlyhelpofferacrossserviceshasbeenpatchywithgapsandalackofco-ordination,inparticularservicesaroundbehaviourissues,riskybehaviours,counselling,mentoringandparenting.TheLocalMedicalCommittee(LMC),CAMHsandkeyworkersfromtheStrongerFamiliesprogrammehavepreviouslyhighlightedthisasanissue.ThishasresultedinlotsofinappropriatereferralsintoCAMHsforchildrenandyoungpeoplewhohaveabehaviourissueratherthanmentalhealth.Thiswasidentifiedintherecentauditcompletedin2013(seeAppendix4).
34.70%
12.70%11.30%
10.60%
10.30%
20.00%
AutismSpectrumDisorder(ASD)
Behavioural,EmotionalandSocialDifficulties
Speech,LanguageandCommunicationNeeds
SevereLearningDifficulties(SLD)
PhysicalDisability(PD)
Others
40
7.49Thiswasrecognisedasabiggapandasignificantamountofworkhasbeencompletedoverthepastyeartodevelopanewearlyhelpstrategy,whichwentliveon5thOctober2015.Adescriptionofthenewserviceisfoundinsection9,1.1.(pg36).7.50ThereisalackofunderstandingbetweenuniversalservicesandtargetedservicesandCAMHsintermsofthresholdsandrolesandresponsibilitiesacrosstheemotionalwellbeingandmentalhealthagenda.ThisresultsinreferralscomingintoCAMHsthatarenotappropriate.Thesearetheneitherreturnedtothereferrerorsignpostedtoanotherservice.Inrealitynotallonwardreferralsgetpickedupandthosethatarereturnedarebacktosquareone.7.51WorkforceUniversal staff via the collaboratives and through partner events with CAMHs haveidentified that staff working in universal services have differing skills, competencies andunderstandingofthegamutofemotionalwellbeingandmentalhealth.Staffsonthewholedo not feel confident to identify need early and then provide appropriate guidance andsupportatanappropriatelevel.7.52ChildhooddevelopmentandschoolachievementsDuring2013/14justoverhalfofthetotalchildrenagedunderfiveyearsachievedalevelofgooddevelopment,thisissignificantlylowerthanthenationalaverage.Around50%ofyoungpeopleachievedhigherGCSEgradescomparedtoanationalaverageof56.8%.7.53Notineducation,employmentortraining(NEET)Thepercentageofyoungpeoplenotineducation,employmentortraininghasdeclinedbetween,2010-2013.Thefiguresfor2013shows5.5%oftotalyoungpeoplewereNEET.7.54Smoking,alcoholandsubstancemisuseDoncasterhasahigherpercentageofyoungpeoplewhosmokeregularlywhencomparedtothenationalaverage.Ratesforunder18yearoldsforalcoholspecifichospitaladmissionsinDoncaster,althoughbeingslightlyhigher,werenotstatisticallydifferentfromthenationalaverage.7.55Lookedafterchildren&HomelessnessAsof5thJuly2016therewere504LookedafterChildren,thebreakdownisasfollows:
55%
12%2%3%
1%
27%
FosterCare
Home&Hostels
PlacedwithParents
PlacedforAdoption
IndependentLiving
PlacedoutofBorough
41
AgeRange NumberofLAC0-3years 684–15years 33316–17years 99
18years&over 47.56In2014therewere299childrenthatwentmissing.Doncasterhasasignificantlylowerrateoffamilyhomelessnessthanthenationalaverage.7.57Hospitaladmissionsforunintentionalanddeliberateinjuries
Descriptor 2013-14 2014-15 2015-16UnintentionalInjuries(0-14yrs) 520 461 386DeliberateInjuries(0-14yrs) 7 1 11UnintentionalInjuries(15-24yrs) 331 272 314DeliberateInjuries(0-14yrs) 23 10 217.58Hospitaladmissionsself-harmThenumberofchildrenpresentinginA&Eforself-harmingcouldnotbeobtainedduetotheabsenceofcodingforself-harminA&E.However,childrenandyoungpeopleadmittedtoacutewardsviaA&Eduetodeliberateself-harmwasobtainedandisillustratedinFigure13.During2013/14,130childrenandyoungpeoplewereadmittedtoacutewardsduetoself-harmwhereasthenumberfellto109in2014/15.Thecaveattothisdataisthatitincludesalcoholpoisoningsoitmustbeinterpretedwiththisconsideration.Figure13:Noofchildrenandyoungpeopleadmittedtoacutewardsduetoself-harm(2013-15).
2433 34
39
130
2429 27 29
109
0
20
40
60
80
100
120
140
Q1 Q2 Q3 Q4 Total
Noofchildrenandyoungpeople
2013-14
2014-15
42
7.59Suicide
Descriptor 2013-14 2014-15 2015-16NumberadmittedtoacutewardsviaA&EorCAMHsforattemptedsuicide
13 12 27
7.60 Performance data provided forQuarter 1 toQuarter 3 in 2015/2016 identified anincrease inthenumberofchildrenandyoungpeoplewhohavebeenadmittedtoacutewardsviaA&Eduetoattemptedsuicideaswellas therebeingan increasingnumberofchildrenandyoungpeoplebeingadmittedtoacutewardsviaA&Eduetodeliberateself-harm.7.61DSCBwanted to explore this data further to gain a better understanding of thosechildrenwhoattemptedtoendtheirlife.Thisisalsoinlinewitharecommendationfromthe recent Ofsted Single Inspection “Undertake a review of those children and youngpeople admitted to hospital for self-harm and attempted suicide to determine reasonsthatwillinformsuitablepreventativework”(Ofsted,2015,p40).7.62Thekeyobjectiveof thisauditwas toundertakea ‘deepdive’ into the thresholds,servicesandsupporttoindividualyoungpeoplewhowereadmittedtoanacutewardduetoattemptingtotaketheirownlife.TheDSCBmulti-agencyaudit toolwasused inorder tomeasurecomplianceandqualitywiththefollowingprocedures:
• Assessment and Care of Children and Young PeoplewithMental HealthNeeds,whoareplacedinanAcuteGeneralHospitalWardPolicy2015
• ChildrenLivingAwayfromHome(includingPrivatelyFosteredChildren)2016• WorkingTogethertoSafeguardChildren2015.
The themed audit day brought together managers/safeguarding leads who were notdirectly involved inanycases. Practitionersweremadeawarethatamulti-agencyauditwastakingplaceandareflectivepractitionerquestionnairewassenttothoseinvolvedforcompletion. The audit groupwanted to explore practitioner views on processes,multi-agencyworking inDoncaster,participationofyoungpeopleandwhat traininghasbeenundertakenandwhatimpactthishasmadetopractice.Questionnairesweresenttoparent/carersfromCAMHstoinformthemoftheauditandtoseektheirviews.Aquestionnaireforyoungpeoplewassenttoidentifiedpractitionerstocapturetheviewsofchildrenandyoungpeople.
43
Thekeyfindingswereasfollows:
7.63Therewereseveralexamplesofgoodpracticeandwhatworkedwell,aselectionofthesearelistedbelow:
• In17cases the responseby theacutehospitalwasappropriateand timelywithreferralstoCAMHsevidence.TheresponsefromCAMHswasequallyappropriateandtimelywithevidenceofreferral
• 13outofthe18youngpeoplewereseenbyaqualifiedCAMHSpractitionerwithin24hoursofadmissiontoanacuteward,inlinewithpolicy.Twootheryoungpeople(aged16/17)wereseenbytheadultcrisisteams.AnotheryoungpersonpresentedatA&Eandwasgoingtobeadmitted(recordedasadmitted)butwas
44
takenhomebyhermotherandthereforeCAMHsdidnothavetheopportunitytoseethisyoungpersonatpointofadmission.Afollowupappointmenttookplace
• In17outof18casesauditorswereconfidentthatthepractitionersknewthesignsandriskindicatorsintermsofself-harmandpoormentalhealthandarticulatedthiswellincaserecords
• 13outofthe17assessmentsevidencedwerechildfocused.Theyoungperson’svoicewasclearlyrecordedandquoted;behavioursandobservationswereevidentinCAMHsandDBHFTrecords
• In16cases,ariskmanagementplanandadischargeplanfollowingtheadmissionwasevidentinbothDHBFTandCAMHsrecords.Plansincludedforexample:removingsharps,tablets,harmminimisation,emojistoshowemotions,beingwithanadultatalltimesandafollow-upappointmentwithapsychiatristwithin7days
• In14outofthe18casestherecordingwaschildfocusedacrossagenciesrecords.Therewaslotsofdetailaboutemotionsandfeelings,gooduseof"youmentioned,yousaid”toevidencebeingchildfocussed.Inaddition,DCSTandIFSTrecordsevidencethesignsofsafetyapproachwithheadingsused“whatisworkingandwellandwhatareweworriedabout"incaserecordingandsupervision
• ForthosechildreninT4services,CAMHscanevidenceregularcontactwiththeyoungperson
• In16outofthe18casestherewasstrongevidenceofdirectworkwiththechild/youngperson.ThemajorityofthisisinCAMHsrecords.Thetypesofworkevidencedismainlytalkingtherapies,butthereissomeevidenceofSDQandRCADScompletedwithyoungpeople,trafficlights,goalssignedbyyoungpeople,mappingaroundmoods,IAPTscoresevidenceprogression.
7.64 There are a number of proposed recommendations for the Quality andPerformance Group to consider when formulating the action plan that will informsuitablepreventativework:
• Thereneedstobeamulti-agencyassessmentofholisticneeds,notjust“currentview”attheearliestpossibleopportunity.Weneedawholechildandwholefamilyapproachforchildren/youngpeoplewhoareexperiencingpoormentalhealth
• Improvedattendanceatteamaroundthechild/familymeetingsbyCAMHspractitioners
• Improvedattendanceatdischargeplanningmeetingsbysocialworkers• Moreevidenced-basedsupportandchallengetoparents/carerstopromotegood
mentalhealthinchildren• Moreinvolvementwithadultmentalhealthservicestosupportfamilieswhere
thereareknownparentalmentalhealthissues,asthereisastronglinkwithparentalmentalhealthandchildren’smentalhealth
• Allagenciesneedtoincreasetheuseofgoalsettingandstandardisedmeasurestoevidenceimpactandprogression
• ThereneedstobeajointprotocoltoensurethatchildrenaccessingT4servicesreceiveatimelymulti-agencyassessment(beforeadischargemeeting)whichisimplementedandembeddedinpractice
45
• Co-ordinatedapproachtoself-harmprovidingchildren/youngpeoplesupportinthecommunity
• DBHFTandCCGtoensuretherightcodingisused,sotheperformancedataisaccurateandhelpsinformservicesaboutlocalneed
• CAMHstoensurethatthereisrobustuseofariskassessmenttool,identifyingrisktoselfandothers
• RDASHtoconsiderbetterwaysofevidencingworkundertakenonelectroniccasefilesystems
• CAMHstoevidencecasesupervision• DMBCtoensuretheCodeofConductforWorkingwithChildrenPolicyhasbeen
sharedandunderstoodwitheducationproviders• CAMHsneedtoreduceDNAappointmentsandensureamoreinclusivewayof
engagingyoungpeopleandhardtoreachfamilies• RDASHtoembedsensitiveenquiryoftrauma,abuseandneglectintopractice
whilstundertakingassessments• ConsiderationgiventohowyoungpeoplePost-16withmentalhealthissuesaccess
furthereducation,trainingandemployment• DSCBtobeassuredthateducationprovidersareawareofandutilisingDepartment
ofEducation(2014)PreventingandTacklingBullyingguidance• Seeingthechild/youngpersonontheirownwithoutparentsisgoodpracticeand
willenablethechild/youngpersontospeakfreely• Useyourelectronicsystemswelltoevidencetheworkundertaken.Usetitles,types
andsubjectareastoensuretheinformationflows• EnsuresupervisionandattendanceatHighRiskManagementmeetingsareclearly
documented• Beclearwhereyoursourceofinformationhascomefromi.e.role/title• Ensureyougatherinformationforyourassessmentsfromtheallappropriatehealth
teams• IfyouarerecommendedEarlyHelpsupport,gainconsentandcompleteanEarly
HelpEnquiryForm.7.65NumberofDoncastermentalhealthserviceuserswhohavedependentchildren
Descriptor 2013-14 2014-15 2015-16NumberofDoncastermentalhealthserviceuserswhohavedependentchildren
2090
7.66SexualAbuseandRapeClinic(SARC)In2014/15therewere17newcasesand14historiccases.CurrentlybothnewandhistoriccasesareseenbySheffieldChildren’sHospital,aswedon’thavesufficientnumberslocallytoenablepaediatricianstokeepthenecessarycompetencies.Thereisanagreedlocalfollow-uppathwaythatworkswellandwewouldlooktokeepthisarrangement.Thereisagapinthatthereisnospecialisedpsychologysupportforthiscohortofchildrenandyoungpeople.Thisissomethingwewilllookatregionallyaspartofthefiveyearplan.7.67ChildreninneedandchildprotectionAtthetimeofcompletingthehealthneedsassessmenttherewere1,646ChildrenandYoungpeoplewhoare‘InNeed’and420ChildrenandYoungPeoplewithasafeguardingplan.
46
7.68DomesticViolenceDoncasterChildren’sServicesTrust(DCST)withPartnershassecuredfundingfromtheDepartmentforEducation(DfE)InnovationFundtosupportthetransformationofpracticetochildren,youngpeopleandfamilies.TheDCSTprojectistospecificallyfocusonDomesticAbuseandtheeffectthishasonchildrenandyoungpeoplebothintheimmediateandlongerterm.Domesticabuseandviolenceisasignificantfeatureforchildrenandyoungpeople(CYP)inover30%ofallreferralstoDoncasterChildren’sServicesTrust,andisprevalentinpolicereferralstosocialcare.Currentlydomesticabuseisnotcommonlyidentifiedbyuniversalandearlyhelpservices;itisusuallyfirstidentifiedbyeitherthepoliceorsocialcareatarelativelyhighlevelofrisk.Atpresent,mostoftheresponsesarefocusedoneithervictimsorperpetrators,andnotonthechildrenandyoungpeopleinthefamily.Theimmediateeffortstoreduceshorttermriskdonotnecessarilyreduceriskinthelongterm,leadingtorepeatvictimisationwithdifferentpartnersinnewrelationships,andyoungpeoplegoingontobecomevictimsorperpetratorsintheiradultlife.Thereareveryfewinterventionsfocusedonchildrenandyoungpeople,andevenfewerfocusedontherecoveryofvictimsandtheirchildrentogether,inordertoachievesustainedreducedriskofvictimisation.7.69HospitaladmissionsformentalhealthTherateper100,000forhospitaladmissionsformentalhealth(age0-17years)hasdeclinedfrom79.5in2010/11to53.9in2013/14.Therate(per100,000)forhospitaladmissionformentalhealthinDoncasterissignificantlylowerthantheEnglandaveragethroughouttheperiodfrom2012to2015.Hospitaladmissionsformentalhealth(age0-17years)havedeclinedinDoncasteroverthepastyears,35peoplewereadmittedduring2013/2014.
47
8.Self-AssessmentToolkit8.1Amulti-agencyteamcompletedtheEastMidlandsStrategicClinicalNetworkself-assessmenttoolkit,whichhasbeenpromotedthroughtheYorkshireandHumberStrategicClinicalNetwork.Thishasbeenusedacrosstheregionasastandardisedmeasure.Thekeyfindingsareasfollows:8.2DevelopingtheWorkforce–3.33/5(rating)ExistingStrengths:
• CAMHsclinicianshavebenefitedfromthepost-graduatediplomaleveltrainingacrossthreemainareasaspartoftheCYP-IAPTprogramme.Thisincludes;twostaffcompletingtheWebsterStrattonparentcourses,fourtraineesundertakingCBTtrainingandthreestaffcompletingserviceleadstraining
• AllstaffwithinCAMHsaretrainedtopracticeinanon-discriminatoryway• Multi-agencypractitionertrainingisalreadybeingdeliveredinsomeschoolsand
thiswillbethebuildingblocktoawiderprogramme.ThisincludesCAMHs,EducationPsychologyandschoolsandeducation.
Areasfordevelopment:Themajorityofthepointsunderthisheadingweredeemedtobenotreadywithacomplex,complexityrating.Keyareasare:• Theneedtotargetthetrainingofhealthandsocialcareprofessionalstocreatea
workforcewiththeappropriateskills,knowledgeandvaluestodeliverafullrangeofevidencebasedinterventions
• Professionalstrainedtobeabletoidentifymentalhealthproblemsearlyandrecognisethevalueandimpactofmentalhealth
• Professionalstrainedonhowtoprovideanenvironmentthatsupportsandbuildsresilience.
8.3Resilience,PreventionandEarlyInterventionfortheMentalWellbeingofChildrenandYoungPeople–3.20/5ExistingStrengths:
• TheEarlyHelpStrategyforDoncasterisnowdevelopedandhasbeenveryrecentlyimplemented.AjoinedupearlyhelpsystemwillpromotetheidentificationofemergingneedsandearlierinterventionwhichisbasedonawholefamilyapproachaspromotedbytheStrongerFamiliesprogramme.Thiswillbringbetterco-ordinationandplugabiggapinserviceprovision
• CAMHsarepilotingaresiliencecollegemodel,whichaimstomeettheneedsofchildren,andyoungpeopleaged12-18yearsoldwithemotionaldistressandmentalhealthproblems.Thisisdonethroughgroupworkandpeersupport
• ThereisacurrentperinatalmentalhealthpilotrunningwhichwillbeevaluatedinMarch2016.Thepilotpathwayoffersjointcasemanagementofcarebetweenmidwifery,consultantobstetricianandpsychiatriccare.
Areasfordevelopment:Althoughthisthemescoredquitehigh,anumberoftheproposalsarerelatedtoNHSE,PHEandDfE.Theonesthatrelatelocallyareasfollows:• Thedevelopmentofwholeschoolapproachestopromotingemotionalwellbeingand
mentalhealth• Supportingself-carebysupportingthedevelopmentofnewappsanddigitaltools.
48
8.4ImprovingAccesstoEffectiveSupport–3.14/5ExistingStrengths:
• ThecurrentCAMHsserviceadherestorelevantNICEguidelines,includingCG158,CG72,CG155,andPH40
• DoncasteralreadyhasasharedTier2and3servicesandthisisco-locatedandhasmanystrengths,includingexcellentaccesstimes
• Therearesomeclearaccessandwaitingtimestandards• Thereisa24/7outofhoursservice• Thepeermentoringprovisionhasbeenheldupasanexemplar• Initialriskassessmentsensurehigh-riskchildrenandyoungpeopleareseenasa
priority.InDoncaster,100%ofthosedeemedurgentattriageareseenwithin24hours.Allreferralsaretriagedwithin24hours
• ThereisastrategiclinkbetweenCAMHsandservicesforSEND• ThereisdedicatedlearningdisabilitiesprovisionwithincoreCAMHs• Therearegooddatasystemsforcollectingdataoncrisis/hometreatmentand
section136.
Areasfordevelopment:Thisistheareawiththegreatestnumberofproposalslocally.Keypointsare:• ThereareasignificantnumberofreferralsperannumtoCAMHsthatshouldnotbe
referred.In2014/15thisequatedto24%• Movingawayfromthecurrenttieredsystemofmentalhealthservicestoinvestigate
othermodelsbasedonexistingbestpractice• EnablingsinglepointsofaccessandOne-Stop-Shopstobecomepartofthelocaloffer• Assigningnamedpointsofcontactinspecialistmentalhealthservices(CAMHs)for
schools,GPpractices• Schoolsassignnamesleadsformentalhealth• Developmentofjointtrainingprogrammes• ImplementationoftheCrisisCareConcordat• Implementationofclearevidencebasedpathwaysforcommunitybasedcare,including
hometreatment(tier3.5)toavoidunnecessaryadmissionstoinpatientcare• Ensurenochildoryoungperson(under18yrs)isdetainedinapolicecellasaplaceof
safety• Thereisnocommunityserviceforeatingdisorders.Currentlyanadhocserviceis
providedineachofthethreeCCGareasfromwithincoreCAMHs.8.5CaringforthemostVulnerable–2.90/5ExistingStrengths:
• ThecurrentCAMHsserviceadherestorelevantNICEguidelines,includingPH28• Commissionersandprovidersacrosseducation,healthandsocialcareandyouth
justicesystemsworktogethertodevelopappropriatebespokecarepathways• Thedesignatedleadprofessionalroleworkswellinanumberofcases.Thereis
roomforimprovementbutthebasicsareinplace• Thereisaspecific,multi-agencyLACresourcewithincoreCAMHs• ThereisamentalhealthworkerplacedwithinthelocalYouthOffendingService• Inmanycases,specialistservices(CAMHs)areavailabletoprovideadvice,rather
thanseethosewhoneedhelp.ThechallengeistogetreferringservicestobetterusethisfunctionasopposedtoreferringstraightintoCAMHs’withoutanyconversations.ThislinkstothenamedCAMHsroles.
49
Areasfordevelopment:Formanyoftheproposalswehavepartialimplementationlocally.Theareas,whichfordevelopmentare:• Mentalhealthassessmentsshouldincludesensitiveenquiryaboutthepossibilityof
neglect,sexualabuse,includingchildsexualabuseorexploitationandforthoseaged16yrsandabove,routineenquiry
• Ensuringthosewhohavebeensexuallyabusedand/orexploitedreceiveacomprehensiveassessmentandreferraltoappropriateevidencebasedservices
• Forthemostvulnerableyoungpeople,strengtheningtheleadprofessionalapproachtoco-ordinatesupportandservicestopreventthemfallingbetweenservices
• Improvingcareofchildrenwhoaremostexcludedfromsociety,i.e.thosewhoarehomeless,sexuallyexploited.
8.6TobeAccountableandTransparent–2.40/5ExistingStrengths:
• Thiswastheareawiththebestperformancewithasmallnumberofproposalsthatdon’thavefullorpartialimplementation
• Thereareclearleadcommissionerarrangements• Thereisaleadaccountablecommissioningbody,thisistheCCG• TheHealthandWellbeingBoardhavestrategicoversightofthecommissioningof
elementsofthepathwayorofferregardingchildrenandyoungpeople’semotionalwellbeingandmentalhealth
• CommissionersensurequalitystandardsfromNICEinformandshapecommissioningdecisions
• TherearesystemstomonitoraccessandwaitmeasuresagainstpathwaystandardsthatarelinkedtooutcomemeasuresandthedeliveryofNICEconcordanttreatmentateverystep.
Areasfordevelopment:
• ThereiscurrentlynosingleintegratedstrategicplanforchildemotionalwellbeingandmentalhealthservicesacrossDoncaster
• Theworkoftheleadcommissionerisnotbaseduponanagreedplan,agreedbyallrelevantagenciesandwithastronginputfromchildrenandyoungpeople
• Co-commissioningofcommunitymentalhealthinpatientandintensivetreatmentbetweenlocalareasandNHSE
• Developmentofdetailedmeasurementoutcomes.
50
9.Workforce9.1Aspartoftheneedsassessmentprocessweaskedpartnerstocollateallavailabledataonactivity,workforceandinvestmentforservices,whichcoverthewholegamutofemotionalwellbeingandmentalhealth,togiveagoodunderstandingofthecurrentworkforce.AtemplatewasdevisedbytheYorkshireandHumberStrategicClinicalNetworktohelpstandardisereporting,thisisthetemplateweused.Itisimportanttonotethatthisdataisbasedonavailabledataonly,whichmayexcludesomedata.
Descriptor NumberofPractitioner/Staffin
postJune2015
NumberofPractitioner/StaffinpostOctober2016
SchoolBasedServices JASP 4 4Thrive 40 60Children’sTrustBasedService AssistantForensicPsychologist 0 1ThirdSector OpenMinds 8 8NHSBasedServices SpecialistCAMHs 29.8 15.6Consultation&Advice 0 5.5IntensiveHomeTreatmentService 0 5PaediatricLiaison 0 1CommunityEatingDisorderService 1.6 11.9LookedafterChildrenCAMHs 2 2LearningDisabilityCAMHs 2 4.1YouthOffendingCAMHs 1 1ADHD 4 3.8Autism 3 3SinglePointofAccessCAMHs 0 2Total 95.40 127.90
9.2Thereisasignificantincreaseinpractitioners/staffinpostinOctober2016asadirectresultofthesystemtransformationaimsandobjectives.9.3TherehasbeenadeliberateshiftofresourcesfromspecialistCAMHstoconsultationandadviceandintensivehometreatmenttobetterreflecttheneedsofthepopulation.Theaimbeingtoidentifyandprovidesupport(aspartofasystemicapproach)attheearlieststagepossible.9.4Therehasbeenasignificantincreaseinthecommunityeatingdisorderresource,toreflectthenewaccessandwaitingtimesstandards,andtheneedforamulti-disciplinaryapproach.9.5Workforceskillsaudit,developmentstrategyanddeliveryplanTheoriginalLTPidentifiedanumberofareasthattheBoroughneedstotransform,inordertoachievetheirambitiontomeettheemotionalhealthandwellbeingofchildrenandyoungpeople.Oneofthoseareaswastheneedtoimprovetheworkforce,withtheaimthateveryonewhoworkswithchildren,youngpeopleandfamiliesareambitiousforeverychild
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oryoungpersontoachievegoalsthataremeaningfulandachievable.Theywillbeexcellentinpracticeandabletodeliverthebest-evidencedcare,becommittedtopartnershipworkingandberespectedandvaluedasprofessionals.IneffectwhatthismeansisthatthisisagoodqualityequitableofferacrosstheBorough.9.6Thefirststepwastocommissionaworkforceauditthatwouldactasthebasisforthesubsequentstrategy.Theauditsetouttoreviewarangeofinformationregardingcurrentcapacity,expectationsandskillsassociatedwithpeopleengagedinthedeliveryofemotionalhealthandwellbeingservicestochildrenandtheirfamilies.Theapproachwastodelivertwolevelsofaudit;firstlyasimplifiedquestionnairedistributedtothewidestpossiblerangeofstaffinthechildren’sworkforce.ThiswillfocusprimarilyonPrimaryCare,HealthVisitingandSchoolNursingaswellasnominatedrepresentativesfromSchools.Asecondlayerofskillsauditaimedtotakeamorein-depthanddetailedlookattheskillsetintheCAMHsworkforce.ThishadtheintentionofunderstandingthegapsrelatingtoboththehighestlevelsofskillsrequirementsinarangeofCAMHsspecificcorecompetencies,theabilityofCAMHsprofessionalstousethoseskillsworkingwithandthroughothers,aswellasunderstandingtheattitudetowardsandreadinessforchangeinthiscoreworkforce.However,astheauditprogressedandtherelationshipwiththepilotschoolsgrew,adeeperdivetookplacethatwasfurthersupportedbyfourlocalityschoolsevents.9.7Theschoolswhichwereengagedatbothlevelsoftheskillsauditexpressedverypositiveattitudestowardstheirresponsibilitiesfortheemotionalhealthandwellbeingoftheirstudents.Everyschoolthatwasspokentowasengagedinsomeactivityaroundpromotingpositivementalhealth,identifyingchildrenwithadditionalneedsorprovidingsomelevelofinhousesupportorguidance.
FindingsSummary-SchoolsSchoolswelcometheopportunitytoworkmorecloselywithCAMHsprofessionalsinthenewmodelMostexpertiseinschoolsisvestedinasmallnumberofpastoralsupportstaffAsmallnumberofschoolshaveexcellentsystemsandprocessesinplace.Theypromotepositivementalhealth,haveaccesstoandusetoolstoidentifyadditionalneedsandtrainingandexpertiseindeliveringbespokeinterventions,andworkcloselyandeffectivelyincollaborationwithexternalprofessionalsincludingCAMHsSkillsacrossallareasofemotionalhealthandwellbeingneedsarevariable.Coupledwithpocketsofexcellentpracticearelowlevelsofunderstandingandskills.Thereisalsoanacknowledgementthatmuchactivityinthisareaisdrivenbyguessworkandwell-meaningTherearenostandardsforthesystemsandprocessesthatshouldbeinplacetounderpintheactivityschoolsengageintoidentifyandintervenetomeetneedGenerally,interventionsinschoolsareappliedinconsistentlyandlackstructureandevidencebaseThepointatwhichschoolsindividuallyexhausttheircompetenceandconfidenceandturntoexternalsupportvariessignificantly.Specialistschoolsinparticular,thoughnotexclusively,haveveryhighlevelsofskillandsupportinfrastructureandusethesetosupporthighlevelsofemotionalhealthandwellbeingneedsbeforecontactingCAMHsforspecialistsupportandadviceSchoolsacknowledgetheyusetoolsandtechniquesthathavebeendevelopedforonesetofneedsandapplyingthemtoothers(e.g.Legotherapyforcommunicationdeficits)ortheymakeeducatedguessesastowhatinterventionscouldbeappliedinparticularcircumstancesThereislimitedsharingofpracticeorknowledgebetweenschools.EmotionalHealthandWellbeingLeadsinschoolshavenosystemsorprocessesinplaceforengagingformallywitheachotheracrossschoolsWhilstsomeschoolshaveverypositiverelationshipswiththeCAMHsservicethesewereoftenbuiltonone-to-onerelationshipsorwhereschoolshadspecificskillsorcompetenciesthatenabledthemtoengagewithCAMHsina‘CAMHsLanguage’
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9.8Thewiderworkforcewereconsultedwiththekeyfindingsasfollows:
FindingsSummary–WiderWorkforceAllpartsofthe‘TeamDoncaster’offerforchildrenandyoungpeopleacknowledgedthatpreventionactivitywasbetter,cheaperandmoreeffectiveoverthewholelifecycle.AllpartnersinthisauditreinforcedtheviewthatdeliveringinterventionsattheearliestpossiblestagewasthebestwaytomeettheneedsofchildrenandyoungpeopleManyservicesintheBorough,particularlythosealreadyaddressingotherhighimpactneeds,haveexcellentsystemsandprocessinplacetopromotepositivementalhealthandprovidemeaningfulinterventionstosupportchildrenandyoungpeoplewithemotionalhealthandwellbeingneeds.SuchservicesmaybebetterplacedtoaddresshigherlevelemotionalhealthandwellbeingneedsthroughaccesstoincreasedskillstrainingandhigherendconsultationandadvicefromspecialistpractitionersinCAMHsThereisanabsenceofservicesintheBoroughwhereyoungpeoplecanreceivecounsellingsupporttoworkthroughparticularissueswithimpartialandindependentexpertsGPsinPrimaryCaredonotfeeltheyhavethetimeorskillstodealwithhighlevelsofemotionalhealthandwellbeingneed.TheynoteaperceptibleincreaseinnumbersofchildrenandyoungpeoplepresentingwithemotionalhealthandwellbeingissuesGPsrecognisethattheydon’thave(andcan’testablishinshortconsultations)meaningfulenoughrelationshipswithchildrenandfamiliestobeabletomakeahugeimpactontheexperienceofthechildoryoungpersonGPs,HealthVisitors,SchoolNursesandthewiderworkforcestruggletoeasilyidentifythesourcesofadvice,informationandsupportavailabletochildren,youngpeopleandtheirfamiliesasthesearenotcentrallycollated,collectedorpresentedTheremaybescopetoinvestigatetheprovisionofsomeemotionalhealthandwellbeingsupportforchildrenandyoungpeopleinprimarycaresettingsSchoolNursesinpartnershipwithschoolsEmotionalHealthandWellbeingLeadssometimesstrugglewithgainingaccesstosuitablespacewithintheschoolestatetodeliveremotionalhealthandwellbeingservicesSchoolsareabletospecifyinanannualplanthekeyareastheyrequireSchoolNursingservicestofocuson.Manyschoolsidentifyemotionalhealthandwellbeingasoneofthoseareas,notallschoolsdosoSchoolNursing,HealthVisitingandCAMHsareallmanagedwithinasinglebusinessunit.Thisprovidesconsiderableopportunityforincreasingtheamountandefficacyofjointworkingandsignificantcoordinationoreffortacrossthedisciplinesinordertofacilitatetheobjectiveofimprovedwhole-childoutcomesSchoolNursingandHealthVisitingservicesreceivelargenumbersofreferralsintotheirservices,thereareconcernsabouthowbesttoidentifytheoneswiththegreatestneedforemotionalhealthandwellbeingsupportTherehasbeensignificantinvestmentindevelopingskillsandunderstandingaround‘attachment’withintheHealthVisitingworkforceandthosetheyworkcloselywithincludingtheEarlyHelpHubTheEarlyHelpHubisakeypartofthesystemformeetingtheemotionalhealthandwellbeingneedsofChildrenandYoungPeopleintheBoroughandincreasingcapabilitywithinthehubtodealwithemotionalhealthandwellbeingneedswilladdressneedmorequicklyTheEarlyHelpAssessment(previouslytheCAF)isoftenseensolelyasatoolforassuringreferralthresholdcriteria.However,itisactuallyanactualassessmenttoolthatcouldhelpensureconsistencyandimprovedcommunicationacrosstheBoroughThereisanopportunitytoenhancefurtherthedeliveryofanemotionalhealthandwellbeingofferamongstHealthVisitorsandSchoolNursesthroughtheprovisionofadditionalskillsandaccesstoconsultationandadvicefromCAMHspractitionersAfocusondevelopingtheCAMHsofferintoschoolscouldbecomplimentedstronglywithaprimarymentalhealthconsultationandadviceofferintonurseriesandchildren’scentres.Thiscouldfocusonearlyresiliencetrainingandthedevelopmentofcompetenciesinrecognisingandprovidingsupportforemotionalhealthandwellbeingneeds
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9.9AnauditwascompletedontheCAMHsworkforce.Thekeyfindingswereasfollows:
FindingsSummary-CAMHsPeerSupportWorkersprovideavaluableandinnovativerolewithintheserviceThereisabroadrangeofprofessions,rolesandqualificationsrepresentedwithintheserviceTheservicehasstruggledinthepasttoretainqualifiedCBTpractitioners.NotallCAMHsstaffaretrainedtothenecessarylevelinCBTTheserviceskillmixseemsheavilyskewedtowardsprofessionalroleswithlimitedscopeforsupportrolesincludingthoseatanassociatepractitionerlevelWithintheservicetrainingneedsarenotclearlyidentifiednorrecordedconsistentlyWithintheservicethereislittleevidencetoshowhowindividualstaffmember’strainingordevelopmentisdrivenbytheneedsoftheserviceTheTrust-wide‘TrainingNeedsAnalysis’hasidentifiedwithinitarangeofcoursesrelevanttothefutureneedsofCAMHsstaff.ManyofthesecourseshavebeencommissionedthroughHealthEducationEngland(YorkshireandtheHumber).TheseincludeCognitiveBehaviouralTherapy,DialecticalBehaviouralTherapy,Mindfulness,MotivationalInterviewing,LeadingStructuredGroups,FamilyInterventiontrainingandTrainingtoSupportCarersCAMHsstaffwouldbenefitfromincreasedlevelsofskillinCognitiveBehaviouralTherapy,MentalisationBasedTherapy,FamilyTherapyandMindfulnessCAMHsstaffrequiresupportanddevelopmenttobeabletodeliverinterventionsthroughothers,especiallyinprovidingadviceandguidancetoothersworkingwithchildrenandyoungpeoplewithouttheneedtoseetheindividualthemselvesSomeeffortneedstobeinvestedinensuringthatallCAMHsstaffincludingthenon-clinicaladmin,clericalandmanagerialstaffsarefullyengagedinthenewservicearrangements.Thattheyareclearabouttheirrolewithinit,theskillsandcompetenciestheywillbeexpectedtohavetoensuresafe,effectiveandevidencebasedinterventionstochildrenandwithandthroughothersSomeCAMHsstaffwillbealreadyskilledtodelivertrainingtogroupsofnon-CAMHsstaffintheBorough.Thereis,however,aneedtoensurethatallstaffwhomaybecalledupontodeliversuchtrainingareskilledatprovidingtrainingtogroupsAstheservicedevelopsstaffwillneedfurthersupporttoensuretheycontinuetodevelopandadapttothechangingneedsofthechildrenandyoungpeopleoftheBorough
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1 PromotingPositiveMentalHealth 2 IdentifyingNeed 3 Intervening4 Commissioningand/orreferringon 5 ConsultationandAdvice 6 SpecialistCAMHS
ImpactArea
1 2 3 4 5 61 Developaneasilyaccessibleandsearchableselfserviceadviceandinformationportal.Staff
acrosschildren’sservicesareabletoshareandshowcasetheirbestpracticeincreasingknowledge,expertiseandconfidenceacrosschildren’sservices.ThiswillcontainarepositoryofbestpracticeexamplesoftoolsandtechniquesforpromotingandinterveningtoimproveEmotionalHealthandWellbeinginChildrenandYoungPeople.Wouldalsoincludesignpostingforexternaladviceandsupportincludingwhereschoolsmightstartwithreceivingassistancewithcommissioningexternalsupport.Theportalwillbeabletobeusedbystaffacrossanyserviceprovidingsupporttochildrenandyoungpeople
P P P P
Schools,HealthVisitors,SchoolNurses,EarlyHelpHub,Children’sCentres,Nurseries.VoluntaryandCharitablesectorincludingyouthclubsandyouthorganisations
SchoolswithCAMHSsupportandadvice
2 Developmentofaninvitationonly(private)professionalsnetwork:Anonlineself-organisednetworkofindividualsacrosstherangeofchildren’sservicessharingtheirownknowledgeandseekingadviceandsupportfromownpeers.WiththeadditionofCAMHSstaffthiscouldalsothenbecomearepositoryofqualifiedbestpracticewithresponsestoquestionsandtheiranswersbeingcuratedand/ormoderatedbyCAMHS.Aswithrecommendation1thiscouldbeintegratedintothe‘EngageDoncaster’portal.
P P P P P
School’sEH&WBstaff,HealthVisitors,SchoolNurses,EarlyHelpHub,Children’sCentresNurseries.DCSTstaff
Schools
3 DevelopmentofaDoncaster-widePromotingemotionalwell-beingandpositivementalhealthcourse:Suchacoursewouldbewidelyaccessibleand,withthesupportofseniorleadersacrosstheBorough,widelyaccessedbyabroadrangeofstafffromthewidestpossiblerangeofchildren’sservices.Benefitswillbemaximisedbynotlimitingthecoursesolelytothosewithaninterestinemotionalhealthandwellbeing.Thefocusofthecoursewouldbeon:Spottingearlysignsofamentalhealthissueinchildrenandyoungpeople,confidencehelpingayoungpersonexperiencingmentalillhealth.Providingearlyhelp,protectingfromharm,preventingaMHissuegettingworse,assistingwithrecoveringfasterfromaperiodoforongoingmentalillhealthandactingtoreducethestigmaassociatedwithmentalhealthissues.
P P P
AllstaffacrosstheBoroughwhoworkwithchildrenand/oryoungpeople.
CAMHSwithEducationalPsychology
4 Developmentanddeliveryofamodelofmotivationalinterviewing/briefinterventionstechniquestraining:rollingoutaseriesofbasicandhigherleveltrainingintheseareaswouldmaximisetheimpactofeverycontactwithachildoryoungpersonandprovidethebasisforaCBTbasedcommonthreadthroughtheBorough.
P P
School’sEH&WBstaff,frontlinestaffinIFST,EarlyHelpHub,children’scentres,Nurseries,Project3
CAMHS
5 Increaseintheavailabilityofcounsellingskillinschools:DevelopmentofaDoncasterSchoolsCounsellingofferinlinewiththeDfErecommendations P P
Schools,EH&WBleadswithsupportfromCAMHS
Schools
6 Developmentanddeliveryofaseriesofsharedlearningopportunitiesforspecificneeds:Conductdisorders,Anxiety,Depression,Hyperkineticdisorders,Attachmentdisorders,Eatingdisorders,Substancemisuse,Deliberateself-harm,Post-traumaticstressStaffacrossthesystemhaveincreasedconfidenceindealingwiththehighestneedareas.
P P
Allchildren’sservices CAMHS
7 Deliveryofsharedlearningopportunitiesformeetinghigherneeds:WorkingwithstaffacrosstheBoroughtoincreaseskillsindealingwithchildrenwithhigherendemotionalhealthandwellbeingneeds P P
FocusedonstaffwhoalreadyworkwithC&YPandfamilieswithmultipleand/orcomplexneeds
CAMHS,DCST
8 Trainingothers:Increasingskills,knowledgeandcompetenceatsharingspecifictoolsandtechniquesrelatingtoemotionalhealthandwellbeinginchildreninyoungpeoplethroughdeliveryoftrainingtootherseitherone-to-oneorgrouptraining
P P
CAMHSclinicalstaff CAMHS
9 Deliveringthroughothers:Increasingskills,knowledgeandcompetenceatsharingspecifictoolsandtechniquesrelatingtoemotionalhealthandwellbeinginchildreninyoungpeoplethroughdeliveryoftrainingtootherseitherthroughone-to-oneorgrouptraining
P P P
CAMHSclinicalstaffHV/SNstaff RDaSH
10 CognitiveBehaviouralTherapy:ThereshouldbeahighlevelofskillsandexpertiseincompetentuseofCBTwithchildrenandyoungpeopleacrosstherangeofCAMHSprofessionals.
P P
CAMHSclinicalstaff CAMHSwithRDaSHL&D
11 CAMHS-Specifichigherlevelinterventions:AdditionallevelskillstraininginMentalisationBasedTherapy,FamilyTherapyandMindfullness P
CAMHSclinicalstaff CAMHSwithRDaSHL&D
12 Adaptingtoanddealingwith‘Change’:InvestinginorganisationaldevelopmentinitiativesinsupportofthechangeswillenabletherapidchangemobilisationrequiredofCAMHSstaffastheschoolspilotstakeoff,aremodifiedandevaluatedandthefinalrolloutbeginsthrough2017
P
CAMHSstaff CAMHS
13 Doncastershouldconsiderthedevelopment,oradoption,ofacorecompetencyframeworkforschoolsstaffinleadingonordeliveringemotionalhealthandwellbeinginschools:Thereis,justpublishedbytheYorkshireandHumberChildren’sWorkforceLeadsGroup,aProfessionalCapabilitiesFrameworkfortheWiderChildren’sWorkforce:earlyinterventionandpreventionItaddressesmanyofthesameissuesregardingthediverseskillsandcompetenciesidentifiedamongstpastoralsupportstaffandEmotionalHealthandWellbeingleadsinschools.
P P P P
School’sEH&WBstaff DoncasterMBCandDoncasterChildren’sServicesTrust
Recommendation WorkforceImpactArea WhichGroupsofstaff? Lead
9.10Thereareaseriesofrecommendationsthatcomedirectlyfromtheabovekeyfindings.
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10.KeyObjectivesTheaboveneedsassessmentisextensiveandgivesanexcellentoverallpictureofneed.However,therewasaneedtodrilldownandpickoutsomekeyareasofneed,whichinturnwillallowustoidentifythekeyobjectives.TheoriginalLTPoutlinesthekeyissuesandkeyobjectives.ForthepurposesofthisupdatedLTPwewillonlyincludethekeyobjectives.
MoveAwayfromtheCurrentTieredSystemByimplementingaconsultationmodelthatmovesawayfromreferralsand
towardsjointworking,advice,guidanceandsupport.
SupportUniversalServicesBycreatingprovisiontospecificallysupportuniversalservices.ThiswillincludenamedCAMHsworkersforschools,PrimaryCareandaPrimaryMentalHealthWorkerwithintheEarlyHelpHub.Thedevelopmentofan
enhancedsinglepointofaccess.
ImplementtheCrisisCareConcordatWewillimplementallaspectsoftheconcordat,inparticulartheembeddingofanew24/7helpline,ensuringnochildoryoungpersonisplacedina
Policecellasaplaceofsafetyandbycreatinganewliaisonprovisionwithinanacutehospitalsetting.
DevelopmentofIntensiveHomeTreatmentProvisionByimplementinganewhometreatmentservicethatactsasanalternativetoinpatientservicesandhasakeyroleinpre-crisisandenablesstepdownfrom
acute/inpatientservices.
EatingDisordersBycreatinganewcommunityservicetoreflectlocalneed.
CaringfortheMostVulnerableTodismantlebarriersandreachouttochildrenandyoungpeopleinneedthroughbetterassessmentandanintegratedflexiblesystemthatprovides
servicesinawaythatareevidencebased.
Children,YoungPeopleandFamilieshaveaVoiceBydevelopingsustainablemethodstoeffectivelyengagewithourchildren,youngpeopleandtheirfamiliessotheyhaveavoiceandshapewhatservices
areprovided.
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11.Outcomes
LocalPriorityScheme Outcome EvidenceEstablishnamedemotionalwellbeingandmentalhealthleadsinschools(internal)
Bettereducationalattendanceandattainment.
Reductioninexclusions
AttendanceregistersandGCSEscores
NumberofexclusionsContinuousconsultationandengagementwith
children,youngpeopleandfamilies
Commissioningandservicedeliverydecisionsareshapedbychildren,youngpeopleandtheir
families
Childrenandyoungpeopleinvolvedincommissioningandontaskandfinish
groups
Appointmentofworkforcedevelopmentlead
Workforcethathastheskillsandcapabilitiestomeetthe
emotionalwellbeingandmentalhealthneedsofchildrenand
youngpeople
Workforcecompetencyquestionnaire
Auditandrollingtrainingprogramme
Workforcethathastheskillsandcapabilitiestomeetthe
emotionalwellbeingandmentalhealthneedsofchildrenand
youngpeople
Workforcecompetencyquestionnaire
CAMHsworkertobeembeddedintheEarlyHelp
Hub
EffectiveMDTtriageandchildrenandyoungpeoplebeingseenbytherightpersonatthe
righttime
ReductioninreferralsIncreaseinsystemicwork
NamedCAMHsleadsinschools&PrimaryCare
Improvedemotionalwellbeingandmentalhealthofchildren
andyoungpeople
Healthbehaviourquestionnaire
Supportingselfcare
Lesschildrenandyoungpeoplerequiringexternalsupport
Improvedresilience
ReferralsintoCAMHsReferralsintoEarlyHelp
HubHealthbehaviour
questionnaire(resiliencescore)
Developmentofsinglepointofaccess
EffectiveMDTtriageandchildrenandyoungpeoplebeingseenbytherightpersonatthe
righttime
ReductioninreferralsIncreaseinsystemicwork
Furtherdevelopevidencebase
Increaseinstaff’scompetenciestodeliverevidencebased
interventions
NumberofCYP-IAPTtrainedprofessionals
withinCAMHs
Implementallareasofthecrisiscareconcordat
Reductioninchildrenandyoungpeoplepresentingincrisis
Improvedresilience
AttendeesatA&E,Section136
Healthbehaviourquestionnaire(resilience
score)Intensivehometreatmentservicetobeprovided
Childrenandyoungpeoplearebettersupportedathome
Reductionintier4admissions
Expansionofpeermentoringservice
Effectivetransition YHtransitiontoolkitbenchmarkingtool
Enhancethecurrent Childrenandyoungpeople’s CAMHsassessment
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assessmentprocesstoincludesensitiveenquiries
levelsofneedareidentified documentation
Enhancethecurrentdonotattendpolicy
Nochildoryoungpersonisdischargedfornonattendance.
DNArates
Developmulti-agencyteamschildrenandyoungpeoplebeingseenbytherightpersonatthe
righttime
Serviceprovisionbreakdown
Improvedcommunitypaediatricservices(incASD
andADHD)
Effectiveassessmentanddischargeservices
Communitypaediatricperformancedashboard
Developmentofdomesticviolencemulti-agencyteams
Reductionindomesticabuserates
GrowingFuturesperformancemetrics
Provisionofeatingdisordercommunityservices
Servicesbeganon1stMarch2016andthiswillbeaphasedevolutionofservice.Consultantpsychiatrypostisonlynewpostvacant.SYEDAaredelivering
educationsessions.
Reductionintier4eatingdisorderadmissions
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12.TransformationPlan&Updates:areasforchange,howthiswillbedeliveredin2016/17andprogressmadein2015/16Thefollowingarethepriorityareasforimplementationin2016/17.Thissectionoffersthedetailonhowandwhytheseprioritieswillbeimplemented,andgivesanupdateonanyprogressmadein2015/16.12.1Resilience,PreventionandEarlyInterventionfortheMentalWellbeingofChildrenandYoungPeopleAim:Toactearlytopreventharmbyinvestinginuniversalservices,supportingfamiliesandthosewhocareforchildren,buildingresiliencethroughtoadulthood.Wealsowanttodevelopandimplementstrategiesthatsupportself-care.AlocaltaskandfinishgrouphasbeensetuptoleadontheimplementationofthisareaoftheLTP.Membershiphasbeenagreedandinitialmeetingsheld.Membershipisattherightlevelandthereisanunderlyingphilosophyofaccountability.12.2SupportuniversalservicesWhyisthisapriority?Thelackofaco-ordinatedearlyhelpofferhasledtohighlevelsofinappropriatereferralsintoCAMHsandthereforechildrenandyoungpeoplenotbeingseenbytherightpersonattherighttime.TherearegapsinuniversalserviceworkforceexpertisearoundemotionalwellbeingandmentalhealthandsignificantvarianceinlinksbetweeneducationandCAMHsandPrimaryCareandCAMHs.ThereisasinglepointofaccessintoCAMHsbutnottothewideremotionalwellbeingandmentalhealthservices.Howwillwedothis:
• Namedmentalhealthleadsinschools/academies• CreateasinglepointofaccessintheChildrenandFamiliesHub• MoveCAMHsdutyfunctionsintotheChildrenandFamiliesHub.
Bycreatingprovisionspecificallytosupportuniversalservices.ThiswillincludenamedCAMHsworkersforschools,namedCAMHsworkersforPrimaryCare.FurtherdetailofthisnewmodelcalledConsultationandAdviceService(CAS)isfoundin12.5Thesecondelementistocreateatruesinglepointofaccess,tobuildontheyearoneworkofembeddingaCAMHsworkerwithintheEarlyHelpHub.TheworkerhasmadegoodlinksandaddedvaluetotheEarlyHelpHubwhichwenowwanttobuildupontocreateatruesinglepointofaccessforemotionalwellbeingandmentalhealth,earlyhelpandsocialcare.Originallytherewastobe1WTECAMHsworkerwithintheEarlyHelpHub,butnowaswelooktobringtogetherthroughonefrontdoor,wewillbecommittingagreaterCAMHsresource.Thiswillincludethedutyresourceandfunctionsmovingtothehub.ThereisclinicalagreementfromCAMHsandweareexploringasapartnershiphowbesttointegratethis.ThereisanaspirationthatthejointresourcebetweenCAMHsandsocialcarewillstarttofacilitatebetterworkingrelationshipsandjointvisits.
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AllschoolsinDoncasterhavebeenaskedtoidentifyaemotionalwellbeingandmentalhealthlead/championinschools.Thisleadwillworkalongsidetheschoolnursingteamandschoolspastoralsupportstafftodevelopinternalpathwaysandsystems,thatensurechildrenandyoungpeoplearesupportedattheearliestopportunitybytheprofessionalwhoisbestplacedtodoso.Throughincreasedunderstandingofandincreasedcompetenciesinemotionalwellbeingandmentalhealththesestaffwillbeabletobetteridentifyneedandthentailorsupportquicklyandeffectively.ThiswillbeunderpinnedbyregularCAMHsconsultationsandthetrainingsupport.
Plansfor2016/17
• Toworktowards100%ofschoolshavinganominatedmentalhealthlead• Developmentofchildrenandfamilieshub.
ProgresstoDate:Aletterhasbeensentouttoallschools/academiesintheBoroughfromtheAssistantDirectorforEducation,askingfornominationsfornamedemotionalwellbeingandmentalhealthleads.Thecurrentnumberofschoolswhohaverespondedisreallypositive.Abreakdownperlocalityisasfollows:North23/35-66%East19/27-70%South31/37-84%Central23/26-88%101/125schoolsintotalResponserate81%InterestinglytheoverallKPItargetforMarch2017is75%soalreadywehaveachievedthis.Theplantoengagewiththeotherschoolsthathaveyettonominateisthatoncethenewconsultationandadvicemodelisimplemented,schools/academieswillsellittotheircolleaguesastheyrealisethebenefits.Thereisafairlyevensplitbetweentheschoolsandacademiesthathaven’trespondedandworkisongoingtoengagewiththese.Workisongoingwiththe14pilotschoolsandwearedelightedwithhowthisisprogressing.Therearerepresentativesfromsomepilotschoolsontherespectivetaskandfinishgroupsthatarechargedwithoverseeingtheimplementation.The(1WTE)CAMHsworkersitswithintheEarlyHelpHub(whichistolinkwiththemulti-agencysafeguardinghub)tobecometheChildrenandFamiliesHubandhasestablishedsomegoodjointworkingrelationshipsandsharingofskillsandinformation.ThisworkisongoingandthehubmanagerandCAMHsclinicalleadforthisareaareworkingthroughhowbesttoincorporatethedutyfunctionsandtheoverallCAMHsresourcewithinthenewhub.Progressrating:VeryGood
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12.3AppsandDigitalToolsWhyisthisapriority?Weknowthatchildrenandyoungpeoplevaluedigitalsupport,butthereisnotaco-ordinatedandvalidatedofferlocally.CurrentlysupportforemotionalwellbeingandmentalhealthpredominantlycomesfromCAMHs.Howwillwedothis:
• Workwiththelocalexpertreferencegrouptoreviewexistingtoolsandtrialnewones.
ThechampionsthatarebeingdevelopedthroughtheworkcommissionedwithYoungMindswillidentify15childrenandyoungpeoplethatwanttobecomechampions(Thesechampionswillbecomeanexpertreferencegroupforthisareaofwork.ProgresstoDate:YoungMindshaveestablishedlocallinks(seesection4.3)andareintheprocessofrecruitingYouthParticipationChampions,whowillactastheexpertreferencegroupintermsofthisareaofwork.Anoptionspaperhasbeendevelopedwithsomepossibledigitaloptionsandwillbediscussedwiththeexpertreferencegroup.ProgressRating:Good
12.4PerinatalmentalhealthWhyisthisapriority?Thereare1,256womeninDoncasterwhoarelikelytosufferfromsomedegreeofmentalillnessduringpregnancyorwithinoneyearofgivingbirth.Howwillwedothis:
• Bylearningfromalocalpilotandnationalguidance• BysubmittingtwobidsforSTFfundingtodevelopahighqualityspecialistperinatal
mentalhealthservice.ThisproposalisdesignedtodevelopconsistenthighqualityspecialistperinatalmentalhealthservicesacrosstheDoncasterandBassetlawHospitalsNHSFoundationTrustfootprintwiththeintentionofimprovinginfrastructure,workforcedevelopmentandclinicalcapacitytoachieveimprovedpatientexperienceandoutcomes.ThisproposalwillcreateastandardisedofferacrossDoncasterwhichimprovesconsistencyandcontinuityofcare.Theproposalhastwoelements:
SpecialistPerinatalMentalHealthServiceforcomplexpresentationsAsteppedcaremodelapproachwithmostwomenbeingsupportedinprimarycare,withaccesstoadviceorreferraltospecialistservicesforthemostcomplexpresentations.Itwill
Plansfor2016/17• Expertreferencegrouptoleadondecisionofwhichdigitaloptiontouse
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coveranywomanidentifiedasrequiringmentalhealthsupportduringpregnancyorupto1yearpostdelivery.Thepathwaywill:
• Bedeliveredbyateamofspecialistmidwife,anddedicatedmentalhealthstaffwhowillassess,support,provideadvice(includingnon-complexprescribing)andsignposting
• AccesstoaConsultantPsychiatristwillbeviatherelevantlocalityservice• Includeprimarycare,IAPT,peersupport,voluntaryservicesandsocialprescribing• Enablerapidaccesstosecondarymentalhealthservicesforanyonewithanidentified
need• Ensurethereisanamedprofessionalwhohasoversightofthewomen’scareacross
localproviders.Theservicewouldtakealeadroleinthetrainingandeducatingofpartnerprofessionals,leadingtoincreasedknowledgeandawarenessresultinginmorewomenbeingidentifiedandsupportedtoaccessappropriateservices.Thereisadefiniteneedwithinthelocalpopulationforaservicesupportingthewomanandherfamily,recognisingthatmentalhealthcandeteriorate(aswellasimprove)duringpregnancyandforthefirstyearafterbirth.NationalreportsaroundPNMH,includingMBRRACE,highlighttherisksandthelongtermhealthbenefitsforourcommunity.Theimpactofthisserviceforwomenwillbeaqualityexperiencewherecareis:
• Personcentred• Co-ordinated/notfragmented• Efficient/ownershipbyallstakeholders(notpassingthebaton)• Inclusiveandcollaborative.
Trainingwillbedeliveredinitiallytoallstaffandsubsequentlywillbecomeembeddedpracticewithpathwaysandguidelinessupportingbothwomen,families,primarycareandstaffensuringthatPNMHiseveryone’sbusiness.Secondingclinicalmidwivestotheteamwillensuresustainabilitysuccessionplanningandcontinuity.SeeAppendix2forspecialistperinatalMHpathway.SpecialistHealthVisitinginterventioninlinewithattachmentpathwayAsaCalltoActionEarlyImplementerSiteRDaSHpilotedanenhanceduniversalmodelofantenatalandpostnatalassessmentfocusingonpromotingperinatalmentalhealthandparentchildattachmenttosupporttheemotionalwellbeingofthewholefamilyandprovideanurturingenvironmentfortheinfantinlinewiththerecommendationsofthe1001Daysstrategy.Buildingonthisweproposeadedicatedteamdrawnfromtheexistingworkforcetoreceivetrainingtoprovidetargetedspecialistinterventionforfamilieswhoarebeyondpreventativeinterventionsandrequireadditionalsupportinlinewiththemulti-agencyAttachmentPathway.SeeAppendix3forattachmentmentalhealthpathway.ThisproposalwillbuildonthegrowingrangeofcommissioningproposalswhicharebeingdevelopedacrosstheSTPfootprint,andwouldutilisegoodpracticewhichhasevolvedandthelearning’sfromtheDoncasterPerinatalMentalHealthPilot.Theengagementandinvolvementofwomenwithmentalhealthissuesintheperinatalperiodandtheirfamilieswillbevitaltoensurethatthesenewservicesmeetneedseffectively,and
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women(andfathers)havethebestpossibleopportunitytodevelopahealthemotionalbondwiththeirchildduringpregnancyandinthefirstyearoflife.Bytheendof2018/19weproposetohaveinplaceanagreedmulti-agencyspecification,withclearinterfacesacrossservices,andpathwayofcareforexpandedmodelofspecialistcommunityprovisiondesignedtoimpactonqualityandhealthoutcomes.ThesecondbidisaregionaloneacrosstheSTPfootprint,thatwilldevelopconsistenthighqualityspecialistperinatalmentalhealthservicesacrossSouthYorkshireandBassetlaw(STP),withtheintentionofimprovinginfrastructure,workforcedevelopmentandclinicalcapacitytoachieveimprovedpatientoutcomes.Thevisionistocreateastandardisedofferacrossthepatchwhichimprovesconsistencyandcontinuityofcare.Theworkforcehasfiveworkstreams.
ProgresstoDate:Duetopilotendingthereisnownospecialistcommunityservicetosupportparentsexperiencingperinatalmentalhealthproblems.TwobidshavebeensubmittedtotheSTFperinatalcommunitydevelopmentfund.ProgressRating:Satisfactory
Areweon-track?Whenyouconsiderprogressagainsttheoriginalmilestonesabove,itisencouragingtoseethatprogressisbeingmade,oftenbeforeweexpecteditto,i.e.namedschoolleads.Weareconfidentthatweareon-tracktoachievetheremainingmilestones.
Plansfor2016/17• AwaittheoutcomeoftheSTFbids• Ifsuccessful,implementthenewprogramme(s).
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12.5ImprovingAccesstoEffectiveSupportAim:Tochangehowcareisdelieveredandbuilditaroundtheneedsofchildren,youngpeopleandtheirfamilies.Wewillmoveawayfromasystemofcaredelieveredintermsofwhatservices,organisationsprovide,toensurethatchildrenandyoungpeoplehaveearlyaccesstotherightsupportattherighttimeintherightplace.AlocaltaskandfinishgrouphasbeensetuptoleadontheimplementationofthisareaoftheLTP.Membershiphasbeenagreedandinitialmeetingsheld.Membershipisattherightlevelandthereisanunderlyingphilosophyofaccountability.12.6MoveawayfromthecurrenttieredsystemofmentalhealthservicesWhyisthisapriority?Thereisvarianceintheskillsandcompetenciesofstaffinuniversalservices(includingschoolsandPrimaryCare).ThereisverylittleconsultationwithCAMHspriortoreferralandahighnumberofinappropriatereferrals.Howwewilldothis:
• ByhavingnewCAMHsworkersbasedwithinthecommunitywhoactasdedicatednamedcontactpointsforallschoolsandGPpractices
• CAMHslocalityworkersprovidingadvice,supportandguidancetoprofessionalsalreadyworkingwithchildrenandyoungpeopleinasystemicapproach
• RemovalofwrittenreferralsintoCAMHswithaccessviatheconsultationandadviceservice
• Removalofreferralthresholds.Byhavingadditionalnewlocality/communitybasedCAMHsworkersthatprovideconsultation,adviceandguidancetoprofessionalsalreadyworkingwithchildrenandyoungpeopleinasystemicway.Thereisaworkerineachofthelocalitiesandtheywillprovideeasieraccessintosupport.Thekeydriverbehindthisistoprovidesupporttothosechildrenandyoungpeoplethathavepreviouslyfailedtomeetthresholdsandbeenleftwithoutsupport.Thenewfunctionswillcomeundertheconsultationandadviceservice(CAS)andnewbrandingisnowtobeexplored.Theroleoftheseworkerswillbetodiscussandprovideadviceandguidanceonthemanagementofcases,includingconsultation,co-workingorliaison,inasytemicway,thereisaneedtomoveawayfromthehandsoffreferralculture.ThiswillmeanthatnochildfromthesesettingsshouldbereferredintoCAMHswithoutadiscussionwiththenamedCASlocalityworker.TheaspirationistototallyremovewrittenreferralsintoCAMHs,wherebyentryintotheservicecomesonlythroughconsultationandco-workingorself-referral.Afurtheraimoftheconsultationmodelisthatcases(asappropriate)willbeledbythemostappropriateperson,bethiscarerorprofessional,supportedbytheCASworker.Inpracticethiswillmeanthedevelopmentofjointassessments,betterawarenessofrolesandresponsibilitiesacrosstherangeofservicesandeffectivecommunication.Wewouldexpectovertheforthcomingyearsthatthenumberofjointassessmentsgodownandthenumberofconsultationsgoesup.Thelongertermaspirationistoprovidesupporttochildrenandyoungpeopleattheearliestpossiblestage,whichwillreducethenumbersneedingspecialistCAMHsinput.ThiswillthenallowovertimearedelpoymentofresourcesfromspecialistCAMHstotheconsultationandadviceserviceandLAC.
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Themodelisasfollows:
Underpinningthiswillbethedevelopmentandimplementationofalocaljointtrainingplan,whilstbeingveryawareofanynationaldevelopmentsviatheschoolspilotprogramme.Doncasterwasunsuccesfulinthebidbuthasdecidedtoimplementthepilotwiththeinterestedschoolslocally.Clinicianswithinrespectiveservices,includingCAMHsandEducationPsychologywilldeveloptrainingprogarmmeswithnamededucationleads.Theevolutionofthiswillbetheexpansionintoawidercommunitymentalhealthprovision,thatbuildsuponnotonlytheabovebutalsothenewlyimplementedEarlyHelpHubandbuiltintotheredesignsofcommunitynursingandtherapyservices,whichwewillbecompletingin2016.ProgresstoDate:Therehasbeenlotsofongoingengagementwithstakeholdersatbothstrategicandoperationallevelstoensurethenewconsultationandadvicefunctionsfitwithinthewidersystem.InSpring,rolesandresponsibilitiesforboththeCAMHslocalityworkersandschoolstaffwereagreed.Thishasbeenthemainareaoffocusin2015/16andwearepleasedtoupdatethatthenewfunctionsofconsultation,adviceandguidanceareinplace,themovetoamoresystemicwayofworkingacrossagencieshasbegun.Therearecurrently4WTECAMHsconsultationandadviceworkerswithDoncastersplitintofourlocalities,eachlocalityhasanamedworker,supportedbytwofloatingstaff(holidaycoveretc).Thestaffwillshareresourceandexpertisetobestmeetneed.Theinitialfeedbackfromschoolsandotherprofessionalshasbeenvery
School/School Mental Health Champion - Identify Possible Mental Health Concerns
- Discuss with Young Person/Family - Agree plan/set up network meeting to consider issues
- Access appropriate services e.g. Educational Psychology
School Champion Contact Designated CAMHs Consultation Team
- CAMHs offer direct consultation based on known information from school and consider school plan
- CAMHs Consultation and
Advice Only
- School Champion/Family/CAMHs agree the
plan
- Consultation and Advice plus CAMHs
staff link with network (school,
family, school nurse etc.)
-Additional CAMHs Consultation to
network
- Ongoing Consultation and
Advice to network
- Potential to work systemically for a
number of weeks/months (revising
plan)
- In addition to ongoing network Consultation and
Advice, an agreed
treatment/ therapy is agreed and delivered by
CAMHs
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positive.ThenewofferbeganwiththenewacademicyearandwillbetestedandevolvedoverthenextsixmonthswiththeaimofremovingreferralthresholdsandwrittenreferralsintoCAMHsbytheSummerof2017.Referralswillbereplacedbyrequestsforcollaborativeworking(inasystemicmanner)andwillmeanacontinuationofsupportratherthanahandoffreferral.Theaimofwhichistotrulyremovetiersandaccesstosupport.ProgressRating:Good
12.7Ensurethesupportandinterventionforyoungpeopleinthementalhealthconcordatareimplemented.Whyisthisapriority?ChildrenandyoungpeopleinDoncasterwereadmittedtohospitalforattemptedsuicideandwehaveothersincrisis.AllelementsoftheCrisisCareConcordatarenotcurrentlybeingimplemented.Howwillwedothis:
• New24/7allagecrisishub• CAMHsinterfaceandliaisonnurseplacedinacutehospitalsetting• LiaisonanddiversionservicetobeawareofCYPservices• Exploreoptionsofregionalsection136suiteandcrisisaccommodation.
ByimplementingtheCrisisCareConcordat,therehasalreadybeenlotsofworkdoneinthisareaandinmanycasesprovisionisalreadyinplace;asection136suitethatisappropriateforassessmentofchildrenandyoungpeople,a16yearoldplusstreettriagesystemanda24/7outofhoursCAMHsprovision.However,thereisstillmuchtodo.ThecrisishubwentliveinSeptember2015andisevolvingtoanallageservicethatwillinterlinkwiththepaediatricliaisonnurseandCAMHsoutofhoursservice,toprovide24/7supportforthoseyoungpeopleincrisis.Arecentauditshowedthatthereisaneedforimprovementsandtheserecommendationswillbeimplemented.ACAMHsinterfaceandliaisonnursewillberesponsibleforprovidingspecialistnursingskillsandknowledge,liaisonandcasemanagementofcomplexcasesbetweenCAMHsandpaediatricwards,A&Eandinpatientproviders.Thispostwillsitwithintheintensivehometreatmentprovisionandprovidefacetofaceassessmentsforthoseincrisiswithinthefourhourtargets.Theywilllinkcloselytotheoutofhour’sserviceandofferadvice,guidanceandtrainingtopaediatricwardsandA&E.Theoutofhour’sservicewillbegivensomeadditionalresourcetoincreasetherotatosupporttheachievementofthefourhourface-to-facetargets.Inresponsetotheannouncementofnon-recurrentpump-primeinvestmentinallage24/7liaisonmentalhealthservices,wewillcontinuetoworkwithadultcolleaguestomapoutthecurrentprovisionacrossallages,whichwillincludethenewCAMHsinterfaceandliaison
Plansfor2016/17• Continuetoembedthenewconsultationandadvicefunctions• Recruitfinal1WTEtomodel• Monitoreffectivenessandallowforaflexibleapproachtoservicedevelopment• Movetonothresholds.
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nurse,comparecurrentprovisiontothemodelservicespecificationandthencommissionaservicetomeettherequirements.ItwouldseemlikelythattheCAMHsinterfaceandliaisonnursewillformpartofthisservicemovingforward.Thelocalliaisonanddiversionserviceareintheprocessofidentifyinganygapsintheirknowledgeofchildrenandyoungpeopleservicesandwillpresentthesetotheemotionalwellbeingandmentalhealthstrategygrouptohelpfacilitateatrainingplan.Thiscanandwillbedonelocallybyservicesaspartofarelationshipandserviceawarenessbuildinginitiative.ThethoughtsanddiscussionsaroundtheregionalprovisionofsuitableaccommodationforChildrenandYoungPeoplehavebeenongoing.DoncastersupportedSheffieldinasuccessfulfundingbidtodeveloparegionalSection136suite.SheffieldarenowdevelopingthisservicewithafewtoDoncaster(andpotentiallyothersinSouthYorkshire)spotpurchasingbedsperannum.Wearenowsolelyexploringalocalsolutiontoshort-termcrisisbedsastheregionaloptionwasn’tgoingtobeaseffective.Weareexploringtheoptionoftrainingfostercarer(s)toprovideintensivesupporttochildrenandyoungpeopleincrisisacrossmentalhealth,substancemisuse,socialcareandyouthoffending.Thiswillbeajointcommissioningarrangement.Theintensivehometreatmentservicewillprovidein-reachtothefostercarersasrequired.WeareaimingforasolutionbyApril2017.ProgresstoDate:The24/7crisissupporthelplinewentliveinSeptemberandauditwascompletedafteroneyeartolookatanyissues.Thereweresomeareasfordevelopmentthatwillbeworkedthroughandreviewedoverthenextsixmonths.Wehavecompletedwithpartnersamappingofcurrentpsychiatryliaisonservicesforallages,thatdetailscurrentpathwaysandresources.Thiswillnowshapedecisionsmovingforwardtoensurewemovetowardsacore24service.TheactionsareheldonthelocalCrisisCareConcordatactionplan.TheCAMHsinterfaceandliaisonfunctionhasbeendetailedintheservicespecificationandthemodelofdeliveryisclear.Thereisagreementfromtheacuteprovideronthemodelandanagreementwiththeproviderintermsoftherelevantgovernancearrangementsetc.ThisserviceisnowupandrunningwithafocusofdevelopingcollaborativeworkingandprovidingdirectCAMHssupportintheacutesettingTheliaisonanddiversionservicehasidentifiedgapsintheirknowledgeofChildrenandYoungPeopleservicesandatrainingplanhasbeenagreedandisbeingfacilitated.Localservicesaresupportingtheliaisonanddiversionservicearoundtheirunderstanding.Thisworkisdevelopingandongoing.WehavelocalsystemsinplacethatmeannoChildorYoungPersonwillbedetainedinapolicecellasaplaceofsafetyfrom1stJanuary2016.Thishasbeencommunicatedviaregionalmeetingsandtheregionalworkwillfurtherenhancethelocalprovision.ProgressRating:Good
Plansfor2016/17• Implementrecommendationsfromcrisishubaudit• EmbedtheliaisonfunctionswithintheacutepaediatricandA&Ehospitalsetting
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12.8DevelopmentofintensivehometreatmentprovisionWhyisthisapriority?Wehavehighnumbersofchildrenandyoungpeoplereferredintoinpatientserviceswithanaveragelengthofstayofapproximately101days.Wearehighwhencomparedtoourneighboursregionallyandcurrentlydonothaveanintensivehometreatmentservice.Howwillwedothis:
• Developingandimplementinganewintensivehometreatmentservicetoactasanalternativetotier4provision.
Bydevelopingandimplementinganewhometreatmentservicethatactsasanalternativetoinpatientservices,hasakeyroleinpre-crisiscareandenablesstepdownfromacute/inpatientservices.Locallythiswillbeamulti-disciplinaryteamconsistingofclinicalpsychology,seniormentalhealthnurses(self-sufficientandprescribers),socialworkerandpeermentors.Theservicewillprovidethesamesupportasifachildwasinanacutesettingbutathomeorinthecommunity,i.e.twicedailyvisitstocheckonphysicalandpsychologicalcondition(asappropriate),supportparents/carerstomanagemedicationsathomeandproviding24/7oncallsupport.TheservicewillprovidedirectsupporttoacutepaediatricwardsandA&EandprovidepeersupporttotheCAMHsinterfaceandliaisonnurse.Alargeportionoftherecurrentfundingwillbeusedtocommissionthisresourceandinitialcostsaredetailedinthetracker.ProgresstoDate:Theservicespecificationiscompleteandfundingarrangementshaveallbeenagreed.Theintensivehometreatmentservicewillofferanalternativetotier4.TheserviceproviderproposedamodelofworkingthatwasagreedbytheMentalHealthStrategyGroupinJuly.Theyhavevisitedotherintensivehometreatmentservicestohelptheirthinking.Mostpostswereinitiallyrecruitedtobuttheseniorpostandsocialworkerpostarestillvacant.Thesearecurrentlyouttoadvert.TheservicemadeaphasedimplementationfromSeptemberandcurrentlyhasnineonthecaseload.TheserviceiscurrentlyrecordingitsdatamanuallyastherelevantKPIsneedaddingtotheproviderssystem(redmine).ProgressRating:Satisfactory
• Spotpurchasebedsatregionalsection136suite• Commissionfostercarer(s)toprovideshort-termaccommodationtothoseincrisis
(asappropriate).
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12.9PromotebestpracticeintransitionWhyisthisapriority?Transitionremainsaproblemforsomeyoungpeople;inparticularitisn’tstartedearlyenough.Howwillwedothis:
• Implementingmodelspecificationfortransition• WorkwithYHSCNtodevelopguidancedocumentsfortransition• Addresourcetopeermentoringservice.
ByimplementingthemodelspecificationfortransitionsfromCAMHsdevelopedbyNHSEngland,continuingtoworkwiththeYorkshireandHumberStrategicClinicalNetworkondevelopingguidanceforcommissionersandprovidertoolkitontransitionandbuildingonthecurrentpeermentoringprovisionwehaveinDoncasterthathasbeenheldupasanexemplar.DoncasterCAMHsemploypeersupportworkerswhothemselveshavealiveexperienceofmentalhealthproblems.Theroleincludessupportingyoungpeopleandtheirfamiliesintheprocessoftransitionthroughtoadultservices,toprovidecontinuityandadvocacy.Thepeersupportworkersattendtransitionmeetingswithserviceuserswithadultcarecoordinatorstoprovideinformationabouttheprocessandassistthefamilyandyoungpersontomanageanyconcernsandanxietiestheymayhave.TherolealsoinvolvesassistingyoungpeoplewhomaybeanxiousaboutdischargefromtheserviceandhelpingthemtomakethetransitionbacktoPrimaryCare.Theworkershelpyoungpeopletomeetpersonal,socialandeducationalgoalssupportingthemtoaccesscollegeandschool(attendingcollegewiththemshorttermaspartofareintegrationcareplan)andbecomemoreactiveinthecommunity.Peersupportworkersarealsomentalhealthpromotionadvocatesandarekeytoservicedevelopmentsandconsultationtoensureserviceusersvoicesareheard.TheyhavepresentedworkshopsinschoolsandcollegesandarekeytodevelopmentaspeerfacilitatorsintherecoverycollegebeingimplementedinCAMHsassistingyoungpeoplethroughpersonalexperiencetomanageanxietyandstigma.Thepostshaveofferedopportunitiestopeoplewhohavementalhealthissuestoaddresstheirownreintegrationintoemployment.PostsareflexibleintermsofparttimeorfulltimehoursdependentontheneedsoftheworkersandtheirownmentalhealthandaresubstantiveNHScontracts.PeerSupportWorkershavesincegraduatedtogainIAPTpostsandtrainingtoband6practitionerlevelviauniversity,paramedicsandprojectleadsinnon-NHScommunityprojectsProgresstoDate:CAMHshavejustcompletedatransitionbenchmarkingexercisewhichwillbereviewedinNovember,withasubsequentactionplan.ThebenchmarkingtoolwasfromtheYorkshireandHumberClinicalNetworkdevelopedtoolkit.Thepeermentoringfunctionsarebeingreviewedwithaviewtoseeinghowthesecanbeexpanded.Fundingforanysubsequenttrainingisavailable.
Plansfor2016/17• Recruittofinalposts• Addtoredmineandstarttoprovideinformationelectronically• Implementthefullmodelofdelivery• Closelymonitordelivery• Reviewserviceaftersixmonthsoffulldelivery.
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ProgressRating:Satisfactory
12.10EatingdisordercommunityserviceWhyisthisapriority?TherehasbeenayearonyearincreaseinreferralsintoCAMHsforeatingdisordersaswellasanincreaseinthoseaccessinginpatientservices.Howwillwedothis:
• Newcommunityeatingdisorderserviceadheringtoaccessandwaitingtimestandards
• Robustlyevaluatethenewmodel.Byimplementingaccessandwaitingtimestandardsforchildrenandyoungpeoplewithaneatingdisorder(NHSEngland)regionallyinconjunctionwithRotherhamandNorthLincolnshire(whichgivesatotalpopulationofapproximately727,000).Theneedandprevalenceacrossthethreeareasisidentifiedinsectionsixandalthoughfallsbelowthenumbersneededtomaintainstaffcompetencies,wefeelthatthereisanunmetneedthatwouldtakeitabovethisminimumnumber.AgreementhasbeenmadelocallythatRotherhamwillbetheleadcommissioneronthisandprovisionalmeetingsandworkshopshavetakenplacetodiscusstheguidanceandhowbestthiscanbeimplementedacrossthethreeareas.Wewillcommissionanexternalresearchagencytodevelopandcompletearobustservicemodelevaluationafter18monthsthatwillshapefuturecommissioningdecisions.
Plansfor2016/17• Reviewtransitionbenchmarkfindings• Peermentoringservicetobereviewedwithaviewtoexpanding.
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ProgresstoDate:ThethreecommissionershaveagreedalocalservicespecificationbasedupontheAccessandWaitingTimeStandardforChildrenandYoungPeoplewithanEatingDisorder,andcontractandprocurementrouteshavebeenagreedandestablished.Rotherhamistheleadcommissioneronthis.Theservicespecificationhasbeenagreedandthereisaclearimplementationplantounderpindelivery.Thephaseddeliverystartedon1stMarch,thediagrambelowshowstheproposedmodelandcapacityacrossthethreeareas.AllvacanciesforDoncasterhavebeenfilledexcepttheconsultantpsychiatrist,whichfailedtogetanysuitableapplicantswhenfirstadvertised.Itisbackouttoadvert.Itisimportanttonotetheserviceisachievingtheprescribedaccessandwaitingstandardsatthispoint,albeitwithoutthefullmulti-agencyresourceinplace.Dataiscurrentlybeingcollectedandprovidedmanuallyuntiladdedtoredmine.RDaSH(mainprovider)havesub-contractedSYEDAtoprovidetheearlyhelp,preventionandeducationelementsoftheservicespecification,thisisanewareainDoncastersowearekeentounderstandneedandimpact.ThenewresourceinSYEDAis2WTEandtheseareaneducationandtrainingmanagerandeducationworker.Performancetodateisoutlinedin4.41.Doncasterhasledonthecommissioningofanevaluationstudyofthenewcommunityeatingdisordermodel.PacechavebeenawardedthecontractandhavebeenincontactwithRDaSHtobegindevelopingtheevaluationframework.Thisworkcommencedon1stMarch2016andtheyareliaisingwiththeCEDSprovidersandlocalcommissionersintermsofsettinguptheevaluationframework.Theevaluationwillbecompletedat16monthswithanevaluationreportsubmittedtocommissionersat18months.ProgressRating:Good
Plansfor2016/17• Recruittothepsychiatrypost• Addtoredmineandstarttoprovideinformationelectronically• Reviewservicedeliveryaftersixmonthsofstarting• ContinuetoraiseawarenessviaSYEDA• Workwithacuteprovidertodeveloplinksbetweencommunityandacute.
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Areweon-track?Therehasbeensomeslippageinacoupleofareas,namelytheintensivehometreatmentserviceandcrisishubgoinglive(withpaediatricexpertise),howeverthereareclearreasonsforthisandrecommendations/solutionstoremedythem.Weareconfidentthatweareon-tracktoachievetheremainingmilestones.12.11CaringforthemostVulnerableAim:Todismantlebarriersandreachouttochildrenandyoungpeopleinneed,throughaflexibleintegratedsystemthatprovidesservicesinawaythattheyfeelsafeandareevidencebased.AlocaltaskandfinishgrouphasbeensetuptoleadontheimplementationofthisareaoftheLTP.Membershiphasbeenagreedandinitialmeetingsheld.Membershipisattherightlevelandthereisanunderlyingphilosophyofaccountability.12.12TraumafocusedcareWhyisthisapriority?Thereisaneedforgreaterawarenessoftheimpactoftrauma,abuseand/orneglectonmentalhealth.CAMHsassessmentsdonotroutinelyincludesensitiveenquiryaboutthepossibilityofneglectandsexualabuse(includingCSE).Thereisvarianceinstaff’scompetenciesinworkingwithvulnerablechildrenandyoungpeople.Howwillwedothis:
• Auditofcurrentpractice,skillsandcompetencies • EnhancedtrainingpackageforstaffworkingwithvulnerableCYP.
Byprovidinganenhancedtrainingpackageforstaffworkingwithvulnerablechildrenandyoungpeople,whichwouldleadtogreaterprofessionalawarenessoftheimpactoftrauma,abuseand/orneglectonmentalhealth,inparticularexistingCAMHsandSocialCarestaff.Runningalongside,therewillbechangesmadetocurrentmentalhealthassessmentstoincludesensitiveenquiryaboutthepossibilityofneglect,sexualabuse,includingCSEforthoseaged16yearsandaboveasroutinepractice.Asmallamountoffundingisallocatedforthedevelopmentifnewresourcesandstafftraining.Thosewithanidentifiedneedwillthen
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bereferredontoappropriateserviceswithongoingsupportmechanismsinplace.ACAMHsworkerwillsitwithinthelocalmulti-agencysafeguardinghub.CAMHsarecurrentlyinvolvedinthelocalfollow-uppathwayforchildrenandyoungpeoplewherethereissuspectedsexualabuseandrape(SARC)andthisworkswell.However,thereisagapregardingdirectandspecialisedpsychology/psychiatrysupportandthisissomethingwearelookingatregionally.ThereislikelihoodthatallSARCassessments(bothforensicandnon-forensic)willbecommissionedbyNHSEinthefuture.ProgresstoDate:Theauditofcurrentpracticewashasbeencompletedandtherearesomerecommendations,thatwillbeimplementedbytheprovider.Thesewillbereviewedaftersixmonths.Thereisstillanintentiontolookattheprovisionofspecialisedpsychology/psychiatrysupportforChildrenandYoungPeoplewherethereissuspectedsexualabuse,thiswillhappeninyearthree.ProgressRating:Satisfactory
12.13Makesurethatchildrenandyoungpeopleortheirparentswhodonotattendappointmentsarenotdischargedfromservices,ratheractivelyfollowedupWhyisthisapriority?DNAratesfor2014/15were9.5%andthecurrentpolicy,whilstrobust,needsmodificationsothatnochildoryoungpersonleavesservicebecauseofDNAs.Howwillwedothis:
• Buildoncurrentpolicyandensurestaffcompliance.Bybuildingonthecurrentpolicytomakeitmorerobustsothatchildren,youngpeopleortheirparentswhodonotattendarenotdischargedfromservices,nomatterhowmanytimestheyDNA.Therewillbeaclearexpectationthatreasonsfornon-engagementaretobeactivelyfollowedup. ProgresstoDate: Thiswasimplementedandhasbeenfinalisedthroughthenewservicespecificationandcontract.Theprovideriscurrentlyamendingpoliciesandproceduresandwehaveaskedforanauditonstaff’scompliancetothepolicy.Thisaudithasbeencompletedandthefindingsandrecommendationswillshapefuturethinking.Progressrating:Good
Plansfor2016/17• Implementtheauditrecommendations.
Plansfor2016/17• Implementtheauditrecommendations.
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12.14Developmulti-agencyteamsavailablewithflexibleacceptancecriteriaforreferralsconcerningvulnerablechildrenandyoungpeople.Improvethecareofchildrenandyoungpeoplewhoaremostexcludedfromsociety,i.e.thosesexuallyexploited,homelessorincontactwiththeyouthjusticesystem.Whyisthisapriority?Thereisvarianceintheprovisionacrossservices.Howwillwedothis:
• Buildonmulti-agencyapproach.Bybuildingonthemulti-agencyapproachwealreadyhavetomakesupportmoreaccessible.WecurrentlyhavegoodsystemsforLookedafterChildrenandthoseintheYouthJusticesystembutoutsideofthistherearenoagreedmechanisms.WewillchangethisbyincreasingtheexpertisewithCAMHsandthecapacitythatisgainedwillallowCAMHsworkerstomoveouttojoinmulti-agencyteams,i.e.Youthhousingandsupportservicesandyouthservices.Doncasterdoesnothaveagangculture.Doncasterdoesthough,havehighlevelsofpovertyanddepravationmeaningforsomechildrenandyoungpeopletheyaremoreatrisk.Ensuringwehaveflexiblemulti-agencyteamswillensurethesechildrenandyoungpeopleareidentifiedandsupported.ProgresstoDate:TheplanistodeveloptheseteamsbyMarch2019,sonoworkdoneonthistodate.ProgressRating:n/a12.15LearningDisabilityspecialistprovisionWhyisthisapriority?Thecareandtreatmentreviewguidanceandpolicyarenotcurrentlybeingimplementedlocally.Howwillwedothis:
• EnsureweareCTRcompliant• ReviewthecurrentpathwayprovisionforLDCAMHs.
Byimprovingtheuniversaloffertochildrenandyoungpeoplewithalearningdisabilityandensuringcompliancetothecareandtreatmentreviewpolicyandguidance.Areviewofthecurrentpathwaywillbecompletedwhichwillshapefuturecommissioningdecisions.Secondlywearecommittedtotheimplementationofnewpracticethatensureswearecompliantwiththecareandtreatmentreviewguidanceandpolicy.Thepostadmissionreviewmentionedbeforeprovidesagoodplatformforustoworkthroughhowbesttodothis,supportedbyadultandspecialisedcolleagues.ProgresstoDate:LocalsystemshavebeensetupforChildrenandYoungPeoplethatarecompliantwiththemandatedguidanceandpolicy;thiswascompletedbyNovember2015.TodatetherehavebeennorequestsforaCTR.ToensurebestpracticealocalMOUunderpinnedbyapolicyhasbeencompletedandagreedbyspecialisedcommissioning.Inaddition,DoncasterhasledonthedevelopmentofaregionalMOUtoensurethateach
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areainYorkshirehasaccesstoanindependentclinicalexpert.Thiswillbeachievedthroughalikeforlikeagreementonsharingthisresourceacrossthepatch.ProgressRating:VeryGood
Areweon-track?Theenhancedtrainingpackagehasslippedduetotheslightlylaterstartoftheworkforceeducatorthatwillleadonthiswork.ThenextareasofworkwillbetomapoutthecurrentprovisionforLAC,LDandYOSpathwayswiththeaimtoimprovetheseservicesin2016/17.12.16TobeAccountableandTransparentAim:Todriveimprovementsinthedeliveryofcareandstandardsofperformance,toensurewehaveamuchbetterunderstandingofhowwegetthebestoutcomesforchildren,youngpeopleandtheirfamilies.12.17LeadCommissionerarrangementsWhyisthisapriority?Toensurewehaveastrategicleadandafigureheadtoco-ordinate.Howwillwedothis:
• Designatedleadcommissioner.Doncaster Clinical Commissioning Group (DCCG) is the lead commissioner for thedevelopment and implementation of our local transformation plan supported by partners.Wehaveanestablishedemotionalwellbeingandmentalhealthstrategygroupchairedbythe
Plansfor2016/17• MonitoreffectivenessoflocalCTRarrangements• ImplementtheregionalMOU• ReviewthecurrentpathwayforLDCAMHs.
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ChiefNurseinDCCGwithappropriateseniormembershipanditisfunctioningwell.Throughacollaborativeapproachthisgroupledonthedevelopmentoftheplan.Theemotionalwellbeingandmentalhealthstrategygroupwillbetheaccountablegroupforthe implementationanddirectoversightof theplan, feedingany issuesupto twostrategicboards;Health andWellbeing Board andChildren and Families Strategic Partnership Boardwhowillmonitor the overall performance of the plan (Appendix 8). In addition to feedingintothesegroups,theEmotionalwellbeingandmentalhealthBoardwill linkdirectlytotheChildren and Families Commissioning Group and report into the Safeguarding Children’sBoardandChildren.Thediagrambelowillustratesthegovernancestructure
ThetermsofreferencefortheEmotionalwellbeingandmentalhealthGroup(Appendix1)outlinethepurposeandfunctionsofthegroupindetail.ProgresstoDate:TheleadcommissionerremainsinplaceandtheEmotionalwellbeingandmentalhealthStrategyGroupcontinuetohavedirectoversightoftheLTPimplementation.Therearetwotaskandfinishgroupsthatsitunderthestrategygroupthatareleadingonthedetailedimplementation.TheleadcommissionerchairsthesemeetingsandfeedsdirectlyintotheStrategyGroupandHealthandWellbeingBoard.Thereisgoodrepresentationandaccountabilityacrosspartners.TheMentalHealthStrategyGroupfeedsdirectlyintotheJointExecutiveCommissioningGroupwhereallcommissioningdecisionsaremade.TheultimateaccountablegroupistheHealthandWellbeingBoard.ProgressRating:VeryGood
Health&WellbeingBoard
DoncasterSafeguardingChildren’sBoard
Children&FamiliesStrategicPartnership
Board
Children&FamiliesCommissioningGroup
EmotionalwellbeingandmentalhealthStrategy
Group
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12.18CollaborationwithspecialistcommissionersWhyisthisapriority?Toreduceanyduplicationincommissioningandtoensurethatserviceslocally,regionallyandnationallyarecommissionedtomeetneed.Howwillwedothis:
• Collaborativeworking.DCCGiscommittedtoworkingwithspecialisedcommissioningandwehaveidentifiedthefollowingkeythemesandissuesarisingfromcommissioningofCAMHsTier4.Thesewillbelistedbelow.ItisimportanttonotethatDoncasterhasconsideredallkeythemesandissuesandhasfactoredallthefollowingintoourthinkingabouttherefreshedplan.ItisthedesireofDoncastertoworkcloselywithspecialisedcommissioningtofindsolutions.ClearlydeterminefromtheplansCCGT4CAMHscapacityrequirements,allCCGstoincludespendandactivityanalysisfor2014/15.Evidencethatwhateverisbeingconsideredwillhavesomeimpactonrateofadmissionscurrentlygoingintoinpatientbeds(%expected)orthatbecausetheserviceiswellestablishedandworkingeffectively,thatthispositionwillremainrelativelystatic.Theintroductionoftheintensivehometreatmentservicewillhaveadirectimpactonthis.Doncasterwouldliketoexploretheopportunityofworkingcollaborativelyonmeasuringthisandinitialdiscussionshavetakenplace.ThehopeforDoncasteristhatthiswillfacilitatediscussionsregardingtheflowdownoftier4financialsavings,tohelpourlocalabilitytomeettheFutureinMindprinciples.ConsiderationofintensivesupportteamstosupportEDcasesandpreventneedforadmissionbutalsoconsiderationofin-reachintopaediatricwardsforthoseonmedicalstabilisation–whatmeasureswouldbeinplacetoevidencethesuccessofthis?Thisisunderconsideration,initialthinkingis:EDClinicswherefullassessmentcantakeplaceandcareplannedtosuitandaccommodatetheneedsoftheindividual.Crisisintervention24/7eitherbyincreasingwhatisthereorsettingitup,tosupportYPwithaviewtomanagingthecrisisandwherepossibletoreducingtheneedforadmission.LearningDisabilityisanareaofsignificantgrowthandgiventhenatureandcomplexitybetweenhealthandsocialcare,howwillthisbeaddressed,aswhilstthenumbersarerelativelysmall,theseyoungpeoplepresentsignificantchallengestothesystem.Robustandcomprehensivecommunityteamsrequiredtoprovidecrisissupport,preventtheneedforadmissionandsupportreducedlengthsofstaytothosewhoneedtobeadmitted(takingviewsoftransformingcareintoconsideration).ThemeemergingaroundinadequateLD/ASD/CAMHsprovisioninTier2/3andisaprioritytoaddressgiventherequirementtodevelopalternativestoinpatientprovisioninpartnershipwithLocalAuthority,CCGsandNHSEngland.Perinatal–considerationofcommunityprovisioneitherbyincreasingwhatiscurrentlyavailableorbysettingupanewservice.
Plansfor2016/17• HealthandWellbeingBoardtosignoffthe2016-2020LTPupdate• ContinuetopromotetheLTPandinparticulartherefreshedversiontopartnersto
ensurebuy-inandunderstanding.
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PlansshouldaddressstepdownfromTier4facilities,whereoftenthereisalackofprovisioninresidentialsettings,daycare,andintensivecommunitysupport/wraparoundtosupportdischarge.Alsosimilarfortheeverincreasingnumberofyoungpeoplewithautism,whattreatmentservicesareavailable/planned?AllplanstoreferenceSecureCAMHsOutreachService,currentlycommissionedbyNHSEngland,potentialforcommissioningbyCCGsgoingforwardandfundingstreamtosupport.ThereshouldbemorerobustengagementandcollaborativeworkingbetweenspecialisedNHSEnglandmentalhealthcommissionersandCCGcommissionerstoensurewecommissionwholesystemspathwaysofcare,inCAMHsandadultservices.Themesemergingonworkforceplanning-risksofnotsecuringsufficientclinicalCAMHsandmentalhealthexperiencedclinicians(evidencedbyclosureofsomeCAMHsinpatientbedsduetostaffingshortages,particularlyRMNs).ProgresstoDate:TheleadcommissionerplaysanactiveroleinYorkshireandHumberClinicalNetworkandhasregularcommunicationwithregionalspecialisedcommissioners.ThisincludeschairingtheMentalHealthCommissionersSteeringGroup.Thereisadirectlinkbothwaysandweareconfidentthatthereisstrongandefficientcollaboration.ProgressRating:VeryGood
12.19EngagementWhyisthisapriority?Thisplanisforourchildrenandyoungpeople,toimprovetheiroutcomesaroundemotionalwellbeingandmentalhealthandassuchwemustprovidetheservicestheyneed.Onlythrougheffectivesustainedengagementcanweprovidetheservicestheyneedinawaytheywant.Howwillwedothis:
• GivingChildren,YoungPeopleandtheirfamiliesavoice• Commissionorganisationtoleadonthispieceofwork• Developsustainablemodel.
Byimplementingoursharedethosofgivingchildren,youngpeopleandtheirfamiliesaviewinshapingcommissioningdecisions.Wewillcommissionanexternalorganisationtodevelopandimplementaplanofcontinuousengagementandconsultationthroughoutthelifeofthe
Plansfor2016/17• Continuetoworkcloselywithspecialisedcommissioning• ExplorecollaborativelythesavingstoNHSEfromreductionsinT4admissionsandif
thesecanflowdown• CommunityEatingDisorderServicetoprovidein-reachintoacutesettingsandwork
closelywiththehomeintensivetreatmentservicetoreduceT4admissions• Ensureeffective24/7crisissupport• LooktocontinuetobolsterADHDandASDcommunitysupport• EnsuresocialcarerespondtorequestsfromT4settingstosupportstepdown.
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plantomakesurethatchildren,youngpeopleandtheirfamilieshavearealvoice.Wewillalsousethisavenueasanothermediumtosensecheckideasandtogaugewhetherthingsareimproving.Adutyofthestrategygroupsistodevelopconsultationwithlocalstakeholdersandensuretheseviewsarefedintothelocaldeliveryplanningprocess.Serviceusers/carerstobeinvolvedbyeitherdirectinvolvementinthegrouponappropriateissues,orviadiscussionswithusergroups.
ProgresstoDate:YoungMindswonthecontractandbeganworkingon1stMarch2016.Locallinkshavebeenestablishedandthisworkisstartingtomoveforwardatapace.Theaimistohave15mentalhealthchampionsthathelpshapetheevolutionoffutureLTP’sandtotestimplementationideas.ThemodelwillensurethatattheendoftheLTP(YoungMindshaveafouryearcontract)Doncasterhasasustainablemodelforengagementandyoungpeopleparticipation.Workisprogressingaspertheworkplan/schedulewithnoconcerns.ProgressRating:Satisfactory
12.20LocalOfferWhyisthisapriority?Tomakesureeveryoneknowsabouttheplan,it’saims,objectivesandintentions.Howwillwedothis:WewillpublishtheLocalTransformationPlanelectronicallyonthefollowingwebsites:
• DoncasterClinicalCommissioningGroup• DoncasterMetropolitanBoroughCouncil• NationalHealthEngland• DoncasterLocalOffer• DoncasterSafeguardingChildren’sBoard• DoncasterCouncilforVoluntaryServices.
ProgresstoDate:TheLocalTransformationPlanwassensedcheckedlocallyandwasfelttobeChildandYoungPersonfriendly,thiswasbackedupbytheYorkshireandHumberStrategicClinicalNetwork.Itandthedatacollectiontemplatewerepublishedonthefollowingwebsitesasperthemandate,publishedonthefollowingwebsites:• DoncasterClinicalCommissioningGroup–published4thDecember2016• DoncasterMetropolitanBoroughCouncil–published4thDecember2016• DoncasterLocalOffer–published11thDecember2016• DoncasterCouncilforVoluntaryServices–published11thDecember2016Thetwooutstandingsitesareasfollows:• DoncasterSafeguardingChildren’sBoard–theboardwanttohavethepresentation
ontheLTPbeforeageingtopublish.Thisisbookedinfor21stApril.Weareinthefinalstagesofgettingituploaded
Plansfor2016/17• 15mentalheathchampionstoberecruitedandactivelystarttoshapecommissioning
andservicedelivery• Continuetodevelopasustainableparticipationapproach.
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• NHSEngland–DCCGcommunicationsleadindiscussionwithNHSEcounterpartaboutthis.
ProgressRating:Good
12.21CommissioningandprocurementWhyisthisapriority?ToensureweactwithintheregulationsandtocommissionservicescompliantwithHealthandSocialCareActandEqualityAct.Howwillwedothis:
• AdherencetoNHSprocurementregulation• AdherencetoEqualityAct• AdherencetoHealthandSocialCareAct.
TheNHSProcurementRegulations2013currentlysetsouttheframeworkwithinwhichthehealthcaresystemshouldbemanagedandmakesitclearthatcommissionersmustseektoobtainservicesfromthoseprovidersbestplacedtomeetthebestinterestofthepatient;marketdevelopmentbeingoneofthekeyprinciplesbywhichtheNHSreformprogrammeaimingtoensurethatpatientsareatthecentreofdrivingchange.
ThisrequiresDoncasterCCGasacommissionertounderstandnotonlythequalityand
characteristicsofcurrentlocalproviders,butalsothoseofpotentialfutureproviders,whomightbeknownornotknownatthepresenttime.Inordertobeabletodemonstratethatthisisthecase,weneedtohaveaprocessforthesystematicanalysisofrelevanthealthcaremarkets,andameansofapplyingtheintelligencegatheredthroughsuchanalysesintothecommissioningprocess,informingservicereviews,procurementandtenderingprocesses,thecreationofoptionsforchoice,thedevelopmentofpluralityinserviceprovision,markettestingandtheassessmentsofcontestability.
Choice,co-operationandcompetitionarekeyelementsintheNHSreformprogramme,andconstitutethepillarsofsystemmanagementfortheCCG,indevelopingsystemswhicharedesignedtoprotectandpromotepatients’andtaxpayers’interests.Toenablethis,asystemmanagementofchoice,co-operationandcompetitionisimplementedwhicheffectivelyuses:
• choiceonthepartofpatientsbetweenprovidersofclinicalservices,settingsandmodelsofcare;
• competitionbetweenprovidersfor,andin,thehealthcaremarket;• governancearrangementsinplaceincontractingorganisations;• contractsbetweenNHScontractingorganisationsandproviders;• strategicpartnerships;and• informationforpatientsandreferrerstoenablethemtomakeinformedchoices,for
commissionerssothattheycansecurethebestservicesforthepeopletheyserve,andforprovidersandclinicianstobenchmarkthemselvesagainst.
12.22EqualityActThisplantakesintofullconsiderationallaspectsoftheequalityact2010,payingparticularfocustochangesarounddisabilityclassification,indirectdiscrimination,rightsofcarersand
Plansfor2016/17• UpdateallsiteswiththerefreshedLTP.
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gender.Allaspectsoftheimplantationofthisplanwilltakeintofullconsiderationandbefullycompliantwiththeequalityact.
12.23TheHealthandSocialCareActDoncasterClinicalCommissioningGroupaspartofthewiderNHSservicesunderstandsitsrolewithintheactandthefuturetransformationofservicesandiscommittedtodoingso.Thisrunsthroughourfiveyearcommissioningstrategy,crucially;weareaclinically-ledorganisation.ThisLocalTransformationPlanisaroundtransformationalchangeandsystematicimprovements,throughtheprovisionofclinically-ledcommissionedservicesthatareinnovative,providevalueformoneyandarebaseddirectlyontheneedsofourpopulation.Astheplanhasoutlinedonanumberofoccasions,ChildrenandYoungPeoplehaveshapedandwillcontinuetoshapethisplan.ThiswefeelmirrorsthekeyelementsoftheHealthandSocialCareAct.ProgresstoDate:Whilstattimesthishasslowedtheprocessdown,wehavefollowedandadheredtoNHSprocurementregulations2013foreverythingprocuredusingtheLTPfunding.Thishasbeenachallengeintermsoftimescalesandthevolumeofsubsequentworkcreatedbutweareconfidentthatwearecompliant.Wewillcommissiontwo-yearcontractswhilststimulatingthemarkettodriveinnovationandchoicemovingforward,inparticulararoundtheprovisionofcommunityeatingdisorderservices.Theplanhasandcontinuestotakeintofullconsiderationtheaboveacts.Progressrating:VeryGood
12.24DevelopmentofOutcomeMeasuresWhyisthisapriority?Sowecanmeasureperformanceandoutcomeseffectively.ThisunderpinstheCommissioningcycle.Howwillwedothis:
• ContinuetoupskillstaffviaCYP-IAPTprogramme• ExpressinterestinbecomingapilotsiteforCORC.
InadditiontothecommitmenttotheCYP-IAPTprogrammewhichfocusesonthedevelopmentofroutineoutcomemeasuresandmorevalidoutcomemeasurementtools,wehaveexpressedaninterest(throughtheYorkshireandHumberStrategicClinicalNetwork)tobeapilotsiteworkingwithCORC.CORChavemadeanoffertoCCG’stomonitoroutcomesacrosssectorsaspartoftheLocalTransformationPlan.Theaimofthisworkwillbetolookathowwecandevelopandimplementeffectiveoutcomemeasuresacrossservicesandsectorstoenableafullerpictureofachildoryoungpersonsoutcomes.Wehaveagreementfromthepartnershiptoexpressinterestasapilotsite.ProgresstoDate:Thereiscurrently1CAMHspractitionerontheCYP-IAPTcourse.TheservicewillbesubmittingarequestforaplaceonatherapypathwayscourseanduptotwoplacesontheEEBPcourse.TheCCGwillsupportthisbycoveringtheshortfallinfunding.Unfortunatelywe
Plansfor2016/17• Continuetoadheretoallactsandregulations.
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wereunsuccessfulinourbidtoCORCtobecomeapilotsite.Locallyaspartoftheservicetransformationplan;wehavecommissionedsomeadditionalresourcetoinformthemeasuresintheCAMHscontractfornextyear.Theproposedreportswillinclude:
• AnenhancedreportrelatedtouseofGoalSettingandscoringacrossthecohortduringthepatientjourney
• ImprovementstotheexistingSDQreporting(toincludesubscalesandclinicalinterpretation)
• Explorationofwidermeasuresthatspanthecohortandhowtheycanbeusedtodemonstrateoutcomes.
Thisworkisongoing.
ThereisarequirementandexpectationthattheCAMHsserviceproviderwilladheretotheprovisionofthenewmentalhealthdatasetanddatawassuccessfullysubmittedtoHSCICforFebruary2016.Wearewaitingforthefirstpublishedextract.
ProgressRating:Satisfactory
12.25DataComplianceWhyisthisapriority?Theserviceproviderismandatedtoprovideandsubmitdataforthenationalminimumdataset.Howwillwedothis:
• Ensuretheserviceprovideriscompliant• Theserviceprovidertoreportelectronicallyagainsttheservicespecificationwhich
reflectstheLTPCAMHsKPIs.ProgresstoDate:Theserviceproviderispartiallycompliantwiththerequirementsoftheminimumdataset.Workisongoingtomeettheserequirements.TheserviceproviderisnotreportingagainstalltheKPIsoftheservicespecificationandforsomeisdoingsomanually.Thismeanstheyarenotincludedinanyminimumdatasetsubmissions.ProgressRating:Un-Satisfactory
Plansfor2016/17• Agreementoflocaloutcomeindicators• MeasureperformanceagainsttheoutcomeslistedintherefreshedLocalPriority
Schemetable.
Plansfor2016/17• Serviceprovidertobecompliantwiththeminimumdataset• Serviceprovidertobecompliantwiththelocalreportingrequirements.
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Areweon-track?Everythingisontrackagainsttheabovemilestones.12.26DevelopingtheWorkforceAim:Thateveryonewhoworkswithchildren,youngpeopleandfamiliesareambitiousforeverychildoryoungpersontoachievegoalsthataremeaningfulandachievable.Theywillbeexcellentinpracticeandabletodeliverthebest-evidencedcare,becommittedtopartnershipworkingandberespectedandvaluedasprofessionals.12.27UniversalservicesWhyisthisapriority?Thereisvarianceintheskillsandcompetenciesofstaffinuniversalservicesandalackofhighlevelco-ordinationofthis.Howwillwedothis:
• Identifyworkforceeducator• Workforceaudit• Workforcestrategy.
Byidentifyingaworkforcedevelopmentleadwhowillleadondevelopingaworkforcestrategyandoverseeitsimplementation.ThisleadwillreportbacktotheEmotionalwellbeingandmentalhealthStrategyGroupandbethefocalpointfortherollinginterdisciplinarytrainingplan.Fundingforthispostwillbeidentifiedinthetrackerin15/16andwewouldlookataninitial18monthpostwithareviewpointtounderstandifthereisstillaneed.Ideallywewouldexpectthistobeatimelimitedposttokickstartthiswork.Thestartingpointwillbeaskillsauditacrossrelevantservices,startingoffinSchoolsandPrimaryCare.Theresultsoftheskillsauditwilldirectlyshapewhattrainingisprovided(basedonneed)andwillbetheethosofidentifyingtrainingneedsthroughoutthelifeofthisplan.RollingtrainingprogrammeswillbeprovidedeitherbyCAMHspractitionersdirectlyorbyexternalorganisationssupportedbyCAMHspractitionerstoallstaffinUniversalChildren’sServiceswiththemesincluding;buildingresilience,recognisingandmanagingstressandanxietyinteenagers,andrecognitionofescalatingorcomplexmentalhealthproblems.Thistrainingwillbeunderpinnedbyraisingawarenessoftheconsultationmodelofdeliveryandhowthisworks,beingclearonrolesandresponsibilitiesacrossservicesandempoweringstaff
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toworkwithinthismodelofdelivery.ThisisakeycomponentofDoncaster’sEarlyHelpStrategy.Fundingisidentifiedinthetrackertofacilitatethisandthisiswhereweplantomakethebiggestspendin2015/16.Therationaleforthisissimple;todevelopaworkforcethatwillprovidethebedrockforfutureservicedevelopments.Commissionerswillworkwiththeworkforcedevelopmentleadtoexplorethepossibilityofan‘InnovationPartnership’wherebyanexternallearningorganisationcansupportdeliveryofevidence-basedandnationallyaccreditedlearning.ProgresstoDate:Theworkforceeducatorservicespecificationhasbeencompletedandtheproviderselected.Thepostcommencedon14thMarchandthefirstfunctionwastocompleteaworkforceauditthatwilldirectlyshapethesubsequentworkforcestrategy.Theauditwascompletedandisanexcellentpieceofwork.Itfocusedonthreeareas:
• School/Academystaff• CAMHs• UniversalServices.
Thereareaseriesofkeyfindingsandsubsequentrecommendationsforeachofthethreeareasthatwillformthebasisofaworkforcestrategy.Thestrategyistobecompletedby30thDecember.Anexistingtaskandfinishgroupwillbethearenatohousethiswork.ProgressRating:Good
12.28TargetedandspecialistservicesWhyisthisapriority?Thereisvarianceintheskillsandcompetenciesofstaffintargetedandspecialistservicesandalackofhigh-levelco-ordinationofthis.Howwillwedothis:
• Trainingstaff.
Byusingthesameethosasforthetrainingofuniversalstaff;needidentifiedbyaskillsauditandthenarollingtrainingprogrammebasedonneed.Examplesofneedlieinpaediatrics.CAMHswillcontinuetheirservicedevelopmentaspartoftheCYP-IAPTprogramme.WorkerswillcontinuetohaveaccesstospecialisttraininginCognitiveBehaviourTherapy(CBT)andsystemicFamilyTherapy(basedonlearningandevaluationofimplementationofCYP-IAPT)andtoregularsupervision,whichwillreinforcethislearningandcontinuetoimprovetheskillswithintheworkforce.Organisationallytheservicewillcontinuetofocusonfullyembeddingtheuseofroutineoutcomemeasuresintoclinicalsupervisionandclinicaldecisionmaking/pathwaydevelopment.
TheCAMHsworkforcewillalsoattendtrainingandfeedbacksessionsfromPeerMentorswhocanadviseandinformregardingyoungpeople’sexperiencesoftheservicestheyhavereceived.Alltrainingwillbeevidence-basedandaccredited.
Plansfor2016/17• WorkforcestrategytobecompletedandagreedbytheMentalHealthStrategyGroup• Implementationoftheworkforcestrategy.
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Paediatricstaffwillbeinvolvedinthetraining,especiallythoseinvolvedincommunitypaediatricstobuildanappreciationandunderstandingoftheinterfacebetweenphysicalandmentalhealth.TheCAMHsinterfaceandliaisonnursewillbepivotaltothisandwillsupportthetrainingofpaediatricstaffthroughprovidingongoingsupportandguidancearoundemotionalwellbeingandmentalhealth.
TherewillbeatargetedprogrammeforChildren’sSocialCarestaffincludingtraininginattachmentandtrauma(buildingontheSocialWorkReformProgrammeagenda).
ProgresstoDate:Thisrelatestothe5.1.ProgressRating:Good
12.29FutureworkforceWhyisthisapriority?Tohaveaworkforcethatisabletodeliverevidenced-basedinterventions.
Howwillwedothis:• ByusingtheplatformoftheCYP-IAPTprogramme.
ByusingtheplatformoftheCYP-IAPTprogrammeasbuildingblockstoensureevidence-basedpracticeisattheheartoffutureCAMHsservicedelivery.Wewillbemonitoringdataacrossservicedeliveryareastoknowlevelsofdemandandtypesofneedandcommissionservicesthatareconfiguredtomeetthisneed.Forexampleweareawarethattherehasbeenanincreaselocallyinthenumberofyoungpeoplepresentingwithdepression,akeyareaofworkforcedevelopmentistocommissiontrainingthatequipsstafftoeffectivelymeetthisincreasedneedusingevidenced-basedinterventions.DoncasterwillberequestingaplaceforoneCAMHspractitioneronaCBTcourseaspartoftheongoingCYP-IAPTprogramme.NorthLincolnshireispartofthepartnershipanditmaybeworthnotingthattheywillberequestingonememberofstaffforCBTandoneforenhancedevidence-basedpractice.Ihaveincludedthecostsforthefullpartnershiponthetracker.
AsapartnershipwearecommittedtoCYP-IAPT.
ProgresstoDate:TheworkforceauditidentifiedtheneedforCAMHstohavegreatercompetenciesinCBT,mentalisationandfamilytherapy.ByusingCYP-IAPTasaplatformtoembedevidencebasedinterventionsintoCAMHs.ThereisonepractitionerattendingtheCYP-IAPTcoursethisyear.ProgressRating:Good
Areweontrack?Everythingisontrackagainsttheabovemilestones.
Plansfor2016/17• WorkforcestrategytobecompletedandagreedbytheMentalHealthStrategyGroup• Implementationoftheworkforcestrategy.
Plansfor2016/17• ContinuetoincreasecompetencieswithinCAMHsviaCYP-IAPT• ProvidetrainingforCAMHsstaffaroundCBT,mentalisationandfamilytherapy.
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Areweon-track?Therehasbeensomedelayingettingtheworkforceeducatorinpost,whichinturnhasdelayedtheworkforcestrategy.LocalPrioritySchemeSummary–Wherewereweattheendof2015.LocalPriorityScheme CurrentStageofImplementation
Establishnamedemotionalwellbeingandmentalhealthleadsinschools(internal)
77%positiveresponsefromschools/academies
Continuousconsultationandengagementwithchildren,youngpeopleandfamilies
DeliveryofengagementworkshopswithCYPandParents
Appointmentofworkforcedevelopmentlead
Workforceauditcompleted.Strategytobecompletedby31stOctober2016(in-linewithLTPrefresh)
Auditandrollingtrainingprogramme AsaboveDevelopan'innovationpartnership’approachwithalocaluniversitytodeliveranaccreditedtrainingprogrammewithnationallyrecognisedmodules
Notintendedfor2016/17implementation
CAMHsworkertobeembeddedintheEarlyHelpHub
Currently1WTEinpostdevelopinglinksandworkingthroughthelogisticsofembeddingintothehub
NamedCAMHsleadsinSchools&PrimaryCare
Allstaffrecruitedtopost(6WTE)andwillgoliveinSeptemberwhenschoolsreturn
Supportingself-care AnoptionspapertobepresentedtostrategygroupinJuly16
Developmentofsinglepointofaccess
ProprietaryworkisunderwaytointegrateCAMHsreferralsintoEarlyHelpHubtoformasinglepointofaccess.Ongoingevolutionofrolesandfunctions.AgreementtomoveCAMHsdutyfunctionsintoaSPOA
Furtherdevelopevidence-base OneCAMHsworkerbookedontoCBTcourse.CAMHssubmittedexpressionofinterestfor2016/17course(s)
ImplementallareasoftheCrisisCareConcordat
24/7crisishelplinewentliveinSeptember2016;CAMHsliaisonandinterfacefunctionmodelagreedwitheightapplicants,expectsomeoneinpostinJuly2016.LiaisonandDiversionserviceisincreasingitsunderstandingofCYPservices.Ongoingregionalworkoncrisisresponsebasedonrecentworkshops.Policecellnottobeusedasaplaceofsafetyfrom1stJanuary2016andlocalsystemsetup.Themappingofallagepsychiatryserviceshasbeencompleted.Exploringlocalcrisissolutionsinparallelwithregional
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workIntensivehometreatmentservicetobeprovided
Servicemodelbeingexploredandallpostsfilled
Expansionofpeermentoringservice FurthertrainingtobeprovidedtodevelopmentorsEnhancethecurrentassessmentprocesstoincludesensitiveenquiries
Auditof50casesfilestocheckcurrentskillsandifthequestionsareroutinelybeingasked
Enhancethecurrentdonotattendpolicy Dipsampleauditofpolicycompliancecompletedandsubsequentfindingsandrecommendationstobeconsidered
Developmulti-agencyteams Notintendedfor2016/17implementation
Improvedcommunitypaediatricservices(incASDandADHD)
BothareNICEcompliant,howevertherehavebeenresourceissuesthathasledtoanincreaseintheautismwaitinglist.Anewcommunitypaediatricmodelhasbeenagreedandfinancialsredistributedtoincreasecapacitywithintheautismpathway
Developmentofdomesticviolencemulti-agencyteams
Multi-agencyteamsareinplace
Provisionofeatingdisordercommunityservices
Servicesbeganon1stMarch2016andthiswillbeaphasedevolutionofservice.Consultantpsychiatrypostisonlynewpostvacant.SYEDAaredeliveringeducationsessions.100%ofCYParemeetingaccessandwaitingtimestandards
RedeploygenericstaffcurrentlyseeingEDcasesnowseenbycommunityteamtoimproveaccesstoself-harmandcrisisandinvestunderspendfromEDfunds
Notintendedfor2016/17implementation
13.RiskstoImplementationTherearesomecontinuedriskstoimplementation,theseareasfollows:WorkforceTherearestillthreepoststoberecruitedtoaspartofthetransformationwithinCAMHs.InadditionbecausesomeofthenewpostshavetakenstafffromthecoreCAMHsservice,thereareagencystaffandstilltwovacancies.ThereisacurrentrisktocoreCAMHsintermsofworkforceandalsoariskintermsofrecruitmenttovacancies.DataTheserviceproviderisnotcurrentlycompliantintermsofdatasubmission.Thisposesarealthreattotheabilitytotrackandmonitorperformancethroughtheperiodoftransformation.
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FinancesThefundingfromNHSEgoesintotheCCGbaseline,whichisarealrisk.Thepublishedallocationis2.38%,howeverwehave3allocations(CAMHsbeingone)thatareinbaseline.Oncethesearetakenout(ifweviewasringfenced)thentheallocationreducesto1.8%.Nationallyguidedincreasesinpensioncostsandlivingwagemeansthatisactualfactweareinanegativepositionjusttofundinflation.ThismeansthereisgreatpressureontheCAMHsallocation.Headroomreserveof1%(approx.£4.5million),whichwehavepreviouslyusedtofacilitateserviceimprovement,andchangenowhastobeheldacrosstheSTPfootprint.Thismeansthatwehavetosetthisasideasmitigationincaseanyprovider(includingacute)don’tmeettheirfinancialrequirements.Thisfurtheraddspressure.Wearespendingapproximatelyhalfourallocationonanintensivehometreatmentserviceyetanysavingsfromreducedtier4activitywillberealisedbyNHSE.CutstoPublicHealthandtheimpactthishasonservices,i.e.HVandSN.TheimpactsofausterityonDoncasterthatisstillreelingfromthepreviousausterity.Thereisaprojectedincreasefromthisfundingsourceyearonyearuntil2010/21,howeveritisnotyetknownifthisistrueadditionalfundingorfromsavingsmadeelsewhereinthesystemthataretoberedistributed.IfthelatteristhecasethenthereisariskbecausethemajorityofthesavingswillsitwithNHSEnglandintermsorreductionintier4admissions.ThenationallandscapefortheNHSisalsounpredictableandfragilewithmanyprovidertrustshavingafinancialdeficit.Thisinturnmakestheredistributionofanyrealisedsavingsverydifficulttoenact.CYP-IAPTFundingTherewasalatereductioninfundingfromNHSEnglandforCYP-IAPTwhichnowplacesaresponsibilityonlocalCCG’stopartfundplaces.Doncasterhascommitted97%ofit’sfundingonrecurrentactivityleavingverylittleleft.Thisadditionalfundinghascomefromthewiderworkforcefundingwhichinturnreducesthatamount.
MitigationofRiskAwaytomitigatetheriskisplanandworkincollaborationwithotherCCG’stoensurewearenotallgoingforthesamestaffandprovidersatthesametime.InDoncasterwehavealreadyformedrelationshipswithRotherham,NorthLincolnshire,SheffieldandotherCCG’sintheareaandthereisacommitmentfromCCG’swithintheYorkshireandHumberStrategicClinicalNetworktoworktogether.Thismaytaketheshapeofregionalcommissioningand/ortimeplanningofrecruitment.
TransformationSupportTosupportthedeliveryoftheplan,itwouldbehelpfultosupportinthefollowingareas:
• Workforce–Support(nationally)toensurethereareenoughpractitionersavailabletofillallthepoststhatareneeded.Itwouldbegreatifemphasiscouldbeplacedontraining more practitioners with skills and expertise in emotional wellbeing andmentalhealth,asthesetypesofstaffunderpinourLocalTransformationPlans.
• Finance–Clarificationonnationalfunding,isthistrueadditionalincomeorexpectedsavings?FundingtocomeintoCCG’stoberingfenced.
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• Collaborative Commissioning – It would be really helpful to jointly explore thepossibilityofanysavingsmadethroughareductionintier4admissionsflowingdownto localCCG’s.Thiswouldallowus to further implement theprinciplesofFuture inMind.
• Continuation of CYP-IAPT – Continued funding to further increase evidence basedpracticeacrossCAMHs.
• DevelopmentofValidatedOutcomeMeasures–Thiswouldbereallyhelpful soascommissionerswecouldhavegreaterconfidenceinmeasuringoutcomes.
• Commissioning Support – From fellow commissioners via the Strategic ClinicalNetwork.
• Evidence Base – Guidance and policies that are evidenced-based, i.e. NICE areextremelyhelpfulinensuringwecommissionevidencedbasedservices.
• DigitalTools/Apps–Itwouldbegreatiftherewasdevelopmentintheefficacyandavailability of digital tools and apps, ideally some that are recommended or evencarryanationalbenchmark.
• Timing – Could we ask that any funding is made available earlier in the year orapportionedoverthefollowingyear,asreceivingfundinglateinthefinancialyearisextremelydifficult.