County Durham Children and Young Peoples Mental HealthEmotional WellbeingTransformation Programme
OCTOBER 2017 REFRESH
No. / Description of project / Alignment with Future in Mind Recs / Planned investment / What project expected to deliver? / Quality / Quantitative / Lead organisation / Lead officer(s) / Partners / Timescale / Key updates / RAG*Resilience, prevention and early intervention
1.1 / Improve access to perinatal mental health care; in line with published guidance / 4 / Awaiting further guidance re allocation / Improved patient pathway based on best practice/evidence
Once national guidance is published the existing working group will amend it’s terms of reference to support the delivery of national guidance / Improved patient experience – self reported measure
Improved family experience, particularly young carers (self-reporting measures with young carer groups) / Early recognition and intervention to prevent deterioration of mental health;
Improved outcomes for the service users and their family (routine outcome measures)
Reduction in in-patient admissions / CCG / MH (NECS)
NH (TEWV) / ND CCG
DDES CCG
TEWV CDDFT / 2018/19 /
Antenatal and postnatal mental health: clinical management and service guidance - NICE guidelines [CG192]Published date: December 2014
Last updated: June 2015
Review date 2018
Improving access to Perinatal Mental Health Services in England – A review published August 2015 (NHS Improving Quality)To be captured within CCG work programme; NHSE guidance states
allocation for improving perinatal MH will be made separately and commissioning guidance will be published before the end of the financial year – still awaited
Antenatal and postnatal mental health NICE quality standard [QS115]Published date: February 2016
We have mapped out current community perinatal mental health provision, identified gaps and developed an outline business case
We have set up a perinatal mental health steering group to review the current position and develop a specialist community pathway (refine business case)
We will submit a bid in 2017/18
1.2 / Identify all aspects of the Children and Young People’s Mental Health – prevention and early help support pathway / 1 / Yes / The overall aim of the project is to increase capacity in the Children and Young People’s Mental Health – prevention and early help support pathway (i.e. front end of the children and young people’s mental health pathway) to improve access to early help and intervention, broaden choice, expand self-help, peer support and extend reach to vulnerable and under-represented groups; scope to link with the refresh the local offer. / More children and young people will have good emotional wellbeing and mental health; they are resilient and equipped to manage life challenges via survey / Reduction in referrals to specialist services / CCG / MH (NECS)
VT (ND CCG)
GO (PH) / ND CCG
DDES CCG
DCC
TEWV / 2017/18 / An initial scoping exercise has been undertaken to start to explore the capacity in the prevention and early help support pathwaywith the aim of understanding where there are pressure points in the system.
The overall aim of the development of a prevention and early help support pathway is to provide a coherent offer to CYP and families that:
- reflects the voice of the child and family
- is easy to access
- provides a single point of contact for assessment and triage
- enables an easy to navigate menu of services to meet identified needs
A task and finish group has been established to define and communicate local “offer.
1.3 / Improve access to bereavement care for children and young people / 1 / Yes / The overall aim is to increase capacity to provide timely and appropriate support and counselling to children and young people who have experience bereavement. / Children and young people report being more resilient and able to effectively cope with a bereavement / More children and young people who have been bereaved will have access to timely support / PH / MH (NCES)
GO (PH) / DDES CCG
ND CCG
DCC / Ongoing / Successful procurement of the service to St Cuthbert’sHospice and the service was implemented for 1 year from April 2017.
The bereavement service provides easily accessible and culturally appropriate post intervention and bereavement counselling and support for the children and young people of County Durham. The service is provided by appropriately qualified counsellors and trained staff and volunteers and offer.
- Bereavement counselling after the death and or suicide of a relative or friend
- Children counselling after the death of parents, siblings, relations or friends
1.4 / Improve the capacity for prevention and early intervention in schools/education settings by embedding the emotional health and resilience nurses into the 0-19 growing healthy service. / 8.3 / No / Public health have invested in five emotional resilience nurses as part of the school nursing service specification across County Durham; the emotional resilience nurses offer community drop in support alongside the Specialist Community Public Health Nurse teams, and will to work towards a ‘one stop shop’ philosophy as outlined in Future in Mind / 5 Resilience Nurses employed by TEWV and co-located within 0-19 teams (1 per locality) / Promotion good mental health and wellbeing and identify problems early / PH / GO (PH)
NH (TEWV)
MB (DCC)
MH (NECS) / DDES CCG
ND CCG
DCC / Ongoing / Networking and awareness raising with teams regarding role and responsibilities
ERN to establish needs of local services and establish any gaps in service provision
ERN to establish communications with all Secondary Schools to introduce their role and responsibilities
Prioritising communication with partners to establish priorities and services available and gaps in service provision
1.5 / Promote Solihull antenatal infant attachment programmes and parenting support and promote nurturing information within the 0-19 service growing healthy programmes / Work to strengthen the antenatal pathway to identify vulnerable children and families and areas of concern in infant attachment with the initiation of early response. The 0-5 healthy child programme also provides a context for identification of areas of concern and development of integrated assessment and closer working across health visitors and early years staff. / Data base developed to record staff training / Families supported in early response / PH / MB (PH) / DCC
ND CGG
DDES CCG
HFT / 2017/18 / 0 – 19 growing healthy team have undertaken significant training in their health visitor work force. There remains a gap in midwifery teams being trained
1.6 / Support ‘Time to change’ anti-stigma campaign / No / Improve public awareness and understanding of mental health. / PH / MB (PH) / DCC
ND CGG
DDES CCG
HFT
Investors in Children (VCS) / Ongoing / Development of awareness sessions within local settingsare now in place. Strong link with VCS through investors in children
1.7 / Review of Early Intervention Psychosis pathway / No / As part of the work towards implementing the access and waiting time standards for first episode psychosis, the young person’s pathway will be explored. / CCG / MH (NECS)
DW (TEWV) / ND CCG
DDES CCG
TEWV
DCC / Ongoing / Early Intervention in Psychosis (EIP) - The CCG has also worked successfully with Tees, Esk & Wear Valley NHS Trust s in County Durham to commission an EIP service for the full age range that ensures people are assessed and received NICE concordat treatment within 2 weeks of referral. The provider is positively `shadow` reporting this access and waiting time target, including those who present in generic mental health services, until it will be formally monitored from April 2017.
Improving access to effective support
2.1 / Develop and implement a model for peer support for parents/carers / 11 / Yes / The overall aim is to develop a model for supporting parents/carers who are caring for a child with emotional and mental health issues.
The following elements will be taken into consideration:
1. Parent/carer advisory group
2. Parent support groups
3. Targeted parent peer supporters training
4. Children’s workforce engagement and recruitment of parent mental health champions
5. Wider network of parents and social media campaign / Children and young people who feel they have someone to turn to when they are worried
Young people feel more supported / More children and young people will have access to peer support;
Families will have access to increased support
Number of peer mentors / PH / MH (NCES)
GO (PH) / ND CCG
DDES CCG
DCC / 2015/16
Ongoing / A parent support network is being funded, which aims to build a peer support network for parents and carers whose children are experiencing mental health problems. The network is based on a range of mechanisms including personal peer networks, social media and the development of an e-network and website.
The project seeks to expand existing networks where possible and link in with national campaigns, working closely with Young minds, Time to Change and other national programmes as well as promoting the use of MindEd resources for parents.
We are now establishing a continuity/ sustainability of programme for the forthcoming 2 years. / CONTRACT MONITORING
2.2 / Embedding of enhanced Community EatingDisorder Service for Children and Young people and monitoring of access and waiting times / 13 / Yes / The overall aim is to enhance the existing Community Eating Disorder Service for Children and Young People (CEDS-CYP) to be compliant with the new access and waiting time standards for children and young people with an eating disorder.
Build capacity in the community eating disorder team by enhancing the service in terms of staffing numbers and skill mix in in line with the Joint commissioning guidance from NHS England and the National Collaborating Centre for Mental Health (NCCMH) defines best practice model of care and waiting and access standards. / Number of urgent cases seen within 1 week & routine cases within 4 weeks
(Aspirational target: 95 per cent of patients being seen within four weeks or one week for urgent cases by 2020) / More children and young people will access to the Community Eating Disorder Service;
Implementation of waiting time standards;
Improved outcomes;
Reduced potential for in-patient admission / ND CCG / MH (NCES)
DC (NECS) / ND CCG
DDES CCG
TEWV / 2015/16
Ongoing / Business as usual – contract monitoring.
Provider & Commissioner UNIFY returns required.
We will now using the expanded team; provide development and training to staff in education, primary care, social services, paediatrics, and other agencies enhancing their skills and competencies to meet the emotional, psychological and social development needs of CYP with eating disorders. / CONTRACT MONITORING
2.3 / CAMHS Crisis 24/7 provision / 12 / Yes / Following the successful CAMHS Crisis and Liaison Service pilot; this project aims to deliver a flexible and responsive service 24/7, 365 days a year, for children and young people experiencing a mental health crisis. / Feedback from children and young people / Comprehensive assessment for children and young people in crisis within 4 hours of referral;
Crisis resolution reducing the need for hospital admissions / ND CCG / MH (NCES)
DC (NECS)
CS (ND CCG / ND CCG
DDES CCG
TEWV / 2015/16 / All three CCGs have recently committed to increase funding to deliver a 24/7 crisis service model.
The funding for the 24/7 service has been agreed and the service specification is written.
Now fully operational and offering a 24/7 service.
We will now using the expanded team; develop and support other professionals by providing open support via telephone to the wider children’s workforce, support and access to clinical advice for Durham Police force Support and access to clinical advice for Acute hospital staff. / CONTRACT MONITORING
2.4 / Develop a model for intensive home treatment (IHT) (potentially linked with the crisis service model) for children and young people with complex needs
CYP Safe Space / 13 / Yes / This project involves piloting a CAMHS intensive home treatment/support service and exploring an integrated service model with CAMHS crisis and liaison. / N/A / N/A / ND CCG / MH (NECS)
DS (TEWV)
DC (NECS) / ND CCG
DDES CCG
TEWV
Success North / Ongoing / The evaluation into the crisis/liaison services showed that the service reversed an increasing trend of admissions through A&E, significant cost reduction in use of paediatric beds and a reduction in Tier 4 use. The evaluation shows an indicative net return on investment of 53% of team costs.
The service is currently evaluating the IHT pilot, early evidence supports that IHT continues to positively impact on the reduction of inpatient bed use.
The CCG are awaiting the outcome of a submitted bid to seek funding for the development of a CYP Safe Space.
The proposal will build on partnerships with VCS to strengthen the current intensive home treatment provision by providing a community hub where young people and their families can access intensive support
2.5 / Deliver the Resilience in Schools Programme along with the Youth Aware Mental (YAM) / 8.3 / NO / Work is well advanced, led by Public Health and DCC Education, to roll out a resilience programme for 75 schools in County Durham. / YAM roll out to all County Durham Secondary Schools. / Annual training programme developed for YAM instructors and helpers / DCC / PM (Ed Psych)
GO (PH) / DCC
Schools / 2017/18 / Continue to focus on strengthening the work to support schools in delivering the resilience and YAM.
We have worked with 25 schools per year to develop and refresh resilience plans and practices.
Establish Multi-agency YAM ‘Train the Trainer’ Programme
2.6 / Provide a ‘universal offer’ to schools of quality assured and reviewed programmes / 8.3 / NO / Develop a framework that schools can adopt – to support them to evaluate the programmes they deliver. / Schools and young people engaged in a process of co-production around how programmes for education are developed and evaluated / Engage schools and young people in a process of co-production around how programmes for education are developed and evaluated / DCC / PM (Ed Psych)
GO (PH) / DCC
Schools / 2018/19 / Consider developing a lead provider framework for schools where accredited training was subsidised
2.7 / Ensure education staff have appropriate professional development opportunities and access to approved online support tools / 8.3 / NO / Establish locality Wellbeing and Resilience networks to bring together school Leads and partners working to support the mental health and EHWB of young people in that area
County Durham minded resource page to provide easy access tools and materials / All Durham Schools have an identified Wellbeing and Resilience Lead.
Schools to be using consistent tools from MindEd / DCC / PM (Ed Psych)
GO (PH) / DCC
Schools / 2018/19 / Combine training offer to schools – Identify training programmes and resources promoted with all schools
Care of most vulnerable
3.1 / Children and Young People’s Autism Pathway / 15, 21 / Subject to scoping / To increase capacity to reduce the wait to treatment with particular focus but not exclusive to Children & Young People waiting an assessment for autism spectrum disorder
To offer an effective triage process and support while waiting for a diagnosis / Improve timely access of assessments
To support families while they await diagnosis / Reduce waiting times for assessment to the national standard and NICE compliant / ND CCG / AA (NECS)
DS (TEWV) / ND CCG DDES CCG
DCC
TEWV / 2018/19 / One element of the work will focus on those currently on the waiting list; getting them assessed as soon as possible and a diagnosis formulated. The second element will focus on the longer term to ensure that the waiting times do not creep up again. This will require all organisations involved to undertake some process improvement work on the pathway together. The outcome of this will be presented to CCGs for decisions on implementation
3.2 / Forensic CAMHS / 15,19 / Yes after 3 year point / Supporting a more cohesive and collaborative approach to the development of services with Health & Justice commissioning leads and CCG Commissioners
Developing an implementation Plan for the North East and Cumbria CAMHS Forensic Outreach Service that will seek to address the needs of this group of young people across the patch.
Agree that the forensic outreach service, when implemented, will support coordination of service provision across multiple providers and often over large geographical distances, in a consistent manner / Needs completing / Needs completing / Health & Justice / CB (NHSE)
MH (NECS) / ND CCG
DDES CCG
DCC / 2018/19 / Locally to support the national agenda we will need to:
Multi-agency pathway review to ensure this vulnerable group of young people have their needs addressed..
3.3 / Develop support to meet the needs of vulnerable population groups and their siblings including:
Looked after children, care leavers, young people who offend, young carers, children and young people with special educational needs or disabilities / 8.10 / NO / We will ensure the mental health and wellbeing needs of young people who are Look after Children (LAC) and care leavers are being met.
Undertake a review of the mental health needs of children who are looked after or care leavers.
Ensure clear pathways of support are embedded to support the mental health needs of vulnerable young people. / Ensure pathways are in place for:
- Young people who offend
- Young Parents
- those who have suffered abuse or neglect
- Young people educated outside of mainstream education
- LAC &Care Leavers
- Young Carers
- Young people with SEND
- Young people with Autism Spectrum Disorder
- Young people at risk of permanent exclusion
- Young people who are LGBT
- Young people from the GRT community
ND CCG
DDES CCG / 2018/19 / We have identified criteria for gaining Young Carers Status and develop and establish a Young Carers Pledge.
We have also developed a dedicated policy for Young Carer’s