HERTFORDSHIRE COUNTY COUNCIL
CHILDREN’S SERVICES AND CORPORATE PARENTING
CABINET PANEL
WEDNESDAY 10 NOVEMBER 2010 10.00 AM
REVIEW OF CHILD, ADOLESCENT MENTAL HEALTH SERVICES (CAMHS) – PROGRESS REPORT
Report of the Director of Children, Schools and Families
Author: Frances Coupe Tel: 01992 555815
Executive Member:- Jane Pitman, Lead Member, Children’s Services
1. Purpose of report
This report is to inform the panel of the progress made with the Children’s Services Transformation (CST) review of CAMHS services funded by the CSF contribution to the CAMHS pooled budget, which is being taken forward by the CAMHS Commissioning Group. Proposed improvements include a specific focus on CAMHS services for children looked after (CLA).
2. Summary
Child Adolescent and Mental Health Services (CAMHS) are funded by a pooled budget with NHS Hertfordshire with a total value of
£14,124,370 for 2010/2011. The pooled budget is made up of the following contributions from NHS Hertfordshire and Children, Schools and Families.
Table 1
Commissioner / Value 2010/11NHS Hertfordshire / £11,815,128
CSF / £2,309,242
Total / £14,124,370
2.1 The pooled budget supports a comprehensive range of services across Tiers 2-4 that provide support for children and young people with emotional health needs. These include:
· Therapeutic support for a range of emotional disorders
· In patient care for eating disorders
· Specialist support for CLA
· Primary Mental Health Workers in schools
· Challenging Behaviour service
· Counselling in schools and within the voluntary and community sector
· Anti bullying support
Hertfordshire Children’s Trust Partnership (HCTP) is currently accountable for the CAMHS services with the County Council (HCC) being the Accountable Body. A CAMHS Commissioning Group, made up of representatives from NHS, CSF and Public Health, is responsible for making decisions about the CAMHS budget, ensuring robust performance arrangements of CAMHS providers are in place and that activity is regularly monitored.
The services funded through the CAMHS budget contribute to HCTP’s Children and Young Peoples’ Plan (CYPP) Priority 4: Children and Young People’s Emotional Wellbeing and Mental heath are well supported.
4.2 It is the CSF contribution of £2,309,242 that is being reviewed a part of the Children’s Services Transformation (CST) Programme. This is made up of the following income streams:
Table 2
CSF contributions to CAMHS pooled budget
Budget / AmountArea Based Grant / £1,517,242
HCC Base Budget (social Workers) / £792,000
3. Recommendations
The panel is asked to note the progress with the review and comment on the proposals for service improvement and efficiency savings.
4. Background
4.2 Nationally it is reported that more than one in ten (11.5%) children and young people have a clinically diagnosed mental health disorder. Around 2% had more than one disorder. Applying the prevalence rates to the latest estimated population, gives the projected numbers of children and young people with emotional health and well being needs in Hertfordshire.
Table 3
Mental health problem / Females / Males / Total / % Total PopnEmotional Disorders / 3,624 / 2,643 / 6,267 / 3.9%
Conduct Disorders / 3,254 / 6,166 / 9,420 / 5.9%
Hyperkinetic Disorders / 312 / 2,045 / 2,357 / 1.5%
Eating Disorders / 437 / 114 / 551 / 0.3%
Psychoses / 54 / 55 / 109 / 0.1%
Less Common Disorders / 250 / 48 / 298 / 0.2%
4.2 CAMHS Commissioned Services
CAMHS is a budget that supports a wide range of services across Tiers 2-4 to support the emotional wellbeing of children and young people. The budget provides funding for a variety of Providers from all sectors, including the voluntary and private sector. Some of these services include:
4.2.1 The Lakes Adolescent Resource Centre (ARC) in Welwyn Garden City is a new countywide service that provides intensive support to young people aged 12-18, whose needs are proving to be beyond the resources of existing services. CAMHS Commissioning Group has funded two Emotional Health and Mental Well-Being Workers to provide full-time targeted support to the children who use the ARC. These workers will sit within the existing Step 2 service and benefit from being part of a multi disciplinary team.
4.2.2 The development of the Early Intervention Service – Step 2 (Appendix 2), alongside additional provision from universal to specialist support. It is important that a comprehensive CAMHS service is seen across all level of provision as detailed below: This service was launched in July 2010 and early monitoring is extremely positive.
4.2.3 Healthy Schools Post - This post works within CSF’s Health and Well Being team to take a strategic lead on mental health and well being and the authorities anti bullying initiatives
4.2.4 Action for Children Protective Behaviours Training to parents/carers and children, alongside training and development for staff working with children and young people.
4.2.5 Counselling in school services to support transition from Primary to Secondary school, alongside emergency support where required.
4.2.6 Community counselling provision within a range of VCS settings delivering counselling services across Hertfordshire for 13 - 19 year olds.
4.2.7 Primary Mental Health Workers within the Behaviour Support Team (MAPS)
4.2.8 Tier 3: Hertfordshire Partnership Foundation Trust (HPFT), - Child and Family Clinics, Targeted Service for Looked After Children, Harper House, Adolescent Outreach Team, and Community Eating Disorder Service.
4.3 Review of Services Provided by HPFT
CAMHS Commissioners began a review of the services provided by HPFT, the main CAMHS provider, in April 2010. The review of the CSF funded elements of the CAMHS budget is included in the Children’s Services Transformation Programme, with savings targets as set out in the table below.
Table 4
Year / Target2011/12 / £100,000
2012/13 / £200,000
2013/14 / £200,000
Total / £500,000
These savings are in addition to the saving of £178,000, which is already in the IPP budget for 2011/12. The required savings have been agreed provisionally with CAMHS Providers, and new contracts are currently being negotiated. These include a £226,000 reduction in CSF’s contribution to HPFT over the last two years of the current contract ( the current contract ends in March 2013) and a saving of approximately £135,000 for the provision of therapeutic input in to the Adolescent Resource Centre (ARC) as a result of identifying more appropriate support through a new service provider at a reduced cost.
5. Progress with the Review
5.1 A Task and Finish Group has been brought together to focus on the CSF elements of the HPFT Contract. The Task and Finish Group reports to the CAMHS Commissioning Group. The review has focused on two key areas of service delivery within HPFT:
· Provision of specialist support for CLA
· The role and function of HPFT social workers transferred from HCC in 2002
5.2 HPFT service for CLA
The key objective of this review is to improve outcomes for CLA and children who are on the edge of care.
Consultation has taken place with a range of stakeholders to help develop a new service specification for the HPFT CLA service. To meet the changing needs of these children it is clear the service provided by HPFT needs to be much more flexible, based on an outreach model, and with a strong focus on work force development and working with parents and carers. There also needs to be much stronger links with Tier 2 services ( such as counselling and behaviour support) as not all CLA will require a specialist intervention by HPFT.
CSF’s commissioning team carried out a brief survey of recent referrals from CSF Social Care and CSF CLA teams (over the last 12 months) to HPFT to identify trends in the types of referrals being made and whether these referrals are being accepted.
The following is a summary of findings:
· There has been an increase in referrals for sexualised behaviour
· There are very high levels of referrals for challenging behaviour and a very mixed response from HPFT to these referrals
· Referrals for rape counselling have generally not been accepted
· There is inconsistency in terms of responding to children “in transition” and the types of therapy/support available for them
· Referrals for suicidal thoughts and self harm appear to be mostly accepted
· There is demand for family therapy and support that is currently not being met
The above findings have been reported back to HPFT with the intention that skills gaps and expertise amongst their workforce are addressed to ensure gaps in service can be met. In response to the findings, a new CLA CAMHS Service Specification has been developed. New job descriptions (Appendix 3) have been drawn up for staff involved in the service. The new service model has been presented to HPFT with a formal response due January in 2011. CAMHS Commissioners will be progressing contract negotiations with HPFT to agree the service redesign and transition plan.
5. 3 The Role and Function of HPFT Social Workers Funded by CSF
Originally 22 social workers were transferred from CSF to HPFT in 2002. These Social Workers provide social care assessments and interventions to children and young people aged 5-18 within the Specialist Child & Family Clinics. There is no written record or evidence of an agreement outlining their roles and function but the assumption has been that they carry out a social work role within a more therapeutic setting.
These roles have not been reviewed since 2002 and, of the 22 staff originally transferred to HPFT only 10.8 WTE remain in post. The others have since left HPFT and been replaced by new staff who are employed on HPFT’s terms and conditions. It was therefore timely and appropriate to develop a new job description for all staff, working as part of a multi-disciplinary mental health team. A copy of the draft is attached as Appendix 3. This is currently being negotiated with HPFT for implementation from April 2011.
6. Financial Implications
6.1 The review of CAMHS will achieve a saving of £678,000 over the period 2011-14.
7. Conclusion
Good progress is being made in reviewing and commissioning CAMHS services to meet the emotional wellbeing and mental health needs of children and young people in Hertfordshire.
Background Papers
Appendices:
1. Draft Children Looked After CAMHS Service Specification
2. Step 2 Early Intervention’s Service Specification
3. Social Worker – Job Description
1