Report to Children and Young People Partnership

AGENDA ITEM

REPORT TO CHILDREN AND YOUNG PEOPLE PARTNERSHIP

21 JULY 2015

REPORT OF THE DIRECTOR OF PUBLIC HEALTH

CHILDREN & YOUNG PEOPLE’S EMOTIONAL AND MENTAL HEALTH STRATEGY – STOCKTON LOCALITY TRANSFORMATION PLAN

Summary

The purpose of the paper is to provide and update on the recent publication of ‘Future in Mind and discuss the implications for local implementation and how this aligns with the local children and young people's emotionalwellbeingplan for Stockton-on-Tees.

Within the Future in Mind, it specified that areas will be required to develop a Local Transformation Plan. Within Tees, work had already been undertaken to develop a Joint Tees Children and Young People’s Emotional and Mental Health Strategy (CYP EMH), and within Stockton a local action plan (Appendix On) has been developed to deliver this strategy, that has previously been discussed by the CYPJCG.

The CYP EMH action plan has been amended to reflect the requirements of “A Future in Mind” and the partnership is asked to recommend its adoption as the local transformation plan for Stockton-on-Tees. To ensure coordination of all current work, is the action plan has also been mapped to the forthcoming children and young people’s mental health needs assessment, which will shortly be discussed at the CYPJCG.

It is also expected that the plan will directly link into the task and finish group recently agreed by the health and wellbeing board to develop a wider mental health implementation plan for all age groups.

Recommendations

1. The partnership and its members are asked to adopt the action plan and recognise it as the local transformation plan to address the emotional and mental health needs of children and young people within Stockton-on-Tees.

1. The partnership are asked to identify a lead person coordinate the implementation of this action planwho can also act as a link into the wider task and finish group of the HWBB that is developing an overarching plan for mental health and wellbeing.

1. Members of the partnership consider developing work plans to address the actions that they are responsible for and the timescales that these may take
   

Background

Significantemphasishas been placed on addressing mental health both locally and nationally. It is estimated that one four people suffer from ill mental heal with nearly half of all diagnosable mental health problems commencing by the age of 14.

TheGovernmentpublication No Health Without Mental Health set a national strategy for improving mental health. Six key principles are set out in No Health Without Mental Health which are:

• More people with mental health problems will recover: More people who develop mental health problems will have a good quality of life – greater ability to manage their own lives, stronger social relationships, a greater sense of purpose, improved chances in education, better employment rates and a suitable and stable place to live;
• More people with mental health problems will have good physical health: Fewer people with mental health problems will die prematurely, and more people with physical ill health will have better mental health.
• More people will have a positive experience of care and support: Care and support, wherever it takes place, should offer access to timely, evidence-based interventions and approaches that give people the greatest choice and control over their own lives, in the least restrictive environment, and should ensure people’s human rights are protected
• Fewer people will suffer avoidable harm: People receiving care and support should have confidence that the services they use are of the highest quality and at least as safe as any other public service
• Fewer people will experience stigma and discrimination: Public understanding of mental health will improve and, as a result, negative attitudes and behaviours to people with mental health problems will decrease.

Further to this, a jointNHSand Department of Health publication “Future in Mind” sets out anapproachfor theNHSboth locally and nationally to address mental health of children and young people.

‘Future in Mind’ is a report of the work of the Children and Young People’s Mental Health Taskforce. It makes a number of proposals the government wishes to see by 2020. These include: tackling stigma and improving attitudes to mental illness; introducing more access and waiting time standards for services; establishing ‘one stop shop’ support services in the community and improving access for children and young people who are particularly vulnerable.

The report emphasises the need to join up across Education, Health, Care to ensure that the offer to children, young people and families is comprehensive, clear and utilises all available resources.

The report followed the announcement of an additional £1.25bn investment. However it is unclear how this will be allocated locally. Further guidance is expected from NHS England. The preparation for this will be the development of a transformational plan.

NHS England have published draft guidance received in May and July which indicates that funding to be allocated for 15/16 and will require a transformational plan to be developed and signed off by Health and Wellbeing Boards by September.

The following objectives will be focussed on 15/16; developing evidence based community, Eating Disorder Services for children and young people and roll-out of the Children and Young People’s Improving Access to Psychological Therapies programme (CYP IAPT).

Final guidance is due to be received 20th July and local transformation plans should span 2015-20 and cover Future in Mind recommendations.

In addition Directors of Public Health have received a letter form NHS England encouraging joint working and support for Health and Wellbeing Board sign off.

Future in Mind identifies key themes fundamental to creating a system that properly supports the emotional wellbeing and mental health of children and young people.

The themes are:

• Promoting resilience, prevention and early intervention
• Improving access to effective support – a system without tiers
• Care for the most vulnerable
• Accountability and transparency
• Developing the workforce

Areas will be required to develop a Local Transformation Plan which will concentrate on achieving these aspirations. The Plan will require that we change the way we commission services and will directly impact on this service in the following ways:

Transparency: A requirement for providers to declare what services they already provide, including staff numbers, skills and roles, waiting times and access to information.

Service transformation: A requirement for all partners, commissioners or providers, to sign up to a series of agreed principles covering: the range and choice of treatments and interventions available; collaborative practice with children, young people and families and involving schools; the use of evidence-based interventions; and regular feedback of outcome monitoring to children, young people and families and in supervision.

Monitoring improvement: Development of a shared action plan and a commitment to review, monitor and track improvements towards the Government’s aspirations, including children and young people having timely access to effective support when they need it.

There is a clear requirement for the LA & CCG to collaborate and ensure there is clear lead commissioning arrangements for children’s mental health.

Within the detail of “Future in Mind”, there are a series of themes identified, and NECS, on behalf of the CCG, and as lead in coordinating the original Tees CYP EMH action plans have summarised these themes from a CCG perspective. This includes outlining how we are currently placed locally. This update has been included in appendix two, however, as outlined earlier, the specific recommendations have been incorporated and aligned with the actions listed in the locality action plan p[provided in appendix one.

FINANCIAL AND LEGAL IMPLICATIONS

1. Outcomes of commissioning decisions in the future may highlight the need for service development / different commissioning models in order to continue to meet the needs of children and young people.
2. There are no specific legal implications of this proposal.

RISK ASSESSMENT

Recommendations within the action plan may have the potential to impact on services and partnership members and risk assessment of specific actions should be considered when partners are developing work plans to address these.

CONSULTATION

The local children and young people's emotionalwellbeingplan for Stockton-on-Tees was produced by a multi-agencyworking group which included consultation. The strategic work plan for the Tees-wide strategy also outlines areas & responsibility for future consultation regarding the pan. Consultation with key stakeholders has also been undertaken as part of the Children and Young People’s Mental Health Needs Assessment which also aligns to this plan.

Name of Contact Officer:Mark McGivern

Telephone No:01642 528706

Email Address:

Appendix 1 - Joint Tees Children and Young People’s Emotional and Mental Health Strategy (CYP EMH) - Stockton Locality Plan

Joint Tees Children and Young People’s Emotional and Mental Health Strategy (CYP EMH) - Stockton Locality Plan

Tees Strategy Action / Future in Mind Reccscovered/ requires consideration / CYP MHNA Recs / Local Stockton Action / Responsible / Deadline / Progress/Comments
1. More children and young people will have good mental health
1.1 Ensure effective commissioning and delivery system for C&YP mental health across Tees Valley, informed by smart use of data and participation of C&YP / 16, 17, 20, 21, 23, 24, 25, 26, 28, 30, 31, 32, 33, 35, 36, 37, 38, 39, 46, 47, 48, 49 / 1,2,8,10,11 / Undertake a health needs assessment for mental health and wellbeing of C&YP / Sub-group CYPJCG
Feed outcomes of HNA to commissioners to inform service development process.
Agree clear HWB governance and accountability for the development and oversight of this plan. / CYPJCG
Produce a clear ‘offer’ to schools, children and young people and other stakeholders to support mental health and wellbeing and communicate (including referral pathways) to all relevant stakeholders / Task-and-finish group of CYPP / Should be linked to developing and communicating clear Early Help offer
Produce a commissioning framework for mental health and wellbeing based on HNA outcomes, particularly focused on prevention / CYPJCG / Framework to encourage collaboration between providers; and tendering by specialist organisations
Work with Catalyst to produce guidance to support VCS organisations re: capacity-building to bid for the framework contract; and to specify areas of the framework the VCS could bid for and expertise required / Task-and-finish group of CYPP / Including encouraging specialism of VCS organisations and encouraging consortia bids where appropriate
Work with providers to encourage diversity of provision and reduce duplication of services offered / Task-and –finish group of CYPP
Work with providers (both commissioned and SBC-provided services) to ensure data is routinely collected, analysed and reported, to enable effective contract monitoring, service development and commissioning including national wait times / LA/CCG / Include in contracts as needed. Develop requirements in liaison with CCG work to develop dataset with TEWV
1.2 Improve identification and support to reduce maternal depression and improve perinatal mental health / 1, 4 / Work with partners to identify need, current provision and gaps in services regarding maternal mental health / CCG with Public Health input – maternity services & GP
NHSE & LA PH – health visiting / October 2014 report to C&YP Partnership / Commissioning health visiting services transfers to the responsibility of Local Authority Public Health in October 2015
Use contractual levers with providers to incorporate routine assessment of maternal mental health and referral / signposting to services according to need / CCG – maternity services NHSE & LA PH – health visiting / Ongoing
Use data to focus efforts on the most vulnerable families / CCG - maternity services & GP
NHSE & LA PH – health visiting / Ongoing
1.3 Build capacity within NHS and LA services (commissioned services and directly provided services) to deliver targeted interventions / 2, 9, 27, 40, 41, 42, 43, 44, 45 / 5,7 / Identify key frontline services requiring additional training, in-line with Early Help Strategy and HNA / CCG
Continue roll-out of training for schools staff through TAMHS contract / LA - CESC / End March 2014
Scope roll-out of mental health first aid training (including dementia) across SBC employees / LA - PH
Develop evidence-based learning programme for frontline staff, building on / maximising existing training available in settings e.g. through TAMHS and CAMHS. To include on understanding and identifying mental health problems, resilience and information on available services / CCG NHSE / LA PH / NB - Community Learning Service may be able to support this through accessing funding from SFA
1.4 Develop and coordinate parenting support / 1, 4 / 10 / Develop agreed approach to parenting programmes as part of early intervention offer, in-line with Fairer Start work and with clear pathways with Early Help programmes / LA – PH & CESC
Explore benefit / feasibility of commissioning parenting programmes across more than one LA area / LA - PH & CESC
1.5 Improve proportion of children who are school ready improving attachment, bonding and attunement, particularly in the most vulnerable families / 1,4 / 10 / Roll out Fairer Start work, focusing on -9 months to 2yrs / Fairer Start Steering Group / Impact on social and cognitive development and mental / emotional health. Covers work with midwifery, health visiting, Children’s Centres
Roll out 2yr old offer / LA - CESC
Explore need for enhanced training with early years providers re: attachment / bonding / attunement / LA - CESC
2. More children and young people with emotional / mental health problems will recover
2.1 Develop VCS capacity to provide early intervention support / 8 / Develop VCS capacity through A Fairer Start and mental health commissioning framework as described in 1.1 and 1.4 above / LA / Particularly for less accessible groups and older adolescents
2.2 Support education setting to make available high quality universal support and targeted interventions, including greater access to consultation from specialist CAMHS / 4 / Commission new school nursing service, to ensure delivery of support (universal and targeted) as part of the Healthy Child Programme / LA - PH / Will deliver in school and other settings
2.3 Improve support to C&YP in transitions years, particularly between services for pre- and post-16yr olds, Primary-secondary, Secondary- +16, CAMHS-AMHS, Care leavers / 15 / 8 / Undertake CHIMAT transitions tool with CAMHS service and with social care (children’s and adults’ services) / CCG / LA – CESC
Use outcomes of tool to develop clear pathway of support between services for children and young people and those for adults / CCG / LA - CESC / Consider particularly where services are available up to age 25yrs. Particularly include support from GPs
Understand whether work is needed to improve pathways between pre-school years and school / CCG / LA - CESC
Further actions TBC based on outcomes of HNA / CYPP
2.4 Ensure appropriate, accessible targeted support is provided for vulnerable groups e.g. Young offenders, Looked After Children (LAC), Children in Need (CIN), Special Educational Needs (SEN), Learning disabilities / 10, 14, 23, 24, 25, 26, 28, 29, 34 / 5 / Develop clear offer for C&YP with SEN, building into Education, Health and Care Plan / CCG / LA - CESC
Understand whether specific work is needed to improve pathways between services for children and young people and those for adults, for people with learning disabilities / CCG / Understand whether specific work is needed to improve pathways between services for children and young people and those for adults, for people with learning disabilities
Analyse current support to LAC and CIN (both assessment and treatment) and define optimum support model, ensuring mental health support is part of an integrated service to LAC and CIN / CCG / LA - CESC / See also 5.2 below
Further actions TBC based on outcomes of HNA / CYPP / E.g. re: Black and Minority Ethnic groups, C&YP with eating disorders, C&YP with substance misuse issues
3. More children and young people with mental health problems will have good physical health and more children and young people with physical ill-health will have better mental health
3.1 Establish a clear link locally between services to improve and protect mental health; and those for physical health / 10 / 8 / Feed into Scrutiny review regarding link between arts, leisure and culture, and mental health and wellbeing / All partners
Account for link between mental and physical health in commissioning services; and vary into existing contracts where needed / All commissioners / E.g. family weight management service
Develop clear and effective referral pathways between key services, particularly for C&YP with a disability or long term condition / CCG /LA
4. More children and young people will have a positive experience of care and support
4.1 Develop, clarify and refine pathways, to provide a clear, cohesive, accessible offer for mental health and wellbeing support / 6, 7, 8 / 6,8 / Clarify referral criteria and pathway between TaMHS and CAMHS service and communicate to stakeholders / CCG & LA / In liaison with providers
Develop most effective focus for targeted CAMHS service in Stockton Borough, accounting for TAMHS provision and outcomes of HNA / LA & CCG / Targeted CAMHS service to focus on delivery in other setting than schools e.g. for 0-3yr olds and 16+yr olds
Work with schools to encourage sign-up to TAMHS contract and to understand their provision for children and young people / LA
Ensure close links and pathways with suicide prevention work through Tees Suicide Prevention Task Force / CCG & LA
Develop and communicate holistic pathway for support for children and young people, across tiers and organisations; and sensitive to local service provision and need and based on outcomes of HNA / All commissioners
Link to Tees work on single assessment process / CCG
4.2 Increase engagement of children, young people, parents, carers and families in evaluating service experience and identifying improvement requirements / 11, 35, 39 / Implement actions from Investing in Children participation work including consideration of peer support networks / TEWV
Undertake further consultation with vulnerable groups of children and young people as needed e.g. young people with eating disorders; and feed this into service development and commissioning / LA - PH
Monitor and explore concerns expressed by service users regarding difficulty accessing CAMHS service / CCG / E.g. expressed via schools and social workers
Feed into Healthwatch work programme where relevant / CYPP
Explore potential to establish standard service feedback for all mental health and wellbeing service providers / All commissioners
4.3 Improve access to information, advice and guidance on children and young people’s mental health and wellbeing; and clarity on how to access all services which contribute to mental health and wellbeing / 5, 10, 16, 18 / 5,3,6 / Produce a clear offer as described in 1.1 with a clear link to the SEND local offer / Task-and –finish group of CYPP / Link with Early Help offer and communications
Develop communications plan for disseminating the offer including use of digital tools / Task-and –finish group of CYPP / Link with Early Help offer and communications
5. Fewer children and young people and families will experience stigma and discrimination
5.1 Review inpatient admissions and costs, with a view to developing a business case for a home-based intensive treatment solutions / 13, 22, 23, 24, 25, 26, 28 / 5,9 / Implement the Tees work on this, locally / CCG / Should support a reduction in admissions
5.2 Increase mental health delivery for LAC and CiN where there are complex behavioural / mental health needs, in order to reduce placements including Out of Area, and reduce placement breakdown / Review needs and current provision for LAC placed out of area / CCG/ LA – CESC / Mar-15
Analyse delivery of the LA enhanced offer to LAC and CIN, including refined referral pathways where needed / LA - CESC / LA-commissioned service. See also 2.6 above
Contribute to developing Tees-wide commissioning plan for LAC mental health / CCG/ LA – CESC / Sep-15
Implement Early Help Strategy implementation plan to reduce escalation of cases to greater levels of need / CYPP
5.3 Roll out of self-harm protocol / Roll out protocol locally through Teeswide Safeguarding Strategy Group / CCG/ LA-PH / Sept. 2014
6. Fewer children and young people and families will experience stigma and discrimination
6.1 Implement a programme of awareness-raising and education across settings and organisations / 2, 3, 12, 19 / 3,4 / Develop and roll out training as described in 1.3 above / LA / CCG/ NHSE
Increase awareness and understanding of mental health and wellbeing through PSHE programmes in schools / LA - PH
Develop two local campaigns designed and delivered by young people / LA /CCG / Maximise work already undertaken
Support major national awareness days / weeks through awareness-raising events, press releases, etc. / CYPP
6.2 Reduce the risk of hate crime / vulnerability to crime for children and young people with mental health issues; or those who have family with mental health issues / Include in the roll out of training in schools described in 1.3 and 6.1 / LA
Look at options to reduce actual risk of harm to C&YP themselves or their parents (who have mental health problems), balancing risk and vulnerability vs. independence / CYPP
Ensuring work reflects that of the local Crisis Care Concordat

Developing a Tees Transformation Plan for Children and Young People’s Mental Health and Wellbeing – Tees Wide Strategic Work Plan