6th October 2003

Dear Colleague

Update to Salford Child and Adolescent Mental Health Services (CAMHS) Strategy

Please find enclosed an update to the Salford CAMHS Strategy. The original Salford and Trafford Strategy was written in 1998 and this document considers developments in national policies and guidance, provides a Salford specific focus when describing existing services and lists actions that need to be undertaken in the short / medium term.

Salford Children’s Services Planning Forum is the forum that has an overview of all developments relating to children, young people and transition into adulthood and ensure consistent and cohesive implementation of a Salford Children’s Strategy. That strategy aims transform the lives of Salford’s children’s, their families and communities through effective partnership built on inclusion and empowerment. CAMHS represent an important aspect of the overall Children’s Strategy. More work is required before Salford has a CAMHS strategy that meets the vision of the Children’s Services Planning Forum. Much of this work will focus on better understanding the approaches used in schools and across the community to promote good mental health and agreeing how to maximise their contribution.

In the meantime this strategy update will be used locally to agree short / medium term actions and to inform the City Council’s Health Scrutiny Committee, the Joint (PCT / Social Services) Executive Commissioning Forum and the Greater Manchester Strategic Health Authority.

Yours sincerely,

Harry Golby

Head of Children’s Commissioning

Salford Primary Care Trust

Encs.

(see attached distribution list)

Copies to:

Paul Woltman, Assistant Director (Children’s Services), Community & Social Services Directorate, Salford City Council

Edna Robinson, Chair of Salford Children’s Services Planning Forum & PCT Chief Executive

Alan Campbell, Chair of Salford Joint Executive Commissioning Forum

Nick Clawson, Associate Director – Clinical Strategy, Greater Manchester Strategic Health Authority

Members of Salford CAMHS Strategy Group

Hilary Wensley, Head of (Adult) Mental Health Commissioning, Salford PCT

THE MENTAL HEALTH OF

CHILDREN & YOUNG PEOPLE

OF SALFORD

UPDATE TO CAMHS STRATEGY

OCTOBER 2003

FINAL (VERSION 3)

1INTRODUCTION

Good mental health is a key component of a healthy active life. A child or young person with good mental health is more likely to fulfil their full potential later in life. There is evidence of an increase in poor mental health amongst children and young people over the last three decades, particularly amongst those who are at risk of social exclusion. The aim of this strategy is to describe the actions to be undertaken to maintain and improve the mental health of children and young people in Salford.

The strategy is written in four sections:

‘context’ describes this strategy’s place in terms of national and local plans for services that will improve outcomes for children and young people; common themes for the development of services fall out of this section.

‘need’ provides an overview of the mental health needs of children and young people in Salford.

‘services’ describes some of the existing services in Salford (this section does not attempt to comprehensively describe all services – it focuses on a few that may be particularly relevant.)

‘actions’ lists what has been done recently and what else needs to be done to address the development themes locally.

2CONTENTS

1Introduction

2Contents

3Context

3.1Scope of Strategy

3.2National Context

3.3Local Context

4Need

4.1Needs Assessment

4.2User Views

5Services

5.1North West Children’s Taskforce Model – PREVENTION

5.24 Tier Model - INTERVENTION

5.3Description of Some Salford CAMHS services

5.4‘Dyson’ Model - PATHWAYS

5.5Investment in Salford CAMHS

6Actions

6.1Recent Progress

6.2Actions to be Undertaken

3CONTEXT

3.1Scope of the Strategy

This strategy has relevance to all children and young people in Salford, whether they are resident in the area, looked after by Salford Social Services, registered with a Salford GP, go to a Salford school or are placed in an independent sector special school. It applies to them from when they are born to the point that they are no longer receiving ‘children’s services’ and their care, where appropriate, has been handed over to adult services (in the vast majority of cases children and young people are aged 0 –19.) It applies when the child or young person is well and are trying to maintain their mental health, when the first signs of a mental health issue is recognised (whether this by the child themselves, a family member, friend or professional), throughout the period that they are receiving an intervention to improve their mental health, until they no longer require that service either because their mental health has been restored or because they have passed through transition into adult services.

3.2National Context

Green Paper ‘Every Child Matters’

The government’s vision for children and young people can be summarised in the five outcomes described in the new Green Paper ‘Every Child Matters’, these are:

  • being healthy: enjoying good physical and mental health and living a healthy lifestyle
  • staying safe: being protected from harm and neglect
  • enjoying and achieving: getting the most out of life and developing the skills for adulthood
  • making a positive contribution: being involved with the community and society and not engaging in anti-social or offending behaviour
  • economic well-being: not being prevented by economic disadvantage from achieving their full potential in life.

This vision sets considerable challenges if the agencies across the education / health / social care spectrum are going to help all children and young people achieve their full potential, particularly those children who are at risk.

Children’s National Service Framework ‘Getting the Right Start’ Emerging Findings

One element of the NSF emerging findings relates to the mental helath and psychological wellbeing of children and young people. The key themes in the document are:

  • commissioning: effective, high quality, joint commissioning arrangements across health, social services and education
  • partnership: joint provision of services and smooth transition between services across health, education, social care, youth justice and voluntary agencies
  • developmentally appropriate care:clarity about the age range CAMHS serve and better transition to adult mental health services
  • evidence based practice, training and a skilled and competent workforce: matching skills and competencies of workforce across whole CAMHS service to local need
  • service composition: ensuring services have the appropriate critical mass of staffing and supporting infrastructure (e.g. appropriate IT, admin, buildings, etc.) to be sustainable
  • access: ensuring services are managed and delivered in a way that the children and young people who need them can access them
  • user views: enabling service users and their families / carers can influence the services that are offered
  • audit and outcomes: routinely collecting and using information that demonstrates the effectiveness of services

Other Developments

The Green Paper and NSF builds on a number of other relevant publications and strategies:

  • Keeping Children Safe - the response to Lord Laming’s report which highlighted a failure of the relevant agencies to intervene early enough, in a properly co-ordinated way, to prevent the death of Victoria Climbie
  • Getting the Right Start: The National Service Framework for Children and Young People which is being developed and will describe a 10 year plan for services, including CAMHS, to meet new standards for services
  • The Kennedy Report into the children’s heart surgery at the Bristol Royal Infirmary which highlighted the importance of designing children’s services from the child’s point of view
  • Quality Protects - a programme to improve services for some of the most vulnerable children in our society – those who are looked after by local authorities; considering issues such as placement stability, support for care leavers, children and young people’s participation, partnership working and services for particular groups of children (e.g. disabled, ethnic minorities, refugees, etc.)
  • Youth Justice Board which provides expert advice on prevention of offending amongst young people through earlier provision of multi agency support for families and juvenile sentencing reforms
  • Full Service Schools which will bring together services previously provided from different location, onto a single site – the local school, for example health education and promotion, housing, teenage pregnancy, crisis intervention and community policing advice
  • Sure Start, Sure Start +, Teenage Pregnancy Grant which provide extra resources to improve the multi agency response to the needs of young parents and young children in deprived areas. These developments bring significant extra resources to Salford, for example in 2003/4 Salford’s Sure Start revenue allocation is £2925k, Sure Start+ £118k and Teenage Pregnancy £135k. Some of the services provided through these developments will help maintain and improve the mental health of children and young people for example additional speech therapy, reading skills projects, domestic violence services and sex and relationship advice services.

Salford Children’s Fund brings an investment of £5.5m to the deprived areas of the city over a five year period, in order to promote and develop preventative services for 5-13 years olds. Over 60 different projects are being supported and are to be externally evaluated. Most , if not all, of these projects have a role in maintaining and improving the mental health of the children and young people who are involved, 5 specifically target this area – Circle Time Training, Young Runaways, Triple P, Child Witness Support and Pyramid Clubs.

  • Education legislation such as the Special Educational Needs and Disabilities Act which promotes the inclusion of all young people

Many of these strategies were brought together in relation to CAMHS in Health Service Circular / Local Authority Circular HSC 2003/003: LAC (2003)2‘Child and Adolescent Mental Health Service (CAMHS) Grant Guidance 2003/04.’ This document described increased allocations to councils, alongside increases to PCT’s baseline allocations, to deliver ‘comprehensive CAMHS services’ in every locality by 2006. A comprehensive CAMHS service is described in several ways:

  • Underpinning principles to inform the commissioning and delivery of services
  • Range of services to meet the full range of users needs
  • Workforce and training to ensure the skills and competencies required to deliver the service are available
  • Organisational arrangements to ensure CAMHS services and their interfaces with other services are effectively managed.

In total in the next two years in addition to its current ‘core’ allocation Salford (City Council and PCT combined) will receive in excess of £550,000 ringfenced funding for CAMHS services. Other sources of funding are available through Children’s Fund, Sure Start, Education Authority and schools allocations

National Good Practice in CAMHS

Various publications (e.g. Department of Health (November 2002) What’s New: Learning from the CAMHS Innovation projects, Alexander T. (November 2002) A Bright Future for All: Promoting Mental Health in education, Meltzer H., Gatward R., Goodman R., Ford T. (2000) The mental health of children and adolescents in Great Britain, Roberts H. (2000) Barnardo’s: What works in reducing inequalities in Child Health, Ashton C. (2001) Promoting Children’s Mental Health within Early Years and School Settings, Audit Commission (1999) Children in Mind: child and adolescent mental health services) reveal that effective CAMHS services have a number of characteristics in common, including:

  • Strategy. Child and adolescent mental health data shows strong inequalities, where poorer children are more likely to experience high levels of mental distress. It is crucial that the overall direction of CAMHS relates closely to the strategies of other agencies working with children to improve their life chances. A clear set of aims and objectives should be articulated, to identify the opportunities for reducing inequalities through joint work where it would add value.Monitoring frameworks are necessary to identify areas of local progress. The NSF will provide a source of good practice standards against which services will need to be monitored.
  • Partnership working. Clear and consistent leadership is needed to develop co-ordinated and integrated approaches. Effective CAMHS have strong relationships with local education authorities, schools, social services and other parts of the health service. In addition, there are numerous opportunities for joining up with the voluntary sector and Connexions. These partnerships should be formed at strategic levels, through established high-level mechanisms; they should also exercise their ability to influence agendas to promote well-being for young people more generally. Multi agency approaches are very effective and should be developed. Therefore, partnerships should be developed at operational levels; for example, CAMHS should offer advice, training and support to partner agencies working with young people and their families.
  • Accessibility. CAMHS must be accessible for young people; they should operate at times when young people are able to use them, and in locations that are not intimidating or difficult to find. Similarly, different models should be used, including outreach, which take the service out to young people, especially for those in communities that have not always benefited from statutory provision.
  • Appropriateness. A range of services should be made available depending upon the needs of young people and the realities of their lives. It should be recognised that they, and their families/carers, have diverse cultural, social and individual needs (for example child from black and ethnic minority communities). Different interventions are necessary to meet diverse needs - taking into account the range of experiences which might indicate poor mental health - including therapies, advice and support.
  • Acceptability. CAMHS should provide non-stigmatising environments, which welcome young people, where staff members respect their diversity and difference.
  • Involvement and participation. Young people, their families and their carers should be systematically and meaningfully involved in the design, implementation and evaluation of services.
  • Adequate resources. CAMHS services should be adequately resourced, using benchmarks and evidence of good practice as means of assessing appropriate funding.Given the multi agency nature of the work, funding should be provided from a range of sources.

3.3Local Context

Salford

Salford is a medium sized metropolitan area within Greater Manchester with a population of around 215,000 of whom approximately 20.4% are aged under 16. In common with many other urban communities with an industrial heritage there are pockets of very high levels of deprivation across Salford with nine of the twenty wards falling within the lowest 10% of wards nationally in the Index of Multiple Deprivation 2000. Five of the inner city wards have a child poverty index score higher than 66.4. Educational attainment within the city is below the national average but rising.

Children’s Services Planning Forum

Local organisations have committed to work together to achieve the best outcomes for children and young people. This work is overseen by the Local Strategic Partnership and within that framework the Children's Services Planning Forum, which is chaired by the PCT Chief Executive, works to 5 key aims for children in Salford:

  • to live in nuturing and well supported families
  • to have high levels of achievement and aspirations
  • to live in, and make a positive contribution to, a community which they respect and which respects them
  • to be able to access relevant and welcoming services
  • to grow up healthy and to minimise the impact to their potential of any health disadvantages, illness or disability

The CSPF is made up of representative of all the agencies that deliver services for children across the city. This includes the voluntary sector, as well as the statutory agencies, which has an equally important role in shaping and delivering services.

Integrated Children’s Services

Salford’s application to become a Children’s Trust Pathfinder Site is a clear statement of the vision to develop integrated services across health / social care / education. Integrated services are expected to achieve easier access through a single point of entry, joined up assessment to reduce the need for children and families to retell their story and better links between services to ensure there are no gaps in provision. Although the application to become a pathfinder was unsuccessful the City Council and Primary Care Trust are continuing to take this work forward. This will be via a phased approach initially through the creation of a joint commissioning function and then by a gradual roll out of integrated services for children, young people and families. CAMHS services are one area where health, social services, education and independent / voluntary sector services all have a contribution to make, so will be a fundamental part of Salford’s integrated children’s services. The CAMHS services, services for sick children and services for disabled children need to be integrated.

The re-configuration of Salford’s children’s health services presents an opportunity to implement the necessary changes within Salford’s CAMHS services. Royal Manchester Children’s Hospital, which provides secondary (district) and tertiary (specialist) health services for Salford’s children and is the base for the Tiers 2/3 CAMHS team (see Section 5.2), is to close in 2008 and tertiary services to transfer to the central Manchester site. In response Salford PCT is planning a development of community based children’s health services building through the local investment finance trust (LIFT) redevelopment of community based facilities. The Pendleton LIFT centre will act as an important resource for Children’s Services across Salford and will be the base for the Tier 2 /3 CAMHS services. New hospital based services for children will also be developed on the Hope site as part of the Salford Health Improvement for Tomorrow (SHIFT) private finance initiative.

The Education and Leisure Directorate work within a framework which promotes the empowerment of children and young people, their parents / carers and all learning settings. All teams within the Directorate from Early Years to the Youth Service, supports a capacity building strategy based on delegating resources to those working with children and young people, providing advice, guidance and training to those partners and challenging expectations and practice. While all teams contribute to this strategy, the Inclusion and Access Division provides a specific focus on supporting vulnerable young people in Salford.