Schedule X Part X

Appendix 1

Schedule x Part x

SERVICE SPECIFICATION

Service / Specialist CAMHS Service for Children and Young People including those Looked After by Hertfordshire County Council
Commissioner Lead / Janet Lewis
Provider Lead / HPFT
Period

1Purpose

For CAMHS CLA Service and Social Workers to provide specialist services for children and young people, their families and carers, who are:

-Children Looked After

-On the edge of care

-Leaving care

-Being repatriated from external care placements.

Including, unaccompanied asylum seekers that are minors.

The service will support their emotional well being and mental health,by providing a community based resource for those who are experiencing mental health issues which are of a moderate or severe nature.

This service will be provided for children and young people designated as “a child in need” by Hertfordshire County Council CSF.

1.1Aims

To work in partnership with other professionals in other agencies to promote and maintain good emotional wellbeing and mental health, by addressing attachment needs and improving placement stability.

To be the key worker, providing assessments and treatments for cases that meet the threshold for involvement, including Child Protection cases where there are issues of mental health and emotional well being, working as part of a multi agency and multi disciplinary team.

To contribute to the development, delivery and review of services for children, young people, their families and carers maximising the life of children and young people.

To deliver, as part of a multi-disciplinary Mental Health team, high quality, fully integrated services in line with local policy and procedures and national legislation, regulation and guidance.

1.2Evidence Base

Prominence is given to the mental health needs of children looked after in the government report ‘Quality Protects and the principles in ‘Every Child Matters (2004) and the NSF (2004) for Children, Young People and Maternity Services are reflected in the service specification. This service contributes to national indicator 50 (NI50) that measures the emotional health and wellbeing of children and young people and national indicator 58 (NI58) that supports the emotional and behavioural health of children in care.

In their 2007 report ‘Narrowing the Gap’, the inspection of children’s services, OFSTED concluded that the biggest challenge continues to be narrowing the gap in opportunities, provision and outcomes between the majority of children and young people and those that are vulnerable or underachieving. Hertfordshire Children’s Trust Partnership (HCTP) has adopted the challenge of narrowing the gap as a key theme for the 2009-2011 Children and Young peoples Plan

In line with Working Together (2010), the Hertfordshire Safeguarding Children Board Procedures (2010) and the requirements of the Children Acts (1989 and 2004), with direct links to the Every Child Matters Outcomes, specifically ‘Be healthy’ (mentally and emotionally healthy) and the National Service Framework for Children, Young People and Maternity Services (Standard 9, The Mental Health and Psychological Well-being of Children and Young People) To promote the Emotional Well Being and Mental Health of Children and Young People living in Hertfordshire.

1.3Objectives

All children and young people, from birth to their eighteenth birthday, who have mental health problems and disorders have access to timely, integrated, high quality, multi-disciplinary mental health services to ensure effective assessment, treatment and support, for them and their families.

To ensure continuity of care is provided, using the ‘care programme approach’ when children and young people are

a) Placed in an external placement or into an in-patient unit from the community

b) Discharged from in-patient services into the community

c) When young people are transferred from child to adult services,

1.4Expected Outcomes

Contribution to effective and informed assessments of Children and Young People where there are concerns with their mental and emotional health.

Delivery of and/or contribution to the care and/or therapeutic plans needed to meet the identified needs of the Child or Young Person using the care programme approach.

Therapeutic support, identified as needed, will be provided to address the impact of trauma and other difficulties on social and emotional functioning.

Care plans and placements that meet the specific needs of a child or young person based on effective assessment of the impact of their history of attachment traumas and other difficulties.

Children and Young People are able to achieve and become economically and emotionally independent

Children and young people have healthy lifestyles free from alcohol and drug abuse

Young people are equipped to manage emotional stresses effectively, able to access support where this is needed.

Young people with enduring mental health problems are well supported in transition to adult services

Support offered recognises the unique and specific difficulties experienced by unaccompanied asylum seekers

Parents and Carers are supported in managing the needs of children and young people in their care, where issues of mental health and emotional well being impacts on the child or young persons functioning.

2Scope

2.1Service Users

Any looked after child or young personaged up to their 18th birthday who are :

-Children Looked After

-Children who are either placed for adoption or who are adopted

-Children who were looked after and now subject to Special Guardianship Orders

-On the edge of care

-Leaving care

-Being repatriated from external care placements.

In the care of Hertfordshire County Council as the corporate parent, and NHS Hertfordshire as the responsible commissioner.

2.2 Service Description

The service will provide integrated health and social care to children and young people experiencing emotional and mental health problems by:

-Providing input to core assessments to children going into care under the age of 10 years (these are seen as a priority group), with a view to capturing what they requirements are and support the package of care that surrounds the child.

-Providing support to care givers and CLA Teams by creating a central point of contact (this could be a child and family clinic) where all referrals are logged.

-Providing early intervention assessments to children entering the CLA system (attachments and trauma) including a review of all care proceedings, and a clinical review of core assessments. The early intervention assessment will support the Core assessment.

-Flexible outreach services to work with CYP in the most suitable setting for the CYP.

-Clinicians/Social Worker to be part of the CLA Teams and locality and assessment teams

-A CAMHS professional attending the:

Hertfordshire Access to Resources Panel on a weekly basis.
Inter Agency Panel on a monthly basis

-Informing and supporting the care plan

-Working with parents/carers to provide support to placements

-Supporting learning and development

-Being integral to the assessment process and provide advice for children and families receiving support via the Herts Family Assessment unit.

-Informing and managing risk assessments (court reports, LD, capacity to parent)

-Supporting children with LD to achieve independence alongside the parents by providing support to the LD residential units, respite units and foster carers.

-Providing support, consultation and training to social workers, ARC, outreach workers, foster carers residential staff and professionals working in children’s homes.

-Providing policies, protocols, and resources to support the joint arrangements for children with complex needs and young people as they transfer to adult care services “Young person in hospital assessed by psychiatrist as having a drug induced psychosis referred to CSF and accompanied by ongoing CAMHS support.”

-Proactive engagement with children and families with a flexibility to meet family needs, e.g. visiting at home, children centres or any other required setting.

-Consultation on interventions for children with sexualised behaviour.

-Contributing to the assessments by and providing clinical support to the asylum and refugee team

-Contributing to the multi disciplinary team at the Adoption Centre by providing a therapeutic service in relation to permanency planning and adoption.

-Contributing to support children subject to Special Guardianship Orders.

-Providing consistent expertise and approach to delivery of therapies, and services.

-Contributing to the Assessment of need and Pathway Plans for care leavers

2.2Accessibility / Acceptability

Child and Adolescent Mental Health (CAMH) professionals provide a balance of direct and indirect services and are flexible about where children, young people and families are seen in order to improve access to high levels of CAMH expertise.

Concepts of mental illness and the understanding of the origins of children’semotional and behavioural difficulties vary across cultures. Services need tobe sensitive to these differences and ensure that staff are equipped with theknowledge to work effectively with the different groups represented withinthe community they serve, in line with Hertfordshire County Council’s policies and procedures with regard to Equality and Equal Opportunity

3Service Delivery

3.1Service Model

It is expected that the Specialist CAMHS Service for CYP and CLA will work in partnership with the following organisations:

Children, Schools and Families Teams
Adult Mental Health Services
Other child and young person mental health services
The CLA Health Team
Paediatric Services
Primary Care Services
Voluntary and Community Sector
Targeted Youth Service (where the 18 plus part of ISS is to be located)
A-DASH

The service will deliver a holistic approach to the assessment and treatment of each child and young person.

Throughout 2010/11 there will be an increased emphasis on SDQ’s and these will be monitored as part of this contract.

3.2Care Pathway

Children looked after require a swift access to CAMHS services:

The Munro Review recognises that drift and delays in making plans for children have serious adverse effects on their development:

“2 month of delay in making decisions in the best interest of a child or young person equates to 1% of a childhood that cannot be restored” (ref??)

Initial Assessment reports to be completed within 7 working days. The assessment process must incorporate home and communication with carers. This will ensure that the home environment and the relationships within the home are considered as part of the assessment. A school observation may also be undertaken.
CORE Assessments to be completed within 35 working days.
If more than a social work intervention is required a professional meeting will take place in no more than 10 working days.
In order to improve transition from children’s services to adult services the CAMHS team shall work with Social Workers in both CSF and ACS to promote smooth transfer of services.
In the case of more referrals being made than the team can easily manage, priorities will always be given to Hertfordshire’s most vulnerable children and/or children whose mental health is putting them at risk of harm. If there is an ongoing capacity issue, prioritisation will be discussed and resolved at the bi-monthly contract management meeting.

4Referral, Access and Acceptance Criteria

4.1Geographic Coverage / Boundaries

4.2Location(s) of Service Delivery

The service will be flexible in relation to locations and service delivery areas within the county. There is an expectation that service delivery follows need and that HPFT will allocate resources to reflect this throughout the period of the contract.

Local arrangements between CLA Teams and CAMHS will be agreed, but likely to be delivered in the following settings:

Stevenage Child & Family Clinic

Southgate Health Centre Stevenage

(Satellite Clinic in Baldock & Hitchin

Welwyn Hatfield Child & Family Centre

51 Bridge Road East, WelwynGarden City

Bishops Stortford Child & Family Clinic

Health Centre, Market Square, Bishop Stortford

Hoddesdon Child & Family Clinic

Hoddesdon Health Clinic

Hemel Hempstead Child & Family Clinic

Marlowes Health Centre

Watford Child & Family Clinic

Peace Children’s Centre

Borehamwood & Potters Bar Child & Family Clinic

Elstree Way Clinic

St Albans Child & Family Clinic

St Peters House St Albans

Forest House

Forest Lane

Harperbury

Farnham House

Six Hills Way,

Stevenage

SG1 2FQ

Apsley One

Brindley Way,

Hemel Hempstead,

HP3 9BF

County Hall

Pegs Lane,

Hertford,

Sg13 8DF

An element of time allocated for the above services within Children’s Homes listed below:

Datchworth, Six Hills, The Barns, The Oaks, Woodland View, Ripon Road, Wilbury and Woolmer Drive.

4.3Days / Hours of Operation

Specialist CAMHS Clinics operate a Monday – Friday 9am to 5pm service. CAMHS Social Work staff would be expected to work more flexibly where it is necessary to meet the needs of the children and young people, their families and carers.

An on call three-tier duty psychiatric team provides out of hours support. This includes an on call consultant psychiatrist who is available for telephone consultations regarding young people presenting in crisis to the A&E service

4.4Referral Criteria and Route

Urgent Referrals can be made by telephone by Carers and Professionals concerned with looked after children and will be responded to within one working day. Written information will need to be made available prior to the appointment

Non urgent referrals should be made in writing and an appointment will be offered within ten working days. Anyone deemed appropriate would be invited to the initial consultation appointment this will enable a common view to evolve on how best to address the child or young person’s difficulties.

HPFT to create a single point of contact (this could be a child and family clinic) where all referrals are logged with a view to the most appropriate part of the service being accessed by the child and family.

4.5Exclusion Criteria

None.

4.6Response Time and Detail and Prioritisation

Urgent referrals will be offered an appointment in one working day.

Non urgent referrals will be offered an appointment in ten working days.

4.7Training

The service workforce will be trained and appropriately qualified for the role that they are undertaking.

The service workforce will be supported to work in multidisciplinary teams across Hertfordshire to support children and young people.

5Discharge Criteria and Planning

The Discharge Letter referred to in clause 18.6.1 of the main contract shall contain basic clinical information about the Service User’s treatment, including, without limitation:

(i)the Service User’s demographics to whom the Discharge Letter refers;

(ii)the dates of the Service User’s admission and discharge;

(iii)the name of the Service User’s responsible lead clinician, Care Co-ordinator and/or Key Worker at the time of the Service User’s discharge and to whom questions about the contents of the Discharge Letter may be addressed, and complete and accurate contact details (including a telephone number) for that person;

(iv)details of any medication prescribed at the time of discharge;

(v)any other relevant or necessary information or instructions, including follow-up arrangements and appointments; and

(vi)the Service User’s status under the 1983 Act at the time of discharge.

6Prevention, Self-Care and Patient and Carer Information

TBC

7Continual Service Improvement / Innovation Plan

Description of Scheme / Milestones / Expected Benefit / Timescales / Frequency of Monitoring

8Baseline Performance Targets – Quality, Performance and Productivity

Performance Indicators / Indicator / Threshold / Method of Measurement / Consequence of Breach
Quality
Insert relevant Vital Signs indicators
Insert relevant indicators from National Indicator Quality Improvement Programme
Insert selected indicators from Transformation Guides
Service User Experience
Experience Improvement Plan
Reducing Barriers
Personalised Care Planning
Outcomes
[Any additional local indicators]
Performance and Productivity
Insert relevant indicators from Transformation Guides
Improving Productivity
Unplanned Admissions
Access
[Any additional local indicators]
Additional Measures for Block Contracts
Staff Turnover Rates
Sickness Levels
Agency and Bank Spend
Contacts per FTE

9Activity

Performance Indicators / Method of Measurement / Baseline Target / Threshold / Frequency of Monitoring

9.2Activity Plan / Activity Management Plan

To be monitored and managed through the Contract management meetings.

9.3Capacity Review

To be monitored and managed through the Contract management meetings.

10Currency and Prices

Basis of Contract / Currency / Price / Thresholds / Expected Annual Contract Value
Block / Cost and Volume / Cost per Case / Other *
Total: / £ / £

* delete as appropriate