CONSULTATION DOCUMENTNovember 2007

WREXHAM TRAINING STRATEGY

FOR

EMOTIONAL WELLBEING OF CHILDREN

AND

YOUNG PEOPLE

Louise Carpenter

Chair, CAMHS Training Sub-Group

Wrexham CAMHS Training Strategy

Scope of document

The purpose of this document is to provide an outline plan for the co-ordination and delivery of training to staff working acrossagencies at Tier 1 and staff working at Tiers 2, 3 and 4, within non-specialist CAMHS settings in Wrexham. The strategy will in the future address the needs of staff providing Tier 2 functions within Specialist CAMHS settings, such as consultation and liaison to colleagues in Tiers 1 and 2.

The plan does not include all mental health related training needs of staff working in Specialist CAMHS and other CAMH services at Tiers 2/3 and 4 (i.e. Educational Psychology) – who will have their own internal professional development plans; although the ethos of these will undoubtedly be needs led and evidence based.

Training Strategy

Aims of Strategy

To improve the mental health and emotional wellbeing of young people by increasing the awareness and knowledge and skills of frontline workers to respond confidently to the mental health issues that they encounter in their work settings.

To ensure that there are a broad base of evidenced based multi-agency learning opportunities that frontline workers and all staff working in all tiers of CAMHS can, and do, access.

Strategic Context

Improving services to children and young people is a key government target, both at national and regional level. Mental health is considered one of the national priorities in the guidance for modernising health and social care. There have been major new initiatives for health improvements, health inequalities, tackling social inclusion and enhancing life-chances of children and young people

Everybody’s Business (W.A.G. 2001) highlighted the responsibility of all staff working with children and young people to have relevant knowledge, skills and attitudes, appropriate to their roles and responsibilities across the tiered structure of service delivery, to promote mental health and psychological wellbeing in children, young people and families.

Children in Mind (The Audit Commission 1999) and Together We Stand (HAS/NHS 1995) followed by Everybody’s Business (W.A.G. 2001)

Targets have been set through strategic national imperatives e.g. The National Service Framework for Children, Young People and Maternity Services (NSF/WAG 2005), Service and Financial Framework target (SAFF, WAG, WHC 2004 (083; 2006), ‘Together We Stand’; The Wrexham Health, Social Care and Wellbeing Strategy Needs Assessment (2003), Rights to Action; the Single Education Plan; Wrexham Promise; Respecting Others, all identify emotional wellbeing as being a strategic priority for all commissioners and service providers.

NSF Key Actions

Key targets relevant to the delivery of child mental health and emotional wellbeing training for staff are:-

To promote early identification and intervention for children and young people with mental health problems.

To increase skills of all staff in the early identification of children and young people with mental health problems.

To increase skills of all staff in responding appropriately to children and young people with mental health problems.

4.20 / All staff who provide Tier 1 functions have access to:
Training that will assist them in assessing the need for referral to specialist services and ensure appropriate levels of intervention.
Training in assessing and managing emotional and mental health problems in children, young people and their families.
4.21 / Staff delivering services at Tiers 2 and 3 have access to regular multi-agency training and/or uni-disciplinary training (in addition to core training) which includes:
principles of the CAMHS Strategy for WalesEverybody’s Business
information about mental health problems and disorders
understanding and working with families
the use of evidence-based therapies
consultation and liaison with child and family support agencies
psychiatric interventions, including the use of medication
knowledge of the Mental Health Act.

Background

Recent surveys have generally reported mental health disorders are present in roughly 10-25% of children; 30-40% of young people may at some time experience a mental health problem, and more than 40% of young people have recognisable risk factors that impact on their emotional wellbeing. (Office of Government Statistics)

In local terms this means that in a population of 32,000 under 18-year olds, at any given time it is likely that 3,328 children and young people are experiencing some form of mental health problem or disorder which is impacting on their life chances. Between 6,400 and 9,600 will experience a mental health problem at some time and, of these, 4,800 are likely to present with a moderate to severe disorder.

Like many areas, Wrexham has areas of significant social deprivation, poverty and social exclusion. In addition there are a number of children and young people with significant needs who have moved into independent children’s homes within the area which cater for children with severe problems (currently 60-70). As they have a higher risk of developing mental health problems and disorders, many of these young people often require additional involvement form local specialist services. In addition to the children and young people moving into the area the Local Authority has 120 children who are “looked after” and there are a further 42 currently on Child Protection Register.

The local picture is further informed by demographic information which suggests that vulnerability is increased by the percentage of low weight births, children with limiting long-term illness, children in lone-parent families, children in families on Income Support and children in overcrowded accommodation. Information extrapolated form 2001 Census data suggests a population rise of 0.34% to 28,605 children by 2003. Further data extrapolation suggests that Queensway, Plas Madoc and Wynnstay experience the highest levels of deprivation locally. Smithfield, Pant and Cartrefle also feature as areas of potential high need. (Data drawn from 2001 Census datasets and the Welsh Index of Multiple Deprivation 2000.)

Over the past three years there have been significant changes to the demographics in Wrexham which will have added implications to addressing emotional wellbeing in the child and adolescent population.

Local Strategic Context

In Wrexham the multi-agency “CAMHSTraining Strategy Sub-group” – a sub-group of the “Emotional Health, Wellbeing and Counselling Task and Finish Group”, has developed a local Action Plan for the delivery of targets relevant to training on the mental health of children, young people and families, in line with national strategic imperatives. The group consists of staff from Specialist CAMHS, the voluntary sector- NSPCC, the Local Authority- Educational Psychology Service, Planning and Development, Youth Service, Prevention and Inclusion, Release and Health represented by School Nurses.

The group has met regularly over the past 18 months and has already responded to identified and perceived need by putting on ad hoc training courses through staff goodwill and using slippage monies where available, and seeking support from a couple of enlightened and helpful managers.

Key staff have given generously of their time and effort but this has had an impact on their primary function. The aim now is to provide a structure and service which is more cohesive, co-ordinated and planned, and which is able to respond to the need in a sustainable manner, thus ensuring enhanced capability and capacity to respond to the emotional wellbeing needs of Wrexham children and adolescents in an evidence-based and optimal manner.

Scope of the Training Strategy

Training in child and adolescent mental health and emotional wellbeing for all staff with professional contacts with children and young people across the tiered structure (Everybody’s Business 2001) in Wrexham County Borough Council’s boundaries.

The Training Sub-group has identified different levels and types of knowledge and skills in child and adolescent mental health required for work at different interfaces across the tiers of delivery of services.

Priority has been allocated on the basis of need and national imperatives. Due to the large numbers requiring training at Tier 1 level, and the need to ensure early intervention and timely help for young people, and the gap in knowledge and skills relating to the early interventions in published NICE guidelines, priority has been accorded to provision of awareness, issue-based and foundation training for frontline staff working with children, young people and families in Wrexham. Similarly, priority is accorded to Tier 2 level staff who have a specific remit to support emotional wellbeing as part of their role, as often this expectation is not matched with knowledge and skills in core or past professional training. However, there is scope as the model rolls out to develop as required.

Training needs

CAMHS emotional/wellbeing training is required across all tiers, agencies and professions where staff come into contact with children and young people.

A training needs analysis is required together with robust partnership work which addresses need and related workforce planning issues.

Training is required for:-

  • Raising awareness of child mental health and emotional wellbeing (which will include induction).

The curriculum would address:

  • What is emotional health and wellbeing?
  • What is a mental health disorder?
  • The developing child; positive brain development and secure attachment.
  • Prevalence, risk, brain development. Trauma/stress/neglect and maltreatment.
  • Worries when working with mental health problems. Context/system.
  • Inter-professional working.
  • Resiliencies in child/family/community
  • Foundation knowledge and skills in child mental health and wellbeing are needed in order that staff can recognise problems in the early stages and have the knowledge and skills to respond appropriately.
  • Undergraduate/core qualification training
  • Core training needs for medical and child care staff to be addressed through close working with local training providers.
  • Training as part of Core Professional Training where it is not a core role as in Psychology and Psychiatry, i.e. Paediatricians, GPs - Child in Mind: social work, nursing, youth work, teaching, occupational therapy.
  • Training on specific conditions/disorders (e.g. ASD, ADHD, Conduct Disorder, depression, eating disorders)
  • Training on specific issues (e.g. self-harm/suicidality, parenting, bullying, the impact of parental mental health on parenting and child development, mental health and substance misuse, looked after children, diversity and dual diagnosis)
  • Multi-agency Induction Training
  • Training for staff new to CAMH Services, across the Tiers
  • Training on specific therapeutic interventions and strategies e.g.- targeted interventions – SAP, Friends, PATHS, Circle Time-cognitive behavioural therapy, active listening, EMDR, brief solution- focused therapy,CBT motivational work with children and youngpeople, communication with young people) at appropriate levels for service role.
  • Enhanced CAMHS Training (e.g. CAMHS Module, University of Wales – WAG 2005
  • Training at post-graduate level, discussion to be initiated re PQAs in SW
  • Training for all staff – could be incrementally achieved through induction and delivery, as appropriate, through Safeguarding
  • Post qualification training in identification.
  • Training for specialist CAMHS professionals, including but not confined to – psychology, psychiatry, psychotherapy, social work, nursing, specialist speech and language and specialist dieticians and OTs.
  • Training for: parents - filial play therapy – treatment - Webster Stratton – hospital/MCC - Webster Stratton – parent empowerment model - psycho-social information - access to resources
  • Training for young people - peer group support - awareness raising - psycho-social information - access to resources
  • Resources for health promotion Healthy schools Health Promotion
  • Training for trainers
  • Training to Enhance Staff Care when working in this arena

CORE CAPABILITIES NEEDED FOR EFFECTIVE WORKING WITH CHILDREN, ADOLESCENTS AND THEIR FAMILIES AROUND

THE ISSUE OF MENTAL HEALTH AND EMOTIONAL WELLBEING

National CAMHS Development Project

Understanding of mental health and emotional wellbeing as it relates to children, young people and their families and carers

Knowledge, skills and attitudes relevant to mental health promotion, education, prevention and early intervention strategies for child and adolescent mental health

Understanding of appropriate settings and communication with regards to children, adolescents and their families

Knowledge of relevant legislations and the national policy framework for multi-agency comprehensive CAMHS and how it applies to their profession/service and practice

Knowledge of services provided by the NHS, Children’s Services (Social Care and Education) and the voluntary sector

Understanding the context and impact of socio-economic, cultural, ethnic and gender issues on the mental health of children, adolescents and their families

Understanding of identification, assessment, intervention and referral strategies for children, young people, their families/carers and communities as it relates to mental health and emotional wellbeing

In summary, linking the capabilities to the national imperatives and initiatives:

Within primary level services (Tier 1) those in contact with children need to be able to have sufficient knowledge of children’s mental health to be able to:

  • identify those who need help
  • offer advice and support to those with mild or minor problems
  • have sufficient knowledge of specialist services to be able to refer appropriately when necessary
  • be able to access support, advice and training to underline their actions and provide sustainability

Aim of training Tier 1 Staff working with children and young people

To enable practitioners at Tier 1 to reach their optimum level of capability to deal with issues of children’s and adolescents’ emotional wellbeing and mental health. This needs to be done through training and development on issues related to child and adolescent mental health and wellbeing that is integrated across a variety of levels and disciplines.

Diagrammatic representation of the Training Triangle

CURRICULUM CONTENT

Mental Health Awareness

Purpose:-to increase participants’ knowledge of mental health issues

-to increase participants’ skills in promoting mental health

-to increase participants’ confidence of referral pathways

-to demonstrate the effectiveness of multi-agency training in promoting multi-agency collaboration

Introduction to children’s mental health.

What is mental health?

Incidence and classification

Vulnerability factors

Early identification of emotional need/mental health problems

Promote resilience

What children say they need

Local structure of services

Referral guidelines

Foundation in Mental Health/Emotional Wellbeing

To increase knowledge of key themes related to child mental health.

Specific themes i.e. emotional intelligence, promoting positive mental health, etc.

Specific Issues - to increase knowledge of specific emotional and mental health problems and disorders.

Topics:

Normal child development and attachment

Attachment/resilience/brain development

Dealing with information sensitively

Adolescent turmoil

Infant mental health

Early years emotional wellbeing

Attachment across childhood

Self-harm

Eating disorders

ADHD

Divorce, separation and reconstituted families

Mental health in schools

Coping with aggression and challenging behaviour

Loss and bereavement

Mental health for refugee and asylum-seeking children

The impact of trauma

Mental health of Children Looked After

Training for trainers

Gay, lesbian, bi-sexual and transgender issues

Communicating with children and young people about difficult issues (Cultural issues interwoven and/or specific courses)

Assessment and early identification

Major mental illness, including schizophrenia and bipolar disorder

Management, care and support

Introduction to parent management

Parental mental health – the impact on children and young people

Awareness

Introduction to Child Mental Health

- reviewed national programmes

Anti-discrimination practice – online ITEQ - racism - gender - ageism

Staff wellbeing

Raising reflective awareness

Multi-Agency Induction (including NQT)

Training the Trainers

  1. Pragmatics – use of equipment etc.
  2. Learning styles/working with groups
  3. Delivery skills

Skills Development For staff working in non-specialist CAMHS settings,( and those new to service who require it) increasing skills in: –

assessing emotional and mental health problems in community/acute settings, to increase active listening skills for staff working with children, parents and young people. Co-working effectively with CYP, understanding and skills in behavioural cases, and managing difficult behaviour, delivering universal and targeted evidenced based interventions such as CBT,SAP and SEAL materials.

Rolling out the training

The role out of training needs to be achieved in a planned and strategic way, targeting key workers and ensuring multi-agency working .This will further require robust monitoring and review.The planning, co-ordinating and review can take place through the CAMHS Strategy Training Sub-group. It would require administrative support and would benefit in efficiency and effectiveness by the appointment of a Training Co-ordinator.

Monitoring

Training will require robust systems established that can be monitored through the Policy and Planning department of the LA and be answerable to the Framework.

Models of Delivery

A wide selection of delivery models has been considered by the subgroup and colleagues have been consulted across the UK in order to ensure learning points from other areas are incorporated into the Wrexham Strategy. The Derbymodel, External providers (YoungMinds), A cascade model, secondments, the Solihull Approach have all been considered before coming to the attached proposal.

Benefits and Implications

All of the above provide sound ways of addressing some of the challenges Wrexham faces in meeting it’s commitment to skill up the workforce in order to meet it’s obligations to children and young people as outlined previously. The proposed model (attached) however allows for an infrastructure to be put in place which will not only provide a knowledge base but will ensure sustainability thus increasing capacity as well as capability year on year. Obviously for this to be successful this will require not only permanent funding, but for all agencies and services within Wrexham County Borough Council from to be committed to the vision of providing their staff with the skills to meet their obligations in this cross cutting domain and to engage in true collaborative practice, i.e. building links to other initiatives which impact on emotional wellbeing.