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Agenda item

Response to Scrutiny Review - Child and Adolescent Mental Health Services

Paul Theaker, RMBC, to report


Barbara Murray and Christina Harrison (RDaSH), Paul Theaker and Ruth Fletcher-Brown presented an update on response to the Scrutiny Review of Child and Adolescent Mental Health Services.


Barbara gave the following powerpoint:-


Rotherham Children and Young People’s Mental Health Services – Progress Report


Service Model

-          Incorporating local and national priorities and agendas

·           Future in Mind, local transformation plans, including eating disorder pathways

·           Building early intervention and prevention

·           Community focussed engagement


Pathway Overviews

-          Learning Disability

·           Specifically working with young people with a mental health problem and moderate to severe learning disability

-          Single Point of Access

·           Receiving all referrals and triaging for urgency on the same day

·           Available as a point of contact for anyone to ring with any concerns

·           Working towards working jointly and some co-location with Early Help and MASH (‘First Response’)

-          Crisis/Intensive Community Support

·           Urgent assessments

·           Short term additional support during crisis supporting people into and out of hospital

·           Longer term interventions where there are high levels of risk

-          Locality Teams

·           Assessments and brief interventions (6-8 sessions)

·           Liaison with other services – GPs, schools, Early Help

-          Psychological Therapies

·           Time limited specialist therapy alongside other workers and consultation to colleagues

·           Longer term work with young people/families

-          CSE

·           Works alongside other colleagues

·           Provides support, advice and consultation to different services

-          Developmental Disorders (ASD and ADHD)

·           Diagnostic assessment for ASD and ADHD

·           Post-diagnosis support for ADHD


Attention was drawn to:

-        All pathway leads were now in post, with the last one, the Locality Work Lead from January 2017.

-        Closer working with Early Help had led to greater mutual understanding of each other’s work and resulted in fewer people “bouncing round” the system in the last few months.

-        Due to the work of the Crisis/Intensive Community Support Team there had been a reduction in Tier 4 or inpatient stays in the last 6-12 months

-        The new lead for Developmental Disorders had changed the pathways and reduced waiting times significantly in a short period.


In accordance with Minute No. 43 of 16th October, 206, Paul Theaker, Operational Commissioner, and Ruth Fletcher-Brown, Public Health Specialist, presented a further update against progress of the Scrutiny Review’s 12 recommendations. 


It was noted that the refresh of the Emotional Wellbeing and Mental Health Needs analysis was complete and a common performance framework that provided improved and standardised data collection across the whole mental health system had been developed and was being tested with service providers.


The timescales for outstanding actions within the response template had been revisited due to the impact of delays in the CAMHS Service reconfiguration and were now achievable and realistic.  There was robust monitoring of the actions taking place through the CAMHS Contract Monitoring Group and CAMHS Partnership Group to ensure that they were completed by the due dates.


Discussion ensued with the following issues raised/clarified:-


-          Findings from the Needs Analysis refresh had shown a need for improved links between CAMHS and SEND and work on pathways for vulnerable groups such as the Youth Justice System.


-          Currently the data captured included numbers of contacts, caseloads and referrals, plus waiting times and interventions.  Each Service collected the high level information but more needed with regard to demographic and geography.    


-          RDaSH would expect to see the right referrals coming through to the right places; the development of a screening tool would help with signposting people to the right service depending on their level of need.    The investment in workforce development had already seen an impact within Early Help with a reduction of 122 people signposted in Quarter 1 to 81 in Quarter 3 and the number of inappropriate referrals sent back reducing from 25 in October to 6 in January.


All courses facilitated by Public Health measured the change in people’s knowledge and confidence which hopefully would have a knock on effect for RDaSH CAHMS Services and get the person to the right service at the right time.  Alongside the Workforce Development wider CAMHS work, consideration would be given as to what training was available and which training providers.  Leeds City Council had carried out work with their providers in quality checking the training that was available.


-          RDaSH Locality Workers were very much engaged with schools and teachers with their consultation meetings affording an opportunity to raise any issues/queries about a child.  RDaSH could deliver formal training but often individual cases were raised with the teacher coming away from the meeting with a broader knowledge and understanding.  RDaSH could provide advice/assistance on an individual case by case basis alongside delivering formal training.


-          In terms of the Education Skills agenda, schools had now set up Social, Emotional and Mental Health school clusters with the aim of preventing young people being excluded from schools.  The clusters were made up of a number of schools within a geographic area and managing those young people. CAMHS Locality Workers linked into that work and worked with schools in the cluster to prevent young people being excluded and keeping them within the school environment. 


-          Video conferencing was a method used by Public Health to receive information.  Recently Public Health had received a series of webinars  appropriate for schools which had circulated accordingly.  Schools did not necessarily have to attend a training session and could deliver the webinar in-house. 


-          If a parent noticed something wrong with their child but the school did not think there was a problem, the role that RDaSH could play was with regard to the emotional health and wellbeing and help schools to be able to understand and know what to look out for.  RDaSH was trying to work much more closely with Education particularly around Autism and ADHD.  There was the Single Point of Access where members of the public could ring and have those conversations: the Locality Worker would then work with the parent and school to understand and support that voice.  An added value of the training was the improved communication. 


-          Work was taking place on producing a Sufficiency Strategy looking at project numbers of young people coming through the system, what specialist provision there was in Rotherham and what was needed going forward.  This issue of whether Rotherham had specialist education capacity for those diagnosed early with developmental disorders would be raised with Education.


-          There were no Key Performance Indicators currently with regard to the Locality Worker model being monitored through the RDaSH contract.   However, work was taking place with RMBC and RCCG to firm up what they would be and how they would be captured.  RDaSH was gathering feedback and information from its partners on an informal basis and it was understood that, from the Council perspective, there would be a Survey Monkey questionnaire processes to gather the information around ease of access.


-          The names and contact information for the Locality Workers would be provided for Elected Members. 


-          Taking into account the performance figures received in the past, was there an argument that the 3 week target waiting time should be reviewed (recommendation 8)? 


-          The current position was that the 3 weeks stretched target would remain for 2017/18.  However, it was important to point out that the 6 weeks national target was where Rotherham was looking at benchmarking itself.  The stretched target was a very local target to push itself.  RDaSH agreed to share the benchmarking information.


The Chairman stated that a lengthy discussion had taken place with regard to the new approach to future updates without the use of the response template since the Service had changed significantly since the original review. Suggestions had been made by Members as to key areas for future updates.


Resolved:-  (1)  That the monitoring and progress made against the response to the Scrutiny Review of Child and Adolescent Mental Health Services be noted.


(2)  That future updates focus on the key areas identified by Members i.e.:-


Waiting time data

Performance management information,

Impact of single point of access and is it preventing escalation where people

Impact of locality working

Training and development across the wider CAMHS workforce

Transition from CAHMS, Policy and CQUINS.


(3)  That an update on waiting times for assessment and treatment be submitted to the Select Commission on a monthly basis.


(4)  That a further update be submitted in October, 2017.

Supporting documents: