Agenda item

Social Emotional and Mental Health Strategy Progress Report/Child and Adolescent Mental Health Services Update

Nigel Parkes, Rotherham Clinical Commissioning Group, and Partners to report

Minutes:

Councillor Watson, Deputy Leader, introduced both the Social Emotional and Mental Health Strategy Progress Report and the Child and Adolescent Mental Health Services Update which would be considered together.

 

Social Emotional and Mental Health (SEMH) Strategy Progress Report

Jenny Lingrell, Joint Assistant Director of Commissioning, Performance and Inclusion and Pepe Di’lasio, Assistant Director of Education, gave the following powerpoint presentation:-

 

What is working well?

-          Pupil Referral Unit provision re-configured

-          Quality of teaching and learning improved

-          SEMH Partnerships were well established

-          SEMH Graduated Response document was used consistently

-          Shared commitment to working together

-          Joint work on Trailblazer bid

-          Good practice modelled in some areas

 

What are we worried about?

-          Slight increase in permanent exclusions last year

-          SEMH Partnerships less well established at primary

-          Challenge of matching increasing demand with available resources (within the Borough)

-          The multi-agency landscape of provision was not well enough understood

 

What needs to happen

-          Co-production of a Strategy taking into account progress on CAMHS Local Transformation Plan and Five Steps to Collective Responsibility.

-          Areas of focus:

·           SEMH Sufficiency: developing a better understanding of need

·           SEMH Partnerships: ensuring arrangements were consistent and transparent

·           Developing alternative and flexible provision to meet need

·           Developing and communicating a multi-agency graduated response to match need and avoid duplication or confusion

·           Supporting the workforce

·           Delivering value for money

·           Learn from Young Inspectors inspection of the exclusion experience

·           Re-imagine the graduated response to ensure that it was holistic and multi-agency

·           Ensure that Services were aligned to meet the needs of children, young people and families

Co-location, flexible provision, integrated points of access etc.

·           Review the local authority traded offer

·           Ensure that there was a shared understanding of need and an appropriate provision landscape

·           Ensure that SEMH Partnerships have a consistent ethos and operating model

·           Test new and innovative approaches

 

Discussion ensued with the following issues raised/clarified:-

 

-          Aspire had new leadership management/governance and were working with a whole range of stakeholders

 

-          Rowan had been Ofsted inspected March 2018 and found to be “Good”

 

-          SEMH was high on the national agenda.  As a result a review of exclusions and SEMH support had been commissioned across the country.  Rotherham had been selected as area for the pilot

 

-          Although not embedded across the Authority, there were some very good examples of supporting children with SEMH issues, getting them into education and providing them with therapeutic care

 

-          A common issue for parents when their child was excluded from school was that they did not know who to talk to

 

-          Although there was the desire, the SEMH approach was less established in primary schools partly due to the struggle to get that many Head Teachers together and formation of a strategy.  All agreed that early intervention and support at primary level was better than being reactive at the secondary stage

 

-          A close eye was needed on the capacity in the PRUs.  The reintegration pathway needed to be considered with some flexibility as to how the PRU delivered their provision e.g. 2 days a week within a PRU and 3 days in a  mainstream setting.  The needs of the children needed to be fully understood; if they could be maintained in school by providing them with the right support but with some flexibility and services wrapped around the children

 

-          The Rainbow Project currently worked with a number lesbian, gay, bisexual and transgender (LGB&T) young people, aged 11-18 years old, some of whom had been excluded from school.  The young people stated that it was impossible to access services.  Currently there was only the Tavistock Centre in London that offered any kind of support but there was a 18-24 month waiting list

 

-          It was acknowledged that there was a growing concern in the mainstream schools’ offer to LGB&T young people.  That was the real importance of working across all the different parts of provision within Early Help Services.  There was some really effective work taking place with the groups and individual support for children delivered through the Early Help offer.  The Inclusion offer needed to take account of the work in Early Help, rather than separate pieces of provision, and ensure that the right support was in place and everyone knew what the pathways were including the young people, parents and workforce

 

 

-          There was a strong LGB&T young people’s group that had really good attendance and commitment from the young people.  It met on a weekly basis as well as providing individual support.  Some of the older young people who had been part of group were now peer mentors.  The group had very close links with the Rainbow Project and there were leaflets and information for other young people

 

-          Sometimes victims of bullying were the ones that were excluded from school

 

-          Exclusions should be a last resort but were a failure as the school had not been able to put in the place the level of support the young person required.  They should never be seen as something labelled against the child

 

-          Home schooling was a national issue at the moment and was one of the key issues that been taken up by the Timpson Review.  It was also a key issue identified by Ofsted and would be a theme in their inspections.  RMBC undertook quality assurance  

 

-          Last year the demographic breakdown for exclusions with regards to ethnicity had reflected the ethnicity of the Borough.  However, with regard to the reasons for exclusion, officers needed to get underneath the exclusion and ask the question why

 

-          The Green Paper was awaited together with the promised extra Mental Health support in schools.  It was a growing issue in schools in terms of Mental Health presenting itself much more than previously and not having the resources/specialist resources they would want.  Head Teachers were having to make cuts in terms of pastoral support so the support was no longer available  

 

-          Environmental factors and childhood trauma may have an impact and needs a therapeutic response even if a diagnosable mental health issue was not present.  Schools were receiving improved support from Child and Adolescent Mental Health Services (CAMHS.)

 

Child and Adolescent Mental Health Services Update

Becky McAllister, Commissioning Manager, CYPS, Nigel Parkes, Rotherham CCG and Barbara Murray, RDaSH, gave the following powerpoint presentation:-

 

What’s working well

-          CAMHS Needs Analysis completed in April 2018

·           Data on levels of service to schools from Rotherham Barnsley Mind and Maltby MAST

·           Impact of CAMHS locality advice and consultation

·           School survey of Mental Health support completed in January 2017

 

-          CAMHS Green Paper Partnership Group April 2018

·           Partnership response to Green Paper consultation

·           Focussed on non-clinical school-based Mental Health support

·           Good representation from schools

·           Incorporated whole school approach

·           Trailblazer bid with Doncaster CCG

 

-          Specialist CAMHS

·           Participation Voice and Influence programme

·           Care Co-ordinator to smooth transitions with Adult Services

·           Locality Advice and Consultation model now embedded

·           Waiting times from initial contact to assessment had reduced to below 6 weeks on a more consistent basis

 

What are we worried about

-          Physical integration of Early Help and CAMHS single point of access

-          Slow progress on wider workforce development

-          Increased demand for ASD assessments

-          Support for families who did not get an ASD diagnosis after waiting for assessment

 

What needs to happen next

-          Lead to be identified for non-clinical CAMHS workforce

-          Review of ASH/ADHD Pathway due to conclude March 2019

-          Implementation of Trailblazer if successful – if not bid again in January 2019

-          Development of a Trauma Pathway

-          Mapping of sensory support and gaps in service

-          Work together to identify opportunities for integrated points of access

 

Jayne Fitzgerald and Sarah Alexander from the Rotherham Parent Carers Forum were also in attendance.

 

Discussion ensued with the following issues raised/clarified:-

 

-          The Rotherham Parent Carers Forum worked very closely with Council and CCG colleagues and represented over 1200 families and saw over 100 of those face to face.RPCF had live experience to help shape provision.

 

-          Autism/ADHD/neuro developmental issues were classed as mental health but were very much separate to the work CAMHS did around young people experiencing mental health difficulties.  Training staff to develop therapies to adapt to people with Autism was raised.  Another key issue was how to support families where there had not been a diagnosis and RDaSH were reviewing the pathway

 

 

-          The Green Paper on the Trailblazer site was quite prescriptive.  The aim of the Mental Health Support Teams was to develop a role for Education Mental Health Practitioners, part of whose role would be to support families and children around their emotional regulation etc. which would fit within Autism work.  The bid included work, particularly within primary schools, to be more aware of issues, picking things up and understanding the wider issues for those young people  It may reduce the numbers that came through for a full neuro development assessment through better understanding of needs that were not necessarily Autism.  Although the neuro development assessment process was not part of the bid but an offshoot it may result in a more informed workforce regarding presentations of young people and what there might be in addition to autism

 

-          The Early Intervention in Psychosis Team worked with people from the age of 14 years.  For those who had a psychosis or early psychosis presentation, CAMHS would work very closely with Early Intervention on that provision.  Alongside that there was a new and developing At Risk Mental Health State Service which was an additional resource within the Pathway to identify very early on, and crossed over with, those that had clear psychosis and emerging personality disorder presentations.  There were additional specialist therapeutic interventions within that Pathway. 

 

-          The CAMHS services had been involved in the Children and Young People Improving Access to Psychological Therapies (IAPT) programme which allowed them to have staff additionally trained in specialist interventions for children around Cognitive Behavioural Treatment (CBT), Systemic Family Practice (increased number of practitioners) and Integrated Psychotherapy Therapy treatment for adolescents particularly for those with depression.  There were also new roles of Psychological Wellbeing Practitioners who had been trained in a very formal and focused way around CBT-based intervention for those with mild to moderate anxiety and depression

 

-          The retention of CAMHS staff had significantly improved and were all permanent staff

 

-          Approximately 97.4% of CAMHS referrals were seen for assessment within a 6 week period.  The majority of clients would commence an element of their treatment at the first appointment; it would be very difficult for someone to carry out an assessment and understand their needs without giving them some advice, support and ideas of what to do.  RDaSH’S internal referrals for specialist therapies e.g. CBT therapies involved a 6 week wait.  Sometimes someone may have an advice and consultation approach which would be stepped up to a more individual approach if that was not felt to be working

 

-          The concerns with regard to ASD assessment and intervention were shared in that services were not managing to meet those needs in a timely way.  It was not just a case of increasing financial resources as there were not the wider resources outside RDaSH available for the service to utilise and it was very reliant on clinical psychologists and there were none who were agency staff.  There was no quick answer to this issue hence the review of the pathway.  RDaSH had been part of a national research project looking at the cost of Autism and Autism assessments.

 

-          Sometimes there were challenges to people not having a diagnosis of Autism and being able to get help they required but it should not make any difference.  The SEMH Strategy should not be about diagnosis but about what their needs were

 

-          The Parents Forum was working closely and had worked with the Local Authority for the last 10 years on genuine partnerships, was nationally recognised and had worked with Ofsted and CQC around the Framework; it was about giving the practitioners the capacity and the resources to deliver when they had other targets.  Ministers at the DfE had acknowledged the lack of a measure in the inspection framework around partnership working and capacity as a priority rather than an educational attainment target.  What was happening in Rotherham was quite innovative

 

-          Autism diagnosis was very important.  For the mental health of that individual it was vitally important that they understood they were Autistic especially for people not diagnosed until adulthood and that and there were a number of people they could meet up with and be no different and they saw it as a positive impact on their mental health and wellbeing.  Even if their needs were met along the way the diagnosis was still an important part but one would like to see needs met whilst awaiting diagnosis

 

-          The response to the School survey had been 23%.  Surveys were perhaps not the best way to find out the information but were quick and easy to respond to.  Consideration would be given as to alternative methods of collecting information within the context of the SEMH Strategy particularly if the Trailblazer bid was successful; there needed to be a more detailed understanding of the current picture within the schools as to how they could use the Trailblazer resources as an additional service

 

-          Tavistock Centre was the only agency for LGB&T young people under the age of 19 years and they had a 2 year waiting list.  In this month alone over 100 people in the Rotherham area had tried to access their services.  Porterbrook in Sheffield had a 61 weeks waiting list and again only took young people from the age of 17 years.  There was clearly a gap in services

 

-          The Tavistock provision was a gender identity service and, therefore, had a specific remit and was a nationally commissioned service. Although not excluded from the Service, CAMHS probably did not do enough with regard to support for LGB&T young people but the young people were linked into other local services and signposted to that support

 

-          The Parents Forum, working with Early Help colleagues, families and volunteers, had identified that there was no service for young people aged under 13 years except Tavistock.  One of the Forum’s peer support workers, working alongside her Early Help Worker for her own child, had set up a befriending service

 

-          There was optimism that the Trailblazer bid would be successful due to a request being received for revised figures.  If not successful, wave 2 of the funding regime could be bid for in the New Year

 

-          There was an Early Help Review currently taking place and also significant work to do looking at the Early Help and Social Care Pathway and the CAMHS Service.  Account needed to be taken of all the factors and ensure that they all matched up.  Work was required to look across the whole of the provision and considered from the point of view of children and young people and their parents and having a single point of contact

 

Resolved:-  (1)  That the progress made to address the need for children with social, emotional and mental health needs be noted.

 

(2)  That the development of a multi-agency SEMH Strategy be supported with a final draft in place by January 2019.

 

(3)  That consideration be given to having a lead case worker for families as their dedicated single point of contact.

 

(4)  That consideration be given to provision and support for young lesbian, gay, bisexual and transgender (LGB&T) people.

 

(5)  That consideration be given a particular focus provision for those young people from LGBT backgrounds.

 

(6)  That the monitoring of progress against the key themes outlined in Appendix 1 of the Child and Adolescent Mental Health Services be noted.

 

(7)  That the report being prepared by RDaSH regarding the ASD pathway come back to the Commission for discussion once finalised.

Supporting documents: