Agenda item

To consider an update report and presentation on the delivery of the Mental Health Trailblazer programme in schools.

Consideration was given to a report and presentation by the Joint Assistant Director of Commissioning, Performance and Inclusion; the Service Manager for CAMHS; and the Clinical Lead for the Mental Health Support Teams. The report and presentation included information in respect of Rotherham’s Child and Adolescent Mental Health Services (CAMHS) pathways. The presentation indicated how the THRIVE model was being implemented by RDASH and the progress in respect of the Mental Health Trailblazer in Schools. It was noted that the Trailblazer, known as ‘With Me in Mind,’ employs a tailored approach for each school and is available to everyone through online resources at www.withmeinmind.co.uk. The Trailblazer was described in the context of the wider CAMHS service and the COVID-19 pandemic. The report depicted the results of two phases of data collection via a survey of young people as part of an annual lifestyle survey. The first data collection efforts took place during the first period of national lockdown and again during October, with the survey closing just before the second national lockdown began.

In discussion, Members noted resilience of young people during the pandemic and the possibility of an element of attrition in the data. It was noted that HELIOS likely came into service at the optimal time just as the pandemic was starting. Members expressed hope that young people would be encouraged to see the positive outcomes and progress that have come from the pandemic. The response noted that the Wellbeing for education return, and the mental wellbieng of staff has been at the forefront of priorities so that staff can be more resilient as well. Some children have a lot of protective factors as far as family environment and economic factors, but some children will not have that, so flexibility has to be built into the programmes to reflect and respond to that. The engagement of young people via digital technology has been really positive, and some young people are more likely to engage with support that way as a gateway, which is something that will continue to be utilised after the pandemic is over.

Members requested clarification around the distribution of values for male and female patients, and the apparent movement of cases from severe to less severe over the course of treatment. The response noted that the numbers are still low for statistical significance, but if, after a year of data collection, the trends persist, it would certainly receive attention.

Members also requested clarification around the percentage of children who reported feeling that their mental health is worse. The response clarified that in October 2020, 48% of respondents said their mental health had not changed and 13% said it had improved.

Further clarification was also requested around the role of schools in collecting the survey information. It was clarified that all responses are anonymous, so there is no way to know which person had responded. Assurance was given that all schools took the survey seriously and identified which age groups responded at which times, so that whole group interventions and appropriate support could be made available. Assurances were provided that the service had followed up with the schools to ensure that the appropriate support had been provided.

Members also requested additional information about the provision of mental health services to special schools and young people with autism and disabilities. The response noted that the pilot includes only 22 schools currently, which have adopted the ‘With Me in Mind’ programme. These do include Rowan and Aspire which had high numbers of students with education health care plans (EHCPs). The programme does not include the special schools at the moment, because the links into special schools already had well-established pathways, and it was understood that the learning disability pathway within the CAMHS service was already very strong so many students with disabilities would receive support through that pathway instead of ‘With Me in Mind.’ Aspirations are to bid for a school to host the programme in future, which will be submitted as soon as the bid is announced, and that opportunity will include the special schools. Further assurances were requested and offered in a future update regarding the learning and intellectual disability pathway.

Members also requested more details around the response from young people who described feeling angry, which was a new emotion surfacing in the responses. Members expressed interest in knowing might be the factors behind that. In response, officers noted that the addition of anger to the responses reflects the overall population. The response of “With me in Mind” and the response of supporting the workforce to better provide the needed support to young people who are presenting with anger and the whole range of emotion. It is true that what young people experience is unique to them and different from the usual, but being able to place the emotion and a mixture of emotions, especially among older children whose future plans and exams have been disrupted, this can include anger. There are not any major trends that are displaying here. So much has happened in a short period of time, but as time goes by, a more complete picture will be available.

Members lauded the positive outcomes the programme will achieve and requested clarification around when schools were closed in relation to the survey period. The response clarified that the data taken from April to June 2020 was during a period that the schools were closed. Members observed that not much can be taken from the data collected while schools were closed, and the data seemed overly positive. It was noted that unless there is a relationship with the person who is collecting the information, children often report more positive feelings than they really feel. Future data was requested to be benchmarked to national research reports. The response from officers clarified that these are not the figures for the wider CAMHS service, but for “With Me in Mind.” The sample size is still rather small currently, but using evidence based approaches has delivered reliable outcomes represented in the report. 

Members noted the complexity of children’s lives, and that for many children being home is not safe but is rather stressful during the pandemic. Members requested clarification around digital interventions and how these were delivered safely. Members also expressed interest in knowing how service providers respond to dropping connectivity during a session, or how to handle triggering and to handle emotional needs during the remote sessions.

Partners and officers noted their awareness that some children have difficulty with digital interventions and access, so remote interventions are offered alongside face-to-face so that children can share openly with the provider. There is an app that has been implemented that allows young people to chat confidentially and openly with the provider, but it is understood that some children would not naturally choose a remote intervention. The digital offer does have its limitations, for example, in the cases of specialised therapies such as trauma. Sometime the support that is needed is best delivered in person, but the service is using a range of approaches to ensure that the service is delivered effectively.

Members requested information about how children with complex needs are being identified and reached; furthermore, how early is this “early intervention” and whether preventative interventions were being used. The response described how children are identified through consultation and the whole school approach was being developed and strengthened to pick things up faster. Preventative interventions were facilitated by the whole-school approach and the whole workforce approach, because part of the intention wass to get the whole groups of children receiving preventative interventions rather than reliance on specialised services.

Members requested further longterm updates that consider how the programme is serving and meeting the needs of a variety of different young people. The response from officer averred that as the one-year anniversary of the programme is just passing, more long term and equalities implications will become clear moving forward and will be included in future assessment of the programme.

Members requested information around any negative response from schools. The response from officers was that engagement from schools had been ver strong overall, but a few schools had been unable to prioritise the survey with their students. This decision by a few of the schools reflects their strategic mobilising of their response in terms of supporting young people at this time. The education wellbeing return has been rolled out across the term, with 140 people represented at these events, which are focused on strategies and those attendees have all cascaded these approaches more widely within their organisations. This suggests that schools are taking the emotional wellbeing and mental health of their students very seriously and are making decisions about how to mobilise support to their students based on the resources available to them during this time.

Members requested information about technological poverty in terms of young people being unable to access online resources. Some young people had been loaned from schools to be able to access the services remotely, and that process has been straightforward and easy to arrange with the schools. During lockdown, government funding supported laptops being sent out to children and distributed during the summer term.

Members expressed curiosity if the service is preparing for a delayed spike in demand related to the pandemic. The response from officers noted that they are monitoring it closely and expecting a spike, and ensuring they are agile enough to respond to a spike if one presents. The response is being prepared through the front end of the service as well, through consultations, advice, and coordinated support work with partner network to respond early.

Further detail was requested as to the efforts in place to keep from having long wait times for young people in need of services. From a CAMHS point of view, we have good response time, reviewed within 24-hour period and responded to. An initial team responds to urgent and crisis referrals. Processes are in place to guide young people to the right point in the service for them. We analyse data to detect and understand bottlenecks to remove any delays.

Members requested further clarification around wait times and the response from officer reaffirmed that there is no wait time in terms of initial access as the response is within 24 hours. There are waits for psychological therapy and into the neurodevelopmental pathway, but not for referrals. The service reviews all referrals into the service within 24 hours, and comprehensive assessments for starting a more structured intervention for a young people are done in a timely manner, and are seen within 8 weeks for the initial appointment.

Resolved:-

1.      That the report be noted.

2.      That the next update be brought in 12 months’ time.

3.      That the Chair of Improving Lives Select Commission give consideration to investigating young patients’ access to technology with a view to preventing digital exclusion from mental health services.