Meeting documents

For the Committee to receive information about Children’s Mental Health Services within Buckinghamshire

·       Introductory presentation

·       Partnership working with Looked After Children

·       Participation from children and young people

·       Mental Health Support Teams – to follow item

·       Kooth online counselling (slide plus video)

Contributors:

Lead Officers -

Jack Workman - Specialist Commissioning Manager – All Age Mental Health

Matilda Moss - Head of Service – Integrated Commissioning

Partner agencies in attendance -

Oxford Health NHS Trust

Barnardos

Kooth

The Chairman welcomed all contributors who were in attendance and acknowledged that they represented a range of partner organisations who were involved in providing mental health services to children and young people.

Mr Workman, Specialist Commissioning Manager, told the Committee that the provision of effective mental health services and widening access for people who wanted to access these services was a nationally mandated expectation. Buckinghamshire had been fortunate enough to be one of the first 50 sites to be included in the trailblazer project (implementing mental health support teams in schools and improving waiting times for young people accessing CAMHS services).

Dr Connolly, Consultant Clinical Psychologist at Oxford Health NHS Foundation Trust, discussed new services for looked after children and the fact that Oxford Health had good working relationships with Buckinghamshire Social Care. Social Care and CAMHS had developed a working party that meets regularly to review the Strengths and Difficulties Questionnaire (a statutory mental health screening tool for Looked After Children).  This was to ensure children received the right support at the right time.

The Chairman asked about actions which had followed the increased drive to improve access to NHS-commissioned services and whether the prevalence of mental health issues had increased nationally. Ms Clarke, Service Director at Oxford Health NHS Foundation Trust told the Committee that routes of access had been opened up to allow children and parents to self-refer. Mr Workman said that the service had increased the percentage of people who were able to access services and this was monitored at a national level, based upon the local prevalence to ensure they could meet service demands.

A Member questioned how open and honest parents had been when referring their own child and whether they tended to hide problems. Ms Clarke assured the Committee that they usually received good quality referrals from parents and parents tended to accurately predict the main areas which children would need help with.

A Member asked for an update about waiting times for eating disorder appointments and specialists as they had experienced issues 10 years ago. Ms Clarke told the Committee that 2015 had been a transformational year for CAMHS services, as it had been identified nationally that young people with eating disorders had been poorly served. The waiting times to see patients within the eating disorder service were accurate, with 100% of urgent referrals receiving assessments within a week and 84% of non-urgent referrals receiving an assessment within 4 weeks.

Dr Roberts, Clinical Director for Mental Health Clinical Commissioning Group (CCG) informed the Committee that a patient would initially be able to access an urgent same-day appointment with their registered Doctor and that a referral would go in straight away with no delays. Dr Rowsell, Head of Psychological Therapies – Oxford Health NHS Foundation Trust, said that the number of patients accessing the CAMHs eating disorder services had grown but this hadn’t led to delayed referrals.

Dr Connolly told the Committee that the service carefully triangulate data about each child within a range of different settings including home, educational and clinical. This builds up a full and complete picture of child behaviour and needs from a range of reliable sources.

A Member asked about how the service quickly supplies help to schools before problems escalate and pupil behavioural issues set in. Dr Connolly told the Committee that the Looked After and Adopted Children Team tended to action referrals within 5 working days, but they faced some challenges as more than half the looked after children population had been placed outside Buckinghamshire.

Ms Hadwin, Head of Service for CAMHS, reported that they were a provider of mental health training for professionals and that the single point of access had a qualified clinician on hand to provide assistance to referrers. There had also been direct provision into Schools who had requested support and there was a vision that additional support would be rolled out to all schools as highlighted in the NHS long-term plan for mental health.

Mrs Moss, Head of Integrated Commissioning, informed the Committee that actions which were taking place within mental health services in Buckinghamshire mirrored the actions timetabled within the NHS long-term plan and that funding for these initiatives was being issued in waves. They would always bid for funding for the voluntary sector and prioritised the recruitment of staff who could work effectively with individual pupils and children with high needs.

In response to Members’ questions, the following main points were raised:

·         Many behavioural escalations could be dealt with within school settings. Dr Rowsell informed the Committee that mild to moderate anxiety and depression could be dealt with effectively in Schools. Mr Workman reported that mental health awareness training was being rolled out to staff within Schools, which provided a toolkit for providing support to children and young people once they had been discharged from the CAMHS service.

·         Ms Hadwin said that there was a co-funded post in the Pupil Referral Unit (PRU) so that children were able to get immediate help and to support children to get back into mainstream school as soon as possible.

·         Dr Rowsell discussed the age range and types of behaviour which were prevalent in the CAMHS service. A child of any age could be seen if there was evidence that an intervention was required. Very young children would usually only receive a service if they displayed moderate to severe mental health issues. Ms Hadwin said that nobody would be turned away from the service. Through the single point of access, if CAMHS services were not appropriate for a child, it was possible to receive signposting, advice and support from reputable third parties.

·         Dr Connolly told the Committee about a recently established service called ReConnect within CAMHS which had received national acclaim. The service was created for parents who have neglected or abused their children and had the main aim of stopping children going into care.  This service was specifically for parents of children under the age of two years.

·         A Member congratulated all partner agencies and commended the enthusiasm of all contributors. When asked whether there was thought to be any gaps in service provision, particularly for looked after children (LAC) who had been placed out of County and the usual protocol, Dr Connolly said that the child’s social worker would assess the situation, phone the single point of access for consultation.  CAMHS would in the first instance support access to local CAMHS services, if there were long waits or difficulties then CAMHS would travel out of county to ensure the assessment took place.  Dr Connolly informed the Members that CAMHS had placed a Psychologist within the main social care building which had helped to improve outcomes and co-ordination of care.

·         Mrs Moss said that the long-term plan would be to widen access to mental health services nationally and to improve working with children who had very complex needs by giving them the right type of placements. Dr Roberts said that there was also a vision to extend the service so that it catered for young people up to 25 years old.

·         Ms Hadwin reported that the main way in which they wanted to make improvements to the service was by combining pathways, to create a more efficient patient journey and improve outcomes for children. They wanted to look at partnership working to make all pathways into the service more efficient

·         Mr Nash, Service Director Children’s Social Care, said that the service faced challenges rather than having significant gaps. There had been more challenging demographic issues in Buckinghamshire and the children and young people who had been placed outside the county had more needs, were often at crisis point and would respond detrimentally to frequent changes of address. He felt that they were now better informed about how to deal with children who were at crisis-point.

·         A Member asked about what restrictions had been placed on social media access for children within residential homes. Dr Connolly said that there were challenges with restricting children’s Wi-Fi access but that they were strict about the types of media accessed.

·         Ms Hadwin said that they had been utilising School staff well and ensuring that they had the right skills to deal with complex issues. Training had already beien delivered to 1197 professionals and was also being offered out to about 360 parents who had expressed an interest. A lot of bespoke training had been offered to parents on the topic of anxiety.Feedback from schools had been largely positive.

·         Ms Bark told the Committee that an SEN lead within a setting would tend to identify any issues and quickly source a solution - providing the right thing to the right person at the right time, as timing was crucial. Mr Whyte told the Committee that they had been working with staff and children as early as possible, to provide an early intervention. Dr Rowsell said that Kooth had been crucial in providing an early source of support for all children over the age of 11 and had been implemented successfully across the county.

The Chairman thanked all contributors.