In December 2009, NHS Gloucestershire, jointly with Gloucestershire County Council and the Gloucestershire Children’s and Young People’s Strategic Partnership (CYPSP), issued a statement announcing their intention to redesign and potentially tender services for children and young people with emotional and mental health difficulties and their families.
This redesign process allows us to build on the improvements already made to local services and to commission a responsive, proactive and cohesive service that provides equity of outcome across the county.
Engaging staff, current users of the service, families and carers has been key to the development of this project and ultimately the development of a new service model. Since March 2009 we have been working hard to provide a range of opportunities for people to give us their views; “tell us what works and what doesn’t”. We have held a number of stakeholder events, attended local meetings and visited children’s centres, schools and community organisations.
The service specification that we have developed recognises the work of local staff in improving the CAMHS services over the past two years, whilst drawing on good practice from across the country and taking into account the views of children and young people, their parents and carers and other key stakeholders.
We believe that the new service will:
• respond to the need for services to be more joined up across agencies
• provide equity of access for children and young people from across the county
• improve the ability to identify an individual’s needs and respond earlier before they become more serious and complex
• allow for early assessment and intervention to help prevent these difficulties becoming more serious, with a clear pathway to early multi agency support
• improve access to more specialist support that is needed as necessary on a ‘step up/step down’ basis
• provide alternatives to inpatient care, so that where very specialist help is needed this will be provided as close to home as possible. This involves supporting children and young people in their local network of family, friends, community and schools wherever possible.
As previously indicated, the new service for children and young people’s emotional health and wellbeing will be launched in April 2011, with a gradual roll out of services during the following months. The service will be provided by 2gether NHS Foundation Trust.
How will services improve on the ground?
Redesigning the service has allowed us to use existing funding previously spent on expensive out-of-county in-patient beds to facilitate change. The joint commissioning approach taken by NHS Gloucestershire and Gloucestershire County Council has also allowed us to make improvements in the range of services and the way they are provided.
Building on the learning from the Targeted Mental Health in Schools Pathfinder, the Primary Mental Health Worker Service will ensure a more joined up approach to care, working with other children’s services, schools and GP services in each of the localities. Offering increased activity over and above that which is currently commissioned; it will provide direct therapeutic work and indirect interventions, advice, consultation and liaison. The service will ensure it has a high profile by providing “link individuals” for all schools and GP practices. It will work with Paediatric teams at Gloucestershire Hospitals NHS Foundation Trust, continuing to link to the Hospital Education Service. The service will also facilitate “step up/step down” from more intense and specialist mental health services.
As a result of feedback, the telephone advice line for professionals from other agencies will be extended to operate from 9-5pm, Monday–Friday.
There will be a strategically planned training programme which can be accessed by practitioners from other agencies.
Access to the Learning Disability Service will be improved with additional clinics provided in some of the county’s special schools. A range of interventions will be delivered, including behaviour and sleep management and liaison with colleagues in the delivery of appropriate Parenting Groups.
The service will prioritise provision for vulnerable children and young people as outlined in the national CAMHS Review 2008 and in line with local priorities. These include homeless children and young people, refugees and asylum seekers, looked-after children and those in contact with the criminal justice system. There are seven core areas of service delivery:
• Looked After Children’s mental health
• Youth Offending, and other vulnerable groups
• Understanding Sexual Behaviour
• Young People’s Substance Misuse Service
• Family Court Assessment
• Complex Engagement
• Infant Mental Health
In addition to the current dedicated Looked After Children’s Primary Mental Health worker, additional capacity has been commissioned to support pre-adoption and fostering assessment, matching of placements and placement stability as well as facilitating access to more mainstream mental health services as appropriate.
As well as being linked to the Youth Offending Service, mental health services will also provide strong links with the ASTRA Service (Alternative Solutions To Running Away), Youth Housing Advice Service and Solutions Leaving Care Team, ensuring more equity of access for vulnerable young people.
‘The Complex Engagement Service’ will deliver a highly flexible and innovative service designed to meet the individual needs and circumstances of children and young people who have complex engagement needs and have difficulties in accessing or sustaining treatment within more mainstream mental health services. The role of the complex engagement team is to work intensively with children and young people experiencing a complex range of behavioural, emotional and mental health needs to prevent escalation of at risk behaviours. This is likely to include Looked After Children, those on the edge of care and children and young people from seldom heard communities.
The Understanding Sexual Behaviour Service will provide evidence-based assessments and treatment for young people who display sexually harmful behaviour. Interventions could include Family Therapy, Psycho-education and CBT.
The Infant Mental Health Service will continue to provide specialist direct work where parents have severe mental ill health or infants are at risk of entering the care system but will now be accessible on a countywide basis.
Access to Specialist Mental Health Services, currently known as ‘Specialist CAMHS’, will be improved with a greater emphasis on flexibility in location of service whenever possible and also extended hours to include some evening and Saturday morning clinics.
The Crisis and Home Treatment Service will provide intensive interventions in order to ensure alternatives to inpatient admission and reduce length of stay. They will also provide seamless care co-ordination for families between community and inpatient care.
Further information
Over the coming months 2gether NHS Foundation Trust will work with staff to finalise the operational details of the new service. New promotional materials are currently being developed and we will ensure that you are kept informed of progress throughout this transition period.
In the meantime, if you would like any additional information on any of the above please contact Helen Ford, Performance Improvement and Development Manager, NHS Gloucestershire, on 08454 221817 or email helen.ford@glos.nhs.uk
