Promoting, protecting and improving our children and young ... · 2.3 We want all children and young people to be emotionally resilient, happy, and confident and to have the best

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Promoting,protectingandimprovingourchildrenandyoungpeople’semotionalwellbeingand

mentalhealth

Doncaster’sLocalTransformationPlan

2016-2020

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Contents

OpenLettertochildrenandyoungpeople

Doncaster’svisionfortransformation

Introduction

CurrentCommissioningArrangements

LocalInvestment

EngagementwithStakeholders

UnderstandingDoncaster’sNeed

SelfAssessmentToolkitFindings

Workforce

KeyObjectives

Outcomes

TransformationPlanandUpdates

RiskstoImplementation

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1.OpenLettertochildrenandyoungpeopleIamwritingtoyoutoexplainwhatchangeswehavemadeinthisnewplanandwhatthecontinuedofferwillbe.LastyearwedevelopedaLocalTransformationPlanthatoutlinedhowweweregoingtochangethesystemsandservicesforthebetter.Iamdelightedtoupdatethatthingsareimprovingandwewillcontinuetobuildonthisinthenewplan,weremaincommittedtochangingthingsforthebetter.Westrivetoensurethatyougetthesupportyouneed,attheearliestopportunity,providedbytherightpersonorpeopleattherighttime.Wearenowstartingtoseesomeofthesebigchangestakingplaceandthisisagoodthing.Stafffromdifferentserviceswillworktogetherbettertosupportthosewhomayneeditaroundtheiremotionalwellbeingand/ormentalhealthsothatyougetthebestsupportpossibleandnotbeingreferredtolotsofdifferentservices.Thecommunityeatingdisorderandintensivehometreatmentservicesarenewandsomethingwehaven’thadinDoncasterpreviously.Bothwillhelpsupportyoungpeoplethatneedthiskindofhelpandalsootherprofessionalsthatneedsomeadviceandguidance.Abigpartofthetransformationishowservicesbettersupportschools.Whathasbeenamazingishowschoolshaverespondedtothis.Therearenowover80%ofschoolsinDoncasterwithanamedemotionalwellbeingandmentalhealthchampionwhowillactastheleadwithintheschool.TheywillbewelltrainedandlinkedintothecommunityCAMHsworkers,eachschoolnowhasanamedCAMHsworker.WehavebeenworkingwithanorganisationcalledYoungMindstodevelopawaytoincludethevoiceandopinionsofchildrenandyoungpeople,inallareas.Thismeanswearelookingatwaysyoucanhelpustocommissionandthenoverseetheimplementationofservices.Ifyouareinterestedinhelpinguspleaseletusknow.Sowhatarethebigplansforthisyear?Wellthereareafew……….

1. ContinuetoworkwithYoungMindstogetthevoiceandopinionsofchildrenandyoungpeople.

2. Developtheexpertiseofstaffbytrainingallstaffthatmayhaveanopportunitytosupportchildrenandyoungpeople.

3. Makesurethenewservicesworkbycontinuouslycheckingthem.4. WearegoingtohavealookathowwecurrentlyprovidesupporttoLookedafter

Children,thosewithLearningDifficultiesandthosethatmayenterYouthJusticeservicesandimprovethem.

5. Checkthattheoutcomeswewanttoseeactuallyhappen.ItisanexcitingtimeandwewantyoutoknowthatTeamDoncasterisabsolutelycommittedtothisplan.Yourssincerely

DamianAllenDirectorofLearningOpportunities&Skills

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2.Doncaster’svisionfortransformationOurvisionsetsouttheambition;ourmissionstatementisourstatementofpurposeaspartnerorganisations.Ourvaluesdrivethecultureofthepartnerorganisationsandprovideananchorforeveryoneagainstwhichtotestbehaviouranddelivery.VisionTeamDoncasterwillworktosecuresustainableimprovementsinchildrenandyoungpeople’semotionalwellbeingandandmentalhealth.MissionToprovidearesponsibleandtransparentpartnershipinordertobringaboutwholesystemtransformation,bydevelopingandimplementingtheLocalTransformationPlan.Values- Theneedsofourpopulationareparamount- Thepartnershipwilldriveforwardcontinuousimprovement- Relationshipsbasedonintegrityandtrust- Childrenandyoungpeople’sviewswillbeconsistentlysought,understoodandbecomepartoftheservicedeliverymodel

2.1Wearenowayearintotheplananditispleasingtoreportthatpartnersareadheringtothemissionandvalues.TheprofileoftheLTPishighandremainsapriorityforTeamDoncaster.ItwasagreedthatitwouldbehelpfultoexpandonthevisiontogivegreaterclarityanddetailaboutwhatisitTeamDoncasterwantstoachievethroughthisplan.2.2WewanttoimprovesecuresustainableimprovementsthatmeanschildrenandyoungpeopleinDoncasterhavegoodmentalhealthandemotionalwellbeing.2.3Wewantallchildrenandyoungpeopletobeemotionallyresilient,happy,andconfidentandtohavethebestchancespossibletosucceedinwhattheywanttodo.2.4Forthosechildrenandyoungpeoplethatneedsupport,wewanttoprovidethisattheearliestpossibleopportunity,withaclearfocusonearlyinterventionandprevention.2.5Encourageamoresystemicapproachwheresupportaroundemotionalwellbeingandmentalhealthwillbeanaddontowhatsupportisalreadyinplaceand/orbeingputinplace,ratherthanahand-offreferral.2.6Theremovalofreferralthresholds,criteriaandwrittenreferrals.Supportwillbepartofasystemicapproach.2.7Todevelopaparticipationapproachwithchildren,youngpeopleandtheirfamiliesinthecommissioningandimplementingallfacetsoftheplan.Theaimistoputchildren,youngpeopleandtheirfamiliesattheheartofthesystemtransformation.2.8Toremovethestigmaofemotionalwellbeingandmentalhealththrougheducationandawarenessraising.2.9Toimprovetheunderstandingofemotionalwellbeingandmentalhealththroughaclearworkforcestrategy,thatwilloffertrainingandeducationtoeveryprofessionalworkingwithchildren,youngpeopleandtheirfamilies.Thismeansthateveryonewill

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understandtheimportanceofgoodmentalhealthandhowtohelp,orknowhowtoaccesshelpwhenit’sneeded.2.10Wewantaspecialistservicethatoffersevidencebasedinterventionsaspartofasystemicapproach,withhighlyqualifiedstaff.2.11Howwillweknowthatthisvisionisachieved?

Morechildren,youngpeopleandtheirfamilieswillberesilient,happyandconfident,withbetterchancesofsuccessevidence–feedbackfromchildren,youngpeopleandtheirfamiliesthroughquestionnaires,i.e.healthrelatedbehaviourquestionnaire,reduceddemandonservicesandgreatereducationalattainment.

Childrenandyoungpeoplewillhavegoodmentalhealthandemotionalwellbeingevidence–routineoutcomemeasures,goalsetting,numbersintreatment.

Childrenandyoungpeoplewhoneedsupportwillgetthisattheearliestopportunityevidence–reductioninnumbersseeninspecialistCAMHs,numbersseenbyconsultationandadviceworkers.

Morechildrenandyoungpeoplewithmentalhealthproblemswillrecoverevidence–individualgoalsetting(whereCYPmeettheirgoals).

Supportforchildrenandyoungpeopleisprovidedbytherightpersonattherighttimeevidence–numbersseenbyconsultationandadviceworkers.

Theremovalofreferralthresholds,criteriaandwrittenreferrals.Supportwillbepartofasystemicapproachevidence–numberreceivingsystemicsupport,numberofwrittenreferrals.

Fewerchildrenandyoungpeoplewilldevelopseriousmentalhealthproblemsandthosethatdoaregiventhebestsupportpossibleinthecommunityevidence–inpatientadmissions,numbersseenbyintensivehometreatmentservice.

Aqualityworkforcethatisexcellentinpracticeandabletodeliverthebestevidencedcareevidence–numbersaccessingtrainingcourses,numberofreferralsintospecialistCAMHs,posttrainingfindings.

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3.Introduction3.1ThisdocumentisarefreshoftheoriginalLocalTransformationPlan(2015-20)submittedinOctober2015whichoutlinedTeamDoncaster’sfiveyearvision.Theessenceofthatplanverymuchremains;withakeyfocusonEarlyInterventionandPrevention,whilststrengtheningchildren,youngpeopleandtheirfamiliesinvolvementinalldecisions.3.2ThefirstplanwassignedoffbyNHSEnglandashavingmetthecriteriainfullwithidentifiedstrengths.Astrongneedsassessmentandgoodengagementwithstakeholders.Theycommendedthattheplanwasveryaccessible,transparentandeasytoread,clearlydescribingtheservicesforchildrenandyoungpeople,recognisingthechallengesinDoncasteranddirectingeffortstowardsmanagingthesechallenges.Therewerealsosomerecommendationsincluding;baselinedataforLocalAuthorityservicestobeadded,strongergovernancearrangementsandfurtherdevelopedoutcomes.3.3Lotsofgoodthingshappenedinthefirstyearoftheplan,namelythedevelopmentofatierlessservice,newintensivehometreatmentandcommunityeatingdisorderteamsandtheengagementwitheducation.Itisimportanttonotethoughthatthetransformationofservicesandultimatelythesystemisstillinitsearlystagesandthereisstillmuchtobedone.Thisplanwillfocusonhowwebestachievethat,withagreateremphasisonthechangemodelneededtodrivechange.3.4TheplaniswrittentositalongsidetheFiveYearForwardViewforMentalHealth(NHSE2016),theSouthYorkshireandBassetlawSustainabilityandTransformationPlan(STP),TransformingCarePartnership(TCP)andDoncaster’sPlaceBasedPlan.3.5ForthepurposesofthisLocalTransformationPlanthepartnerserviceswillbereferredtoasTeamDoncaster,whichisthelocalpartnershipnameforthefollowingservices;DoncasterClinicalCommissioningGroup,DoncasterMetropolitanBoroughCouncil,DoncasterChildren’sServicesTrustandThirdSectorpartners.

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4.CurrentCommissioningArrangements4.1DoncasterClinicalCommissioningGroup,TheLocalAuthorityandChildren’sTrustmovedtoaJointExecutiveCommissioning(JCEG)arrangementinJune2015andagreedontwopriorityareas;oneofthesebeingemotionalandmentalhealth.4.2TheJCEGacknowledgedthattherearemanycontributingfactorsthataffectemotionalandmentalhealth,andaimstoevolvethejointcommissioningarrangementstoawholesystemintegratedapproachtoensurebetteroutcomes.Thiswillspanthelifeofachild,withaclearfocusonthe0-1001daysagendaandtransitionintoadultservices.4.3Theaspirationofthisplanisthatchildrenandyoungpeoplewillbeinvolvedincommissioningatalllevelsandalsotobeinvolvedintheimplementationofservices.TheworkwithYoungMindsisthefirststeptodoingthisfromanemotionalandmentalhealthperspective.4.4.Doncastercommissionsanumberofproviderstodeliverarangeofcommunityandacuteservices.Rotherham,DoncasterandSouthHumberNHSFoundationTrust(RDaSH)RDaSHisaspecialistmentalhealthtrustofferingmentalhealthandcommunityservicesinDoncaster,Rotherham,NorthLincolnshire,NorthEastLincolnshireandManchester.AsDoncaster’sleadCAMHsprovider,RDaSHprovidesalltheelementsoftheCAMHsprovision.ThisincludesspecialistCAMHs(includingtheoutofhoursservice),LookedafterChildren,LearningDisabilityandYouthOffendingspecialistservicesandthenewprovision;consultationandadvice,intensivehometreatment,paediatricliaisonandworkforceeducator.RDaSHactastheleadproviderforthenewcommunityeatingdisorderserviceandtheleadforDoncasterforChildrenandYoungPeople–IncreasingAccesstoPsychologicalTherapies(CYP-IAPT).RDaSHhosttheADHDteamandprovideclinicalpsychologyinputintotheautismpathwayanddiabetesbestpracticetariff.DoncasterandBassetlawFoundationHospital(DBHFT)DBHFTareahospitalTrustthatprovidearangeacuteservices,includingaccidentandemergencyandacuteandcommunitypaediatrics(incADHDandASD).DBHFTaretheleadorganisationforautismassessmentsandtherapyservicesandhostthe24/7crisissupportandmentalhealthliaisonservices.DoncasterChildren’sServicesTrust(DCST)DCSTisanindependentorganisationsetuptodeliversocialcareandsupportservicestochildren,youngpeopleandfamiliesinDonncaster.ItwasthefirstTrustofitskindwhenestablishedinOctober2014andoffersarangeofservices.TheseincludetheYouthOffendingservicewhichhasitsowndedicatedCAMHsworkerandaforensicpsychologist.DCSTisleadingonanumberofinnovativedevelopmentprogrammes,includingGrowingFutures,PauseProjectandMockingbird.CollaborativesEarlyHelpCollaborativegroupsarelocalstrategicpartnershipgroupsandwereconceivedasakeyelementofDoncaster'sEarlyHelpStrategy.Collaborativesarefundamentallydecisionmakingbodieswiththepowertomakedecisionsonprovisionandcommissioningofservicessoastosecureimprovedoutcomesforchildrenandyoungpeopleaged0-19years.Insodoing,Collaborativesreceiveneedsbasedassessmentoflocalchildrenandfamilies,performanceinformationofexistingserviceprovisionandtobeabletoplan,

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sourceandsecurefunding,redirectresourcesandprioritiesofkeyagenciesinordertoachieveimprovedoutcomes.TheCollaborativesareempoweredtoproducealocalplanwithafocusonreducinginequalities,prioritisingpreventionandearlyintervention.4.5Doncasteralsocommissionsarangeofservicesthatcontributetowideremotionalwellbeingandmentalhealth,physicalhealthandcareneedsforvulnerableand/orhardtoreachchildrenandyoungpeople.JASPJASPisapart-time,interimeducationalprovisionforkeystages3and4pupilsreferredbyCAMHswhoare:

- experiencingsevereandenduringmentalhealthdifficulties- havingdifficultyaccessingamainstreameducationfull-time- activelyinvolvedwithCAMHs.

Theaimsoftheservicearetokeepthiscohortofchildrenandyoungpeopleengagedineducation.YoungMindsYoungMindsistheUK’sleadingcharitycommittedtoimprovingtheemotionalwellbeingandmentalhealthofchildrenandyoungpeople.DoncasterhascommissionedYoungMindsoverthenextfiveyearstobuildasustainableparticipationmodelwithchildren,youngpeopleandfamiliestogivethemarealvoiceinhowservicesarecommissionedandprovided.SouthYorkshireEatingDisorderService(SYEDA)SYEDAareanindependentcharitythatsupportsawiderangeofpeoplefrommanydifferentbackgroundswitharangeofeatingdisorders.Theyprovidetherapeuticsupport,facilitatesupportgroups,offerabefriendingserviceandoffereducationandtrainingsessionsinschools,colleges,toprofessionalsandthewidercommunity.OpenMindsOpenMindsisalocalcharitythatprovidesacounsellingservicetochildrenandyoungpeople.Theyofferarangeofserviceswhichinclude;counselling,CBTandNLP.

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5.LocalInvestment5.1ThereisaclearlyidentifiablebudgetforCAMHswhichcomprisesoffundingfromDoncasterClinicalCommissioningGroupandtheLocalAuthorityandismanagedbytheStrategyandDeliveryManagerforChildrenandMaternity,withCAMHssittingwithinthisportfolio.DoncasterClinicalCommissioningGroupandtheLocalAuthorityhavemaintainedasignificantfinancialcommitmenttoCAMHsandwillcontinuetodoso.TheLocalTransformationPlanfundingenhancesthisbaseleveloffundingandishelpingtosupportsystemtransformation.5.2Doncasteriscommittedtoinvestinginemotionalwellbeingandmentalhealthandtheestimatedspendin2016/17isasfollows:

SpecialistCAMHs: £1,655,338SinglePointofAccessCAMHs: £120,000Consultation&AdviceCAMHs: £80,000IntensiveHomeTreatmentService: £220,000PaediatricLiaison: £50,000LookedafterChildrenCAMHs: £80,000LearningDisabilityCAMHs: £80,000YouthOffendingServiceCAMHs: £35,000CYP-IAPT: £35,000WorkforceEducator: £50,000WorkforceStrategy £100,000AutismPathway: £516,825ADHD: £200,000JASP: £372,814Thrive: £72,398YouthOffendingServiceAssistantForensicPsychologist: £35,000WaitingListNHSEFunding*: £90,000

Total*: £3,792,375

*thisexcludesthepotentialfundinglistedin5.9.

43%

3%2%

6%

1%2%

2%1%

1%

1%3%

13%

5%2%

10%

2%2%

DoncasterSpendSpecialistCAMHs:

SinglePointofAccessCAMHs:

Consultation&AdviceCAMHs:

IntensiveHomeTreatmentService:

PaediatricLiaison:

LookedafterChildrenCAMHs:

LearningDisabilityCAMHs:

YouthOffendingServiceCAMHs:

CYP-IAPT:

WorkforceEducator:

WorkforceStrategy

AutismPathway:

ADHD:

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5.3Abreakdownofhowthisspendwillbemadeagainstthelocalpriorityschemeindicatorsisbelow:

LocalPriorityScheme Q1 Q2 Q3 Q4Establishnamedemotionalwellbeingandmentalhealthleadsinschools(internal)

£12,500

Continuousconsultationandengagementwithchildren,youngpeopleandfamilies

Appointmentofworkforcedevelopmentlead

£10,000

£10,000 £10,000 £10,000

Auditandrollingtrainingprogramme

£35,000 £35,000 £30,000

CAMHsworkertobeembeddedintheEarlyHelpHub

£10,000

£10,000 £10,000 £10,000

NamedCAMHsleadsinschools&PrimaryCare

£20,000

£20,000 £20,000 £20,000

Supportingselfcare Developmentofsinglepointofaccess

Furtherdevelopevidencebase

£18,275

Implementallareasofthecrisiscareconcordat

£12,500 £12,500 £12,500 £12,500

Intensivehometreatmentservicetobeprovided

£55,000 £55,000 £55,000 £55,000

Expansionofpeermentoringservice

Enhancethecurrentassessmentprocesstoincludesensitiveenquiries

Enhancethecurrentdonotattendpolicy


Developmulti-agencyteams Improvedcommunitypaediatricservices(incASDandADHD)

£129,206.25 £129,206.25 £129,206.25 £129,206.25

Developmentofdomesticviolencemulti-agencyteams

Provisionofeatingdisordercommunityservices

£177,966

Thedifferencebetweenthefiguresin5.2and5.3isthespendonotherareasnotincludedinthelocalpriorityschemeindicators,i.e.specialistCAMHs.Anyindicatorswithnoallocatedspendwillhavespendin2015/16.

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5.4Theprimaryfundingsourcesare:

ClinicalCommissioning

Group

LocalAuthority

NHSEngland*

Children’sServicesTrust

Collaboratives

£2,385,338

£508,340

£685,000

£35,000

£57,398

*thisexcludesthepotentialfundinglistedin5.8.5.5Itshouldbenotedthattheaboveestimatesincludethemajorityoffundingspentonemotionalwellbeingandmentalhealth,howevertheremaybeadditionalfundingwheredetailedinformationisn’tavailable.However,thiswouldbelimitedaswehaveunpickedseveralchildrenserviceblockcontractsandhaveagoodunderstandinglocallyonspend.5.6Theremaybechangestofundingthatoccurinyearthatweareunabletopredictatthisstage.Therearenoreductionstofinancesplannedinyear.5.7ImplementingtheFiveYearForwardViewforMentalHealthservicessetsatrajectoryforincreasedaccess,whichisbasedonexistingprevalencedataandallocatesfundingtothisonanationallevel.Thisfundingwillthenbeallocatedlocallytosupporttheincreaseincapacityandsystemtransformation.

5.8Thefundingprofileforchildrenandyoungpeopleisasfollows:Thereforeitisanticipatedthattherewillbeincreasedlevelsoffundingeachyearuntil2020/21.Weareunsureatthepointofwritingthisplanhowthiswilltranslatelocallyandwhatthefuturelevelsoffundingwillbe,and/orifcommissioningresponsibilitieswillflowdowntoCCG’swithanyadditionalfunding.5.9Inadditiontothis,aletterdated26thSeptemberfromtheNationalMentalHealthDirector(NHSEngland)wassenttoCCGaccountableofficers.Thisletterannouncedthatanadditional£25millionnationallyhasbeenidentifiedwhichcanbemadeavailableforCCG’sin2016/17.ThisfundingisinadditiontothemoniesalreadyallocatedtoCCG’sandbrings

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forwardtheexpecteduplifttobaselinefundingtomeetthepublishedlevelssetfor2017/18(£170millionnationally),whilstalsoprovidingnon-recurrentfunding.Aswithallallocationsofnewmoney,itiscriticalthatweareabletodemonstratetheimpactofthisinvestment.ItisexpectedthatthesefundswillsupportCCGstoachievethefollowing:

• Acceleratetheirplansandundertakeadditionalactivitiesthisyeartodrivedownaveragewaitingtimesfortreatment,andreducebothbacklogsofchildrenandyoungpeopleonwaitinglistsandlengthofstayforthoseininpatientcare.

• SupportCCGstocontinuetoinvestintrainingexistingstaffthroughtheCYP-IAPTtrainingprogramme,includingsendingnewstaffthroughthetrainingcourses.CYP-IAPTcollaborativesarerecruitingtotrainingplacesnow,soCCGsshouldbeidentifyingwiththeirpartnersthestafftosendonthetrainingcourseandanyadditionalresourcesrequiredtoreleasestaff;and

• Accelerateplanstopump-primecrisis,liaisonandhometreatmentinterventionssuitableforunder18s,withthegoalofminimisinginappropriateadmissionstoinpatient,paediatricoradultmentalhealthwards.ThisshouldincludeworkingwithNHSEnglandspecialisedcommissioningteamstodevelopintegratedpathways.

5.10Inordertosecurereleaseofthefulladditionalfunding,CCGswillbeaskedtoprovidedetailsofhowtheyintendtoimproveaveragewaitingtimesfortreatmentbyMarch2017.Thisfundingwillcomedownintotwopayments;thefirstwillbeallocatedinOctober2016onafairsharesbasis,thesecondpaymentwillbemadeinJanuary2017subjecttoCCG’sdemonstratingprogresstowardstheirimprovementstargets.

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LocalPriorityStream ExpectedOutcome Q3Oct-Dec15/16 Q4Jan-Mar16 Q3Oct-Dec15/16 Q4Jan-Mar16

Localprioritystream1Establishnamedmentalhealthandwellbeingleadsinschools(internal) £5,000

Localprioritystream2

Continiousconsultationandengagementwithchildren,youngpeopleandfamilies

£90,000 £90,000

Localprioritystream3Appointmentofworkforcedevelopmentlead £10,000 £10,000

Localprioritystream4 Auditandrollingtrainingprogramme £100,000 £100,000


Developan'innovationpartnership'approachwithalocaluniversitytodeliveranacreditedtrainingprogrammewithnationallyrecognisedmodules

Localprioritystream6CAMHsworkertobeembeddedintheEarlyHelpHub £10,000 £10,000

Localprioritystream7NamedCAMHsleadsinschools&PrimaryCare £20,000 £20,000

Localprioritystream8 Supportingselfcare £40,000 £40,000Localprioritystream9 Developmentofsinglepointofacess £50,000 £50,000Localprioritystream10 Furtherdevelopevidencebase £45,000 £45,000

Localprioritystream11Implementallareasofthecrisiscareconcordat £76,306 £131,280 £76,306 £131,280

Localprioritystream12Intensivehometreatmentservicetobeprovided £55,000 £50,000

Localprioritystream13 Expansionofpeermentoringservice £10,541 £10,541

Localprioritystream14Enhancethecurrentassessmentprocesstoincludesensitiveenquiries £5,000 £5,000

Localprioritystream15Enhancethecurrentdonotattendpolicy

Localprioritystream16 Developmulti-agencyteams

Localprioritystream17Improvedcommunitypaediatricservices(incASDandADHD) £25,000 £25,000 £25,000 £25,000

Localprioritystream18Developmentofdomesticviolancemulti-agencyteams £35,000 £35,000 £35,000 £35,000

Localprioritystream19Provisionofeatingdisordercommunityservices 177,966 177,966


RedeploygenericstaffcurrentlyseeingEDcasesnowseenbycommunityteamtoimproveaccesstoselfharmandcrisisandinvestunderspendfromEDfunds

Total £136,306 £804,787 £136,306 £804,787

PlannedSpend ActualSpend

5.11Alltransformationmoniesreceivedin2015/16werespentonareasidentifiedwithintheoriginalLTP.Abreakdownisasfollows:

5.12CommunityEatingDisorderServiceFundingFundingforacommunityeatingdisorderservicesitswithinDoncasterCCG’sbaselinefundingandisasfollows:

BaselineAllocation TotalSpend

£177,966

£177,966

5.13Commissionersandprovidersareconfidentthatthefullfundingallocationswillbespentin2016/17asperthetermsoftheLocalTransformationPlan.

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5.14PerinatalMentalHealthAnotherobjectivewithintheFiveYearForwardViewistoincreaseaccesstospecialistperinatalmentalhealthsupport.Thetablebelowshowstotaladditionalfundingandhowthiswillbeallocated.Doncasterwon’treceiveanydirectlocalfundinguntil2019/20,insteadadditionalfundingisallocatednationallytosupportnationalprogrammes.However,DoncasterhassubmittedtwobidsforSTFmoniesthatwouldbringextrafundingintoDoncasteruntil2019/20.

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6.EngagementwithStakeholders6.1In2014Doncasterconsultedwithlotsofitschildrenandyoungpeopleinpreparingthechildrenandyoungpeoples’plan.TheconsultationwaswiderangingandpulledtogetherbytheYouthCouncilwithseveralkeythemesemerging.Oneofthetoppriorityareaswasemotionalhealth.Doncasterhasacollaborativemodelofprimaryschoolsandchildrencentresbeingalignedintermsofgeographyandthesegroupshaveconsultedwithchildren,youngpeopleandfamiliesintheirareastounderstandlocalneed.Againemotionalhealthandwellbeingcameoutasakeypriority.Primarilyaroundthelackofprovisionforlowerlevelemotionalhealthneedsandwellbeing,especiallytheidentificationofgapsinmentalhealthprovision.6.2Buildingonthisarethefindingsfromachildrenandyoungpeople’sdemocracyeventheldthisyear.Acollaborationofyoungpeoplefromavarietyofsettingsheldaneventwherefourpriorityareaswerediscussed;oneofthesewasemotionalwellbeingandmentalhealth.Theeventwasagreatsuccessandthekeyfindingsareasfollows:

Notenoughisdeliveredinschoolsonmentalhealthissues,someschoolsonlyofferaone-offlesson.YoungpeoplestatedthatMentalHealthis‘Likeasecret’notseen,itsinvisible.WhenaMentalHealthissueisraisedteachers/schoolscanmakeitworseandunsafe,lackoftrainingandexperience.

YoungPeoplefeelnotenoughadvertising,publicityandawarenessisdeliveredoravailableonmentalhealth.YoungpeoplefeelthereisarealstigmaaroundmentalhealthandCAMHSsMoreneedstobedonetoaddressthis.YoungpeoplestatedtherearestilllotsofissuesarondPeerPressureandthatmoreneedstobedone.

Youngpeoplefeelthereisareallackoffundingforchildrenandyoungpeople'smentalhealthservice.Moreworkneedstobedoneonpathwaysintomentalhealthservices,theyarenotclear.CurrentspendingonchildrensMentalHealthdoesn’tmakesense,moreisspentonadults.

Havetotalktomorepeoplethannecessary,unlikesmokingwelladvertised,clearpathwayinplace.Lotsofissuesregardingtransitionfromchildtoadultservices.Moreneedstobedoneonearlyinterventionandwaitingtimes.MoresupportforyoungpeoplewhoarelivingwithMentalHealthwitinthefamily.e.g.youngcarers,managingtheirattendanceatschool.

MentalHealth

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6.3Solutions6.4DoncasterPublicHealthco-commissionedapupilHealth-RelatedBehaviourQuestionnaire(HRBQ)incollaborationwithEducation,atDoncasterCouncil.ThequestionnairewascompletedbySchoolsHealthEducationUnit.ThisprovidesusefuldatatoshowtheimpactofstrategiesinplaceandinformsusaboutthephysicalandemotionalhealthandwellbeingofschoolchildreninDoncaster,inordertoplanforthefuture.Topicsofthequestionnairewereasfollows,althoughthecontentdiffereddependingonage:-EmotionalHealthandWellbeing-HealthyEating-PhysicalActivity-Dentalhealth-Safety-Bullying-Substanceuse-RelationshipsandSexualHealth.6.5Allschools(includingthoseforchildrenwithSpecialEducationalNeeds)wereinvitedandencouragedtoparticipateduringthelasttermoftheacademicyear14/15.Initially,63primaryschoolsandall18secondaryschoolsagreedtotakepart.However,duringthedatacollectionphase,twelveschools(2secondaryand10primary)withdrewfromthesurveyorfailedtocompletebeforethedeadlinedateforcompletion.NoSENschoolsagreedtoparticipate.6.6SchoolswereaskedtosurveyYear4andYear8pupilsasessentialandYear6andYear10pupilsasoptional,eitherusinganonlineversionofthequestionnaireoronpaper.SomeschoolsalsosurveyedYear3pupils.6.7Intotalthisequatesto2,607boysand2,576girls,atotalof5,183.Thepertinentonesforthisplanaretheonesundertheemotionalhealthandwellbeingsection.Thekeyfindingswereasfollows:

Education–Schoolsneedtodomore,currentlyonlyofferedinPSHE/Citizenshipbutshouldweaveintoothersubjectse.g.Drama.Moretrainingforteachers/mentorstoreduceneedonCAMHs.Publicity–MorepositivepublicityneedstobedonetostopstigmaaroundMentalHealthandCAMHs.Youngpeoplesuggestrunninga'TimetoChange'campaign.GoodPractice-OthergoodpracticeservicesneedtobefollowedsuchasEClinic,Pyramid(BalbyCarr).Support-Youngpeoplewouldprefersupportfromapersontheyhavearelationshipwith,someonetheytrust,notnecessarilysomeonefromschool.Importantthatthepersonhastheskills&experienceinMentalHealth.Youngpeoplealsowelcomehomeservicesworkingwithallthefamilyandcarers.

YoungMinds-Youngpeoplewelcomedthe'YoungMind'programmethathasbeencommissionedinDoncasteroverthenext5years.

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6.8Compositeself-esteemscoresforPrimarySchools

Onthewholethecompositeresponsesarequitegood,howeverthereare28%ofchildrenaskedwhohavelowtomediumlevelsofself-esteem.Thereisafairlyevensplitbetweenmalesandfemalesandacrossthetwoyeargroups.6.9CompositeresiliencescoreforPrimarySchools

Againonthewholethecompositeresponsesaregenerallygood,howeverthereareoverathirdofthechildrenaskedwithalowtomediumlevelsofresilience.Againthereisafairlyevensplitacrossmaleandfemaleandyeargroups.6.10Compositeself-esteemscoresforSecondarySchools

Onthewholethecompositeresponsesarequitegood,howeverthereare22%ofchildrenaskedwhohavemediumlevelsofself-esteem.Howevertherearestillapproximatelyathirdofchildrenaskedwithlowtomediumlevelsofself-esteem.

6.11CompositeresiliencescoreforSecondarySchools

Year4 Year6 All Male Female Male Female

Values0-4(low) 5% 6% 4% 5% 5%Values5-9(medium) 21% 26% 19% 22% 23%Values10-14(med-high)

42% 42% 39% 37% 40%

Values15-18(high) 32% 26% 38% 36% 32%ValidResponses 656 678 433 419 2208


Low(upto19) 18% 14% 16% 15% 16%Med-Low(20-22) 19% 19% 21% 18% 19%Med-High(23-25) 22% 26% 25% 28% 25%High(26+) 41% 41% 38% 40% 40%ValidResponses 576 607 404 396 2002


Values0-4(low) 5% 9% 5% 8% 7%Values5-9(medium) 15% 27% 18% 27% 22%Values10-14(med-high)

35% 38% 36% 39% 37%

Values15-18(high) 44% 26% 42% 25% 34%ValidResponses 623 652 313 314 1956


Low(upto19) 18% 42% 34% 54% 38%Med-Low(20-22) 21% 20% 24% 21% 21%Med-High(23-25) 22% 22% 22% 15% 21%High(26+) 29% 16% 20% 9% 20%ValidResponses 554 600 274 279 1752

18

Therearesomebigdifferencesbetweengendertypes,withalmosthalfthefemalesaskedhavingalowlevelofresilienceinyear8andoverhalfinyear10.Thisisworryingandsomethingthatclearlyneedstobeaddressed.Thisquestionnairesuggeststhatmalesaremoreresilientthanfemales.6.12Theplanistorecommissionthisquestionnairein2017andthisisthemeasurementtooltoseeifthingsareimprovinglocally.6.13CAMHsaskedserviceuserstocompleteanexperienceofserviceandsessionfeedbackquestionnaire(seeappendix7).Thekeypointswereasfollows:

• Reportingthroughexperienceofservicequestionnaire(ESQ)formsshowedthat74%ofparents/carersfelttheywerewelltreatedbythepeoplewhosawtheirchild.

• Thesessionfeedbackquestionnaire(SFQ)thatbothserviceusersandparents/carersfeltlistenedtoo,talkedaboutwhattheywantedtotalkabout,understoodthemeetingandfeltthemeetinggavethemideasonwhattodo,sooverallpositivefeedback.

• Therewasageneralthemeofdissatisfactionwiththefacilitiesintermsofthewaitingareaandappointmenttimes.

• Therewasareoccurringthemerelatingtochangesinkeypersonnel.6.14Throughout2015/16therehasbeenasignificantamountofengagementwithstakeholderstoensurethattheLTPwasverymuchapartnershipplan,andthatitwasonevery-one’sagenda.Thisincludedpresentationsatalltherelevantboards,groupsandmeetingsincludingthoseforchildren,youngpeopleandtheirfamilies.Thishasbeenareallyhelpfulexerciseasitashelpedshapetheimplementationprocessthroughabetterunderstandingofindividualserviceneedswithinthewidersystemtransformation,inparticularwithschools.6.15Thefeedbackfromthevastmajorityofstakeholdershasbeenpositive,whichhasreallyhelpedembedtheplanacrossallareaswithinthesystem.Weareinapositionwherethereisgoodownershipandthereisasolidbasetokeepmovingforward.6.16Thisisfeltparticularlystronglyinschoolsasevidencedin77%ofschoolsnominatingaemotionalwellbeingandmentalhealthnamedleadwithintheirschool.Thenamedleadactsasthechampionandpointofreferencebetweenschoolsandotherservices,i.e.CAMHslocalityworkers.Theresponsefromschoolshasbeenextremelypositive.Thereisaclearplantosupportthoseschoolsyettonominatewiththeaimofhaving100%nominationbyMarch2017.6.17Aseriesoflocalityworkshopswereheldwithschoolrepresentativestodevelopandagreerolesandresponsibilities,andwhattheinterfacewiththenewCAMHslocalityworkerswouldbe,inparticularconsideringthemoveawayfromtiersandreferralthresholds.Allfindingswerecollatedandjointlyanalysedwithrepresentativesfromschoolsandagreementshavebeenmadeonrespectiveroles,responsibilitiesandtheinterface.Thishasbeensensecheckedwithchildren,youngpeopleandtheirfamilies.6.18TherehasbeenlotsofengagementwiththeCAMHsstafftogettheirthoughtsonhowbesttosupportthetransformation,whichhasbeenreallyvaluable.Thisworkison-going.

19

7.UnderstandingDoncaster’sNeed7.1Thechildrenandyoungpeople’semotionalwellbeingandmentalhealthneedassessmentforDoncaster(2015)wasdeemedtobeastrongneedsassessmentbyNHSEnglandandwasthefoundationfortheoriginalLTP.Thisneedsassessmentandinformationinthefollowingsectionssetsoutthecaseforchange.InformationSources

- Emotionalwellbeingandmentalhealthneedsassessment- EastMidlandsStrategicClinicalNetworkself-assessmenttoolkit- DoncasterSafeguardingChildren’sBoardmulti-agencyauditofchildren’s

mentalhealth7.2PrevalenceofkeyriskfactorsformentalhealthMentalhealthproblemsaffectabout1in10childrenandyoungpeople.Theyincludedepression,anxietyandconductdisorder,andareoftenadirectresponsetowhatishappeningintheirlives.Alarmingly,however,70%ofchildrenandyoungpeoplewhoexperienceamentalhealthproblemhavenothadappropriateinterventionsatasufficientlyearlyage.Theemotionalwellbeingofchildrenisjustasimportantastheirphysicalhealth.Goodmentalhealthallowschildrenandyoungpeopletodeveloptheresiliencetocopewithwhateverlifethrowsatthemandgrowintowell-rounded,healthyadults.Thingsthatcanhelpkeepchildrenandyoungpeoplementallywellinclude:

• beingingoodphysicalhealth,eatingabalanceddietandgettingregularexercise• havingtimeandthefreedomtoplay,indoorsandoutdoors• beingpartofafamilythatgetsalongwellmostofthetime• goingtoaschoolthatlooksafterthewellbeingofallitspupils• takingpartinlocalactivitiesforyoungpeople

Otherfactorsarealsoimportant,including:

• feelingloved,trusted,understood,valuedandsafe• beinginterestedinlifeandhavingopportunitiestoenjoythemselves• beinghopefulandoptimistic• beingabletolearnandhavingopportunitiestosucceed• acceptingwhotheyareandrecognisingwhattheyaregoodat• havingasenseofbelongingintheirfamily,schoolandcommunity• feelingtheyhavesomecontrolovertheirownlife• havingthestrengthtocopewhensomethingiswrong(resilience)andtheabilityto

solveproblems.

Mostchildrengrowupmentallyhealthy,butsurveyssuggestthatmorechildrenandyoungpeoplehaveproblemswiththeirmentalhealthtodaythan30yearsago.That’sprobablybecauseofchangesinthewaywelivenowandhowthataffectstheexperienceofgrowingup.(MentalHealthFoundation).7.3PopulationanddeprivationprofileDoncasteristhelargestgeographicmetropolitanboroughinthecountrywithanareaofmorethan225squaremiles.Doncasterhasapopulationof302,400,ofwhich72,100are

20

childrenandyoungpeople(0-19years).Childrenandyoungpeopleundertheageof20makeup23.7%ofthepopulationofDoncaster,whichissimilartothenationalaverage(23.8%).Thenumberofchildrenaged0to4yearshasslightlydeclinedin2015(19,200);thischangeisdifferenttotheregionalornationaldata,whichshowsanincrease.Twelvepercentofschoolchildrenarefromminorityethnicgroups,whichisanincreaseofoveronepercentwhencomparedwith2014(10.9%).(Childhealthprofile(CHP),2015).7.4Doncasterhasanequalproportionofmaleandfemalechildrenandyoungpeopleandahomogenousdistributionofchildrencanbeobservedthroughoutalltheagegroups(Figure2).7.5Figure2:Numberofchildren&youngpeopleinDoncasterdividedbygenderandagegroupsSourcemid2013estimate.

9806

9382

1079

9

1063

8

1045

3

1014

8

3744

3776

0

2,000

4,000

6,000

8,000

10,000

12,000

Males Females

Noofchildrenandyoung

people

Ages 0-4

Ages 5- 10

Ages 11- 16

Ages 17- 18

21

7.6ChildpopulationinDoncaster(2015)

Doncaster

YorkshireandtheHumber

England

Children(age0to4years)2013

19,200(6.3%) 334,100(6.3%) 3,414,100(6.3%)

Children(age0-19years)2013

72,100(23.7%) 1,278,600(24.0%) 12,833,200(23.8%)

Children(age0-19years)in2020(projected)

71,400(23.2%) 1,305,700(23.6%) 13,325,100(23.6%)

Schoolchildrenfromminorityethnicgroups,2014

4,782(12.0%) 150,330(22.3%) 1,832,995(27.8%)

Childrenlivinginpoverty(ageunder16years)2012

23.8% 20.8% 19.2%

Lifeexpectancyatbirth,2012

Boys77.5Girls81.7

78.582.2

79.483.1

Source:CHP20157.7Doncasterisrankedthe39thmostdeprivedofthe362LocalAuthoritiesinEnglandwithconsiderablevariationbetweenthemostaffluentwardsandthemostdeprivedwhichnumberamongstthemostdeprivedneighbourhoodsintheUnitedKingdom.7.8ChildrenandAdolescentMentalHealthServiceDataBasedonnationalprevalencedata(ONSmentalhealthofchildrenandyoungpeople),thefollowinghighlevelassumptionscanbemadeabouttheemotionalwellbeingandmentalhealthofchildrenandyoungpeopleinDoncasteraged5to16yrs.

AllMentalDisorders DoncasterPopulationofchildrenandyoungpeople

5to105,040

5to1610,800

11to165,260

7.7%ofchildrenagedbetween5to10yearshaveamentaldisorder

388

9.6%ofchildrenandyoungpeopleagedbetween5to16yearshaveamentaldisorder

1,037

11.5%ofyoungpeopleagedbetween11to16yearshaveamentaldisorder

605

22

7.9.ThefollowingdatashowsthekeyperformanceareasforCAMHsagainstkeyperformanceindicators.ItisusefultonotethatCAMHsisanintegratedservicesodataisnotshownintermsoftiers.Thedatarelatesto2015/16unlessotherwisestated.7.10ReferralDataAtotalof1,451referralswerereceived.

7.11NumberofUrgentReferralsTherewereatotalof13urgentreferralsreceived.Thechartbelowshowsthenumberofthosedeemedurgentassessedwithin24hours.

7.12NumberonNon-UrgentReferralsTherewereatotalof752referralsthatweredeemedtobenon-urgent.Thechartbelowshowsthenumberthatwereassessedwithin4weeks.

0

50

100

150

200

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

NumberofReferrals

100%

0%

%ofurgentreferralsassessedwithin24hours

92%

8%

%ofnon-urgentreferralsassessedwithin4weeks

23

7.13Numberofassessedchildrenandyoungpeoplestartingtreatmentwithacareplanwithin8weeksofreferralTherewereatotalof626assessmentscompletedandthechartbelowshowsthenumberstartingwithin8weeksofreferral.

7.14NumberofpatientsleavingtheserviceinaplannedwayAtotalof913patientslefttheservicein2015/16.Thechartbelowshowshowmanyleftinaplannedway.

7.15Numberofpatientsreturningtoservicewithin30daysofaplanneddischarge16patientsreturnedintotheservicewithin30days,thisequatesto1.75%.7.16AccessandWaitingTimesDoncasteronthewholehaspositiveaccessandwaitingtimes,thatcomparefavourablywiththeCAMHsbenchmarkingreport(2013).

88%

12%

Numberassessedstargngtreatmentwithacareplanwithin8weeks

98%

2%

Numberofpatientsleavinginaplannedway

24

25

7.17GeneralServiceTheaveragewaitingtimeforanassessment(non-urgent)isapproximately21dayswhichiswithinthe28daytarget,andtheaveragelengthoftimefortreatmenttostartis22daysafterassessment,thisgivesatotalof43dayswhichequatesto6weeks.Thenationalbenchmarkisonaverage15weeks(105days),withaveragewaitingtimesincreasingconsistentlysinceJanuary2011.Thiselementoftheserviceintermsofaccesstimesisperformingreallywell.

26

7.18LearningDifficultiesTheaveragewaitingtimeforassessmentis23daysforthiselementandthenafurther36daysfortreatmenttostart.Thisequatesto59daysand/or8.4weeks.Thisisjustoverthe56daytarget.7.19LookedafterChildrenTheaveragewaitingtimeforassessmentis28daysforthiselementandthenafurther51daysfortreatmenttostart.Thisequatesto79daysand/or11weeks.Thisissignificantlyoverthe56daytarget.Thiswillbethepathwaywherewewillfocustheadditionalfundingwiththeaimofimprovingcapacitytodrivedownthewaitingtimestoaccessingtreatment.7.20YouthOffendingServiceThereisadedicatedCAMHsworkerbasedwithintheYouthOffendingService(YOS)thatoffersfasttracksupporttoyoungpeoplewithintheYouthJusticesystem.

Descriptor ActivityNumberofYPassessedwithamentalhealthneed(ASSET)

30

NumberofYPoncaseload 86NumberofYPstartingtreatmentwithin8weeks 13 43%NumberofconsultationswithYP 25

7.21Inpatient(tier4)admissions&beddays

Numberofadmissions PCT CCG

Service 2012/13 2013/14 2014/15 2015/16 GrandTotal

AcuteCAMHS 9 9

Adolescent 13 16 16 45

AutisticSpectrumDisorder 1 1

Child 7 12 5 24

EatingDisorders 5 2 2 9

LearningDisability 4 9 6 19

ComplexLearningDisability 1 1

LowSecure 2 1 1 4

PICU 1 1 2 4

MediumSecure 1 1

Notknown/Notstated 2 2

Totalpatients 33 38 31 17 119

27

AnalysisTherewasaslightreductioninthenumberofadmissionsin2014/15comparedtothepreviousyearandverysimilarnumberto2012/13.Thenumber(31)isstillahighnumberregionallyandbasedonadditionaldatafromNHSEngland,Doncasteristhesecondhighestreferrerintheregionforinpatientservicesatarateof52per100,000.Thishastobelinkedtonolocalhomeintensivetreatmentservice.Whencomparingourdatatoareasthathaveahometreatmentservicethenumberofadmissionsintheseareasissignificantlyless.Thenumbersfor2015/16areforthefirstthreemonthsofthefinancialyear(Apr–Jun)andiftheratesweretostayconsistentfortherestoftheyear,theforecastedannualtotalwouldshowasignificantincrease.Thebreakdownofdatamaybedoesn’tgiveadetailedpicture,forexampleweareawarelocallythattherewereactuallysixinpatientsforeatingdisorder,howeverfourofthesepatientswillhavebeeninanon-specialisteatingdisorderservice.Thenumbersacrosstheservicesareprettyconsistentoverthethreeyears,withthefollowingexceptions:

• IncreaseinacuteCAMHsin2015/16.• Reductioninadmissionsforchildservices.

Occupiedbeddays PCT CCG

Service 2012/13 2013/14 2014/15 2015/16 GrandTotal

AcuteCAMHS 617 617

Adolescent 1187 1263 1320 3770

AutisticSpectrumDisorder 47 47

Child 900 1147 745 2792

EatingDisorders 12 12

LearningDisability 381 181 218 780

ComplexLearningDisability 320 632 683 1635

LowSecure 347 364 142 853

PICU 24 67 160 251

MediumSecure 243 243

Notknown/Notstated 56 56

GrandTotal 3402 3406 3138 1110 11056

28

AnalysisAgainthenumbersareprettyconsistentacrossthethreeyears,withaforecastedsignificantincreasein2015/16.Theaveragelengthofstayisapproximately101daysandagainthishasn’treallyvariedoverthethreeyears.Therehavebeenchangesinthenumberofdaysthoughacrossservices:

• Yearonyearincreasesforadolescentservices• Yearonyearincreasesforlearningdisability,particularlyfrom2012/13to2013/14• Nodaysinmediumsecure.

7.22Tier4Spend

Tier4Spend 2014-15 2015-16 £2,668,815 £1,581,674Therehasbeenasignificantreductioninspendin2015-16duetoareductioninadmissions.7.23SecureChildren’sHomeThenumberofDoncasteryoungpeopleinasecurechildren’shomewastwo.Thenumberinasecuretreatmentcentrewastwo.Thisdataisprovisionaland2014/15and2015/16figureswillbefinalisedintheretrospectiveannualYouthJusticestatisticspublications.Notethesefiguresareamonthlysnapshotofthecustodialpopulation,takenonthelastFridayofthemonthorfirstFridayofthefollowingmonthdependingonwhichisnearertoactualmonth.7.24CYP-IAPTDoncasterChildrenandYoungPeople’sMentalHealthService(CAMHs)teambecamepartoftheChildrenandYoungPeople’sImprovingAccesstoPsychologicalTherapies(CYP-IAPT)inOctober2012.ForthepurposesoftheapplicationtobeapartofCYP-IAPT,thepartnershipforDoncasterincludesNorthLincolnshireCAMHs-thiswasdecidedduetothesmallerteaminNorthLincolnshireandmadethebidding/applicationprocessmoreachievableforbothservices.DoncasterispartoftheNorthEastCollaborativeandisawave2site,joiningoneyearaftertheinitialpilotbegan,thiswasalongsideseveralservicesfromTees,EskandWearValleyNHSTrust(TEWV).TheNorthEastcollaborativeislinkedtoNorthumbriaUniversity,anytrainingrequirementsarefacilitated/providedthroughNorthumbriaUniversity,withanagreementthatsomeofthetrainingwouldbeprovidedinYorkratherthanNewcastletoreducetheimpactoftravel(timeforstudentsandcostforthepartnerships).Thetwokeyareasoftransformationanddevelopmentwereasfollows:

1. Training2. Transformationofservice.

7.25TrainingThetrainingisdeliveredatlevelseven,postgraduatediplomalevelandbelowisasummaryofthetrainingopportunitieswhichDoncasterCAMHshasaccessed,alongwithanupdateonthetrainees:

29

7.26ParentingInterventions• (2012/13)-twoplacesforDoncaster,staffcompletedthetraininganddelivered

WebsterStrattonparentingcourses• Bothparentingtraineeshavesincelefttheservice,onetopursueprivatework,the

othertoworkinanotherCAMHsservice• Nofurthertrainingplacesrequestedfromtheareaasthisworkisalready

predominantlyprovidedbyotherservicesinDoncaster.7.27CognitiveBehaviouralTherapy(CBT)

• FourtraineeshaveundertakentheCBTtraining,twoin2012/13,twointhefollowingyear(2013/14).TheCBTtrainingfocusesoninterventionsforanxietyanddepression

• Fromthefourtrainees,onepersonfailedanelementofthecourse,onepersondidnotcompleteduetoillness.Onepersonhasrecentlylefttheservice.

• DoncasterCAMHshasidentifiedafurtherneedforanotherplaceonthe2015/16training,giventheneedandlossoftrainedworkforce.Thisplacewasgranted.

7.28ServiceLead• ThreestaffthathadinvolvementwithintheDoncasterCAMHsteamundertookthe

serviceleadstraininginwavetwo;notallcompletedthecoursework,butundertookprojectstoaddresstransformationofservices

• NosubsequentserviceleadshavebeenidentifiedfromDoncastertocompletetheserviceleadscourse.

7.29Supervisortraining

• SeveralclinicianshaveaccessedCYP-IAPTsupervisiontrainingfromDoncaster,therewerenostaffwhohadappropriateexperiencetoundertaketheformalsupervisorstraininginCBTorInterpersonalPsychotherapyforAdolescents

• Afamilytherapistprovidedsupervisionforthesystemicfamilypracticecourse,theyhaverecentlylefttoworkwithinaCAMHstier4unit

• ItwashopedtosendaCBTtherapisttocompletethesupervisorstrainingthisyear,buttheyareonmaternityleave.

7.30SystemicFamilyPractice(SFP)

• Introducedin2013/14,branchedbetweensystemicpracticeforeatingdisordersandsystemicpracticeforself-harm

• TwotraineescompletedtheSFPtraining,oneineachoftheareas-eatingdisorderandself-harm.

7.31InterpersonalPsychotherapyforAdolescents(IPT-A)

• Introducedtotheprogrammein2014/15• Oneclinicianiscurrentlyundertakingthetraining,expectedtocompletein

November2015.7.32EnhancedEvidenceBasedPractice(EEBP)

• Thiswasintroducedin2014/15,atGraduateCertificate/AdvancedDiploma• OnecliniciancommencedtheEEBPcourse,butwithdrewduetopersonalandwork

circumstances.

30

7.33TransformationThefollowing,detailstheaspectsofservicedevelopmentwhichDoncasterCAMHshadagreedtodevelopaspartoftheCYP-IAPTapplicationprocess,alongsideabriefsummaryoftheprogresstodate:Ensureaccessandwaitingtimestotreatmentdonotdeteriorateduringthetrainingperiodasaresultofthisproject-therehasbeennodeteriorationinwaitingtimesforaccesstoservice,remainingconstantat25to28daysforaroutinereferral.Ensurethatthetransformationtakesaccountofthediversityandculturalneedsofthecommunityyousupport-on-goingdevelopmentofservicestakesintoconsiderationtheneedsoftheyoungpeoplefromtheDoncasterareaandhowthischanges. CommittoallTier3CAMHs,andTier2CAMHswhoarepartoftheproject,undertakingsessionbysession/frequentoutcomemonitoringusingtheCYP-IAPTdatasetwhichisusedtoguidetherapeuticinterventionsandsupervision-theabilitytocaptureroutineoutcomemeasureshasbeendevelopedwithinthepatientrecordssystem,thereisinformationavailablethroughbothrawdataandtabulatedviewsforusewithinsupervision.Theinformationgatheredalsosupportsclinicaldecisionmakingprocesses.Furtherworkisrequiredwithintheservicetofullyembedtheuseandmonitoringofroutineoutcomemeasures. Moveoverthelifeoftheprojecttoacceptself-referrals–self-referralhasbeenavailableforyoungpeopletoaccessviatheTalkingShopinDoncasterasadrop-inonedayaweek.Childrenandyoungpeoplecanalsocontacttheservicedirectlytodiscussreferrals.

Createalocalsteeringgrouptosteertheprojectlocallytoincludehealthandlocalauthoritycommissioners,NHSandvoluntarysectorproviders-alocalsteeringgroupwassetupinitially,astheprojecthasdevelopedandmainaspectshavebeenfocussedontrainingplacesandthedevelopmentoflocalpathways.Thishasnowbeenabsorbedintolocalbusinessdivisionmeetingsandmeetingswithcommissioners. Supportnewpartnershipsworkingwithyourcollaborativesastheycomeonlineinfutureyears-wearepartofthecollaborativesteeringgroup,whichprovidesanopportunityforlearningandsupportfornewandexistingmembersofthecollaborative. WorkwiththeHEIstoselectappropriatelyskilledtraineesandsupervisors-recruitmenttopostgraduatecoursesarefullyestablishedandembeddedintopracticewiththeNorthumbriaUniversity. Ensurethattrainees,supervisorsandservicemanagersselectedtoundergothetrainingcanattendtrainingandcanundertaketheassignmentsnecessarytopassthetraining-traineeshavebeensupportedtoattendtrainingasrequired,postgraduatetraineeshavebeenfullyback-filledwithinservicetoallowfortheappropriatetimeandresourcetobeavailableforthem. EnsurethattheinfrastructureanddatasystemsaresufficientlyrobusttoallowdatacollectionoftheIAPTdatasetandensuredataissentasrequired-therewasfinancialsupporttoemployadataanalystwithinthefirstyearoftheproject,whichsupportedthedatacaptureforthenationalreportingrequirement.Theremovalofthiscontinuestobechallengingfortheinformationdepartmentasreportingstructuresandparameterschange

31

frequently.Thisshouldbecomeeasierinthenearfutureasreportingwillbedeliveredthroughthementalhealthdataset. AgreethatdatasenttotheprojectofficebecomesthepropertyoftheChildrenandYoungPeople'sIAPTProject-agreedlocally. Receiveandtransferallfundsinaccordanceoftheobjectivesoftheproject,andensurethat,asNHSbodiesevolve,thatorganisationswhichmayfollowoninthecommissioningroleareawareof,understandandacceptthecommitmenttotheIAPTproject–fundinghasbeenmadeavailabletotheserviceasperrequirement. AgreetoparticipateinserviceaccreditationtoIAPTstandards-thisisongoing,serviceaccreditationwillbeconsideredthroughthe‘DeliveringWith,DeliveringWell’criteria.7.34DatacollectionandanalysisThechildrenandyoungpeople’sIAPTdatacollationandanalysisdocumentproducedbytheCORCcentralteam(July15)providesasummaryofdemographicdataandservicelevelcompleteness.Doncasterhasmixedresultsacrosstheboard,scoringwellincertainareas,i.e.Sourceofreferralrecordatassessmentandcompletedgoalatassessment,andnotsowellinotherareas,i.e.pairedgoalinformationandpatientsatisfaction.Thismeansthereisstillworktodo.7.35PerinatalMentalHealthIn 2014, the Review of Health services for Looked after Children and Safeguarding inDoncaster,highlightedthat:Perinatalmentalhealthservicesworkwellforthoseexpectantwomenwhorequiresupportformildtomoderatementalhealthneeds.TheyareprioritisedwithintheIncreasedAccesstoPsychologicalTreatmentservice(IAPT)andtheadultmentalhealthaccessteamareabletoofferrapidassessment.Thepathwayislessclearforthoseexpectantwomenorwomenwhorequireurgentcrisisinterventionpost-delivery,andthereisongoingdiscussionacrosshealthprovidersonhowbesttorespondtotheirneeds.There are collective national and local recommendations that highlighted the need for aspecialistcarepathwaytosupportthisclientgroup.Doncaster CCG commissioned a piece of work to review Mental Health Services inDoncaster that resulted in a report highlighting 26 recommendations. One of therecommendations focused on the requirement to develop specialist care pathways, forexample,thecurrentmentalhealthservicesdidnotprovidecareinaco-ordinatedwayforpregnantwomen.Thismeantthattheircarewasfragmentedatbest.Moreconcerningisthat there are notmany choices open to womenwho are experiencing amental healthcrisis pre/post birth. This results in either mothers being sent out of area to high costplacementstoMother&BabyUnits,orchoosingtostaylocallyandbeingseparatedfromtheirbabies.Theneedforaspecialistperinatalmentalhealthserviceisundisputed.InDoncasteralonewehave4000 livebirthsannuallyand figuresquoted in theGuidance forCommissioners,PerinatalMentalHealthServicessuggestthatfor4000maternitiesatleast1,256willsuffersomedegreeofmental illnessduringpregnancyorwithinoneyearofgivingbirthandof

32

those136willneedintensesupportfromsecondarymentalhealthservicesoradmissiontohospital.For4000maternities:

• 8womenwillexperiencepostpartumpsychosis• 8womenwillexperiencechronicseriousmentalillness• 120womenwillexperienceseveredepressiveillness• 400-600 women will experience mild-moderate depressive illness and anxiety

states• 120womenwillexperiencePostTraumaticStressDisorder• 600-1200womenwillexperienceadjustmentdisordersanddistress.

PracticalMentalHealthCommissioningNov2012TherewastheestablishmentofaworkinggrouptolookatmodifyingthePerinatalMentalHealth service pathway and as a result, a pilot knownas theDoncaster PerinatalMentalHealthAdvisoryPilotwassetuptorunforthethreemonthsfromMarchtoMay2014.Theobjective of this pilot was to establish the demand for such a service. It was promotedalmostexclusivelytothematernitydepartmentalthoughwedidnotrefusereferralsfromothersourcessuchasGPsorotherpsychiatrists.ThepurposeoftheAdvisoryServicePilotwasto:

• Determine and evidence the level of need – previously the community mentalhealthteamandtheirmidwifeappointmentssawtheseladiesseparately

• To test a joint pathway developed through the work of the Doncaster PerinatalMentalHealthGroup.

7.36PerinatalAdvisoryServicePilotDuring the three month pilot there were 99 referrals for consideration; each of thesereferrals was discussed at amultidisciplinary teammeeting. Of the 99 referrals 28wereconsidered tobe inappropriate, 36were felt to requireaprimary care levelof inputandwereeitherdivertedtotheirGPortotheIAPTservice.SixclinicswererunatAnte-natalClinicswiththreewomenbeinginvitedtoeachclinic.Theaimoftheclinicwastoconductathoroughpsychiatrichistory,establishthecontextofthepregnancyandanycurrentorpastpsychiatrictreatment.Thenextstephasbeentocommissionafurtherpilot;apsychiatryliaisonservice.Thekeyfindingswereinclusive:

• Atotalof388referralsweremadetotheclinic.

33

Reasonforreferral. Number

Pasthistoryofpostnataldepression 13Previoushistoryofdepression 10Currentdepressiveepisode 7Previoushistoryoflowmood 6Generalisedstress/anxiety 6Currentpresentationoflowmood. 4Medicationreview 3Thoughtsofself-harm. 2Obsessivecompulsivedisorderwithassociatedanxiety 2Historyofpsychosis 1Phobiainrelationtomedicalprocedures 1Historyofmentalhealthproblems 1PersonalityDisorder 1TOTAL 57OutcomeforthepatientsseeninclinicItneedstobenotedthatduetotheirpresentingneedssomepatientshadmorethanoneoutcomefollowingtheirassessmentinclinic.

Outcomes NumberReferredbacktoGeneralPractitionerwithadviceinrelationtomedicinesmanagement

18

ReferredbacktoGeneralPractitionerwithnofurtheradviceorfollow-up

15

ReferredbacktoGeneralPractitionerwithsupportplaninplace 4Tocontinuewithinput/supportfromsecondarymentalhealthservices 4ReferredtoIAPT 14Referredforcounselling 1Referredtosocialservices 1Referredtoaccessforsecondarymentalhealthservices 5Safeguardingreferralmade 1Referraltosecondarymentalhealthservicesdeclined 1TOTAL 64Findings

• Ofthe57patientsseen,only5werealreadyknowntoandinreceiptofsecondarymental health services, and 2 reported to havemadeprevious suicide attempts,butnocurrentriskwasidentified

• However,33(58%)wereeithercurrentlyorhadpreviouslybeentreatedinprimarycareformentalhealthproblems

• 10reportedtohavingpreviouslybeenunderthecareofsecondarymentalhealthservices

• 12wereassessedashavingpreviouslyexperiencedthoughtsofself-harmbutwithno current risk.Most identified their children or the fact theywere pregnant asprotectivefactors

• 3 reported to regular use of cannabis. 2 stated that they had not used itwhilstpregnant,1reportedtostillbearegularuser.Asafeguardingreferralwasmadeinrelationtotheseparticularwomen

34

• 3 of thewomen reported to regularly drinking alcohol above the recommendedlimits,butallstatedthattheyhadstoppedduetotheirpregnancy

• 1reportedtostillbesmokingduringherpregnancy• 1womanreportedthatshehadbeenviolenttowardherpartner• 1womanreportedtohaveexperienceddomesticviolencebutthiswaswhilstwith

apreviouspartner.7.37EatingDisordersEstimatedincidenceforDoncasterhasbeencalculatedusingdatafromMicalietal.(2013):AnorexiaNervosa

• Femalesaged10-49years=13.6casesper100,000population=11newcasesperyear

• Malesaged10-49years=1.3casesper100,000population=1newcaseperyear.BulimiaNervosa


• Malesaged10-49years=1.6casesper100,000population=1.2newcaseperyear.EDNOS


• Malesaged10-49years=4.2casesper100,000population=3.3newcaseperyear.ThefollowingdatareflectsCAMHsreferralstotheeatingdisorderpathway.The2014dataisYTD(asof16.04.14).

ThedatasuggestsanincreaseintotalreferralstotheEDpathwaysince2011.In2014,therehavebeen19referralsintotalinlessthanfourmonths-thesamenumberofreferralsasforthewholeoftheprevious12months.Thetablebelowoutlinestheagebreakdown.

02468

101214161820

2009 2010 2011 2012 2013 2014

N re

ferr

als

Referrals to pathway

Total

Male

Female

35

Confirmed2014/15dataacrosstheregion(forthoseCCGareaswhowillbepartofthecollaborativeisasfollows:DoncasterTotalnumberofnewcasesunder18years: 34Totalnumberofnewcasesover18years: 6RotherhamTotalnumberofnewcasesunder18years: 19Totalnumberofnewcasesover18years: 10NorthLincolnshireTotalnumberofnewcasesunder18years: 23Totalnumberofnewcasesover18years: 20Totalnumberofreferrals: Under18years: 76Totalreferrals: 1127.38CommunityEatingDisorderServiceThenewcommunityeatingdisorderservicebeganinApril2016andtheserviceisevolvingtohaveallfacetsofthehubandspokemodel.TheserviceisprovidedacrossDoncaster,RotherhamandNorthLincolnshire.ThedatabelowrelatestoDoncasteronly.

Descriptor Apr May Jun JulNumberofemergencycasesreceived 0 0 0 0Numberofurgentcasesreceived 1 1 2 0Numberofnon-urgentcasesreceived 3 1 0 1NumberofcasesadmittedintoT4 0 0 1 0Seenwithinaccesstarget 100% 100% 100% 100%

0

1

2

3

4

5

6

7

8

4 8 9 10 11 12 13 14 15 16 17

N re

ferr

als

Age at Referral

2011

2012

2013

2014

36

SouthYorkshireEatingDisorderAssociationhavebeencommissionedtoprovidethefollowing:

• Raiseawarenessaroundeatingdisordersandhowtobestsupportthese;and• Provideeducationandawarenessraisingsessionsforyoungpeople,theirparents

andprofessionals.

Descriptor Apr May Jun JulAwarenessRaising-Numberofprofessionalattendingtraining

0 14 0 0

EducationSessions-Numberofprofessionalattendingtraining

0 0 0 0

TrainingSessions-Numberofprofessionalattendingtraining

0 0 0 1

7.39OutofHoursServiceCAMHsoperateanoutofhoursservice24/7.Therewere50call-outstotheOOHworkerduringDec14andJune15,whichisthehighestacrosstheproviderpatchofDoncaster,RotherhamandScunthorpe.

7.40Section136Thefollowingdatarelatestothenumberofunder18yearoldsonasection136whowerebroughttothe136suiteasaplaceofsafety:2013–2014: 2YP2014–2015: 5YP2015–2016: 3YP7.41PoliceCellsThefollowingdatarelatestothenumberofyoungpeoplewheretheuseofcustodyasaplaceofsafety.Detailsasfollows:2012–2013: 0YP2013–2014: 2YP2014–2015: 1YP2015–2016: 0YP

2

7

5

10

7

109

32

3

8 87

9

23 3

2 2

5 5

0

5

10

Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15

CalloutbyBaseLocalityDec2014-June2015

Doncaster Rotherham Scunthorpe

37

7.42AdultAccessTeamTheaccessteamarebasedwithanacutesettingandseeyoungpeopleandadultsaged16yearsoldandabovewithamentalhealthissue.Theysaw15sixteenyearolds,16seventeenyearoldsand15eighteenyearolds,givinganannualtotalof46youngpeople.7.43PerinatalMentalHealthIn 2014, the Review of Health services for Looked after Children and Safeguarding inDoncaster,highlightedthat:Perinatalmentalhealthservicesworkwellforthoseexpectantwomenwhorequiresupportformildtomoderatementalhealthneeds.Theyareprioritisedwithintheincreasedaccesstopsychologicaltreatmentservice(IAPT)andtheadultmentalhealthaccessteamareabletoofferrapidassessment.Thepathwayislessclearforthoseexpectantwomenorwomenwhorequireurgentcrisisinterventionpost-delivery,andthereisongoingdiscussionacrosshealthprovidersonhowbesttorespondtotheirneeds.There are collective national and local recommendations that highlighted the need for aspecialistcarepathwaytosupportthisclientgroup.Doncaster CCG commissioned a piece of work to review Mental Health Services inDoncaster that resulted in a report highlighting 26 recommendations. One of therecommendations focused on the requirement to develop specialist care pathways, forexample,thecurrentmentalhealthservicesdidnotprovidecareinaco-ordinatedwayforpregnantwomen.Thismeantthattheircarewasfragmentedatbest.Moreconcerningisthat there are notmany choices open to womenwho are experiencing amental healthcrisis pre/post birth. This results in either mothers being sent out of area to high costplacementstoMother&BabyUnits,orchoosingtostaylocallyandbeingseparatedfromtheirbabies.Theneedforaspecialistperinatalmentalhealthserviceisundisputed.InDoncasteralonewehave4000 livebirthsannuallyand figuresquoted in theGuidance forCommissioners,PerinatalMentalHealthServicessuggestthatfor4000maternitiesatleast1,256willsuffersomedegreeofmental illnessduringpregnancyorwithinoneyearofgivingbirthandofthose136willneedintensesupportfromsecondarymentalhealthservicesoradmissiontohospital.For4000maternities:

• 8womenwillexperiencepostpartumpsychosis• 8womenwillexperiencechronicseriousmentalillness• 120womenwillexperienceseveredepressiveillness• 400-600 women will experience mild-moderate depressive illness and anxiety

states• 120womenwillexperiencePostTraumaticStressDisorder• 600-1200womenwillexperienceadjustmentdisordersanddistress.

PracticalMentalHealthCommissioningNov2012TherewastheestablishmentofaworkinggrouptolookatmodifyingthePerinatalMentalHealth service pathway and as a result, a pilot knownas theDoncaster PerinatalMentalHealthAdvisoryPilotwassetuptorunforthethreemonthsfromMarchtoMay2014.Theobjective of this pilot was to establish the demand for such a service. It was promotedalmostexclusivelytothematernitydepartmentalthoughwedidnotrefusereferralsfrom

38

othersourcessuchasGPsorotherpsychiatrists.ThepurposeoftheAdvisoryServicePilotwasto:

• Determineandevidencethelevelofneed–previouslythecommunitymentalhealthteamandtheirmidwifeappointmentssawtheseladiesseparately

• TotestajointpathwaydevelopedthroughtheworkoftheDoncasterPerinatalMentalHealthGroup.

7.44ChildhoodDevelopmentThepercentageofchildrenachievingagoodlevelofdevelopmentattheendofreceptioninDoncaster(53.1%)islowerthanthenationallevel(60.4%).During2013/14,1,981childrenachievedgoodlevelsofdevelopment(CHP2015).Table3:Percentageofchildrenachievinggoodlevelofdevelopmentattheendofreception(2011-14)

Year

Noofchildrenachievinggood

levelofdevelopmentat

theendofreception

Percentageofchildrenachieving

goodlevelofdevelopmentattheendofreceptionin

Doncaster(%)

PercentageofchildrenachievinggoodlevelofdevelopmentattheendofreceptioninEngland

(%)

2011 1,997 57.0 59.0

2012 2,177 62.0 63.5

2012/13 1,623 43.3 51.7

2013/14 1,981 53.1 60.4

Source:CHP2012-157.45SpecialEducationNeedsDoncasterhasabout6,386childrenwhorequirespecialeducationalneeds(withorwithoutstatement)andthisequatesto13.2%ofschoolchildren(DfE.2015).ThehighestpercentageofchildrenwithSENinacommunityfromDoncasterwas36.4%whilethelowestwas8.6%.Atotalof1278pupilswereidentifiedaspupilswithSENduring2014-15;theyeitherhadastatementofSENoranEducation,HealthorCarePlan.

39

PupilswithSENwhohadastatementweredividedinto:

7.46SchoolsSchoolsareincludedintheuniversaloffertochildrenandyoungpeopleandprovideawiderangeofservicestosupportchildrenandyoungpeople.Thesupportofferedtochildrenandyoung people around emotional health and wellbeing is varied. A recent audit ofcounsellingprovisionwithinschoolsshowedthereisvarianceacrossschools(samplesizeof50%ofallschools).ForfulldetailsseeAppendix5.However,themainpointswere:

• Overhalfofschoolsdon’tprovideface-to-facecounsellingforarangeofemotionalhealthandwellbeingissues

• Approximately 70% didn’t have an external organisation provide face-to-facesupport

• Trainingassistantsdoprovidesupportinsomeschools,butinthemajorityofcaseswheretheydoprovidesupport,theyhavehadnoformaltraining

• Insomeschoolsthereisanominatedleadforemotionalhealthandwellbeing• Schools and CAMHs are not closely configured and don’t have robust systems to

enableeffective jointworking. Thismeans there is very little consultation, adviceandguidanceprovidedintoschoolsfromCAMHs.

7.47Anemerging theme fromrecentengagementwith schools so far is the requirementfor more targeted support for children and young people who seem to be strugglingemotionally,andaneedforstafftrainingonemotionalhealthincludingkeyissuessuchasself-harm.7.48EarlyHelpOfferMostchildren,youngpeopleandfamilieshaveanumberofbasicneedsthatcanbesupportedthrougharangeofuniversalservices.Theseservicesincludeeducation,earlyyears,health,housing,youthservices,leisurefacilitiesandservicesprovidedbyvoluntaryorganisations.However,somefamilieshaveneedswhichwillrequireadditionalsupporttoenablethemtoreachtheirfullpotential.InDoncastertheearlyhelpofferacrossserviceshasbeenpatchywithgapsandalackofco-ordination,inparticularservicesaroundbehaviourissues,riskybehaviours,counselling,mentoringandparenting.TheLocalMedicalCommittee(LMC),CAMHsandkeyworkersfromtheStrongerFamiliesprogrammehavepreviouslyhighlightedthisasanissue.ThishasresultedinlotsofinappropriatereferralsintoCAMHsforchildrenandyoungpeoplewhohaveabehaviourissueratherthanmentalhealth.Thiswasidentifiedintherecentauditcompletedin2013(seeAppendix4).

34.70%

12.70%11.30%

10.60%

10.30%

20.00%

AutismSpectrumDisorder(ASD)

Behavioural,EmotionalandSocialDifficulties

Speech,LanguageandCommunicationNeeds

SevereLearningDifficulties(SLD)

PhysicalDisability(PD)

Others

40

7.49Thiswasrecognisedasabiggapandasignificantamountofworkhasbeencompletedoverthepastyeartodevelopanewearlyhelpstrategy,whichwentliveon5thOctober2015.Adescriptionofthenewserviceisfoundinsection9,1.1.(pg36).7.50ThereisalackofunderstandingbetweenuniversalservicesandtargetedservicesandCAMHsintermsofthresholdsandrolesandresponsibilitiesacrosstheemotionalwellbeingandmentalhealthagenda.ThisresultsinreferralscomingintoCAMHsthatarenotappropriate.Thesearetheneitherreturnedtothereferrerorsignpostedtoanotherservice.Inrealitynotallonwardreferralsgetpickedupandthosethatarereturnedarebacktosquareone.7.51WorkforceUniversal staff via the collaboratives and through partner events with CAMHs haveidentified that staff working in universal services have differing skills, competencies andunderstandingofthegamutofemotionalwellbeingandmentalhealth.Staffsonthewholedo not feel confident to identify need early and then provide appropriate guidance andsupportatanappropriatelevel.7.52ChildhooddevelopmentandschoolachievementsDuring2013/14justoverhalfofthetotalchildrenagedunderfiveyearsachievedalevelofgooddevelopment,thisissignificantlylowerthanthenationalaverage.Around50%ofyoungpeopleachievedhigherGCSEgradescomparedtoanationalaverageof56.8%.7.53Notineducation,employmentortraining(NEET)Thepercentageofyoungpeoplenotineducation,employmentortraininghasdeclinedbetween,2010-2013.Thefiguresfor2013shows5.5%oftotalyoungpeoplewereNEET.7.54Smoking,alcoholandsubstancemisuseDoncasterhasahigherpercentageofyoungpeoplewhosmokeregularlywhencomparedtothenationalaverage.Ratesforunder18yearoldsforalcoholspecifichospitaladmissionsinDoncaster,althoughbeingslightlyhigher,werenotstatisticallydifferentfromthenationalaverage.7.55Lookedafterchildren&HomelessnessAsof5thJuly2016therewere504LookedafterChildren,thebreakdownisasfollows:

55%

12%2%3%

1%

27%

FosterCare

Home&Hostels

PlacedwithParents

PlacedforAdoption

IndependentLiving

PlacedoutofBorough

41

AgeRange NumberofLAC0-3years 684–15years 33316–17years 99

18years&over 47.56In2014therewere299childrenthatwentmissing.Doncasterhasasignificantlylowerrateoffamilyhomelessnessthanthenationalaverage.7.57Hospitaladmissionsforunintentionalanddeliberateinjuries

Descriptor 2013-14 2014-15 2015-16UnintentionalInjuries(0-14yrs) 520 461 386DeliberateInjuries(0-14yrs) 7 1 11UnintentionalInjuries(15-24yrs) 331 272 314DeliberateInjuries(0-14yrs) 23 10 217.58Hospitaladmissionsself-harmThenumberofchildrenpresentinginA&Eforself-harmingcouldnotbeobtainedduetotheabsenceofcodingforself-harminA&E.However,childrenandyoungpeopleadmittedtoacutewardsviaA&Eduetodeliberateself-harmwasobtainedandisillustratedinFigure13.During2013/14,130childrenandyoungpeoplewereadmittedtoacutewardsduetoself-harmwhereasthenumberfellto109in2014/15.Thecaveattothisdataisthatitincludesalcoholpoisoningsoitmustbeinterpretedwiththisconsideration.Figure13:Noofchildrenandyoungpeopleadmittedtoacutewardsduetoself-harm(2013-15).

2433 34

39

130

2429 27 29

109

0

20

40

60

80

100

120

140

Q1 Q2 Q3 Q4 Total

Noofchildrenandyoungpeople

2013-14

2014-15

42

7.59Suicide

Descriptor 2013-14 2014-15 2015-16NumberadmittedtoacutewardsviaA&EorCAMHsforattemptedsuicide

13 12 27

7.60 Performance data provided forQuarter 1 toQuarter 3 in 2015/2016 identified anincrease inthenumberofchildrenandyoungpeoplewhohavebeenadmittedtoacutewardsviaA&Eduetoattemptedsuicideaswellas therebeingan increasingnumberofchildrenandyoungpeoplebeingadmittedtoacutewardsviaA&Eduetodeliberateself-harm.7.61DSCBwanted to explore this data further to gain a better understanding of thosechildrenwhoattemptedtoendtheirlife.Thisisalsoinlinewitharecommendationfromthe recent Ofsted Single Inspection “Undertake a review of those children and youngpeople admitted to hospital for self-harm and attempted suicide to determine reasonsthatwillinformsuitablepreventativework”(Ofsted,2015,p40).7.62Thekeyobjectiveof thisauditwas toundertakea ‘deepdive’ into the thresholds,servicesandsupporttoindividualyoungpeoplewhowereadmittedtoanacutewardduetoattemptingtotaketheirownlife.TheDSCBmulti-agencyaudit toolwasused inorder tomeasurecomplianceandqualitywiththefollowingprocedures:

• Assessment and Care of Children and Young PeoplewithMental HealthNeeds,whoareplacedinanAcuteGeneralHospitalWardPolicy2015

• ChildrenLivingAwayfromHome(includingPrivatelyFosteredChildren)2016• WorkingTogethertoSafeguardChildren2015.

The themed audit day brought together managers/safeguarding leads who were notdirectly involved inanycases. Practitionersweremadeawarethatamulti-agencyauditwastakingplaceandareflectivepractitionerquestionnairewassenttothoseinvolvedforcompletion. The audit groupwanted to explore practitioner views on processes,multi-agencyworking inDoncaster,participationofyoungpeopleandwhat traininghasbeenundertakenandwhatimpactthishasmadetopractice.Questionnairesweresenttoparent/carersfromCAMHstoinformthemoftheauditandtoseektheirviews.Aquestionnaireforyoungpeoplewassenttoidentifiedpractitionerstocapturetheviewsofchildrenandyoungpeople.

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Thekeyfindingswereasfollows:

7.63Therewereseveralexamplesofgoodpracticeandwhatworkedwell,aselectionofthesearelistedbelow:

• In17cases the responseby theacutehospitalwasappropriateand timelywithreferralstoCAMHsevidence.TheresponsefromCAMHswasequallyappropriateandtimelywithevidenceofreferral

• 13outofthe18youngpeoplewereseenbyaqualifiedCAMHSpractitionerwithin24hoursofadmissiontoanacuteward,inlinewithpolicy.Twootheryoungpeople(aged16/17)wereseenbytheadultcrisisteams.AnotheryoungpersonpresentedatA&Eandwasgoingtobeadmitted(recordedasadmitted)butwas

44

takenhomebyhermotherandthereforeCAMHsdidnothavetheopportunitytoseethisyoungpersonatpointofadmission.Afollowupappointmenttookplace

• In17outof18casesauditorswereconfidentthatthepractitionersknewthesignsandriskindicatorsintermsofself-harmandpoormentalhealthandarticulatedthiswellincaserecords

• 13outofthe17assessmentsevidencedwerechildfocused.Theyoungperson’svoicewasclearlyrecordedandquoted;behavioursandobservationswereevidentinCAMHsandDBHFTrecords

• In16cases,ariskmanagementplanandadischargeplanfollowingtheadmissionwasevidentinbothDHBFTandCAMHsrecords.Plansincludedforexample:removingsharps,tablets,harmminimisation,emojistoshowemotions,beingwithanadultatalltimesandafollow-upappointmentwithapsychiatristwithin7days

• In14outofthe18casestherecordingwaschildfocusedacrossagenciesrecords.Therewaslotsofdetailaboutemotionsandfeelings,gooduseof"youmentioned,yousaid”toevidencebeingchildfocussed.Inaddition,DCSTandIFSTrecordsevidencethesignsofsafetyapproachwithheadingsused“whatisworkingandwellandwhatareweworriedabout"incaserecordingandsupervision

• ForthosechildreninT4services,CAMHscanevidenceregularcontactwiththeyoungperson

• In16outofthe18casestherewasstrongevidenceofdirectworkwiththechild/youngperson.ThemajorityofthisisinCAMHsrecords.Thetypesofworkevidencedismainlytalkingtherapies,butthereissomeevidenceofSDQandRCADScompletedwithyoungpeople,trafficlights,goalssignedbyyoungpeople,mappingaroundmoods,IAPTscoresevidenceprogression.

7.64 There are a number of proposed recommendations for the Quality andPerformance Group to consider when formulating the action plan that will informsuitablepreventativework:

• Thereneedstobeamulti-agencyassessmentofholisticneeds,notjust“currentview”attheearliestpossibleopportunity.Weneedawholechildandwholefamilyapproachforchildren/youngpeoplewhoareexperiencingpoormentalhealth

• Improvedattendanceatteamaroundthechild/familymeetingsbyCAMHspractitioners

• Improvedattendanceatdischargeplanningmeetingsbysocialworkers• Moreevidenced-basedsupportandchallengetoparents/carerstopromotegood

mentalhealthinchildren• Moreinvolvementwithadultmentalhealthservicestosupportfamilieswhere

thereareknownparentalmentalhealthissues,asthereisastronglinkwithparentalmentalhealthandchildren’smentalhealth

• Allagenciesneedtoincreasetheuseofgoalsettingandstandardisedmeasurestoevidenceimpactandprogression

• ThereneedstobeajointprotocoltoensurethatchildrenaccessingT4servicesreceiveatimelymulti-agencyassessment(beforeadischargemeeting)whichisimplementedandembeddedinpractice

45

• Co-ordinatedapproachtoself-harmprovidingchildren/youngpeoplesupportinthecommunity

• DBHFTandCCGtoensuretherightcodingisused,sotheperformancedataisaccurateandhelpsinformservicesaboutlocalneed

• CAMHstoensurethatthereisrobustuseofariskassessmenttool,identifyingrisktoselfandothers

• RDASHtoconsiderbetterwaysofevidencingworkundertakenonelectroniccasefilesystems

• CAMHstoevidencecasesupervision• DMBCtoensuretheCodeofConductforWorkingwithChildrenPolicyhasbeen

sharedandunderstoodwitheducationproviders• CAMHsneedtoreduceDNAappointmentsandensureamoreinclusivewayof

engagingyoungpeopleandhardtoreachfamilies• RDASHtoembedsensitiveenquiryoftrauma,abuseandneglectintopractice

whilstundertakingassessments• ConsiderationgiventohowyoungpeoplePost-16withmentalhealthissuesaccess

furthereducation,trainingandemployment• DSCBtobeassuredthateducationprovidersareawareofandutilisingDepartment

ofEducation(2014)PreventingandTacklingBullyingguidance• Seeingthechild/youngpersonontheirownwithoutparentsisgoodpracticeand

willenablethechild/youngpersontospeakfreely• Useyourelectronicsystemswelltoevidencetheworkundertaken.Usetitles,types

andsubjectareastoensuretheinformationflows• EnsuresupervisionandattendanceatHighRiskManagementmeetingsareclearly

documented• Beclearwhereyoursourceofinformationhascomefromi.e.role/title• Ensureyougatherinformationforyourassessmentsfromtheallappropriatehealth

teams• IfyouarerecommendedEarlyHelpsupport,gainconsentandcompleteanEarly

HelpEnquiryForm.7.65NumberofDoncastermentalhealthserviceuserswhohavedependentchildren

Descriptor 2013-14 2014-15 2015-16NumberofDoncastermentalhealthserviceuserswhohavedependentchildren

2090

7.66SexualAbuseandRapeClinic(SARC)In2014/15therewere17newcasesand14historiccases.CurrentlybothnewandhistoriccasesareseenbySheffieldChildren’sHospital,aswedon’thavesufficientnumberslocallytoenablepaediatricianstokeepthenecessarycompetencies.Thereisanagreedlocalfollow-uppathwaythatworkswellandwewouldlooktokeepthisarrangement.Thereisagapinthatthereisnospecialisedpsychologysupportforthiscohortofchildrenandyoungpeople.Thisissomethingwewilllookatregionallyaspartofthefiveyearplan.7.67ChildreninneedandchildprotectionAtthetimeofcompletingthehealthneedsassessmenttherewere1,646ChildrenandYoungpeoplewhoare‘InNeed’and420ChildrenandYoungPeoplewithasafeguardingplan.

46

7.68DomesticViolenceDoncasterChildren’sServicesTrust(DCST)withPartnershassecuredfundingfromtheDepartmentforEducation(DfE)InnovationFundtosupportthetransformationofpracticetochildren,youngpeopleandfamilies.TheDCSTprojectistospecificallyfocusonDomesticAbuseandtheeffectthishasonchildrenandyoungpeoplebothintheimmediateandlongerterm.Domesticabuseandviolenceisasignificantfeatureforchildrenandyoungpeople(CYP)inover30%ofallreferralstoDoncasterChildren’sServicesTrust,andisprevalentinpolicereferralstosocialcare.Currentlydomesticabuseisnotcommonlyidentifiedbyuniversalandearlyhelpservices;itisusuallyfirstidentifiedbyeitherthepoliceorsocialcareatarelativelyhighlevelofrisk.Atpresent,mostoftheresponsesarefocusedoneithervictimsorperpetrators,andnotonthechildrenandyoungpeopleinthefamily.Theimmediateeffortstoreduceshorttermriskdonotnecessarilyreduceriskinthelongterm,leadingtorepeatvictimisationwithdifferentpartnersinnewrelationships,andyoungpeoplegoingontobecomevictimsorperpetratorsintheiradultlife.Thereareveryfewinterventionsfocusedonchildrenandyoungpeople,andevenfewerfocusedontherecoveryofvictimsandtheirchildrentogether,inordertoachievesustainedreducedriskofvictimisation.7.69HospitaladmissionsformentalhealthTherateper100,000forhospitaladmissionsformentalhealth(age0-17years)hasdeclinedfrom79.5in2010/11to53.9in2013/14.Therate(per100,000)forhospitaladmissionformentalhealthinDoncasterissignificantlylowerthantheEnglandaveragethroughouttheperiodfrom2012to2015.Hospitaladmissionsformentalhealth(age0-17years)havedeclinedinDoncasteroverthepastyears,35peoplewereadmittedduring2013/2014.

47

8.Self-AssessmentToolkit8.1Amulti-agencyteamcompletedtheEastMidlandsStrategicClinicalNetworkself-assessmenttoolkit,whichhasbeenpromotedthroughtheYorkshireandHumberStrategicClinicalNetwork.Thishasbeenusedacrosstheregionasastandardisedmeasure.Thekeyfindingsareasfollows:8.2DevelopingtheWorkforce–3.33/5(rating)ExistingStrengths:

• CAMHsclinicianshavebenefitedfromthepost-graduatediplomaleveltrainingacrossthreemainareasaspartoftheCYP-IAPTprogramme.Thisincludes;twostaffcompletingtheWebsterStrattonparentcourses,fourtraineesundertakingCBTtrainingandthreestaffcompletingserviceleadstraining

• AllstaffwithinCAMHsaretrainedtopracticeinanon-discriminatoryway• Multi-agencypractitionertrainingisalreadybeingdeliveredinsomeschoolsand

thiswillbethebuildingblocktoawiderprogramme.ThisincludesCAMHs,EducationPsychologyandschoolsandeducation.

Areasfordevelopment:Themajorityofthepointsunderthisheadingweredeemedtobenotreadywithacomplex,complexityrating.Keyareasare:• Theneedtotargetthetrainingofhealthandsocialcareprofessionalstocreatea

workforcewiththeappropriateskills,knowledgeandvaluestodeliverafullrangeofevidencebasedinterventions

• Professionalstrainedtobeabletoidentifymentalhealthproblemsearlyandrecognisethevalueandimpactofmentalhealth

• Professionalstrainedonhowtoprovideanenvironmentthatsupportsandbuildsresilience.

8.3Resilience,PreventionandEarlyInterventionfortheMentalWellbeingofChildrenandYoungPeople–3.20/5ExistingStrengths:

• TheEarlyHelpStrategyforDoncasterisnowdevelopedandhasbeenveryrecentlyimplemented.AjoinedupearlyhelpsystemwillpromotetheidentificationofemergingneedsandearlierinterventionwhichisbasedonawholefamilyapproachaspromotedbytheStrongerFamiliesprogramme.Thiswillbringbetterco-ordinationandplugabiggapinserviceprovision

• CAMHsarepilotingaresiliencecollegemodel,whichaimstomeettheneedsofchildren,andyoungpeopleaged12-18yearsoldwithemotionaldistressandmentalhealthproblems.Thisisdonethroughgroupworkandpeersupport

• ThereisacurrentperinatalmentalhealthpilotrunningwhichwillbeevaluatedinMarch2016.Thepilotpathwayoffersjointcasemanagementofcarebetweenmidwifery,consultantobstetricianandpsychiatriccare.

Areasfordevelopment:Althoughthisthemescoredquitehigh,anumberoftheproposalsarerelatedtoNHSE,PHEandDfE.Theonesthatrelatelocallyareasfollows:• Thedevelopmentofwholeschoolapproachestopromotingemotionalwellbeingand

mentalhealth• Supportingself-carebysupportingthedevelopmentofnewappsanddigitaltools.

48

8.4ImprovingAccesstoEffectiveSupport–3.14/5ExistingStrengths:

• ThecurrentCAMHsserviceadherestorelevantNICEguidelines,includingCG158,CG72,CG155,andPH40

• DoncasteralreadyhasasharedTier2and3servicesandthisisco-locatedandhasmanystrengths,includingexcellentaccesstimes

• Therearesomeclearaccessandwaitingtimestandards• Thereisa24/7outofhoursservice• Thepeermentoringprovisionhasbeenheldupasanexemplar• Initialriskassessmentsensurehigh-riskchildrenandyoungpeopleareseenasa

priority.InDoncaster,100%ofthosedeemedurgentattriageareseenwithin24hours.Allreferralsaretriagedwithin24hours

• ThereisastrategiclinkbetweenCAMHsandservicesforSEND• ThereisdedicatedlearningdisabilitiesprovisionwithincoreCAMHs• Therearegooddatasystemsforcollectingdataoncrisis/hometreatmentand

section136.

Areasfordevelopment:Thisistheareawiththegreatestnumberofproposalslocally.Keypointsare:• ThereareasignificantnumberofreferralsperannumtoCAMHsthatshouldnotbe

referred.In2014/15thisequatedto24%• Movingawayfromthecurrenttieredsystemofmentalhealthservicestoinvestigate

othermodelsbasedonexistingbestpractice• EnablingsinglepointsofaccessandOne-Stop-Shopstobecomepartofthelocaloffer• Assigningnamedpointsofcontactinspecialistmentalhealthservices(CAMHs)for

schools,GPpractices• Schoolsassignnamesleadsformentalhealth• Developmentofjointtrainingprogrammes• ImplementationoftheCrisisCareConcordat• Implementationofclearevidencebasedpathwaysforcommunitybasedcare,including

hometreatment(tier3.5)toavoidunnecessaryadmissionstoinpatientcare• Ensurenochildoryoungperson(under18yrs)isdetainedinapolicecellasaplaceof

safety• Thereisnocommunityserviceforeatingdisorders.Currentlyanadhocserviceis

providedineachofthethreeCCGareasfromwithincoreCAMHs.8.5CaringforthemostVulnerable–2.90/5ExistingStrengths:

• ThecurrentCAMHsserviceadherestorelevantNICEguidelines,includingPH28• Commissionersandprovidersacrosseducation,healthandsocialcareandyouth

justicesystemsworktogethertodevelopappropriatebespokecarepathways• Thedesignatedleadprofessionalroleworkswellinanumberofcases.Thereis

roomforimprovementbutthebasicsareinplace• Thereisaspecific,multi-agencyLACresourcewithincoreCAMHs• ThereisamentalhealthworkerplacedwithinthelocalYouthOffendingService• Inmanycases,specialistservices(CAMHs)areavailabletoprovideadvice,rather

thanseethosewhoneedhelp.ThechallengeistogetreferringservicestobetterusethisfunctionasopposedtoreferringstraightintoCAMHs’withoutanyconversations.ThislinkstothenamedCAMHsroles.

49

Areasfordevelopment:Formanyoftheproposalswehavepartialimplementationlocally.Theareas,whichfordevelopmentare:• Mentalhealthassessmentsshouldincludesensitiveenquiryaboutthepossibilityof

neglect,sexualabuse,includingchildsexualabuseorexploitationandforthoseaged16yrsandabove,routineenquiry

• Ensuringthosewhohavebeensexuallyabusedand/orexploitedreceiveacomprehensiveassessmentandreferraltoappropriateevidencebasedservices

• Forthemostvulnerableyoungpeople,strengtheningtheleadprofessionalapproachtoco-ordinatesupportandservicestopreventthemfallingbetweenservices

• Improvingcareofchildrenwhoaremostexcludedfromsociety,i.e.thosewhoarehomeless,sexuallyexploited.

8.6TobeAccountableandTransparent–2.40/5ExistingStrengths:

• Thiswastheareawiththebestperformancewithasmallnumberofproposalsthatdon’thavefullorpartialimplementation

• Thereareclearleadcommissionerarrangements• Thereisaleadaccountablecommissioningbody,thisistheCCG• TheHealthandWellbeingBoardhavestrategicoversightofthecommissioningof

elementsofthepathwayorofferregardingchildrenandyoungpeople’semotionalwellbeingandmentalhealth

• CommissionersensurequalitystandardsfromNICEinformandshapecommissioningdecisions

• TherearesystemstomonitoraccessandwaitmeasuresagainstpathwaystandardsthatarelinkedtooutcomemeasuresandthedeliveryofNICEconcordanttreatmentateverystep.

Areasfordevelopment:

• ThereiscurrentlynosingleintegratedstrategicplanforchildemotionalwellbeingandmentalhealthservicesacrossDoncaster

• Theworkoftheleadcommissionerisnotbaseduponanagreedplan,agreedbyallrelevantagenciesandwithastronginputfromchildrenandyoungpeople

• Co-commissioningofcommunitymentalhealthinpatientandintensivetreatmentbetweenlocalareasandNHSE

• Developmentofdetailedmeasurementoutcomes.

50

9.Workforce9.1Aspartoftheneedsassessmentprocessweaskedpartnerstocollateallavailabledataonactivity,workforceandinvestmentforservices,whichcoverthewholegamutofemotionalwellbeingandmentalhealth,togiveagoodunderstandingofthecurrentworkforce.AtemplatewasdevisedbytheYorkshireandHumberStrategicClinicalNetworktohelpstandardisereporting,thisisthetemplateweused.Itisimportanttonotethatthisdataisbasedonavailabledataonly,whichmayexcludesomedata.

Descriptor NumberofPractitioner/Staffin

postJune2015

NumberofPractitioner/StaffinpostOctober2016

SchoolBasedServices JASP 4 4Thrive 40 60Children’sTrustBasedService AssistantForensicPsychologist 0 1ThirdSector OpenMinds 8 8NHSBasedServices SpecialistCAMHs 29.8 15.6Consultation&Advice 0 5.5IntensiveHomeTreatmentService 0 5PaediatricLiaison 0 1CommunityEatingDisorderService 1.6 11.9LookedafterChildrenCAMHs 2 2LearningDisabilityCAMHs 2 4.1YouthOffendingCAMHs 1 1ADHD 4 3.8Autism 3 3SinglePointofAccessCAMHs 0 2Total 95.40 127.90

9.2Thereisasignificantincreaseinpractitioners/staffinpostinOctober2016asadirectresultofthesystemtransformationaimsandobjectives.9.3TherehasbeenadeliberateshiftofresourcesfromspecialistCAMHstoconsultationandadviceandintensivehometreatmenttobetterreflecttheneedsofthepopulation.Theaimbeingtoidentifyandprovidesupport(aspartofasystemicapproach)attheearlieststagepossible.9.4Therehasbeenasignificantincreaseinthecommunityeatingdisorderresource,toreflectthenewaccessandwaitingtimesstandards,andtheneedforamulti-disciplinaryapproach.9.5Workforceskillsaudit,developmentstrategyanddeliveryplanTheoriginalLTPidentifiedanumberofareasthattheBoroughneedstotransform,inordertoachievetheirambitiontomeettheemotionalhealthandwellbeingofchildrenandyoungpeople.Oneofthoseareaswastheneedtoimprovetheworkforce,withtheaimthateveryonewhoworkswithchildren,youngpeopleandfamiliesareambitiousforeverychild

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oryoungpersontoachievegoalsthataremeaningfulandachievable.Theywillbeexcellentinpracticeandabletodeliverthebest-evidencedcare,becommittedtopartnershipworkingandberespectedandvaluedasprofessionals.IneffectwhatthismeansisthatthisisagoodqualityequitableofferacrosstheBorough.9.6Thefirststepwastocommissionaworkforceauditthatwouldactasthebasisforthesubsequentstrategy.Theauditsetouttoreviewarangeofinformationregardingcurrentcapacity,expectationsandskillsassociatedwithpeopleengagedinthedeliveryofemotionalhealthandwellbeingservicestochildrenandtheirfamilies.Theapproachwastodelivertwolevelsofaudit;firstlyasimplifiedquestionnairedistributedtothewidestpossiblerangeofstaffinthechildren’sworkforce.ThiswillfocusprimarilyonPrimaryCare,HealthVisitingandSchoolNursingaswellasnominatedrepresentativesfromSchools.Asecondlayerofskillsauditaimedtotakeamorein-depthanddetailedlookattheskillsetintheCAMHsworkforce.ThishadtheintentionofunderstandingthegapsrelatingtoboththehighestlevelsofskillsrequirementsinarangeofCAMHsspecificcorecompetencies,theabilityofCAMHsprofessionalstousethoseskillsworkingwithandthroughothers,aswellasunderstandingtheattitudetowardsandreadinessforchangeinthiscoreworkforce.However,astheauditprogressedandtherelationshipwiththepilotschoolsgrew,adeeperdivetookplacethatwasfurthersupportedbyfourlocalityschoolsevents.9.7Theschoolswhichwereengagedatbothlevelsoftheskillsauditexpressedverypositiveattitudestowardstheirresponsibilitiesfortheemotionalhealthandwellbeingoftheirstudents.Everyschoolthatwasspokentowasengagedinsomeactivityaroundpromotingpositivementalhealth,identifyingchildrenwithadditionalneedsorprovidingsomelevelofinhousesupportorguidance.

FindingsSummary-SchoolsSchoolswelcometheopportunitytoworkmorecloselywithCAMHsprofessionalsinthenewmodelMostexpertiseinschoolsisvestedinasmallnumberofpastoralsupportstaffAsmallnumberofschoolshaveexcellentsystemsandprocessesinplace.Theypromotepositivementalhealth,haveaccesstoandusetoolstoidentifyadditionalneedsandtrainingandexpertiseindeliveringbespokeinterventions,andworkcloselyandeffectivelyincollaborationwithexternalprofessionalsincludingCAMHsSkillsacrossallareasofemotionalhealthandwellbeingneedsarevariable.Coupledwithpocketsofexcellentpracticearelowlevelsofunderstandingandskills.Thereisalsoanacknowledgementthatmuchactivityinthisareaisdrivenbyguessworkandwell-meaningTherearenostandardsforthesystemsandprocessesthatshouldbeinplacetounderpintheactivityschoolsengageintoidentifyandintervenetomeetneedGenerally,interventionsinschoolsareappliedinconsistentlyandlackstructureandevidencebaseThepointatwhichschoolsindividuallyexhausttheircompetenceandconfidenceandturntoexternalsupportvariessignificantly.Specialistschoolsinparticular,thoughnotexclusively,haveveryhighlevelsofskillandsupportinfrastructureandusethesetosupporthighlevelsofemotionalhealthandwellbeingneedsbeforecontactingCAMHsforspecialistsupportandadviceSchoolsacknowledgetheyusetoolsandtechniquesthathavebeendevelopedforonesetofneedsandapplyingthemtoothers(e.g.Legotherapyforcommunicationdeficits)ortheymakeeducatedguessesastowhatinterventionscouldbeappliedinparticularcircumstancesThereislimitedsharingofpracticeorknowledgebetweenschools.EmotionalHealthandWellbeingLeadsinschoolshavenosystemsorprocessesinplaceforengagingformallywitheachotheracrossschoolsWhilstsomeschoolshaveverypositiverelationshipswiththeCAMHsservicethesewereoftenbuiltonone-to-onerelationshipsorwhereschoolshadspecificskillsorcompetenciesthatenabledthemtoengagewithCAMHsina‘CAMHsLanguage’

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9.8Thewiderworkforcewereconsultedwiththekeyfindingsasfollows:

FindingsSummary–WiderWorkforceAllpartsofthe‘TeamDoncaster’offerforchildrenandyoungpeopleacknowledgedthatpreventionactivitywasbetter,cheaperandmoreeffectiveoverthewholelifecycle.AllpartnersinthisauditreinforcedtheviewthatdeliveringinterventionsattheearliestpossiblestagewasthebestwaytomeettheneedsofchildrenandyoungpeopleManyservicesintheBorough,particularlythosealreadyaddressingotherhighimpactneeds,haveexcellentsystemsandprocessinplacetopromotepositivementalhealthandprovidemeaningfulinterventionstosupportchildrenandyoungpeoplewithemotionalhealthandwellbeingneeds.SuchservicesmaybebetterplacedtoaddresshigherlevelemotionalhealthandwellbeingneedsthroughaccesstoincreasedskillstrainingandhigherendconsultationandadvicefromspecialistpractitionersinCAMHsThereisanabsenceofservicesintheBoroughwhereyoungpeoplecanreceivecounsellingsupporttoworkthroughparticularissueswithimpartialandindependentexpertsGPsinPrimaryCaredonotfeeltheyhavethetimeorskillstodealwithhighlevelsofemotionalhealthandwellbeingneed.TheynoteaperceptibleincreaseinnumbersofchildrenandyoungpeoplepresentingwithemotionalhealthandwellbeingissuesGPsrecognisethattheydon’thave(andcan’testablishinshortconsultations)meaningfulenoughrelationshipswithchildrenandfamiliestobeabletomakeahugeimpactontheexperienceofthechildoryoungpersonGPs,HealthVisitors,SchoolNursesandthewiderworkforcestruggletoeasilyidentifythesourcesofadvice,informationandsupportavailabletochildren,youngpeopleandtheirfamiliesasthesearenotcentrallycollated,collectedorpresentedTheremaybescopetoinvestigatetheprovisionofsomeemotionalhealthandwellbeingsupportforchildrenandyoungpeopleinprimarycaresettingsSchoolNursesinpartnershipwithschoolsEmotionalHealthandWellbeingLeadssometimesstrugglewithgainingaccesstosuitablespacewithintheschoolestatetodeliveremotionalhealthandwellbeingservicesSchoolsareabletospecifyinanannualplanthekeyareastheyrequireSchoolNursingservicestofocuson.Manyschoolsidentifyemotionalhealthandwellbeingasoneofthoseareas,notallschoolsdosoSchoolNursing,HealthVisitingandCAMHsareallmanagedwithinasinglebusinessunit.Thisprovidesconsiderableopportunityforincreasingtheamountandefficacyofjointworkingandsignificantcoordinationoreffortacrossthedisciplinesinordertofacilitatetheobjectiveofimprovedwhole-childoutcomesSchoolNursingandHealthVisitingservicesreceivelargenumbersofreferralsintotheirservices,thereareconcernsabouthowbesttoidentifytheoneswiththegreatestneedforemotionalhealthandwellbeingsupportTherehasbeensignificantinvestmentindevelopingskillsandunderstandingaround‘attachment’withintheHealthVisitingworkforceandthosetheyworkcloselywithincludingtheEarlyHelpHubTheEarlyHelpHubisakeypartofthesystemformeetingtheemotionalhealthandwellbeingneedsofChildrenandYoungPeopleintheBoroughandincreasingcapabilitywithinthehubtodealwithemotionalhealthandwellbeingneedswilladdressneedmorequicklyTheEarlyHelpAssessment(previouslytheCAF)isoftenseensolelyasatoolforassuringreferralthresholdcriteria.However,itisactuallyanactualassessmenttoolthatcouldhelpensureconsistencyandimprovedcommunicationacrosstheBoroughThereisanopportunitytoenhancefurtherthedeliveryofanemotionalhealthandwellbeingofferamongstHealthVisitorsandSchoolNursesthroughtheprovisionofadditionalskillsandaccesstoconsultationandadvicefromCAMHspractitionersAfocusondevelopingtheCAMHsofferintoschoolscouldbecomplimentedstronglywithaprimarymentalhealthconsultationandadviceofferintonurseriesandchildren’scentres.Thiscouldfocusonearlyresiliencetrainingandthedevelopmentofcompetenciesinrecognisingandprovidingsupportforemotionalhealthandwellbeingneeds

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9.9AnauditwascompletedontheCAMHsworkforce.Thekeyfindingswereasfollows:

FindingsSummary-CAMHsPeerSupportWorkersprovideavaluableandinnovativerolewithintheserviceThereisabroadrangeofprofessions,rolesandqualificationsrepresentedwithintheserviceTheservicehasstruggledinthepasttoretainqualifiedCBTpractitioners.NotallCAMHsstaffaretrainedtothenecessarylevelinCBTTheserviceskillmixseemsheavilyskewedtowardsprofessionalroleswithlimitedscopeforsupportrolesincludingthoseatanassociatepractitionerlevelWithintheservicetrainingneedsarenotclearlyidentifiednorrecordedconsistentlyWithintheservicethereislittleevidencetoshowhowindividualstaffmember’strainingordevelopmentisdrivenbytheneedsoftheserviceTheTrust-wide‘TrainingNeedsAnalysis’hasidentifiedwithinitarangeofcoursesrelevanttothefutureneedsofCAMHsstaff.ManyofthesecourseshavebeencommissionedthroughHealthEducationEngland(YorkshireandtheHumber).TheseincludeCognitiveBehaviouralTherapy,DialecticalBehaviouralTherapy,Mindfulness,MotivationalInterviewing,LeadingStructuredGroups,FamilyInterventiontrainingandTrainingtoSupportCarersCAMHsstaffwouldbenefitfromincreasedlevelsofskillinCognitiveBehaviouralTherapy,MentalisationBasedTherapy,FamilyTherapyandMindfulnessCAMHsstaffrequiresupportanddevelopmenttobeabletodeliverinterventionsthroughothers,especiallyinprovidingadviceandguidancetoothersworkingwithchildrenandyoungpeoplewithouttheneedtoseetheindividualthemselvesSomeeffortneedstobeinvestedinensuringthatallCAMHsstaffincludingthenon-clinicaladmin,clericalandmanagerialstaffsarefullyengagedinthenewservicearrangements.Thattheyareclearabouttheirrolewithinit,theskillsandcompetenciestheywillbeexpectedtohavetoensuresafe,effectiveandevidencebasedinterventionstochildrenandwithandthroughothersSomeCAMHsstaffwillbealreadyskilledtodelivertrainingtogroupsofnon-CAMHsstaffintheBorough.Thereis,however,aneedtoensurethatallstaffwhomaybecalledupontodeliversuchtrainingareskilledatprovidingtrainingtogroupsAstheservicedevelopsstaffwillneedfurthersupporttoensuretheycontinuetodevelopandadapttothechangingneedsofthechildrenandyoungpeopleoftheBorough

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1 PromotingPositiveMentalHealth 2 IdentifyingNeed 3 Intervening4 Commissioningand/orreferringon 5 ConsultationandAdvice 6 SpecialistCAMHS

ImpactArea

1 2 3 4 5 61 Developaneasilyaccessibleandsearchableselfserviceadviceandinformationportal.Staff

acrosschildren’sservicesareabletoshareandshowcasetheirbestpracticeincreasingknowledge,expertiseandconfidenceacrosschildren’sservices.ThiswillcontainarepositoryofbestpracticeexamplesoftoolsandtechniquesforpromotingandinterveningtoimproveEmotionalHealthandWellbeinginChildrenandYoungPeople.Wouldalsoincludesignpostingforexternaladviceandsupportincludingwhereschoolsmightstartwithreceivingassistancewithcommissioningexternalsupport.Theportalwillbeabletobeusedbystaffacrossanyserviceprovidingsupporttochildrenandyoungpeople

P P P P

Schools,HealthVisitors,SchoolNurses,EarlyHelpHub,Children’sCentres,Nurseries.VoluntaryandCharitablesectorincludingyouthclubsandyouthorganisations

SchoolswithCAMHSsupportandadvice

2 Developmentofaninvitationonly(private)professionalsnetwork:Anonlineself-organisednetworkofindividualsacrosstherangeofchildren’sservicessharingtheirownknowledgeandseekingadviceandsupportfromownpeers.WiththeadditionofCAMHSstaffthiscouldalsothenbecomearepositoryofqualifiedbestpracticewithresponsestoquestionsandtheiranswersbeingcuratedand/ormoderatedbyCAMHS.Aswithrecommendation1thiscouldbeintegratedintothe‘EngageDoncaster’portal.

P P P P P

School’sEH&WBstaff,HealthVisitors,SchoolNurses,EarlyHelpHub,Children’sCentresNurseries.DCSTstaff

Schools

3 DevelopmentofaDoncaster-widePromotingemotionalwell-beingandpositivementalhealthcourse:Suchacoursewouldbewidelyaccessibleand,withthesupportofseniorleadersacrosstheBorough,widelyaccessedbyabroadrangeofstafffromthewidestpossiblerangeofchildren’sservices.Benefitswillbemaximisedbynotlimitingthecoursesolelytothosewithaninterestinemotionalhealthandwellbeing.Thefocusofthecoursewouldbeon:Spottingearlysignsofamentalhealthissueinchildrenandyoungpeople,confidencehelpingayoungpersonexperiencingmentalillhealth.Providingearlyhelp,protectingfromharm,preventingaMHissuegettingworse,assistingwithrecoveringfasterfromaperiodoforongoingmentalillhealthandactingtoreducethestigmaassociatedwithmentalhealthissues.

P P P

AllstaffacrosstheBoroughwhoworkwithchildrenand/oryoungpeople.

CAMHSwithEducationalPsychology

4 Developmentanddeliveryofamodelofmotivationalinterviewing/briefinterventionstechniquestraining:rollingoutaseriesofbasicandhigherleveltrainingintheseareaswouldmaximisetheimpactofeverycontactwithachildoryoungpersonandprovidethebasisforaCBTbasedcommonthreadthroughtheBorough.

P P

School’sEH&WBstaff,frontlinestaffinIFST,EarlyHelpHub,children’scentres,Nurseries,Project3

CAMHS

5 Increaseintheavailabilityofcounsellingskillinschools:DevelopmentofaDoncasterSchoolsCounsellingofferinlinewiththeDfErecommendations P P

Schools,EH&WBleadswithsupportfromCAMHS

Schools

6 Developmentanddeliveryofaseriesofsharedlearningopportunitiesforspecificneeds:Conductdisorders,Anxiety,Depression,Hyperkineticdisorders,Attachmentdisorders,Eatingdisorders,Substancemisuse,Deliberateself-harm,Post-traumaticstressStaffacrossthesystemhaveincreasedconfidenceindealingwiththehighestneedareas.

P P

Allchildren’sservices CAMHS

7 Deliveryofsharedlearningopportunitiesformeetinghigherneeds:WorkingwithstaffacrosstheBoroughtoincreaseskillsindealingwithchildrenwithhigherendemotionalhealthandwellbeingneeds P P

FocusedonstaffwhoalreadyworkwithC&YPandfamilieswithmultipleand/orcomplexneeds

CAMHS,DCST

8 Trainingothers:Increasingskills,knowledgeandcompetenceatsharingspecifictoolsandtechniquesrelatingtoemotionalhealthandwellbeinginchildreninyoungpeoplethroughdeliveryoftrainingtootherseitherone-to-oneorgrouptraining

P P

CAMHSclinicalstaff CAMHS

9 Deliveringthroughothers:Increasingskills,knowledgeandcompetenceatsharingspecifictoolsandtechniquesrelatingtoemotionalhealthandwellbeinginchildreninyoungpeoplethroughdeliveryoftrainingtootherseitherthroughone-to-oneorgrouptraining

P P P

CAMHSclinicalstaffHV/SNstaff RDaSH

10 CognitiveBehaviouralTherapy:ThereshouldbeahighlevelofskillsandexpertiseincompetentuseofCBTwithchildrenandyoungpeopleacrosstherangeofCAMHSprofessionals.

P P

CAMHSclinicalstaff CAMHSwithRDaSHL&D

11 CAMHS-Specifichigherlevelinterventions:AdditionallevelskillstraininginMentalisationBasedTherapy,FamilyTherapyandMindfullness P

CAMHSclinicalstaff CAMHSwithRDaSHL&D

12 Adaptingtoanddealingwith‘Change’:InvestinginorganisationaldevelopmentinitiativesinsupportofthechangeswillenabletherapidchangemobilisationrequiredofCAMHSstaffastheschoolspilotstakeoff,aremodifiedandevaluatedandthefinalrolloutbeginsthrough2017

P

CAMHSstaff CAMHS

13 Doncastershouldconsiderthedevelopment,oradoption,ofacorecompetencyframeworkforschoolsstaffinleadingonordeliveringemotionalhealthandwellbeinginschools:Thereis,justpublishedbytheYorkshireandHumberChildren’sWorkforceLeadsGroup,aProfessionalCapabilitiesFrameworkfortheWiderChildren’sWorkforce:earlyinterventionandpreventionItaddressesmanyofthesameissuesregardingthediverseskillsandcompetenciesidentifiedamongstpastoralsupportstaffandEmotionalHealthandWellbeingleadsinschools.

P P P P

School’sEH&WBstaff DoncasterMBCandDoncasterChildren’sServicesTrust

Recommendation WorkforceImpactArea WhichGroupsofstaff? Lead

9.10Thereareaseriesofrecommendationsthatcomedirectlyfromtheabovekeyfindings.

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10.KeyObjectivesTheaboveneedsassessmentisextensiveandgivesanexcellentoverallpictureofneed.However,therewasaneedtodrilldownandpickoutsomekeyareasofneed,whichinturnwillallowustoidentifythekeyobjectives.TheoriginalLTPoutlinesthekeyissuesandkeyobjectives.ForthepurposesofthisupdatedLTPwewillonlyincludethekeyobjectives.

MoveAwayfromtheCurrentTieredSystemByimplementingaconsultationmodelthatmovesawayfromreferralsand

towardsjointworking,advice,guidanceandsupport.

SupportUniversalServicesBycreatingprovisiontospecificallysupportuniversalservices.ThiswillincludenamedCAMHsworkersforschools,PrimaryCareandaPrimaryMentalHealthWorkerwithintheEarlyHelpHub.Thedevelopmentofan

enhancedsinglepointofaccess.

ImplementtheCrisisCareConcordatWewillimplementallaspectsoftheconcordat,inparticulartheembeddingofanew24/7helpline,ensuringnochildoryoungpersonisplacedina

Policecellasaplaceofsafetyandbycreatinganewliaisonprovisionwithinanacutehospitalsetting.

DevelopmentofIntensiveHomeTreatmentProvisionByimplementinganewhometreatmentservicethatactsasanalternativetoinpatientservicesandhasakeyroleinpre-crisisandenablesstepdownfrom

acute/inpatientservices.

EatingDisordersBycreatinganewcommunityservicetoreflectlocalneed.

CaringfortheMostVulnerableTodismantlebarriersandreachouttochildrenandyoungpeopleinneedthroughbetterassessmentandanintegratedflexiblesystemthatprovides

servicesinawaythatareevidencebased.

Children,YoungPeopleandFamilieshaveaVoiceBydevelopingsustainablemethodstoeffectivelyengagewithourchildren,youngpeopleandtheirfamiliessotheyhaveavoiceandshapewhatservices

areprovided.

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11.Outcomes

LocalPriorityScheme Outcome EvidenceEstablishnamedemotionalwellbeingandmentalhealthleadsinschools(internal)

Bettereducationalattendanceandattainment.

Reductioninexclusions

AttendanceregistersandGCSEscores

NumberofexclusionsContinuousconsultationandengagementwith

children,youngpeopleandfamilies

Commissioningandservicedeliverydecisionsareshapedbychildren,youngpeopleandtheir

families

Childrenandyoungpeopleinvolvedincommissioningandontaskandfinish

groups


Workforcethathastheskillsandcapabilitiestomeetthe

emotionalwellbeingandmentalhealthneedsofchildrenand

youngpeople

Workforcecompetencyquestionnaire

Auditandrollingtrainingprogramme

Workforcethathastheskillsandcapabilitiestomeetthe

emotionalwellbeingandmentalhealthneedsofchildrenand

youngpeople

Workforcecompetencyquestionnaire

CAMHsworkertobeembeddedintheEarlyHelp

Hub

EffectiveMDTtriageandchildrenandyoungpeoplebeingseenbytherightpersonatthe

righttime

ReductioninreferralsIncreaseinsystemicwork

NamedCAMHsleadsinschools&PrimaryCare

Improvedemotionalwellbeingandmentalhealthofchildren

andyoungpeople

Healthbehaviourquestionnaire

Supportingselfcare

Lesschildrenandyoungpeoplerequiringexternalsupport

Improvedresilience

ReferralsintoCAMHsReferralsintoEarlyHelp

HubHealthbehaviour

questionnaire(resiliencescore)

Developmentofsinglepointofaccess

EffectiveMDTtriageandchildrenandyoungpeoplebeingseenbytherightpersonatthe

righttime

ReductioninreferralsIncreaseinsystemicwork

Furtherdevelopevidencebase

Increaseinstaff’scompetenciestodeliverevidencebased

interventions

NumberofCYP-IAPTtrainedprofessionals

withinCAMHs

Implementallareasofthecrisiscareconcordat

Reductioninchildrenandyoungpeoplepresentingincrisis

Improvedresilience

AttendeesatA&E,Section136

Healthbehaviourquestionnaire(resilience

score)Intensivehometreatmentservicetobeprovided

Childrenandyoungpeoplearebettersupportedathome

Reductionintier4admissions

Expansionofpeermentoringservice

Effectivetransition YHtransitiontoolkitbenchmarkingtool

Enhancethecurrent Childrenandyoungpeople’s CAMHsassessment

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assessmentprocesstoincludesensitiveenquiries

levelsofneedareidentified documentation


Nochildoryoungpersonisdischargedfornonattendance.

DNArates

Developmulti-agencyteamschildrenandyoungpeoplebeingseenbytherightpersonatthe

righttime

Serviceprovisionbreakdown

Improvedcommunitypaediatricservices(incASD

andADHD)

Effectiveassessmentanddischargeservices

Communitypaediatricperformancedashboard


Reductionindomesticabuserates

GrowingFuturesperformancemetrics


Servicesbeganon1stMarch2016andthiswillbeaphasedevolutionofservice.Consultantpsychiatrypostisonlynewpostvacant.SYEDAaredelivering

educationsessions.

Reductionintier4eatingdisorderadmissions

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12.TransformationPlan&Updates:areasforchange,howthiswillbedeliveredin2016/17andprogressmadein2015/16Thefollowingarethepriorityareasforimplementationin2016/17.Thissectionoffersthedetailonhowandwhytheseprioritieswillbeimplemented,andgivesanupdateonanyprogressmadein2015/16.12.1Resilience,PreventionandEarlyInterventionfortheMentalWellbeingofChildrenandYoungPeopleAim:Toactearlytopreventharmbyinvestinginuniversalservices,supportingfamiliesandthosewhocareforchildren,buildingresiliencethroughtoadulthood.Wealsowanttodevelopandimplementstrategiesthatsupportself-care.AlocaltaskandfinishgrouphasbeensetuptoleadontheimplementationofthisareaoftheLTP.Membershiphasbeenagreedandinitialmeetingsheld.Membershipisattherightlevelandthereisanunderlyingphilosophyofaccountability.12.2SupportuniversalservicesWhyisthisapriority?Thelackofaco-ordinatedearlyhelpofferhasledtohighlevelsofinappropriatereferralsintoCAMHsandthereforechildrenandyoungpeoplenotbeingseenbytherightpersonattherighttime.TherearegapsinuniversalserviceworkforceexpertisearoundemotionalwellbeingandmentalhealthandsignificantvarianceinlinksbetweeneducationandCAMHsandPrimaryCareandCAMHs.ThereisasinglepointofaccessintoCAMHsbutnottothewideremotionalwellbeingandmentalhealthservices.Howwillwedothis:

• Namedmentalhealthleadsinschools/academies• CreateasinglepointofaccessintheChildrenandFamiliesHub• MoveCAMHsdutyfunctionsintotheChildrenandFamiliesHub.

Bycreatingprovisionspecificallytosupportuniversalservices.ThiswillincludenamedCAMHsworkersforschools,namedCAMHsworkersforPrimaryCare.FurtherdetailofthisnewmodelcalledConsultationandAdviceService(CAS)isfoundin12.5Thesecondelementistocreateatruesinglepointofaccess,tobuildontheyearoneworkofembeddingaCAMHsworkerwithintheEarlyHelpHub.TheworkerhasmadegoodlinksandaddedvaluetotheEarlyHelpHubwhichwenowwanttobuildupontocreateatruesinglepointofaccessforemotionalwellbeingandmentalhealth,earlyhelpandsocialcare.Originallytherewastobe1WTECAMHsworkerwithintheEarlyHelpHub,butnowaswelooktobringtogetherthroughonefrontdoor,wewillbecommittingagreaterCAMHsresource.Thiswillincludethedutyresourceandfunctionsmovingtothehub.ThereisclinicalagreementfromCAMHsandweareexploringasapartnershiphowbesttointegratethis.ThereisanaspirationthatthejointresourcebetweenCAMHsandsocialcarewillstarttofacilitatebetterworkingrelationshipsandjointvisits.

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AllschoolsinDoncasterhavebeenaskedtoidentifyaemotionalwellbeingandmentalhealthlead/championinschools.Thisleadwillworkalongsidetheschoolnursingteamandschoolspastoralsupportstafftodevelopinternalpathwaysandsystems,thatensurechildrenandyoungpeoplearesupportedattheearliestopportunitybytheprofessionalwhoisbestplacedtodoso.Throughincreasedunderstandingofandincreasedcompetenciesinemotionalwellbeingandmentalhealththesestaffwillbeabletobetteridentifyneedandthentailorsupportquicklyandeffectively.ThiswillbeunderpinnedbyregularCAMHsconsultationsandthetrainingsupport.

Plansfor2016/17

• Toworktowards100%ofschoolshavinganominatedmentalhealthlead• Developmentofchildrenandfamilieshub.

ProgresstoDate:Aletterhasbeensentouttoallschools/academiesintheBoroughfromtheAssistantDirectorforEducation,askingfornominationsfornamedemotionalwellbeingandmentalhealthleads.Thecurrentnumberofschoolswhohaverespondedisreallypositive.Abreakdownperlocalityisasfollows:North23/35-66%East19/27-70%South31/37-84%Central23/26-88%101/125schoolsintotalResponserate81%InterestinglytheoverallKPItargetforMarch2017is75%soalreadywehaveachievedthis.Theplantoengagewiththeotherschoolsthathaveyettonominateisthatoncethenewconsultationandadvicemodelisimplemented,schools/academieswillsellittotheircolleaguesastheyrealisethebenefits.Thereisafairlyevensplitbetweentheschoolsandacademiesthathaven’trespondedandworkisongoingtoengagewiththese.Workisongoingwiththe14pilotschoolsandwearedelightedwithhowthisisprogressing.Therearerepresentativesfromsomepilotschoolsontherespectivetaskandfinishgroupsthatarechargedwithoverseeingtheimplementation.The(1WTE)CAMHsworkersitswithintheEarlyHelpHub(whichistolinkwiththemulti-agencysafeguardinghub)tobecometheChildrenandFamiliesHubandhasestablishedsomegoodjointworkingrelationshipsandsharingofskillsandinformation.ThisworkisongoingandthehubmanagerandCAMHsclinicalleadforthisareaareworkingthroughhowbesttoincorporatethedutyfunctionsandtheoverallCAMHsresourcewithinthenewhub.Progressrating:VeryGood

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12.3AppsandDigitalToolsWhyisthisapriority?Weknowthatchildrenandyoungpeoplevaluedigitalsupport,butthereisnotaco-ordinatedandvalidatedofferlocally.CurrentlysupportforemotionalwellbeingandmentalhealthpredominantlycomesfromCAMHs.Howwillwedothis:

• Workwiththelocalexpertreferencegrouptoreviewexistingtoolsandtrialnewones.

ThechampionsthatarebeingdevelopedthroughtheworkcommissionedwithYoungMindswillidentify15childrenandyoungpeoplethatwanttobecomechampions(Thesechampionswillbecomeanexpertreferencegroupforthisareaofwork.ProgresstoDate:YoungMindshaveestablishedlocallinks(seesection4.3)andareintheprocessofrecruitingYouthParticipationChampions,whowillactastheexpertreferencegroupintermsofthisareaofwork.Anoptionspaperhasbeendevelopedwithsomepossibledigitaloptionsandwillbediscussedwiththeexpertreferencegroup.ProgressRating:Good

12.4PerinatalmentalhealthWhyisthisapriority?Thereare1,256womeninDoncasterwhoarelikelytosufferfromsomedegreeofmentalillnessduringpregnancyorwithinoneyearofgivingbirth.Howwillwedothis:

• Bylearningfromalocalpilotandnationalguidance• BysubmittingtwobidsforSTFfundingtodevelopahighqualityspecialistperinatal

mentalhealthservice.ThisproposalisdesignedtodevelopconsistenthighqualityspecialistperinatalmentalhealthservicesacrosstheDoncasterandBassetlawHospitalsNHSFoundationTrustfootprintwiththeintentionofimprovinginfrastructure,workforcedevelopmentandclinicalcapacitytoachieveimprovedpatientexperienceandoutcomes.ThisproposalwillcreateastandardisedofferacrossDoncasterwhichimprovesconsistencyandcontinuityofcare.Theproposalhastwoelements:

SpecialistPerinatalMentalHealthServiceforcomplexpresentationsAsteppedcaremodelapproachwithmostwomenbeingsupportedinprimarycare,withaccesstoadviceorreferraltospecialistservicesforthemostcomplexpresentations.Itwill

Plansfor2016/17• Expertreferencegrouptoleadondecisionofwhichdigitaloptiontouse

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coveranywomanidentifiedasrequiringmentalhealthsupportduringpregnancyorupto1yearpostdelivery.Thepathwaywill:

• Bedeliveredbyateamofspecialistmidwife,anddedicatedmentalhealthstaffwhowillassess,support,provideadvice(includingnon-complexprescribing)andsignposting

• AccesstoaConsultantPsychiatristwillbeviatherelevantlocalityservice• Includeprimarycare,IAPT,peersupport,voluntaryservicesandsocialprescribing• Enablerapidaccesstosecondarymentalhealthservicesforanyonewithanidentified

need• Ensurethereisanamedprofessionalwhohasoversightofthewomen’scareacross

localproviders.Theservicewouldtakealeadroleinthetrainingandeducatingofpartnerprofessionals,leadingtoincreasedknowledgeandawarenessresultinginmorewomenbeingidentifiedandsupportedtoaccessappropriateservices.Thereisadefiniteneedwithinthelocalpopulationforaservicesupportingthewomanandherfamily,recognisingthatmentalhealthcandeteriorate(aswellasimprove)duringpregnancyandforthefirstyearafterbirth.NationalreportsaroundPNMH,includingMBRRACE,highlighttherisksandthelongtermhealthbenefitsforourcommunity.Theimpactofthisserviceforwomenwillbeaqualityexperiencewherecareis:

• Personcentred• Co-ordinated/notfragmented• Efficient/ownershipbyallstakeholders(notpassingthebaton)• Inclusiveandcollaborative.

Trainingwillbedeliveredinitiallytoallstaffandsubsequentlywillbecomeembeddedpracticewithpathwaysandguidelinessupportingbothwomen,families,primarycareandstaffensuringthatPNMHiseveryone’sbusiness.Secondingclinicalmidwivestotheteamwillensuresustainabilitysuccessionplanningandcontinuity.SeeAppendix2forspecialistperinatalMHpathway.SpecialistHealthVisitinginterventioninlinewithattachmentpathwayAsaCalltoActionEarlyImplementerSiteRDaSHpilotedanenhanceduniversalmodelofantenatalandpostnatalassessmentfocusingonpromotingperinatalmentalhealthandparentchildattachmenttosupporttheemotionalwellbeingofthewholefamilyandprovideanurturingenvironmentfortheinfantinlinewiththerecommendationsofthe1001Daysstrategy.Buildingonthisweproposeadedicatedteamdrawnfromtheexistingworkforcetoreceivetrainingtoprovidetargetedspecialistinterventionforfamilieswhoarebeyondpreventativeinterventionsandrequireadditionalsupportinlinewiththemulti-agencyAttachmentPathway.SeeAppendix3forattachmentmentalhealthpathway.ThisproposalwillbuildonthegrowingrangeofcommissioningproposalswhicharebeingdevelopedacrosstheSTPfootprint,andwouldutilisegoodpracticewhichhasevolvedandthelearning’sfromtheDoncasterPerinatalMentalHealthPilot.Theengagementandinvolvementofwomenwithmentalhealthissuesintheperinatalperiodandtheirfamilieswillbevitaltoensurethatthesenewservicesmeetneedseffectively,and

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women(andfathers)havethebestpossibleopportunitytodevelopahealthemotionalbondwiththeirchildduringpregnancyandinthefirstyearoflife.Bytheendof2018/19weproposetohaveinplaceanagreedmulti-agencyspecification,withclearinterfacesacrossservices,andpathwayofcareforexpandedmodelofspecialistcommunityprovisiondesignedtoimpactonqualityandhealthoutcomes.ThesecondbidisaregionaloneacrosstheSTPfootprint,thatwilldevelopconsistenthighqualityspecialistperinatalmentalhealthservicesacrossSouthYorkshireandBassetlaw(STP),withtheintentionofimprovinginfrastructure,workforcedevelopmentandclinicalcapacitytoachieveimprovedpatientoutcomes.Thevisionistocreateastandardisedofferacrossthepatchwhichimprovesconsistencyandcontinuityofcare.Theworkforcehasfiveworkstreams.

ProgresstoDate:Duetopilotendingthereisnownospecialistcommunityservicetosupportparentsexperiencingperinatalmentalhealthproblems.TwobidshavebeensubmittedtotheSTFperinatalcommunitydevelopmentfund.ProgressRating:Satisfactory

Areweon-track?Whenyouconsiderprogressagainsttheoriginalmilestonesabove,itisencouragingtoseethatprogressisbeingmade,oftenbeforeweexpecteditto,i.e.namedschoolleads.Weareconfidentthatweareon-tracktoachievetheremainingmilestones.

Plansfor2016/17• AwaittheoutcomeoftheSTFbids• Ifsuccessful,implementthenewprogramme(s).

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12.5ImprovingAccesstoEffectiveSupportAim:Tochangehowcareisdelieveredandbuilditaroundtheneedsofchildren,youngpeopleandtheirfamilies.Wewillmoveawayfromasystemofcaredelieveredintermsofwhatservices,organisationsprovide,toensurethatchildrenandyoungpeoplehaveearlyaccesstotherightsupportattherighttimeintherightplace.AlocaltaskandfinishgrouphasbeensetuptoleadontheimplementationofthisareaoftheLTP.Membershiphasbeenagreedandinitialmeetingsheld.Membershipisattherightlevelandthereisanunderlyingphilosophyofaccountability.12.6MoveawayfromthecurrenttieredsystemofmentalhealthservicesWhyisthisapriority?Thereisvarianceintheskillsandcompetenciesofstaffinuniversalservices(includingschoolsandPrimaryCare).ThereisverylittleconsultationwithCAMHspriortoreferralandahighnumberofinappropriatereferrals.Howwewilldothis:

• ByhavingnewCAMHsworkersbasedwithinthecommunitywhoactasdedicatednamedcontactpointsforallschoolsandGPpractices

• CAMHslocalityworkersprovidingadvice,supportandguidancetoprofessionalsalreadyworkingwithchildrenandyoungpeopleinasystemicapproach

• RemovalofwrittenreferralsintoCAMHswithaccessviatheconsultationandadviceservice

• Removalofreferralthresholds.Byhavingadditionalnewlocality/communitybasedCAMHsworkersthatprovideconsultation,adviceandguidancetoprofessionalsalreadyworkingwithchildrenandyoungpeopleinasystemicway.Thereisaworkerineachofthelocalitiesandtheywillprovideeasieraccessintosupport.Thekeydriverbehindthisistoprovidesupporttothosechildrenandyoungpeoplethathavepreviouslyfailedtomeetthresholdsandbeenleftwithoutsupport.Thenewfunctionswillcomeundertheconsultationandadviceservice(CAS)andnewbrandingisnowtobeexplored.Theroleoftheseworkerswillbetodiscussandprovideadviceandguidanceonthemanagementofcases,includingconsultation,co-workingorliaison,inasytemicway,thereisaneedtomoveawayfromthehandsoffreferralculture.ThiswillmeanthatnochildfromthesesettingsshouldbereferredintoCAMHswithoutadiscussionwiththenamedCASlocalityworker.TheaspirationistototallyremovewrittenreferralsintoCAMHs,wherebyentryintotheservicecomesonlythroughconsultationandco-workingorself-referral.Afurtheraimoftheconsultationmodelisthatcases(asappropriate)willbeledbythemostappropriateperson,bethiscarerorprofessional,supportedbytheCASworker.Inpracticethiswillmeanthedevelopmentofjointassessments,betterawarenessofrolesandresponsibilitiesacrosstherangeofservicesandeffectivecommunication.Wewouldexpectovertheforthcomingyearsthatthenumberofjointassessmentsgodownandthenumberofconsultationsgoesup.Thelongertermaspirationistoprovidesupporttochildrenandyoungpeopleattheearliestpossiblestage,whichwillreducethenumbersneedingspecialistCAMHsinput.ThiswillthenallowovertimearedelpoymentofresourcesfromspecialistCAMHstotheconsultationandadviceserviceandLAC.

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Themodelisasfollows:

Underpinningthiswillbethedevelopmentandimplementationofalocaljointtrainingplan,whilstbeingveryawareofanynationaldevelopmentsviatheschoolspilotprogramme.Doncasterwasunsuccesfulinthebidbuthasdecidedtoimplementthepilotwiththeinterestedschoolslocally.Clinicianswithinrespectiveservices,includingCAMHsandEducationPsychologywilldeveloptrainingprogarmmeswithnamededucationleads.Theevolutionofthiswillbetheexpansionintoawidercommunitymentalhealthprovision,thatbuildsuponnotonlytheabovebutalsothenewlyimplementedEarlyHelpHubandbuiltintotheredesignsofcommunitynursingandtherapyservices,whichwewillbecompletingin2016.ProgresstoDate:Therehasbeenlotsofongoingengagementwithstakeholdersatbothstrategicandoperationallevelstoensurethenewconsultationandadvicefunctionsfitwithinthewidersystem.InSpring,rolesandresponsibilitiesforboththeCAMHslocalityworkersandschoolstaffwereagreed.Thishasbeenthemainareaoffocusin2015/16andwearepleasedtoupdatethatthenewfunctionsofconsultation,adviceandguidanceareinplace,themovetoamoresystemicwayofworkingacrossagencieshasbegun.Therearecurrently4WTECAMHsconsultationandadviceworkerswithDoncastersplitintofourlocalities,eachlocalityhasanamedworker,supportedbytwofloatingstaff(holidaycoveretc).Thestaffwillshareresourceandexpertisetobestmeetneed.Theinitialfeedbackfromschoolsandotherprofessionalshasbeenvery

School/School Mental Health Champion - Identify Possible Mental Health Concerns

- Discuss with Young Person/Family - Agree plan/set up network meeting to consider issues

- Access appropriate services e.g. Educational Psychology

School Champion Contact Designated CAMHs Consultation Team

- CAMHs offer direct consultation based on known information from school and consider school plan

- CAMHs Consultation and

Advice Only

- School Champion/Family/CAMHs agree the

plan

- Consultation and Advice plus CAMHs

staff link with network (school,

family, school nurse etc.)

-Additional CAMHs Consultation to

network

- Ongoing Consultation and

Advice to network

- Potential to work systemically for a

number of weeks/months (revising

plan)

- In addition to ongoing network Consultation and

Advice, an agreed

treatment/ therapy is agreed and delivered by

CAMHs

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positive.ThenewofferbeganwiththenewacademicyearandwillbetestedandevolvedoverthenextsixmonthswiththeaimofremovingreferralthresholdsandwrittenreferralsintoCAMHsbytheSummerof2017.Referralswillbereplacedbyrequestsforcollaborativeworking(inasystemicmanner)andwillmeanacontinuationofsupportratherthanahandoffreferral.Theaimofwhichistotrulyremovetiersandaccesstosupport.ProgressRating:Good

12.7Ensurethesupportandinterventionforyoungpeopleinthementalhealthconcordatareimplemented.Whyisthisapriority?ChildrenandyoungpeopleinDoncasterwereadmittedtohospitalforattemptedsuicideandwehaveothersincrisis.AllelementsoftheCrisisCareConcordatarenotcurrentlybeingimplemented.Howwillwedothis:

• New24/7allagecrisishub• CAMHsinterfaceandliaisonnurseplacedinacutehospitalsetting• LiaisonanddiversionservicetobeawareofCYPservices• Exploreoptionsofregionalsection136suiteandcrisisaccommodation.

ByimplementingtheCrisisCareConcordat,therehasalreadybeenlotsofworkdoneinthisareaandinmanycasesprovisionisalreadyinplace;asection136suitethatisappropriateforassessmentofchildrenandyoungpeople,a16yearoldplusstreettriagesystemanda24/7outofhoursCAMHsprovision.However,thereisstillmuchtodo.ThecrisishubwentliveinSeptember2015andisevolvingtoanallageservicethatwillinterlinkwiththepaediatricliaisonnurseandCAMHsoutofhoursservice,toprovide24/7supportforthoseyoungpeopleincrisis.Arecentauditshowedthatthereisaneedforimprovementsandtheserecommendationswillbeimplemented.ACAMHsinterfaceandliaisonnursewillberesponsibleforprovidingspecialistnursingskillsandknowledge,liaisonandcasemanagementofcomplexcasesbetweenCAMHsandpaediatricwards,A&Eandinpatientproviders.Thispostwillsitwithintheintensivehometreatmentprovisionandprovidefacetofaceassessmentsforthoseincrisiswithinthefourhourtargets.Theywilllinkcloselytotheoutofhour’sserviceandofferadvice,guidanceandtrainingtopaediatricwardsandA&E.Theoutofhour’sservicewillbegivensomeadditionalresourcetoincreasetherotatosupporttheachievementofthefourhourface-to-facetargets.Inresponsetotheannouncementofnon-recurrentpump-primeinvestmentinallage24/7liaisonmentalhealthservices,wewillcontinuetoworkwithadultcolleaguestomapoutthecurrentprovisionacrossallages,whichwillincludethenewCAMHsinterfaceandliaison

Plansfor2016/17• Continuetoembedthenewconsultationandadvicefunctions• Recruitfinal1WTEtomodel• Monitoreffectivenessandallowforaflexibleapproachtoservicedevelopment• Movetonothresholds.

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nurse,comparecurrentprovisiontothemodelservicespecificationandthencommissionaservicetomeettherequirements.ItwouldseemlikelythattheCAMHsinterfaceandliaisonnursewillformpartofthisservicemovingforward.Thelocalliaisonanddiversionserviceareintheprocessofidentifyinganygapsintheirknowledgeofchildrenandyoungpeopleservicesandwillpresentthesetotheemotionalwellbeingandmentalhealthstrategygrouptohelpfacilitateatrainingplan.Thiscanandwillbedonelocallybyservicesaspartofarelationshipandserviceawarenessbuildinginitiative.ThethoughtsanddiscussionsaroundtheregionalprovisionofsuitableaccommodationforChildrenandYoungPeoplehavebeenongoing.DoncastersupportedSheffieldinasuccessfulfundingbidtodeveloparegionalSection136suite.SheffieldarenowdevelopingthisservicewithafewtoDoncaster(andpotentiallyothersinSouthYorkshire)spotpurchasingbedsperannum.Wearenowsolelyexploringalocalsolutiontoshort-termcrisisbedsastheregionaloptionwasn’tgoingtobeaseffective.Weareexploringtheoptionoftrainingfostercarer(s)toprovideintensivesupporttochildrenandyoungpeopleincrisisacrossmentalhealth,substancemisuse,socialcareandyouthoffending.Thiswillbeajointcommissioningarrangement.Theintensivehometreatmentservicewillprovidein-reachtothefostercarersasrequired.WeareaimingforasolutionbyApril2017.ProgresstoDate:The24/7crisissupporthelplinewentliveinSeptemberandauditwascompletedafteroneyeartolookatanyissues.Thereweresomeareasfordevelopmentthatwillbeworkedthroughandreviewedoverthenextsixmonths.Wehavecompletedwithpartnersamappingofcurrentpsychiatryliaisonservicesforallages,thatdetailscurrentpathwaysandresources.Thiswillnowshapedecisionsmovingforwardtoensurewemovetowardsacore24service.TheactionsareheldonthelocalCrisisCareConcordatactionplan.TheCAMHsinterfaceandliaisonfunctionhasbeendetailedintheservicespecificationandthemodelofdeliveryisclear.Thereisagreementfromtheacuteprovideronthemodelandanagreementwiththeproviderintermsoftherelevantgovernancearrangementsetc.ThisserviceisnowupandrunningwithafocusofdevelopingcollaborativeworkingandprovidingdirectCAMHssupportintheacutesettingTheliaisonanddiversionservicehasidentifiedgapsintheirknowledgeofChildrenandYoungPeopleservicesandatrainingplanhasbeenagreedandisbeingfacilitated.Localservicesaresupportingtheliaisonanddiversionservicearoundtheirunderstanding.Thisworkisdevelopingandongoing.WehavelocalsystemsinplacethatmeannoChildorYoungPersonwillbedetainedinapolicecellasaplaceofsafetyfrom1stJanuary2016.Thishasbeencommunicatedviaregionalmeetingsandtheregionalworkwillfurtherenhancethelocalprovision.ProgressRating:Good

Plansfor2016/17• Implementrecommendationsfromcrisishubaudit• EmbedtheliaisonfunctionswithintheacutepaediatricandA&Ehospitalsetting

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12.8DevelopmentofintensivehometreatmentprovisionWhyisthisapriority?Wehavehighnumbersofchildrenandyoungpeoplereferredintoinpatientserviceswithanaveragelengthofstayofapproximately101days.Wearehighwhencomparedtoourneighboursregionallyandcurrentlydonothaveanintensivehometreatmentservice.Howwillwedothis:

• Developingandimplementinganewintensivehometreatmentservicetoactasanalternativetotier4provision.

Bydevelopingandimplementinganewhometreatmentservicethatactsasanalternativetoinpatientservices,hasakeyroleinpre-crisiscareandenablesstepdownfromacute/inpatientservices.Locallythiswillbeamulti-disciplinaryteamconsistingofclinicalpsychology,seniormentalhealthnurses(self-sufficientandprescribers),socialworkerandpeermentors.Theservicewillprovidethesamesupportasifachildwasinanacutesettingbutathomeorinthecommunity,i.e.twicedailyvisitstocheckonphysicalandpsychologicalcondition(asappropriate),supportparents/carerstomanagemedicationsathomeandproviding24/7oncallsupport.TheservicewillprovidedirectsupporttoacutepaediatricwardsandA&EandprovidepeersupporttotheCAMHsinterfaceandliaisonnurse.Alargeportionoftherecurrentfundingwillbeusedtocommissionthisresourceandinitialcostsaredetailedinthetracker.ProgresstoDate:Theservicespecificationiscompleteandfundingarrangementshaveallbeenagreed.Theintensivehometreatmentservicewillofferanalternativetotier4.TheserviceproviderproposedamodelofworkingthatwasagreedbytheMentalHealthStrategyGroupinJuly.Theyhavevisitedotherintensivehometreatmentservicestohelptheirthinking.Mostpostswereinitiallyrecruitedtobuttheseniorpostandsocialworkerpostarestillvacant.Thesearecurrentlyouttoadvert.TheservicemadeaphasedimplementationfromSeptemberandcurrentlyhasnineonthecaseload.TheserviceiscurrentlyrecordingitsdatamanuallyastherelevantKPIsneedaddingtotheproviderssystem(redmine).ProgressRating:Satisfactory

• Spotpurchasebedsatregionalsection136suite• Commissionfostercarer(s)toprovideshort-termaccommodationtothoseincrisis

(asappropriate).

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12.9PromotebestpracticeintransitionWhyisthisapriority?Transitionremainsaproblemforsomeyoungpeople;inparticularitisn’tstartedearlyenough.Howwillwedothis:

• Implementingmodelspecificationfortransition• WorkwithYHSCNtodevelopguidancedocumentsfortransition• Addresourcetopeermentoringservice.

ByimplementingthemodelspecificationfortransitionsfromCAMHsdevelopedbyNHSEngland,continuingtoworkwiththeYorkshireandHumberStrategicClinicalNetworkondevelopingguidanceforcommissionersandprovidertoolkitontransitionandbuildingonthecurrentpeermentoringprovisionwehaveinDoncasterthathasbeenheldupasanexemplar.DoncasterCAMHsemploypeersupportworkerswhothemselveshavealiveexperienceofmentalhealthproblems.Theroleincludessupportingyoungpeopleandtheirfamiliesintheprocessoftransitionthroughtoadultservices,toprovidecontinuityandadvocacy.Thepeersupportworkersattendtransitionmeetingswithserviceuserswithadultcarecoordinatorstoprovideinformationabouttheprocessandassistthefamilyandyoungpersontomanageanyconcernsandanxietiestheymayhave.TherolealsoinvolvesassistingyoungpeoplewhomaybeanxiousaboutdischargefromtheserviceandhelpingthemtomakethetransitionbacktoPrimaryCare.Theworkershelpyoungpeopletomeetpersonal,socialandeducationalgoalssupportingthemtoaccesscollegeandschool(attendingcollegewiththemshorttermaspartofareintegrationcareplan)andbecomemoreactiveinthecommunity.Peersupportworkersarealsomentalhealthpromotionadvocatesandarekeytoservicedevelopmentsandconsultationtoensureserviceusersvoicesareheard.TheyhavepresentedworkshopsinschoolsandcollegesandarekeytodevelopmentaspeerfacilitatorsintherecoverycollegebeingimplementedinCAMHsassistingyoungpeoplethroughpersonalexperiencetomanageanxietyandstigma.Thepostshaveofferedopportunitiestopeoplewhohavementalhealthissuestoaddresstheirownreintegrationintoemployment.PostsareflexibleintermsofparttimeorfulltimehoursdependentontheneedsoftheworkersandtheirownmentalhealthandaresubstantiveNHScontracts.PeerSupportWorkershavesincegraduatedtogainIAPTpostsandtrainingtoband6practitionerlevelviauniversity,paramedicsandprojectleadsinnon-NHScommunityprojectsProgresstoDate:CAMHshavejustcompletedatransitionbenchmarkingexercisewhichwillbereviewedinNovember,withasubsequentactionplan.ThebenchmarkingtoolwasfromtheYorkshireandHumberClinicalNetworkdevelopedtoolkit.Thepeermentoringfunctionsarebeingreviewedwithaviewtoseeinghowthesecanbeexpanded.Fundingforanysubsequenttrainingisavailable.

Plansfor2016/17• Recruittofinalposts• Addtoredmineandstarttoprovideinformationelectronically• Implementthefullmodelofdelivery• Closelymonitordelivery• Reviewserviceaftersixmonthsoffulldelivery.

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ProgressRating:Satisfactory

12.10EatingdisordercommunityserviceWhyisthisapriority?TherehasbeenayearonyearincreaseinreferralsintoCAMHsforeatingdisordersaswellasanincreaseinthoseaccessinginpatientservices.Howwillwedothis:

• Newcommunityeatingdisorderserviceadheringtoaccessandwaitingtimestandards

• Robustlyevaluatethenewmodel.Byimplementingaccessandwaitingtimestandardsforchildrenandyoungpeoplewithaneatingdisorder(NHSEngland)regionallyinconjunctionwithRotherhamandNorthLincolnshire(whichgivesatotalpopulationofapproximately727,000).Theneedandprevalenceacrossthethreeareasisidentifiedinsectionsixandalthoughfallsbelowthenumbersneededtomaintainstaffcompetencies,wefeelthatthereisanunmetneedthatwouldtakeitabovethisminimumnumber.AgreementhasbeenmadelocallythatRotherhamwillbetheleadcommissioneronthisandprovisionalmeetingsandworkshopshavetakenplacetodiscusstheguidanceandhowbestthiscanbeimplementedacrossthethreeareas.Wewillcommissionanexternalresearchagencytodevelopandcompletearobustservicemodelevaluationafter18monthsthatwillshapefuturecommissioningdecisions.

Plansfor2016/17• Reviewtransitionbenchmarkfindings• Peermentoringservicetobereviewedwithaviewtoexpanding.

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ProgresstoDate:ThethreecommissionershaveagreedalocalservicespecificationbasedupontheAccessandWaitingTimeStandardforChildrenandYoungPeoplewithanEatingDisorder,andcontractandprocurementrouteshavebeenagreedandestablished.Rotherhamistheleadcommissioneronthis.Theservicespecificationhasbeenagreedandthereisaclearimplementationplantounderpindelivery.Thephaseddeliverystartedon1stMarch,thediagrambelowshowstheproposedmodelandcapacityacrossthethreeareas.AllvacanciesforDoncasterhavebeenfilledexcepttheconsultantpsychiatrist,whichfailedtogetanysuitableapplicantswhenfirstadvertised.Itisbackouttoadvert.Itisimportanttonotetheserviceisachievingtheprescribedaccessandwaitingstandardsatthispoint,albeitwithoutthefullmulti-agencyresourceinplace.Dataiscurrentlybeingcollectedandprovidedmanuallyuntiladdedtoredmine.RDaSH(mainprovider)havesub-contractedSYEDAtoprovidetheearlyhelp,preventionandeducationelementsoftheservicespecification,thisisanewareainDoncastersowearekeentounderstandneedandimpact.ThenewresourceinSYEDAis2WTEandtheseareaneducationandtrainingmanagerandeducationworker.Performancetodateisoutlinedin4.41.Doncasterhasledonthecommissioningofanevaluationstudyofthenewcommunityeatingdisordermodel.PacechavebeenawardedthecontractandhavebeenincontactwithRDaSHtobegindevelopingtheevaluationframework.Thisworkcommencedon1stMarch2016andtheyareliaisingwiththeCEDSprovidersandlocalcommissionersintermsofsettinguptheevaluationframework.Theevaluationwillbecompletedat16monthswithanevaluationreportsubmittedtocommissionersat18months.ProgressRating:Good

Plansfor2016/17• Recruittothepsychiatrypost• Addtoredmineandstarttoprovideinformationelectronically• Reviewservicedeliveryaftersixmonthsofstarting• ContinuetoraiseawarenessviaSYEDA• Workwithacuteprovidertodeveloplinksbetweencommunityandacute.

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Areweon-track?Therehasbeensomeslippageinacoupleofareas,namelytheintensivehometreatmentserviceandcrisishubgoinglive(withpaediatricexpertise),howeverthereareclearreasonsforthisandrecommendations/solutionstoremedythem.Weareconfidentthatweareon-tracktoachievetheremainingmilestones.12.11CaringforthemostVulnerableAim:Todismantlebarriersandreachouttochildrenandyoungpeopleinneed,throughaflexibleintegratedsystemthatprovidesservicesinawaythattheyfeelsafeandareevidencebased.AlocaltaskandfinishgrouphasbeensetuptoleadontheimplementationofthisareaoftheLTP.Membershiphasbeenagreedandinitialmeetingsheld.Membershipisattherightlevelandthereisanunderlyingphilosophyofaccountability.12.12TraumafocusedcareWhyisthisapriority?Thereisaneedforgreaterawarenessoftheimpactoftrauma,abuseand/orneglectonmentalhealth.CAMHsassessmentsdonotroutinelyincludesensitiveenquiryaboutthepossibilityofneglectandsexualabuse(includingCSE).Thereisvarianceinstaff’scompetenciesinworkingwithvulnerablechildrenandyoungpeople.Howwillwedothis:

• Auditofcurrentpractice,skillsandcompetencies • EnhancedtrainingpackageforstaffworkingwithvulnerableCYP.

Byprovidinganenhancedtrainingpackageforstaffworkingwithvulnerablechildrenandyoungpeople,whichwouldleadtogreaterprofessionalawarenessoftheimpactoftrauma,abuseand/orneglectonmentalhealth,inparticularexistingCAMHsandSocialCarestaff.Runningalongside,therewillbechangesmadetocurrentmentalhealthassessmentstoincludesensitiveenquiryaboutthepossibilityofneglect,sexualabuse,includingCSEforthoseaged16yearsandaboveasroutinepractice.Asmallamountoffundingisallocatedforthedevelopmentifnewresourcesandstafftraining.Thosewithanidentifiedneedwillthen

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bereferredontoappropriateserviceswithongoingsupportmechanismsinplace.ACAMHsworkerwillsitwithinthelocalmulti-agencysafeguardinghub.CAMHsarecurrentlyinvolvedinthelocalfollow-uppathwayforchildrenandyoungpeoplewherethereissuspectedsexualabuseandrape(SARC)andthisworkswell.However,thereisagapregardingdirectandspecialisedpsychology/psychiatrysupportandthisissomethingwearelookingatregionally.ThereislikelihoodthatallSARCassessments(bothforensicandnon-forensic)willbecommissionedbyNHSEinthefuture.ProgresstoDate:Theauditofcurrentpracticewashasbeencompletedandtherearesomerecommendations,thatwillbeimplementedbytheprovider.Thesewillbereviewedaftersixmonths.Thereisstillanintentiontolookattheprovisionofspecialisedpsychology/psychiatrysupportforChildrenandYoungPeoplewherethereissuspectedsexualabuse,thiswillhappeninyearthree.ProgressRating:Satisfactory

12.13Makesurethatchildrenandyoungpeopleortheirparentswhodonotattendappointmentsarenotdischargedfromservices,ratheractivelyfollowedupWhyisthisapriority?DNAratesfor2014/15were9.5%andthecurrentpolicy,whilstrobust,needsmodificationsothatnochildoryoungpersonleavesservicebecauseofDNAs.Howwillwedothis:

• Buildoncurrentpolicyandensurestaffcompliance.Bybuildingonthecurrentpolicytomakeitmorerobustsothatchildren,youngpeopleortheirparentswhodonotattendarenotdischargedfromservices,nomatterhowmanytimestheyDNA.Therewillbeaclearexpectationthatreasonsfornon-engagementaretobeactivelyfollowedup. ProgresstoDate: Thiswasimplementedandhasbeenfinalisedthroughthenewservicespecificationandcontract.Theprovideriscurrentlyamendingpoliciesandproceduresandwehaveaskedforanauditonstaff’scompliancetothepolicy.Thisaudithasbeencompletedandthefindingsandrecommendationswillshapefuturethinking.Progressrating:Good

Plansfor2016/17• Implementtheauditrecommendations.

Plansfor2016/17• Implementtheauditrecommendations.

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12.14Developmulti-agencyteamsavailablewithflexibleacceptancecriteriaforreferralsconcerningvulnerablechildrenandyoungpeople.Improvethecareofchildrenandyoungpeoplewhoaremostexcludedfromsociety,i.e.thosesexuallyexploited,homelessorincontactwiththeyouthjusticesystem.Whyisthisapriority?Thereisvarianceintheprovisionacrossservices.Howwillwedothis:

• Buildonmulti-agencyapproach.Bybuildingonthemulti-agencyapproachwealreadyhavetomakesupportmoreaccessible.WecurrentlyhavegoodsystemsforLookedafterChildrenandthoseintheYouthJusticesystembutoutsideofthistherearenoagreedmechanisms.WewillchangethisbyincreasingtheexpertisewithCAMHsandthecapacitythatisgainedwillallowCAMHsworkerstomoveouttojoinmulti-agencyteams,i.e.Youthhousingandsupportservicesandyouthservices.Doncasterdoesnothaveagangculture.Doncasterdoesthough,havehighlevelsofpovertyanddepravationmeaningforsomechildrenandyoungpeopletheyaremoreatrisk.Ensuringwehaveflexiblemulti-agencyteamswillensurethesechildrenandyoungpeopleareidentifiedandsupported.ProgresstoDate:TheplanistodeveloptheseteamsbyMarch2019,sonoworkdoneonthistodate.ProgressRating:n/a12.15LearningDisabilityspecialistprovisionWhyisthisapriority?Thecareandtreatmentreviewguidanceandpolicyarenotcurrentlybeingimplementedlocally.Howwillwedothis:

• EnsureweareCTRcompliant• ReviewthecurrentpathwayprovisionforLDCAMHs.

Byimprovingtheuniversaloffertochildrenandyoungpeoplewithalearningdisabilityandensuringcompliancetothecareandtreatmentreviewpolicyandguidance.Areviewofthecurrentpathwaywillbecompletedwhichwillshapefuturecommissioningdecisions.Secondlywearecommittedtotheimplementationofnewpracticethatensureswearecompliantwiththecareandtreatmentreviewguidanceandpolicy.Thepostadmissionreviewmentionedbeforeprovidesagoodplatformforustoworkthroughhowbesttodothis,supportedbyadultandspecialisedcolleagues.ProgresstoDate:LocalsystemshavebeensetupforChildrenandYoungPeoplethatarecompliantwiththemandatedguidanceandpolicy;thiswascompletedbyNovember2015.TodatetherehavebeennorequestsforaCTR.ToensurebestpracticealocalMOUunderpinnedbyapolicyhasbeencompletedandagreedbyspecialisedcommissioning.Inaddition,DoncasterhasledonthedevelopmentofaregionalMOUtoensurethateach

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areainYorkshirehasaccesstoanindependentclinicalexpert.Thiswillbeachievedthroughalikeforlikeagreementonsharingthisresourceacrossthepatch.ProgressRating:VeryGood

Areweon-track?Theenhancedtrainingpackagehasslippedduetotheslightlylaterstartoftheworkforceeducatorthatwillleadonthiswork.ThenextareasofworkwillbetomapoutthecurrentprovisionforLAC,LDandYOSpathwayswiththeaimtoimprovetheseservicesin2016/17.12.16TobeAccountableandTransparentAim:Todriveimprovementsinthedeliveryofcareandstandardsofperformance,toensurewehaveamuchbetterunderstandingofhowwegetthebestoutcomesforchildren,youngpeopleandtheirfamilies.12.17LeadCommissionerarrangementsWhyisthisapriority?Toensurewehaveastrategicleadandafigureheadtoco-ordinate.Howwillwedothis:

• Designatedleadcommissioner.Doncaster Clinical Commissioning Group (DCCG) is the lead commissioner for thedevelopment and implementation of our local transformation plan supported by partners.Wehaveanestablishedemotionalwellbeingandmentalhealthstrategygroupchairedbythe

Plansfor2016/17• MonitoreffectivenessoflocalCTRarrangements• ImplementtheregionalMOU• ReviewthecurrentpathwayforLDCAMHs.

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ChiefNurseinDCCGwithappropriateseniormembershipanditisfunctioningwell.Throughacollaborativeapproachthisgroupledonthedevelopmentoftheplan.Theemotionalwellbeingandmentalhealthstrategygroupwillbetheaccountablegroupforthe implementationanddirectoversightof theplan, feedingany issuesupto twostrategicboards;Health andWellbeing Board andChildren and Families Strategic Partnership Boardwhowillmonitor the overall performance of the plan (Appendix 8). In addition to feedingintothesegroups,theEmotionalwellbeingandmentalhealthBoardwill linkdirectlytotheChildren and Families Commissioning Group and report into the Safeguarding Children’sBoardandChildren.Thediagrambelowillustratesthegovernancestructure

ThetermsofreferencefortheEmotionalwellbeingandmentalhealthGroup(Appendix1)outlinethepurposeandfunctionsofthegroupindetail.ProgresstoDate:TheleadcommissionerremainsinplaceandtheEmotionalwellbeingandmentalhealthStrategyGroupcontinuetohavedirectoversightoftheLTPimplementation.Therearetwotaskandfinishgroupsthatsitunderthestrategygroupthatareleadingonthedetailedimplementation.TheleadcommissionerchairsthesemeetingsandfeedsdirectlyintotheStrategyGroupandHealthandWellbeingBoard.Thereisgoodrepresentationandaccountabilityacrosspartners.TheMentalHealthStrategyGroupfeedsdirectlyintotheJointExecutiveCommissioningGroupwhereallcommissioningdecisionsaremade.TheultimateaccountablegroupistheHealthandWellbeingBoard.ProgressRating:VeryGood

Health&WellbeingBoard

DoncasterSafeguardingChildren’sBoard

Children&FamiliesStrategicPartnership

Board

Children&FamiliesCommissioningGroup

EmotionalwellbeingandmentalhealthStrategy

Group

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12.18CollaborationwithspecialistcommissionersWhyisthisapriority?Toreduceanyduplicationincommissioningandtoensurethatserviceslocally,regionallyandnationallyarecommissionedtomeetneed.Howwillwedothis:

• Collaborativeworking.DCCGiscommittedtoworkingwithspecialisedcommissioningandwehaveidentifiedthefollowingkeythemesandissuesarisingfromcommissioningofCAMHsTier4.Thesewillbelistedbelow.ItisimportanttonotethatDoncasterhasconsideredallkeythemesandissuesandhasfactoredallthefollowingintoourthinkingabouttherefreshedplan.ItisthedesireofDoncastertoworkcloselywithspecialisedcommissioningtofindsolutions.ClearlydeterminefromtheplansCCGT4CAMHscapacityrequirements,allCCGstoincludespendandactivityanalysisfor2014/15.Evidencethatwhateverisbeingconsideredwillhavesomeimpactonrateofadmissionscurrentlygoingintoinpatientbeds(%expected)orthatbecausetheserviceiswellestablishedandworkingeffectively,thatthispositionwillremainrelativelystatic.Theintroductionoftheintensivehometreatmentservicewillhaveadirectimpactonthis.Doncasterwouldliketoexploretheopportunityofworkingcollaborativelyonmeasuringthisandinitialdiscussionshavetakenplace.ThehopeforDoncasteristhatthiswillfacilitatediscussionsregardingtheflowdownoftier4financialsavings,tohelpourlocalabilitytomeettheFutureinMindprinciples.ConsiderationofintensivesupportteamstosupportEDcasesandpreventneedforadmissionbutalsoconsiderationofin-reachintopaediatricwardsforthoseonmedicalstabilisation–whatmeasureswouldbeinplacetoevidencethesuccessofthis?Thisisunderconsideration,initialthinkingis:EDClinicswherefullassessmentcantakeplaceandcareplannedtosuitandaccommodatetheneedsoftheindividual.Crisisintervention24/7eitherbyincreasingwhatisthereorsettingitup,tosupportYPwithaviewtomanagingthecrisisandwherepossibletoreducingtheneedforadmission.LearningDisabilityisanareaofsignificantgrowthandgiventhenatureandcomplexitybetweenhealthandsocialcare,howwillthisbeaddressed,aswhilstthenumbersarerelativelysmall,theseyoungpeoplepresentsignificantchallengestothesystem.Robustandcomprehensivecommunityteamsrequiredtoprovidecrisissupport,preventtheneedforadmissionandsupportreducedlengthsofstaytothosewhoneedtobeadmitted(takingviewsoftransformingcareintoconsideration).ThemeemergingaroundinadequateLD/ASD/CAMHsprovisioninTier2/3andisaprioritytoaddressgiventherequirementtodevelopalternativestoinpatientprovisioninpartnershipwithLocalAuthority,CCGsandNHSEngland.Perinatal–considerationofcommunityprovisioneitherbyincreasingwhatiscurrentlyavailableorbysettingupanewservice.

Plansfor2016/17• HealthandWellbeingBoardtosignoffthe2016-2020LTPupdate• ContinuetopromotetheLTPandinparticulartherefreshedversiontopartnersto

ensurebuy-inandunderstanding.

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PlansshouldaddressstepdownfromTier4facilities,whereoftenthereisalackofprovisioninresidentialsettings,daycare,andintensivecommunitysupport/wraparoundtosupportdischarge.Alsosimilarfortheeverincreasingnumberofyoungpeoplewithautism,whattreatmentservicesareavailable/planned?AllplanstoreferenceSecureCAMHsOutreachService,currentlycommissionedbyNHSEngland,potentialforcommissioningbyCCGsgoingforwardandfundingstreamtosupport.ThereshouldbemorerobustengagementandcollaborativeworkingbetweenspecialisedNHSEnglandmentalhealthcommissionersandCCGcommissionerstoensurewecommissionwholesystemspathwaysofcare,inCAMHsandadultservices.Themesemergingonworkforceplanning-risksofnotsecuringsufficientclinicalCAMHsandmentalhealthexperiencedclinicians(evidencedbyclosureofsomeCAMHsinpatientbedsduetostaffingshortages,particularlyRMNs).ProgresstoDate:TheleadcommissionerplaysanactiveroleinYorkshireandHumberClinicalNetworkandhasregularcommunicationwithregionalspecialisedcommissioners.ThisincludeschairingtheMentalHealthCommissionersSteeringGroup.Thereisadirectlinkbothwaysandweareconfidentthatthereisstrongandefficientcollaboration.ProgressRating:VeryGood

12.19EngagementWhyisthisapriority?Thisplanisforourchildrenandyoungpeople,toimprovetheiroutcomesaroundemotionalwellbeingandmentalhealthandassuchwemustprovidetheservicestheyneed.Onlythrougheffectivesustainedengagementcanweprovidetheservicestheyneedinawaytheywant.Howwillwedothis:

• GivingChildren,YoungPeopleandtheirfamiliesavoice• Commissionorganisationtoleadonthispieceofwork• Developsustainablemodel.

Byimplementingoursharedethosofgivingchildren,youngpeopleandtheirfamiliesaviewinshapingcommissioningdecisions.Wewillcommissionanexternalorganisationtodevelopandimplementaplanofcontinuousengagementandconsultationthroughoutthelifeofthe

Plansfor2016/17• Continuetoworkcloselywithspecialisedcommissioning• ExplorecollaborativelythesavingstoNHSEfromreductionsinT4admissionsandif

thesecanflowdown• CommunityEatingDisorderServicetoprovidein-reachintoacutesettingsandwork

closelywiththehomeintensivetreatmentservicetoreduceT4admissions• Ensureeffective24/7crisissupport• LooktocontinuetobolsterADHDandASDcommunitysupport• EnsuresocialcarerespondtorequestsfromT4settingstosupportstepdown.

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plantomakesurethatchildren,youngpeopleandtheirfamilieshavearealvoice.Wewillalsousethisavenueasanothermediumtosensecheckideasandtogaugewhetherthingsareimproving.Adutyofthestrategygroupsistodevelopconsultationwithlocalstakeholdersandensuretheseviewsarefedintothelocaldeliveryplanningprocess.Serviceusers/carerstobeinvolvedbyeitherdirectinvolvementinthegrouponappropriateissues,orviadiscussionswithusergroups.

ProgresstoDate:YoungMindswonthecontractandbeganworkingon1stMarch2016.Locallinkshavebeenestablishedandthisworkisstartingtomoveforwardatapace.Theaimistohave15mentalhealthchampionsthathelpshapetheevolutionoffutureLTP’sandtotestimplementationideas.ThemodelwillensurethatattheendoftheLTP(YoungMindshaveafouryearcontract)Doncasterhasasustainablemodelforengagementandyoungpeopleparticipation.Workisprogressingaspertheworkplan/schedulewithnoconcerns.ProgressRating:Satisfactory

12.20LocalOfferWhyisthisapriority?Tomakesureeveryoneknowsabouttheplan,it’saims,objectivesandintentions.Howwillwedothis:WewillpublishtheLocalTransformationPlanelectronicallyonthefollowingwebsites:

• DoncasterClinicalCommissioningGroup• DoncasterMetropolitanBoroughCouncil• NationalHealthEngland• DoncasterLocalOffer• DoncasterSafeguardingChildren’sBoard• DoncasterCouncilforVoluntaryServices.

ProgresstoDate:TheLocalTransformationPlanwassensedcheckedlocallyandwasfelttobeChildandYoungPersonfriendly,thiswasbackedupbytheYorkshireandHumberStrategicClinicalNetwork.Itandthedatacollectiontemplatewerepublishedonthefollowingwebsitesasperthemandate,publishedonthefollowingwebsites:• DoncasterClinicalCommissioningGroup–published4thDecember2016• DoncasterMetropolitanBoroughCouncil–published4thDecember2016• DoncasterLocalOffer–published11thDecember2016• DoncasterCouncilforVoluntaryServices–published11thDecember2016Thetwooutstandingsitesareasfollows:• DoncasterSafeguardingChildren’sBoard–theboardwanttohavethepresentation

ontheLTPbeforeageingtopublish.Thisisbookedinfor21stApril.Weareinthefinalstagesofgettingituploaded

Plansfor2016/17• 15mentalheathchampionstoberecruitedandactivelystarttoshapecommissioning

andservicedelivery• Continuetodevelopasustainableparticipationapproach.

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• NHSEngland–DCCGcommunicationsleadindiscussionwithNHSEcounterpartaboutthis.

ProgressRating:Good

12.21CommissioningandprocurementWhyisthisapriority?ToensureweactwithintheregulationsandtocommissionservicescompliantwithHealthandSocialCareActandEqualityAct.Howwillwedothis:

• AdherencetoNHSprocurementregulation• AdherencetoEqualityAct• AdherencetoHealthandSocialCareAct.

TheNHSProcurementRegulations2013currentlysetsouttheframeworkwithinwhichthehealthcaresystemshouldbemanagedandmakesitclearthatcommissionersmustseektoobtainservicesfromthoseprovidersbestplacedtomeetthebestinterestofthepatient;marketdevelopmentbeingoneofthekeyprinciplesbywhichtheNHSreformprogrammeaimingtoensurethatpatientsareatthecentreofdrivingchange.

ThisrequiresDoncasterCCGasacommissionertounderstandnotonlythequalityand

characteristicsofcurrentlocalproviders,butalsothoseofpotentialfutureproviders,whomightbeknownornotknownatthepresenttime.Inordertobeabletodemonstratethatthisisthecase,weneedtohaveaprocessforthesystematicanalysisofrelevanthealthcaremarkets,andameansofapplyingtheintelligencegatheredthroughsuchanalysesintothecommissioningprocess,informingservicereviews,procurementandtenderingprocesses,thecreationofoptionsforchoice,thedevelopmentofpluralityinserviceprovision,markettestingandtheassessmentsofcontestability.

Choice,co-operationandcompetitionarekeyelementsintheNHSreformprogramme,andconstitutethepillarsofsystemmanagementfortheCCG,indevelopingsystemswhicharedesignedtoprotectandpromotepatients’andtaxpayers’interests.Toenablethis,asystemmanagementofchoice,co-operationandcompetitionisimplementedwhicheffectivelyuses:

• choiceonthepartofpatientsbetweenprovidersofclinicalservices,settingsandmodelsofcare;

• competitionbetweenprovidersfor,andin,thehealthcaremarket;• governancearrangementsinplaceincontractingorganisations;• contractsbetweenNHScontractingorganisationsandproviders;• strategicpartnerships;and• informationforpatientsandreferrerstoenablethemtomakeinformedchoices,for

commissionerssothattheycansecurethebestservicesforthepeopletheyserve,andforprovidersandclinicianstobenchmarkthemselvesagainst.

12.22EqualityActThisplantakesintofullconsiderationallaspectsoftheequalityact2010,payingparticularfocustochangesarounddisabilityclassification,indirectdiscrimination,rightsofcarersand

Plansfor2016/17• UpdateallsiteswiththerefreshedLTP.

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gender.Allaspectsoftheimplantationofthisplanwilltakeintofullconsiderationandbefullycompliantwiththeequalityact.

12.23TheHealthandSocialCareActDoncasterClinicalCommissioningGroupaspartofthewiderNHSservicesunderstandsitsrolewithintheactandthefuturetransformationofservicesandiscommittedtodoingso.Thisrunsthroughourfiveyearcommissioningstrategy,crucially;weareaclinically-ledorganisation.ThisLocalTransformationPlanisaroundtransformationalchangeandsystematicimprovements,throughtheprovisionofclinically-ledcommissionedservicesthatareinnovative,providevalueformoneyandarebaseddirectlyontheneedsofourpopulation.Astheplanhasoutlinedonanumberofoccasions,ChildrenandYoungPeoplehaveshapedandwillcontinuetoshapethisplan.ThiswefeelmirrorsthekeyelementsoftheHealthandSocialCareAct.ProgresstoDate:Whilstattimesthishasslowedtheprocessdown,wehavefollowedandadheredtoNHSprocurementregulations2013foreverythingprocuredusingtheLTPfunding.Thishasbeenachallengeintermsoftimescalesandthevolumeofsubsequentworkcreatedbutweareconfidentthatwearecompliant.Wewillcommissiontwo-yearcontractswhilststimulatingthemarkettodriveinnovationandchoicemovingforward,inparticulararoundtheprovisionofcommunityeatingdisorderservices.Theplanhasandcontinuestotakeintofullconsiderationtheaboveacts.Progressrating:VeryGood

12.24DevelopmentofOutcomeMeasuresWhyisthisapriority?Sowecanmeasureperformanceandoutcomeseffectively.ThisunderpinstheCommissioningcycle.Howwillwedothis:

• ContinuetoupskillstaffviaCYP-IAPTprogramme• ExpressinterestinbecomingapilotsiteforCORC.

InadditiontothecommitmenttotheCYP-IAPTprogrammewhichfocusesonthedevelopmentofroutineoutcomemeasuresandmorevalidoutcomemeasurementtools,wehaveexpressedaninterest(throughtheYorkshireandHumberStrategicClinicalNetwork)tobeapilotsiteworkingwithCORC.CORChavemadeanoffertoCCG’stomonitoroutcomesacrosssectorsaspartoftheLocalTransformationPlan.Theaimofthisworkwillbetolookathowwecandevelopandimplementeffectiveoutcomemeasuresacrossservicesandsectorstoenableafullerpictureofachildoryoungpersonsoutcomes.Wehaveagreementfromthepartnershiptoexpressinterestasapilotsite.ProgresstoDate:Thereiscurrently1CAMHspractitionerontheCYP-IAPTcourse.TheservicewillbesubmittingarequestforaplaceonatherapypathwayscourseanduptotwoplacesontheEEBPcourse.TheCCGwillsupportthisbycoveringtheshortfallinfunding.Unfortunatelywe

Plansfor2016/17• Continuetoadheretoallactsandregulations.

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wereunsuccessfulinourbidtoCORCtobecomeapilotsite.Locallyaspartoftheservicetransformationplan;wehavecommissionedsomeadditionalresourcetoinformthemeasuresintheCAMHscontractfornextyear.Theproposedreportswillinclude:

• AnenhancedreportrelatedtouseofGoalSettingandscoringacrossthecohortduringthepatientjourney

• ImprovementstotheexistingSDQreporting(toincludesubscalesandclinicalinterpretation)

• Explorationofwidermeasuresthatspanthecohortandhowtheycanbeusedtodemonstrateoutcomes.

Thisworkisongoing.

ThereisarequirementandexpectationthattheCAMHsserviceproviderwilladheretotheprovisionofthenewmentalhealthdatasetanddatawassuccessfullysubmittedtoHSCICforFebruary2016.Wearewaitingforthefirstpublishedextract.

ProgressRating:Satisfactory

12.25DataComplianceWhyisthisapriority?Theserviceproviderismandatedtoprovideandsubmitdataforthenationalminimumdataset.Howwillwedothis:

• Ensuretheserviceprovideriscompliant• Theserviceprovidertoreportelectronicallyagainsttheservicespecificationwhich

reflectstheLTPCAMHsKPIs.ProgresstoDate:Theserviceproviderispartiallycompliantwiththerequirementsoftheminimumdataset.Workisongoingtomeettheserequirements.TheserviceproviderisnotreportingagainstalltheKPIsoftheservicespecificationandforsomeisdoingsomanually.Thismeanstheyarenotincludedinanyminimumdatasetsubmissions.ProgressRating:Un-Satisfactory

Plansfor2016/17• Agreementoflocaloutcomeindicators• MeasureperformanceagainsttheoutcomeslistedintherefreshedLocalPriority

Schemetable.

Plansfor2016/17• Serviceprovidertobecompliantwiththeminimumdataset• Serviceprovidertobecompliantwiththelocalreportingrequirements.

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Areweon-track?Everythingisontrackagainsttheabovemilestones.12.26DevelopingtheWorkforceAim:Thateveryonewhoworkswithchildren,youngpeopleandfamiliesareambitiousforeverychildoryoungpersontoachievegoalsthataremeaningfulandachievable.Theywillbeexcellentinpracticeandabletodeliverthebest-evidencedcare,becommittedtopartnershipworkingandberespectedandvaluedasprofessionals.12.27UniversalservicesWhyisthisapriority?Thereisvarianceintheskillsandcompetenciesofstaffinuniversalservicesandalackofhighlevelco-ordinationofthis.Howwillwedothis:

• Identifyworkforceeducator• Workforceaudit• Workforcestrategy.

Byidentifyingaworkforcedevelopmentleadwhowillleadondevelopingaworkforcestrategyandoverseeitsimplementation.ThisleadwillreportbacktotheEmotionalwellbeingandmentalhealthStrategyGroupandbethefocalpointfortherollinginterdisciplinarytrainingplan.Fundingforthispostwillbeidentifiedinthetrackerin15/16andwewouldlookataninitial18monthpostwithareviewpointtounderstandifthereisstillaneed.Ideallywewouldexpectthistobeatimelimitedposttokickstartthiswork.Thestartingpointwillbeaskillsauditacrossrelevantservices,startingoffinSchoolsandPrimaryCare.Theresultsoftheskillsauditwilldirectlyshapewhattrainingisprovided(basedonneed)andwillbetheethosofidentifyingtrainingneedsthroughoutthelifeofthisplan.RollingtrainingprogrammeswillbeprovidedeitherbyCAMHspractitionersdirectlyorbyexternalorganisationssupportedbyCAMHspractitionerstoallstaffinUniversalChildren’sServiceswiththemesincluding;buildingresilience,recognisingandmanagingstressandanxietyinteenagers,andrecognitionofescalatingorcomplexmentalhealthproblems.Thistrainingwillbeunderpinnedbyraisingawarenessoftheconsultationmodelofdeliveryandhowthisworks,beingclearonrolesandresponsibilitiesacrossservicesandempoweringstaff

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toworkwithinthismodelofdelivery.ThisisakeycomponentofDoncaster’sEarlyHelpStrategy.Fundingisidentifiedinthetrackertofacilitatethisandthisiswhereweplantomakethebiggestspendin2015/16.Therationaleforthisissimple;todevelopaworkforcethatwillprovidethebedrockforfutureservicedevelopments.Commissionerswillworkwiththeworkforcedevelopmentleadtoexplorethepossibilityofan‘InnovationPartnership’wherebyanexternallearningorganisationcansupportdeliveryofevidence-basedandnationallyaccreditedlearning.ProgresstoDate:Theworkforceeducatorservicespecificationhasbeencompletedandtheproviderselected.Thepostcommencedon14thMarchandthefirstfunctionwastocompleteaworkforceauditthatwilldirectlyshapethesubsequentworkforcestrategy.Theauditwascompletedandisanexcellentpieceofwork.Itfocusedonthreeareas:

• School/Academystaff• CAMHs• UniversalServices.

Thereareaseriesofkeyfindingsandsubsequentrecommendationsforeachofthethreeareasthatwillformthebasisofaworkforcestrategy.Thestrategyistobecompletedby30thDecember.Anexistingtaskandfinishgroupwillbethearenatohousethiswork.ProgressRating:Good

12.28TargetedandspecialistservicesWhyisthisapriority?Thereisvarianceintheskillsandcompetenciesofstaffintargetedandspecialistservicesandalackofhigh-levelco-ordinationofthis.Howwillwedothis:

• Trainingstaff.

Byusingthesameethosasforthetrainingofuniversalstaff;needidentifiedbyaskillsauditandthenarollingtrainingprogrammebasedonneed.Examplesofneedlieinpaediatrics.CAMHswillcontinuetheirservicedevelopmentaspartoftheCYP-IAPTprogramme.WorkerswillcontinuetohaveaccesstospecialisttraininginCognitiveBehaviourTherapy(CBT)andsystemicFamilyTherapy(basedonlearningandevaluationofimplementationofCYP-IAPT)andtoregularsupervision,whichwillreinforcethislearningandcontinuetoimprovetheskillswithintheworkforce.Organisationallytheservicewillcontinuetofocusonfullyembeddingtheuseofroutineoutcomemeasuresintoclinicalsupervisionandclinicaldecisionmaking/pathwaydevelopment.

TheCAMHsworkforcewillalsoattendtrainingandfeedbacksessionsfromPeerMentorswhocanadviseandinformregardingyoungpeople’sexperiencesoftheservicestheyhavereceived.Alltrainingwillbeevidence-basedandaccredited.

Plansfor2016/17• WorkforcestrategytobecompletedandagreedbytheMentalHealthStrategyGroup• Implementationoftheworkforcestrategy.

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Paediatricstaffwillbeinvolvedinthetraining,especiallythoseinvolvedincommunitypaediatricstobuildanappreciationandunderstandingoftheinterfacebetweenphysicalandmentalhealth.TheCAMHsinterfaceandliaisonnursewillbepivotaltothisandwillsupportthetrainingofpaediatricstaffthroughprovidingongoingsupportandguidancearoundemotionalwellbeingandmentalhealth.

TherewillbeatargetedprogrammeforChildren’sSocialCarestaffincludingtraininginattachmentandtrauma(buildingontheSocialWorkReformProgrammeagenda).

ProgresstoDate:Thisrelatestothe5.1.ProgressRating:Good

12.29FutureworkforceWhyisthisapriority?Tohaveaworkforcethatisabletodeliverevidenced-basedinterventions.

Howwillwedothis:• ByusingtheplatformoftheCYP-IAPTprogramme.

ByusingtheplatformoftheCYP-IAPTprogrammeasbuildingblockstoensureevidence-basedpracticeisattheheartoffutureCAMHsservicedelivery.Wewillbemonitoringdataacrossservicedeliveryareastoknowlevelsofdemandandtypesofneedandcommissionservicesthatareconfiguredtomeetthisneed.Forexampleweareawarethattherehasbeenanincreaselocallyinthenumberofyoungpeoplepresentingwithdepression,akeyareaofworkforcedevelopmentistocommissiontrainingthatequipsstafftoeffectivelymeetthisincreasedneedusingevidenced-basedinterventions.DoncasterwillberequestingaplaceforoneCAMHspractitioneronaCBTcourseaspartoftheongoingCYP-IAPTprogramme.NorthLincolnshireispartofthepartnershipanditmaybeworthnotingthattheywillberequestingonememberofstaffforCBTandoneforenhancedevidence-basedpractice.Ihaveincludedthecostsforthefullpartnershiponthetracker.

AsapartnershipwearecommittedtoCYP-IAPT.

ProgresstoDate:TheworkforceauditidentifiedtheneedforCAMHstohavegreatercompetenciesinCBT,mentalisationandfamilytherapy.ByusingCYP-IAPTasaplatformtoembedevidencebasedinterventionsintoCAMHs.ThereisonepractitionerattendingtheCYP-IAPTcoursethisyear.ProgressRating:Good

Areweontrack?Everythingisontrackagainsttheabovemilestones.

Plansfor2016/17• WorkforcestrategytobecompletedandagreedbytheMentalHealthStrategyGroup• Implementationoftheworkforcestrategy.

Plansfor2016/17• ContinuetoincreasecompetencieswithinCAMHsviaCYP-IAPT• ProvidetrainingforCAMHsstaffaroundCBT,mentalisationandfamilytherapy.

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Areweon-track?Therehasbeensomedelayingettingtheworkforceeducatorinpost,whichinturnhasdelayedtheworkforcestrategy.LocalPrioritySchemeSummary–Wherewereweattheendof2015.LocalPriorityScheme CurrentStageofImplementation

Establishnamedemotionalwellbeingandmentalhealthleadsinschools(internal)

77%positiveresponsefromschools/academies

Continuousconsultationandengagementwithchildren,youngpeopleandfamilies

DeliveryofengagementworkshopswithCYPandParents


Workforceauditcompleted.Strategytobecompletedby31stOctober2016(in-linewithLTPrefresh)

Auditandrollingtrainingprogramme AsaboveDevelopan'innovationpartnership’approachwithalocaluniversitytodeliveranaccreditedtrainingprogrammewithnationallyrecognisedmodules

Notintendedfor2016/17implementation

CAMHsworkertobeembeddedintheEarlyHelpHub

Currently1WTEinpostdevelopinglinksandworkingthroughthelogisticsofembeddingintothehub

NamedCAMHsleadsinSchools&PrimaryCare

Allstaffrecruitedtopost(6WTE)andwillgoliveinSeptemberwhenschoolsreturn

Supportingself-care AnoptionspapertobepresentedtostrategygroupinJuly16

Developmentofsinglepointofaccess

ProprietaryworkisunderwaytointegrateCAMHsreferralsintoEarlyHelpHubtoformasinglepointofaccess.Ongoingevolutionofrolesandfunctions.AgreementtomoveCAMHsdutyfunctionsintoaSPOA

Furtherdevelopevidence-base OneCAMHsworkerbookedontoCBTcourse.CAMHssubmittedexpressionofinterestfor2016/17course(s)

ImplementallareasoftheCrisisCareConcordat

24/7crisishelplinewentliveinSeptember2016;CAMHsliaisonandinterfacefunctionmodelagreedwitheightapplicants,expectsomeoneinpostinJuly2016.LiaisonandDiversionserviceisincreasingitsunderstandingofCYPservices.Ongoingregionalworkoncrisisresponsebasedonrecentworkshops.Policecellnottobeusedasaplaceofsafetyfrom1stJanuary2016andlocalsystemsetup.Themappingofallagepsychiatryserviceshasbeencompleted.Exploringlocalcrisissolutionsinparallelwithregional

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workIntensivehometreatmentservicetobeprovided

Servicemodelbeingexploredandallpostsfilled

Expansionofpeermentoringservice FurthertrainingtobeprovidedtodevelopmentorsEnhancethecurrentassessmentprocesstoincludesensitiveenquiries

Auditof50casesfilestocheckcurrentskillsandifthequestionsareroutinelybeingasked

Enhancethecurrentdonotattendpolicy Dipsampleauditofpolicycompliancecompletedandsubsequentfindingsandrecommendationstobeconsidered

Developmulti-agencyteams Notintendedfor2016/17implementation

Improvedcommunitypaediatricservices(incASDandADHD)

BothareNICEcompliant,howevertherehavebeenresourceissuesthathasledtoanincreaseintheautismwaitinglist.Anewcommunitypaediatricmodelhasbeenagreedandfinancialsredistributedtoincreasecapacitywithintheautismpathway


Multi-agencyteamsareinplace


Servicesbeganon1stMarch2016andthiswillbeaphasedevolutionofservice.Consultantpsychiatrypostisonlynewpostvacant.SYEDAaredeliveringeducationsessions.100%ofCYParemeetingaccessandwaitingtimestandards

RedeploygenericstaffcurrentlyseeingEDcasesnowseenbycommunityteamtoimproveaccesstoself-harmandcrisisandinvestunderspendfromEDfunds

Notintendedfor2016/17implementation

13.RiskstoImplementationTherearesomecontinuedriskstoimplementation,theseareasfollows:WorkforceTherearestillthreepoststoberecruitedtoaspartofthetransformationwithinCAMHs.InadditionbecausesomeofthenewpostshavetakenstafffromthecoreCAMHsservice,thereareagencystaffandstilltwovacancies.ThereisacurrentrisktocoreCAMHsintermsofworkforceandalsoariskintermsofrecruitmenttovacancies.DataTheserviceproviderisnotcurrentlycompliantintermsofdatasubmission.Thisposesarealthreattotheabilitytotrackandmonitorperformancethroughtheperiodoftransformation.

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FinancesThefundingfromNHSEgoesintotheCCGbaseline,whichisarealrisk.Thepublishedallocationis2.38%,howeverwehave3allocations(CAMHsbeingone)thatareinbaseline.Oncethesearetakenout(ifweviewasringfenced)thentheallocationreducesto1.8%.Nationallyguidedincreasesinpensioncostsandlivingwagemeansthatisactualfactweareinanegativepositionjusttofundinflation.ThismeansthereisgreatpressureontheCAMHsallocation.Headroomreserveof1%(approx.£4.5million),whichwehavepreviouslyusedtofacilitateserviceimprovement,andchangenowhastobeheldacrosstheSTPfootprint.Thismeansthatwehavetosetthisasideasmitigationincaseanyprovider(includingacute)don’tmeettheirfinancialrequirements.Thisfurtheraddspressure.Wearespendingapproximatelyhalfourallocationonanintensivehometreatmentserviceyetanysavingsfromreducedtier4activitywillberealisedbyNHSE.CutstoPublicHealthandtheimpactthishasonservices,i.e.HVandSN.TheimpactsofausterityonDoncasterthatisstillreelingfromthepreviousausterity.Thereisaprojectedincreasefromthisfundingsourceyearonyearuntil2010/21,howeveritisnotyetknownifthisistrueadditionalfundingorfromsavingsmadeelsewhereinthesystemthataretoberedistributed.IfthelatteristhecasethenthereisariskbecausethemajorityofthesavingswillsitwithNHSEnglandintermsorreductionintier4admissions.ThenationallandscapefortheNHSisalsounpredictableandfragilewithmanyprovidertrustshavingafinancialdeficit.Thisinturnmakestheredistributionofanyrealisedsavingsverydifficulttoenact.CYP-IAPTFundingTherewasalatereductioninfundingfromNHSEnglandforCYP-IAPTwhichnowplacesaresponsibilityonlocalCCG’stopartfundplaces.Doncasterhascommitted97%ofit’sfundingonrecurrentactivityleavingverylittleleft.Thisadditionalfundinghascomefromthewiderworkforcefundingwhichinturnreducesthatamount.

MitigationofRiskAwaytomitigatetheriskisplanandworkincollaborationwithotherCCG’stoensurewearenotallgoingforthesamestaffandprovidersatthesametime.InDoncasterwehavealreadyformedrelationshipswithRotherham,NorthLincolnshire,SheffieldandotherCCG’sintheareaandthereisacommitmentfromCCG’swithintheYorkshireandHumberStrategicClinicalNetworktoworktogether.Thismaytaketheshapeofregionalcommissioningand/ortimeplanningofrecruitment.

TransformationSupportTosupportthedeliveryoftheplan,itwouldbehelpfultosupportinthefollowingareas:

• Workforce–Support(nationally)toensurethereareenoughpractitionersavailabletofillallthepoststhatareneeded.Itwouldbegreatifemphasiscouldbeplacedontraining more practitioners with skills and expertise in emotional wellbeing andmentalhealth,asthesetypesofstaffunderpinourLocalTransformationPlans.

• Finance–Clarificationonnationalfunding,isthistrueadditionalincomeorexpectedsavings?FundingtocomeintoCCG’stoberingfenced.

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• Collaborative Commissioning – It would be really helpful to jointly explore thepossibilityofanysavingsmadethroughareductionintier4admissionsflowingdownto localCCG’s.Thiswouldallowus to further implement theprinciplesofFuture inMind.

• Continuation of CYP-IAPT – Continued funding to further increase evidence basedpracticeacrossCAMHs.

• DevelopmentofValidatedOutcomeMeasures–Thiswouldbereallyhelpful soascommissionerswecouldhavegreaterconfidenceinmeasuringoutcomes.

• Commissioning Support – From fellow commissioners via the Strategic ClinicalNetwork.

• Evidence Base – Guidance and policies that are evidenced-based, i.e. NICE areextremelyhelpfulinensuringwecommissionevidencedbasedservices.

• DigitalTools/Apps–Itwouldbegreatiftherewasdevelopmentintheefficacyandavailability of digital tools and apps, ideally some that are recommended or evencarryanationalbenchmark.

• Timing – Could we ask that any funding is made available earlier in the year orapportionedoverthefollowingyear,asreceivingfundinglateinthefinancialyearisextremelydifficult.

Documents

Promoting, protecting and improving our children and young ... · 2.3 We want all children and young people to be emotionally resilient, happy, and confident and to have the best