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Delivering a comprehensive
CAMHS: Integrated Service
Developments for Children in the
East Midlands
Dr Fiona Gale, East Midlands CAMHS Programme Lead –
CSIP
Paul Farrell, East Midlands CAMHS Tier 4 Implementation
Manager - CSIP
The importance of mental health
National Service Framework for Children, Young
people and Maternity Services (DH, DfES 2004)
Mental health problems in children are associated with
educational failure, family disruption, disability,
offending and antisocial behaviour, placing demands
on social services, schools and the youth justice
system. Untreated mental health problems create
distress not only in the children and young people, but
also for their families and carers, continuing into adult
life and affecting the next generation.
POLICY
• The CAMHS agenda locally and nationally reflects a
number of drivers for change including national policy
developments. :
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Improvement, Expansion and Reform: the next three years: priorities and
planning framework 2003-2006, comprehensive CAMHS be available in all
areas by 2006, for a full range of conditions and problems. A key target
was to increase investment (PCTs) and service activity (providers) by 10%
per annum to 2006.
Every Child Matters (2003) and Children Act (2004)
The National Service Framework for Children, Young People and Maternity
Services (2004) is a 10 year programme. The core part of the children’s
policy agenda. Key features of this standard include the requirements for
comprehensive CAMHS from 0-18 years of age, through comprehensive
CAMHS via four tiers of service, to provide timely, integrated, high quality,
multi-disciplinary mental health services. .
National Standards, Local Action: Planning Framework 05/06 – 07/08
CAMHS remains a PSA target, with a focus on sustaining development
towards a comprehensive level.
PSA Targets likely to be supported
by improvements in CAMHS
Stay Safe
Be Healthy
•Reduce teenage pregnancies
•Reduce drug use
•Improve stability for
children looked after
Achieve Economic
Well-being
Enjoy & Achieve
•Reduce 16’s to 18’s not in
education, employment or
training
•Increase participation in
higher education
Make a Positive
Contribution
•Reduce crime
•Improve development at
age 5
•Improve school attendance
•Improve educational
attainment at 11, 14 and
16 (3 targets)
“Partnership is the key to
providing effective services that
will improve the lives of all
children [young people]. The work
is a vital component of securing
the future of our society – children
are our future…” (Serving Children Well –
LGA, 2002)
Strategic Framework for Delivering and integrated CAMHS
Highly
Specialist
Services
“Out of Authority
Placements”
TIER 4
Secure Units
Assertive Outreach
Neuropsychiatry
Crisis Intervention
In-Patient Units
Intensive Fostering
Service
Home Treatment
Day Services
Specialist
Services
Secure Children’s
Homes
Severe Mental
Health
difficulties and
highly complex
cases
Behaviour
Support Services
TIER 3
Special Schools
Primary Mental Health Workers
Specialist Teams
Moderate to
severe
mental
health
difficulties
Substance Misuse
Psychology
Targeted
Services
In Need
Psychiatry
Primary Mental Health Workers
Psychiatric Outpatient
Multi-Agency Locality Teams
Social Workers
Universal
Services
Vulnerable
TIER 2
Educational Psychology
Multi Agency Support services
Voluntary Sector
TIER 1
All Children
GP’s
Voluntary Sector
Surestart
School Nurses
Children’s Centres
Connexions
Youth Workers
Extended Schools
Health Visitors
The 4-tier model for CAMHS:
Presenting Difficulties & Projected Prevalence
Very serious
problems – life
threatening or very
specialist treatment
Tier 4
Severe and complex problems
Requiring multi-disciplinary
team working
Tier 3
Moderately severe problems requiring
attention from professionals trained in
child mental health
Tier 2
Mild early stage problems
Tier 1
Example projected local prevalence derived from:
Treating Children Well, Kurtz Z., Mental Health Foundation, 1996
National Service Framework for
Children (NSF)
Standard 9 Themes
 Early Years
 Mental Health Promotion and Early Intervention
 Partnerships with Children, Young People and their
Families
 Access and Location of Services
 Improving Service Equity
 Partnership Working
 Training and Development
 Developing High Quality Multi-disciplinary CAMHS
Teams
 Planning and Commissioning Services
CAMHS - 10 Markers of Good Practice:
1. All staff working directly with children and young people have sufficient
knowledge, training and support to promote the psychological well-being of
children, young people and their families and to identify early indicators of
difficulty.
2. Protocols for referral, support and early intervention are agreed between all
agencies.
3. Child and adolescent mental health (CAMH) professionals provide a balance of
direct and indirect services and are flexible about where children, young
people and families are seen in order to improve access to high levels of
CAMH expertise.
4. Children and young people are able to receive urgent mental health care
when required, leading to a specialist mental health assessment where
necessary within 24 hours or the next working day.
5. Child and adolescent mental health services are able to meet the needs of all
young people including those aged sixteen and seventeen.
CAMHS - 10 Markers of Good Practice:
6. All children and young people with both a learning disability and a mental
health disorder have access to appropriate child and adolescent mental health
services.
7. The needs of children and young people with complex, severe and persistent
behavioural and mental health needs are met through a multi-agency
approach. Contingency arrangements are agreed at senior officer levels
between health, social services and education to meet the needs and manage
the risks associated with this particular group.
8. Arrangements are in place to ensure that specialist multi-disciplinary teams
are of sufficient size and have an appropriate skill-mix, training and
support to function effectively.
Issues across the region…
•Support and development of Multi-agency strategic
CAMHS Partnerships
•Integrated Commissioning Frameworks
•Continuing improvement of services across all levels of
need
•Focus on improving services for particularly vulnerable
or hard to reach children
•Integration within all improvement agendas, even
where it seems children might not be the immediate
focus
•Workforce
•Leadership
Why we should provide integrated
services…
Sadie: I had to go through so many channels. It feels like, like
for years, I’ve been going through the system…
Parent
Robyn: …I am very scared…there is something wrong with
me…I think I might be mentally ill.
Age 11
Angela :
“ My child is not a ‘nutter’. It’s getting over to them that he needs
help for other reasons, not because he is totally nuts…”
Parent
Key Elements in a Service that
“Works”
Strong inter-agency commitment over the medium to longterm, including
- a steering group or strategy group willing to tackle
tricky issues, and
- a commitment to consulting with and acting on
children’s and families’ views
Links with existing services within CAMHS
- including the integration of the service within the
CAMHS tiered framework and
- CAMHS development strategy
Links with other services and initiatives outside CAMHS
- e.g. education, the voluntary sector & area-based
initiatives
Regional and Local Perspectives on
Integrated CAMHS Service Delivery:
Tier 4 CAMHS - Regional
Multi-agency CAMHS – Tier 2 Nottinghamshire
Multi-agency consultation forum – Tier 1/2 Northampton
East Midlands CAMHS tier 4
Review the current situation for the population of the East
Midlands, across the Tier 4 services and for young people in
Out of Area Placements
Examine current commissioning arrangements across the
region and across the agencies of health, social care and
education.
Consider the development of a shared framework within
which future Tier 4 services could be planned and delivered.
Identify care pathways across the continuum of CAMHS
services and highlight any gaps within CAMHS Tier 4
provision.
Implementation
• Commissioning
Regional Model
Local Needs
Networks
•Provision
Change the System
Partnership
Needs Led
•Workforce
Multi Agency
Diverse
MALT is the
development of multi
agency teams working
within Integrated
Children's Services.
Working together with
Youth and Community,
Education, Health and
the voluntary sector to
improve the emotional
wellbeing and mental
health of children and
young people.
MALT
Specialist camhs
MALT
school
GPs
Children
young people
and families
MALT
Acute
MULIT
AGENCY
ACTION
PANELS
PATHWAYS
Multi Agency Locality Team
parents
Young person
GPS
Other
professionals
Families of schools
Community
paediatricians
Direct work
Action Panel
liaison
MALT
School nurse
advice
Tier 2
consultation
Behaviour support
Mental heath specialist
Family support
Ed psy
training
Parenting courses
acute
Tier 3 specialist
camhs
Family work
acute
Multi-agency Consultation Forum,
Northampton CAMHS- Guiding Principles.
•Each forum has senior clinical members from
each agency in attendance. Members need to
have decision making authority.
•A partnership plan and agreed mission
statement is established for each forum.
•Regular reviews and evaluations ensure that
aims and objectives of forums are achieved.
Aim of Non-School Attenders Forum;
•Non-School Attenders Forum – multi-agency forum with
members from CAMHS, Hospital and Outreach Ed. Services,
Connexions, EWO’s, Educational psychologist, Specialist
Mental Health Teachers.
•Referrals accepted from any organisation for children and
young people that have not attended school for more than 20%
of the time.
•Parental permission is sought to discuss the case at the forum.
•Referrer attends the forum and presents the young persons
case, the forum members decide which agency or agencies can
meet the young persons needs.
•A integration into school action plan is developed, families are
informed of this following the forum meeting.
•The action plan is implemented and reviewed regularly.
People who have referred and presented cases to the forum:
predominantly education welfare officers, a school special needs
advisor, primary mental health worker, therapeutic care home
supervisor. The forum meets monthly for 3 hours.
Over a year we have had
•15 referrals
•5 girls, 10 boys (33% girls to 67% boys)
•2 looked after children (14%)
•1 mixed race child (7%)
•2 (13%) from primary schools – 1 in year 5, 1 in year 6
•13 (87%) from secondary schools – 1 in year 7 (8%), 7 in year 8
(54%), 3 in year 9 (23%), 2 in year 10 (15%)
Results:
•1 went straight back to school when forum supported a change of
school for her (7%)
•1 remained in the same school and was supported by behaviour
support team to increase attendance (7%)
•I young person already had all the agencies involved and the
forum could not think of any other support that could be provided.
Advice has been given however on an alternative exam scheme,
supported by Hospital and Outreach Education which seems to be
engaging him and encouraging him to attend school more (7%)
•1 case initially attended the outreach base successfully but
parent was unable to support the next part of the suggested plan
so this then broke down and he is currently not in school (7%)
•3 cases are currently awaiting the outcomes of initial
assessments (20%)
•2 cases are back in school full time (13%)
•2 cases are currently attending the HOE outreach base for 3 full
days a week (13%)
•1 case is attending the learning support unit in school for 3 days
a week (7%)
•2 LAC cases moved to new accommodation
Discussion Point:
How do we further develop integrated
CAMHS, both Regionally and Locally?
Fiona Gale, Regional CAMHS Programme Lead - CSIP
[email protected]
Paul Farrell, Regional Tier 4 CAMHS Implementation Manager
– CSIP
[email protected]