1 A new Child and Adolescent Mental Heath Service (CAMHS) Have your say James Fortune Lead Commissioner, Children s Services, Wiltshire Council/Wiltshire CCG
2 Developing an improved Children and Young People s (CYP) Emotional Wellbeing and Mental Health Service We are commissioning a new CAMH Service across the Swindon, Wiltshire and Bath and North East Somerset geographical footprint. A modern service is needed to meet the changing needs of children and young people and respond to the ambitions for change and improvement set out in Future in Mind, the Five Year Forward View for Mental Health and our Local Transformation Plan for Children and Young People s Mental Health and Wellbeing. Following a competitive tender exercise, Oxford Health NHS Foundation Trust has been selected as the preferred provider. We are now working with Oxford Health to shape the service delivery model with stakeholders. This will inform the development of the service specification which will include outlining how the impact of the service will be measured.
3 A new service delivery model Developed nationally by the Anna Freud National Centre for Children and Families and The Tavistock and Portman NHS Foundation Trust, Oxford Health has put forward the THRIVE Model as the proposed service delivery model for CAMHS in Wiltshire. The THRIVE Model conceptualises five needs-based groupings for children and young people with mental health issues and their families; thriving, coping (also known as getting advice), getting help, getting more help and getting risk support. Based on national research in terms of what works, the model then outlines the input that is required for each group. The model looks at CAMHS as a whole system recognising the important contribution that all agencies across health, education and social care (including the voluntary sector) have in supporting CYP emotional wellbeing and mental health needs. It represents a new model of care which is integrated, person centred and provides a needs-led approach to delivering mental health services for children, young people and their families.
4 Children and young people adjusting to life circumstances. Mild/temporary difficulties e.g. bullying, bereavement, parents separating. CYP s needs Children and young people with mild to moderate mental health difficulties who would benefit from focused evidence based treatment with clear aims e.g. anxiety disorder. Children and young people who are unable to benefit from evidence based treatment and remain a significant concern and risk, including those who often go into crisis. Children and young people are resilient, emotionally well and have the skills to manage their emotions and mental health Children and young people with more severe mental health difficulties who require significant input including extensive longer term treatment which may include some inpatient care and extensive outpatient provision e.g. psychosis, eating disorders, emerging personality disorders.
5 Digital support ( , phone, web); significant role for schools and parents/carers - good support and interventions available in school; help and advice for parents/carers and professionals working in universal services. WHAT WORKS Community CAMHS Provider takes the lead and offers evidence based treatment and interventions. Multi-agency collaboration where social care may be the lead agency. Target at risk groups, awareness raising and promote psychological wellbeing and health at a whole community level. Community CAMHS Provider takes the lead and offers evidence based specialist interventions and treatment.
6 Key principles of the THRIVE model (1) Cultural shift from being a diagnostic service (medical model) to being a service which can support and offer advice to those who have concerns about CYP emotional & mental health and will offer evidenced based interventions when required (social model). No more service tiers as endorsed by Future in Mind and received well by local stakeholders through consultation events. One Single Point of Access but also No Wrong Door. No family or child/young person will be turned away because they do not meet service criteria no more inappropriate referrals. All children and young people will receive an offer of the right help according to their needs.
7 Key principles of the THRIVE model (2) At a minimum all children, young people and families will be able to access information and advice. Every child/young person/family will have access to a named supporter to help them navigate their way around the system. CAMHS works as a whole system rather than as just one provider - stronger partnerships local integrated, multi-agency care pathways that enable the delivery of effective, accessible, holistic evidencebased care. Bigger emphasis on early intervention and prevention with focus on helping children and young people to build resilience as well as encourage self-help techniques. CAMHS much more visible in community settings. Treatments and interventions will be evidence based (CYP IAPT/NICE approved)
8 What age related difficulties will be addressed by the service? 0-4 years: Concerns about attachment, routines and boundary setting, separation anxiety. 4-8 years: Anxiety, aggression, oppositional or challenging behaviour, concerns about attachment, low self-esteem, bereavement, loss, trauma, routines and boundary setting, hyperactivity, emotional distress, low mood. 8 years upward: Anxiety, low mood, depression, withdrawn behaviour, compulsive and obsessive behaviour patterns, low selfesteem, distorted body image, issues regarding gender/identity, inappropriate sexual behaviour, substance misuse, bereavement, loss, self-harm, eating disorders.
9 The range of conditions to be addressed Emotional and behavioural disorders (moderate to severe). Conduct disorder and oppositional defiant disorder. Eating disorders. Deliberate Self-harm. Depression and Suicidal thoughts. Dual diagnosis including comorbid drug and alcohol use. Neuropsychiatric conditions. Attachment disorders. Post-traumatic stress disorders and trauma. Significant mental health problems where there is comorbidity with Mild/moderate learning disabilities or comorbid physical and mental health problems. Mood disorders. Anxiety disorders. Co-morbid Autistic Spectrum Condition (aged five and above). Chronic Fatigue/Somatisation Syndrome. Obsessive Compulsive Disorder & Tourette s. Psychotic illness (Young people aged 14 and over with first symptoms of psychosis will be referred to the Early Intervention in Psychosis Service and joint work will take place where appropriate).
10 Access into the service In Wiltshire the service will be available to all CYP aged 0-18 who are registered with a Wiltshire GP. CYP from military families living within Wiltshire will also have access to the service. CYP and their families can self-refer, although this is best done in collaboration with an adult. The opportunity to self-refer will be proactively marketed by Oxford Health. Schools, in particular, will be informed that a referral via a GP is no longer required to access the service. Referrals from professionals will be accepted over the phone, online or by post/fax.
11 Coping/Getting advice Pathway (1) This will offer: Information, advice, telephone and consultation to the children s workforce, CYP and their families. A programme of training to the wider children s workforce with strong and effective partnership working arrangements. A named CAMHS practitioner for every secondary school and a named CAMHS practitioner for clusters of primary schools. Ask a therapist webinars offering practical support and help for parents/carers and professionals.
12 Coping/Getting advice Pathway (2) Direct support to Social, Emotional and Mental Health Centres of Excellence in mainstream schools. Access to online emotional support and counselling. Parenting programmes offered in schools and community settings.
13 Getting Help Pathway (1) This will offer: Evidence based interventions for CYP who are experiencing the first signs of mental health, behavioural or emotional concerns and where support from schools and other agencies have not been effective. These may include but not be limited to: Family issues where this having an adverse effect on the CYP Mild to moderate emotional and behavioural disorders Child behaviour problems (sleep, feeding, tantrums) once physical causes have been considered and the behaviour falls outside what might be considered to be within the range of normal behaviour
14 Getting Help Pathway (2) Conduct disorders Anxiety, depression, stress and other mood disorders, e.g. low self-esteem Adjustment disorders Mild to moderate phobias Anger management issues Persistent difficulties in making and maintaining relationships with family and peers, including insecure attachments Parents/carers who would benefit from time limited parenting support to help understand their child s challenging behaviour including help with routines and boundary setting (which may be delivered in conjunction with Children s Services).
15 Getting Help Pathway (3) Generally 6 sessions of an intervention will be offered but the number will not be restricted where there is clinical indication that a CYP would benefit from further time limited input. Most interventions to be provided in community settings, however some digital based interventions will be available. For some CYP, CAMHS practitioners will offer supervision to other professionals to support their needs being addressed by universal services e.g. health visitors, school nurses, educational pastoral staff. CAMHS practitioners will be co-located in Wiltshire Council Integrated Children s Services Locality Hubs. Access to face to face talking therapies (including counselling) from community settings e.g. GP surgeries.
16 Getting Help Pathway (4) Dedicated CAMHS practitioner for CYP who come into contact with the Wiltshire and Swindon Sexual Assault Referral Centre. CAMHS Lead practitioner for CYP who display harmful sexual behaviours across B&NES and Wiltshire. Therapeutic support for foster carers, special guardians and adopters (including pre- and post-adoption support) with aim of preventing placement breakdown and promoting placement stability.
17 Getting More Help Pathway (1) This will offer: Assessment and treatment as appropriate for CYP, using evidence based interventions where there are serious concerns around: Emotional and behavioural disorders (moderate to severe) Conduct disorder and oppositional defiant disorder Eating disorders Deliberate self-harm Depression and suicidal thoughts Dual diagnosis including comorbid drug and alcohol use Neuropsychiatric conditions Attachment disorders
18 Getting More Help Pathway (2) Post-traumatic stress disorders and trauma Significant mental health problems where there is comorbidity with mild/moderate learning disabilities or comorbid physical and mental health problems Mood disorders Anxiety disorders Co-morbid Autistic Spectrum Condition (age five and above) Chronic fatigue/somatisation Syndrome Obsessive Compulsive Disorder & Tourette s Psychotic illness (Young people aged 14 and over with first symptoms of psychosis will be referred to the Early Intervention in Psychosis Service and joint work will take place where appropriate).
19 Getting More Help Pathway (3) Specialist Eating Disorder Service offering NICE-concordat assessment and treatment for children, young people and their families. Assertive outreach (OSCA) for CYP who find it difficult to engage. Specialist Mental Health and Learning Disability Service with aim to improve early identification, provide mental health interventions/treatment and coordinate the care of CYP with moderate to severe learning disabilities and/or Autistic Spectrum Condition with comorbid mental health difficulties. Specialist integrated pathways for specific mental health conditions in accordance with national standards.
20 Getting More Help Pathway (4) Family Assessment and Safeguarding Service that provides specialist assessment, and evidence based treatments including parent-infant psychotherapy, family work, consultation and liaison to professionals for those families where children are identified as most vulnerable to abuse and neglect. Flexible transition support, provided by OSCA team to vulnerable young people aged years who have been in receipt of a CAMH service when they turn 18 years and do not meet the referral criteria for adult mental health services. Infant Mental Health Service for those aged 0-5 years.
21 Risk Support Pathway This will offer: The Assertive and Crisis Care team will operate 24/7, 365 days a week to deliver: Assertive outreach 24 hour/7-day emergency/crisis assessment and intensive intervention to reduce the number of hospital admissions Plans in place for CYP in mental health crisis Timely advice to professionals working in Acute Emergency Departments, health based Places of Safety (s136 suites), and Police and Ambulance control rooms In collaboration with adult mental health liaison services, CYP Mental Health Liaison in Acute Emergency Departments delivered 7 days a week and beyond office hours (9am till 8pm)
22 A visual model (1)
23 A visual model (2)
24 A visual model (3)
25 Consultation questions 1. What do you like about this model? What are the strengths of this model? 2. What concerns do you have about this new model? What are the weaknesses of this model? 3. What is the most important part of the model to get right? Who/what should be prioritised? 4. How should we measure the success of this new approach? What Key Performance Indicators should we use? 5. How should children and young people s feedback and views be incorporated into the model to improve the service?
26 Thank you! Any questions? Please return your comments and responses to
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