Emotional Wellbeing and Mental Health Service for Children and Young People - Background

 

Our vision

 

“To develop a culture of emotional wellbeing and mental health support for children and families that is based on strengthening early intervention and prevention and building resilience. We will listen to and work in partnership with our community to give children and young people the best start in life.”

 

Surrey County Council and the Clinical Commissioning Groups (CCGs) in Surrey are committed to supporting children and young people to have the best start in life. A fundamental element of having this best start is their emotional wellbeing and mental health (EWMH).

Both nationally and in Surrey, there is a consensus that we need to change the way we think about and deliver Emotional Wellbeing and Mental Health (EWMH) services for children.

  • EWMH is a national and local priority.
  • New and emerging government policy calls for services to be brought closer to school settings and emphasises prevention and early help.

 

Our strategy


We have produced a Emotional Wellbeing and Mental Health Strategy for Children and Young People which represents our collective ambition for focused improvement across services. A child friendly version of the strategy, authored by members of the Surrey County Council Rights and Participation Team for CAMHS (Child and Adolescent Mental Health Services) and SEND (Special Educational Needs and Disability) is also available.

 

  pdf Emotional Wellbeing and Mental Health Strategy for Children and Young People (4.05 MB)

  pdf Emotional Wellbeing and Mental Health Strategy for Children and Young People easy read version (1.48 MB)

 

The story so far - what we did between October 2018 and March 2020


An independent review in October 2018 highlighted that there is a universal commitment to delivering high quality CAMHS services to children and young people in Surrey. The Mindsight model is innovative, with a number of high performing services and clinical interventions are perceived as high quality. However, the vision for Mindsight is not being wholly delivered, nor is it deliverable in the current context. Challenges which are currently facing the service include: multi-agency relationships are not working to provide early help to children and young people (especially schools and GPs), the commissioning structure provides a complex landscape for CAMHS and crucially, demand on the service has been 53% higher than predicted, although this number is only marginally higher than the national average.

Throughout 2018, we became increasingly aware that people were not happy with services. We were told about long waits and delays for services, difficulty understanding referral routes and pathways, not enough appropriate support for people with complex and enduring needs, a perceived lack of listening and professional respect, inequality accessing services for people who are more vulnerable or from disadvantaged groups and poorly managed transfers between children’s and adult services.

This is not right and we recognised that many children and young people are not getting the emotional wellbeing and mental health support they need to make the best start in life and fulfil their potential.

 

Engagement

In January 2019 we held a series of engagement events about EWMH where children, young people, families, teachers, GPs, social workers, care professionals, voluntary sector organisations and other interested people told us what matters most to them.

 

  pdf Launch event presentation slides (1.68 MB)

  pdf EWMH Workshop Leaflet (580 KB)


Five themes emerged from these workshops which we now know reflect the aspects of services most important to everybody who took part:

  • Early intervention and community support
  • Collaborative working
  • Creating a navigable system
  • Communication with children, young people and parents
  • Environmental design

 

Engagement outcomes

We understand that immediate and longer-term action is necessary to put these matters right and we are committed to transforming services for the better so that children and young people in Surrey flourish, along with those who care for them.

Comprehensive information about what people said during the engagement and the resulting analysis and conclusions are contained in the report which provides evidence to support the five themes, what they mean and how they impact children and young people who need to use services and their families. It also includes recommendations for Surrey County Council and the Surrey CCGs to act upon. Examples of recommendations are:

  • Improve communication with parents by mental health services about what a referral means and what to expect from the system. This will help increase trust and decrease frustration.
  • Make consultation areas child and young person friendly.
  • Make sure everyone knows what is available in the system, for whom and how to access it.
  • Set aside a proportionately higher budget for early intervention and community support to help deal with lower level issues.
  • Consult with schools and voluntary services to learn from them and support them going forward.
  • Foster a culture of collaborative working where the child is at the centre and the professionals involved can all share information vital to that child's recovery.
  • Continue to engage with parents and young people – go to them.

 

Following engagement we understand there is more to learn about pathways, challenges, system interdependencies and alternative service solutions. Commissioners are committed to delivering the aspirations contained in the EWMH strategy and to improving the experience and outcomes for our children and young people as soon as possible.

Given the complexity of the system, commissioners will bring together key stakeholders to test new approaches. Partners have agreed that to effectively transform the emotional wellbeing and mental health system of support for children, young people and their families we need to much more effectively involve and include the voluntary, community and faith sectors, social care, early help, schools, GP practices and broader NHS services.

 

  pdf Public Engagement Report (4.43 MB)

  pdf Public Engagement Report - Summary version (672 KB)

 

 

What we did next  

Surrey County Council and the Surrey CCGs have now embarked on the next steps towards improving services.

Following engagement with children and young people, their parents, professionals, voluntary organisations and community groups we know that we need to focus change on the following areas:

  • Early intervention and community support to be more readily available to ease problems and avoid escalation
  • Collaborative working between professionals; sharing information vital to a child's recovery
  • Effective system navigation so that everyone knows what is available in the system, for whom and how to access it
  • Communication with parents and young people, focusing on what a referral means and what to expect from the system
  • Environmental design and making consultation areas child and young person friendly

 

Our Transformation Programme is looking at how health and care partner organisations can collaboratively make a change. Children and young people’s emotional wellbeing and mental health needs cannot be met by a single agency alone. The programme sets out to achieve successful solutions to issues and challenges that have been identified.

We need to work with everybody across health, care and education to make sure they understand the new ways we want to work together to care for and support children and young people. To achieve this in Surrey we need to act and work differently. We are in the process of creating a culture and environment in which we will be jointly responsible for using our resources to provide better results for children and young people.

 

The Transformation Programme


The Transformation Programme Timeline

 

Transformation priorities

 

There are five themes to our transformation work:

  1. Access and support to services
  2. Early intervention
  3. Vulnerable groups
  4. Social Emotional and Mental Health (SEMH/BEN)
  5. Crisis

 

1. Access and support to services (single point of access, joint front door)

 

Why we need to change

  • To reduce long waiting times.
  • To help people better understand the system and how to navigate within it.
  • To enact an effective multi-agency triage.
  • To provide an appropriate response depending on need.
  • To enable a speedy and appropriate response to crisis.
  • To allow access to Therapies.
  • To improve outcomes.

 

How we intend to change

  • Ensure alignment of SCC, SH and SABP front door and contact centre with the right professionals offering a graduated response at the right time. SCC and SABP have agreed an action plan for integration.
  • This new model will be part of system-wide changes to the front door across the council and health.
  • Deliver care in local settings where it makes sense to do so, instead of clinical environments.
  • Bring clinical expertise to triage.
  • Establish clear self-referral pathways; Self-Referral to the SPA pilot is being explored.
  • One Stop has transferred into the Children’s Single Point of Access and an improvement plan is in progress to improve decision-making and risk management.
  • Improve digital access to information and support, such as virtual counselling. Significant uptake of online tools and apps like Kooth (online counselling and emotional well-being platform) has been achieved.
  • Ensure swift access to crisis response where needed.

 

  pdf Access workstream - project mandate summary (925 KB)

CAMHS SPA Improvement and Development – Quarterly Bulletins are available via the SABP website.

  pdf June 2019 Bulletin (164 KB)

  pdf September 2019 Bulletin (140 KB)

 

2. Early intervention

 

Why we need to change

  • To reduce unnecessary waiting times for children and young people.
  • To Increase care provision in the community and support resilience.
  • To recognise schools, children, young people and parents as decision makers in care solutions and address any disconnect with EWMH services.
  • To maximise the assets of the Voluntary Sector.
  • To ensure services are more responsive to place based needs by working with integrated partners and primary care.
  • To be inclusive of Early Years care, Health Visiting services and Developmental Paediatrics.
  • To improved access to digital tools.
  • To lessen inappropriate demand on clinical services and combat the culture of referral-assessment-treatment as the only option.
  • To improve outcomes.

 

How we intend to change

  • Work with newly proposed Early Help and Family Support Hub and align to the Early Help Outcomes Framework.
  • Identify Voluntary Sector providers and work together to provide early help.
  • Provide new service models in 3 school clusters (primary, secondary and special) as Accelerator Sites to deliver early help services differently.
  • Ensure participating schools also offer a culture of promoting resilience.
  • Consider digital models of self-help.
  • Test EWMH model as part of SHP Children’s Hub pilot.
  • Increase the number of Primary Mental Health Workers for consultation training and support linked to schools.
  • Establish a model for all schools to become Emotionally Healthy Schools.
  • Increase awareness in schools of what support can be offered by the Council and in local communities.
  • A bid has also been submitted for Surrey Heartlands to become a trailblazer.

 

  pdf Early intervention workstream – project mandate summary (120 KB)

  pdf Finalised Accelerator School Sites in Surrey (83 KB)

 

3. Vulnerable groups

 

Why we need to change

  • To proactively align with the needs of vulnerable groups of children who are more susceptible to EWMH issues.
  • To identify the best places to offer treatment.
  • To recognise vulnerability in order to intervene earlier.
  • To improve outcomes.

 

How we intend to change

  • Expand the remit of the existing service for LAC, Care Leavers, CSA, and post-adoption support to include other vulnerable groups including Children in Need, such as those who have experienced domestic violence, CSE, and those excluded from school.
  • Proactively offer targeted support. Work with this expanded cohort using tried and tested methods of support, as well as early intervention services such as music, sports, arts groups.
  • Change the daily lived experience of the young people in Surrey identified as being particularly vulnerable.
  • Offer support in non-clinical settings.
  • Work with the new Family Safeguarding Teams to explore a new model of delivery by co-locating a Primary Mental Health Worker and Community Connector within two of these 22 Teams (4 members of staff in total).

 

  pdf Vulnerable groups workstream – project mandate summary (126 KB)

 

4. Social and Emotional Mental Health (SEMH/BEN)

 

Why we need to change

  • To better align with Special Educational Needs and Disability (SEND) services.
  • To reduce waiting times.
  • To Improve the experience of families in all circumstances, including pre and post diagnosis.
  • To enable multi-agency teams.
  • To clearly explain the requirement on attending a clinic.
  • To recognise schools, children, young people and parents as decision makers in care solutions.
  • To identify the right help for children with behavioural issues.
  • To improve outcomes.

 

How we intend to change

  • Work with a cluster of schools to provide a different model of support for CYP with behavioural, emotional and neurodevelopmental disorders (such as Autism Spectrum Disorder or Attention Deficit Hyperactivity Disorder).
  • Front-load provision at the early intervention end of the pathway.
  • Construct a multi-disciplinary team around a keyworker model, in line with AMBIT principles (Anna Freud Centre).
  • Align to Surrey County Council SEND transformation programme.

 

  pdf Social and Emotional Mental Health workstream – project mandate summary (98 KB)

  pdf Finalised Accelerator School Sites in Surrey (83 KB)


5. Crisis

 

Why we need to change

  • To remove division between locally commissioned Children and Young People Mental Health NHS services and nationally commissioned specialised services.
  • To test integrated mental health commissioning across the whole pathway for children and young people with mental health problems with NHS England.
  • To address unbalanced and inconsistent response to crisis.
  • To eliminate the disconnect which can exist between inpatient and community services impacting recovery and length of stay.
  • To improve outcomes.

 

How we intend to change

  • Test a new approach as a result of the national New Care Models Programme to include the development of a local Tier 4 (crisis support) offer with the potential for in-patient bed provision in Surrey.
  • Ensure that CYP who are approaching or recovering from crisis and their families will be supported through a full range of services across all relevant agencies, building a robust multi-agency approach with joint accountability for outcomes; with integrated pathways and improved communication.
  • Ensure the right response is in place for incoming crisis referrals.
  • Improve communication, information sharing and close working with education and criminal justice.
  • Extend and develop the HOPE offer and Children’s Eating Disorder Services with robust wraparound community arrangements.
  • Provide more support for schools who are working with children and young people in crisis.
  • The Crisis Work-stream will be building on community crisis services such as Extended HOPE, the enhanced Eating Disorders pathway and the paediatric liaison service with the 3rd Sector.

 

  pdf Crisis workstream – project mandate summary (666 KB)

 

Redesigning the service

 

Commissioners have undertaken a process of self-assessment to identify how much change is required and what actions need to be taken to move services, systems and cultures closer to our aspirational position. We have worked with key partners to develop plans to deliver improvements. We will begin to trial some new approaches to improve support for children and young people’s emotional wellbeing and mental health in the near future. These new approaches will be evaluated so that we can understand whether they are making a difference for children and young people and their families.

 

How have we redesigned services?

Commissioners investigated the use of a model called THRIVE to support the way in which services are redesigned. This model was developed by the Tavistock & Portman NHS Foundation Trust and the Anna Freud Centre for Children and Families, in consultation with children, families and service providers.

The model balances the needs to provide good quality early intervention and resilience-building to tackle issues early, with the need for some children and young people to access more specialist or medicalised care. The THRIVE model is recommended in the NHS Long Term Plan which has just been published.

The key features of the model are that it:

  • outlines groups of children and young people and the sort of support they may need, making a clear distinction between support and treatment (services)
  • focuses on a wish to build on individual and community strengths wherever possible, and to make sure children and families are active decision makers in the process of choosing the right care
  • has been successfully used in other parts of England to shape a positive culture and support and services for children and young people’s emotional wellbeing and mental health
  • has a structure that is closely aligned with what we are trying to achieve in Surrey.

 

Our THRIVE Framework

The figure below shows how to apply THRIVE segments to meet the needs of children and young people in Surrey.

 

The Thrive Framework

 

Getting Advice

Depending on the age of the child or young person, this will mean providing access to early intervention and prevention through schools, colleges and children's centres, health visitors, school nurses, GPs, helplines and websites for support.

We will provide early support to referrers in schools and general practice.


Getting Help

The support and services to children and young people will be provided through community counselling, hospices and bereavement services, counselling or mentoring in schools, education psychologists, education support centres, targeted youth support teams, family support and support to referrers.


Getting Risk Support

The support and services will include specialised crisis support and day and inpatient units, where children and young people with more severe mental health problems can be assessed and treated.


Getting More Help

The support and services will be provided to children and young people including multi-disciplinary working in a community setting to meet the needs of more severe, complex and enduring mental health needs. They will also include an eating disorder service.

 

Further Information

 

 

Emotional Wellbeing and Mental Health Service for Children and Young People - Homepage

  Emotional Wellbeing and Mental Health Service for Children and Young People - Information for the Market