Better Outcomes, New Delivery Collaborative Partnerships in Wandsworth A case study in developing community based mental health services for children and young people. Philip Prior – Head of Schools and Community Psychology Service, LB Wandsworth March 2012 March 2012

Around 52,000 C+YP aged between 0-19 Indices of Multiple Deprivation – ‘middle’ ranking London borough. High contrast with extremes of relative affluence and poverty Three areas of high volume / multiple incidence (including mental health) need: Battersea, Tooting and Roehampton Circa 80 ‘maintained’ schools and a developing academy and free school sector Some information about Wandsworth

Child Well-being Index - Wandsworth Source: NHSW Public Health 2010 – from CWI 2009

Improve mental health and psychological well being across Wandsworth Focus energy and resources on vulnerable groups. Create synergies with existing services and providers Reduce reliance on / overburdening specialist services (e.g. Tier 3 CAMHS) Principles of mutuality, collaboration and partnership Easier access to consultation and interventions for children,young people and families. Embed services and build capacity in schools and community based settings What we (have always) wanted to do:

Fragmented preventative and community based services Widespread schools dissatisfaction with access to specialist mental health Educational Psychologists managing large Statutory Assessment workload – restricted capacity for interventions Local Authority playing limited role in developing comprehensive CAMHS Resources tied up in ad hoc projects and ‘posts’ Lack of shared strategic vision across education, health and social services Where we were in 2002:

In 2003, a small group of school heads and the PEP convened to discuss how Place to Be might help provide mental health services directly to schools in the borough P2B appeal lay in making services available in non clinical settings (i.e. schools) – place to be, to talk, to think (and latterly a place for parents) P2B Steering Group established - presentations held in local schools and visits arranged for heads to see a school in an established P2B hub (Southwark) Securing match 50:50 funding (against schools contribution) locally proved a major obstacle to ‘take off’. Significant local scepticism about the potential role of a voluntary sector partner Steering group waxed and waned for 3 years, but a core continued to champion P2B despite challenges and set backs What happened next:

Securing an educational departmental under spend, and contribution from the PCT finally enabled the Wandsworth P2B hub to start up in 2006 in 5 schools (including one special school) Local support enlisted – council members, senior LA officers, borough police, PCT and other schools – successful ‘Seeing is Believing events held Funding arrangements remained ad hoc until 2011 – most significant, consistent support from Wandsworth. Intermittent support from PCT, GoL, Met Police and some corporate sponsorship – but often a ‘white knuckle ride’ securing funding Since 2008 other VCS providers began taking on local contracts e.g. Catch 22, Family Action and Contact a Family Wandsworth P2B hub grew to 11 primary schools (nearly 20% of total) – by 2012 Squaring the circle – and some luck:

Funding through LA ‘secured’ through CAMHS budget (EIG) – but PCT funding remains elusive. Schools now contribute closer to 66% of the cost P2B now incorporated into the Targeted Mental Health in Schools (TaMHS) network, led by the Schools and Community Psychology Service (ex EPS) Service provided by P2B now recognised as high quality and well managed, supported by excellent data analysis / outcome measures. These are absolutely critical in terms of future stakeholder support and buy-in P2B piloting new models of delivery to appeal to a more diverse range of schools Other providers beginning to emerge e.g. Kids Company Head of SCPS has oversight of the council CAMHS budget and is one of the LA Children’s services CAMHS Commissioners Where we are today:

Where were by 2010 (simplified) Wandsworth Schools and Community Psychology Service Tier 2 CAMHS lead service Wandsworth Place 2 Be Hub TAMHS Marlborough Family Groups mental health first aid P2B parent worker School / cluster commissioned Kids Co, Nightingale Therapy service, BLSS, Shine, school counsellors etc Sure Start / Integrated Children’s Centres PMHWs and EPs Tier 3 CAMHS

Where we hope to be in Schools and Community Psychology Service Tier 2 CAMHS lead service Core Psychological Services Traded Services Wandsworth Place 2 Be Hub TAMHS / Tier 2 Mental Health Consultancy Other school / cluster commissioned mental and psychological health services / VCS providers Sure Start / Integrated Children’s Centres PMHWs and EPs Tier 3 CAMHS Marlborough Family Groups Nurture Group Network Emotional Literacy Support Assistants CBT / Psychologica l therapy services GP group practice pilot

1) Funding – LA budgets under constant pressure / ‘haircuts’. Complex procurement procedures and contracting arrangements. New commissioning players – schools / academies, GP consortia. Demise of the PCT 2) Expansion of the VCS sector – Increasing number of providers entering arena – increased competition between VCSs for ‘market share’ 3) Reduction and realignment in public sector – Role increasingly restricted to commissioning and contract management. Council services becoming mutuals / social enterprises and competing directly with VCSs 4) Other conundrums – Rapid development of academies and free schools, wider impact of health service reforms, uncertainty over future role of local government, impact of new government led initiatives e.g. IAPT 5) Constants – the needs of ‘unsponsored children’, vulnerable groups remain 6) ??? – can our TaMHS project (and P2B) change, adapt, survive and thrive? The future: Opportunities and Challenges

Better Outcomes, New Delivery Collaborative Partnerships in Wandsworth A case study in developing community based mental health services for children and young people. Philip Prior – Head of Schools and Community Psychology Service, LB Wandsworth March 2012 March 2012