Specialist Child and Adolescent Mental Health Service (CAMHS) Introduce myself – nearly 3 years in this role, working closely with commissioners and partner agencies to develop services Key points today: Overview of current services and structure Underpinning principles and philosophy Clarity about accessing the service – Requests For Involvement Specialist Child and Adolescent Mental Health Service (CAMHS) May 2012 Alison Chisholm, Service Manager

Overview of service Secondary/specialist multi-disciplinary mental health service for children and young people from 0 – 18 (19 with additional needs) Community Mental Health Teams (Tier 3) Inpatient Unit (Tier 4) – Wessex House, Bridgwater Outreach/home treatment Specialist substance misuse service – integrated with community CAMHS ND CAMHS – specialist service for Deaf children and young people Learning Disabilities/Mental Health - Additional Needs resource Links to Youth Offending Team – one seconded CAMHS post C0MPASS (Musgrove Park Hospital) – psychological interventions for children and young people with life limiting conditions Overview – more details on subsequent slides…

Community CAMHS – (1) Multi-disciplinary teams (psychology, psychiatry, nurses, social workers, therapists, occupational therapists, primary mental health link workers, managers) Mendip: Priory House, Wells South Somerset: Balidon Centre, Yeovil Taunton Deane: CAMHS West, Foundation House Somerset Coast: Taunton

Community CAMHS (2) Assessment - formulation/diagnosis Care planning – Recovery model Collaboratively agreed goals and timescales Wide range of direct therapeutic interventions: Brief Solution Focused Therapy, Cognitive Behaviour Therapy, Family Therapy, Creative Therapy, medication Advice and consultation “Signposting” to more appropriate services Training Brought the Taunton and Somerset Coast teams together in June 2009, to build capacity and strengthen service delivery across the West of the county – CAMHS West. Also identified range of other bases across Somereset Coast and West Somerset – GP practices, children’s centres, accessing Rio remotely to make best use of practitioners’ time and reducing travel where possible Recognise that on the East of the county geography presents different challenges, so working closely with Nigel and the teams to develop closer working across the patch, but in different ways. Upgrading our community bases to ensure they are fit for purpose – Foundation House completed, Balidon Centre in progress Size of multi-disciplinary teams – equivalent of approximately 8 whole time equivalents in each sector, so essential to make best use of our limited resources – at the lower end in terms of CAMHS Mapping/national benchmark

Community CAMHS (3) Referral criteria: Mental health = significant impact on function (e.g. inability to attend to school due to severity of anxiety) Significant or severe levels of risk of harm to self or others Complex problematic substance misuse Timescales: Emergency – within 24 hours/immediate Urgent – within 7 day Routine – within 3 weeks

Community CAMHS (4): mental health conditions depression anxiety obsessive compulsive disorder psychosis significant self harm and/or suicidal ideation eating disorder complex emotional and family problems Attention Deficit Hyperactivity Disorder (complex, or with additional needs) post traumatic stress disorder dual diagnosis (e.g. Autistic Spectrum Condition/Learning Disability plus any of above)

Substance misuse Integrated specialist substance misuse treatment service Working with young people with complex and high risk drug and alcohol problems Joint working with Community CAMHS for young people with additional mental health needs Inter-agency working (YOT, Targeted Youth Service, Turning Point 4 whole time specialist substance misuse workers, based in CAMHS community teams across the county 4 x Tier 3 very experienced and committed Substance Misuse Workers

Referral sources: GPs Health Visitors Special Educational Needs Co-ordinators (SENCOs) School pastoral leads/Heads of Year School Nurses Parent and Family Support Advisors (PFSAs) Children’s Centres* Children’s Social Care* Youth Offending Teams and Targeted Youth Support Service* Educational Psychologists Somerset Direct Paediatricians (community and acute) Acute hospitals children’s ward Integrated Therapy Service* Somerset Advocacy Service* Children and young people discharged from Specialist CAMHS with an agreed ‘fast track’ route to re-referral as part of an agreed discharge/relapse management plan (“Orange Card”) *NB The Request for Involvement must be discussed with and agreed by relevant managers within each organisation.

Key principles - and challenges Committed to develop an early intervention model - as well as meeting the needs of the most vulnerable children and young people Partnership and multi-agency working – across the continuum of education provision Information sharing – acknowledging the tensions Identifying, achieving and measuring outcomes Sustaining reduced waiting times Ensuring high quality and evidence based practice Implementing the Recovery Care Programme Approach – in line with adult and older people’s services, putting the child and young person at the heart of the process, building on their aspirations and goals – [separate sheet in packs]

Challenges for 2012 and beyond (1) Small CAMHS service against national benchmarking: approx 133 wte staff (55 wte Inpatient, 78 wte Community) Pressures on overall NHS budgets Likelihood of decrease in resources although age range changed from 17 to 18 with new Service Specification Steady increase in numbers and complexity of referrals to CAMHS from all sources (305 in March 2012) Current caseload: 1800

Challenges for 2012 and beyond (2) Impact of known and unknown changes in other agencies (particularly CSC/Local Service Teams/Education) Impact of rise in numbers of children and young people subject to Child Protection Plans or becoming LAC Responding to statutory framework re Looked After Children (including very complex young people placed in Somerset by external agencies) Responding to new commissioning arrangements under Health and Social Care Bill – Clinical Commissioning Group (GPs)

Responses for 2012 and beyond (1) Review service delivery model – focus on solution focussed approach (“ready, willing and able” to access treatment) Review referral criteria and processes Improve access and information e.g. telephone help line web based information (self help, information for professionals, contact details) Ongoing critical review of all posts/reinvestment/redesign/skill mix Further develop Recovery Care Programme Approach (personalised care planning) including robust review and timely discharge/transitions I hope this has provided you with an understanding of CAMHS , its strategy and the aspirations of the service There are lots of challenges facing us, along with colleagues in other children’s services, and in the current climate, even more important to work effectively together – with the emphasis on early intervention and prevention Overall, I believe there is a will and enthusiasm within the service to move ahead with a sense of collaboration both within the Trust and with our partner agencies, and with commissioners

Responses for 2012 and beyond (2) Develop integrated training strategy across Children and Young People’s Service – focus on early intervention, sharing skills and building confidence Priority training programme for School Nurses Develop care pathways across integrated services (e.g. ADHD, ASD, eating disorders, additional needs) Pro-active and positive engagement with new commissioners and stakeholders – including education

Examples of additional services and joint agency models Evidence based training packages on specialist subject areas, including: Making sense of behaviour that is difficult to understand Preventative interventions De-escalation and re-integration strategies Direct interventions with family and schools regarding individual young people Active planning under way with Educational Psychology and Integrated Therapy Service – working towards a programme building on evidence based TAMHS pilot

And finally… Recognising the limits and limitations of a commissioned Specialist Mental Health Service Welcoming opportunities to learn more about the challenges facing schools Finding creative and collaborative solutions Shared goals – improving outcomes for young people

Contact details: Alison Chisholm CAMHS Service Manager Alison.chisholm@sompar.nhs.uk Tel: 01823 368368 Sue Pearson Team Manager - CAMHS West Sue.pearson@sompar.nhs.uk Nigel Potter Operational Manager – Mendip and South Somerset Nigel.potter@sompar.nhs.uk Tel: 01749 836561 or 01935 384140 Maria Gascon-Ramos Operational Manager - National Deaf CAMHS (ND CAMHS) Ndcamhstaunton@sompar.nhs.uk Tel: 01823 368373 or text: 07798 667966 Follow links on website to access Information for Professionals and Information for Families leaflets, and Request For Involvement forms http://www.sompar.nhs.uk/Childrenandyoungpeople.aspx