Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service Jackie Powell, Senior Lecturer and Julia Waldman, Senior Research Fellow, Department of Social Work Studies

Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service What is the Behaviour Resource Service? A Multi Agency approach to meeting the Health, Education and Social care needs of children and young people with complex needs The service is shared between :- Education Health Social Services An integrated service comprising two teams: – 4 bedded residential unit for year olds – Community Team for children years: –Psychiatry, clinical psychology, educational psychology, teaching, social work, occupational therapy, community support and nursing. –Managed together in one service

Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service Who receives the service? Children and young people ages years – Extreme behaviour related to mental health /severe emotional difficulties – Difficulties with education placement related to mental health/severe emotional problems – Risk of self harm or harm to others – Home circumstances vulnerable to breakdown How is the Behaviour Resource Service different from other services? – Government Grant (Part) funded project for innovative mental health services for children – Three year project – Project fills a gap in previous provision – Set up as an additional service for a small group (approximately 50 per year) not as a substitute for existing service – Service addresses the needs of the children with extreme complex needs

Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service National Context The BRS is one of 24 projects in England funded through Department of Health CAMHS grant see Young Minds website a requirement of the funding was for external evaluation Department of Social Work Studies commissioned to evaluate 2 of the projects

Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service The evaluation has four aims :  to describe the organisation and operation of the BRS as it evolves over the three-year period  to identify and analyse outcomes for Service users (children, young people, kin and other carers) both in terms of behavioural and social changes and Service satisfaction levels  to examine the nature of inter-agency relationships and collaborative working arrangements established within the BRS  to understand the impact of the BRS on Services and agencies associated with children and young people presenting challenging behaviour

Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service The BRS as a complex and diverse social experiment "Rather than treating such diversity as problematic, pluralistic evaluation acknowledges, even gives central place to, the varying perspectives proffered by different parties within a particular initiative” Fuller and Petch The pluralism of the Service required that these perspectives be gathered whilst the complexity indicates that outcomes need to be understood alongside process issues influencing progress. The evaluation team also had a commitment to the principles of partnership and participation that demanded a negotiating approach to the design of the study, the methods of data collection and presentation and use of findings (Guber & Lincoln).

Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service Presentation is mainly concerned with the 1st and 3rd research aims  to describe the organisation and operation of the BRS as it evolves over the three-year period  to examine the nature of inter-agency relationships and collaborative working arrangements established within the BRS paying particular attention to the overall management systems and structures of the service, using a framework of 4 overlapping sets of activities to understand the processes involved

Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service Building on collaborative activity, which  Established shared concerns and interests  Mapped needs and gaps in resources  Situated these within wider policy context, including shifting locality boundaries  Leading to recognition of inter-dependency  Facilitating service planning in a collaborative way  Collaboration opened doors for central government grant aid

Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service Building Structures and processes from vision to preparing for a new service involved  Funding issues  Shared space - geographical and conceptual  Human resource issues  Development of policies and procedures  Information systems All led to the need for agencies to act and think differently

Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service Collaborative management of the operational service  Evolution from steering groups to Management Board, who’s challenges include  Balancing tensions operational tasks and the continuing of development of structures and processes  Interface between senior and front line management  Managing service and organisational diversity alongside nurturing a new inter-agency service culture Achieved by the well-established working relations between individuals which are strong enough to cope with degrees of conflict, risk-taking and uncertainty

Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service Creating a learning organisation Monitoring and review activities Shifting identities Contribution of external evaluation Endorsements

Development and management of child and adolescent mental health services across agency boundaries – the experience of the Behaviour Resource Service Key factors in developing and managing integrated CAMHS Building on established collaborative initiative and its associated relationships Senior manager sustaining the strategic vision and supporting operational management Problem-solving in the integrated service context Managing diversity within a new inter-agency service culture Using risk, trust and negotiations skills within context of shifting power relations