1. CHILD & ADOLESCENT MENTAL HEALTH SERVICES Siobhan Grady, Assistant Director – Being Healthy

2. CAMHS – multidisciplinary services Tiered service structure Tier 4 e.g. inpatient Tier 3 Child & Family Guidance Special Assessment & Therapy Tier 2 e.g. Primary MH workers, School Nurse with special interest Brief Solution Focused therapists Tier 1 e.g. teachers, Health Visitors, School Nurses, GPs, Social Workers School Counsellors etc

3. CAMHS – LOCAL DELIVERY a small local service, spread across different agencies and management structures Check point – Counselling Service TIER 2 - 4 Primary MH Workers Office based at Parkfield House, Paignton. Delivering service predominantly home visiting, school and community locations 1 Primary MH Worker - dedicated Children Looked After Office based at Union House, Torquay as part of permanency and planning team Brief solution Focused Therapists - 4.2 therapists Based within secondary school School Nurse – Mental Health Promoter 0.5

4. Tier 3 - Specialist Assessment Team 3 social workers with specialist mental health Based at Parkfield House, Paignton. Court pre trial work, sexual abuse, support to foster carers Child & Family Tier 3 (covers both Torbay and S. Devon) 15 wte [Devon PCT] psychologists, psychotherapists, mental health nurses, social worker, OT, Infant MH worker, 5 admin, manager Child & Family Guidance Tier 3 4 wte Medical Staffing [Devon Partnership Trust] psychiatrists Recommended: 20 clinicians per 100,000 (Torbay 132,500) [York Lamb 2005 report]

5. BUDGET 2006/07 CAMHS Grant – NHS @ £124,000 CAMHs Grant – LA @ £223,000 CAMHS Training – NHS @ £21,000 Recurrent Base budget specialist services – 676,131 – tier 3 (NHS) Investments made by NHS 2003/04 – £10,000 2004/05 – £49,000 2006/07 – £44,000

6. JAR Findings “The combined work of all services in promoting the mental health of children and young people is inadequate overall” “..services for those with mental health and learning difficulties, especially for those requiring behavioural interventions, is inadequate, as is the service provided to some 16 and 17 year olds”

7. JAR findings continued… “Access for children and young people to CAMHS is inadequate. A below average number are being seen in under four weeks, with some non-specialist cases being seen after 26 weeks.” “.. Some aspects.. remain under developed and under resourced” “… a lack of capacity at specialist levels … referral criteria are not explicit and there is no single point of entry”

8. JAR findings continued… “Much progress has been made from a very low base in developing a comprehensive CAMHS based on a clear strategic plan” “..an effective multi-professional team” “..some good primary and early intervention elements” “Targeted screening leads to early identification of mental health difficulties in Looked After Children…good support for their emotional and mental health”.

9. CAMHS - progress Service Level Agreement in place for provision 2007/08 offering service range 0 to 18 years. 08/09 SLA with Devon under development, investigating best practice etc.) Single point of referral and entry introduced 01.08.07 Clinic activity analysis completed Choice & Partnership Approach – Training for tier 3 team in Nov Clinics rescheduled – increased capacity Progress towards separation of Tier 3 into Torbay and S. Devon teams – Identified Skill mix and budget Emergency arrangements under review with out of hours models of care proposed. Transition arrangements clarified between children and adult providers.

10. Further Service Improvement Capacity identification to address specialist targeted work i.e. rapid assessment team for CLA. More Torbay outreach clinics planned Eating disorder Assessment – nursing Weekend on call Learning disability – most complex Dedicated family therapy ADHD provision and care pathway. Mental health promotion

11. Referrals Current wait times Tier 2 average wait time is 6/7 weeks Tier 3 shortage wait 4 weeks – longest wait 26 weeks