child and adolescent mental health service transformation plan … · review child and adolescent...

Child and Adolescent Mental Health Service Transformation Plan 2015 - 2020 October 2016 REFRESH

Commissioner Lead NHS South Tyneside CCG

Commissioning Partners South Tyneside Council

NHS England Specialist Commissioning

Provider Lead Northumberland Tyne and Wear NHS Foundation Trust

South Tyneside NHS Foundation Trust

South Tyneside CAMHS Transformation Plan 2015 - 2020 (Refresh) 2

Contents

1.0 Introduction ...................................................................................................................................... 3

1.2 Five Year Forward View for Mental Health Implementation Plan (2016) .................................... 4

2.0 Local Context – refresh ..................................................................................................................... 5

2.1 Key Issues ...................................................................................................................................... 6

2.2 High Level Priorities ...................................................................................................................... 7

2.3 Those at risk .................................................................................................................................. 8

2.4 Health Related Behaviour Questionnaire ................................................................................... 11

2.5 Level of need ............................................................................................................................... 12

3.0 Population ....................................................................................................................................... 13

3.1 Maternal and Pre-school ............................................................................................................. 13

3.2 School Age Children .................................................................................................................... 14

3.4 Unmet needs ............................................................................................................................... 17

4.0 Projected Need and Demand .......................................................................................................... 17

4.1 Services ....................................................................................................................................... 18

4.2 Universal ..................................................................................................................................... 18

4.3 Targeted ...................................................................................................................................... 19

4.4 Matrix .......................................................................................................................................... 20

4.5 Third Sector ................................................................................................................................. 21

5.0 Present Feedback from Children, Young People and Families ....................................................... 22

6.0 Key Priorities identified in South Tyneside (2015) including (brief) update: .................................. 24

7.0 Future Plan ...................................................................................................................................... 25

7.1 Detailed Project plans ................................................................................................................. 25

7.3 Next steps ................................................................................................................................... 34


1.0 Introduction Following the publication of “Future in Mind” – promoting, protecting and improving our children

and young people’s mental health and wellbeing (report of the government's Children and Young

People’s Mental Health Taskforce in 2015), South Tyneside Clinical Commissioning Group worked

with partners to develop its Local Transformation Plan for Children and Young People’s Mental

Health and Wellbeing for the period 2015 -2020.

The CCG submitted its Transformation Plan in October 2015 and it was fully assured. The

transformation plan outlined clear plans for the next two years to systematically transform services

for children and young people across all partners.

The plan was approved by the respective Health and Wellbeing Board (October 2015) and was

subsequently published on the CCG website.

This refresh document provides an overview of progress against the original transformation plan and

outlines future priorities, identified by local information/evidence to date, and the publication in July

2016 of: The Five Year Forward View for Mental Health.

By 2020/21, there must be a significant expansion of access to high-quality mental health care for

children and young people, equating to 70,000 additional children and young people each year

receiving evidence-based treatment.

Our LTP is a ‘living’ document. The joint work to improve outcomes set out in the initial plan,

requires continued commitment to working together to ensure success. South Tyneside’s plan has

now been in place for a year and this refresh will reflect local progress and further ambitions based

on the increasing financial envelop the Mental Health implementation plan and

evidence/information to date, and should be read in conjunction with the initial transformation

plan.

1.1 National Policy – refresh

NHS Five Year Forward View (2014)

The NHS Five Year Forward View was published in 2014, which outlines the vision for the future of

the NHS and more broadly articulates a case to develop a new relationship with patients and the

community and new models of care in order improve the mental and physical health outcomes for

the population.

Future In Mind (2015)

In March 2015 a parliamentary taskforce published its findings and recommendations following a

review Child and Adolescent Mental Health Services (CAMHS), this report made a total of 59

recommendations in order to:

Promote resilience, prevention and early intervention

Improve access to effective support (a system without tiers)

care for the most vulnerable

accountability and transparency


Develop the workforce, that has the right mix of skills, competencies and experience

This was swiftly followed by a Government pledge and later a commitment to invest more funding in

emotional well-being and mental health services for children and young people.

Local Transformation Plans for Children and Young People’s Mental Health and Wellbeing (2015) is

NHS England guidance, ‘for local areas on meeting the ‘Future In Mind’ recommendations and

details of the funding allocation for each area.

The key objectives for the additional funding are to:

Build capacity and capability across the system

Commitment to the roll-out the Children and Young People’s Improving Access to

Psychological Therapies programme (CYP IAPT) as Sutton are part of the South East CYP IAPT

collaborative (London and Reading), including salary support via the match funding available

from NHS England

Develop evidence based community Eating Disorder services for children and young people

Improve perinatal care

Bring education and local children and young people’s mental health services together

around the needs of the individual child through joint mental health training

Deliver Parity of Esteem between mental and physical health

Support the most vulnerable and,

Close the treatment gap so that more children and young people can have access to timely,

high quality, coordinated support

1.2 Five Year Forward View for Mental Health Implementation Plan (2016)

This sets out the actions required to deliver the Five Year Forward View for Mental Health. Whilst

the Five Year Forward View for Mental Health is a single programme, it contains different and

related elements across the health system for all ages. A core strand within this programme is

children and young people.

The key features of the implementation plan are:

Greater collaborative commissioning between the NHS and partner organisations

Improved access to 24/7 crisis resolution and liaison mental health services that

prevent the need for inpatient beds and inappropriate out of borough placements

All areas having eating disorder services for children and young people in place that

ensure 95% of children in need receive treatment within one week for urgent cases,

and four weeks for routine cases.

Increasing the capacity and skill set of the local workforce.

Other key additional legislation includes Reducing health inequalities – the Health and Social Care

Act 2012, The Children and Families Act 2014, Crisis Care Concordat (DH & signatories, 2014) -

provision of crisis services and appropriate places of safety for which work in Sutton is taking place.


2.0 Local Context – refresh South Tyneside has consistently poorer health and wellbeing outcomes across a range of health

behaviours, illnesses, disabilities and early deaths when compared with England and other similar

areas. We will never precisely know how much of our current health burden is attributable to issues

people experienced in childhood, but we are increasingly understanding that it is emotional health

and wellbeing of children is a leading priority when trying to improve self-efficacy and the health of

the South Tyneside Population, reduce health inequalities, and reduce demand now and in the

future for health and social care services. In particular, healthy social and emotional development in

babies and toddlers is important as it is the "building block(s) for healthy behaviour and educational

attainment" in the future and helps to prevent behavioural problems and mental illness (NICE,

2012)[4].

We do know, for example, that people with mental ill health use more emergency hospital care than

those without mental ill health; over three times more accident and emergency (A&E) attendances

and nearly five times more emergency inpatient admissions (Dorning, Davies and Blunt, 2015) [5].

South Tyneside has recognised MHEW of children and young people for some time and there is

a local strategy to help prevent the development of MHEW issues and support children and families

as appropriate with evidence-based services. South Tyneside has also produced a partnership

transformation plan in line with the ambition set out by the Department of Health and NHS England

inFuture in Mind [6]. Future in Mind clearly sets out the standards and services that must be in place

to promote, protect and improve our children and young people's mental health and wellbeing.

South Tyneside Council People Select Committee held a Commission on the Mental Health and

Emotional Wellbeing of Children and Young People. The final Commission Report was published on

27thApril 2015 and presented to South Tyneside Council's Cabinet on 17th June 2015 [7]. The People

Select Committee report recommended a further needs assessment is conducted to understand the

mental health needs of children and young people in South Tyneside for inclusion in the Joint

Strategic Needs Assessment for 2016/17.

This needs assessment has been conducted in partnership with South Tyneside CCG (STCCG),

Northumberland Tyne and Wear NHS Trust (NTW), South Tyneside Foundation Trust, Third Sector

organisations, South Tyneside Council and the Young People's Parliament.

This needs assessment attempts to draw together the most up-to-date information on:

population risk factors and indicators that relate to causal or contributory factors for MHEW

problems in children and young people, including issues around use of the internet/ social

media and Self Harm.

the prevalence and incidence of mental health conditions in children and young people and

the resulting harms,

local service provision and support for MHEW, not just in specialist Child and Adolescent

Mental Health Services (CAMHS) but across the range of universal and targeted settings

available to children and their families,

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The local views of children and young people on the local approach to MHEW and the

services that are available to them.

This information will be used by the Health and Wellbeing Board and Children and Families Board to

inform the development of the local prevention and early help services, implement the MHEW

strategy, transform local services, and inform Commissioning Plans for 2017/18 and beyond.

2.1 Key Issues

Measuring the actual levels of MHEW need in children and young people is very difficult to

do in practice and risks drawing attention to complex (and diagnosed) needs, and thus

missing undiagnosed/ unidentified needs and diminishing the role of prevention. In addition

to this, when children and young people are supported by mental health services there is

very little information on associated needs, such as being looked after, gay, lesbian, bisexual,

or transgender, having a chronic health condition, or being in contact with youth justice

services.

Work conducted by the Young Person's Parliament clearly highlights that young people in

South Tyneside recognise the importance of mental health and want it to be considered as a

priority,

Children and young people feel very distant from, and therefore do not always access, the

services that are available to them locally. Issues cited including a lack of confidence in the

level of confidentiality of services,

Children and families do not understand what services are available to them locally and how

these services work together,

The continuity of care for children and their families between mental health services has

been identified as an area that needs improvement,

Children and young people have identified that there is a clear gap in help and support for

"low-level" mental health and wellbeing support at times of stress and anxiety - such as

during family difficulties or exams. This includes a lack of awareness in children, parents/

carers, and professionals around understanding MHEW issues, and ways of offering simple

support or promoting self-care,

Self-harm is cited by professionals and young people as an issue in South Tyneside. The

statistical data available do potentially support this finding. However, further anecdotal

reports from teaching staff, school nurses, educational psychologists and young people

themselves point towards more of a hidden harm issue in South Tyneside,

Locally the attention of statutory organisations is on the provision and quality of more

specialist services, rather than clear programmes to improve prevention and early help, and

therefore resources are disproportionately weighted towards treatment,

Need to improve the use of champions for positive MHEW in children and young people,

which are currently identified in every school. Young people cited a number of good

https://www.gov.uk/government/publications/improving-mental-health-services-for-young-people


example of help and support in the schools setting, but they also cited where support is

lacking,

The needs assessment had a number of limitations that should be address over time by the

Children and Young People's MHEW Strategy Group. These include:

o A lack of views by clinical professionals and parents/ carers on the needs of children

and young people, and the local provision of services. Some excellent work has been

conducted with schools, but we must expand the conversation to other professional

groups and families,

o A lack of specific quantitative data on the level of self-harm that doesn't result in a

hospital admission in children and young people. A further survey of schools

pastoral leads and/ or children, young people and/ or families would be beneficial in

understanding the scale of the local issue.

o Clarity on meaning and interpretation of performance data from tier 2 and 3 child

and adolescent mental health services in South Tyneside

2.2 High Level Priorities

The needs assessment illustrated the important link between mental health problems and many of

the social and deprivation risk factors that are present in South Tyneside. We know that

socioeconomic deprivation is particularly associated with multiple long term conditions, specifically

mental health disorders (Barnett et al., 2012) [8]. Strategic action to reduce deprivation and improve

economic prosperity for all communities in South Tyneside should be a system-wide priority.

The specific additional priorities identified are:

To ensure that the promotion, protection and improvement of the mental health of children

and young people is seen as a key priority in local health and wellbeing strategies and

commissioning plans,

For commissioners to take an integrated, system-wide view of MHEW in children and young

people to ensure that prevention is resourced appropriately to avoid an increase in more

expensive demand,

Ensure that risk factors of mental health and emotional wellbeing are recognised and

recorded as part of children service delivery - this includes training for staff and changes to

contracts to ensure that risk factors are recorded consistently,

A structured and well promoted offer of evidence-based parenting programmes is needed in

South Tyneside to work as part of the universal and targeted support offer,

A clear skills development and training strategy is required to ensure that all frontline

workers in contact with children and young people have the appropriate skills to offer low-

level support and provide help in accessing appropriate services (recommended by NICE);

these skills should include identifying and supporting young people who are (or at risk of)

self-harming,


Ensure that all local services offering MHEW support to young people meet the You're

Welcome standards and activity promote confidentiality,

Commissioners and providers must prioritise continuity of care for children and families in

specialist mental health services as a measure of quality and performance, and ensure that

data-sharing and risk management do not become a barrier to providing a quality service,

To produce, publish and actively promote a map of local services available to prevent, identify and

manage MHEW problems in children and young people, using appropriate media and feedback from

young people, families and professionals.

2.3 Those at risk

There are a number of risk factors for mental health and emotional wellbeing that have been

identified through research. These include:

Poverty,

Maternal and infant health,

Learning disabilities,

Ethnicity, gender, and sexual orientation,

Work, education and early years development,

Family breakdown or social issues (including when children require care and support),

Lifestyle and behaviours (although these can be a result of MHEW need as well as a cause),

Offending,

Chronic disease.

On many of the areas above South Tyneside is shown in routinely collected (and publicly available)

data to be worse than the England average, and often regional peers.

Using the Children and Young People's Health Benchmarking Tool we can see South Tyneside's

absolute and relative position on a number of key risk factors:

Poverty

There are over 6,500 children under 16 living in poverty in South Tyneside (2013), which at

25.9% is significantly higher than the national (18.6%) and regional averages (23.3%),

Maternal and infant health

South Tyneside has the worst smoking in pregnancy rate in the country at 25.9% (2014/15),

Locally breast feeding initiation and maintenance rates are low at 53% for initiation and only

24.4% at 6-8 weeks. These rates are significantly lower than national averages,

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Evidence clearly illustrates the importance of reducing the exposure of babies to second-

hand smoke, and promoting breast feeding to improve the health of the baby and promote a

strong bond between the mother and child. These both lead to improved MHEW in the child

over their lifetime,

Although South Tyneside has made great progress on reducing under 18 conceptions (down

by half since the early 2000s) they are still higher than the national average.

Learning disabilities

People with learning disabilities are more likely to experience mental health problems

(Emerson, E. et al, 2008)[9]. Estimation of the population prevalence of learning disability is

problematic and should be treated with caution. The estimated number of children with a

learning disability in South Tyneside are:

o 80 5-9 year olds,

o 175 10-14 year olds,


These rates for different age groups reflect the fact that as children get older, more are

identified as having a mild learning disability. The Foundation for People with Learning

Disabilities (2002)[10] estimates an upper estimate of 40% prevalence for mental health

problems associated with learning disability, with higher rates for those with severe learning

disabilities. The estimated total number of children with learning disabilities with mental

health problems in South Tyneside are:

o 35 5-9 year olds,


o 95 15-19 year olds.

Ethnicity, gender, and sexual orientation

South Tyneside has a predominantly white population with over 93% of the 0-19 population

recognised as White British, leaving around 2,000 non-white children. The largest non-white

population group is the Asian/ Asian British: Bangladeshi at around 2% of the 0-19

population which is largely found in the Riverside/ Ocean Road areas of South Tyneside.

The Government estimates put the numbers of LGB between 5-7% of the population. At an

approximate rate of 6%, this would equate to 9,167 LGB people in South. [11]

There are no data around LGBTQ young people or those who don't identify as cisgender.

There are no comprehensive data about LGBTQ young people who accessed MHEW services.


Work education and early years development

The percentage of children achieving a good level of development at the end of reception is

significantly worse than the national average, at 60% locally (2014/15). This is even lower for

children who are eligible for free school meals at 46%,

South Tyneside (in 2014) has a significantly higher proportion of 16-18 year olds not in

education employment or training (6%) when compared to the national average (4.7%),

Family breakdown or social issues

South Tyneside had 180 families in 2013/14 recorded as homeless (number of applicant

households with dependent children or pregnant women accepted as unintentionally

homeless or eligible for assistance) -this give South Tyneside a significantly higher rate than

the national average.

Looked-after children are more likely to experience mental health problems (Ford, T. et al,

2007)[12]. It has been found that among children aged 5 to 17 years who are looked after by

local authorities in England, 45% had a mental health disorder, 37% had clinically significant

conduct disorders, 12% had emotional disorders, such as anxiety or depression, and 7%

were hyperkinetic (Meltzer, H. et al, 2003)[13].

In 2014 South Tyneside was recorded as having 310 children in care which gives a

significantly higher rate than the national and regional average.

There is a clear association between domestic violence, abuse and substance misuse and

mental health problems in mothers, and also children. There can also be an impact on child

emotional and cognitive development.

o Around 10% of South Tyneside's 900 substance misuse clients (who are known to

service) are living with a child, another 40% of clients have a child but don't live with

that child.

Lifestyle and behaviours

South Tyneside has over a third of year 6 pupils classified as being overweight or obese

(significantly higher than the national average). This could have significant implications for

the emotional health of many children in South Tyneside,

There are also a significantly higher proportion of children aged 15 smoking regularly in

South Tyneside (7.7%) compared to the national average of 5.5%,

Locally there are also significantly higher rates of hospital admissions due to alcohol specific

conditions and substance misuse than England.

In 2014-15 there were 154 young people (<18) in specialist substance services in the South

Tyneside community. There has been a steady decline in numbers in treatment since 2012-

13 (then 173 per year). The majority of children in service are males (68%).


Offending

South Tyneside has a significantly higher rate of 10-17 year olds receiving their first

reprimand, warning or conviction per 100,000 population when compared to the national

rate. This equated to 78 children in 2014 in South Tyneside. This has increased year on year

in South Tyneside since 2012, but not statistically.

Chronic disease

All children will likely have many different health problems during infancy and childhood,

but for most children these problems are mild, they come and go, and they do not interfere

with their daily life and development. For some children, however, chronic health conditions

affect everyday life throughout childhood.

Chronic condition is an "umbrella" term. Children with chronic illnesses may be ill or well at

any given time, but they are always living with their condition. Some examples of chronic

conditions include (but are not limited to) asthma (the most common), diabetes, and cancer.

To reduce the risk of mental health problems there is a suggested Five-a-Day for Health and

Happiness:

Connect - how to connect with people around you

Be active - exercise, move about, change your surroundings

Keep learning - try something new, learn to cook, read

Take notice - ask questions, notice positive things in your life

Give - do something for someone else, say thank you, volunteer

2.4 Health Related Behaviour Questionnaire

In 2006 and 2012/13 there was a health related behaviour questionnaire completed in

schools in South Tyneside (conducted by the SHEU at Exeter University).[TH1]

The 2012 survey showed that in year 4-6 (aged 8-11 year olds in primary school) 72% were

worried about at least one of the items listed in the questionnaire:

41% worried about exams/ tests, 30% about crime, 28% about family problems.

The table below illustrates the emotional wellbeing results results for years 8 and 10 from

both the 2006 and 2012/13 surveys:

HRBQ 2006 Secondary schools only. Participation 1117 young people from 7 Secondary Schools

HRBQ 2012 Primary aged 8-11 (Years 4-6) Secondary aged 12-15 (Years 8-10) Participation 1,292 young people from 11 Primary and 5 Secondary schools


Question 2006 2012/13 Difference

Pupils who report that in general they were 'quite a lot' or 'a lot'

satisfied with their life

68% 58% -10%

Top four concerns (year 8) Boys

Exams 35% 20% -15%

Family problems 35% 15% -20%

Health problems 31% 14% -17%

Career X 12% n/a

The way I look X 43% n/a

Girls

The way I look 46% 43% -3%

Exams 39% 33% -6%


Friendship problems 37% 19% -18%

Top four concerns (year 10) Boys

Exams 42% 42% 0%

Career 34% 20% -14%

Money X 20% n/a


The way I look X 18% n/a

Girls

Exams 57% 65% +8%

The way I look 52% 52% 0%

Career X 33% n/a


Schol work X 30% n/a

Friendships 41% X n/a

The main issues of concern cited by pupils continue to be exams and "The way I look". This

also corresponds with qualitative data collected from the Youth Parliament.

2.5 Level of need

The levels of MHEW need in children and young people is very difficult to measure accurately as

many mental health and emotional wellbeing problems go undetected and unrecorded in a format

that is useful for needs assessment. Therefore much of the need information below is derived from

estimates and bespoke studies.


3.0 Population There are around 32,900 children aged 0-19 years in South Tyneside (2014, taken from PHE Child

Health Profile, 2016). One in four of the under 20 population is classified as living in poverty. Every

year there are around 1,600 births.

3.1 Maternal and Pre-school

Maternal mental health is a particular topic of concern because of the effect they can have

on the foetus, baby, wider family and mother's physical health and the fact that problems

often are not disclosed, recognised or treated during this period. Mental health problems in

women can occur during pregnancy (the antenatal period) and the postnatal period, which is

defined as up to one year after childbirth. The antenatal and postnatal periods are often

called the perinatal period, when referring specifically to mental health. There are a range of

mental health problems that can affect women during perinatal periods including

depression, anxiety, post-traumatic stress disorder (PTSD), postpartum psychosis and

adjustment disorders and distress.

Based on the number of women giving birth in South Tyneside, the figures below show how

many women we would expect to have certain mental health problems in pregnancy and

the postnatal period. These estimates are based on national estimates of these conditions

and local delivery figures only, and have been rounded up to the nearest five. They do not

take into account socioeconomic factors or anything else which is likely to cause local

variation. We are not aware of any data or research on exactly how maternal mental health

differs by socioeconomic status that would allow us to take this into account in the

estimates.

NHS South Tyneside

Estimated number of women with postpartum psychosis (2013/14) 5

Estimated number of women with chronic SMI (2013/14) 5

Estimated number of women with severe depressive illness (2013/14) 50

Estimated number of women with mild-moderate depressive illness and anxiety (lower estimate) (2013/14)

160

Estimated number of women with mild-moderate depressive illness and anxiety (upper estimate) (2013/14)

240

Estimated number of women with PTSD (2013/14) 50

Estimated number of women with adjustment disorders and distress (lower estimate) (2013/14)

240

Estimated number of women with adjustment disorders and distress (upper estimate) (2013/14)

475

Adding all these estimates together will not us an overall estimate of the number of women

with antenatal or postnatal mental health conditions in South Tyneside, as some women will

have more than one of these conditions. It is believed that overall between 10% and 20% of

women are affected by mental health problems at some point during pregnancy or the first

year after childbirth.

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There are relatively little data about prevalence rates for mental health disorders in pre-

school age children. A literature review of four studies looking at 1,021 children aged 2 to 5

years inclusive, found that the average prevalence rate of any mental health disorder was

19.6% (Egger, H et al, 2006). Applying this average prevalence rate to the estimated

population within the area, gives a figure of 1,320 children aged 2 to 5 years inclusive living

in South Tyneside who have a mental health disorder.

3.2 School Age Children

Mental and Behavioural Disorders

Prevalence estimates for mental health disorders in children aged 5 to 16 years have been

estimated in a report by Green et al. (2004). Prevalence rates are based on the ICD-10

Classification of Mental and Behavioural Disorders with strict impairment criteria - the

disorder causing distress to the child or having a considerable impact on the child's day to

day life.

Prevalence varies by age and sex, with boys more likely (11.4%) to have experienced or be

experiencing a mental health problem than girls (7.8%). Children aged 11 to 16 years olds

are also more likely (11.5%) than 5 to 10 year olds (7.7%) to experience mental health

problems.

The estimated number of children in South Tyneside with mental health disorders are:


o 1,170 11-16 year olds,

o Out of the estimated total 1,970 5-16 year olds with a mental health disorder,

around 60% are boys,

These prevalence rates of mental health disorders have been further broken down by

prevalence of conduct, emotional, hyperkinetic and less common disorders (Green, H. et al,

2004). These estimates are

o 515 5-10 year olds and 700 11-16 year olds with conduct disorders,

o 2455-10 year olds and 530 11-16 year olds with emotion disorders,

o 1805-10 year olds and 150 11-16 year olds with hyperkinetic disorders (around 90%

of these are estimated to be boys),

o 1405-10 year olds and 125 11-16 year olds with less common disorders,

Neurotic Disorders

A study conducted by Singleton et al (2001) has estimated prevalence rates for neurotic

disorders in young people aged 16 to 19 inclusive living in private households.

o Males aged 16-19 years;


Mixed anxiety and depressive disorder 190

Generalised anxiety disorder 60

Depressive episode 35

All phobias 25

Obsessive compulsive disorder 35

Panic disorder 20

Any neurotic disorder 320

o Females aged 16-19 years;

Mixed anxiety and depressive disorder 435

Generalised anxiety disorder 40

Depressive episode 95

All phobias 75

Obsessive compulsive disorder 35

Panic disorder 25

Any neurotic disorder 670

Autistic Spectrum Disorder (ASD)

A study of 56,946 children in South East London by Baird et al (2006) estimated the

prevalence of autism in children aged 9 to 10 years at 38.9 per 10,000 and that of other

ASDs at 77.2 per 10,000, making the total prevalence of all ASDs 116.1 per 10,000.

A survey by Baron-Cohen et al (2009) of autism-spectrum conditions using the Special

Educational Needs (SEN) register alongside a survey of children in schools aged 5 to 9 years

produced prevalence estimates of autism-spectrum conditions of 94 per 10,000 and 99 per

10,000 respectively. The ratio of known to unknown cases is about 3:2. Taken together, a

prevalence of 157 per 10,000 has been estimated, including previously undiagnosed cases.

The European Commission (2005) highlights the problems associated with establishing

prevalence rates for Autistic Spectrum Disorders. These include the absence of long-term

studies of psychiatric case registers and inconsistencies of definition over time and between

locations.

The numbers of children with autistic spectrum disorders if the prevalence rates found by

Baird et al (2006) and by Baron-Cohen et al (2009) were applied to the population of South

Tyneside are:

o Autism in children aged 9-10 years old 15,


o Other ASDs (9-10 year olds) 25,

o ASDs in children aged 5-9 years 130.

Suicide and Self Harm

Looking at suicides in the UK between 1997 and 2003, one study has made the following

observations (Windfuhr, K., 2008):

o Three times as many young men as young women aged between 15 and 19

committed suicide

o Only 14% of young people who committed suicide were in contact with mental

health services in the year prior to their death, compared with 26% in adults.

o Looking at the difference between sexes, 20% of young women were in contact with

mental health services compared to only 12% of young men

Levels of self-harm are higher among young women than young men. The rates of self-harm

in young women averaged 302 per 100,000 in 10 to 14 year olds and 1,423 per 100,000 in 15

to 18 year olds. Whereas for young men the rates of self-harm averaged 67 per 100,000 in

10-14 year olds and 466 per 100,000 in 15 to 18 year olds (Hawton, K., 2012). Self-poisoning

was the most common method, involving paracetamol in 58.2 % of episodes (Hawton, K.,

2012).

In comparison with the 2009/10-2011/12 period, the rate of young people aged 10 to 24

years who are admitted to hospital as a result of self-harm in South Tyneside is higher in the

2012/13-2014/15 period. The admission rate in the 2012/13-2014/15 period is higher than

the England average. Nationally, levels of self-harm are higher among young women than

young men.

(Data source: Hospital Episode Statistics, Health and Social Care Information Centre).

In 2014/15, this meant that there were 134 admissions as a result of self-harm in the 10-24

year old age group. It's important to note that these admissions may represent the tip-of-

the-iceberg with regards to self-harm as much may go unreported/ undetected.

Estimated need for services at each tier

Estimates of the number of children and young people who may experience mental health

problems appropriate to a response from CAMHS at Tiers 1, 2, 3 and 4 have been provided

by Kurtz (1996).

Estimated number of children / young people who may experience mental health problems

appropriate to a response are;

o Tier 1 - 4,400 o Tier 2 - 2,055 o Tier 3 - 545 o Tier 4 - 25


3.4 Unmet needs

It is clear from this needs assessment that many of the key services and support are in place in South

Tyneside. What does appear to be lacking is work on promotion, awareness raising and self-care

relating to MHEW, and the clarity of pathways and access routes for more specialist services, for

professionals, parents/ carers and children themselves.

The needs of parents are largely unmet in terms of information and advice about how to support

young people with MHEW issues. Family Therapy is now being offered by the Lifecycle Service;

however more could be done to support families who are not in formal services.

Support for young people will low level emotional health issues is not consistent across the board.

Young people tell us that they do not have 'someone to talk to' in Universal setting. Low level

support provided at the right time can prevent young people from suffering from more complex

serious mental illness.

From the needs assessment, it is not clear if Resilience skills are being built by Universal staff such as

GP's, school staff, school nurses, health visitors, practice nurses, sport coaches and youth workers . A

clearer training offer is needed for the borough outside of the schools setting.

Support for women pre and perinatal needs to be met through good quality psychological support.

In particular the needs of women with personality disorder are largely missing.

A comprehensive robust program of support is needed for young people in crisis which is currently

not being provided.

The needs young people who are referred to mental health services are not consistently being met

in a timely manner. Waiting times for young people are a concern and they are being closely

monitored as part of service contracts.. The target outlined in the CAMHS Transformation Plan is 4

week standard wait by 2020 and a 25% less waiting time for vulnerable young people such as those

who are looked after.

The needs of young people who are diagnosed with an eating disorder are also not being met. This is

a specific target of the CAMHS transformation plan.

4.0 Projected Need and Demand The future mental health and emotional wellbeing needs of children and young people are difficult

to outline accurately and quantitatively. The 0-19 population in South Tyneside is set to rise from

32,900 in 2014 to 33,600 in 2025 (PHE, 2016). This relatively small increase in the CYP population is

unlikely to lead to any significant increase in demand for services, however we do know that the

costs (and expenditure) on mental health services are rising. This is recognised by the Future in Mind

as an issue, hence the increased emphasis on intervening early and promoting universal wellbeing as

opposed to simply treating mental health problems.

Locally, there is a general shift toward prevention and early identification of mental health and

emotional wellbeing issues, as the recognition of these needs increase. However, increasingly local

children's services will have to continue to adapt and incorporate emotional health and wellbeing as

a cross-cutting issue, as well as developing bespoke interventions where the need arises.


4.1 Services

There are a range of assets and services available in South Tyneside that seek to prevent, identify,

and manage/ treat MHEW issues in South Tyneside. These services extend from those that are

universally available to all, through to those that are either targeted as particular populations or

groups, or those that a specialist services for children and young people meeting particular criteria.

4.2 Universal

General Standards and Confidentiality

Our Healthy Schools Award has been achieved by all schools in South Tyneside. It also extends to the

Early Years with all of our Children Centres, who are also signed up to the award. All of our Children

Centre and Daycare settings staff are trained to use Growth Mind-sets with children and their

families. The Outreach staff are also trained in Dino-school, Incredible Years and Solihull parenting

programmes.

Many of our schools have Emotional Health/Mental Health Champions; this role could be developed

to act as a bridge to clinical services.

As part of the Healthy Schools and Change4Life Programme in South Tyneside there has been a

further work on confidentiality and the rights of young people when accessing services. This is now

promoted though some printed information and a confidentiality statement that is available on

theChange4Life website.

Further work is needed on promoting confidentiality in children's services. This should include a

structured approach to ensuring local services reach the You're Welcome standards, and that

services actively promote confidentiality in all of their materials and websites.

Training for Children and Young People

The Young People's Parliament have taken part in Young Minds training and Mindfulness training.

Our Young Peoples Parliament has a Mental Health Subgroup which looks specifically at Mental

Health Issues for young people and feeds back into the CAMHS and Emotional Resilience Groups.

Workforce Development and Resources

A Primary School Risk Taking Behaviour/ Emotional Resilience resource was launched in September.

The impact of this resource is not yet understood. This was adapted from the Evidence based SEAL

programme.

Through the Healthy Schools Programme, resources have been provided to schools (primary,

secondary and special) to encourage them to do sessions on stress, mental health, and emotional

wellbeing. It is not clear how these have been used in practice, and what the impact of the resources

has been. Clear and structured feedback on these resources needs to be collected to determine the

benefits of this approach. This is now being collected through the Healthy Schools programme.

We have a number of generic services which have staff trained in Mental Health First Aid, however

this does not form part of a local structured approach to workforce development at this stage.

Likewise, we have a number of staff trained in the PENN resilience programme.

http://www.change4lifesouthtyneside.co.uk/


We have a high number of school based staff who are trained in bereavement support.

Our Sports Development Team and Outdoor Education team have all had training in positive

discipline, emotional resilience techniques and basic mental health.

4.3 Targeted

Early Help Service

Services for Young People listened to the views around positive activities needed for young people

with emotional / self-esteem problems. So they have set up groups (called Participa8) exclusively for

young people who have confidence/esteem issues, may have Special Educational Needs and/or

struggle to access mainstream positive activities. Children/young people can only join the group on a

referral basis, age range is 8 plus.

Our Emotional Resilience Service offers 1-2-1 support for young people to ease transition or for

young people who school refuse. The service has now extended to offer bereavement support.

Specialist

Youth Justice Service

The Youth Justice Service is a multi-agency team, which means that it is made up of staff from all the

main local authority departments and agencies all working together. Its main aim is to prevent

offending and anti-social behaviour by young people in the communities of South Tyneside. In terms

of Mental health, there is a Senior Mental Health Practitioner that employed within the YOS to

provide consultation, advice and support to YOS colleagues. They also provide an assessment service

for young people referred by YOS staff. The Practitioner is part of the wider CAMHS (Child and

Adolescent Mental Health Service), acting as a link between the YOS and Mental Health Services.

Leaving Care

South Tyneside leaving care service supports young people who are looked after with a variety of

issues from employment, education, health and wellbeing. They act as a gateway to mental health

support and health services.

Child and Adolescent Mental Health Services

Tier 2 Lifecycle Service - Commissioned by South Tyneside CCG; started on 1st October 2015 as part

of a phased roll-out and full introduction in March 2016

The Lifecycle Service provides a whole person tier 2 therapeutic and non-therapeutic services to

young people of any age and their families. Tier two supports young people who have difficulties

with attachment, behaviour, eating disorders, development, emerging OCD, anxiety and depression.

A key role for the Lifecycle Service is providing the children and young people's IAPT programme

(Increasing Access to Psychological Therapies). The lifecycle service collapses the age boundaries

associated with young people service to ensure there are no issues with transition.


The Lifecycle service sees between 10 and 20 new children and young people cases per week with a

constant case load of between 150 and 200 children. As well as holding a case load of children the

service works closely with schools and children's professionals on training and education.

Children and Young People's Service (CYPS) - Provided by Northumberland Tyne and Wear and

commissioned by South Tyneside CCG

The service consists of a multidisciplinary team of mental health practitioners including psychiatrists,

nurses, social workers, psychological therapists and psychologists, occupational therapists and

administrative staff. The integrated team operates to meet the tier 3 specialist mental health needs

of all children and young people regardless of their circumstances or other needs. They operate

within a multi-agency framework and undertake the delivery of the specialist mental health element

a specific plans for a young person. The service can also provide consultation, advice and support

directly to families but also to other agencies working with children and young people presenting

with mental health.

NTW produces a monthly performance report for STCCG (who then also share this with partners).

There is separate report on LAC referrals as a result of some challenges by People Select Committee

on how the children and young people's services work together with Children's Social Care.The CYPS

service sees around 100 referrals per month.

There have been some historical waiting time issues with CYPS, and this was highlighted by People

Select in 2015. There has been significant progress against waiting time targets for accessing CYPS,

with all historical long-term waiting time patients (prior to October 2014) now in treatment. Data for

quarters 1,2 and 3 of 2015/16 also demonstrate that overall the number of young people waiting

longer than 12 weeks for treatment has reduced, with 71% of children now waiting less than 12

weeks for treatment and 61% waiting less than 9 weeks.

4.4 Matrix

The MATRIX works with young people under 18 in South Tyneside, their families and carers. The

service provides help, support and advice to those whose lives have been affected by drug and

alcohol misuse or those who are at risk of developing drug and alcohol problems. Young people who

access this project have access to a trained counsellor as well as robust signposting and referral

pathway to mental health Services. The service is also a good example of a confidential, accessible

and trusted service for young people.

In 2014-15 there were 154 young people (<18) in specialist services in the community (PHE, 2015).

There has been a steady decline in numbers in treatment since 2012-13 (then 173 per year). Service

users are largely males (68%), 65% in South Tyneside use two or more substances and 100% started

using before the age of 15 - an absolutely crucial role for prevention here.


Key vulnerabilities include

Involved in offending/ ASB 44%

Affected by domestic abuse 29%

Affected by other substance misuse 22%

NEET 19%

LAC (5%) CIN (8%) CP (4%)

Gaps:

Structured (evidence-based) training offer to young people and families in South Tyneside,

Data and evidence of impact of the workforce development approach (and associated

resources) in South Tyneside,

A clearer estimate on the scale and impact of the current prevention offer needs to be

understood. Is the current offer likely to have a significant impact on population outcomes?

The local diagnostic pathway for Autistic Spectrum Disorder needs to be improved in line

with NICE guidance, and input from children and their families.

4.5 Third Sector

Relationships Works

Relationship Works, based in Ocean Road Community Association, provides young people with

advice about family and sexual relationships through a number of drop-in sessions and educational

intervention at schools, to educate teenagers about healthy relationships.

Escape

Escape is a third sector charity which exists to promote the emotional, social, educational and

vocational competence of children and young people, by offering a range of therapeutic

interventions, including counselling, advice, guidance and support, to enable them to reach their

potential and remove the barriers to personal success.

Bright Futures

Bright Futures works with young women aged 11-25 around a range of issues to raise their self-

esteem and confidence around a range of issues which affect them including alcohol and substance

misuse, sexual health and relationships, homelessness, family relationships, friendships, school,

education, training, crime and anti-social behaviour. Bright Futures offers young women the

opportunity to take part in educational group work sessions using interactive and engaging

resources to make the sessions we deliver fun and suitable for all abilities.


5.0 Present Feedback from Children, Young People and Families There are a number of sources of information that we can draw on when considering the views of

young people and their families both locally and nationally.

Nationally speaking, there have been a few major consultations undertaken recently. The

'Young Minds Taskforce Report Consultation' and 'Youth Select Committee Call for Evidence

about Children, Young People's Mental Health' was undertaken with young people and their

families.

In 2013 the Department of Health (with other partners) led a significant engagement

exercise on improving CYP outcomes (DH, 2013).

Young people talked about mental health information still not being readily available. They

understood the value of good quality information stating that they wanted more

information online to be endorsed by professionals. They stated that campaigns about

mental health need to be as prevalent as physical health campaigns with schools being the

main vehicle for this as 82% of the 5,600 surveyed stated that school needs to educate them

to look after their mental health and prepare them for real life.

Both young people and parents recognised school staff training as an area for development

as a gateway to services ,this is echoed by our local Mental Health Question Time Panel

which highlighted a need to treatment services to be more linked into schools.

In addition to the nationally understood views of children and young people on MHEW there

have been a number of consultation exercises conducted in South Tyneside.

In 2015, the South Tyneside Young People's Parliament organised a Borough-Wide School

Council Health project. The project included hosting three events focussed on health and

wellbeing (South Tyneside Young People's Parliament, 2015). The events brought together 2

to 3 members of each Secondary School Council together to discuss a range of topics

including emotional wellbeing. The project did bring in a broader range of view as each

school council took consultation questions back to their respective schools to include all

children.

The results from the consultation identified that mental health and sexual health are the

joint top issues for young people in South Tyneside. The consultation also highlighted that

confidentiality was the biggest barrier for young people when it came to accessing support,

followed by not having enough information.

Young people identified that they'd most like to receive information at Schools and

education settings, followed by Health care services.

Following the Borough-Wide School Council Event the Young People's Parliament hosted a

workshop during Mental Health Awareness Week (commencing 11th May 2015)

The Young People's Parliament have also taken the opportunity to shape the services

delivered as part of the South Tyneside Clinical Commissioning Group's new Mental Health


Lifecycle Service. The Youth Parliament were consulted on the specification and the services

offered.

However, despite the YPP's involvement in the commissioning of the Mental Health Lifecycle

Service and a good overall knowledge of mental health in South Tyneside, young people still

struggle to understand what services are available to them locally and how to access help.

On 9th December, members of the Public Health Team met with the South Tyneside Youth

Parliament to discuss levels of awareness of MHEW in young people, the approach to MHEW

taken by schools and other universal services, and local services for MHEW. At this session it

was clear that the local offer of help for MHEW was too complicated and not widely

understood.

This is a reoccurring theme in all of the consultations; young people want transparency in

terms of how services work and to have an understanding of how services fit together. This

was further reinforced by our second round of consultation with our Youth Parliament,

Young people completed a 'SWOT (strength, weaknesses, opportunities and threats) analysis

of both CAMHS and school based support services'. There were a number of reoccurring

themes that came from this exercise. The main theme was a lack of understanding across

the board about what support was available or what would happen when they got there.

Most of the young people's comments were about accessing the service and not the quality

of the service itself which it useful in understanding future work direction.

The young people in this exercise as well as the Young Minds report also highlighted the

issue of trust when receiving treatment. They explained that continuity of staff is essential to

the service they received. They also discussed lack of partnership working as a concern with

only 42% stating that multiple services had worked well together.

A massive issue raised in a number of reports was that of confidentiality. Clear boundaries

and information for young people about what should or should not be shared needs to be

present for service delivery to be effected. This was reinforced by our local Borough Wide

School Council where confidentiality came out as the top barrier to support that young

people face.


6.0 Key Priorities identified in South Tyneside (2015) including

(brief) update: 1. To develop a single point of access Single Point of Access partially operational between the lifecycle model and CAMHS service 2. To map current provision commissioned across South Tyneside Mapping of provision complete, undertaken in partnership 3. To enhance links to Adults emotional wellbeing and mental health services Lifecyle service in place to support children and young people operational for 0-25 service 4. To develop a common language between services Ongoing: 5. To propose models of integrated working across services New Lifecyle model in place and complements the current specialist CAMHS provision 7. To develop an emotional wellbeing and mental health strategy LTP & JSNA are equivalent docs, and both focus on strategies for EHWB

8. To complete a training needs analysis Training audit has commenced with partners 9. Commission multi-agency training on emotional wellbeing and mental health concerns Training needs will be identified by the audit 10. To address some of the concerns raised with current providers to improve services Service improvement is key to the whole transformation process, and supported by robust Service Spec’s and KPI’s and monitored through NECS. 11. To map adult primary and secondary mental health services Ongoing 12. Develop information sharing protocols across organisations that work within South Tyneside Ongoing: through robust joint commissioning arrangements access to data has improved significantly across partner organisations


7.0 Future Plan In 2015/16 we developed our original five year high level plan to capture the work necessary to truly transform Children and Young Peoples mental health. In addition, the Five Year Forward View included clear requirements for Commissioners and CCG’s. South Tyneside’s forward plans capture the work outlined in both publications to ensure that we continue to make progress to transform mental health services.

7.1 Detailed Project plans

COPING

Interlink with Thrive

Model Project

Develop a proposal in relation to the roll out of a resilence

programme within schools ( linked with work from ERG)

Mapp out what was traditionally available at Tier one and

link to outcome measures within Thrive Model

Develop Proposal in relation to locality based youth group

"Particip8 specifically for young people with issues around

low self esteem .

Develop proposal in relation to multi agency training

programme . As a minimum should include Anti Bullying,

C4L, LSCB, Mindfulness training

Develop Evidence based Resource package on line to

promote self help

Identify present Early Programme offered within South

Tyneside, and establish outcome of review undertaken

and the options being considered

Deliver a Anti Stigma Campaign and General Awareness

Campaign for Children and Young People within South

Tyneside

Scope / Purchase/ Deliver a online postive mental health

programme with consideration of apps / alternative digital

tool

Improving Access to

Effective Support

Develop a user focused map outlining the pathways into

CAMHS ,which can be used for users, carers and all

organisations

Complete data analysis highlighting present health needs

of children and young people within South Tyneside

Following data analysis develop a future plan of service

design based on evidenced need

Establish the implications for providers in relation to

adopting the Thrive model

Roll out School Pilot for Mental Health Champion - with

defined specification

Ensure that there is evidence within the Health School

Programme that Early Help and Wellbeing is adequately

being reflected

Promote School Nurse Drops in as safe place to discuss

mental health issues

Ensure that there is a rolling refresher programme around

PENN training for staff

Ensure that there is involvement of Mental health

Professionals in assessment and planning in relation to

EHCP

Extend use of Peer Support Networks for Young People

and Parents - however initially map out existing peer

support

Clear pathway between each agency to be documented

Joint protocol between STFT / NTW

Each organisation to offer assurance in relation to level of

training

Map present flow of children and young people with

mental health needs across health , educuation,social care

and youth justice

Developing the WorkforceReview national guidelines around national workforce

standards to bench againsts

Ensure that Transformation plan is signed off at HWB

Ensure that the plan is Published on the CCG website

Develop a quarter update report to the Health and

Wellbeing Board

Ensure that the Joint Commissioning Group is provided a

update on a monthly basis

Ensure that the Scunity Committee is provided with

quarterly update

Coping - Focusing on

promoting resilence within

the whole system and

building capacityResilence , Prevention and

Early Intervention for

Mental Wellbeing of

Children and Young People

To be accountable and

Transparent

Making Change Happen


COPING


Model Project







low self esteem .





promote self help






Tyneside



tool

Improving Access to

Effective Support



organisations











being reflected







EHCP



support




training



and youth justice






Wellbeing Board




quarterly update






Mental Wellbeing of



Transparent



Interlink with

Thrive Model Project

Paper to be presented on the Implications for South

Tyneside in relation to the maternity Review

Review existing model and establish national

specification

Identify potential interface between life cycle model and

support to motheres and yound people

Ensure all community midwifes and health vistors have

perinatal mental health champion traing

Ensure present services have one point of access

Demonstrate through contract montoring evidence of self

referral to services

Improving Access to

Effective Support



organisations

Ensure that data provided by NTW / STFT demonstrates

clear evidence of outcome

Ensure that each agency has a clear did not attend policy

Ensure that the Crisis Concordat is clearly linked with this

plan

Ensure that there are weekly meting between NTW/

STFT / LA and there is a governace process to esculate

any issues.

Update transformation plan to incorporate health

pathways

Identify present support in relation to individuals who

self harm

Develop a commissioning overview plan on a page

following agreement of plan


training

Developing the

Workforce

Ensure that staff working with the CAMHS / Lifecycle

model are able to demonstate that staff have attended

the CYP IAPT programme




Wellbeing Board




quarterly update

Getting Help

Resilence ,

Prevention and Early

Intervention for

Mental Wellbeing of

Children and Young

People

To be accountable

and Transparent

Making Change

Happen


Interlink

with Thrive

Model

Project

Demonstrate an increase of 60 % in referral

rates across the two service

Develop a proposal in relation to meeting

the needs of children to access services out

of hours



of area

Review present support for children and

young people who are deemed to be in

crisis

Improving Access

to Effective

Support

Develop a proposal in relation to improving

access to CAHMS for LAC Children

Present a proposal in relation to embedding

the CTR process for children and young

people


access to CAHMS for LAC Children - Produce

a report that explores the current access

and outcomes for LAC children


Develop a quarter update report to the

Health and Wellbeing Board

Ensure that the individualised package of

care commissioned services are meeting the

needs of children and young people within

Sotuh Tyneside

Ensure that the Joint Commissioning Group

is provided a update on a monthly basis

Ensure that the Scunity Committee is

provided with quarterly update

Getting Help

Getting

Help

Resilence ,

Prevention and

Early Intervention

for Mental

Wellbeing of

Children and

Young People

Making Change

Happen


Interlink

with Thrive

Model

Project

Demonstrate an increase of 60 % in referral

rates across the two service



of hours



of area



crisis

Improving Access

to Effective

Support


access to CAHMS for LAC Children

Present a proposal in relation to embedding

the CTR process for children and young

people


access to CAHMS for LAC Children - Produce

a report that explores the current access

and outcomes for LAC children





care commissioned services are meeting the

needs of children and young people within

Sotuh Tyneside

Ensure that the Joint Commissioning Group

is provided a update on a monthly basis



Getting Help

Getting

Help

Resilence ,

Prevention and

Early Intervention

for Mental

Wellbeing of

Children and

Young People

Making Change

Happen


ensure that there are clear protocol and

procedures in place which ensure that all

children / Young people who are in crisis

has a clear crisis intervention plan in place

Develop a proposal around a multi agency

model of crisis intervention across agency

Review bed usage within inpatient service

and develop and implement a strategy on

inpatient bed usage.



crisis

Improving

Access to

Effective

Review NTW proposal in relation to eating

disorder services

Identify perinatal mental health model of

care in early setting




care commissioned services are meeting

the needs of children and young people

within Sotuh Tyneside

Ensure that the Joint Commissioning

Group is provided a update on a monthly

basis



Getting Risk Support

Getting Risk

Support

Resilence ,

Prevention

and Early

Intervention

for Mental

Wellbeing

of Children

and Young

People


7.3 Next steps

The refresh will be formerly discussed at the Joint Commissioning Health & Wellbeing group in

November 2016

The refresh has been signed off formerly discussed at the CAMHS Transformation Board in August 2016

Plans will be edited into a plain English version to ensure that it is accessible to all.

A summary document that outlines the plans will be developed following full assurance, and sign off from all partners

The plans will be made available via website.

Links to the plans will be made available on Local Authority websites.

child and adolescent mental health service transformation plan … · review child and adolescent...

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