CAMHS transformation funding allowed us to think creatively alongside our commissioner about how we could move CAMHS Services from the traditional model out into the wider children's services community. We know that not all children and young people with emotional and mental health difficulties are able to access specialist mental health services and therefore increasing the capacity and confidence of the wider children and young people's workforce is key to providing the help and support that many children and young people need. With this as our focus we have CAMHS clinicians embedded within children's services in Wiltshire.
What We Did
CAMHS transformation funding allowed us to think creatively alongside our commissioner about how we could move CAMHS Services from the traditional model out into the wider children’s services community. We know that not all children and young people with emotional and mental health difficulties are able to access specialist mental health services and therefore increasing the capacity and confidence of the wider children and young people’s workforce is key to providing the help and support that many children and young people need.
With this as our focus we have CAMHS clinicians embedded within children’s services in Wiltshire.
Early Help in Wiltshire encompasses a number of teams and services including YOS, Behaviour Support, Early Years, Traveller Support, LGBT Support Group, NEET workers, Integrated Family Intervention Service, Education Welfare officers, CAF coordinators, prevention Team. There are 2 full time CAMHS clinicians embedded in this team providing training, consultation and direct work jointly with the worker within children’s services. An example of where this has impacted directly on young people is the work they have done with the LGBT group that meets regularly in 3 venues across Wiltshire. They have supported one group following the death of a group member as well as giving them the opportunity to talk about their emotional and mental health in a safe way as well as some psychoeducation about a wide range of mental health issues. The Early Help practitioners also offer advice and intervention days for parents and carers about a wide range of emotional and mental health difficulties. They provide a mental health perspective to all referral that come into early help.
The parenting coordinator works with both statutory and non-statutory agencies across Wiltshire to coordinate and support the delivery of the STOP parenting programme for adolescents. She also provides consultation and supervision to the group facilitators ensuring fidelity to the model.
Thrive Hub Practitioner
Senior Mental Health Practitioners are embedded in 12 Secondary Schools in Wiltshire – this has recently increased from 6. They provide consultation and training to all staff within the school. They also work with young people either through drop in sessions, individual sessions or group work. Group work has included anger, anxiety, exam stress and self-harm. They are also working with PHSE leads to support the delivery of sessions about mental health to pupils. They are working with the pastoral leads within the school to ensure that mental health is one of the priorities within the school and that there is a positive culture around managing mental health difficulties. In one school a number of agencies working with the pupils have developed a joint drop in where pupils can see CAMHS, School Nurse, Sexual health Nurse or a young persons drug and alcohol worker. The Thrive Hub practitioner also supports the peer mentoring scheme in place in schools and in particular provide support and advice to the peer mentors.
Harmful Sexual Behaviour.
This is a recent addition to the team. It was recognised that there was a lack of specialist support to those in children’s services working with children and young people who display harmful sexual behaviour. This clinician will provide consultation, training and undertake direct work jointly with other agencies. They will develop a professional practice group where skills can be shared and developed. They will be looking a NICE Guidance and ensure that the service delivered in Wiltshire meets the required standards.
Looked After Children Therapist
A Family Therapist works with the looked after Health Team providing training, consultation and direct work. He is able to join initial and review assessments making them holistic meeting both the physical and emotional health needs of the child. He is able to ensure that should a child need a specialist mental health intervention they go directly to the most appropriate treatment within CAMHS. An example of the difference this has made has been seen in the work that he has done with 2 unaccompanied asylum seekers. He has been able to meet with them (with an interpreter) allowing them to tell their storey and to understand what their emotional needs might be. These young people would not have reached the threshold for specialist mental health support and may have gone on to develop difficulties. The early signs are that they are settling well and making good use of the sessions.
Child Sexual Exploitation
A family therapist is working with the CSE Team again providing training, consultation and direct work. He works with the team to help them understand the impact of the trauma they have experienced on their emotional and mental health and supporting them to support the young person who may not want to engage with other services. We know that for this group of young people one trusting relationship is key – the CAMHS worker supports this. This is a multi-agency team and the CAMHS clinician works to pull the agencies together to think systemically about the young persons needs. He is able to ensure that those young people who do need a specialist mental health intervention are gently introduced to specialist CAMHS and are supported to attend appointments.
Multi Agency Safeguarding Hub.
Clinicians are based within the MASH on 3 days of the week. They sit alongside social workers, police, Safeguarding Nurses providing consultation around cases that come into the MASH where there are concerns about emotional and mental health. They provide training about common mental health problems to increase awareness and understanding.
The team is managed by an access coordinator, her role is to ensure that any referral that does not require a specialist mental health intervention is offered advice about the most appropriate service and supported to access that service. She links directly to all the clinicians mentioned above where they are likely to be able to meet the needs of the child, family or young person. She attends multi agency referral meetings to ensure that any referrals that are appropriate for the Wellbeing Team or specialist CAMHS are identified
As a service we continue to work with our commissioner to further develop the Wellbeing Team responding to need expressed by partner agencies for engagement with mental health services.
We currently have CAMHS staff embedded within:
Family Therapist and Clinical Psychologist – Wiltshire Council Early Help Service – linking with 16 teams as described above.
Family Therapist – Looked after Children Health Team – Virgin Care
Family Therapist – Child Sexual Exploitation Team – Wiltshire Council
Senior mental Health Practitioners -12 secondary schools across Wiltshire
Specialist Clinician (Harmful Sexual Behaviour) – working across all Children’s Services in Wiltshire.
Parenting Coordinator – Working across all children’s services across Wiltshire
Senior Mental Health Practitioners working in the Multi Agency Safeguarding Hub
Management of this team is via the access coordinator who
We continue to meet with partner agencies to review our model of working with all the agencies where staff are embedded. A recent example of driving the service forward is at a recent review of the role of the clinicians in the MASH we agreed that CAMHS would extend their role from offering consultation, sign posting and training to accepting referrals appropriate for CAMHS directly through the MASH. The clinician will make contact directly with the family to understand their needs. This will mean that children, young people and their families will get the help and support they need in a more timely way
Thrive Hub schools have increased from 6 to 12 since the team started.
Partner agencies are invited to attend the Wellbeing Team meetings and are seen very much as part of the team shaping the work that we do going forward.
Young People were involved in the writing of the Wiltshire CAMHS transformation plan. They were consulted about what they wanted, a priority for them were services that were easily accessible and that met their needs. The Wiltshire Wellbeing Team is accessible to children and young people who do not need a specialist mental health service but who are having difficulties and want support. Young people did not specify that they wanted specialist mental health services – the Wellbeing Team works to ensure that all those who work with children and young people have a level of skill that allows them to with confidence support a young person experiencing emotional distress without having to pass them on to someone else and to have specialist support to do this.
Within CAMHS we have a participation lead and a young persons participation group. They will be supporting us to develop the trust website to reflect the work of the Wellbeing Team. They have already worked with Wiltshire Council to develop a website for young people living in Wiltshire.
At the beginning of the project we surveyed staff working within the Early help Teams about their confidence in working with children and their knowledge about young people with emotional and mental health difficulties, this is being revisited.
Looking Back/Challenges Overcome
The main challenge is that Wiltshire is a very large County and accessing teams countywide has been difficult. Use of technology including facetime has helped with this.
Some of the Thrive Hub schools have not really embraced the consultation and training model and are simply wanting the CAMHS practitioner to see all the children they are worried about. With the second wave of schools that have come on board we have been clearer about the model and what we are trying to achieve. With the initial school we are working closely with them to demonstrate the benefits of training and consultation – we are getting there!
The model is sustainable and is central to how we plan to deliver CAMHS Services within our new contract (should we be successful). All the posts are permanent. We continue to work with the commissioner to further develop this model and this is very well supported.
Evaluation (Peer or Academic)
The service is very new (less than one year) and has not yet been evaluated. As previously mentioned the Early help Practitioners surveyed staff within the early help team around confidence and knowledge and this is in the process of being repeated.
Thrive Hub practitioners have also surveyed school staff about their knowledge and confidence around mental health issues and will repeat that in the new academic year. We are capturing data about numbers of children and young people who have access the wellbeing team and numbers of consultations delivered.
Where clinicians are undertaking 1-1 work clinicians are using ROMS to measure outcomes. We have many examples of qualitative feedback from partner agencies and parents.
Any child or young person referred to CAMHS who does not require a specialist mental health intervention is supported to access the most appropriate help. Children and young people are no longer bounced around the system meaning that they get the help they needs and referrers are not left feeling frustrated and unable to help.
Within the Thrive Hub Schools young people can access CAMHS directly through a drop in service.
There are many more staff within Children’s services and schools who have directly access to consultation from an experienced CAMHS Clinician supporting them to work more effectively with a young person or family. Staff feel more confident and contained.
The Wellbeing Team can ensure that should a child or young person need a specialist mental health intervention they can access this in a seamless way that does not require a referral. They see the right person for the right treatment in a timely way.
Services are more joined up CAMHS clinicians are part of multi-agency meetings and decision making meetings where appropriate cases can be picked up or advice given. CAMHS feels more accessible to a wide range of professionals.
Vulnerable children and young people (LAC and CSE) have easy access to a CAMHS service both at prevention and early intervention level as well as access to specialist mental health intervention. Those working with them have access to specialist consultation and training to increase their capacity and confidence in identifying and working with emotional and mental health difficulties.
We share good practice amongst the very wide group of professionals working with children and young people in Wiltshire. Much of the work that we do is multi agency.