Extended Hope helps young people and their families to come through a distressing period and receive community treatment and support. It bridges a gap in provision by providing an out-of-hours response to support young people aged 11-18 in emotional and mental health crisis and brings together health and social care expertise to help individuals whose needs cannot be met by one agency alone.
From start: Yes
During process: Yes
In evaluation: No
PP Collaborative: Yes
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Rob Berry - Communications Officer Surrey and Borders Partnership NHS Foundation Trust
Extended Hope helps young people and their families to come through a distressing period and receive community treatment and support.
It bridges a gap in provision by providing an out-of-hours response to support young people aged 11-18 in emotional and mental health crisis and brings together health and social care expertise to help individuals whose needs cannot be met by one agency alone.
The need in Surrey was clear: 28 adolescents were detained in a police cell due to mental health needs (Jan-July 2014); Nine individuals were admitted to an adult psychiatric ward due to lack of appropriate adolescent provision (April 2013-March 2014); 270 service-users were admitted to a paediatric ward due to deliberate self-harm (Feb-Nov 2014)
Extended Hope provides telephone support and face-to-face assessment seven days per week, with two residential respite beds in Guildford. The service was established after a successful bid by Surrey County Council to the DfE Children’s Social Care Innovation Programme to extend the existing Hope service, which is a health/social care/education partnership, providing intensive community support/intervention/day programme.
Wider Active Support
It is run jointly between Surrey County Council and Surrey and Borders Partnership NHS Foundation Trust with ongoing transformation funding provided by Surrey’s NHS CCG collaborative. The workforce consists of social care staff/residential workers/psychiatric nurses/consultant psychiatrist.
Extended Hope provides a service for the whole of Surrey, working in partnership with the County Council and with excellent working relationships with emergency services and the broader health and care system.
Extended Hope was co-designed by parents/carers/young people/CAMHS Youth Advisers, which consists of current and previous service-users. These continue to provide valuable input on all aspects of the service.
Looking Back/Challenges Faced
The challenges which were overcome with Extended Hope are:
• A lack of provision for young people in mental health crisis out of hours
• Young people in mental health crisis attending A&E, when they would be better off elsewhere
• Tier 4 admissions to acute psychiatric care because no alternatives were available
• Admissions to mainstream pediatric inpatient care because no alternatives were available
• Breakdowns in care placements because of a lack of out of hours mental health support
The Extended Hope Service is now fully embedded into the structure of the Hope Service, becoming the third Hope site (Epsom Hope, Guildford Hope and Extended Hope). The Hope Service is a multi-agency service for young people aged 11-18 who are experiencing complex mental health, emotional, social and behavioural needs which could cause a placement breakdown or may require a Tier 4 hospital admission.
Evaluation (Peer or Academic)
A Department of Education evaluation, https://www.gov.uk/government/publications/extended-hope-project (July 2017), found the service was successful in its primary aim of providing a more suitable out of hours provision than was previously available. It also found that young people and families were more resilient and empowered in relation to their mental health and reported a better experience of services.
At an annual cost of £658,000, an independent cost benefit analysis by York Consulting in Oct 16 found that the benefit of the service in this time was more than £1.96m, saving the public purse £3 for every £1 invested, by preventing:
• Psychiatric and paediatric hospital admissions, where an alternative would have been more appropriate
• Young people attending A&E for mental health reasons
• Children in care being placed out of county
• Requests for foster placements because of a lack of respite for parents – and breakdowns in existing care placements because of a lack of out of hours mental health support
• Section 136 detentions.
Between its launch in Oct 2015 and July 2016 it handled 1,050 telephone contacts, with 196 face-to-face interventions. Two-thirds (66%) of telephone contacts and three-quarters (76%) of face-to-face contacts prevented events such as Tier 4 admissions; (A&E) presentations; placement breakdowns; or paediatric ward stays.
We have been working with colleagues in Gloucestershire to share our experience as they are trying to secure funding to set up a similar service as with commitment it is replicable elsewhere. Our service presented at the CAMHS National Conference last year and we are making a film to disseminate the approach and promote the model more widely.
Senior Extended Hope staff have also presented at internal Trust events, including the Trust’s Service Improvement Programme event and Members’ event.