Primary Mental Health Team - Wirral CAMHS- Cheshire & Wirral Partnership NHS Foundation Trust

Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference

In 2016, Future in Mind awarded Wirral CAMHS Primary Mental Health Team (PMHT) funding for their service transformation plans. In order to better support their pupils, schools in Wirral said they would need information related to signposting, immediate access to CAMHS advice, resources and training. The team developed a new approach which focused on a training and consultation model in a bid to support 131 schools & parents, social care, health and third sector agencies within the Wirral.We currently offer the following:

Our current flagship co-produced work is ‘The Peer Education Project’ which has been running for five years. Following community consultations offered to all schools in the locality, young people told us they wanted to be educated about mental health by their peers. To meet this need, we co-developed a programme whereby senior students receive professional training in Mental Health First Aide then work with the team to co-produce school-wide education sessions delivered by the students to the wider student body. The project develops young people’s understanding of mental health while also promoting resilience and reducing stigma. Evaluations show significant reductions in stigma and an increase in understanding around mental health as well as subjectively reporting that information feels more relevant to them when communicated by peers.

We have recently launched ‘Helping your child thrive’ workshops for parents co-produced with parents. Following a number of focus groups we identified that parents were requesting training around resilience. Since April 2018 we have delivered the workshop to over 700 parents with evaluations being overwhelmingly positive in terms of increased understanding and confidence around mental health. We are now in the process of training parents to co-facilitate these ongoing workshops in schools and community hubs.

We distribute our resource pack (formatted according to THRIVE model) which contains signposting information to young people, schools, parents and the CYP workforce. The resource pack contains a list of websites, self-help resources, organisations as well as crisis support.

The team work in partnership with local schools with each school assigned a named PMHW. We work to develop the whole school approach to mental health, thereby improving resilience and emotional wellbeing of young people in schools. Working in this way often allows us to link in with other professionals from the CYP workforce within the school environments and with our focus on partnership working ensures holistic information about the young person is made available to all professionals involved in a case.

After a round of community consultations, one of the key needs parents and partner agencies identified was for immediate advice and support. To this end, we began to provide access to immediate advice by launching an advice line (open 9am-10pm Monday to Friday and 12pm – 8pm Sat-Sun). This advice line is open to anyone who would like support regarding a child or young person’s mental health. We complete approximately 2000 telephone consultations per year. The outcomes of which are direct referrals into CAMHS, telephone support, signposting to other services or provision of resources.

The PMHT also delivers a minimum of 2 training sessions every month. In a true partnership model these training days are co-facilitated by head teachers, wellbeing professionals employed by schools and/or service users. The attendees include teaching staff, pastoral workers, social care and third sector agencies whose primary aim is to support CYP. Topics include anxiety, attachment, challenging behaviour, parental mental health, Next-Step cards (communication tool) self-harm and suicide, eating disorders, learning disabilities, bereavement, skills groups in schools (Managing emotions & theraplay based groups), trauma, mental health awareness & resilience.

We also offer whole school mental health awareness training

Co-production is a vital part of the PMHT approach; we run our localities ‘Listen Up Group’ which is a forum for young service users to review and feedback on developments in CAMHS. This has resulted in co-produced designs for trust buildings, routing service documentation and our ‘MyMind’ website. We are currently facilitating consultations between graphic-designers and service users to coproduce artwork for the relaunch of our site. Over the last year we have introduced a further listen-up group for parents.

Quality improvement is embedded in the culture of the project. We regularly and routinely use PDSA & reflective cycles, evaluations and LEAN thinking, to guide continuous improvements.

Following the set-up of the team and implementation of these co-produced projects we have seen consistent positive outcomes, including 40% reduction in children and young people being admitted to paediatric wards for risk assessments, a 2% reduction in young people being referred for therapeutic treatment, and we are 7% behind the national average of increasing referrals consistent over several years.

What makes your service stand out from others?

Our service stands out from others because we consult with stakeholders prior to any service development as well as innovating developments based on their views;

Schools told us they wanted access to immediate advice, therefore we established the CAMHS Advice Line.

Schools, Social Workers, Health Visitors and School Nurses told us what mental health training they felt they needed, therefore we established the rolling training programme based on this need

Young People told us they wanted to learn about mental health from their peers, therefore we established the Peer education project.

Parents told us they wanted mental health awareness workshops that focused on resilience and emotional well-being rather than mental illness, they wanted these to be run in the community and co-facilitated by parents. Therefore we launched our ‘Helping Your Child Thrive’ workshops in schools and community settings and are currently recruiting parents to train to be co-facilitators.

We co-produce and co-deliver all our training sessions with service users, experts by experience volunteers, or colleagues from education. One of our most common points of feedback is that hearing service-users personal stories is very powerful.

We have established very positive relationships with education – over 85% of all Wirral schools have attended 1 or more of our training sessions, we have strong links between the ‘PMH Link Worker’ and the schools’ ‘Emotional Wellbeing Lead’. Most schools use and promote the CAMHS Advice line to their parents as well as utilising self-help resources the team have provided.

We commit to continual service improvement to improve the mental health of children and young people in the Wirral, using Quality Improvement methodology and principles

How do you ensure an effective, safe, compassionate and sustainable workforce?
We believe that it is important to provide a service which promises mental health support and advice from experienced mental health practitioners. Therefore, we have ensured that the PMHT workers are all band 6 and all have relevant experience within a CAMHS service. Our PMHT all have significant experience giving advice, working with varied stakeholders & contains specialists in a variety of therapeutic interventions, e.g. CBT, EMDR, DBT and Theraplay. This ensures a unique depth and breadth of experience is provided to the locality. Research has demonstrated that, mental health practitioners who work on telephones and in community settings are more likely to experience burn out, it has been imperative to appropriately provide the clinicians with a range of methods of working, currently our staff: Work 2 days per week on the advice line. Provide consultations for schools Develop and deliver training for teachers, social workers and parents Deliver bespoke training Contribute to our co-production projects Risk assessments on the children’s ward 1:1 therapeutic work Supervising student placements This diverse method of working has provided our staff with a variety of additional experiences allowing them outstanding and continual professional development. Not only are these individuals maintaining their clinical skills, they are also developing skills related to developing and delivering training along with working in partnership with the community. Furthermore, all CWP staff have access to professional development training which the team utilise regularly ensuring they are fully appraised on interventions and pathways within the service, meaning advice is high-quality and up to date. We also provided additional staff training to the service such as for the advice line. In order to ameliorate the impact of the high demand and intensity of the work, we place staff wellbeing at the forefront of our thinking and planning, including when calculating team capacity. CWP has excellent recruitment and retention rates as well as having strict supervision policy ensuring all staff are offered both clinical and managerial supervision at regular intervals. In addition to careful planning, the team regularly engages in reflective practice, which allows the them to learn from their experiences and those of their peers. E.g. reflections are completed post-training. These reflections are documented and used for improvements to the service and training programme We also have weekly team meetings, which allow the team time to come together and focus on service development, as well as ongoing projects within the team. This regular contact also provides protected time to discuss any difficulties and explore ways to support our staff which is a standing agenda item. The PMHT also has bi-annual team away days which provides time for the staff to come together, think strategically and boost morale. Staff on the advice lines have access to regular debriefs throughout the day and a monthly reflective practice group.
Who is in your team?	Band/grade	Number	Whole-time equivalent
Team Manager	7	1	1.0
PMHT Workers	6	6	5.4
Clinical Support Worker	3	2	1.8
Admin/Staff	3	1	1.0

Do you share your work with others? If so, please tell us how.

The PMHT advocates that our work is disseminated to as wide an audience as possible. When we first launched our service we ensured that all schools and CYP organisation were invited to our launch event and we have continued to develop our relationships.

We attend termly meetings with the schools in our area and provide them with resources and support allowing them to promote mental health and wellbeing in their schools. Furthermore, we also facilitate accelerator school meetings where schools will come together and share best practice with each other. During these meetings we also provide advice and examples of best practice within our service as well as organising networking events which promote a whole school approach.

We co-produced a World Mental Health Day celebration book asking all schools in the locality to share their events from the day and photographs. This was then professionally collated and bound before disseminating to contributing schools and within the service. This has been very well received fostering relationships & encouraging service engagement.

In order to share our resource packs, which collates all forms of support and help in to a concise directory, we distribute these at our networking events, training events (2 every month), termly meeting with schools, via the advice line and at market stall events. We have co-produced these with the Early Help Team and it is also distributed on our MyMind website. This creates a seamless service where Early Help embedded and accessible throughout the locality feeding into referral pathways and community support.

We are currently building the presence of the team on social media. We photograph and tweet at all of our training events with schools and the CYP workforce. We are in communication with several local agencies regarding facilitating a message board for local agencies and our twitter feed is also hosted on the MyMind website ensuring the whole community is informed about the work that goes on.

Sharing our work with other teams in Wirral CAMHS and those in other mental health teams is important. We attend regular meetings with PMHTs across CWP, during these meetings we share our current projects and we have also developed a resource database which is now used by all PMHTs in CWP. As such resources are kept up-to-date and quality is assured. We also have close relationships with the partnership teams in Wirral and we share our work and results with them via quarterly and annual reports.

We are improving the provisions which we offer to parents/carers whose children experience mental distress. We have organised several focus groups with parents/carers and disseminated a survey across the Wirral, exploring what provisions would help them support their children. We presented our finding to parents at the parent strategy presentation day.

We have always shared our work with those outside of Wirral and CWP by attending conferences and events all over the UK. This allows us to share ideas and build links with other services nationally. We have attended the Primary Mental Health regional conferences, ‘Health Futures Network’ (North West mental-health professional conference run by Chester University), SEND events, iThrive and British Psychological Society (BPS) conferences.

What outcome measures are collected, how do you use them and how do they demonstrate improvement?

Ensuring that our service is appropriately evaluated is imperative as PMHT utilises PDSA cycles reviewing all aspects of the service.

Currently we produce annual and quarterly reports which have been subject to continual improvement and now contain information regarding consultations on our advice line, our feedback for training and psychoeducation groups within schools. These include demographics, volumes, service improvements and their statistical impact, descriptive and brief inferential statistics and brief thematic analysis of feedback. This has allowed us to work in a flexible way and adapt intelligently to shifting and newly identified needs in the locality.

Our advice line consultation data includes information such as call volumes & durations, the nature of the call, caller and outcome. This data helps to examine prominent presenting difficulties as well as how to better support our predominant callers. We also collect qualitative data regarding the service from each caller after the consultation is completed which is reviewed at team meetings and included in reporting. This data helps us to ensure that our service is meeting the immediate needs of local residents in terms of accessibility and quality of advice & support.

We also evaluate all of our training programmes; this data explores aspects of the training which attendees found useful as well as satisfaction with training and confidence working with young people on the topic before and after the training. This data allows us to monitor the effectiveness of the training ensuring value is provided.

Qualitative data is reviewed in the reflective session immediately after the training, minuted, recorded & re-reviewed when preparing training and used to make improvements prior to the next session on the same topic. We also review this data at later intervals, such as our away-day planning session, to evaluate the long-term impact of training.

Similarly, we also evaluate our skills groups and workshops. Here we measure wellbeing before the start of the workshop and after the final session, session by session satisfaction and use a workshop questionnaire for the teacher who helped facilitate the group. This helps us to demonstrate that our projects have a positive influence on wellbeing and that the facilitators are able to continue running the workshop within their school. Therefore, schools are provided with skilled teachers who can facilitate these types of group and continue with robust outcome measures.

We have also measured outcomes for our Peer Mentoring Project; this has included measuring individuals understanding of mental health before and after the peer education programme. This includes young people trained as Peer Mentors who co-produce the psychoeducation and those who they educate. Analyses show similarly substantial increases in understanding of mental health following the project for all involved. This would suggest that mental health first aid has greatly improved individuals understanding of mental health and embeds this understanding within the community at a peer-to-peer level, with a view to reducing stigma around mental health.

Has your service been evaluated (by peer or academic review)?

The Annual Wirral Schools survey collates the experience of the service by Wirral schools; the response since the implementation of the project has been that the needs of schools were being met for training, advice and consultation.

How will you ensure that your service continues to deliver good mental health care?

The focuses of the project is to upskill and develop confidence in our parents/carers and the CYP workforce allowing them to facilitate resilience and wellbeing in our young people. In all co-produced work within the community we ensure that the projects are forward thinking and are resilient to change. Therefore, we establish links between roles rather than individuals; this ensures multi-agency working operates seamlessly during staff changes. We also encourage that multiple attendees per organisation are upskilled and learning is cascaded within the trainees agency ensuring skills provided are retained within local organisations.

Following training, the attendee will return to their school and feedback what they have learnt from the session. This method of cascading best practice to all staff and inserting skills into the local agencies systems as well as staff members changes approaches and understanding of mental health indefinitely. We use a database of who has been trained to monitor this, both in terms of schools and individuals trained. By ensuring that we all take responsibility to prevent and identify mental health difficulties, pressure on specialist CAMHS and adult mental health services are alleviated via building resilience and early identification within schools and the community sustainably.

Individuals having an advice line consultation where the outcome is not referral into specialist CAMHS receive telephone support and signposting to community services. This information giving from experienced staff ensures that individuals who do not meet criteria for referral receive high-quality mental health support and signposting that was not previously available.

The project has built on a very fruitful relationship with local commissioners, and other agencies, which will be positive as the project nears its conclusion and sustainability planning phase. We continue to monitor our progress through a variety of different measures. These findings so far have been extremely indicative that our project has the potential to reduce admissions to paediatric wards as well as necessity for therapeutic interventions. We continue to disseminate our findings to commissioners, other agencies and services with the NHS.

What aspects of your service would you share with people who want to learn from you?

During the transformation journey we have encountered several challenges. The project was ambitious as we sought to provide provisions to 131 schools, as well as supporting approximately 72,000 children with a relatively small team. In order to achieve this it was necessary to gain support from CYP workforce.

This proved difficult as we initially had to combat the negative stigma associated with CAMHS due to long waiting lists for both assessments and support. Furthermore, it was necessary to develop joint goals with education as our services have different objectives and face distinctive challenges. This required us to demonstrate the benefits of us all making mental health our business as opposed to reliance on specialist mental health services. In order to upskill the workforce we provided our advice line, monthly training, termly meetings and resources. Through effective support we have been able to develop a better working relationship with the CYP workforce and they now champion the project.

Now we have developed strong working relationships with CYP workforces, and we regularly meet to discuss how to further improve our provisions. Occasionally, it can be difficult to get everyone in the same place at the same time due to conflicting diaries. However, through flexibility and persistence we are able to make this work. Collaborative working has been pivotal in allowing us to provide a service which meets the needs of parents/carers, CYP workforce and young people.

We would like to advocate that persevering and adapting to challenges in order to promote collaborative working is hard. However, without the support of the CYP workforce we would be unable to have effectively transformed our service and provided support to as many people as we have.

Additional Questions

The following questions are an opportunity for you to provide further details on how you implement positive practice in your service delivery and how you ensure your service is advancing access and equalities. Answers to these questions will not influence how your PPiMH awards application is assessed, however any responses received may contribute to the potential inclusion of your service/team as a positive practice example within published guidance developed by NCCMH and NHS England.

How many people do you see?

We complete approximately 2000 telephone consultations per year on the Advice line

We provide approximately 150 school consultations meetings a year

We provide a minimum of 20 training days to the children’s workforce per year (35 places each – 700+ places per annum)

We provided 10 bespoke whole school training sessions last year

We rolled the Peer Education project out to 11 secondary schools 2018/19

We will deliver 75 mental health awareness workshops to parents in 2018/2019 and have already trained over 700 parents.

How do people access the service?

People can access our service by contacting our advice line number. We have promoted the advice line in all schools and organisations across Wirral, asking them to provide this to parents. We promote the advice-line as the next point of contact after reviewing Early Help resources hosted on our improved MyMind website.

We’ve recently visited the most-frequent GP referrers on the Wirral encouraging them to share our number with families which preliminary review has shown improvements in the detail of our consultations. We regularly set up market stalls at existing events to promote mental health awareness. We are on the Wirral’s Local Offer website and we have also promoted our service via posters & flyers with GP’s surgeries and hospitals in the area

Parents access the workshop via their child’s school.

How long do people wait to start receiving care?

Support from the advice line is anything from immediate up to 2 days wait for a call back. We are actively working on our call back list and this has been supported by our out-of-hours advice line which extends the line from 9am till 10pm Mon – Friday and 12 – 8pm Saturday to Sunday via the out of hours advice line. There are very few people who have to wait over 48 hours for their call to be returned.

How do you ensure you provide timely access?

We ensure that our advice line is operated by a minimum of 2 mental health clinicians and this can increase to 3 if necessary. We also now have an out of hour’s advice line so we can provide support to parents at a more convenient time for them. We continue to monitor the call volumes and we will organise staff levels in accordance.

We’ve implemented a new telephone triage role as of November 2018 to answer and prioritise calls based on risk identified. This has led to substantial positive feedback from regular users of the advice line

**What is your service doing to identify mental health inequalities that exist in your local area?**

Our service seeks to identify & reduce inequality of mental health provisions in Wirral – we have identified the 40 schools with the highest levels of disadvantaged children, and are forming stronger alliances with these schools to provide additional mental health training and consultations. The rolling training programme and parent workshops aim to increase the early identification of mental health problems in children and young people, and the children’s workforce are then supported to offer early intervention

What inequalities have you identified regarding access to, and receipt and experience of, mental health care?

We are actively working closely with our CAMHS Learning Disability (LD) services to ensure that our number is distributed to the people who are using their services and are working with them to ensure that our telephone manner and skills are appropriate for this client group. Annual training is now also provided to all advice-line staff on LD issues by the CAMHS LD team. This serves an important function as LD populations experience inequalities not only in service provision but accessing services, ensuring this is as smooth as possible cannot be overstated. Furthermore, we we distribute our advice line number with organisations who advocate and support individuals at risk of inequality such as our large local charity ‘Wirral Multicultural Organisation’.

CWP CAMHS has several priority referral pathways for local groups identified as having either specialist need or reduced access to services. E.g. gendered services (men’s, women’s & trans), eating disorders etc. Our team has helped to identify and advocate for these specialist needs as the presenting issues and inequalities are often identified in schools and the community and fed into CAMHS through us. Our advice-line prioritises referrals from groups identified as at risk of inequality, further disadvantaged groups are discussed as identified and access is afforded where required. It also ensures that clinicians are apprised of sensitive issues in detail prior to their first face-to-face contact with service users, improving the service user journey and experience.

Our training programme is produced and reviewed to best-fit the reported mental health difficulties in young people living in the area, particularly those with a learning disability or eating disorders.

**What is your service doing to address and advance equality?**

Our service adheres to the relevant legislation which promotes equality. We have developed a relationship with The Proud Trust and they provided LGBT training for schools and some CWP staff. This training helped to reduce stigma and raise awareness of difficulties experienced by members of the LGBT community. As well as highlight that individuals within the LGBT community are at greatest risk of suicide.

We have also worked hard to improve understanding and reduce stigma associated with mental illness, we have done this via our training, Peer Mentoring Project and advice line. These projects include LGBT issues helping to reduce stigma and we talk directly about stigma as a core part of all of our trainings. Research shows stigma reduction is more effective when information is provided by peers or in-group members which is part of the great value of our Peer Education Project and fits with our mission to work in partnership, effectively creating an ‘in-group’ of local professionals in the CYP workforce.

We facilitate a training workshop at the annual Wirral ‘Children in care’ conference, exploring the mental health needs of children in care. This workshop is co-facilitated by a care leaver

How do you identify the needs of a person using the service?

Individuals who contact the advice line are offered an initial consultation over the phone. This consultation is conducted by a band 6 mental health professional (including mental health nursing and social work) that has specialist training in the assessment of mental health. The assessment incorporates a holistic approach including examining the influence of physical, psychological, emotional and social needs on one’s mental wellbeing. These assessments often take around thirty minutes to complete and following this the individual will be signposted or referred to the appropriate service.

We assess the needs of professionals through our regular review meetings, training requests and evaluations. Professionals consistently report their networking opportunities at our training events add significant value and this often allows professionals to identify need in their own organisation based on the good practice of other schools (such as lack of LGBT provision as discussed). We receive this feedback verbally and on our evaluation forms and pass the information back to specialist CAMHS which greatly informs our service insights into the locality as a whole.

How do you meet the needs of people using the service and how could you improve on this?

Firstly, we know that the service we provide appropriately addresses the needs of our young people, parents/ carers and CYP workforce because we have asked them what support would be most helpful and evaluated the services provided making sure that our feedback meets our stated aims. Our feedback shows that we meet our aims consistently on the multifarious projects the team undertakes.

School staff told us that they required signposting support, access to advice, resources and specific training. We have ensured that prompt advice and support is offered to all via our advice line, as well as providing training on a monthly basis on the topics they identified.

We disseminate our resource pack which contains signposting information at all our events and via the advice line. We have also co-produced a database of useful resources with bordering localities which has been uploaded to our website and is sent following consultations.

We continue to monitor the effectiveness of these provisions by conducting focus groups and distributing surveys as well as using qualitative data from our link-worker meetings and reflections from our face-to-face training to monitor the needs of those who use the service.

What support do you offer families and carers? (where family/carers are not the service users)

Parents/carers have access to our advice line; here they have the opportunity to talk to a mental health professional about a child or young person. During this consultation, the clinician is able to conduct a short assessment of the young person’s mental health to advise the caller on the best course of action. We provide resources and advice as well as being able to refer young people to specialist CAMHS or other local third sector agencies if necessary. We also provide parents with our resource pack which contain all validated local organisations which they can access for support.

Families and carers are also afforded the opportunity to meet staff face-to-face at market stall events within schools, at parent’s evenings and community events throughout the locality. We are proud to keep up our attendance at these events through motivation of staff despite a busy events schedule for every team member.

Our resource pack is also available to families and carers on our ‘MyMind’ website which is under continual improvement. The site will eventually host the majority of resources held on our database that has been co-produced by the inter-locality task group.

Further information

Is there anything else you want to share about what makes you an example of positive practice?

We believe that best practice is hinged on collaboration and co-production. In order to successfully meet the needs of the community; we will continue to put young people, their families and the CYP workforce first when transforming services. We will seek out their needs, amplify their voice and provide a service that works for all in our local area.

Population details

Brief description of population (e.g. urban, age, socioeconomic status):

The service provides mental health support and psychoeducation for anyone supporting a child or young person who lives within Wirral, (approx. 72,000 young people). Due to diversity of Wirral’s population we support individuals from a wide range of socioeconomic and environmental backgrounds. Four of the 20 highest neighbourhoods in terms of service users experiencing clinical depression fall in our locality and are linked to the deprivation and ACE’s there. Yet conversely some of the most expensive residential property in the north of England and several high performing fee-paying schools are also situated on Wirral. We keep these high levels of inequality in mind when developing services. The aim of the project is to increase access to CAMHS expertise through training and consultation. The aim of the project is to upskill the children’s workforce & parents in mental health, based on the principle that mental health is everybody’s business

Size of population and localities covered: The service covers the Wirral area:

We offer training and consultation support to 131 schools (Includes; special, alternative, independent & 16+ provision)

We provide bespoke training to professionals working with young people

We also provide training and consultation for other professionals in the children and young people’s (CYP) workforce.

We provide bespoke mental health awareness workshops for parents.

We hold regular meetings with schools to develop the whole school approach to mental health.

We work closely with identified ‘Accelerator Schools’ who cascade learning to their colleagues.

Our advice line provides immediate access to support & advice for parents & professionals alike (Mon- Fri 9am-10pm and Sat- Sun 12-8pm).

Commissioner and providers

Commissioned by (e.g. name of local authority, CCG, NHS England): Wirral CCG

Provided by Cheshire Wirral Partnership NHS Trust

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Primary Mental Health Team – Wirral CAMHS- Cheshire & Wirral Partnership NHS Foundation Trust

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