‘Mental Health Matters’ is Southampton: Engagement Document Southampton’s Transformation Plan for Children & Young People’s Mental Health September 2015 Transformation Plan for Children and Young People’s Mental Health and Wellbeing Contents 1 Introduction 3 2 Mental Health Matters 4 3 Promoting resilience, prevention and early intervention 9 4 Improving access to effective support – a system without tiers 17 5 Community Eating Disorder service 30 6 Care for the most vulnerable 36 7 Accountability and transparency 47 8 Developing the workforce 57 Appendices A Consultation and Headstart 61 B Mental Health Matters 65 C Early Intervention Strategy 85 D Headstart Magazine 101 E School nursing overview 114 F Be Well Strategy 120 G GP Champions for Youth Health 121 H Options appraisal for DSH and Crisis team 126 I Secure CAMHS outreach specification 128 J Families Matters Expansion outcome plan 134 K Children’s Integration Presentation 147 L Joint Health and Wellbeing Strategy 159 M Southampton EIP summary 160 N TRIumPH Treatment and Recovery 162 O CAMHS referral and discharge data 163 P CAMHS paediatric liaison service 181 Katy Bartolomeo Senior Commissioner – mental health and substance misuse Southampton Integrated Commissioning Unit 2 Transformation Plan for Children and Young People’s Mental Health and Wellbeing 1. Introduction 1.1 Southampton City Clinical Commissioning Group, Southampton City Council and their partners from both the health and voluntary sector are committed to “promoting, protecting and improving our children and young people’s mental health and wellbeing”. Whilst there are already areas of very high quality provision within the city we recognise that dramatic and significant changes and improvements are needed in order to ensure that all children and young people in Southampton, including those with particular vulnerabilities, can easily access high quality, outcome focussed, and evidence-based services appropriate to their need, when required. 1.2 This document sets out how we will as a city, follow the national guidance set out in Future in Mind to develop services and an over-arching service model which responds to Southampton’s specific needs and vulnerabilities and makes best use of its strengths. 1.3 This is a working document which will be updated to reflect the further development of this plan for transformation such as plans specific to service design which are made in response to service user and other stakeholder engagement and consultation as part of Southampton’s Mental Health Matters service review. 1.4 This plan and future revisions will be published on the Southampton City CCG and Southampton City Council websites both to inform stakeholders of our plan and intentions but also to hold us accountable to realise these changes. 1.5 In November 2014 NHS England and the Department for Health invited proposals from CCGs to lead and accelerate collaborative commissioning arrangements for children and young people’s mental health. Southampton was successful in their bid and undertook a rapid piece of work to build on the joint commissioning arrangements between Southampton City Council and Southampton City Clinical Commissioning Group. Southampton have an Integrated Commissioning Unit (ICU) however there was more work that needed to be done to support joint commissioning to extend from just health and social care to include education, housing and youth services and also bridge the gap in commissioning between children’s and adult services commissioning. The ICU had begun to focus on bridging this gap with mental health and substance misuse commissioners that span all ages. 1.6 The long-term aim for joint commissioning is to have joined up services that cover not just health issues such as mental health, sexual health, substance misuse but also housing, homelessness, benefits, debt, employment, children in care and at risk of care, domestic violence and sexual exploitation. This has formed a significant part of the work of the ICU for the last 6 months. 1.7 The project aimed to improve joint commissioning across health, social care and education at Tier 2/3 and to also look at collaborative commissioning across the transition age span to 25. Following this piece of work and the release of Future in Mind the CCG and City Council have launched ‘Mental Health Matters’ a review of mental health services across the City. 1.8 On the 4th December 2014 Southampton hosted the first round table mental health conference that spanned all ages and was presented by the Health & Wellbeing Board, Healthwatch and supported by the CCG and City Council. 1.9 This plan sets out how Southampton intends to further develop and expand this positive work that has already begun and how it will fit within the wider context within the City’s development. 3 Transformation Plan for Children and Young People’s Mental Health and Wellbeing 2. Mental Health Matters Southampton 2.1 In 2014 Southampton’s Health and Wellbeing Board decided to do a full review of mental health services for all age groups, due to concerns being raised about current services and a wish to focus on early intervention and prevention services. As part of the review we held a mental health matters workshop event in December 2014. This event was attended by 84 individuals from NHS, private and voluntary providers, service users, carers and public health. The main feedback from this event was that people wanted the opportunity to be part of the review and have a ‘blank page’ approach. 2.2 The major themes identified at the event were as follows:  more joined up services and budgets and greater co-operation across services, that should be outcomes based rather than activity focussed  clearer and easier access and services that ‘hold’ and redirect people, actively avoiding people being ‘bounced around.  support for people in a crisis including ‘out of hour’s provision’ which responds quickly and prevents people getting worse.  stronger partnerships with service users, their families and carers – they need to be at the centre of all support. Service user and carer networks should be supported alongside peer support projects.  peoples physical and mental health needs should be addressed together and primary care needs to be better able to support people with mental health.  more support to enable people to obtain and maintain their accommodation and a wider range of housing options with a default of people having their own tenancies.  better integration across services such as those for long term conditions and substance misuse  services which are ‘ageless’, but recognise the specific needs of older adult and younger patients.  more early help and targeted support for younger people including stronger links with schools and education to help them deal with mental health issues.  more focus on prevention, early intervention and recovery/resilience and on community based solutions as a first option.  more help for people to obtain and maintain employment and social networks which increases resilience, reduces isolation and prevents crisis.  gaps in current services including personality disorders, ADHD and high functioning autism and Asperger’s addressed. 2.3 In addition to feedback obtained locally we have looked at good practice elsewhere and identified the following features for inclusion in our design:  A well-trained multi-skilled workforce which can work across and respond to the unique needs of individuals regardless of their presentation or cultural background.  Methods to help people find and maintain work such as Individual Placement Support.  A focus on 0-25 services with better transition and more aligned eligibility between children’s and adult services.  Psychological therapies which meet NICE guidelines.  Out of hours crisis services including alternatives to acute hospital admission for short periods. 4 Transformation Plan for Children and Young People’s Mental Health and Wellbeing  Rehabilitation services to support the transition back to independent living following an acute hospital stay.  Shared care arrangements with primary care which provide holistic approaches to physical and mental health.  Development of young person’s IAPT, community eating disorder services for young people and improved perinatal mental health.  Better Care Southampton – joining up care 2.4 In August 2015 engagement officially started with the publishing of Mental Health Matters which sets out proposals (offered as a first draft) for mental health services in the city and requests the views of all th stakeholders to help us to shape it further. The engagement period ends on the 16 October 2015, great effort has been taken to ensure we have engaged with all stakeholders including children, young people, parent/carers, schools and GP’s and with hard to reach groups. Comprehensive details of the groups and forums who have been engaged with can be found at Appendix A but has included:  Teen safe house – attended group to gather input  Attachment group with 20 foster carers – attended group  Sent to all head teachers, deputy heads and PSHE leads  GP and school representation on 0-19 Co-commissioning and operational group all heavily engaged with review and Mental Health matters  Solent (CAMHs provider) asked to gather input/feedback from service users  No Limits (Counselling and other CYP services provider) asked to gather input/feedback from service users – developed shortened survey monkey for CYP which has been circulated to other services to use with service users with currently 40 responses from CYP  Sent to Youth Options who have collected input from many service users  Face to face engagement at Brookvale (14-18 CAMHs) within waiting room  Mental Health Matters engagement document went to Consult and Challenge group (co-production group)  Mental Health Matters session at the GP Target day where all GPs were introduced to the review and received copies of the feedback forms  As part of the Headstart work which is integral to this there has also been a substantial amount of work and consultation (see Appendix A) including: o Imagine the Future boat trip with 250 young people from Southampton from this the top three health and wellbeing issues that they identified were, bullying, physical worries (body image – too thin, too fat) and self-esteem. o Primary head teachers inclusion group, In Year Fair Access Group attended by secondary deputy heads, series of 1:1 meetings with head teachers o ICE bus trips to schools – run by voluntary sector provider No Limits to offer a drop in session for CYP and the opportunity to fill in a Headstart questionnaire over the lunch period, results of these sessions are due to be analysed in October o Pupil survey due to happen in October which will feed into the transformation plan This review will help strengthen our transformation plan and provide a strategy that has been shaped by children, young people and their families. A copy is attached below. 2.5 Better Care Southampton – joining up care. Health and social care, along with community and voluntary organisations and other partners are working on a programme to join up care called Better Care Southampton. It involves joining up services to put patients at the centre of their own care. There is a focus 5 Transformation Plan for Children and Young People’s Mental Health and Wellbeing on prevention and early intervention and building on the role of individuals in managing their own health and wellbeing. 2.6 Better Care Southampton is working toward reorganising health, social care, housing and other services into integrated teams based around GP practice populations (called ‘clusters’) over the next five years. We are already working on how our mental health services fit into this plan and join up with other services. th 2.7 The engagement, which includes work with hard to reach groups, will end on 30 September following which the information will be evaluated and new models across mental health will be scoped. This will lead to a formal consultation December 2015 – January 2016 and implementation of new models from April 2016. 2.8 Please see Appendix B for a full copy of the engagement document ‘Mental Health Matters’. Transformation Plan Investment 2.9 Due to the timelines for the Mental Health Review it is proposed that most of this year’s Transformation Fund money is dedicated to ‘system enabler’ schemes that will allow providers to be best placed to undertaken the large scale change that is going to be required to really deliver on the vision of Better Care Southampton, the Mental Health Matters review and Future in Mind. Towards the end of 2015/16 we would be looking to identify the ongoing recurrent use of the Transformation Fund but anticipate that it will focus on crisis care, one stop shops/community based treatment/early intervention and treatment, and the development of a 0-25 CAMHS team. 2.10 We have identified 11 local priority workstreams this year as shown below: Local priority Supplement existing ED team to become evidence compliant achieving Improved waiting stream 1 times and access, improved outcomes, reduced admissions to Tier 4 £42,667 Pro-rata costing for full year effect – for staffing breakdown see Chapter 5 Local priority Implement change management programme including staff training and enhanced stream 2 administration to collect and analyse data with a focus on outcomes data both used for YP- £47,232 IAPT and CORC (CAMHS Outcomes Research Consortium) measures both to collect and use the outcomes for clinical and th erapeutic improvements Project Manager £37,691 (Consultant) Staff training and data quality audit work £8,541 linked across workstreams Local priority Non- recurrent investment in infrastructure, IT to ensure that systems are able to record all stream 3 data and easily extract it by linking to the TPP System One programme and data warehouse £38,845 development. This will also include investment in mobile systems to promote community working models. This will include IT development across transformation pathways for CAMHS to pump prime outcome measures collection and analysis. IT Consultant - £18,845 Database build and analyst time - £5,000 Software contingency for development and purchase £15,000 Local priority To extend the hours of intensive care packages and Deliberate Self Harm (DSH) support. To stream 4 pilot extended hours offer for CAMHS and support University Hospital Southampton (UHS) £50,000 to reduce admissions. Furthermore to offer a session on a Saturday and review the impact. This will support the on -call duty system for doctors and help inform future 7 day working. Band 7 nursing cover for extended hours - £16,100 Plus antisocial hours enhancement - £5,313 Band 8 supervision and liaison £15,017 Agency nursing shifts – £13,570 6 Transformation Plan for Children and Young People’s Mental Health and Wellbeing Local priority CYP and families engagement in the future development of the transformation plan and stream 5 mental health review, including hard to reach groups, work on anti -stigma and suicide £10,000 prevention awareness training in schools Local priority Employment of a consultant to project manage the development of the care pathways – stream 6 with a particular focus on early intervention and prevention agenda and the development of £53,465 a robust and detailed workforce strategy. The development of CYP IAPT in Southampton will be enhanced by having a consultant IAPT practitioner to assist this work both in developing the model and beginning the change management needed. In addition employing an assistant psychologist to undertake some of the work required for baseline audits and measures... Developing a system for identifying those falling through the gaps in whole system by looking at rejected referrals, DNA and high use of other services such as A&E and voluntary sector organisations. Project management - £37,691 Assistant psychologist – £9,517 Consultant CYP IAPT practitioner - £6,257 Local priority Pump prime improvements in IT systems and infrastructure - to allow outcomes and stream 7 minimum data set to be recorded in EIP (please note that that local priority 3 will be used to £58,000 make changes to CAMHS IT system but EIP is a different provider), to develop the ACG tool so that it is able to not only analyse data from primary care and secondary care hospitals but also from mental health providers and ambulance providers. The ACG tool can be used to analyse patient identifiable data for providers and primary care and patient level (non- identifiable for commissioners). Further development of App technology to suppo rt different care pathways to support children, young people and families and empower self - care; this will include further enhancement of the current BASE app which focusses on anxiety. EIP development – backfill to work with clinicians, development and test forms for data capture, training for clinicians to use forms, develop reporting, trial of tablet mobile platform - £28,000 ACG tool development - £20,000 BASE App development - £10,000 Local priority Supplement existing CAMHS teams to tackle those breaching current waiting time standard stream 8 and allow for the reduction of the standard from April 15 onwards. Currently there are long £67,000 delays for Autism assessments and CBT, however we have also set an ambitious target to reduce the waiting time standard from 18 weeks to 7 weeks. The funding will purchase additional sessional time with a particular focus on autism and CBT. This will also provide an opportunity to pilot Saturday clinics and some limited extension of working hours to evaluate patient feedback and take up of these services. Sessional work to address autism and CBT waiting list - £67,000 Breakdown of this spend will be dependent on intervention completed from routine (i.e. CBT) to complex (i.e. autism) and therefore flexibility is required. Sessional use of consultant @ £114 per hour plus enhancement for antisocial hours - £37.62 per hour Local priority Supplement existing EIP team with CAMHS clinicians to become evidence compliant and to stream 9 ensure that CYP are being seen within EIP teams and not remaining in CAMHS teams – £50,000 currently there are only 2 under 18’s within or EIP team. Meeting booked with EIP leadership team to consider proposals but first draft is to fund MDT sessional inpu tand pathway development to include CAMHS consultant psychiatrist sessions, menta lhealth nurse and Systemic Family Therapy sessions. Local priority AMH money and not CAMHS transformation money. Supplement existing EIP team to stream 10 become evidence compliant and meet waiting time standards £87,000 7 Transformation Plan for Children and Young People’s Mental Health and Wellbeing Local priority Improve links between CAMHS, schools and primary care services with identified CAMHS stream 11 link in all schools. To extend the primary care mental health worker role so that it extends to £26,986 all schools in the city and the development of a Schools Forum for primary schools in line with the current secondary schools offer. Introduction of engagement worker role within CAMHs to assist with these priorities and engagement including with hard to reach groups in addition to some focussed work for training of public health nurses to ensure role out across the schools in the city. Senior nursing time - £14,557 Engagement worker sessions - £12,429 8 Transformation Plan for Children and Young People’s Mental Health and Wellbeing 3. Promoting resilience, prevention and early intervention 3.1 Southampton is a city committed to prevention and early intervention, our Primary Prevention and Early Help Joint Commissioning Strategy states that Southampton’s vision is “An Early Intervention City with multiagency service provision that works to ensure children’s needs are met at the earliest stage. Where possible, and children’s welfare is assured, these needs will be met within their family and community resources.” One of Southampton City Councils seven priorities is Prevention and Early Intervention. Southampton City CCG’s ‘Plans and Priorities’ also evidence the City’s commitment to promoting resilience, prevention and early intervention, with two of the seven published linking closely to this theme: Prevention and timely support - We want to ensure that those most in need of care receive the help they need early on which may later prevent admissions into hospital with lengthy stays. Helping people manage their own care - We want to prevent, where possible, the need for more specialist services by helping individuals to better manage their own care, with help from closer working between relevant services and wider community-based support. 3.2 The Headstart programme focuses on universal help for all children and young people, together with ‘step up’ targeted support where necessary. The programme is funded by the Big Lottery whose mission is ‘to improve the mental well-being of at-risk 10 to 16 year-olds by investing up to £75m in up to 12 local partnerships to facilitate and support’. By ‘at risk’ the Big Lottery refer to children who are ‘at risk of developing mental ill-being’. Southampton is in the fortunate position of being one of the 12 HeadStart pilot areas in the UK and as such will be submitting a bid for up to £10M in February 2016 to extend the programme we have been delivering under HeadStart since the summer of 2014. Securing this funding will result in a substantial boost in the early help available to young people in a variety of settings; school, family, community and in the ever-increasing digital realm. It is important to link the Headstart project in to the transformation plan, if Southampton is not successful in the Stage 3 Headstart bid then this area of work will need to have greater focus in the transformation plan. However, if it is successful then we will need to consider how we can have equity for all age ranges as these initiatives specifically focus on 10-16 year olds. There was a recent event held in Southampton “Imagine Boxes” where 200 school pupils were consulted with on various topics including mental health and well-being. Analysis from this consultation is not yet complete but will be fed into both the Headstart programme and wider mental health review. 3.3 The Southampton mission developed by the Headstart and CAMHs co-commissioning group (details of membership shown in 6.5 on page 38) is “To raise the emotional well-being and mental health of children and young people living in Southampton;  Pre-birth to 25 years – with focus on the family  Prevention and early intervention focus  CYP are supported to find their own solutions from the options available  CYP are encouraged to lead and co-produce new solutions for themselves and others  To develop a community of practice: Adults and older CYP who come into contact with CYP are skilled identifying problems at the earliest stage and are able to support through brief interventions or direct CYP to appropriate service  Seamless provision of mental health and well-being support centred around CYP – holistic, whole system, whole place approach  Proportionate universalism approach – universal provision for all, with step up and step down support for at risk groups  Equality of provision across the city  Encourage peer support and community led approaches – with adequate training and continued support  Take a strength/asset based approach – building on what is already available with communities 9 Transformation Plan for Children and Young People’s Mental Health and Wellbeing  Ensure an evidenced based approach and where evidence isn’t available ensure innovative approaches are evaluated  Ensure development of emotional well-being and mental health is integrated within wider strategic approach to raise the health and wellbeing of CYP and families in Southampton The CAMHS co-commissioning group have designed a short survey to go to schools to enable more thorough mapping of the mental health and wellbeing services already being provided within schools and to establish the gaps the schools feel there are in the current model to inform future service and model design. 3.4 The Southampton Healthy Ambition service replaced Southampton’s school nursing service in April 2015. It delivers public health nursing, and leads delivery of the 5-19 year old elements of the Healthy Child Programme. Children, young people and families face a number of challenges in Southampton, and the size of the City’s 5-19 population is set to grow. Key priorities for the service include: emotional wellbeing and mental health, educational engagement (attainment, attendance and exclusion), physical health and healthy lifestyles, provision for high risk groups and working in an integrated way. Provision under the new service extends to embrace provision for 16-19 year olds in Further Education for the first time. 3.5 Better Care Southampton have developed a pilot to test out the role of Community Navigators, this will focus initially on; People who are frequent attenders to primary care and or urgent care services. People, who are not receiving intensive case management from a health or social care professional, but have an identified significant underlying unmet need. Risk stratified patients by the Multi-Disciplinary Team (involving primary care, community health services, social care, housing, voluntary sector). Initially focused on patients in top 2% to 5% at risk. The role of this navigation is to receive and make referrals from/to primary care and cluster teams, provide information about how to access community resources. Directly link people to activities/community resources e.g. leisure (sport, interests), employment, education, welfare rights, housing, friendship schemes, time banking schemes and volunteering to support others/co support. To provide the point of contact to access other universal services for known people, to provide active follow up of all people referred to confirm citizens are taking action, discover if the identified solution is working, identify if the person needs additional support to take action or other solutions. Furthermore to map community resources and local organisations encourage people to up load information on to either the Southampton Information Directory (SID) or Placebook and identify through a process of coproduction gaps in community resources/assets required by the community and clinical teams (linking into the JSNA and Community asset map) to improve health and wellbeing. Key Priorities Current 1. Continue to develop whole school approaches to promoting mental health and well-being. 1.1. On-going evaluation and development of Southampton’s new Healthy Ambition service to ensure school nurses are leading and delivering the Healthy Child Programme 5-19 and working effectively at community, family and individual level and that the Emotional Health & Wellbeing workers are fully embedded in the service and linking to the CAMHS team. 1.2. Work with schools to ensure a more consistent use of counsellors and the DfE’s guidance on evidenced- based school counselling across the city through Headstart work and other initiatives such as the Link Pilot Project. 1.3. Continue commitment to Headstart with a successful stage 3 bid, attracting up to £10 million funding over the next five years. 2. Develop prevention and early intervention services, including harnessing learning from the new 0-2 year old early intervention pilots. 10