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Andrew Clarke National Implementation Lead

Specialist Child and Adolescent Mental Health Services for High Risk Young People with Complex Needs. (Community F:CAMHS). Andrew Clarke National Implementation Lead National Specialised Commissioning Team – Mental Health & Health and Justice NHS England Dr Heidi Hales

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Andrew Clarke National Implementation Lead

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  1. Specialist Child and Adolescent Mental Health Services for High Risk Young People with Complex Needs. (Community F:CAMHS). Andrew Clarke National Implementation Lead National Specialised Commissioning Team – Mental Health & Health and Justice NHS England Dr Heidi Hales Consultant Adolescent Forensic Psychiatrist North West London FCAMHS

  2. Overview of Health and Justice and Specialised Commissioning Workstream • Mental Health and Dementia Programme • CYP MH Transformation Programme • CYP MH Transformation Workstream

  3. Background: FiM and the Programme • Future In Mind (2015) identified key themes, fundamental to creating a system that properly supports the emotional wellbeing and mental health of children and young people: • Promoting resilience, prevention and early intervention • Improving access to effective support – a system without tiers • Care for the most vulnerable • Accountability and transparency • Developing the workforce • The Five Year Forward View for Mental Health (February 2016). Strategy setting out priorities to improve mental health care across the whole NHS. • Implementing the Five Year Forward View for Mental Health (July 2016) outlines the plan for delivering the recommendations set out in the Five Year Forward View for Mental Health • The Programme is funded by £1.4bn pledged to improve children and young people’s mental health outcomes between 2015-16 and 2020-2021. • The Workstream sits within and reports to the national Programme for vulnerable groups.

  4. Outline of Workstream Projects Workstream Project 1: Specialist Child and Adolescent Mental Health Services for High Risk Young People with Complex Needs (Community Forensic CAMHS). This project focuses on developing small and discrete Community F:CAMHS teams. Improving pathways and transfers between local services and reducing out of area placement or the reliance on admission to secure care. Services are targeted towards CYPs with complex, high risk presentations, beyond the traditional Tier 3 remit. Workstream Project 2: Development of a Framework for Integrated Care for the Children and Young People’s Secure Estate (SECURE STAIRS). A whole system approach to integrated care within the Children and Young People’s Secure Estate. Drawing from Trauma Systems Therapy, Enabling Environments and Psychologically Informed Environments. Workstream Project 3: Collaborative Commissioning Networks (CCN). The development of CCNs across England to enable full clinical pathway consideration for children and young people in contact with Health and Justice commissioned services.

  5. Summary One Programme One Workstream Three Workstream Projects One Complex Cohort High Harm, High Risk, High Vulnerability Children and Young People

  6. WP1: Specialist Child and Adolescent Mental Health Services for High Risk Young People with Complex Needs (Community F:CAMHS) • DevelopEngland-widespecialist child and adolescent mental health services for high risk young people with complex needs. • Improve pathways and transfers between local services and secure inpatient services. • Develop a secure outreach provision to support and compliment the work already provided by mental health providers within secure settings to continue such work after discharge. • Focus on children with complex high risk presentations in a range of settings who are giving cause for professional concern and are beyond traditional Tier 3 Children and Young People’s Mental Health Services remit. • Improve mental health and wellbeing for the cohort in question.

  7. Community F:CAMHS - Where Did We Start?Map of ‘Highly Specialist’ Community F:CAMHS Services (after Dent et al. 2013) and National Mapping and Proposed Service Model

  8. National Service Specification for F:CAMHS

  9. Community FCAMHS: what is it? A regional specialist service for young people with high risk behaviours who are: • under 18 years old at the time of referral (no lower age threshold) • presenting with severe disorders of conduct and emotion, neurodevelopmental or serious mental health problems or where there are legitimate concerns about the existence of such disorders • usually involved in dangerous, high-risk behaviours towards others whether they are in contact with the youth justice system or not • in exceptional cases, are not high risk (not primarily dangerous to others) but have highly complex needs (including legal complexities) and are causing major concern across agencies

  10. Community FCAMHS: who is it for? :the young people in question high rates of mental health and neurodevelopmental disorders high rates of co-morbidity (complex needs) high rates of substance misuse high rates of special educational needs high rates of previous abuse high rates of risk to others high rates of self-harm high rates of multiple agency involvement

  11. FORMULATION The importance of having a holistic formulation not just a simple diagnosis Concepts TENSION SEE-SAW Understanding and acknowledging the tension between caring for the person and managing the risk – that is often placed in different clinicians ANY DOOR …. Support the young person knock at the door they like best – to access the service they need EMPOWERING LOCAL TEAMS With collaboration, co working, training, support and supervision SYSTEMIC WORK Review the whole system around the child

  12. Outline Model for Community FCAMHS: integrated liaison model Substance Misuse Services Young sex offenders Youth Offending Teams (YOTs) Liaison & Diversion ForensicChild & Adolescent Mental Health Team “Looked after” sector and ‘welfare’ secure accommodation Courts Custody (commissioned in-reach OR good liaison with in-reach teams) National Adolescent Forensic Inpatient Services Locality and other Specialist CAMHS Education

  13. FCAMHS Clinical Model

  14. Referrals can come from any professional, including:

  15. What Community FCAMHS offers? • Advice, consultation, assessment, support with interventions to - • support the team with their management plan • support positive risk taking • avoid • Secure placement • YJS involvement • School exclusion • To be a second opinion in complex cases

  16. What Community FCAMHS offers? (2) • Supporting transitions: • in and out of secure placements • Between children’s and adult services • Training resource for front-line workers • Informing and developing strategic links between local mental health services and the youth justice system • To be an interface with the Youth Justice System • With local services, identifying gaps in provision and developing allied services

  17. Catchments for Regional Community F:CAMHS 2017-2018 and National Progress North of England North East* (including north Cumbria and parts of North Yorks) Midlands and East of England Wessex London South East South of England

  18. Community F:CAMHS KPIs Referrals received, and those that led to either indirect or direct case involvement

  19. Community F:CAMHS KPIs Cases receiving feedback from a referrer/other professional

  20. Monthly KPIs • Quarterly Financial Tracker • Anna Freud Centre Evaluation Commencement: April 2018 – March 2021 • A range of questions will be addressed in the evaluation, including: • What are the characteristics of young people accessing F:CAMHS? • What are the outcomes and experiences of young people? • What are the experiences of staff, including referrers? • What is the cost effectiveness of F:CAMHS? • A mixed-method realistic evaluation with five sources of data. Next Steps • Data collection of staff surveys commenced September 2018 • Draft Report – December 2019 • Interim Report – March 2020 • Final Report - March 2021. • NHSE Long Term Plan

  21. Case Vignettes Dr Heidi Hales

  22. FCAMHS / Secure healthcare Interface

  23. FCAMHS / Secure healthcare Interface What would be helpful? Quick Information Sharing - From local GP, YJLD, FCAMHS into prison services of history /background From secure healthcare teams of dates of meetings Good Liaison between all services What would be helpful? Quick Information Sharing – From local FCAMHS and CAMHS about what is possible for follow up care From secure healthcare team of diagnoses and care in custody and risk information Good Liaison between all services

  24. Thank You Andrew.Clarke14@nhs.netheidi.hales@nhs.net

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