Children and Young People’s Mental Health and Wellbeing Joint Delivery Board minutes: October 2022

Attendees and apologies

• Nicola Dickie (Chair), COSLA (Convention of Scottish Local Authorities)
• Aileen Blower (AB), Mental Health and Social Care Directorate, Scottish Government
• Amanda Farquharson (AF), Integration Joint Board (IJB) Network
• Abbie Wright (AB), MSYP (Member of the Scottish Youth Parliament)
• Angela Scott (AS), SOLACE
• Carrie Lindsay (CL), Association of Directors of Education in Scotland (ADES)
• Cheryl Burnett (CB), National Parents Forum of Scotland (NPFS)
• Hannah Axon (HA), Cosla
• Judy Thomson (JT), NHS Education for Scotland (NES)
• Martin Dorchester (MD), Children in Scotland (CiS) Forum Representative
• Morven Graham (MG), Association of Scottish Principal Educational Psychologists (ASPEP)
• Paul Carberry (PC), Coalition of Care and Support Providers in Scotland (CCPS) Forum representative
• Richmond Davies (RD), NHS Chief Executives
• Rosy Burgess (RB), Scottish Youth Parliament (MSYP support)

Additional Attendees

• Lee Wilson, Service Manager on behalf of Angela Leitch,  NHS Chief Executives
• Kaydence Drayak, MSYP, Scottish Youth Parliament
• Beau Johnston, MSYP, Scottish Youth Parliament
• Maureen McAteer (MAc), Sponsor T&F group 3, Barnardos
• Ruth Miller (RM), Sponsor T&F group 3, Association of Scottish Principal Educational Psychologists (ASPEP)
• Suzy OConnor (SO), NHS Education for Scotland

Support

• David Leitch (DL), Mental Health and Social Care Directorate, Scottish Government
• Carolyn Wales (CW), Mental Health and Social Care Directorate, Scottish Government
• Elaine Kelley (EK), Mental Health and Social Care Directorate, Scottish Government
• Della Robb (DR), Mental Health and Social Care Directorate, Scottish Government
• Jean Carwood-Edwards (JCE), Professional Advisor, Scottish Government
• Leon Young, Mental Health and Social Care Directorate, Scottish Government
• Maggie Fallon (MF), Mental Health and Social Care Directorate, Scottish Government
• Peter Innes (PI), Mental Health and Social Care Directorate, Scottish Government
• Ruth Christie (RC) Mental Health and Social Care Directorate, Scottish Government
• Emma Papakyriakou, (EP) Mental Health and Social Care Directorate, Scottish Government
• Eilidh Shearer (ES), Mental Health and Social Care Directorate, Scottish Government

Apologies

• Hugh McAloon (HMc), Scottish Government (Co-chair)
• Alison Taylor (AT), Deputy Director: Improvement Attainment and Wellbeing, Learning Directorate, Scottish Government
• Alison Sutherland (AS), Sponsor T&F group 6,  North Ayrshire Council
• Amanda Farquharson,  Integration Joint Board (IJB) Network
• Angela Davidson (AD), Scottish Government
• Caroline Hiscox, NHS Grampian
• Laura Meikle (LM), Improvement Attainment and Wellbeing, Learning Directorate, Scottish Government
• Michael Chalmers, Director of Children and Families
• Hugh Masters (HM), Perinatal and Infant Mental Health Programme Board

Items and actions

Welcome and introductions

ND chaired the meeting.

The Chair welcomed everyone to the ninth board meeting and provided apologies.

The Chair summarised that board members had received final reports of three Task and Finish groups and additional papers on the engagement work and recommendation chart updated from the Task and Finish groups final reports.

The Chair invited CW to provide Joint Delvery Board updates which included:

• a ‘next steps’ workshop will take place on 8 November to discuss the interim findings from the Public Health Scotland review of the work of the Joint Delivery Board, gather reflections on feedback of the work of the board, and discuss next steps
• the next Joint Delivery Board meeting will take place on 13 December with final reports from Task and Finish group 3 - support mental health pathways and services for children and young people in vulnerable situations and in need of care and protection, and Task and Finish group 6 - developing a programme of education and training to increase the skills and knowledge required by all staff to support children and young people's mental health
• the final meeting of the board will take place on the 9 Feb 2023 to agree final recommendations which will be shared with the Minister for Mental Wellbeing and Social Care and COSLA
• a Learning and Sharing Practice event will take place on the 14 March 2023 to celebrate the work across Scotland to support children and young people’s mental health board and Task and Finish group members will be invited to attend. The Minister for Mental Wellbeing and Social Care and COSLA spokespeople will be invited  
• there is a slight delay with the October newsletter, which will be issued early November. Members were asked to share the newsletter with their networks and through social media to ensure it reaches wide audiences

The Chair introduced the Task and Finish groups who had submitted their final reports, which were shared before the meeting.

The Chair noted that board members unable to make the meeting were invited to send in any comments on final reports in advance.

Final report task and finish group one – communities

Chair invited MG to present the final report.

MG provided a background to the Task and Finish group’s deliverable and shared the work of the group aligned to the three main aims including, the promotion of good and emerging practice, supporting the evaluation design, and review of the implementation of the community mental health supports and services framework. MG highlighted the progress made by the group and recommendations proposed for the board’s consideration.

The Chair invited the board’s comments on the recommendations. The following points were raised:

• whole system approach

• examples of how to deliver a whole systems approach and information on how this can be achieved would be useful to share, examples of this are coming through the communities support and service framework delivery/school counselling and could be drawn out further across local authorities and examples from Scottish Government
• children's services planning was highlighted as important across the work of this group and other Task and Finish groups work

• the communities supports and service framework could be more explicit about the benefits of working with the third sector and local grassroots projects
• the framework has a focus on early intervention / prevention, the recommendations of this group do not want to lose this but build on the whole system approach

Meeting unmet need across community supports and services

• positive response from members on the progress of the community supports and services and examples of good practice, however some concerns were raised about waiting times and unmet need
• addressing the unmet need requires a local understanding of needs, resources and where the gaps are and linking across health and social care partnerships and third sector
• data sharing issues were highlighted as being increasingly prevalent. Data remains important in understanding gaps. The group emphasised the importance of having clear outcomes so that any data was meaningful
• further opportunities to link up with CAMHS were discussed

Experiences and outcomes

• the board explored working towards a common set of 'experience of service and support' measures prioritised by children, young people and their families, which is the most important outcome measure
• scottish youth parliament independent evaluation explored a number of areas including signposting, CAMHS, education, targeted support for children, young people and families. MSYP’S and the scottish youth parliament created a set of measures for the independent evaluation, which could be used as a starting point
• hearing the voices of practitioners is important if change is to be achieved
• this group has raised the importance of identifying outcomes to report into and be part of children’s services planning

Summary of responses and actions

Board members supported the recommendations and will take them, and subsequent board discussions on them, into account when producing the final Joint Delivery Board recommendations.

Final report task and finish group four - CAMHS

The Chair invited EK to present the final report.

This Task and Finish group has provided helpful input into the implementation of the CAMHS service specification. EK outlined the work of the group, key achievements and learning. EK presented the recommendation aligned to NHS benchmarking, data gathering, NHS Boards experience and performance in the implementation of the service specification.

The Chair welcomed comments from Board members on the recommendations.  The following points were raised:

• whole systems approach

• ND services are not a service in the same way that CAMHS is, the intent was to embed the specification into universal service provision
• making the work around CAMHS more visible within the children’s service planning arena. Ensuring partners are aware of what is happening and collaborating to share good practice  
• early data from the community services shows positive initial links to CAMHS. Identify where CAMHS fits and aligns within the review of the community supports and services framework and as part of the national care standards. Information on varying CAMHS provision is available through some of the crisis group mapping
• the CAMHS specification has 3 of 7 standards about experience of children, young people and families, not clinical outcomes. Being guided to the right place with someone with the right knowledge and skills to support them is key, along with raising awareness of the range of services and supports available. Strong support a discussion with children services planning group. For example the neurodevelopmental pathway is the GIRFEC pathway
• there are visible links to Health Boards but how do the third sector and health and social care partnerships better engage with CAMHS?
• better understanding is required of what needs to be on a local level and what needs to be done at a national level including clear communication
• how can the Board gather all the evidence across a whole range of areas of work to bring together all the good practice across the 32 local authorities
• the work this Task and Finish group is doing to try and improve data in CAMHS will show where children and young people are redirected to rather than rejected
• members welcome the links with suicide prevention within the recommendations

Raising awareness 

• need raise awareness of CYP and their families regarding the range of services and supports available, including alternatives to CAMHS/specialist services, which are more appropriate for individual needs or signposting when referrals are not appropriate for CAMHS. This was supported by what parents and carers said in the Communities Task and Finish group independent evaluation
• there is a need to raise awareness and provide guidance/supports for professionals such as GPs around  'single point of access' to the range of services available and impart that confidence to the parents/carers. Providing CAMHS and neurodevelopmental professionals support these arrangements and parents and carers are fully included/give informed consent, then the experience and outcomes are positive. This can include low wait times for CAMHS, neurodevelopmental assessment if required, and building on the single agency assessment, avoiding duplication
• routine involvement of children, young people and families
• the key aim is to improve the capacity of children's services locally to routinely involve children, young people and families at all levels of service delivery, i.e. as specified in the national CAMHS and neurodevelopmental specification
• reference within the recommendation around the ongoing evaluation with children and young people, should be clearer
• identifying and meeting unmet needs
• concern was raised over unmet needs, the children furthest away from services e.g. criminally exploited, involved in drug misuse and excluded from school. How can the system wrap around them opposed to those children and young people fitting in to what is there?

Chair summary and actions

Board members supported the recommendations and will take them, and subsequent board discussions on them, into account when producing the final Joint Delivery Board recommendations.

Final report task and finish group 5 -  neurodevelopmental service specification

Chair invited DR to present the final report.

DR presented on the work and recommendations for the Task and Finish group deliverable.

• DR highlighted three main areas, including the tests of change currently being undertaken to  develop learning around the implementation of the specification; additional tools developed by the Task and Finish group to support successful implementation; and to provide recommendations to the Joint Delivery Board that reflect the discussions and the advice of the group
• CL also shared information on the Fife test of change to develop a new neurodevelopmental assessment pathway, highlighting that there would be outputs from across this work to be shared more widely

The Chair welcomed comments from board members on the recommendations. The following points were raised:

Governance

• organisations, other than Scottish Government, could hold some of those recommendations, particularly around networking and improvement
• need to explore where to locate the networks, Scottish Government support might help keep it going
• co-chairing with partners with support from Scottish Government for secretariat could be a helpful model for future networks

Ongoing funding concerns

• the funding situation around budgets continues to be challenging
• early interventions will save resource downstream, this needs to be demonstrated, and the budget appropriately focused on prevention. The board needs to carefully consider its recommendations about investment and what should be a priority
• some non-recurring money to support the changes we want to make is always helpful, with improved outcomes and experiences. Money for prevention and improved outcomes should be the goal

Engagement

• there was broad agreement for the need to involve and hear the voice of children and young people and lived experience, however concerns over the voice of practitioners and people who deliver services are missing
• there is a set of standards in each national specification that relate to the workforce. Essentially, the staff governance and working in partnership standards
• Involvement of children and young people within recruitment as a challenge was highlighted within the Independent evaluation for of community services
• Children, young people and families should be encouraged and supported to suggest ideas and improvements for the future service developments, and not just giving feedback

Support for 3 – 5 year olds

• it was highlighted through the work of the Task and Finish group focused on 3 – 5 year olds, that although CAHMS technically has a remit for under 5s, in practice this often is not the case with CAMHS not offering support to younger children. It would appear that there is a wide variation across different areas
• SD explained that if we are mindful and support parents and carers of 3-5 year olds we will do a lot better. We already have a skilled under 5s Early Learning and Childcare (ELC) workforce and Health Visitors so important to build on GIRFEC to support those colleagues rather than duplicating
• parents need to have confidence in the system we are building. GIRFEC is not about waiting. Routine engagement with the team around the child should inform the children’s plan. A diagnostic assessment without this support is unlikely to improve the experience of children and parents
• appropriate help should not be conditional on a diagnosis

Chair summary and actions:

Board members supported the recommendations and will take them, and subsequent board discussions on them, into account when producing the final Joint Delivery Board recommendations

Engagement 

The Chair highlighted engagement had been an important thread throughout the work of the board.

The Chair invited the MSYPs to present on the work of the independent evaluation of the communities supports and Services as part of Task and Finish group one – communities.

MSYP’s presented the approach and interim findings of the independent evaluation. The aim of the evaluation was to understand service user experiences, involvement of children and young people in service design and delivery, and wider awareness of services funded by the Scottish Government’s community services fund. The MSYP’s presented their recommendations for consideration by the Board. The SYP’s final report on the evaluation will be submitted to the Scottish Government in the coming weeks.

The Chair invited EP to present the engagement recommendations.

EP presented the recommendation specifically relating to the Joint Delivery Board engagement work. EP highlighted that findings from the all engagement work undertaken has been considered and incorporated where appropriate, within and across Task and Finish group final reports and recommendations.

The Chair invited comments and questions. Key points raised included:

• important to add ‘trusted adult’ within recommendations along with parents and carers
• there is a theme throughout all recommendations around hearing and engaging with service delivery practitioners
• concern raised around ‘silent’ voices not being heard i.e. children and young people not in school system and not being signposted
• further engagement should build on existing engagement knowledge where more targeted approaches can be explored

One young person shared their experience and that of their peers spending extensive time in hospital without much outside contact and recommended reaching out to hospital charities that often run support groups, to gather hospitalised children and young people’s views

Board members supported the recommendations and will take them, and subsequent board discussions on them, into account when producing the final Joint Delivery Board recommendations.

Task and finish groups – draft recommendations

A summary document of the previous recommendations and board’s comments was shared prior to the meeting. The discussions from the three Task and Finish groups presented in this meeting and the final two in December will contribute to the further development of this document into a final report. This will then inform the final board meeting taking place in February 2023 where final recommendations will be agreed.

The Chair invited board members to comment on any areas they would like to draw out/highlight in terms of continuity to add to the paper.

No comments were received.

Task and Finish Groups – Reporting Templates

The Chair highlighted reporting templates had been shared for the remaining two workstreams with final reports and presentation due in December. The remaining workstreams include:  

• Task and Finish group 3 – Support mental health pathways and services for children and young people in vulnerable situations and in need of care and protection, aligned to the work of the promise
• Task and Finish group 6 – Developing a programme of education and training to increase the skills and knowledge required by all staff to support children and young peoples mental health

The Chair invited board members to ask questions to delivery leads.

No questions/further comments were received.

Any other business and close  

The Chair asked of any other items of business from board members.

The Chair invited MF to provide some wider policy updates:

• MF updated on the publication of the mental health and wellbeing strategy which has now been pushed back to Spring 2023 and the suicide prevention strategy and 10 year action plan, which was launched at the end of September.  The Minister for Mental Wellbeing and Social Care made a Statement to Parliament in the Chamber – a link to the statement can be found here Ministerial Statement: Suicide Prevention Strategy and Action Plan | Scottish Parliament TV

The Chair thanked everyone for their ongoing support; the next meeting will take place on 13 December 2022.