Children and Young People's Mental Health Task Force: recommendations

Supporting and Developing the Multi Sector Workforce

Working with children and young people with mental health support needs is rewarding but can be challenging and attention needs to be paid to ensuring staff feel valued and supported in their work. There are opportunities to improve recruitment and retention through measures such as protected learning time and prioritising staff well-being. Key to supporting the workforce is having the right training and development in place, and this has been a focus of the Workforce Workstream over the last six months.

Recommendation 12: Scottish Government and COSLA should support the implementation of a programme of education and training for the multi-sector workforce in support of the Taskforce’s ambitions for a whole system approach model.

Principles

This multisector workforce training approach should be underpinned by a number of key principles:

• Workforce development should build upon GIRFEC and the National Practice Model principles.
• A workforce model should support collaborative working across early years, schools, primary care, further and higher education and community settings.
• Professionals who work across all the services children, young people and their families access, and work together to support children and young people's mental health and neurodevelopmental needs should, where practical, be trained together. This will allow greater understanding of the expertise of and challenges faced by those working together.
• The development of the workforce should include a knowledge and skills framework with 4 levels based on contact with, and competencies required, to work with children, young people and families rather than sector, discipline or employer.

Levels

• Informed- all staff in the Scottish workforce including those working in health, social care and third sector settings.
• Skilled- staff who have direct and/or substantial contact with children, young people and their families.
• Enhanced- staff who have more regular and intense contact with children, young people and their families who may be at risk of, or be affected by, mental health and wellbeing concerns.
• ​Specialist- staff who, by virtue of their role and practice setting, provide an expert specialist role in the assessment, care, treatment and support of children and young people and their families who have mental health and neurodevelopmental support needs that cannot be met at the earlier levels.

The following cross cutting themes should be covered at all levels:

• Child, adolescent and family development, including neurodiversity,
• Engaging with children, young people and families;
• Mental health and wellbeing across perinatal and infant periods, as well as across childhood, adolescence and young adulthood;
• Assessment, formulation and diagnosis, where appropriate, of difficulties including neurodevelopmental diversity;
• Evidence based support and interventions aimed at strengthening attachment, parenting and family relationships.

Identified Education and Training needs

Public health approach - A public health approach to enhance knowledge and awareness about the spectrum of mental health and wellbeing, highlighting universal human emotional experience (across the whole range of developmental stages, including the perinatal period and infancy), as distinct from mental health problems. This work would include specific areas; such as neurodiversity, ACES/Adversity/Trauma, and Suicide prevention, as well as the importance of evidence-based promotion, prevention and early intervention work to support mental health and wellbeing.

Suicide Prevention - Training delivered to all sectors of the children and young people's workforce that links to the Mental Health Improvement and Suicide Prevention Framework, and the Strategic Workforce Development Plan, including a universal resource on mental health improvement and suicide prevention.

Undergraduate mental health training - Building on the work already underway, formulation of mental health training to be included in refreshed undergraduate curricula for relevant sections of the wider children and family's workforce, including teachers, social workers, health visitors and school nurses. Much of this would map onto the broader education and training needed for the skilled, enhanced and specialist workforce described below.

Adverse Childhood Experiences (ACES) /Adversity/Trauma/ Resilience- To apply the best evidence base in terms of the consolidation and development of staff skills and knowledge and maintain well-being in the face of demanding roles, particularly where a requirement for ongoing relational engagement is key;

• The NES (2017) Transforming Psychological Trauma: Knowledge and Skills Framework for the Scottish Workforce is a robust, evidence-based framework and should be used to support workforce planning and subsequent training development and implementation.
• Reflective practice or clinical supervision structures to be planned to focus on support for staff to deliver safe, high quality, evidence-based, relational approaches while maintaining their own resilience and wellbeing.

Delivery of a one-year development plan for staff who are new to work in Children and Young People's Mental Health (CYPMH) services - To include the above topics delivered at a skilled and enhanced level, as well as additional training on physical health monitoring. This is likely to be particularly relevant for nurses and Allied Health Professionals (AHPs) joining CYPMH services.

Education, training and practice support in evidence-based psychological interventions- To cover the range of promotion, early intervention and intervention for the spectrum of mental health and wellbeing across the perinatal, infant, child, adolescent and young adult periods. Also to continue to develop supervisors in specific evidence based psychological therapies who can maintain and develop the quality of the interventions.

Implementation of Workforce education and training

Effective delivery of education and training that leads to changes and improvements in practice will require significant consideration of implementation factors. These will include:

a) The availability of resources and tools to guide selection of usable evidence-based approaches and interventions.

b) Leadership, organisational and competency factors

c) Supervision/Coaching

d) Protected and resourced learning time

Recommendation 13: Scottish Government and COSLA should work with partners to ensure that the supply of well-trained staff is maintained and expanded. This should include working alongside the Third Sector on a recruitment drive for children and young people's mental health services to attract bright, compassionate people of all ages and backgrounds to this work.

Once recruited, the workforce should be encouraged and supported within their organisations through ongoing training, career advancement opportunities and wellbeing initiatives.

Scotland is changing in terms of breaking down the stigma surrounding mental health and neurodevelopmental profiles of need and the GIRFEC framework provides a holistic approach to children's health and wellbeing. Young people in particular now speak more openly about their mental health and neurodevelopmental needs and have lobbied, along with their families, for mental health to be regarded as important as physical health. The Taskforce is committed to improving mental health and neurodevelopmental services and responses for children and young people across Scotland, which promote good mental health, intervene early when problems develop and provide high quality specialist input when needed. This requires a motivated, skilled and supported workforce to deliver these aims and to meet increasing requests for help from services.

Recent media attention and political and public scrutiny have often been negative and critical of services and those who work within them. There is a need to create a positive narrative around working in this area and lessons can be learned from other parts of the UK where high-profile media campaigns and recruitment drives have proven successful.

Working with children and young people with mental health and neurodevelopmental support needs can be challenging because of the nature of their difficulties which are often in the context of physical health, family and social adversity. However, the right input can transform their lives for the better, allowing them to flourish and meet their potential.

At the enhanced and specialist levels of practice there are also opportunities to increase the supply of allied health professionals and psychologists and to increase the number of nurses and doctors working in children and young people's mental health. This can be done by expanding training numbers as well as by promoting in-service development opportunities.

There are opportunities to improve recruitment and retention through measures such as protected learning time and prioritising staff well-being.

Across universal and third sector organisations there are also opportunities to increase the availability of skilled staff in counselling, psychotherapy and other therapeutic interventions.