Children and Young People's Mental Health Taskforce: delivery plan

Purpose of the workstream

To make recommendations on how Scotland's mental health framework should operate effectively to deliver prevention and early intervention mental health services for young people experiencing emotional distress and related conditions while ensuring those with clinical mental health conditions and neurodevelopmental conditions are supported to access the appropriate services.

Key questions to be answered

1. What interventions and responses do we need to provide in the community, in primary, social work, third sector and voluntary sector to meet the needs of children and young people with mental health problems?

3. What are the gaps?

In 2018/19 we will initiate the following strands of work:

• Scope out the requirements for scaling best practice in children and young people's mental health primary care.
• Advise on the development of children and young people's community mental health and family hubs.
• Link with and learn from the ongoing work in local authorities and the wider education and children and young people's services communities on the development of recommendations to enhance mental health and counselling services in education settings.
• Engage with third sector organisations to establish the support required to build capacity to deliver support for mental health services in the community.
• Consider the requirements of a coherent approach to delivering self-support services to children and young people.

• Work with partners to develop and publish a recommended children and young people's framework that acts as guidance commissioning and delivering for best practice in community mental health support and services.

In 2019/20 we will:

• Obtain approval for and develop a generic services work plan based on the work in 2018/19, including an evaluation plan.

• Work with our partners to support the delivery of the short and medium term actions identified in the generic services work plan.

In 2020/21 we will:

• Continue to work with our partners to support the delivery of the generic services work plan with focus directed towards delivery of the long term actions identified in the plan.

Key Outputs

Advice and recommendations on:

• An approach to a community children and young people's mental health services which is informed by best practice, fits with local priorities and delivers to consistently high standards.
• Core commissioning requirements and specifications for community children and young people's mental health services.
• Improved performance from those local systems who have needed help/support.
• Improved national and local reporting arrangements.
• Understanding and clarity achieved for children and young people, their families, advocates and other supporters about what help is available, appropriate and how to access it.

Outcomes and Impact

The workstream will advise on appropriate outcome and impact indicators which will be refined aligned to the workplan outlined above.

Purpose of the workstream

To produce advice on a Specialist CAMHS Specification that will provide Specialist CAMHS for children, young people (C&YP) and families who need it.

The Specialist CAMHS Specification might include: (i) inclusion criteria (ii) a capacity model (iii) service standards (iv) service focused on 'what matters to me' (v) a range of quality and outcome measures (vi) partnership working arrangements consistent with GIRFEC (vii) inclusion arrangements on a rights based approach (viii) Defined support to other strands of activity in the C&YP Mental Health Taskforce.

Key questions to be answered

1. What is the estimated current profile and level of needs for Specialist CAMHS using the data and analysis we have available from a range of sources.

3. What is the current staffing resource Specialist CAMHS (professional mix, grades, full time equivalent, funding requirements).

In 2018/19 we will initiate the following strands of work:

• Convene a working strand subgroup with contributions from clinicians who hold a wide spread of knowledge and experience. Using our wider networks to sound proposals.

• Work closely with the other work strands to identify common short, medium and long term goals and use this to review progress.

• Produce proposals to improve service delivery and reduce waiting times in the short term, particularly in the 5 boards identified for additional help.

• Provide a summary paper on:
  • ­ current provision of specialist CAMHS across Scotland, including scope and range of service
  • ­ current profiles and levels of need
  • ­ proposals for a Service Model to meet those needs
  • ­ proposals for a capacity and workforce model
  • ­ proposals for the support required from Specialist CAMHS for other parts of the system.
• Contribute to the digital support platform.
• Plan an engagement session with staff, children, young people and their families to discuss the above.

In 2019/20 we will:

• Obtain approval for and develop and work plan for IV above, including an evaluation plan.

• Work with our partners to support the delivery of the short and medium term actions identified in the Specialist CAMHS work plan.

In 2020/21 we will:

• Continue to work with our partners to support the delivery of the Specialist CAMHS work plan with focus directed towards delivery of the long term actions identified in the plan.

Key Outputs

• Specialist CAMHS Workstream will provide advice and recommendations on:
• A clear service specification.
  • ­ Defined guidance on who the service should be provided for.
  • ­ Improved access to service.
  • ­ Increase capacity of service.
  • ­ Improvements in patient journey and satisfaction.
  • ­ Improved outcomes defined by children, young people and families and carers, and informed by evidence and experience.
• A Web-based support resource.
• A specification on what support Specialist CAMHS will provide other strands of the Taskforce i.e. Education, Communities and Primary Care.

Outcomes and Impact

Advice and recommendations on:

• ­ A comprehensive suite of outcome and impact indicators for children and families will be refined aligned to the workplan.

Children, young people and their families and carers will experience improved outcomes, using measures relevant to them and guided by evidence and practice.

Reduction in rejected referrals and increase in children and young people accessing appropriate supports in timely manner.

Purpose of the workstream

To produce advice on a Neurodevelopmental Service Framework and Specification that will improve support and care for children, young people and their families with neurodevelopmental concerns, and also provide access to a Neurodevelopmental Service for children, young people and families who need it.

Key questions to be answered

1. What are the current profiles and levels of need, based on existing data and knowledge?

3. What should the Neurodevelopmental Service provide?

In 2018/19 we will initiate the following strands of work:

• Convene working group with contributions from clinicians and professionals who hold a wide spread of knowledge and experience.

• Use our wider networks to sound out ideas and proposals.
• Work closely with the other work strands to identify common short, medium, long term goals and use this to review progress.

• Provide a summary paper on:
  • ­ current provision of Neurodevelopmental services,
  • ­ current profile and level of need,
  • ­ scope and range of Neurodevelopmental services to be provided including current and predicted activity data.
  • ­ Scope and range of supports to be provided to other strands to improve the recognition and support provided to this group.
• Contribute to the digital platform of support for this group

• Plan an engagement session with children, young people and their families to discuss above.

In 2019/20 we will:

Obtain approval for and develop a work plan for above summary paper, including an evaluation plan.

Work with our partners to support the delivery of the short and medium term actions identified in the Neurodevelopmental Specialist Service implementation plan.

In 2020/21 we will:

Continue to work with our partners to support the delivery of the Neurodevelopmental Specialist Service work plan with focus directed towards delivery of the long term actions identified in the plan.

Key Outputs

• Provide advice and recommendations on:
• a Neurodevelopmental Service Specification which provides a clear specification of the role and responsibilities of the Neurodevelopmental Service and other agencies with whom they collaborate in supporting children and young people and will:
  • ­ Defining the inclusion criteria and arrangements on a rights based approach.
  • ­ Describe a capacity model.
  • ­ Produce service standards.
• Actions to improve the capacity of Primary care, Education and Community to support children in this pathway and identify those children who need further support.

• A service focused on 'what matters to me'.

• A service reporting a range of quality outcomes meaningful to children, young people and their families and guided by evidence and practice.

• Develop partnership working arrangements consistent with Getting It Right For Every Child.

• Incorporate a Web-based support resource into the care pathway and contribute to it.

• Improvements in children and families journey and levels of satisfaction of service.

• Deliver immediate action to increase capacity of those health boards where children and young people are currently waiting more than 18 weeks for specialist neurodevelopmental assessment and support.

Outcomes and Impact

Understand the levels of need, and demand for services in order to better manage flow, reduce delay and build capacity and capability i.e. deliver immediate improvements in services.

A shared understanding of the needs of children, young people and their families of neurodevelopmental concerns, and of how the whole system model and stepped care could/should be applied across education, health, social care and the third sector.

Children, young people and families' contributions are valued, listened to and incorporated into the whole system model.

Increased levels of support at all levels for children, young people and their families.

Reductions in waiting times for children, young people and their families who require specialist neurodevelopmental help to four weeks.

Increase efficiency of multidisciplinary neurodevelopmental assessment.

Increase effectiveness of multidisciplinary services to provide post-diagnostic support.

Increase satisfaction of support provided to children, young people and their families.

Reduced levels of stress for children, young people and their families.

Improved functional outcomes for children, young people and their families.

Purpose of the workstream

To ensure a focused response to children and young people who are at heightened risk of poor mental health, but who have often not been able to access mental health services. These include: younger children; care experienced children and young people; black and ethnic minority youth; refugee families; those who for various reasons do not have a settled home - e.g. children in temporary accommodation or who move home regularly - young people in transition to adult services; and other marginalised groups.

Key questions to be answered

1. Confirm the groups of children that come within the definition above, that may have mental health needs but who have had difficulty accessing mental health services?

2. Are there also young adults who are excluded from getting a mental health response or service because of their specific characteristics or organisational structures – e.g. due to the age of transition from children to adult services.

3. What best practice is already in place to endeavour to ensure effective support to these groups?

4. What are the reasons that these groups are often excluded from a mental health service or response?

5. What existing work is taking place with other initiatives, that this work needs to link with and build on? This may include: the Care Review, Drug and Alcohol Strategy, Child Poverty; ACEs awareness; GIRFEC and practice refresh.

6. How might health visitors and/or schools be assisted to better address the mental health needs of these children? What other universal services might also need to address this?

7. Where children and young people are receiving more targeted or intensive support, including children who are accommodated, how can those services be assisted to better address mental health needs? Including how can specialist staff build the capacity And confidence of other practitioners.

8. Are there other additional supports that can be provided to children who have mental health needs, that can be met appropriately without referral to specialist services?

9. How should specialist mental health services respond to these groups?

In 2018/19 we will initiate the following strands of work:

• Undertake data gathering and analysis in relation to key questions.
• Liaise with the Independent Care Review, to ensure a joined up approach to meeting the mental health needs of care experienced young people.
• Identify and engage with other key stakeholders groups for this otherwise diverse combinations of groups of children, young people and (potentially) young adults, ensuring necessary representation in consideration of these issues.
• Identify and engage with the various key professional interests for this otherwise diverse combinations of groups of children, young people and (potentially) young adults, ensuring necessary representation in consideration of these issues.
• Identify best evidence and best practice across the country, and take account of all available evaluations of outcomes.
• Advise on principles for providing support to these groups as part of the GIRFEC approach that ensures that mental health needs are not only identified and assessed, but responded to appropriately.
• Develop and encourage use of models of practice that identify mental health problems in these 'at risk' groups early, and make an offer of services that will engage them to reduce or mitigate these problems and the risk of mental illness.
• Advise on targeting additional and necessary support to those children who require direct support from specialist services (liaising with that workgroup). Advise on development of service specifications for commissioned services and models that reflect this, which may involve either adjustments to practice in current services, or the enhancement or new approaches through additional capacity in services.
• Advise on and encourage use of models of consultancy and networking that ensure practitioners who support these children receive necessary specialist advice.
• Establish multi-agency learning approaches to support a shared view about interventions and best practice, and about the role of specialist and other services.

In 2019/20 we will:

• Obtain approval for and develop a children and young people at risk work plan based on the work in 2018/19, including an evaluation plan.
• Work with our partners to support the delivery of the short and medium term actions identified in the generic services work plan.

In 2020/21 we will:

• Continue to work with our partners to support the delivery of the children and young people at risk work plan with focus directed towards delivery of the long term actions identified in the plan.

Key Outputs

• Children who need support but who were previously often excluded from mental health services, have access to services that have made changes to their approach, and also to new dedicated services.
• Young children with mental health needs are better supported by health visitors and other early years services, alongside their families.
• Increase capacity for mental health in the core workforce. This will include trauma/attachment informed understanding of behaviour that challenges services or raises anxiety for practitioners, helping to ensure appropriate referrals for specialist services.
• Improve the capacity of the care system to support children and young people's mental health, by supporting and training staff, by providing specialist staff to do this, and by providing specialist and other services where this is also required.
• Practitioners who provide additional support to these groups, are better supported regarding meeting their mental health needs.

Outcomes and Impact

Children and young people at various ages and stages have earlier and more effective responses to their mental health needs, preventing those needs from developing and escalating

Fewer young people require specialist services because their mental health needs were not addressed through effective and earlier intervention.

Looked after children experience more settled placements and fewer placements moves, with significant improvement across health, social and educational outcomes.

Young people in aftercare are more able to make the transition from living in care settings.

Purpose of the workstream

Support the development and expansion of a diverse workforce in education, communities, and in primary care settings. To increase capability, we will develop a programme of training in the NHS, and support similar endeavours in third sector, social work and education.

Key questions to be answered

1. What skills are needed to support the Taskforce strands?

2. What are the workforce issues, numbers, supply demand, pipeline, capacity and capability?

In 2018/19 we will initiate the following strands of work:

• Convene a cross sector workforce development sub-group.
• Provide a summary of intelligence and data about current workforce numbers, supply, pipeline, capacity and capability.
• Develop a workforce plan to cover the 4 strands with short, medium and longer-term goals;
  • ­ Generic (to include wellbeing)
  • ­ Specialist
  • ­ Neurodevelopmental
  • ­ At Risk

In 2019/20 we will:

• Work with partners to support the delivery of the short and medium term actions in the workforce plan.

In 2020/21 we will:

• Work with partners to support the delivery of the workforce plan particularly the longer-term elements.

Key Outputs

• A workforce development plan with recommendations to guide decision making and investment for workforce development.
• Designed, delivered, commissioned education and training.

Outcomes and Impact

Success will be evidence of a competent, trained and expanded workforce tailored to meet needs, including greater capacity for specialist CAMHS to support community-based services. That programme will inform future workforce plans.

Purpose of the workstream

To lead and provide expertise on data, analytics evidence and intelligence required by the Taskforce and the four topic workstreams to make informed decisions, evidence progress and improvement.

To develop approaches to digitally enhance children and young people's mental health services.

Key questions to be answered

The workstreams will have a number of key priorities and questions to be answered and this data workstream will aim to provide that intelligence to inform and allow action to be taken.

In 2018/19 we will:

• Establish the Information & Knowledge Workstream including the terms of reference of the group and agree meeting schedule.
• Work with a Principal Information Analyst from ISD to provide support and meet the needs of the Taskforce and workstreams.

• Meet with each workstream to understand their analytics and intelligence needs and develop an agile action and delivery plan for each.
• Provide a key facts/overview using existing data sources of how children and young people access and use services related to mental health (this will be NHS focused to start with).
• Gap analyses of where data needs to be collected to answer key questions identified by the four workstreams.
• Scope existing digital services in relation to the four workstreams and identify scope for enhancement of services.

In 2019/20 we will:

• Prioritise and deliver the four workstreams needs/gaps in data to be filled. This may be through developing existing data collections or through new bespoke collections and importantly will be wider than just NHS sources. For example move the existing CAMHS waiting times return from aggregate data to person level with additional journey points added. Or filling the gap in knowledge around the activity the third sector or education services undertake.
• The data collected and analysed will be used to learn and share how we can improve people's journeys through services, and their outcomes.
• Present the analytical outputs in a variety of formats - e.g. infographics, dashboard appropriate to user needs.
• Identify and make recommendations on pilot implementation of delivery of digitally enhanced services.

In 2020/21 we will:

• Ensure that workstream needs continue to be met.
• Consider the sustainability of ongoing data collection, analytics and intelligence.
• Work with partners to advise on the implementation of digitally enhanced services across Scotland.

Key Outputs

• Appropriate resource in place to support the four workstreams and Taskforce.
• Data workstream action and delivery plan – this will be agile and will reflect priorities.
• Data gaps filled (to be determined via the action and delivery plan – more detail can be added once these have been prioritised)
• Dashboard/visual outputs for Taskforce and workstreams.
• Blueprint for the implementation of digitally enhanced services in relation each of the service workstreams.
• This will be added to once plans are underway.

Outcomes and Impact

By filling the gaps in data will allow for evidence based decision making to be made.

Understand the true extent of mental health needs for children and young people and can commission/plan services appropriately.

Monitoring of services and their efficiency and effectiveness including outcomes for children and young people

Analytics and intelligence help to improve services and therefore they can provide a better experience for children and young people experiencing mental health problems.

Access where appropriate to digitally enhanced services.

Purpose of the workstream

To ensure children and young people's mental health funding is measured consistently, is traceable and its effectiveness can be properly assessed.

Key questions to be answered

1. How much is spent on children and young people's mental health each year?

2. What is it spent on?

3. Is that expenditure providing value for money in terms of children and young people's mental health?

In 2018/19 we will:

• Use the recent Audit Scotland report as the starting point to identify current spend on CYP mental health.
• Work with NHS, Scottish Government and COSLA finance colleagues to develop a broader picture of the services currently funded.

In 2019/20 we will:

• Develop a systematic approach to identifying children and young people's mental health spend and work with partners to adopt this consistently across services.
• Explore how we can better ensure that funding for children and young people's mental health has an impact on the ground.
• Develop early models to assess value for money/returns on investment. Test these with partners and work to enhance them.

In 2020/21 we will:

• Work with partners to support embedding approach to consistently identify and report expenditure.
• Work with partners to support introduction of universally accepted mechanisms to tie funding to delivery.
• Work with partners to explore how we can learn more about the impact of funding on delivery of services.

Key Outputs

Consistent and universally recognised approaches across all children and young people's mental health services to:

• ­ Identifying spend;
• ­ Tying funding to delivery; and
• ­ Measuring value for money/ return on investment.

Outcomes and Impact

Clearer links to funding decisions and mental health provision for children and young people.

Enhanced understanding on the value of different types of investment.