Children and Young People's Mental Health and Wellbeing Joint Delivery Board: final report

Introduction

The Children and Young People's Mental Health and Wellbeing Joint Delivery Board (JDB) is the most recent national programme of work led by COSLA and Scottish Government seeking to support children and young people's mental health.

Figure one: Children and Young People's Mental Health Policy Timeline- Key developments.

Timeline of recent key developments ...

March 2017 Scotland's Mental Health Strategy (2017-2027)

June 2018 Children & Young People's Mental Health Taskforce

Sept 2018 Children & Young People's Mental Health -Audit Scotland Report

May 2019 Youth Commission on Mental Health Report

July 2019 Children & Young People's Mental Health Taskforce Report

June 2019 Rejected Referrals CAMHS: A Qualitative and Quantitative Audit Report

Aug 2019 Children & Young People's Mental Health and Wellbeing Programme Board

March 2021 Children & Young People's Mental Health & Wellbeing Joint Delivery Board

Taking into account learning and recommendations from previous work, referenced at figure one, and the evolving context, the JDB convened in Spring 2021 and focused on eight deliverables. These included:

1. Continue to enhance community-based support for emotional wellbeing/mental distress through ongoing investment and support for local partnerships.

2. Ensure crisis support is available 24/7 to children and young people.

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.

4. Develop a support programme to enable the implementation of the CAMHS service specification.

5. Agree and support the implementation of a neurodevelopmental service specification /principles and standards of care.

6. Develop 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.

7. Work jointly with the Perinatal and Infant Mental Health Programme Board to consider what is currently available and what is required in the future to support the mental health and wellbeing of 3-5 year olds across Scotland and produce recommendations.

8. Through a selection of appropriate media platforms, we will ensure:

• information on the work of programme board reaches stakeholders, young people, parents, and families
• information on the interconnecting work of other boards reaches relevant stakeholders
• information on how to access mental health support is available to staff supporting children and young people.

These deliverables have been progressed by the JDB, with each deliverable supported by a Task and Finish Group.

Individual Task and Finish Groups considered how to progress their deliverable taking into account the previous work undertaken in the area and current context. Consequently, work undertaken across the breadth of the JDB has been wide-ranging and taken different forms including research, Tests of Change, evaluation, sharing good practice and the production of learning resources. Based on learning from the work they undertook, each Task and Finish Group made recommendations to the JDB which were considered within the Board's final recommendations provided at page 20.

An outline of the work undertaken by the JDB, as described by young members of the Board, can be found here. Full details on the role and remit of the Board can also be found on the Board's webpage.

The following report details work undertaken on each of the deliverables and considers progress made towards the JDB's intended outcomes. It also provides a set of recommendations from the JDB which address how their work can be continued and embedded, and what should be important next steps in supporting children and young people's mental health.

Board Membership and Supporting Principles

The Board aimed to include representation from stakeholders with a wide range of expertise and responsibility for supporting children and young people's mental health and wellbeing. Organisations/associations represented at the JDB are outlined in Appendix B. Membership of the Task and Finish Groups was also wide-ranging and informed by the specific focus of their work.

A priority for the JDB, across all its work, has been meaningful engagement with children and young people. A set of principles for participation and engagement were developed to support consideration of this at the Board itself, where children and young people were represented through Scottish Youth Parliament (SYP), and within Task and Finish Groups. For more information on participation and engagement please see page 15.

Outcomes and Measuring Progress

In the context of working towards its deliverables, the JDB recommended a whole systems approach to evaluation be considered for work being undertaken across the breadth of its remit. Public Health Scotland (PHS) was asked to consider how this could be progressed. This resulted in an agreed outcomes framework (Appendix C) which is inclusive of:

• the short-term outcomes – the changes within the direct control of the deliverables
• the intermediate outcomes – the changes which the deliverables can contribute toward, either individually and/or in combination
• wider population outcomes – the changes that the work of the JDB will contribute to longer term.

PHS subsequently undertook a review of learning from the JDB both as a whole and of its individual deliverables. This included drawing on the outcomes and any existing monitoring or evaluation findings, to begin to consider the difference the deliverables are already making or have the potential to make, toward improving the mental health and wellbeing of children and young people. This exercise has informed the understanding of progress made by the JDB outlined in this report, subsequent reflections and considerations for future policy and delivery of children and young people's mental health support.

Action on our Deliverables

A brief overview of action undertaken on each deliverable is provided below. Information and updates on key learning from the work of each Task and Finish Group is provided on the JDB's website.

Deliverable One: Continue to enhance community-based support for emotional wellbeing/mental distress through ongoing investment and support for local partnerships.

A Task and Finish Group was established which focused on supporting the development of services aligned to the Community Mental Health and Wellbeing Supports and Services framework and underpinned by associated funding. The group:

• Developed anticipated outcomes for the Framework and utilised these to produce a good and emerging practice document with and for local delivery leads, as well as supporting a good practice event for all local authorities that was well received by attendees
• Advised on independent evaluation of services aligned to the Framework. The Scottish Youth Parliament (SYP) were commissioned to undertake an evaluation of community mental health services. The Key findings from this evaluation are summarised in infographics on page 10 the full report is available on the SYP webpage.
• Reviewed the implementation of the Framework. The group considered 6-monthly reporting data provided by local authorities on services aligned to the framework. At the time of consideration, 2 data sets were available (July-December 21, Jan-July 22). Available data from 6 monthly reports can be found here
• Consideration was also given to areas where the Framework would merit being strengthened or expanded.

Having considered learning from across its work, the Task and Finish Group found that the implementation of the Framework and associated funding, had enabled local authorities to develop new and existing supports and services for children and young people based on identified needs. The flexibility of approach within the Framework had empowered local areas to be innovative and creative, with good and emerging practice developing across Scotland in relation to early intervention and prevention. The value of opportunities to share good and emerging practice was highlighted and the early data collected was found to be encouraging. However, opportunities were identified to improve provision and recommendations were made to the JDB on this basis.

The Scottish Youth Parliament's Independent Evaluation of Community Mental Health Services For Children And Young People

Key Findings

• 66% of young people agreed or strongly agreed that the services meet their needs and involve them in making decisions about their support.
• 67.4% of young people agreed or strongly agreed that the services help them to better understand their mental health and wellbeing.
• 54.3% of young people find out about the services from a teacher or lecturer.
• 74.3% of young people said that they definitely or mostly know where to go for help since they started receiving support.
• 73% of young people agreed or strongly agreed that they feel safe and supported while using the services.
• 71.6% of young people agreed or strongly agreed that they received support when they needed it, and 63.9% of parents and carers agreed.
• 21.7% of young people suggested that they still feel stigma since they started receiving support.
• 59.4% of parents and carers agreed or strongly agreed that their child is happier and more able to cope since using the services.
• 60.7% of the services offer support for young people aged 16-25.

Deliverable Two: Ensure crisis support is available 24/7 to children and young people.

This Task and Finish Group sought to understand gaps in crisis support for children and young people by mapping its availability across Health and Social Care Partnerships. It considered children and young people's needs in relation to crisis support and sought to understand how new and developing services at a national level might impact on the provision of crisis care.

Key observations included a lack of a shared definition of crisis support; further opportunity for the local provision of crisis supports, which could be considered through the Community Mental Health and Wellbeing Supports and Services Framework and the need to enhance connections between services provided for children and young people to support their mental health. The group particularly highlighted the opportunity to support these connections through Children's Services Planning.

Deliverable Three: 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.

The Task and Finish Group supporting the progression of this deliverable identified key areas for improvement in the mental health and wellbeing support available to children and young people in vulnerable situations, while reviewing data and evidence and the views of children and young people to support this. Actions focused on:

• Building a resource which helps those working with children and young people in vulnerable situations to understand their specific mental health support needs, including a set of key principles for staff working with care experienced children and young people and children and young people in vulnerable situations
• Building a bank of good and emerging practice in supporting the mental health and wellbeing needs of children and young people in vulnerable situations from across sectors
• A co-designed digital resource focused on relationships and the key behaviours and skills that make the biggest difference to care experienced children and young people, when these are demonstrated by the adults that support them.

These resources will continue to be developed and disseminated beyond the life of the JDB and shared with children and young people's services as appropriate.

Throughout its discussions, the JDB agreed that the needs of this group of young people should be prioritised, this has been noted within the JDB priorities for future action on page 18.

Deliverable Four: Develop a support programme to enable the implementation of the CAMHS service specification.

Work aligned to this deliverable sought to support the broad implementation of the CAMHS Service Specification, bringing together relevant areas of expertise to inform discussion and development around elements of implementation. This has:

• Informed the allocation of an additional £40 million CAMHS funding in 2021/22
• Supported and advised on Health Board engagement on CAMHS provision
• Informed ongoing data improvement.

Deliverable Five: Agree and support the implementation of a neurodevelopmental service specification/principles and standards of care.

Supported by the JDB, The National Neurodevelopmental Specification: Principles and Standards were published on the 8th September 2021.

In order to further develop understanding of how the specification can be implemented and the resources required, five Tests of Change areas (Aberdeen City, Fife, East Lothian, Highland and Forth Valley) were identified. Each area addressed specific aspects of the specification. Events to share learning from the Tests of Change to date with stakeholders have been undertaken and it is intended that learning will continue to be captured and shared beyond the life of the JDB.

A Self-Assessment Tool has also been developed by the Task and Finish Group to support the ongoing implementation of the specification.

Deliverable Six: 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.

Building on the Children and Young People's Mental Health and Wellbeing: A Knowledge and Skills Framework for the Scottish Workforce and following co-operation with the wider Task and Finish Groups to identify training and learning needs, a number of learning resources were developed by this Task and Finish Group:

• a Digital Learning Map that maps high quality training resources to the knowledge and skills framework and allows staff to plan their learning journeys and leaders to plan learning and development for staff groups
• a first point of contact/signposting resource which considers the education and training needs of whomever first comes in contact with a young person with a mental health issue, how they respond and support that person to get effective help
• an Evaluation Toolkit to help organisations to evaluate the quality of training at all practice levels
• the One Good Adult Job Description a job description for adults who work with children and young people, developed by children and young people
• a Promise Sway Resource aimed at organisations and individuals who have an interest in mental health education and training resources and materials that are relevant to the work of the Promise. The resource pulls together education, training and good practice relevant to the workforce supporting care experienced children, young people and adults.

All resources are hosted on the Digital Learning Map and will continue to be supported by NHS Education for Scotland (NES).

Deliverable Seven: Work jointly with the Perinatal and Infant Mental Health Programme Board to consider what is currently available and what is required in the future to support the mental health and wellbeing of 3-5 year olds across Scotland and produce recommendations for further action.

It was recognised that the mental health and wellbeing of 3-5 year olds represented a gap in national mental health policy development. This Task and Finish Group began to address this by identifying and understanding the nature of the support available and what was required to support the mental health and wellbeing of children 3-5 year olds. Work included:

• Developing an addendum for the Principles for Participation and Engagement with Children and Young People paper to support appropriate and effective ways of engaging with younger children
• Commissioning Early Years Scotland (EYS) to undertake engagement activity with children, parents, carers and the Early Learning and Childcare (ELC) workforce across 7 local authorities. This resulted in the 'Mental Health, Happiness and Wellbeing Project'
• EYS also conducted an audit of existing ELC professional learning resources available to support the mental health and wellbeing of 3-5 year olds
• Collaborating with Public Health Scotland (PHS) to synthesise the evidence and data collected. PHS extrapolated the key messages about supporting young children's mental health and wellbeing to shape and inform the groups recommendations
• Communicating and consulting with colleagues, stakeholders, and policy areas where there were significant links and interdependencies.

There was a wealth of learning across the group's work. The Mental Health, Happiness and Wellbeing Project provided a strong indication of the views of children, parents and the ELC workforce. This learning is summarised in the infographics below.

As with the other groups, learning informed recommendations made by the Task and Finish Group to the JDB which were considered within the final recommendations.

Mental Health, Happiness and Wellbeing Report

Children told us how much they love to play, especially outdoors and with their friends, and that cuddles from people they love and trust give comfort when they're feeling sad.

79% of children said that different types of play made them feel happy or excited.

Friends give me a cuddle and it makes me happy again

Strong bonds between the workforce, children and families were apparent in feedback and are the foundation for positive early years

Half of all parents of children aged 3-5 surveyed told us that they would approach their ELC setting if they had any concerns about their child's mental health, happiness, and wellbeing.

88% of staff felt there should be more access to professional learning opportunities.

"There are various charities I'd contact, but this would be alongside the ELC setting because I know mental health support for young children under 12 years is extremely difficult to get."

Parents Of P1-P3 Children said that ELC settings were vital in supporting transition to school, but COVID exacerbated anxieties

65% said they received assistance from their child's ELC setting to support their child's mental health and well-being.

Visits before school starts would be appreciated so the parents have a greater understanding of the set up and can discuss more with their child.

Everything in one Place Parents told us that there would be real benefit in the creation of a 'one stop shop' model of support with information, advice and support about children's mental health, happiness, and wellbeing.

Deliverable Eight: Through a selection of appropriate media platforms, we will ensure:

• information on the work of programme board reaches stakeholders, young people, parents and families
• information on the interconnecting work of other boards reaches relevant stakeholders
• information on how to access mental health support is available to staff supporting children and young people.

A Task and Finish Group supporting this deliverable undertook a series of actions to progress the JDB's ambitions including:

• Producing an accessible quarterly JDB newsletter providing updates on the work of the Board and wider relevant information, available here
• Producing regular Information Bulletin's updating on work being undertaken across the wider mental health policy landscape, available here
• Sharing a series of videos on community-based supports on social media. An example of the videos can be found here
• Supporting accessibility - efforts have been made to consistently use plain language and a supporting A-Z glossary has also been developed by children and young people to support public facing documents, like the newsletter.

The group identified a number of ongoing challenges in reaching and meeting the needs of its desired audiences. These challenges were shared with the JDB and considered within the Board's final recommendations.

Engagement with Children and Young People

Whilst not a deliverable, the engagement of children and young people has been central to the work of the JDB. This has built on the previous engagement and research that has informed this workstream to date. The Board had specific Children and Young People's Engagement Officers to ensure the voices of as many children and young people with lived experience were heard.

Since its inception, young people have been represented on the Board through the Scottish Youth Parliament (SYP) and SYP undertook workshops and events to gather the views of young people on accessing information and support for mental health and wellbeing. Members of the Scottish Youth Parliament (MSYP's) also produced blogs to share experiences, these were communicated through the JDB newsletter in March 2022 and July 2022. Workshops were also undertaken with Who Cares? Scotland to hear from those with care experience, which focused on supporting children an young people in vulnerable situations, aligned to the Promise.

A range of engagement was also undertaken with the support of third sector partners. YouthLink Scotland was commissioned to work in partnership with Young Scot, Scottish Youth Parliament, and Children's Parliament to gather the views of children and young people on accessing information and support for mental health and wellbeing. Infographics summarising the results from the Insights report can be found below. Learning from engagement with children and young people informed the work of the Task and Finish Groups, the decisions made by the JDB and the final recommendations.

Access to mental health and wellbeing information and support
 
Views from children and young people

Views from 8 – 12 year olds

Where they access information*
73% parent/carer
53.9% A friend
51.7% Family member (other than parent/carer)
48.9% class teacher
29.7% websites
14.1% Social media
9.9% youth worker/youth club
14.8% Coach/worker at a sport or activity
5.6% A counsellor or social worker
48.9% Other adults in school

Children told us
‘It is important that they get support when they need it – this means at the time they are feeling anxious, upset or distressed’

Children report they want more opportunities to talk and learn about mental health and wellbeing in school.
Children like to do an activity with an adult when they explore their mental health and wellbeing, for example a game or doing something creative.
Children will ask for information and support from adults they trust, whoa re kind to them and who have the time.

Accessing support
97.8% of children have access to a device at home to look for information however few children think websites or social media platforms are places to go for information or support, preferring face-to-face support.
1 in 10 children do not have good enough connectivity for a video call.

Face-to-face support should be:

• Private
• Comfortable
• Welcoming

Children’s core needs, identified by them:

• Opportunities to play
• To be free from bullying
• To have a supportive home environment
• To have a good education

  Children said they hope and aspire to:

• Have more self-control
• Be/feel less angry
• Be less anxious
• Be smarter about their feelings
• More able to speak out
• Be able to control their emotions better
• Not be depressed
• Control their feelings with knowledge of support strategies

*This question was multiple choice, with respondents identifying as many sources they would use, therefore results do not total 100%. 

Access to mental health and wellbeing information and support
Views from children and young people

Views from 12 to 25-year-olds

Almost half of children and young people aged 12 – 25 told us they do not feel good about their mental health and wellbeing.

Accessing support*
12 – 25-year-olds access information on mental health and wellbeing from:
62.8% websites
46.6% friends
42.9% parent/carers
29.6% social media
28.9% GP Practices

53.6% feel confident finding information when they need it
41.1% feel confident they will be given the correct information when they need it
48.2% would prefer face-to-face support

Face-to-face and online mental health and wellbeing support should feature:

• Trust
• Privacy
• Feelings of safety and familiarity
• Non-judgemental engagement
• A sense of understanding and empathy

The most common barriers to using online/digit support:

• A lack of access to devices
• Internet connection
• A lack of privacy

Concerns about school-based support are:

• Confidentiality
• Anonymity
• Privacy
• stigma

*this question was multiple choice, with respondents identifying as many sources they would use, therefore results do not total 100%.