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

Appendix A - Strategic and supporting recommendations

Strategic and supporting recommendations are outlined below. Consideration has been given to whether these recommendations should be progressed over the short (S), medium (M) or longer (L) term.

Strategic Recommendation One

Appropriate good practice sharing events and networks should be continued/established to ensure learning from the Joint Delivery Board is disseminated, and platforms provided that continue to support good practice development across the mental health continuum in line with relevant frameworks, specifications and/or standards. Support for practice platforms must be coordinated to allow for information sharing and strong connections between groups to address shared issues.

Supporting recommendations

In March 2023 the JDB will host a Learning and Sharing good practice event focused on work undertaken across its 2-year timeframe, with a particular focus on impact at a delivery level (S)

In early 2023 the Scottish Government should facilitate a session for children's services partners focused on sharing learning from implementing the Neurodevelopment Service Specification, Principles and Standards of Care in Test of Change areas (S)

In early 2023 COSLA, Scottish Government, third sector partners (YouthLink Scotland, Scottish Youth Parliament, Young Scot, Children's Parliament, Children in Scotland, and Early Years Scotland) should consider showcase sessions to share findings and learning from their engagement activity and from the engagement approaches with wider policy teams and stakeholders. The involvement of children and young people is key to this event (S)

Scottish Government should continue to support and resource the good and emerging practice network aligned to the Community Mental Health and Wellbeing Supports and Services Framework (S)

Scottish Government should continue the CAMHS Improvement Programme through established work within the CAMHS policy teams and the CAMHS and Neurodevelopmental (ND) Programme Board alongside key stakeholder groups (S)

Scottish Government and relevant partners should establish a CAMHS and ND Implementation Support Team (CaNDIST) to provide individualised support to NHS Boards and other relevant partners on issues where they require further expertise to support full implementation of the CAMHS and ND Service Specifications (M)

Scottish Government should establish regional planning support arrangements to co-ordinate regional planning and delivery of the regional elements of the CAMHS Service Specification (M)

Scottish Government should establish and support a national ND Network to further the nationwide implementation of the ND Specification. This should include sharing the learning from the Tests of Change, and exploring how best to share publications, materials and other resources (M)

Scottish Government should consider, in conjunction with the Infant Mental Health Advisory and Implementation Group establishing a successor to the Infant Mental Health Advisory and Implementation Group with an expanded remit of 0-5 years. This group should support implementation of infant mental health services across Scotland and undertake practical action to improve the provision of support for children 3-5 years olds who require assessment and specialist individualised support for their mental health.

Strategic Recommendation Two

Scottish Government, Local Government, the third sector, Health Boards and relevant partners should seek to further understand, develop and deliver a whole systems approach to mental health provision at a national and local level, ensuring connections between services are established, optimised and well understood by those that deliver and use them.

Supporting recommendations

Scottish Government and COSLA should identify and disseminate examples that demonstrate how whole systems approaches have been developed and delivered (S)

Whole systems approaches to mental health should be considered alongside ongoing delivery of related commitments including UNCRC, GIRFEC, the Promise and the National Trauma Training Programme (ongoing)

The Scottish Government together with Local Government, Health Boards and Children's Services Planning stakeholders, in the public and third sector, should work in partnership to further embed children and young people's mental health and mental wellbeing within development and delivery of Scotland's approach to Children's Services Planning. Each area's Children's Services Plan should include information which sets out how local organisations will work collaboratively to plan, co-design and deliver a whole system approach to mental health and wellbeing which:

• encompasses prevention, early intervention, universal services, and targeted services that provide crisis/intensive support
• makes available a flexible range of delivery options (e.g. an appropriate balance of face to face and digital supports) that meets the needs of children, young people and families
• communicates this offer effectively to local children, young people and families, organisations, and frontline practitioners
• takes into account the specific needs of children and young people in vulnerable situations and those with a greater risk of experiencing mental health issues
• takes account of relevant service specifications (Neurodevelopmental and CAMHS) and national guidance (S/M)

Scottish Government and COSLA should ensure that high level governance for children and young people's mental health provision continues to involve relevant cross sector partners. It must sit within a clear and connected policy landscape where links to other groups are clearly mapped and understood, ensuring whole systems approaches are supported by joined up policy making and an understanding of delivery (S)

During 2023, COSLA and the Scottish Government should review and update the children and young people's Community Mental Health and Wellbeing Supports and Services Framework, taking into account feedback and learning from Task and Finish Group One. The framework should remain focused on 5-24yrs (26 for care experienced) but ensure closer links with pre-5 work occur. A focus on 16-25 provision, mental health support for higher risk groups (e.g. LGBT) and transition from children's services to adult services will also be critical. Whilst it must place continued emphasis on early intervention, the review should also consider the additional provision of crisis support through the framework (S/M).

Scottish Government should consider funding for community-based mental health services on a multi-year basis to provide the stability that enables cross-system connections to be formed. Other means to support whole systems approaches through approaches to funding should also be considered (M)

Scottish Government and partners should review the implementation of the CAMHS service specification and Neurodevelopmental specifications to make sure these services are meeting the needs of children and young people in vulnerable situations. (M)

Strategic Recommendation Three

Actions progressed by the governance structure that follows the Joint Delivery Board should be underpinned from the outset by a clear set of short, medium and long-term outcomes and a shared understanding of how progression towards mental health goals will be monitored and evaluated.

Supporting recommendations

The incoming high level governance group must initially agree outcomes to be progressed, the programme of work which will enable outcomes to be achieved and how progress towards mental health outcomes will be monitored. The group must give regard, both to this report, the outcomes agreed by the JDB (Appendix C) and wider relevant outcomes (S)

Consideration should be given to reporting through Children's Services planning structures, maximising utility of funding and consolidating reporting asks (S/M)

Considering links to Children's Services planning processes, the Scottish Government and relevant partners should work to standardise data in CAMHS, ND Services and information to support improved service planning and patient experience of service (M)

Approaches considered to monitor progress under the new governance group should take into account other work being undertaken to support improvements across mental health and the wider public sector, inclusive of approaches to implementing quality standards (current and under development) and wider health and wellbeing outcomes; ensuring data asks are proportionate and co-ordinated. (S)

Strategic Recommendation Four

In alignment with the UNCRC and the ethos of previous mental health work, Scottish Government, Local Government and relevant strategic partners, should ensure children and young people from all backgrounds are a core partner in improving mental health matters that affect them at personal, community and wider society level and have their views taken seriously.

Supporting recommendations

Work on children and young people's mental health policy and strategy at a national level should continue to be informed by the Principles for Youth Participation and Engagement, with COSLA and Scottish Government undertaking a regular review of the principles to ensure they remain up to date. The psychological safety of children and young people must be paramount to this process and resulting engagement (ongoing)

The engagement of children and young people must be central to work resulting from the JDB including:

• Any review of the Community Mental Health and Wellbeing Supports and Services Framework
• The development and testing of mental health information and resources
• The implementation of the CAMHS and Neurodevelopmental Service Specifications.

Scottish Government should work with partners to establish national, independent, and routine arrangements to engage with children, young people and their families to feedback on their experience of the ND specification. The voices of children and young people with additional support needs should be undertaken alongside the existing work stream within Scottish Government looking at children and young people with a learning disability who are accessing CAMHS. Further opportunities should also be identified for children, young people and their families to contribute to the evaluation of mental health supports services, sharing their experiences

Engagement of children and young people should also be central to wider mental health developments including the new Mental Health and Wellbeing Strategy (ongoing)

Views and information gathered from young people by the JDB, and its predecessors should be fully considered within the next steps for this work and utilised within wider mental health policy work to avoid repetition (ongoing)

Focus on engaging with children from 'all backgrounds' across this work should seek to ensure inclusion of children and young people both with protected characteristics as well as other characteristics not covered by the Equality Act 2010

Parents, carers and family members such as siblings must also be central in future developments to policy/guidance supporting children and young people's mental health and wellbeing, ensuring their voices are heard and they have the opportunity to engage fully in planning and development.

Strategic Recommendation Five

A shared and accessible language should be used to describe mental health and associated services, to ensure services are designed with a common goal and children, young people and their families feel able to access them.

Supporting recommendations

Considering links to the GIRFEC refresh, Scottish Government's Children, Young People, Relationships and Families Unit should liaise with the Redesign of Urgent Care programme to ensure that any definition of crisis takes account of stakeholders' views on the needs and experiences of children and young people. This definition should be adopted once signed off by the Redesign of Urgent Care Mental Health Workstream group and used consistently across services and disciplines (M)

Scottish Government, COSLA and relevant partners should include the term 'happiness' when referring to children's mental health and wellbeing, so that the phrase mental health, happiness and wellbeing comes to be regarded as familiar terminology for children, parents/carers and professionals. (ongoing)

Strategic Recommendation Six

Quality learning resources and training opportunities considered by the JDB are developed, disseminated, supported, evaluated and accessible for the children and young people's mental health and mental wellbeing workforce. These must align to the strategic planning processes that relate to children and young people's mental health and continue to evolve to ensure the needs of our communities are met.

Supporting recommendations

Over 2023, learning and training resources developed under the JDB should be completed, disseminated and evaluated, supported by appropriate resource and multi-agency collaboration at a national and local level. This should include:

• The Neurodevelopmental self-assessment tool to support local areas progress with the implementation of the Neurodevelopment Service Specification (SG)
• The Neurodevelopmental Learning Framework (SG)
• The One Good Adult Job Description (NES)
• The First Point of Contact Resource (NES)
• The Training Evaluation Toolkit (NES)
• the Promise Sway (NES)
• The Digital Learning Map (NES)
• Key Principles for staff working with care experienced children and young people and children and young people in vulnerable situations (SG)
• The good and emerging practice document sharing effective practice when working with children and young people in vulnerable situations.(SG)
• The new digital resource, co-designed with care experienced children and young people which focuses on relationships and the key behaviours and skills that make the biggest difference to care experienced children and young people. (SG)

(lead organisation for each resource indicated in brackets)

Scottish Government and COSLA should consider identifying local mental health champions to promote and embed available resources

Scottish Government, through the incoming Mental Health Workforce Strategy and together with organisations for whom the training is relevant, should consider enhanced resource for additional, dedicated training and education infrastructure to help with dissemination, embedding and staff time for education, training and support

Inline with developing knowledge and policy in 3-5 year old mental health, Scottish Government, COSLA and relevant stakeholders across early learning and childcare should seek to:

• raise awareness about the knowledge and skills needed by the ELC workforce to support young children's mental health, happiness and wellbeing
• raise awareness across the ELC workforce of the range of existing resources and learning opportunities that aim to support young children's mental health happiness and wellbeing
• raise awareness about the reasons and importance of placing family wellbeing at the heart of supporting young children's mental health, happiness, and wellbeing
• identify the gaps in materials and resources available for the ELC workforce with regard to supporting young children's mental health, happiness and wellbeing and adapt/develop as required
• explore possible ways of supporting the ELC workforce to have more opportunities to undertake professional learning about children's mental health, happiness and wellbeing. (S/M)

Strategic Recommendation Seven

Scottish Government should continue to provide funding for mental health and wellbeing services across the mental health continuum, including prevention and early intervention, in line with agreed commitments that result from the work of the JDB.

Supporting recommendations

Children and young people's mental health governance should continue to be resourced to allow ongoing, cross sector engagement in decision making and mechanisms by which practitioner voice is heard (ongoing)

Sufficient funding for prevention should continue and be developed further. Scottish Government and COSLA should seek to further understand the impact of this investment to inform long term investment in services across the continuum of support (ongoing)

Any expansion of community-based supports and services, resulting from the proposed review of the framework, should be supported by a corresponding expansion of funding (S/M)

Learning from the work of the Joint Delivery Board should inform future funding decisions. In particular, final reporting from the Neurodevelopmental Tests of Change should inform discussions between Scottish Government, COSLA and relevant partners on financial/resource planning for full implementation of the ND Specification. (S/M)

Strategic Recommendation Eight

Beyond the life of the Board Scottish Government, Local Government, Health Boards and the third sector should produce targeted communication on mental health and wellbeing to ensure that all stakeholders including children and young people, parents and carers, mental health and mental wellbeing professionals can access the information that they need to support themselves and/or others.

Supporting recommendations

Through community and children's planning and other relevant local mechanisms, Local Government, third sector and Health Boards should work closely to communicate and promote locally available mental health support, ensuring relevant information reaches children, young people, parents and carers. Where possible, promotion should be via existing channels to ensure maximum reach (ongoing)

Scottish Government should develop and disseminate, to practitioners, parents and carers, communications that provide clarity on the expectations of CAMHS as a service for 0-5 year olds (S)

Scottish Government and COSLA should consider developing appropriate communications with and for parents/carers represented on the Board to raise awareness around the work and recommendations of the Board. This should also link with wider policy areas who may be considering developing resources for parents/carers (ongoing)

Scottish Government, COSLA and relevant partners should consider developing communications on 'social norms', detailing commonplace experiences with mental health and wellbeing for children and young people, parents and carers and professions with no mental health background to support wider understanding of mental health and when to seek help (S/M)

A campaign should be considered for children and young people, parents, carers and relevant professionals, emphasising role non-clinical interventions can play in supporting children and young people. A wider range of communications should be considered (S/M)

A national awareness campaign should be undertaken to raise awareness of mental health and wellbeing for the 3-5 age group building on the successful Wellbeing for Wee Ones campaign, and additional resources and initiatives should be developed which encourage a shared language and understanding across parents, carers, and professionals. The appointment of a National Champion as a face of the campaign is recommended (S/M)

The Information Bulletin should continue to be created, published, and shared on a regular basis by Scottish Government, enabling partners across the system to continue to understand the scale, scope, and direction of travel across the children and young people's mental health policy landscape (ongoing)

Routes should be explored to ensure communications on early intervention and community-based supports reach primary care practitioners and they feel confident in signposting/ supporting children, young people and their families into these services (S)

Scottish Government, COSLA and the third sector should give consideration to the development of a platform to share and celebrate good practice to support children and young people's mental health, demonstrating and promoting progress (S)

Sufficient funding is required at national and local level to support strong communications on support available for children and young people's mental health and wellbeing (S)

Consideration should be given to how national communication channels (e.g. Aye Feel/Parent Club) might support high level messaging where possible (S)

Scottish Government should commission research to look at the need for a National Helpline to support parents and carers of young children (birth to 5 years old). This should include engagement with parents/carers of babies and young children to establish the following (S/M):

• what extra support is needed to sustain positive emotional wellbeing and mental health and happiness, that helps build resilience (for both child and parent/carer)?
• what existing resources address these support needs and where is the gap?
• what modality would parents/carers find most helpful for accessing support?
• Is birth to 5 years the preferred age group, or should this be narrower/broader?
• Whether this could be delivered as an expansion of currently available telephone lines.

Strategic Recommendation Nine

Scottish Government and COSLA should seek to influence policy development across the wider social determinants of children and young people's mental health, including education and family support, to further embed approaches that support mental health and mental wellbeing.

Supporting recommendations

The development of wider policy should consider:

Work with ELC providers and local authorities, in the context of ELC provision, to enhance flexible and responsive relational approaches to children's mental health, happiness and wellbeing; enhance the provision of family learning and support; and support/enable the release and support staff to undertake professional learning in mental health

The establishment of a National Review Group to examine and improve connections between Health Visiting, Early Learning and Childcare, parents/carers and others, including the sharing and use of data

Seeking to ensure that the new National Education Agency considers children's mental health, happiness and emotional wellbeing is at the heart of all policy and practice. And that the new inspection framework places significant focus on supporting children's mental health, happiness, and wellbeing within ELC provision

Supporting collaborative working within Children's Service Planning Partnerships to improve holistic whole family support, including an exploration of the impact of family support models of ELC provision on children's mental health, happiness, and wellbeing

Seeking to influence the development of future guidance to ensure this takes account of the mental health and wellbeing needs of children and young people. Scottish Government and key partners including Local Government, third sector and other public bodies, should consider if guidance which already exists regarding health assessments for children and young people in vulnerable situations needs to be updated or reviewed to include mental health and wellbeing support. This should align with work already underway within Scottish Government to review guidance on child protection and rights and to implement the Promise.