Children and Young People Mental Health and Wellbeing commissioning - - PowerPoint PPT Presentation

Children and Young People Mental Health and Wellbeing commissioning development programme

Expert-led seminar 4

Building robust partnerships: Education spotlight

• YoungMinds is the UK’s leading charity championing the

wellbeing and mental health of young people.

• We exist so that young people have the strongest possible voice

in improving their mental health. We strive to make sure everything, from Government policy to practice in schools and services, is driven by young people’s experiences and aspirations.

• We support parents to help their children through difficult times,

we equip professionals to provide the best possible support to the young people that they work with, and we empower young people to change their world.

YoungMinds

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http://cypmhcommissioning.nelcsu.nhs.uk/

Programme overview

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http://cypmhcommissioning.nelcsu.nhs.uk/

Commissioners are well placed in the system to be…

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Seminar learning outcomes

Overarching aim: To provide techniques for effective partnership working, with a focus

• n schools and colleges

Learning Outcomes

• I have mapped and understand my organisation’s partnerships
• I have a framework for partnership working
• I understand how partnership can help me as a system leader to

achieve whole system transformation

• I understand what MH&WB services schools and colleges

commission and their commissioning process

• I am able to effectively engage schools and colleges in the

commissioning process

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MORNING

• Introduction
• Policy context
• Mapping your partnerships
• Children and young people’s

perspective

• Essential elements of effective

partnerships

• Purpose
• Trust
• Communication
• Engagement

Session plan

AFTERNOON

• Mental health in the context
• f schools and colleges
• Drivers for schools and

colleges

• The role of schools and

colleges and how they commission:

• Internal culture, capacity

and approach

• Using external services
• Purchasing expert help

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The role of partnership in transforming the children’s mental health system

http://cypmhcommissioning.nelcsu.nhs.uk/ 8

NHS England: 2020 Commitment

The £1.4b supports a range of central and local programmes to improve the capacity and capability of children and young people’s mental health

• services. STP plans incorporate Local Transformation Plans that set out

how the following will be delivered.

• At least 70,000 more CYP receiving swift and appropriate access to care each year
• Completed national roll-out of CYP IAPT Programme with at least 3,400 more staff

in existing services trained to improve access to evidence based treatments

• 1,700 additional new staff to support improved access to evidence based

treatments

• Evidence based Community Eating Disorder services for CYP across the country :

95% of those in need of eating disorder services seen within 1 week for urgent cases & 4 weeks for routine cases.

• Improved access to and use of Inpatient Care, having the right number and

geographical distribution of beds to match local demand with capacity, and leading to an overall reduction in bed usage.

• Improved Crisis Care for all ages, including investing in places of safety.

• Five Year Forward View: sets out that partnerships (with patients, local

communities, the voluntary and community sector, across local bodies and with industry and employers) is critical to achieving the NHS vision

• Future in Mind: partnerships across local health systems are central to

transformation of the CYPMH system - especially to deliver improvement in promotion, prevention and early intervention and care for the most vulnerable young people

• Local Transformation Plans: plans for locally led transformation of the
• CYPMH. CCGs work with commissioners and providers across health,

social care, education and youth justice and the voluntary sectors and plans are signed off by the Health and Wellbeing Board

• Sustainability and Transformation Plans: partnerships in 44 areas

covering all of England, to improve health and care. STPs bring together CCGs, VCSE, CCGs, Trusts, local authorities.

• The Children Act 2004 introduced the 'duty to cooperate in the making
• f arrangements to improve well-being’

Partnerships in policy

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• 1. Elements – people and
• rgs – behaviour,

knowledge

• 3. Purpose –

values, culture, ‘the way we do things round here’

• 2. Relationships – pathways,

info, how people and orgs relate

Achieving the kind of systems children and young people want requires whole-systems

• change. This requires we

address: elements, relationships and the purpose of our local

• systems. Partnership is

critical to all of these.

Partnership and systems change

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• 1. Individually, map the range of partnerships that

contribute to achieving whole system transformation for CYPMH in your local area - detailing partners and links

• 2. In groups, share your partnership maps and discuss:

what purpose do your partnerships serve within your local transformation?

Exercise: mapping our partnerships

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Common forms of partnership in CYP mental health system:

• 1. Strategic (overarching and often with CYP focused subgroups)

e.g. STPs, HWBs, LTP/CYP MH boards/groups

• 2. Joint commissioning – pooled or aligned
• 3. Planning and design – services, pathways, programmes
• 4. Operational – integrated service delivery e.g. joint case work, co-

location, information sharing, advocacy

• 5. Individual case level - professionals with CYP and parents

Defining partnerships

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Transforming CYP experience of the system

Partnership is critical for achieving the kind of local mental health system we know children and young people want. CYP want a system that consistently:

• Is friendly, warm and respectful
• Works together
• Spots problems early
• Enables them to find help
• Responds to their needs rather than make us fit in to a service
• Helps them manage their day to day life better and achieve what

matters to me

YoungMinds engagement for National Taskforce

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• Who are the ‘partners’ for these young people?
• Who helps them achieve the outcomes that matter to

them?

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The young person’s perspective

Influence on child development and CYP mental health

Mapping the potential ‘partners’- Bronfenbrenner’s socioecological model

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What makes partnerships effective?

• Evaluating partnerships is highly challenging however,

research has demonstrated links between partnership working and improved processes and therefore final outcomes.

• The differences in power and between hierarchical and

collaborative forms of governance mean a standardised, ‘one size fits all’ approach is unlikely to deliver effectiveness across all partnerships.

• Effective partnerships require public service leaders who

understand and engage with the different pressures on partnerships to navigate the best route through inevitably difficult terrain.

Partnership working across UK public services, An Evidence Review. 2015. Published by the What Works Scotland Evidence Bank

What we know about partnerships

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Time Hist story

People le

Sk Skills Ro Roles

Str tructures

Accountability Engagement

Reso sources

Data ta shar haring and nd info nformation

Envir ironment

Alignment in n targets s across s secto tors Different po policy agendas

Cu Culture

Pow

• wer di

differences Adapted from JIT Scotland (2009) HEALTH, SOCIAL CARE AND HOUSING PARTNERSHIP WORKING

Partnership influencing factors

The enablers and constraints to partnership working are often two sides of the same coin

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Table Discussions

Looking at the kinds of elements that can act as enablers and constraints for partnerships and thinking about the partnerships you have mapped:

• 1. What are proving to be the key enablers for

partnership working?

• 2. What are proving to be the key constraints on

partnership working?

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Children at risk; in need; Social Care vulnerable SEMH - Social, emotional and mental health Challenging behaviour; Education special needs Children with mental illnesses; psychiatric disorders Health

Culture across the system

Language is an example of the different cultures within settings across the system e.g. different words are used to describe the same groups of children. How do we navigate these cultural differences to find a shared language and common purpose in our partnerships?

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Partnership context for schools and colleges

• Different structures e.g. State maintained, Academy, Multi

Academy Trust, Free School, Independent

• Changes to the role of local authority (relationship and

support for schools has changed e.g. traded services)

• Each school and college is different – culture/ethos,

resources, skills and knowledge, and relationships with external providers

• Mental health and academic attainment can be perceived

as different and sometimes competing agendas

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Applying the elements of effective partnership within local children’s mental health systems

Essential elements of effective partnerships

• 1. Shared purpose and aims
• 2. Trust between partners
• 3. Effective communication
• 4. Engaging the right people including the voice of children,

young people and families Together these elements can encourage a shared culture across the system, centred around the needs of children, young people and families

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“Developing clear, common or agreed aims is essential if partners are to make any progress.” (Vangam and Huxham, 2009) Common approaches:

• Shared vision statement
• Common outcomes framework
• System-wide ‘We statements’
• Memorandums of Understanding

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• 1. Shared purpose and aims

Reinforce trusting attitudes Aim for realistic (initially modest) but successful

• utcomes

Gain underpinnings for more ambitious collaboration

From Vangen and Huxham, 2009

• 2. Trust between partners

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• 3. Effective communication
• Walk the talk – behaviour is everything and

communicates most effectively – model honesty and check understanding

• Drip drip; big bang - ongoing marketing strategies,

clear and regular communication

• Challenge the rhetoric – talk about what the vision

looks like in reality at every opportunity

• Shared, simplified language. Translate essential

technical terms

• Share and celebrate wins (everyone wants to be part
• f success)

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• 4. Engaging the right people

“ Get the right people in the room - Consistent representation at the appropriate strategic level is

• critical. A lack of continuity in who attends meetings

makes it impossible to maintain a shared vision and to sustain progress. Equally, in order to maintain momentum, the individuals in the partnership need to be invested with the power to make decisions and the same level of representation is needed from all partners.”

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Exercise 1

Thinking of the partnerships you mapped earlier; On four post-it notes…

• Note an example of a partnership which needs

improving; one for each of the element areas

• 1. Shared purpose and aims
• 2. Trust between partners
• 3. Effective communication
• 4. Engaging the right people
• Reflect on, and note, any ideas/action that could be

taken to improve things (either by you or others)

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Exercise 2

Spend two minutes at flipchart, pairing with a different person at each one. Explain to one another why you have identified the weaknesses you have and discuss the possible actions; share ideas and examples of what has worked. Place the post-it note on the flipchart.

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Exercise 3

Case studies

• How do they reflect the elements of effective

partnership working?

• What do you recognise about your own effective

partnerships?

• What actions/ideas might you take/influence to

happen as a result of this exercise?

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Mental health and schools and colleges

Table Discussions

• 1. What are your challenges in building partnerships

with schools and colleges?

• 2. What drivers are you aware of for schools and

colleges to address pupil mental health and emotional wellbeing?

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Mental health and schools

“The growing number of children and young people experiencing poor mental health is one of the biggest challenges facing our teachers. International comparison studies have found the wellbeing of school- aged children in England / the UK to be ‘average’ or ‘below average’. The picture is worse still for studies that have specifically considered educational wellbeing.”

YoungMinds (2017) Wise Up

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• An estimated three children in every classroom has a

diagnosable mental health problem. This rises to one in four children when we include emotional distress.

• Around one in every twelve young people deliberately self-harm,

though this may rise to almost one in three for girls aged 15.

• Rates of depression and anxiety in teenagers have increased by

70% in the past 25 years.

• The number of young people calling Childline about mental

health problems has risen by 36% in the last four years.

• An ONS study found that children with mental health problems

are less likely than their peers to gain academic qualifications, and more likely to have significant time off school, be excluded

• r get into trouble with the police.

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Mental health and schools

• 16-18 brings lots of issues for transition from CAMHS to adult services
• Colleges recruit from many commissioner/provider geographies
• Health geographies are not co-terminus with natural FE partnerships
• Colleges say a high number of students first present in the college

setting

• Colleges don’t tend to have the same relationships with parents as

schools have

Association of Colleges

Mental health and colleges

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• Attainment/progress, absence, exclusions, destination
• Positive link between wellbeing and educational

attainment

• Ofsted framework which makes links between:

achievement, teaching, leadership and pupil behaviour- and pupil emotional wellbeing

• Diminishing the Differences (closing the gap) -

schools are measured on disadvantaged pupil’s progress and attainment

• SEND changes – joining up support. The Local Offer,

Education, Health and Care Plans, etc

Drivers

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Reality - mixed picture

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What you can/should/ must do? When you need external help?

Have we got the right skills and knowledge?

The external environment varies Every school/college is different

Every school and college is different

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• We know that schools already do a range of things, to support

positive mental health which can be summarised as:-

• Prevention: activities that raise awareness of mental health and

emotional wellbeing and promote good mental health and behaviours; and tackle stigma.

• Identification: recognising emerging issues as early and

accurately as possible.

• Early support: interventions and programmes that support

children and young people with emerging problems or those with less serious issues.

• Access to specialist support: working effectively with health

services to provide swift access to the right specialist support and treatment.

• Education professionals are not mental health specialists and

knowledge and practice in the mental health field is constantly

• developing. This means that action taken by schools must be

supported by advice and support from specialist services.

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What is the role of school/colleges in the system?

Resilience and mental health

Picking out the river downstream Specialist services Prevention Earlier intervention Stopping CYP falling in the river Getting help quicker

Resili lience ence - child ldre ren n enabled ed to swim

http://cypmhcommissioning.nelcsu.nhs.uk/

School Perspective

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• Presentation from school representative from clinical

network

Purchase ‘expert’ help into school

• r college

Use external services Internal culture, capacity and approach

Counselling Additional support Assessments In school/college developments Pathways, referrals, external case work

Manualised programmes

How schools and colleges commission

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Exercise

Based on the model map what you know about local provision in schools and colleges including;

• 1. What you have commissioned
• 2. What partners have

commissioned

• 3. What schools and colleges have

commissioned themselves

• Compare and share what is

working well and where there are gaps?

Purchase ‘expert’ help into school or college Use external services Internal culture, capacity and approach

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• Pilot programme clearly demonstrated the value of strengthening links between

NHS CYPMHS and schools. Key elements included:

 single points of contact / access  clearly defined protocols and pathways to specialist support  strategic leadership from health and education  making best use of existing resources (local CYPMHS networks)

• No single model emerged as being the most effective, as pilots developed their

approach to suit local circumstances, priorities and aims.

• Most pilot areas are committed to sustaining work from the pilot

Mental Health Services and Schools Link Pilots; Evaluation Report 2017

NHS England/Department for Education CYP MH Services and Schools pilot

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22 Pilot sites School named worker CYP MHS named worker

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Next steps

• Department for Education are expanding pilot into 1,200 new schools in 20

CCG areas.

• The extension will aim to
• test the sustainability of delivering the programme in a larger number of

schools.

• focus some of its activity in “Opportunity Areas” - identified as the most

challenged when it comes to social mobility (Bradford, Doncaster, Fenland & East Cambridgeshire, Hastings, Ipswich, Stoke, Blackpool, Oldham, West Somerset, Norwich, Scarborough and Derby)

Further work underway

• Growing number of examples of local work plans underway to strengthen

links with schools and colleges

• Lead commissioners working with other agencies to ensure CYP care

pathways include schools & colleges

• Local Transformation Plans. - key line of enquiry “do plans demonstrate

engagement with key partners including schools and colleges?”

• 1. Internal culture, capacity and

approach

• Without effective planning, there is no inevitable advantage

to a whole-school approach (Catalano et al., 2002; Durlak et al., 2011)

• Variations in effectiveness relate to variations in
• implementation. Effective means (Banerjee et al. 2014) ;
• Leadership
• Planning time
• Inclusion of whole school community inc. explicit staff

induction and professional development activities

• Strategies to promote the well-being of the staff themselves
• Engagement with parents and the community
• Operational coordination and sustaining of the programme

practices

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• 92% report a school ethos/environment that promotes

mutual care and concern

• 64% felt promotion of mental health and wellbeing is

integrated into school day

• 89% report at least one parental engagement activity, 57%

face-to-face sessions

• Mental Health Lead
• 49% have dedicated lead for Mental Health (of which 40%

is SLT member) but 68% have a dedicated member of staff responsible for linking to specialist mental health services

• Their remit includes coordinating and developing mental

health provision in school (85%)

Supporting mental health in schools DfE survey 2017

School wide approaches to promote MH and wellbeing

• Positivity toward their teacher

resulted in students displaying an average of 56% less "oppositional defiant" behaviour: such as argumentativeness and vindictiveness toward authority

• figures. This was still reduced by 22%

up to three years later.

• Researchers found the beneficial

effect on behaviour was as strong, if not stronger, than that of established school-based "intervention programmes" such as counselling and other anti-bullying therapies.

Obsuth, I., Murray, A.L., Malti, T. et al. (2016).

Teacher-student relationships

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• 46% of dedicated mental health leads were

responsible for teaching pupils about MH and wellbeing

• Training
• 51% of leaders say staff equipped to identify

behaviour linked to mental health issues

• 90% of schools offer staff training on supporting

pupils’ mental health and wellbeing (47% all staff)

• 12% use free online training such as MindEd

Supporting mental health in schools DfE survey 2017

Teaching

• Ensuring schools and colleges are integrated with local pathways
• Effective referral systems between schools, colleges and a range
• f local services, including VCS services where appropriate
• Effective communication and information sharing between

schools and colleges and other local partners

• Joint case work between schools or colleges and local partners
• 2. Use external services

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• 68% have designated member of staff responsible for

linking with specialist mental health services

• Fewer than one in five (19%) had a named single point
• f contact in NHS or other CYPMHS to contact for help

and advice. Triage

• 82% use ad-hoc staff concerns as way of identifying needs
• 24% use targeted screening of pupils to identify mental

health needs

Supporting mental health in schools DfE survey 2017

External specialist support

• 3. Purchase expert help
• Few studies have made comparisons between prevention

programmes and other active/targeted interventions.

• A number of studies demonstrate that school-based depression

and anxiety prevention programmes (delivered as universal or targeted interventions) can be effective in the short-term when compared with non-intervention groups.

• Influencing factors, other than the specific content, are important

as well as moderating factors of treatment effects including

• child, gender, age, ethnicity and symptom severity
• The implementation of the programme into the school

environment and the obstacles associated with this.

From: Stallard, P. (2013).

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• 61% of schools offer counselling
• Around half of staff are involved in pupil counselling
• Other staff in or linked to schools with MH

responsibility: SENCO, Ed Psych, School nurse, external MH specialists working in school

Non-CYPMHS support

Supporting mental health in schools DfE survey 2017

Table exercise

Returning to your mapped provision; As a group take 10 minutes to discuss key points of interest. It may be useful to reflect on the four enablers for effective partnerships in your discussion: e.g.

• To what extent do schools and

colleges share the local vision and aims?

• What has been the result of trust

with schools e.g. pooled resources?

• Who are you engaging with

schools and colleges? What is their level and remit?

Purchase ‘expert’ help into school or college Use external services Internal culture, capacity and approach

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• East Sussex:
• The expansion of the schools mental health link worker service as part of

the CAMHS transformation work is positive in strengthening support to lower levels of mental health need to school aged children. For example, the Discovery College is an initiative that is improving young people’s emotional health and well-being.

• Gloucestershire:
• A current pilot to provide more mental health support in schools as part of

the local ‘futures in mind’ plan is providing early help to children and young people to support their emotional health and well-being. This pilot has helped to ensure that children and young people who have mild to moderate mental health needs receive the support they need to prevent their mental health needs escalating.

• Leeds:
• School and college leaders are supportive of the new SEMH strategy. A

significant number of young people who have SEMH needs now receive appropriate support. As a result, they are developing better attitudes to learning and are making stronger progress in their social and emotional development.

Some examples (and case study handouts);

Further Resources

Schools in Mind

• Anna Freud Centre toolkit to make schools and college staff aware of the range of validated

instruments that can be used to measure and monitor student mental wellbeing. http://www.annafreud.org/services-schools/schools-in-mind/ Building Children and Young People's Resilience in Schools – IHE

• The review outlines the potential actions that can be taken in schools in order to build resilience for

all children and young people and reduce inequalities in resilience. http://www.instituteofhealthequity.org/resources-reports/building-children-and-young-peoples- resilience-in-schools Youth Well Being Directory

• provides a list of local and national organisations for anyone up to the age of 25, along with

important information you may find helpful http://www.youthwellbeing.co.uk/ The Academic Resilience Approach.

• Free resources developed with schools, academics and young people based on research evidence

and practice. An extensive toolkit that supports whole assessment and improvement for building student resilience. http://www.boingboing.org.uk/academic-resilience-approach/ National Children’s Bureau.

• A whole school framework for emotional wellbeing and mental health: a self-assessment and

improvement tool for school leaders. https://www.ncb.org.uk/sites/default/files/uploads/documents/Health_wellbeing_docs/ncb_framewor k_for_promoting_well-being_and_responding_to_mental_health_in_schools.pdf

• Resilience Approaches to Supporting Young People’s Mental Health: Appraising the

Evidence Base for Schools and Communities Professor A. Hart and Dr B. Heaver 2015

Useful resources

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