Inquiry into Child and Adolescent Mental Health Services (CAMHS)

National Assembly for Wales
Children, Young People and Education Committee

CAM 40

Inquiry into Child and Adolescent Mental Health Services (CAMHS)
Evidence from : Integrated Youth Services, Wrexham County Borough Council

1. The availability of early intervention services for children and adolescents;

Counselling

1.1 Schools based counselling services for children and young people are available so that children and young people have access to a counsellor. Counselling is available both in school and at the local Info Shop for those who do no attend school or wish to attend in an alternative location from school. Counselling is also available during the school holidays for those who need it. Children and young people can self refer, as can other professionals and parents but joint referrals pathways from educational psychologists and from CAMHS to the counselling team are also present to enhance accessibility to this service.

CAMHS Support

1.2 There is a pathway for workers from specialist youth projects to access a mental health practitioner for consultation, or appointments can be offered for the young person to meet with the CAMHS worker to address any concerns around their mental health (In2change/YJS/Inspire). After assessment the CAMHS workers can then take the case to CAMHS Multi-Disciplinary Team for discussion, therefore ensuring that a young person has access to early intervention services as and when required.

Diversionary activities

1.3 Young people have requested specific information on diversionary hobbies and interests and are supported to identify and explore any interests they may have. Involvement in these interests aims to enable young people to develop their skills in these areas, reducing social isolation and being given opportunities to contribute to their communities in a positive way. Increased engagement with support and diversionary services reduces the chance that a young person will present in crisis i.e. self harming behaviour, family breakdown, homelessness, unemployment, and those engaging in positive activities are less likely to engage in unhelpful behaviours. Therefore, decreasing the numbers of young people engaging in anti social behaviours and supporting young people to identify and access appropriate support services and positive activities that interest them proves to be cost effective across services.

Information points & displays

1.4 Integrated Youth Services have maintained information points located within the local hospital. This offers information to visitors on a number of different topics and services. Most popular topics include information on growing up, sexual health and relationships, and services work to ensure that this information is always available and accessible to young people. Integrated Youth Services also maintain information boards on which displays are changed routinely to cover a range of topics throughout the year which are applicable to Young People. Examples include: transitions to secondary school, moving on to college or further studies, exam stress, volunteering, emotional health and wellbeing, physical health conditions and nationally recognised events such as No Smoking Day.

Early Intervention Programmes

1.5 Inspire a hospital youth work service have been involved in the piloting of an early intervention programme for young people with anxiety and low mood and have since delivered this intervention to varying targeted groups of young people. Inspire have also co-developed an intervention group for young people mismanaging a health condition and have delivered this group alongside the community health team. Inspire have provided both awareness and preventative support to young people on emotional health and wellbeing. Positive evaluations were received on the emotional health of young people post workshops and groups via both qualitative and quantitative measures, and Inspire has potentially benefited the future costs of specialist CAMHS services via preventative care.

2. Access to community specialist CAMHS at tier 2 and above for children and adolescents with mental health problems, including access to psychological therapies;

Youth Justice Service

2.1 The Youth Justice Service in Wrexham have a full time Mental Health Practitioner attached to the team, who both acts in a consultative role as and when the staff require specialist advice. They also carry their own case load, providing timely interventions to the children and young people that have been identified as needing input through the YJS assessment process. The Mental Health Practitioner also forms a part of the wider YJS Health team which comprises of substance misuse workers and a Speech And Language Specialist (SALT). They hold monthly multi-disciplinary meetings, which includes a member of the WCBC parenting team. The purpose of this meeting is to discuss and track the young people / parents on their case load and discuss next steps in the young persons health team case management.

Inspire Youth Work In Hospital Project

2.2 Inspire Youth Work in Hospital Project provides a great example of Tier 2 support that is offered to young people aged 11-18 years old who reside in Wrexham County Borough. The project was set up in partnership with Wrexham CAMHS and children's ward at the Wrexham Maelor Hospital, after a need was identified that further support was required to support young people that presented / were admitted to hospital with self-harming behaviours including drug and alcohol intoxication. Inspire is has become a great example of joined up working in Wrexham, where the service delivery was jointly planned via a project management board.

2.3 Inspire is made up of Wrexham County Borough Council (WCBC) youth workers and CAMHS staff (a Mental Health Practitioner and an Assistant Psychologist). Inspire offers young people the opportunity to create their own care plan, with support from a staff member over 8 sessions (which can be weekly, fortnightly or at regular intervals as identified by the young person). Inspire work in partnership with CAMHS to ensure that the holistic needs of the young person are met, including their mental health needs. Where appropriate, Inspire will also work in partnership with NWAS (North Wales Adolescent Service) and CAMHS as identified on a young person's care plan.

2.4 Inspire are often used in an assertive outreach role in an effort to ensure that young people access appropriate CAMHS support. This can include contacting/visiting young people at home if they require a mental health risk assessent which is done in conjunction with CAMHS. During this process, the worker’s role can be to challenge young peoples / family stigma around mental health. Both CAMHS and Inspire meet young people where they feel comfortable, which could be in school, their family home, in a youth club setting or in a local cafe. The aim first and foremost is to engage with the young person in the hope that once they engage with a worker that they will then feel more willing/comfortable to access therapy.

Evidence

2.5 Due to the nature of the funding of Inspire and In2change, it has always been necessary to show clear evidence and distance travelled for the work which is done. This includes using measuring tools such as a Drug and Alcohol Use Screening Tool (DUST) and Coping Scales for Children and Youth (Brodinsky, et al. 1992). We now use the Results Based Accountability model to report back to our funders.

3. The extent to which CAMHS are embedded within broader health and social care services;

Training

3.1 Regular training is offered via the various workforce development departments within Wrexham County Borough Council (WCBC), addressing subjects such as emotional health and well being, self harm, healthy lifestyles (including drugs and alcohol). The workforce are encouraged to identify and are supported to attend more specialised training as identified through an individual's Annual Appraisal (Personal Development Plan). These included training courses such as Mental Health First Aid (MHFA) and Applied Suicide Intervention Skills Training (ASIST).

Bibliotherapy

3.2 WCBC Wrexham Library play an active part in the all-Wales Bibliotherapy Initiative by hosting this initiative, which offers both parents and children the opportunity to access books that will help to improve their emotional health and wellbeing. This initiative is actively promoted by Wrexham CAMHS.

Healthy Schools Schemes

3.3 The Welsh Network of Healthy Schools Schemes (WNHSS) plays an integral part in developing health and wellbeing in Wrexham schools. All schools participate in the scheme, which now includes pre- schools and youth clubs. One of the aims of the scheme is 'to promote actively the self esteem of all members of the school community', which therefore ensures that CAMHS is embedded within broader health and social care services.

Behaviour & Attendance Action Plans

3.4 CAMHS attendance is imperative at children and young peoples individual Behaviour and Attendance Action Plans. This helps to ensure that the mental health needs of the child or young person are taken into account when their Behaviour and Attendance Action Plans are being drawn up. Therefore ensuring that the child or young person can attain and succeed in their Behaviour and Attendance Action Plans.

Access to CAMHS

3.5 Access to the Child and Adolescent Mental Health Service has increased over recent years via consulation, via a weekly drop in at a local education centre and via the telephone helpline.

Referral Pathway

3.6 A CAMHS Referral pathway has been developed in conjunction with Wrexham Integrated Youth Services to support staff to make appropriate referrals to CAMHS. A referral pathway of this nature also ensures that the young person receives adequate support to access Child and Adolescent Mental Health Service and that staff are advised on appropriate advice to be enabled to support the young person appropriately.

Educational sessions

3.7 Inspire deliver educational sessions in schools, PRU's and youth settings, covering topics such as: Emotional Health and Wellbeing, Body Image and dealing with stress. During the emotional health session one of the aims of the session is to challenge the stigma associated with mental health, alongside increasing young people's resilience and better able to deal with the stresses of everyday life. Inspire also offer accreditation opportunities to young people wherever possible.

4. Whether CAMHS is given sufficient priority within broader mental health and social care services, including the allocation of resources to CAMHS;

N/A

5. The effectiveness of the arrangements for children and young people with mental health problems who need emergency services;

Audit

5.1 Inspire/CAMHS conduct an audit to monitor protocols in place for the management of deliberate self harm in children and young people. The audit is based on standards set in the NICE guideline 16: Self harm: The short term physical and psychological management and secondary prevention of self harm in primary and secondary care. The local standards for the audit state that all young people who present to A&E with deliberate self harming behaviour should be admitted and receive a risk assessment from a mental health practitioner before discharge. The audit outlines both challenges and learning points for adhering to existing protocols.

6. The extent to which the current provision of CAMHS is promoting safeguarding, children's rights, and the engagement of children and young people;

Environment

6.1 In recent years Integrated Youth Services have funded the refurbishment of a corridor that young people access to get to CAMHS at the Wrexham Maelor Hospital. Following consultation with young people, they fed back that they found the corridor very ‘dark and depressing’, like ‘doom and gloom’, ‘cluttered with things’, ‘unwelcoming’ and ‘not young person friendly’. Young people suggested that a ‘colourful’ theme would be an improvement in making the corridor ‘more friendly’ and ‘less daunting’. They also asked for additional direction signposting as the young people often worried about getting lost. The revamped corridor has contributed to young people having a positive experience accessing CAMHS services. More recently CAMHS gained funding to revamp their waiting area, also in consultation with young people. It has been painted colourfully and there is art work displayed in the waiting area that has been created by young people who have previously accessed CAMHS.

Feedback from Young People

6.2 Integrated Youth Services actively encourage young people to provide feedback and evaluation on any work they complete within the projects, gaining feedback on 1-1 work, group work, any diversionary activities, as well as any paperwork or evaluation processes. Feedback gained from young people via various evaluations and consultations has demonstrated that young people believe they have made positive changes in their lives through working with the Integrated Youth Services; they have expressed experiences of achievement, improved emotional health and wellbeing and many have stated to have a newly found positive outlook on life.

Young person centred approach

6.3 CAMHS always aim to be flexible in their approach, adapting service delivery to meet the needs of individual young people within a client centered model: being creative with interventions and working collaboratively with young people to achieve their goals, empowering them to have control over any changes they make to their life.

Education, Training & Employment

6.4 Integrated Youth Services have supported young people to maintain or re-establish links with education, training or employment. Young people have been linked in with support systems within schools and colleges and have been supported to address any issues impacting on them not attending. Young people have also been supported to access further training courses and university, as well as employment and volunteering. Integrated Youth Services aim to increase a young persons overall wellbeing and resilience, boosting confidence and motivation, supporting the young person to take positive steps towards obtaining work or a training course of their choice.

7. Any other key issues identified by stakeholders.

N/A