Doncaster’s Local Transformation Plan



-673100-40640000righttop2019This Transformation Plan sets out the strategic vision, progress and next steps for the transformation of children and young people’s mental health services in Doncaster across 2019-2020.01000002019This Transformation Plan sets out the strategic vision, progress and next steps for the transformation of children and young people’s mental health services in Doncaster across 2019-2020.241540250002672715Doncaster’s Local Transformation Plan07300Doncaster’s Local Transformation Plan-6759888450300Table of Contents Page Number TOC \o "1-3" \h \z \u Table of Contents PAGEREF _Toc16690236 \h 2 1. Open Letter to Children and Young People4 2. Local Transformation Plan Ambition 2019-202062.1 Resilience, Prevention and Early Intervention for the Mental Wellbeing of Children and Young People72.1.2 Perinatal Mental Health92.2. CYP Mental Health Services working with educational settings (including Mental Health Support Teams)172.2.1 The Removal of a Tiered Support System1 PAGEREF _Toc16690244 \h 72.2.2 Urgent and Emergency (Crisis) Mental Health Care PAGEREF _Toc16690245 \h 202.2.3 Intensive Homebased Treatment Provision212.2.4 Community Eating Disorders Service252.2.5 Early Intervention in Psychosis282.3 Caring for the Most Vulnerable292.3.1 Looked After Children292.3.2 Transforming Care31 2.3.3 Learning Disabilities33 2.3.4 Special Educational Needs (SEND)442.4 The Children’s Sleep Service462.5 Young Minds and participation49 2.6 Workforce53 3. Understanding Local Need53 4. Transparency and Governance………………………………………………................... 58 5. Data Access and Outcomes61 6. Finance63 7. Appendices64 This Page is left intentionally blank 1. Open Letter to Children and Young People I am delighted to write to you, reporting on the fantastic progress we have made in the last year and to let you know what the areas of focus are for next year. The emotional health and wellbeing of Doncaster’s children and young people remains a top priority and we remain committed to ensuring that we hear the voice of our local children and young people and wherever possible, use their voice to shape the services delivered across Doncaster. It is with great pride that I can report that this year, we have for the first time a child friendly version of the Local Transformation Plan written and produced by our participation champions.Here’s what we’ve been doing during 2018-2019….We continue to make good progress against the plan.? We are the only area in the country to have received a green rating from the NSPCC for, four consecutive years at a national level.? ??On year one we can report that our joint expression of interest in partnership with Rotherham to become a Trailblazer site was successful.? We will be piloting a four-week wait to access treatment for children and young people and we will be able to have the presence of Mental Health Support Teams across some of our Doncaster schools. Both of these exciting developments will formally launch in December 2019 and a more detailed update is included further in this plan. We have had a significant decrease in the number of children and young people admitted to an inpatient setting (mental health hospital) and no child or young person from Doncaster living with autism or a learning disability has been admitted to an inpatient setting for 17 months. This is a big improvement and achievement of which we are very proud.As this programme of work is always evolving, there naturally remain some challenges, which require attention. These include further improvements to our waiting times for autism and ADHD assessments, out of hours support and transitions at key points for children and young people such as; the transition from primary to secondary school, secondary school to college and then into adult services. Some further areas of focus include:Embedding Mental Health Support Teams in schools and ensuring that what the teams are offering, meets the needs identified by our children and young people Launching a post diagnostic support service for children diagnosed with autism and their familiesWorking with our Young Advisors to hold an Emotional Health and Wellbeing Fayre Continue to work with local and national colleagues to pilot a new Mental Health Assessment Framework for Looked After Children ?We acknowledge the importance of emotional health and wellbeing as identified by young people through the Make Your Mark Campaign and the Children and Families Forum Event and I assure you that this remains as important to Team Doncaster.? I look forward to another year of making great strides in listening to our children and young people and building an offer that supports young people to achieve great outcomes. 1.1 Open Letter from Children and Young People Welcome to Doncaster’s Plan for Young People’s Emotional Health and Wellbeing. Its official title is The Doncaster Children and Young People’s Emotional Health and Wellbeing Local Transformation Plan (LTP). The actual plan is very long but we wanted to create a version that is clear, simple and interesting for children and young people…because it is about us!We are a group of local young people, parents and carers, working with Team Doncaster and YoungMinds to make sure that the voices of children and young people are represented in the local emotional wellbeing services that affect them.Team Doncaster’s top priority it to ensure that all children and young people receive appropriate help and guidance for their emotional wellbeing and have easy access to support. They want to offer this to all young people experiencing a hard time; whether it be stress, anxiety or anything else troubling their emotional wellbeing.When we talk about ‘Team Doncaster’ we mean all of the organisations in the area who work with children and young people, including Doncaster CCG, Doncaster Council, Doncaster CAMHS, schools, youth centres and lots more.Team Doncaster want children and young people to be able to feel comfortable discussing their feelings and to design services that meet the needs of every child and young person. It is essential that the correct support is available to those who want to access help.Feedback from children and young people is greatly valued by Team Doncaster, who want to hear the voice of every child and young person in order to provide the best support possible. Voices are wanted to show that together, we can improve the support services for children, young people and families in order to create a comfortable environment where children and young people’s health and wellbeing is given the priority it deserves.Doncaster Emotional Wellbeing Participation Champions2. Local Transformation Plan Ambition 2019-2020Our vision and mission statement is our intent as partner organisations. Our values drive the culture of the partner organisations and provide an anchor for everyone against which to test behaviour and delivery. Vision and MissionTeam Doncaster will work to secure sustainable improvements in Children and Young People’s emotional health and wellbeing. It will provide a responsible and transparent partnership in order to facilitate whole system transformation by successfully implementing the Local Transformation Plan. Values The needs of our population are paramountThe partnership will drive forward continuous improvement Relationships will be based on integrity and trust The views of Children and Young People will be consistently sought, understood and be assimilated in to the service delivery model 1072515247015More children, young people and their families will be resilient, happy and confident with better chances of successEvidence – feedback from children, young people and their families, through questionnaires i.e. health related behaviour questionnaire, reduced demand on services and greater educational attainment 0More children, young people and their families will be resilient, happy and confident with better chances of successEvidence – feedback from children, young people and their families, through questionnaires i.e. health related behaviour questionnaire, reduced demand on services and greater educational attainment How will we know that this vision is achieved? 1097915212725More Children and Young People with mental health problems will recoverEvidence – individual goal setting (where CYP meet their goals)0More Children and Young People with mental health problems will recoverEvidence – individual goal setting (where CYP meet their goals)1110615154305Children and Young People will have good emotional wellbeing and mental health Evidence – routine outcome measures, goal setting, numbers in treatment 0Children and Young People will have good emotional wellbeing and mental health Evidence – routine outcome measures, goal setting, numbers in treatment 1112520105410Children and Young People who need support will get this at the earliest opportunityEvidence – reduction in numbers seen in specialist CAMHs, numbers seen by consultation and advice workers0Children and Young People who need support will get this at the earliest opportunityEvidence – reduction in numbers seen in specialist CAMHs, numbers seen by consultation and advice workers1080770220345Support for Children and Young People, provided by the right person at the right timeEvidence – numbers seen by consultation and advice workers0Support for Children and Young People, provided by the right person at the right timeEvidence – numbers seen by consultation and advice workers1066165-305435A quality workforce that is excellent in practice and able to deliver the best evidenced careEvidence – numbers accessing training courses, number of referrals into specialist CAMHs, post training findings 0A quality workforce that is excellent in practice and able to deliver the best evidenced careEvidence – numbers accessing training courses, number of referrals into specialist CAMHs, post training findings 1074420135890Fewer Children and Young people will develop serious mental health problems and those that do are given the best support possible in the communityEvidence – inpatient admissions, number seen by the intensive home treatment service 0Fewer Children and Young people will develop serious mental health problems and those that do are given the best support possible in the communityEvidence – inpatient admissions, number seen by the intensive home treatment service 1080770140970The removal of referral thresholds, criteria and written referrals for support will be part of the systemic approachEvidence – number receiving systemic support, number of written referrals 0The removal of referral thresholds, criteria and written referrals for support will be part of the systemic approachEvidence – number receiving systemic support, number of written referrals 2.1 Resilience, Prevention and Early Intervention for the Mental Wellbeing of Children and Young People 2.1.1 The Children’s Front Door In 2018 CAMHs were able to join the Children’s Front Door, representing a shift towards a true multiagency access point for children, young people, their families and practitioners alike. The benefit of CAMHs being a part of the front door is that CAMHs expertise can be provided as part of the universal service offer, insofar as any query sent into the Front Door identifying Social, Emotional and/or Mental Health needs is automatically triaged by a CAMHs worker to ensure that the most appropriate service can be provided for children and young people whether this be support with emotional health and wellbeing via CAMHs or liaising with other members of the front door to meet the identified support needs via a different route, for example; housing support, social care support or early help support. The graph and table below details the number of enquiries received to the Children’s Front Door with a presenting issue of child mental health. The Graph also illustrates the percentage of enquiries received with child mental health as the presenting issue as a proportion of all referrals to the front door. Early Help Hub EnquiriesTotalNo. of Contacts9011No. of Enquires with Presenting Issue of Child Mental Health1169% of enquiries with a presenting issue of Child Mental Health13%The table below clearly indicates that 606 (52%) of enquiries that identified child mental health as the presenting issue progressed to a multiagency approach. This is highly reassuring and demonstrates that in Doncaster, the system is transforming Screening Decision August 2017- February 2019:TotalContinue with Universal Services29Currently open with CSC3Information, Advice and Guidance118Join existing EH Pathway107No Consent at point of enquiry36Parent / Carer declined service 91Proceed to Multi-agency606Proceed to Single agency89Referral to Outside Agency6Referral to Specialist Service20Requires Children's Social Care52Screening to be completed1211692.1.2 Perinatal Mental Health A huge success across 2018-2019 was the successful launch of our Perinatal Mental Health (PNMH) Service. The service is commissioned across Sheffield, Rotherham and Doncaster and a summary of the achievements to date has been provided by the Service below. This is particularly exciting for Doncaster, as this is a brand new provision and fills a previously vital gap in service. What does the service provide?The Sheffield, Rotherham and Doncaster Perinatal Mental Health Service provides specialist assessment and treatment to mums and their families living in Sheffield, Rotherham and Doncaster. We provide support before, during and after pregnancy (up to child being one year old).The Service is run in partnership between Sheffield Health and Social Care NHSFT, Rotherham, Doncaster and South Humber NHSFT and Light, our local perinatal peer support charity.The service is available to women who:Are planning to try and have a babyAre pregnantHave a child less than 12 months oldHave previously been diagnosed with a serious or complex mental health problemMight be developing a serious or complex mental health problemSome of the services offered include:Pre-conceptual adviceSpecialist mental health assessmentOne to one appointmentsPeer supportAccess to a team of specialistsGeneral advice and signpostingThe Perinatal MH Service system that is now in place across Sheffield, Rotherham and Doncaster provides the following:all patients now see the same named nurse throughout their carenew pathways are in place a consistent service delivery based on NICE guideline pathwaysThe Journey so far…May 2018 saw the announcement that Sheffield, Rotherham and Doncaster’s bid for Wave 2 Community Services Development Fund (CSDF) for Perinatal Mental Health Services was successful. Funding of ?880,101 was allocated to Sheffield CCG (as host CCG for the service for 2018/19 with the lead Provider identified as SHSC) on behalf of the Sheffield, Rotherham and Doncaster Perinatal Mental Health Service. RDaSH and LIGHT being the key partners for delivery of the service. The main aim of the bid was to:establish a single specialist perinatal community mental health service (PNMH) working flexibly across the geographical areas of Sheffield, Rotherham and Doncasterintegrate specialist community expertise with local services, making effective use of technology and peer support, and promote access and wellbeing across local communitiesThe starting point for each of the services across Sheffield, Rotherham and Doncaster varied enormously with Sheffield having a small but well established service in place, Rotherham with one nurse in post and Doncaster had no Perinatal MH Service at all. Working with commissioners, providers and LIGHT (our Peer Support Partner) across all 3 localities we agreed a work programme to meet the above aims, whilst building relationships and networks. The work programme consisted of 5 key work streams:Recruitment, Training and InductionModel, Pathway, Procedures and PremisesSystems, Information, Outcomes and EvaluationCommunications, Engagement and User involvement Governance and partnership developmentImplementation of the actions began with recruitment to key posts to take the project forward. Below are the key achievements against the 5 workstreams during 2018/19 and the first half of 2019/20:Recruitment, Induction and TrainingThe Perinatal MH workforce across the three localities has come a long way in the last 12 months. The service went from a total of 6 clinicians (3 part time) serving an area with a birth rate of over 13,000 per year to over 30:Sheffield WTERotherham WTEDoncaster WteAdditional detailPractice lead role1.00Admin Band 41.00Project Manager 1.00Consultant Psychiatrist1.001.001.00 Consultant to start in NovemberPsychologist 0.700.70Both employed by SheffieldParent Infant Psychotherapist1.00x2 people, both employed by Sheffield, both working across the 3 areasOccupational Therapist 0.800.80Community Team Manager 0.801.001.00Specialist Community Nurses 4.002.80Social Worker 0.200.200.20Sheffield and Rotherham S Worker still to be appointedCommunity Nursery Nurses 1.601.80?Team level Administrative / Secretarial1.000.501.00?Temporary Community Nurses2.002.00Recruited but not yet in postThe service is nearly at full establishment; all staff in post have been inducted and trained. The only exception to this is the Consultant Psychiatrist who starts in November 2019 and the Social Worker post for Sheffield and Rotherham which is under discussion.Model, Pathway and ProceduresNational Perinatal MH Pathways have been published and are in the process of being adopted across all Perinatal MH Services including Sheffield, Rotherham and Doncaster. The pathways cover:Pathway 1 - Pre-conceptual advicePathway 2 - Specialist assessmentPathway 3- Emergency (being followed but with interim arrangements of using the crisis team for Rotherham and Doncaster emergencies until the Consultant is in post)Pathway 4 - Psychological (our psychological offer is currently being developed)Pathway 5 - Inpatient care Process maps have been developed in line with national pathway guidance for the following:Pre-pathway advicePre-conception advice (Pathway 1)Patient specific enquirySpecialist Assessment (Pathway 2)Emergency Assessment (Pathway 3)DNAThe service has also commenced the development of Standard Operating Procedures (SOPs).Systems, Information, Outcomes and EvaluationMore recently, a Performance Framework has been produced for the Service which has been challenging. This is mainly due to the fact that the 3 localities span two individual provider Trusts working with two different clinical systems. Data reporting for one service is currently being managed manually however we are keen to address this this financial year.The service has adopted National Performance outcomes for the PNMH Service and also have a procedure in place to obtain client feedback via LIGHT (below for more detail). An evaluation of the service was undertaken at the start of 2019/20 and submitted to NHSE. Communications, Engagement, User Involvement (and Peer Support)Much work has been undertaken through the Communication workstream:All branding and logos of the new service agreed and materials orderedOpen Days held for Rotherham, Doncaster and Sheffield Formal Launch of the Service took place on 1 May 2019RDaSH and SHSC website developedTraining Plan communicated for external stakeholdersLikewise, from an Engagement perspective, Service User Events have taken place bi-monthly with results influencing the development of the service. Peer Support PartnerIn addition to the Perinatal Specialist Team, a Peer Support charity called LIGHT has been contracted. LIGHT supports the emotional wellbeing & mental health of mums and their families during pregnancy, birth and up to 2 years following birth. The service is working closely with LIGHT to coproduce, develop services and provide peer support.The partnership model with LIGHT is being held as a beacon of good practice across the Yorkshire and Humber region.Since September 2018, LIGHT has:Recruited, trained, supervised and managed 5 new staff plus volunteersSet up and run x 2 weekly support groups in each locality and 1:1 sessionCo-run PNMH Service User engagement groups across the region to gain feedback on service design, co-production and governanceFacilitated PNMH service user feedback Provided the online forum for all clients Undertaken research in to the level of support for dads Activity/ DataIt is estimated that more than 600 women in our local area will receive support from the service at some point every year. The ‘newly’ appointed Perinatal MH Community Nurses started to see patients from January 2019. From the same time, the newly appointed Clinical Nurse Lead and the Perinatal MH Community Nurses for Doncaster began to set up the new service in Doncaster establishing key relationships across the Doncaster locality and supporting the CMHTs in assessing and seeing women with Perinatal Mental Health problems but not taking on caseloads (due to the fact that there was no Consultant cover to provide the level of input and medical cover required). Interim arrangements for the Consultant cover are now in place (April 2019) and we have recruited a Consultant Psychiatrist who is to start in November 2019. Therefore, data is available for 2018/19, however, the numbers seen were lower than expected, due to the aforementioned reasons. Comparison of number of women seen in the Sheffield, Rotherham and Doncaster Perinatal MH Service in Quarter 4 of 2018/19Activity2017/18Q42018/19Q42019/20Q1RotherhamTotal number of referralsTotal number of people seen4341484510157SheffieldTotal number of referralsTotal number of people seen134741528914592DoncasterTotal number of referralsTotal number of people seen----9069TOTALTotal number of referralsTotal number of people seen177115200134336218By the end of Q1 data was beginning to emerge to suggest that demand was on the increase and, due to annual and sickness levels in the service, was outstripping capacity. Decisions were taken to temporarily recruit to an additional 4 Community Nurses to ease the pressure whilst workflow and demand was analysed. The Nurses are due to commence during September 2019.Impact/ OutcomesThe outcome measures we have agreed as a service cover Patients, Staff and the Service. We have used a mixed method approach to measuring each of these areas: PatientsPatient Feedback – Patient related Outcome Experience Measures - (POEM)Attached below is a copy of the above questionnaire. Arrangements are in place with LIGHT our Peer Support Partner to make contact with families that have used the service to obtain their feedback based on the questionnaire. This is a process that has received full Caldicott Guardian approval. Feedback through Complaints and ComplimentsOur service uses Friends and Family Test (FFT) to obtain feedback. In addition, the service receives individual feedback from patients in the form of emails, letters and cards. Below are summarised extracts from the compliments we have received over the last few months:424688090805Paying Thanks to (Named Nurse)00Paying Thanks to (Named Nurse)219792794615‘’ Without (named nurse) support I dread to think what the outcome might have been’’00‘’ Without (named nurse) support I dread to think what the outcome might have been’’20568095010Applauding the service00Applauding the service4239391263945‘’ Your service is invaluable’’00‘’ Your service is invaluable’’202134255270‘’ We owe so much to you’’00‘’ We owe so much to you’’Service User Events- FeedbackWe hold regular Service User Events via LIGHT throughout the year. Key to the development of the Service was the Service User Event held in October 2018. Attached below are two of the key outputs from the day which are included as an example of how we use feedback from our Service User Events to help shape the Peer Support Groups across the area and the running of the events.\s \sSerious Untowards Incidents (SUIs)Serious Untoward Incidents (SUIs) are a key factor in our Governance arrangements for the Service. Learning from all SUIs is shared across the Service. Currently any SUIs that do take place are discussed, reported on and actions taken within the relevant organisation as well as discussed at the monthly Steering Group meetings. Going forward, all SUIs will also be summarised in reports produced for the new Board.Staff Survey MonkeyWe have undertaken a staff survey monkey to gain feedback from staff on their experience of working in a new or expanding service. We plan to undertake Staff Surveys bi-yearly to compare results and take the appropriate action to address any areas requiring attention.Staff Supervision and Mandatory TrainingWe measure compliance with staff supervision and Mandatory Training requirements for the Service on a 6 monthly basis.In addition, we held a specific ‘What have we learnt about setting up and embedding a new service’ at our extended Steering Group Meeting in June 2019. Contracted ActivityThe Service will be monitored and report against delivery of a target of 4.5% of the birth rate for each area which has been accepted by the 3 CCGs and the service aims to achieve a stretch target of 5%.Time targets for each part of the care pathway have been agreed with the target being ‘60%’:Routine initial assessment - referral to assessment time 10 working days.Urgent assessment – referral to assessment time 2 working daysEmergency assessment – referral to assessment time 4 hours.Pre-conceptual Advice appointment – referral to appointment time 6 weeks.Psychological intervention – referral to intervention time of 6 weeks.Future PlansAs the Service is still very much in its infancy there are still many building blocks that need to be developed and or/refined as well as new challenges to face. Our key areas of focus for 2019/20 are as follows:To ensure we have robust Governance arrangements firmly in place (MOU, contracts, sub contract, data reporting, standard operating procedures, Partnership Board and Operational meetings running smoothly and with clear Terms of Reference and are working towards CCQI compliance) for 2019/20To complete the Annual Development Plan for the Service by ensuring plans are in place to meet the expectations outlined in the Long Term Plan for Perinatal Mental Health Services whilst also ensuring integration with the Local Children’s and Maternity programmes and systemsContinue to meet our targets and reporting requirements To develop plans to improve the IT infrastructure, digital and reporting systems through the use of recently announced NHSE fundsTo continue to understand capacity and demand issues and work flow to optimise the efficiency of our serviceTo ensure we have fully developed and agreed Pathways in place for the delivery of our service offer to women across the three localitiesDevelop our approach and offer to vulnerable groupsTo support and continue to work with LIGHT to ensure there is a seamless transition from discharge, for the women we see, to peer support groups and services Continue to train and educate the public and health and social care services about Perinatal Mental HealthSummaryIn summary, we feel the Service has made significant progress over this last year, since the successful announcement of the bid. We have undertaken a successful recruitment plan and have welcomed over 20 new staff into the Service. We are delighted to have interim arrangements in place to allow us to see women and their families in Doncaster and look forward to November when the new Consultant Psychiatrist commences with the service. The relationships and cross boundary working that has been built and developed over the course of the last year can only stand us in good stead to take the Service forward. We have managed to create a true one service/team approach across all we do in the Sheffield, Rotherham and Doncaster Perinatal Mental Health Service.Our unique work with our charity organisation partner LIGHT to provide peer support to women and families has proved very successful and has allowed service users to be fully involved in the development of the Perinatal MH Service, something we are all very proud of.We look forward to the coming year to expand the service that has been built on a strong foundation. 2.1.3 Educational Psychology Our Educational Psychology Service is integral to building resilience, prevention and early intervention. The service works in partnership with many services, including schools and CAMHs and plays a vital role in the provision of the graduated response across education. The service has also played a pivotal role in the development of our Trailblazer locally insofar as supporting the engagement with children and young people, research and subsequent interpretation and presentation of the findings. The service has also ensured that the graduated response has been built into and reflected in the model for the Mental Health Support Teams (MHSTs).For the purposes of this, refreshed Local Transformation Plan, we have worked with the Educational Psychology Service to prepare an update to provide a greater insight as to how the service contributes to the children and young people’s emotional wellbeing agenda. The service cross cuts with a number of Future in Mind themes which will be covered as part of this update. The Educational Psychology Service (EPS) provides support for all the schools and educational settings in Doncaster. We engage in early intervention as part of our work by providing advice to settings. We have also developed a Mental Health Wellbeing Self Evaluation Tool, as part of the trailblazer project, which aims and supports schools to assess their own practice as part of a whole school approach and to implement the next steps required to support children’s mental health and wellbeing. As part of the trailblazer, we engaged in a range of focus groups that involved 6 educational settings including 1 special school, 2 primary schools, 2 secondary schools and 1 college to understand and gain children’s and young people’s views on the most effective ways to engage with mental health support teams. We analysed these findings and presented these to the wider stakeholder networks. As part of the Educational Psychology Service, we provide guidance within a consultation approach to joint work with school staff in developing school policies that support children and young people’s mental health and well-being. The Educational Psychology Service also offers a range of training which can be provided to school staff to develop either a whole school approach/targeted intervention. The aim of the training is to develop resilience for children, young people and support children’s mental health, and well-being. The Educational Psychology Service also offers supervision to school staff members in order to support the well-being of school staff and to support effective practice. When considering a system without tiers/referrals. The Educational Psychology Service (EPS) does not work on a referral basis, schools can share their concerns and we will problem solve with them either on an individual level or on a whole class/whole school approach. As part of our practice we do expect schools to have followed a graduated approach, plan, do , review as per the Code of Practice, 2015 in order to develop a consistent response and culture of practice across Doncaster. From September 2019 we will be conducting Pyramid Planning Meetings which aim to work more efficiently and to improve the sharing of good practice among schools. In Pyramid Planning Meetings, we expect to see the SENCOs of a certain pyramid of schools, within a local area. The objective of this is to jointly problem solve with other services such as; ASCETS, CAMHS locality workers, SEN officers, the Behaviour Outreach Support Service (BOSS) around the most complex cases. Naturally the service plays a pivotal role in transitions between Primary and Secondary Schools. Due to the Educational Psychologist working within Pyramids of schools (Secondary and feeder primaries), we are in a great position to aid transition between educational settings. As part of our work in the Pyramid Planning Meetings Secondary and Primary schools will be sitting together and discussing cases, this will support Secondary schools’ understanding of children who are moving in to their school. We also plan to focus one of these meetings exclusively on transition around December/January time to ensure that this dialogue is started early in the year to provide the best possible opportunities for planned and smooth transitions for our local children and young people. The service works with children who can often have many needs and a varying complexity of need. Our core work is with children who have an Educational Health and Care plan or with those that may need one. We also work very closely with children who are at risk of exclusion, children disengaging from education or looked after children. Our job is to make sure the adults who work with these children understand their needs and how to support their development. We have developed and presented a series of training packages focused on Attachment, Trauma and Emotional literacy. As part of our work, during consultations we try to raise awareness of the effect trauma can have on children and young people and how trauma informed practice can help counter act it. We often work with the most vulnerable young people. A Senior Educational Psychologist sits on the inclusion panel regularly. The inclusion panel aims to provide support for children who are at risk of exclusion or who have been permanently excluded from schools. By having an Educational Psychologist on the panel this allows psychological formulations to take place in order to inform the next steps. We also work with the Pupil Referral Units to improve their Social Emotional Mental Health (SEMH) practices.One of the most important parts of our job is to make sure the views of children and carers are represented. Part of our role is to be advocates for children and young people if needed. We are adept at adapting our approaches to work with different children and young people depending on their needs, for example; talking mats, MEP cards etc. to ensure their voices are heard and their needs are met. We have developed and delivered a series of courses (around 20 courses) focused on different aspects of Special Educational Needs and delivered these members of education services across Doncaster. We are committed to supporting the development of the wider children’s workforce across Doncaster. 2.2 CYP Mental Health Services working with educational settings (including Mental Health Support Teams)2.2.1 The Removal of a Tiered Support System Consultation and AdviceDoncaster’s Consultation and Advice Service is based on the THRIVE model of practice developed and advocated by the Anna Freud Centre – Tavistock and focusses primarily on the first two elements of the model; Getting Advice and Getting Help. This model of practice has resonated through the plan from its inception onwards. Doncaster’s interpretation of the model relates to getting advice and then early intervention (Getting Help) where required (usually in education settings), with a view to preventing children and young people from needing to be seen and to wait to see specialist services. By adapting to this culture of working we are able to improve access to CAMHs, which historically has always been considered as difficult to access with GPs often perceived as the gatekeepers to accessing support. Doncaster has made significant investment to the Consultation and Advice Service, with Local Leaders and Providers alike recognising the need to reframe how support was offered to children, young people and their families. Data capture for the service began in Quarter 3 2016-17 and the graph below illustrates a positive picture in relation to the use and subsequent embedding of the service across the system. It is clear to see that the service is highly subscribed and that children and young people are being able to access this service on a regular basis. To support us with understanding our local need, we are able to see the use of the service, split across primary and secondary school settings, which is then further aggregated to both planned and unplanned consultations. The graph above illustrates a fairly even split in relation to usage across primary and secondary schools for planned consultations which provides assurance when considering equity of access. We can also see that there are a vast amount of planned consultations and we can therefore infer that schools are improving when identifying emotional health and wellbeing needs and that children and young people are able to access services in a planned way, either autonomously or supported by their school. Similarly, there is an even distribution across primary and secondary settings when considering unplanned consultations. Again this is reassuring when reflecting on equitable access across settings, but also shows how the service is able to respond well and flex to the needs of children and young people from both planned and unplanned perspectives. When considering system transformation and improving timely access to appropriate services as a way to reduce the need for specialist CAMHs, the table below shows that in Doncaster we can evidence some success in this area. Year on year we can see a decrease in those children and young people being stepped up to specialist CAMHs, indicating that the Consultation and Advice service is successfully identifying and meeting the needs of our children and young people. Of course, this is only one element of a much wider service and system, but does evidence that Doncaster are consistently and successfully moving towards a true system without tiers, providing the right support at the right time by the most appropriately skilled professional. ?Total Number of Consultations Per YearNumber Escalated to Specialist CAMHsAs a Percentage (%)2016/17963222.292017/182594562.152018/193129561.79Total 66861342.00Access StandardThe prescribed CAMHs access standard for 2018/19 was 32%. In Doncaster we achieved an access standard of 31% (as at January 2019), which although doesn’t fully meet the standard set out nationally, it does show that Doncaster are moving in the right direction in relation to increasing the access to our CAMHs Service. Waiting TimesCAMHs Referral to Assessment (RTA)The table below captures the average waits from referral to initial assessment for the Doncaster’s CAMHs Service. It is clear that since April 2018, the service has been able to reliably see children and young people within 28 days from referral, which again evidences increased and timely access to the service. Month% Patients waiting <18weeksAverage wait (days)Apr-17100.00%30.1May-17100.00%32.3Jun-1797.70%36Jul-1795.80%44.4Aug-1796.40%48Sep-1798.60%20.9Oct-17100.00%16.9Nov-17100.00%31.8Dec-17100.00%32.2Jan-18100.00%38.4Feb-18100.00%25.3Mar-18100.00%43.6Apr-18100.00%29May-1895.00%Jun-1897.00%32Jul-18100.00%Aug-18100.00%20Sep-18100.00%20Oct-18100.00%14Nov-18100.00%22Dec-18100.00%19Jan-19100.00%20Feb-19100.00%23.4Mar-19100.00%15CAMHS Referral to Assessment (RTA)A similar trend is represented with regards to referral to treatment for our CAMHs Service. We can see that the majority of children and young people commenced treatment within 4-5 weeks of referral, which is a pleasing trend. What is clear is that the service is operating well within NICE guidelines with regards to waiting times and is seeing children and young people comfortably within the 18 week threshold prescribed Nationally. Month% Patients waiting <18weeksAverage wait (days)Apr-17100.00%27.5May-1798.00%24.6Jun-1798.00%26.4Jul-17100.00%24.9Aug-17100.00%28Sep-1798.00%29.7Oct-17100.00%27.8Nov-17100.00%23.1Dec-17100.00%24.6Jan-18100.00%35.7Feb-18100.00%25.2Mar-18100.00%21.4Apr-18100.00%28May-1897.00%Jun-1845Jul-1890.00%8Aug-18100.00%35Sep-18100.00%59Oct-1899.00%27Nov-1899.00%33Dec-18100.00%31Jan-19100.00%33Feb-19100.00%29Mar-19100.00%23.7The Mental Health Trailblazer Four Week Wait (4WWT)The information detailed above places Doncaster in a strong position for improvement aligned to the 4WWT element of the Mental Health Trailblazer. 2.2.2 Urgent and Emergency (Crisis) Mental Health CareAs at January 2019, Tier 4 admissions and length of stay for Children and Young Persons (CYP), with Learning Disability (LD) and Autistic Spectrum Disorder (ASD), in South Yorkshire TCP were higher than the current national average. Current policy stipulates that commissioners keep a Risk Register (RR) of Children and Young Persons that may require Tier 4 admission. As part of developing and maintaining this risk register there needs to be active and dynamic stratification of risk, linked to interventions that proactively reduce that risk. This is referred to as dynamic stratification process (DSP). NHS Doncaster CCG have developed and maintained the Proactive monitoring & support meeting since 2018.The role of the Children and Young People’s (CYP) Proactive Monitoring & Support Meeting is to review children and young people with a primary diagnosis of Learning Disability, Autism or both who are at risk of hospitalisation or placement breakdown. For those CYP that are in hospital, the Group will review discharge planning as a means of reducing any potential risk within the community and prevent further hospital admission. The Group will provide clear accountability and focus that will support Case Managers in risk assessment and care planning.The Group forms part of the Sheffield, Doncaster, Rotherham and North Lincolnshire (SDRNL) Transforming Care Programme (TCP) and ensures that that children, young people and their families receive the right support at the right time, in the right place to meet their needs and enable them to live at home or in the local community, and that the partnership has clear plans in place to successfully deliver this.Specific elements of this groups work include:Listening and responding to the voice of children, young people and their families both to inform and assess the effectiveness of their careEnsuring that the partnership has a ‘Proactive Monitoring & Support Register’ that includes children and young people in place; which is actively monitored and managedDevelopment of a robust assurance process for Care (Education) Treatment Review’s C(E)TRs ensuring that the partnership is aware of all C(E)TR’s and that a minimum of 90% are completed within agreed timeframes Ensuring recommendations from C(E)TR’s are considered and where possible implementedEnsuring the C(E)TR policy is implemented consistently across the partnership as per the memorandum of understanding and respective policyEnsuring systems are in place to monitor the impact on admissions and discharges for under 18yr olds and /or up to 25yr olds for those Young People Looked After and/or in educationDevelop a process for tracking CYP at risk of admission to hospital and admitted to hospitalEmbedding principles within the transition process to ensure seamless pathway from children and adulthoodAs at September 2019, the PM&S meeting has significantly reduced the number of inpatient admissions to hospital by working collaboratively, exploring all available options before admissions to secondary care.Month(2019)JanFebMarAprMayJuneJulyAug SepNo of Admissions1100203002.2.3 Intensive Homebased Treatment Provision In response to an exceptionally high level of Tier IV admissions, Doncaster Leaders invested significant resource in order to develop an Intensive Homebased Treatment Service to ensure that outcomes for our local children and young people were improved and to reduce the need to utilise Tier IV provisions. The service was not available when the Local Transformation Plan was developed and as such, date is only available from 2017-18 onwards. Referrals in year YearReferrals2017/18252018/19155Reasons for ReferralCondition2017/182018/19Anxiety01ASD10Conduct Disorder01Eating Disorder10Emotional Issues452Gender Issues01In Crisis1594Neuro Dev Conditions10Self Harm15Suspected 1st EIP10From the volume if referrals received in 2018/19, it is evident that since its inception, the Intensive Homebased Treatment Service has become a core part of the local service offer, with 155 referrals. With the most prominent reasons for referral being crisis, closely followed by emotional issues. 2846721181819Melanie Cook – Intensive Community Support Team Lead Over the last twelve months we have continued to develop and grow as both a service and a team, we have looked at what outcome measures we can use to best highlight our interventions and what interventions are most effective, we continue to work closely with our partner agencies in an effort to reduce admissions to in patient units, which has had significant impact upon admissions. Following admission we ensure that we maintain strong links with the inpatient units to enable a more supportive discharge plan, supporting both young person and family. We will take a role in Mental Health Act assessments, 136 assessments and work collaboratively with adult services for an alternative to admission especially considering the best interests of the young person. When it is identified that someone may be at increased risk of admission we work closely with the wider team/service to identify strategies that may enable the young person to remain in the community. The young people that have need to be admitted to in patient units have been from all aspects of CAMHS including the Intellectual Disability Team (ID) and Eating Disorder teams (CED’s) as well as having undergone Mental Health Act assessments resulting in them being detained under a section. The journey has at times been difficult, people have left the team and others have joined which has at times felt quite disjointed, however with every new person that has joined the team new ideas have been discussed, which has led to increased motivation and enthusiasm to try and implement these new suggestions. We have worked closely with the Paediatric Liaison Nurse to reduce young people from attending the emergency dept. to assist this we have offered an urgent slot every day so that young people are given the opportunity to visit the clinic base for a more prompter response time, we provide a seven day follow up following discharge from paediatric units. As a team we continue to review our interventions and open cases, we meet weekly to discuss the cases that have been open to us for a while and look at what has changed, what progress has been made, do they continue to require the increased level of support, we also meet once a week with a consultant psychiatrist in the high risk assessment team meeting (HRAT) this is to look at the need of individual young person and evaluate effectiveness of intervention not just from the ICST the wider CAMHS service are also invited to attend and bring cases that they feel are increased risk, this leads to a discussion and a plan of care moving forward. Whilst working with a young person we ensure that we remain in contact with the individual case manager, however if there is no one currently identified we will hold the case until such time as one is, however this has led to us holding cases that have no longer required intensive support, this has led to us having experienced quite a high number of young people to remain with us for longer than was probably helpful. This has led to us not being able to successfully measure the impact of our team, and has at times left the team feeling that they are not working with the young people who are in greater need. 00Melanie Cook – Intensive Community Support Team Lead Over the last twelve months we have continued to develop and grow as both a service and a team, we have looked at what outcome measures we can use to best highlight our interventions and what interventions are most effective, we continue to work closely with our partner agencies in an effort to reduce admissions to in patient units, which has had significant impact upon admissions. Following admission we ensure that we maintain strong links with the inpatient units to enable a more supportive discharge plan, supporting both young person and family. We will take a role in Mental Health Act assessments, 136 assessments and work collaboratively with adult services for an alternative to admission especially considering the best interests of the young person. When it is identified that someone may be at increased risk of admission we work closely with the wider team/service to identify strategies that may enable the young person to remain in the community. The young people that have need to be admitted to in patient units have been from all aspects of CAMHS including the Intellectual Disability Team (ID) and Eating Disorder teams (CED’s) as well as having undergone Mental Health Act assessments resulting in them being detained under a section. The journey has at times been difficult, people have left the team and others have joined which has at times felt quite disjointed, however with every new person that has joined the team new ideas have been discussed, which has led to increased motivation and enthusiasm to try and implement these new suggestions. We have worked closely with the Paediatric Liaison Nurse to reduce young people from attending the emergency dept. to assist this we have offered an urgent slot every day so that young people are given the opportunity to visit the clinic base for a more prompter response time, we provide a seven day follow up following discharge from paediatric units. As a team we continue to review our interventions and open cases, we meet weekly to discuss the cases that have been open to us for a while and look at what has changed, what progress has been made, do they continue to require the increased level of support, we also meet once a week with a consultant psychiatrist in the high risk assessment team meeting (HRAT) this is to look at the need of individual young person and evaluate effectiveness of intervention not just from the ICST the wider CAMHS service are also invited to attend and bring cases that they feel are increased risk, this leads to a discussion and a plan of care moving forward. Whilst working with a young person we ensure that we remain in contact with the individual case manager, however if there is no one currently identified we will hold the case until such time as one is, however this has led to us holding cases that have no longer required intensive support, this has led to us having experienced quite a high number of young people to remain with us for longer than was probably helpful. This has led to us not being able to successfully measure the impact of our team, and has at times left the team feeling that they are not working with the young people who are in greater need. 362309379562When a young person is admitted to in patient units we have ensured that we maintain regular contact throughout the admission and have started the process of working towards discharge, we attend reviews and support case managers through the process of admission and agreeing a plan of care to support discharge. If the young person is open to either Intellectual Disability Team or Community Eating Disorder’s Team we have liaised with each team to identify if they require our intensive support post discharge or whether this will be easily managed within their own teams. We have undertaken DBT training in conjunction with YOS and we have since commenced a DBT informed group as part of the enduring pathway which we as a team feed into. As a team we do not provide a structured therapeutic intervention but utilise a variety of interventions to support a young person through a period of emotional distress, which include Cognitive Behaviour Therapy and Dialectical Behaviour Therapy informed interventions, risk management, WRAP (Wellness Recovery Action Plans), systemic family interventions, recovery focused, self-harm support. We do not have a waiting list as we are responsive to need. We may not always work with a young person but support the networks around them, this is especially true of looked after children and this decision is taken in conjunction with the care co-ordinator and the team supporting the young person. We will work with the family and offer support and psycho education around self-harm and other presentations, we offer risk management around commencement of medicationAs a new service we went through several tricky development phases but this was important as it enabled us to build a culture of resilience, openness and transparency. We can be direct and challenge each other whilst knowing all opinions are listened to and everyone is respected. Our success as a team is directly attributable to the efforts of every single member of the team; we each bring different qualities and collectively enhance each other and the growth of the service. As a team we provide supervision and support on a formal and informal basis this can be accessed on all levels, from individual, groups and peers, providing space to reflect, consider the impact our work has upon both ourselves but also those we work with. If a young person or family is in crisis the team pulls together, ensuring both the family but also the worker is supported, working flexibly to ensure appropriate outcomes, we regularly meet to discuss case management and ensure that all care plans, crisis management plans are reviewed and up dated as required. 00When a young person is admitted to in patient units we have ensured that we maintain regular contact throughout the admission and have started the process of working towards discharge, we attend reviews and support case managers through the process of admission and agreeing a plan of care to support discharge. If the young person is open to either Intellectual Disability Team or Community Eating Disorder’s Team we have liaised with each team to identify if they require our intensive support post discharge or whether this will be easily managed within their own teams. We have undertaken DBT training in conjunction with YOS and we have since commenced a DBT informed group as part of the enduring pathway which we as a team feed into. As a team we do not provide a structured therapeutic intervention but utilise a variety of interventions to support a young person through a period of emotional distress, which include Cognitive Behaviour Therapy and Dialectical Behaviour Therapy informed interventions, risk management, WRAP (Wellness Recovery Action Plans), systemic family interventions, recovery focused, self-harm support. We do not have a waiting list as we are responsive to need. We may not always work with a young person but support the networks around them, this is especially true of looked after children and this decision is taken in conjunction with the care co-ordinator and the team supporting the young person. We will work with the family and offer support and psycho education around self-harm and other presentations, we offer risk management around commencement of medicationAs a new service we went through several tricky development phases but this was important as it enabled us to build a culture of resilience, openness and transparency. We can be direct and challenge each other whilst knowing all opinions are listened to and everyone is respected. Our success as a team is directly attributable to the efforts of every single member of the team; we each bring different qualities and collectively enhance each other and the growth of the service. As a team we provide supervision and support on a formal and informal basis this can be accessed on all levels, from individual, groups and peers, providing space to reflect, consider the impact our work has upon both ourselves but also those we work with. If a young person or family is in crisis the team pulls together, ensuring both the family but also the worker is supported, working flexibly to ensure appropriate outcomes, we regularly meet to discuss case management and ensure that all care plans, crisis management plans are reviewed and up dated as required. 2.2.4 Community Eating Disorders Service Doncaster, in partnership with Rotherham and North Lincolnshire has commissioned a Community Eating Disorder Service (CEDS). This was initially commissioned as a pilot in 2015/16.The Service provides an evidence-based NICE-concordant service which supports both individuals with eating disorders and their family / carers. It is required to adhere to the NHS England document “Access and waiting time standards for children and young people with an eating disorder” (2015).Performance to date has been strong with NHSE and local targets being met on a consistent basis. The graph above shows that the service sees 100% of routine cases within four weeks against a service operating standard of 95%. This graph also evidences that this standard has been maintained for over a year, which is reassuring in terms of service sustainability. The service has and remains proactive when considering all aspects of quality and innovation. The CEDS has been actively engaged in national and regional programmes of CEDS development and implementation, such as the National Whole Team Training and Yorkshire & Humber Eating Disorder Collaborative. Through these forums the service has maintained good links with other CEDS and engaged in sharing good practice and learning. This has continually influenced service development and delivery over the past 3 years. In this context, the service chose not to sign up for QNCC-ED accreditation, as this has a cost implication which was felt not to be justified given the other positive influences on CEDS development. This is something that being reconsidered given that CEDS now has more firmly established structures and processes. In preparation for this refreshed Local Transformation Plan, we have worked with the service and staff based in the service have provided reflections in relation to the journey of eating disorder services for children and young people since the inception of Future in Mind (2015). These reflections and two Doncaster specific pen portraits are detailed below. 284672336430Tom Brockwell – Clinical Psychologist & Eating Disorder Pathway Lead It’s an exciting time to work in Eating Disorders!... The changes I have witnessed since I started in the team in January 2017 have been astounding. The increased funding and national guidance for Eating Disorders (ED) in children and young people and the formation of specialist Children and Young People’s Community Eating Disorder Services (CYP-CEDS) has been fundamental in improving the quality of care nationally for this vulnerable and high risk group; reducing waiting times and Tier 4 admissions, as well as improving access to evidence based psychological therapies and improving clinical outcomes. I am grateful to RDASH and our commissioners for facilitating the development of the CYP-CEDS in line with this guidance and delivering on these promises, as I am aware many areas have not been so fortunate and therefore struggle meet the needs of this vulnerable group. I feel incredibly proud and privileged to work in such this passionate, well-performing and caring team which continues to develop and flourish with this continued support.Prior to the launch of the specialist CYP-CEDS, each locality CAMHS managed Eating Disorders within their generic CAMHS service provision. This tended to consist of psychiatric and nursing care, with limited access to psychological therapies, but differed in each locality. Where psychological therapies were being delivered, these were not always consistent with NICE guidelines and access to these may have required long waits. The formation of CYP-CEDS has led to the grouping together of a specialist group of interested and motivated clinicians from professions comprising; Psychiatry, Psychology, Family Therapy, Dietetics, Nursing and Social Work. This grouping facilitates true multi-disciplinary team (MDT) working, from assessments through to MDT reviews and provides young people and families with joined up care across both the physical and mental health features of an ED presentation. This has also supported equality of ED care across the three localities, as opposed to differing and disparate approaches. The formation of the specialist team has supported shared learning and development, both in terms of in-service training and development, but also in relation to accessing external specialist training. The result of this is that we now have a team where all staff are trained in at least one evidence based NICE concordant psychological therapy and expertise exists within the team regarding management of issues such as Diabulimia, Avoidant and Restrictive Food Intake Disorder (ARFID), blood analysis and Re-feeding Syndrome. A high level of training and MDT working supports the team to manage higher levels of risk than previously, meaning that fewer cases require inpatient treatment. This also supports team members to feel developed, cared for and contained, meaning that staff turn-over is reduced and clinicians who have been invested in remain in post and patients continue to have access to high quality specialist care. Whereas, high staff turn-over was initially a problem in the early days of CYP-CEDS development, it is now greatly reduced and the service is now operating on a full complement of staff.00Tom Brockwell – Clinical Psychologist & Eating Disorder Pathway Lead It’s an exciting time to work in Eating Disorders!... The changes I have witnessed since I started in the team in January 2017 have been astounding. The increased funding and national guidance for Eating Disorders (ED) in children and young people and the formation of specialist Children and Young People’s Community Eating Disorder Services (CYP-CEDS) has been fundamental in improving the quality of care nationally for this vulnerable and high risk group; reducing waiting times and Tier 4 admissions, as well as improving access to evidence based psychological therapies and improving clinical outcomes. I am grateful to RDASH and our commissioners for facilitating the development of the CYP-CEDS in line with this guidance and delivering on these promises, as I am aware many areas have not been so fortunate and therefore struggle meet the needs of this vulnerable group. I feel incredibly proud and privileged to work in such this passionate, well-performing and caring team which continues to develop and flourish with this continued support.Prior to the launch of the specialist CYP-CEDS, each locality CAMHS managed Eating Disorders within their generic CAMHS service provision. This tended to consist of psychiatric and nursing care, with limited access to psychological therapies, but differed in each locality. Where psychological therapies were being delivered, these were not always consistent with NICE guidelines and access to these may have required long waits. The formation of CYP-CEDS has led to the grouping together of a specialist group of interested and motivated clinicians from professions comprising; Psychiatry, Psychology, Family Therapy, Dietetics, Nursing and Social Work. This grouping facilitates true multi-disciplinary team (MDT) working, from assessments through to MDT reviews and provides young people and families with joined up care across both the physical and mental health features of an ED presentation. This has also supported equality of ED care across the three localities, as opposed to differing and disparate approaches. The formation of the specialist team has supported shared learning and development, both in terms of in-service training and development, but also in relation to accessing external specialist training. The result of this is that we now have a team where all staff are trained in at least one evidence based NICE concordant psychological therapy and expertise exists within the team regarding management of issues such as Diabulimia, Avoidant and Restrictive Food Intake Disorder (ARFID), blood analysis and Re-feeding Syndrome. A high level of training and MDT working supports the team to manage higher levels of risk than previously, meaning that fewer cases require inpatient treatment. This also supports team members to feel developed, cared for and contained, meaning that staff turn-over is reduced and clinicians who have been invested in remain in post and patients continue to have access to high quality specialist care. Whereas, high staff turn-over was initially a problem in the early days of CYP-CEDS development, it is now greatly reduced and the service is now operating on a full complement of staff.474453552091Becky Bridgewater – Systemic Family PractitionerI am the newest member to the team having joined in January 2019 as a systemic family practitioner; prior to this I had worked within the core Doncaster CAMHS team for several years. Whilst in my previous role I saw the impact that having a dedicated eating disorders team had, enabling both staff and families to have timely and informative access to support and advice. Helping to alleviate some of the anxiety and worry that comes with eating disorders, with there being a clear pathway for referring those where there are concerns around eating. As a practitioner in core CAMHS there was, and still is, an open dialogue between the teams, with referrals being discussed at the point of first contact and on-going communication as needed. The support and intervention offered to families is guided by NICE guidelines, each member of the team has attended training on Family Based Treatment and Cognitive Behavioural Therapy for eating disorders. We are encouraged to continue our professional development, sharing what we have learnt and finding new and creative ways of workingThere is understanding of the importance of medical monitoring however this is not done so at the expense of the families own experiences, for example appointments are not led solely by the checking of weight but time is given to the exploration of the impact of eating disorders on the family as a whole and individuals. Families have expressed gratitude at each being included in the support and recovery journey, with intervention’s being tailored to each family. Supervision can be accessed on all levels, from individual, groups and peers, providing space to reflect, consider the impact our work has upon both ourselves but also those we work with. If a young person or family is in crisis the team pulls together, ensuring both the family but also the worker is supported, working flexibly to ensure appropriate outcomes. At times this has included out of hours and weekend support to colleagues in paediatrics. Training has been given to colleagues in CAMHS services alongside wider settings such as other health professionals and schools. Key relationships have been developed with safeguarding and pastoral leads at school, paediatricians and staff on the Children’s Ward at DRI. All of the above has resulted in the development of a specialist team for eating disorders in Doncaster, families receive timely and specialist support from a dedicated team, from disciplines including mental health nursing, psychology, psychiatry, dietetics and systemic family therapy00Becky Bridgewater – Systemic Family PractitionerI am the newest member to the team having joined in January 2019 as a systemic family practitioner; prior to this I had worked within the core Doncaster CAMHS team for several years. Whilst in my previous role I saw the impact that having a dedicated eating disorders team had, enabling both staff and families to have timely and informative access to support and advice. Helping to alleviate some of the anxiety and worry that comes with eating disorders, with there being a clear pathway for referring those where there are concerns around eating. As a practitioner in core CAMHS there was, and still is, an open dialogue between the teams, with referrals being discussed at the point of first contact and on-going communication as needed. The support and intervention offered to families is guided by NICE guidelines, each member of the team has attended training on Family Based Treatment and Cognitive Behavioural Therapy for eating disorders. We are encouraged to continue our professional development, sharing what we have learnt and finding new and creative ways of workingThere is understanding of the importance of medical monitoring however this is not done so at the expense of the families own experiences, for example appointments are not led solely by the checking of weight but time is given to the exploration of the impact of eating disorders on the family as a whole and individuals. Families have expressed gratitude at each being included in the support and recovery journey, with intervention’s being tailored to each family. Supervision can be accessed on all levels, from individual, groups and peers, providing space to reflect, consider the impact our work has upon both ourselves but also those we work with. If a young person or family is in crisis the team pulls together, ensuring both the family but also the worker is supported, working flexibly to ensure appropriate outcomes. At times this has included out of hours and weekend support to colleagues in paediatrics. Training has been given to colleagues in CAMHS services alongside wider settings such as other health professionals and schools. Key relationships have been developed with safeguarding and pastoral leads at school, paediatricians and staff on the Children’s Ward at DRI. All of the above has resulted in the development of a specialist team for eating disorders in Doncaster, families receive timely and specialist support from a dedicated team, from disciplines including mental health nursing, psychology, psychiatry, dietetics and systemic family therapy\s \sIn terms of the future direction of the CEDS, Commissioners across all three sites have been working together to consider the implications of the NHS Long Term Plan and how we might seek to meet the deliverables set out. At the time of writing, we are in the process of scoping what an all-age CEDS might look like, the demand for this and any additional resource required. At the very least, we aspire to have a 0-25 CEDS with the very real possibility of an all-age service (dependent on the outcome of our scoping, in partnership with our adult commissioning and provider colleagues). We can therefore provide assurance that we are cognisant of our obligations to deliver as part of the Long Term Plan and we are reflecting these in our discussions and planning in order to improve the outcomes for children and young people living with an eating disorder. 2.2.5 Early Intervention in Psychosis Research has shown that the delay between onset of psychotic symptoms and first treatment is usually between one and two years. It is also well documented that the longer the individual remains untreated, the greater the opportunity for serious physical, social or legal harm. The period of untreated psychosis has been shown to involve distress for individuals and their relatives including ineffective and demoralising attempts to get help. Doncaster CCG in collaboration with RDaSH has recently reviewed the current Early intervention service offer to individuals aged 14 to 35. The aim of the service is to:Reduce the length of time young people remain undiagnosed and untreated (Duration of Untreated Psychosis – DUP)Reduce the stigma associated with psychosis and improve professional and lay awareness of the symptoms of psychosis and the need for early assessmentDevelop meaningful engagement, provide evidence based interventions and promote recovery during the early phase of illness Increase stability in the lives of service users, facilitate development and provide opportunities for personal fulfilmentProvide a user centred service that works in partnership with CAMHS, primary care, education, social services, youth and other servicesFocus upon recovery and independence from mental health services where possibleAt the end of the treatment period ensure that care is transferred, where necessary, thoughtfully and effectively or discharge is fully planned forMinimise the effects of illness and it’s impact on social functioning.Performance to date has been strong with NHSE and local targets being met on a consistent basis. 2.3 Caring for the Most Vulnerable 2.3.1 Looked After ChildrenThere was an acknowledgement that the waiting times for children and young people accessing the Looked after Children’s (LAC) pathway were significantly higher when compared to non LAC children and young people, thus representing a large health inequality. The decision was taken in Doncaster to invest additional resource in the pathway with a view to reducing the inequity experienced by children who were looked after. The graph below demonstrates the average waiting times for referral to assessment (RTA) for those children and young people on the CAMHs and LAC pathways. The graph above clearly demonstrates progression in relation to aligning the average waits to access the respective pathways, thus meaning that children who are looked after are not disadvantaged when compared to their non- looked after counterparts. Similarly, the graph below details a similar trend when considering the average referral to treatment (RTT) waiting times for both pathways. Overall, we are confident that the additional resource invested has fulfilled the aspirations set out and has led to parity across the pathways, improved timeliness and outcomes for looked after children and young people when compared to those children and young people who are not looked after. As with some other pathways, as part of this refresh, the CAMHs Looked after Children’s Service have shared what they consider to be their achievements and challenges over the past year and their future plans. Embedded beneath this is a case study detailing some of the work the service does to support other practitioners in Doncaster. The achievementsChildren referred to the LAC CAMHS pathway are seen in a timely manner, as evidenced above We accept telephone referrals which has greatly improved our accessibility The DfE project with the Anna Freud Centre (Improving Mental Health Assessments for children entering care) is underwayPsychologist recruited and in postWe are offering regular and consistent consultation to residential homes and provide a written summary of consultationTeam members report a decreasing number of placement breakdowns. We have developed a discharge form that summarises goals from intervention. Despite staffing challenges, we continue to provide training regarding anxiety and self-harm to foster carers twice per year, training on understanding gender non variant children/ working with transgender children, trauma specific training, and attachment training to residential care homes and LAC nursesOur Senior LAC Clinician presented to the National Working Group on childhood sexual exploitation and is now part of a parliamentary working group regarding ‘parents as partnership exploitation safeguarding’ meetingsWe routinely use SDQ, RCADS and Trauma Symptom Checklist which is uploaded on to our system and used to inform interventionWe now have a part time dedicated administrator in place for the teamAll members of the team are committed to providing a high quality service to this vulnerable populationThe challengesIdentified need to continue to work on re-administering outcome measures at discharge – sometimes this does not happen because endings are not planned (eg sudden placement move)Aspirations/ Hopes for DevelopmentPilot a group approach to group consultation with foster carers and evaluate this Additional training (e.g. Theraplay Level 2, DDP Level 2) to provide consolidation and extension of skills so that these therapies can be offered in house and thus more cost effective than outsourcing this work. Case Study\s2.3.2 Transforming CareThere is strong partnership working across the South Yorkshire Transforming Care footprint and this is well embedded into the South Yorkshire and Bassetlaw Integrated Care System (ICS) Mental Health and Learning Disability (MH/LD) Steering Group.? C&YP are a key priority within this group and one of the main priorities within the ICS is Autism/ADHD.? A working group has been set up to work with people with lived experience and other key stakeholders to fully map out existing provision services, identify gaps and develop more innovative approaches to supporting children and young people with autism.? A series of workshops are being designed and run to ensure we have a consistent approach to supporting people with autism/ADHD and a move to an all age pathway approach to prevent gaps in services across a person’s life journey.? The TCP have been working collaboratively around the proactive monitoring processes and CETR’s ?for C&YP, sharing learning and protocols to embed across which enables a more consistent approach.? There is a national drive to develop CETR hubs across TCP/ICS footprints to deliver a more robust and sustainable approach and have submitted a bid to fund a hub across the Sheffield, Doncaster and Rotherham footprint.? This has been based on a pilot which has been funded by the TCP to bring in CETR coordination resource to ensure CETR’s are done in line with national guidelines and more importantly to ensure that any actions and recommendations are completed within the correct timescales which has a significant impact on either a person being discharged from hospital or an avoided admission to hospital.? The feedback from this role is really positive and the bid is based on expanding this capability across the footprint.? Part of the bid includes a C&YP CETR chair to provide more capacity in the system to focus on a more preventative approach of community CETR’s which, when done in a timely manner has a good success rate of preventing admissions.With regards to workforce the ICS have secured funding to bring in workforce transformation leads to work across MH, LD and autism for all ages.? The roles will undertake a baseline audit of the current health and social care workforce, identifying existing gaps and map against the long term plan requirements to get a view of future gaps.? The roles will also research new roles and new ways of working that have been piloted nationally and do some testing with key stakeholders to identify and make recommendations on what could work locally.? They will also work with key stakeholders to identify other innovative ways to address the workforce gap, ensuring this is done in coproduction with people with lived experience.? An enhanced framework has also been developed across Yorkshire and Humber. The enhanced supported living framework has been commissioned over the Y&H footprint to address gaps and barriers that have been identified throughout the transforming care programme.? This framework is about delivering person centred care to individuals with learning disabilities, autism or both who present with other comorbidities that create more complex needs and challenging behaviours.? This framework has been commissioned to meet the needs of anyone who is 16 and above and the rationale is to both provide least restrictive care in the community to enable people to move out of long term hospital settings, but to also provide young adults a service that can meet their needs to prevent future hospital admissions.? The framework providers will work closely with local specialist trusts and commissioners to ensure there is the right support at the right time with agreed contingency plans if things start to deteriorate where people can wrap around quickly to prevent any unnecessary missioners have worked collaboratively across the TCP agenda to try and generate solution focussed ways to respond to the various objectives of the programme of work, one example being the development of a train the trainer model for parents/carers. The rationale behind this model, being the ability to develop informal parent/carer peer support networks across the ICS Footprint, with a view to providing some out of hours support for those with a lived experience, from those with a lived experience. We have secured funding as a TCP to undertake a pilot of a train the trainer model.? We will look to utilise the ECHO platform as well as traditional methods to reach a wider target audience.? The Echo platform is a tried and tested platform for delivering good quality training to a number of stakeholders who can be difficult to engage with and who struggle to find time to attend traditional classroom training sessions.? Although there are other online training modules, generally the feedback is they are not as effective as classroom training.? The ECHO platform is a hybrid that gives the feel of the classroom approach, but utilising technology can be accessed anywhere and by anyone which enables effective and good quality training to be delivered, but saves a significant amount of time for people who need to access the training and is more flexible.Doncaster have implemented a robust Dynamic Risk Stratification process which has been recognised and shared by NHS England as a Gold standard model. Monthly Proactive Monitoring & Support meetings are in place to ensure case management is focussed and co-ordinated. The group has regular attendance from a variety of Service Areas including: CAMHS; DCST; Transitions; Education; Continuing Health Care; CCG Quality/Safeguarding; DMBC/CCG Commissioning. The success of the group is down to the excellent relationships that the team have worked hard to build and continue to maintain. ?A CETR deep dive involving partners from across the footprint and including representation from Advocacy services, highlighted a number of areas of development. A subsequent CETR Quality tool was developed to implement recommendations. A recent report written by Speak Up suggests that families are satisfied with the CETR process in Doncaster and have had positive experiences. Doncaster’s admissions data from 2015 onwards mirrors the progress made from a strategic and operational perspective, as Doncaster have had only six admissions, none of which have been made in the last 17 months, which indicates that we are improving outcomes for members of our transforming care community. Doncaster’s priorities over the coming year are as follows:Review of the PM&S group including areas of escalation and opportunities to align with other strategic working groupsReview of all residential placements for CYP with ASD/LDWork with Speak Up to roll out CETR training to professionals and develop an ASD information pack for newly diagnosed CYPEmbed Proactive Monitoring & Support process into Transition pathway as part of the Doncaster All Age ASD/LD StrategyUpdates against these objectives will be provided to NHSE as part of both the LTP and TCP assurance process. 2.3.3 Learning Disabilities In addition to providing enhanced investment into the LAC pathway, commissioners also increased the investment into the CAMHs Learning Disabilities pathway with a similar aspiration of reducing inequalities regarding the timeliness of access. The graphs above evidence a similar trend to the LAC pathway insofar as the additional investment made has supported to reduce inequalities in terms of timeliness of access to the service for both Referral to assessment and treatment. We acknowledge a need to improve some of the gaps in data collection and are working with the provider to address this. What we can safely say is that the parity across the CAMHs and LD pathways has been addressed and continues to improve. Pathway UpdateThe Principle Psychologist for the pathway has provided an update for the purposes of this refresh and we hope this provides a useful insight into the past years activity and progress, covering the period September 2018-September 2019. The current service model for children and young people with a moderate to severe Intellectual Disabilities (ID) is a specialist ID CaMHS pathway within mainstream CaMHS that provides support for children (5-18 yrs) with mental health needs and/or challenging behaviour. The model is informed by Do Once and Share: National Care Pathway. Over the past 12 months the service has grown in staffing numbers and as a result developed and consolidated new and current ways of working. The team has gained in addition to a Nurse Consultant & a Learning Disability Nurse the following new members:Principal Clinical PsychologistChild & Adolescent PsychiatristLearning Disability NurseOccupational TherapistClinical Support WorkerThis improved workforce has meant we have been able to expand on the existing work offered and increased the number of assessments and interventions offered to young people and families. Currently, there is no waiting time for children and young people to be seen in the CAMHS ID pathway. As soon as we receive a referral it is discussed within a week and allocated for an initial assessment which occurs within 4 weeks. For a child and family this means that they are made contact with quickly and receive a home visit (or where most suitable for the family) by two clinicians. The child may be present for this initial assessment or the family may wish to discuss the presenting difficulty initially away from the child due to the child’s level of functioning/nature of difficulty. Other times the child initially may meet with a clinician at school supported by a teacher or teaching assistant and a follow up meeting with the family will occur shortly after. A comprehensive assessment is completed with the family/carers, child (if appropriate) and other professionals such as Teachers and Social Workers to enable a formulation to be developed collaboratively with the family and wider network of people working and caring for the child/ young person. Outcomes measures, risks assessments and safeguarding concerns are all completed and/or reviewed throughout this process with the family and child. Once the formulation is shared and agreed upon, a care plan of further assessment/intervention is written collaboratively and in an accessible format for both child and family. This is shared with education, social care, other health professional etc. with consent. The intervention/ further assessment is then provided by the appropriate clinician or clinicians within the team in the appropriate setting and reviewed using ID specific outcome measures and patient/family feedback. Throughout this process the clinician/ clinicians share their assessment and formulations and intervention outcomes with the team in team meetings and during supervision so that risk factors, safeguarding concerns and good clinical practice is ensured across all children and families seen within the service. Once a care-plan has been completed or the young person is 17 & ? years old the team support a smooth transition out the service by either providing the family with accessible documents to share with other services about the work completed with us or by meeting with adults services and sharing information on the adolescents strengths and needs and helping to plan appropriate adult services.Over the past 12 months, the service has provided diagnosis and assessment of a range mental assessment difficulties including anxiety, phobias, depression and PTSD, and counselling services to help the young person and their family cope with their child’s disability and the associated difficulties, assessment of challenging behaviour and Positive Behaviour Plans, family work, specialist individual therapies (such as adapted CBT, Theraplay) pharmacological treatment, liaison and joint working with other agencies. We have good multi-disciplinary working, and shared understanding of cases with many of the cases having two clinicians joint holding the cases due to complexity. What we have found invaluable to this process are our good interagency relationships and links through attending the Proactive Monitoring & Support meetings, chairing the Social Emotional Wellbeing Being Group with Special Schools and from the consultations with schools. The school consultations continue to enable easier access to the service. Alongside the individualised care-plans, we continued to deliver preventative emotional regulation groups to young people in the special need schools, and teaching and psychoeducation for parents. Consultations and training through the parent Carer Forums also continues. Our ADHD clinics in schools are working well as both parents and teachers can be present together which is valuable when assessing the effectiveness of medication. Within the service, we have weekly team meetings where cases are discussed and service issues reviewed. In addition to the team meetings, monthly senior leadership meetings take place which reviews service developments and clinical governance considerations with members of the Rotherham CAMHS ID service.The psychiatry clinics continue to run smoothly without disruption. The current clinic base is particularly suitable for needs of children with ID due to the low arousal waiting area. This year, the team also got access to an additional base for administrative use near two of the Special schools.Sarah McFarlane, Learning Disability Nurse describes below her experiences of the changes as a longstanding team member over the last 12 months:7327901345565Sarah McFarlane, Learning Disability NurseCommencing my post as a Registered Learning Disability nurse in the CAMHS Intellectual Disability (ID) Team in 2015 I formed part of a multi-disciplinary team which originally included a Psychiatric Consultant, Occupational Therapist, a Nurse Consultant and a Mental Health Practitioner. Unfortunately within the year the team reduced significantly. During this time we had 3 admissions to tier 4 services. However, we still continued to provide parent groups, preventative groups in schools, school consultations and a medication clinic. Despite the reduced staffing we still provided a service that families were happy with.In August 2018 our Principal Clinical Psychologist joined the team and later in the year a new Registered Learning Disability Nurse and an Occupational Therapist. A new Psychiatrist Consultant joined the team in January 2019 and we gained a Clinical Support worker in August 2019. The new team members improved the quality of support offered to young people and their families from the CAMHS ID team. Schools and families were been supported with functional analysis of behaviours for the most challenging young people. Young People have been able to access individualised care plans, communication tools and strategies to manage challenging behaviours. Staff within the team been able to deliver more training to teachers and support staff. There has been an increase of the delivery of preventative groups in schools. The nurse consultant has been able to provide more ADHD clinics in schools. More complex young people have been assessed and needs met including supporting the diagnosis of Autism and Learning Disability. One young lady that was described by her mother as ‘manipulative’ had a diagnosis of global development delay aged 17 which would not support her access to services as an adult. Unfortunately her family broke down and she required alternative living arrangement which was in a youth halfway centre. The young lady was extremely vulnerable and wrongly placed. Following her assessment and diagnosis of moderate (on the low end) Intellectual Disability by the Clinical Psychologist she has been able to access appropriate adult services and the staff team supporting her have been able to understand her strengths and needs. On reflection I am excited to have access to a team that specialises in supporting the most vulnerable and complex young people and families. The level of work has not decreased however, the quality of support we can offer as a specialist service has increased. I am happy with the progress we are making and I am excited at the future prospects.00Sarah McFarlane, Learning Disability NurseCommencing my post as a Registered Learning Disability nurse in the CAMHS Intellectual Disability (ID) Team in 2015 I formed part of a multi-disciplinary team which originally included a Psychiatric Consultant, Occupational Therapist, a Nurse Consultant and a Mental Health Practitioner. Unfortunately within the year the team reduced significantly. During this time we had 3 admissions to tier 4 services. However, we still continued to provide parent groups, preventative groups in schools, school consultations and a medication clinic. Despite the reduced staffing we still provided a service that families were happy with.In August 2018 our Principal Clinical Psychologist joined the team and later in the year a new Registered Learning Disability Nurse and an Occupational Therapist. A new Psychiatrist Consultant joined the team in January 2019 and we gained a Clinical Support worker in August 2019. The new team members improved the quality of support offered to young people and their families from the CAMHS ID team. Schools and families were been supported with functional analysis of behaviours for the most challenging young people. Young People have been able to access individualised care plans, communication tools and strategies to manage challenging behaviours. Staff within the team been able to deliver more training to teachers and support staff. There has been an increase of the delivery of preventative groups in schools. The nurse consultant has been able to provide more ADHD clinics in schools. More complex young people have been assessed and needs met including supporting the diagnosis of Autism and Learning Disability. One young lady that was described by her mother as ‘manipulative’ had a diagnosis of global development delay aged 17 which would not support her access to services as an adult. Unfortunately her family broke down and she required alternative living arrangement which was in a youth halfway centre. The young lady was extremely vulnerable and wrongly placed. Following her assessment and diagnosis of moderate (on the low end) Intellectual Disability by the Clinical Psychologist she has been able to access appropriate adult services and the staff team supporting her have been able to understand her strengths and needs. On reflection I am excited to have access to a team that specialises in supporting the most vulnerable and complex young people and families. The level of work has not decreased however, the quality of support we can offer as a specialist service has increased. I am happy with the progress we are making and I am excited at the future prospects.Additionally, to the above, we have been able to develop the service further in line with the NHS Ten Year Plan, NHS England (2019) and Transforming Care Agenda (2015) for example,We have improved pathways for children and families to access support for example developing a sensory processing pathway and a challenging behaviour pathway within the service.In addition to the consultations enabling easier access to the service, the consultations also provide schools with resources and understanding of the children’s needs and what support is required, promoting less referrals. We have also provided more training to the teaching staff in several of the special needs schools.We have further considered the needs of the children who are transitioning and making this as seamless and comprehensive as possible. Joint meetings with the adult Learning Disability Services have been set up to review and plan for teenagers who are due to transition to adult services The referral criteria were reviewed this year; making sure it prohibits the use of an intelligence quotient (IQ) threshold only. Instead we aligned our referral criteria with the DSM V criteria for moderate/severe/profound intellectual disabilities and specified adaptive functioning as part of the criteria to accessing the service.Work was completed on informing families about CETRs and sharing information about the support available to them as part of the review from the team. A clear pathway for the service has been developed to ensure a consistent approach. Guidance on behavioural assessments and Positive Behaviour Plans prior to CETR has also been produced for the team.Guidance has also been developed around group work and consultations for schools. This has made the consultations more effective and productive and aims to do the same with group work when they start again in September 2019. We have developed a family pack (accessible versions) to give to families detailing the team members and their role, national and local resources, useful contacts, and a calendar for families to keep appointments with the team. This will be a useful resource for families to keep their child’s reports, profiles, and clinic letters in. Time has been spent on raising the awareness of the service and mental health needs of children with ID by attending health meetings, parent events, education events and providing ongoing training and support to frontline mainstream services.Moreover, we have adapted Systm One so that it can capture the information that is relevant to our client group including appropriate outcome measures, ID friendly careplans & accessible. The CAMHS ID pathway was presented to the NHS England Chief Executive Simon Steven by means of a case study and their involvement in the Proactive and Monitoring Support meetings and excellent feedback was received. Team members have continued to have students and trainees and have encouraged shadowing by other CAMHS team membersAlthough we have managed to develop the service over the past 12 months and have had a number of achievements, there have been some challenges to face and some future aims. These include:Ensuring that we meet national guidelines around physical health monitoring for those who are prescribed antipsychotics. The route to request these is not always smooth as we have to go through the GP or the Paediatricians for ECG. Also, children might need desensitisation work which has an impact on capacity of the nurses.Currently the nurses and/or Health Care Assistant complete basic physical observations. Although the Psychiatrist may request blood investigations using lab forms and admin can access the results on an online systems, the ECGs pose the major challenge. Ensuring that families and other agencies are aware of the Principals behind STOMP/STAMP, and that the role of medication is only an adjunct in managing challenging behaviour. There needs to be more work around raising awareness. The effectiveness of Occupational Therapy (OT) and Psychology Assessments means increased demand – We have put a Sensory OT pathway in place to address the lack of OT capacity. The review of referral criteria and a business plan to be written for an Assistant Psychologist will hopefully assist with Clinical Psychologist’s increased demand for specific psychology assessments.Other services/agencies/teams understanding of children’s with ID mental health needs and the role of the CAMHS ID in addressing them. We plan to provide more training in education, in-house and for external agencies over the next 12 months.Develop a mental health pathway and ADHD pathway within the service to ensure consistent clinical practice and following NICE GuidanceTwo case studies produced by Tom Redding & Eve Barratt Baines have also been produced to demonstrate the work completed by the team.603849672859RF Case StudyBy Tom Redding, LD NurseRyan is aged 10 years and 7 months and is diagnosed with severe autism, learning disabilities, non-verbal communication and presents with heightened anxiety levels that lead on to presenting with self-injurious behaviour and physical aggression towards others. Ryan struggles to communicate effectively and looks to seek control of his immediate environment to promote predictability, routine and structure in his world. Ryan at present is not in education and waiting to seek an appropriate school provision that can meet Ryan’s needs.The Behaviours Ryan can display a series of challenging behaviours including: Attempts to break items – Scratching- Kicking – Nipping - Hitting outHead Banging- Biting own tongue- Biting own fingersSlapping side of his head- Hitting forehead with clenched fist- SpittingUrination- Bite othersFirstly an initial mental health assessment was completed to gain further information on reason for referral and to highlight need. Alongside this consent forms, goal setting, information pack, questionnaires and behavioural assessment tools were completed (Motivational Assessment Scale & Nisonger). There is always a reason behind behaviours that challenge. Observations were completed predominantly in the school environment due to Ryan associating me (Tom – care coordinator) within this environment. Should Ryan see Tom in his home environment this may have distressed him and not provided a natural observation. Charts known as (Antecedent, Behaviour, and Consequence) ABC Charts were created to Ryan’s individuality to be completed by Ryan’s family and school staff supporting Ryan in view to completing a functional behaviour assessment. The functional behaviour assessment was completed to understand the reasons for the behaviour’s Ryan presents with and with this evidence base to promote the correct strategies to be implemented. Alongside this process of awaiting ABC charts to aid the functional analysis work, I supported Ryan and family in promoting a better sleep quality as this was a goal target set with family. I requested family completed four weeks sleep charts, sleep diary to then analyse look at the routine Ryan has, whether he struggles to settle, awakenings in the night and whether the environment was catered to been low stimulus. 00RF Case StudyBy Tom Redding, LD NurseRyan is aged 10 years and 7 months and is diagnosed with severe autism, learning disabilities, non-verbal communication and presents with heightened anxiety levels that lead on to presenting with self-injurious behaviour and physical aggression towards others. Ryan struggles to communicate effectively and looks to seek control of his immediate environment to promote predictability, routine and structure in his world. Ryan at present is not in education and waiting to seek an appropriate school provision that can meet Ryan’s needs.The Behaviours Ryan can display a series of challenging behaviours including: Attempts to break items – Scratching- Kicking – Nipping - Hitting outHead Banging- Biting own tongue- Biting own fingersSlapping side of his head- Hitting forehead with clenched fist- SpittingUrination- Bite othersFirstly an initial mental health assessment was completed to gain further information on reason for referral and to highlight need. Alongside this consent forms, goal setting, information pack, questionnaires and behavioural assessment tools were completed (Motivational Assessment Scale & Nisonger). There is always a reason behind behaviours that challenge. Observations were completed predominantly in the school environment due to Ryan associating me (Tom – care coordinator) within this environment. Should Ryan see Tom in his home environment this may have distressed him and not provided a natural observation. Charts known as (Antecedent, Behaviour, and Consequence) ABC Charts were created to Ryan’s individuality to be completed by Ryan’s family and school staff supporting Ryan in view to completing a functional behaviour assessment. The functional behaviour assessment was completed to understand the reasons for the behaviour’s Ryan presents with and with this evidence base to promote the correct strategies to be implemented. Alongside this process of awaiting ABC charts to aid the functional analysis work, I supported Ryan and family in promoting a better sleep quality as this was a goal target set with family. I requested family completed four weeks sleep charts, sleep diary to then analyse look at the routine Ryan has, whether he struggles to settle, awakenings in the night and whether the environment was catered to been low stimulus. 474453422694Ryan was provided visual information such as social stories with photos requested by me from family to use as object of reference to prepare Ryan for the change and promote expectation. Steps were agreed and planned with family in stages as too much change would be too much for Ryan to cope with. Family was also provided a detailed sleep routine plan providing them with steps to deliver the plan but also to manage the situation should it not work effectively. I would complete daily communication then reduce this to every other day then weekly once the plans became more established and affective. Ryan’s sleep quality improved from four hours broken sleep to six hours unbroken sleep, this improved Ryan’s tolerance and ability to cope and identified a reduction in the unwanted behaviours in the home environment. Ryan was discussed regularly in the intellectual disability team meetings with consent from parents and regular collaborative working via face to face, telephone and email between me, family and school.After four weeks, I completed a functional behaviour assessment and recommendations were set out to family, school and other professionals working with Ryan. During this time Ryan’s school placement was at risk of breakdown due to the behaviours Ryan presented with and school informing that the recommendations had been trialled prior to CAMHS involvement. My role was to advocate for Ryan therefore I challenged Ryan’s school that they provided no evidence base suggesting they completed the proposed recommendations prior to CAMHS involvement and the identified areas that would reduce the unwanted behaviours. Secondly they were unwilling to promote Ryan’s skill development, inclusion and communication needs. I advised Ryan’s mum to contact Special Educational Needs and Disabilities Information Advice and Support Service (SENDIASS) to support, advocate on behalf of Ryan and his family during this difficult process. Although there was significant improvements in Ryan’s mental health and reduction in behaviours within the home environment , Ryan’s school was not willing to trial the recommendations suggested. Within weeks Ryan was excluded on a fixed date proceedings, I provided telephone support to Ryan’s family during this difficult period. I worked alongside family, his current school, education and SENDIASS to seek an appropriate school placement that was able to meet Ryan’s needs due to his current school informing all parties they was not able to meet Ryan’s needs long term. Ryan was supported back into school on a two to one staffing ratio, isolated from peers and restricted access to school facilities. I advocated on Ryan’s and family’s behalf this was not ethically right and questioned the decision and policies school had in place to implement this from a legal framework. As a result Ryan was permanently excluded in June 2019 as anticipated by me Ryan’s behaviour would increase with frequency, severity and intensity. During this difficult period a positive behaviour support plan was implemented, provided to school and family to recognise the triggers, reduce the unwanted behaviours, improve skill development and enhance quality of life. Ryan at present is still awaiting a school placement that can meet his needs. At the request of family and permission from my manager I have visited potential school placements, ensured the functional behaviour assessment is implemented into Ryan’s Education, Health, Care Plan to ensure the next school placement will trial the recommendations. Ryan’s behaviour deteriorated at home as a result of limited structure and outlet. I advised family to seek social care support due to the increase in violence and aggression towards family members in view to seek respite and further advocacy support to build momentum on seeking a school placement. Family acknowledged this but decided not to pursue, regular phone calls take place between myself and family at present with Ryan’s behaviour improving. Ryan’s care plans and risk assessments are updated to reflect his current presentation. 00Ryan was provided visual information such as social stories with photos requested by me from family to use as object of reference to prepare Ryan for the change and promote expectation. Steps were agreed and planned with family in stages as too much change would be too much for Ryan to cope with. Family was also provided a detailed sleep routine plan providing them with steps to deliver the plan but also to manage the situation should it not work effectively. I would complete daily communication then reduce this to every other day then weekly once the plans became more established and affective. Ryan’s sleep quality improved from four hours broken sleep to six hours unbroken sleep, this improved Ryan’s tolerance and ability to cope and identified a reduction in the unwanted behaviours in the home environment. Ryan was discussed regularly in the intellectual disability team meetings with consent from parents and regular collaborative working via face to face, telephone and email between me, family and school.After four weeks, I completed a functional behaviour assessment and recommendations were set out to family, school and other professionals working with Ryan. During this time Ryan’s school placement was at risk of breakdown due to the behaviours Ryan presented with and school informing that the recommendations had been trialled prior to CAMHS involvement. My role was to advocate for Ryan therefore I challenged Ryan’s school that they provided no evidence base suggesting they completed the proposed recommendations prior to CAMHS involvement and the identified areas that would reduce the unwanted behaviours. Secondly they were unwilling to promote Ryan’s skill development, inclusion and communication needs. I advised Ryan’s mum to contact Special Educational Needs and Disabilities Information Advice and Support Service (SENDIASS) to support, advocate on behalf of Ryan and his family during this difficult process. Although there was significant improvements in Ryan’s mental health and reduction in behaviours within the home environment , Ryan’s school was not willing to trial the recommendations suggested. Within weeks Ryan was excluded on a fixed date proceedings, I provided telephone support to Ryan’s family during this difficult period. I worked alongside family, his current school, education and SENDIASS to seek an appropriate school placement that was able to meet Ryan’s needs due to his current school informing all parties they was not able to meet Ryan’s needs long term. Ryan was supported back into school on a two to one staffing ratio, isolated from peers and restricted access to school facilities. I advocated on Ryan’s and family’s behalf this was not ethically right and questioned the decision and policies school had in place to implement this from a legal framework. As a result Ryan was permanently excluded in June 2019 as anticipated by me Ryan’s behaviour would increase with frequency, severity and intensity. During this difficult period a positive behaviour support plan was implemented, provided to school and family to recognise the triggers, reduce the unwanted behaviours, improve skill development and enhance quality of life. Ryan at present is still awaiting a school placement that can meet his needs. At the request of family and permission from my manager I have visited potential school placements, ensured the functional behaviour assessment is implemented into Ryan’s Education, Health, Care Plan to ensure the next school placement will trial the recommendations. Ryan’s behaviour deteriorated at home as a result of limited structure and outlet. I advised family to seek social care support due to the increase in violence and aggression towards family members in view to seek respite and further advocacy support to build momentum on seeking a school placement. Family acknowledged this but decided not to pursue, regular phone calls take place between myself and family at present with Ryan’s behaviour improving. Ryan’s care plans and risk assessments are updated to reflect his current presentation. 526211707365Case Study 2 Child XBy Eve Barratt Baines & Dr Roberta Radcliffe-BirdsChild/Young Person’s Age and Gender:X is a 15 year old male Main areas of concern and risk:X was referred to the Child and Adolescent Mental Health Intellectual DisabilitiesTeam due to social isolation and occupational deprivation which was perceived torelate to X’s high levels of anxiety and Hyperacuisis (extreme sensitivity to everyday noises). The main risk is that X’s development and learning will be further affected by his unwillingness and inability to engage in any activities outside of the house.X has the following diagnoses:Anxiety disorder - Autism - Intellectual Disability -AgoraphobiaPost-Traumatic Stress Disorder - Separation Anxiety - School PhobiaDowns Syndrome - Global Developmental DelayX also experiences additional difficulties which include:Multi-Sensory Impairment (Retinal detachment and loss of sight in right eye)Hyperacuisis - ACE Procedure - Peg Feeds - Spinal Problems00Case Study 2 Child XBy Eve Barratt Baines & Dr Roberta Radcliffe-BirdsChild/Young Person’s Age and Gender:X is a 15 year old male Main areas of concern and risk:X was referred to the Child and Adolescent Mental Health Intellectual DisabilitiesTeam due to social isolation and occupational deprivation which was perceived torelate to X’s high levels of anxiety and Hyperacuisis (extreme sensitivity to everyday noises). The main risk is that X’s development and learning will be further affected by his unwillingness and inability to engage in any activities outside of the house.X has the following diagnoses:Anxiety disorder - Autism - Intellectual Disability -AgoraphobiaPost-Traumatic Stress Disorder - Separation Anxiety - School PhobiaDowns Syndrome - Global Developmental DelayX also experiences additional difficulties which include:Multi-Sensory Impairment (Retinal detachment and loss of sight in right eye)Hyperacuisis - ACE Procedure - Peg Feeds - Spinal Problems180975457200Assessment and analysis:Assessments completed by the Principal Clinical Psychologist included mental health assessment and a comprehensive assessment of his anxiety, PTSD and social phobia. X was seen regularly every fortnight since September 2018 by the Clinical Psychologist initially developing a relationship with X and helping him to accept a new person into his home. They also looked at trying different relaxation exercises including progressive muscle relaxation, guided imagery and deep diaphragmatic breathing. The sessions also introduced recognising emotions in ourselves and others however X found this difficult and so the work was tailored to his speed and ability. The work was specifically designed for young person with a severe intellectual disability and a diagnosis of an autism spectrum disorder i.e. using visual concrete materials. The Clinical Psychologist also spent some time sharing different models of anxiety and emotional regulation with X’s mother discussing the importance of the arousal curve and helping to develop a toolkit for X and those supporting X in helping regulate his emotions, for example; using relaxation exercises, physical activities, special interests and other people who can offer support and help. The Clinical Psychologist in collaboration with X’s mother also developed a formulation of how X’s difficulties had developed and what was maintaining the anxieties and what was helping reduce them.The CAMHS-ID Team Consultant Child and Adolescent LD Psychiatrist has also assessed X and completes frequent discussions in the clinic with X’s Mum to review medication; discuss progress; and oversee X’s care plan collaboratively with the Principal Clinical Psychologist.Assessments completed by the Principal Clinical Psychologist and Consultant Child and Adolescent LD Psychiatrist highlighted that the number of environments which X was willing to access and the range of activities he would engage in on a day to day basis were extremely limited. X’s difficulties were therefore impacting negatively upon his daily life as this has limited the range of opportunities which X is able to access in terms of social interactions, learning activities/environments, leisure occupations, and life skills. In light of this, following a multi-disciplinary team discussion at a CAMHS ID Team meeting, it was agreed that X would benefit from accessing the Sensory Processing Care Pathway for an Occupational Therapy (OT) assessment of his sensory processing abilities/needs. This assessment was requested particularly in relation to X’s diagnosis of Hyperacuisis and apparent sensory sensitivities which appear to be contributing significantly towards X’s current difficulties relating to leaving the family home to go out into the community; to access an educational provision; and to engage in outdoor leisure occupations or activities which involve noise in the family home. The purpose of this OT assessment therefore, was to assess X’s sensory processing abilities/needs to identify how X’s sensory processing may be impacting upon the challenges he is currently experiencing and to offer recommendations relating to adaptations to activities/environments and strategies to facilitate regulation which may support X to function more optimally in a range of environments/activities.00Assessment and analysis:Assessments completed by the Principal Clinical Psychologist included mental health assessment and a comprehensive assessment of his anxiety, PTSD and social phobia. X was seen regularly every fortnight since September 2018 by the Clinical Psychologist initially developing a relationship with X and helping him to accept a new person into his home. They also looked at trying different relaxation exercises including progressive muscle relaxation, guided imagery and deep diaphragmatic breathing. The sessions also introduced recognising emotions in ourselves and others however X found this difficult and so the work was tailored to his speed and ability. The work was specifically designed for young person with a severe intellectual disability and a diagnosis of an autism spectrum disorder i.e. using visual concrete materials. The Clinical Psychologist also spent some time sharing different models of anxiety and emotional regulation with X’s mother discussing the importance of the arousal curve and helping to develop a toolkit for X and those supporting X in helping regulate his emotions, for example; using relaxation exercises, physical activities, special interests and other people who can offer support and help. The Clinical Psychologist in collaboration with X’s mother also developed a formulation of how X’s difficulties had developed and what was maintaining the anxieties and what was helping reduce them.The CAMHS-ID Team Consultant Child and Adolescent LD Psychiatrist has also assessed X and completes frequent discussions in the clinic with X’s Mum to review medication; discuss progress; and oversee X’s care plan collaboratively with the Principal Clinical Psychologist.Assessments completed by the Principal Clinical Psychologist and Consultant Child and Adolescent LD Psychiatrist highlighted that the number of environments which X was willing to access and the range of activities he would engage in on a day to day basis were extremely limited. X’s difficulties were therefore impacting negatively upon his daily life as this has limited the range of opportunities which X is able to access in terms of social interactions, learning activities/environments, leisure occupations, and life skills. In light of this, following a multi-disciplinary team discussion at a CAMHS ID Team meeting, it was agreed that X would benefit from accessing the Sensory Processing Care Pathway for an Occupational Therapy (OT) assessment of his sensory processing abilities/needs. This assessment was requested particularly in relation to X’s diagnosis of Hyperacuisis and apparent sensory sensitivities which appear to be contributing significantly towards X’s current difficulties relating to leaving the family home to go out into the community; to access an educational provision; and to engage in outdoor leisure occupations or activities which involve noise in the family home. The purpose of this OT assessment therefore, was to assess X’s sensory processing abilities/needs to identify how X’s sensory processing may be impacting upon the challenges he is currently experiencing and to offer recommendations relating to adaptations to activities/environments and strategies to facilitate regulation which may support X to function more optimally in a range of environments/activities.224287336430X was assessed by the OT using the Adolescent/Adult Sensory Profile Questionnaire. This is typically completed as a self-report questionnaire in which behavioural responses to everyday sensory experiences are evaluated by the individual. However, parents/carers may also assist in the completion of the questionnaire where appropriate and due to X’s intellectual disabilities, his Mum completed this questionnaire on X’s behalf. The results of the questionnaire enable the therapist to measure and profile the effect of sensory processing on functional performance and analyse patterns of sensory processing.X’s sensory processing assessment highlighted him to present with sensory processing needs particularly relating to the processing of auditory, tactile and visual sensory input and indicated X’s predominant pattern of sensory processing to be that of sensation avoidance. X’s sensory processing needs therefore would appear to be contributing significantly towards the challenges he is experiencing in accessing activities and environments outside of the family home and in light of this the OT provided a report detailing the assessment outcomes and recommendations which are aimed to help X better regulate his sensory responses. Careful consideration was given when providing recommendations as it was important to take into consideration a number of factors including but not limited to X’s needs associated with his diagnosis of Autism; his personal interests (to promote X’s engagement with the recommendations); and existing strategies already in place, for instance, oral motor activities were provided which were in line with and built upon existing calming visualisation and breathing exercises provided by the Principal Clinical Psychologist. X’s sensory profile report was shared with the CAMHS ID Team; X’s Mum; and with the Senior Special Educational Needs (SEN) Officer involved in updating X’s Education Health and Care Plan (EHCP) (with parental consent) so that X’s sensory processing support needs could be taken into consideration in terms of this holistic support plan.The OT continues to work with X and his Mum as part of his CAMHS ID Team care plan to support the introduction of the OT recommendations within the home setting. Initial focus is being given to:Introducing self-regulation activities to help with calming to contribute to the full-team approach to support X to reduce levels of anxiety Adapting activities and environments to reduce problematic sensory stimuli with the aim to remove barriers to X’s availability for engagement Providing activities which offer a sensory motivator and appeal to X’s personal interests to promote X’s levels of engagement00X was assessed by the OT using the Adolescent/Adult Sensory Profile Questionnaire. This is typically completed as a self-report questionnaire in which behavioural responses to everyday sensory experiences are evaluated by the individual. However, parents/carers may also assist in the completion of the questionnaire where appropriate and due to X’s intellectual disabilities, his Mum completed this questionnaire on X’s behalf. The results of the questionnaire enable the therapist to measure and profile the effect of sensory processing on functional performance and analyse patterns of sensory processing.X’s sensory processing assessment highlighted him to present with sensory processing needs particularly relating to the processing of auditory, tactile and visual sensory input and indicated X’s predominant pattern of sensory processing to be that of sensation avoidance. X’s sensory processing needs therefore would appear to be contributing significantly towards the challenges he is experiencing in accessing activities and environments outside of the family home and in light of this the OT provided a report detailing the assessment outcomes and recommendations which are aimed to help X better regulate his sensory responses. Careful consideration was given when providing recommendations as it was important to take into consideration a number of factors including but not limited to X’s needs associated with his diagnosis of Autism; his personal interests (to promote X’s engagement with the recommendations); and existing strategies already in place, for instance, oral motor activities were provided which were in line with and built upon existing calming visualisation and breathing exercises provided by the Principal Clinical Psychologist. X’s sensory profile report was shared with the CAMHS ID Team; X’s Mum; and with the Senior Special Educational Needs (SEN) Officer involved in updating X’s Education Health and Care Plan (EHCP) (with parental consent) so that X’s sensory processing support needs could be taken into consideration in terms of this holistic support plan.The OT continues to work with X and his Mum as part of his CAMHS ID Team care plan to support the introduction of the OT recommendations within the home setting. Initial focus is being given to:Introducing self-regulation activities to help with calming to contribute to the full-team approach to support X to reduce levels of anxiety Adapting activities and environments to reduce problematic sensory stimuli with the aim to remove barriers to X’s availability for engagement Providing activities which offer a sensory motivator and appeal to X’s personal interests to promote X’s levels of engagement258792370936The CAMHS ID Team continue to work collaboratively with SEN because moving forwards, it will be important for X’s sensory processing needs and sensory preferences to be included in his Education Health and Care Plan (EHCP) so that the relevant adaptations to activities/environments can be made and the appropriate support approaches put in place to provide X with the best opportunities to optimise his functional performance and access to an increased range of activities and environments. The aim is to share our work with tutors and teachers and those around him who are there to support him. It is important that other people are also helping to develop and grow his toolbox of emotional regulation strategies and continue with the work in supporting X and his motherIn addition to this, due to X’s medical needs, he frequently attends hospital appointments and requires medical procedures. In light of this, the Principal Clinical Psychologist has developed a Hospital Plan for people with Intellectual Disabilities (WRAP) to reflect X’s levels of communication and comprehension; risk factors; the things which are important to X; and his likes and dislikes. X’s Mum is aware to take this plan with her when attending appointments with X so that all staff engaging with X are aware of his needs and can apply key support approaches in their interactions with him to ensure X’s holistic needs are best supported.00The CAMHS ID Team continue to work collaboratively with SEN because moving forwards, it will be important for X’s sensory processing needs and sensory preferences to be included in his Education Health and Care Plan (EHCP) so that the relevant adaptations to activities/environments can be made and the appropriate support approaches put in place to provide X with the best opportunities to optimise his functional performance and access to an increased range of activities and environments. The aim is to share our work with tutors and teachers and those around him who are there to support him. It is important that other people are also helping to develop and grow his toolbox of emotional regulation strategies and continue with the work in supporting X and his motherIn addition to this, due to X’s medical needs, he frequently attends hospital appointments and requires medical procedures. In light of this, the Principal Clinical Psychologist has developed a Hospital Plan for people with Intellectual Disabilities (WRAP) to reflect X’s levels of communication and comprehension; risk factors; the things which are important to X; and his likes and dislikes. X’s Mum is aware to take this plan with her when attending appointments with X so that all staff engaging with X are aware of his needs and can apply key support approaches in their interactions with him to ensure X’s holistic needs are best supported.Video Message This next video link shows the impact that the service can have on a family. We received consent from the mother participating in the video to show the video for purpose of this report. Special Educational Needs (SEND) In May 2019 Doncaster was subject to a Joint Local Area SEND Inspection. An abundance of preparatory work had taken place in readiness for the inspection and the overall outcome was positive. The headline details from the inspection are as follows:Local area leaders are committed to improving the life chances of children and young people with SEND. The strategies that they have used have secured improvements to the quality of health, education and social care provision. This is having a positive impact on the quality of services for most children and young people. The ‘big picture’ in Doncaster is one of steady improvement. The voice of children and young people with SEND is given high priority in Doncaster. Local arrangements ensure that the ideas of children and young people influence leaders’ strategic planning and the development of services. For example, the local offer has been shaped by the voice of children and young people.Child and adolescent mental health services (CAMHS) work effectively with education professionals to support the needs of children and young people with SEND. Systems to identify emerging need operate in a well-established and timely fashion, especially for children and young people with hearing impairments, and young people who are involved with the youth offending service (YOS).Support for children in the local area aged 0 to 5 years is cohesive and coherent. Frontline practitioners in early years services show a clear commitment to improving health, education and care provision for young children with SEND. Partnership working is contributing to better outcomes for this group of young children.Areas of StrengthAccess to services is a relative strength in the local areaChildren and young people with complex needs benefit from specialist health visiting and school nursing servicesSENDIASS in Doncaster is viewed positively by parents who have accessed the serviceThe local offer is informative and well considered. Children and young people are actively involved in its formulation and development. Indeed, local area leaders actively seek the views of children and young people with SENDChildren and young people who are looked after and who have SEND make gains in their learning due to the bespoke support they receive through the virtual school and local settingsA greater number of young people are living independently due to more accessible accommodation being commissionedAreas for developmentThe emerging needs of children and young people with SEND are not consistently identified well by schools. As a result, any additional support is not always timely or appropriateThe health needs of some children and young people are not always identified at the earliest opportunitySome children and young people with ASD and ADHD wait for too long for a formal diagnostic assessment of their needs, despite improvements because of the GDA pathway.There is too much variation in the quality of EHC plans. Health and care professionals do not contribute consistently well to the plansThe CCG is not routinely collecting information about the holistic impact of their services in relation to children and young people with SENDThe proportion of children and young people with SEND who receive fixed-term exclusions is too high. Similarly, the number of permanent exclusions of children and young people with SEND is too highPleasingly, Doncaster were not issued with a request for a written statement of action from Her Majesty’s Inspectors (HMI), thus indicating the strong position Doncaster are in, with which to move forward and improve on the areas identified above and to maintain our areas of strength. We are also pleased to be able to update that the resource allocated to the role of the Designated Clinical Officer (DCO) for SEND has increased to enable this to be a full time role, recognising the positive impact the DCO was starting to have at the time of the SEND inspection. We envisage that increasing the capacity of the DCO will support Doncaster CCG and the wider system with some of the specific areas of improvement relating to EHCPs and system connectivity. The full outcome letter can be accessed here. SEND Strategy We are also pleased to be able to share our SEND Strategy which was finalised in July 2019. The strategy also reflects our plans to address the areas for development as cited in our Joint Area SEND Inspection. \s2.4 The Children’s Sleep Service Doncaster were one of the first areas nationally to commission a sleep service for children and young people and the only sleep service in the country to include children with disabilities as part of the service offer. This cross cuts across many areas of delivery such as SEND and Transforming Care. The Chief Executive Officer of The Children’s Sleep Charity has kindly provided us with an update in relation to their last 12 months of delivery in Doncaster. This was specifically written for the LTP refresh 2019. The Children’s Sleep Charity was developed through the Founder’s own personal experience of the chronic impact of sleep deprivation and the little support that is available when sleep issues emerge. The charity was established in 2012 and has been commissioned in Doncaster since 2014. As far as we are aware it is the first sleep service of its kind in the country. Any family can access the service by self-referral as long as the child is age 12 months upwards. We have developed excellent partnerships with a number of key organisations including Sheffield Children’s Hospital’s sleep team; Professor Elphick sits on our Board of Trustees. The Sleep Practitioners have strong relationships with the Paediatricians in Doncaster and the success of the sleep service in the town resulted in Bassetlaw Clinical Commissioning Group buying in our service. We work collaboratively with other organisations at a local and national level to ensure that we learn from them and we can share our learning. In October 2017 we launched the first Sleep Manifesto for Children and Young People in Westminster; this was supported by over 50 organisations including leading charities such as Scope and Family Fund. Over the last 12 months we have continued with our campaigning work and we will be presenting a second manifesto in partnership with The Sleep Council in March 2020. We always promote the pioneering work taking place in Doncaster around sleep at these national events. We continue to have widespread interest in the work that we carry out in Doncaster. During the last year we have been commissioned to train the team at Alder Hey in Liverpool after a Paediatrician heard about our work at a conference. We are also in talks with commissioners in North Yorkshire and Bury, all keen to replicate the model. A Sleep Practitioner travelled to Russia to share information about our work and we are currently involved in a research project in Canada. In the last 12 months we have moved into new accommodation in Woodfield Park providing us with the facilities to deliver training on site to parents and professionals. Our Sleep Practitioners are also able to hold sleep clinics here as well as in the community. We are also able to hold training sessions on our premises for professionals and parents. We continue to offer drop in sessions throughout the town where we highlight the importance of sleep. This has allowed us to build up relationships with other charities such as YMCA and also to reach out to corporate organisations such as BT. Our work featured in a double page spread of the Doncaster Free Press which generated significant interest. AchievementsThe lasts 12 months have seen a whole host of achievements for our charity. Our methods have been the focus of a national research project that found on average children gain an additional 2.4 hours sleep per night. The research also demonstrated benefits in parental mental wellbeing as a result of intervention. We delivered a national conference in Birmingham to share findings with commissioners at a national level in March 2019. A full research report can be downloaded from here Sheffield Children’s Hospital have produced a paper demonstrating the effectiveness of our methods in weaning children off melatonin or preventing them being prescribed melatonin through some work carried out at their clinics. The work that we carried out with the hospital led to national media coverage, This was followed by further coverage in July by the BBC which appeared on the news and also the Victoria Derbyshire Show Our work was recognised in the town by Doncaster Business Chamber and in December 2018 we were awarded the ‘Charity of the Year’ award. We also gained 4 national awards in recognition of our work in the last year these are from the Foundation for Social Improvement, Small Charity, Big Impact, Royal Society for Public Health award for Children and Young People, Children and Young People Now Award for Charity of the Year and the GSK Impact Award from the King’s Fund. A film of our work was made as part of the award, this features our work in Doncaster and an interview with the Head of Strategic Commissioning and can be seen here and plans to address theseChallenges that we face are around meeting the increasing demand for our service. Clinics are now frequently booked up well in advance and we are often very close to not meeting our KPI objectives as a result. Another challenge is that we are increasingly seeing more complex cases, these can take up more time. Early intervention around sleep is key and at the moment there is no provision to support this approach in the town. We need to address these by securing more funding to provide information to parents in the early years. Our Sleep Tight training is an evidence based course that provides Family Support workers with the skills to deliver a 5 week parenting course in their localities, funding to deliver this would be the first step to providing a tiered approach to sleep issues. We are also aware that young people need support to change their sleep habits. We have developed training for school staff but again do not have the resources to deliver this in the town. Implementing this training would ensure that they have good quality information about sleep to try to minimise the risk of more complex sleep issues developing. We have secured external funding from a corporate organisation to develop a ‘Sleep Talkers’ programme. A project that will train volunteers in the local community to have basic information about sleep to share with families. They will also signpost on to the sleep service. We have secure pathways now at the Child Development Centre but we do not have them established at CAMHS and would like support to develop these.ImpactThe practitioners have seen 306 children with only 14 needing to be referred on for medical support to either Doncaster Royal Infirmary or Sheffield Children’s Hospital. As well as preventing children and families touching the NHS the impact of improving sleep has wider impacts including improving mental health and physical wellbeing as the case studies demonstrate. 2673353105150Case Study 1Child A is a typically developing 2 years 6 months little girl who was struggling to settle to sleep with frequent night waking. Prior to intervention she was waking at least 2 or 3 times each night and the family were finding it difficult to get her to sleep before 9.30pm. The Sleep Practitioners assessed the case and she was sleep deprived by around 4 hours per night. A sleep programme was developed in partnership with the family once a detailed assessment had taken place. Changes were made to the sleep times in order to support the child’s circadian rhythm. The family were empowered with sleep knowledge around the physiology of sleep and sleep associations; as a result they were able to identify potential triggers for the issues they were experiencing. Following the initial clinic appointment the Sleep Practitioner provided follow up support and after 2 weeks parents reported an improvement in night wakings. After 5 weeks of intervention Child A was sleeping through the night from 7.30pm until 7am. The intervention had improved this child’s sleep duration by approximately 28 hours sleep per week. Parents shared that they no longer dread bedtime and the whole family enjoy the new routine spending quality time together. The impact was that the child’s daytime behaviour was improved and parents sleep duration increased significantly too having a positive impact on their overall wellbeing. 00Case Study 1Child A is a typically developing 2 years 6 months little girl who was struggling to settle to sleep with frequent night waking. Prior to intervention she was waking at least 2 or 3 times each night and the family were finding it difficult to get her to sleep before 9.30pm. The Sleep Practitioners assessed the case and she was sleep deprived by around 4 hours per night. A sleep programme was developed in partnership with the family once a detailed assessment had taken place. Changes were made to the sleep times in order to support the child’s circadian rhythm. The family were empowered with sleep knowledge around the physiology of sleep and sleep associations; as a result they were able to identify potential triggers for the issues they were experiencing. Following the initial clinic appointment the Sleep Practitioner provided follow up support and after 2 weeks parents reported an improvement in night wakings. After 5 weeks of intervention Child A was sleeping through the night from 7.30pm until 7am. The intervention had improved this child’s sleep duration by approximately 28 hours sleep per week. Parents shared that they no longer dread bedtime and the whole family enjoy the new routine spending quality time together. The impact was that the child’s daytime behaviour was improved and parents sleep duration increased significantly too having a positive impact on their overall wellbeing. 543464465825Case Study 2Child B is a 6 year old little boy who is currently on the assessment pathway with the likelihood being a diagnosis of autism. Prior to intervention he was falling asleep in his parent’s bed at around 10pm. They had previously tried to get him to sleep in his own bed without success. A detailed assessment was made at the sleep clinic by the Sleep Practitioner. A sleep programme was developed that was highly structured. Parents felt that the programme was achievable and were keen to implement it with support. There were difficulties initially with Child B getting into the parent’s bed during the night while they were asleep. With the ongoing support of the Sleep Practitioner the family were able to remain consistent in their handling of the issue. After a period of 6 weeks of intervention the family reported that Child B was falling asleep in his own bed and staying there all night. He was now getting the recommended amount of sleep for his age and his functioning during the daytime improved. Parents were also benefiting from an uninterrupted night’s sleep, they stated that they were very sceptical about the intervention to begin with and had thought that a melatonin prescription would be the only way forward. Mum shared that both parents felt better as a result of improved sleep and that they were better equipped to deal with any day time behaviours although these were less challenging since the sleep has improved. Doncaster have made a clear commitment to continue to fund the service for another two years and to continue and build upon the excellent work being delivered by The Children’s Sleep Charity. Below is a quote from a Local Consultant Paediatrician, Designated Doctor for Safeguarding and the Designated Medical Officer for SEND “My experience with the service is Brilliant. I was one of the people who was very keen for this service to start in Doncaster. So far this service is one of the prides of Doncaster Children’s Services. The service users are really happy from my own experience. It is oversubscribed from the community paediatrics point of view and really we can't do without it. I cannot over emphasis it’s importance to the children and families who need it and accessing it. They work very closely to the sleep service and clinics in Sheffield which is really useful”00Case Study 2Child B is a 6 year old little boy who is currently on the assessment pathway with the likelihood being a diagnosis of autism. Prior to intervention he was falling asleep in his parent’s bed at around 10pm. They had previously tried to get him to sleep in his own bed without success. A detailed assessment was made at the sleep clinic by the Sleep Practitioner. A sleep programme was developed that was highly structured. Parents felt that the programme was achievable and were keen to implement it with support. There were difficulties initially with Child B getting into the parent’s bed during the night while they were asleep. With the ongoing support of the Sleep Practitioner the family were able to remain consistent in their handling of the issue. After a period of 6 weeks of intervention the family reported that Child B was falling asleep in his own bed and staying there all night. He was now getting the recommended amount of sleep for his age and his functioning during the daytime improved. Parents were also benefiting from an uninterrupted night’s sleep, they stated that they were very sceptical about the intervention to begin with and had thought that a melatonin prescription would be the only way forward. Mum shared that both parents felt better as a result of improved sleep and that they were better equipped to deal with any day time behaviours although these were less challenging since the sleep has improved. Doncaster have made a clear commitment to continue to fund the service for another two years and to continue and build upon the excellent work being delivered by The Children’s Sleep Charity. Below is a quote from a Local Consultant Paediatrician, Designated Doctor for Safeguarding and the Designated Medical Officer for SEND “My experience with the service is Brilliant. I was one of the people who was very keen for this service to start in Doncaster. So far this service is one of the prides of Doncaster Children’s Services. The service users are really happy from my own experience. It is oversubscribed from the community paediatrics point of view and really we can't do without it. I cannot over emphasis it’s importance to the children and families who need it and accessing it. They work very closely to the sleep service and clinics in Sheffield which is really useful”2.5. Working with Young Minds- Participation Over the last twelve months YoungMinds has continued to build on the engagement conducted in Years 1 – 3 of the Doncaster participation project; recruiting and inducting a panel of Mental Health and Wellbeing Participation Champions – four young people, two parent carers and one professional – and, with these champions, co-creating three audit tools to use in the assessment of the quality and scope of participation in local youth focused settings.Since the October 2018 refresh of the Local Transformation Plan the scope of the project has been revisited and refreshed by YoungMinds and Doncaster CCG to best reflect local needs and challenges and progress has been made against the following key deliverables:Supporting the Participation Champions to conduct participation audits of five local services providing support to young people, across universal, education and mental health settings.Co-producing a youth friendly version of the Doncaster LTP with the Participation Champions and other local young people.In March and July YoungMinds Conducted Participation Audits (using the abovementioned tools) of both Doncaster CAMHS and Doncaster Housing for Young People DHYP) and have reported their findings.Through this work YoungMinds and the Participation Champions are highlighting existing good participation practice happening in local services for young people and also making recommendations around opportunities for improved participation throughout the local system. There are some excellent examples of engagement with young people happening already within services, for example at Doncaster Housing for Young People (DHYP). Through their Service User Involvement Framework – which is reviewed with young people - the organisation evidences a clear strong and ongoing commitment to ensuring young people have a real say strategically and in service delivery. Participation AuditsIn March and July YoungMinds Conducted Participation Audits (using the abovementioned tools) of both Doncaster CAMHS and Doncaster Housing for Young People DHYP) and have reported their findings.Through this work YoungMinds and the Participation Champions are highlighting existing good participation practice happening in local services for young people and also making recommendations around opportunities for improved participation throughout the local system.There are some excellent examples of engagement with young people happening already within services, for example at Doncaster Housing for Young People (DHYP). Doncaster Housing for Young PeopleDuring the Participation Audit conducted at the service, staff shared considerable evidence of their strong and ongoing dedication to ensuring young people have a real say strategically and in service delivery. Examples include:A Service User Involvement Framework which is regularly reviewed with young people.A Youth Service Forum which genuinely directs the work of the organisation; working on service development, reviewing policy procedures and being involved in recruitment.Involvement of service users in event planning and delivery, including budget management and the redesign of resources and the organisation’s website.The Participation Champions found it very difficult to come up with recommendations – they were very impressed with the service, the staff and the levels of participation. Most of their ideas were based around further promotion of the great work the organisation is doing.Since conducting the audit, DHYP have provided updates about how they have addressed the Participation Champions’ suggestions:Developing the organisation’s website (with young people) to include information identified as lacking through the audit including broader information about mental health and wellbeing, the staff members responsible for participation, examples of work done by the Youth Service Forum, advocacy services for young people and case studies of young people’s experiences of the services provided by DHYP.Ordering posters and leaflets about mental health (including positive messages), local activities for young people and support options. Doncaster CAMHSParticipation Champions highlighted that the participation at Doncaster CAMHS is in need of improvement. The audit at the service identified a number of recommendations, including the following:Co-design of a specific, youth friendly CAMHS presence online including social media and the CAMHS website.Co-creation of youth friendly CAMHS criteria to include online because young people don’t always know when they should reach out for help from CAMHS.Involve young people in redesigning/reviewing the layout of the reception area to ensure:Information is better organised and displayed.More positive information is displayed e.g. about rmation is displayed about staff members because young people can see who they may interact with.Co-design of documents including letters and plans to make them more ‘human’ rather than clinical.Better promotion of CAMHS and other options for support alongside the criteria for the support offered for the following reasons:Some young people arrive in CAMHS and don’t know what it is.Young people don’t understand the CAMHS criteria and don’t know if they should refer themselves or if they could be helped in another way or by another service. CAMHS is seen by some young people as “really bad” and you only use the service if there is something really wrong with you.The Mental Health Passport should be available to all young people using CAMHS, not just those transitioning to adult mental health services. It would help prevent young people having to tell their story more than once.Over the remainder of the financial year 2019/20 the Participation Champions will carry out a further three Participation Audits of local youth focused services, including one school and produce a final consolidating their findings from all audits and proposing recommendations for developing participation throughout the local system.Developing a Youth Friendly LTP In August and September 2019 YoungMinds facilitated workshops with Participation Champions, young people from DHYP and professionals from Doncaster CAMHS and Doncaster CCG to develop a youth friendly version of the Doncaster Local Transformation Plan. The group worked through the content of the full plan, selecting elements they felt would be relevant and interesting for young people, making the language more accessible and deciding on design features. The finished Youth Friendly LTP is detailed below. Doncaster Young Advisors To further enhance the voice of Doncaster’s Children and Young People, a group of local Young Advisors has been established. The remit of our Young Advisors spans across many areas, but a priority area highlighted not only by our Young Advisors but also by the findings from the Make Your Mark Campaign is the emotional health and wellbeing of Doncaster’s Children and Young People. Local leaders have worked with our Young Advisors to frame a programme of work that accurately reflects the common themes identified by children and young people. The Young Advisors will work across Doncaster through a variety of mediums to raise awareness of the children and young people’s emotional health and wellbeing agenda. Taking into consideration and complementing existing programmes of work to ensure the resource is maximised as effectively as possible, consequently avoiding duplication. The service will be underpinned by the principles of inclusivity and accessibility to make sure that a holistic picture of children and young people’s emotional health and wellbeing is produced and any activity is informed by and aligned to this. The areas of work identified are as follows: To work with children, young people and their families/carers to develop a video to raise awareness of the following issues, as determined by a recent Children and Families Forum Event: AnxietyExam StressBody ImageDepression To work with an author, primary school aged children and their families/carers to develop a storybook to raise awareness of emotional health and wellbeing in an age appropriate and accessible way To work with children, young people, families/carers and key stakeholders to plan, organise and develop an emotional health and wellbeing festival with links to the Mental Health Trailblazer. The festival will be accessible to all who wish to attend and may include, but won’t be limited to the following: Art TherapyMusic TherapySound Therapy Breathing work Mediation and mindfulnessVarious exercise e.g. boxing, dance, combat, yoga, Pilates Live music with a variety of musiciansLive talks from people that have experienced mental health issues, how they overcame them, what strategies they used etc. Feel good food An evaluation will be provided at the end of the programme of work to explore the impact, outcomes and next steps from the activities described above. 2.6 Workforce It is widely acknowledged in Doncaster and across the ICS that the biggest challenge is and remains the development of the children and young people’s workforce, both in the present and prospectively in order to meet the demand for services. This is led not only by the activity flowing through local services and what children and young people tell us, but also by national directives such as the Five Year Forward View and the NHS Long – Term Plan. In Doncaster, various work has been completed to act as a basis for further development such as the previously commissioned consultation work which generated the 13 recommendations for the wider workforce and an action plan for CAMHs. Whilst this was a good start, it has been challenging to move beyond this point, recognising that this is such a large area of work which cuts across many different agendas and portfolios and not wanting to duplicate what may be planned across the ICS footprint. Pleasingly, the ICS will be commissioning a specific role to work across the ICS, reviewing the workforce and future requirements across all-age mental health, learning disabilities and autism. The job description for this post is embedded below. From a Doncaster perspective, we are hoping to commission a bespoke piece of work to review our local workforce and how we will need to transform this to meet both the Local Transformation and Long Term Plan’s ambitions, as such, we will ensure that any plans to commission this piece of work, interface with the ICS work in order to complement and not duplicate the work already planned. \s3. Understanding Local Need3.1 Joint strategic needs assessments (JSNA)Joint Strategic Needs Assessments (JSNAs) are local assessments of current and future health and social care needs that could be met by the local authority or the NHS. They contain a range of quantitative and qualitative evidence, and focus on specific groups and issues relevant to the local area.The Children and Young People’s emotional wellbeing and mental health need assessment for Doncaster (2015) was deemed to be a strong needs assessment by NHS England and was the foundation for the original LTP. Recognising the volume of change that has taken place over the last four years, the original needs assessment in full has been included as an appendix in this document.A specific Children and Young People’s Joint Strategic Needs Assessment (JSNA) was completed in 2017. A full copy of the JSNA can be found here. Headlines from the document include: Population: The biggest change in the population of children and young people between 2011 and 2014 has been an increase in the 5-9 year old age group and a decrease in the 15-19 year old age group.Ethnicity: Doncaster in comparison to the national and regional averages does not have a high proportion of children from non-white ethnic groups. According to the 2016 School Census 88% of school children are in the White British ethnic group. This compares to 77% in Yorkshire and Humber and 72% across England.In 2016, over one quarter (27%) of enquiries for Early Help relate to children aged between 8 and 11 years old. 55% of enquiries related to boys. There is a trend for enquiries relating to girls (7-10 years) to be younger than boys (9-12 years).During 2013/2014, 130 children and young people were admitted to acute wards due to self-harm whereas the number fell to 109 in 2014/2015. The caveat to this data is that it includes alcohol poisoning so it must be interpreted with this consideration.In 2016, the percentage of pupils reaching a good level of development in Doncaster (69.7%) is higher than the national average (69.3%). Pupils in the South locality performed higher than the national average, the East and North are comparable whereas Central pupils achieved slightly below the national average.The proportion of young people aged 16–18 that are known to be ‘not in education, employment or training’ (NEET) is slightly higher than the national average, particularly in the Central and North localities.Across the four locality areas, domestic violence was identified as a factor in a higher proportion of assessments within Central area (45% of assessments completed) than the other three areas. A higher proportion of assessments completed for younger children, identified domestic violence as a factor with 50% of assessments completed for children aged three and under identifying domestic abuse, compared to 30% for children aged twelve or over.At the end of March 2016 approximately 78% of children in need had abuse/neglect identified as their primary need. This is a significantly higher rate than the national figure (50%) or statistical neighbour authorities (56%).The findings from the JSNA indicate a need to focus on those children and young people who have been subject to abuse, domestic violence or neglect and the impact of such adverse childhood experiences. In 2019 Doncaster’s overall JSNA was refreshed in order to provide a more up to date picture of the current local need. This has supported with framing the development of this refreshed LTP. PrevalenceThere are estimated to be more than 4,300 children (aged 5-16) mental health disorders in Doncaster, this is a rate of 10.2% (compared to 9.2% for England). Children with learning disabilities (LD) – NICE (the National Institute for Health and Clinical Excellence) estimate that 36% of children and young people with LD experience mental health problems, much higher than for children with LD. The causes for this higher prevalence have a number of causes: Behaviour, pain, physical ill health, complications arising from medication, as well as attendant social and psychological factors.Children who are refugees and asylum seekers. In Doncaster there are estimated to be 327 asylum seekers. There are currently fewer than 5 unaccompanied asylum children. Nationally the majority of unaccompanied child asylum seekers are aged 16-17.LGBT (Lesbian, Gay, Bisexual, and Transgender) young people. The Office of National statistics (ONS) estimate amongst young people between 4.9% and 6.0% are consider themselves to be LGBT. If these rates are applied to Doncaster 16-19 years olds would mean there are around 800 LGBT young people in Doncaster.Children in contact with the criminal justice system. Research undertaken for the Children’s commissioner found that that children and young people in the youth justice system have higher than normal levels of depression (18%), anxiety disorders (10%) and psychotic like symptoms (5%). In Doncaster in 2017 the rate for first time entrants into the youth justice system was slightly lower than the national rate. In the preceding years this rate has been significantly higher.3.2 Pupil Lifestyle SurveyThe Pupil Life Style Survey (PLS) is a Doncaster-wide survey carried out in both primary and secondary school aged children. The survey covers a wide variety of health and wellbeing topics that affect children, and provides useful data to show the impact of strategies in place and to inform future planning. The survey was commissioned by Doncaster’s Public Health team in 2015 and again in 2017. The survey provides data on a range of different aspects of health and wellbeing in young people, including mental health. The survey concentrates on pupils in year 4 and year 83.2.1 Comparison of changes between 2015 and 2017Improved perception of safety in and out of school Increased high measure of resilienceIncrease in screen time (screens other than television)Increase in children feeling worried about growing up and changes to their body.3.2.2 Findings from 2017: Primary pupils32% of boys and 27% of girls responded that they did physical activity on five days or more in the week before the survey18% of pupils responded that they spent 3 hours or more watching a television screen on the day before the survey26% of pupils responded that they spent 3 hours or more looking at any other sort of screen on the day before the survey42% of pupils responded that they at least ‘sometimes’ feel afraid of going to school because of bullying11% of pupils responded that they ‘often’ or ‘very often’ feel afraid of going to school because of bullying32% of pupils responded that they have been bullied at or near school in the last 12 months3.2.3. Findings from 2017: Secondary pupils33% of pupils responded that they take part or had taken part in the past in at least one of the gambling activities listed: play arcade games to win money; buy lottery tickets; play gambling games online (e.g. bingo, card games like poker); place money bets with my friends.39% of boys and 23% of girls responded that they did physical activity on five days or more in the week before the survey41% of pupils responded that they got 'less than 8 hours’ sleep the night before the survey63% of pupils responded that the amount of sleep they normally get is enough for them to stay alert and concentrate on their school work31% of pupils responded that they have experienced at least one negative behaviour in a relationship with a past or current boyfriend/girlfriend (e.g. Hurtful or threatening language; Anger or jealousy when wanting to spend time with friends; Checking phone). The percentage of pupils who report themselves as worried about one of more issues increased to more than 90% in girls and nearly 70% I boys in year ten.The most frequently mentioned concern was about exams and tests, however Physical health, the way they look and bullying also featured.The proportions of children reporting high resilience scores falls in both boys and girls as they move from year 4 to year 10.The report also found that pupils with special educational needs and disabilities (SEND) were less likely to be happy and had lower self-esteem. They were also more likely to have lower resilience. SEND pupils were also more likely to be carers3.3 Hospital ActivityThere were around 4,360 psychiatric attendances at A&E in Doncaster in the 3 years 2016/17 to 2018/19.Young people (0-19) account for 14.4%, The numbers of attendances peaks in the 20-24 year age group and then declines The 2019 refreshed JSNA informs us that there is still some considerable work to do for children in education. The Mental Health Support Teams and Mental Toughness Project should support us to address these needs. There is also a clear and identified need to address self-harm across the 0-25 age range as this remains an issue. In Doncaster, we value and understand the importance of the JSNA in order to inform our priorities to meet the needs of our community and in particular Children and Young people. However, we also acknowledge the value of an objective review which goes beyond data, but rather provides a position from a critical friend. It is with this in mind that Doncaster completed a Peer Review with our respective Children’s Colleagues in Barnsley. Details can be found below:3.3.1 Evaluation of Children’s Mental Health (CMH) Peer Challenge in Barnsley and Doncaster- November 2018center0Area of Evaluation00Area of Evaluation101085107950Scale1 is low 6 is highComments To what extent did the self-assessment tool help you to accurately and comprehensively reflect on your local arrangements? 46Some engagement issuesWe responded to specific criteria – it would have been helpful to add our ownReally helpful – a stock takeIt was thorough and it provoked self-challengeMight have helped to have had some examples of the sort of narrative requiredAs a receiver of another completed self-assessment template, to what extent did reading and critiquing this add value to your own thinking about CMH?2224Interesting to compare writing and completion styles, e.g. positive vs negative self-reflectionWe spotted interesting practiceIt was very helpful and we reflected on our own area even more having gone through another area’s self-assessmentTo what extent did the challenge meeting enable you to make your challenge of another LA Area meaningful136HelpfulTo what extent did the challenge meeting help you to reflect on your strengths and areas for development?(please also describe the degree to which you felt challenged)244Insufficient challenge – too kindIn theory good, in practice more difficult: need to manage talk time of some individualsChallenge conversations were balanced and allowed reflectionTo what extent did the process work for you? For example – what reflection/ action has it prompted?28It helped our ongoing strategic planning and implementation It has helped us to think about concentrating on specific areas of activityIt highlighted our areas of weakness and pinpointed areas to progressFeedback from a multi-agency perspective has been valuableA robust process. The challenge meeting added more valueAny general comments you would like to make about the peer challenge PROCESSMaybe a narrower scope would have been betterWould work with a different scope: ‘workforce’; 24/7 crisis servicesPerhaps an expectation of an action plan and then maybe follow up sessionProfessional and well managed processWell chairedInteresting and engaging due to being a novel experienceWould be helpful to broaden the peer engagement – clinicians in particular4. Transparency and Governance In Doncaster, the Children and Young People’s Emotional Health and Wellbeing agenda, has been sighted at a senior level for some considerable time, a position which was strengthened through the inception of the Children and Young People’s Plan (2017), a plan which in many ways, builds on aspects of our Local Transformation plan, via the Happy and Healthy work stream. The LTP sits within the Healthy and Happy theme, thus ensuring a coordinated approach with regards to reporting ant accountability. The Children and Young People’s Plan set out very clearly a series of mutually agreed partnership priorities to ensure that those agencies with a responsibility for children and young people work and plan together, and take collective responsibility for improving children's outcomes.?The Plan sets out the overall ambition for children and young people, how this translates into action, and how we measure the impact we are having. It sets out who is doing what and the priorities for the lifetime of the plan and acts as the overarching document that directs strategic commissioning across the partnership.4.1 Governance StructuresThe diagram below illustrates the governance structure for the Children and Young People Plan. The LTP sits within the Healthy and Happy Theme with the lead commissioner accountable for this theme.The Health and Wellbeing Board have devolved accountability to the Children and Families Executive Board to sign off the LTP. The Emotional Health and Wellbeing Partnership (formerly the Mental Health and Wellbeing Strategy Group) have responsibility for overseeing the implementation of the LTP and has both a strategic and operational role, as discreet task and finish groups are developed, aligned to local need in order to pick up and complete any operational elements related to implementation. To complement the work being completed to reduce the stigma so often associated with using the words ‘mental health’, we decided to rename the former Mental Health and Wellbeing Strategy Board to the Emotional Health and Wellbeing Partnership. We also chose the word ‘partnership’ to further communicate the joint ownership of this agenda, beyond that of simply health agencies with a view to engendering a culture of change. The governance structure detailed above demonstrates tangible links to other strategic reforms such as SEND. The SEND Strategy and action plan is picked up via the Inclusion Board which feeds into the Emotional Health and Wellbeing Partnership to ensure members of this group are sighted and therefore cognisant of the SEND Agenda. The Commissioning Lead for Children’s Mental Health and SEND sits on both groups and thus acts as the conduit at a strategic level. 4.1.2 Team StructuresOver the last eighteen months, Doncaster has experienced some change in terms of the team structures in relation to the Commissioning of Children and Young People’s Services. There is now a Joint Head of Strategic Commissioning for Children and Young People’s Services who works across Doncaster Council and Doncaster CCG. Various Children’s Commissioning Theme Leads report into the Head of Service, therefore ensuring clear lines of accountability and integration in a managed way. It has been encouraging to see that the prominent focus on children and young people’s emotional health and wellbeing remains as part of the NHS Long Term Plan. There are clear and tangible links which can be made and will sedge way into the wider, local strategic context as the LTPs start to take on a different role both nationally and locally. Doncaster is in a strong position with a number of the fixed deliverables set out in the Long Term Plan, in particular:At least 66,000 women in total accessing specialist perinatal mental health services by 2023/24 – in 2019 Doncaster has launched, in partnership with Rotherham and Sheffield, a Perinatal Mental Health Service. Over time, we expect to see more women being supported across the footprint, thus contributing to meeting the National objectiveAchievement of 95% CYP Eating Disorder standard in 2020/21 and maintaining its delivery thereafter – Pleasingly Doncaster are meeting and have sustained this standard for some time Joint agency Local Transformation Plans (LTPs) aligned to STP plans are in place and refreshed annually [to 2020/21] – as previously alluded to, Doncaster has been working to align local plans together for some time and discussions have started at a high level as to how we will make the LTP a Joint Agency Plan, with collective ownership in the truest sense. Our Children and Young People’s Plan (2017) evidences that we have a strong track record of working jointly across all levels and we are confident that we can achieve this with the LTP. Doncaster can also evidence progress against the targeted (not fixed) deliverable of the Long Term Plan:Mental Health Support Teams (MHSTs) to cover between a quarter and a fifth of the country by 2023/24 – Doncaster have been successful in becoming a Trailblazer Site, piloting two MHST’s across a number of Doncaster Schools and Colleges from December 2019. There are areas of the Long Term Plan which will need some further development from a Doncaster perspective. These include:100% coverage of 24/7 crisis provision for CYP which combines crisis assessment, brief response and intensive home treatment functions by 2023/24 – Doncaster has a very highly regarded Intensive Homebased Treatment Team, however there is the acknowledgement that this could be better supported by increased out of hours provision Comprehensive 0-25 support offer that reaches across mental health services for CYP and adults in all STPs/ICSs by 2023/24 [drawing from a menu of evidence-based approaches to be made available in 2020] – conversations have started at a high level in relation to 0-25 provision. We recognise that this is imperative but also has a significant impact on Doncaster’s ability to meet the SEND Reforms. We will be moving towards an all – age ADHD pathway over the next 12 months, which is likely to form a test area for us when considering pathway design, development and delivery and how this interfaces with the rest of the systemWorkforce5. Data Access and Outcomes 6. Finance CYP Mental Health Investment Plans The NHS Long Term PlanUnder the Long Term Plan there is a commitment that funding for children and young people’s mental health services will grow faster than both overall NHS funding and total mental health spending.For Doncaster this represents an additional ?894k investment by 2023/24Indicative Investment Plans ?2020/212021/222022/232023/24Required Growth5.40%3.60%3.30%3.10%Indicative Investment?296k?208k?198k?192k7. Appendices 7.1 Children and Young People’s Mental Health and Wellbeing Need assessment for Doncaster\s7.2 Apps and Digital Tools 7.2.1 The Safer Schools InitiativeDoncaster schools have been able to benefit from the Safer Schools app and associated seminars provided by The Ineqe Safeguarding Group. This is a free resource for schools partnership with Zurich Municipal.?The initiative provides access to contemporary and credible online safety and safeguarding guidance, advice and training.?A launch event was held earlier in the year and now local schools in Doncaster have access to the Safer Schools app. Children, young people and their parents can also access the app, which comes with useful features such as a school news feed to keep users up to date with their respective schools news and announcements. Professionals can also access training and CPD courses to enhance their practice and knowledge base when working with children and young people. The link below provides a more detailed overview of this free offer to schools. The Children’s PortalOur Children’s Portal which forms part of Doncaster’s Family Information Service remains active and updated. This resource is focussed around empowering children and young people to find support and information at a time that suits them, recognising that not all children and young people may want to access face to face support. The portal can be accessed by clicking here. 7.2.4 The Local OfferDoncaster’s Local Offer was highlighted in the recent Ofsted report as being a particular area of strength. Work is being completed to make this resource more interactive. As part of this, a video has been produced, which is available on YouTube to explain what the Local Offer is. This can be accessed below. ................
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