Agenda item

To receive a report on child and adolescent mental health and well-being in the context of Covid-19.

The Panel received a presentation on child and adolescent mental health from:

·         Kathryn Collin, Head of Children’s Commissioning, Haringey,  North Central London (NCL) Clinical Commissioning Group (CCG);

·         Michele Guimarin, Joint Commissioning Manager for Vulnerable Children, LBH and NCL CCG; and

·         Andrew Smith, Project Manager for Children’s Mental Health, Haringey, NCL CCG.

Ms Collin reported that CAMHS delivered a wide variety of services that ranged from universal to targeted and specialist interventions.  The Trailblazer project was very important as it filled a gap in early help.  The prevalence of mental ill health was growing.   Services had remained open during lockdowns and the needs of the most vulnerable had been prioritised.  There had been a need to undertake work virtually and services had done their best to adapt.  Inequalities in access had nevertheless become apparent.  Trailblazer staff had been redeployed and worked on a new mental health and well-being help line for families that operated during the day from Monday to Friday. 

A One Stop Shop for help and advice had been created.  This included a web page covering the SEND Local Offer that had everything in one place. There had been 428 webpage hits in September 2020 and an average of 250 hits per month. Kooth was a national digital support service that had been commissioned in Haringey.  There had been wider promotion of it in the borough and this had led to a large increase in young people accessing the service.   It had a key role in providing support for children not accessing support through traditional therapy services and was especially well used by boys. 

There had been a number of training exercises and events, including bereavement training.   Schools were being supported, including through the provision of a “one-stop” referrals.  There had been increased one-off investment into Educational Psychology, Hope in Tottenham and Open Door counselling to make sure there was an expanded offer to meet growing demand.  There had also been investment in mental health crisis and liaison support at the North Middlesex Hospital.  There was also now a 24/7 crisis helpline for professionals as well as a Crisis Line for families and Out-of-Hours nursing support.  Unnecessary hospital admissions had been reduced by 75%.   

Services were working towards a four week waiting time and there was an Access Team providing triage and a single point of entry.  There was now a need to monitor waiting time for interventions and treatments after referral.  Most referrals were from professionals but self-referral was also possible.  Waiting times had reduced considerably, with Open Door seeing 75% of referrals within four weeks and Haringey CAMHS increasing the number it saw within four weeks from 25% to 55%.    People were currently more likely to keep appointments.  Demand for services was greatest in the most deprived areas of the borough.  52% of CAMHS service users were BAME and 75% of those who used the Trailblazer service.  88% of those who used the Crisis Service and 100% of Trailblazer service users had stated that they would recommend it. 

Ms. Guimarin reported on progress with the Trailblazer initiative.  It was part of a national pilot scheme and involved 34 schools in the east of the borough.  The initiative was a partnership between the CCG, Council and a range of partners.  Schools also had significant input.  The pandemic had made it necessary to transfer most work on-line, with only the most vulnerable children being seem face-to-face.  Work had been undertaken directly with parents and children.  Schools has asked for additional support and efforts had been made to respond to this.  It had been a very challenging time and the number of children supported in the second quarter of the year had dropped significantly. Interventions were delivered using a range of methods, including evidence-based workshops/interventions, whole school systemic work and the provision of advice for children, young people and their families.   Priorities for next year included improving joint working, extending the Trailblazer initiative to cover the whole of the borough, stabilising and sustaining the crisis pathway, improving access to support for eating disorders and developing further the all age autism strategic plan.

In answer to a question regarding challenges for the forthcoming year, Ms. Guimarin stated that working closely with schools to address Social, Emotional and Mental Health (SEMH) was the priority.  Approximately one in six children now had a mental health need.  Thought needed to be given to how to support children returning to school and to build their resilience.  Some children had flourished during the period when they were not in school due to the absence of peer pressure and bullying but others had struggled. 

In answer to a question regarding virtual appointments, Ms. Collin stated that quick progress had been made with its introduction.  Lots of young people were very IT literate and not all wanted face-to-face appointments.  However, virtual appointments did not suit everyone.  Staff also found them more tiring and they could also be adversely affected by technical issues. Face-to-face appointments were still wanted by many people and worked better for some sorts of intervention.  The learning from working virtually would be considered but the intention was to revert back to face-to-face working as much as possible.  In respect of eating disorders, Ms. Guimarin commented that a lot of parent education could be undertaken effectively on-line with small groups.  Training and professional development could be delivered this way and at a time that was convenient for professionals.

In respect of autism, Ms. Collin stated that there was a borough wide strategic plan as well as specific services that supported young people and adults and suggested that a specific discussion on this be arranged for a future meeting of the Panel.   Investment had been expanded and additional needs were being identified so that support could be provided.  Particular efforts were being made to keep people in the borough but this could be difficult past the age of 18.  Some young people with autism could fall through the net though and there had been a number of admissions to CAMHS tier 4 services.   It was agreed that a visit be arranged to the Grove School for children with autism be arranged for the Panel once lockdown restrictions are relaxed.

Ms. Guimarin reported that the Council’s language and autism team had undertaken specific support work with the Tottenham Hotspur Foundation. In addition, the Trailblazer initiative was working with children in schools through the provision of after school youth services.  Work had also been undertaken with staff in CAMHS and the Eating Disorder service to develop a better understanding of autism amongst them. 

In answer to a question, Ms. Guimarin reported that the CAMHS workforce was very diverse with over 50% coming from BAME backgrounds, including many team leaders.  Success was measured through a number of different ways, including outcome measures, strength and difficult questionnaires and benchmarking against comparable services elsewhere.  Satisfaction levels with Open Door were currently average compared against similar services but it aspired to be a top performer.

RESOLVED:

1.    That an item on the all age Autism Strategic Plan be submitted to a future meeting of the Panel; and

2.    That a visit be arranged for Panel Members to the Grove School when the relaxation of Covid restrictions allow.