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ACCESSING APPROPRIATE CAMHS IN ESSEX - the Single Gateway Pilot Lonica Vanclay, ECC and Karen Egglestone, Catch 22 20 th March Tina Russell, ECC and Michelle Hembling, The Junction 29 th March

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Why are we doing this? Standard 9 of the National Service Framework for Children, Young People & Maternity Services states: all C&YP from birth to their 18 th Birthday who have mental health problems and disorders should have access to timely, integrated, high quality, multi-disciplinary services to ensure effective assessment, treatment and support for them and their families

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The tapestry of CAMHS provision ECC (LA) CAMHS Tier 2 Team Counselling (Schools) CAMHS Family Therapies Diagnosis, medication, teaching, consultation Leverton secure childrens home Brookside in-patient ward NEPFT/SEPT Longview/Poplar in-patient ward Tier 3 NEPFT Team in North SEPT in South Group Therapies Healthy schools Midwifery Services PSHE in schools Pastoral Teams (Secondary Schools) SEAL Peer and Learning Mentors Anti-Bullying Policies and Activities Schools Health Visitor support Home School Liaison Workers Group and skills programmes to develop self esteem and confidence (Schools & Voluntary Organisations) Partnership commissioned and voluntary sector provided services eg Catch 22, The Junction, Place2Be, Young Concern Tier 1 Universal Tier 2 Targeted Tier 3 Complex Tier 4 Acute Communication and Language skills development & Family Support Communication and Language skills Early Years Provision Education Psychology Service Childrens centres / Early years activities / Support Private provision spot purchased

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Commissioning approach Strategic partnership structure County Joint Commissioning Committee (ECC/LA, NHS, Schools Forum) and County CAMHS Partnership (with providers incl schools, voluntary sector ) 4 Locality Commissioning and Delivery Boards Joint commissioning health, school and LA for Tier 2 some locally commissioned; LA seconded staff to Tier 3. Aligned commissioning schools commission themselves (and vol sector provide) Partnership produced a commissioning toolkit resource to assist schools with commissioning for emotional health and wellbeing and Commissioning Support Officers (LA employed but Schools Forum agreed) to assist.

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Challenges with a Tapestry of Services Resources and capacity.. Sufficient knowledge of all services and across services Developing good working relationships Building a comprehensive overview

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Involvement of the Voluntary Sector By localising commissioning (4 quadrants) and open tendering in line with a Strategic Approach agreed by the Partnership of a tapestry we enabled voluntary sector provision. We know vol sector is more accessible, flexible and wanted them to have a role. Structured their focus on early intervention built into LA CAMHS Tier 2 teams remit to support and advise vol sector

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Outcomes for Services Developed a common highlevel childrens outcomes framework Promote use of SDQ, Outcomes Star or SOUL with categories of met/positive change; partly met/no or little change and not met/negative change Collation is a challenge!!

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Benefits of voluntary sector involvement Harnesses and maximises different commissioner resources and provider expertise Choice for users about location and type on intervention Single gateway can direct appropriately and reduce duplication and ping pong

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Challenges with voluntary sector engagement Different provision in different quadrants Collating information into a provider directory for the gateway to use Improving awareness of referrers (esp schools and GPs) and trust/confidence in the vol sector provision

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What is the CAMHS Single Gateway? A single referral access point to CAMHS across the North Essex Cluster (and a similar one in South Essex) Simple, efficient, consistent & standardised approach Streamlining referrals avoiding delays in assessment/treatment Integrated, promoting cross-agency working Advice & guidance for referrers Data collection point to help identify gaps, emerging need etc A comprehensive referral screening service which will signpost/direct referrals to most appropriate CAMHS Improved experience for C&YP, families & referrers Reduction in inappropriate referrals Reduced inequalities Based in one building, manned by CAMHS professionals from all Tiers voluntary, ECC Tier 2 and Tier 3.

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Operational process Referrer discusses any concerns about emotional and mental health of the C&YP with Parents/Carer and if appropriate with the C&YP and obtains consent to refer to CAMHS Single Gateway Can phone to discuss Refer by email, safe haven fax or post Referral screened by a team member and - if Tier 1/early community Tier 2 referrer given information about service for family to contact - directed straight to appropriate Tier 2 or 3 service - forwarded to relevant MultiAgency Panel if other agencies also needed/involved

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Why this approach? Earlier pilot (BCFPI) of standard screening tool highlighted benefits of this less ping pong between services There are benefits in a tapestry of services choice, location/access, range of methods - but referrers esp schools and GPs were confused about where to go Wanted to continue to commission and build awareness of the range of services Action research pilot approach Existing providers operate (rather than a separate assessment/referral function) at least initially to help build understanding across providers/tiers

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CAMHS Single Gateway Expected Outcomes Evidence that the MH & Emotional needs of C&YP are being screened in a consistent way Easy, efficient and equitable access to CAMHS when C&YP need them Reduction in inappropriate referrals and ping-pong between Tiers Greater integration of CAMHS across all Tiers and better use of resources Better levels of support for Referrers Identification of service gaps, emerging areas of need to inform future commissioning

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Challenges for Gateway Resources and capacity.. Balance local knowledge/relationships with one centralised service Different processes across organisations complicates and sometimes duplicates data recording etc Interface with Social Care and other single gateways into services one single gateway for all or specialist knowledge/advice What level of professional/clinical expertise to operate the gateway?

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Key concluding messages Start with building a partnership strategic framework Make time to develop engagement and mutual understanding and respect Recognise strengths and differences (USP) of each partner and harness them Simplify access but build a tapestry of services Huge benefits result from a unified approach to ensuring the most appropriate service for families and real partnership working

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Further Information Overall Approach: Lonica Vanclay Lonica.Vanclay@essex.gov.uk Gateway: CAMHS Single Gateway North Essex Holmer Court Essex Street (off Headgate) Colchester CO3 3BT

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Any Questions?