Leading change

The Learning Disability and CAMHS Nursing Lead for schools across North Staffordshire Combined Healthcare NHS Trust led on the redesign and implementation of new service pathways for specialist children’s learning disability health services. This project has led to improved outcomes and experiences of those using the services as well as better provision of personalised care.

Where to look

Improving outcomes for children and young people is a priority for the Five Year Forward View for Mental Health with an identified need to expand access to high quality treatment in the community so that 70,000 more children and young people will be seen each year in order to support their mental health needs (Five Year Forward View Mental Health – One Year on. 2016). For this to be fulfilled, it is advocated that the skills of staff working in these areas are enhanced to ensure they can deliver evidenced based therapies such as mindfulness, Cognitive Behavioural Therapies (CBT) and positive behavioural support. The Learning Disability and CAMHS nursing lead with the team at North Staffordshire Combined Healthcare NHS Trust were able to target improved outcomes for children and young people through the provision of mental health, social care and learning disability services in the West Midlands to enrich the service pathways for children with learning disabilities locally.

The Children’s Learning Disability (LD) Team provides a range of specialist health services for children and young people aged 0–18 years that have a significant developmental delay or a moderate to severe learning disability. The team supports children and young people with multiple and complex difficulties related to their learning disability when their needs cannot be met by mainstream services with reasonable adjustments. The Learning Disability and CAMHS Schools Nursing Lead identified unwarranted variation in the waiting times for children and young people between referral to and assessment at the service. This was in addition to an increasing number of children and young people being referred to the service.

What to change

The Nursing Leads identified the requirement to increase awareness of the need for support within educational settings, for children and young people with mental health issues as well as signposting to the services available to children and young people locally.

The CAMHS in Schools project has been developed and co-commissioned between health services and the local education authority in order to deliver a mental health service within local schools. This approach is supported by national guidance which highlighted the need – ‘all schools need professional mental health services on site’ (Place to Be 2016).

How to change

The nursing leads reviewed and redesigned the children’s LD team’s pathways in several ways, including the service criteria, clinical management pathways as well as recruiting to new roles to support the enhanced service model. Education and training for staff locally ensured staff locally had a wider range of skills in the provision of evidence based therapies for children and young people and to support the CAMHS’ new ways of working.

The aim of the new service is for nurses in schools to be skilled and empowered to drive forward new ways of working whilst offering a wide range of interventions not previously available locally. These include:

• Positive behavioural support
• Assessments and interventions
• Mindfulness and wellbeing
• ‘Stop Think Do’ – social skills training
• Consultations for staff, children and family members
• Staff support and supervision
• Offering support with specific issues such as sleep and continence
• Safeguarding support
• Information and signposting

This also provided an opportunity for collaborative working to ensure strong relationships are built and maintained between mental health professionals’ and school and college leaders’ which is essential when ensuring services are directly aligned to children and young people’s needs.

Adding value

Better outcomes – Increasing the visibility of CAMHS services has had positive results on outcomes. Having a strong presence within schools to provide support, advice and interventions for young people, staff and families, has led to improved access to support and interventions in a timely way. A waiting list audit undertaken by the nursing leads has identified a 69% decrease in children on the waiting list as a result of the new service and its pathways. Of these children, 93% have been allocated to mental health, LD or social care support services in the interim and a 64% reduction in mainstream primary school children needing to be referred to CAMHS due to the other support available.

These significant changes in waiting times are extremely positive. The figures remain closely monitored so the pathways and services offered can be tailored to meet local needs as well as encouraging the nurse leaders and their teams to use reflective and evidence-based practice to routinely consider different and possibly more effective ways of delivering care.

Better experience – Staff have responded extremely well to the service and its new approach to care and feedback from children and their families has also been very positive, including:

“My child practices some of the mindfulness techniques when needed which is an additional tool to use to manage different emotions”

Better use of resources – A full impact assessment hasn’t yet been completed, however the success of the programme in relation to resources can be seen in the reduction in the number of children in main stream schools deteriorating to the levels where they need CAMHS locally. This is expected to free up resources within the CAMHS services to support children with complex mental health support needs.

Challenges and lessons learnt for implementation

It is normal to feel initially apprehensive about a new structure, especially when the previous pathway has been long standing.

Some of the challenges we have faced included finding the time to make the changes as well as how to manage families’ expectations of the groups, especially where they have had experience of the pre-existing services.

It is important to be clear from the start what the evidence tells you and to analyse the information available to you, no matter how small the ‘data set’ may be.

It is also crucial to find the time to reflect on your successes and challenges and to celebrate how far you have come and how much has been achieved.

Due to the successes of the new service, the team are looking to extend their nursing offer through continued professional development (CPD) for areas such as non-medical prescribing, to further improve child safety and person-centred care. A new Mental Health Support Team is being established, supervised by NHS children and young people’s mental health staff, to provide specific extra capacity for early intervention and ongoing help. Their work will be managed jointly by schools, colleges and the NHS.

For more information contact

Julie Ford – RNLD; Behavioural Psychotherapist
JuliaD.ford@combined.nhs.uk

Julie Anne Murray – Deputy Director of Nursing, AHP and Quality
JulieAnne.Murray@combined.nhs.uk