The Greater Manchester i-THRIVE Programme team spoke with Dr Liz Bailey, Clinical Lead for the Virtual Mental Health Team for Our Children with Disabilities, Manchester University NHS Foundation Trust, to discuss the creation of a virtual mental health team as part of a local transformation plan to support children and young people.
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Background
The Transforming Care agenda is driving the development and delivery of more community services for people with learning disabilities and/or Autism Spectrum Conditions (ASC). There is a lack of appropriate placements for this group of children and young people (CYP) if they are unable to live at home. As such, this group of CYP are often placed in care at a distance from their home in potentially high cost residential placements, where they may not receive the required support to meet their needs. These CYP often have a high and complex level of mental health need, which may contribute to placements frequently breaking down. A comprehensive, intensive and person-centred mental health service is essential to meet their individual needs, to ensure that the right support is provided at the right time. Currently, due to the COVID-19 pandemic, CYP are not able to engage in their usual routines, activities and regulating strategies, and this has led to an increase in mental health needs and challenging behaviours.
There is an increased recognition of the relationship between the vulnerabilities of Our Children (local term used for Looked After Children; LAC) in developing complex mental health needs, and their difficulties accessing services. The statutory guidance on Promoting the Health and Wellbeing of Looked After Children (Department of Education & Department of Health, 2015) stresses that the mental health and emotional wellbeing of Our Children deserves parity with physical health, and there is a need for timely, targeted and dedicated mental health support.
The publication of Future In Mind (2015), the Five Year Forward View for Mental Health (2016) and the Green Paper on children’s mental health (2017), all highlight the need for increased recognition, investment and re-visioning of service delivery in order to meet the needs of CYP and their families. It emphasises the importance of partnership working and the need for this to be a core element of service development. These documents highlight the need for flexible and accessible mental health services that offer skilled and evidence based interventions for LAC and their carers, with an emphasis on training staff and carers to develop strategies to care for this group of CYP.
In Manchester, a large number of LAC are placed outside of the locality and this poses particular challenges to the system in coordinating effective mental health support particularly for those with learning disabilities and/or ASC. Thus, there was a need to extend the mental health offer for this group of CYP.
How was the Manchester Virtual Mental Health Team for Our Children with Disabilities developed?
Funding for two years was allocated by the Manchester Clinical Commissioning Group (CCG) in partnership with Manchester University Hospital NHS Foundation Trust (MFT) to extend the emotional wellbeing and mental health offer for Manchester CYP in care with a severe learning disability and/or ASC who are placed outside of Manchester. This is in line with Manchester’s local transformation plans and supports the wider Greater Manchester plans to implement the THRIVE Framework for system change (Wolpert et al., 2019) throughout the region.
Dr Liz Bailey: Parents/carers and other key stakeholders were consulted through informal interviews and meetings to co-design a virtual mental health team. They thought with us about the virtual team’s offer and how future services should be shaped. The most crucial theme to arise from these consultations was a need for services to be more integrated to best help and support CYP and their families. Young people’s views were also sought through informal interviews to capture their experiences of Child and Adolescent Mental Health Services (CAMHS) and what a “good” service looks like for them.
The Manchester Virtual Mental Health Team For Our Children with Disabilities:
The Virtual Mental Health Team was set up in March 2019 and sits within the existing CAMHS LAC Service. The team is composed of multi-disciplinary health professionals totalling the equivalent of 2 full time members of staff:
Image 1: Multi-Disciplinary Team for Our Children with Disabilities
The team supports CYP in the care of Manchester Local Authority, up to the age of 18 years, who:
AND
How is the Manchester Virtual Mental Health Team aligned with the THRIVE Framework for system change?
When developing the virtual team service, the THRIVE Framework was key in thinking about the needs of this group of young people.
Shared decision making: Through a process of shared decision making, professionals can refer CYP via Manchester’s single point of access service referral form. Once a referral has been received and triaged, the team offers needs-led care, underpinned by Person Centred and Positive Behaviour Support approaches, to ensure the young person is at the centre of their care. The team delivers an enhanced offer of specialist assessments and direct interventions.
Building capacity within the wider children’s workforce: The team delivers training and consultation, such as trauma informed care, directly and indirectly to the wider children’s workforce. Throughout the COVID-19 pandemic, the team has continued to provide intensive support to CYP and staff teams through telephone and video contact, as well as video training sessions for staff.
The virtual mental health team is aligned with a number of THRIVE Framework needs based groupings:
Getting Advice and Signposting:
- By attending case planning meetings and LAC reviews, the team are able to provide a holistic overview of the CYP’s mental health needs, and offer advice and signposting to the children’s workforce;
- The team monitors the quality of therapeutic provision;
- The team deliver workshops and training for carers, as necessary, and;
- The team provides consultation as well as training to the wider workforce. This helps build greater capacity and skill of the wider children’s workforce. Consultation and training allows professionals to feel confident in managing cases and think holistically about other services that families could benefit from. This enables the wider workforce to proactively work with the most vulnerable groups.
Getting Help:
- The team provides brief multi-disciplinary assessments of emotional and behavioural; functioning including mental health assessments of CYP with learning disabilities, ASC or complex needs, and;
- The team provides brief evidence based or informed interventions for CYP and/or their parents/carers, using clear outcomes and goal based measures to assess change.
Getting More Help
- The team provides comprehensive, detailed assessments of emotional and behavioural functioning including mental health assessments of CYP with learning disabilities, ASC or complex needs and challenging behaviour;
- Specialist, more extensive interventions, tailored to the needs of the child/young person are delivered;
- Pharmacotherapy is offered, where appropriate and necessary, and;
- Extensive, tailored parent/carer interventions are offered.
Risk Support
- An integrated multi-agency approach with joint accountability for outcomes is embedded;
- Comprehensive risk assessment and safety plans co-produced between agencies and young people are provided, where appropriate;
- The team supports agencies in risk management; building confidence in utilising networks, and providing training and consultation around risk, and;
- The team provide consultation and guidance around the young person’s needs when their placement is at risk of breakdown.
What have been some of the challenges in developing the virtual team?
Dr Liz Bailey: The young people referred to our service often have several professionals involved in their care and it is important to consult with all professionals involved to develop a joint, coherent network around the young person. This can often be time consuming and labour intensive.
What has been the impact of implementing the virtual team?
Dr Liz Bailey: The virtual team has received some very positive feedback from social workers, carers and families; with families commenting on having an increased understanding of the young person’s needs. Furthermore, professionals are reporting feeling competent and confident in their jobs, and feeling as though there is an increase in the quality of life for children, through reduced restrictive interventions and prevention of inappropriate hospital admissions. We have also been heavily involved in supporting with the transition to adult services when our young people reach 18 years old.
What is the future of the team?
- It will be important to secure funding to continue with our service at the end of the pilot period, to ensure that some of the most vulnerable children in our society still receive this specialist service that targets their mental health and emotional wellbeing;
- We are developing more video training sessions to ensure that we can still provide training to our carers and professionals given the current restrictions due to the COVID-19 pandemic;
- We aim to work with our partners and share the learning from our pilot to support other areas in developing a specialist service for this group of vulnerable young people, and;
- We need to further develop our strategy, in line with the CAMHS LAC team service plan to offer support to those post-18 years old.
If you would like further information, please contact Dr Liz Bailey; Liz.Bailey@mft.nhs.uk.
Edited by the Greater Manchester i-THRIVE Programme Team and National i-THRIVE Programme Team.
Written June 2021.