The Greater Manchester i-THRIVE Programme team caught up with Chantal Basson, Consultant Clinical Psychologist, and Joanne Needham, Operational Manager at Healthy Young Minds, Pennine Care NHS Foundation Trust to gain an understanding of Oldham’s whole system offer for young people .
What was the problem you were trying to solve?
Early identification of emergent mental health needs can be important in promoting change for children and young people. For young people struggling with emotional regulation, early identification can lead to better uptake and improved outcomes from intervention.
Clinicians at Healthy Young Minds (HYMs: Oldham’s CAMHS service) reported that they were increasingly seeing young people at a stage when challenging behaviour patterns were already well established. This raised concerns that the symptoms of children and young people who required support to help meet their needs in regulating their emotional behaviour were not being identified early enough, making it difficult to initiate change.
A common intervention to help young people with difficulties in emotional regulation is Dialectical Behaviour Therapy (DBT). Clinicians were concerned given the later presentation of young people with these needs, DBT was not having the intended effects children and young people were often presenting with very complex needs requiring multi-agency working and increased resources. In addition, research has illustrated how the lack of early intervention leads to an increased risk of needing help or support from services in the future.
An early identification model was therefore developed in Oldham that included multi-agency care plans to provide holistic help and support to try and alter the path for young people and help services to respond to these young people in more effective and timely ways.
What is Oldham’s offer for young people who require support in regulating their emotional behaviour?
Oldham’s current pathway was born out of the 2016 CQUIN and when services in Oldham were aligning themselves with the THRIVE Framework for system change (Wolpert et al., 2019). Capacity building and training for the wider children’s workforce was seen as a priority in order to help support children and young people who had difficulties regulating their emotional behaviour.
Healthy Young Minds provided a training day for professionals in universal services, including schools and social services. The training was aimed at providing staff with the skills and knowledge for early detection, as well as strategies to help prevent behaviour escalation. Staff were also trained to administer the Behavioural, Emotional Skills Training (BEST), a 3-9 week DBT informed programme, for parents or young people (aged 9-11) presenting with difficulties in regulating emotional behaviour. Professionals working through the BEST pack resource with young people or parents, received consultation and supervision from an experienced member of the HYM’s specialist DBT team.
A multi-agency care plan is developed in partnership with the professionals, to help communicate, support and deliver clear and consistent care for children and young people, and to ensure shared cross-sector responsibility and accountability.
Through shared decision making, those young people who complete the BEST training and continue to struggle with emotional regulation and relationship management can be referred to HYMs for more intensive DBT.
How does this fit into local plans to implement the THRIVE Framework?
The THRIVE Framework for system change was developed through a partnership between the Tavistock and Portman NHS Foundation Trust and the Anna Freud National Centre for Children and Families. The THRIVE Framework is a whole-system, needs based framework for supporting children and young people’s emotional health and wellbeing.
Oldham’s pathway is an example of whole system working through links with the wider workforce allowing professionals to work across all needs based groupings of the THRIVE Framework. By HYM’s workers providing training as well as on going supervision and consultation to the wider workforce, this helps build greater capacity and skill for the children’s workforce to effectively advise and signpost children, young people and their families presenting with difficulties in regulating their emotions. Delivering the BEST resource has increased the offer within the Getting Help needs based grouping and if children and young people need further support they can be referred to HYMs.
By providing supervision and consultation, HYMs help to further build capacity across the system. This is aligned with the THRIVE Framework principles of drawing on the existing strengths and resources in the system wherever possible, and ensuring that mental health and wellbeing is everyone’s business.
How has Oldham’s offer affected young people and their families?
Young people who have utilised the BEST pack resource have reported being able to better understand different ways to manage their emotions and behaviours.
HYMs colleagues have reported that young people who access the service for support and have previously utilised the BEST pack resource find it easier to access DBT.
Some comments from staff that attended the HYM’s training day and utilise supervision.
HYMs are looking at providing more training days for the wider system in early detection of emotion regulation difficulties and equipping them with skills to best support young people in a timely way. The team are also looking to train more professionals to use the BEST resource, thus building greater capacity across the professional network.
Edited by the GM i-THRIVE Programme Team, and the National i-THRIVE Programme Team.
Written November 2019.