With thanks to Emma Leigh MBE, Clinical Projects Manager, NHS Eastern Cheshire CCG for describing the approach Eastern Cheshire CCG took to developing a new needs-based model for children and young people’s mental health.
What was the problem you were trying to solve?
We prefer not to use the word ‘problem’! What we are trying to achieve in Eastern Cheshire is a change of direction for children and young people’s mental health services, shifting from the existent models that exclusively revolve around CAMHS.
Our aim is to develop robust and effective pathways that offer:
- Choice and a range of provision with easily accessible information (Getting Advice and Signposting)
- A range of provision that includes advice and guidance through to intensive interventions for those children and young people requiring it (Getting Help, Getting More Help, Getting Risk Support)
- Support for children and young people who are thriving through prevention and promotion of emotional wellbeing, supporting them to be resilient and mentally well
What changes are you making to your local model?
Initially our emerging service model will extend our current CAMHS provision, to support those children and young people ‘Getting Help’. To do this, NHS Eastern Cheshire CCG and our local provider of mental health services, Cheshire and Wirral Partnership Trust, will be working together with one of our local third sector providers to deliver increased access to support. It is hoped that this will see young people who do not require medical support gain more timely access to evidence-based treatment. Support from the clinical team will however be available if required but support will be delivered and provided wholly by our third sector.
How did you develop your local model?
NHS Eastern Cheshire CCG, working with our transformation partners, Cheshire East Council and NHS South Cheshire CCG took a participatory approach to developing our model. Fundamentally, it starts with the young person’s voice, so we commissioned an organisation called Stitch Ltd to work in our local schools and local community to use the THRIVE framework for system change (Wolpert et al., 2019) as a basis to determine what our young people think and feel should be included as sources of support in the future as well as considering what works well now. Our Young Advisors (young people aged between 15-24, who show community leaders how to engage young people in community life, local decision-making and improving services) supported this and developed similar suggestions, but focussed specifically on linking with young people who had already been supported by mental health services in Cheshire. In this way, we considered both how to keep our young people resilient as well as supporting them to recover.
Our next step was to assess the feasibility of our whole system adopting a THRIVE-like approach; a process overseen by the Centre for Public Innovation (CPI). Data from a number of sources was collected detailing current CAMHS use, Public Health information and capacity within the third and voluntary sector. This offered an initial costings and capacity insight into what our local health economy will look like when delivering a children’s mental health service based on broader provision offering sources of help and support beyond the scope and reach of CAMHS.
These hugely influential pieces of work have been brought together with existing local activity, such as our areas’ involvement in the development of the Department of Education’s Emotionally Healthy Schools Programme, to support a significant part of our local Transformation Plan activity.
The approach we are taking in Eastern Cheshire will start by introducing the needs-based approach to ensure that those young people who require targeted support (though not necessarily with medication) receive it in the timeliest manner.
Our 0-16 CAMH service is trialling a 6-month pilot of our new approach to ‘Getting Help’ whilst further aspects of i-THRIVE are developed within Eastern Cheshire. In this way, NHS Eastern Cheshire CCG will be able to test how the process works locally while also continuing to work with local children and young people’s mental health providers to transition to an i-THRIVE approach.
Our approach has impacted service users in a wholly positive way. It has reinforced young people’s roles and value in creating the types of services which will meet their needs and create positive outcomes. The benefits of working with our clinicians in the development of this approach has meant appropriate clinical expertise remains at the centre of model, prioritising safety and a grounding in evidence.
How does your model address interagency working and integration?
Interagency working and integration is central to what our model hopes to achieve locally. There is senior leadership support from all key organisations to ensure that our plan to transform our current CAMHS service to an i-THRIVE approach to supporting children and young people’s mental health will take place.
Our clinical staff within CAMHS are beginning to work in partnership with colleagues in our third sector organisations to support the delivery of an initial pilot programme which supports the delivery of care and support for children and young people who are ‘Getting Help’. This work involves staff jointly supporting those children who do not require CAMHS support, but require some clinical management should their care need to be stepped-up. The young person’s regular support (which is informed by evidence and outcomes focused) is provided in one of our community-based settings, by a third sector provider.
How were commissioners involved?
Commissioners from NHS Eastern Cheshire CCG are the driving force behind implementing i-THRIVE locally. Working with our partners in NHS South Cheshire CCG and Cheshire East Council, we are committed to ensuring that children and young people’s mental health services are transformed and made sustainable for the future – and we strongly believe that this involves all people and organisations that come into contact with and support our young people.
If you would like more information, please contact Emma Leigh MBE, firstname.lastname@example.org.
Written September 2016.