18 November 2010 / AGENDA ITEM 13
MENTAL HEALTH IN SCHOOLS
1.0Matter for consideration
1.1For the Committee to consider the work of the Targeted Mental Health in Schools Team (TaMHS), known locally as the Emotional Health and Wellbeing in Schools Team (EWIST) and to note the outcomes achieved for young people and families giving consideration to the future direction of the service.
2.0Recommendation(s)
2.1To scrutinise the impact of the work, the processes that support the delivery of this service and the principles for continued joint working in the future within the current economic climate.
3.0Summary of key issues
3.1Introduction
3.1.1Phase 1 and Phase 2 roll out of the project has been successful and welcomed by the Cluster of Schools involved.
3.1.2The pathfinder has continued to fit neatly with current and ongoing developments working closely with Child and Adolescent mental health Services (CAMHS), parenting team and Integrated Teams. The Emotional Well-being in Schools team have continued to develop processes and ways of working that best meet the demands of our schools. This style of flexible management has required ongoing evaluation and joint decision making to progress what has created new ways of working and thinking.
3.2Background
3.2.1In 2008 Blackpool Council in conjunction with NHS Blackpool were successful in acquiring funding through a pathfinder bid to improve the delivery of Child and Adolescent Mental Health Services. The bid proposed new ways to deliver mental health services to young people through an integrated well being team in Blackpool, building on the existing good practice of the Inclusion Support Team ( IST). Historically the Inclusion Support Team supported schools with young people with challenging behaviour who were at risk of exclusion from school. The funding through the bid allowed growth and the Emotional Health and Wellbeing In Schools Team ( EWIST) evolved. This provided a team that can support schools once they identify their vulnerable pupils based on challenging behaviour and risk of exclusion but could also include those young people who present concerns around emotional well being and mental health. EWIST support provides a multi disciplinary service with a holistic approach, supporting young people, their families and the practitioners in school, to embed long term improvements.
3.2.2EWIST has successfully addressed young people’s needs at an early stage through prevention, intervention and access to appropriate services, and has established pathways into targeted and specialist services where required. Over the previous three years the cluster based model has been rolled out slowly, starting with 15 Blackpool schools in year 1 and this year being made available to all Blackpool schools.
3.3Integrated Working
3.3.1The service continues to work closely with the Change for Children Team and Learning and Schools. Meeting with schools to improve and refine processes that lead into the single point of access has been an ongoing development and is reviewed regularly. The ‘Think Family’ process locally has been recognised nationally and TaMHS integrated approach has been embedded into conferences to share good practice with other authorities.
3.3.2Work continues together across Blackpool Council and NHS Blackpool, and the recent changes to funding streams has had an impact on the integrated model that has been developed. The departmental restructure provides a backdrop for further development and there is a current revision of the model looking beyond March 2011. Further work is being undertaken at a senior level to determine the best possible solutions for mainstreaming of this project with integrated teams being the key for delivery of the outcomes.
3.3.3Links formed within Learning and Schools has enabled closer working with school advisors and consultants. There has also been opportunities to further develop strategies and processes with the Child and Family services at NHS Blackpool which includes Specilaist CAMHS health visitors, schools nurses and health mentors, which assists in promoting integrated team working.
3.3.4Integrated working has been supported by modernisation of the work environment. As well as the service being able to work in school bases there has been a successful trial of using citrix Kiosks and work has continued on workspaces to embed this as a full efficient work model. This way of working fits with corporate goals locally as well as with the ethos of an integrated team.
3.3.5A thesis undertaken by an external Educational Psychologist on decision making processes in a multi disciplinary team has assisted the team in making changes and developing the delivery model through to the final phase roll out (September 2010).
3.3.6Schools have been reflective in the development of the team. In response to this, some schools have changed communication methods internally, looked at pastoral support structures, while others are considering the support systems they currently use. All schools have considered what works well for them in order to gain the most benefit and work more efficiently with the school support services provided. The schools going into phase 3 have benefited from the learning in phase 1 and 2 so this has supported a smooth transition. Electronic access to council systems in some schools has been set up as part of the integrated access and this appears to be going well.
3.3.7Schools currently can access funding through the front line caseworkers but also have access to their own funds to commission positive activities for their pupils which contributes to, and supports the work and interventions provided by EWIST
3.3.8The Healthy Schools Consultant has continued to support Family SEAL, training staff and introduced resources that can be shared across all schools. Team members have shadowed trainers delivering Family Seal in order to develop their own skills and knowledge to be able to deliver to schools, building the schools capacity.
3.3.9The Mental Health Awareness Training programme is being sustained by EWIST colleagues, and further training is planned into this academic year. An evaluation was completed which has resulted in a request to set the current training within a larger framework and to incorporate the work being undertaken by the CAMHS Training Consultant. A four level model, progressively building skills, is currently being explored.
3.3.10A training course, Emotional Literacy Support Assistants, has been developed by the Specialist Senior Educational Psychologist which offers up skilling in this area for school staff and ongoing supervision from the team on a half termly basis.
3.4Key objectives
- Improving outcomes for young people
- Improved emotional wellbeing and resilience factors for young people
- Improved access to support services and specialist services
- Reducing the risk of fixed term and permanent exclusion from school
- Contributing to improving attendance at school, increased participation.
- Increasing school’s capacity to meet the needs of vulnerable young people
- Improving participation and readiness to learn and therefore impacting on learning outcomes
3.5Key features of the service include
Early detection and response to potential emotional or mental health problem
Early detection and response to challenging behaviour and risk of exclusion
Assessment skills to identify need, appropriate use of services within the team and from specialist services as required
A multi disciplinary core offer from the whole team
Common Assessment Framework is baseline as a process tool followed by specialist assessments to compliment where required. All action plans and review cycles based on Common Assessment Framework
Budget holding Lead Practitioner funding available to all frontline practitioners to empower front line decision making.
Provide direct access for schools to an integrated team to support emotional well being, behaviour and mental health.
Provide advice, consultation support and challenge as well as direct work with teachers, practitioners, families and young people.
Build school’s capacity to respond to the challenges around emotional wellbeing and behaviour through training, co working, skill sharing and promoting good practice across Blackpool.
3.6Project development & delivery model
3.6.1The EWIST team acts as a conduit between clusters of schools and specialist services, delivered through and in schools. The service is very accessible and allows preventative work to be done soon after identification with no waiting lists in place. On average in phase 1 one secondary school has a cluster of up to 5 primary schools. Each cluster of schools has a mini EWIST team, a small team to work in a multidisciplinary way providing a holistic service to that group of schools. The success of this model has been built upon as the final phase delivery model emerged. Each of the 4 clusters from September 2010 support two secondary schools and several primary schools. This model has been agreed by the Steering Group and resources committed from central teams based on the effectiveness so far.
3.7Impact & Outcomes
3.7.1In the last academic year 452 cases of support have been provided through the team. (316 the previous academic year). The impact as measured through the standardised Goodmans assessment shows a very good value added on top of what would normally be expected. The impact data collected from parents and young people shows excellent results and teachers feel equally supported. The feedback collected on service deliveryis extremely good. The team provides an open access to schools so support can be received for any young person, as well as managing fuller support roles that involve direct work. 29 groups of young people were supported in a group setting, equating to 93 young people accessing support on topics such as; anger; self esteem; motivation; speech and language; mediation; relationships; safeguarding; feeling special; friendship; transition; and bullying.
3.7.2Compared with other regions involved in TaMHS, the Blackpool landscape shows more strongly embedded systems of integrated working, such as Common Assessment Framework and the practice of budgets being held by front line practitioners. Referrals into specialist services are low in numbers and very high quality relieving pressures on specialist services. There were 10 referrals to specialist CAMHS 2008-2009 and 11 2009-2010, showing the effectiveness of early intervention and the positive impact on specialist services.
3.7.3Strengths and Difficulties Questionnaires (SDQ’s) shows positive results.
Of the 205 and 209 respondents respectively, 199 (97.1%) felt the intervention had been helpful whilst 131 (62.7%) felt that the intervention had made things better. On the effect of the intervention 62% said things were better and 31% said stayed the same. The overall value added as mentioned previously was good.
3.7.4The team worked with 10 young people who were looked after by the local authority over the course of the year, and liaised with Social Care in many more instances regarding young people about whom school or EWIST had concerns.
3.8Sustainability
- Funding is dependent on Area Based Grants and TaMHS pathfinder funding so the sustainability plan is of paramount importance if the service is to continue in its current form post March2011.
- Service re design is being considered and how teams can join up effectively to work to agreed indicators and targets.
- Building on the good practice of the EWIST team, extending the learning, to support presence participation and achievement
- Additional integrated delivery- looking at wider services and briefs their aims and targets and looking at the potential of further integration.
- Structures of councils and PCT will impact and provider commissioning relationships with NHS Blackpool
- Preserving the highest quality team and provision for the young people and families of Blackpool
- Preserving a local commitment to vulnerable young people families and early intervention
3.8.1It is envisaged that the project will be embedded into mainstream services after March 2011. Discussions around the options for this are currently underway through the Steering Group and The Children’s Emotional Health & Well Being Board and a proposal is being drawn up involving key stakeholders to be presented to the Steering Group in December 2010.
4.0Witnesses / representatives
4.1As requested by the Committee members, the following persons have been invited to attend the meeting to speak on the matter:
- Kathryn Boulton, Head of Educational Diversity
Relevant officer:
Sue Crouch, Assistant Director for Commissioning Child Health
Tel: (01253) 476, e-mail
Appendices attached:
None
Background papers:
None
Websites and e-mail links for further information:
None
Glossary:
CAMHS – Child Adolescent Mental Health Services
CLA – Children Looked After
SDQ’s – Strength & Difficulties Questionnaires
EWiS – Emotional Well being in Schools
TAMHS – Targeted Mental Health in Schools
ELSA – Emotional Literacy Support Assistants