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[PROJECT TITLE]

Milton Keynes

Children & Young People’s Mental Health & Wellbeing Local Transformation Plan (LTP) 2015-2020

LTP Refresh- October 2017

Author:

Hannah Pugliese. Children and Maternity Commissioner

Owner:

Fiona West. Senior Children and Maternity Commissioner

Programme

MK Children & Young People Mental Health & Wellbeing Transformation Programme

Document Status:

Draft

Date:

14/08/17

Revision History

Version number

Date

Reviewer

Change Reference & Summary

0.1

14/08/17

Author

1st draft

0.2

15/09/17

Author

1st draft for circulation

0.3

18/09/17

Reviewer

Formatting and proof read

0.4

19/10/17

Author

Incorporate comments from LTPDG and the Integration Board

1

25/10/17

Reviewer

Final for publication

Contents

Section reference

Contents

Page

-

Executive Summary

6

Table 1

Key targets include

7

Fig A

Milton Keynes Effective Support “Windscreen”

8

1

Introduction

9

Table 2

LTP Priorities Addressed by Year

10

1.1

Purpose of the LTP Refresh 2017/18

11

2

Finance

12

Table 3

Financial overview; C&YPs mental health and wellbeing transformation pathway

12

3

Activity

14

3.1

Referrals

14

Fig B

Total Referrals by Year

14

Fig C

Referrals by Month and Year

14

Fig D

Rejected Referrals

15

Fig E

Total Contacts by Month

15

Fig F

First Attended Appointments

16

Fig G

Follow up Appointments

16

Fig H

DNA’s per Month

17

Fig I

Waiting Times in Days

17

Table 4

Trajectory for Improved Access to C&YP Mental Health Services

18

4

Communication and Engagement

18

Fig J

MySayMK; engagement event undertaken with children and young people

21

Table 5

Stakeholder analysis and engagement plan

22

Fig K

Perinatal Mental Health (PNMH) Collaborative; learning from women with lived experience

25

5

Governance and Oversight

26

Fig L

MK C&YP MH&WB LTP Governance Structure

26

Table 6

Overview and Membership of C&YPs MH&EWB LTP DG

27

Table 7

Overview and Membership of Milton Keynes Integration Board

28

Table 8

Overview and Membership of BLMK Children’s Commissioning Delivery Group

29

6

Delivering the Plan

29

6.1

What’s been achieved and/or underway

29

6.1.1

Prevention and Early help

30

Table 9

School Clinic Presenting Issue Audit

30

6.1.2

Specialist Services and Changes to Specialist CAMHS

33

Fig M

New Model for Specialist Children and Young People’s Mental Health Services

34

6.1.3

Interface with Specialist Commissioning

35

6.2

Ongoing Challenges

35

6.3

Strategic Priorities and Future Development

36

Table 10

Priority One - Projects to deliver

36

Table 11

Priority Two - Projects to deliver

37

Table 12

Priority Three - Projects to deliver

38

Table 13

Access Target for Milton Keynes

38

Table 14

Priority Four - Projects to deliver

39

6.4

Evidencing and Measuring Success

39

Table 15

MK LTP KPI’s

39

6.4.1

Table 16

Commissioning for Quality and Innovation (CQUINs) and Quality Schedule

41

6.4.2

CCG Improvement and Assessment Framework (IAF)

43

6.4.3

5 Year Forward View Mental Health Dashboard

44

7

Understanding Local Need

44

Fig N

Adverse Childhood Experiences (ACE’s)

46

8

LTP Ambition 2017-2020

47

8.1

Vision for 2020

47

8.2

A whole system approach

48

Fig O

A Whole System Approach

50

Fig P

Mental Health Plan Model; MK College

51

9

Workforce

52

9.1

Multi-agency Workforce Plan

52

Fig Q

The Current State

54

Fig R

New Model of Care

55

9.2

CYP IAPT

56

9.3

Specialist CAMHS

56

Fig S

2017 Service Model Breakdown

57

Fig T

2020 Staffing Model Breakdown

57

Fig U

All Staffing 2015, 2017, & 2020

57

Fig V

CAMHS Staffing 2015, 2017, & 2020

58

Fig W

Eating Disorder Staffing 2015, 2017, & 2020

58

Fig X

LIST Staffing 2015, 2017, & 2020

59

9.4

Crisis Care

59

Fig Y

Integrated Care Pathway

60

9.5

The Wider Workforce

60

Fig Z

Multi-agency Perinatal Mental Health Champions Training

61

10

Collaborative and Place Based Commissioning

62

Table 17

MK actions within the Midlands and East Collaborative Commissioning Plan

62

10.1

The STP Footprint

63

10.2

Health and Justice

64

11

CYP Improving Access to Psychological Therapies (CYP IAPT)

65

12

Eating Disorders

66

Table 18

Staffing Model for the Lifespan Eating Disorder Service

66

13

Data

67

14

Urgent & Emergency (Crisis) Mental Health Care for C&YP

67

15

Integration

69

16

Early Intervention in Psychosis (EIP)

69

17

Impact and Outcomes

70

18

Other Comments

70

18.1

Risks to Delivery

70

Table 19

Risks and Mitigation

70

19

The Delivery Plan

72

Table 20

MK LTP Road Map

72

20

Appendices

73

Table 21

Appendices

73

Executive Summary

It has been nearly 2 years since the Milton Keynes Children & Young People’s Mental Health & Wellbeing Local Transformation Plan (MK LTP) 2015-2020 was originally published. The multiagency group that oversees delivery of the plan has seen a shift in membership as we have focussed more strongly on the wider system for mental health and wellbeing.

We have continued work towards delivering change against the original priorities and to respond to new and emerging issues so that by 2020 Children and young people in Milton Keynes will be able to say:

1. I experienced good support and care when I had a mental health crisis and needed urgent care.

2. I experienced good support from people involved in my care to help me achieve and meet my goals even though I have complex needs and can have challenging behaviour.

3. I was able to access specialist care and support when I needed it.

4. People around me had the skills and confidence to know how to help and support me.

5. When I needed help with my eating disorder, I was able to access a service quickly that met my needs.

6. The people who help me with my complex physical and social needs are able to support me to deal with my emotions, and keep me mentally well.

7. When I became very ill with a psychosis, I was able to access a service quickly that met my needs.

8. I experienced good support for my emotional and mental health during and after my pregnancy, which helped me to form a good bond with my baby.

9. When I returned to Milton Keynes after I’d been in hospital, I experienced good care and support which enabled me to settle back into home and school.

Investment in the pathway has been maintained and whole system approach has led to innovation and commitment from a wide range of stakeholders who have been ‘inspired to make a difference’, to be part of something that will tangibly improve outcomes for local children and young people.

The focus on specialist care in year 1 of the plan delivered:

· Improved access and reduction of the waiting list for specialist services

· Sustainable 24/7 services for children and young people (CYP) in crisis

· Improved processes and multiagency working for CYP who have been in Tier 4 units and are being discharged back to local services

· Improving and enhancing perinatal mental health services

· Working with the community eating disorder service to move towards compliance with new national standards

· Improvements to early intervention in psychosis services to ensure compliance with new national guidelines

We have built on the success of year 1 and in year 2 have made significant progress in the following areas:

· Increased confidence and competence in the wider children’s workforce to support children and young people with emotional and mental health problems

· Improving multiagency support for CYP with complex need and/or complex and challenging behaviour

· Development of CYP IAPT

· Development of a single point of access to specialist mental health services

· Improved liaison with non-mental health services to identify CYP early including (Corporate Parenting Services, Youth Offending Team (YOT) and Special Educational Needs and Disabilities (SEND).

Much work has been done to improve the way they we measure the impact of this change and to build a workforce that is skilled and equipped to maintain the trajectory of change over the remaining years of the plan and beyond.

· The number of referrals to specialist services has stabilised

· The numbers of rejected referrals and unattended appointments has decreased

· We have also seen a decrease in the numbers of children and young people seen in both first and follow up appointments, the provider view is that this is partly due to issues with the data.

· Waiting times decreased significantly in 2016 but have begun to rise from spring 2017 and are now averaging between 8-12 weeks. Further work is being undertaken to address this.

· The dedicated community eating disorder service is providing a service in line with the recommended model

· 95% achievement against the 1 hour assessment target for the crisis and intervention service

· Each School has committed to having a Governor who is responsible for mental health

· Milton Keynes has joined the Reading IAPT collaborative

· Staffing numbers have increased including the addition of support and liaison service to provide ‘ mental health in reach’ to critical non mental health services

· Multi agency training has been rolled out across health and social care to improve skills and confidence in the wider workforce

Table 1: Key targets include:

Year 1

Year 2

Year 3

Year 4

Year 5

Access Waiting list for Sp CAMHS

below 18 weeks

below 12 weeks

below 8 weeks

below 8 weeks

below 8 weeks

Numbers of CYP who access care

-

1981

2105

2167

There are still challenges addressed and these have fed into development of the priority areas for the next phase of change.

Priority One Keep children and young people in the driving seat of change to reducing stigma so that CYP can access help at the right time and in the right place without fear of consequence.

Priority Two Develop Integrated (Health and Social Care) services for children and young people who have complex and challenging behaviour; including those with learning disabilities and autism and those who may have been abused or neglected

Priority Three Increased confidence and capacity in the wider children and young people’s workforce so that CYP with mental health and emotional difficulties are identified early and can access appropriate care and support

Priority Four Access to evidence based specialist mental health services within a specified time frame for a minimum of 35% of the Children and Young People that experience a mental health problem in MK by 2020/21

Although this is a 5 year plan there is a continued ethos to do the very best with the services and resources we have now, to catch issues and gaps as they arise while also working to deliver longer term objectives. This requires a whole system approach our commitment to which is captured in Fig A below.

Fig A: Milton Keynes Effective Support “Windscreen”

*Incredible years parenting training

*Family Centre MIND clinics

*Head teacher and Governors Conference (leading to a lead Governor for mental health in every school)

*Community & Voluntary Sector Development

*Arts Project – hearing the voice of CYP

*Expert Parent Programme

*School Nursing Primary School Clinics

*Healthy YP Events and Award

*SMILE YMK

*Mental health first aid training for schools

*Positive Behaviour Support Training

*AIM 2 Training and creation of a virtual team

*Voluntary sector provision

*Primary Care Home

*Assessment Clinics in Children and Family Centres

*CAMHS Liaison and Support to:

-Special Educational Needs & Disabilities

-Youth Offending Team

-Looked After Childrens Services

*Foster Carers Support

*Single Point of Access to Specialist Services

*Telephone referrals Line

*CAMHS duty services

*CYPIAPT

*Specialist care Pathways

-Anxiety and Mood Disorder

-Psychosis

-Eating Disorder

-Neuropsychiatry

-Emotional Dysregulation

*24/7 Crisis Response

*Care, Education and Treatment Review

*In Patient Liaison

*East Midland Specialist Commissioning Plan

*East Midlands Forensic CAMHS

Development Project

LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4

LEVEL 1

Early Help and Prevention

Schools and Educational Settings

Primary Care

Universal Services

Early Help Local Authority Settings

Community and Voluntary Sector

Peer Support

Parent and Carers Peer Support

Targeted training to meet additional needs

Assessment of need

Advice and Sign Posting

Locality based services for Mild to Moderate needs

In Reach services for specific groups of vulnerable children

Access to specialist services for advice

Community Crisis Care

Eating Disorders

Interface with In Patients

Specialist Care Pathways

Children with complex behaviour

Working in partnership with Specialist Commissioning

Transforming Care

High Needs Review

1Introduction

Will the LTP be both refreshed and republished by the deadline of 31 October 2017 with checked URLs

Is the LTP appropriately referenced in the STP? Does the plan align with the STP and other local CYP LTPs (CCGs are requested to provide a paragraph on alignment)

It has been nearly 2 years since the Milton Keynes Children & Young People’s Mental Health & Wellbeing Local Transformation Plan (MK LTP) 2015-2020 was originally published. Throughout that period we have strived to maintain a balance between commitment to the priorities originally identified and responding to new and emerging issues as they arise.

The multiagency group that oversees delivery of the plan has seen a shift in membership as we have focussed more strongly on the wider system for mental health and wellbeing. It has been exciting to see new people and organisations embrace the CYP mental health and wellbeing agenda and to hear from them that they are ‘inspired to make a difference’, to be part of something that will tangibly improve outcomes for local children and young people.

Locally the governance arrangements have changed and the LTP Delivery Board is now chaired by the Director for Health and Social Care Integration, and reports though the ‘Integration Board’ to the Health and Wellbeing Board. Wider governance arrangements have also changed with a larger focus on the Sustainability and Transformation Partnerships (STP); which for Milton Keynes means us working with a new set of partners from Bedfordshire and Luton. Initially the BLMK STP Plan was light on mental health and wellbeing content but this is now changing as the Accountable Care System Develops and recognises the fundamental importance of mental health as established in the 5 Year Forward View. Further detail can be found in Section 8.

The original 9 priorities identified in the MK LTP for transforming mental health and wellbeing for children and young people (CYP) in Milton Keynes have been turned into a diagram, which can be seen on the front of this document, and are also listed below.

1. Better support & care for children who have a mental health crisis and need urgent care either in hospital or at home

2. Better care for children and young people with complex needs and/or complex and challenging behaviour including those with learning disabilities and autism

3. Better access to specialist mental health care for children and young people

4. Improving core skills and confidence to be better able to support young people suffering from emotional difficulties in the wider community

5. Improving our community eating disorder service.

6. Better psychological support for children with either complex physical care needs or social care needs, including those who have been abused or neglected

7. Early help for those suffering from psychosis

8. Better care for mothers suffering either poor emotional or mental health around the time their baby is born.

9. Ensuring local support for young people coming back into Milton Keynes after receiving care elsewhere

We have not attempted to address all of the priorities at the same time and a high level overview of the focus for the plan can be seen in table 1 below:

Table 2: LTP Priorities Addressed by Year

Year 1 end of 2015/16-

· Improved access and reduction of the waiting list for specialist services

· Sustainable 24/7 services for children and young people (CYP) in crisis

· Improved processes and multiagency working for CYP who have been in Tier 4 units and are being discharged back to local services

· Improving and enhancing perinatal mental health services

· Working with the community eating disorder service to move towards compliance with new national standards

· Improvements to early intervention in psychosis services to ensure compliance with new national guidelines

Year 2 2016/17

· Increased confidence and competence in the wider children’s workforce to support children and young people with emotional and mental health problems

· Improving multiagency support for CYP with complex need and/or complex and challenging behaviour

· Development of CYP IAPT

· Development of a single point of access to specialist mental health services

· Improved liaison with non-mental health services to identify CYP early including (Corporate Parenting Services, Youth Offending Team (YOT) and Special Educational Needs and Disabilities (SEND).

The MK LTP has been widely discussed and publicised at a number of events and forums across the year (see Section 4). The documents associated with the plan are all published with an easy read summary both on the CCG and council Websites, links below:

Children and Young People's Mental Health & Wellbeing Local Transformation Plan

Health and Wellbeing Board - Milton Keynes Council

1.1 Purpose of the LTP Refresh 2017/18

The purpose of this document is to provide an annual report on the work undertaken to transform the mental health and emotional wellbeing pathway in Milton Keynes over the past year and to establish the priorities for the next 3 years of the plan. The format of this document follows the KLOE provided by NHS England for this year’s refresh process. We have taken a holistic approach and have included work undertaken across the pathway as well as work undertaken as enablers to change i.e. workforce strategy and communication plan.

MK Children & Young People Mental Health & Wellbeing LTP 2017 Refresh

MK Children & Young People Mental Health & Wellbeing LTP Refresh 2017

Page 1 of 73

Page 71 of 71

2Finance

"Does the LTP include a baseline (15/16) actual for 2016-17 and planned trajectories which include:

- Finance (including identification of, at least, the additional investment flowing from this LTP's share of Budget allocations and performance to date)

- staffing (WTE, skill mix, capabilities);

Investment in transforming the pathway has been maintained. This is demonstrated in Table 3. Investment has been maintained and uplifted in line with the CCG’s allocation to CYPIAPT, Crisis Care, Access and Community Eating Disorders. Investment has been made to provide transformation support which has freed up clinicians to deliver care. The other key area to receive investment has been the complex care pathway where work is ongoing to appoint to posts and evaluate the Impact of change.

All information of staffing and workforce can be found in Section 9.

Table 3: Financial overview; Children and Young Peoples mental health and wellbeing transformation pathway

Expenditure

Actual

Forecast

Planned

2015/16

2016/17

2017/18

2018/19

Service Description 2017/18

Service Description 2015/16

Comment

Contract end

Commissioner

£

£

£

£

Specialist Children and Young Peoples Mental Health Service (CAMHS)

CAMHS Tier 3

Includes Future in Mind and Parity of Esteem investment for: CYPIAPT, Crisis Care, Access, Community Eating Disorders Total £398k

April’19

MKCCG

2,216,846

2,609,842

2,690,199

2,815,832

Inpatient agency support for CYP

CAMHS inpatient agency support

April’19

MKCCG

26,784

2,492

27,161

27,161

LTP Transformation Support

CAMHS Transformation Support

To support transformation and release clinical time

April’19

MKCCG

43,029

54,060

56,232

Complex and Challenging Behaviour

Complex and Challenging Behaviour

Will move into CAMHS contract from 18/19

N/A

MKCCG

130,000

130,128

135,374

CAMHS Tier 2

S/A

April ‘17

MKC

421,000

-

200,000

-

CAMHS Tier 2

Recurrent NHS Funding; will move into CAMHS contract from 18/19

April ‘17

MKCCG

200,000

200,000

N/A

CAMHS CYP Access Funding (one-off)

April ‘17

MKCCG

112,500

-

-

Mental Health Expenditure within Continuing Care

Mental Health Expenditure within Continuing Care

MKCCG

225,277

98,757

98,757

98,757

Contribution to Looked After Children Worker

S/A

MKC

20,000

20,000

20,000

20,000

In-Patient Admissions

S/A

NHS England

Total

S/A

Not Available

2,889,907

2,996,620

3,301,548

3,234,599

3Activity

Activity (e.g. referral made/accepted; initial and follow-on contacts attended; waiting times; CYP in treatment) with clear year on year targets and performance to date for improving access and capacity to evidence based interventions"

There have been improvements in data quality over the past year and there is a detailed information schedule in place between the Specialist CAMHS provider Central and North West London, and the CCG. This will support better analysis of activity and changes in need and facilitates more targeted systems discussion about changing need and performance of teams and services.

Despite these improvements the historical data is not as reliable and because of this is it challenging to draw accurate conclusions from the data available. There is also variation in the data associated with the transformation activity within specialist services. Specifically the change to a new IT system and major estates move and rebuild of the CAMHS facility.

3.1Referrals

The number of referrals between 2015/16 and 2016/17 saw a significant increase however the forecast outturn for 2017/18 is slightly lower. It is too early to know if this is an accurate projection and what the cause may be as all recent trends have been towards increasing numbers of referrals. There is a seasonal pattern to referrals which can be seen in the second graph below.

Fig B: Total Referrals by Year Fig C: Referrals by Month and Year

The next graph shows the numbers of referrals rejected by specialist CAMHS. This is relatively new information and will be helpful in identifying areas where there may be a need for targeted work.

Fig D: Rejected Referrals

The graph below shows the total contacts seen per month. The provider has advised that the data from September to February 2015/16 is likely to be corrupted by a change in IT systems and is therefore unreliable. The dip in attended contacts for April, June and July is being monitored to understand the medium term trend. The following 2 graphs then show the contacts split between first attended appointments and follow up appointments. There is no statistically significant change in the ratio between these.

Fig E: Total Contacts by Month

Fig F: First Attended Appointments

Fig G: Follow up Appointments

The number of DNA’s continues to reduce as the service has introduced text messaging and a range of other initiatives to improve efficiency.

Fig H: DNA’s per Month

Waiting times have remained constantly below the 18week target. They have increased from an average of 8 weeks in 2016/17 to an average of 9 weeks in 2017/18. This increase is being monitored.

Fig I: Waiting Times in Days

The CCG and CNWL are working towards being able to track the national access target accurately from the local data set but we are not yet satisfied that we can track this accurately enough to report at this stage. The agreed trajectories for increasing access to 35% of prevalence by 2021 are in Table 4.

Other KPIs can be seen in section 6.4 Evidencing and Measuring Success.

Table 4: Trajectory for Improved Access to C&YP Mental Health Services

Figures below based on prevalence figures issued by NHSE

Milton Keynes prevalence figure = 6191

2016/17

2017/18

2018/19

2019/20

2020/21

Revised CCG forecast %

23.4%

30.0%

32.0%

Revised CCG numbers

1448

1860

1984

National Trajectory %

28%

30%

32%

34%

35%

National Trajectory numbers

1733

1857

1981

2105

2167

4 Communication and Engagement

Does the refreshed LTP clearly evidence engagement with a wide variety of relevant organisations, including children, young people and their parents/carers from a range of diverse backgrounds including groups and communities with a heightened vulnerability to developing a MH problem and aligned to key findings of the JSNA, youth justice and schools & colleges? Does it evidence their participation in: - governance- needs assessment- service planning- service delivery and evaluation

- Treatment and supervision

Is the refreshed LTP published on local websites for the CCG, local authority and other partners? Is it in accessible format for children and young people, parents, carers those with a learning disability and those from sectors and services beyond health, with all key investment and performance information from all commissioners and providers within the area?

Communication and Engagement have been a fundamental element of the MK LTP. A Communication and Engagement Plan has been developed, discussed extensively and signed of at the LTP Delivery Group (see Section 4, Table 5). This plan has been helpful in structuring our communication and engagement activity but it is the partnerships and collaborations that have developed that have led to the best examples of innovation and improvement:

“Everyone has an equal seat round the table”

“There is representation and an equal voice from many partners all contributing to the LTP. This has enabled new relationships to be built between agencies”

“A platform to raise ‘prevention’. Public Health as a ‘Partner’ of the LTP. Contacts are widening people’s understanding of mental health”

Examples of key partnerships and pieces of work that have resulted in coproduction and/or have been significantly influential in how we are delivering the transformation have been included in this section in Fig J. Also included in this section are the key objectives of the plan, how we have engaged a range of groups, and what our key messages have been.

As part of this refresh we held a workshop to understand the impact of the transformation to this point and to identify the priorities going forward. We then extended the questions raised at the workshop to a wider group of stakeholders by distributing a simple proforma.

The key objectives of the MK LTP Communication and Engagement Plan are to:

· Keep children and young people at the centre of all we do…keep hearing their voices and actively seek their views to inform the plan and the actions we take

· Inform and engage all stakeholders in the local community of the key areas relating to the 5-year local transformation plan including; the areas for development and revision or redesign; this includes updates to all stakeholders who were involved in the 2014 local pathway review

· Communicate regularly to a wider group of service users and local stakeholders, keeping them up to date with transformation and provide opportunity to receive feedback and be involved in shaping the plan

· De-stigmatise and raise awareness of mental health and emotional wellbeing issues for local children, young people and their families, and other stakeholders with a dual focus on prevention and ‘how to keep healthy’

· Raise the profile of the services in the children and young people’s mental health and emotional wellbeing pathway – what, where, when and how to access them including ensuring that they can signpost where to get help and support in Milton Keynes.

· Create clear, concise, targeted and easily accessible information for children, young people, their families/carers, and professionals working with children in Milton Keynes including self-help information and information to support families, carers and professionals working with children and young people

· As well as standard communication channels, there should be a focus on developing online communications and information such as dedicated webpages and tool kits

Key messages and headlines from the plan are:

· The mental health and emotional wellbeing of children and young people and their families has been identified locally and nationally as a priority

· There is a local 5-year transformation plan to support children and young people’s mental health and emotional wellbeing services; 2015 – 2020

· The nine priorities in this plan have been identified from recommendations of the local review – these correlated with national priorities set out by the government

· The local review has been built on the views of children, young people, their carers and families as well as other stakeholders

· Services are being redesigned to fit local need and new national guidance for improved access and waiting times

· The involvement of children, young people and their parents, and carers in the redesign of child and adolescent mental health and emotional wellbeing services in Milton Keynes is critical to success.

· Across Milton Keynes health, education providers and children’s services are working closely together to be more inventive in the way they provide effective help and support locally to children, young people and their families.

· As a result of the transformation programme universal services will be able to offer increased support to children and young people - focussing on increasing personal resilience

· This programme of work will increase the investment in community and voluntary services to maximise these resources and the work they do with children and young people

Fig J: MySayMK; engagement event undertaken with children and young people.

MySayMK Conference

MySayMK is run by Youth Cabinet on an annual basis. There were two workshops about Mental Health at the event in July 2017.

In the first workshop Children and Young People were consulted about:

· What Emotional Wellbeing means to them

· What works for Children and Young People and what are the barriers

· How creative activities can support mental health

Their feedback was extensive and the following themes emerged

· The culture of schools influences whether or not young people can talk about and raise issues re mental health in school

· Teachers should be properly trained and have confidence to support children and young people in school

· All environments could be made more conducive to supporting Emotional Wellbeing and Mental Health

· Children and young people value of peer support and would like training to support the development of this approach

· Stigma and discrimination are major barriers in school.

Children and Young People were very aware and happy to talk about Emotional Wellbeing and Mental Health, many were confident about managing themselves, supporting others and seeking help when required.

The second workshop used a ‘speed dating’ style of communicating that involved asking each other “What do you see as mental health” This was followed by small groups prioritising the issues raised.

Issues included:

· Importance of removing stigma, discrimination and stereotyping

· Support within schools around test/exam periods that cause stress

· Increase availability of services

· Increased awareness and understanding of parents, carers and the public

· Teachers being educated about mental health and recognizing mental health as an issue

· Finding better learning patterns so struggling pupils have a better chance

The three top priorities for action were:

1. Developing teacher confidence, awareness and appropriate support for children and young people with mental health needs in schools

1. Providing more bespoke support in schools to meet individual needs

1. Action to remove stigma, discrimination and stereotyping.

Table 5: Stakeholder analysis and engagement plan

Stakeholder

How the change will be of benefit

How affected by the transformation process

Engagement/ communication approach/method

Additional Information

1

Children and young people

· Improved choice and easier access to services

· Improved environment

· Personalised care

· Opportunity to be a partner in planning, receiving and evaluating care

· More options for how care can be received i.e. on line CBT

· Care closer to home

· Reduced stigma

· Better mental and emotional health

· Improved outcomes for life

· Improved transition both between services and across life span

· Location of service delivery, mode of delivery and staff delivering the services may change

· There may be some disruption during period of transformation particularly during building work

Multifactorial and intrinsic to the whole plan including:

· Participating in partnership in planning and evaluating their own care (Treatment and supervision)

· Through the DBT participation forum(Treatment and supervision/ service delivery and evaluation)

· Through specifically designed engagement events and focus groups (service planning/ service delivery and evaluation)

· Through the Youth Cabinet involvement in – local government- Health and Wellbeing Board- Events and Conferences (Governance)

See Fig J: key engagement event undertaken with children and young people.

See page 31: Arts and Heritage Alliance project… understanding the language of children and young people

2

Families and carers

· Improved choice and easier access to services

· Delivery of evidence based practice

· Clarity of care pathways

· More options for how care can be received i.e. on line CBT

· Improved family outcomes

· Care closer to home

· Improved transition both between services and across life span

· Improved communication between the people involved in planning and delivering care including schools



· Members of LTP Delivery Group (Governance)

· Parents and Careers Alliance

· Patient Congress

· Health watch

· Through specifically designed engagement events and focus groups(service planning/ service delivery and evaluation)

· Expert Training Programme (Treatment and supervision)

See Fig K: perinatal mental health collaborative, learning from women with lived experience

3

Universal services, particularly education providers, early help providers e.g. children’s centres and GP’s

· Increased training to improve skills and knowledge

· More children and young people have access to targeted and mental health care

· More options for how care is delivered i.e. on line CBT

· Clarity of care pathways and evidence base for specialist interventions

· Improved access to specialist advice

· Universal services will need to understand the breadth of services on offer through traded service agreements

· Referral routes and location of service delivery may change


· Involvement in specific workstreams and Task and Finish Groups (service planning/ service delivery and evaluation)

· Development of the JSNA, Director of Public Health Report (needs assessment)

4

CAMHS service providers and their employees

· Improved partnership working across the health and social care economy

· Improvements in the environment from which service is delivered

· Opportunities for developing lifespan services

· Increased training leading to a better skilled workforce

· Recruitment and retention opportunities

· Provider contract implications to be worked through and communicated as appropriate

· Changes to job descriptions – roles and responsibilities- following period of consultation


· Critical to specific workstreams and Task and Finish Groups (service planning/ service delivery and evaluation)

5

Targeted & specialist non mental health services

e.g. children’s social care, SEND

· Opportunities for the recognition of good practice and innovation


· More children and young people have access to targeted and mental health care

· More options for how care is delivered i.e. on line CBT




· Services will need to understand the breadth of services on offer through traded service agreements



6

Adult Mental Health and Learning Disability Services



· Improved transition arrangements

· Opportunities for developing lifespan services







7

Community and voluntary sector providers



· Services will need to understand the breadth of services on offer through traded service agreements




There is no “one size fits all” solution to communication and this plan has identified the most effective and preferred way for each group of stakeholders to receive information.

A variety of communication methods and channels have been identified including:

· As part of clinical work

· Arts and media work

· Letters

· Websites/FAQ sections

· Email

· Brochures

· Newsletters (printed or by email)

· Face to face meetings/workshops

· Local press/radio

· Range of social media platforms

The above is not an exhaustive list and the communication and engagement plan is considered to be dynamic and developing; new ways of getting the message out including developing the use of new media channels (Facebook, Twitter) are emerging all the time and will be utilised as appropriate.

Fig K: Perinatal Mental Health (PNMH) Collaborative; learning from women with lived experience

Start of our MK PNMH journey

· Long history in MK of committed individuals but… lack of strategic coordination

· Provider led scoping paper and gap analysis

· Local incidents leading to serious case review

· Rise in regional/national profile of perinatal mental health

· Priority for local maternity services liaison committee

· Support from Thames Valley Strategic Clinical Network

Our response

· Forming a collaborative

· Investing in services

· Clarifying the pathway

· Developing training (see Fig Z)

Learning from women with lived experience…

· Agencies and clinicians hearing first-hand experience

· Getting support from organisational leads to change

· Convincing people that perinatal mental health is a priority… clinician time spent in collaborative activity

· Coproducing aims and objectives of the group

· Establishing a common language

· Building on existing relationships and strengths

· Reviewing data

· Progressing and monitoring the programme of work… Holding us to account

5Governance and Oversight

Has the LTP been signed off by the Health and Wellbeing Board and other relevant partners, such as specialist commissioning, local authorities including Directors of Children's Services and local safeguarding children's boards, Children's Partnership arrangements and local participation groups for CYP and parents/carers?

Are there clear and effective multi-agency governance board arrangements in place with senior level oversight for planning and delivery and with a clear statement of roles, responsibilities and expected outputs?

A multiagency stakeholder group has been maintained to oversee delivery of the MK LTP. This group meets on a monthly basis and a highlight report is developed for each meeting. An example highlight report can be seen in Appendix 1. The LTP Delivery Group feeds into the Milton Keynes Place Integration Board. The purpose of this board is to deliver the Place Based change and business for the MK Health and Social Care economy. Terms of Reference can be found in Appendix 2, and an overview including membership in Table 6 below.

The MK LTP also feeds into the BLMK STP in 2 ways; through the Children’s Commissioning Delivery Group, and as one of the workstreams in the Mental Health 5 Year Forward View Delivery Task and Finish Group. The governance arrangements can be seen the chart below.

Fig L: Milton Keynes C&YP MH&WB LTP Governance Structure

Table 6: Overview and Membership of C&YPs MH&WB LTP DG

Milton Keynes Children & Young People’s Mental Health & Wellbeing

Local Transformation Plan Delivery Group

Purpose of the Group

The purpose of the Children & Young People’s Mental Health & Wellbeing Local Delivery Group (DG) Board will be to jointly develop, own, drive and deliver the Milton Keynes Children & Young People’s Mental Health & Emotional Wellbeing Local Transformation Plan (MK MH&WB LTP).

Members of the LTP Delivery Group Board will provide resource and specific commitment to the Senior Responsible Officer (SRO) who is accountable for successful delivery of the plan and will chair the meeting.

The Board will be a decision making body with accountability for the MK MH&WB LTP based on promoting quality and ensuring the achievement and delivery of agreed priorities. It will be responsible for the sign off of projects within delegated financial limits and ensuring relevant governance processes are followed.

Job Title

Role at the Meeting

Organisation

Director Health and Social Care Integration

Chair

MK Council/MK CCG

Children, Young People and Maternity Senior Commissioner

Deputy Chair

MK CCG

Children, Young People and Maternity Commissioner

Programme Manager

MK CCG

Joint Commissioner, Children and Young People

Project Manager

MK Council/MK CCG

Project Manager, Mental Health and Business Transformation

Project Manager

CNWL-MK

Service Manager CAMHS, and Life Span Services MK

Workstream Lead

CNWL-MK

Chair of Children & Maternity Programme Board

Member of DG

MK CCG

Programme Manager, PMO Office

Member of DG

MK CCG

Senior Finance Manager

Member of DG

MK CCG

Mental Health Commissioner

Member of DG

MK CCG

Children’s Commissioning Co-ordinator

Member of DG

MK CCG

Head of Corporate Parenting

Member of DG

MK Council

Head of Settings and School Effectiveness

Member of DG

MK Council

Acting Head of Service, Public Health

Member of DG

MK Council

Operational Manager, Youth Offending Team

Member of DG

MK Council

Leadership & Governance Development Manager, School Leadership & Governance Services

Member of DG

MK Council

Team Leader, Youth Faculty

Member of DG

MK Council

Service Director, Mental Health Services

Member of DG

CNWL-MK

Clinical Director, MK Mental Health Services

Member of DG

CNWL-MK

Senior Manager, Children’s Universal and Specialist Health Services

Member of DG

CNWL-MK

Senior Manager for Speech and Language Therapy and Adult Hearing Services

Member of DG

CNWL-MK

School Nurse Team Lead

Member of DG

CNWL-MK

Clinical Director for Paediatrics

Member of DG

MKUHFT

Matron for Children’s Services

Member of DG

MKUHFT

Director of Organisation Effectiveness

Member of DG

MK College

Head of ALS and SEND

Member of DG

MK College

Head Teacher

Member of DG

Romansfield School

Operational Lead for CYP Complex and Continuing Care

Member of DG

Nene, Corby, and MK CCG’s

Deputy Chief Executive Officer

Member of DG

Healthwatch

Representative

Member of DG

COMPASS

Representative

Member of DG

Patient Congress

Representative

Member of DG

Parents and Carers Alliance (PACA)

Representative

Member of DG

Youth Information Service (YIS)

Table 7: Overview and Membership of Milton Keynes Integration Board

Milton Keynes Integration Board


Health and Wellbeing Board partners are committed to co-ordinating health and social care commissioning and service design and delivery, taking joint responsibility for implementing strategies to improve outcomes.

Job Title

Role at the Meeting

Organisation

Director Health and Social Care Integration

Chair

MK Council/MK CCG

Chief Officer

Representative

MK CCG

Director of Strategy and Planning

Representative

MK CCG

Head of Quality

Representative

MK CCG

Assistant Director – Primary & Community Services

Representative

MK CCG

Corporate Director People

Representative

MK Council

Service Director, Children and Families

Representative

MK Council

Service Director, Adult Services

Representative

MK Council

Assistant Director, Joint Commissioning, Adult Services

Representative

MK Council

Director of Public Health

Representative

MK Council

GP

Representative

Newport Pagnell MC

Medical Director

Representative

MKUHFT

Service Director

Representative

CNWL

Deputy Chair of Healthwatch

Representative

Healthwatch

Table 8: Overview and Membership of BLMK Children’s Commissioning Delivery Group

BLMK Children’s Commissioning Delivery Group


An STP wide forum for progressing system wide working and transformation relating to the children and maternity agenda.

Job Title

Role at the Meeting

Organisation

Director of Nursing and Quality

Chair

Beds CCG

Senior Children, Young People, and Maternity Commissioner

MK Lead CYPM Commissioner

MK CCG

Joint Commissioner Children and Young People

Joint commissioner for MK CYP

MK Council

Children and Maternity Commissioner

Beds Lead CYPM Commissioner

Beds CCG

Joint Children’s Commissioner

Luton Lead Children’s Commissioner

Luton Council

Children, Young People, and Maternity Commissioner

CYPM Commissioner

MK CCG

Clinical Lead

Clinical Director

Clinical Lead

Bedfordshire CCG

EoE Clinical Network (maternity)

This refreshed document has been signed off by:

Governance Group

Date

Milton Keynes Children & Young People’s Mental Health & Wellbeing Local Transformation Plan Delivery Group

28/09/2017

Milton Keynes Integration Board (on Behalf of HWB)

04/10/2017

6Delivering the Plan

6.1What’s been achieved and/or underway

Does the plan clearly evidence outcomes of existing services including achievements and challenges, alongside a coherent statement of strategic priorities?

There has been a consistent pace of change across the past 2 years both for the specialist services and across the wider children’s system. The following section briefly describes these changes and the outcomes they have achieved and focusses on a few examples where there has been a significant impact. This section also demonstrates the challenges that remain, how these are being tackled and are linked to the strategic priorities for the next stage of the plan.

6.1.1 Prevention and Early help

Delivery of the ‘Incredible Years’ parenting training programme has taken place in Children and Family Centres across the city. This has been positively evaluated by parents who are experiencing emotional wellbeing and mental health difficulties.

The School Nursing Service has established clinics in primary schools for parents who want support with a range of health advice regarding their children. Included in this have been emotional, behaviour and sleep, one clinic per school per term was offered.

Below is an audit of attendance and issue/health concerns:

Table 9: School Clinic Presenting Issue Audit

Issue

Number

%

Behaviour

171

19.8%

Continence

84

9.7%

Enuresis

95

11%

Emotional Wellbeing

83

9.6%

General Wellbeing

138

15.9%

Healthy Eating

82

9.5%

Long term/chronic condition

41

4.7%

Hygiene

7

0.8%

Sleep Management

47

5.4%

Weight Management

46

5.3%

Poor attendance related to health

54

6.25%

Medication management

15

1.7%

TOTAL

863

100%

SMILE YMK are an inspirational service open to young people aged 13 to 19 from across Milton Keynes via a referral system. It provides a range of informal learning activities to support and engage young people who are currently experiencing low level anxiety and depression. It is an early intervention project, built upon five principles for boosting wellbeing, connect, be active, keep learning, give to others, be mindful.

Smile YMK has expanded in 2017 and is now delivering new sessions in MK College, Children and Family Practice North, the Rivers Centre and MK Academy. Children and young people accessing SMILE YMK have found that is has had a positive impact on not only their mental health but on other aspects of their lives. Information about SMILE YMK and the outcomes experienced by the young people can be found on YouTube: Smile YMK PowerPoint 2017 - YouTube

Aim 2 Training- In early 2017 CAMHS transformation funding was used to commission an AIM2 training programme for practitioners working with children and young people who exhibit Harmful Sexual Behaviour (HSB). Twenty two local practitioners attended the first course which has trained them to use the AIM2 model for assessment; this was followed by training in AIM2 Intervention.

A course for staff who provide specialist supervision to those conducting AIM2 work has also been completed, this looks specifically at a number of areas including the use of Internet. Plans are in place to further commission a course to look in more detail at cases with children and young people with learning needs/communication problems later this year.

Trained staff now operate as a ‘virtual team’ working across services to respond to a range of cases and not just those who enter the formal criminal justice system which has been the norm in the past. The service is co-ordinated by the Milton Keynes Youth Offending Team and overseen by a steering group which includes managers from across services.

This project is in its’ early stages, however, it is anticipated that it will close a significant gap in a service area which has challenged in the past. The links with issues such as CSE, gangs and youth violence, domestic abuse, trafficking etc. are becoming increasingly clear so this investment will position Milton Keynes well in the future.

An Arts Project has been commissioned in partnership with Public Health to work with the Cultural Education Partnership and the Arts Council. Through this project we aim to better understand the voice of children and young people, particularly in terms of how they communicate both verbally and non-verbally about their mental health and emotional wellbeing. A group of artists including a film maker are going to work with children and young people across the age span to produce art and film that can be used to support and help us reach young people who may not be easily heard, and to inform and educate the children’s workforce.

We have been working with the Milton Keynes Community Foundation to help us understand better the landscape for community and voluntary sector organisations. With increased pressure on budgets for health and social care there is recognition locally of an increasing reliance on the community and voluntary sector for services that are non-specialist and meet mild health needs. However, the community and voluntary sector is also experiencing reductions in funding and is increasing reporting that they can access grants for specific projects but are struggling to access core funding to keep organisations running. This has a particular impact on smaller, local organisations. In recognition of this situation a small amount of funding has been made available to locally research the organisations that are providing mental health and emotional support in our community. Community foundation has hosted a series of breakfast meetings to engage with the sector and have co-produced a brief for the work. Further breakfast meetings are planned to take this work forward to think creatively about how partners could work together to manage and improve the system and to understand where available funding should be targeted.

Healthy Young People’s Network (HYPN) and Health and Wellbeing Awards

The aims of the Network are to provide: a collective, cross organisational, approach to cascading health and wellbeing messages, ensuring that Children and Young People’s Emotional Wellbeing and Mental health is embedded in to all the Healthy Young People’s Network (HYPN) events. The HYPN Steering group plan at least one key event a year totally dedicated to this area. The new 0-19 Health and Wellbeing Awards is now launched for any organisation working with Children and Young People to achieve. Mental Health and Emotional Wellbeing has been threaded through all the elements of award criteria. The success of the Network and awards is because of the commitment and collaboration across agencies.

There is a close working relationship with Youth Cabinet and the Healthy Young People’s Network. At the Network meeting in October 2016 members of Youth Cabinet presented their views and experiences of emotional wellbeing and mental health to a range of stakeholders including schools, health, and community and voluntary sector. Young Carers spoke about their experiences including the impact of this on their lives. This provided information and challenge to organisations and services and encouraged more reflective practice.

Milton Keynes Self Care Project

“The actions that individuals take for themselves, on behalf of and with others in order to develop, protect, maintain and improve their health, wellbeing or wellness.”

Public health is currently working with the local pharmacy lead in the Bletchley area, supported by a working group, to promote Self Care in the local area. This is a pilot, which if successful, will be rolled out across the Milton Keynes area. Initial activity has been to understand existing provision and identify gaps. This work will be used to develop a local directory which will include a range of health and wellbeing information to enable local people to understand and access local provision. This work will be promoted through a local event in Self-care week in Oct 2017.

Mental Health First Aid training in schools

Public Health is working with Children’s Centres and partners including MIND to provide Mental Health First Aid training in schools. This includes piloting this training with a local primary school to understand what is needed, what works well, and develop an evidence-base of good practice. In addition, the newly available free mental Health First Aid training has been cascaded to secondary schools. The potential of further funding to roll out more widely across all schools is currently being explored.

MySayMK Conference

See Fig J

National Citizenship Service (NCS)

The Healthy Young People’s Network received a presentation from National Citizenship Service in April 2017. The young people talked about how health and wellbeing is central to what they do. When attending the ‘NCS Mad Market Place’ in August 2017 a number of potential projects emerged; for example building a Sensory garden for children and young people with Special Educational Needs.

Teaching Conference – A successful conference on “Promoting the positive mental health and wellbeing of children and young people in schools” was held on Wednesday 12 July at Cranfield University. 154 school staff, governors and officer colleagues attended what was a very successful day. Presentations were given by MKC Leadership and Governance, CCG, YoungMinds, Mind and the Self-Esteem Team (Natasha Devon). Six workshops were offered and hosted by Milton Keynes Primary Pru, Compass, Educational Psychology team, Place2Be, MKC Inclusion and Intervention Team and CAMHS. 97% of delegates perceived the conference to be “good” or “excellent” and 56 delegates signed up to being on a working group to support and influence this work moving forward.

6.1.2Specialist Services and Changes to Specialist CAMHS

Specialist Children and Young People’s Mental Health Services are moving away from a tiered service with multiple points of entry to a streamlined evidenced based model with a single point of access, built on the principals of the Choice and Partnership Approach (CaPA) and Children and young People’s IAPT. Clear specialist care pathways are being developed and a range of support and liaison services are being established to ‘in reach’ in key areas of need. The model can be seen in Fig M.

The new model has been identified in a new service specification based on the national service specification template. It is anticipated that transition to the new model will be complete by December 2018 but that key elements will come on line before then; an overview of this time line can be seen in the road map Fig 20

Waiting lists have reduced and remained below 18weeks since the beginning of 2016; the average wait for a routine appointment is between 6-8 weeks. Since the end of June CAMHS have offered initial assessment & screening appointments in Children & Family centre clinics for children & young people who have been directly referred in to the service. The provision operates from 6 Children & Family centre sites across Milton Keynes, increasing access & social inclusion.

CAMHS has been working towards CAPA over the last 18months. Social Care now has open access to a duty and referral system between 9-5 Monday to Friday for consultation. CAPA is being built in to the new model pathway as the transformation progresses. This includes the development of Children and Young People’s Improving Access to Psychological Services (CYPIAPT) as well as a range of evidence based specialist care pathways:

· Eating Disorders- Waiting list for urgent eating disorder referrals less than 1 week

· Anxiety and Mood Disorder

· Emotional Dysregulation- Delivery of Dialectical behavioural Therapy

· Neuro- Psychiatry

· Psychosis

Integrated Care Pathway agreed with MKUH for care of CYP in crisis accessing mental health care through the hospital is working well. Delivering access to 24/7 CYP Mental Health Services for assessment, short term intervention and signposting for young people with urgent needs, and up to 4 weeks of home support for young people in crisis.

The processes for monitoring young people who need care in a hospital out of area have been strengthened and a new protocol is in place to support seamless discharges and transition to community services

Fig M: New Model for Specialist Children and Young People’s Mental Health Services

Liaison and support for non-mental health services has been strengthened with the addition of:

· New mental health posts in the Special Educational Needs and Disabilities team to strengthen early identification and support for children in education who are displaying behaviour that challenges or raised concerns for those who are working with them

· New arrangements agreed for looked after children including foster carer support- recruitment commenced. This will mean that some of our most vulnerable children including those who have been abused and neglected will be assessed not only for their physical health needs but also for their emotional and mental health needs. An experienced mental health practitioner will be based with the looked after children’s team and ensure that children and young people who have been assessed as needing targeted or specialist care and intervention can access that care without waiting referred through the usual pathways. The provision for supporting foster carers has been reviewed and is being tailored to improve the knowledge, skills and resilience of foster carers. The aim is to create a stronger and more sustainable pool of foster carers who understand the needs of children who have been abandoned, abused and neglected. To support foster carers to provide homes where children and young people can begin to rebuild themselves in an environment that offers stability and healthy attachments. To ensure that Child abuse and neglect NICE guideline published in: October 2017 are implemented locally.

· New arrangements in place in the Youth Offending Team. A dedicated experienced mental health practitioner is working with the YOT to provide mental health services as early as possible to prevent more serious concerns from developing. And to identify previously undiagnosed serious mental health problems and ensure access to evidence based intervention and support.

The Community Perinatal Mental Health Service has also developed over the past year and has seen the growth of a small team following investment of parity of esteem money. The service provides specialist care for women who are pregnant or have given birth in the past year. Including …

Multiagency training programme launched- See Fig Z.

A multiagency care pathway developed and launched across the city and promoted through the PNMH ‘Champions Training’.

Through the local Transforming Care programme Care, Education and Treatment Reviews (CETR) have been established. The system is beginning to work in a more integrated way across adult and children’s services particularly at the time of transition. A local High Needs Review has looked at the approach taken locally to meet the needs of children and young people with high levels of educational, health and social care needs. One of the local special schools (for children with autism) is developing a new post that will work in partnership with CAMHS to provide personalised care and assessment for the young people at the school who experience challenging behaviour and/or have mental health problems.

6.1.3Interface with Specialist Commissioning

An integrated plan has been developed for the Midlands and East regions to set out how we will work together over the next 3 years. More information on this and the regional forensic developments can be found in Section 15.

6.2Ongoing Challenges

There are ongoing challenges for the Milton Keynes LTP and these challenges feed into the strategic and operational priorities for future development.

Achieving whole system change; mental health and wellbeing… everyone’s business. A number of schemes and projects (see 6.1.1) are focussed on improving the context for children and young people, and increasing the knowledge and skill in the wider children’s workforce. However, there is much more to do and several of the workstreams identified for the next stage of the plan remain focussed on the wider health, social care and community sector.

Reducing resources in community and voluntary sector provision is impacting on the number of resources available for children, young people and families that are below the threshold for specialist services.

Children and young People with Complex and Challenging behaviour; which may include ASD, ADHD, Conduct Disorder, LD, and/or no diagnosis. There are national and local drivers to get this right but it is challenging in the context of reducing resources within health and social care. Significant work has been done locally to understand the issues and to improve the multiagency response to provide integrated care particularly in a crisis. Despite this work we continue to have:

· Long waiting lists for diagnosing ASD

· Limited post diagnostic support available – not meeting varied population needs

· Perception that need is not being addressed early- escalation of need, increased crisis

· Increased spend – high cost low volume

· Friction between agencies

· Increased demand and complexity of need

6.3Strategic Priorities and Future Development

Areas where further development is needed and future commissioning focus? Does it include specific plans to improve local services?

Priority One (2017/18): Keep children and young people in the driving seat of change to reducing stigma so that CYP can access help at the right time and in the right place without fear of consequence.

Objectives:

· Understanding the voice of C&YP and the language and forms of communication they choose to use, developing a shared language and understanding

· Changing the environments that C&YP occupy to create safe places for emotional and mental wellness to flourish

Priority One - Projects to deliver:

Table 10

Project

Deliverables

1

Schools mental health and emotional wellbeing support programme delivered through Leadership and Governance Services

· Each school identifies a mental health and wellbeing governor and senior leader- leadership

· Schools mental health and wellbeing steering group

· Recommended training packages

· School policy for mental health and wellbeing

· Toolkit for schools- learning about mental health and wellbeing in the classroom

2

Mental health and wellbeing arts project in schools

· Arts project delivered across 2 primary, 2 secondary and 1 special school

· CYP reflect through creative processes what mental health and emotional welling means for them

· Art (film and mixed media) that can be shared with a wide audience to support training events and promote cultural change

3

Mental health and emotional wellbeing campaign

· Coproduce a campaign for Milton Keynes with children and young people and in partnership with arts charities and local businesses.

4

C&YP, Parents and Carers as experts in care

· Expert parent training programme delivered and extended- pool of expert parents

· Peer support established in secondary schools

· Peer mentoring

Priority Two (2017/18): Develop Integrated (Health and Social Care) services for children and young people who have complex and challenging behaviour: Including those with learning disabilities and autism and those who may have been abused or neglected

Objectives:

· Reduce the number of C&YP that go out of area to meet Health, social care and educational needs by meeting their needs locally

· Refocus resources

· Locally agreed pathways of care; ways of working (Health and social care, children and adult workforce)

· Improved confidence and resilience of parents and carers and their communities

Priority Two - Projects to deliver:

Table 11

Project

Deliverables

1

Health and Care needs assessment for complex and challenging behaviour

· Quantified understanding of local needs

· Understanding best practice models

· Strategic agreement of priorities for action and change across health and social care

2

Testing new ways of working across adult/children, health, social care

· Improved crisis response meetings

· Transition meetings

· Research post in adult LD – in-reach to Children with Disability Teams

3

Implementing the high needs review

· Improved capacity within specialist and mainstream educational settings

· Positive behaviour support (PSB) training for schools and settings

· PBS for parents and carers

4

Training for health and social care

· See next table 12

5

Support and liaison posts

· Special school post (Walnuts School)

· SEND Team

· YOT

· Looked after children team

6

Business case for change

Priority Three (2017/18): Increased confidence and capacity in the wider children and young people’s workforce so that CYP with mental health and emotional difficulties are identified early and can access appropriate care and support

Objectives:

· The wider workforce knows how to talk to children and young people with mental health problems to make good decisions about how and where they can access care

· The wider workforce is equipped with the right skills and knowledge to provide evidence based interventions for mild mental health and emotional problems.

Priority Three - Projects to deliver:

Table 12

Project

Deliverables

1

Training platform

· Recommended training packages accessed by universal health services- mental health first aid

· Primary care home pilot implements enhanced Mental health training for GPs and evaluated using a rage of metrics including patient reported outcome measures

· Maximising opportunities from PLT events for GPs

· Evidence based intervention provided for mild mental health problems within universal services, primary care, early help services, a range of non-mental health specialist and targeted children’s services

2

Community and voluntary sector scoping project

· An understanding of local provision including SWOT

· Focussed decisions about future engagement and investment

· New ways of working across the sector – through partnerships to achieve greater sustainability

Priority Four (2017/18): Access to evidence based specialist mental health services within a specified time frame for a minimum of 35% of the Children and Young People that experience a mental health problem in MK by 2020/21

Table 13: Access Target for Milton Keynes

Year

2018/19

2019/20

2020/21

% of total prevalence

32%

34%

35%

Actual number

1981

2105

2167

Objectives:

· Implement CYP IAPT

· Complete implementation of single point of access

· Complete implementation of specialist care pathways

· Maintain and develop 24/7 crisis support and liaison services

Priority Four - Projects to deliver:

Table 14

Project

Deliverables

1

CYP IAPT

CYP IAPT in place by April 2018 and fully established by December 2018

2

SPA and Duty System

Single point of access (SPA) in place by April 2018

Waiting list maintained below 12 weeks for routine cases

3

Specialist Care Pathways

Specialist care pathways established by December 2018

4

Crisis

24/4 crisis support and liaison services are maintained

6.4Evidencing and Measuring Success

Are there clear mechanisms and KPIs to track progress that are shown over the plans period? i.e. Show yr1, 2, 3 etc.

Key performance indicators for the LTP are a combination of data and progress made against the plan, these have been summarised in the table below:

Table 15: MK LTP KPI’s

Year 1

Year 2

Year 3

Year 4

Year 5

Access Waiting list for Sp CAMHS

below 18 weeks

below 12 weeks

below 8 weeks

below 8 weeks

below 8 weeks

Access

% of CYP with MH who access care

-

30%

32%

34%

35%

CYP IAPT

Agree model & spec

PROM in place

Reading Collaborative

Training commenced

Training completed

-supervisor

-management

-CBT

Service established

Training rotation established

Continuity plans in place

Maintained and developed

Eating Disorders

Build on existing service to ensure compliance with NICE guidelines

Meet access and waiting time standards for evidence based care

Join local quality assurance network for CED

Commission service across wider footprint to meet population standard

See below

See below

Eating Disorders

Waiting times

Urgent cases seen within 1 week

Routine cases seen within 4 weeks







Liaison and Support in reach

Complete business cases for YOT, LAC, SEND

Agree how the services will operate- recruit to posts

Initiate services and evaluate impact

24/7 Crisis Care

Build on 24/7 crisis service to offer increased home support

Maintain KPIs, specifically to see CYP within 1 hour of presenting at A&E

As previous

As previous

As previous

Perinatal Mental Health

Commission specialist service

Establish collaborative

Develop integrated care pathway

Establish specialist service

Develop and deploy multiagency champions training

STP wide bid successful

Maintain and further develop training

Meet new access and waiting time standards

Access and waiting time standards TBC

Access and waiting time standards TBC

Reducing stigma

Listening to what CYP and their families say

Coproducing a response to year 1 information

MK wide campaign

Independent stakeholder survey… what has changed

Whole system working

Establish LTP governance and whole system engagement

Evidence of engagement with universal, targeted and specialist services from statutory and voluntary sectors

Coordinated offer

Independent stakeholder survey… what has changed

Complex and challenging behaviour

Understand the scope and extent of the issues

Health and care needs assessment

Learning from cases

New ways of working- liaison and support- crisis response

Work as a whole system to identify medium and long term solutions- business case for change

Reduced waiting times for ASD Diagnosis

Reduced out of area placements

Targets to be confirmed

Reduced waiting times for ASD Diagnosis

Reduced out of area placements

Targets to be confirmed

6.4.1Commissioning for Quality and Innovation (CQINS) and Quality Schedule; Table 16

Quality and safety is improved and monitored through contractual mechanisms, examples of the Quality Schedule and CQINs can be seen below. These are reported on by the specialist CAMHS provider on a monthly or quarterly basis and monitored through the Clinical Quality Review Meeting.

The quarter 1 report has been received and this demonstrates good progress in progressing the actions required to deliver the CQUIN.

Table 16:

CQIN

Transitions out of Children and Young People’s Mental Health Services (CYP MHS)

Specialist CAMHS provider CNWL

1.The number of young people who have transitioned out of the sending service in question during the reporting period whose case notes evidence Joint-Agency Transition Planning, defined as:

1.1. Those service users approaching transition who have had a meeting to prepare for transition, at least six months before transitioning, or for individuals who are less than six months from transition age on joining the sending service and at least one month before transition. The meeting should include:

· The young person

· The appropriate key worker from the sending service

· Where applicable, a dedicated point of contact for transition from the receiving service; and

· Where appropriate and the young person agrees, the young person’s parent(s)/carer(s)

Where a face to face meeting is not practicable, for example when a young person is moving out of area, this indicator score may be fulfilled by evidence that there has been contact between all the above parties, for example, via a video conference;

AND

1.2. Those service users with complete transition plans at least 6 months prior to transitioning, signed off by:

· The sending service

· Where applicable, the receiving service

· The young person

· Where appropriate, and where consent is given, the young person’s parent(s)/carer(s)

The transition plan must include personal transition goals, jointly agreed with the young person. Where they are transitioning into a receiving service, these goals will be picked up later in a post-transition questionnaire on transition experience.

For those entering CYPMHS less than 6 months before their date of transition, these requirements must be fulfilled on entry into CYPMHS and no later than one month before transition;

AND

1.3. Those service users with a named and contactable transition key worker, at least 6 months prior to transition, in the sending service or, where transitioning into AMHS or other relevant CCG-commissioned services, at the receiving service. This key worker must be known to the young person and their contact details shared with the young person.

For those entering CYPMHS less than 6 months before their date of transition, these requirements must be fulfilled on entry into CYPMHS and no later than one month before transition;

AND

1.4. Those young people leaving CYP MH services who will not transition to a CCG commissioned service but back to primary care who have a discharge plan that has been developed and shared with the young person and shared with primary care.

2. The number of young people who reported feeling prepared for transition at the point of discharge from CYPMHS within the reporting period as captured by a Pre-Transition / Discharge Readiness survey.

3. The number of young people who have transitioned to AMHS from CYPMHS within the reporting period who indicate that they have met their personal transition goals as agreed in their transition plan as captured by a Post-Transition Experience survey.

Quality Schedule

Specialist CAMHS provider CNWL

Provider to evidence a combination of hard (statistical) and soft (qualitative) patient experience data collection methodologies that show changes to patient experience across (a) the organisation and (b) within different operational areas. Provider will engage with all patients and users (including children and young people) to ensure feedback, engagement and improvements take place.

To ensure robust processes for flagging of safeguarding risk factors and quality of recording across the parent/child record exist in all children's services (Paed OT, SALT, CAMHS, Community Paediatrics and CCN). Continue to develop and monitor the implementation of the flagging icon (blue boy icon) within the electronic record for safeguarding vulnerabilities linking to child and parent/care.

Patients that require 'specialing' (1:1) care within adult in patient unit will have their needs reviewed regularly in order to maintain appropriate levels of safety."100% of patients that require 'specialing' (1:1) will have a risk assessment carried out that identifies why enhanced observations are required which will be reviewed regularly. These patients will also have a care plan informing what needs are being met by 'specialing'.

Recommendations for future care needs should be included when discharge planning is commenced."

6.4.2CCG Improvement and Assessment Framework (IAF)

The CCG has been assessed as achieving 90% compliance with a self-assessed list of minimum service expectations for Children and Young People’s Mental Health which are weighted to reflect preparedness for transformation.

· Has the CCG, working with partners, updated and re-published the assured local transformation plan (LTP) from 2015/16 which includes baseline data?

· Is the dedicated community eating disorder service, commissioned by the CCG, providing a service in line with the model recommended in the access and waiting time and commissioning guidance?

· Is the Children and Young People’s Eating Disorder Team, commissioned by the CCG, a member of the quality assurance network?

· Does the CCG have collaborative commissioning plans in place with NHS England for Tier 3 and Tier 4 CAMHS? (It was expected that all CCGs had this in place by the end of December 2016)

· Has the CCG published joint agency workforce plans detailing how they will build capacity and capability, including implementation of Children and Young People’s Improving Access to Psychological Therapies programmes (CYP IAPT) transformation objectives?

· Non ISFE return (CCG financial submission to NHS England)

· Is the CCG forecast to have increased its spend on Mental Health Services for Children and Young People by at least their allocation of baseline funding for 2016/17 compared to 2015/16, including appropriate use of the resources allocated from the Autumn Statement 2014 and Spring Budget 2015?

6.4.35 Year Forward View Mental Health Dashboard

Children and Young people (CYP) Mental Health

Comments

CYP(i)

% of CCGs with a total greater or equal to 5 in the CCG IAF mental health transformation CYPMH milestones

90% achievement

CYP(ii)

Number of CYP receiving at least two contacts in NHS funded community services in the reporting period

Local reporting capability being developed

Awaiting confirmation from MHDSD data

CYP(iii_a)

Proportion of CYP with eating disorders seen within 1 week (urgent)

100%

CYP(iii_b)

Proportion of CYP with eating disorders seen within 4 weeks (routine)

85%

CYP(iv)

a. Total number of bed days for CYP under 18 in CAMHS Tier 4 wards

Awaiting data from specialist commissioning

b. Total number of admissions of CYP under 18 in CAMHS Tier 4 wards

Awaiting data from specialist commissioning

CYP(v)

a. Total bed days of CYP under 18 in adult in-patient wards

Local data collection in place

b. Total number of CYP under 18 in adult in-patient wards

Local data collection in place

CYP(vi)

% of C

[project title] - milton keynes · web viewmk children & young people mental health & wellbeing ltp...

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