Durham & Darlington CAMHS Crisis & Liaison Team Clare Anderson – Clinical Nurse Specialist

County Durham Child Health Profile March 2016 Indicator County Durham Child mortality rate (1-17 years)   MMR / Dtap / IPV Hib vaccination (2 years) GCSEs achieved (5 A*-C inc English and maths) 16-18 year olds not in education, employment or training First time entrants to the youth justice system Children in poverty (under 16 years) Family homelessness Teenage mothers Hospital admissions due to alcohol specific conditions Hospital admissions due to substance misuse (15-24 years) Hospital admissions for mental health conditions Hospital admissions as a result of self harm (10-24 years) Significantly better than England average Not significantly different from England average Significantly worse than England average Data not available County Durham Child Health Profile March 2016

Aims of the service The service is for Children & Young People including those with a learning disability, up until their 18th birthday and presenting with an acute mental health need that requires an urgent mental health assessment and plan of care Develop a flexible & responsive service to meet the needs of Young People experiencing a mental health crisis. Reduce waiting time for Psychiatric assessment when young people are in crisis.

Nurse led mental health care which includes: Open access 8am-10pm Initial assessment appointment – which we will aim to commence within 1 hour of referral being received by our service. (4 hours max) Comprehensive mental health and risk assessments Intensive support within the home/appropriate setting for up 72 hours post assessment or until the risks are contained. Telephone support Liaison and consultation with other professionals and members of the children’s workforce Training to other services and professionals

What it looks like: Nursing team - 7 staff In operation since May 2014 6 Band 6’s, 1 Band 7 (+1 Band 4 admin) In operation since May 2014 8am – 10pm 7 days per week Area covered is all of Durham and Darlington* (936 miles2) 2 acute hospitals 25 miles apart Service available to any young person under 18 years (under 18’s population size 126,632) Only referral criteria is that the presenting issue must be mental health crisis

Referrer – May 2014 – August 2016

Reduction in use of Paediatric beds Between 21.5.14 and 31.08.16, the crisis team were able to free up 370 overnight beds that would otherwise have been used whilst young people awaited a duty mental health assessment the following day

Increase in crisis assessments in the community In addition, of the presentations assessed outside of acute hospital settings, 443 individuals presented with suicidal ideation, panic attacks or threats of self-harm. Traditionally, presentations such as these would be directed to A&E, so the presence of the crisis team has alleviated pressure on A&E departments within the county by an additional 443 presentations. Overall reduction of 813 overnight beds

Training & Development Police training GP’s Local authority care home staff training Independent Reviewing Officers Supported lodging providers Foster carers and fostering officers

Service Developments Crisis care plan work Post suicide support Working with vulnerable groups of young people Joint work with police & schools Awareness raising for support available Supervision and support to professionals affected by suicide

Young people’s feedback and participation Focus groups for young people and parents when developing service, including vulnerable groups Every young person/family receives feedback form and suggestions are acted upon Young person and parent have been involved in recruitment and presentations to award judges Parent now involved in training professionals

Emerging outcomes/benefits Reduction in overnight beds Reduction in time waited for young people and families Increase in service user & partner agency participation to shape service Closer working with young people and parents in developing care/safety plans. Increase in community assessments Identifying risks earlier Increase in multi agency working Developing new practice Empowering partner agencies by support and training

(Just over) 2 years on…. Winner of 3 awards: Shortlisted for 2 more: Positive Practice in Mental Health Nursing Times Award Contribution to Medical Development Trust Award for Developing Excellent Services (2015) Shortlisted for 2 more: National Patient Safety Awards Trust Award for Developing Excellent Services (2016) NHS England good practice case study

Next steps…..(hopefully) Re-commissioning: Extension to 24/7 working Extension to full liaison service Intensive home treatment Enough staff to achieve all of the above

Future plans: Working with 111 commissioners - Enhance the current service to include call transfer to CAMHS crisis service Potential further reduction in ambulance use Potential further reduction in A&E attendance Increase in early CAMHS support Closer links to Tier 4 inpatient units – leave and discharge planning More work on crisis planning – closer work with children’s workforce around positive risk management

Thank you. clare.anderson1@nhs.net

Urgent and Emergency Care for Children & Young People Item 3b- ABA Urgent Emergency_CYP Urgent and Emergency Care for Children & Young People Barbara Rayment, Director Youth Access and Chair of ERG t

New national guidance: our starting point Item 3b- ABA Urgent Emergency_CYP New national guidance: our starting point Parity of esteem: with physical health and adult mental health Targets and standards: equal treatment to those for adults, BUT recognising the difference for CYP and not disadvantaging/penalising CYP due to age difference.

Item 3b- ABA Urgent Emergency_CYP Key proposal .   A response from a mental health emergency service within one hour of receiving a referral. Within four hours of receiving the referral the child or young person should have been appropriately assessed and Have a care and/or safety plan in place, and at a minimum be enroute to their next location (if geographically different) or Have been accepted and scheduled for follow-up care by a responding service, or Have been discharged as there is no further need for emergency mental health care.

Item 3b- ABA Urgent Emergency_CYP What CYP told us: Strong support for time scales Strong support for a crisis intervention service Very keen on continuity: i.e. triage, assessment, crisis intervention, longer term care and treatment together, rather than all- age hospital-based liaison service Very keen to be seen at a range of alternatives to the ED