Mindsight CAMHS service and a Behaviour, Emotional and Neurodevelopmental Pathway Dr Phil Ferreira-Lay Clinical Director for CYPS Lead Consultant Child Psychiatrist Consultant Psychiatrist in Adult ADHD & ASD Service Phil.Ferreira-Lay@sabp.nhs.uk

What we stand for We provide services to improve the mental health and wellbeing of children and young people in Surrey We consider this our duty and in line with our values, which guide all that we do – it’s all about doing the right thing and is in line with the principles and values outlined in the NHS Constitution - to treat people well involve and not ignore create respectful places be open, honest and accountable We proactively seek feedback from people who use our services in order to learn lessons and improve. And the way we treat and involve our staff is also important to us and we were delighted this summer when we were named by the Health Service Journal and Nursing Times as one of the top 100 places to work in the NHS. But our CAMHS services are also about making connections – with mental and physical health, families, communities and the places we live.

Service Model Diagram Our integrated service model puts children and young people at the heart of all we do with a focus on getting them to the right support first time and preventing ill health. You will see here there are four levels of service: Wellbeing and resilience which includes prevention and online support services Targeted services for specific needs such as looked after children and a new adopted support service Specialist Services which include a new complex behaviour service and eating disorder services Crisis Support service which will include more 24hr support for children and young people including a home treatment team for 16-18yr olds We are providing this new model of care in partnership with other voluntary, statutory and private providers who are all experts in child and adolescent support. All the CAMHS partners are ambitious about supporting Surrey families to live well and achieve an excellent quality of life.

One Team We’re going to move on now to talk about our partnership (Question 1.2) as we are here today as part of a partnership of organisations committed to providing the best possible services – you can see the logos of the organisations that form a part of our partnership on the screen. Together we form One Team for Surrey

What is Different ' CAMHS One Stop' - Referral & Information Centre for all referrals, which will navigate children and young people to the most appropriate service and through the system, 0300 222 5755, from 1 April A “no wrong door” i.e. all children, young people and families will be supported to find the right help at the right time The threshold criteria for acceptance into CAMHS will be lowered and volumes are expected to increase significantly Expanded operating hours 8am-8pm Monday to Friday and 9-12 on Saturday 0300 222 5755. Services will be made more accessible and user friendly through convenient locations and online services Automated clinical scheduling will ensure capacity, appointments and room availability is transparent and easier to manage A more managed model of care with clear outcome monitoring after every session A fully operationalised range of NICE compliant pathways, including: New behaviour pathway Introduction of CYP IAPT Additional and specific support for adopted children and their families. Many other current CAMHS pathways will be enhanced Reporting requirements from commissioners on activities and outcomes will be more demanding Continued work with CAMHS Youth Advisors and development of an employment pathway for young people.

CAMHS-One Stop (Beacon) Means No Wrong Door

Building Wellbeing and Resilience Guided self help and support materials Primary mental health Kooth.com CYP IAPT TAMHS Youth Support Service Voluntary Sector Counselling Parental Support Programmes We want to provide help and support to children and young people when they begin to feel unwell – to build wellbeing and resilience before their condition may worsen and they may risk having to attend A&E or be admitted to hospital. Our partnership will provide this support at all levels of need in a number of ways, including…

Targeted Services Primary Mental Health 3Cs Looked After Children* (expanded) Adopted Children* CAMHS Care Leavers (expanded)* HOPE and Extended HOPE STARS (Sexual Trauma and Recovery Support) (expanded)* PIMHS (Parent and Infant MH Service) Behaviour Pathway for children with Neurodevelopmental Disorders*

Specialist Services Community CAMHS CYP Learning Disabilities Service Eating Disorder Service Mindful 16-25 year olds (Expanded)

Crisis Support Services Extended HOPE Service 365 / 24 / 7 psychiatrist on call Paediatric liaison Home treatment team for 16 - 18 year olds Extending the safe haven model for children and young people Referral through CAMHS One-Stop

Behaviour Pathways- Why are we here? In 2013/14, as part of a wider stakeholder engagement to set our 5 year strategic direction, Surrey Commissioners identified the need for improvements to Behavioural services for children and young people. With the re-procurement of CAMHS services, an opportunity arose to address these concerns. We had the opportunity to specify a much more joined-up model of service provision and address some of the “gaps” in the care and management of children and young people with Behavioural Problems.

Needs assessment - Surrey National prevalence: 1 in 10 children between age 5 and 16 years have a mental health problem “There is an estimated increase in the number of children with mental health disorders in Surrey from 5,884 in 2009 to 6,014 in 2012, based on an increase in the population estimates.” Surrey Health Needs Assessment, Jan 2014

Needs assessment - Surrey The prevalence of ADHD in the UK is estimated at between 2 and 5%. In North West Surrey that equates to a population of around 2,000 - 5,000 children.

NW Surrey Service Illustration Acute Paediatrics Behavioural Services – ASPH seeing about 1,500 - 2,000 children per year Developmental Paediatrics – VCSL seeing about 250 new patients per year Tier 3 Specialised CAMHS services – SABP seeing about 200 patients per year Youth Counselling --VCSL Education and Schools – PMHW/ School link workers/Educational Psychologist Surrey County Council – Tier 2 Targeted CAMHS services -- SABP Family Support Service Youth support service Voluntary/third sector e.g. Carers’ Support, Family Voice, Surrey Youth Action The current services available in NWS are confusing and unclear. GP’s and Families often find themselves bounced between agencies who due to increasing demand and lack of capacity raise thresholds and acceptance criteria. This slide shows the complexity of the current system. There is significant of lack of joined up working between health and education where our children spend the vast majority of their time and where most intervention should be aimed.

Young Person’s Journey- Since April 2016 Beacon SPA Screens Referral Referrals will come via the Single Point of Access (SPA) and will include all Children and Young People meeting the criteria with mild to severe difficulties Decision will be made whether the CYP needs to be referred into the BEN pathway. This first stage assessment stage will involve telephone interviews with families, schools and other professionals to gather background information. Also clinical details and completed clinical ASD & ADHD questionnaire. If the young person is not eligible for BEN pathway the young person will be signposted to other areas of the CAMHS service for an initial face-to-face assessment interview.

Hub Received Completed Tool Accepted referrals for the BEN Pathway will either go into the ASD, ADHD pathway or Complex Behaviour Pathway (incl. FASD)

Diagnostic Assessment Diagnostic assessment will differ depending on the complexity and will be done in a variety of locations within Surrey depending of the need of the young person. If the outcome is: Positive they will have a multidisciplinary review, therapeutic interventions plus medication where indicated Negative they would step down and be discharged out of the other service

Step Down & Exit Plans Transition to adult ADHD or ASD service Discharge if moved out area No longer require support Discontinued medication

Pre-Diagnostic & Post-Diagnostic Support Pre-diagnostic support - Will involve individualised and / or group based interventions such us parenting groups, ADHD/ASD support and psychoeducation. For ASD this can involve parenting groups and web based support and psychoeducation Post-diagnostic support – individual and group based interventions will be available.

Get in touch CAMHS One Stop 0300 222 5755 website sabp.nhs.uk/mindsightsurreycamhs email Communications@sabp.nhs.uk https://twitter.com/sabpNHS https://www.facebook.com/sabpnhs

Thank you