East of England Community FCAMHS Stakeholder Event – summary and feedback Dec 2018

Introduction/Background FCAMHS is a Regional Specialist Child and Adolescent Mental Health Service for High Risk Young People with Complex Needs. Set up to address Unmet need Commissioned by NHS England Country wide pilot split into 13 regional services Aim of pilot service is to ensure Parity of provision For East of England the bid was won by CPFT

Possible Referrers include: East of England- Map of Geographical Area Safeguarding SCH YOS STC SARC Inpatient LAC MST Education CSC CPS / Police GPs / HVs Residential CJS East of England- Map of Geographical Area Norfolk Cambridgeshire and Peterborough Bedfordshire Hertfordshire Suffolk Essex

Referral Criteria under 18 years old at the time of referral (no lower age threshold) presenting with severe disorders of conduct and emotion, neurodevelopmental or serious mental health problems or where there are legitimate concerns about the existence of such disorders usually involved in dangerous, high-risk behaviours towards others whether they are in contact with the youth justice system or not in exceptional cases, are not high risk (not primarily dangerous to others) but have highly complex needs (including legal complexities) and are causing major concern across agencies

CAMHS vs FCAMHS – Acceptance criteria Concerns about self-harm Not appropriate if self-harm if primary risk concern Age Threshold may vary Children need to be under 18 at time of referral Tend to discharge (not always the case): -if no diagnosis present -if children have CD -if no intervention possible Not diagnosis-led (eg. Features of CD and/or LD) CAMHS care coordinate/are the lead health professional in a case referred to FCAMHS FCAMHS do not care coordinate Locality based- tend to see children at specific clinic locations Regional: -often, we do not see children directly -when we do, we will arrange to see them at a place where they feel safe eg. educational setting or home setting.

Who we see: Complexity ACEs LAC, CPP ‘edge of care’ in secure estate Looked after children Who we see: Complexity ACEs LAC, CPP ‘edge of care’ in secure estate CJS/Police, special educational needs abuse, CSE , ‘missing’ episodes multi agency involvement   al education Multi agency involvement Previous abuse Child sexual exploitation

Who we see: Possible Risk Behaviours Sexually harmful behaviour Internet offending Terrorism/Radicalisation Stalking Fire setting Violence Property damage Threats

Who we see: Types of Mental Health Concerns NOT diagnosis led Neurodevelopmental difficulties Mental Illness Conduct Disorder Comorbidities Learning Disability

What we do Clinical Advice Consultation Multiagency liaison Assessment Intervention where indicated. Mediate transitions in and out of secure care   FCAMHS also has a non-clinical element covered in further slides

What we do Assessment Multiagency Liaison Consultation Advice Intervention Referrer/ lead agency remains involved throughout Joint working

Few Practical Points for Referrers Joint work No care-coordination Collateral and Supporting Information Information Sharing Current response times

Aloof from other provision What FCAMHS is not commissioned to be Aloof from other provision A repository for all local cases with complex needs A service which is able to provide targeted interventions for all specific high risk groups A (long) report-writing service (unless specifically required) A gatekeeping service

Operational Structure Directorate admin Lead Directorate General manager Directorate Clinical Director Band 4 Senior Admin Appointed 1.0 WTE Service Manager Appointed 0.8 WTE Clinical Lead/ / Consultant Psychiatrist Interim in Post Band 3 Peer Support worker Appointed 0.4 WTE Band 3 Admin Appointed 1.0 WTE Band 8c Consultant Psychologist Secondment Started 1.0 WTE Band 8a Psychologist Appointed 0.8 WTE Band 6/7 Psychologist Appointed 1.0 WTE Band 7 SMHP (Nurse) Appointed 1.0WTE Band 7 Social Worker Appointed 1.0 WTE Band 8a / 7 MHP Vacant 1.0 WTE Band 7 SMHP Vacant 1.0 WTE

Activity 1 - Current Pathways Inquire What links and services currently exist for this group of young people? Good Models: What do you feel is working well? Imagine What would you like FCAMHS to provide in order to help you support these young people?

Activity 2 – Training Opportunities Inquire Are there any topics that you would like FCAMHS to provide training to your team on?

Exercise 2 – Training requests Risk Assessments Specific clinical interventions

Non-Clinical Functions and Expected Outcomes of FCAMHS

What we do - Non-Clinical: Development of joint working arrangements Development of strategic links between local, regional and national networks. Identifying gaps in local and regional service provision. FCAMHS – leadership role. Provide training for practitioners from all agencies in relation to areas within the service’s specialist remit

Expected Outcomes Provision of clinical and non-clinical service functions Assessment in child’s locality/current placement Access, transition to and discharge from secure settings Admission to secure settings only when indicated Safe, timely and effective assessment Improve mental health and wellbeing by identifying and addressing mental health needs of high risk young people

Expected Outcomes (cont.) Minimisation of risk to self and others Individualised developmentally-appropriate framework of care YP and Family involved in decision making Safeguarding principles embedded in service Service accessible to all young people from the catchment area, even if currently placed OOA

THANK YOU