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

5. 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

6. 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.

7. 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

8. 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

9. Referrer – May 2014 – August 2016

10. Reduction in use of Paediatric beds
Between and , 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

11. 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

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

13. 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

14. 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

15. 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

16. (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

17. 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

18. 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

19. Thank you. clare.anderson1@nhs.net

20. 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

21. 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.

22. 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.

23. 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