1. BOND Tees Valley Pilot Workshop 5 12.7.12

3. Re-cap on what we have learnt during workshops Barriers and challenges Input from the BOND team Reflections on the learning

4. Commissioners – with a budget and an interest in supporting CYP emotional and mental health in order to improve their outcomes i.e. health, education, welfare, etc Providers of not-for-profit services for CYP which provides therapeutic or psychological interventions, and/or support to CYP with mental health problems

5. CVSOs have an important role to play and often offer good access in local communities, to a broad range of services Commissioners need to be confident in the VCS CYP mental health is often perceived as statutory CAMHS’ business – demand for clinical services outstrips capcity Early intervention works and is cost effective Schools increasingly engaging in commissioning – and need to know about VCS services Need a broad range of services to meet a broad range of need

6. Access Service ‘tiers’ 14

7. Mental health expertise Service ‘tiers’ 14

8. Mental health expertise Service ‘tiers’ 14 Access GP LA School

9. Mental health expertise Service ‘tiers’ 14 Access School Counselling Activity based Mediation Young Carers D.V. Drop in Mental Health Services

10. Funding Competition vs partnership Specialist vs generic Statutory service domination of partnerships Capacity to compete –process excludes smaller organisations or less ‘networked’ VCSOs New requirements e.g. PBR, outcome measures Business planning on shifting sand– personnel, policy, environment Need for new business approaches – marketing, cost benefit analysis, etc

11. Ensuring services are ‘safe’ and high quality Fully understanding the market Developing services for the most difficult to reach groups Ensuring timely access to appropriate MH expertise in the right part of the system Identifying best value for money

12. Identifying pupils with a mental health problem and getting help quickly Want to refer directly to CAMHS Want information back from services about pupils so that can help them in school setting Knowing what works and the difference between services Services must show an impact on a pupils’ ability to learn

13. Opportunities for… External Environment -Market and competition -Commissioning and delivery system -Policy and drivers -MH spectrum/definitions -Commissioning environment -Quality assurance Information gathering & exchange Identifying critical issues and barriers

14. Tier 4: Inpatient Care Infrequent competition amongst larger MH provider trusts Some variety of providers More frequent tendering + increasing competition (usually LAs, NHS) Numerous providers + commissioners Large + small organisations More VCS Less clinical governance Smaller contracts Frequent tendering Tier 3: Clinical/ medical care (diagnosis/ medication) Tier 3/2 interface: Primary MH services LAC, YOS, other targeted CAMHS Tier 2/1 interface: ‘Generic’ School + community based e.g. counselling + IAG services Related services e.g. drop-in, youth support, family support Limited contestability Increasing levels of competition

15. Emotional wellbeing, mental health, mental disorders? Early intervention mental health services? Types of interventions Settings/age groups TaMHS Evidence based practice?

16. Children at risk; in need; Social Care vulnerable Children with emotional and behavioural difficulties; Education special needs Children with mental illnesses; psychiatric disorders Health

17. Flourishing Moderate mental health Languishing Mental disorder From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being Number of symptoms or risk factors

18. FlourishingModerate mental health Languishing Mental disorder From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being Number of symptoms or risk factors

19. Category Types of work included 1. Social and emotional skills development of pupils Social and Emotional Aspects of Learning (SEAL) programmes, Nurture groups and Circle time 2. Creative and physical activity for pupils drama, music, art, yoga, outward bound activities 3. Information for pupilsadvice lines, leaflets, texting services, internet based information 4. Peer support for pupilsbuddy schemes, peer mentoring 5. Behaviour for learning and structural support for pupils behaviour support, behaviour management, celebrating success, lunchtime clubs, calm rooms 6. Individual therapy for pupilscounselling, cognitive and/or behavioural therapy 7. Group therapy for pupils interpersonal group therapy, cognitive and/or behavioural therapy groups 8. Information for parentsleaflets, advice lines, texting services, internet based information 9. Training for parents parenting programmes such as Webster Stratton and Triple P programmes 10. Counselling/ support for parents individual work for parents, family therapy, family SEAL – can include children and parents or just parents, or a combination 11. Training for staffspecific training from a mental health professional 12. Supervision and consultation for staff on-going supervision or advice from a mental health professional 13. Counselling/ support for staffprovision to help staff deal with stress and emotional difficulties Types of mental health work in schools (from TaMHS national evaluation 2012)

20. Level of evidenceType of evidence 1++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias 1+ Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias 1– Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias* 2++High-quality systematic reviews of case–control or cohort studies High-quality case–control or cohort studies with a very low risk of confounding, bias or chance and a high probability that the relationship is causal 2+ Well-conducted case–control or cohort studies with a low risk of confounding, bias or chance and a moderate probability that the relationship is causal 2– Case–control or cohort studies with a high risk of confounding bias, or chance and a significant risk that the relationship is not causal* 3 Non-analytic studies (for example, case reports, case series) 4 Expert opinion, formal consensus *Studies with a level of evidence ‘–‘ should not be used as a basis for making a recommendation

21. Commissioning (what’s involved? Where does procurement fit in? CYP participation?) Outcomes? Value for money?

22. Identify needs Outcomes? Plan and design pattern of services Look to the market - Does it provide what we need? Tender & Procure Disinvest? Develop market? how well is the service delivering outcomes? What have we learnt about needs? Resources? Priorities? Strategic process for allocating resources

23. Weak Commissioning  Historically and provider led  Little effective challenge Adequate Commissioning (status quo)  Good control over existing contracts  Narrow approach to commissioning around procurement and purchasing Effective Commissioning  Commissioners engaging with communities on the pattern of services required  Commissioners shaping structure of delivery  Active redesign of services  Personalisation  Decommissioning Intelligent Commissioning Maximise value from total local public sector budget Outcome driven Empowering users and local communities Widespread embracing of behavioural change Some community led commissioning Semi-autonomous personalisation Driven by customer experience Aiming to be here…. Many organisations operate here REACTIVE COMMISSIONING

24. Volunteer capacity (how cost effective is this?) Organisationally held knowledge and expertise Non-profit making – will this demonstrably make it cheaper than the competitor’s? Local brand (how strong is your brand? What is the perception locally?) Accessibility and less stigma - how do you demonstrate the benefit? Attract other funding – have you promoted your track record?

25. Twelve compulsory components must all be evidenced to demonstrate the provider is “commissionable”. These are spread across: Accountability Compliance Empowerment... with an opportunity to shine through evidence of added Values The ACE–Value Commissioning Ready Framework

26. Increased access to psychological therapies (IAPT) Payment by Results DfE – devolved decision making – pupil premium Funding environment for VCS Health reforms…

27. NHS NHS Commissioning Board Monitor (economic regulator) Clinical Commissioning Group Department of Health CQC (quality) Providers Public Health England (Local health improvement in LAs) Local authorities (via health & wellbeing boards) HealthWatch Local HealthWatch

28. The only constant characteristic is change Competition is increasing Have to look outside usual funding sources Some providers are joining together in order to try and strengthen position of VCS Relationships are highly valued and building trust and reputation remains important Communication from and between services and schools is part of quality provision

29. Opportunities for… External Environment -Market and competition -Commissioning and delivery system -Policy and drivers -MH spectrum/definitions -Commissioning environment -Quality assurance Information gathering & exchange Identifying critical issues and barriers Internal Environment VCSOs… where are you in this? Marketing Cost effectiveness VfM Outcomes

30. In ‘discipline’ groups As a result of the workshop programme; - what have you been prompted to think about - changes you have in mind to make - any action you have taken already Prompts on sheets to help Discuss and record main points

31. Opportunities for… External Environment -Market and competition -Commissioning and delivery system -Policy and drivers -MH spectrum/definitions -Commissioning environment -Quality assurance Information gathering & exchange Identifying critical issues and barriers Internal Environment VCSOs… where are you in this? Marketing Cost effectiveness VfM Outcomes What does this mean for our… Review Change management Organisational Plan Based on strategic plan Vision Mission Strategy Local external environment Participate Influence Challenge Find out Needs & priorities? Partnership? Competition? Opportunities? Based on Bryson, J. 1988