The CAMHS/HeadStart Project Officer advised the scrutiny panel that work had been undertaken with the Head of Service for CAMHS to identify rates of referral. In respect of Middlesbrough's children and young people, Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) CAMHS had reported a dip in referrals for specialist support, which was attributed to the introduction of HeadStart early help support in schools. Referrals submitted by schools, over the past 3 years, had been:-
2015/2016 - 2,600
2016/2017 - 1,400
2017/2018 - 1,700.
The dip in referrals equated to non-recoverable savings of £600,000. TEWV were redirecting savings into early help provision, which included providing additional staff resource to the HeadStart delivery in schools.
The Project Officer advised Members that in 2015 the Governments Future in Mind (FiM) report was published. The report highlighted the need to make dramatic improvements in childrens mental health services and highlighted that although the needs of young people continued to increase, investment and services were insufficient in meeting demand. The report set out five key themes that planned to enhance a systemic changed approach to improve childrens emotional wellbeing:
Promoting resilience, prevention and early intervention
Improving access to effective support system without tiers
Care for the most vulnerable
Accountability and transparency
Developing the workforce
Local areas were challenged to achieve this systemic change by 2020. Members heard that a local programme of transformation commenced in 2014, following a £1 million Big Lottery grant that had been awarded. The grant was awarded to develop a local approach to support the emotional and mental health of children and young people at an early stage. The funding was invested in testing a new model of support in school, the home, the community and through digital solutions. Following the end of the Big Lottery grant, FiM, Public Health and Middlesbrough Achievement Partnership allocated funding to roll out the tested HeadStart model. The HeadStart, theory of change model, was attached at Appendix 1 of the submitted report.
The scrutiny panel was advised that current funding came to an end in August 2020. A number of external funding opportunities were being explored and a sustainability plan was in development.
HeadStart was a prevention and early intervention delivery model, which aimed to improve the resilience of pupils to enable them to cope with the pressures of life and to prevent the onset of common mental health conditions. Wherever possible, the model was adapted to suit the needs of individual schools. All of Middlesbrough's mainstream primary and secondary schools were now engaging with the HeadStart Programme.
The Project Officer informed the scrutiny panel that there were five key features of HeadStart:
Workforce development to upskill staff to better understand and cope with pupil emotional and mental health. The educational pathway was available to all school staff, regardless of their role.
Emotional well-being practitioners based in all schools providing universal support at an early stage.
Transition support for years 6 - 7 and years 11 - 12.
Accredited training to create HeadStarter pupil mental health champions.
A single referral point for emotional wellbeing practitioners, CAMHS clinicians and school nurses, was currently in development. Implementation planned to establish an integrated pathway of support.
The scrutiny panel heard that another key feature was Tootoot, an online digital referral tool. As part of HeadStart, schools were given a one year license for the tool. The tool enabled children and young people to report anything from bullying to a mental health concern. The simple-to-use app made it easier for students to speak-up and gave them confidence that their concerns were being taken seriously. Tootoot came packed full of insightful reports and metrics that enabled schools to discover trends and identify whether safeguarding and wellbeing measures were effective. It was commented that the tool was used more widely in secondary schools.
The scrutiny panel heard that work was underway with sixth form and further education colleges to introduce the HeadStart model. The work was progressing well with all colleges engaging in the process. To support delivery and development of that work, the team was currently awaiting to be informed whether a bid, for £50,000 from Nesta, had been sucessful.
The Project Officer advised that in respect of the accredited training to create HeadStarter pupil mental health champions, champions had been recruited in 32 schools with 250 guided learning hours delivered. The training was the first accredited pathway for youth mental health champions in the country. The first accreditation had been achieved by a group of Sunnyside Acacemy pupils. An article detailing the postive work of the pupils had been published on the Council's website. The pupils had recently been accredited with a silver award. There were three standards that were awarded to schools - bronze (introduction), silver (involvement in a community project) and gold (presentation of learning to others). The training was available to all schools across Middlesbrough. There were currently 285 HeadStarters across the town.
The Project Manager commented that future work was being planned to arrange a conference for the HeadStarters.
In response to a Member's query regarding staffing, it was advised that the HeadStart model was currently delivered by three members of staff - The CAMHS Transformation/HeadStart Programme Manager, the CAMHS/HeadStart Project Officer and the HeadStart School Development Officer. An apprentice also worked with the team.
A discussion ensued regarding concerns for future funding/delivery of the HeadStart Programme.
The Mental Health and Emotional Wellbeing Service Manager from the Junction Foundation advised that funding for Reach Partnership ended in July 2019. Members were advised that early help for pupils was delivered by the Reach Partnership.
The scrutiny panel was advised that Reach was delivered by three Voluntary Community Sector (VCS) organisations (the Junction Foundation, the Link in Redcar and Middlesbrough MIND). Reach delivered one to one support, counselling and therapeutic group work to pupils across Middlesbrough. Primary schools were allocated a practitioner for half a day per week and secondary schools were allocated one full day per week.
The work of Reach was aimed at young people at risk of emotional or mental health difficulties and those with existing mild to moderate difficulties. Two thirds of pupils referred to Reach presented with anxiety and low mood. Group work was flexible according to the needs of the young people and the school, but mainly focussed on raising awareness of emotional well-being, building resilience and teaching coping strategies, including work on issues such as confidence and self-esteem, stress, anxiety, low mood and anger.
Reach engaged with approximately 350 pupils per year. There was a team of two co-ordinators that worked with approximately 15 counsellors/emotional wellbeing practitioners.
In terms of impact, Reach outcomes were reported as approximately 74% positive change, 18% no change and 7% negative change. It was explained that when a negative change had been reported, education and local statutory services were consulted to determine an alternative pathway.
The current referral time for Reach was around 6 weeks, however, as a result of HeadStart's training opportunities, schools had the opportunity to provide interim one-to-one pastoral support in the meantime. It was also advised that Reach worked with groups, in respect of common presentations such as anxiety, to ensure pupils received support in the interim period.
With current funding ending in July 2019 for Reach, a discussion ensued regarding the impact on staffing, delivery of therapeutic services and CAMHS referral rates. Future funding opportunities were discussed at length and Members were made aware that schools had access to funding, which could have been utilised to sustain the HeadStart Programme and Reach Partnership in future.
AGREED as follows:
That the information presented at the meeting be considered in the context of the scrutiny panel's investigation.