Agenda item

(1)          The Chairman welcomed Susan Cruickshank to the meeting. She was accompanied by Jo Scott (Programme Director - Kent and Medway Children Young Peoples Services, Sussex Partnership NHS Foundation Trust).

 

(2)          Susan outlined her role as the Clinical lead for the Children in Care (CIC), Children & Young Peoples’ Mental Health Service (ChYPS) in Kent and Medway.  She explained that KCC made a significant contribution to this service which provided mental health services to support Kent and Medway children placed with foster carers and in care homes.   It was a specialist service targeted at Kent and Medway CiC but not children who had been placed in Kent and Medway by another local authority.   CiC that had been placed in Kent were supported by the mainstream ChYPS service.  

 

Q – How many Kent and Medway CiC do you support and how many CiC placed in Kent are supported by the mainstream CAHMS service?

 

(3)          Susan stated that there were 450 Kent and Medway CiC who were currently accessing the service.  There were 20 non Kent and Medway CiC placed in Kent who were identified as accessing the mainstream ChYPS.

 

Q – Are these children spread across the County?

 

(4)          Susan replied that the majority of looked after children were placed in the Thanet area.  However, the volume of referrals vary and where they access the service would depend on where they are placed not where their social worker was based.  She stated that there were CIC team members in all 4 ChYPS hubs  located across the County and data was being complied on which areas referrals were coming from.

 

Q – As you have stated that 20 CiC placed in Kent accessing the mainstream CAHMS, these means that those who have tier 2 or tier 3 needs are not getting a service is that the case?

 

(5)          Jo explained that a lot of these young people are referred into the mainstream service via an emergency service.  If these young people are referred by their GP and meet the threshold for access to the mainstream ChYPS then they receive a service.  Also some of these CiC may receive support from the CAMHS teams in the area which they come from.  She acknowledge that the number reported as CiC accessing the mainstream service in Kent and Medway was surprisingly low and there may be under reporting.  Jo undertook to supply the Committee with the up to date figures for these CiC accessing Kent and Medway services.

 

Q – Can you explain why CiC need a special CAMHS?

 

(6)          Susan stated that this was a complicated question.  She explained that prior to coming into the care system, young people are likely to have experienced a range of traumatic events e.g. neglect and abuse. Whereas the majority of mainstream young people are less likely to have had such traumatic experiences in their earlier years, therefore CiC were at a disadvantage because of the range of problems that they had experienced. Some children were more resilient than others and were able to get on in the world but some did end up needing specialist interventions. Also there were some CiC in tier 4 inpatient beds  because they needed intensive mental health support that can only be provided in an inpatient setting. 

 

Q – In relation to the Troubled Families programme, 55% of those in the programme needed support from CAMHS and could potentially become CiC, do you support this programme?

 

(7)          Jo stated that we are not aware of the statistics quoted and therefore cannot comment on the accuracy of the 55% quoted.  The ChYP service is part of a network of provision including well-being services.

(8)          Susan referred to the Hackney Model which had a dedicated team of social workers who were trained to support young people who were on the cusp of being taken into care.  She agreed that the Troubled Families initiative was a great addition to KCC service.  She offered to supply written evidence to the Committee on the Hackney model.   In relation to young people on the cusp of becoming a CiC as they were not LAC they would not meet the criteria for the CIC team.  

 

Q – From evidence that we have heard from foster carers and Independent Review officers, it is evident that CiC had appointments with various professionals during the school day, foster carers in particular felt that this impacted upon the CiC parity of esteem with their peers.  Do you have any suggestions as to how this impact can be minimised by professionals working together? 

 

(9)          Susan stated that she was an advocate of the Hackey model, she had worked with mental health and social workers for 27 years and she had seen in recent years an erosion in the confidence of social workers to work directly with children.  Social workers needed support and the Hackney model provided this.

 

(10)       Susan explained that the CIC team tried to promote good mental health without needing to see the child, this could be done where possible by skilling up the network around the child, which was frequently better for the child than sitting in a room with a therapist.  She had seen evidence over the past 12 years that this had worked and the less people involved with the child the better.  She had found that often people, such as foster carers wanted the child to attend a therapy session but also wanted to prescribe when this should be held.  She stated that secondary school aged CiC were prioritised for 3.30pm onwards appointments. 

 

(11)       In relation to a child with attachment problems, Susan stated that it was more appropriate to promote a safe foster carer placement rather than seeing a therapist. 

 

(12)       I also offer support to staff in schools to carry out low level work with children for example play therapy, she did not advocate taking children out of school for therapy unless it was absolutely necessary to do so.  However, if it was a case of a child being taken out of school to receive one hour’s therapy in order to support them to be better able to work at school then a balance needed to be struck.

 

(13)       Jo pointed out that the appointments also needed to be convenient for the person giving the child a lift.

 

(14)       Susan stated that she had evidence of people putting a child in a taxi to attend an appointment but she did not think this was appropriate. 

 

(15)       Susan stated that 8% of the caseload of CAMHS was CiC with CiC making up 1% of the general population.

 

Q – Are there staff in place to upskill social workers to provide the necessary support?

 

(16)       Susan stated that there was a 9 to 5 duty clinician available to provide advice and support for an professional including social workers, this was an ongoing piece of work which still required some tweaking. 

 

(17)       Jo stated that there was inconsistency across Kent in relation to how well this service was used.

 

Q – Could you expand on what early interventions you have in schools for CiC please.

 

(18)       Susan stated that the Virtual Schools model has had a positive impact on academic attainment for CiC.  The CIC team had a good working relationship with the Kent Virtual School.  In the mainstream school system there was one designated Teacher for LAC in each school. 

 

(19)       Susan explained that there were only 13 full time staff in her team and therefore it was not possible to visit all schools. 

 

Q – What are you views on the current CAHMS contract?

 

(20)       Susan stated that things were now different regarding multi agency working.  She mentioned that Ofsted in 2013 had indicated some areas for improvement.  She referred to the significant amount of money that the local authority spent on assessment during care proceedings for CiC and also referred to the Hackney model. 

 

Q – If we introduce the Hackney Model what percentage what referrals be reduced by?

 

(21)       Susan stated that the benefits of a specialised CAMHS service for CIC was the level of need  70% of CiC were likely to develop some kind of mental health problem and therefore there needed to be a systematic approach.

 

Q – Why are CiC excluded from wellbeing services?

 

(22)       Susan highlighted that currently the wellbeing services commissioned by KCC exclude LAC which is a problem as the Sussex Partnership Service works as part of a network of provision to support young people of all levels of need.  The decision to exclude will have been a KCC decision and todo with access being via CAF in some cases it was what these young people needed.

 

Q – Are GP’s able to refer CiC for a Family Common Assessment Framework (fCAF)?

 

(23)       Susan explained that CiC were automatically in this system and therefore they did not have a fCAF. 

 

Q – When a child leaves care does the CAHMs follow them?

 

(24)       Susan explained that because KCC who had commissioned the service did not have corporate parent responsibility for the young person unless a home or care order was in place we close the case and refer on if there is alternative provision.

 

(25)       Jo confirmed that if the young person was being seen by the mainstream service then this would continue. 

 

(26)       Susan explained that she worked with the Kent and Medway Partnership Trust regarding the referral of a young person from the CAMHs to the adult service.  This was monitored on a monthly basis. She stated that she liked to think that children accessing the CAMHs had improved mental health. 

 

Q – Are you seeing an increase in the number children and young people referred as a result of mum’s excess alcohol consumption in pregnancy?  What impact does foetal alcohol syndrome have on a child’s mental health?

 

(27)       Susan explained that unless there were obvious facial features, it was not until the child went to school and was slow to develop that this problem would be picked up.  She stated that there was only one psychiatrist in the county who specialised in this area of work, foetal alcohol syndrome was an under researched area.

 

Q – How can we get the much needed integrated approach to supporting CiC?

 

(28)       Jo stated that arguably anyone who worked with a CiC, e.g the school, health service and social workers should work together, however she acknowledged that the system was often not good at doing this and that there was not a reliably cohesive whole service around a young person.

 

(29)       Susan stated that there was a need to weigh what people were asking for against what it was possible to provide.  It was important to focus on what could be achieved rather than set services up to fail.   The key was establishing how to meet the needs of the child with the pot of money and services available.  Outcomes needed to be realistic “think child - think family” and then how this can be commissioned.

 

Q -  Do professionals and commissioners ever sit down in the same room to discuss the problems?

(30)       Susan stated that one of the positive things to come out of the service that she managed was the good relationship with the commissioning officers and therefore when problems occur we look for solutions.

 

(31)       Jo mentioned the need to focus on the core issues for specific areas at district or multi-district level rather than at county level. 

 

Q – Would “west Kent” be too large an area to focus on?

 

(32)       Susan explain that it would depend on the population, if you looked at the number of CiC, there were not many in Sevenoaks compared to Thanet.

 

(33)       The Chairman thanked Susan and Jo for attending the meeting and for answering questions from Members, their responses had been very helpful.