Appendix 1
Schedule x Part x
SERVICE SPECIFICATION
Service
Specialist CAMHS Service for Children and Young People
including those Looked After by Hertfordshire County Council
Commissioner Lead
Janet Lewis
Provider Lead
HPFT
Period
1
Purpose
For CAMHS CLA Service and Social Workers to provide specialist services for children and
young people, their families and carers, who are:
-
Children Looked After
-
On the edge of care
-
Leaving care
-
Being repatriated from external care placements.
Including, unaccompanied asylum seekers that are minors.
The service will support their emotional well being and mental health, by providing a
community based resource for those who are experiencing mental health issues which are of
a moderate or severe nature.
This service will be provided for children and young people designated as “a child in need”
by Hertfordshire County Council CSF.
1.1
Aims
To work in partnership with other professionals in other agencies to promote and maintain
good emotional wellbeing and mental health, by addressing attachment needs and
improving placement stability.
To be the key worker, providing assessments and treatments for cases that meet the
threshold for involvement, including Child Protection cases where there are issues of mental
health and emotional well being, working as part of a multi agency and multi disciplinary
team.
To contribute to the development, delivery and review of services for children, young people,
their families and carers maximising the life of children and young people.
To deliver, as part of a multi-disciplinary Mental Health team, high quality, fully integrated
services in line with local policy and procedures and national legislation, regulation and
guidance.
Appendix 1
1.2 Evidence Base
Prominence is given to the mental health needs of children looked after in the government
report ‘Quality Protects and the principles in ‘Every Child Matters (2004) and the NSF
(2004) for Children, Young People and Maternity Services are reflected in the service
specification. This service contributes to national indicator 50 (NI50) that measures the
emotional health and wellbeing of children and young people and national indicator 58
(NI58) that supports the emotional and behavioural health of children in care.
In their 2007 report ‘Narrowing the Gap’, the inspection of children’s services, OFSTED
concluded that the biggest challenge continues to be narrowing the gap in opportunities,
provision and outcomes between the majority of children and young people and those that
are vulnerable or underachieving. Hertfordshire Children’s Trust Partnership (HCTP) has
adopted the challenge of narrowing the gap as a key theme for the 2009-2011 Children and
Young peoples Plan
In line with Working Together (2010), the Hertfordshire Safeguarding Children Board
Procedures (2010) and the requirements of the Children Acts (1989 and 2004), with direct
links to the Every Child Matters Outcomes, specifically ‘Be healthy’ (mentally and
emotionally healthy) and the National Service Framework for Children, Young People and
Maternity Services (Standard 9, The Mental Health and Psychological Well-being of Children
and Young People) To promote the Emotional Well Being and Mental Health of Children and
Young People living in Hertfordshire.
1.3 Objectives
All children and young people, from birth to their eighteenth birthday, who have mental
health problems and disorders have access to timely, integrated, high quality, multidisciplinary mental health services to ensure effective assessment, treatment and support,
for them and their families.
To ensure continuity of care is provided, using the ‘care programme approach’ when children
and young people are
a) Placed in an external placement or into an in-patient unit from the community
b) Discharged from in-patient services into the community
c) When young people are transferred from child to adult services,
1.4
Expected Outcomes

Contribution to effective and informed assessments of Children and Young People
where there are concerns with their mental and emotional health.

Delivery of and/or contribution to the care and/or therapeutic plans needed to meet
the identified needs of the Child or Young Person using the care programme
approach.

Therapeutic support, identified as needed, will be provided to address the impact of
trauma and other difficulties on social and emotional functioning.

Care plans and placements that meet the specific needs of a child or young person
based on effective assessment of the impact of their history of attachment traumas
and other difficulties.

Children and Young People are able to achieve and become economically and
emotionally independent
Appendix 1
2

Children and young people have healthy lifestyles free from alcohol and drug abuse

Young people are equipped to manage emotional stresses effectively, able to access
support where this is needed.

Young people with enduring mental health problems are well supported in transition
to adult services

Support offered recognises the unique and specific difficulties experienced by
unaccompanied asylum seekers

Parents and Carers are supported in managing the needs of children and young
people in their care, where issues of mental health and emotional well being impacts
on the child or young persons functioning.
Scope
2.1 Service Users
Any looked after child or young person aged up to their 18th birthday who are :
-
Children Looked After
-
Children who are either placed for adoption or who are adopted
-
Children who were looked after and now subject to Special Guardianship Orders
-
On the edge of care
-
Leaving care
-
Being repatriated from external care placements.
In the care of Hertfordshire County Council as the corporate parent, and NHS Hertfordshire
as the responsible commissioner.
Service Description
2.2
The service will provide integrated health and social care to children and young people
experiencing emotional and mental health problems by:
-
Providing input to core assessments to children going into care under the age of 10
years (these are seen as a priority group), with a view to capturing what they
requirements are and support the package of care that surrounds the child.
-
Providing support to care givers and CLA Teams by creating a central point of
contact (this could be a child and family clinic) where all referrals are logged.
-
Providing early intervention assessments to children entering the CLA system
(attachments and trauma) including a review of all care proceedings, and a clinical
review of core assessments. The early intervention assessment will support the
Core assessment.
-
Flexible outreach services to work with CYP in the most suitable setting for the CYP.
-
Clinicians/Social Worker to be part of the CLA Teams and locality and assessment
teams
-
A CAMHS professional attending the:
Appendix 1
2.2
o
Hertfordshire Access to Resources Panel on a weekly basis.
o
Inter Agency Panel on a monthly basis
-
Informing and supporting the care plan
-
Working with parents/carers to provide support to placements
-
Supporting learning and development
-
Being integral to the assessment process and provide advice for children and
families receiving support via the Herts Family Assessment unit.
-
Informing and managing risk assessments (court reports, LD, capacity to parent)
-
Supporting children with LD to achieve independence alongside the parents by
providing support to the LD residential units, respite units and foster carers.
-
Providing support, consultation and training to social workers, ARC, outreach
workers, foster carers residential staff and professionals working in children’s homes.
-
Providing policies, protocols, and resources to support the joint arrangements for
children with complex needs and young people as they transfer to adult care services
“Young person in hospital assessed by psychiatrist as having a drug induced
psychosis referred to CSF and accompanied by ongoing CAMHS support.”
-
Proactive engagement with children and families with a flexibility to meet family
needs, e.g. visiting at home, children centres or any other required setting.
-
Consultation on interventions for children with sexualised behaviour.
-
Contributing to the assessments by and providing clinical support to the asylum and
refugee team
-
Contributing to the multi disciplinary team at the Adoption Centre by providing a
therapeutic service in relation to permanency planning and adoption.
-
Contributing to support children subject to Special Guardianship Orders.
-
Providing consistent expertise and approach to delivery of therapies, and services.
-
Contributing to the Assessment of need and Pathway Plans for care leavers
Accessibility / Acceptability
Child and Adolescent Mental Health (CAMH) professionals provide a balance of direct and
indirect services and are flexible about where children, young people and families are seen
in order to improve access to high levels of CAMH expertise.
Concepts of mental illness and the understanding of the origins of children’s emotional and
behavioural difficulties vary across cultures. Services need to be sensitive to these
differences and ensure that staff are equipped with the knowledge to work effectively with
the different groups represented within the community they serve, in line with Hertfordshire
County Council’s policies and procedures with regard to Equality and Equal Opportunity
Appendix 1
3
Service Delivery
3.1
Service Model
It is expected that the Specialist CAMHS Service for CYP and CLA will work in partnership
with the following organisations:

Children, Schools and Families Teams

Adult Mental Health Services

Other child and young person mental health services

The CLA Health Team

Paediatric Services

Primary Care Services

Voluntary and Community Sector

Targeted Youth Service (where the 18 plus part of ISS is to be located)

A-DASH
The service will deliver a holistic approach to the assessment and treatment of each child
and young person.
Throughout 2010/11 there will be an increased emphasis on SDQ’s and these will be
monitored as part of this contract.
3.2
Care Pathway
Children looked after require a swift access to CAMHS services:
The Munro Review recognises that drift and delays in making plans for children have serious
adverse effects on their development:
“2 month of delay in making decisions in the best interest of a child or young person equates
to 1% of a childhood that cannot be restored” (ref??)

Initial Assessment reports to be completed within 7 working days. The assessment
process must incorporate home and communication with carers. This will ensure that
the home environment and the relationships within the home are considered as part
of the assessment. A school observation may also be undertaken.

CORE Assessments to be completed within 35 working days.

If more than a social work intervention is required a professional meeting will take
place in no more than 10 working days.

In order to improve transition from children’s services to adult services the CAMHS
team shall work with Social Workers in both CSF and ACS to promote smooth
transfer of services.

In the case of more referrals being made than the team can easily manage, priorities
will always be given to Hertfordshire’s most vulnerable children and/or children
whose mental health is putting them at risk of harm. If there is an ongoing capacity
issue, prioritisation will be discussed and resolved at the bi-monthly contract
management meeting.
Appendix 1
4
Referral, Access and Acceptance Criteria
4.1 Geographic Coverage / Boundaries
Child and Adolescent Mental Health (CAMH) professionals provide a balance of direct and
indirect services and are flexible about where children, young people and families are seen
in order to improve access to high levels of CAMH expertise.
4.2 Location(s) of Service Delivery
The service will be flexible in relation to locations and service delivery areas within the
county. There is an expectation that service delivery follows need and that HPFT will
allocate resources to reflect this throughout the period of the contract.
Local arrangements between CLA Teams and CAMHS will be agreed, but likely to be
delivered in the following settings:
Stevenage Child & Family Clinic
Southgate Health Centre Stevenage
(Satellite Clinic in Baldock & Hitchin
Welwyn Hatfield Child & Family Centre
51 Bridge Road East, Welwyn Garden City
Bishops Stortford Child & Family Clinic
Health Centre, Market Square, Bishop Stortford
Hoddesdon Child & Family Clinic
Hoddesdon Health Clinic
Hemel Hempstead Child & Family Clinic
Marlowes Health Centre
Watford Child & Family Clinic
Peace Children’s Centre
Borehamwood & Potters Bar Child & Family Clinic
Elstree Way Clinic
St Albans Child & Family Clinic
St Peters House St Albans
Forest House
Forest Lane
Harperbury
Farnham House
Six Hills Way,
Stevenage
SG1 2FQ
Apsley One
Brindley Way,
Hemel Hempstead,
Appendix 1
HP3 9BF
County Hall
Pegs Lane,
Hertford,
Sg13 8DF
An element of time allocated for the above services within Children’s Homes listed below:
Datchworth, Six Hills, The Barns, The Oaks, Woodland View, Ripon Road, Wilbury and
Woolmer Drive.
4.3 Days / Hours of Operation
Specialist CAMHS Clinics operate a Monday – Friday 9am to 5pm service. CAMHS Social
Work staff would be expected to work more flexibly where it is necessary to meet the needs
of the children and young people, their families and carers.
An on call three-tier duty psychiatric team provides out of hours support. This includes an on
call consultant psychiatrist who is available for telephone consultations regarding young
people presenting in crisis to the A&E service
4.4
Referral Criteria and Route
Urgent Referrals can be made by telephone by Carers and Professionals concerned with
looked after children and will be responded to within one working day. Written information
will need to be made available prior to the appointment
Non urgent referrals should be made in writing and an appointment will be offered within ten
working days. Anyone deemed appropriate would be invited to the initial consultation
appointment this will enable a common view to evolve on how best to address the child or
young person’s difficulties.
HPFT to create a single point of contact (this could be a child and family clinic) where all
referrals are logged with a view to the most appropriate part of the service being accessed
by the child and family.
4.5
Exclusion Criteria
None.
4.6 Response Time and Detail and Prioritisation
Urgent referrals will be offered an appointment in one working day.
Non urgent referrals will be offered an appointment in ten working days.
4.7 Training
The service workforce will be trained and appropriately qualified for the role that they are
undertaking.
The service workforce will be supported to work in multidisciplinary teams across
Hertfordshire to support children and young people.
Appendix 1
5
Discharge Criteria and Planning
The Discharge Letter referred to in clause 18.6.1 of the main contract shall contain basic
clinical information about the Service User’s treatment, including, without limitation:
(i)
the Service User’s demographics to whom the Discharge Letter refers;
(ii)
the dates of the Service User’s admission and discharge;
(iii)
the name of the Service User’s responsible lead clinician, Care Co-ordinator and/or
Key Worker at the time of the Service User’s discharge and to whom questions
about the contents of the Discharge Letter may be addressed, and complete and
accurate contact details (including a telephone number) for that person;
(iv)
details of any medication prescribed at the time of discharge;
(v)
any other relevant or necessary information or instructions, including follow-up
arrangements and appointments; and
(vi)
the Service User’s status under the 1983 Act at the time of discharge.
6
Prevention, Self-Care and Patient and Carer Information
TBC
7
Continual Service Improvement / Innovation Plan
Description of
Scheme
8
Milestones
Expected Benefit
Timescales
Frequency of
Monitoring
Baseline Performance Targets – Quality, Performance and Productivity
Performance
Indicators
Quality
Insert relevant
Vital Signs
indicators
Insert relevant
indicators from
National Indicator
Quality
Improvement
Programme
Indicator
Threshold
Method of
Measurement
Consequence of
Breach
Appendix 1
Performance
Indicators
Indicator
Threshold
Method of
Measurement
Consequence of
Breach
Method of
Measurement
Baseline Target
Threshold
Frequency of
Monitoring
Insert selected
indicators from
Transformation
Guides
Service User
Experience
Experience
Improvement Plan
Reducing Barriers
Personalised
Care Planning
Outcomes
[Any additional
local indicators]
Performance and
Productivity
Insert relevant
indicators from
Transformation
Guides
Improving
Productivity
Unplanned
Admissions
Access
[Any additional
local indicators]
Additional
Measures for
Block Contracts
Staff Turnover
Rates
Sickness Levels
Agency and Bank
Spend
Contacts per FTE
9
Activity
Performance
Indicators
Appendix 1
9.2
Activity Plan / Activity Management Plan
To be monitored and managed through the Contract management meetings.
9.3
Capacity Review
To be monitored and managed through the Contract management meetings.
10 Currency and Prices
Basis of Contract
Currency
Price
Thresholds
Expected Annual
Contract Value
Block / Cost and
Volume / Cost per
Case / Other *
Total:
* delete as appropriate
£
£