Sub-theme: Joint Working; Future Development

Ease of Access: Being able to access services quickly and appropriately was reported as being important to all the participants. The participants being able to meet together to discuss referrals was valued as a way to make appropriate referrals to the appropriate agencies, to share workload and reduce waiting lists, with the result that some referrals were not made following advice being given. When participants were asked how they would take the pilot project forward they all referred to the importance of working as a multi-agency team:

78 “In an ideal world, we would all sit and work together….

and agree things as a team.” SS1 Page174, line 152-153

“You’d respond to the young person’s need, … you’ve got the professionals at the table, … that means they (YP’s) get the right thing.” CW1 Page 199-200, line 293-295

“More open discussions and more closer working.” EP2 Page 167, line 249-250

All the participants referred to the waiting lists for CAMHS services and felt that children were not able to access services when they were needed. Participants reported wanting to be able to offer support and intervention before a child is in crisis. EP 1 saw the purpose of the Pilot Project as being an exploration of how CAMHS might provide early intervention and together with CW2, identified early intervention as making support more effective:

“The pilot is to broaden out our understanding of what CAMHS can do at a much earlier stage and I think the pilot has enabled us to see that in joint consultation at a very early stage”

EP1, Page 153-154, line 57-59

“We are seen as a mental health service and that definition alone you have to have a diagnosis under the ICD-10…. you’ve got to be in crisis.” CW2 Page 214, line 174-179

79 Capacity Building: EP1 and CW2, referred to the strategic goal of building capacity within schools to support children with mental health needs. CW2 talked extensively about moving resources to support teachers and practitioners in schools in managing and supporting children’s mental health. She also felt that that school was the appropriate place for this support to take place as it was without ‘stigma’ and she also felt working in schools meant that the wider family would be more likely to access support meetings.

EP1 talked about improving school systems and developing systemic ways of managing need with school senior leadership teams. She felt that this would be a more time effective way of managing resources, as opposed to responding to individual need. EP1 also talked about providing staff in schools with the training to develop the skills and the confidence to undertake work related to mental well- being, with the ultimate goal being that:

“They (school staff) are doing that initial bit of the assessment and planning interventions themselves….. reducing the need for targeted and specialist services.” EP1 Page 157-158, line 171-173

School staff reported how working with and meeting CAMHS and EPs was what they wanted in the future, but also how the effect of this close working was giving them confidence in their own practice:

“There’s nothing better than when an EP or CAMHS sits down and says actually the advice you’ve given that family or that young person is exactly what we’d do. So it makes you feel that for the next person who comes along we don’t need to ring you.” SS2 Page 185, line 202-205

Interestingly, those participants with management responsibility and responsibility for staff; EP1, CW2 and SS2 all talked about building increased capacity in

80 schools staff, whereas the other three participants talked about their hopes for capacity building in the future, but made more reference to the obstacles that might prevent this. Namely; time and resources. EP1 referred to how he hoped to have more of his time ‘commissioned’ for joint work, CW1 referred to being able to have as many EP assessments as needed and SS1 wanted time to do direct work with children:

“That’s my ideal world. To be able to work with the kids…” SS1 Page 177, line 232-233

“You know just spending time with your kids. That’s all they need sometimes.” SS1 Page 177, line 242-243

Another strand of capacity building was training. The training was mentioned by all of the participants at varying points through the interviews. CAMHS and EPs saw themselves as the training providers, but CAMHS put greater importance on the training being delivered having a united message. EP1 talked about how the opportunity to deliver shared training was also an opportunity for EPs and CAMHS to share expertise.

Consultation: While all the participants reported that meetings with one another were useful for promoting understanding between one another and developing relationships, it was the shared consultations that were reported to be most useful in supporting young people. Every participant mentioned the importance of these consultations, where children and families were discussed and the information supplied reflected upon, sometimes group problem solving strategies were used and a plan of action, with roles and responsibilities, was minuted.

“I think one of the things it (the pilot work), clearly shows is that it works better when all the professionals are in the same room having a discussion, that multi-agency way of looking at things CW1 Page 198-199 line 262-265

81 Participants also referred to how the consultations directly informed the plan to support young people, but were also a way of sharing knowledge and expertise.

“The consistent message, the joint consultations, the feedback has been phenomenal….. they feel that something different has occurred.” CW2 Page 212, line 130-132

“So we’ve offered training around attachment, anxiety… then we’re able to draw on that in consultation, so all that skilling up has facilitated things.” EP1 Page 156, line 115-117