The Mental Health of Children and Young People: A Framework for Promotion, Prevention and Care

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7. Additional and Specific Supports

Context

7.1 Evidence suggests that some groups of children and young people are at greater risk of developing mental health problems than their peers. There is also evidence to suggest that some groups are likely to find more difficulty accessing support and help that they need. Additional or specific action is required to ensure that these children and young people are able to access support for their emotional and mental health and wellbeing across promotion, prevention and care.

7.2 Among those at greater risk of developing mental health problems are children and young people:

  • Who are or have been looked after or accommodated, including those adopted from care
  • Who have experienced or are at risk of neglect or abuse (including domestic abuse)
  • Who have a learning and/or physical disability (or multiple variations thereof)
  • Who have a chronic or enduring illness (including mental illness)
  • Who are from homeless families or who are homeless
  • Whose parents have problems of illness, dependency or addiction
  • Who are refugees or from asylum-seeking families
  • Who are gay, lesbian, bisexual or transsexual
  • Who are at risk of or involved in offending, or are in custody
  • Who are from ethnic minority or cultural minority backgrounds (including travellers)
  • Who have communication difficulties
  • Whose parents are in prison
  • Who have experienced trauma/loss
  • Who are involved in custody or access disputes

This is not an exhaustive list.

7.3 All agencies and professionals in contact with children and young people have a shared responsibility for protecting and safeguarding their welfare. However, it is the core function of children and families social work to safeguard and promote the welfare of children in need. On behalf of local authorities, social work services carry out statutory duties under the Children (Scotland) Act 1995 76 including the identification, assessment and support of children in need; provision of support to families; provision of assessments and information to the Children's Reporter and Children's Hearings; provision of services to children with and affected by disability; the protection of children who may be at risk of abuse and neglect; services to looked after and accommodated children including fostering, residential and after care services, and adoption services. Social work services intervene in the lives of some of the most vulnerable children and their families and have a key role to play in promoting their mental health and wellbeing through identifying and assessing needs and risks and delivering help and support to build resilience and protective factors.

7.4 Within the NHS, hospital and community child health services have an important role in early identification and early intervention for children and families where emotional and behavioural problems are emerging alongside physical health problems. Community child health services have a particularly important role in providing and co-ordinating appropriate services for children and young people with complex needs, in close partnership with local authority and other partners.

7.5 The Additional Support for Learning (Scotland) Act 2004 provides a further legislative framework for assessing and meeting the needs of children and young people, whatever those needs might be.

Overarching philosophy and culture

7.6 Although there are many factors which are well established as increasing children's vulnerability to mental health problems, there are also many protective factors which need to be considered and supported. These include an individual child's attributes, their relationship with a range of others including their families and their peers, and the availability of support networks, such as befriending schemes. Any assessment of a child's needs, whether formal or informal, should therefore focus on their strengths and skills as well as their difficulties.

Service elements and activities

* In the "Lead Partners" column, 2-3 partners are identified, with the suggested lead partner highlighted in bold. This is indicative only, and there is a much wider network of partners who should be consulted as appropriate. These are listed in Annex 1. The involvement of children, young people, parents and carers is assumed.

Service Elements

Activity

Outcomes

LEAD Partners *see above

Proactive multi-agency liaison to establish specific local policies and procedures to identify and support those in need of additional or specific emotional support in a range of contexts

  • Multi-agency liaison to undertake a local needs assessment to identify groups of children and young people requiring additional or specific emotional and mental health support.
  • Service redesign and joint commissioning of support services to meet need.
  • Establishment of formal inter-agency information sharing protocols in relation to families at risk and in need of multi-disciplinary support.
  • Integrated assessment, care planning, service delivery and review for children and families in need of additional support.
  • All policies, procedures and practices relating to children and young people in need of additional support have an explicit mental health promotion element.
  • Integrated delivery of accessible support services for children, young people and their parents/carers.
  • Referral protocols and pathways for NHSCAMHS are agreed and transparent.
  • Social work services
  • Education authority
  • NHSCAMHS staff (inc. Primary Mental Health Workers)
  • LAC health staff
  • NHS child health services

CAMHS contribution to the health assessment of individual children and young people

  • Assessment of the mental health needs of children and young people as part of any health assessment, including environmental and social factors which might impact on the mental health of the young person.
  • Interventions offered by appropriately qualified staff on the basis of mental health needs assessment.
  • Establishment of formal, shared assessment protocols.
  • Input to parent/carer held health records.
  • All of the child's or young person's needs are assessed to inform holistic care planning.
  • NHSCAMHS staff (inc. Primary Mental Health Workers)
  • Social work services
  • Education staff (and in particular, LAC Designated Teachers)
  • LAC health staff

Provision of general training, consultation and support on the emotional and mental health needs of particular groups for:

• Residential care workers

• Foster carers

LAC Designated Teachers

• Respite carers

• Adoptive parents

• Social workers

• Housing staff

• Youth justice teams

• Police

• Children's Reporters

• Members of the Children's Panel

• Safeguarders

• Adoption Panel members

• Foster Panel members

• Child Protection Committee members

  • NHSCAMHS staff work with local authorities, constabularies and the Scottish Children's Reporter Administration to plan, provide and review training opportunities in mental health for staff who work with or make decisions about children and young people with additional support needs.
  • Provision of ongoing consultation and support to these staff by NHSCAMHS.
  • Development and agreement of referral protocols with key partner agencies.
  • Regular planning and review meetings between NHSCAMHS and key partner agencies on service delivery and assessment for vulnerable children and young people.
  • Establishment of explicit arrangements within each NHSCAMHS team for looked after and accommodated children and young people, including those placed in substitute family care, children's homes, residential schools and secure care (whether in the statutory or independent sector).
  • Establishment of explicit arrangements for staff supervision and opportunities for mentoring when dealing with children and young people with additional requirements.
  • Parents/carers and staff have a basic understanding of emotional and mental health and development.
  • Parents/carers and staff recognise the importance of their contribution to children's emotional and mental wellbeing.
  • Parents/carers and staff have a basic understanding of protective factors and how these can be nurtured.
  • Parents/carers (including prospective parents/carers) and staff know what specialist advice and support is available to them and how to access it.
  • Referral protocols and pathways for NHSCAMHS are agreed and transparent.
  • Social work services
  • NHSCAMHS staff (inc. Primary Mental Health Workers)
  • LAC health staff
  • CPD Co-ordinators

Provision of training and consultation on specific mental health issues ( e.g. aggressive behaviour, self-harm, ADHD) for:

• Residential care workers

• Foster carers

LAC Designated Teachers

• Respite carers

• Adoptive parents

• Social workers

• Housing staff

• Youth justice teams

• Police

• Children's Reporters

• Members of the Children's Panel

• Safeguarders

• Adoption Panel members

• Foster Panel members

• Child Protection Committee members

  • NHSCAMHS staff work with local authorities, constabularies and the Scottish Children's Reporters Administration to plan, provide and review topic-specific training opportunities for staff who work with or make decisions about children and young people with additional support needs.
  • CAMHS input to child protection training and systems.
  • Parents/carers and care staff understand the child or young person's behaviour and feel confident in responding.
  • Parents/carers and care staff are supported and feel confident in implementing specific approaches to address these issues.
  • Social work services
  • NHSCAMHS staff (inc Primary Mental Health Workers)
  • LAC health staff
  • CPD Co-ordinators

Input to adoption and fostering panels, child care reviews and Children's Hearings

  • CAMHS staff contribute to the work of adoption and fostering panels, child care reviews, Children's Hearings, and other decision making fora for children and young people in need of specialist care.
  • Panel members and decision makers understand issues relating to mental health and wellbeing and the impact of particular life events on care and support needs.
  • Adoption, fostering and Children's Hearing panel members and decision makers are able to identify children at risk of poor mental health.
  • Children and young people in high risk groups, or whose mental health is a matter of concern, receive assessment of their needs and therapeutic help and support from appropriately qualified professionals.
  • LAC health staff
  • NHSCAMHS staff (inc. Primary Mental Health Workers)
  • NHS community child health services
  • Specialist adoption staff

Accessible and confidential support for looked after and accommodated children and young people, those adopted from care, and those who have been abused

  • Work with the local authority to plan and provide non-stigmatising and readily accessible counselling support for looked after and accommodated children and young people.
  • Involvement in the development and implementation of anti-bullying and safe caring policies in placements for accommodated children.
  • Accommodated children and young people feel safe.
  • Children and young people have opportunities to talk in confidence when they are feeling troubled.
  • Social work services
  • NHSCAMHS staff (inc. Primary Mental Health Workers)
  • LAC health staff
  • NHS community child health services

Input to care for children and young people with physical health problems, both in hospital and in the community

  • Liaison between NHSCAMHS staff, medical and nursing staff in other departments, education and social services staff to discuss and make arrangements for all of a child's or young person's needs to be addressed.
  • Establishment of discharge protocols and procedures which take account of the child's or young person's mental health needs.
  • The emotional as well as physical, educational and social needs of children and young people are addressed.
  • Children, young people and their families are supported to cope with their condition.
  • Holistic plans are in place for children being discharged from hospital.
  • NHSCAMHS staff (inc. Primary Mental Health Workers)
  • NHS child health services
  • Education staff providing outreach teaching

Provision of support and advice to parents whose child has physical health problems

  • Advice for families on the potential emotional and mental health aspects of their child's condition - promotion, prevention and care.
  • Liaison to ensure that parents' and siblings' emotional and mental health needs are recognised and supported.
  • Parents understand the emotional and mental health aspects of their child's experience and condition, and feel confident in supporting them.
  • The emotional needs of the child's family (including siblings) are recognised and addressed.
  • NHS child health services
  • NHSCAMHS staff (inc. Primary Mental Health Workers)
  • Social work services
  • Education staff providing outreach teaching

Interagency communication about assessment, action planning and reviews for children and young people with complex needs

  • Agencies work together to establish robust information sharing protocols and systems.
  • Professionals discuss with parents, carers, children and young people the circumstances in which information will be shared, and seek their consent.
  • Children, young people and their parents/carers are given appropriate information about the assessment, action planning and reviews, and appropriate support organisations.
  • All professionals in contact with an individual child understand their needs.
  • Children, young people and parents/ carers know what will happen and are actively involved in the assessment, action planning and review processes.
  • Children's needs are met holistically.
  • Children, young people and their parents/carers experience seamless services.
  • NHS child health services
  • NHSCAMHS staff (inc. Primary Mental Health Workers)
  • School management team
  • Social services staff

Awareness raising and joint work with housing services and organisations about children's and young people's support needs, e.g. when an adult is discharged from care

  • Policies and protocols are established to ensure appropriate links between social work services, health services, and housing services.
  • The housing support needs of individual children and young people are recognised and addressed.
  • Housing is appropriate for the needs of individual children and young people.
  • Housing support services are appropriate for young people.
  • Housing associations/ agencies
  • Social work services
  • NHS Primary Care team
  • NHS community child health services