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Agenda item

Agenda item

INTRODUCTION

Dr Joe Dawson, Head of Service SEN and Disabilities/Principal Psychologist, Leicester City Council to introduce children’s health and wellbeing in the City and outline some of the key challenges.

Minutes:

Dr Joe Dawson, Head of Service SEN and Disabilities/Principal Psychologist, Leicester City Council gave a general introduction on children’s health and wellbeing in the City and outlined some of the key challenges.

 

As general background, Dr Dawson commented that:-

 

  • Approximately 10% of school age children would require some form of professional support for mental health issues, and they were more likely to be boys rather than girls and be aged 11-15 years old than 5 -10 year olds.
  • There were a range of known environmental factors that could impact upon mental health, including housing and social deprivation.  There was a significant association between poor mental health and educational outcomes, which then often led to poor attendance and poor life outcomes. These could then be exacerbated into a cycle of entrapment.
  • Mental health had impacts upon life changes and these could lead to criminality and a whole host of resource heavy behaviours which often resulted in poor life experiences of people.
  • There was a clear understanding by those involved that this needed to be addressed for both the individual concerned and for the effective use of resources.
  • 50% of looked after children were likely to have clinically diagnosed mental health disorders; which is significant and needed to be taken seriously.
  • The risks and protective factors for children young people and their families had long been documented by the Audit Commission and the Mental Health Foundation, and, whilst these factors were well known, the real issues were about the need to put into practice something that recognises those risks and resilience factors and deals with them in the best interest of the children and young people.
  • There was a focus on children and young people but some of the processes within the system could often cloud the vision of what was being done and could stop the system having a clear overview of what it was delivering as a whole.
  • Language could also be a barrier both within the system and accessing it as there was a range of different terms used such as mental illness, mental health, emotional wellbeing and psychological wellbeing etc.  This was both a barrier to people in understanding what professionals were talking about and sometimes it was used by professionals to keep people out of the system and by others to reinforce the perception of needing to involve a specialist and to transfer the responsibility of care to others.  This delineation was often encouraged as a consequence of the referral process.  There was a view that the language used was jargon laden, which could became impenetrable to some trying to access different parts of the system.
  • Different agencies also had different targets and these could be competing with and, sometimes working against, other local authority, health, criminal justice and voluntary sector agencies’ targets.
  • Budget pressures could also impact on services as reducing preventative protective measures were often the first services to be withdrawn as part of budget cuts, but this could result in increased pressures for specialist services at a later date.
  • Diagnosis was not a straight forward process.  There was a general belief that when a doctor, psychologist or psychiatrist gave a diagnosis, it was readily understood by everyone and meant the same thing to everyone.   Unlike a diagnosis of a physical illness or condition, a diagnosis of a psychological or psychiatric illness could have a range of difficulties and categorisations within them and were, therefore, problematic in creating difficulties comprehension and expectations.  It could also cause difficulties in accessing services.  Services were generally organised in a tiered model approach; but children and young people didn’t move in tiers. They moved up and down within models and tiers and it was often forgotten that if a child needed a high level of intervention, then it did not necessarily mean that the lower levels of intervention should automatically drop out.  These lower levels of intervention were equally important to support and reinforce the higher level interventions.
  • The needs of the young person should be considered as a whole, as the lines between being sad and depressed or experiencing social difficulties and having autism could be finely balanced and open to interpretation.  Some of the diagnostic toolkits worked on the principles of providing a best fit approach to a diagnosis, which may always be appropriate. 
  • ‘Service-land’ as a whole was controlled by those operating within it and sometimes people could get lost within the system. Changes in thresholds and resources could prevent access to the service point and provide barriers that resulted in people getting lost between services.    There was still more work needed to have better joined up working practices and there were still some examples of a silo approach.  Even where partnership working existed, there was a need to have more partnership and creative working to achieve better outcomes to meet children’s needs.
  • There were sometimes inherent barriers between professionals as they did not always know who did what within other parts of the system, or what types of service were available to make referrals and sometimes where and how to make those referrals.  Language could be used as a barrier and could sometimes be barrier between professions and whether the person receiving a service was a client or a patient.
  • The process of change always presented difficulties in moving from the relative comfort of current practice to what was required.
  • Leicester had a history of being a pathfinder for targeting children’s mental health issue with good links between the police, schools, specialist CAMHS services and school nurses and local authority teams etc.  The city had been a national leader in such practices and experiencing their demise as funding was withdrawn.
  • External factors which could impact upon children’s mental wellbeing included mental stress, anxiety, financial pressures, homelessness, family pressures etc.  These could all add to, and exacerbate, the state of mental health.
  • Changes in statutory obligations and responsibilities could often be disruptive as professionals could become pre-occupied with understanding what was needed in the changed circumstances instead of delivering the services.
  • There was a need to create a better model for service delivery to remove barriers so that the best outcomes were achieved for children and young people who were in need of help and intervention measures.

 

In response to the Chair’s question, Dr Dawson commented that there were specialist and targeted services both within schools and in community settings.  The city also had an innovative service which he believed did not exist in any other local authority.  A number of psychologists were employed by the Council (funded by CCG) to look at those young people that didn’t meet the CAMHS specialist service thresholds and who were hovering around Tiers 2 and 3 within the system.  The psychologists worked with this cohort in their homes, schools and in group work to stop them getting worse and hitting the CAMHS threshold in the future.  There were also other good therapeutic interventions in Leicester; but these were under increasing pressures from resources, which meant they could not be delivered as widely as would be liked.  It was acknowledged that this pressure was faced by other local authorities

 

The Strategic Director of Children’s Services commented that both officers and schools recognised the importance of outcomes for children.  These issues were dealt with on daily basis and were taken seriously. Everyone was keen to work in partnership across services and agencies to address this.  There was a need for officers and schools to understand the whole system; as various organisations and agencies had individual parts of the system but not all of the system.  There was an issue of trying to understand the complexity of the whole system in delivering both universal and specialist services and to trying to identify where gaps existed or where there was duplication of services.  It was felt that this series of presentations would help with a better understanding of the specialist services.  It was also recognised that this work been ongoing for many years and was always developing and changing to reflect the constant changes evolving in society as a whole.

 

Board Members made the following comments and observations:-

 

  • It was recognised that there were issues in a linear model of service delivery, whereas users were more exploratory in their nature of navigating through the system.

 

  • There was a clash of social models of intervention and support with medical models.  There was a need for collaborative working in providing open and clear pathways and to be collectively more creative in service delivery.

 

  • There was support for everyone using the same language to fully understand other services within the system.  For example, ‘early help’ was often interchangeable with ‘early intervention’ in some services, but had different meanings to others in the system. All words/phrases used within the service should have the same meaning.

 

A member of the public asked a question in relation to the loss of subjects such as drama, music and dance etc from the school curriculum that he felt provided support and helped the wellbeing of children and young people.   He also asked if teachers received training to detect early changes in children’s and address them in order to prevent issues developing and requiring specialist support. 

 

In response, Dr Dawson commented that he was unable to comment upon curriculum changes, as there was little evidence to say these subjects had an impact on mental health.  However, the Social and Emotional Aspects of Learning programme (SEAL) had been evaluated and had showed significant impacts on wellbeing and resilience and was a useful resource within schools to support children’s, teachers and staff resilience.  It had been a national decision to remove psychology of development in children from teacher training courses and colleges; however the service did offer this training to maintained schools and academies. 

 

The Chair thanked Dr Dawson for his informative and thought provoking introduction.