Child and adolescent mental health – a guide for healthcare professionals
June 2006
Multi-agency working
One of the major themes running through the Children Act and subsequent initiatives is the need for effective partnership working across different agencies, including health and social care, to ensure competent, coordinated support for children and young people. CAMHS, by their very nature, are supplied by a wide variety of different practitioners, including GPs, practice and school nurses, teachers and youth justice workers, as well as mental health specialists. The range of agencies involved makes the provision of CAMHS complex, and successful cross-agency working is vital. The Children Act placed a duty on LAs to make arrangements to promote cooperation between agencies, and a duty on key players to participate in this cooperation. [Go to note 88]. The children’s NSF highlights the importance of collaborative working, and points to ways of achieving this. There is a need for effective, multi-agency strategies for commissioning and delivering mental health services. Multi-agency agreements clarifying the level and scope of service provision are also necessary. It is the responsibility of PCTs and LAs to develop and oversee the commissioning strategy, and all appropriate parties should fully participate in this process. [Go to note 91]. It is also important that there are sufficient resources available; effective inter-agency working is currently being impeded by competition for resources. [Go to note 51].
In order to ensure that the needs of children are met, the government aims to integrate key children’s services through Children’s Trusts. [Go to note 108]. These are located within LAs, and it is planned that every area should have a Children’s Trust by 2008. Thirty-five Children’s Trust pathfinders were set up when the scheme was announced in 2003, and will be independently evaluated over a three-year period to inform policy and best practice guidance. The final evaluation report is due in April 2007. Children’s Trusts include children’s health services, children’s social services and local education authorities, and should potentially include youth offending teams, and services such as Sure Start and Connexions, is an advice and information service aimed at 13-19 year olds. It covers topics including education, careers, money and health. More information can be found here at www.connexions-direct.com Children’s Trusts ensure that planning and commissioning of services is carried out by a single body with agreed strategies and a pooled budget. This integration aims to ensure effective cooperation between all the different services involved, and multidisciplinary working will be a key feature. There should also be opportunities for children, young people and their families to participate in the trusts, although early evaluation has shown that the effectiveness of this varies greatly across different areas. [Go to note 109]. Children’s centres are being set up to integrate the delivery of services to children, bringing together in one place non-acute health services, child health preventive services and family support. The government has set a target of establishing 2,500 children’s centres by March 2008, with the eventual aim of a children’s centre in every community. [Go to note 36].
For different agencies to work effectively together to achieve the best outcomes for patients, it is important that they are able to share information about each patient. 'The children’s and maternity services information strategy' (2004) was published alongside the children’s NSF, and sets out necessary action at a national level to facilitate recommendations made in the children’s NSF. It addresses ways in which to share information within the NHS and with and between other agencies. It also comprises information to support cross-agency working and for the direct care of children and young people, as well as access to knowledge, training and development. [Go to note 110]
The development and roll out of effective information systems is a key priority: CAMHS mapping in 2003 found that only 24 per cent of services had access to electronic databases to support their work. [Go to note 1]. Cross-government guidance on information sharing on children and young people was published in April 2006. This outlines when, why and how professionals should share information, and can be accessed here at www.everychildmatters.gov.uk/informationsharing. The aim is to provide practitioners with the necessary knowledge to decide when and how information should be shared with other professionals. [Go to note 112]. The DH, through the 'NHS Connecting for Health' project, is looking to modernise the healthcare information technology system. This would allow health professionals greater access to shared information, including patient records, prescription information, appointment details and up-to-date research on illnesses and treatment. This is currently in the early stages of development, and has the potential to greatly facilitate joint working. This system must be implemented in a way that is practical and efficient for both practitioners and patients. There are many concerns with sharing information, including issues about confidentiality, and any new system must be introduced gradually to allow not only effectiveness, but confidence among health professionals and patients.
In order to implement the proposed changes in children’s care, those working with children need to adopt different approaches to how they work. [Go to note 76]. Cultural barriers, which can be deeply entrenched within traditional children’s services, need to be broken down. Early evaluation of Children’s Trusts found that inter-agency relationships were most effective where there was a shared vision, agreed terms of reference, trust, and a willingness to cooperate between partners. An inability to establish working arrangements at a strategic level inhibited effective working. [Go to note 109]. The DfES’ Children’s Workforce Unit has proposed a variety of strategies, including a children’s workforce strategy to ensure that the workforce is capable of delivering change. [Go to note 113]. 'The common core of skills and knowledge for the children’s workforce' has been produced by the DfES working with stakeholders to enable effective team-working across disciplines, and setting out the areas of expertise that everyone working with children should have. The aim is that over time, all practitioners who come into contact with children and young people will be able to demonstrate the basic skills covered by this programme, and that it will eventually form part of the requisite qualifications for working with children, young people and families.
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The 'Every child matters' website provides a variety of resources to promote effective multidisciplinary working. [Go to note100]. Initial evaluation of Children’s Trusts has emphasised the urgent need for training to support new ways of working and ensure that frontline staff understand different roles across professions. This is especially pertinent as the restructuring is causing concern among frontline staff, and new roles are being developed. [Go to note 109]. It is also important that professionals who are not specialists in mental health receive training to enable them to identify and support children and young people with mental health needs. For example, professionals such as those in accident and emergency and general practice should be able to see beyond the physical injuries of self-harm and recognise it as a mental health problem that requires further help. (See the section on 'Self harm and suicide' here for more information about self-harm.) The Royal College of Paediatrics and Child Health in association with the Royal College of Psychiatry is developing courses on mental health for paediatric and GP trainees, in recognition that there are behavioural and psychosocial aspects of paediatrics that are not covered by current training. [Go to note 114]. It is particularly important that GPs receive training on early identification of mental health disorders in children and young people.
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Recommendation:
- It is essential that all professionals providing CAMHS receive adequate training and support enabling them to work effectively together. Measures that have already been taken to implement multi-agency working must be continued and extended. Governments need to ensure that the resources, including training in the healthcare information technology system,112 are available to allow this to happen.