-
East Riding of Yorkshire Strategy
For
Emotional Health and Wellbeing of
Children and Young People
(0 to 18 years)
Version
Date
Authors
NHS ERY Approval
ERYC Approval
Review
1.2
29 June 2012
Neil Griffiths, Gwynneth
Carmichael, Sharon Watts
June 2015
Contents
Foreword ................................................................................................3
Vision ......................................................................................................4
Objectives ...............................................................................................4
Definition of emotional health and wellbeing ...........................................4
Introduction .............................................................................................5
Background ............................................................................................5
Local Context ..........................................................................................5
Current Service Provision .......................................................................6
Challenges..............................................................................................9
Vulnerable Groups ..................................................................................9
Interdependencies ................................................................................10
Key Actions for the Children and Young People’s Emotional Wellbeing
Steering Group .....................................................................................10
Outcome Measures ..............................................................................12
References ...........................................................................................13
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Foreword
Improved emotional health and wellbeing is associated with a range of better
outcomes for people of all ages and backgrounds. These including improved
physical health and life expectancy, better educational achievement, increased
skills, reduced health risk behaviours such as smoking and alcohol misuse,
reduced risk of suicide, improved employment rates and productivity, reduced
anti-social behaviour and criminality, and higher levels of social interaction and
participation.
The emotional health and wellbeing of children and young people is nurtured
primarily at home, however everyone delivering children and young people’s
services (particularly early years and schools) have a role in improving
outcomes and reducing inequalities. This includes supporting the public to
make healthier and informed choices to improve emotional health and wellbeing
and improving access to services when they are needed.
This strategy has been produced to support Local Authority and NHS
commissioners and service providers to improve the emotional health and
wellbeing of children and young people (0 to 18 years) in the East Riding of
Yorkshire. It is the first strategy for emotional health and wellbeing of children
and young people in East Riding of Yorkshire and supersedes the 2010 East
Riding of Yorkshire Child and Adolescent Mental Health Strategy.
Action to implement this strategy will only be effective if there is sustained
partnership working across all sectors. To facilitate this partnership working, a
Children and Young People’s Emotional Health and Wellbeing Steering Group
has been established, reporting to the Children’s Trust.
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Vision
We want children and young people in East Riding of Yorkshire to have
the best possible emotional health and wellbeing, to build social and
emotional resilience, promote good parenting skills and to identify
problems early and respond to them quickly.
Objectives
•
•
•
•
•
To strengthen social and emotional resilience
To promote emotional health and wellbeing especially for vulnerable
groups
To promote good parenting skills
To ensure parents, young people and professionals know where to go for
assessment, intervention and support
To commission services that are able to respond quickly and
appropriately to need
Definition of emotional health and wellbeing
To avoid confusion the term emotional health and wellbeing is used throughout
this strategy and is intended to encompass the whole spectrum of emotional and
mental health and wellbeing, including autism as well as targeted and specialist
Child and Adolescent Mental Health Services (CAMHS). Other national policy
or strategy documents, such as the National Advisory Council reports and
Keeping Children & Young People in Mind, refer to mental health and emotional
wellbeing, while others prefer psychological wellbeing.
Emotional wellbeing isn’t about feeling happy all the time, but rather being able
to enjoy and participate in life and having the resilience and skills to deal with
the problems that life presents from time to time.
Governance arrangements
Progress on delivery of this strategy will be monitored by the Emotional Health and
Wellbeing Strategy Group reporting to the Children’s Trust Board and Health and
Wellbeing Board.
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Introduction
The foundations of good emotional health and wellbeing are laid at the start of
life in pregnancy, childhood and adolescence. Since the majority of mental
illnesses can be traced back to childhood, it is important that interventions which
protect health and well-being and promote resilience to adversity in childhood
and adolescence are readily available. If mental health problems occur there
should be early and appropriate intervention.
Additionally strategies to promote parental mental health and effectively treat
and support parents with mental health disorders are important since parental
mental health has a direct influence on the child’s emotional health and
wellbeing.
This strategy is for all stakeholders, whether professionals, parents or children
and young people themselves to work together to reduce risk factors, promote
protective factors and to ensure universal, targeted and specialist services are
available to support and intervene when required to provide the best possible
emotional health and wellbeing for children and young people in East Riding of
Yorkshire.
Background
Feedback from children, young people and their families as well as from health,
education and social care professionals has consistently highlighted a lack of
clarity about where to go for help with emotional health and wellbeing problems.
Difficulties accessing assessment, treatment and support have also been
reported. This strategy’s vision and objectives are designed to address these
difficulties and lead to a set of proposed actions to help improve understanding
and access to appropriate support.
We know, for example, that it can be difficult to access assessment and support
for autism and have developed a separate strategy for children, young people
and adults with autism to help address this.
National policy has promoted strong partnership working and the idea that
emotional health and wellbeing is everyone’s business but this still needs more
work. In particular, midwives, health visitors and early years professionals all
have a critical role to play in promoting resilience and intervening early where
needed. It is important to ensure that all staff in all settings have the right skills
and knowledge to be able to respond to emotional health and wellbeing needs
when they encounter them. Training packages are available and should be
considered for inclusion in mandatory training requirements for those who work
with children and young people.
Local Context
National estimates by the ONS in 2004 suggest around 1 in 10 five to sixteen
year olds have a clinically significant mental health problem, mainly conduct
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disorders, emotional disorders and hyperkinetic disorders, however these are
based on populations significantly different from the East Riding of Yorkshire.
The table below outlines the key differences.
Children 0-4
% of total population
Children 0-19
% of total population
School age children from BME group
% of school age population (5-16)
% of children < 16 living in poverty
East Riding of
Yorkshire
16,300
4.8%
73,500
21.7%
1,551
3.7%
13.3%
England
3,267,100
6.3%
12,417,500
23.8%
1,586,340
24.6%
21.9%
The relatively low levels of deprivation and low BME population mean that the
national estimates are likely to overstate the true position for East Riding of
Yorkshire as these are both factors that increase the risk of emotional health
and wellbeing problems.
Similarly the Department of Health recommends tier 3 CAMHS workforce of
around 15 per 100,000 total population, based on average need for England, but
this will be lower in East Riding of Yorkshire.
The development of a performance dashboard to help establish the true
baseline of emotional health need, activity and waiting times for East Riding of
Yorkshire is a key action arising from this strategy. The ONS statistics also
provide comparative prevalence data for specific demographic groups which
could be used to help establish the true level of emotional health and wellbeing
need in East Riding of Yorkshire localities if broken down to Lower Super Output
Area.
Current Service Provision
The following list of services all play an important role in the promotion and
support of children and young people’s emotional health and wellbeing:
Health Services
Public Health
Health Visiting
School Nursing/Special School
Nursing
Community Paediatric services
including paediatric therapies
Learning Disability services
Primary Mental Health Workers
Looked After Children Health Team
CAMHS
Education
Early Years
Primary Education
Secondary Education
Educational Psychology
Social and Emotional (SEAL)
Behaviour Team
Special Educational Needs services
Social Care
Voluntary Sector
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Think Family
Family Support Interventions
Safeguarding Children
Looked after Children Services
Permanency and Adoption Team
See separate mapping exercise
Youth Justice Services
Youth Offending Team
Multi-Agency
Children’s Centres
Social and Communication Panel
They work together to deliver the four tier model of Child and Adolescent Mental
Health Services outlined in Together we stand (Health Advisory Serivce, 1995):
Tier 1:
Services provided by practitioners working in universal services (such as GPs,
health visitors, teachers and youth workers), who are not necessarily mental health
specialists. They offer general advice and intervention for less severe problems,
promote mental health, aid early identification of problems and refer to more
specialist services. A Common Assessment Framework (CAF) may be required
where referral is needed.
Tier 2:
Services provided by specialists working in community and primary care settings in a
uni-disciplinary way (such as primary mental health workers, psychologists and
paediatric clinics). They offer consultation to families and other practitioners,
outreach to identify severe/complex needs, and assessments and training to
practitioners at Tier 1 to support service delivery.
Tier 3:
Services usually provided by a multi-disciplinary team or service working in a
community mental health clinic, child psychiatry outpatient service or community
settings. They offer a specialised service for those with more severe, complex and
persistent disorders.
Tier 4:
Services for children and young people with the most serious problems. These
include day units, highly specialised outpatient teams and inpatient units, which
usually serve more than one area.
An alternative view of this model is shown in Figure 2 (from…) on page 8.
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Challenges
While we have made considerable progress in delivering good outcomes for children
and young people, we know that there are a number of challenges which include
•
Delivering accessible services across a large rural area and within tight resource
constraints.
•
Further improving services and opportunities for children and young people with a
disability.
•
Maintaining full engagement of provider and commissioner partners in the rapidly
changing NHS and educational landscape, particularly with the establishment of
a number of new NHS commissioning bodies and the rapid increase in
Academies in East Riding of Yorkshire.
Vulnerable Groups
National evidence has identified that there are a number of groups who are
considered to be more at risk of developing emotional health problems than others,
including children and young people:
•
•
•
•
•
•
•
•
•
•
•
from low-income households; families where parents are unemployed or
families where parents have low educational attainment
who are looked after by the local authority
with disabilities (including learning disabilities)
from black and other ethnic minority groups
who are lesbian, gay, bisexual or transgender (LGBT)
who are in the criminal justice system
who have a parent with a mental health problem
who are misusing substances
who are refugees or asylum seekers
in gypsy and traveller communities
who are being abused.
Other vulnerable groups identified locally include:
•
•
young carers
non-standard intake to schools, i.e. children and young people who
move schools during the academic year
There are targeted resources in East Riding of Yorkshire for some of these
groups, for example for young people misusing substances and for looked after
children and young people.
Further equality impact analysis is needed to ensure that children and young
people from other vulnerable groups have access to the emotional health
promotion and support that they need. As part of redesign work, gap analysis
and business case development, consideration will be given to further targeting
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of services at these vulnerable groups, for example staff with specialist
expertise and knowledge in working with children and young people with
learning disabilities.
The proposed performance dashboard will include information on these
vulnerable groups so that access and outcomes can be compared with the
wider population of children and young people.
Interdependencies
Because of the broad nature of emotional health and wellbeing, a number of
related strategies contribute to the overall range of services and support
offered to children, young people and their families. The most important of
these are listed below:
1. Autism Strategy
2. Health Visitor Expansion Plan
Additionally there are a number of initiatives that will have significant impact on
the emotional health and wellbeing of children and young people in East Riding
of Yorkshire, in particular:
1. Family Nurse Partnership
2. Troubled Families Initiative
The emotional health and wellbeing of children and young people has also
been identified as a key priority in the Health and Wellbeing Strategy for East
Riding of Yorkshire.
Key Actions for the Children and Young People’s Emotional Wellbeing
Steering Group
The high level objectives and actions set out here will form part of an ongoing
action plan to be developed and monitored by the Children and Young
People’s Emotional Health and Wellbeing Steering Group.
Objective 1
To strengthen social and emotional resilience
1. Ensure awareness of emotional health and wellbeing is embedded in all
service provision for children and young people, particularly children’s
centres, early years settings and schools, but also including healthcare
settings such as GP surgeries, A&E and paediatric services
2. Encourage self help and peer support e.g. through mental health first aid
courses, bibliotherapy (“Better with Books”) or Computer-based
Cognitive Behavioural Therapy (CCBT)
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3. Monitor progress of the Health Visitor Expansion Programmes and in
particular the introduction of a Family Nurse Partnership, targeting first
time parents under 20
4. Monitor progress of the Troubled Families Initiative
Objective 2
Promote emotional health and wellbeing
1. Establish multi-agency training programme to raise awareness and
confidence in the health, social care and education workforce
2. Increase and strengthen links with the voluntary sector
3. Develop programme to reduce stigma associated with mental health
problems and mental health services
Objective 3
Promote good parenting skills
1. Ensure greater availability of targeted and universal parenting
programmes
2. Develop separate provision for programmes aimed at supporting
parents to promote emotional wellbeing from programmes subject to
court order
Objective 4
To ensure parents, young people and professionals know where to go for
assessment, intervention and support
1. Develop map of services to promote and support emotional health and
wellbeing of children and young people in East Riding of Yorkshire
2. Facilitate earlier identification of need for support and intervention
3. Ensure parents’ and young people’s voices are heard in planning
services
4. Improve communication between professional groups employed by a
variety of provider organisations
5. Improve access to primary care mental health services including
preparatory work for the introduction of Improving Access to
Psychological Therapies (IAPT) for children and young people
Objective 5
To commission services that are able to respond quickly and
appropriately to need
1. Provide easy access to early intervention when required
2. Create performance dashboard to gather all relevant data on diagnosis,
activity and waiting times, including for interdependent services e.g.
Health Visiting, FNP, Troubled Families initiative
3. Redesign existing services and pathways to maximise outcomes from
existing resources
4. Develop business cases for increased capacity where gaps are
identified
5. Monitor delivery of the Autism Strategy
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6. Work within national and regional frameworks to ensure Looked After
Children from East Riding of Yorkshire and those placed in East Riding
of Yorkshire by other authorities are easily and quickly able to access
services to support emotional health and wellbeing, particularly tier 2
and 3 CAMHS
Outcome Measures
The outcome measures proposed in Promoting the emotional health of children
and young people (HAD, 2004) have been adapted to measure success in the
implementation of this strategy.
Outcome
Improvements in overall emotional
health
Source of Data
Local area ‘wellbeing profile’ of all local
performance indicators relevant to the
wellbeing of children and young people
Findings from Strengths and Difficulties
Questionnaire (e.g. as used for looked
after children)
Findings from other assessment tools
and scales used in specific interventions
with children
Early Years Foundation Stage Profile
results at age five
Parents and carers more confident in
nurturing their child’s emotional health
Evaluation reports from parent support
programmes; formal evaluations
Childcare and learning environments are
attractive, supportive and safe
Range of data from annual surveys – to
give more detailed picture on health,
bullying, participation, enjoyment and
security
Encourage childcare and learning
providers, especially schools, early years
settings and Children’s Centres, to
develop meaningful outcomes that can
contribute towards improvements in
emotional health and wellbeing
Performance against relevant wellbeing
indicators
Better attendance
School and college level data
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Better behaviour
School and college level data
Better attainment
School and college level data
Greater placement stability for looked
after children
Local authority data
Better access to services when help is
needed
Data on the range and success of inschool groups/interventions (for example
SEAL silver set, nurture groups, pyramid
clubs)
Data on the range and success of local
programmes and projects – for example
behaviour and education support teams,
parenting programmes, counselling and
drop-in services
Staff more confident and competent in
identifying and supporting children with
emotional health needs
Evaluation of tier 1 training for
practitioners (children’s mental health)
Community and leisure environments are
attractive and safe
Responses to relevant annual survey
questions
References
Promoting Emotional Health and Wellbeing through the National Healthy
Schools Standard, Health Development Agency, 2004
Promoting the emotional health and wellbeing of children and young people;
Guidance for Children’s Trust partnerships, including how to meet NI50, DCSF,
2010
Children and Young People Promoting Emotional Health and Well-being,
Information Series, DH, NHS South East, NHS South East Coast, Care Services
Improvement Partnership, 2008
One year on, the first report from the National Advisory Council for Children’s
Mental Health and Psychological Well-being, DCSF, 2010
Making children’s mental health everyone’s responsibility, NAC Final Report to
Ministers, 2011
Talking about talking therapies, Young Minds, 2011
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National Service Framework for Children, Young People and Maternity Services
The Mental Health and Psychological Well-being of Children and Young People,
DH 2004
Children and Young People’s Emotional Wellbeing and Mental Health National
Support Team The learning: ‘What good looks like’, DH, 2011
Better Mental Health Outcomes for Children and Young People, A Resource
Directory for Commissioners, National CAMHS Support Service, 2011
Child Health Profile East Riding of Yorkshire, CHIMAT, 2012
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