Agenda item

A report on CAMHS Carelink is enclosed.

The cabinet member recommended that the committee consider this report at the last meeting :

http://moderngov.southwark.gov.uk/documents/s65488/Appendix%201%20Best%20start%20in%20life%20Southwark%20school%20standards%20report%202016.pdf

The following council, Southwark Clinical Commissioning Group (SCCG), and South London and Maudsley NHS Foundation Trust (SLaM) officers presented and took questions on the reports enclosed with the agenda:

·  Alasdair Smith, Director , Children , Families and Adult Services

·  Dick Frak, Interim Commissioning Director, Children , Families and Adult Services

·  Kate Moriarty-Baker, Interim Director of Quality & Chief Nurse, SCCG

·  Rachel Flagg, Head of Joint Commissioning for Children and Young People (SCCG and Council)

·  Elizabeth Murphy, Consultant Child & Adolescent Psychotherapist, SLaM, Southwark CAMHS Carelink for Looked After Children

The following issues were raised in the discussion with the committee:

·  Our population of Looked After Children (LAC) are often based out of Southwark. This is more challenging for the council in its corporate parenting role  The committee asked how young peoples health needs are addressed and officers responded that there is an out of borough nurse and we  also work with GP receptionists to ensure registration.

·  Can you reassure on transition for young people into local borough CAMHS services? With fostering done locally then this is easier. For the cohort that often moves further out it is harder. We often have to escalate concerns further afield. We have had children with a huge risk, with self harm for example, not accessing services. Elizabeth Murphy said she does extensive work with young people moved out of borough to advocate for young people to receive services from the borough that the young people are located in. We advocate but cannot force local CAMHS to provide services.  . However sometimes that is not adequate and that the local CAMHS will not step in or  it will be too late by the time the young person is accepted. In these circumstances social care will privately commission services if young people are not able to access local services.

·  Young people with higher needs are often the people the council struggle to provide services closest to home.

·  Members asked if the council ought to do more on accommodation and asked about young people on the fringe of care? Alasdair Smith responded that there is a question of quality and what that is.  Our commissioned services are not where we want them to be. Our staying put (with foster carers) is working well. The availability of public housing has reduced drastically for all people. We have people based in Kent for ten years and it makes senses for them to live there. The developing post 16 accommodation strategy acknowledges that young people are now sometimes placed outside of borough

·  How integrated are care services with education? For LAC it is very integrated as they are required to have plan within 20 days and we do track those young people. It is sometime complex with children in one borough and schools in another. Are we able to extend the virtual school for care leavers? Alasdair Smith said our borough NEET figures are good. The council have encouraged schools to take up the extra money pupil premium makes available. 

·  What about children and young people who may be adopted and the children are not aware?  Recently officer went into school and shared “secure base model” which is based on the attachment model, which more schools are keen on adopting. This has tools based around sensitivity / belonging. These help teachers to understand some of the behaviour and issues that adopted and fostered children face.

·  Do we have a team that works with young people of at risk going into care? We do have teams working on this. Sometimes it is right to that young people do come into care but we are working to reduce the need for this and keeping this under review.

·  Is there a churn with personal advisors? It is not as stable as we would want; presently we use an agency while we develop our vision. We are working on that and agree it is critical.

·  Elizabeth Murphy said that CareLink accept all children for an assessment if we receive a referral where someone is raising a concern.

·  Kate Moriarty-Baker said that care leavers have poorer outcomes for physical & mental health, Child Sexual Exploitation and we need to identify risks and mitigate. We have repositioned care leavers within safeguarding as they have already reached that threshold.

·  How big is the Carelink case load and what proportion of young are being seen by. About 500 in care per year and the Carelink case load is of 190 -220 .Do we screen children? Some children only come into care momentarily. There is screening for 9 categories of adverse incidence in childhood, the ACE survey is online and anybody can access there risk (http://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean). 4 of more adverse categories indicate a need for mental health support services and most children in care will have experienced at least 4 incidents.  

·  What is being commissioning for these young people will need further down the line? Officer said that care leavers will need a range of services down the line: parental support services, etc. There is a joint strategic needs assessment – however this doesn't always meet needs. Elizabeth Murphy said that SLaM researchers could help with developing services. Dick Frak said that there are some risky behaviour indicators in the emerging strategy that that demonstrate that particular responses are needed and this will be picked up in the Mental Health Strategy, due for completion in March.