Early Help 4 Mental Health

The challenge

Following an inadequate judgement by Ofsted, Devon County Council initiated work on the development of a new strategy, sponsored by the Local Safeguarding Children Board.

This included a review of early help, which indicated there were gaps in the emotional, psychological and social wellbeing of the school-aged population. Devon County Council’s Public Health Team and Exeter Medical School, began the development of a service to meet this gap.

Building on the evidence, extensive consultation and engagement with schools, young people and their families was undertaken; leading to the identification of several emerging themes impacting young people’s mental health in Devon.

The solution

Between 2013-2015, the Public Health Team worked with local schools to co-design an early intervention service called Early Help 4 Mental Health.  Early Help 4 Mental Health had the aim of promoting and supporting resilience in children and young people by tackling mental health problems early on.

Effective partnership working and support was a critical component of the Early Help 4 Mental Health Programme. Early in the programme’s development, detailed consultation and co-designing took place with stakeholders, in order to develop a service that truly reflected what was needed. This work lay the foundations for strong working relationships between partners.

Strong links have since developed between Early Help 4 Mental Health, schools and mental health services. Other services have also been identified to support the wider needs of the young people on the programme, and other agencies involved, such as the Devon Multi-Agency Safeguarding Hub, Devon Rape Crisis, Primary Care, and other Young Devon projects such as Victim Support and the Princes Trust.

Following the consultation and co-design process the Early Help 4 Mental Health Programme focused on two elements:

Direct early-intervention services for young people

Providing targeted prevention and interventions to support the mental health of children and young people 11–18 years (or up to aged 25 if identified as having special educational needs or a care leaver).  It is aimed at young people who are vulnerable, and whose mental health is beginning to deteriorate.  They are supported through online and face-to-face support (either individually or as part of a group). This is delivered by Young Devon and Xenon who were awarded this contract.

A school-support programme

• To support the development of a whole school approach for emotional, psychological and social wellbeing.
• To build capacity of school staff to support their own wellbeing and that of their students.
• To provide specialist mental health advice to schools.

This service is provided by Virgin Care Services Ltd, who were awarded the contract. The programme was introduced in September 2015 with a phased roll-out.

Despite being delivered by different organisations, joint planning and communications mean that the providers work in tandem to promote the support available to young people.

The impact

The programme has demonstrated real value and improvements in children’s emotional wellbeing.

A rigorous performance management and reporting system was created, which gives detailed data relating to outcome measures being used by providers. This is set into contracting arrangements.

However, it is also important to measure how children and young people feel, and whether the services are making a difference.  Devon therefore use a number of methods to capture this, including:

• Measuring the impact of the direct support offer; by using the YP-Core tool which measures emotional wellbeing following individual counselling sessions. The YP-Core measures responses to 10 standard questions, and uses a scoring system.  To date this has shown that 74 per cent of the young people experienced improvement in their scores.
• Introducing a goal based outcome measure where young people create their own goal and then score to what extent they feel they are achieving this. Of those children who were happy to complete goals measures, 94 per cent demonstrating progress. In general the goals have focused on developing coping strategies and psycho-education.
• Capturing through the use of the online service Kooth (provided by Xenzone), which assesses the effectiveness of the therapeutic alliance. With 69 per cent of logins occurring outside of office hours, Kooth offers flexible evening support that fits with young people’s lives. 

One major success has been the efforts to encourage young men to ask for help, through social media activities. This is most significant in face-to-face services, where 36 per cent of young people accessing the service were men in the last quarter of 2017, compared to 29 per cent nationally, but this trend has started to be seen online as well.

Developing local leadership and accountability

The emergence of young people's mental health as an area of focus came about as the health and wellbeing board were alerted to a deterioration in children’s mental health.  This correlated with the qualitative feedback directly from schools, those working with children and young people, and via Healthwatch. This led to a focused board discussion on young people's mental health; and in partnership with other key committees, began to raise the profile strategically. 

A Contract Oversight Group was formed at the beginning of this programme, made up of wider stakeholders (some of which have jointly funded the programme).  These include clinical and mental health commissioners, representatives from schools (primary, secondary and special) and from school governors and a representative from Devon County Council Children’s Social Services. The role of this group is to:

• ensure the terms and conditions, as agreed in the contract, are fulfilled by providers
• ensure the quality of the children and young people’s Emotional, Psychological, and Social Wellbeing Service meets the expectations of service users and commissioners
• consider, in the light of evidence and evolving practice, any changes to be negotiated throughout the life of the contract.

In terms of on-going engagement with partners, the programme sends regular reports to schools. This is done through a termly public health briefing via education and school communication networks, and keeps them up-to-date with developments and successes.

Contact

Rachel Humphries

Public Health Department, Devon County Council

[email protected]

This case study, written by Su Turner of Insight to Impact Consulting Ltd, is taken from the forthcoming LGA publication ‘Lessons in local leadership and accountability for children’s mental health services’.