Self harm is broadly defined as when someone damages or injures their body on purpose. The external causes codes for intentional self-harm include: Self-poisoning Hanging, drowning or jumping Fiream/explosive Using other implement Other In 2006/07, the inpatient emergency admissions rates for self-harm was 38.3 per 10,000 population aged 13 to 18 years. In 2010/11 it was 44.8 per 10,000 population aged 13 to 18 years.
A woman’s age at conception is calculated as the number of complete years between her date of birth and the date she conceived.
Karen turner 5th nov 2012 confederation of heads of yp services annual convention final
Confederation of Heads of Young People’sServices – Annual Convention 5th & 6thNovember 2012Health and Wellbeing in Young PeopleKaren Turner
Mortality in Childhood (0 - 14)UK compared to European 12
Hospital inpatient emergency admissions for intentional self- harm among 13-18s• In 2010/2011, the number of admissions for those aged 13-18 years was 17,000. This is a rate of 45 per 10,000 population aged 13-18 years.• Hospital emergency admissions rates for intentional self-harm among 13-18 year-olds increased by 16.9 per cent from 2006/07 to 2010/11.• Among 13-18s, females are at least three times more likely to be admitted for self-harm than males. Source: Hospital Episode Statistics (HES) 3
Under 18 conception rate• Overall conception rate in under 18s in England in 2010 was 35.4 per 1000 women in this age group.• The conception rate among under 18s has declined from 40.6 per 1000 women in 2006. Over the same period the overall conception rate amongst all women has increased from 78.5 to 82.5 per 1000 women in all age groups.• Highest rate of under-18 conception is in the North-East (44.3 per 1000 women ) and lowest in the South-East (28.3 per 1000 women).• Under-16 conception has remained relatively stable from 2006 to 2009, although it did decline in 2010. 4
Substance abuse• In 2011, around one in six (17%) pupils reported ever having taken drugs compared to 29% in a previous survey in 2001. Took drugs in the last month, last Ever taken drugs Taken drugs in the last year year and ever: 2001-2011• 12% of pupils reported having taken drugs in Taken drugs in the last month 35 the last year in 2011, and this has declined 30 steadily from 20% in 2001. 25• Drug use in the last year was reported by similar proportions of boys and girls. 20• Drug use in the last year increased with age: 15 n P e c r t 3% of 11 year olds reported taking drugs in 10 the last year, and this increased to 23% 5 amongst 15 year olds. 0• Early drug use was more likely to be volatile 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 substances in younger pupils while those aged 14-15 reported taking cannabis as the first drug they tried. Source: Smoking, drinking and drug use among young people in England in 2011, The Health and Social Care Information Centre 5
Smoking prevalence at 15 years Proportion of 15 year olds who were regular Overall• Smoking is the primary cause of smokers, England Boys preventable morbidity and premature 30 Girls death. There is a large body of evidence showing that smoking behaviour in early adulthood affects 20 health behaviours later in life. n P e c r t 10• The Tobacco Control Plan sets out the Governments aim to reduce the 0 prevalence of smoking among both 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 adults and children and includes a national ambition to reduce rates of • Between 2001 and 2011, the regular smoking among 15 year olds in proportion of pupils aged 15 who England to 12 per cent or less by the report that they are regular smokers end of 2015. fell from 22% to 11% (Regular smokers are defined as usually• The indicator shows the number of smoking at least one cigarette per persons aged 15 who are self-reported week). smokers as a proportion of the total • In 2011 there was no difference in number of respondents (with valid smoking between boys and girls. recorded smoking status) aged 15 Previously girls reported smoking more than boys. Source: Smoking, drinking and drug use among young people in England in 2011, The Health and Social Care 6 Information Centre
Mental health• One in ten children aged 5 – 16 years has a clinically diagnosable mental health problem• Half of those with lifetime mental health problems first experience symptoms by the age of 14, and three quarters before their mid-20s• As part of the ONS wellbeing programme, a children and young people’s wellbeing project has been set up to ensure that the Measuring National Well-being Programme covers measures of children and young people’s well-being• Self-harming in young people is not uncommon (10-13% of 15 – 16 year olds have self harmed)• Some children are significantly more likely to experience mental health problems than others – e.g. those with disabilities, LAC, and those living in families with complex and multiple problems. 7
Mental health• There is a 49-fold variation across PCTs in rate of inpatient admissions for mental health disorders per 100,000 population aged 0-17 years, where London length of stay was >3 days.• Rate ranges from 3.4 to 166.1 admissions across PCTs in England• No statistical correlation between admission rates and deprivation i.e. the level of deprivation does not have a significant impact on the rate of admissions. This result is borne out by high rates of admission in South West, South Central and South East Coast Rate of inpatient admissions >3 days’ duration in SHA regions. children per 100,000 population aged 0–17 years for mental health disorders by PCT Directly standardised rate 2007/08–2009/10. The highest rates are highlighted in dark blue, lowest rates in light blue 8
Children and Young People’s Health Outcomes StrategySecretary of State for Health asked the independent CYP Health Outcomes Forum to: • Identify the health outcomes which matter most for children and young people, • How well they are supported by the existing indicators in the Public Health and NHS Outcomes Frameworks, and • How the different parts of the health (and wider system) will contribute and work together in the delivery of these outcomes.
The Forum’s 8 themes•Health outcomes that matter most for children, young people and their families• Putting children, young people and their families at the heart of what happens• Acting early and intervening at the right time• Integration and partnership• Safe and sustainable services• Workforce, education and training• Knowledge and evidence• Leadership, accountability and assurance
Young People’s Voices and RightsThe Forum found:• Young people felt that insufficient attention was paid to their health and well-being needs and• Too many public health campaigns are aimed at adultsThe Forum said:• Young people have the right to be involved not just in their own health, but the wider system• Young people want and need to be involved in the commissioning, design and development of public health campaigns and services aimed at young people• Young people need relevant, age-appropriate information to enable them to make informed choices and take responsibility for their own health and well-being
Overview of key Forum recommendations• 9 new indicators for the Public Health Outcomes Framework and changes to other indicators.• 5 new indicators for the NHS Outcomes Framework and changes to other indicators.• A number aimed at organisations within the health system, e.g. NHS CB, PHE, the MHRA, NICE, CQC, Monitor, on the contribution that they need to make in order that improved outcomes can be delivered .
NHS Outcomes FrameworkProposed New Indicators:1. Integrated care – developing a new composite measure.2. Effective transition from children’s to adult services.3. Age-appropriate services – with particular reference to teenagers.4. Time from first NHS presentation to diagnosis or start of treatmentA range of other ‘stretch’ indicators, for example:• By 2013/14, DH and the NHS CB should incorporate the views of children and young people into existing national patient surveys in all care settings.
Public Health Outcomes FrameworkProposed New Indicators:• Number of children and young people living in decent housing• Educational attainment and progress for all children and young people with LTCs• Proportion of children who experience bullying• Proportion of children and young people with mental health problems who experience stigma and discrimination.
Public Health Outcomes Framework (cont’d)• Proportion of children and young people who play games on a computer 2+ hours on weekdays• Proportion of mothers with mental health problems, including postnatal depression• Proportion of parents where parent child interaction promotes secure attachment in children age 0-2• Proportion of parents with appropriate levels of self-efficacy• Children, young people and families have access to age-appropriate health information to support them to lead healthy lives
Next steps• DH, with organisations in the new system, to produce the action plan• SofS to launch the Children and Young People’s Health Outcomes Strategy before Christmas• Establish new governance arrangements for delivering the Strategy, with CMO chaired Children and Young People’s Health Board• Re-establish the Forum under Christine Lenehan and Ian Lewis as co-Chairs, with amended membership• First meeting of the new Forum 13 February 2013• First Annual Summit to be held in September 2013.
Child and adolescent mental health service - Promoting good health and improving practiceTime to change – anti stigma campaign• New children and young people’s work-stream• Pilot to test approaches to tackling mental health stigma and discrimination in children and young people
Children & Young People’s Mental Qu Dr ality Health e-portal Evi ive de n bas nce ed 1) e-learning modules for: • non-NHS staff in universal settings; teachers, youth workers, police, clergy, social workers • NHS staff in universal settings; GPs, paediatricians, nurses, other health professionals, • School, FE and University counsellors • NHS funded staff with a specific focus on CYP with mental health problems 2) e-therapies Ou Us tc info erfoc omes rme uss d ed
Evidence based interventions: Children and Young People’s IAPT (Improving Access to Psychological Therapies)• Evidence based practice, outcomes monitoring• Service Transformation for CAMHS• Funding £8 million a year 2011/12 - 2014/15• Additional £22 million over 2012/13 - 2014/15
Salford Year 1 SitesCollaborativeHEI - ManchesterUniversityCAMHSPartnershipsDerbyManchester &SalfordPennine NorthPennine SouthBarnsleyReading LondonCollaborative CollaborativeHEI – ReadingUniversity HEI – UCL/KCLCAMHS CAMHSPartnerships PartnershipsOx and Bucks Lambeth &Wilts, Bath & NE SouthwarkSomerset HertsGloucs SussexSwindon WestminsterBournemouth, HaringeyDorset & Poole Cambridge Wandsworth Greenwich
Salford Year 2 Sites NorthumbriaCollaborative CollaborativeHEI – Manchester HEI –University NorthumbriaCAMHS UniversityPartnerships CAMHSCentral Lancashire PartnershipsNorth Lancashire TeesBolton Durham Reading North Yorkshire Collaborative Darlington Rotherham HEI – Reading Doncaster University CAMHS Partnerships London Berkshire Collaborative Bedfordshire Luton HEI – UCL/KCLSouth-West Kensington & CAMHS Chelsea PartnershipsCollaborative Tower HamletsHEI - Exeter HackneyUniversity CamdenCAMHS IslingtonPartnerships Waltham ForestDevon RichmondTorbay BromleyPlymouth Croydon
Delivering better health outcomes through the new health system• Young People’s Voices → HealthWatch• Health and wellbeing boards• JSNAs/JHWS• Commissioning for improved health outcomes (public health and treatment and care)
JSNAs and joint health and wellbeing strategies – tools for shared leadershipHWB provides forum for What services do we need to commission (or de-repositioning JSNA as truly commission), provide and shape; both separatelyjointly owned and leading to and jointly? – commissioning plansjoint commissioning decisionsto serve the whole population. So what are our priorities for collective action, and how will we achieve them together? – the JHWS Explicit linkfrom evidence to service What are we doing now, how well is it working and how planning efficient is it? - a analysis on our progress So what does that mean they need, now and in the future and what assets do we have? – a narrative on the evidence - the JSNA What does our population & place look like? – The intention of JSNA is evidence and collective insight to link local needs with commissioning decisions – by adding Engagement the layer of the JHWS with users HEALTH & WELLBEING this link is being made and the public BOARD easier for local areas to understand.