CYPMH conference 2016 Future in Mind Vision to Implementation CAMHS Transformation in Health and Justice - Caroline Twitchett, Emily Nicol (NHS England)

1. www.england.nhs.uk
COMMISSIONING FOR HEALTH & JUSTICE
CHILDREN & YOUNG PEOPLE
Caroline Twitchett
Children’s Quality Lead, Health and Justice
Cliff Hoyle
HJ Commissioner, South West Regional Team
Bekki Whisker
Service Manager & Clinical Nurse Specialist
Wetherby YOI and Adel Beck SCH

2. www.england.nhs.uk
• Responsibility for commissioning health services in the 4 Young Offender
Institutions (under 18s), 3 Secure Training Centres (one of which, Oakhill, is
not currently within NHS England regulations), and 14 Secure Children’s
Homes (6 SCHs are welfare only) with an overall population of 1,400.
• NHS England also directly commissions Liaison and Diversion services and
health services within Sexual Assault Referral Centres (SARCs).
• Commissioning of health services for Health and Justice is carried out by 4
regions and their local commissioning teams, of which there are ten across
England.
Health and Justice: Commissioning
2

3. www.england.nhs.uk
• Standards for the ‘Healthcare of Children and Young People in Secure
Settings’ (published 2013) designed in order to help plan, deliver and quality
assure the provision of children and young people's health services in secure
settings.
• NHS England sets out in our published Commissioning Intentions that we will
deliver to these standards within the secure estate for children and young
people (CYPSE).
• Core CYPSE outcome specifications have been developed; together with the
YJB we developed an enabling specification to enable safe and timely access
to CYP held in CYPSE
• All children placed in the CYPSE are screened and assessed using the
Comprehensive Health Assessment Tool. Evidenced based tool designed
specifically for CYPSE.
• Performance indicators (HJIPS) are being introduced from 1 April 2016
Health and Justice: Commissioning in more detail
3

4. www.england.nhs.uk
Health and Justice: numbers in contact with the YJS
• There are small numbers of children and young people (under 18s) within
custody, but much higher numbers in contact with justice services (and therefore
accessing other services, including health via this route) overall.
• In 2013/14 there were 45,893 defendants (aged 10-17) proceeded against in the
courts. Of these 33,902 were sentenced for their offences. Those who were not
sentenced may have been found not guilty or had the case against them
dropped. Of those that were sentenced:
• 9,001 young people were sentenced to first tier (sentences, including fines and
discharges);
• A further 22,675 young people were sentenced to community sentences,
including youth rehabilitation orders.
• A small number of young people were sentenced to immediate custody (2,226)
accounting for 6.6 per cent of all young people with sentences. The most
common type of custodial sentence given was a Detention and Training Order
(DTO), where half the time is typically served in custody and the remainder in
the community on licence and under YOT supervision.

5. www.england.nhs.uk
• The Healthy Children, Safer Communities strategy stated that over a third of
children in the CYPSE has a diagnosed mental health disorder. This may be
layered with several other needs, making them a complex and vulnerable
cohort to assess and treat.
• For many children and young people their experience of a secure setting
brings them into sustained and meaningful contact with health services for
the first time.
• A literature review of studies into the mental health of young offenders
concluded that children and young people in the Youth Justice System are
at least three times as likely to have mental health problems than their non-
offending counterparts.
• In the population as a whole around 20 per cent of children suffer from
some form of mental health problem; a smaller number, 13 per cent of boys
and 10 per cent of girls (aged 11-16), suffer from a psychiatric diagnosis of
mental health disorder.
• The literature review found that in the studies it included, the prevalence of
a diagnosed disorder among those in custody was far higher, ranging from
46 to 81 per cent, and among those in the community from 25 to 77 per
cent.
Children and Young People in the secure estate : Morbidity

6. www.england.nhs.uk
• Looked After Children: There is an overlap between children and young people
in the Youth Justice System and those in contact with children’s social care. The
proportion of children and young people in custody who have experienced
serious child maltreatment is at least twice that in the population as a whole.
• Liaison and Diversion: Indicative data from waves one and two of the Liaison
and Diversion programme shows that 55% of children and young people had one
mental health condition, 32% had two mental health conditions and 23% were
experiencing three or more mental health conditions.
• SARCs: Data collected on paediatric SARC cases for Q1 and 2 of 2015/16
shows 1851 children and young people under the age of 17 in contact with
SARCs in England (the highest proportion in the North West).
• It is projected that for 2014/15 24.5% of all London SARCs clients (all ages) will
have a vulnerability factor of a mental health condition.
Children and Young People: Morbidity
6

7. www.england.nhs.uk
• The Health and Justice CAMHS Transformation workstream is part of
the CAMHS Transformation delivery programme. The project
includes:
• The roll out of a Collaborative Commissioning Network, which will
ensure full clinical pathway consideration for children in contact with
Health and Justice direct commissioning;
• The development of a specialised mental health model of care for
Young Offender Institutions including Enhanced Support Units in the
secure estate for children and young people and
• development of an integrated specialised mental health model of care
for Secure Children’s Homes;
• Joint working with Specialised Commissioning in the delivery of
community FCAMHS (Forensic Child Adolescent and Mental Health
Services) and Complex Needs Services.
Health and Justice: CAMHS Transformation
7

8. www.england.nhs.uk
PAEDIATRIC
SARC
YJB
SECURE
SECURE
WELFARE
TRANSITION
LIAISON &
DIVERSION
HEALTH AND JUSTICE CYP SERVICES
C
O
M
M
U
N
I
T
Y
J
U
S
T
I
C
E
ALL
CAMHS

9. www.england.nhs.uk
PAEDIATRIC
SARC
YJB
SECURE
SECURE
WELFARE
TRANSITION
LIAISON &
DIVERSION
HEALTH AND JUSTICE CYP SERVICES
C
O
M
M
U
N
I
T
Y
J
U
S
T
I
C
E
ALL
CAMHS

10. www.england.nhs.uk11/04/2016

11. www.england.nhs.uk
What have we done?
• Missed opportunities
• Early help and intervention
• Prevention
• Communication
• Consistency
• Relationships
• Quality

12. www.england.nhs.uk
What is the future?
• How will he transition to adult services?
• Who will help him?
• What are his chances?