Halton CCG & Borough Council

Waiting lists for Children and Adolescent Mental Health Services (CAMHS) in Halton were high and the system of referrals was not working as it should. 

The NHS Halton Clinical Commissioning Group (HCCG) and Halton Borough Council together with the 5 Boroughs NHS Trust, decided to do something different and embarked on a new approach.

The obvious areas to tackle were the long waiting lists and the ineffective referral system. But, taking a broader view, they decided to start at the beginning: early intervention.
Instead of increasing investment in the tier three crisis services that were so much in demand, HCCG and the Borough Council looked to tier two early intervention services. Their strategy was to address mental health issues before they had time to escalate. They would focus on reaching out to children rather than waiting for crises to emerge.
And that’s where the partnership approach between the 5 Boroughs NHS Trust and XenZone came in. We began working together on a transformative approach that would support children and young people with their emotional health and well-being at the earliest opportunity.
We began by crunching the numbers to establish the right type and level of services needed. Using local Joint Strategic Needs Assessment data, combined with research on the number of children and young people who may experience mental health issues appropriate to a response from CAMHS within Halton, meant that estimates could be made as to the level of support young people in the area would need over time. This research showed that most need would come from tier one and tier two groups – in THRIVE language, the ‘Coping’ and ‘Getting Help’ quadrants. It also showed that most referrals would come from those older than 11.
With this knowledge front of mind, the 5 Boroughs Trust and XenZone began to shape the services and skills needed to support Halton. The service would need a mix of skills, including specialisms around weight management, family therapy, emotional well-being support in schools, and counselling (both face-to-face and online) through Kooth.
These therapeutic services would need to deliver to children from age four to 19, but would also support young people with disabilities and those who are in care or care leavers up to age 25. Group work and a one-to-one programme of support for young people with self-harming behaviours was also included in the system design.
We knew for this collaborative approach to work we needed to work hand-in-glove with a host of skilled partners to build a central point of support for every child or young person in need of help. This would include healthcare professionals, local community groups, charities, social care services, schools, colleges and other education providers, statutory and non-statutory bodies, voluntary, community and faith sector organisations, youth offending services, NHS Hospital Trusts, including A&E, local paediatric wards and liaison services. It was an ambitious undertaking, but we had to make every effort to link these services. We also needed overarching pathways for referral work, as well as clear signposting and safeguarding protocols.

As a partnership, we agreed that early access was key. We therefore needed to establish:

  • A non-stigmatising culture
  • A fast, easy way to self-refer
  • An easy referral option for professionals
  • Self-help and drop-in support
  • Different places to get help: school, community, clinic or online
  • Short waiting times
  • A joined-up team approach so the right intervention could be given at the right time
  • Training and consultation for schools

Getting these elements right was crucial in building a mixed model of therapeutic interventions, where children and young people whenever possible, would be given a choice about the type of help they would receive.

We also wanted to see a link from this service to tier three services. Or, in THRIVE language, the ‘getting more help’ and, required specialist face-to-face help (i.e. young people with emerging psychosis or an active eating disorder for example), ‘getting more support’ services. To meet this ambition, we redesigned the service to incorporate half a day a week of psychiatry time. This meant that a psychiatrist could support the team or review and advise on any cases we were working with.

Importantly, as part of our joined-up approach, the XenZone and CAMHS teams would be co-located. Tier two services would also use the same processes as tier three, meaning that young people could access all areas of the service without repeating their ‘story’ every time they needed help.

Where we are today
XenZone has been working closely with 5 Boroughs NHS Trust in Halton for more than two years. Children and young people today are benefitting from the central point of contact for all mental health services.
Those from the age of four and upwards can receive therapeutic one to one work and counselling in school or the community as well as benefit from the other services delivered.
Those from age 11 are referring themselves to Kooth anonymously and are using our digital counselling services for free or accessing face to face counselling. Through Kooth, we offer access to professional online counselling, access to self-help materials and live forums, the opportunity to read or contribute to our online magazine and the ability to leave messages for counsellors at any time. The service is available up to 10pm every day of the year.
In 2016, over 650 individuals logged in to the service to get help. A significant number in Halton use our forums for support; we see discussion threads being accessed on average over 80 times a month. And 13% of new registrations last quarter were from traditionally hard to reach black and minority ethnic children and young people – a much higher percentage than is typical with face to face counselling.
Our service also offers face to face counselling. Younger children are getting access to this support in schools, in the community or in clinics, depending on the parent or carer’s choice.
In developing this new one-stop-shop service, we have made schools the cornerstone of our early intervention and prevention strategy. And where we are delivering professional training, equipping frontline staff, parents and children and young people with the skills they need for their own psychological health.
To this end, the team is spending time in schools talking to children about the new service. We are holding regular assemblies or workshops on issues affecting the children, from bullying or exam stress, to developing emotional resilience. We also run small group work around self-harm using Dialectical Behaviour Therapy (DBT) skills. The team is working closely with other professionals, such as social workers and GPs to make sure children and young people know where and how to find help.
During 2016, over 450 children and young people registered with Kooth. Most had heard about our service from school (28%), CAMHS (18%) or their GP (14%).

Has this approach worked?

In a word: yes.

Commissioners have observed ‘less noise in the system’. Negative comments from frustrated parents, GPs and schools have reduced. Professionals are finding the service easier to work with and, crucially, children and are being seen much more quickly. Professionals, such as teachers or GPs are now referring in to this single point. Referrals are assessed and allocated either to psychiatry, psychology or to the co-located team of CAMHS and Kooth. Either way, children are given the right intervention, quickly and without fuss. As a joined-up team, we can refer right across the system according to need.
Use of Kooth’s online counselling service is growing each month. In the last quarter alone, Kooth has been accessed over 600 times by those registered. Most are presenting with anxiety or stress, issues around family relationships and friendships – issues that our counsellors are able to support themselves, or through their links with specialist teams.
We are still gathering more evidence as to how the whole system is helping, but we can see today that we have done what we set out to achieve. We have reshaped the support offered to young people and driven forward a strategy of early intervention. This integrated approach, embedding organisations to work together for the benefit of children and young people with tier one and two issues, has transformed waiting times and the process of referrals, which had bogged down the previous system.
By building a system to suit the child or young person, rather than expecting them to work round us, we are helping more and more people with mental health problems recover.

“I am very pleased with the chat I had with my counsellor, it really helped me. I haven’t spoken to anyone else yet but I am sure you have a lot of people like her. You are amazing people and I’m happy there’s someone out there who cares about young people’s feelings.” Kooth user