Children, young people and families

Team: Wirral Children and Young Peoples Mental Health Services
Contact: rachel.jarmain@nhs.net 

What we wanted to achieve

This project aimed to make Wirral Children and Young Peoples Mental Health Services (CYPMHS) more accessible and inclusive for children and families from diverse ethnicities and cultures, by identifying factors that limit them seeking help. It aligns with Core20 PLUS5's overarching goals of reducing healthcare inequalities among children and young people, particularly among ethnic minority communities, by identifying and addressing barriers to access (NHS England, 2022).

In Wirral, 95.2% of people identified themselves as white (Office for National Statistics, 2022). Snapshot referral data for Wirral highlights an underrepresentation of children and young people from diverse ethnicities in referrals (2.8%).

What we did

Wirral CYPMHS collaborated with Wirral Multicultural Organisation (WMO) to explore barriers and solutions. The project used mixed methods to collect quantitative and qualitative data.

Participants included WMO staff and parents who answered questions about their awareness of CYPMHS, how referrals work, and satisfaction with the service.

An online questionnaire was designed for WMO staff. This addressed familiarity with referrals, confidence in making them, personal experiences with CYPMHS, and ideas for enhancing accessibility. Face-to-face discussions were arranged with staff and families, facilitated through WMO's existing coffee mornings, with interpreters provided by the centre. Families also completed a short questionnaire.

Results

WMO staff confidence levels in the referral process varied - notably 88% had never made a referral to CYPMHS and lacked familiarity with the referral procedure. The findings revealed significant dissatisfaction with service variety and waiting times.

Approximately 60% of parents were familiar with CYPMHS, but a quarter lacked knowledge of the referral process. Confidence in seeking mental health support stood at 40%, while 60% felt comfortable discussing mental health. All participants rated various aspects of the service positively.

Both cohorts suggested increasing accessibility to staff contact, and emphasised need for multilingual resources and more transparent referral procedures.

Next steps

The next steps involve providing multilingual versions of referral forms, training for WMO staff, organising drop-in sessions, and working with schools and community groups with children and young people from diverse communities, to promote mental health awareness, community connections and understanding of emotional health and wellbeing provision.

Overall, this project highlights the importance of enhancing CYPMHS to meet the needs of children and families from ethnic minority backgrounds in Wirral.

This information has also been shared with commissioning colleagues, schools, community groups, GPs and equality, diversity and inclusion colleagues within CWP, to share across care groups.

Team: Wirral 0-18 Children and Young People's Mental Health Service
Contact: sophie.foster15@nhs.net / matthew.howie@nhs.net  

What we wanted to achieve

The project aimed to develop a novel therapeutic intervention for neurodivergent children and young people and their families. Research has demonstrated that neurodivergent young people face barriers to accessing psychological interventions in children and young people’s mental health services (CYPMHS). 

The intervention aimed to support children and young people to develop skilful behaviours and coping skills to help them regulate emotions and behavioural responses, and support them to develop a better understanding of their neurodiversity. It was important that this intervention adopted a systemic approach, supporting and upskilling parents and carers. It was envisaged that the project would enhance access to interventions and promote better outcomes for neurodivergent children and young people.

What we did

A 12-week rolling skills group intervention was developed, consisting of a two-hour session per week with up to 10 young people. Prior to the group, children, young people and families were offered a pre-treatment session to discuss the programme and identify and address any barriers which may impact engagement. There is also a separate parent and carer session.

The group covers four modules: 
•    Coping skills.
•    Emotion skills.
•    Understanding me.
•    Social and communication skills.

Results

Findings highlighted that, on average, the young people rated the overall satisfaction as 9 out of 10, ‘importance of topics’ as 9 out of 10, and ‘feeling listened to’ as 8.2 out 10. Feedback shows that the group reduces psychological distress and increases parents’ and carers’ understanding of the young person. 

• Reduction in revised children's anxiety and depression scale scores from 89.6 to 66.2.
• Reduction in parental stress from 53.4 to 47.2.
• Increase in parent and carer understanding from 22 to 32.2. 

Parent feedback has included:

• “At first it was too long. At the end, it wasn’t long enough.” 
• “I don’t know where I would be without the group.”

Next steps

The next steps are to develop an ending process which helps young people to transition to community services. We would like to incorporate more signposting to community services. We aim to continue working with children, young people and carers and families to collaboratively improve Skills for Me. We will also be reviewing and finalising handouts to be shared with Cheshire East and West CAMHS services.
 

Team: Starting Well
Contact: joanne.hall15@nhs.net 

What we wanted to achieve

There is a national drive to give children the ‘best start in life’ and research indicates that a child’s life chances can be predetermined by their early communication skills. The cognitive gap between children from different social backgrounds is widely acknowledged. CWP’s Starting Well team supports the early identification of oral language skills for children from age two to age two-and-a-half to ensure appropriate action is taken. Early years leads used the guidance handbook from Public Health England’s Early Language Identification Measure and Intervention (ELIM) to change practice and improve consistent and effective support for oral language development, knowing this is a precursor for overall cognitive achievements.

What we did

Early years leads delivered training to appropriate Starting Well staff on effective use of the ELIM. Electronic Patient Record (EPR) templates were updated to record when an ELIM is completed, including the outcome, the action, or the reason for not competing. EPR staff were given training on the use of templates to ensure data accuracy.
 
Early years leads developed partnership working. Actions from an ELIM assessment were shared with the parent and childcare provider. The ELIM pathway includes the council triangulating the use of ELIM actions in practice on their visits to childcare settings. 
 
Documentation and reporting are electronic which helps to understand and analyse the data sets and gives assurance that the process is effective. Nursery nurses, health visitors and early years workers all complete ELIM assessments and work with parents to agree next steps in learning for individual children that is consistent and shared with their childcare providers for a joined-up approach.

Results

Between 1 January 2023 and 31 December 2023:

• 2,877 children had an ELIM assessment alongside their HCP two to two-and-a-half-year review.
• 696 out of the 2,877 of children were found to need support with their oral language development.
• 584 out of the 696 children were offered early help through the Starting Well service directly or by advice and support to their family or childcare provider.
• Only 112 out of the 696 were referred directly to speech and language therapy.

Next steps

The next steps are to submit and publish the ELIM data nationally, celebrate the intervention that Starting Well offers for children identified with low-level oral language needs (without the need for referral to specialist services), and to build a joint, multi-disciplinary triage and referral process with local speech and language services to ensure children are accessing the right level of service at the right time, or ‘waiting well’ for support.

Team: Wirral Mental Health Support Team
Contact: isabell.sutherland@nhs.net 

What we wanted to achieve

The transition between primary and secondary school is a key milestone in a child’s development, with many studies identifying the long-term impact poor transition has on children and young people’s psychological wellbeing (Sayers et al., 2012).

The aims and objectives were:

• Evaluate whether secondary school mental health leads felt the transition offer was beneficial in supporting children and young people’s wellbeing through the transitioning period.
• Evaluate whether Mental Health Support Team (MHST) practitioners felt the transition offer was beneficial in supporting children and young people’s wellbeing through the transitioning period.

What we did

Alongside the 94 primary schools in Wirral, four secondary schools were also identified and agreed to take part in the enhanced transition programme. The MHSTs primary school offer was whole-class workshops in the last term of school and consultations with mental health leads to discuss year six pupils who needed additional one-to-one intervention. The MHSTs secondary school offer was induction day sessions to all year seven pupils at each secondary school, participation in parents evenings and coffee mornings, summer school sessions for enhanced transition sessions within the new school, and practitioners available on the first day of school as a point of contact.

Results

The feedback from the questionnaires for all secondary schools was positive and suggestions all focused on continuing and / or developing further support from the MHST.  Feedback included:

• ‘’We really love the sessions. They are clear and engaging and now that we have a strong relationship with the team, they have tailored it to our school, which was really helpful.”
• “Some of the children have not required further support from us now in school.”
• “All the support was gratefully received and I feel it has supported a smooth and successful transition.”
• “We really appreciate MHST input into transitions and would like to be involved in anything additional you can offer.”

Next steps

Feedback from last year’s provision is currently being used to design this year’s transition work. The MHST service has been successful in securing funding for a further team, which means the service is now able to work with eight secondary schools in the most deprived areas of Wirral. These schools will also now be offered transition work alongside the primary schools, meaning the project will be expanded to double the number of secondary schools.

Changes will be made to the project based on learning from last year, including starting the process of engaging schools earlier in the academic year, offering enhanced transition sessions whilst pupils are in primary school to avoid the summer, developing a set programme that any practitioner can pick up and offer in their schools, having more focus on sessions in secondary schools rather than over the summer, and longer-term support in secondary schools for children with additional needs.

Team: Wirral 0-18 Children and Young People’s Mental Health Service  
Contact: kirstyanne.irving@nhs.net

What we wanted to achieve

The activity group team wanted to create a fun space, designed by young people, to give them a sense of achievement and ownership. They wanted to open conversations between the activity group and encourage friendships through a shared activity. They also wanted to find an area in which young people would feel safe in the community and felt that if the young people helped to create their own, this would encourage them to attend and engage more with the Children and Young People Mental Health Service (CYPMHS).

What we did

The young people in the activity group were consulted to think about designing different areas of the garden. They wanted to include a bug house, a fairy garden, planters, a seating area and somewhere to grow fruit and vegetables. The team reached out to garden centres, charities and local people to help with the ideas. They secured donations of plants, benches, bird houses, hedgehog houses, paints and soil planters. 

Results

A young person expressed how they really enjoyed completing the project. Parents stated that it felt like it gave the young people a sense of achievement as many would take their parents round to proudly showcase their work. Colleagues stated that the young people really engaged with the experience and became more confident to attend other projects and groups. One young person began drama classes and even returned to college, whereas before they were struggling to leave the house. One young person began growing their own vegetables and even made houses and fairies at home with their family for the garden. The garden project encouraged the young people to engage together, take note of other ideas and opinions, and the team could see the young people’s confidence and pride growing each week.

Next steps

The team would like to obtain a greenhouse to grow fruit and vegetables. The intention is to ask the young people who are involved in the group to contribute with the upkeep of the garden to promote autonomy and self-efficacy. In warmer weather the team would like other practitioners to use the space to host their own sessions, whether it is working on the garden directly or using the calming space to encourage young people to begin therapy and promote better engagement and increased confidence in a less clinical environment. The space could also be used to host art classes and mindfulness sessions eventually.
 

Team: Wirral Mental Health Support Team
Contact: steve.spence@nhs.net

What we wanted to achieve

Wirral Mental Health Support Team (MHST) offers brief, evidence-based interventions to children and young people of primary school age, presenting with mild to moderate mental health problems, and their parents and carers. The majority of referrals to Wirral MHST are for children and young people with anxiety.

Many families encounter difficulties in attending regular face-to-face appointments in a clinic setting, for numerous reasons, including work and family commitments, transport availability or costs and mobility difficulties. The MHST wanted to offer parents and carers an accessible, flexible and evidence-based intervention to support them with understanding and responding to their child’s anxiety. 

What we did

In 2020, Wirral MHST joined 33 other sites in a randomised controlled trial with the University of Oxford to compare their parent-led online support and intervention (OSI) for child anxiety with the service’s ‘treatment as usual’ offer, and to evaluate the effectiveness of the approach. Parents and carers work through online modules at times that suit them and are supported with weekly 20-minute telephone appointments with a practitioner trained in the treatment intervention. From Wirral, 13 parents and carers were recruited and engaged in the intervention, along with 420 from other centres across the UK. Parents and carers completed questionnaires about their child’s anxiety symptoms and quality of life. When the study concluded, Wirral MHST, alongside Cheshire MHSTs, extended the use of the OSI by training more practitioners to use the OSI approach. Practitioners attended a two-day training course, with one day focused on the online parent-led cognitive behavioural therapy (CBT) content, and one day on the OSI platform. To date, CWP has trained 79 practitioners in the OSI intervention.

Results

Parents and clinicians reported that the OSI digital platform was easy to use. The result from the overall study showed that even though OSI is a shorter offer of parent-led CBT, it is as effective as longer individual CBT for a child in reducing anxiety symptoms. Less treatment time for the same outcomes means that more families can access support more quickly, and the intervention is more cost effective. The delivery of the intervention through the online platform may also be more accessible to some parents and carers, thus overcoming barriers to treatment. The published study can be viewed in The Lancet Psychiatry and in The Conversation.

Next steps

Wirral MHST will continue to offer this intervention to families. OSI offers an online, flexible option for families who may struggle to engage in regular face-to-face appointments in a clinic setting. It may also help families access more timely support for child anxiety problems.
 

Team: The Gateway Programme Team
Contact: elizabeth.collins21@nhs.net ​​​

What we wanted to achieve

In 2022, the Gateway Programme was launched across Cheshire and Merseyside (C&M), which is an approach for multi-agency professionals to provide a consistent evidence-base and recommendations for young people with moderate to severe mental health difficulties combined with risk factors, including risk of tier 4 admission. Reference to multi-agency collaboration features in national policy, place-based strategy and professional standards, and whilst its importance is recognised by experts by experience (EBEs) and legal rulings, practical challenges concerning varied terminology, perceptions and assumptions across professions and employers are seldom acknowledged. Timely, multi-agency action to address the complex unmet needs of young people for person-centred care must acknowledge this challenge.

What we did

Acknowledging challenges concerning variation in terminology and perceptions across professions and employers, the Gateway Programme Team (GPT) established a learning and information offer, including Gateway Community of Practice (COP) for colleagues with a professional interest in the Gateway, as an opportunity for collective learning across shared endeavours concerning person-centred care, to address complex unmet needs of young people. NHS and local authority professionals were invited to quarterly online meetings to receive place-level Gateway updates, share information, ideas and examples of good practice, whilst networking and hearing from EBEs. COP agendas were coproduced with participants, focusing on appetite for consistency of approach across nine Gateways within C&M during multi-agency discussions.

Results

The GPT welcomed 30 C&M professionals to online COP in October 2022. Feedback was generally positive. Attendance increased to 50 by February 2023 and feedback indicated appetite for networking and developing relationships. GPT identified additional resource to co-host the first in-person COP with colleagues leading implementation of Complex Needs Escalation Support Tool (CNEST) across shared stakeholders. GPT hosted six COPs (four online and two in person) in 18 months. 

COP stakeholder list includes 200 NHS and local authority professionals in C&M. Almost 300 have participated in COP online or in-person. Evaluation of COP in February 2024 described presentations and breakout sessions as ‘good’ or ‘very good’.  Many respondents noted opportunities to meet in person were valued, with comments including that the event had a “wonderful range of speakers”, and that it “exceeded expectations”. When asked how they found the experience of COP membership, respondents described it as ‘useful’ or ‘very useful’ and comments included:

• “Like-minded people with children and young people at heart.”
• “It’s amazing how much has been done in a short time. It shows what drive and leadership can accomplish.”

Next steps

COP evidence was included in qualitative analysis reporting on Gateway implementation at the conclusion of the programme. Utilising the COP evaluation, the GPT secured further additional resource for support beyond the programme. Slides from the COP are already available online will be accompanied by film and animation resources, coproduced with professionals and EBEs to further support the development of multi-agency relationships, in addition to securing administrative support.
 

Team: Wirral 0-18 Children and Young People’s Mental Health Service (CYPMHS)
Contact: kimberley.embra@nhs.net

What we wanted to achieve

The aim was to offer a specialist mental health pathway within Wirral 0-18 Children and Young People’s Mental Health Service (CYPMHS) to families with a child age 0-5 at multiple levels, offering expertise and advice to the local workforce via consultation and training, specialised assessment and therapeutic intervention to families. Also, partnership working across local and national services in line with local and government initiatives. Infant development is shaped by environment and care giving, and during this crucial period, stress and trauma can impact on healthy development. Meeting the needs of the youngest children and their families leads to less demand on services in years to come. This pathway has been coproduced with families and partnering agencies and shaped provision.

What we did

• The Early Years Team connected with partner agencies to offer a successful weekly Joint Thinking Space (JTS) - initially called ‘consultation’ but renamed to sound less medical - for local early years professionals to think about families with children under 5. Offering advice and guidance, connecting with partnership agencies or a children and young people’s mental health assessment.
• They offered evidence-based interventions, including video interaction guidance, and staff have received further training. including theraplay.
• Worked closely with psychotherapy colleagues through a therapeutic offer.
• Part of the local best start for life and family hubs initiative, promoting infant mental health locally. 
• The team also attended Cheshire and Merseyside groups to ensure consistency of best practice.

Results

Results showed a significant increase in referrals for under 5s in 2023. Pre-pathway, three referrals were received in 2021, 24 in 2022 and 56 in 2023 - a 700% increase from 2021 to 2022 and 133% increase from 2022 to 2023. Qualitative feedback from colleagues reflects positive themes around accessibility and developing confidence in care management, including:

• “It was readily available and easy to access to ensure the right pathway was identified for the child and family I was supporting.” Early years family worker 
• “It is difficult to assess if a child is delayed developmentally or if a parent / child relationship is an issue. The joint thinking space enables a more targeted approach and I’ve found that very useful.” Health visitor
• “I’ve referred one mum who benefited significantly from your service’s input and the change for her and her son was so positive and beneficial for them both.” Health visitor

Next steps

Continuing collaborative working; strengthening links with perinatal services, local early years education and ethnic minority communities. Consolidating training completed in 2023 within practice. Further therapeutic intervention such as groups (circle of security/mentalisation). Continuing liaison with the early years workforce to develop national strategy. Liaise with other CAMHS services within CWP and hopefully replicate to ensure this is a wider offer.

Team: Cheshire and Merseyside Eating Disorder Service (CHEDS) 
Contact: clair.jostingmoulder@nhs.net 

What we wanted to achieve

The aim was to support a parent/carer to become a peer support mentor within the Cheshire and Merseyside Eating Disorder Service (CHEDS) for young people.

What we did

Following her daughter’s recovery, Cathy wanted to give something back to the eating disorder service and support others going through similar experiences. She started volunteering with CHEDS and supporting other parents within the service. She trained to become a peer mentor and attends the online parent group for the eating disorder service. She has had a positive impact at a local Trust level by direct consultation on treatment pathways and being integral to the coproduction of service user and carer information leaflets and documentation. She has also spoken at the multi-family group information evenings. 

Results

Cathy is an incredible role model for any parent or career of a child suffering from a mental health disorder and in particular an eating disorder such as anorexia nervosa. With first-hand experience of supporting her daughter to navigate a very long, exhausting and often terrifying journey of accessing treatment through community services, medical wards, tier 4 services and inpatient wards, Cathy showed incredible courage, compassion, commitment and engagement with all the services supporting her daughter and family.

She is a phenomenal role model for all the families that have an eating disorder in their home and often in control of their lives. She listens with sympathy, empathy and understanding, and offers advice and active listening with a message of hope that throughout times of great difficulty, change, recovery and an ability for individuals and families to get their lives back is possible. 

Cathy won the Royal College of Psychiatrists Carer Contribution of the Year award in the North West division. 

Next steps

Cathy continues to offer support for families and carers and hoping to support more people to become peer support mentor.
 

Team: Wirral 0-18 Children and Young People’s Mental Health Service 
Contact: cwp.wirralcamhs.complexcare@nhs.net

What we wanted to achieve

There was an identified gap in service provision for children and young people within Wirral 0-18 Children and Young People’s Mental Health Service (CYPMHS) who do not fit into a therapeutic pathway. These young people require more intense intervention and a flexible approach to their care, to support their needs and this is not within the current capacity level of the service.

The team completes visits in school, home and community settings, which allows added flexibility outside of the existing 0-18 offer. The team wanted to support colleagues in managing complexity and increase capacity within the team to be responsive to those with higher levels of need.

What we did

The team developed a pathway for children and young people who have high levels of complexity, including complex mental health needs, social care needs, or a level of complexity within the system, requiring containment. They hold a caseload of children and young people requiring more intense, working with the young person in a person-centred way. For example, completing visits at home, school, or wider community. The team works collaboratively with the system (social care, school and health) to understand barriers or challenges and support understanding of the young person and drive forward the care plan. We provide consultation to colleagues within Wirral CYPMHS to enhance knowledge and confidence in dealing with complex cases. 

Results

Feedback has been positive and quantitative data highlights that on average, a complex case takes four hours per week. The pathway allows capacity to increase within Wirral CYPMHS. Qualitative feedback from internal and external colleagues has included:

• “The multi-agency approach has been so beneficial in escalating and moving things forward. I hope we get to work on cases together in the future.”
• "The pathway massively supported with a really challenging case that required significant input and multi-professional discussion. They gave a lot of time and advice and were always available to discuss and help with thinking around how the system can best support the young person.”

Next steps

The pathway hopes to develop further moving forward and expand the offer to children and young people in the Wirral locality. The hope is to offer support to children and young people isolated at home who are not attending education or engaging with social activity. The team would like to further develop the support provided to systems around children and young people by collaborating with health and social care colleagues. The aim is to continue to provide support to colleagues within Wirral CYPMHS to enhance skills development and confidence when working with complexity.