Community Forensic Adolescent Services: A Comprehensive Integrated Regional Service'

1
Community Forensic Adolescent Services A
Comprehensive Integrated Regional Service.

• Forensic Adolescent Network Meeting, St Andrews
  Hospital, 3rd October 2008
• DR NICK HINDLEY
• Child and Adolescent Forensic Psychiatrist
• Child and Adolescent Forensic Mental Health
  Service, Warneford Hospital, Headington, Oxford
  OX3 7JX
• Email nick.hindley_at_obmh.nhs.uk

2
Introduction

• Context for development
• Philosophy and remit of service
• Components of service
• Successes
• What can be expected
• Continuing concerns

3
The Context of CAF Team Development

• development of YOTs
• prison in-reach to NHS
• comprehensive CAMH services
• creative commissioning
• childrens NSF
• early intervention
• complex needs
• transition
• learning disability
• CJS and mental disorder

4
Philosophy

• comprehensive service to a given area
• Oxon, Bucks, Berks and MK (2.1m)
• flexible use of experienced and qualified team to
  deliver Tier 4 specialist service
• based in mental health but committed to
  multi-agency working
• equivalence of service across institutions
• clinical and institutional role
• promotion of continuity and attachment
• team active, accessible and approachable
• broad interpretation of forensic

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Integrated Liaison Model for a Forensic CAMH
Service
Substance Misuse Services
Young sex offenders
Youth Offending Teams (YOTs)
Child Adolescent Forensic Mental Health Team
Looked after sector and secure accommodation
Courts
National Adolescent Forensic Inpatient Services
Prison In-reach
Locality Specialist CAMHS
Education
6
Scope of Overall Regional Service

• Prison in-reach HMYOI Huntercombe
• Specialist regional resource
• advice
• formal consultation
• assessment, liaison and clinical intervention
• service development and training
• other prison/institutional liaison
• other strategic functions

7
Funding, Location and Structure

• funded jointly by prison in-reach monies and
  initially DH development grant
• prison in-reach monies via local pct (SLA)
• regional community service funded by DH (SLA)
  until April 2008
• regional community service funded by regional
  specialist commissioning from April 2008
• team managed within mental health NHS trust (Oxon
  and Bucks Foundation MHT)
• located within CAMHS but strong links with adult
  forensic service and multi-agency environment

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What Team?

• child and adolescent forensic psychiatrist
• child and adolescent clinical and forensic
  psychologist
• clinical nurse specialist
• forensic team practitioner
• administrator

9
Overall Service Clinical issues

• Wide-ranging differ in emphasis
• Core child and adolescent work in prisons and
  other settings
• Forensic (risk-related) work in community
  settings
• Identifying needs and risks in all contexts

10
Prison In-reach Interaction between CAF Team
and YOI
Y.O.I. Casework, Officers, Child Protection,
Suicide Prevention, Family Liaison, Movements,
Substance Misuse, Forensic Psychology, Education,
Healthcare and Primary Mental Health Workers

• C.A.F. Team
• Consultation
• Joint working
• Assessment
• Interventions
• Multi-agency liaison
• Facilitation of access to
• CAMHS (incl. transfers)
• Education

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Prison Working Successes

• multi-disciplinary working in the prison
• multi-agency liaison with outside agencies
• a variety of interventions (tier 3 and 4)
• continuity of support for boys from region (in-
  or outward)
• focus on mental disorder and health
• support of senior figures in prison, PCT, YOT,
  DoH, Home Office, HM Inspectorate
• out of hours mental health cover via mental
  health trust

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Regional Community Child and Adolescent Forensic
Service Clinical Network

• Regional Child and Adolescent Forensic Service
• advice
• consultation
• specialist assessment and management
• strategic development and professional support

• CAMHS/YOT Linkworker
• appropriate CAMH background
• interested in this group of young people
• belongs to both agencies
• wide range of liaison functions

Local YOT
Local Specialist CAMHS Service
Other Local Agencies
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Regional Community Service How it Works

• advice
• formal consultation
• assessment and intervention
• wide-ranging access if clear need
• joint working with local CAMHS
• strategic development
• CAMHS/YOT linkworker network
• training
• complex needs
• structured risk
• varied liaison functions
• local, regional, national

14
Community Working Successes

• establishment of stronger links between
  childrens mental health services (CAMHS) and
  criminal justice system
• development of a regional mental health network
  focussing on support for local services but with
  availability of specialist input as needed
• local multi-agency solutions to complex and
  worrying problems
• provision of service to young people across a
  variety of settings

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Interface Issues What Local CAMH Services Should
be Doing Themselves

• gaining preliminary oversight and developing
  formulation of a case
• considering issues of risk
• developing short-term risk management
• evaluating need for further (joint) evaluation
• liaising further if needed
• ? identifying team member for further training in
  structured assessment

16
Interface Issues What Local CAMH Services Should
Expect From a Regional CAF Team

• accessibility
• good communication
• clarity relating to function and responsibilities
• specialist knowledge of
• relevant institutions
• custody, community agencies, courts
• practice
• Mental Health Act, information sharing etc
• risk management
• good collaborative relationships

17
Continuing Concerns

• young people with sexually harmful behaviours
• pervasive developmental disorders and learning
  disability post 16
• transitions to adult services
• commissioning vulnerability and maintaining
  strategic support from senior managers for
  CAMHS/YOS working