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An innovative project in Southampton draws together agencies from social services, health and education in a bid to offer a comprehensive package of help to children who are displaying severe challenging behaviour. Natalie Valios reports

What do you do when you have a child whose mental health, education and social care difficulties are too complicated to be dealt with by a single agency service? In normal circumstances, they'd end up with numerous professionals involved in their life each, in all probability, unaware of what the others are doing.

But in Southampton a multi-agency group has come up with a solution. The Behaviour Resource Service is a jointly funded, jointly planned and fully shared project between social services, education and health agencies for children displaying severe challenging behaviour which requires a consistent and co-ordinated response.

The service has two branches - a community team service and a four-bed short-term residential assessment unit, both with social services managers. Their aim is to provide an intensive, locally-based assessment service for children and young people whose multiple difficulties are demonstrated in seriously challenging behaviour.

The community team service is for those aged between five and 18 and the residential unit for 13 to 18-year-olds. The service works in an integrated way so that all young people who go through the residential unit are followed up by the community team.

Between one third and a half of referrals are looked-after children; the others are all vulnerable to becoming looked after. To be referred to the service, children and young people should fulfil three of four criteria. They should:

- Be unable to function in mainstream or specialist education provision.

- Display extreme behaviour due to severe mental health/emotional difficulties which requires a multi-agency assessment.

- Be at risk of significant harm to themselves or others.

- Be at risk of family or substitute family breakdown.

Relevant mainstream services should already be in place so, for example, they should have an allocated social worker and access to the local child and adolescent mental health service.

An extra criterion for admittance to the unit is that the young person's mental health and behaviour is deteriorating, needing an assessment that can't be carried out in the community.

The community team staff bring together family and professionals so that they can share their accumulated information of the child. Generally speaking, professionals are unaware of the others' involvement, says community team manager Sue Allan. Community team staff conduct a holistic assessment.

"We put them together in a room to look at the assessment we have produced. A complex intervention plan is agreed so that they are all working to the same aim.

"Our prime objective is to co-ordinate the professional and family network to ensure it is working together and if there's a therapeutic gap we will fill it."

The network is brought back together at frequent intervals to check the plan's progress and amend it. In theory, once the network is working together the team can taper off its activity. The reality is that the team finds it hard to close a case because the professional network doesn't have the time or resources to work to the same intensity as it can.

"We supplement what is going on, but don't replace it. Otherwise we will never be able to withdraw because the young people have an enduring need for services for years to come."

In the residential unit, one of the four beds is retained for young people presenting in emergency situations, which typically occurs out of hours. They have been batted between one agency and the next, with ad hoc and unplanned services, or expensive out of area placements, says Allan. This bed is accessed by agreement between the unit's psychiatrist and manager to ensure that the focus is kept on the mental health needs of the young person.

The remaining three beds are for planned admissions for six-week assessments. The philosophy is that every hour of the day is part of the assessment. Children have a daily journal where they record what is happening to them, their achievements and reflections. Individual time is built into the day for every child, and there is a weekly individual care planning programme.

"It's as nurturing and comfortable as a residential unit can be," says Allan.

The consequence of such an environment is a high disclosure rate of abuse. At least half the children who have gone through the unit have disclosed abuse, and nearly all children and young people using both the community team and the residential unit have had experiences of domestic violence. For all young people there's a high incidence of parental mental illness or learning difficulties.

This is the paradox of the service, says Allan. "We are effectively helping and assessing them, but also taking the lid off things that have been happening over the years. They don't come out cured and they often come out acting up even more."

Encouraging children to say what has happened in their lives often means they can't return home or to their carer.

This gives the service practical problems about what to do next. If a young person needs another placement when they leave the unit, there is little time to find somewhere suitable and, as Allan points out, the first placement after abuse has been disclosed is crucial.

Residential staff work with children on an outreach basis when they leave the unit. For many, bedtime is a time of anxiety with its accompanying memories of abuse, so residential staff will visit the placement at this time to help the child.

The project is being independently evaluated by the University of Southampton. And an economic evaluation funded by the Department of Health is examining what these young people would cost society without the project, for example, if they went on to spend a life time in prison or psychiatric care. And as a mark of the project's work it has recently been awarded NHS beacon status.

Although the project has yet to measure outcomes, it has a good rate of success in diverting young people from secure accommodation, hospital-based care, and the criminal justice system. It has also helped young people back into school after exclusion; supported foster placements on the verge of collapse; and made diagnoses to explain a young person's behaviour, such as early stages of psychotic illness, post-traumatic stress disorder following abuse, and neurological disorders.

Project Profile

- Project: Behaviour Resource Service.

- History: It was planned by a multi-agency child and adolescent mental health service strategy group in the late 1990s, comprising Southampton Community Health Services NHS Trust, Southampton and South West Hampshire Health Authority, Southampton Council's social services directorate and its education directorate. The group identified a gap in the service, bid for and was awarded a mental illness specific grant (now the CAMHS innovation grant). The service has two parts - a residential assessment unit and a community-based team. The community team became operational in January 2000 and the residential unit one month later.

- Funding: The MISG provided nearly half the funding and the other half was covered in equal shares by health and the council. The project is now in the third and final year of the grant. It has continuing funding from the Department of Health for the next two years that will taper off, and is currently looking at partner agencies to top up the funding. The project is in negotiation with Hampshire Council and may expand the service to south west Hampshire.

- Staff: In the residential unit are team manager Jamie Schofield, a unit leader, six nurses - comprising RMNs and learning difficulty nurses - and 14 residential social workers. In the community team are Sue Allan, team manager; one part time and one full-time clinical psychologists; full-time child and adolescent psychiatrist; part-time educational psychologist; part-time occupational therapist; two community support workers; a social worker; and teacher.

- Clients: Children and young people who have the most complex mental health/education/and social care difficulties in Southampton and whose needs are beyond the reach of a single agency service. In the first year, January 2000-1, 55 young people used the service.

- Contact: Sue Allan, team manager, 315 Coxford Road, Lordswood, Southampton, Hampshire SO16 5LH. Tel: 023 8079 9100.