Working together, helping children

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.