To receive the above report.

Rebecca Askew, Senior Educational Psychologist, introduced the report to the Members which covered the current and future service provision from the Wellbeing and Behaviour Support Teams based on local Social, Emotional and Mental Health (SEMH) considerations and developments to support the increased SEMH needs. Members were asked to consider proposal 7.1 from the report.

Support from the team was open to all CYP people in RBWM schools (5-18 years) except for private schools. It was agreed that the team would offer both direct work such as consultation and initial assessment, time limited focused interventions, group work/workshops, Early Help meeting support and signposting.

During the last academic year, members of the team continued to support CYP known to the social care PODS through the provision of Dyadic Developmental Therapy based consultations for 0.4 Full-time Equivalent (fte). The team delivered preventative work such as Psychological Perspectives in Education and Primary Care (PPEP Care) Training and mental health training, such as Young Carers.

During the academic year, two full time Wellbeing Practitioners left the team due to a limited opportunity to progress within the team structure, and a lack of CYP focused course options/funds for Cognitive Behavioural Therapy (CBT) Diploma. Therefore, the practitioner left the RBWM Wellbeing Team and enrolled on the Children and Young People's Mental Health Services (CYPMHS).

This added further pressure to the Wellbeing Team this year with no reduction on referrals through the Early Help Hub or other group and whole school initiatives. Therefore, Early Help Hub wait times increased.

There were six Wellbeing Practitioners in the Wellbeing Team including; Counsellor 0.2fte, Play Therapist 0.4fte, Art Psychotherapist 0.4fte, CBT Practitioners 1.4fte and Dyadic Developmental Psychotherapist 0.5fte. With the implementation of the Getting Help Teams from September 2020, there would be an additional 1.5fte of practitioner time (CBT-based) available to RBWM. The Getting Help Wellbeing Practitioners were employed by Berkshire Healthcare Foundation Trust (BHFT) but would support within the Wellbeing Team using the Early Help systems.

The Behaviour Support Team offered a range of individual, group and systems-based support to schools to CYP and their families in the Borough. The service was freely accessible to maintained primary schools. Requests for individual pupil support could be accessed through the Early Help Hub, group work and training requests sent directly to the team. Academies, middle and secondary schools could purchase any one of the five package options at any point during the academic year.

During the academic year, one full time team member left to pursue training to join a Mental Health Support Team in Wokingham and another team member retired. This reduced the Behaviour Support staff capacity from 3.4fte to 1.8fte.

The team continued to deliver the Nurture programme but scaled back the offer of in-school transition work. The Onwards and Upwards Summer Transition programme for vulnerable children who were about to enter secondary school proceeded with planning considerations considering safety measures and government guidelines.

Rebecca Askew referred to table 4.5 of the report, which provided detail to the referral rates in comparison to referral rates in from other teams. The Wellbeing team rates were higher in comparison to their capacity, therefore there were high wait times.

COVID-19 further compounded team wait times, despite telephone check-ins and online tele-therapy sessions. This was because some children did not want to engage by telephone or via online platforms and it was difficult to close cases because of the limitation in generalising therapeutic strategies, and therefore reliably evaluate a reduction in symptoms.

There was a nine-month wait for Dyadic Developmental Psychotherapy, an eight-month wait for Counselling and a six-month wait for Art Psychotherapy, Play Therapy and Cognitive Behavioural Therapy. To reduce Play Therapy wait times, one practitioner increased their time from two days a week to three days a week. Two volunteer Play Therapists would be taken on board in September 2020, who would volunteer one day a week.

There was not further capacity at the No.22 Youth Counselling Service in Maidenhead, but there was some capacity for additional referrals in Windsor. There had been a noticeable increase in referrals for young people under 18 years old in May 2020, with 40% of the wait list being under 18-year-olds. There were 424 young people on the counselling wait list due to a greater client flexibility to access online sessions.

The Wellbeing Team Practitioners were holding a total of 41 cases, with 88 CYP on the wait lists and 6 CYP being assessed prior to intervention. The Behaviour Support Team were holding 18 cases between 2 practitioners’, with 27 cases on their wait list. There was a five-month wait time for cases that had been triaged as lowest priority, which was not good enough and therefore there were plans to reduce wait times.

The cases for both teams had become more complex during the last two years, with referrals to the hub regularly outlining self-harm and an increase in reference to Post Traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), risk of exclusion and incidences of aggressive behaviours towards parents, school staff and peers. There was an extension of involvement to be supportive to all involved as a result.

There was a rising demand for social, emotional, wellbeing and mental health support. Waiting times for completion of triage within specialist CAMHS increased, particularly for young people who needed non-urgent assessment and intervention. More than 36% of referrals to CAMHS Common Point of Entry (CPE) were found to not need specialist assessment and many of these cases were referred to Early Help, in addition to requests from schools and other professionals such as Social Workers. CAMHS also referred complex cases to Early Help which required long-term intervention and/or higher intensity training, neither of which could be met by the Wellbeing Team within the Early Help process.

The Chairman asked if the funding for the programme was coming primarily from schools buying into the service. The Members were informed that there were different funding methods for each team. The Wellbeing Team was funded by the Schools Forum whilst Behaviour Support Team was funded by a combination of funds.

Rebecca Askew said COVID-19 had an impact on the data, with approximately 16% of CYP exposed to a traumatic event develop PTSD, rising to 25.2% for those experiencing an interpersonal trauma such as physical or sexual abuse/attack. Findings from a study done during the Avian Flu Pandemic suggested the potential impact of COVID-19 on psychological/mental health. Research on the Impact of Social Isolation showed an increase in suicidal ideation, self-harm, and eating disorder related risk behaviours. CYP in enforced isolation/quarantine were up to 5 times more likely to require a mental health service, which could be seen on a local and national level.

The Behaviour Support Team and Wellbeing Team worked collaboratively to support bereavement and emotional-based school referral, which was likely to increase in the next academic year. This was outlined in the Phase 3 Action Plan Menus of Support.

The first proposal was to create change in the team structure to retain experienced staff. There was interest from an experienced colleague who was interest to take up some of Rebecca’s responsibility so that Rebecca could focus on strategic and operational planning which will be crucial next year.

There was substantial work to be done within social care to save money, as a lot of money had been spent on therapeutic support by privately commissioned services. There was a view to enhance the consultation offer and extend this to Social Care Managers.

Due to the success of the second bid, The Mental Health Supports Team was planned to be fully implemented from January 2022, with schools signed up to host the teams.

The second proposal was to increase counselling capacity to minimise backlog of referrals and wait time. The counselling sessions could take up to 15 weeks, with a counsellor on the team for 2 days a week, which was not enough in comparison to the number of referrals.

The third proposal was to integrate the Wellbeing Team and Behaviour Support Team into one service. There were complexities to carry this forward due to the different funding streams for both teams.

The fourth proposal was the consideration for funding in training in order to remain competitive with CAMHS and ensure there was staff retention.

The CReST Measurement Tool was a free dynamic tool that enabled a ‘whole system’ view, showed wait times and the movement of referrals. Further recovery and restoration planning were underway across East Berkshire to help share resources and pick up learnings.

There was continued development of the early intervention offer which would include virtual training, which was currently given. Approximately 500 people had signed up to the recent training in the Borough, which was positive feedback. There would be a review of the Local Transformation Plan (LTP), which was on hold but was on the Clinical Commissioning Groups’ (CCG) agenda.

The makeup of the Getting Help Teams included two recently recruited CBT staff and a Clinical supervisor who would support triages, signpost complex cases or send back to CAMHS.

The team was signed up to University of Oxford survey, which was an online mental health and wellbeing survey that was free this week and paid by the CCG going forward. The survey showed how young people felt in relation to wellbeing, with 19 schools across the Borough who signed up to the service. A practitioner survey was also shared to teams and was soon to be completed, which would help in local learning.

The Wellbeing Champions and Nurture Group Programme continued despite COVID-19 and supported the Attachment Aware Schools Award. Schools had started to sign up to this. Transition support would continue, with the Onwards and Upwards programme to be continued this summer with due consideration of health and safety measures. 

The Chairman said the mental health of young people would be severely tested, and some children may have witnessed domestic abuse during the COVID-19 lockdown. The integrated approach from CCG and local authorities to provide mental health support was encouraged, so that young people could receive the support they needed. The Members were informed that there was a good collaborative and co-constructive relationship with CCG that had grown over the last few years.

The Chairman asked if the CCG had a larger commitment for funding or if the vast amount of funding was coming from the Schools Forum. The Members were informed that CCG provided funding for the Getting Help team in its entirety as well as other developments in training and support. There were continued conversations on funding in preventative measures rather than direct therapeutic work.

Kevin McDaniel said there was an investment of £2,000,000 from the Mental Health Transformation Plan. There was a small pool of skilled professionals in these areas and the challenge was to have enough resources in the teams. The collaboration of services allowed senior practitioners with the ability deal to deal with more complex cases.

The Chairman asked if there was a way to create a role for experienced practitioners to help in staff retention. The Panel were informed that the role placed in Proposal 1 was financed within the funding of £120,000 for the wellbeing service, with no additional funding commitments. The other proposals were put on hold because there was insufficient funding for these from what the Schools Forum originally approved budget for the project.

The Chairman said there would need to be investment from local and national government due to the forecasted increase in mental health concerns for young people in the next couple of years due to COVID-19.

The Members noted the report.

RESOLVED UNANIMOUSLY: That Proposal 1 - the retention of experienced staff - be approved.