Since June 2018 the Anna Freud Centre, supported by Research in Practice, Action for Children and the Child Outcomes Research Consortium, have been leading work across nine pilot sites to develop a child-centred approach to understanding and supporting the mental health and wellbeing of children in care.
This includes the introduction of a mentalising approach to wellbeing and mental health assessments, and a new Virtual Mental Health Lead role which coordinates support and ensures the voices of children in care are heard in care planning processes. As the project draws to a close, a series of blogs are sharing learning from some of the pilot sites that have been our partners on this journey.
In this second blog Laura Gough, local pilot lead and Service Manager for Doncaster’s Child Protection Service, shares how multi-agency colleagues in Doncaster have expanded and built on the pilot framework to meet the needs of young people in their area.
Aims of the Doncaster pilot
Doncaster Children’s Trust is proud to be one of just nine children’s services in the country that are taking part in this exciting pilot. This month we attended the pilot’s final celebration and learning event where Kanisha, our care-experienced young advisor, shared her view of the pilot’s importance.
Kanisha spoke for many young people when she warned that the current procedure for assessing mental health, which relies on the young person completing a strengths and difficulties questionnaire (SDQ), often risks becoming a: ‘bit of a tick box exercise…you might just be feeling low one day, full of teenage hormones…but before you know it you’ve ticked too many boxes and wham…you’re off to CAMHS!’
For Kanisha, the most important aspect of the mentalising assessment process has been that it feels ‘more personal to the young person – you’re able to explain why you feel a certain way rather than just ticking the box’. A ‘wellbeing journal’, which is written in the young person’s own words and can be shared with other agencies, then prevents young people from the ‘frustrating’ need to ‘repeat their story again and again’ if referred to other support.
A young person-led, multi-partnership team
Our Doncaster pilot is a real team effort, including representation from the Children’s Trust, Child and Adolescent Mental Health Services (CAMHS), Children in Care Nursing, Commissioning and Social Care. In this respect the team helpfully links into lots of different areas of the child experiences.
A shared focus on the voices of young people offers the critical golden thread throughout. As a full-time young advisor on the pilot’s governance board, Kanisha herself has worked tirelessly to co-design our pilot resources, share pilot information with local care-experienced young people, and ensure service user feedback informs our pilot adaptations and local improvements.
One of the most influential adaptations suggested by Kanisha and our other local young advisors has been to change the name of the assessments’ written documentation – from ‘wellbeing passport’ (originally suggested in the national pilot framework), to ‘wellbeing journal’.
Kanisha has explained that whereas the name ‘passport’ potentially brought up connotations of professional-led documentation, ‘journal suggests something more personal to the young person’ – ‘this is something that is theirs, and they can fill it in how they like’. We shared our version of the journal at a previous national learning event, and now the new name has been enthusiastically taken up by national partners and other pilot sites.
The Virtual Mental Health Lead – working across CAMHS and social care
In Doncaster we have made the unique decision to split the Virtual Mental Health Lead (VMHL) role across two people in different agencies – Robynne, a Clinical Psychologist based in CAMHS, and Sue, an Independent Reviewing Officer (IRO) and Senior Social Worker. As a team, we’ve found that this cross-agency collaboration lent itself especially well to enabling service integration in aid of promoting child-centred practice.
Early evidence suggests access to support from Robynne is already allowing social workers and nurses to feel more supported, in some cases preventing unnecessary referrals to CAMHS. In cases where the process has highlighted a young person’s need for extra support, Robynne has often been able to advise social work and nursing practitioners that this might be most effectively provided through a trusted adult already known to the child (a foster carer, teacher, social worker).
Sue’s position as a senior social worker and IRO has been equally vital. When supporting social workers she’s particularly well-positioned to ‘translate’ elements of the new approach to align with social work practice and concepts. The safeguarding and standards aspect of her IRO role has also allowed her to embed the pilot process into existing processes – for example by liaising with her colleagues in the review service to ensure that wellbeing journals are kept updated.
Paula, our Named Nurse for Looked after Children and a practitioner working on the pilot, shared at the national learning event that ‘mentalising conversations with the young person’ have been enabling the establishment of trusting relationships, which we know ‘is especially important for our children coming into care. Meanwhile ‘one-to-one sessions with the VMHL have enabled a much more in-depth analysis of need, and facilitated the formulation of support plans.’
We are incredibly proud of all that has been achieved so far through the pilot. It has been a challenging year with COVID-19, but we’ve managed to work with 58 children through the pilot and the resources we’ve created have been shared with other pilot areas across the country.
Kanisha has developed a questionnaire to collect feedback from young people who have gone through the new assessment process. We will be analysing key themes over the next few months, but the early signs are very positive. In the meantime, we’ll be busy exploring with leaders in Doncaster how the learning from the pilot can be taken forward locally.
Read the previous blog on Supporting the wellbeing of children in care: Piloting a mentalising approach in North Tyneside.