19 July 2016
CCGs embrace effective VCS models
New evidence suggests we may be at the start of a voluntary sector-driven transformation of young people’s mental health services
Clinical Commissioning Groups (CCGs) and local authorities are increasingly turning to Voluntary and Community Sector (VCS) delivery models to drive CAMHS transformation. That is the key finding of a report published today by Youth Access, the advice and counselling charity.
In particular, many local commissioners are enthusiastically embracing the YIACS (Youth Information, Advice and Counselling Services) model, recognising it as key to the provision of more accessible, integrated early intervention and prevention services without the clinical and age barriers inherent in statutory CAMHS.
Areas where YIACS are set to play an integral role in CAMHS transformation include: Liverpool - Young Persons Advisory Service; Hampshire - a consortium of eleven YIACS, led by No Limits; Bristol - Off The Record Bristol; and Croydon - Off The Record Croydon and Croydon Drop In. (See Liverpool case study below.)
Barbara Rayment, Director of Youth Access, says:
“We are excited to see so many progressive CAMHS commissioners across the country who recognise the benefits of handing a more prominent delivery role to YIACS and other voluntary sector services. There is a long way to go yet, but a clear direction of travel is emerging that can only be good news for young people in the long term.
“However, we remain concerned that there are still areas where there is little evidence of change - to the detriment of young people. Future in Mind gave a clear steer about the need for a better investment in early intervention services, rather than the late intervention that makes up too much of our current offer to young people. Investment in flexible, responsive and open access YIACS is a key part of the change that is needed.”
Youth Access also remains deeply concerned at signs that the funding and provision of services for young adults may be deteriorating.
Barbara Rayment says:
“There is widespread recognition of the need to put in place services that would better meet the needs of 16-24 year olds and avoid the ‘cliff-edge’ that confronts young people transferring from child to adult mental health services. However, it appears that local transformation planning processes have not gone far enough in this area and we have yet to see evidence that adult mental health commissioners are taking their share of responsibility for this age group. Young adults will continue to be ignored and let down unless CAMHS and AMHS can come together more systematically to jointly plan and commission age-appropriate services across the transition.”
Prof. Dame Sue Bailey, Chair of the Children and Young People’s Mental Health Coalition, says:
“There was a clear signal in Future in Mind, that doing more of the same isn’t good enough, so we welcome this report which highlights the key role that YIACS are playing in supporting young people’s mental health. There is so much more to be done to meet the mental health and developmental needs of all young people. So, we all have to work together, building on our strengths to help young people build on theirs.”
Notes for Editors
1. About Youth Access
Youth Access is the national membership association for a network of around 170 Youth Information, Advice and Counselling Services (YIACS) www.youthaccess.org.uk
2. About the YIACS model
The YIACS model is a proven, integrated health and wellbeing model that empowers young people (typically aged 13-25) through alleviating distress and defending rights. YIACS provide accessible, young person-centred support on a wide range of issues from mental health, sexual health, drugs and alcohol to homelessness, money and employment. YIACS grew out of a need to bridge both the gaps and failings of statutory and adult-oriented services in meeting the needs of young people. Through interventions such as counselling and other psychological therapies, advice work, health clinics, community education and personal support, YIACS offer a unique combination of early intervention, prevention and crisis intervention for young people.
3. The report
A foot in the door: VCS providers’ view of CAMHS transformation is a report on a survey of 58 YIACS and focusses on eight themes: Engagement of VCS; Involvement of Young People; The YIACS model; Investment in VCS; Early intervention; Tackling the social determinants; Transitions – meeting the needs of young adults; Transparency & protectionism.
4. Case study
Liverpool CCG embraces the YIACS model
Liverpool’s CAMHS Local Transformation Plan built upon an existing three year strategy developed by Liverpool Mental Health and Emotional Wellbeing Partnership Board. The strategy included a needs-led Integrated Comprehensive CAMHS pathway, which had been developed using an outcomes based framework, with the aim of ensuring mental health services and support was accessible to all children, young people and their families within Liverpool. The pathway takes an asset based approach, ensuring accessible information and support is available at all levels i.e. public health, early intervention, early identification, prevention and intervention. Key to delivery is a partnership of providers, including a strong voluntary sector contribution. One of the voluntary sector providers is Young Persons Advisory Service (YPAS), which adheres to Youth Access’ YIACS model and has been commissioned to provide services for young people across the pathway.
YPAS’s mission is to improve the mental health and emotional well-being of children, young people and families in a non-stigmatised environment. YPAS has an established counselling and psychotherapy service which is delivered alongside a range of complementary services designed to help young people with practical issues, including a general drop-in service, information and advice and a variety of group work programmes. Services are provided through YPAS’s city centre premises, as well as through outreach work in schools and communities. Young people can self-refer to YPAS and referrals are also accepted from a wide range of professionals across health, education and social care. There is high and increasing demand for YPAS’s services, with an average of 43 referrals per week being received for its counselling & psychotherapy service alone.
The engagement of the voluntary sector was seen by commissioners as vital to the successful development of the Local Transformation Plan. YPAS were invited to contribute to transformation planning from the outset and felt central to the development of the plan. They attended meetings, contributed evidence, consulted on papers and their users' views were sought. They felt that their voice, as well as that of their users, had been heard and had influenced objectives.
The plan has a focus on addressing the issue of rising need and demand outstripping supply across the statutory sector and VCS. There was a consensus that it was necessary to look at how services could be delivered differently, with a need for a greater focus on provision of timely, relevant support through schools and in communities so that fewer young people would require specialist interventions. Key areas for development include: mental health promotion; early intervention; the transition of young people to adult provision; improving access; an enhanced integrated model of delivery; participation and stakeholder engagement; outcome monitoring; and joint commissioning.
YPAS – and the YIACS model – are at the core of the plan for early intervention. Delivery of early help will be through ‘Community Mental Health Hubs / YIACS’ reaching into neighbourhoods to deliver: multi agency Single Point of Access; drop-in services; information, advice and counselling; GP drop-ins; group work programmes; peer support; counsellors in schools; and online counselling. YPAS will lead the development of two new community-based hubs (‘YPAS plus’) promoting an inclusive, integrated one stop shop model working across CAMHS, Health, Education and Social Care. YPAS will also be leading on counselling in primary schools (the Seedlings Project) and has received set-up costs for an online platform to provide information, advice and therapeutic services.
Monique Collier, Chief Executive of YPAS, says:
“Liverpool CCG has a clear understanding of the YIACS model and believes that an integrated model of delivery is vital to enable the priorities for the city to be realised. The increased investment in response to Liverpool’s Local Transformation Plan will enable our CAMHS partnership to collectively respond to the mental health and emotional wellbeing needs of Liverpool’s children, young people and families within an improved framework of: timely, accessible, early and preventative.”
Lisa Nolan, Liverpool CCG CAMHS Commissioner, says:
“YPAS offer a needs-led, accessible, flexible service to children, young people and their families within Liverpool. The services they deliver are a core element of the CAMHS integrated offer to support children and young people’s mental health and emotional wellbeing. Outcomes have been excellent for the work delivered which is a result of the fantastic work delivered by the skilled and flexible workforce. The YIACS model offers a one stop shop to support the mental and physical health of children, young people and their families. This is an excellent service and it has been agreed that this model will be developed further as part of our CAMHS transformational plan and youth mental health model.”
Liverpool’s Local Transformation Plan: http://www.liverpoolccg.nhs.uk/health-and-services/children-and-young-peoples-mental-health-camhs/
Lisa Nolan, Liverpool CCG CAMHS commissioner,Lisa.Nolan@liverpoolccg.nhs.uk
Monique Collier, Chief Executive of YPAS – Monique@ypas.org.uk; 0151 702 6084 / 07917658157
5. Policy context
The Government report of the work of the Children and Young People’s Mental Health and Wellbeing (CYPMHW) Taskforce, Future in Mind, was published in March 2015, setting out “what we need to do to overcome the status quo”. One of the report’s proposals was to increase investment in the existing network of Youth Information, Advice and Counselling Services (YIACS) – the primary VCS deliverers of mental health services – as a way of increasing the accessibility of services to young people.
To ensure accountability in the distribution of new funding for children and young people’s mental health, all CCGs were required to produce a Child and Adolescent Mental Health Services (CAMHS) Local Transformation Plan in conjunction with local stakeholders. These plans were developed during the second half of 2015 and published by early 2016. Little attention has been paid to the role of voluntary sector providers in local developments.
6. Further information
For a copy of the reports, case studies and access to interviewees, please contact:
James Kenrick, Youth Access
020 8772 9900 ext. 25 / 07535 344881; firstname.lastname@example.org