This case study of the Camden CAMHS in Schools service was developed through reports written by staff at the Tavistock and Portman NHS Foundation Trust, and a conversation with Victoria Blincow, Camden CAMHS in Schools Service Lead.
The Camden CAMHS in Schools service is provided by the Tavistock and Portman NHS Foundation Trust (TPFT). CAMHS clinicians have been working in 55 of Camden’s schools since 2011. The area is culturally and economically diverse, with children and young people (CYP) from some of the most deprived families in Britain living in the area. Schools can struggle to meet the emotional wellbeing needs of children and families within their budgets. However, this service is provided free to all primary, secondary and special schools, and is funded through joint commissioning by the local authority and the CCG. Schools can opt to purchase additional support direct from TPFT as an “enhanced offer”, usually providing an extra day per month of the service within the school.
The Camden CAMHS in Schools offer
Clinicians are based in secondary schools up to one day per week, in primary schools’ half a day per fortnight, and in special schools two or more days per week.
All clinicians working in schools are senior members of the multidisciplinary community CAMHS teams. They have both generic and specialist skills and work in partnership with each school’s designated mental health and well-being lead to develop the bespoke service that fits with the school’s culture and specific needs.
What do they do?
All clinicians provide a holistic offer across all THRIVE needs based groupings, which includes mental health consultations with school staff, observations, and liaison with other agencies, such as social care and voluntary sector organisations. As all clinicians are members of multi-disciplinary CAMHS teams, when a need for Getting Help or Getting More Help has been identified they can enlist further specialist help from their CAMHS colleagues, e.g., by requesting psychiatric or psychological assessment, or additional therapeutic resources.
They receive direct referrals from the school, and meet with CYP and their families independently, or in collaboration with school staff. This can include offering onsite assessments or providing Getting Help through therapeutic interventions with CYP and their families, providing workshops for CYP’s and/or their parents, delivering whole-class and/or whole-school interventions, and developing the capacity of school staff through the provision of staff training at Inset Days.
How it is provided
The CAMHS in Schools service is served by senior CAMHS clinicians who also provide the Camden CAMHS offer based community teams either at the Tavistock Centre or the South Camden Team base in Euston. Clinicians within these teams spend at least one day a month providing generic CAMHS input to the 55 primary and secondary schools in the borough. Based on a number of factors, including whole time equivalence, clinicians are assigned to up to three schools. Through collaborative discussions with the schools, clinicians work in partnership to effectively allocate their time.
Victoria Blincow helped design the Camden CAMHS in Schools service and is the service lead. We spoke with her to understand more about how the service works.
The Camden CAMHS in Schools service takes a whole-school approach to promoting Thriving, help and support. Through co-location, clinicians build strong relationships with the schools they work with by integrating with the school’s culture and developing an understanding of the school’s needs. The school system is viewed as the client, and clinicians strive to be responsive and integrated members of the school community. The outcome of this is that schools can easily access a known CAMHS clinician and feel supported through partnership working.
The CAMHS in Schools service is very closely linked to wider health and local authority provision which takes a whole system approach to meeting CYP and family needs. Although one clinician is the main contact point for each school and provides a generic CAMHS service, each clinician has the support of the whole multi-disciplinary CAMHS team in which they are embedded. These close relationships allow flexibility in the help offered within the school setting. For example, if family work is recommended, a family therapist can either go into the school or may work with the family in a CAMHS setting together with the school clinician, supporting transition and engagement.
The service has also found that providing Risk Support in schools can be effective due to the close interagency collaboration and schools having more contact with the child’s family and extended network. Clinicians are also able to build staff capacity in directly supporting the CYP or improving access to more specialist provision for those in the Getting More Help needs based grouping.
Examples of support and help provided
Below are some examples of the work carried out by the Camden CAMHS in Schools service:
- Whole-class mindfulness interventions
- Informal coffee mornings for parents to promote CYP and family Thriving, alongside Getting Advice and Sign-posting
- Population-based Getting Help parenting interventions, e.g. an Incredible Years Parenting Group for Bengali parents
- Liaison with other agencies e.g. safeguarding, Early Help, paediatrics, and attending Children in Need (CIN) meetings
- Parent’s evening “Inclusion Café’s” – drop-ins for parents in collaboration with the multi-agency inclusion providers to support and promote engagement and self-referral
- Peer mentoring programmes
- Staff training and capacity building
Capacity building is a key aspect of the CAMHS in Schools service provision. CAMHS clinicians offer training to staff, CYP and parents in Camden’s schools on mental health themes and the promotion of wellbeing, e.g., through Inset Day training and regular reflective practice sessions with staff. This is an important part of supporting Thriving and helps to build resilience at a system level.
In addition to providing training, clinicians build capacity in school staff by working alongside them, providing clinical supervision and jointly attending meetings with school staff, CYP and their families. Rather than the clinician undergoing assessments and suggesting strategies for teaching or supporting staff in behaviour management, clinicians also support capacity building of education staff in understanding the presenting difficulties and work collaboratively to develop individual and class-based intervention plans and strategies together. Clinicians respect schools as effective communities to holistically support the emotional health and wellbeing of their students and the promotion of ‘Thriving’ for all.
The Camden CAMHS in Schools service has found that capacity building is helpfully promoted through the service itself which seeks to model and encourage reflective practice in school communities, and through collaborative partnership working with school staff though their regular interactions with their co-located named CAMHS clinician.
Feedback from school staff
An audit of the Camden CAMHS in Schools service was conducted to review how schools experienced the service. Very high levels of satisfaction from school staff was identified, which seemed particularly related to the easier access to CAMHS, alongside the support in enabling successful liaison with the multi-agency services involved with the CYP and families within the school communities. Schools also valued the regular support through consultation, reflective practice and ‘working alongside’ school staff provided by clinicians. One school staff member said that the part of the service they most valued was the one-on-one time with the CAMHS clinician to discuss the children they were concerned about. It is important to remember that teachers interact and work with children and their families with mental health needs on a daily basis and deserve and need increased support.
The audit also suggested that those schools with closer proximity to the community CAMHS team bases received a more flexible service than those further away. This could have implications for replication in more rural areas where schools have a greater geographical spread and/or offer education services to small numbers of students.
The THRIVE framework (Wolpert et al., 2016) was developed by the Tavistock and Portman NHS Foundation Trust and the Anna Freud National Centre for Children and Families. THRIVE is a whole-system, needs-based framework for supporting children and young people.
The Camden CAMHS in Schools service is an excellent example of whole-system working with its links to health and local authority provision, with clinicians working across all needs-based groupings of the THRIVE framework. The THRIVE framework suggests that it should be the most experienced practitioners supporting shared decision making with young people ‘Getting Advice and Signposting’. The senior clinicians who make up the CAMHS in Schools service provide experienced shared decision making with young people in consultation with school staff, alongside high-quality supervision and case management to clinical trainees who may be supporting the work. The qualified clinicians are fully accountable and responsible for the young people in their care.
For more information about Camden CAMHS in Schools service please contact Victoria Blincow at: VBlincow@tavi-port.nhs.uk.
Written February 2018.