In North Yorkshire we’ve been set the challenge to apply a customer focus to all our services – from bin collection to road works. Children’s social care is no exception. We’re on a journey to reshape our services for looked after children and we want to put their voices, the voices of our ”customers”, right at the centre.
It all started with austerity looming in 2010, when we knew that we didn’t have the option of doing more of the same. If we wanted to improve children’s outcomes while also making savings, we were going to need to re-think our whole approach.
Like most authorities we knew that looked after children were not always getting the support they needed for their emotional wellbeing at the right time. We were concerned that the existing service available from children and adult mental health services (Camhs) was inconsistent across the authority and looked after children’s access to services was impacted by where they lived rather than led by their specific needs.
For a start, we committed £500,000 to Camhs annually but it wasn’t always clear what outcomes we were getting for this investment. We brought our three different Camhs providers around a table to have an open and honest conversation, forming a steering group to develop a new strategy. We were bold, direct and asked difficult questions. In this instance we were the customers and needed to know exactly what they were delivering for us.
We agreed that all support for children and young people needs a clear focus on outcomes and this applies to social care too. In children’s social care we are now embedding the strengths and difficulties questionnaire (SDQ) in our assessment and review processes to give us a better picture of the mental health and wellbeing of all looked after children. Where children access mental health services, Camhs providers are also using the SDQ, capturing their outcomes to demonstrate impact. Above all the scores now trigger action, not just reflection.
The goal is a system where everybody takes responsibility for children’s mental health and wellbeing and we have started by designing a new self-harm pathway. We got 30 people in a room together for three hours, including providers, carers, frontline workers and young people, and worked out what people could do at each level of the system to support a child who is self-harming. Taking this approach across our services means we can demystify issues around children’s mental health and upskill our children’s workforce so that everyone feels confident about what they can do, without automatically referring on.
We’ve also developed our specialist offer, so that it is easier for their carers and social workers to get expert advice to understand children’s emotional needs and help keep their placements stable. Camhs now offer surgery hours each month so that carers and social workers can come and talk about looked after children they have concerns about. They’re also developing closer links with our schools and children’s homes.
Young people have consistently told us that they’re tired of re-telling their story and having changes in their key workers. In response, we’ve developed the No Wrong Door service, with support from the government’s innovation programme. It’s an innovative approach to managing placement transitions which provides consistent relationships with carers and professionals who will follow them through the system. It designs services around young people using specialist support such as a life coach (clinical psychologist), a communication support worker and an intelligence analyst to manage and reduce risk.
Accepting we needed a total rethink and adapting to change hasn’t been without its difficulties but we made a commitment to explore new ideas, even if we didn’t think they would work. This was tested out recently when staff put forward a proposal for offering a life appreciation day for young people leaving care. The idea was to bring together all of the people who are important in their life and mark their transition to independence. I’ll admit that some didn’t think it would work but we made a commitment to take the idea to our children in care council. To our surprise, they loved it and wanted to start development straight away. This is such a clear example of the importance of involving children and young people in service design; we need to be open-minded and willing to keep getting it wrong until we get it right. We’ll soon be offering life appreciation days to all young people leaving care.
We’re still on our journey but have demonstrated how strong collaboration between Camhs providers and a local authority can develop a great service for young people. Most importantly, we are listening to children and young people to find out about their priorities and having an honest conversation about what could be done better.
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