Provision for Children's and Young People's In-reach and Discharge Support for NHS Devon CCG

Background Information and Service Specification

NHS Devon Clinical Commissioning Group (the CCG) is considering their options for commissioning Health Based Mentoring In-reach and Discharge Support for Children and Young People up to the age of 18, who are registered with a GP within the county of Devon and for whom NHS Devon CCG is the Responsible Commissioner. Children and young people up to the age of 18 years, but who would be viewed as 'temporary residents' e.g. overseas students may be also able to access provision dependent on the commissioner's approval and the provider's agreement that the service will make a beneficial impact on a case by case basis. The service offer would cease upon the individual's 18th birthday or the end of the academic year in which they turn 18, whichever is most appropriate and/ or, the individual no longer being Ordinarily Resident in the County of Devon or Devon CCG ceasing to be the individual's Responsible Commissioner.

There is potential for the age range of those eligible to increase at a later date, to encompass children and young people up to the age of 25 in line with the CCG's longer term ambitions for children and young people's services.

This service is a pilot and therefore will build the evidence to support ongoing service development including the level of demand and capacity needed. At this time it is estimated that 35 children and young people per month would be supported by the service. It is expected that the service will work with and support children whilst on, an acute hospital ward as well as within the community following discharge (and prevention of admission). It will be critical for the service to rapidly build strong relationships with acute care settings, discharge teams and CAMHS teams within the county of Devon, so they are aware of the service's offer and are seen as a trusted partner. Support may be delivered alongside specific evidence based therapeutic intervention delivered by other service providers e.g. CAMHS. It is therefore critical that the service provider has experience of working in partnership with other services and of working with CYP and their families, with EHWB needs. The support being considered within this PIN relates to holistic, person centred support to reduce escalation in needs and behaviours, prepare for discharge and to prevent potential readmission through placement/home breakdown.

A detailed service specification for the Health Based Mentoring In-reach and Discharge Support for Children and Young People with Emotional Health and Well Being Needs service will be developed by commissioners.

1.1 Scope

Key objectives of a successful service will be to:

1.1.1Support individuals whose behaviour related to underlying emotional health and wellbeing needs is anticipated to/ or has, escalated due to being in an acute health environment, or who do not respond well to receiving care other than for health needs, in an acute health environment. This could include preventing admission/ readmission for CYP known to services.

1.1.2 Where appropriate, initiate/ start planning this support while the individual is still an in-patient to enable relationships to be built.

1.1.3Provide or source the provision of, individual bespoke packages of care which are co-produced with the child or young person and their family or carers, including jointly agreed outcomes. This will include elements that are outside normal working hours across a 7 day week (i.e. to include weekends) but is not anticipated to be a 24/7 offer. An example could be supporting a young person to access a club or an activity at the weekend.

1.1.4To train a cohort of mentors, including young/ peer mentors, that could be embedded in other organisations with appropriate skills and expertise.

1.1.5To enabled individuals/ families to manage provision via personal budgets.

1.1.6Ensure support is grounded in positive and meaningful activities for the individual in relation to their needs and support integration back into the community.

1.1.7To support a withdrawal of the service with appropriate plans and self-management tools and techniques.

1.1.8Ensure meaningful engagement with acute care settings and CAMHS services which identifies appropriate CYP for the service and supports/ compliments mental health needs and care plans.

1.1.9Ensure meaningful engagement with all appropriate partners in identifying the individuals needs and appropriate provision.

1.1.10Ensure that communication is conducted in a timely way and is appropriate to the needs of the recipient.

1.1.11Ensure adherence to relevant statutory and legal requirements.

1.1.12Ensure staff are appropriately trained staff and support children and young people.

1.1.13Ensure that environments provided are both safe and secure. This includes both physical and psychologically security and safety.

1.1.14Ensure that everyone accessing the service, including families or carers, are treated with compassion, respect and dignity, without stigma or judgement.

1.1.15Ensure that all relevant stakeholders and partners understand how and when to access the provision and what the offer is.

1.1.16Embed the principles of THRIVE throughout the pathway of support and care to the child/young person and their family.

1.2 Requirements

The provider will:

1.2.1Demonstrate experience of partnership working to support individuals.

1.2.2Demonstrate experience in working with children, young people and their families, who have emotional health and wellbeing needs.

1.2.3Demonstrate experience and the ability to evaluate service delivery against outcomes and benefits realised.

1.2.4Have existing infrastructure to support the delivery of services for CYP with needs relating to emotional health and wellbeing, behaviours that challenge, family breakdown.

1.2.5Have pre-existing relationships with other organisations, and act as an infrastructure organisation to support the brokerage of provision, by other more specia…