Mental Health Services for Children & Young People in Brighton & Hove

Child developmental needs

• Absence/truancy from school    
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Absence/truancy from school

Attendance less than 90%.

Good attendance is important because:

• Statistics show a direct link between under-achievement and absence below 90%
• Regular attenders make better progress, both socially and academically
• Regular attenders find school routines, school work and friendships easier to cope with
• Regular attenders find learning more satisfying
• Regular attenders are more successful in transferring between primary school, secondary school, and higher education, employment or training

 

Parents & carers have a responsibility to make arrangements for the education of their children either at school or “otherwise”.  Education “otherwise” includes being taught at home by a parent or private tutor. They must provide an education that is efficient, full-time and suitable for their child’s age, skills and capability, taking into account any special needs that the child may have. For more information on Elective Home Education in Brighton & Hove please visit here

 

Brighton & Hove Educational Psychology Service have developed a tool to support understanding why children are persistently absent from school.  This is called the ATTEND Form and is available for all schools to use to problem solve the situation with their Educational Psychologist.

 

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Absence/truancy from school

Parents can be signposted to information on NHS Choices to ensure their child is well enough to attend school.

• Incidence of absence/missing from home    
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Incidence of absence/missing from home

An indicator of a child being at possible risk of exploitation is linked to children beginning to go missing from home, with their whereabouts unknown.

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Incidence of absence/missing from home
• Pan Sussex Child Protection Procedures: Missing Children 
• Missing People Pan Sussex Missing Children’s Service Operational Instructions
• Persistent poor behaviour in school  
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Persistent poor behaviour in school

Persistent poor behaviour, where the child does not respond to the standard school behaviour policy (including use of consequences)/reward measures by school and parents/carers:

• Behaviour is impacting child’s ability to learn.
• Behaviour is impacting child’s relationships with peers and with adults in school.
• Behaviour is impacting child’s access to education (frequent removal from classroom, including internal exclusion).

 

Schools take a staged approached, based on their Behaviour Policy, which might include setting up a support plan and undertaking a review of child’s learning needs and consideration of whether the child needs to be recognised as SEN.

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Persistent poor behaviour in school
• Risk of social exclusion    
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Risk of social exclusion
Social exclusion is “a process that deprives individuals and families, groups and neighbourhoods of the resources required for participation in the social, economic and political activity of a society as a whole” (Pierson, 2002).
 
People who are socially excluded do not have access to the same institutions, services and social support networks that most people in a society take for granted. Although poverty is usually the main cause of social exclusion, there may be other contributing factors, such as racial discrimination or low educational achievement.
 
• World Health Organisation Definition
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Risk of social exclusion
• Where to go for… 
• Poor relationships  
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Poor relationships

The impact of a child being poorly regarded or having their needs ignored by care givers can be felt throughout a person’s life and is a likely cause of future demand on a wide range of services to respond. If poor relationships are suspected in children aged 5 and under, the family should be signposted to the Health Visiting Service for further support / advice. Poor relationships in education (with peers and/or with adults) is a key indicator, often manifesting as or described as poor behaviour or bullying (victim and/or perpetrator).

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Poor relationships
• Language and communication difficulties  
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Language and communication difficulties

Pre-school

Children’s speech and language will be routinely reviewed at the 27 month health review. Those identified with difficulties will be offered interventions through the Healthy Child Programme 0 – 19 team, Children’s Centre team and specialist Speech and Language Therapy or Seaside View Child Development Centre as appropriate

 

School-age
If a child has language or communication difficulties all referrals to S LT are made through school. Schools can refer directly Sea Side View. HCP team 5-19 can make direct referrals to Sea Side View.

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Language and communication difficulties
• Disability or additional special educational needs    
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Disability or additional special educational needs

Many children will need extra help with their learning at some point, but this does not necessarily mean that they have a Special Educational Need or Disability (SEND).

 

Children and young people have SEND if they:

• Have a significantly greater difficulty in learning than the majority of others of the same age
• Have a disability which prevents or hinders them from using the facilities generally provided in mainstream schools or colleges.

 

Special provision must be made for children and young people with SEND. Sometimes this may only be for a short time and sometimes support will be needed for the whole of someone’s life.

 

Read more about how schools and other educational settings support children with SEND here

 

Identifying and assessing special educational needs and disabilities (SEND)
If you are concerned about your child’s health or development, you should speak to a professional who works with you or them in the first instance. Depending on your child’s age or circumstances, this might be a health visitor, nursery worker, teacher, social worker or your GP.

 

You can also contact Amaze, the local SEND Information, Advice and Support Service, for advice around diagnosis and assessment.

 

If your child is at school or nursery, there are certain set processes for assessing their needs and the support that may help them. Find out more about how schools and other settings must support children and young people with SEND here

 

Where there are shared concerns about a child or young person’s developmental progress, they may be referred for assessment through the following services:

• Children’s Disability Service at Seaside View Child Development Centre Integrated services for children and young people with SEND including health, education and social care
• Brighton & Hove Inclusion Support Service School-based support for children and young people with SEND
• Community Mental Health and Wellbeing Services Mental health services for children and young people with and without SEND

 

The assessment process might involve seeing different specialist services or being seen in more than one place, for example at the Seaside View Assessment Centre or school or nursery.

 

Read a detailed overview of identifying special educational needs for all age groups from GOV. UK.

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Disability or additional special educational needs
• Pan Sussex Safeguarding Procedures: Disabled Children
• Amaze
• Where to go for
• Difficulty in achieving in education  
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Difficulty in achieving in education

Schools should review a child’s learning needs, in accordance with the SEND Code of Practice. A pupil has special educational needs and disabilities (SEND) where their learning difficulty or disability calls for special educational provision, namely provision different from or additional to that normally available to pupils of the same age.

 

Schools should make regular assessments of progress for all pupils. These should seek to identify pupils making less than expected progress given their age and individual circumstances. This can be characterised by progress which:

• is significantly slower than that of their peers starting from the same baseline
• fails to match or better the child’s previous rate of progress
• fails to close the attainment gap between the child and their peers
• widens the attainment gap

 

Where progress continues to be less than expected the school, should assess whether the child has SEND.

 

For some children, SEND can be identified at an early age. However, for other children and young people difficulties become evident only as they develop.

 

Persistent disruptive or withdrawn behaviours do not necessarily mean that a child or young person has SEND. Where there are concerns, there should be an assessment to determine whether there are any causal factors such as undiagnosed learning difficulties, difficulties with communication or mental health issues. If it is thought housing, family or other domestic circumstances may be contributing to the presenting behaviour a multi-agency approach, supported by the use of approaches such as the Early Help Assessment, may be appropriate. In all cases, early identification and intervention can significantly reduce the use of more costly intervention at a later stage.

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Difficulty in achieving in education
• Potential for becoming Not in Education, Employment or Training (NEET)    
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Potential for becoming Not in Education, Employment or Training (NEET)

Young people up to the age of 16 are required by law to be in full time education. Young people aged 16-18 are required to be participating in some form of education, training or employment with training.

Young people who are not fully engaged in school may be at increased risk of becoming NEET at age 16. It is important to identify these young people early, before they disengage from education, so that help can be put in place to support them. Some indicators that a young person is at risk of becoming NEET may include, but is not limited to:

• increased levels of absence or truancy
• low levels of prior attainment
• behavioural or social difficulties
• chaotic family background
• offending or at risk of offending
• in care/care leaver
• young parent

 

Schools have a duty to ensure that all young people on their roll are engaged in an appropriate curriculum and have access to the right support to enable them to achieve. Level 2 single agency support should be sought from the school in the first instance.

 

Every school must ensure that pupils are provided with independent careers guidance from year 8 to year 13.

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Potential for becoming Not in Education, Employment or Training (NEET)
• Youth Employability Service
• Slow in meeting developmental milestones    
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Slow in meeting developmental milestones

Pre-school
Children will routinely have their developmental milestones assessed by way of ASQ-3 assessment at their 9-12 month and 27 month health reviews. If a child is attending an Early Years setting they will be offered an ‘Integrated Review’ incorporating findings from the ASQ-3 domains with the Early Years Foundation Stage development assessment categories. If a child requires support that is additional to, or different from their peers a SEND Support Plan should be put in place. Children identified as slow to meet their milestones may be referred to the appropriate specialist services, for example, Seaside View Child development Centre, including BHISS Early Years Team.

 

If there are concerns regarding speech, language and communication then a referral should be made for Speech and Language Therapy for Children. Children can be reviewed using ASQ -3 assessments at any time from the age of 1 month. This can be accessed by contacting the Healthy Child Programme Team (Health Visiting Service) for their geographical location.

 

School-age
School-age children who are not meeting their developmental milestones and not progressing in school should be discussed with the Special Educational Needs Coordinator to see if additional assessments or support is required.

All Children in their reception year are offered a vision and hearing screening test by the 5-19 Healthy Child Programme team. If the child is identified as having a possible concern they will be referred to an orthoptist or audiologist with parent/carer consent.

 

If there are subsequent concerns about a child’s vision or hearing this should be discussed with the child’s parent/carer to check whether they are already seeing a specialist. If they are not already being seen by audiology or an optician parent/ carers should be advised to seek a free eye assessment. Special Educational Needs Coordinators can make a referral to audiology directly from Year one onwards.

 

If there are concerns about a child’s fine or gross motor skills schools should refer to and liaise with their link therapist. Parents can get further support and advice from their School Nurse, or ask their GP for a referral to audiology.

 

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Slow in meeting developmental milestones
• Schools and parent/carers can access supportive health and wellbeing information through NHS Choices, or contacting the appropriate HCP 5-19 team
• Missing health checks/immunisations    
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Missing health checks/immunisations

Babies are offered regular health and development reviews until they are two years old to make sure their development is on track and support parents & carers. The reviews are usually done by health visitors in the home, or they may take place at a GP surgery, baby clinic or children’s centre

 

Children are offered a range of vaccines from the age of eight weeks to 14 years. Deciding not to vaccinate a child puts them at risk of catching a range of potentially serious, even fatal, diseases. For more information on the NHS Vaccination programme see here

 

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Missing health checks/immunisations
• Baby health and development reviews
• Childhood Vaccine Timeline
• Immunisation leaflets and guidance for parents
• Minor health problems  
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Minor health problems
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Minor health problems
• Contact NHS Choices for information about managing minor health problems. If worried about an urgent medical concern, call 111 and speak to a fully trained advisor.
• Where to go for: Health
• Early signs of offending/anti-social behaviour  
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Early signs of offending/anti-social behaviour

Early signs of offending or anti-social behaviour may include:

• School disruption
• Missing from education
• Missing from home
• Coming to police notice
• Coming to the attention of Community Safety Team
• Family breakdown
• CAMHS referral
• Poverty/deprivation

It is important to note that early signs of offending/ASB are often also symptoms of trauma or exploitation

 

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Diversion scheme- Adolescent Services:

Children and young people (aged 10-17) who are arrested for a criminal offence and admit guilt are referred to the Diversion scheme, unless the police make an immediate disposal such as a community resolution. All referrals are from the Police, and the decision-making is via a joint panel with Police, YOS and other services as appropriate.

 

An assessment is undertaken by Adolescent Services with the child or young person and family/ carers, with input from any involved professionals and the case is then referred back to the panel for a decision. If an alternative outcome is agreed (or potentially a caution), Adolescent Services offer a voluntary programme to address offending related issues and risk or safeguarding issues in liaison with other agencies as appropriate.

 

The purpose is to divert young people from the criminal justice system and if successful, they will complete their programme without getting a criminal record. The programme may include work on offending behaviour, restorative justice (e.g. mediation) substance misuse sessions, family work, sessions with the Police Officer (e.g. knife crime) or services such as CAMHS. The length of the programme would be agreed at the start in relation to risk and need and although this would not usually be longer than 3 months they may be able to offer longer term intervention where required.

 

If the young person re-offends, they can be referred back to the Diversion panel, provided they admit the offence. The decisions are made on the seriousness of the offence and harm to the victim, the victim’s perspective (where known), the young person’s circumstances and the context of the offence and related risk and safeguarding issues (e.g. if offending is related to CSE or other forms of exploitation). The primary aim is to prevent further offending by offering a package based on the young person’s needs.

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Early signs of offending/anti-social behaviour
• Underage sexual activity    
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Underage sexual activity

The age of consent for sex in England and Wales is 16 for both men and women. The age of consent is the same regardless of the sexual orientation of a person and whether sexual activity is between people of the same or different gender.

 

It is an offence for anyone to have any sexual activity with a person under the age of 16. However, Home Office guidance is clear that there is no intention to prosecute teenagers under the age of 16 where both mutually agree and where they are of a similar age.

 

It is an offence for a person aged 18 or over to have any sexual activity with a person under the age of 18 if the older person holds a position of trust (for example a teacher or social worker) as such sexual activity is an abuse of the position of trust.

 

The Sexual Offences Act 2003 provides specific legal protection for children aged 12 and under who cannot legally give their consent to any form of sexual activity. There is a maximum sentence of life imprisonment for rape, assault by penetration, and causing or inciting a child to engage in sexual activity.

 

Schools and other agencies will / may have a confidentiality policy which clearly dictates what information they will pass to interested parties in relation to under age sexual activity if the young person is aged 13 years and above.

Young people can access their Sexual Health clinic or a Sexual Health Outreach Nurse for contraception, STI testing, treatment and information through sexual health and contraception clinic (SHAC). Trained youth support practitioners are available at a range of community venues and can provide confidential information, advice and signposting. Young people can access free condoms, chlamydia testing and pregnancy testing from a range of community settings.

 

Some secondary school offer support and advice with regard to sexual health to young people at a weekly drop in run jointly by School Nurse and Youth Worker .

 

Free Emergency Hormonal Contraception (EHC) is available from Pharmacies across Brighton & Hove. Please phone the pharmacy before attending to ensure the trained pharmacist is available to dispense the EHC. Young people can also access free EHC from their GP or local sexual health clinic. Details can be found here

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Underage sexual activity
• Sexual health and contraception clinic (SHAC)
• Pan Sussex Safeguarding Procedures: Sexually Active Children 
• Where to go for: Sexual Health
• Early signs of drug/alcohol misuse    
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Early signs of drug/alcohol misuse

Alcohol and substance misuse services are offered to young people.

 

Level 2 (targeted) services are available to support children and young people via ru-ok?. These services work to reduce and mitigate the risks to young people and those considered vulnerable. Youth projects in Brighton and Hove offer prevention support to young people around substance misuse. The targeted service will:

• Promote improved educational outcomes for vulnerable pupils who may be involved in substance misuse
• Offer advice and consultation to school staff, including drug coordinators, on substance misuse management issues.
• Provide individual support at a targeted level for young people who may be engaged in substance misuse, this will include supporting young people who are at risk of exclusion or who are returning from exclusion
• work with families and other agencies to support the young person.

 

Referrals to the service will be accepted from professionals and young people themselves.

 

Young people should be referred when a substance related incident occurs and where there are concerns that they are becoming involved in regular absence or are displaying changes in behaviour, due to substance misuse. Young people’s consent must be gained for the referral and confidentiality and need for safeguarding should be addressed..

 

Drinkaware have a definition of the early signs of alcohol misuse and the ‘Talk to Frank’ website offers a definition of the early signs of drug misuse

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Early signs of drug/alcohol misuse
• ru-ok?
• Talk to Frank
• Pan Sussex Safeguarding Procedures: Young Persons’ Substance Misuse
• Where to go for…
• Poor self-esteem    
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Poor self-esteem

Self-esteem should be viewed as a continuum, and can be high, medium or low, and is often quantified as a number in empirical research. When considering self-esteem it is important to note that both high and low levels can be emotionally and socially harmful for the individual. Indeed it is thought an optimum level of self-esteem lies somewhere in the middle of the continuum.

 

Socially children with low self-esteem can be withdrawn or shy, and may find it difficult to have fun. Although they may have a wide circle of friends they are more likely to yield to group pressure and more vulnerable to being bullied.

 

Living with low self-esteem can harm your mental health, leading to problems like depression and anxiety, and as they get older children may rely on health harming behaviours, such as smoking and drinking too much, as a way of coping.

 

Research has also shown that low self-esteem has to linked to an increased risk of teenage pregnancy.  Read more

 

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Poor self-esteem
• NHS – Dealing with low self-esteem
• Childline: Building Confidence & Self Esteem
• NSPCC: children plagued by low self esteem and loneliness 
• E-Wellbeing
• Low level emotional & behavioural issues that may be linked to attachment and/or emotional development delay    
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Low level emotional & behavioural issues that may be linked to attachment and/or emotional development delay

Certain individuals and groups are more likely to develop emotional and behavioural problems than others. One in ten children and young people (aged 5-10) has a clinically diagnosed mental health disorder. Risk factors are cumulative with children exposed to multiple risks such as social disadvantage, family adversity and cognitive or attention problems being much more likely to develop emotional and behavioural problems.

 

An important key to promoting children’s mental health is understanding the protective factors that enable children to be resilient when they encounter problems and challenges.

 

Resilience is linked to self-esteem and confidence, a belief in own self-efficacy and ability to deal with change and ability to adapt and being able to have a range of problem solving approaches.

 

Brighton & Hove Educational Psychology Service support schools with understanding attachment through their Attachment Aware Behaviour Policy Guidance which evidences the importance of whole school approaches on children’s attachment needs.

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Low level emotional & behavioural issues that may be linked to attachment and/or emotional development delay
• E-Wellbeing
• Information for professionals and other referrers on Children & Young People’s Mental Health & Emotional Wellbeing Services in Brighton & Hove
• Mental health & behaviour advice for schools 
• What is Resilient Therapy & the Resilience Framework? – Boingboing
• Young carers    
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Young carers

A Young Carer is a young person under 18 who has a responsibility for caring for a relative (or very occasionally a friend) who has an illness or disability, including some-one with mental health or substance misuse problems. For many young carers, caring can lead to feelings of pride and help develop additional skills. However, caring can also lead to a variety of losses for the child, and have a negative impact on their mental or emotional health, and/or educational attainment and attendance. It can also have an impact on friendships and social activities.

 

All agencies in contact with young carers should consider if they are in need of support services in their own right, and / or whether the family might benefit from additional support.  A key way to ensure the young carer’s responsibilities are minimised is to ensure that the ‘cared for’ is accessing relevant services.  This might include Adult Social Care, GP’s, Amaze, The Parenting Team or and wellbeing support.

 

See The Carers Hub Website for further information and to make a referral.  Following a referral The Young Carers Coordinator/ITF Family Coach can ensure that the right support is offered to the family through relevant information and advice, and / or targeted support through The Young Carers Project, who support young carers aged 6 and over.

 

A Early Help Strengthening Families Assessment and Plan can be completed if the Young Carers Coordinator/Family Coach identifies the following:

• the family have little or no support network around their health or caring roles, including through friends, family and professionals
• the young carers is doing multiple inappropriate tasks, such as personal care, budgeting or precociously mature, emotional support
• there is a significant impact on the young carers school attendance and attainment
• there is a significant impact on the young carers mental or physical health

A Team Around the Family Meeting may be set up, or an Integrated Team for Families, Youth and Parenting Services Family Coach allocated, where the threshold is met.

 

The local authority should consider whether any provisions of the Children Act 1989 or The Children and Families Act 2014 and The Care Act 2014, should be applied.  Depending on the extent and effect of caring responsibilities, the young carer may come within the definition of a Child In Need under Section 17 of the Children Act 1989.

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Young carers
• Pan Sussex Safeguarding Procedures: Young Carers
• Young Carers Project
• Bullying    
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Bullying

Bullying is a common form of deliberately hurtful behaviour, usually repeated over a period of time, where it is difficult for the victims to defend themselves. It can take many forms, but the three main types are physical (e.g. hitting, kicking, theft), verbal (e.g. racist or homophobic / religious remarks, threats, name calling) and emotional (e.g. isolating an individual from social activities, cyberbullying).

 

The damage inflicted by bullying is often underestimated and can cause considerable distress to children to the extent that it affects their health and development. In the extreme it can cause Significant Harm, including self-harm.

 

There are many reasons why children bully others, and they might not even realise that what they’re doing is bullying. Peer pressure plays an important part in bullying, and children may bully because they want the approval of others. On the other hand, they might bully others because they feel powerless – perhaps because they’ve been a victim of bullying,  or they have suffered inconsistent parenting, or lacked warmth and care.

 

In Brighton & Hove Safety Net’s services are designed to support the mental, physical and emotional well-being of children and young people aged 8 –13 (and sometimes 7-year-olds) across the city. The service works with children, families, schools and neighbourhoods, building communities where children know they have the right to feel safe and adults are actively involved in protecting them from harm.

 

The council’s Community Safety Casework Team can provide support in some cases of bullying or prejudice-based incidents (hate incidents) as per the leaflet for parents in the link. Please note that the email address to contact the team has changed to communitysafety.casework@brighton-hove.gov.uk

 

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Bullying
• Advice for Schools: Preventing and tackling bullying
• Safety Net
• Bullying UK
• Brighton & Hove City Council’s leaflet for parents, which includes advice for talking to the school about the problem as well as ways to support your child.
• Children who have previously been in Care, and children living away from their birth parents e.g adopted children, Special Guardianship Orders, Kinship Care.  
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Children who have previously been in Care, and children living away from their birth parents e.g adopted children, Special Guardianship Orders, Kinship Care.

Children who were previously in care and are now living in adoptive families or with family and friends under special guardianship or child arrangement orders will be living with the impact of the circumstances and experiences which led to the need for them to leave the care of their birth parents.

 

Many of these children can struggle to respond to usual parenting approaches and strategies because of their past experiences of neglect, abuse and trauma.  They have learned their own strategies to feel safe; these don’t always work in their new families and this can present significant challenges to their new parents and carers.  This can also mean that some interventions will be less successful for these children than they are for children who are growing up with the parents they were born to and haven’t experienced repeated changes of primary carer.

 

All children placed with Special Guardians from care, and all children adopted from care are entitled to:

• Priority School Admission – please contact School Admissions
• Pupil Premium Plus payments made to support their school in meeting their additional needs (as long as the parents or carers have informed the school of their status) – discuss with your class teacher at school
• Assessment for Special Guardianship or Adoption Support needs: This entitlement extends to Children and their carers if subject to an SGO or child arrangement order / Residence Order.  For Adopted children, the child, the parents, and any siblings of the child in the adoptive family are entitled to assessment of their adoption support needs.  These assessments are additional to any other assessments of the child’s needs and development.
• Therapeutic Support – The Adoption Support Fund is a fund provided by the Department of Education which exists to fund specialist therapeutic assessments and therapy for children who are adopted from care, or who were in care and are now subject to a Special Guardianship Order. The fund offers up to £2500 per year for specialist assessments of therapeutic needs and up to £5000 per year for therapy.  Unfortunately those children subject to child arrangement orders or residence orders are not eligible for this funding.  Those children who are subject to SGO but were not previously in care are also not eligible for this fund.

 

If a family would like an assessment of their support needs (which is required in order to access the Adoption Support Fund), they should make contact with:

 

The Brighton and Hove Adoption Team at: Adoptionhelpline@brighton-hove.gov.uk   01273 295455

 

The Brighton and Hove Family and Friends Team at: Famfriends@brighton-hove.gov.uk   01273 295694

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Children who have previously been in Care, and children living away from their birth parents e.g adopted children, Special Guardianship Orders, Kinship Care.