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22/25 HSDR Evaluating the implementation of the Transforming Children and Young People's Mental Health Provision Green Paper - Supporting Information

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Published: 28 February 2022

Version: 1.0 February 2022

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Deadline: 1pm on 25 May 2022

The vision for the proposals set out in the Transforming Children and Young People’s Mental Health Provision Green Paper is for children and young people to have better mental health and wellbeing, supported and promoted by schools, colleges, parents/carers and the health and care system. In this programme of work, relevant education settings include state-funded and independent schools and colleges including special schools, Alternative Provision and Pupil Referral Units covering the age range 5-18.

Please also see the new report (published on 12 May 2022), Transforming children and young people’s mental health implementation programme – data release, setting out data on the delivery and uptake of government support for schools and colleges, including mental health support team coverage and senior mental health lead training grants.

The three core elements of the implementation programme are:

Mental Health Support Teams (MHST)

MHSTs work alongside, and integrate with, the mental health and wellbeing support that already exists in education settings or wider local areas and should be additional to this support and not be associated with disinvestment in existing support. MHSTs support the mental health and wellbeing needs of children and young people in primary, secondary and further education (ages 5 to 18) and use an evidence-based approach to provide early intervention on some mental health and emotional wellbeing issues.

MHSTs teams have three core functions:

  • to deliver evidence-based interventions to individuals or groups of children and young people for mild-to-moderate mental health issues;
  • to support the Senior Mental Health Lead (where established), in each school or college, to introduce or develop their whole school or college approach, and;
  • to give timely advice to school and college staff, and liaise with external specialist services, to help children and young people to get the right support and stay in education.

Each MHST works with around 7,000 pupils across 10-20 schools and colleges - with provision being agreed locally to reflect the needs of children and young people, the setting and local system. MHSTs generally include newly trained Education Mental Health Practitioners, higher-level therapists/senior staff, a service lead/team manager and administrative support.

Senior Mental Health Leads

A Senior Mental Health Lead is a strategic leadership role, in a school or college, responsible for overseeing the whole school/college approach and working closely with MHSTs. We know many schools and colleges already have existing mental health leads. The training offered by DfE will equip Senior Mental Health Leads with knowledge and skills to introduce or develop their setting’s holistic approach to mental health and wellbeing. The senior, lead role is not mandatory and, where it is in place, the role is flexible and allows schools and colleges to shape it to meet their setting’s individual needs. In October 2021, schools and colleges were invited to begin applying for a training grant. As at 14 January 2022, of over 8000 who had applied to reserve a grant, 6,650 eligible schools and colleges had completed their application for a Senior Mental Health Lead training grant by confirming their booking on a DfE quality-assured training course. Many Senior Mental Health Leads have commenced this training and will be starting to apply the learning in schools and colleges this (2021/22) academic year.

4 Week Waiting Time pilot (4WW)

4 Week Waiting Time pilots (4WW) are an integral part of the implementation programme. The primary objective, to date, has been to build consensus on a meaningful definition of ‘access and waiting times’ across all Children and Young People Mental Health Services, testing with service users, parents and carers, and identifying the potential impact on equalities and health inequalities. Twelve pilot sites were identified, as part of the original 58 MHSTs, in the first wave in 2018, with a further two sites being identified in 2021/22. Additional funding has facilitated an extension of the 4WW pilots to reinstate activities paused due to the COVID-19 pandemic and to provide data that will better enable the programme to develop trajectories and model costings for the potential introduction of an access and waiting time standard. Pilot sites are located as follows: Bromley; Gloucestershire; Greater Manchester; Camden; Oxford; Doncaster & Rotherham; Haringey; Buckinghamshire; Northumberland; Tower Hamlets; North Staffordshire & Stoke on Trent; South Warwickshire; Liverpool & Sefton; and Nottingham & Nottinghamshire.

Early implementation

The Children and Young People’s Mental Health Trailblazer initiative was launched in 2018 to take forward the proposals set out in the Transforming Children and Young People’s Mental Health Provision Green Paper. This initiative is being implemented in successive waves - with the first wave funding the creation of 58 MHSTs in 25 Trailblazer sites. A phased approach has seen new cohorts of MHSTs established each year. 125 MHSTs were commissioned in 2019/20 and are now operational, 104 MHSTs are currently in development, and an additional 112 teams will be established in 2021/22. The total number of MHSTs will reach 399, covering an estimated 3 million children and young people (around 35% of pupils in England) by 2023.

Building on the phase 1 evaluation

The focus of the phase one evaluation has been to understand how MHSTs in the Trailblazer sites are implementing the programme and what activities are being developed, along with the perceived benefits and outcomes. An interim report was published in July 2021 and the final report is due in Summer 2022.

Trailblazer sites (the first cohort of 58 MHSTs established in 2018/19) were used to test the approach, gather evidence and experience, and demonstrate that proposed plans can be successful, before rolling out to the rest of the country. Twelve of these sites are also piloting 4WWs. The implementation of each element of the programme means that not all schools and colleges that are working with an MHST will be in an area that is part of a 4WW pilot or has accessed the Senior Mental Health Lead training. This provides an opportunity to gather evidence on the difference in outcomes when there are only MHSTs in a given area, compared with MHSTs who also have a trained Senior Mental Health Lead and are in an area with 4WWs.

This is a complex implementation programme to evaluate and research teams are asked to consider whether pragmatic ways of identifying appropriate comparators, in the planned research, are available, for example, this may include developing comparators solely for some outcomes. Core data will include NHS Mental Health Services Data Set (MHSDS) and National Pupil Database (NPD) for a range of information on activity and outcomes and linkage between these two. This data linkage is being developed through the EChild+ programme.