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Get the help you need, at the time you need it - Access (Community Health, Wellbeing and SEND)

What is "Access" - Community Health, Wellbeing and SEND (Special Educational Needs and/or Disabilities)?

In 2018 Plymouth began developing an integrated offer for Community Health, Wellbeing and SEND support for children, young people and families. This involved incorporating services currently delivered by Plymouth City Council (PCC) University Hospitals Plymouth NHS Trust (UHP) and Livewell Southwest (LSW).

The vision for Access is that CYP, families and professionals will be able to get advice and help from the most appropriate service, at the level required and in a timely way without having to keep repeating the same story.
 

Why is this important?

Families in Plymouth have consistently told us that they want better information, with a single entry point when they need to access specialist services for their child's additional health, disability or special educational needs. Other things parents have told us are:

  • I have to repeat my story over and over again
  • Why don't services talk to each other?
  • I don't know who can help or what services are available.
  • It feels like there are well kept secrets.

We believe that Access can achieve the following:

  • Less repetition for families
  • Single request for support rather than numerous referrals
  • Timely response to need
  • Increase families confidence in services
  • Joint planning
  • Less duplication
  • Robust assessments to support multi-disciplinary planning
  • System view of each child/young person's journey
  • Greater visibility of service demand

Which services are within scope of Access - Community Health, Wellbeing and SEND?

  • Livewell Southwest (LSW) - Child and Adolescent Mental Health Services (CAMHS), Speech and Language, Health Visiting, School Nursing
  • University Hospitals Plymouth NHS Trust (UHP) - Child Development Centre/Community Paediatric Services
  • Plymouth City Council (PCC) SEND Service - Early Years Inclusion Service, Sensory Support Team, Communication and Interaction team, Local Authority Occupational Therapy Team, Children's Disability Social Work Team, 0-25 SEND Statutory Assessment Team, Plymouth LA Educational Psychology Service and Short Breaks.

Where are we now?

The development of this integrated offer is complex and therefore, the implementation is taking place using a phased approach.

Since Access went live in September 2018 we have established:

  • A greater understanding of how each service works.
  • A multidisciplinary team (MDT) discussion takes place weekly and has proved useful in helping to ensure that the right help is provided for children and young people at the right time.
  • A request for help form has been piloted which can be used to access all services within the scope of Access: Community Health, Wellbeing and SEND.
  • LSW have redesigned services to which focuses on early help. It is based on the iThrive model of support.
  • PCC SEND services have implemented the Graduated approach to inclusion model

Unfortunately the Coronavirus pandemic has prevented us from moving forward as quickly as we had hoped but we are now ready to progress to the next phase. The focus of this phase is to develop an improved early help response so that CYP, families and professionals can get advice and support at the level required in a timely way without having to keep repeating the same story.

In order to do this we are hoping to align early help processes already in place. In addition to this we will be extending the use of the request for help form as a tool where a written request is required.
 

How to get help through Access

Access is based on the iThrive model of support. The National iThrive programme aims to improve outcomes for children and young people's mental health and wellbeing. More information about the iThrive Framework for system change (Wolpert et al. 2019) can be found via http://implementingthrive.org/about-us/the-thrive-framework/

The iThrive framework conceptualises need in five categories; Thriving, Getting Advice and Information, Getting Help, Getting More Help and Getting Risk Support. Emphasis is placed on prevention and also the promotion of mental health and wellbeing across the whole population. CYP and their families are empowered through active involvement in decisions about their care.
 

Thriving

At any one time around 80% of CYP are experiencing the normal ups and downs of life but do not need individualised advice or help. They may however benefit from prevention and promotion strategies to consider the best way to meet their needs.
 

Getting advice and information

There is a range of advice and help available in Plymouth for CYP and their families through "universal" or "targeted" provision within the community and schools Many children and young people will have their needs met with this level of support and wherever possible it will give CYP and their families the opportunity to consider options themselves so that they can make their own choices.

The Plymouth Local Offer provides information for CYP, their families and professionals about what services they can expect from a range of local agencies (including their entitlements). The Local Offer covers provision for children and young people from birth to 25 years and includes information on education, health and social care services.

LSW provides 'Health for Kids' and Health for Teens' websites, which provide a variety of information for children young people and families to access on a variety of topics.  Additionally they provide a Chat Health service, which enables young people and families to get advice from health care professionals via a secure messaging service.
 

Getting help

Sometimes advice and information is not enough and help is required. In the first instance we would encourage CYP and families to have an open discussion with the school/setting and health workers.

Schools and settings use the "Plymouth Graduated Approach to Inclusion" framework to support the "assess, plan, do, review" cycle of support for individual CYP with needs. Using this framework, outcomes based planning takes place and consultation is available from Local Authority SEND professionals. Families and professionals can either contact PCC SEND professionals linked to their school/setting or they can contact the PCC Children's Gateway on 01752 668000.

LSW also provide mental health support to schools.

LSW have a "Request for Help" system which means that if families or professionals are concerned about a child's speech or language development, they can discuss the child's needs by contacting the team on 01752 434844

LSW also provides an Early Help pathway number for CYP who might require CAMHS on 01752 431613

For early concerns around child development in the first instance please discuss with Primary Care services such as Health Visiting, School Nursing or the GP. Following these contacts, it might be agreed with the CYP and family that it would be helpful to bring together services already working with the CYP i.e. Health Visitor and Early Years for a discussion around next steps to take.

For concerns about CYP who are already known to the Child Development Centre or have been referred to the service, contact can be made by emailing plh-tr.cdcplymouth@nhs.net or calling 01752 439400.
 

Getting more help

It might be agreed between families and professionals that a request for "more help" is required so that a more specialist assessment or intervention can take place. Wherever possible this will be following a discussion, consultation or meeting with the service, who are likely to be able to provide this support. The discussion will also identify the most appropriate way for the request to be made/logged. This may include:

  • A request for help telephone conversation or consultation has taken place with a service and they have agreed that they have enough information to accept the request.
  • A service has attended a multi-agency meeting in relation to the child or made an observation and it has been agreed that they have enough information to accept the request.
  • In some cases there may have been little or no opportunity to have a request for help conversation or consultation and/or there may be a lot of information to share. In these situations we recommend you complete a request for more help form.

Completed forms should be sent to Accessearlyhelp@plymouth.gov.uk

One of the aims of Access is that families and professionals don't have to keep repeating themselves by having to complete numerous referrals or forms. The request for help form is brief and will hopefully provide a summary of the current situation. It is however unlikely that it will provide enough information for a decision to be made, so please also submit any additional information that you have available which evidences the work that has already taken place. This may include:

Getting risk support

Where you are concerned about the risk for a CYP, workers should escalate these concerns within their own organisations safeguarding processes.

If you have an urgent child protection concern, please call Plymouth Multi Agency Safeguarding Hub on 01752 668000 or 01752 346984 of out hours. You can also email MASH@plymouth.gov.uk.

 

Who can request help through Access?

The integrated offer from Access is designed to help support the needs of individual CYP and their families including those with SEND.

The aim is that everyone should be able to get early advice and help before requiring more specialist help. Please contact the Plymouth Early Help and SEND Advice Line.

Where more help, assessment or intervention is required from a service, in all cases key questions to consider before making a referral will be:

  • What is the presenting need?
  • What is the desired outcome?
  • What have you tried already and what has been the impact? Please include evidence of an assess, plan, do, review process.
  • Who is currently involved?
  • Do you need additional advice, support or help?
  • If so at what level?

Is consent required before requesting more help?

Yes, families will need to give consent for a request for more help to be made through Access.

It is important that families understand the functions and purpose of Access and that in agreeing to help being requested, they are consenting to relevant information being shared amongst representatives from within the three agencies, LSW, UHP and PCC.

An information sharing agreement has been created for this project, which sets out the purpose of the data sharing and standards and helps all the parties involved in sharing to be clear about their roles and responsibilities.
 

What happens next?

All requests for more help will be considered by services and a decision made about whether they are the most appropriate service to be involved at this time. As previously described, in most cases a conversation, consultation or meeting will have taken place and the service will be expecting the request.

If the information submitted indicates that more help is not required at this time, information and advice about early help will be provided.

Once a decision has been made, the professional who has requested the involvement will be informed of the outcome and it will be their responsibility to share this with the family.

It will be important to recognise that there is likely to still be a waiting time for individual services.

At times a request for more help is received, but it is not clear which service/services are required and it might be appropriate to discuss these cases with a multi-disciplinary team (MDT)
 

What is the MDT Discussion?

MDT discussions take place once a week and are useful in ensuring that the right help is provided for CYP. Team members include senior practitioners from services within PCC, LSW and UHP.

Within the weekly MDT, there is also an opportunity to discuss CYP who are in crisis or have complex issues where a coordinated response may be required.

The Access MDT has a range of responses available, which are personalised for CYP and families' needs. These include:

  • Advice and information
  • Assessment by single service or combination of services
  • Crisis response where there is significant risk to a CYP

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Plymouth's Local Offer is organised into four main categories covering the following age ranges:

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