The CAMHS team are implementing systemic, relationship therapy with additional behavioural and CBT programmes as appropriate. Similarly, they use the Assessment Intervention Moving on (AIMS) sexual offending programme with children as part of a wider offer, including systemic or family therapies addressing the complex family trauma.
The challenge
The Child and Adolescent Mental Health Service (CAMHS) provided by CWMHT was providing behavioural programmes, including Cognitive Behavioural Therapy (CBT) for the Coventry and Warwickshire Youth Justice teams, but were aware this approach was not working well. The cases coming to them were increasingly complex and the brief behavioural programmes using no more than 12 sessions did not address their needs. Children and young people were not engaging with the programmes, and the Youth Justice staff felt they were not working as hoped. At the same time, they were experiencing an increase in Out of Court Disposals which was resulting in an increasing demand for their services.
The approach
The CAMHS team switched to a more complex, relational, and systemic approach to working with young people. They are now implementing systemic, relationship therapy with additional behavioural and CBT programmes as appropriate. Similarly, they now use the Assessment Intervention Moving on (AIMS) sexual offending programme with children as part of a wider offer, including systemic or family therapies addressing the complex family trauma. The CAMHS team often work with young people over a period of more than a year and beyond the time frame of the court order.
Importantly, the CAMHS teams are seconded to the Youth Justice (YJ) service so their work is embedded within the YJ response. This has supported multidisciplinary case discussions with a trauma focus, and the mental health professionals have been able to provide training and support for work with young people who have experienced trauma.
Internal data shows that most cases are above the age of 14 years, but younger children have been included in this work. There is a difference in process according to the seriousness of the outcome, however. Where a pre-sentence report is required, a full health and development assessment will identify need, ensuring that an intervention is always in place and can be part of the court decision making. The standard processes for Out of Court Disposals and Early Intervention and Prevention are less well developed. These processes are being improved in recognition that some children who would benefit from this service are not reaching it, or not reaching it early enough.
Local implementation
The local work has benefitted from CAMHS having a place in strategic planning in the Coventry and Warwickshire Youth Justice response. This has allowed shared ways of working to thrive despite different contractual arrangements across the area.
The inclusion of the health team in the operational management of the Youth Justice team has helped to achieve system-wide change. The new approach has buy-in from practice leads and operational management as well as frontline staff.
Evidence of impact
There has been no formal evaluation of their change in practice, but extensive use is made of routinely collected data and self-reports from young people. Routine data show a reduction in the number and seriousness of offences over time for children the CAMHS team have worked with. None of those who have been referred to the integrated AIMS programme have reoffended. Young people are engaging well and say they feel the service has helped them. However, the total numbers of children who have finished working with the service are small, and there is no comparison data so no firm conclusions can be drawn yet.
Service manager
The Youth Justice offer is something I’m quite proud of, its evolved into something that really works…the process of how all of this coheres is critical. We have avoided having fragmented services without any thought about where or how they fit together coherently...we have tried to make sure that we get the process right, that we have the right people in place
Service user
Feeling my opinion is valued and listened to. I feel like I can trust the people I talk to.
Contact details:
Coventry and Warwickshire Mental Health Trust (CWMHT)
Coventry City Council
Warwickshire County Council