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When my colleague Hannah Stace and I were appointed to establish the Gateway Programme Team in August 2022, we were excited to be part of this clinican led, co-produced, Complex Needs Escalation Support Framework. Designed for multi-agency utility across all 9 Places in Cheshire and Merseyside, to promote timely action to address complex, unmet needs of children and young people, the model represented an excellent opportunity for evidence-based integration across a range of professions and employing organisations. We were delighted that stakeholders involved in Gateway's design had clearly stated their commitment to hold children, young people and their carers at the heart of the model from the earliest point in appreciative enquiry.
Aligned to strategic objectives reflecting the aims of the Transformation Programme for Children and Young People and NHS Long Term Plan, the Gateway Programme's key principles and underpinning values ensured implementation corresponded with other national publications, including The Marmot Review, which particularly resonated given post-pandemic system challenges experienced in the UK by health and care during 2022/23.
As this 18 month period of support for the Gateway Programme draws to a conclusion and we reflect upon what we have learned, I am reminded of the strength of ownership at Place for this model. Whilst consistency is undoubtedly crucial for system working, to ensure information and learning may be shared appropriately for equity of service, ownership at Place is also essential, so professionals closest to the young person and their carers may advance appropriate action in a timely manner.
Professionals acting as Gateway Chairs since August 2022 have been fundamental to implementation at Place, developing visibility of the model across employing organisations and promoting membership representing health and care, whilst avoiding unwarranted variation by leading co-production of Terms of Reference. 11 colleagues have acted as Gateway Chair during this period and we have been grateful to them for leadership and support provided for Gateway Members, as captured in the role descriptions developed in 2023.
As a result, we have enjoyed a superb level of engagement with professionals via Gateway Community of Practice. Online and in-person events have been supported by colleagues strongly committed to care for children, young people and carers, with a passion for sharing information, experience and best practice across the network. The atmosphere generated by the Community of Practice has been so postive and energetic, it would be impossible to leave events without feeling inspired.
Perhaps the greatest privilege of the period was working with Level Up Experts by Experience, who generously shared their time, knowledge and extensive skills to support implementation of Gateway. The resources they developed, including recorded material, in partnership with the Programme Team to support professionals engaged in Gateway are invaluable and we were delighted to see it featured in their award winning application to the Patient Experience Network Annual Awards in 2023 (PENNA).
Gateway is an example of what is possible when policy and research aligns with practice: Implementation of a new model across the diverse professions and organisations caring for children and young people across 9 Places requires detailed planning, in addition to an energetic and caring workforce, which recognises the importance of developing effective professional relationships.
Whilst the professional training, range of employing organisations, team and individual experiences Gateway Members bring will be rich in diversity (and this is most welcome, if we are to appropriately serve our communities at Place well) we must recognise that, without compassionate management and leadership, there will be a risk efforts to generate integration lead to misunderstanding, inadvertantly resulting in unhelpful barriers to timely action. By acknowledging difference and engaging in the development opportunity Gateway implementation has presented, Gateway Chairs and Members in Cheshire and Merseyside have been alert to the possibility of potentially unhelpful barriers, focussing on professional standards in common to develop multi-agency solutions, with a shared language developing around the model, which continues to be amplified. This emerging system identity evolving alongside Gateway development at Place is welcome.
The formal evaluation of Gateway, conducted by Liverpool John Moores University, will report later in 2024. The Gateway Programme Team would like to thank professionals and Experts by Experience from Cheshire and Merseyside supporting implementation of the Gateway Programme between August 2022 and March 2024. We are especially grateful to Dr Fiona Pender for her vision and leadership, who has guided us with kindness and compassion.
WATCH: Our First Gateway Conversation - Implementing Gateway at Place
Darren Birks, Senior Partnerships and Transformation Manager for Mental Health in Wirral Place, and Sarah Bradshaw, Commissioning Administrator for Primary Care, Mental Health and Learning Disabilities in Wirral Place, joined the Gateway Programme Team, Elizabeth Collins and Hannah Stace, to discuss their experience implementing Gateway at Place.
The Wirral Gateway was established in 2022. Darren and Sarah share their reflections on what has gone well, the reasons why and lessons learned.
This week the government launched a strategy setting out ambitions over the next 5 years to:
- reduce suicide
- improve support for people who have self-harmed
- improve support for people bereaved by suicide
The strategy was informed by consultation during 2022, which included consideration of steps required to support multi-professional working across individuals, local government, NHS organisations, voluntary, social and community partners, in addition to the private sector.
It includes over 100 actions required across government and a wide range of organisations.
As Gateway Programme Manager, I particularly noticed the reference to bespoke actions and intervention required for certain groups, including children and young people. In addition, there is recognition of the need to ensure:
…actions are focused on prevention and early intervention while also ensuring there is the right support for people…strong collaboration, with clarity of roles, is essential. Suicide prevention is the responsibility of multiple government departments, as well as wider public, private and VCSE sector organisations
This aligns with the CNEST and Gateway model, which focus on early identification of complex, unmet needs for children and young people, in addition to providing an opportunity for multi-agency agreement of actions required by professionals to address those unmet needs.
Having experienced implementation of CNEST and Gateway in Cheshire and Merseyside during the past 12 months, I welcome the strategy’s promotion of cross-sector working and joint action, including at a local level. I look forward to learning more about how the actions are taken forward in other integrated care systems, in addition to Cheshire and Merseyside.
BLOG: Hannah Stace, Gateway Project Support, discusses the upcoming Community of Practice Event
By Hannah Stace, Gateway Project Support:
Thank you to everyone who attended the event in October, we got some really good feedback and I thought it was really interesting that so many people would like to see more case studies. Here's some of the key themes from the feedback we recieved:
We're currently developing a fictional case study to help make it easier to understand how certain elements of the Gateway work. We hope to have this ready for an event in the near future so please let us know what the most common challenges are that you're facing, and we'll incorporate them into the case study.
Also, we're excited to invite professionals involved in in the Children and Young People’s Mental Health Gateway to our next Community of Practice Event on Tuesday 14 February 2023, 9.30am-11.00am. If you would like to joing the next Community of practice event please email: Gateway Project Support, Hannah Stace, hannah.
Following feedback, we’ve redeveloped the agenda to have a more detailed focus on peer support and shared learning.
At the event we’ll be discussing:
- Peer support
- Shared learning
- Updates from Gateway chairs
- Progress on local gateways
- Challenges gateways have had to overcome
- Research on multi-agency problem solving
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WHY IS CHANGE IN CAMHS IMPORTANT? |
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It is estimated that 50% of all lifetime mental health disorders start by mid-teens (Kessler et al., 2007), emphasising the need for effective, early mental health support.
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Less than 1/3 of children referred to CAMHS received treatment within a year, 32% remained on the waiting list at the end of the year.
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Hospital admission can increase a young person’s risk to self through dependency on services or learning and adopting new risk behaviours (Taiminen et al., 1998) and should therefore only be used when completely necessary.
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Less than 3% of children in England accessed CAMHS in one year, a small fraction of those who need help.
(Childrens Commissioner, 2018)
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This project, conducted at Liverpool John Moores University, aims to identify, evaluate and share learning on what works well and could be construed as good practice in the Gateway Meetings.
We plan to investigate this using a mixed-methods approach utilising both quantitative and qualitative measures to inform our conclusions. A real-world validation and Living Lab approach will be utilised.
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QUANTITATIVE RESEARCH |
QUALITITATIVE RESEARCH |
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THIS IS YOUR OPPORTUNITY TO GET INVOLVED... We aim to complete a further two focus groups in 2023 and will be recruiting for these in the upcoming months. We would greatly appreciate and encourage involvement from professionals with experience of the Gateway Meetings as your insights and opinions will help to inform our project and conclusions. We also hope that open discussions between colleagues from different boroughs and disciplines, will allow you to share insight into positive work practices and experiences with one another. Elizabeth Collins will share information regarding the focus groups when the details are confirmed, and invite you to take part. |
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MEET THE RESEARCH TEAM |
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Dr Rafaela Neiva Ganga Rafaela is a lead researcher on the real-world validation of health services. As an expert on methodological design and service, she is experienced in helping innovators apply a range of research methods to understand their services' real health benefits. |
Dr Grahame Smith Grahame is a mental health nursing academic and a reader in mental health and service lead. He is the founder and centre lead for the Centre for Collaborative Service in Dementia, an accredited health living lab. |
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Gemma has over 30 years of clinical experience as a nurse consultant and Clinical Lead in CAMHS and has been working on research into children’s mental health for 20 years.
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Naomi Atkinson Naomi has a first class honours degree in Psychology and an MSc in Clinical and Health Psychology. Within these degrees she managed two long-term research projects. |
References:
Childrens Commisisoner (2018). Children's mental health briefing A briefing by the Office of the Children's Commissioner for England November 2018 https://www.childrenscommissioner.gov.uk/wp-content/uploads/2019/02/childrens-mental-health-briefing-nov-2018.pdf (accessed 23 February 2023)
Kessler, C. R., Amminger, G. P., Aguilar‐Gaxiola, S., Alonso, J., Lee, S., D, & Ustun, T. B. (2007). Age of onset of mental disorders: A review of recent literature. Current Opinion in Psychiatry, 20(4), 359-364.
Taiminen, T. J., Kallio-Soukainen, K., Nokso-Koivisto, H., Kaljonen, A., & Helenius, H. (1998). Contagion of deliberate self-harm among adolescent inpatients. Journal of the American Academy of Child and Adolescent Psychiatry, 37(2).
