The Healthcare Quality Strategy for NHSScotland outlines a shared aim for NHSScotland to become a world leader in healthcare quality. The Healthcare Quality Strategy includes three quality ambitions that relate to providing care that is person-centred , safe and effective. The quality ambitions are:

1. ‘mutually beneficial partnerships between patients, their families, and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making
2. there will be no avoidable injury or harm to people from the healthcare advice they receive, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times, and
3. the most appropriate treatments , interventions , support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated’.

Implementation of ICPs within CAMH services will support the achievement of these quality ambitions. A number of national patient safety programmes are under way or in development. As mandated in the Healthcare Quality Strategy, Healthcare Improvement Scotland is leading on the development of the Scottish Patient Safety Mental Health Programme . This programme will cover the whole age spectrum in mental health and  ICPs will be central to the programme’s development and delivery. The paediatric and primary care patient safety programmes will also have interfaces with the CAMH ICP work.

In the last 10 years, numerous new policies, practice models and improvement programmes that apply to health, education and social care providers have been introduced (see the separate background reading document). Common themes emphasise the importance of the emotional well-being and mental health of children and young people and the importance of placing the child or young person and their parents/carers at the centre of all decision-making and every care encounter. Key to this is a need for:

• better communication and sharing of information between practitioners and services
• more integrated services with joined-up planning processes, and
• reciprocal support arrangements.

The standards for ICPs for CAMH services relate primarily to NHSScotland and the resultant ICPs will be NHS-based. However, ICPs provide a framework which promotes care centred on the child or young person and highlights the points on the pathway where information should be routinely shared with the child or young person, their parents/carers, where appropriate, and between agencies and practitioners. Integral to this are the rights of children and young people with regard to their own personal information and how this is managed and shared. This needs to be balanced against parents/carers’ information requirements and child protection issues.

ICPs also outline where support, liaison, and consultation are required to allow the multi-agency workforce to best meet the needs of the child or young person and their parents/carers.

The other national drivers with most significant links to ICPs for CAMH services are outlined below.

NHSScotland Specialist CAMHS Balanced Scorecard

The draft NHSScotland Specialist Child and Adolescent Mental Health Services Balanced Scorecard provides a common core set of key performance indicators for use across all NHS boards in Scotland. The balanced scorecard will be used to monitor the success of NHS boards in implementing CAMH policy and to support national data benchmarking of CAMH services across Scotland. Development of ICPs is included explicitly within the balanced scorecard as one of the key development areas that will contribute to achievement of the following high level objectives:

• good clinical outcomes, and
• person-centred services.

Development and implementation of ICPs for CAMH services also feature within a number of the key performance indicators. It is intended that the key performance indicators will be useful in three ways:

1. they will provide data which will support decision-making relating to local CAMH service redesign
2. they will provide data which will support national implementation monitoring and will identify where further national focus and support activity is required, and
3. they will provide benchmarking information which will be helpful to individual NHS boards and to all those with an interest in gaining a better understanding of the national position relating to CAMH service provision.

HEAT Targets

Health improvement, efficiency, access and treatment (HEAT) targets are a core set of Ministerial objectives, targets and measures for NHSScotland. The targets reflect Ministers’ priorities for the health portfolio and are refreshed and revised, usually every three years. There are a number of mental health specific HEAT targets which are applicable to CAMH services. We have worked with colleagues in Scottish Government, NHS Education for Scotland and the Information Services Division of NHS National Services Scotland to ensure that, where possible, ICP development and implementation delivers against the HEAT targets in mental health. ICPs are an important tool to support NHS boards to deliver against these mandatory targets.

Public Health Institute for Scotland Needs Assessment Report on Child and Adolescent Mental Health (2003) (SNAP)

The SNAP Report outlines the strategic vision for the mental health of children and young people in Scotland. It emphasises that all agencies and organisations have a role in supporting mental health and well-being across the whole continuum – from mental health promotion, through preventing mental illness, to supporting, treating and caring for those children and young people experiencing mental health difficulties of all ranges of complexity and severity.

The Mental Health of Children and Young People: A Framework for Promotion, Prevention and Care (2005)

The Framework was developed to support services to implement the recommendations of the SNAP report. It is intended to be used by health, education and social work services to aid planning and delivery of integrated approaches to children and young people’s mental health services. In essence, it is intended to promote and shape coherent, interagency planning.

The Framework fits within, and endorses, the vision for an integrated approach to children’s services planning and delivery set out in For Scotland’s Children , which assumes a holistic approach with the child at the centre. It also links strongly with the fourth edition of Health for All Children in Scotland (Hall 4) . Hall 4 recommends a holistic approach to child health screening and surveillance with an emphasis on health promotion, primary prevention and targeted active intervention with vulnerable families . NHS boards and their planning partners have been tasked with implementing the Framework by 2015.

Getting it Right for Every Child (GIRFEC)

Getting it Right for Every Child (GIRFEC) is a set of guiding principles and a fundamental way of working that provides the foundation for work with all children and young people. GIRFEC builds from universal health and education services. It drives the developments that will improve outcomes for children and young people by changing the way adults think and act to help all children and young people grow, develop and reach their full potential (see Table 1). GIRFEC is an evolving process and will be updated over time as new thinking and practice emerges.

Table 1: Scottish Government (2008). Modified from ‘the guide to getting it right for every child’

The ability to share information about children and young people, to aid decision-making around their needs, is fundamental to GIRFEC. Over the coming years, the national eCare framework will be developed to further support information-sharing in relation to this. In the future, practitioners will be expected to record information using shared language, structured round a standard practice model, sharing key relevant information through the eCare framework.

The GIRFEC practice model (see Figure 2) and associated tools have been designed to be used locally to complement practitioners’ own materials and processes to improve practice, and ultimately secure better outcomes for children and young people.

 Figure 2: GIRFEC practice model. Scottish Government (2008). Reproduced from ‘the guide to getting it right for every child’

Education (Additional Support for Learning) (Scotland) Act 2009

This 2009 Act makes certain amendments to the Education (Additional Support for Learning) (Scotland) Act 2004.

The 2009 Act reinforces the concept of ‘additional support needs’ as referring to any child or young person who, for whatever reason, requires additional support for learning. Such needs can arise from any factor which causes a barrier to learning including social, emotional, cognitive , linguistic disability, or family and care circumstances.

The 2004 Act imposes duties on education authorities and others. It provides a framework for local authorities and other agencies to support all children and young people who have identified additional support needs. Of particular relevance, the Act stipulates that:

• ‘education authorities must seek and take account of advice and information (including formal assessments) from other agencies (eg health, social work services)’, and
• ‘other agencies have duties to help each education authority discharge its duties under the Act… For the purposes of the Act other agencies include any other local authority, any health board or any other agency specified by Scottish Ministers’.