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Download the Liaison and Diversion Bulletin: February 2015.

Welcome to February’s Liaison and Diversion (L&D) Bulletin, bringing you L&D news and updates together in one place. Key steps of the L&D pathway are the identification, assessment and referral of service users into treatment and support services provided by partner organisations. Each month we look at how a particular L&D scheme is successfully applying the national operating model, focusing on a particular aspect of their service. This month we report on the Wakefield L&D trial scheme and how it has used its experience as a youth service to develop an all-age service that engages with its service users holistically, including through an ongoing focus on education for the young people with whom it works. In other news, we bring you the latest on support to wave 1 and 2 trial schemes, including a new development – core training for L&D staff through a “train the trainers” model, plus information on the Prevent Terrorism Agenda and understanding how the NHS England’s Equalities and Health Inequalities Group supports and advises the Liaison and Diversion Programme.

In this issue:

L&D news report

• Wakefield L&D – Establishing relationships, supporting education, raising aspirations
• Wakefield L&D – Helping young people to re-engage with education: a case study
• Wakefield L&D – Becoming an all-age service
• Wakefield L&D – Policing and support under one roof
• Wakefield L&D – Robust analysis
• Wakefield L&D – The right mix of people and skills

News in brief

• Support to wave 1 and 2 schemes
• The ‘Prevent’ terrorism strategy
• Equalities and Health Inequalities

L&D news report:

Wakefield L&D – Establishing relationships, supporting education, raising aspirations

The Wakefield Liaison and Diversion (L&D) trial scheme developed from the Youth Offending Team (YOT) and was first established as a youth service in 2010. Operating as a trial site since April 2014, the scheme now works with people with a wide range of vulnerabilities of all ages at risk of offending, as well as people coming into custody and the magistrate’s court. The scheme covers the whole Wakefield metropolitan area including Castleford, Pontefract, Normanton, Featherstone and Knottingley.

The Wakefield L&D scheme works with the courts, police custody and probation services, as well as stakeholders like mental health organisations, substance misuse services and educational establishments. It’s also in regular contact with local voluntary organisations, including those that offer temporary housing. The core team’s multi-agency, multi-skilled make-up means it’s ideally placed to help reduce the risk factors for reoffending among the people referred to it through providing short-term support and signposting service users into longer-term support services.

“Our clients often have problems expressing themselves and have a wide range of vulnerabilities,” says Caroline Ellis, coordinator of the Wakefield L&D scheme.

Successful referrals, Ellis continues, depend on the team being able to match the client to the service. Many of Wakefield L&D’s clients don’t meet the threshold for mainstream mental health or other appropriate services. With no funding exchange between organisations, the relationship between L&D and other services and the trust they build up is vital.

The mental health practitioners in the L&D team at Wakefield often work with clients over a number of weeks. Sometimes clients are deemed “too risky” by other services – either because of a forensic history or difficulty engaging with them. Nonetheless, once someone has been assigned to L&D they’re given community support as well as help with any educational or health issues they may have.

Eddie Lim, an all-ages project worker for L&D, says it’s often about “touching base with people, making home visits and continuing to engage with other services they might be accessing. We’ll speak to them in custody, assess their needs and find out what’s missing in terms of their support.”

This might involve continuing or establishing access to mental health services, or referring them to social services. It could just be about making sure they’re getting the right benefits or, in the case of one individual, a bus pass. It seems a simple thing, but helping someone get about more freely so they can perform essential chores like picking up groceries or visiting the Post Office can make a huge difference to their quality of life.

Ongoing contact allows the L&D practitioner to build up a picture of the person concerned, and begin to identify where problems might originate – from substance misuse and trauma, to undiagnosed autism or harmful sexual behaviour. Multiple risks are all too common, explains Ellis.

“I saw homelessness, malnutrition, risk of child sexual exploitation and an inability to engage with school in a single case,” she says.

If an intervention is required it starts with a full assessment, after which a plan of work for supporting a person is drawn up. The support period is determined by how much and how long that person requires support, rather than how serious their offending may have been.

Support at Wakefield takes a range of forms, including – uniquely – art therapy. Although unconventional, this has been a hugely successful in helping the team engage and assess clients and build relationships.

Wakefield L&D – Helping young people to re-engage with education: a case study

April Underwood provides educational support for the Wakefield L&D scheme and the YOT. Most of the clients she sees have complex needs, which is one reason the integrated approach from education, health and welfare officers works so well.

In November 2013 Underwood started working with a vulnerable teenager who’d had several youth conditional cautions and received a community resolution. The young woman’s home life was unstable; she was neglected by her mother and had gone missing from home on several occasions. She was seriously underweight, was taking drugs and having unprotected sex. There were also concerns that she might be sexually exploited.

Underwood helped the teenager get support for her substance misuse, addressing factors predisposing her to drug and alcohol use. She also arranged a health intervention so the teenager could get information about improving her diet. Crucially, Underwood helped encourage the young woman back into education, beginning with an intensive summer arts college project.

“I went into college with her and made sure she was engaged with other services, particularly social services. There can be false starts and setbacks so you have to stick with it and make sure there’s some stability,” she adds.

The three-pronged approach to tackling the teenager’s lifestyle boosted her self-confidence and independence. She went back to school full time, excelled there and started to look ahead to her future. She hasn’t offended again.

Many of the young people that the team at Wakefield sees have disengaged with education.

Caroline Ellis says, “We did a snapshot of young people coming through our services. At the time, 47% were in specialist education or had a statement of special educational needs.”

Re-engaging young people at risk of offending with school or college is one of Wakefield’s foremost aims. The hope is that through support from the L&D scheme, this will happen before the young person has a criminal record.

“Think about the damage done to young people and their future through involvement with the criminal justice system,” says April Underwood, “or how their ability to get into college or get a job is impacted once they’ve got a criminal record”.

Building or rebuilding trust between a school, young person and parents is vital. Something may have gone wrong back in primary school that’s never been addressed, or the child may have picked up a negative perception of school from their parents.

“Raising their aspirations is the key to preventing them reoffending,” says April Underwood, adding, “Better self-esteem and confidence built on improved trust can help with that”.

Wakefield L&D – Becoming an all-age service

When Wakefield became a trial site for the new national operating model, Ellis’ team conducted an operational review and identified elements of the youth model that were relevant and working well.

“It was a case of working out what was relevant to the adult service,” she says.

“We’re not a health-based trust, so we didn’t know what mental health services were out there and how we were going to access them. It was a whole new world to us.”

They started with the courts.

“We were able to second two band six practitioners from our mental health provider, one of whom had some court experience. We put both practitioners into court, working together, building relationships with probation and the court staff. That gave us the measure of the clients coming through and what sort of issues they had.”

After establishing relationships at the court, they worked with custody and healthcare staff in the police station. With these different pieces of the puzzle starting to fall into place, that’s when things really started to take off for Wakefield as an all-age service.

“The beauty of it being an all-age service is that we don’t let go. Somebody at 20 is still a young person. And if they’ve got a mild learning difficulty, their developmental age may be younger still,” comments Ellis.

One of the other strengths of the all-age approach is that the scheme doesn’t look at youngsters or adults in isolation. Very often, young people behave the way they do because they have trouble at home with parents. By being able to talk to the parents and understand their needs too, the L&D team can help to improve lives across families.

According to Helen Crossley, an officer with West Yorkshire Police who sits with the L&D team, “The majority of young people that offend do so because of the circumstances that they’ve been brought up in. When we do an assessment we’re looking at the contributory factors to why they offend in the first place.”

It’s a more holistic approach. If a parent has alcohol, drug or mental health issues, and is deemed at risk of offending, support workers can now address those problems at the source – rather than only helping the person (often the young person) being affected.

“If needs be, other family members can be referred to services they should be accessing or referred into the adult side of L&D,” says Crossley

Wakefield L&D – Policing and support under one roof

The development of the all-age service and the recruitment of new staff that followed made working out of the original YOT base in Wakefield town centre increasingly impractical.

“It made it difficult to set up a new service in those first few months,” comments Caroline Ellis.

“We had new people and we were testing out new ways of working and it was hard to physically come together as a team. People were in different offices and there weren’t even enough desks.”

Eventually the team negotiated with the police for their own space in the newly opened Normanton Police Station – moving there permanently in September 2014.

“Just being here has massively increased knowledge of the service and their confidence in it and us,” says Brian Woodhouse, an arrest referral officer at the Wakefield L&D scheme and a former CID detective.

The team initially made conscious efforts to reach out to the police in their sphere and proactively offer assistance. Since the move to the new Wakefield police HQ at Normanton, there’s been much less need.

Phil Jones, a mental health practitioner with the L&D team, adds, “The police now just come up and ask us when they need us.”

Woodhouse was a vital link in forging relationships with the police force.

“Brian’s familiar with the protocol in custody and can negotiate that environment,” says Caroline Ellis.

“Before the move to Normanton he went over to the old police station every day, three times a day, to educate and promote, as well as pick up referrals. And we built on that. We also worked very closely with the substance misuse service as they were based in custody, and the new custody healthcare nurses. There was a lot of groundwork, but it really made a difference once people could actually experience the benefit to themselves and their work.”

“Word is getting out that L&D can assist custody officers,” says Woodhouse. “We get police officers coming up and saying, ‘We’ve heard that you might be able to help us with this…’ and then present us with the scenario.”

The team has also been able to link in well with the ASBO team, with whom they share an office.

“Here, the ASBO team can access the data that L&D needs, then convey that information in person. Getting involved before a client comes into custody and identifying the risks that are causing their disruptive and unsociable behaviour can pay dividends,” says Clint Hepworth, team manager for the Wakefield trial scheme.

Wakefield L&D – Robust analysis

Comprehensive assessment is a key strength of the Wakefield L&D scheme’s YOT origins. At first the team relied on the assessment tools brought in by individual practitioners. As time’s gone by, they have put together a generic tool for adults based on the common elements and the bits that were missing. It’s proved successful and is appreciated by the team.

“We’ve tried to marry up our assessment tool with the tools the mental health teams use so there’s some commonality,” says Ellis.

The team is also proud of the young person’s mental health pathway that it’s developed with the YOT. A young person is assessed using ASSET. If they score 2 or more on the mental health SQUIFA (screening questionnaire interview for adults) assessment, there’s further investigation and their case is brought to a group of practitioners consisting of L&D, a health practitioner from the YOT, and a dual diagnosis and substance misuse worker. They carry out a full assessment using CHAT (Comprehensive Health Assessment Tool).

“An assessment is done at the young person’s pace,” explains Caroline Ellis, “And it’s up to the practitioner and young person together to decide when it’s complete”.

Once the assessment is finished the group discusses and decides the actions that will best help the young person. This may include consultation with the forensic CAMHS team (which might take the young person on as a case directly), or a referral to the community CAMHS.

“We find that the referrals that we make into CAMHS are well informed. The young person is already engaged with L&D, so they are more likely to attend.”

Wakefield L&D – The right mix of people and skills

Having the right mix of people and skills has been critical to Wakefield L&D’s success. Initially, Caroline Ellis planned to recruit mostly mental health practitioners, but soon realised there was an opportunity to enhance the breadth of skill she could potentially access. The core team now has 13 staff members from many different backgrounds: substance misuse workers, education officers, a psychologist, victim support service and probation.

“One of the things that we looked at in recruiting the practitioners to the team was their capacity to work in the community and what links they had into the community or were aware of. By seconding people from different organisations we’ve been able to tap into a whole raft of other links,” she says, adding, “One of our practitioners, for example, has worked with voluntary organisations within local ethnic communities”.

Phil Jones admits there was some initial anxiety around how everyone would fit together and how the service would use everyone to the best of their abilities.

“There needn’t have been,” he says. “Take Nicola, the specialist women’s worker, for example. She has been able to do some very challenging work – particularly with people with personality disorders. She’s engaged really well with them and worked at a high level. I don’t think we’d have been able to achieve that with a traditional workforce model. The most important skill here is relationship building, and I think we’ve got just the right balance for that.”

Caroline Ellis agrees.

“Every single member of the team can engage with the client group that we have. If you can’t engage, everything else will fail.”

News in brief

Support to wave 1 and 2 schemes

The next month is going to be particularly busy for the new 13 wave 2 schemes, announced in early December 2014, which will be delivering the national operating model from April 2015. The L&D central team, from NHS England and the Offender Health Collaborative, support them by various means. In addition to direct mobilisation support, they are doing this through a series of monthly learning events, the production of practical guides for L&D managers and practitioners and, the latest development, core training delivered through a “train the trainers” model.

Learning events

Four learning events have been held so far, with the latest covering service user engagement, learning disability and data collection. The morning featured sessions looking at how wave 1 schemes have approached service user engagement and learning disability provision, as well as what wave 2 sites need to do before they go live on 1 April. Participants also heard first hand from service users. The afternoon was a lively session on data collection, with participants eager to compare experiences of collecting the data set.

The 5 learning event on Tuesday 3 March (communications and stakeholder engagement, sense-checking) has taken place and will be reported on in next month’s bulletin and the final event will take place in Leeds on Wednesday 25 March (final review day).

Manager and practitioner resources

The Offender Health Collaborative is also supporting L&D schemes by producing a series of practical guides for L&D managers and practitioners on eight key elements of the operating model. The series will have a common look and feel, but each resource will work as a stand-alone reference tool. They will be structured and formatted to facilitate quick reference, providing a handy “how to” guide. Look out for the first two titles to be released soon.

Core training

The central L&D team will be contacting NHS England regional teams and schemes in the next week to inform them of a new training opportunity.

The Offender Health Collaborative is developing training courses to equip selected staff from each scheme with the skills and materials to deliver focused training to the rest of their team and subsequent recruits. This training will cover key skills and competences that have been identified as the minimum necessary for all staff in the core team to acquire as part of their induction. A two-day “train the trainer” course will be offered to all wave 2 schemes in the second half of March. Recognising that it may also be of benefit to wave 1 schemes, the course will also be offered in April to those wave 1 schemes.

The ‘Prevent’ terrorism strategy

The Prevent Strategy is a cross-Government policy that forms one of the four strands of CONTEST – the Government’s counter terrorism strategy. The NHS is key to the support and delivery of the Government’s Prevent Strategy. The Prevent agenda requires healthcare organisations to work with partner organisations to contribute to the prevention of terrorism by safeguarding and protecting vulnerable individuals who may be at a greater risk of radicalisation and making safety a shared endeavour.

There are currently 9 Regional Prevent Coordinators (RPC) hosted by NHS England regional teams responsible for promoting Prevent to providers and commissioners of NHS services, supporting organisations to embed Prevent into their policies and procedures, and delivering training. It would therefore benefit Liaison and Diversion schemes to tap into existing work in their areas, see below links for contacts and more information.

As commissioners and providers of L&D services we would encourage you to familiarise yourselves with the Prevent strategy to raise awareness for recognising and safe guarding clients thought to potentially be at risk of radicalisation.

Equalities and Health Inequalities

The Liaison and Diversion programme has its own Equalities and Health Inequalities group which meet regularly to assess and ensure that the work of the programme complies with legal duties, namely the Equality Act (2010) and the Health Inequalities duties of the HSCA (2012).

It works to ensure that the programme has equality of access, experience and outcomes for the whole population (including those who fall under protected characteristics of the Equality Act and the other characteristics relevant to health inequalities, such as ones socio-economic status) and that the programme contributes to closing of the gap in equity of access, outcomes and integrated care with appropriate healthcare services and also the gap in equity to justice outcomes.

The Equalities and Health Inequalities group will be regularly promoting key issues via the Liaison and Diversion newsletter. A good starting point in ensuring your scheme is appropriately considering and addressing equalities and health inequalities issues is to perform an Equalities Impact Assessment (EIA) on your service. NHS England has a best practice toolkit that walks organisations through their EIA or your trust may have its own pro-forma to complete. It is important that this information is fed back to NHS England teams and reviewed regularly.

As well as having a national function regarding ensuring equalities for the programme, the group can also support NHS England regional teams with equalities and health inequalities issues.