Youth Justice and Public Health in Greenwich: Addressing Root Causes

Youth Justice Youth Justice Team and Public Health (October 2024)

Acronyms/Glossary Acronyms/Glossary ADHD ADHD Attention Deficit Hyperactivity Disorder PSHE PSHE Personal Social Health Education ASD ASD Autism spectrum disorder PWITS PWITS Possession With Intent To Supply EET EET Education, Employment and Training SALT SALT Speech And Language Therapy ECHP ECHP Education, Health and Care Plan SEND SEND Special Education Needs and Disabilities FTE FTE First Time Entrant SLCN SLCN Speech, Language and Communication Needs STI STI Sexually Transmitted Infections MDMA MDMA Methylenedioxymethamphetamine, commonly known as ecstasy SYV SYV Serious Youth Violence MH MH NEET NEET Mental Health YJS YJS Youth Justice Service Not in Education, Employment and Training YO YO Youth Offending NHS NHS National Health Service YP YP Young Person(s) OHID OHID Office for Health Improvement and Disparities YPSMS YPSMS Young Persons Substance Misuse Service PHE PHE Public Health England

Introduction Introduction Reducing youth offending and serious youth violence is a key national, regional and local priority. In the Royal Borough of Greenwich, developing a Public Health approach has been suggested as the best way forward focusing on prevention and addressing the root causes of criminality. A public health approach includes consideration of: Evidence-based action preparing the system with clear data and local intelligence to inform actions Health-inequalities and wider determinants of health Multi-organisation and multi-sectoral co-operation Understanding of the root causes of crime and vulnerabilities and recognition that almost all causes of childhood offending lie outside of the direct influence of the youth justice system (Public Health England, 2019) A life-course approach Prioritising working with gangs Contextual safeguarding Education, for example informing young people on the effects of sexting, cyber bullying, healthy relationships through Personal Social, Health Education (PSHE) Reduction in school exclusions and positively strengthening all aspects of inclusion Diversionary services that support people away from crime and into opportunities The importance of prevention and early intervention within families as well as for individual children The local youth offending cohort in the borough have seen decreases in first time entrants (FTEs) over recent years (from 434 per 100,000 of local 10-17 year-old population between January to December 2017 to 360 between January and December 2021). However, in 2021, Royal Greenwich had the highest rate of FTEs across London. OHID Indicator Children and young people who offend or at risk of offending often have challenging health and wellbeing needs: emotional wellbeing and mental health; speech, language and communication needs; unstable family and home-life circumstances including exposure to violence, domestic abuse and substance misuse; and other ACEs such as a history of offending in the family. As modern technology has developed, so has the drug market: the issue of county lines has become an increasing concern, adding another layer of vulnerability to these already vulnerable children and young people. There is a clear link between drugs, crime and child exploitation. Metropolitan Police Commissioner Cressida Dick said that serious violence affecting our young people is connected to drugs in one way or another ; and specifically linked it to the market and the availability . She added that this is, in my view, at the root of it all; it really is .

Public Health England Whole System Approach Public Health England Whole System Approach There is no single solution to preventing youth offending, reoffending and violence: a broad range of actions are needed across the system, moving away from siloed working. Preventing children coming into contact with the youth justice system is complex. Public Health England (PHE) recommend a whole system approach to SYV and YO, that includes the following (Public Health England, 2019): Clearly articulated vision what is trying to be achieved and widely shared Distributed leadership working to a common vision across the system Creating the right environment (for change) - by articulating why this group of young people are vulnerable and that improving their outcomes will have an impact on the whole system Place-based approach - the definition of place is best defined by local leaders - it considers where crime takes place, deprivation, service boundaries and partner agencies Collaborative approach - bringing stakeholders together from a broad range of functions to jointly develop and take ownership of the programme; sharing strategic plans and working towards joint outcomes Map and understand the system - this provides a thorough understanding of the system, maps stakeholders and identifies potential leaders at all levels Use data from across the system to build a local picture utilising health data alongside youth justice and other sources of data to provide an accurate local picture Source: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/828228/CAPRICORN_resource.pdf

Contextual safeguarding Contextual safeguarding Contextual Safeguarding is an approach to understanding, and responding to, young people s experiences of significant harm beyond their families. It recognises that the different relationships that young people form in their neighbourhoods, schools and online can feature violence and abuse. Parents and carers have little influence over these contexts, and young people s experiences of extra-familial abuse can undermine parent-child relationships (Firmin, 2017). This requires an in-depth knowledge of areas where young people are engaging and understanding the interplay and weight of influence in their relationships. Locally, an effective response would require developing a strategic approach to identify ways of gathering intelligence on spaces and embedding processes to safeguard these spaces and at-risk families, as well as working with families to manage risk and trauma. Listening to the voices of local children and young people would be a crucial part of this approach. A contextual safeguarding approach presents opportunities for local authorities and crime partnerships to work closely with the NHS. Social prescribing link worker models can help to address knife crime due to the fact that young people involved in and at risk of violence often engage with health care before accessing other support services. Four Domains of Contextual Safeguarding There are four domains of contextual safeguarding which provide the foundations of systematic change in the way that services describe, and respond respond to, abuse in adolescence: 1. Target 2. Legislative Framework 3. Partnerships 4. Outcomes Measurements

Chapter Aims Chapter Aims Aim 1: Establish the current health needs of first-time entrants in the youth justice system in Royal Greenwich Aim 2: Determine effectiveness of the current service provision for first-time entrants in the youth justice system in Royal Greenwich Aim 3: Provide a series of recommendations based on any gaps or unmet needs identified from the local intelligence. With a better understanding of the health and wellbeing needs of this cohort we can support action amongst key stakeholders with evidence- based insights and recommendations for action. It will help with service planning and provide information to the Youth Justice Board. Health and multi-agency data has an essential role to play in preventing offending. When used alongside youth justice data it can: Measure the levels and nature of violence in a local area Identify the population groups and geographical areas most affected Inform the development, targeting and evaluation of prevention and earlier intervention activity Help shift the narrative of children as criminals to some of the most vulnerable members of society Adding to the complexities around serious youth violence is that national definitions do not exist, and the data relates to the victims age, not the perpetrator, up until the age of 25. However, youth offending refers to under 18s. Relation to commissioning aim: inform commissioning plans amongst stakeholders such as local authority commissioners responsible for Public Health, adult social care and children s services, NHS commissioners responsible for medical conditions and services such as SEND including autism.

Aim 1: Establish the current health needs of first-time entrants in the youth justice system in Royal Greenwich Aim 2: Determine effectiveness of the current service provision for first-time entrants in the youth justice system in Royal Greenwich Aim 3: Provide a series of recommendations based on any gaps or unmet needs identified from the local intelligence.

Who is at risk and why? Who is at risk and why? Children who offend (those under the age of 18) are more likely to have complex health needs than the wider population (Lader et al., 2000). They are also more likely than non-offenders to engage in risky health behaviours, including smoking, alcohol and substance misuse (Chitsabesan et al., 2006). The 2012 Chief Medical Officer's report highlighted that, in England and Wales: The rate of suicide in boys aged 15 17, who have been sentenced and remanded in custody, may be as much as 18 times higher than the rate in non-offenders; Some 18% of 13 18-year-olds in custody have depression, 10% have anxiety, 9% have post-traumatic stress disorder and 5% have psychotic symptoms; Of children and young people on community orders, 43% have emotional and mental health needs; Over a quarter of children and young people in the youth justice system have a learning disability. Some 60% of boys in custody have specific difficulties in relation to speech, language or communication; Children who are Looked After make up 30% of boys and 44% of girls in custody; One in 10 girls in custody have been paid for sex; Around 39% of children and young people in custody have been on the child protection register or experienced neglect or abuse; One in eight children and young people in custody have experienced the death of a parent or sibling; Some 40% of children and young people in custody have previously been homeless; Over half of children and young people who offend, have themselves been victims of crime (Department of Health, 2012). Education, employment and training (EET) are protective factors against involvement in anti-social and offending behaviour. Young people not in education, employment or training (NEET) are five times more likely than their peers to become involved in the youth justice system and three times more likely to suffer depression, leading to longer term health problems and costs to society (Audit Commission, 2010: Against the odds). In addition, a young person aged 16 and over returning to the community from custody is four times more likely to be NEET (Youth Justice Board, National Indicator 45: Education Training and Employment data, 2010).

Who is at risk and why? Who is at risk and why? First time entrants to the youth justice system First time entrants to the youth justice system Children and young people at risk of offending or within the youth justice system often have more unmet health needs than other children. Children and young people at risk of offending or within the youth justice system often have greater mental health needs than other young persons. The rate of 10 to 17-year-olds receiving their first reprimand, warning or conviction per 100,000 population in Royal Greenwich is 277.5. This is higher than the England rate of 148.9/100,000 and the London rate of 166.3/100,000. Greenwich has the 2nd highest rate1 of first time entrants to the youth justice system in London, second to Islington despite the rate decreasing since 2010. First time entrants to the youth justice system (10-17 year olds) 2012-2022 Children in care (0-18 year olds) 2012-2022 Children in Care Children in Care Children and young people in care are among the most socially excluded in children in England. There are significant inequalities in health and social outcomes compared with all children and these contribute to poor health and social exclusion of care leavers later in life. The rate of Children in care in Royal Greenwich (70/10,000) in 2022/23 is the same as the England rate but higher than and London rate (52/10,000). Greenwich has the 7th highest rate in London. 1. Unpublished data for 2023 has changed the sources of counts from PNC to local data, which indicates that Greenwich has a lower rank (18 out of 30 LBs)

Who is at risk and why? Who is at risk and why? Children in relative low income families (under 16s) Children in relative low income families (under 16s) The Marmot Review (2010) suggests there is evidence that childhood poverty leads to premature mortality and poor health outcomes for adults. Reducing the numbers of children who experience poverty should improve these adult health outcomes and increase healthy life expectancy. There is also a wide variety of evidence to show that children who live in poverty are exposed to a range of risks that can have a serious impact on their mental health. The Marmot Review recommended a policy objective of giving every child the best start in life. Health Equity in England: The Marmot Review 10 Years On outlines that since 2010, progress has been made in early years development, as measured by children s readiness for school. However, clear socioeconomic inequalities persist, with a graded relationship between these measures and level of deprivation. Rates of child poverty, a critical measure for early child development, have increased since 2010 to 2011 with over four million children affected, particularly in families with parents in work. However, child poverty rates are still highest for children living in workless families, in excess of 70 percent. The proportion of Children in relative poverty in Royal Greenwich is 19% which is lower than the England proportion of 19.8% but higher than London (15.8%). Greenwich has the 6th highest figure in London. Children in relative low-income families (under 16s) 2014/15-2022/23

Who is at risk and why? Who is at risk and why? Education Education Young people who are not in education, employment or training (NEET) are at greater risk of a range of negative outcomes, including poor health, depression or early parenthood. The Government recognises that increasing the participation of young people in learning and employment makes a lasting difference to individual lives. The proportion of 16 to 17 year olds not in education, employment or training (NEET) or whose activity is not known in Royal Greenwich (3.3%) is lower than the England average (5.2%) but is similar to the London average (3.4%). Greenwich has the 14th highest proportion of NEETs in London despite a descending trend. Evidence indicates that the educational experience of children up to the age of 12 years should provide opportunities for engagement in tasks considered fulfilling and worthwhile in order to promote their mental wellbeing. Disillusion or exclusion from school are risk factors for children s mental wellbeing. Children who frequently miss school can fall behind with their work and do less well in exams, which could lead to reduced life chances in later life. The more time a child spends around other children, whether in the classroom or as part of a school team or club, the more chance they have of making friends and feeling included, boosting social skills, confidence and self-esteem. The rate of Secondary school suspensions (per 100 pupils) in Royal Greenwich (12.3) is lower than the England average (18.9) but is higher than the London average (9.69). 16 to 17 year olds not in education, employment or training (NEET) or whose activity is not known Secondary school suspension: rate per 100 pupils

Who is at risk and why? Who is at risk and why? Housing and Homelessness Housing and Homelessness Homelessness is associated with severe poverty and is a social determinant of health. It often results from a combination of events such as relationship breakdown, debt, adverse experiences in childhood and through ill health. Homelessness is associated with poor health, education and social outcomes. Young people experiencing homelessness are extremely vulnerable, and face complex and compounding challenges. They lack relationship and independent living skills, formal support and struggle to access services. They are more likely to have experienced trauma, abuse and other adverse experiences. They are more likely to have been absent and/or excluded from school, and not be in education, employment or training (NEET). There are high levels of self-reported mental health problems, self-harm, drug and alcohol use. There is an increased risk of exploitation, abuse and trafficking, and involvement in gang and/or criminal activity. They are at more risk of sexually transmitted infections (STIs) and unwanted pregnancies and can come under pressure to exchange sex for food, shelter, drugs and money. The rate per 1,000 estimated households owed a prevention or relief duty under the Homelessness Reduction Act, where the main applicant is aged 16-24 years, in Royal Greenwich is 3.4. this is higher than the England rate of 2.4/1,000 and slightly lower than the London rate of 3.7/1,000/. Greenwich has the 5th highest proportion of estimated households owed a prevention or relief duty under the Homelessness Reduction Act in London, and the rate has been increasing. Homelessness - households owed a duty under the Homelessness Reduction Act (main applicant 16-24 yrs)

Demographics of Cohort Demographics of Cohort Between 2019/20 and 2022/23 there were 355 first time entrants (FTE) to the Royal Greenwich Youth Justice System. Date source for this section is Youth Justice Assessment Tool. Age and gender Age and gender There were 291 male and 64 female male to female first-time entrants (82% males, 18% females). The number of male offenders increases with age from 10 under 12 year olds to 85 aged 17 and over. The number of females peaks in 15 year olds (19) and reduces to 8 in 17+ years. Ethnicity Ethnicity Ethnicity reported by FTEs is varied compared to the same age population ethnicity profile of Royal Greenwich. The proportion of Black ethnicities in FTEs is underrepresented compared to the Greenwich Census 2021population (averaging 28% over the years compared to 34%) whilst those with an ethnicity recorded as White are overrepresented; averaging 53% over the 4 years compared to 41% of the population. Asian are also underrepresented, while Mixed are slightly above the census population.

Demographics of Cohort Demographics of Cohort Education and employment Education and employment 55 out of 355 FTEs (15%) were identified as children with Special Education Needs and Disabilities (SEND) between 2019/20 and 2022/23. In comparison 3.9% of all pupils in Royal Greenwich Schools have SEND. Of these 55 FTE classified as SEN, 53% have an Education, Health and Care Plan (EHCP). The number of FTEs with an EHCP was highest in 2021/22 nearly double any other year. Nearly 1in 3 FTEs are in education, training and employment (ETE). Of these 69% are in education (including school, home tuition, college/university) and 16% are employed. Deprivation Deprivation There is undoubtedly a complex relationship between crime and deprivation with recorded crime in London more prevalent in the neighbourhoods with the highest levels of income deprivation. Deprivation is not simply those with a low income; it s more to do with how people live. Perhaps it is better described as a consequence of having limited access to other resources. Well-publicised research has identified numerous factors which correlate with the risks of violence increasing. 1 in 3 of Royal Greenwich's FTEs reside in the most deprived areas of the borough.

Demographics of Cohort Demographics of Cohort Mental Health Mental Health There are a number of risk factors that increase the chances of children getting involved in offending, and many of these are similar to the risk factors for mental health problems. For example: a higher likelihood of having been subject to trauma or severe neglect high levels of social disadvantage. Between 2019/20 and 2022/23 there were: 31 (8.7%) FTEs diagnosed with a formal MH condition 66 (18.6%) FTEs were in contact with MH services and 80 (22.5%) FTEs had concerns about MH Between 2019/20 and 2022/23 there were 355 first time entrants to the Royal Greenwich Youth Justice System. Substance misuse Substance misuse Young people who persistently abuse substances often experience an array of problems, including academic difficulties, health-related problems (including mental health), poor peer relationships, and involvement with the youth justice system. Evidence of substance misuse was found in 147 out of 355 FTEs (41%). Cannabis, although has seen reduction over the 4 years, from 91.1% to 68.8% has remained the most prevalent substance misused.

Demographics of Cohort Demographics of Cohort Risk of serious harm score Risk of serious harm score Risk assessment analyses the risk factors relating to reconviction and risk of serious harm. Risk of serious harm has two important dimensions: the relative likelihood that an offence will occur and the relative impact or harm of the offence what exactly might happen, to what or whom, under what circumstances, and why. Some crimes (e.g., shoplifting) have relatively little impact or harm but, statistically, are the most common. Others (e.g., homicide) are rare but cause immeasurable harm. ROSH scores for FTE s in Greenwich (where recorded) are: low 48 medium 190 High 15 Proportionally these scores are in line with national data. Context / Circum- stance Victim Offence Offender

Offence and Outcome Offence and Outcome From the 355 FTEs in the YJS in Royal Greenwich there were 517 offences committed. The highest number of offences were categorised as violence against the person making up nearly half of the offences committed. The second and third highest recorded offences were drugs related or motoring offences being 1 in 10 offences each. 1 in 5 offences were knife related The majority of outcomes following offences result in either a youth conditional caution, referral order or youth cautions Youth conditional cautions are given for all knife related offences. Offence Category Violence against the person Drugs Motoring offences Robbery Theft and handling Stolen Goods Public Order Vehicle Theft / Unauthorised Taking Criminal Damage Sexual offences Other Fraud and forgery Racially aggravated Breach of bail Arson Breach of Statutory order Domestic burglary Non Domestic Burglary Grand Total Number of offences 227 64 60 34 34 25 16 12 11 11 7 5 5 2 2 1 1 517

Aim 1: Establish the current number of first-time entrants in the youth justice system in Royal Greenwich. Aim 2: Determine effectiveness of the current service provision for first-time entrants in the youth justice system in Royal Greenwich Aim 3: Provide a series of recommendations based on any gaps or unmet needs identified from the local intelligence.

Health Services working with first time entrants Health Services working with first time entrants Following the appointments with the nursing service, outcomes for individuals included: Phone call with parents, follow up letter Direct referral to GP for further support Follow up direct work with Nurse Referral to Immunisation clinic Support to access SHC Support to access L&D worker STI testing and support to access CASH C-Card given Reasons for non-attendance include DNA, Transferred out of area, Not engaging with YJS, Seen by LAC Nurse, and On Remand Nursing Service Nursing Service Between October 2023 and February 2024, 70% of FTEs referred to the nursing service attended their appointments. Health trends of those who attended: 4 in 5 has opticians outstanding 1 in 10 has vision issue 1 in 2 has dental check-up outstanding 1in 10 has dental Issue 1 in 3 has outstanding Immunisations 1 in 4 are overweight 1 in 10 has other health issue 1 in 10 has Mental Health concerns (all under CAMHS) Less than 1 in 10 has sleep issues 1 in 2 are sexually active I in 3 has unprotected sex 1 in 5 have been STI tested Nearly 1 in 2 are vaping 1 in 4 are substance users 1 in 3 are smoking cigarettes There were no attendees who had hearing issues

Health Services working with first time entrants Health Services working with first time entrants Speech & Language Therapy Speech & Language Therapy The YJS require every young person who becomes known to their service to have their Speech, Language and Communication Needs (SLCN) screened. This forms part of the case formulation which case workers undertake. The screen entails a one-hour session with a young person and their caseworker, followed by discussion of strategies and advice with the caseworker. The Speech and language therapy department in Oxleas helps people to: Develop language skills for daily life (for example, metalinguistics: non-literal language, inference, multiple meanings, figurative language). Understand complex information and words associated with the criminal justice system. Develop conversation and social skills e.g. body language, turn taking, nonverbal communication. Develop their vocabulary and the way they put sentences together. Express their feelings and emotions more effectively, for example verbal or non-verbal/pictorial. Aid their understanding of different types of emotions, and how these can result in a range of feelings. Develop strategies to manage their own communication difficulties. These communication skills will help offenders to: Deal with the triggers that spark anti-social behaviour. Find ways to overcome drug-related problems with short-term memory, to deal with authority figures, for example, coping at interviews. Understand, and be understood, by professionals and services working within youth justice settings, for example, police, court officers, prison staff social workers. Cope better with the social challenges in, for example, institutional life, education and work settings.

Health Services working with first time entrants Health Services working with first time entrants Speech & Language Therapy Speech & Language Therapy Demographics of cohort Demographics of cohort Since December 2023, young people are known to Triage team via Out of Court Disposals. Over a year, there are approx. 84 sessions for the JYS cohort (1 day) 55 young people completed the Speech, Language and Communication (SLC) screen Of which 78% of young people screened had a SLC need with the most prevalent need being with Receptive (understanding of) language Main input Main input Other input Other input 1. Assessment of SLCN Support at clinical health team meeting 1. Onward referral (e,g, ASD) Psychoeducation Support for network around young person Short pieces of intervention 2. 2. 3. 4. Current s Current service challenges and opportunities ervice challenges and opportunities Service Opportunities: Service Opportunities: Service Challenges: Service Challenges: Triage team trained to screen and refer for young people known through OOCD (achieves December 2023) New service launched July 2023 with steady transition to YJS Case Managers carrying out screening and referring to SLT. Increased screening and discussions/referrals from case managers within YJS. Too early to comment on barriers to accessing service but anticipated to be similar themes as with previous service model (non-attendance due to complexities in young person s life) Support for triage team colleagues to independently screen and access SLT service.

Health Services working with first time entrants Health Services working with first time entrants Young Persons Substance Misuse Service Young Persons Substance Misuse Service The Young Persons Substance Misuse Service provides Tier 2b (Brief Intervention, education and Harm reduction); Tier 3 (Full Treatment Journey); Possession With Intent To Supply (PWITS) interventions to 10-18yr olds (Extends to 21 for Care Leavers and 25 for SEND YP). with problematic substance use living in the Royal Borough of Greenwich. It is a consent-based intervention also offering Therapeutic, Creative approaches, Harm reduction and Education, Community Resolutions and Substance Misuse Training advice and guidance for professionals. The service is represented at Clinical Health Team, Risk Management Panel and Out of Court Disposal Panel as standard. Attendance at other professionals meetings as required. YJS has access to all YPSMS Specialists with a YJS lead within the team. The Creative Arts programme helps young people get a greater sense of self while engaging with creative projects and activities. In addition to Substance Misuse Support, as above, a podcast is produced to assist Young People in their understanding of their journey with the YJS. The notional capacity of the service is 70 Young people. It is anticipated that approximately 25% of the of the caseload will be involved with YJS. Demographic overview: Demographic overview: The young people referred into the Young Persons Substance Misuse Service from the Youth Justice service in the year 2020-24 are all male. Of the twenty young people referred to date there is a broad spread of ethnicities with White British being the predominant group followed by Black African, Other White and then Other black. There were two referrals of individuals one from the Nepalese community and one from Afghanistan. Whilst there was only one under 15yo referred the dominant (65%) age groups referred were 15yo and 17yo. Only 15% were aged 16. 10% were aged 18. Universally the principal drug used is cannabis (at various levels). Most Young people discharged from YPSMS report a reduced use of cannabis, with a small proportion reporting cessation. What is unclear is whether this is actual or disguised compliance. Other drug reports include MDMA, Nitrous Oxide, cocaine and also alcohol. These being on a significantly lower level than cannabis use.

Health Services working with first time entrants Health Services working with first time entrants Young Persons Substance Misuse Service Young Persons Substance Misuse Service What is working well in the service? What is working well in the service? The last four years have seen a steady use of cannabis. For many young people it is the drug of choice, not only as it is being used by peers but also as an alternative approach to managing mental health and neuro diverse conditions. Management of ADHD by cannabis use is prevalent. There appears to be an increase in the number of Young People receiving formal diagnosis of ADHD /ASD this in turn is leading to number of them seeking a way of managing their emotions and behaviours. A rise in MDMA use in early 2023 seems to have levelled out. This rise seemed to coincide with some adverse reactions around MDMA use Young people were alerted to this adverse reaction by Substance Misuse Workers and through communication through other professionals. Poly drug use appears to be at its highest rate amongst females and individuals who are exploring their sexual and /or gender identity. Current service challenges and opportunities Current service challenges and opportunities Three months with two staff short has been challenging. This is shown especially in terms of recording. This needs to be improved upon and this improvement should be seen in the last quarter of year 2023/24. Staff were recruited not only to fill vacant posts but also to bring experience on board to provide schools based group work and also the potential for offering group work to YJS young people encountering similar challenges and similar YJS orders. As a team we are seeking greater diligence in receiving feedback from our Young People. The recruitment of additional Sessional workers for the creative arts programme will lead to greater and more varied opportunities for our young people to receive both Arts Award status as well as submitting to the Koestler Awards, alongside having experience that they would otherwise not have. A further staff member recruited into a new role is termed Pathfinder . Their responsibility will be to seek out onward paths for young people leaving the YPSMS. This is funded from Central Government funds following the Dame Carol Black report. This has taken a significantly long time to bring into post.

Health Services working with first time entrants Health Services working with first time entrants Greenwich CAMHS Greenwich CAMHS Context of service Context of service Greenwich CAMHS provides specialist consultation, assessment and treatment to children and young people from age 0 to 18 years. The service aims to provide high quality, evidence-based mental health & wellbeing support and treatment to children, young people and families that incorporates the core principles of Children & Young People s Mental Health (CYP-MH), formerly referred to as CYP IAPT, within a THRIVE aligned service delivery framework. Greenwich CAMHS is made up of seven distinct pathways, each with a multidisciplinary team offering different modalities that support assessment and treatment of children and young people. Advice, support and treatment is offered through schools, RBG Children s Services and children s centres as part of the early intervention offer. Children and young people that receiving support from the Youth Justice Service (YJS) can access all services offered across the seven pathways, dependent on their assessed need. There two specific services offered to children and young people receiving support from YJS. 1. Liaison & Diversion Practitioner, whose role is to assess young people in police custody, referring and signposting to other services. The L&D practitioner offers brief interventions where a mental health need is identified. The L&D practitioner works across the GCAMHS Adolescent team and the YJS. 2. Clinical Health Team (CHT) is a weekly multi-professional forum designed to provide timely access to specialist mental health expertise for young people vulnerable to and from mental health difficulties and conditions and to prevent escalation of difficulties. The CHT provides a thinking space to enhance YOS Officer confidence, skills, assessment and understanding of mental health difficulties. Greenwich CAMHS contributes to the Pre-MACE, Entry to Care & High Cost Placements Panels, Corporate Parenting Board

Health Services working with first time entrants Health Services working with first time entrants Greenwich CAMHS Greenwich CAMHS Liaison & Diversion Activity Liaison & Diversion Activity CHT Activity Oct 2023 CHT Activity Oct 2023- -April 2024 April 2024 82 Referrals April 2023- April 2024 20 Brief Intervention, 45 Advice & Information, 3 CAMHS Care Coordination, 14 No Further Action Referral Sources: Police Custody 30, CAMHS 9, CHT 16, Consultation 10, OOCD 17 Age range of referred YP was 10 to 18 years (10=1; 11=1; 13=4; 14=9; 15=21; 16=27; 17=17 & 18= 2) 26 of 51 available consultations slots 23 male & 1 female 2 YP already known to CAMHS 1 YP prioritised for CAMHS initial assessment 12 YP referred to L&D for brief intervention, advice & information, or MH & Wellbeing screening Service Challenges: Service Challenges: Service Opportunities: Service Opportunities: Waiting Times in Specialist CAMHS Long-term sickness impacting CHT cover The introduction of the Integrated Clinical Team which will work across RBG Children s Services to enhance early intervention. Mental Health & Wellbeing Support to ARRCC Dedicated posts to provide mental health and wellbeing support YP leaving care (18+)

Aim 1: Establish the current number of first-time entrants in the youth justice system in Royal Greenwich. Aim 2: Determine effectiveness of the current service provision for first-time entrants in the youth justice system in Royal Greenwich Aim 3: Provide a series of recommendations based on any gaps or unmet needs identified from the local intelligence.

Recommendations Recommendations 1. 2. 3. 4. 5. Annual update with a review of data to be presented to the youth Justice Management board. Agreed quarterly data set to the Heath and Justice subgroup from services Proposal to expand to look at reoffending rates, and the needs of reoffenders in future editions of YJS JSNA Chapter Embedding the learning from cost communications study to improve interventions in relation to SALT Utilise the new KPIs to measure outcomes