The CYP-IAPT’s core value of participation is promoted by the CWP developing a positive and actively collaborative therapeutic alliance providing Samaira and her family with information about what to expect regarding consent, confidentiality, data protection and what sessions typically involve and the type of mental health needs worked with. This would enable Samaira to feel fully involved, at the centre of choosing each stage of intervention working and planning together to use CBT methods in and out of sessions to achieve her chosen goals.  The CWP would ensure information would only be shared within clinical supervision, and only with family if agreed necessary to support therapeutic targets and self-help exercises. Information identifying risk requiring safeguarding would be discussed with Samaira and addressed with the safeguarding officer/clinical supervisor. Therefore Samaira’s experience of the CYP-IAPT service would provide her with an overriding sense of ownership, participation and involvement of choice guided by CYP-IAPT core values, Fraser guidelines, expertise of CWP, use of outcome measures from each session and what children and young people have said they want for their mental health service in order to improve it.   

CYP-IAPT seeks to have full participation of CYP and their families/carers to help shape the service understanding this basic human right (Children’s Act, 2004) and (Every Child Matters, date? ). Future in Minds date? and IAPT guides to participation (Badham and Wade, 2010) and (National Youth Agency, 2009) document comprehensive details about how to involve young people in policy making to achieve the top of the ladder of participation (Hart, 1992 cited by Badham and Wade, 2010). This framework aims to be inclusive of a range of views, age, avoid tokenism and improve health outcomes for example with Participation Priorities 3, 5 and 7 (YoungMinds and DH, 2011) identified in the IAPT pledges “Feeling Good”, “Doing the Job Right” and “Running the service well”. Participation potentially works at every level of the CYP-IAPT service for Samaira; how she is treated by her GP, the referral process, how she receives health care for her mental health and her feedback into the service either during her treatment or after. She would have an equal opportunity to become involved with CYP-IAPT transformation planning as an ambassador for her local service contributing to implementation plans shared with funders, steering groups and commissioners of care to improve the service for CYP and their families to achieving the pledges that have been agreed by collaboratives across England.

As a group we decided to look at the issues within the problem based learning task (PBL) through the core principles of the Children and Young Peoples Improving Access to Psychological Therapies (CYIAPT) programme; accessibility, accountability, participation, evidence based and awareness. I chose to explore the core principle of accountability in Samaira’s case. 

I will use Samira’s case to argue that accountability needs to be seen as positional and complex when put into practice. I will argue this conception is useful as it will help us understand the different ways a practitioner working with Samaira could be ‘pulled’ by different lines of accountability when working with Samaira.

Accountability can be defined as a ‘a situation in which someone is responsible for things that happen and can give satisfactory reason for them’ (Cambridge Dictionary, 2017) The intention to put this into practice for children and young people’s mental health services can be seen in The Future In Mind Easy Read document when it lays out it dreams for 2020. The dream is that; ‘Services are open and honest and say how long people have to wait, how well they help people and what this costs.’ (The department for Health, 2015, 16). The full report outlines 9 key steps that could be taken for the children and young people’s mental health services ‘to be accountable and transparent’ (The department for Health, 2015, 59). If we look at these measures we can draw a clear line of accountability upwards from Samaira to politicians. The document talks about having lead commission arrangements. In Bristol this ‘dream’ is in the process of being into practice with the ‘Emotional Health and Wellbeing Transformation Plan for Children and Young People’ which states that emotional wellbeing of children and young people is a priority for The Mayor, the Health and Wellbeing Board and the new Bristol Strategy for Children, Young People and Families. (Bristol clinical commissioning group, 2016, p.3)

 

 

- Outline a clear line of accountability upwards

- Organisational reporting, local clinical commissioning group, department for health, politicians, (Taxpayers?). Mental health as a political hot topic in both major party’s manifestos

- Comment how this in turn could go to voter tax payer and report stating the financial benefits of better mental health services.

- Comment practically how this may create tensions when working with Samaira’s

- The importance of rapidly developing a relationship with Samaira to get an accurate assessment as there is not money for open ended work unfocused, untargeted work.

- the reverse could be true as the argument could be made as Samaira is in the window where mental health problems rapidly increase could work with her in a preventative way and this could be both evidence based and cost effective.  

- May over focus on outcome measures than relationship building with Samaira could feel like a box ticking exercise for Samaria 

- ROM’s may put Samaira off as she has is concerned about medical records

- Samaira maybe a targeted young person because she is from a BME background which has historically underserved and services are supposed to be targeted at those most in need. Maybe encouraged to work with her because of targets/monitoring 

 

 

 

 

- ROMS may put Samaira off but also could be a way of demonstrating value to her as she is concerned about missing lessons

- If Samaira’s assessment produces a clear area to work on and set goals could demonstrate to Samaira that everyone is not just overreacting. 

- If Samaira has a positive experience will probably highlight this to friends filter out to wider community.

Accountability. (n.d.) In Cambridge Dictionary. Retrieved from http://dictionary.cambridge.org/dictionary/english/accountability

Department for Health (2015). Future in mind Better support for your mental health and wellbeing Information for children and young people Easy Read version of: Future in mind: promoting, protecting and improving our children and young people’s mental health and wellbeing. London: NHS England

 

Williams, L. (2015). Future in mind Promoting, protecting and improving our children and young people’s mental health and wellbeing. London: NHS England

 

Bristol Clinical Commissioning Group (2016). ‘Emotional Health and Wellbeing Transformation Plan for Children and Young People’ Bristol: NHS England 

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