Fiona Dyer tells us about the Centre for Youth and Criminal Justice’s IVY Project, which is designed to address the gap in mental health assessment and management for high risk youths with complex needs.
*As of November 2019, Kibble, a specialist child and youth care charity and social enterprise, took over the hosting of the IVY Project. Dan Johnson, Clinical Director at Kibble, gave us an update.
Young people’s access to mental health provision
It is an established fact that young people who engage in violence often present with complex mental health and psychological difficulties, and to a significantly greater degree than the general population of young people. This group has a high level of complex needs but are often unable to access the help required from existing services due to reasons such as:
- Sub-threshold presentations: many young people at risk of acting violently or who engage in self-harm or suicidal behaviours may not meet the diagnostic criteria for mental disorders and may therefore be excluded from services they need. This is particularly common with young people who suffer from complex trauma and attachment disorder.
- Barriers to engagement: the very complex and anti-social nature of their needs mean those few high risk young people who are offered Child and Adolescent Mental Health Services (CAMHS) are often unable or unwilling to engage with these services.
- Capacity: not every service, system or locality possesses the specialist skills required to help these high-risk young people.
- Exclusion criteria: serious (violent) offending is an exclusion criterion for services in many regions. As a result, a lot of young, violent offenders are ineligible for these services.
Due to these issues with access to services, high-risk youth – young people who present a risk of serious harm to others – are a very disadvantaged and disempowered group. They easily fall below service thresholds and are often only identified when their psychological needs, posed risk, or self-harm have escalated to such a degree as to warrant secure care or prison.
The IVY Project
The IVY Project was set up to address the above barriers that prevent high-risk young people from getting access to the services they need.
The project is a reflection of the Scottish Government’s commitment to ensuring that all young people have equitable access to services. Since its establishment in 2013, the IVY Project has provided and continues to provide highly specialised services to some of Scotland’s most high-risk and challenging young people.
The IVY Project uses a multi-disciplinary, tiered approach to provide risk assessment, formulation and management for high-risk young people aged 12 to 18 years who present with complex needs and high risk, violent behaviour. There are three levels to this tiered service.
Level 1- Consultation and risk formulation clinic: this level is available for all accepted referrals. It exists to make certain that risk assessment and management is in accordance with best practice. The consultation process occurs during a 2-hour discussion with relevant professionals. The outcome of this discussion–in accordance with best practice in formulation – is that: the presenting problems are clarified; the risk factors are rated for presence and relevance; there is a formulation of risk; a detailed description of the most plausible risk scenarios applying to the young person is written; and a set of recommendations for ongoing risk management is established. Upon the completion of this process, there are three possible outcomes:
- No further involvement from the service;
- Where concerns over acute or serious mental illness/disorder are identified, specific recommendations and, where necessary, a letter from the Chair of the group are sent to the local CAMHS/local practitioner for processing into health;
- Where no acute mental illness symptoms are identified but there are serious concerns over chronic presentations, a recommendation for progressing to level 2 is made.
Level 2- Additional psychological assessments: at this level, the complex cases identified as needing specialist forensic assessment are given the necessary assessment. This could include cognitive, personality, attachment disorder, trauma, and psycho-sexual functioning assessments among others.
Level 3- Highly specialist treatment: a psychological therapies care plan is provided that is based on the principles accepted as best practice in treating high-risk youth. Direct work will follow an extensive, formulation-led framework for mental disorder/psychological disturbances. The psychologists work in partnership with the local authority/lead professional in structuring the treatment recommendations in accordance with the high risk young person’s plan and assessment.
The Centre for Youth and Criminal Justice are still involved in the project, with IVY’s team of psychologists working alongside staff from the Centre to provide this highly specialist service to young people. The project has also had secondments and staff services from Glasgow Forensic CAMHS service and Renfrewshire Whole System’s team.
Evaluation of the IVY Project
The project has led to improved outcomes for over 220 young people, their families, communities and wider systems. These young people posed a serious risk to themselves and others around them. The positive effects of the IVY Project are far ranging. There has been explicit support and commendation of the project by the Expert Group on the Prevention of Sexually Harmful Behaviour and the Expert Review of Mental Health and Young Offenders. The feedback from formal and informal evaluations of the project identified positive aspects, including:
- At the individual level, high-risk young people have much-needed access to in-depth assessment and formulation of their psychological, mental health and offending risk needs. The IVY Project has managed to reach the most vulnerable and marginalised group in mental health.
- The young people benefit from the assessment and their communities also benefit through the reduction of the violent tendencies of these young people.
- The expertise of the IVY Project makes the decision-makers’ assessments more informed and, as a result, more defensible.
- The model of service delivery of the IVY Project has promoted capacity building and knowledge sharing among different professionals, services and geographical areas.
Practitioner responses from feedback forms during one quarter in 2021 have been extremely positive. One practitioner said that; “they felt that the consultation was thorough and supported practitioners to consider all aspects of the young person’s life/vulnerabilities. I feel that we were well supported to do so by the panel and having some initial feedback about some potential options we could work on prior to getting the report was also helpful.” Another commented that; “I felt this was a very thorough consultation. There were a lot of helpful and insightful questions which have helped me to think on a deeper and more rigorous level as to the many presenting factors which have contributed to the young person’s presenting behaviours.”
The Scottish Government funds this service, therefore there are no costs to referrers or those using the service.
This case-study was compiled by Michael Farinu in 2019 and updated by Jason Watt in 2021