While reduced numbers of referrals have been reported in some areas, lockdown has meant increased levels of other types of activity – for example in relation to contact maintenance. The reduced personal contact that has necessarily resulted from school closures has made it harder for MHSTs to maintain current levels of activity and contact; they have in effect been running to stand still.
Examples of positive practice include the development of an “Improving school attendance” video workshop in Hounslow. It is aimed at parents of children and young people struggling with the return to education. Remote ways of working also allowed Hounslow to reconsider their current model of embedding practitioners in partner schools and allowed the MHST offer to be extended to all mainstream schools through remote delivery. This positively impacted access to services for CYP across the borough as it was no longer limited by practitioners’ physical availability in a particular school for a specific number of sessions per week.
The South West London (SWL) cluster has initiated strategies that support inclusion and return to school for school refusers. It has also introduced self-referrals for parents and CYP to mitigate the reduction in numbers of referrals to MHSTs.
Lewisham services also remained open to referrals and worked with children and young people across the summer holidays, again to off-set any reduction in referrals and risks associated with reduced levels of contact.

Changes to how children and young people are referred to MHSTs have been made is several areas, to enable easier and more efficient referrals and to off-set the barriers associated with isolation and school closure.
In Lewisham, the MHST has begun to work collaboratively with other agencies and stakeholders, including on the development of referral pathways. An MHST staff support line has been established in that area, to allow easier referral to services, with referrals accepted from MHST staff, education staff, parents and other professionals. SWL also now accepts self-referral from parents, children and young people.
In Islington, an adapted referral route has been put in place to include referrals from the CAMHS Children’s Wellbeing Practitioner (CWP) team. This may be an example of where close existing links between CAMHS and schools are supportive of MHSTs. In Islington, for example, the 2018 survey reported that all 83 schools had services commissioned through CAMHS.
Hounslow is developing a step up and step-down referral pathway with Tier 2 and Tier 3 CAMHS, linking up with the CAMHS Single Point of Access process to improve access for young people and families.

It may be more difficult to engage with marginalised groups of children and young people. The 2018 survey found that addressing the needs of LGBTQ children and young people, for example, was a challenge. A recent study by Oxford University found that there were issues specific to Black, Asian and Minority Ethnic (BAME) young people that could be a barrier to involvement with MHSTs, such as worries around higher mortality from Covid-19 in the BAME community. It also found that providing remote support was harder with young people with autism spectrum disorder (ASD) or other vulnerabilities.
In 2020 information returns, several examples of attempts to target specific groups were highlighted. Hammersmith & Fulham and West London described an adaptations offer to create culturally sensitive, appropriate and flexible support to increase access to services to children and young people from BAME backgrounds, with a specific focus on black boys.
Islington reported difficulties in engaging with service users about service plans, especially vulnerable groups. To mitigate this, they have set up a steering group with schools, involved an experienced Participation Officer in planning and in the regular meetings with a participation working group, and used data to monitor and tackle inequalities of access.

Hounslow have implemented a new model to improve access to the service. This includes a dedicated practitioner for each school who maintains proactive engagement efforts via telephone, email and weekly video call for school link workers.
Lewisham has also introduced a school link worker role, to provide a day-to-day contact with schools and enable the development of a bespoke MHST offer.
Haringey has developed a mild to moderate obsessive compulsive disorder (OCD) offer to secondary schools.