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1 85,300 children were supervised by Youth Offending Teams in 2010/11, a reduction of 20% from 2009/10 Around 25% of children who offend have very low IQs of less than 70 43% of children on community orders have emotional and mental health needs, and the prevalence amongst children in custody is much higher 60% of children who offend have communication difficulties and, of this group, around half have poor or very poor communication skills Around 33% of all children accessing local drug and substance misuse services are referred from the youth Justice system 27% of children and young people who offend are not in full time education, training or employment at the end of their period of youth Justice young lives around:How health and Justice services can respond to children withmental health problems and learning disabilities who offendA briefing paper by Robert Newman with Jenny Talbot, Roger Catchpole and Lucie RussellChildren who offend - the facts:Fair Access to Justice single column_Layout 1 19/11/2012 07:45 Page 12 Who is this briefing for?

2 This briefing paper has been prepared for youth Justice professionals andpractitioners, local government directors of children s services and lead members,directors of public health , clinical commissioning groups and healthcare. Why is it useful?This briefing paper will help to inform the development of Joint health and WellbeingStrategies. It will be of particular use to those involved in commissioning services,and for those concerned to ensure that the particular needs of children who offend,especially those with mental health problems and learning disabilities, are recognisedand met. SummaryHigh numbers of children who offend have health , education and social care needs,which, if not met at an early age, can lead to a lifetime of declining health andworsening offending behaviour, with significant long term costs to the taxpayer, andto the victims of these crimes. Despite considerable improvement in provision for children s mental health evidenceshows that health and youth Justice services are not working effectively together torespond to these children.

3 Reforms to health and social care in England, and the emphasis on localism, providea chance to improve joint working between youth Justice and healthcare services tomake a real difference for children who offend. health and Wellbeing Boards, together with Clinical Commissioning Groups, will beresponsible for shaping the future of health and social care provision for their localareas, a top priority of which is to tackle the health inequalities that children andyoung people who offend frequently briefing paper seeks to encourage effective joint working between health andWellbeing Boards and youth Justice services, in particular, to ensure that localstrategies reflect the needs of children and young people who offend, especiallythose with mental health problems and learning disabilities. It outlines a practicalaction agenda and provides examples of good practice to help turn these young livesaround.

4 AcknowledgementsThe authors would like to thank Nicola Ellis, Primary Care Lead from NHS Bury Public HealthDepartment, Lorraine Khan Associate Director from the Centre for Mental health and Ian LangleyHampshire YOT manager, for taking the time to read the text and contribute their uniqueperspectives. Thanks also to Julia Wickson who conducted interviews with children and youngpeople, and Prison Reform Trust team members who assisted with publication of this briefing thanks go to the children and young people from Raising your Game,1whosecontributions have helped to shape and to illuminate this report, and to Mencap for their help inmaking arrangements for interviews. Fair Access to Justice single column_Layout 1 19/11/2012 07:45 Page 23 Action agenda Action by Youth Offending Teams (YOTs) and YOT management boards:Undertake a health and wellbeing needs assessment to produce reliable1information on the support needs of children and young people who offend; usethese data to inform your local Joint Strategic Needs Assessment (JSNA) andJoint health and Wellbeing Strategy (JHWS).

5 See Youth Justice health and Well-being Needs Assessment Toolkit: a strategy to ensure matters relating to youth crime, the voices of children2who offend and their health and wellbeing needs are reflected in your localauthority JSNA and JHWS, and are represented at the health and WellbeingBoardArrange to meet local Clinical Commissioning Groups (CCGs) to discuss the3particular health and wellbeing needs of children who offend and those at risk ofoffendingWork with other YOTs and YOT management boards whose area is covered by4the same Police and Crime Commissioner to influence your Commissioner spolicy and funding decisions; see with local liaison and diversion pilots to highlight the health benefits of early5interventions for children who offend or who are at risk of offending; see YouthJustice Liaison Diversion Practical Toolkit: by health and Wellbeing Boards:Work with local youth Justice services to ensure the particular health needs of6children and young people who offend are reflected in your JSNA and JHWS ( ), and are represented on the health and WellbeingBoardUndertake an equality impact assessment to ensure that children under the7supervision of youth Justice staff and those identified as being at risk of offendingare not marginalised, and that all services comply with the public sector equalitydutyClarify what arrangements have replaced Children s Trusts and, where necessary,8set up children s committees to ensure the unique needs of children and, inparticular, children who offend are taken account of.

6 The focus of children scommittees should be the planning and delivery of integrated services to deliverjoined up care pathways, including timely Access to Child and Adolescent MentalHealth Services (CAMHS) and other specialist services, improving transitions fromchild to adult services and building on the lessons learned from Children s Trusts(see Annex 2: Engaging children and young people)Review CAMHS to ensure they conform to the comprehensive CAMHS model; @dh/@ Access to Justice single column_Layout 1 19/11/2012 07:45 Page 34 Ensure professional development for specialist health staff, and mental health and10learning disability awareness training for specialist health staff and others working inthe youth Justice by Clinical Commissioning Groups: Work closely with, or consider delegating to, an expert group of local authority and11 NHS children s commissioners to commission services for children with mentalhealth problems, learning disabilities and communication difficulties.

7 Such a groupcould agree a youth offending service commissioning plan, and manage aligned orpooled budgets Ensure adequate resourcing of health and wellbeing services delivered in youth12offending teams and an appropriate mix of specialist expertise to delivercommissioning objectivesAction by the Department of health : Prioritise the health needs of children who offend in forthcoming guidance on JSNAs13and JHWSs Deliver on the commitment made in Healthy Children, Safer Communities2to14produce new guidance for commissioners on meeting the challenges ofcommissioning health services for children in the youth Justice system, and ensurethat the needs of children with mental health problems and learning disabilities areincluded in this guidanceWork with the Offender health Collaborative3to ensure age-appropriate liaison and15diversion services for children and young peopleAction by the Youth Justice Board (YJB):Monitor youth Justice input into JSNAs and highlight where needs assessments fail16to take account of the particular needs of children who offendAction by NICE.

8 The NICE Quality Outcomes Indicator Programme and Commissioning Outcomes17 Framework should include indicators and outcomes relating to child and adolescentmental healthAction by the Care Quality Commission (CQC):Youth Justice inspection arrangements involving the CQC should assess the impact18of NHS changes on the provision of health services to YOTs. CQC should continueto monitor how the health needs of children and young people who offend, or whoare at risk of offending, are being Access to Justice single column_Layout 1 19/11/2012 07:45 Page 4 Introduction This briefing paper is about children and young people aged 10 to 17 years with mentalhealth problems, learning disabilities and communication difficulties who offend and whoare at risk of offending (hereafter referred to as children who offend and youngoffenders ). It seeks to inform local service managers and decision makers about theimportance of improving health provision for this vulnerable, and often marginalised,group of children and to provide some pointers towards strategic improvement.

9 Thebriefing paper should further stimulate debate locally about how professionals andpractitioners concerned with children s services and with youth Justice and healthservices in particular can make best use of opportunities presented by NHS reforms andthe increased focus on localism. The briefing paper outlines some of the challengesposed in achieving these objectives at a time of great change in the delivery of localauthority and health services. There have been advances over the last decade in healthcare provision for children whooffend. There is evidence, however, that much more remains to be done. A commontheme of this research is the failure of local services to work effectively together, resultingin many children with complex health and social care needs slipping through the net. Amore joined up approach between health and youth Justice services would make the mostof the time these children spend under the supervision of youth Justice services, toaddress their health needs and to help turn their lives around.

10 The Healthy Children, SaferCommunities4strategy, published in 2010, is a step in the right direction, butimplementation will be a challenge during the period of instability caused by wider recent years the shift in offender health policy for children and adults has been towardsimproving Access to mainstream services, as opposed to creating specific and dedicatedservices for offenders. This has been especially so for children who offend, of whomaround 97% are subject to community supervision. The thematic focus of this briefing paper is mental health , learning disability andcommunication difficulties. While not attempting to look in any detail at physical health , health education or drug and substance misuse, it is acknowledged there is considerableoverlap, and often interdependency, and that children s support needs will often becomplex, rarely corresponding to the artificial boundaries constructed for the purposes ofstrategic planning and service commissioning.