Dear Ms Coombes The following response has been written on behalf of Outwood Grange Academies Trust as requested in your Regulation 28: Preventing Future Deaths report dated 10 October 2023. Format of Response:
1. Provision of Mental Health and Wellbeing (MHWB) Services involved with the Academy
2. Referrals to MHWB services in Barnsley Local Authority
3. Discharge from MHWB services in Barnsley Authority
4. Further guidance from DfE on support in schools for pupils who are transgendering Appendices: A: I-Space referral form B: Barnsley MHWB Services referral flow-chart C: Branching Minds/Compass Be referral form D: I-Space discharge form E: I-Space process information document (All attached in pdf format)
1. Provision of Mental Health Services involved with the Academy As part of the expected graduated response to support young people who may be struggling with their mental health and wellbeing, Outwood Academy Shafton offers a wide range of internal and external interventions and has built strong, positive relationships with external agencies to ensure that students can receive the best possible interventions which can support their wellbeing and learning. Alongside this, we have ensured training of our own Inclusion and pastoral staff to enable them to deliver one to one or group work sessions which help us to create a bespoke intervention package to help, guide and support our students and families. 1 of 5

The starting point for access to these services is referral by pupil, parent or member of staff to a member of the Academy’s Inclusion team. This team is line-managed by the Vice Principal, Deep Support (who is usually also the Designated Safeguarding Lead), and includes the Inclusion Co-ordinator, SENDCO, Safeguarding Officer, SEND Officer and a team of 6 Learning Managers who support students in each academic year group. This team meets weekly, on a Thursday evening, to discuss all pupils on the vulnerable register. It is at this meeting that pupils will also be added to this register as new information or new referrals come to light. In terms of referral for internal interventions, a pupil is added to the waiting list and referred into one of these services as soon as a slot becomes available. Because pupils on the vulnerable register are discussed weekly, there is a constant re-evaluation of waiting lists such that a pupil may well move up in priority if new information has been received via CPOMS as a cause for concern. External agencies involved include: ● Branching Minds: Launched August 2022- now exists as a single point of contact for referral into adolescent mental health services in the borough. All access to CAMHS is now through this single point of referral. ● Compass Be: Launched in Barnsley in September 2022- Compass Be Mental Health Support Team (MHST) works with children, young people, and families in education settings in Barnsley and is the NHS procured service for this function. They support young people with low mood, fears and concerns, challenging behaviours, family relationships and transitioning adjustments. The service is made up of Education Mental Health Practitioners and Supervising Practitioners, Trainees and Assistant Practitioners from a range of health and education backgrounds working alongside a specialist Family Practitioner and Bereavement Counsellor. ● I-Space: Additional counselling service procured and paid for by the academy to fill any gap in service. They specifically support young people with Anxiety, depression, suicidal thoughts, self-esteem, stress, anger, bullying, self-harm, bereavement, family breakdown, abuse, neglect. ● AdAstra: A community interest company, formed in 2013, and part of the local offer in Barnsley. They work with groups of students on managing emotions, anxieties/worries, exam stress. They also offer a support group for young people who identify as LGBTQIA+. ● Think First for the Future: A social enterprise organisation that partners with schools to deliver a structured Behaviour and Resilience Mentoring Provision which is proven to have a positive measurable impact on engagement in learning. ● Youth Justice Service: Youth Justice Service work with children aged 10 to 18 who are involved or are at risk of being in the criminal justice system. This would be as a result of behaviour that has been determined by police to be an offence. They work with the child, their parents or carers and in partnership with any other professional working with the family to prevent further/any offending. ● Early Help: referral for Early Help either as part of a graduated response where a family support worker may be required or as a step-down from a social-care Child in Need or Child Protection plan. ● Internal interventions delivered by our own team of specialists including bespoke interventions around trauma, social skills and social stories, life skills, self-esteem and confidence, resilience, emotional regulation, anxiety. 2 of 5

2. Referrals to MHWB services in Barnsley
2.1: I-Space ISpace is a Wakefield-based Community Interest Company working with young people, their families, schools and communities to support progress and raise aspirations. Their work encourages young people to reach their full potential; become active citizens who want to improve their emotional, social, physical and economic environments. They partner with schools to provide innovative services that give students the opportunity to achieve in education, build life skills and work towards a brighter future - and they work closely with local communities to come up with solutions for local issues. Their team specialise and are passionate about working within the youth arena and are trained in a range of therapeutic and family work interventions. Their practitioners are experienced and qualified in working in a range of areas, including: ● Emotional wellbeing & mental health ● Early intervention and prevention ● Drug work ● Youth justice ● Youth & Community work ● Parent support work They use a range of techniques, strategies and interventions in their work, always based on an assessment of the needs of each individual. They consider personal differences such as culture, ethnicity, values and beliefs to inspire and motivate all young people to develop their potential. Referral to I-space is via the Inclusion team at the academy who would work with the young people and their family to complete the referral form (Appendix A). Where there is a possible delay in service due to a waiting list, a pupil would remain on the vulnerable register and be triaged weekly at the aforementioned Inclusion Meeting. In addition to the services available in school from ISpace at the time of Alex’s death they now also host a wellbeing drop-in session for students who no longer access iSpace but may need a catch-up. This session is also open for students and families who may be waiting to see iSpace to become familiar with colleagues and to learn a little more about the support available.
2.2: Branching Minds and Compass Be Referrals to Compass Be can be made through Branching Minds, which is a multi disciplinary team who provide advice, support and guidance for new referrals for all children and young people’s mental health services in Barnsley as a single point of contact. The team do not hold any case loads or provide direct support to children and young people, but the referral will be triaged and if suitable for 3 of 5

the service it will then be forwarded to Compass Be. Branching Minds accept requests for support from young people, parents, carers and professionals Branching Minds have since issued an updated referral flow-chart which is included as Appendix B to this report. This is intended to clarify the routes into the services for schools and others who refer. Referral forms for Branching Minds are readily available and the referral form can be found at South West Yorkshire Partnership website or on the CompassBe website. These have also been included as Appendix C of this response. Both professionals and parents can ring in for advice. The advice now given is to use the single contact number in an urgent referral scenario. Referrals are triaged by the services on the same day. The service is clear that referrals need to be made as part of a graduated response which should include appropriate MHWB support internally at school. Branching Minds begin an information gathering process when a referral is made and they sometimes need to seek additional information. All cases are treated on an individual basis and some cases may need other services to support and not MHWB services. Branching Minds look at which service may be most appropriate in terms of ways forward for an individual. Branching Minds is a triage service. The Branching Minds Barnsley team work Monday - Thursday from 9am to 4:30pm and Friday, 9am to 4m (excluding bank holidays). For emergency support outside of these hours, patients are directed to contact their out of hours GP or NHS 111. Further advice is also given by the service to ONLY contact 999 or attend A&E is someone’s life is at immediate risk.
2.3 CAMHS Since the implementation of the Branching Minds single point of access process, all referrals from school to CAMHS are now through this route. Parents can, of course, access Branching Minds directly as above or speak to their GP for support.
3. Discharge from MHWB services in Barnsley Authority
3.1: I-Space The academy has worked with I-space to review processes around how a young person is discharged when their allocated sessions come to an end. This review had already taken place prior to the inquest and has now been in place for over a year. A copy of the discharge form (Appendix D) shows that the service now provides a discharge report to the inclusion team in school. This details how the school could support further and would be used to detail how any further re-referral to the service would best be considered. In any event, a pupil who has received support from the I-Space service would remain on the academy’s vulnerable register and, therefore, be triaged weekly as to whether any re-referral or referral to an escalated service might be deemed necessary.
3.2: Branching Minds and Compass Be 4 of 5

When a referral is accepted or not accepted by these services, an outcome letter goes to the referrer and the GP. If the parent is the referrer then this outcome letter only comes to school with parental consent. There are specific reasons why a referral would not be accepted by the service. The main reason highlighted is if the child is receiving any other support via any other service. This could be a school-based MHWB service (such as Ispace), CAMHS or a private therapist. A referral may also not be accepted if they already hold information shared via a GP or other safeguarding/family support service which means that the referral was deemed not appropriate. We have been informed by the service that whether a referral is accepted is based on a case by case approach. When Compass is allocated a case they will communicate verbally with the school to ensure they are aware of specific students and interventions that will be covered. They will also update the waiting list for our students. The aim at the moment is to have a four week turnaround in terms of support, however, this depends on the caseload and differs from school to school. A student usually accesses six sessions from Compass and then at this stage the referrer receives an outcome letter outlining what had been covered in the sessions. As above, if the school is not the referrer they will only receive the outcome letter if the parent or carer chooses to share this with them. Compass will, however, update verbally during the half termly link meeting sessions in school. Also if Compass has an ongoing concern about a student in the academy where they are not the referrer then they will bring the academy's attention to the concern via email or telephone contact which is then noted on the academy’s CPOMS system and discussed at the Inclusion meeting.
3.3 CAMHS Where a student has been accessing CAMHS the formal discharge letter is sent to the child’s parent/carer and to the GP. The school would not be informed of this unless the parent chose to inform.
4. Further guidance from DfE on support in schools for pupils who are transgendering At the time of writing this response there has been no update on the expected DfE guidance on supporting pupils who are transgendering. There has been some media update that a delay in the release of this guidance, promised a number of months ago, has been caused by matters of law surrounding disclosures to parents and carers where a young person confides in a member of staff in a school setting. It is felt that this guidance is long overdue and that schools are trying hard to piece together best practice in the absence of any official stance or response. Many schools have, indeed, pieced together their policies and procedures sourcing what they can from local authorities, public health and the third sector.

Dear Ms Combes Thank you for your Report to Prevent Future Deaths which was received by the Department for Education on 10 October 2023. This is a tragic case of a life cut short far too young. My thoughts are with Alex’s family and friends, and everyone who knew him. I am mindful of the timing of this response, so close to Alex’s birthday, at what will undoubtedly be a most difficult time for his loved ones. It may be useful to begin with setting out the Department’s requirements of schools and colleges in respect of safeguarding and mental health provision, in addition to responding to the action directed to the Department. All schools and colleges must have regard to the statutory guidance Keeping children safe in education, and school staff should also have regard to the Department’s advice on Mental health and behaviour in schools. Keeping children safe in education is clear that governing bodies and proprietors have a strategic leadership responsibility for their school or college’s safeguarding arrangements and must ensure that they comply with their duties under legislation. The guidance states that schools and colleges should work with local authority children’s social care, the police, health, and other services to promote the welfare of children and protect them from harm. This includes providing a coordinated offer of early help when additional needs of children are identified.

All schools should have a child protection policy and mental health provision should be included in that policy. Whilst there is no requirement on schools to have a standalone mental health policy, many choose to do so. School staff cannot act as mental health experts, but they should ensure that they have clear systems and processes in place for early intervention and identification, referral to experienced skilled professionals, and clear accountability systems. It is important that schools have an understanding of the local services available, including school nurses, and how and when to draw on, or commission, them. Where required, schools should expect parents and pupils to seek and receive support elsewhere, including from their GP, NHS services, trained professionals working in specialist child and adolescent mental health services, voluntary organisations, and other sources. Many individual schools are able to commission individual support and health services for pupils, to give increased flexibility and provide an early intervention response. It is important that schools commission appropriately qualified and experienced external providers, as this will provide assurance that they are properly trained, supported, professionally supervised, insured, and working within agreed policy frameworks and standards, and are accountable to a professional body with a clearly articulated complaints procedure. Local authorities are ultimately responsible for protection and welfare of all children in a local area. Those duties do not preclude a school or college from offering support and procuring mental health services for its pupils. The Mental health and behaviour in schools advice sets out school roles and responsibilities in relation to mental health and provides advice and guidance on working with other professionals and external agencies. The Department for Education is not prescriptive in what support services schools can use
– that authority is delegated to school leaders to ensure that the support is tailored for children by those who know them best. Schools have delegated budgets to make those decisions and should escalate cases to children’s social care or to child and adolescent mental health services when there is cause for concern over and above the support that a school puts in place. 2

All concerns, discussions and decisions made, and the reasons for those decisions, should be recorded in writing. Information should be kept confidential and stored securely. It is good practice to keep concerns and referrals in a separate child protection file for each child. The designated safeguarding lead is responsible for ensuring that child protection files are kept up to date. Records should include a clear and comprehensive summary of the concern; details of how the concern was followed up and resolved; a note of any action taken, decisions reached; and the outcome. As you will appreciate, each child is unique, as are the circumstances of the support they may need throughout their time at school. It is with this in mind that the Department seeks to give school leaders as much flexibility as possible in deciding appropriate support managed within the school. This flexibility is governed by a statutory safeguarding framework that operates inside a much broader safeguarding system that includes local authorities, police, and health, as the statutory safeguarding partners. Whilst the sad circumstances of Alex’s case would not have met the threshold for a child serious incident, or action by the Child Safeguarding Practice Review Panel, there is local learning for the Barnsley Safeguarding Children Partnership, and they may well appreciate sight of the Regulation 28 in Alex’s name, if you have not already shared with them. The Department is working with the Minister for Women and Equalities to develop guidance to support schools and colleges in relation to children who are questioning their gender. We know that this is a complex and sensitive issue, and that some schools and colleges feel that they need more support in this area in order to help pupils, students, and parents to deal with concerns raised. The Department will hold a full public consultation on the draft guidance prior to its publication. 3

I trust the information provided in this response satisfies the action attributed to the Department for Education. I would be interested to see the responses from colleagues at the Department for Health and Social Care, and from Outwood Academy Shafton, to understand whether and where we can further strengthen our guidance to support schools when safeguarding our children. With best wishes to you, and to the family and friends of Alex.

Assistant Director – Safeguarding Strategy and Systemic Improvement Department for Education 4

Dear Ms Combes,

Thank you for your Regulation 28 report to prevent future deaths dated 10 October 2023 about the death of Alex Dews. I am replying as the Minister with responsibility for mental health and patient safety.

Firstly, I would like to say how saddened I was to read of the circumstances of Alex’s death and I offer my sincere condolences to his family and loved ones. The circumstances your report describes are concerning and I am grateful to you for bringing these matters to my attention. Please accept my sincere apologies for the significant delay in responding to this matter.

Your report raises concerns over the provision of mental health care for young people in schools. In preparing this response, Departmental officials have made enquiries with NHS England and the Department for Education, and I understand that that Department and Outwood Grange Academies Trust Outwood Grange Academies Trust have each already carefully considered the matters of concern in your report and have provided you with comprehensive responses setting out the actions being taken to improve the mental health support being provided in schools.

I have been advised by the local NHS that, if a child or young person in Barnsley is struggling with their mental health, referrals can be made by professionals, and self- referrals from children and young people and from their families/carers to Branching Minds. This is the single point of contact for child and adolescent mental health services (CAMHS) and mental health support teams.  If a professional is unsure about what support is needed, a telephone call to Branching Minds is encouraged to obtain advice with the case being explored/discussed further as a collaboration. Each referral is assessed based upon the individual situation, background, risk or triggers.

A recommendation is then made as to whether the referral is appropriate for CAMHS. If a child or young person is receiving support from an alternative service at the time of referral, this would not prevent them from being accepted into CAMHS. The clinician on duty would make contact with the young person and/or parent/carer to have a discussion about what support is being received and if this was meeting their need. They would also assess the suitability of continuing this support whilst waiting for a CAMHS assessment/intervention.

Depending on the presenting need, the young person may be advised to complete an ongoing course of counselling before commencing with CAMHS treatment to allow for the benefits of the current treatment to be realised. However, they would not be declined on the basis of receiving another service.

Barnsley CAMHS encourages access to appropriate support whilst waiting and is embedding a 'waiting well' approach. Barnsley health and social care partners continue to work with schools to ensure they are clear on the pathways and processes for referring to mental health services, including CAMHS, and have access to risk assessment advice.  

More generally, we are aware that some children and young people are not able to access support they need in a timely manner. Through the NHS Long Term Plan, we are continuing to expand and transform NHS mental health care and spend on children and young people’s mental health services has increased from £841 million in 2019/20 to just over £1 billion in 2022/23.

NHS England’s priorities and operational planning guidance for 2024/25 sets out the aim to increase the number of children and young people accessing community mental health services to 345,000 by the end of March 2025 compared to 2019 and we are ahead of schedule in rolling out Mental Health Support Teams in schools and colleges. We achieved our original ambition of covering 25% of pupils in England a year earlier than planned. We expect this to increase to 44% by spring 2024. And we plan to go further, extending coverage to 50% of pupils by 2025.

In addition, NHS England is working towards implementing new access and waiting time standards for mental health services including one for children and their families and carers to start to receive community-based mental health care within four weeks from referral.

With regard to children’s gender identity services, NHS England continues to overhaul these following the serious clinical and safeguarding issues which were raised regarding services at the Tavistock clinic and the recommendations set out by in her landmark report into children’s gender services published in April 2024. Following recommendations from , two new services opened at the start of April and will operate under a fundamentally different service model, supported by clinical experts in mental health, neuro-development and safeguarding.

I hope this response is helpful. Thank you for bringing these concerns to my attention.