Council and NHS trust create step-down care

Cherry Tree Cottage in North Hertfordshire is an Ofsted-registered children’s residential home offering interim placements for young people experiencing or recovering from mental health crisis.

It opened in December 2023 following a joint commitment from Hertfordshire County Council and the Hertfordshire Partnership University NHS Foundation Trust (HPFT) to ensure the “best outcomes” for this cohort of young people. With £1.4 million investment from the council and additional funding committed by HPFT, Cherry Tree Cottage was transformed from a derelict building into a four-bedroom home that is “safe, warm and welcoming”.

During the 12-week placements, young people aged 12 to 17 receive tailored therapeutic support from a multi-disciplinary care team made up of health and social care professionals.

“Social care staff provide the day-to-day care and nurture, as within any children’s home, together with the input and guidance of mental health clinicians,” says Miranda Gittos, Hertfordshire County Council’s director of specialist services and commissioning.

The service was set up following a needs analysis, which looked at the increasing complexity in mental health needs among children and young people in local authority care.

“With limited capacity to meet this need within existing residential accommodation, we worked with health colleagues to develop a business case to secure funding for this ground-breaking model,” Gittos says.

Cherry Tree Cottage is “suited to” supporting young people who are self-harming or expressing suicidal thoughts by offering them a “bridge of stability” as they move away from crisis or risk-taking behaviour, Gittos says.

“The aim is to support them to make a transition back into their usual residence without experiencing a repeat breakdown,” she adds. “Too often, children with severe mental health needs are discharged from hospital with high levels of needs their families cannot cope with. It also helps prevent additional trauma caused by delayed discharge from an acute unit.”

The children’s home also aims to reduce instances where young people seek help at A&E, require in-patient care and are subject to detention under the Mental Health Act.

Steve Gentry, Hertfordshire Council’s head of service for children’s residential and ARC services, says that working collaboratively gives them the opportunity to “share their knowledge base and expertise” and “meet the needs of the child in an holistic sense”.

A team of 20 people work onsite on a rotational basis, including a manager, registered nurses and child and adolescent mental health practitioners, residential workers and support staff.

Staff were jointly recruited with a lead representative from health and social care overseeing the process. Gittos says that when commissioning joint services, it is important to “allow enough time to work through governance processes” as well as working collaboratively to ensure “policy and process of both health and social care are adhered to”.

Gentry says: “The passion and drive from the NHS and Herts social care carried this project forward. We all have the same vision for the best outcomes for children.”

Impact

Cherry Tree Cottage is part of a comprehensive residential strategy designed by Hertfordshire County Council to reduce reliance on private providers.

The cost of a placement at Cherry Tree Cottage is £6,386 per week, compared to “£17,500 a week for a private placement” which has risen to “£20,000 per week” in the past six months, Gittos says. But Gentry explains it isn’t just about the financial savings.

“We know that these young people would benefit from more affordable local accommodation that is closely linked to local services,” he says. “This ensures consistency of care and improves their chances of remaining stable.

“The expertise is all in one place and we’re able to really target work with the families. We empower parents and carers by giving them strategies, non-violent resistance training and basic trauma-informed training to help them feel more confident.”

Carers work on supporting the young person to create positive coping mechanisms and they are encouraged to practice good sleeping habits, healthy eating and breathing techniques.

Gentry says that risk assessments at discharge “clearly demonstrate de-escalation of risks”.