Poverty proofing Rotherham child and adolescent mental health services 2026

Poverty proofing delivery partner model

Children North East are working in partnership with Rotherham, Doncaster and South Humber (RDaSH) NHS Trust to fulfil its ambitious promise to “poverty proof” all of its services by December 2025. The trust has committed to piloting a bespoke Delivery Partner Model developed in partnership with Children North East (CNE).

Poverty Proofing is a nationally recognised tool, designed to educate and enable health care professionals to identify, acknowledge, and reduce the impact of poverty, advocating for equality of access to healthcare, services and technologies that contribute to overall health outcomes experienced by those living in poverty.

A locally trained team (LTT) of people have been trained and are being supported by Children North East to carry out this work in line with the ethos and principles of Poverty Proofing.

• Phase 1: 3 model audits carried out by Children North East
• Phase 2: a further 6 audits carried out by the locally trained team with support from Children North East
• Phase 3: all other trust services will engage in the Poverty Proofing process during 2025 and 2026. Children North East will deliver training to all staff; the locally trained team will carry out scoping of services and engage patients and staff in consultations; and the trust strategy team members will deliver feedback and write reports for each service. Moving forward, services will become more poverty informed, learning how to work with their patients to identify barriers, so that poverty becomes everyone’s business, and no-one is left out or left behind

This whole system approach is unique and has accountability at every level and a commitment to alleviate barriers that apply across the whole system.

Poverty proofing Rotherham child and adolescent mental health services

Rotherham child and adolescent mental health services (CAMHS) is located at Kimberworth Place in Rotherham S61 1HE, which is described on the website as a state-of-the-art hub for services helping children and young people in Rotherham. Child and adolescent mental health services is just one of many different services housed in this building, alongside learning disability services, community children’s complex health care nursing service, physiotherapy, occupational therapy and speech and language therapists, amongst others. Plenty of free accessible parking is available outside the building.

In the financial year ending 2024, Yorkshire and the Humber had the highest proportion nationally of children aged under 16 in relative low income families (30.4%). The Income Deprivation Affecting Children Index (IDACI) from Sept 2025 shows 22.1% of children in Rotherham are experiencing deprivation linked to low income, compared with 17.1% in England as a whole. There is a wide variety of evidence to show that children who live in poverty are exposed to a range of risks that can have a serious impact on their mental health.

According to the Children and Young People’s Mental Health Coalition parliamentary briefing in July 2024:

“About one in five 8 to 25-year-olds had a diagnosable mental health problem in 2023. Children in the least well-off 20% of households are four times more likely to experience serious mental health difficulties by age 11 compared to those from the wealthiest 20%.”

Factors such as safe housing, financial security and access to care play a vital role in shaping mental health outcomes, yet not everyone has equal access to these protective conditions. When individuals face persistent disadvantage and are exposed to more harmful circumstances, the risk of them experiencing mental health problems increases (The Mental Health Foundation (2025). The Foundation Reports, Tackling Mental Health Inequalities in the UK: Expert Consensus on Priority Areas. Delphi Study.)

Poverty proofing ethos

No activity or planned activity should identify, exclude, treat differently or make assumptions about those whose household income or resources are lower than others.

Voice

The voice of those affected by poverty is central to understanding and overcoming the barriers that they face.

Place

We recognise that poverty impacts places differently, and so understanding place is vital in our response. Organisationally we also need to be clear about why and how decisions are made. This understanding of context is essential.

Structural inequalities

The root causes of poverty are structural. What structural changes can we make at an organisational level to eliminate the barriers that those in poverty may face.

Poverty proofing process

Stage 1: training and consultation with staff

Staff completed a ​three-hour​ training session.

Stage 2: scoping

Time was spent gathering information about the setting and how it works. This stage included conversations with staff and management. 9 staff (in different roles) were spoken to in 1-to-1 conversations, with several other voices captured ad hoc and through brief group discussions in staff offices.

Stage 3: patient and community consultations

We spoke to ​7​ people in total. This included ​5​ people in the service waiting area, one parent over the phone and one parent shared their views through an email.

Stage 4: feedback session

Findings were written up into this final report.

Stage 5: review

Around ​nine​ months after completion, the trust will complete a review, identifying impact, good practice and potential considerations moving forward.

Common themes

The next sections of this report highlight the most common themes to come out of the poverty proofing consultations. For each theme the report covers:

• what works, what you do now that supports those experiencing poverty
• the barriers and challenges faced by those experiencing poverty
• recommendations, each recommendation comes with a set of considerations for “poverty proofing” the service

The themes are presented alphabetically, and this does not imply any hierarchy of importance. The themes for Rotherham child and adolescent mental health services were:

• communication
• navigating and negotiating appointments
• patient empowerment
• staff awareness and guidance
• travel

Communication

Communication is important to consider in Poverty Proofing both from a health literacy perspective of how information is communicated and understood and in ensuring there are reciprocal lines of communication between services and service users. O’Dowd (2020) reported that availability of care was a particular concern for those on a low income and there were significant inequalities in care availability for the most deprived areas. Communication is a key factor in ensuring availability of care.

What works

People find the service relatively easy to contact.

Barriers and challenges

Phone number for callbacks is withheld

When a young person or parent relies on receiving a callback from the child and adolescent mental health service, it comes through as a withheld number. For some, this means their phone will reject the call, while for others it may silence it so it does not ring. People may also be less likely to answer their phone from a withheld number when considering factors such as low literacy and language skills, and reduced confidence and self-advocacy skills, all of which are associated with poverty. When NHS numbers are withheld, patients may miss important calls about appointments and cannot callback. This could cause them to lose earlier appointment slots and fall further down waiting lists. These effects are greater for people in poverty, who already face more barriers to accessing services and are less able to recover from missed contact.

Staff:

“Number is withheld. Phone doesn’t accept withheld numbers for some people.”

“We share a phone line with Neurodevelopment team. Families will ring back, then leave a message again. If we had someone who could take those calls, it would cut out that step.”

“Even our admin are so stretched, they end up taking 30 voicemails, rather than speaking to people there and then.”

Perceived lack of communication from the service

Two parents spoke about what they perceived to be a lack of communication from the service. One related to a blood test request, that she said had not been discussed with her first, as the parent. Another said that while they understood about confidentiality, they felt there was a complete lack of communication from the service. For families already facing financial and social pressures, this uncertainty can make it harder to engage with services, reduce confidence in professionals, and ultimately limit the support the child receives.

“The only communication I’ve had from them was a blood test request form in the post, for selective serotonin reuptake inhibitors (SSRIs) screening. At this time, she was 14. They should have spoken to an adult before suggesting medication for an adolescent. I rang to discuss it with them, but no one called me back. I’m sure my child would like a pill to make these feelings go away, but she’s not in a position to understand all the risks and benefits.”

“I’m aware of groups, but that’s because I’ve found them myself, not through the service. It would be nice if they communicated with me, I understand confidentiality.”

Recommendations for communication

Phone number for callbacks is withheld

• Look into the current communication system, which relies heavily on families leaving messages and waiting for callbacks. Explore whether someone can answer those calls instead, and respond in real time, thus removing the extra step.
• Investigate whether outward calls from child and adolescent mental health can display a recognisable number instead of “no caller ID”.
• After a missed call, send a free text explaining who called and why, and provide a direct callback number.
• Allow families to request a time slot for child and adolescent mental health services to ring them back.
• Ensure calls are free to return, by changing to a freephone number.

Perceived lack of communication from the service

• Make it clear to parents from the start, what can and cannot be shared and how they will be involved in their child’s care.
• Ask parents for their preferred communication method and record this on the system. Revisit this question at intervals to keep up to date.
• Be forthcoming with regular updates, without relying on the parent to ask.

Navigating and negotiating appointments

Life can be particularly unpredictable when living on a low income. The challenges, for example around childcare or zero hours’ contracts can make attending appointments very difficult. Pressures on the NHS around waiting times and stretched services can mean there is little scope for flexibility and strict discharge policies are applied for those who miss appointments, effectively severing access for those with changeable circumstances. Furthermore, social problems often accompany poverty, and sometimes life can be chaotic, which makes consistent appointment attendance difficult. Availability and flexibility of care are important for improving access to health care for those on a low income.

The King’s Fund (2021) report states that:

“Services need to be flexible, accessible, responsive and offer continuity of care.”

What works

Some flexibility with appointments

Families really appreciate when flexibility is offered by practitioners. This includes timings of appointments, to allow parents to work around employment commitments, wherever possible. There is also flexibility around the location of appointments, in many cases, to make use of family hubs and libraries, which may be easier for the family to travel to. From a poverty perspective, appointment flexibility is really positive practice, as it helps reduce not only the financial cost of travel, but also the time taken out of someone’s day to attend.

Staff:

“We do try and use family hubs and libraries where possible. We use quite a few different hubs but when you can get space.”

“Not all sessions are at Kimberworth but predominantly. Usually have appointments elsewhere because people can’t get here. Much harder for us to go out and see people. Tried having a few clinics in different places but hard to fill the slot. We do have people that are travelling several buses to get here.”

“We negotiate the time with people, but we’re also bound by the space we have. Phone people up to make appointments. None of us have admin support doing that for us. Everyone’s followed up with a text, given a text reminder, on SystmOne. Unless people opt out. Just negotiate with people. We can talk about is there somewhere that is more convenient?”

“We’ve just set up Dinnington early help centre. I’m seeing two or three people there.”

“(Name of practitioner) leading the care, so I specified that we needed late afternoons. That was to work around work. Been great. All the other things have been through email, received it. Text reminders 24 hours before.”

“Appointment made through (name of practitioner), over the phone. Normally fit them round work.”

“Yeah, I’ve been asked when appointments work for me. It can add to the stress, having to leave work. (Name of practitioner) has been able to work around us. There was an appointment booked that I didn’t get to because I was at work. I rang the practitioner straight back and worked it out.”

“Yeah, given a text reminder.”

Different referral routes

There are various referral routes into the child and adolescent mental health services, including schools, GPs and self-referral. This makes access more flexible and achievable, regardless of a family’s circumstances. When referrals can come from multiple settings (for example, schools noticing behavioural changes), problems can be identified earlier, preventing escalation and reducing long‑term inequalities.

Staff:

“People can refer through school, their GP or they can self-refer. Sometimes if someone refers to the crisis team, they might get passed to us, less waiting time.”

While different referral routes open up more opportunities for access, one staff member spoke about an increase in self-referrals. This makes it more important than ever to ensure that the self-referral paperwork is easy to read, set out appropriately and uses language that the majority of people can understand, as laid out in the NHS Accessible Information Standard. Complex or unclear self‑referral systems add an extra barrier on top of existing disadvantages, meaning children and families in poverty would be less likely to successfully access child and adolescent mental health services, should the current paperwork not meet health literacy standards. While this has not been evidenced as a barrier in child and adolescent mental health services, it could be something to explore, with the support of the Health Literacy team in the trust.

Staff:

“Feels like we’re getting more self-referrals. Even the wording, it feels like it’s complex.”

Barriers and challenges

Time off work to come to appointments

Despite the flexibility described above, this is only possible within the wider service structure of 9am to 5pm, Monday to Friday. However, some staff in one team have chosen to work slightly later, which will enable some appointments up until 6pm.

Staff:

“Some staff have requested to change their hours to later, starting early July.”

When asked to identify any barriers they see in the service, staff described parents needing to take time off work to attend appointments as being a significant challenge. This might mean unpaid time away from work, and may create tension with an employer about repeated time off, potentially resulting in job loss. The extended hours being introduced by some practitioners may help to alleviate some of this pressure. However, it is important to consider how this will be applied, as it could come down to the luck of the draw whether a person is allocated a practitioner who works later. Perhaps at entry point into the service, a family could be asked, “Will you require out of hours appointments?” and allocate practitioners accordingly.

Staff:

“Parents taking time off work to come to appointments, that is the main barrier to accessing.”

“Parents might be looking after children who are really struggling, so they are having to take time off work. Or they are being asked to come to multiple therapy sessions. We have parents saying they’ve already taken lots of time off work and sometimes work is not very understanding.”

“Issue of, can parents bring them to Kimberworth Place? Can parents even get the time off work?”

“They’re likely to tell us if they can’t get here. More often we get, ‘this is tricky because I work, how late can you go?’ It is 9 to 5 but I do stretch it. But it’s a stretch. People can’t risk their jobs.”

“We are both missing work to get here, but it’s not important, need to be seen.”

Lack of awareness of different appointment locations

As already discussed, appointments can be offered in various locations, however not all families are aware of this. Consequently, they may continue making long or costly journeys unnecessarily.

“They only seem to have one place to access child and adolescent mental health services, it’s two buses. If they could have like mobile hubs. That’s something that I would definitely choose to access, perhaps in school holidays.”

The same parent expressed her disappointment that no appointments were offered to her child during the school holidays.

“We’ve had no appointments in school holidays. I could have taken her, I could have facilitated that cos I only work two days, but they’ve not offered anything. Disappointing.”

Staff missing appointments

While only spoken about by one parent, it is important to share her experience. She explained that the support worker allocated to her daughter, has repeatedly not turned up for appointments, so much so, that only around half of her planned appointments have actually taken place. These appointments should have taken place in school, so no unnecessary journeys were taken by the family. However, as her child has autism, routine is important and she benefits from consistency.

While this experience is not overtly financial, it is well documented that in healthcare settings, poverty is linked to reduced self‑advocacy, as patients with lower education, financial literacy, and resources are less likely to question medical decisions or raise concerns, which can exacerbate existing health inequalities.

“The support worker allocated misses more appointments than she attends. They’re meant to be weekly. She doesn’t communicate, just doesn’t rock up. One week she said she couldn’t get parked at the school, another time she missed the train, then she missed the bus. I liaised with the pathway lead, and while apologetic, there was not a resolution. People are obviously allowed to be unwell (the issue was lack of communication and frequency of it happening). She (daughter) has autism, she needs consistency. (Support worker) was still late yesterday. This creates a negative impact on (daughter’s) routine.”

Difficulty booking community rooms

Rotherham child and adolescent mental health services covers a large geographical area, which can make it difficult for some families to get to Kimberworth. Being able to offer sessions out in the community can therefore make a big difference to families, in terms of travel and time costs. One barrier that makes this challenging for staff, is that it can be difficult to book rooms. The process for booking family hub rooms is different to the internal room booking system. A practitioner may be on the phone to a parent, trying to arrange their next appointment, but because they do not have direct access to see if the family hub room is available at the chosen time, they are unable to confirm the appointment there and then. Instead, it requires an additional step, to check room availability, then get back to the parent. By streamlining the process for booking community rooms, patient families are more likely to get an appointment at a time and location that suits them, thus helping to reduce avoidable costs and address inequalities. Additionally, it would reduce the time practitioners spend doing this admin.

Staff:

“We can use children’s centres or family hubs in localities.”

“We try to coordinate appointments with families, but not always as much flexibility as we’d like, it depends if we can book rooms.”

“Staff will moan about not getting rooms. Here and Now sessions, only one staff does them out in the community. They use hubs… We have a room booking system, could we have family hub rooms added to that? They are all council rooms, so I would imagine they use the same system.”

Barriers with schools

While not specifically mentioned by families, this important point was raised by a member of staff. There is sometimes an issue with schools, that are unhappy about the child or young person missing time at school to attend child and adolescent mental health services appointments, and which may result in fines being given.

Families on lower incomes are disproportionately affected by these school fines, as they are less able to absorb the financial penalty compared to more affluent families. Hart and O’Reilly (2017) suggest that limited understanding of child and adolescent mental health services and mental health needs among school staff can hinder effective communication and collaboration, which may lead to inappropriate responses such as issuing fines for absences that are actually due to essential child and adolescent mental health service appointments.

“Have most problems with schools, because of missing time out of school. The parent will say ‘I get fines for leaving school.’ Will write one but it is additional work. Most often I’ll ring the school or will ask the parent to take the letter and give contact details. There is a lot of care planning. General Data Protection Regulation (GDPR) of getting through to the college. Contacting GP to put things on the system.”

Waiting times

Two families spoke of a significant wait before gaining access to the child and adolescent mental health services . From a poverty perspective, this may affect the family’s ability to claim financial support. While a diagnosis is not required to claim Disability Living Allowance (DLA), for example, delays can limit access to supporting evidence and professional advocacy, potentially making it more difficult for families to demonstrate need and successfully secure their claim.

“Diagnosed autism and ADHD in 2025, it took three and a half years to get to this appointment.”

“Generally, the main issue is navigating. We had a crisis situation a couple of months ago. Getting in was the issue. It was a bad situation, in terms of not being able to access talking therapies, 4 or 5 months wait.”

Recommendations for navigating and negotiating appointments

Time off work to come to appointments

• Consider expanding routine service hours, for example, until 7pm and occasional weekends. Ensure this is a service-wide policy, not dependent on individual staff flexibility.
• Offer more remote and virtual appointments where appropriate.
• Ask about availability at point of referral and allocate practitioners accordingly.
• Help families negotiate time off with their employer by providing simple appointment letters explaining NHS attendance requirement and the importance of parental involvement.

Lack of awareness of different appointment locations

• Clearly communicate all location options at first contact, possibly a list or a map.
• Routinely offer location choice, rather than waiting for parent to ask.
• Actively identify travel barriers during triage, by asking simple questions: “How will you get to appointments?” Record this and plan accordingly.
• Offer appointments all year round, including school holidays.

Staff missing appointments

• Introduce more robust communication protocols for cancelled appointments.
• Establish clear expectations for staff, and monitor and review at team level.
• Where disruption is unavoidable, always try to prepare the child in advance.

Difficulty booking community rooms

• Add family hubs, children’s centres, and council rooms into the same digital booking system used internally.
• Provide real-time visibility of availability.
• Ensure clinicians have permissions to view and book community rooms directly.
• Make it standard practice that appointments are booked and confirmed during the same call or contact.
• Allocate protected room slots for child and adolescent mental health service use.
• Embed in service policy that community delivery is not an optional extra, but is a core equality and access measure.

Barriers with schools

• Review any current formal agreements with schools.
• Consider establishing new formal agreements to recognise child and adolescent mental health service appointments as authorised absences.
• Provide standardised child and adolescent mental health service appointment letters for schools, to include appointment confirmation, contact details for verification, and ensure letters explicitly state that “This appointment should be treated as authorised absence”.
• Communicate directly with schools where needed (with parental consent).

Waiting times

• Consider offering group programmes and online tools and resources while families wait.
• Strengthen alternative pathways, such as voluntary sector services and mental health support teams.

Page last updated: November 09, 2026

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