Skip to main content

Poverty proofing Doncaster child and adolescent mental health services 2025

1 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.

2 Poverty proofing Doncaster child and adolescent mental health services

The poverty proofing audit for Doncaster child and adolescence mental health services (CAMHS) began in April July 2025 to better understand the experiences of families and individuals who are living in poverty. The services also included were the CAMHS Crisis team and Intensive Community Support team (ICST) who offer support to CAMHS services in North Lincs and Rotherham.

The Doncaster child and adolescence mental health service is made of the following teams.

  • Getting help: multi-disciplinary team contributing towards assessments and providing evidence-based treatment and interventions to children, young people and families accessing support from our service. Getting help pathway offers treatment for children and young people at the early onset of emotional and mental health difficulties. We might be able to help a child or young person if they are worried about their mental or emotional wellbeing.
  • Getting advice: the getting advice pathway provides a single point of access consultation and advise point for young persons, their parent and carers.
  • Mental Health Support team.
  • Children in care: work with looked after children, care Leavers, and their carers to promote health and wellbeing.
  • Intellectual disabilities: the service assesses and treats children and young people aged 0 to 18 who have a significant intellectual disability and additional complex behavioural or mental health needs.
  • Community eating disorders: is a specialist service which assesses and treats children and young people aged 0 to 19. The service treats children and young people with eating disorders including anorexia nervosa, bulimia nervosa, binge eating
  • Crisis team: help to offer support to children who present in mental health crisis. The service is available 24 hours a day, 7 days a week.
  • Intensive community support: offer an alternative to tier 4 mental health facility admissions. They provide intensive community-based mental health support and therapeutic interventions when needed. it helps young people stay at home and avoid crisis situations. For those needing tier 4 admission, the service ensures close coordination to shorten inpatient stays and offers continued support after discharge. The intensive home treatment service focuses on risk management and providing support to the young person and their family, using therapeutic approaches when appropriate. It ensures regular consultation and advice, with information shared among professionals involved in the young person’s care.
  • Psychological therapies: offers service to 5 to 18-year-olds following assessment through approaches such as compassion focused, cognitive behavioural, cognitive analytic, art, family and child psychotherapy.

The work was conducted in partnership with staff, families, and young persons to build up a rich picture of the barriers and challenges faced by those accessing Doncaster Doncaster child and adolescence mental health service (CAMHS). Due to the nature of the service, Crisis team and intensive community support it was advised it would be better for the wellbeing of the patients and families that no consultations be sort from those presenting in crisis. While this was the case, service leads assured that those using the service may have come through via crisis referrals, so their voice would still be captured.

Doncaster CAMHS is mostly based at Crystal Building on the Tickhill Road Site DN4 8QN. The service provides mental health assessment, therapy and interventions for children and young person’s up to the age of 18 years. Support is also offered to their families and carers when their child or young person is experiencing emotional or mental health difficulties. The care pathways available include psychological therapies, intellectual disabilities, easting disorders and support for children in care and this is provided by a multi-disciplinary team who offer support provide help and advice. The service utilises other bases within Doncaster city centre for their crisis and intensive community support and in Conisbrough for the eating disorders. The team also work out of GP surgeries within Doncaster.

According to the Indices of Multiple Deprivation Doncaster is ranked 37th most Deprived (from 317) local authorities in England in the 2019 English Indices of Multiple Deprivation (IMD) where one is the most deprived and 317 is the least deprived. This is a rise of five places from forty-two in the previous IMD of 2015. The overall rank of Doncaster in the Indices has remained much the same over a 15-year period following IMD’s in 2004, 2007, 2010, 2015 and 2019 with the average rank over those studies being forty. Doncaster is in the top 20% most deprived local authorities in England. Sixty percent of Doncaster population live in areas ranked in the “most” deprived or “worse than average” quintiles. The data collected in 2024 is due to be released in late 2025.

Key findings from a Mind report of August 2021 tells us:

“There’s still a lot of shame about money and mental health. Many feel mental health is a white, middle-class conversation they can tap into.”

In addition, the impact of child poverty is severe affecting children’s health, wellbeing and future economic opportunities (Joseph Rowntree Foundation, 2025) and what is more concerning is that child poverty is continuing to rise (Mallorie, 2024).

3 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.

3.1 Voice

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

3.2 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.

3.3 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?

4 Poverty proofing process

4.1 Stage 1: training and consultation with staff

Staff were invited to attend the 3-hour training on poverty proofing in between July and August 2025 and 32 staff members attended. Further offers are available to attend training in any future dated session already planned

4.2 Stage 2: scoping

Time was spent gathering information about the setting and how it works. This stage included conversations with staff and management, observing interactions and reviewing key areas such as the website and communications.

4.3 Stage 3: patient and community consultations

We spoke to five people who use the service. We spoke to eight staff who work in the service. We also managed to receive survey 29 completed by patients, family, or carers and 31 from staff.

4.4 Stage 4: feedback session

A feedback session was held with Naomi Handley-Ward, Service Manager for the Child and Adolescent Mental Health Service) and Lucy Hammond, Service Manager for Crisis and Intensive Community Support, where findings were discussed, and changes were collaboratively discussed that could be implemented. We then produced this final report.

4.5 Stage 5: review

Around 12 months after completion, the trust will complete a review, identifying impact, good practice and potential considerations moving forward.

5 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 Doncaster child and adolescent mental health services were:

  • communication
  • health-related costs
  • navigating and negotiating appointments
  • patient empowerment
  • staff awareness and guidance
  • travel and transport

5.1 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.

5.1.1 What works

5.1.1.1 The service is welcoming

The people using the service when asked if the service was welcoming majority agreed to and strongly agreed t this question. The was strong positive feedback about the staff attitude, approachability and helpfulness, many respondents used the word such as:

“Friendly.”

“Helpful.”

“Welcoming.”

“Kind.”

“Accessible.”

“Some staff are welcoming and kind.”

“Because they made it easy to communicate an information was passed around easily.”

“Staff are always helpful.”

5.1.1.2 Lines of communication

The service uses face to face, virtual and telephony line of communication and as clinicians manage their own diaries. It means calls into the services are usually responded to promptly and they are usually to relay a message relating to agreed appointments. When it comes to appointment multiple communication channels are offered based on preference and access to digital.

5.1.1.3 The service can identify poverty

Staff who work at Doncaster child and adolescent mental health service (CAMHS) responded that as a service they can identify if their child. Young person or family maybe experiencing poverty. This is though judgement of staff but also thorough using verbal screen in part of assessments.

“When a patient s admitted we find ourselves having to fill in forms and apply for benefit on the patient’s behalf.”

5.1.2 Barriers and challenges

5.1.2.1 Lines of communication

While there is varied lines of communication on offer there were some respondents who asked for clearer signposting. This was through having more standardised or easy read summarises to be shared with families after contact.

“Sometimes they just don’t fill in the forms and we wouldn’t know why.”

There are times when translation services may be required for an appointment, but these have been seen to be unreliable in some instances especially where phone interpreters don’t turn up, there is poor connection. It would be beneficial to explore what the feedback is for those patients who had requested the use of an interpreter what their experience was like. This can also be the case where messages need to be relayed to staff or who messages are passed on to when named clinicians are off duty.

“The translator didn’t turn up. We were there, but the translator wasn’t.”

“Being able to relay messages to staff is important and diverting them when a staff member isn’t around is crucial to ensure continuity of care.”

5.1.2.2 Digital access

While service can offer appointment via digital means. Not all patient shave access to this easily; with some missing appointments due to this. It would be beneficial to explore how this can be offered especially where young person may be in school where they have access to Wi-Fi and would need a private space to have their appointment is allowed during school hours.

“Sometimes I don’t have the bus-fare or the data to have the appointment.”

“If you don’t have Wi-Fi…. that’s another barrier.”

5.1.3 Recommendations for communication

5.1.3.1 Lines of communication
  • Develop easy-read printed packs on benefits, entitlements, and local support.
  • Provide support on from filling or a guide on how to complete forms. This can be audio or visual for increased accessibility.
  • Ensure reception and waiting area leaflets match what staff say.
  • Ensure staff better understand the out-of-office task diversion system to avoid delay in responding to patients.
  • Service to monitor experience with the new translation service provider and use appropriate feedback channels to ensure issues are tackled.
5.1.3.2 Digital access

Explore options on how to offer digital appointments better.

5.2 Health related costs

“Money buys goods and services that improve health; the more money families have, the more or better goods they can buy.” (Joseph Rowntree Foundation, How does money influence health? 2014).

The Food Foundation (2023) found that in order for the poorest fifth of the population in the UK to meet the Government recommended healthy diet guidance they would need to spend half of their disposable income, compared to just 11% for the least deprived fifth.

A study by the Centre for Mental Health UK found from the young people the spoke to on the emphasis on further work is needed to improve the mental health, support available including action to address waiting times to expand mental health services to increase funding (Centre for Mental Health, 2024).

5.2.1 What works

5.2.1.1 Cost to patients

Very few survey respondents reported directly paying for items, with a few sharing that they occasionally buy extra medicines and equipment. However, 37% of respondents when asked what more the service could do selected “Provide more financial help” which can be seen as a clear sign on need.

5.2.2 Barriers and challenges

While generally prescription cost for children and young persons are free. A theme forms the lack of knowledge on the support available with the NHS. Considering that some of the patients may transition into adult service to be able to have knowledge of that is on offer can have future benefit. Over half of the respondents indicate that the service should in support of patients facing financial barriers provide

“Better communication and Outreach.” This was asked as.

“Certainly, around what other recourses are available in the community is always good to know.”

“General information on services and support options and help available.”

“General Financial help available.”

5.2.2.1 Staff awareness

While staff indicated that they were aware on how to identify those that may be experiencing poverty, some staff expressed a lack of awareness on how to support or signpost patient.

“It’s not something I would be familiar with… healthcare cost schemes.”

5.2.2.2 Cost to patients

Because of patient’s support needs there are times that clinician can suggest the purchase of lockable safes for medication and sharps safety.

“We do recommend… a lock box with medication… overdose experiences are significantly reduced.”

5.2.3 Recommendations for health related costs

5.2.3.1 Health related cost
  • Routinely give families information about prescription prepayment schemes, hardship funds, or local welfare support in the discharge or aftercare pack.
  • Explore NHS provision of lockboxes as part of safeguarding practice.
5.2.3.2 Financial support
  • Create a small hardship fund or voucher scheme for urgent medication, travel, or food for families in crisis.
  • Provide clear signposting to prescription prepayment, local welfare, and Citizens Advice.
  • Empower staff by providing information about benefit and support potentially available to young people and families.

5.3 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.”

5.3.1 What works

5.3.1.1 Waiting times

Referral into the into Doncaster Child and Adolescent Mental Health team are triaged by the getting help team. There has been a significant reduction in waiting times which is presently between four and eight weeks. When patient is transferred into the respective team the waiting time us under four weeks for eating disorders, Intensive community support, crisis, intellectual disabilities and children in care.

“When the service was transformed a couple of years back, this helped to be able to risk manage and allow for patients to be seen quicker.”

5.3.1.2 Appointment location and times.

Most of the appointment are at Crystal Building on Tickhill Road site. Staff and patients also spoke of appointment being offered at home, school, family hubs, with the aim to reduce travel or maximise appointment time allocated.

“We can complete school visits rather than expecting families to travel to clinic and even run clinics in schools, we offer appointments by phone or teams where appropriate if this is more accessible.”

5.3.2 Barriers and challenges

5.3.2.1 Appointment locations and times

While flexibility on location and times for appointment is available during weekdays from 8am until 6pm time is still as a barrier.

“It’s not every time I can get time off from work to bring… to an appointment. If the service was available till 8pm it would be better.”

A theme emerged around the places to offer appointment which focused on the unsuitability of some home environments for appointment to take place there. While it was sometimes seen to be beneficial to get a better insight into the family dynamic to be able to offer support to family some staff found going beyond their remit.

“I’ve taken people to get food parcel in the past, when they’ve had no food.”

5.3.2.2 Complex health systems

When staff were asked which poverty-related barriers apply to patients accessing services eleven staff members informed, complex health systems (difficult to navigate, referrals appointments et cetera). This indicates a need to make the services easer to navigate through relevant information shared with young people and their families.

“Offering appointments outside of school or worktime after 5pm.”

“More accessible appointment location. Supporting families to access appointments in working hours and, or offering out of working hours appointments.”

“My children are under a few services so when I get a message reminding me of an appointment sometimes it doesn’t specify which child or which service.”

5.3.2.3 Referrals and discharge

Self-referrals are available on-line or referral can come from school, GP or other healthcare professional. Some staff explained that when parent visit the GP, they are told to go directly to the service to refer and when they don’t have access to data to be able to do the self-referral they end up going round in circles due to miscommunication.
While some referrals make it over the threshold to be able to interact with the service can be difficult to arrange and require multiple attempts. Due to the policy for discharge some patients end up in a revolving door scenario of being discharged before being seen.

“It took three referrals and discharges before we eventually got seen.”

5.3.3 Recommendations for navigating and negotiating appointments

5.3.3.1 Complex health systems
  • Clear messaging reminders on appointment.
  • Consider standardised text reminders for appointment to include patient name and service from.
5.3.3.2 Appointment times
  • Consider having set days when the service can have provision until 8pm.
  • Use family hubs or community centre when homes not suitable for appointment.
5.3.3.3 Referrals
  • Dedicated phone line for self-referral which has professional trained to only take referral details to then be passed to a triage system.
  • Referral training to professional.
  • Track referral and discharge data where there are failed appointment and re-referrals.

5.4 Patient empowerment

Being in poverty can be hugely disempowering and contribute to reduced literacy skills (Literacy Trust, 2012), lower educational attainment, lower levels of confidence and less engagement with health behaviours and healthcare (Sheehy-Skeffington and Rea, 2017). Services can support this by tailoring support to different education and literacy levels, working alongside patients and families to build health literacy and confidence in managing their health as independently as possible and ensuring there are opportunities to share their views and shape services.

5.4.1 What works

5.4.1.1 Patient feedback

Scoping Crystal building showed that ways to provide feedback were displayed. When speaking to one family it was raised that it would be capture the children or young person’s perception of the space or experience of being in the space. One family described the reception space and “calm and quiet environment”.

“The staff are friendly and helpful.”

“The people at the desk are very nice.”

5.4.1.2 Care continuity

Families when asked to spoke of how great it was to see the same clinician in most contact situations. This helps create a rapport and provides continuity of care.

“Nurse B has been understanding with X always works with us to make sure we see her.”

“The service was quickly available to us and super accommodating… liaised with myself when needed.”

5.4.2 Barriers and challenges

5.4.2.1 Patient feedback

While quick response (QR) code feedback was offered it was widely underused. Staff shared that there seemed to be a preference form parent to buy cards or write letters with messages of gratitude. What did concern staff was that if their service was to be rated on feedback that only came through via Care opinion this would mean that a lot was being missed

“We have a QR code… on every wall… but I don’t think we get anywhere near the response.”

“If a parent has taken the time to buy a thank you card… for us to them to have to put it into ‘Care Opinion’, that could be a good way to capture patients’ opinion.”

Some parents voiced that the waiting area has a television advert the service should be using that to share more information about the services as there were no leaflets available that they could use for light reading while waiting. When a relating question was asked to staff one staff member shared.

“I don’t really know what’s in the waiting room… I’ve never taken any notice.”

5.4.2.2 Care continuity

While it is clear that continuity of support is there, while still under the service a theme came up in relation to children in care; and how when they come to transition some are unsure about what that looks like. When asked about things that the service could change for those experiencing poverty a response was captured of:

“This is not so relevant to our service in that foster carers and other key workers attend with the children we see.”

It can be deduced form this that while they are getting support while still in care, there is uncertainty of what life after care looks like for them and this might require exploration.

5.4.3 Recommendations for patient empowerment

5.4.3.1 Patient feedback
  • Provide child friendly feedback options. Emoji buttons and short forms.
  • Device a service information channel which can serve to provide more information, provide answers to common questions and offer entertainment and distraction in waiting periods.
  • Get written cards and letter of gratitude added to formal your opinions.
  • Reintroduce paper feedback option in waiting areas alongside quick response (QR) codes.
5.4.3.2 Continuity of care

Provide more bespoke support to those about to leave care or care leavers. This can also be linked to promise 9 of the Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH) promises.

5.5 Staff awareness and guidance

This theme is around identifying the social and economic needs of patients and giving holistic care so that they can be fully supported. Research has shown that those living in England’s most deprived areas tend to receive the worst quality healthcare, for example with longer waits and worse experiences accessing appointments (O’Dowd, 2020). Patients will have different needs depending on individual, demographic, systemic and social needs, and countless other factors.

5.5.1 What works

5.5.1.1 Staff awareness

As mentioned previously above evidence from the feedback that staff can recognise if patients are experiencing poverty and go above and beyond to support patient experiencing poverty challenges. Staff informed that their services do have ways to identify if a patient is experiencing poverty through:

“Formal financial screening tools that are routinely carried out.”

“Judgements of staff.”

Also, when they have realised this some have referred families on for additional support or have gone above and beyond themselves

“Recognition that staff often finance secretly patients travel, food etc. Staff do not claim this back as it goes beyond the trust’s stance.”

“I have a working understanding of services that I can signpost to or food banks.”

5.5.2 Barriers and challenges

When staff were asked if people accessing the service would experience any poverty-related barriers, staff reported:

“Staff Awareness (staff unaware or unequipped to help).”

This is an indication of the need for staff to have additional support to know what is available and where they signpost. While some staff say they know how to do this.

“We do signpost and make referrals to Your Place, Food bank et cetera but then are told off for being ‘Case holders’ when we are not meant to be…”

“I’ve advised Citizens Advice before for support.”

Some also do not know where to start when faced with such a situation

“It’s not something I would be familiar with.”

When staff were asked what could better support them to support people accessing their services and experiencing poverty, they reported on signposting, accessibility of appointments, increased awareness as teams.

“Maybe a small handout explaining what they could get help with given at first appointment.”

“Have lots of information available to signpost to feel that we are able to positively make a difference to our service users.”

Another theme that came out is in relation to the staff support. As above where previously mentioned that staff get to pay for items for patient out of their own pocket but not claim back. There is also how the mileage claim process is seen not to be beneficial to some staff.

“Ways of accessing funds before pay day. The mileage system is relatively difficult to complete, and I believe does not compensate staff sufficiently.”

5.5.3 Recommendations for staff awareness and guidance

5.5.3.1 Staff awareness and support
  • Review mileage and payroll system that may disadvantage low paid staff or look into system that can support.
  • Increase staff awareness of financial support options and this can be achieved through a developing a poverty proofing toolkit (schemes, benefits, cost support, food banks).
  • Offer regular training on cost-of-living support which can be part of the learning half days.
  • Refer people to Citizens Advise Doncaster for income benefits check the link in the references.

5.6 Travel and transport

Healthwatch UK (2019) showed that travel is a key issue for people, with 9 out of 10 people consulted saying a convenient way of getting to and from health services is important to them. Difficulties with transport were also identified as a common reason that people will miss appointments. There is a phenomenon known as the poverty premium, where those with less money end up having to pay more for essential items, which further perpetuates the cycle of poverty. For some families (who do not have access to a car) public transport and taxis are more expensive than it would be to drive.

5.6.1 What works

5.6.1.1 Home, community and school visits

Several staff shared that they offer visit at home or school or in the community to support families, on the financial burden they might incur by having to attend clinic appointments.

5.6.1.2 Free car parking

For those who attend appointment at Crystal building there is free car parking available. This does not have a time limit, however finding a space can sometimes take time

5.6.2 Barriers and challenges

5.6.2.1 No awareness of NHS Health Travel Cost Scheme

For all the patient survey responses received there was none which showed an awareness of the travel reimbursement schemes that are offered in the NHS. Staff when asked poverty related barrier that may be experiencing their patient from accessing their service over 75% indicated that travel and transport (cost of parking, public transport, taxi’s) as being an area of concern.

“We used to give bus fares back to them… we used to get taxis for them, but we’ve been asked not to do that anymore.”

5.6.2.2 Travel as part of treatment

For some patients who are receiving therapy treatment this might require the travel to participate in exposure tasks (for example, phobia work going to a park, shops).

“Travel is a barrier to treatment, particularly where therapy involves community exposure tasks.”

5.6.2.3 Parking charges

Some patients shared that they must pay for parking at some of the other locations used by the service in some cases struggling to find where to park, with some indicting not knowing how long they would have to park for.

“Main issue is lack of parking facility.”

“They have provided meals and transport to my meetings before.”

There is a shed concern on parking charges with staff as they informed that there is an upcoming relocation to Doncaster Town Centre which will likely introduce parking charges for staff and increased financial pressure.

5.6.3 Recommendations for travel and transport

5.6.3.1 Travel cost
  • Provide clear information on the NHS Travel reimbursement schemes.
  • Sharing in appointment letter is parking is free or paid and giving an indication of length of appointment.
  • Source any charities that may be linked to exposure therapies that may offer support and cover travel cost.
  • The service to offer free bus passes where appropriate for patients to be able to attend appointment (information available on the staff intranet).

6 References

Page last reviewed: December 24, 2025
Next review due: December 24, 2026

Problem with this page?

Please tell us about any problems you have found with this web page.

Do not include personal or medical information in your message. For example, NHS number, date of birth or medical history.

If you would like us to contact you about your issue, please enter your contact information below.