We rated Mosaic as outstanding because:

• We highlighted many areas of outstanding practice relating to integrated schools provision, holistic family work, joint assessments and responsiveness, the emergency team pathway, child exploitation work, flexibility of service, specialised training delivery, trends monitoring and staff development.

• This service has a strong focus on working with families and young people. The way the service links working with families, parents, carers, schools, children and young people is truly inspirational. There were many accounts given to the inspection team of client centred, individualised care for whole families which were difficult to report here due to anonymity, but reflect a service that has changed lives.

• The schools based team was an established part of the overall service and had workers allocated to all secondary schools in the area, including pupil referral units and other specialised facilities. This was an example of good, integrated provision with the aim of early identification and intervention for young people. Interventions used by workers were individually planned with use of appropriate tools and strategies to engage young people. Feedback for the schools based team included imaginative and sensitive ways to ensure pupils could access services confidentially.

• The family team provided a structure, evidence based service to the families. This was based on evidence that if a family could support the client effectively this will often help reduce drug related harm even if the client does not engage well in the service. Family members were assessed, had a care plan and a keyworker. They received one to one and group work sessions. Feedback about this service was positive and family members felt it improved their coping skills and family situations.

• The way teams and staff were able to work together was highly responsive. We saw examples where treatment staff had been able to attend joint reviews with schools based workers to assess risk and explain treatment options. Family team members had been able to join sessions when carers where present with treatment clients to explain what support was available. Carers had been able to attend complimentary therapies sessions whilst accompanying family members to sessions or groups.

• A pathway had been set up between the emergency department staff team and MOSAIC staff to reduce repeat attendances to the department for young people who were severely intoxicated. This intervention was proving effective but was being monitored for themes and trends with a view to improving this if possible.

• Managers had supported a member of staff to become a specialist in child sexual exploitation. All clients who were at risk were given a specialist assessment and work was carried out with them to reduce the risks of being exploited and to support clients who were being exploited. This work had started several years ago and was now firmly established across Mosaic and the wider provider team. It is testament to the service that this worker still works within the service whilst retaining responsibilities for training and education across the wider service and beyond.

• The service was highly responsive in terms of meetings clients needs. There were innovative approaches to providing integrated person-centred pathways of care, that involved other service providers, particularly for people with multiple and complex needs. Staff worked flexibly to meet clients’ needs from accessing the service through to discharge

• Clients could access services in ways and times that suited them. Clients told us that staff were flexible with their appointments and were understanding if clients had to rearrange. Staff offered appointments on two evenings a week and would arrange appointments around work and childcare needs. Clients also told us that staff were discreet when arranging appointments, particularly in schools or when making contact. Staff also offered appointments at alternative places such as the clients home or school if clients could not come to the service. Staff had continued to maintain contact and arranged sessions when clients were in residential treatment services and undergoing detoxification. Clients had been seen urgently on occasion in custody or the emergency department.

• Staff and peer mentors delivered a wide ranging number of standard and bespoke training to other agencies, including primary care staff, providers of care for looked after children, midwives and school nurses. Schools keyworkers provided training to teachers as part of in-service training and to parents as evening sessions as well as to young people as part of core education.

• Staff were actively involved in monitoring emerging trends and concerns alongside other agencies, including working with voluntary and statutory agencies. This was particularly evident in the work being undertaken by Mosaic in relation to increased use of benzodiazepines, particularly Xanax, within the local area and education and information for young people and other services about this.

• The service was safe, with sufficient well qualified staff to meet client’s needs. Staff completed comprehensive risk assessment and risk management plans. Safeguarding was treated as a priority and there were effective systems in place to safeguard clients.

• Leaders had an inspired shared purpose, strived to deliver great care and motivated staff to succeed. There was a great commitment towards continual improvement and innovation. Staff told us they were supported but also given space to be innovative and devise highly individualistic care. Staff were motivated and passionate about the work they did for MOSAIC.

We do not currently rate independent standalone substance misuse services.

We felt this was an excellent, well run service for children and young adults. Children and young adults needs were clearly at the centre of care delivery. The service continued to develop and respond to local need. There was a culture of learning and improvement throughout the service which was supported and encouraged by managers.

The service was based within a large modern building that had good health and safety arrangements. Arrangements were in place to manage environmental and clinical risks.

Staff were skilled, responsive to need and client focussed. Assessments and care plans were thorough and detailed, with clearly defined outcomes. Staff used best practice in planning treatment and care. There were evidence based psychological approaches used throughout the service and access to counselling and complementary therapies.

Staff were respectful and supportive towards clients. Service user participation and feedback was actively sought. There was an accredited training programme for peer support workers who were previous clients to work within the service. Peer support workers described ongoing support and development.

There were clear referral pathways into the service and discharge/transfer pathways, including transitional planning for young adults moving to adult services. Staff worked flexibly, offering evening appointments and treatment groups.

The service had well established links with young carers’ organisations. A therapeutic support worker had been employed to link with a local dog shelter with opportunities for dog walking and social contact.

The service had a clear organisational and team vision. Managers ensured that information about the service was communicated through the wider organisation and that information from the organisation was communicated to the team. Staff were encouraged and supported to develop skills and gain qualifications.