1. Implementing service transformation in a recession environment:
findings from a qualitative evaluation of Children and Young People IAPT (CYP IAPT)
Aris Komporozos-Athanasiou and Louise Lafortune*, University of Cambridge
Background
•DOH1
aims to expand Children and Adolescent Mental
Health Services (CAMHS) to cover 60% of children and
young adults in England by 2016, through “whole system
transformation” powered by staff and managers training
in evidence based practice, and routine outcomes
measure (ROMs).
•Five Learning Collaboratives made up of local CAMHS
partnerships (composed of NHS trusts, local authorities,
voluntary sector organisations) and Higher Education
Institutes have been set up to make this happen. And
expansion is ongoing, with new partnerships being
formed across the country.
•In the context of an economic recession, the dual
challenge for the NHS is to transform CAMHS while
managing the increased strains placed upon those who
deliver (transforming) frontline services.
NIHR CLAHRC
Cambridgeshire & Peterborough
Con
References
1. DoH 2010 / 2. Doh 2012 / 3. Exworthy 2012 / 4. Pettigrew 1988 / 5. Dopson
2003 / 6. Census 2011 / Ferlie 2013.
*Contact: Louise Lafortune at ll394@medschl.cam.ac.uk
Objective & approach
•According to DoH2
, this challenge can be addressed
through ‘sharing the success stories’ and through
demonstration of the value of CYP IAPT, especially from
the perspective of service users & frontline staff.
•We conducted a case study to examine how the shift
towards an evidence-based environment and a focus
on ROMs is negotiated in practice with other aspects of
clinical work within the service, such as organisational
culture, teamwork, and service user involvement.
•This work is part of a comprehensive evaluation, which
looks at the implementation, outcomes and cost of CYP
IAPT.
Findings
Perceived problem 1: Lack of buy-in from front line staff
& low morale as a result of continuous organisational
changes, cost cutbacks.
Emergent solutions:
•Transformation should be operationalized in
organizational governance (not as abstract concept)
•CAHMS managers should better engage with staff’s
concerns around how IAPT data is used in relation to
‘performance management’
•Reporting systems should be easy to use by staff
Conclusions
Our case study highlighted specific tensions that should be
addressed for transformation to succeed. We suggest that
more attention be paid to the cultural meanings of
implementation and the emerging realities of networked
governance that are needed in CYP IAPT.
Methods
Theoretical framing
•We conceptualize transformation not simply in relation to
‘clinical practice’ but also as a change in dominant
ideologies, the underlying cultural systems of meaning,
and the shifting power relations within the service.3-5
Design
•Interpretative case study at the CAMHS in Cambridge
(Dec 2012 – June 2013); part of the UCL/KCL Learning
Collaborative which covers an estimated population of
1.3M aged 0-19 years.6
Data sources
•Document analysis of CYP IAPT guidance notes,
implementation records, meeting agendas and minutes
covering a period of 18 months.
•In-depth interviews (n=11) with key stakeholders (Trust
and clinical managers, consultant psychologists, CYP
IAPT trained staff, voluntary representatives).
•Non-participant observation of meetings and related
events (n = 6); and informal discussions.
Findings
Perceived problem 2: Collision of ethos between the
multi-partnership and multi-agency culture of IAPT and the
structure of health authorities resulting in the latter loosing
touch of day-to-day enactment of transformation.
Emergent solutions:
•(Some) members of the executive should be part of
transformation steering boards
•Efficient integration of stakeholders from the voluntary
sector, schools and commissioning groups
•Establishing and maintaining informal communication
channels alongside formal meetings is very important
Perceived problem 3: Conflict between evidence-based
requirements and requirements of day-to-day clinical
practice (e.g. appropriateness of ROMs re severity;
perception of relevant ROMs varies among clinicians)
Emergent Solutions:
•Embed conversations about putting ROMs into practice in
team meetings to promote collaboration, discussions
around the meaning and importance of different types of
evidence.7
•Establish a clear mandate for service user involvement.