An Integrated CAMHS Pathway
Liverpool CAMHS Partnership
Lindsey Marlton
CAMHS Service Manager
Alder Hey Children’s NHSFT
L...
Need:
• Approx. 100,000 c&yp
• Liverpool is 1 of the most deprived
cities in UK
• High proportion of LAC, young
cares, c&y...
Liverpool’s CAMHS Partnership
•
•
•
•
•
•
•

Needs led
Family centred
Multi-agency – range of providers
Provides continuum...
The journey
In-patient
provision

Pre-2003
Alder hey
community
mental health
teams

2+1
service, Al
der hey
Providers:

Commissioners:

Outcomes:

Alder hey
Foundation
Trust –
Community
Mental health
teams
Regional
units

Liverpoo...
Regional In-patient Units:

2003-2006
SLD team
CAMHS tier 3
community teams,

Working Together
HAVEN

CABI
YPAS counsellin...
Providers:

Commissioners:

Outcomes:




Alder Hey
(many teams)
VCS:
YPAS
Regional
units

Liverpool PCT
Liverpool City
...
Regional Home Based
Treatment

Regional In-patient Units:

2007-2010
SLD team

YOS mental health
provision
CAMHS
16-18 tea...
Providers:

Commissioners:

Outcomes:




Alder Hey
(many teams)
VCS:
YPAS, PSS, B
arnardos, MY
A
Regional
units and
HBT...
Comprehensive CAMHS Pathways 2010-2013
C&YP
&
Families

Training:

Public
Mental
Health
Self-care,
Website
Mental
Health
p...
Providers:

Alder Hey
(2 teams with
SPA)
VCS:
YPAS, PSS, B
arnardos, MY
A
Regional
units and
HBT

Commissioners:

 Liverp...
Liverpool’s CAMHS Partnership
Performance Monitoring:
• Activity – CAMHS returns/National data
set/national benchmarking
•...
Liverpool’s CAMHS Partnership
CTB structures and CCG Governing Body
MHEWB Partnership Board
MHEWB Operational Delivery Gro...
Liverpool’s CAMHS Partnership
So What??
• Reduction in specialist CAMHS referrals
from 11/12 to 12/13
• 90% of those acces...
Liverpool’s CAMHS Partnership
•

•
•
•
•
•
•

All providers using CORC measures- session by
session pilot
VCS all quality ...
Liverpool’s CAMHS Partnership
Challenges:
• Professional hierarchy
• Funding
• Restructure

2 out of 3 overcome!!
Liverpool’s CAMHS Partnership
Providers Perspective:
Challenges:
•
•
•
•
•
•

A new way of doing things
Professional snobb...
Liverpool’s CAMHS Partnership
Providers Perspective:
How did we address the challenges?
• Forged relationships (initially ...
Liverpool’s CAMHS Partnership
The Providers Perspective:
How have we overcome the challenges?
•
•
•
•
•

Joint training op...
Liverpool’s CAMHS Partnership
Providers Perspective:
Where are we now?
• Multi-Agency SPA: supported by Partnership
Agreem...
Liverpool CYP IAPT Partnership

Value added strengths to the Partnership:
YPAS:
ADHDF:
Alder Hey:
Liverpool CCG:
Liverpool...
Liverpool’s CAMHS Partnership
The Providers Perspective:
Sustainability:
• Embed CYP IAPT into core practice
• Invest in s...
Why CYP IAPT in Liverpool?
• Liverpool is a unique city with diverse needs
• Offer CYP and families greater choice
• Impro...
What it will look like ?
Our vision: Virtual Single Point of Access

CHOICE
APPOINTMENT
COMMUNITY
CLINICS

Inappropriate
r...
Next steps:
• Recruit back fill to posts (Dec 2013)
• Release supervisors and trainees for training (Jan 2014)
• Service t...
Future Aspirations
Sustainability:
• Embed CYP IAPT into core practice
• Invest in staff training, recruitment retention –...
Liverpool’s CAMHS Partnership
WHAT NEXT?
Liverpool CAMHS
Outcomes Strategic
Map and Pathway
Improved mental health of
Children & Young People
[& their Families]

I...
GAPS:
• Transition – CAMHS to AMHS and Tier 3-4 pathway
• Early years and maternal mental health
• Neuro-developmental pro...
Future Challenges:

•Integrated commissioning – funding
•Integrated care – culture, personalities
•Changing NHS – relation...
Future Opportunities:
• Integrated commissioning and care
• CCG and LCC priorities
• Liverpool’s children and young people...
2014-2017 strategy:
Joint commissioners

Range – VCS,
independent and
statutorypartnership

UNCRC
Working Together to ensu...
Thanks for listening !!!!
Any Questions !!!!!!!
Lindsey Marlton
Lindsey.marlton@alderhey.nhs.uk

Monique Collier
monique@y...
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An integrated care pathway – CAMHS and counselling working together-Liverpool CAMHS partnership and Professor Mick Cooper

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An integrated care pathway – CAMHS and counselling working together-Liverpool CAMHS partnership and Professor Mick Cooper

  1. 1. An Integrated CAMHS Pathway Liverpool CAMHS Partnership Lindsey Marlton CAMHS Service Manager Alder Hey Children’s NHSFT Lindsey.marlton@alderhey.nhs.uk Monique Collier CEO Young persons Advisory Service monique@ypas.org.uk Lisa Nolan Programme Delivery Manager (Children and Maternity) Liverpool CCG Lisa.nolan@liverpoolccg.nhs.uk
  2. 2. Need: • Approx. 100,000 c&yp • Liverpool is 1 of the most deprived cities in UK • High proportion of LAC, young cares, c&yp with disabilities, BME communities and refugee and asylum seekers High risk factors therefore mental health problems likely to be high Tier Number 1 12828 (15%) 2 5986 3 1582 (1.85%) 4 64 (7%) (0.075%) Main presenting problems: - Emotional disorders, behavioural and self harm Adverse Childhood Experiences: - physical, emotional, sexual abuse, domestic violence, household substance misuse, household mental illness, parental separation and divorce, parent in prison Main referrers: - Education, child health services, GP L4, L8 and L6 postcodes account for 27% of referrals
  3. 3. Liverpool’s CAMHS Partnership • • • • • • • Needs led Family centred Multi-agency – range of providers Provides continuum of care with targeted support Engaging, Involving and inclusive Jointly commissioned Strong How did we get here?
  4. 4. The journey
  5. 5. In-patient provision Pre-2003 Alder hey community mental health teams 2+1 service, Al der hey
  6. 6. Providers: Commissioners: Outcomes: Alder hey Foundation Trust – Community Mental health teams Regional units Liverpool Health Authority Not monitored or reported
  7. 7. Regional In-patient Units: 2003-2006 SLD team CAMHS tier 3 community teams, Working Together HAVEN CABI YPAS counselling Tier 2 BEST YPAS Support Service ‘Mad, Bad or Misunderstood’, AS Pathway
  8. 8. Providers: Commissioners: Outcomes:   Alder Hey (many teams) VCS: YPAS Regional units Liverpool PCT Liverpool City Council      Dev. of choice Less stigmatising provision New ways of working More community based provision Joint and partnership working Emerging performance monitoring process Policy driven
  9. 9. Regional Home Based Treatment Regional In-patient Units: 2007-2010 SLD team YOS mental health provision CAMHS 16-18 team Working Together CAMHS tier 3 community teams, CABI CAMHS LAC YPAS counselling AS Pathway HAVEN BEST Tier 2 YPAS Support Service TAMHS, MYA ADHD Foundation Participation team, MYA Banardos Young Carers & ‘Keeping the Family in Mind’ Training and MH Promotion: ‘Mad, Bad or Misunderstood’, Healthy schools Partnership, Mental health promotion
  10. 10. Providers: Commissioners: Outcomes:   Alder Hey (many teams) VCS: YPAS, PSS, B arnardos, MY A Regional units and HBT Liverpool PCT Liverpool City Council Social Care       Dev. of choice Less stigmatising provision New ways of working More community based provision Joint and partnership working participation Thinking family Improved performance monitoring process Policy driven
  11. 11. Comprehensive CAMHS Pathways 2010-2013 C&YP & Families Training: Public Mental Health Self-care, Website Mental Health promotion Provider: voluntary CAMHS and c&yp Universal services Tier 4 Dewi Jones Unit (0-14) MBM Inside Out, Master class Mental health first aid Specific training Consultation & support: Telephone, individual, group Alder Hey Single Point of Access Triage (multiagency) Provider: Voluntary CAMHS Statutory CAMHS (Primary Mental Health Service, Specialist CAMHS) Tier 4 YPC (1418), CHEDS Tier 4 OAT (Independ ent Sector) Voluntary Sector CAMHS (YPAS, ADHDF, PSS, Banardos YC) AHCFT 0-16 years Out of Hours Psychiatry Mersey Care 16 plus care aims methodology Other services (signposted)
  12. 12. Providers: Alder Hey (2 teams with SPA) VCS: YPAS, PSS, B arnardos, MY A Regional units and HBT Commissioners:  Liverpool PCT/CCG • Liverpool City Council • Schools • Social Care Outcomes:        Dev. of choice • Single point of Less access stigmatising  Multi-agency provision triage and New ways of working working  More accessible More information community  Consultation based provision and training Joint and accessible to partnership frontline working provision participation Thinking family Robust performance monitoring process
  13. 13. Liverpool’s CAMHS Partnership Performance Monitoring: • Activity – CAMHS returns/National data set/national benchmarking • Outcomes – CAMHS returns/ CORC • Quality – CAMHS Returns/ Contract visits / COR
  14. 14. Liverpool’s CAMHS Partnership CTB structures and CCG Governing Body MHEWB Partnership Board MHEWB Operational Delivery Group (ODG) FYI SPA development IAPT project Board Tier 3/4 pathways Transition Participation Equalities MHP and Training
  15. 15. Liverpool’s CAMHS Partnership So What?? • Reduction in specialist CAMHS referrals from 11/12 to 12/13 • 90% of those accessing services showing improvement in mental health (CORC) • 90% high satisfaction with services (CORC) • Increase year on year of universal staff accessing training
  16. 16. Liverpool’s CAMHS Partnership • • • • • • • All providers using CORC measures- session by session pilot VCS all quality assured Choice of provider Built local workforce – range of interventions Strong equalities agenda Strong participation agenda Focus on early identification and prevention IAPT ready
  17. 17. Liverpool’s CAMHS Partnership Challenges: • Professional hierarchy • Funding • Restructure 2 out of 3 overcome!!
  18. 18. Liverpool’s CAMHS Partnership Providers Perspective: Challenges: • • • • • • A new way of doing things Professional snobbery/hierarchy Competition for Funding Lack of awareness No relationships Phase 2 CYP IAPT Application rejected
  19. 19. Liverpool’s CAMHS Partnership Providers Perspective: How did we address the challenges? • Forged relationships (initially commissioner driven) • Joint development and facilitation of training for the children’s workforce: Mad, Bad or Misunderstood, CAMHS Master Class • Active involvement in the development of the Comprehensive CAMHS pathway – knowing where we fit
  20. 20. Liverpool’s CAMHS Partnership The Providers Perspective: How have we overcome the challenges? • • • • • Joint training opportunities Collaborative working Learning from our mistakes Respect and appreciation for varied disciplines Relationships, Relationships, Relationships!!
  21. 21. Liverpool’s CAMHS Partnership Providers Perspective: Where are we now? • Multi-Agency SPA: supported by Partnership Agreements and Honorary Contracts • Working collaboratively to fulfil existing service requirements • Working collaboratively to secure new service development opportunities • Embracing CYP IAPT and the opportunity for further service transformation
  22. 22. Liverpool CYP IAPT Partnership Value added strengths to the Partnership: YPAS: ADHDF: Alder Hey: Liverpool CCG: Liverpool City Council : Access, Innovation, MDT and Participation Creative Pathway Development Clinical Expertise and Innovation Involving Patients & Public in all we do Prioritising the most vulnerable
  23. 23. Liverpool’s CAMHS Partnership The Providers Perspective: Sustainability: • Embed CYP IAPT into core practice • Invest in staff training, recruitment retention – ensuring right people for the job • Expansion of CYP IAPT Partnership to meet the needs of the broader population • Service transformation will ‘future proof’ our partnership for changing commissioning priorities • Data captured to inform future commissioning priorities
  24. 24. Why CYP IAPT in Liverpool? • Liverpool is a unique city with diverse needs • Offer CYP and families greater choice • Improve access to Evidence Based therapies  Modality  Locality  Referral routes • Improve Health Outcomes of Children and Young People • Willing to learn from each other • Belief in the model • Belief in our Partnership
  25. 25. What it will look like ? Our vision: Virtual Single Point of Access CHOICE APPOINTMENT COMMUNITY CLINICS Inappropriate referral: signpost Alder Hey Partnership YPAS Partnership ADHD Foundatio n Partnershi p Psychologica l Therapies Support Services / IAG Training / Consultation Specialist CAMHS Psychologic al Therapies Information Advice Guidance (IAG) Meaningful and Effective Participation CYP / Parent Programme s
  26. 26. Next steps: • Recruit back fill to posts (Dec 2013) • Release supervisors and trainees for training (Jan 2014) • Service transformation begins:  Implementation of session by session ROM’s  Structures and mechanisms in place to address the GIFT participation priorities  Delivery of Evidence Based Therapies  Improved mechanisms / opportunities for self referral  Improved mechanisms for re-entry into services • Contribute to local, regional and national opportunities for shared learning Service transformation will be embedded into the very culture of our Partnership through regular MDT meetings and the development of a robust communication strategy.
  27. 27. Future Aspirations Sustainability: • Embed CYP IAPT into core practice • Invest in staff training, recruitment retention – ensuring right people for the job • Expansion of Partnership to meet the needs of the broader population • Service transformation will ‘future proof’ our partnership for changing commissioning priorities • Data captured to inform future commissioning priorities Improved Outcomes: • Further development of ROM’s • Investment in IT to enable user friendly session by session monitoring • Investment in IM&T systems to enable appropriate data capture • Utilisation of data to identify need and inform service development • Children, young people and families at the heart of development and delivery of services
  28. 28. Liverpool’s CAMHS Partnership WHAT NEXT?
  29. 29. Liverpool CAMHS Outcomes Strategic Map and Pathway Improved mental health of Children & Young People [& their Families] Improved Environments so that Children, Young People & families can Thrive Increased Identification of C&YP with early indicators of distress and risks Reduction in Mild to Moderate Distress Reduction in the development of Moderate To Serve distress Alder Hey - Specialist CAMHS MYA- MHP, training and engagement Alder Hey – Early intervention (PMHS) and LAC/CIN Reduction in life long distress In-patient care – Dewi Jones (alder hey) and YPC (CWP) and OATS YPAS – therapeutic/counselling and support service PSS – refugee and asylum seekers therapeutic support ADHD Foundation Barnardos YC and KFIM Key: Delivery- public mental health, early intervention, targeted Contracts – LCC Funding- LCC/CCG/social care/schools (pooled budget) Performance managed – LCC Delivery – specialist Contracts– CCG Funding- CCG Performance managed – CCG Delivery – In-Patient (regional) Contracts– Spec Comm Funding- CCG top slice Performance managed – Spec Comm
  30. 30. GAPS: • Transition – CAMHS to AMHS and Tier 3-4 pathway • Early years and maternal mental health • Neuro-developmental problems (ASD and ADHD) • Mental health promotion • In balance in access – too many at specialist level • In balance in funding and therefore delivery – more focus on specialist than early intervention • Integration at commissioning level
  31. 31. Future Challenges: •Integrated commissioning – funding •Integrated care – culture, personalities •Changing NHS – relationship management •Economic climate and social determinants
  32. 32. Future Opportunities: • Integrated commissioning and care • CCG and LCC priorities • Liverpool’s children and young peoples/whole family agenda • Public health changes • Mental health promotion and FYI developments (participation) • Training menu • Transition • Research opportunities • Neuro-developmental pathway • Datasets CYP IAPT
  33. 33. 2014-2017 strategy: Joint commissioners Range – VCS, independent and statutorypartnership UNCRC Working Together to ensure mental health and emotional wellbeing is ‘Everybodies Business’
  34. 34. Thanks for listening !!!! Any Questions !!!!!!! Lindsey Marlton Lindsey.marlton@alderhey.nhs.uk Monique Collier monique@ypas.org.uk Lisa Nolan Lisa.nolan@liverpoolccg.nhs.uk

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