brief presentation which looks at how cuts in funding will impact on care pathways / re-design of CAMHS services

1. Impact of austerity on re-design
Birmingham CAMHs

2. Central components of CAMHs
re-design

3. Work to date
• Defining groups / pathways
• Process mapping
• Content analysis
• Defining content
To do
Define organisation and structure

4. Process Mapping -
what we have learnt
• Timeliness
• Inconsistency / variation – procedures,
standards
• Specific / specialist – poorly defined and
protected
• Choice / Partnership the most planned part of
our system

5. YES
•SOCIAL CARE DECISION DECISION
ERA LIASES ASSESSMENT ASSMT & RISK DECISION AWAIT GATEWAY GATEWAY
•SCHOOLS POINT POINT
WITH YES - MANAGEMENT POINT ASSESSMENT (HTT/TIER 4) ASSESSMENT
•COMMUNITY SCAP •HTT INPUT
REFERRER •WHO (HOSPITAL •REQUEST •COMMUNITY
•GP’S •TIER 4 BED
REFERRER
EMERGENCY
/ERA AND •WHEN WARD, HTT/TIER 4 ASSMT CAMHS 7 DAY
•OUT OF B’HAM & YES •EXIT
TELEPHONE •WHERE COMMUNITY, •STAY IN /COME ERA/MEDIC •JOINT PLAN
FOLLOW-UP
EXIT
IN BHAM NO PATHWAY
RISK NO - EXIT SCHOOL, CLINIC) INTO HOSPITAL REVIEW/ASSESSMENT WITH MH & SS
•OTHER HEALTH
ASSESSMENT FOR FURTHER •DISCHARGED
PROFRESSIONALS • HANDOVER
ASSMT & RISK SOCIAL CARE INPUT, TO SOCIAL
•SCAP TO LOCAL
EXIT E NO MANAGEMENT JOINT ASSMT CARE
CAMHS TEAM,
PATHWAY TO •INVOLVE SOCIAL PROVISION
(NON-BHAM)
CARE
SCAP •DISCHARGE FROM
HOSPITAL
•POLICE OOH OOH OOH OOH OOH OOH OOH
•EDT SOCIAL HANDOVER SWITCH ON CALL SPR , TELEPHONE SPR OR MANAGEMENT •HTT MAKES ARRANGMENTS
CARE FROM ERA BOARD CONTACTS SPR INVOLVE RISK ASSESSMENT REGISTRA •HHT •ASHFIELD ADMITTED
REFERRER
•A & E TO ON CALL OR HANDOVER FROM CONSULTANT •ADVISE OVER THE ASSESSMENT •INPATIENT •EXIT, 7DAY FOLLOW UP
•RAID SPR ERA CLINICIAN PHONE •ONGOING DEPENDING ON HANDOVER
•SCAP •FACE TO FACE •CONTAINMENT
•EXIT
PSYCHOLOGY PSYCHOLOGY
ERA CLINICIAN PSYCHOLOGY URGENT URGENT PSYCHOLOGY DECISION POINT
ADMIT TO PAEDS BED DECISION PSYCHOLOGY TREATMENT AS •OUTPATIENT
REGARDING ASSESSMENT USUAL, 2/3 •OUTPATIENTS WAITING LIST
EMERGENCY PLANNED WITHIN RESOLVED •ON GOING (13 WEEKS)
PSYCHOLOGY PSYCHOLOGY PSYCHOLOGY NEXT 24 HOURS WITHIN 3 TREATMENT
HOSPITAL
HP REFER TO REFERRAL DUTY NON URGENT (UNLESS SESSIONS •TREAT AS •LOCALITIES
PAEDS
BCH •PHONE PSYCHOLOGIST/ PSYCHOLOGY MITIGATING (ASSESSMENT INPATIENT CAMHS & OUT
PSYCHOLOGY •FORM SPECIALIST – •PSYCHOLOGY OUTPATIENT CIRCUMSTANCES) COMPLETED, •LONGER PIECE OF OF B’HAM
•VERBAL REVIEW REFERRAL WAITING LIST CARE PLAN) WORK
MON-FRI 9-5 •SIGN POST ELSEWHERE
OOH
RING SPR
KNOWN •ADVISE OR EXIT END
/EXSISITING
LOCALITY TEAM
CASES •REFER TO A&E
COMMUNITY
•TELEPHONE
•PHONE CALL
REVIEW &
CAMHS
•IS SESSION •FACE TO FACE ASSESSMENT
MANAGEMENT
•TURN UP COMPLETED
•FACE TO FACE
•INCIDENT •SPEAK TO
CONTACT
COLLEAGUES
•REFER TO ERA
(WHO, WHEN ,
WHERE)
LD ALL ABOVE MINUS REFER TO ERA
ALL OF TIER 3 – INTERNAL PROCESS OF USING INTERNAL CLINCIANS (LESS ROBUST)
LAC
TRANSFER BACK TO T3
OOH •COMMUNITY CAMHS •TELEPHONE/FAX •TELEPHONE SCREENING DECISION POINT
HTT RING SPR •POS ASSESSMENT (WITHIN 4 HOURS) ASSESS OR REJECT
•ERA INPATIENT HTT INPUT, ALONGSIDE TIER 3
POLICE TO BCH POLICE DECISION POINT ASSESSMENT MHA DECISION POINT DECISION POINT ADMISSION TO T4
136 SUITE
POS SWITCHBOARD, POS MEDICALLY FIT IN HOURS - DR / AMP (ERA) DETAINED NOT DETAINED MANAGE-MENT PLAN
COORDINATOR UNFIT ED OOH – ON CALL SPR DUTY AMP
REFERRAL FROM SCREENING CAMHS LIASON
GENERAL PAEDS SIGNPOSTING END •ASSESSMENT ON GOING
LIASON CAMHS AT BCH, ERA ASSESS •CRISIS MANAGEMENT
JOINT ASSESSMENT WITH REFERRER •LIASON MANGEMENT

6. Key issues regarding pathways
• Importance of
– good decision making (evidence driven)
– making it simple and understandable (enhancing patient
and clinical experience)
– each component part doing its job well (competent +
skilled workforce)
– avoiding unnecessary hand offs, cul de sacs and passing on
(enhancing patient experience, responsibility taking)
– clarity regarding what people should do (keeping high
standards)
– organisational structure which supports the work people
are expected to complete (making it manageable).

7. Community CAMHS – basic pathway

8. Clinical pathways
• Each pathway have worked on content
– What should people be providing, in terms of
assessment, formulation and treatment
– Expectation that clinical staff will follow structure
and content of pathways
– Possible to break the pathway into constituent
parts with specific responsibilities to be
completed at each stage (to a specific level)

9. Basic CAMHs process

10. Formulation and goal Emotion recognition (use Mindfulness/relaxation/g
setting (use additional rating scales and mood rounding skills training
assessment questions to monitoring forms, bag of (tracks available to
help formulate as well as feelings, feelings cards) download from
outcome measure Activity scheduling (may Cognitive strategies to
questionnaires to identify need to involve parents address
depression-specific in making sure activities distortions/deficits (use
issues) are available and think good feel good
Psycho-education about realistic) worksheets or Friends
depression (direct to self- Problem solving skills red/green thoughts
help materials as well as training worksheets )
discussing depression, Relapse
what it is, how common prevention/blueprinting
it is and how it affects
you)
Mood - assessment, formulation, psycho- education, intervention

11. Stock take
• Each of the groups were asked, in preparation for the
awayday to take stock
• Some groups e.g. City wide CAPA, SCAP are in the midst of
implementation and have coherent plans. LD probably in
same place.
• Neuro-developmental, Emotional / Behavioural are well
positioned to look at implementation – fitting in with existing
CAPA model. Some issues such as use of groups outstanding
• STEP pathways – most challenging area not just content but
also how to incorporate lean organisation – are there more
radical patient friendly solutions
• ED pathway – slightly out of kilter with other pathways (set up
later) – some clear progress that can be made

12. Pathways – where to gate keep

13. Which pathways?

14. Raising Thresholds

15. Merged pathway – based on integration of clinical presentations (?interventions)

16. ‘I skate to where the puck is going to
be, not where it has been’
Preparing for the future Things that can help us
• Patient experience
• IAPT
• Training
• Trust values
• Valuing basic care (and
tasks)