Management seminar St trainees CAMHS

1. Major
Competency:Management
April 2013 ST C&A
North West Deanery

2. April/May 2013
1 – Introduction [self, team, department, multi agency]
2 - Finance
3 – Commissioning
4 – Workshop
5-8 (preparation) – Timmorri@liverpool.ac.uk
9/10- Presentation

3. Personal introduction
• Current placement
• Management courses/experience
• Strengths & weaknesses
• Why attending this course?

4. Whatever happens?
• Massive turmoil
• Adaptation and innovation
• Need the right number of staff with the right skills
in the right place at the right time for the right
price!
• Winners and Losers

5. Major Competency
• Managing a budget
• Managing Risk
• Handling complaints
• Involving service users
• Evidenced based practice
• Applying good practice standards
• Monitoring and analysing outcomes
• Audit
• Influencing organisations

6. Managing Yourself
• How is your desk & office organised?
• What clinical and administrative tasks do you
delegate? e.g. booking appointments, messages,
notes & filing.
• How do you organise your diary & tasks – paper or
computer?
• How easy am I to work with (this is not only about
being nice)

7. Managing Yourself
Exercises
• Review weekly job plan & log of activity for one
week
• How much do I cost to employ?
• 360 appraisal – exercise or utility
• Preparation for next session – will you? Action
orientation or words?

8. Core Clinical Skills for C&A Psychiatrists
• Identification and treatment of psychosis, severe depressive
illness, organic mental states, severe somatoform disorders
• Psychopharmacology
• Advice in respect of high risk of self-harm, suicide and harm
to others
• Advice on treatment of severe, complex ADHD, OCD and
TICS
• Advice on and management of Eating disorders
• Identification of, formulation of, and advice in, complex cases
e.g child protection, LAC, Youth offending
• Certain types of paediatric liaison work
• Assessment of complex or atypical ASD

9. Competencies of a C&A
Team

10. Is there clarity?
• What we do
• What we could do
• What we should do
• What we are asked to do
• How we do it together

11. Clinical Competencies of a Team
• Initial formulation and diagnosis of most cases
• Risk assessment of self-harm and harm to others
• Formulation and management of most cases of self-
harm
• Initial ADHD assessment and treatment of cases not
needing medication
• Family therapy clinics
• Parent management skills
• Cognitive-behavioural therapy

12. Potential Risks at Team Level
• The model is not owned by everyone in teams
and services
• No appropriate skill mix in teams
• Too many interfaces
• Isolation, confusion of roles
• Lose good practice, especially working
together in patch teams
• If one is the only specialist in that area what
happen when they are off?

13. MDT
• “One obstacle to the smooth running of
multidisciplinary teams is the desire of doctors to be
in charge.” Cottrell 1993

14. Departmental Organisation
• What are the structures & processes?
• Who is in the department?
• Who decides what, and where?
• What are the lines of management –
personnel/clinical?
• What are the management/departmental
meetings – who attends and what is decided?
• What arrangements are there for appraisal?

15. Departmental Organisation
Exercises
• Review departmental structure and personnel [3
mins ]
• Review structure & purpose of departmental
meetings [3 mins]
• Describe 3 potential improvements

16. Leadership & Teamworking
• Who sets goals & how are these evaluated?
• How is activity information used?
• Is there a service description & priorities?
• Is there a regular development day? How is
this organised & evaluated?
• How are new developments planned &
agreed?
• How is expertise recognised?

17. Communication & Meetings
• What is the remit?
• Who attends – and how is this decided?
• What is the agenda?
• Are minutes kept and distributed?
• Focussing on what has to be decided, and what actions are
agreed
• How are decisions and actions implemented and reviewed?
• How to deal with non-attenders, or people who talk too
much or too little?

18. Clinical Governance
• What are the structures & processes for
clinical governance?
• How does CAMHS relate to these?
• How is audit organised?
• What protocols are in place and how are
these reviewed?
• What audits have been completed?
• How are clinical incidents reported and
reviewed?

19. Conflict & Negotiation
• How to manage people who moan (problems)?
• How is efficiency & effectiveness monitored?
• What about punctuality and absence?
• What are the disciplinary processes?
• Difficult people e.g. non-participation,
critical/hostile

20. Service Development
• What are the departmental processes for
generating & developing the service?
• How are these negotiated within the trust/CCG
and with other agencies?
• What funds are available for development?
• What are the national trends & drivers for
development priorities?

21. Managing Change
• How is change planned & implemented?
• Is change negotiated or imposed?
• How are team members involved or
informed?
• How do people react?

22. Working in CAMHS
“I’m all for progress, it’s
change I can’t cope with”
Mark Twain

23. External context
• Which trust & directorate? CCG?
• CD, MD, CEO, Ch, board: who & how?
• When & where? Who represents you?
• Multiagency CAMHS planning? Who, when &
where?
• Health England impact on CAMHS

24. Fragmented funding, multiple
assessments and gatekeepers
Conduct
disorder
Statement
of SEN
Children
in need
At risk
register
ASSET APIR
£3
billion
Social
Worker
Youth
offending
team
Child
psycho-
logist
Ed
welfare
officer
Connex
-ions
PA
SENCO &
Ed Psycho-
logist
LEA special
educational
needs
Connex
-ions
EWSCAHMSYOTSocial
Services
Youth
workers
Youth
Service
£300
million
£300
million
£100
million
£350
million
£500
million
£1
billion
= assessment
= worker
= agency
Health
visitor
ccg
Risks to
parents
£?
million
Children’s
Fund
£150
million

25. The overall goal of comprehensive child and
adolescent mental health services should be
that of delivering seamless multi-sectoral
mental health services for children,
adolescents, young people and their families.
The services must be effective, sensitive and
appropriate to the needs of the local
population, and based on achieving the best
from partnerships in care.
TOGETHER WE STAND, HAS, 1995

26. GPs, Paediatricians, Teachers, School Nurses,
Youth Justice Workers, Health Visitors,
Social Workers, Voluntary Agencies etc
Tier 1
Individual Professionals Trained
in Children and Young People’s Mental Health
e.g. Psychiatrists, Psychologists, Therapists etc
Specialist Multi-disciplinary
Teams
Tier 2
Tier 3
Very
specialist
services, incl.
children away from home Tier 4
The 4-tier model for CAMHS
PrimaryM
entalHealthW
orkersetc
Health Advisory Service, 1995. Together We Stand

27. National Service Framework forNational Service Framework for
Children, Young People and MaternityChildren, Young People and Maternity
ServicesServices
NSF Standard 9:
The Mental Health and Psychological Well-being
of Children and Young People

28. “All children and young people, from
birth to their eighteenth birthday, who
have mental health problems and
disorders have access to timely,
integrated, high quality multidisciplinary
mental health services to ensure
effective assessment, treatment and
support, for them, and their families.”
NSF Standard 9:
The Mental Health and Psychological Well-being
of Children and Young People

29. Universal
Targeted
Specialist
Every Child Matter

30. • Services are shaped by their histories and
organised for the convenience of the provider not
the client (Cabinet Office, 2001).
• Audit Commission report (2002): a general
consensus that agencies need to work more closely
together to meet the needs of young people, but
different spending priorities, boundaries and
cultures make this difficult to achieve in practice
• Interagency working of such services tend to
'underlap' rather than overlap and agencies can
ignore the complexity their clients present
Multi-agency work

31. Barriers
Professional barriers – different professional cultures
leading to different perceptions of role and priority and
disagreement about assessment and intervention with
young person
Communication barriers - often different professions and
different organisations approach the same issue from a
different perspective and use different terms;
Organisational barriers - different organisations may
have different goals, priorities and structures;
Resource barriers - there may not always be sufficient
money or time to support joint working.

32. Another Place Anthony
Gormley

33. So what are users saying theySo what are users saying they
want?want?
• What children, young people and their families and
carers want is often quite simple.
• They want consistent relationships with people who
can help and to be treated with dignity and respect.
CAMHS Review 2008

34. Features of effective services – as defined byFeatures of effective services – as defined by
children, youngchildren, young
people and their parents and carerspeople and their parents and carers
• Awareness
• Of mental health and how to deal with it
• Trust
• Build a trusting relationship
• Regular contact with the same staff
• Clarity over confidentiality arrangements

35. Features of effective servicesFeatures of effective services
• Accessibility
• Convenience
• Accessible information and advice available
• Single point of entry to specialist mental health services
• Age-appropriate services
• Communication
• Being listened to, given individual attention
• Straightforward, no technical jargon

36. • Involvement
• Being valued
• Opportunity to discuss what services and interventions
are available
• Support when it’s needed
• Available when the need first arises, not when things
reach crisis point
• Support and follow up
Features of effective servicesFeatures of effective services

37. • Holistic approach
• services that think about you as an individual; for example,
providing help with practical issues and addressing your
physical health as well as your mental health
Summary of key findings from Focus groups and interviews with
children, young people, parents and carers, conducted specifically for
the Independent CAMHS Review Expert Group.
Features of effective servicesFeatures of effective services

38. Some Levers for Change
• Users and carers [Families]
• NSF Change for Children - Every Child Matters
• Comprehensive CAMHS
• Workforce challenge
• NHS Modernisation
• Commissioner-driven through contracting,
contestability and service redesign
• Performance indicators
• Activity data
• Waiting times

39. “All models are wrong but
some are useful”
W Demming

40. How to develop a service?
• Developing new roles, to bring new people into
the mental health workforce
• Developing the roles of existing staff, to enable
them to take on more or different tasks
• Ensuring that the skills of all staff are being
used in the most efficient and effective way

41. Key lessons and actions
• No single blueprint for CAMHS
• Small changes can be easy wins
• Change one role and change all
• Leadership to support change is essential both
from clinicians and managers
• There is more shared in common that distinct
between professions [ Ten Essential Shared
Capabilities]
• Will involve cultural change

42. Solutions [AIMS]
• Child & Family input into service design
• Clarity about realistic roles
• Recognise finite capacity and capabilities and
avoid wishing unrealistic demands upon them
• Vertical and horizontal integration of services
• Clarify corporate responses

43. Solutions [ACTIONS]
• Use explicit plans and protocols for demand
management
• Re-organise services to respond to need not
diagnostic labels
• Consider information needs of all stakeholders
• Recognise concept of burden and impact
• Complexity means multiple respondents may be
needed
• Matching between wants, needs, evidence of
effectiveness and availability of expertise
• Supportive information systems

44. There are no well worn paths….
…. People and services will need
to move out of their comfort
zones.

45. Preparing For A
Consultant Post
• What kind of post are you looking for?
• What posts are currently available in the North
West?
• Ways to appraise a vacant post