Child and adolescent mental health service redesignYale & SEPT international healthcare management programme

• Dr Paul Millard• Consultant Child and Adolescent Psychiatrist• Clinical Director Children’s Services, CPFT

Problem

• Role definition and communication are poor between services providing for children and adolescents in Cambridgeshire with mental health and behaviour problems. - Access is complicated- There is inconsistent use of evidence based

interventions- There is duplication and waste- Commissioners believe services do not provide

good value for money

Objective

• To define roles and responsibilities- Collaborate with commissioners and providers

to agree care pathways for children with mental health and behaviour problems

- A single point of access for all referrals- Use evidence based interventions- Specify who does what at each stage of the

pathway

Background

• HAS report led to split into Tier 2 and 3 CAMHS• Tier 3 services have defined themselves as mental

health and NOT behaviour• Cambridgeshire LA has developed services for parent

support and behaviour problems• Early Intervention Locality Services have been

commissioned to provide for “mild and emerging mental health problems”

• GPs are “unhappy with access to CAMHS”• LA are “unhappy with services delivered by CAMHS”• However, parents and children who access services

rate them highly• Local context is to save 20-40% in NHS and LA

Root cause analysis

• New services have multiplied access points• Services have been developed to fill gaps

rather than meet need• Lack of shared understanding of how to

intervene in mental health and behaviour problems

• Lack of agreement about roles

Strategy

• Strengthen senior management team• Generate sense of urgency• Identify key partners and what will motivate

them• Develop a shared vision with partners,

commissioners and stakeholders• Maintain communication with staff and

partners• Implement and embed changes

Implementation

• Workstreams- Evidence, staff, capacity, IT, infrastructure,

single point of access, pathways• Multiagency groups• Set timeline

- Appoint new AD October 2010- Visioning Dec/Jan 2011- Workstreams Feb-July 2011- Define pathways and implementation July to

Sept 2011- Implementation Sept 2011 onwards

Evaluation

• Single point of access• Defined pathways• Written information about access and

pathways• Improve GP satisfaction• Improve parent and child satisfaction• Achieve financial targets

Learning

• Good leadership AND management• Need to involve everyone• Communication is not a one-off• Sustaining energy• Delivering on timelines• This is only the start