Children and Young People’s Strategic Partnership

Child & Adolescent Mental Health Child & Adolescent Mental Health Services: Services:

Needs Assessment & Gap Analysis Needs Assessment & Gap Analysis Presentation and Proposal for Action Presentation and Proposal for Action

September 2004September 2004

Graham Pratt, Yvonne Campen, Lucy Erber, Meera Spillett Graham Pratt, Yvonne Campen, Lucy Erber, Meera Spillett

Background to Presentation

CAMHS Services locally not based on any needs assessment

Essex wide issues relating to risk - red lights Essex wide commissioning issues relating to the

different tiers of services Fits to CYPSP priorities Regional Development Worker - Training/facilitation

package for local areas commissioned from HASCASS

July training for ‘trainers’ attended by Hugh Johnstone and presenters

Why do a Needs Assessment?

All CAMH services should be commissioned on a multi-agency basis, informed by the assessment of local need, the views of service users and carers and the best available evidence to ensure that services deliver effective outcomes and best value for money.(Emerging Findings, Children’s NSF, 2003)

Bradshaw’s Typology of Need (1972)

1) Normative need

2) Comparative need

3) Expressed need

4) Felt need

Typology Explained

1) Normative (Top Down)

What the authorities (national and international) state is needed for a given group (e.g. children) and/or in a specific area (e.g. mental health). Normative need is based both on evidence and an assumption about what a given group will be entitled to as a norm in that society.

Key Documents For Normative Needs Assessment:

Children’s NSF (DoH) Children’s Bill (DfES) International

Classification of Diseases (WHO)

2) Comparative (Top Down)

Need that is identified when comparisons are made between areas, as for example in benchmarking, peer review and evaluation

Using the National CAMHS mapping exercise partnerships can identify organisations with similar catchment areas and demographics and compare the range of services on offer

Services offered in another area can alert a partnership to unmet need on their own patch

3) Expressed (Bottom Up)

Simply what people say they need, though they require the opportunity to do so

Expressed need normally becomes known because purposeful efforts have been made to consult people.

Sometimes need is expressed through investigations into complaints and incidents

4) Felt Need (Bottom Up)

The need that professionals feel, through their experience, is there and perhaps not being met

Professionals are close to clients and are valuable in needs assessment

They do however have a partial view, depending on which clients they see, where they are based and at what level they practise

Need may also be felt by members of the public, but never expressed

Gap Analysis and Planning

Service gaps - where there is a known need but no service in place that meets it

Knowledge about local service provision is achieved through: Local service mapping National CAMHS mapping

Need for a service is established through: Local needs assessment National directives and priorities

1) children with learning

disability autistic spectrum disorders minority ethnic groups those requiring in-patient

care those with behavioural

problems those in the criminal justice

system clinicians and users views

Planning Should Include:

2) Consideration of arrangements

for commissioning and funding highly specialist services (tier4), taking account of provision on regional or supra-regional basis

3) Identification of the age range

for which CAMHS is the most appropriate provider, to include the extension of the service to cover the age range of 0-18

Planning should Include:

More effective handling of the transition to adult mental health, to include local agreements for the handling of referrals of young people between the ages of 16-18 years

Source: National CAMHS Support Service, 2003 Assessment Matrix for a Comprehensive CAMHS

Local Gaps in Services

The Gaps Children and Young People’s Strategic Partnership already known about but where needs assessment for future predictions of need unknown:

children with learning disability autistic spectrum disorders minority ethnic groups those requiring in-patient care those with behavioural problems those in the criminal justice system universal mental health promotion children at risk of or self-harming

Action planning

CAMHS need to develop flexible approaches

to engaging children, young people and their families. These may include outreach, home visiting, flexible appointment times and a varied location of services

Kurtz and James, 2003

Issues for CYPSP

We are expected to have a needs assessment in order to be able to commission, plan and deliver CAMHS - do the Partnership consider we have this information or is it that different parts of the puzzle are held in different agencies?

In order to assist in planning and delivering services more effectively do the partnership agree that a needs assessment and gap analysis of current provision is needed?

Options for Needs Assessment and Gap Analysis

Do nothing

Undertake this ourselves

Get this down independently by consultants

Commission work independently but link to HASCASS training for identified staff

Inconsistency in services would be continued impact on ratings

Issues of capacity Loss of ‘our’ story and

engagement of staff Would harvest the

knowledge of staff and get their ownership of the work