Liverpool’s CAMHS Partnership

Lisa Nolan Programme Delivery Manager (Children and Maternity) Liverpool CCG [email protected]

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?

The journey

Pre-2003 In-patient provision Alder hey community mental health teams 2+1 service, Alder hey

Providers:

Commissioners: Alder hey Foundation Trust

– Community Mental health teams

Regional units

Liverpool Health Authority

Outcomes:

Not monitored or reported

2003-2006

Regional In-patient Units: SLD team CAMHS tier 3 community teams, Working Together HAVEN BEST CABI YPAS counselling Tier 2 YPAS Support Service AS Pathway ‘Mad, Bad or Misunderstood’,

Providers: Commissioners:

Alder Hey

(many teams)

VCS:

YPAS

Regional units

Liverpool PCT Liverpool City Council

Outcomes:

       Dev. of choice Less stigmatising provision New ways of working More community based provision Joint and partnership working Emerging performance monitoring process Policy driven

2007-2010

Regional Home Based Treatment Regional In-patient Units: YOS mental health provision SLD team CAMHS tier 3 community teams, CAMHS 16-18 team HAVEN Working Together BEST CABI YPAS counselling Tier 2 YPAS Support Service CAMHS LAC AS Pathway 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

Providers: Commissioners:

Alder Hey

(many teams)

VCS:

YPAS, PSS, Barnardos, MYA

Regional units and HBT

Liverpool PCT Liverpool City Council Social Care

Outcomes:

        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

C&YP & Families Universal services Public Mental Health

Self-care, Website Mental Health promotion

Provider: voluntary CAMHS and c&yp Comprehensive CAMHS Pathways 2010-2013 Training:

MBM Inside Out, Master class Mental health first aid Specific training Alder Hey (Primary Mental Health Service, Specialist CAMHS)

Consultation & support:

Telephone, individual, group

Single Point of Access

Triage (multi agency)

Voluntary Sector CAMHS (YPAS, ADHDF, PSS, Banardos YC) Provider: Voluntary CAMHS Statutory CAMHS

care aims methodology

Tier 4 Dewi Jones Unit (0-14) Tier 4 YPC (14-18), CHEDS Tier 4 OAT (Independ ent Sector) AHCFT 0-16 years Out of Hours Psychiatry Mersey Care 16 plus Other services (signposted)

Providers:

Alder Hey

(2 teams with SPA)

VCS:

YPAS, PSS, Barnardos, MYA

Regional units and HBT

Commissioners: Outcomes:

 Liverpool PCT/CCG • Liverpool City Council • Schools • Social Care       

Dev. of choice Less

•

stigmatising provision



New ways of working



More community



based provision Joint and partnership working participation Thinking family Robust performance monitoring process Single point of access Multi-agency triage and working More accessible information Consultation and training accessible to frontline provision

Liverpool’s CAMHS Partnership

• • •

Performance Monitoring:

Activity – CAMHS returns/National data set/national benchmarking Outcomes – CAMHS returns/ CORC Quality – CAMHS Returns/ Contract visits

• • • •

Liverpool’s CAMHS Partnership

So What??

Reduction in specialist CAMHS referrals by 21% form 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

Liverpool’s CAMHS Partnership

• All providers using CORC measures • • • • • VCS all quality assured Built local workforce Strong equalities agenda Strong participation agenda Focus on early identification and prevention

• • • • • • • • •

Liverpool’s CAMHS Partnership

Less stigmatising Less medical

Why VCS?

More Flexible Innovative and creative Skills of workforce Added value Community based Engaging and involving Asset based

Liverpool’s CAMHS Partnership

Challenges:

• • • Professional hierarchy Funding Restructure

Liverpool’s CAMHS Partnership

WHAT NEXT?

• • •

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

3 4

Tier

1 2

Number

12828 (15%) 5986 (7%) 1582 (1.85%) 64 (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

Future Challenges

: •Integrated commissioning – funding •Integrated care – culture, personalities •Changing NHS – relationship management •Economic climate and social determinants

• • • • • • •

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

Future Opportunities

: • Integrated commissioning and care • CCG and LCC priorities • Liverpool’s children and young peoples/whole family agenda • Public health changes • IAPT (Improved Access to Psychological therapies) • Mental health promotion and FYI developments (participation) • Training menu • Transition • Research opportunities • Neuro-developmental pathway • Datasets

2014-2017 strategy:

Range – VCS, independent and statutory partnership PROVIDER DECISION MAKERS Joint commissioners CHILDREN, YOUNG PEOPLE & FAMILIES UNCRC Working Together to ensure mental health and emotional wellbeing is ‘

Everybodies Business’

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

MYA- MHP, training and engagement

Increased Identification of C&YP with early indicators of distress and risks

Alder Hey – Early intervention (PMHS) and LAC/CIN YPAS – therapeutic/counselling and support service PSS – refugee and asylum seekers therapeutic support ADHD Foundation

Reduction in Mild to Moderate Distress

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 Reduction in the development of Moderate To Serve distress

Alder Hey - Specialist CAMHS

Delivery – specialist Contracts – CCG Funding- CCG Performance managed – CCG Reduction in life long distress In-patient care – Dewi Jones (alder hey) and YPC (CWP) and OATS Delivery – In-Patient (regional) Contracts – Spec Comm Funding- CCG top slice Performance managed – Spec Comm

Liverpool’s CAMHS Partnership

• • • • • •

Outcomes:

Improved mental health of children, young people and their families Improved environments so that children, young people and families can thrive Increased Identification of children and young people with early indicators of distress and risk Reduction in mild to moderate distress Reduction in the development of moderate to severe distress Reduction in life long distress