Transcript Transformation of Mental Health Services for Children and

www.england.nhs.uk
Slides by Peter Fonagy, Kathryn
Pugh, Anne O’Herlihy, Robin Barker
CYP – IAPT Programme
Could the profile of children and young
people’s mental health get any higher?
• Health Select Committee Report
• Ministerial Children and Young People’s Mental
Health and Wellbeing Taskforce
• Collaborative Commissioning Pilots
• Department for Education Guidance
• UK Youth Parliament national campaign for 2015
• Young Minds Vs campaign …..
• NHS England Tier 4 Review
• Five Year Forward View and Achieving Better Access
to Mental Health Services by 2020
www.england.nhs.uk
17/07/
2015
Where are we going? ‘golden threads’
running through legislation and policy
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Parity of Esteem between physical and mental health
Whole life course
Evidence based treatment
Prevention and early intervention
Timely access and waiting times
No decision about me without me
Choice
Personalisation
Outcomes that matter to children, young people and their
families
• Recent publications: Tier 2/3 Specification for CAMHS
and Transition and transfer to and discharge from care
seehttp://www.england.nhs.uk/resources/resources-for-ccgs/
www.england.nhs.uk
Impact of mental disorder: Most lifetime
mental disorder arises early adulthood
Age of onset of lifetime mental illness – predates subsequent illness by several decades
www.england.nhs.uk
Source: Kim-Cohen et al, 2003; Kessler et al, 2005; Kessler et al, 2007
Mental illness during childhood
and adolescence in the UK:
£11,030 to £59,130 annually per child
Lifetime cost of a 1-year cohort of children with Conduct
Disorder: £5.2 billion
Costs of adult crime with history
Including costs of
of CD
various agencies
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£60 billion in England and Wales
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£22.5billion attributable to CD
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£37.5 billion to subthreshold CD
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Health
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Social services
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Education
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Justice
Evidence-based practice has substantial clinical & cost benefits
Little & Edovald, 2012; Suhrcke, Puillas & Selai, 2008
Only 6% of current spending on mental health goes to services aimed at children
and young people
Kennedy, 2010
www.england.nhs.uk
With permission P Fonagy
CAMHS fit for the future – CYP IAPT
Began in April 2011 with specific remit (and limited budget) to work with
existing CAMH services to:
• Improve collaborative practice with children, young people and families
• Deliver a workforce to offer evidence based practice (EBP) as
recommended by NICE in
o CBT for anxiety disorders and depression
o Parenting training for conduct disorder (age 3-10)
o Systemic Family Practice for conduct disorder (over 10s),
depression and self-harm, and eating disorders
o Interpersonal Psychotherapy for adolescents (IPT-A) for
depression
o Competency based curriculum using Roth and Pilling CAMHS
competencies
• Training for supervisors and service leads
• Outreach and enhanced supervision workshops for other staff not
attending
training courses within the CYP IAPT Programme.
www.england.nhs.uk
CAMHS fit for the future
• Using ROMs (routine outcomes monitoring)
• To guide therapist and supervisor
• To help client monitor and understand how treatment is
progressing
• Across ALL Professions
• Empowering service users to take control of their care,
establish treatment goals, choose treatment approaches and take
opportunities to improve their own health
• Improving access to evidence-based therapies
• Introducing evidence-based organisation of care
www.england.nhs.uk
Map
In 2015 CYP IAPT
is working with
CAMHS & partner
agencies that
cover 68% of 0-19
population.
www.england.nhs.uk
Therapist trainee numbers by modality
across 4 years of CYP IAPT (n=749)
300
IPT-A
250
SFP
29
Parenting
200
CBT
68
21
76
150
56
61
99
99
100
2012/13
2013/14
2014/15
43
100
33
50
64
0
2011/12
www.england.nhs.uk
Trained supervisor numbers by modality
across 4 years of CYP IAPT (n=249)
100
90
IPT-A
80
7
12
SFP
70
Parenting
60
29
CBT
31
50
40
12
23
19
30
11
20
33
10
29
19
24
0
2011/12
www.england.nhs.uk
2012/13
2013/14
2014/15
Trained service transformational leads
across 4 years of CYP IAPT (n=178)
70
60
50
40
65
30
51
20
30
32
2011/12
2012/13
10
0
2013/14
Servcie lead trainees
www.england.nhs.uk
2014/15
Responding iteratively to service needs
• In 2014-15, 184 CAMHS staff are to complete a
New Enhanced Evidence Based Practice
curriculum – brief short course at certificate
level for Band 5-6 to create a CAMHS workforce
that can work effectively
• Parenting offered as PG Dip and PG Cert
• Collaboratives take on a greater level of local
support and challenge
www.england.nhs.uk
Quality assurance
• Accreditation council - CYP IAPT principles
embedded in established accreditation
processes for individual therapists, modality
courses, services to support demonstration of
and commitment to quality assurance
• BABCP assuring CBT, Parenting
• AFT will assure Systemic Family Practice
• BPS will assure IPT-A with IPT-UK assuring
relevant courses
www.england.nhs.uk
Moving forwards - how to get to 100%
by 2018
• Who does what – 65% of CYP IAPT is workforce development
• Offering courses at a more local level
• Replacement training
• More use of remote learning e.g. Northumbria
• Greater level of responsiveness to service needs and where
CAMHS is now
• Continued support for added value improvements to practice
• Filling the gaps for the CAMHS workforce
• LD, ASD
• Tier 4
• New curricula e.g. NICE approved combination treatment, use of
practice based evidence
• Modifying curricula to widen workforce of therapists
www.england.nhs.uk
Coming on stream……
• Taskforce Report – March 2015
• Building on CYP IAPT, service standards Delivering With
Delivering Well
• Draft standard service specification for Transition, including
the Liverpool CQUIN payment incentive
• Draft standard service specification - Targeted & Specialist
CAMHS building on best practice and incorporating
commissioning for evidence based, outcomes focussed
collaborative CAMHS
• System Dynamic Model for education, social care and
health
• Co-Commissioning grants – there is still time!
• For new commissioners – MindEd training modules
www.england.nhs.uk
Contacts:
[email protected]
[email protected]
www.cypiapt.org
www.england.nhs.uk