Transcript Document

Adding substance to the myths:
Responsiveness, appropriateness and
effectiveness according to the CAMHS
discharges project
National Mental Health Benchmarking Project
November 2008
Peter Brann
Eastern Health CAMHS
Dept of Psychological Medicine
Monash University
A joint Australian, State and
Territory Government Initiative
Warning: There will be graphs
A joint Australian, State and
Territory Government Initiative
Background
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Challenge to CAMHS about efficiency
Long standing perception that CAMHS is
viewed through the narrow focus of Adult
Mental Health
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Aside from outsiders such as Andrews, severity
seen as synonym for a few diagnostic groups
Case management seen as antonym to treatment
However efficiency irrelevant if the population
is neither appropriate nor treatments effective
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Discharges project
Peter Brann
EH CAMHS & Monash University
National Mental Health Benchmarking Project CAMHS November 2008
Page 3
History
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Forum agrees to detail the nature of CAMHS clients
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First retrospective audit
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Demographic
Waiting time
Length of Episode
Diagnostic profiles
Outcomes
All clients discharged April – June 06 ambulatory services
Results highly engaging and provocative
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Audit repeated April- June 07
 Contact time and who with
 Carer and Client Outcomes
 In-patient Units
Peter Brann
EH CAMHS & Monash University
National Mental Health Benchmarking Project CAMHS November 2008
Page 4
The participating CAMHS
Sneezy – OP
Adol. IP and Day Program
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Sleepy – OP plus Adol. IP
Happy – OP and Adol. IP
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Dopey – OP teams only
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Grumpy – OP only
Bashful – OP and for younger
age weekday IP
Peter Brann
EH CAMHS & Monash University
National Mental Health Benchmarking Project CAMHS November 2008
Page 5
Demographics
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Dataset complete with some missing values
Numbers
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Four Inpatient Units
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Separations 24 to 56
Mean age 8.6 to 16.1 (mean 15.1 for Adol Units)
Gender 55% female (Adol Units) 17% (Child Unit)
Ambulatory
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Peter Brann
EH CAMHS & Monash University
Discharges 44 to 1110
Mean age 9.6 to 14.1
Gender 47% female
National Mental Health Benchmarking Project CAMHS November 2008
Page 6
What, you don’t have to wait for a year!!!
Waiting Time
120
100
Days
80
60
40
20
0
Org A
Org E
Org C
Mean Referral to Assessment
Peter Brann
EH CAMHS & Monash University
Org B
Org D
Org F
Mean Referral to Treatment
National Mental Health Benchmarking Project CAMHS November 2008
Average
of
Forum
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And don’t they stay with CAMHS forever…
Length of Episode
500
But
intriguing
variation
400
days
300
200
100
0
Org A
Org E
Org C
Org B
Org D
Org F
Median days Assessment to Discharge
Median days Assess to Last Recorded Contact
Average days Assessment to Discharge
Peter Brann
EH CAMHS & Monash University
National Mental Health Benchmarking Project CAMHS November 2008
Average
of Forum
And
difference
between
the two
indicators
suggests
paperwork
delays
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Principal diagnoses (>2% of dwarf average)
Org F
F93 Emotional
F92 Mixed
disorders onset
disorders conduct
childhood (inc anxiety)
and emotions
F43 Reaction to severe
stress, and
ajustmentdisorders
Org D
F84
Pervasive
develop'l
disorders
F91 Conduct
disorders
F30-F39 Mood (affective)
disorders
Z63 Other problems
related to primary support
incl family circumstances
Org B
F98 Other
behavioural emot
onset child adol
Org C
F99 Mental
disorder, NOS
F40-F41 Phobic and
other anxiety disorders
Org E
F90 Hyper
kinetic
disorders
ZZRec No Diagnosis
Recorded
Org A
0%
10%
Peter Brann
EH CAMHS & Monash University
20%
30%
40%
50%
60%
National Mental Health Benchmarking Project CAMHS November 2008
70%
80%
90%
100%
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Diagnostic issues
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Aside from the tier question
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Why such different profiles?
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Is this what we want from CAMHS?
Provoked extensive discussions
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Value of diagnosis
Labelling and stigma
Clinician practices and dwarf procedures
Models of care
Peter Brann
EH CAMHS & Monash University
National Mental Health Benchmarking Project CAMHS November 2008
Page 10
after all that, any difference?
Score
20
Mean HoNOSCA score and Completion Rate
100%
16
80%
12
60%
8
40%
4
20%
0
0%
Org A
Org E
Org C
Org B
Mean total Assessment 2007
Assessment Completion
Peter Brann
EH CAMHS & Monash University
Org D
Org F
Average
of Forum
Mean total Discharge 2007
Discharge Completion
National Mental Health Benchmarking Project CAMHS November 2008
Page 11
And in inpatient settings?
HoNOSCA Total Scores and Completion Rates
20
100%
Average
Admission
16
Score
75%
Average
Discharge
12
50%
8
25%
4
0
Completion
Admission
Completion
Discharge
0%
Org A
Peter Brann
EH CAMHS & Monash University
Org B
Org D
Org F
National Mental Health Benchmarking Project CAMHS November 2008
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and is that just self serving clinicians?
Parent SDQ mean scores and completion rates
100%
20
80%
15
60%
10
40%
5
20%
0
0%
Score
25
Org A
Org E
Org C
Org B
Org D
Assess't SDQ total
Average of
Forum
Discharge SDQ total
Completion Rate Assess't
National Mental Health Benchmarking Project
Peter Brann
EH CAMHS & Monash University
Org F
November 2008
Completion Rate Discharge
CAMHS -
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And at the end of all our
travels?
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All the obtained data prompted activity to improve collection
All myths are assisted with data
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CAMHS clients are not waiting as long as believed
CAMHS has a large amount of variability in diagnostic profiles
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CAMHS is effective
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Models of care
Diagnostic practices
Belief systems
However variability in effectiveness that warrants exploration
Clinician rates heading towards being adequate
Parent/Client completion rates require work
Jurisdictional and National data underestimate completion rates
CAMHS benefit from having this material available even though
its potential misuse and separation from funding levels is a risk
Peter Brann
EH CAMHS & Monash University
National Mental Health Benchmarking Project CAMHS November 2008
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