day 1: intro to cyp-iapt and transformaon · 5-15 year olds percent unknown to any service 35% 76%...

Day1:IntrotoCYP-IAPTandTransforma6on:CoreAimsandValues

25thJune2015DrCatherineGallop

WiththankstoPeterFonagyandAnnYork

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IAPT for Children and Young People:

The Context….

2

Ageofonsetforlife6mementaldisorder

Source:Kim-Cohenetal,2003;Kessleretal,2005;Kessleretal,2007

Mental health problems are the greatest health problem faced by children and young people

Prof Pat McGorry

ACCESS: % With anxiety or diagnosable depression not in contact with mental health services

Source: Ford et al. (2005) Child & Adol Ment Health, 10:2-9

Dean et al., (2004) DoH; McCrone et al., (2008) King’s Fund

80%

70%

60%

50%

40%

30%

20%

Adults with depression

5-15 year olds

Percent

unknown

to any

service

35%

76%

Interna6onalPerspec6veonCAMHS

•  Alarmsregardingtheineffec&venessandfragmenta6onofcommunity-basedmentalhealthcareforchildrenandfamilies

•  majorityofchildrenreceivingcommunity-based‘‘usualcare(UC)’’donotshowclinicalimprovement

•  largemeta-analy&creviewreportedfewdifferencesbetweenUCtreatmentandcontrolgroups(waitlist)

ThecontextofCYPIAPT:Costs 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 of CD

Including costs of various agencies •£60 billion in England and Wales

•£22.5billion attributable to CD •£37.5 billion to subthreshold CD

•  Health •  Social services •  Education •  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

Fragmenta6onofservices

forchildrenandyoungpeople

Currentserviceprovision:asnapshot

Fragmenta6onofservicesforchildren&youngpeople

Ar6ficialstructuraldivisionsintermsof

Differentlinesoffunding

DH DfE

DWP LA

Health

Social services

Education

Employment

Fragmenta6onofservicesforchildren&youngpeople

Ar6ficialstructuraldivisionsintermsof

Statutoryvsvoluntaryproviders

Fragmenta6onofservicesforchildren&youngpeople

Ar6ficialstructuraldivisionsintermsof

Separa6onofphysicalandmentalhealth

Physical Mental

Fragmenta6onofservicesforyoungpeopleaged12-25

Ar6ficialstructuraldivisionsintermsof

Under18

Over18

Age

Manyservicedesignsarenotyoungpersonfriendly

Inaccessible in terms of location, time,

criteria for access

Manycurrentservicedesignsarenotyoungpersonfriendly

SummaryoftheissuesfacingCAMHS

• Significantshortagesofsufficientlytrainedprofessionals • CurrentlevelofCAMHSstafftrainingis‘poorand ge^ngworse’ • Difficul&eswithaccess(veryfewservicesofferaself- referralroute) • Poorhandlingoftransi&onbetweenchildandadult services • Inappropriateprovisionofadultservicestoyoung people • Datathatcouldandshouldbeusedforself-cri6calprofessionalprac6ce,performancemonitoringand commissioningisrarelycollected

No Health Without Mental Health (2011)

“The Government is investing around £400 million over the Spending Review period to ensure that adults with depression and anxiety in all parts of England have access to a choice of psychological therapies. This investment will also enable the expansion of psychological therapies in children and young people’s services”

CYP IAPT Launch Paul Burstow (25.10.11) “The Government is now investing £32 million in psychological therapies, including talking therapies, for children and young people with mental health problems” “This investment in children’s mental health is vital. Talking therapies are proven to work, and so we are expanding services to treat children and young people with the tailored care that they need. “We know psychological therapies work. Our aim is to transform existing mental health services for children so our children get the best treatment possible, from services that are more responsive to their needs.”

Children and Young People’s IAPT

Implementation

Kathryn Pugh Project Manager, NHS England

Professor Peter Fonagy CYP IAPT National Lead

IAPT Website: WWW.IAPT.NHS.UK

WhatIsCYP-IAPT? Asimpleevidencebasedimplementa6onofEBP

• CYPIAPTwasconceivedasacentrallyini&ated modifica6onofCAMHSinthedirec&onofEBP • Itisachievingremarkabledegreeofculturalchangein termsoftheacceptabilityofprinciplesofEBP interpretedbroadlythroughamodestinvestmentin: • servicechange

• trainingserviceleads • supervisorsandtherapists

TheCYPIAPTProgramme • Usingrou&neoutcomesmonitoring

• Toguidetherapistandsupervisor • Tohelpclientmonitorandunderstandhow treatmentisprogressing • AcrossALLprofessions • EmpoweringYPtotakecontroloftheircare,

establishtreatmentgoals,choosetreatment approachesandtakeopportuni&estoimprove theirownhealth • Improvingaccesstoevidence-basedtherapies

ServiceTransforma6onProgramme•  Projecthasreachedtargettoworkwithservicescovering60%of0-19popula6onby2015.

•  Learningcollabora&vesmadeupofuniversi&esandlocalareapartnershipswhooffermutualsupport,problem- solvingandlearningnetworks.

• Ongoingclientfeedbackfacilitatedbyfrequentoutcome

monitoring,combinedwith:

•  Excellentsupervision,•  ensuringtherapy• modelfidelityand,con6nuedcollabora6veprac6ce

•  Clinicians/prac66onerstodeliverbestevidencebasedinterven6ons,complementedby:

•  Effec6veandsuppor6veservicedeliverymodels-shapedbyserviceusers-enablescontextfor:

Effec6veServices

Evidencebased

interven6ons

Outcomesmonitoringandfeedback

Supervision

ThreeMajorcomponentsoftheCYPIAPTtransforma6on

1.ClosingtheskillsgapinCAMHS:EvidenceBasedPrac=ce

Enhancingtheskillsof

Appropriatelyprac66oners,

skilledsupervisors&service

CAMHSmanagersinEBP

workforce

OverviewofCYPIAPTTrainingProgrammes

1.   OutreachServiceDevelopmenttowiderservices2.   OutreachSupervisorTrainingtowiderservices3.  PGCer6ficateinClinicalLeadershipandService

Transforma&on4.  PGCer6ficateinSupervisingEvidencedBased

PsychologicalTherapies5.  PGDiplomainEvidencedBasedPsychological

Therapies6.  PGCer&ficateinEnhanceEvidencedBasedPrac&ce

Whatisevidence-basedprac6ceinchildmentalhealth?

CYP

Clinician

Researcher

Afundamentallypar6cipatoryandco-produced(co-constructed) enterpriseinwhichclient,researcherandclinicianareallfullyengaged

Evidencebasedprac6ce

Researchevidence Pa6entpreferencesandvalues

Clinicianobserva6ons

+ +

Quan6fiableresultsAcceptabletorecipientsU6lityforclinicians=

ThreemajorcomponentsoftheCYPIAPTtransforma6on2.Rou=neOutcomeMonitoring

•  Rou6neOutcomeMonitoringreferstomeasurementsofclients’progressinclinicalprac6ceandtheongoingtherapeu6crela6onship,usingstandardisedinstruments,aimingtoevaluateand,ifnecessary,adapttreatment.

•  ClientsareinvitedtofilloutRou6neOutcomeMeasures(ROMs)atthebeginningoftreatment,duringtreatmentandattheendoftreatment.

•  Subsequently,cliniciansandclientsareprovidedwithfeedbackabouttheresponsetotreatment.Basedonthefeedback,decisionscanbemaderegardingcon6nuing,alteringortermina6ngtreatment.

Measurementforapurpose: GuidingtreatmenttobePeroutcomes

3

2.5

2

1.5

1

0.5

0

TAU EBP

15%

EBP+Outcomes Monitoring

33%

NumberofdiagnosesPre

NumberofdiagnosesPost

Usual care

Manualized therapy

Therapy delivered on without Match

basis of Match

Weiszetal.(2012).Tes8ngstandardandmodulardesignsforpsychotherapytrea8ngdepression,anxiety,andconductproblemsin youth:arandomizedeffec8venesstrial.ArchivesofGeneralPsychiatry,69(3),274-282.

ThreemajorcomponentsoftheCYPIAPTtransforma&on 3. Shift to collaborative practice

Patient-reported outcomes

Practitioner

Client Clinical decision-

making

Redressingthebalanceofexper&se

.

Collaborative Practice

•  involvesthechild,youngpersonorparentandthementalhealthprofessionaljointlyiden6fyingproblemsandagreeinggoalsfortreatment

• partnershipexper6se•  shareddecisionmaking• provisionofarangeofevidence-basedapproaches

Empoweringyoungpeople

Understandand modifytreatment

progressviaPROMs

Par6cipate

Par6cipateintrainingofinservicedesign

prac66oners&managers

FutureinMind-reportofthena&onalCAMHSTaskforce

•  hqps://www.gov.uk/government/uploads/system/uploads/aqachment_data/file/414024/Childrens_Mental_Health.pdf

•  PublishedbeforetheElec6on,wearewai6ngtoseehowtherecommenda6onsaretakenforwardbythenewgovernment

•  Whatwedoknowisthatitwillinformthecon6nueddevelopmentofCAMHSinEngland

•  Thereportar6culateshowweneedtosetabouttackling

theproblemstocreateasystemthatbringstogetherthepoten6aloftheweb,schools,socialcare,theNHS,thevoluntarysector,parentsandchildrenandyoungpeoplethemselves

09/07/2015Informa6onsubjecttorapidchangeso

checkforupdates:a.a.r.york@exeter.ac.uk;drannyork@outlook.com

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FutureofCYP-IAPT•  CYPIAPTCentralTeamhasexpandedandbecometheCAMHSstrategyandpolicyteamforNHSEngland

•  Mustdemonstratevalueyearonyearoftheimpactofthenewinvestment

•  WillhavetoreporttoPublicAccountsCommiqeeregularlysodatarepor6ngwillbeintegral

•  Livenego6a6oncon6nueswithHEEabouttraining•  CommitmenttoroleoutCYP-IAPTtransforma&onto100%

•  ButwillmorphintoawiderCAMHStransforma&onprogramme.......

16/04/2015Informa6onsubjecttorapidchangeso

checkforupdates:a.a.r.york@exeter.ac.uk;drannyork@outlook.com

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Transforma&onPlansarethewaytoaccessthenewmoneyforCAMHS

AutumnStatement£30Mrecurrentlyfor5yrs–forea&ngdisorders

•  DevelopevidencebasedcommunityEa6ngDisorderservicesforchildrenandyoungpeople:capacityingeneralteamsreleasedtoimproveself-harmandcrisisservices

hqp://www.england.nhs.uk/wp-content/uploads/2015/02/mh-access-wait-6me-guid.pdf

BudgetAnnouncementSpring2015£250Mrecurrently

•  Buildcapacityandcapabilityacrossthesystemsothatby2020,70,000morechildrenandyoungpeoplearetreatedperyear

•  Roll-outtheChildrenandYoungPeople’sImprovingAccesstoPsychologicalTherapiesprogrammes(CYPIAPT)

•  Improveperinatalcare

•  PilotajointmentalhealthtrainingprogrammeforsinglepointsofaccessinspecialistCAMHSandschools,tes6ngitover15CCGs

09/07/2015

Informa6onsubjecttorapidchangesocheckforupdates:a.a.r.york@exeter.ac.uk;

drannyork@outlook.com34

Transforma&onplans:wherearewenow?

§  NHSEisworkingwithpartnerstodevelopguidanceandabespokeassuranceprocess

§  ‘ Unitofplanning’likelytobetheHealthandWellbeingBoard§  Youwillneedtoshowevidenceofpartnershipworkingandsign

upnotjustlocallybutalsowithNHSEnglandspecialistcommissioning

§  Youwillneedtoshowthatchildren,youngpeopleandparentsare

involvedinplanninganddelivery§  Leqeraler6ngCCGsandNHSEnglandteamshasbeensentoutSlidethankstoKathrynPugh,ChildandAdolescentMentalHealth

ProgrammeManager

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InterimguidanceonTransforma6onPlans

•  hqp://www.pcc-cic.org.uk/ar6cle/child-and-adolescent-mental-health-services-camhs-transforma6on-plans-interim-guidance

•  allTransforma6onPlanstobeassuredandallCAMHSalloca6onsmadebytheendofSeptember

•  From2016/17,anyrefreshofTransforma6onPlansandthecon6nuingdevelopmentofserviceswillbeembeddedwithinmainstreamplanningandassuranceprocesses.

Transforma6onplanswillneedto•  BeTransparent–publishing

–  Baselineinvestmentbylocalcommissioners–  Whatservicesareprovidedincludingworkforceinforma6on–  Referralsreceived,accepted,wai6ng6mes

•  DemonstrateServicetransforma&oninlinewithprinciplescovering–  rangeandchoiceoftreatmentsandinterven6onsavailable;–  collabora6veprac6cewithchildren,youngpeopleandfamiliesandinvolving

schools;–  useofevidence-basedinterven6ons;andregularfeedbackofoutcomemonitoring

tochildren,youngpeopleandfamiliesandinsupervision.

•  Monitorimprovement–  Developmentofasharedac6onplanandacommitmenttoreview,monitorand

trackimprovementswithappropriategovernancestructures.

SlidethankstoKathrynPugh,ChildandAdolescentMentalHealthProgrammeManager37

NHSEMentalHealthTaskforce

•  hqp://www.england.nhs.uk/ourwork/part-rel/mh-taskforce/

•  FormedMarch2015–  Taskistodevelopanewfiveyearna6onalstrategyformentalhealth

–  Coveringservicesforallages–  Tobepublishedinautumn2015–  Spanshealthandcaresystem

•  Termsofreference:hqp://www.england.nhs.uk/wp-content/uploads/2015/03/mh-tor-fin.pdf

09/07/2015Informa6onsubjecttorapidchangeso

checkforupdates:a.a.r.york@exeter.ac.uk;drannyork@outlook.com

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