future in mind - cyp iapt and ed - midlands€¦ · partnerships map following recruitment of 6th...
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Future in Mind - CYP IAPT and ED
Anne O’Herlihy, Project Manager CYP IAPT and the Children and Young People’s Team, NHS
England
Peter Fonagy, National Clinical Lead for CYP IAPT Kathryn Pugh, Children and Young People’s Programme
Lead
Youth Mental Health: New Economic Evidence
• Mental health related costs for 12-15 yr olds average £1778 pa over only 3yr follow
up. (NB health, social care and school-based costs only - did not include employment, welfare benefits or criminal justice)
• Highest costs for hyperkinetic disorders (£2,780 pa)
• Education system incurred 90% of assessed costs (£1,564 pa)
• Youth justice system: YP 8x more likely to have contact (with additional costs) over 18
month.
• Benefits: twice as likely to be claiming benefits (27% vs 14%)
• Treatment gap: less than half (45%) of 12-15/16-25yr olds were in contact with services
related to their MH needs, 54% if severe mental illness. Treatment gap has been known about for two decades.
• Lower rates of service contact than any other age group
Martin Knapp et al, 2016 PSSRU, LSE
2
• Children with Conduct Disorder are 10 times more costly to the public sector by the age of 28 than any other child
• Overall lifetime costs associated with moderate behavioural problem amount to £85,000 per child
– Severe behavioural problem: £260,000 per child
Economic case for change: FiM examples
An example of cost-effective intervention from NICE Additional cost-effectiveness for lifetime earning gains not included
3
www.england.nhs.uk
NICE Recommended Therapies for Children & Young People
www.england.nhs.uk
What is CYP IAPT - a way of working
• CYP IAPT learned from Adult IAPT but is specific to the needs of children and families and the agencies that support them.
• CYP IAPT is a set of principles for a way of working, not a service
• It was not resourced to create services, but to change them introducing key principles across the whole of CYP MHS
• Improve access to:
• Evidence Based Practice (EBP)
• Strong supervision and high fidelity
• Regular outcome and feedback monitoring (ROM)
• Shared decision making and collaborative care – CYP and parent/carers participation in all aspects of care, service delivery and design
• Access through self-referral
www.england.nhs.uk
Core Implementation Components
•Fixsen et al., 2009
Staff selection
Preservice training
Supervision and
coaching
Performance evaluation
Decision support data
systems
Facilitative administrative
supports
System interventions
Integrated
&
Compensatory
www.england.nhs.uk
Clinician
expertise
Evidenced Based
Practice
Shared Formulation
&
Agreed Intervention
Goals
YP/Family’s goals
preferences, values, and
unique context
+ +
Research evidence
Adapted and used with thanks to Peter Fonagy and Duncan Law Frueh et al (2012) Evidence-Based Practice in Adult Mental Health. Handbook of Evidence-
Based Practice in Clinical Psychology. Published online.
www.england.nhs.uk
Our Goal:
Appropriate CYP MH services
www.england.nhs.uk
Where next for CYP IAPT? (NHS England & HEE)
Now integral part of the Transformation Programme in England - embedding evidence based, outcome focussed collaborative service transformation with FULL PARTICIPATION
Model of delivery is through a collaborative and mentoring scheme between learning collaboratives (HEI) that work in partnership with local providers
Increased geographical coverage of service transformation programme to100 % by 2018 – greater reach and depth
Continue to offer training across CYP MH partnerships (NHS, LA, Vol sect): CBT, SFP, IPT-A, Parenting, Supervision, Service Transformational Leadership, EEBP, outreach service development, outreach enhanced supervision
(2011-16: 1,371 therapists; 348 supervisors; 309 service leads)
•Children and young people with learning disabilities or autistic spectrum disorder
•Working with 0-5s
•Counselling
•Combination - Prescribing and therapy
•Inpatient CAMHS
•Eating Disorder
Deliver new curricula – evidence based interventions for
National Accreditation Council – assure quality of training and embedding of principles
www.england.nhs.uk
CYP IAPT Learning Collaboratives
HEIs (n=8)
Assure quality
Organise training
Deliver content in partnership
Yr1 Partnerships (n=18; 2011/12)
CYP MHS-NHS/Vol.S/LA-Commissioners
Yr2 Partnerships (n=24; 2012/13)
Yr3 Partnerships (n=25; 2013/14)
Yr4 Partnerships
(n= 15; 2014/15)…
Mentorship &
Peer Support
Yr 5 Partnerships (n=14; 2015/16) …
Yr 6 Partnerships (n=tbc; 2016/17)…
Yr 7 Partnerships (n=tbc; 2017/18)-end of central funding…
www.england.nhs.uk
Regular outcome and feedback monitoring
by all practitioners
Inform, guide collaborative treatment and reflect on progress
and practice
• Managers ensure that:
o Nominated practitioner who is responsible for supporting use of
ROM
o Appropriate systems for collection of data
• Supervisors/clinical leads must ensure practitioners can:
o Determine collaboratively with CYP and family/carers key goals
o Understand how to interpret outcomes data & use in session
and supervision
o Use outcome data to decide if a change of therapy is needed
www.england.nhs.uk
What’s the evidence?
Use of feedback forms/measures can: • Improve clinicians ability to detect worsening of
symptoms (Lambert, 2010)
• Provide information that may have otherwise been missed (Worthen & Lambert, 2007)
• Reduce drop out (e.g. Miller et al. 2006)
• Increase speed to reach good outcomes (Lambert et al. 2005)
• Improves outcomes (Bickman et al 2011)
Summary from Duncan Law (London and South East Collaborative)
www.england.nhs.uk
Empowering young
people enables them
to….
1. Take control of their care
2. Establish treatment goals
3. Choose the route to health that’s best for them
4. Strengthen agency & trust
www.england.nhs.uk
Progress so far
15 www.england.nhs.uk
CYP IAPT
Partnerships Map
Following recruitment of
6th collaborative,
programme on target to
work with services
covering 80% of 0-19
population by March
2016.
This goes up to 87%
when including ‘light
touch’ outreach and
service leadership work
to prepare partnerships
for full modality training
www.england.nhs.uk
Number of trainees 2011-2015
(n=1,977)
16
318
145
183
123
242
87
52 52 42
79 63
76 58
21
63 53 49 52 36
183
0
50
100
150
200
250
300
350
London & South East Oxford & Reading North East South West North West
Therapists
Supervisors
Service Leads
Enhanced evidencebased practice
www.england.nhs.uk
• Young people seen more quickly-time
between referral and assessment
decreased by 73%
• YP achieved significant clinical
improvement over fewer sessions -
number of days between assessment
and discharge decreased by 21%
Is it working?
239
299
64
235
Days between referral andassessment
Days between assessmentand discharge
Pre CYP-IAPT With CYP-IAPT
Improved access through self-referral routes, single point of
access, outreach services, evening and weekend
appointments.
www.england.nhs.uk
Derby - Family A – 16 year old presenting with self-harm and
overdose 16 sessions (completed case)
www.england.nhs.uk
Greater involvement of children,
young people and
their parents or carers:
Throughout treatment and every aspect of their care
Recruitment and interview
panels
Staff appraisal and
training
Website and information
design
Planning and delivery of
mental health awareness
Mystery shopped service
evaluation
Environ-mental changes
Speaking with clinical
directors
New feedback systems ‘you said, we did’
Increased CYP participation
56%
34%
Pre CYP-IAPT2 With CYP-IAPT
CYP agreed they had
recovered sufficiently to be
discharged - percentage of
closed cases by mutual
agreement increased
www.england.nhs.uk
Resources
DATA: Chimat and CAMHS ebulletin –
http://www.chimat.org.uk/camhs
CORC: http://www.corc.uk.net/
NHS Benchmarking Report 2015
MHSDS-flowing from Jan 2016
• Resource for all adults to increase awareness and understanding
• Includes free e-learning sessions for all those working with CYP (incl. ED sessions)
• MindEd for Families
https://www.minded.org.uk/
GIFT Sign up for www.myapt.org.uk;
see video clips
https://www.youtube.com/user/Cern
isLimited/videos
www.england.nhs.uk
• New online resource created for and
with parents and carers to help improve
mental health care for children and young
people
• Over 900 parents/carers identified 5 key areas:
• access, equality and diversity
• communication
• service leadership and delivery
• methods of engagement
• workforce development
• Best practice case studies,
videos, resource directory
www.youngminds.org.uk
www.england.nhs.uk
1. Co produce products and resources
- where are the gaps?
- what would be helpful?
2. National core and wider interest groups Diverse representation of CYP and parent and carers using services (incl.
youth justice, those that tend not to use statutory services)
3. Embed across system
- through support clinical networks, CYP IAPT collaboratives and
partnerships, workshops and masterclasses, monitoring impact at all levels
4. Best practice case studies, videos, resource website,
directory www.youngminds.org.uk
Participation across whole CYP MH system (national, regional, and local level)
www.england.nhs.uk
CYP Community Eating Disorder (CED)
referral to treatment standard and
commissioning guidance
25/11/2016
www.england.nhs.uk
Eating Disorders (CYP)
Access and waiting time standard
Those referred for assessment or treatment for an eating disorder should receive NICE
concordant treatment within one week for urgent cases and within 4 weeks for every other case.
Aim is for 95% of those referred for assessment or treatment receive
NICE concordant treatment with the ED standard RTT by 2020
Introduced and monitored in 2016-17 via MHSDS and UNIFY data collection; tolerance levels
to be set and standard implemented from 2017-18 – NEW extension for inpatient care-2017
The Role of Education Eating disorder curricula group convened in partnership with HEE
(October 2015) building on:
Systemic family practice curriculum for eating disorder
Existing whole team training packages for multi-disciplinary community eating
disorder services/teams – to be delivered 2016-17
Modality specific evidence based interventions anticipated to be in line with
updated eating disorder NICE guideline to be published in 2017
www.england.nhs.uk
Recommended training for CEDS-CYP teams
Training goal
Develop multidisciplinary
eating disorder teams
Understand the complex
nature of eating disorders
Develop a strong team
culture
Develop early intensive skills
training and regular support
and supervision
Adopt core CYP-IAPT
principles
Evaluate the impact of
training on transformation of
services
Also, CEDS-CYP will have a role in training for
other professionals
• Raising awareness
• Primary care
• Education
• Other children services
The relationships developed through the training can
be used to provide regular support to the teams
involved in improving early identification of children and
young people at risk of developing an eating disorder
www.england.nhs.uk
A Community Eating Disorder Service for Children and Young People (CEDS-CYP)
A new service to meet this challenges
• An appropriately trained,
supported and supervised team
• Use of information technology for
teamwork from different
geographical locations
• Eg. Following a “hub and
spoke” model
Requirements
Receive a minimum of 50 new eating disorder
referrals a year
Cover a minimum general population of 500,000 (all
ages)
Use up-to-date evidence-based interventions to
treat the most common types of coexisting mental
health problems (for example, depression and anxiety
disorders) alongside the eating disorder
Enable direct access to community eating disorder
treatment through self-referral or from primary care
services (for example, GPs, schools, colleges and
voluntary sector services)
Include medical and non-medical staff with
significant eating disorder experience
www.england.nhs.uk
Benefits for children, young people,
their families and carers
Improved access and reduction in waiting times to treatment
Children, young people, their families and carers know how to ask for help in their local areas
Better knowledge of how to recognise eating disorders and how to access appropriate care when needed
Every person receiving appropriate evidence-based eating disorder treatment, based on their needs
Receiving treatments for eating disorders and coexisting mental health problems from 1 team
Improved outcomes, sustained recovery, reduction in relapse, and reduced inpatient admissions
Continued transformation of CYPMH evidence-based, outcome-focused, working collaboratively with children, young people and families
Less need for transfer to adult services and long periods of treatment
Less need for inpatient admission with the disruption to school and family life
CYP and families have more involvement in commissioning services that meet their needs.
www.england.nhs.uk
Data update for ED • MHSDS flowing from Jan 16
• UNIFY data collection on ED RTT – 2 submissions by Nov 2016
• Technical Guidance published Mar 16
https://www.england.nhs.uk/mentalhealth/resources/
• Prevalence Survey commissioned by DH – due to report in 2018
• HEE CYP MH workforce mapping with NHS Benchmarking to
report Autumn 2016 (CYP MH across NHS and non-NHS providers)
• QNCC-ED launched improvement and accreditation network - – will
host CED-CYP service directory (August 2016) to support a peer-led
network, access to whole team training.
www.england.nhs.uk
Contact: kathryn.pugh1.nhs.net