Improving Access to CAMHS I nvolving young people in service design Beverley Mack Bexley CAMHS

Adolescent Assertive Outreach Project NSF Development Initiative Short term funding from DOH Project has operated since 2006 Significant involvement of young people Project is subject to evaluation

Aims of the project To target 16 &17 year olds who are vulnerable to developing mental health problems & who find it hard to access CAMHS To develop close partnerships with partner agencies working with vulnerable young people To provide a flexible approach to service delivery

How were young people involved? Needs analysis & recommendations for service design Members of project steering group Design & production of age appropriate materials – website, posters, cards & film Service evaluation - providing feedback & conducting interviews

Needs Analysis Aim: To understand & overcome the barriers for young people in accessing CAMHS Method: Focus group comprising 8 young people from Bexley Youth Council & Young People’s Parliament aged years including 1 CAMH service user  Initial exploratory research, obtaining qualitative information through discussion and semi-structured interviews  Focus group assisted in developing a questionnaire Questionnaire completed by 95 young people

Themes from interviews: Young people told us the barriers to access were: A negative perception of CAMHS – name, (mental health –stigmatising), location, association with hospital, décor, lack of choice / flexibility of appointment times & therapist, too formal Concerns about confidentiality - limit trust

Themes from questionnaires: Young people told us they wanted: To be involved in developing services (16 & 17 year olds) Contact with CAMHS independent of parents / carers Information about CAMHS:  Information about treatments  Rules re confidentiality  Information provided via website (preferred conduit), literature, other age-appropriate & user friendly materials, info via drop-in

Greater accessibility  Preferred referral routes : 1st Self-referral - YP able request a service by talking directly to CAMHS staff 2 nd GP 3 rd School  Choice of outreach services away from the clinic  Treatment locations : Most preferred - current CAMHS clinic or community settings e.g. Connexions, Youth Centre Fewer preferred – school or home

Greater flexibility of service provision  Appointment times – preferences: 1 st Weekday evenings 5-7pm 2 nd Weekdays 9-5pm 3 rd Saturdays 10am-1pm  Therapist choice – Gender was cited as most important Age & ethnicity not deemed important

How did young people want CAMHS to communicate with them? 1 st choice - Letter 2 nd choice -Mobile phone 3 rd choice - Text message 4 th choice -

The clinical environment Young people said they would feel most comfortable with: Separate waiting areas & therapy rooms for children and adolescents decorated with age appropriate leaflets and posters In the waiting area, they wanted.. Staff profiles & posters reflecting cultural diversity, quiet music, drinks available & pleasant decorations

How did the feedback change the service? Clinical assertive outreach – flexible approach to engagement, venues, times, greater negotiation, self referral, drop -ins Liaison & consultation with partner agencies Development of age appropriate materials Improved clinical environment - décor, young people’s art work, designated waiting area for adolescents, more leaflets

Young people as members of the project steering group 2 young women – previously CAMHS service users and Care Leavers Introduced to group & known by steering group Chair – (manager of Leaving Care Team) & C&YP’s Rights Officer Attendance facilitated – reminder calls, transport to meetings Paid a fee for attending Committed, interested and made a positive contribution

Information & age appropriate materials Young people worked with professional designers and CAMHS clinicians to design & produce : Posters & business cards – young men from gangs created brand name ‘Camhs Care’ Film ‘Brewing’ – created by young people & shows 2 adolescents with MH problems & their ‘journey’ to CAMHS Shown to young people in schools /colleges aged 14+ as part of PSHE to promote discussion of mental health. Some film sessions led by peer mentors

Website – Young people worked on the background research, development, design & content of the site, created podcasts, audio clips and poetry, site name, search terms, artwork and performed at the website launch Young people & parents continue to be involved in the website steering group

Service Evaluation Young people invited to complete satisfaction questionnaires following discharge Offered interviews – to be undertaken by young person member of steering group

Involving young people in service design Benefits for young people: Young people make a positive contribution (ECM) to developing their communities Help to develop services that better meet their needs Focus for creativity, builds sense of achievement Educational and skill building Introduction / experience of the world of work Challenges for young people: Creating a place alongside adult professionals – not being daunted Managing a different relationship to CAMHS / therapists (as compared to patient / therapist)

Involving young people in service design Challenges for professionals: Requires professionals to communicate clearly & comprehensibly Need to be mindful of the power relationship between adult professionals & young people in order to facilitate constructive involvement Involve meaningfully – young person’s views are integral to the process

Young people’s involvement - benefits to services: Young people shaped the design and direction of the project and gave the service a strong mandate Their creativity is inspirational & has helped us to achieve our aims – to make CAMHS more accessible Through their presence on steering group we are actively accountable to young people A partnership is created between service providers & service users Perspective of young people to assist, guide, influence & oversee project throughout Challenge the professionals Provide valuable insight & advice about adolescent preferences / lifestyles Creates a humbling experience for professionals