Developing a Service Model for CAMHS Dr Sarah Aitken Consultant in Public Health Medicine

Everybody’s Business 2001 - Welsh Assembly Government published Everybody’s Business, a 10 year strategy for Child & Adolescent Mental Health Services (CAMHS) The CAMHS strategy has been incorporated into the NSF for Children, Young People and Maternity Services in Wales The strategy emphasizes A multi-agency approach A four tier strategic concept Partnership

Four Tiers Tier 1 – Primary or direct contact services Tier 2 – First line specialist services provided by individuals. Tier 3 – Second line specialist services provided by teams Tier 4 – Very specialised services, including inpatient and residential services

Problems with implementation Variable age ranges for Specialist CAMHS. Variable access criteria for Specialist CAMHS Variable service delivery models for Specialist CAHMS Limited capacity Specialist CAMHS Variable competence and capacity in Tier 1

Making progress Wales Audit Office/Health Inspectorate Wales - undertaking a joint review of implementation CAMHS Regional Commissioning Networks have been set up for each the three Health Regions in Wales. The Regional Commissioning Support Unit (RCSU) in SE Wales identified CAMHS as an initial priority. RCSU SE Wales asked NPHS for an evidence based service model they could commission

Evidence Based Practice Systematic review of Specialist CAMHS Interventions 2002 [Fonagy P et al. What works for whom? 2002] CAMHS Evidence Based Practice Unit (EBPU) set up Systematic review updated 2006 Good practice statements published in “Drawing on the Evidence” [CAMHS EBPU 2006]

Consensus of Opinion Consensus of expert opinion is best option to fill gaps in the evidence. Clinical workshop asked to address specific questions Any good evidence missed by the review? Any disagreements with the evidence statements? Consensus where gaps in evidence Multi-modal service models

Results - Tier 1 Primary Healthcare Education sector Social care Physical examination Develop mental assessment Education sector Individual Education Plan (IEP) Behavioural Support Programme Assessment by Educational Psychologist Social care Assessment by senior practitioner

Results – Specialist CAMHS Primary Mental Health Service Gathering of information on previous assessments Assessment of need for specialist intervention Multi-disciplinary discussion of the referral Assessment by most appropriate specialist Most appropriate intervention Cognitive behaviour therapy Family therapy Behaviour therapy Medication

Results - Multi Modal Intervention Key worker Multi agency links Multidisciplinary team Tailored to needs of child Variety of settings Intensive home therapy Day hospital Delivered by best person at best time in best place for the child’s needs

Results – highly specialised services For safety of child For safety of others For very intensive interventions

Next stage CAMHS needs to be commissioned as a whole system or the parts of the system will be continue to be overwhelmed Commissioners need to agree their responsibilities NHS [LHBs, HCW] Local authorities Assess the gaps in current service provision against the service model Commissioners need to prioritise the gaps and develop a plan to fill them