Clinical Psychologist Counselling Psychologist Improving the Transition for Young People from CAMHS to CMHT: a Pilot Project Dr Joanne Cocksey & Dr Lisa Da Silva Clinical Psychologist Counselling Psychologist JC & LDS

Background NATIONAL Identified need for an improvement to the process of transition for young people from CAMHS to CMHT (Children and Young People in Mind: National CAMHS Review, 2008; No Health without Mental Health, 2011). In London only 4% of young people reported a good experience of transition, with many disengaging from services (Singh et al., 2008). LOCAL In Berkshire, the Windsor, Ascot & Maidenhead (WAM) locality, service user feedback indicated that young people and their parents experienced the transition from child to adult services as challenging. Differences in ways of working and expectations between children and adult services led to service user distress/confusion, complaints, and negative inter-service communication. A lack of liaison and care planning between CAMHS and CMHT resulted in disjointed and late transitions and extended out of area placements. JC Differences between the services in relation to engagement with parents and expectations regarding the young person’s motivation to access and engage with treatment. A number of complaints and disengagement by the young people, while parents reported feeling helpless.

Objectives and opportunities Improve the quality of care for young people and their families plan transitions around individual client needs. Ensure a more seamless client experience. Improve the engagement of young people with complex mental health problems in transition. Provide peer support and focused learning opportunities for parents/carers . Bringing together existing resources in CAMHS and CMHT to more effectively manage transitions: Enhancing collaboration and sharing knowledge between professionals/teams Decreasing costs (reduce replication of input and time in out of area placements) JC Bringing together existing resources in CAMHS and CMHT to more effectively manage transitions. Enhancing collaboration between CAMHS and CMHT services to plan transitions around individual client needs. Sharing knowledge and learning between teams and professionals. Working more effectively and decreasing costs (e.g. placements, duplication of interventions).

The pilot CAMHS – CMHT joint meetings Transitions Group Parents’ Group JC

CAMHS-CMHT meeting Monthly meeting between CAMHS and CMHT Team Managers, Leads and Senior Clinicians. Young people are discussed in the meeting from when they turn 17, leading to improved transition planning and early joint care co-ordination. Since the start of the project approximately 52 young people have been reviewed in the meeting. Of these, 14 have been/are being transitioned to CMHT. Of these 2 disengaged once transitioned to the CMHT. In the year prior to the start of the project there were 3 complaints regarding the transition from CAMHS to CMHT. Since the project, no complaints have been received from this cohort. JC

Parents’ Group All parents, relatives and carers of the above cohort, focussing on peer support and skills review/learning. JC

Transitions Group Clients aged 17 and 18 years of age who meet criteria for CMHT or just below. Focuses on the development of skills to manage emotional and psychological difficulties, and provides peer support. Modular with a range of topics: Self-care; Anxiety; Low mood; Identity; Self-esteem; and Relationships. Weekly for 1½ hours away at non-mental health premises. Facilitated by a CAMHS and a CMHT psychologist . Individual reviews at the end of each module. LDS

Transitions Group 37 young people considered 17 offered 6 accepted 10 discharged 4 to be reassessed post crisis 6 to specialist services 37 young people considered 6 accepted LDS 11 declined

Outcomes of Transitions Group Measures Revised Child Anxiety and Depression Scale (RCADS) JC

Outcomes of Transitions Group Measures CORE LDS- Time 1 is their first measures and Time 2 is their most recent measures CORE . a UK standardised quality evaluation, audit and outcome assessment tool for the psychological therapies. has moved from moderate severe to moderate

Outcomes of Transitions Group Measures Education and Employment LDS 2/6 were in education at the start. All of them were in education or employment by the end of the group which was in line with their goals.

Outcomes of Transitions Group Measures Feedback LDS Likert scale: 1 Completely disagree; 10 Completely agree

Challenges Majority of those offered the group declined it (11 of 17) = low numbers Timetable issues Anxiety about groups Heterogeneous group Repetition of previous input Engaging parents JC/LDS -timetable- consider alternative times, e.g. evenings. Think about venue and managing risk -repetition of input- use peoples experiences in a positive way in the group, consolidation of skills and opportunity to learn new things. Has worked well -anxiety about groups- some have been supported into the group despite anxiety but some haven't responded to this. Engaging parents-more involvement of parents during referral process. Joint assessment with the young person. -numbers – cross locality, expanding the age range but knowing it will make it more heterogeneous.

Conclusions Addressing an identified need for this age group. Enhanced joint working and better communication between CAMHS and CMHT. Improved care planning and joined up preparation for transition. Reduced likelihood of disengagement. Enhanced service user experience. JC

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