Liverpool’s CAMHS Partnership Lisa Nolan Programme Delivery Manager (Children and Maternity) Liverpool CCG Lisa.nolan@liverpoolccg.nhs.uk

Liverpool’s CAMHS Partnership Needs led Family centred Multi-agency – range of providers Provides continuum of care with targeted support Engaging, Involving and inclusive Jointly commissioned Strong How did we get here?

The journey

Alder hey community mental health teams In-patient provision Pre-2003 Comprehensive CAMHS 2+1 service, Alder hey

Alder hey Foundation Trust – Community Mental health teams Providers: Alder hey Foundation Trust – Community Mental health teams Regional units Commissioners: Liverpool Health Authority Outcomes: Not monitored or reported

2003-2006 Tier 2 Regional In-patient Units: SLD team CAMHS tier 3 community teams, YPAS counselling ‘Mad, Bad or Misunderstood’, YPAS Support Service Working Together BEST AS Pathway Regional In-patient Units: CABI 2003-2006 SLD team HAVEN

Liverpool City Council Providers: Alder Hey (many teams) VCS: YPAS Regional units Commissioners: Liverpool PCT Liverpool City Council Outcomes: Dev. of choice Less stigmatising provision New ways of working More community based provision Joint and partnership working Emerging performance monitoring process Policy driven

2007-2010 Tier 2 CAMHS tier 3 community teams, YPAS counselling Training and MH Promotion: ‘Mad, Bad or Misunderstood’, Healthy schools Partnership, Mental health promotion YPAS Support Service Working Together ADHD Foundation BEST YOS mental health provision AS Pathway Regional In-patient Units: CABI Regional Home Based Treatment Participation team, MYA Banardos Young Carers & ‘Keeping the Family in Mind’ 2007-2010 SLD team CAMHS LAC CAMHS 16-18 team HAVEN TAMHS, MYA

Liverpool City Council Social Care Providers: Alder Hey (many teams) VCS: YPAS, PSS, Barnardos, MYA Regional units and HBT Commissioners: Liverpool PCT Liverpool City Council Social Care Outcomes: Dev. of choice Less stigmatising provision New ways of working More community based provision Joint and partnership working -participation Thinking family Improved performance monitoring process Policy driven

Voluntary Sector CAMHS (YPAS, ADHDF, PSS, Banardos YC) Comprehensive CAMHS Pathways 2010-2013 C&YP & Families Training: MBM Inside Out, Master class Mental health first aid Specific training Consultation & support: Telephone, individual, group Tier 4 Dewi Jones Unit (0-14) Alder Hey (Primary Mental Health Service, Specialist CAMHS) Public Mental Health Self-care, Website promotion Tier 4 YPC (14-18), CHEDS Single Point of Access Tier 4 OAT (Independent Sector) Voluntary Sector CAMHS (YPAS, ADHDF, PSS, Banardos YC) Provider: voluntary CAMHS and c&yp Triage (multi-agency) AHCFT 0-16 years Out of Hours Psychiatry Universal services Provider: Voluntary CAMHS Statutory CAMHS Mersey Care 16 plus Other services (signposted) care aims methodology

Liverpool City Council Providers: Alder Hey (2 teams with SPA) VCS: YPAS, PSS, Barnardos, MYA Regional units and HBT Commissioners: Liverpool PCT/CCG Liverpool City Council Schools Social Care Outcomes: Dev. of choice Less stigmatising provision New ways of working More community based provision Joint and partnership working - participation Thinking family Robust performance monitoring process Single point of access Multi-agency triage and working More accessible information Consultation and training accessible to frontline provision

Liverpool’s CAMHS Partnership Performance Monitoring: Activity – CAMHS returns/National data set/national benchmarking Outcomes – CAMHS returns/ CORC Quality – CAMHS Returns/ Contract visits

Liverpool’s CAMHS Partnership So What?? Reduction in specialist CAMHS referrals by 21% form 11/12 to 12/13 90% of those accessing services showing improvement in mental health (CORC) 90% high satisfaction with services (CORC) Increase year on year of universal staff accessing training

Liverpool’s CAMHS Partnership All providers using CORC measures VCS all quality assured Built local workforce Strong equalities agenda Strong participation agenda Focus on early identification and prevention

Liverpool’s CAMHS Partnership Why VCS? Less stigmatising Less medical More Flexible Innovative and creative Skills of workforce Added value Community based Engaging and involving Asset based

Liverpool’s CAMHS Partnership Challenges: Professional hierarchy Funding Restructure

Liverpool’s CAMHS Partnership WHAT NEXT?

Main presenting problems: Need: Approx. 100,000 c&yp Liverpool is 1 of the most deprived cities in UK High proportion of LAC, young cares, c&yp with disabilities, BME communities and refugee and asylum seekers High risk factors therefore mental health problems likely to be high Main presenting problems: Emotional disorders, behavioural and self harm Adverse Childhood Experiences: - physical, emotional, sexual abuse, domestic violence, household substance misuse, household mental illness, parental separation and divorce, parent in prison Main referrers: Education, child health services, GP L4, L8 and L6 postcodes account for 27% of referrals Tier Number 1 12828 (15%) 2 5986 (7%) 3 1582 (1.85%) 4 64 (0.075%)

Future Challenges: Integrated commissioning – funding Integrated care – culture, personalities Changing NHS – relationship management Economic climate and social determinants

GAPS: Transition – CAMHS to AMHS and Tier 3-4 pathway Early years and maternal mental health Neuro-developmental problems (ASD and ADHD) Mental health promotion In balance in access – too many at specialist level In balance in funding and therefore delivery – more focus on specialist than early intervention Integration at commissioning level

Future Opportunities: Integrated commissioning and care CCG and LCC priorities Liverpool’s children and young peoples/whole family agenda Public health changes IAPT (Improved Access to Psychological therapies) Mental health promotion and FYI developments (participation) Training menu Transition Research opportunities Neuro-developmental pathway Datasets

CHILDREN, YOUNG PEOPLE & FAMILIES PROVIDER 2014-2017 strategy: DECISION MAKERS CHILDREN, YOUNG PEOPLE & FAMILIES PROVIDER Joint commissioners Range – VCS, independent and statutory-partnership UNCRC Working Together to ensure mental health and emotional wellbeing is ‘Everybodies Business’

Improved mental health of Liverpool CAMHS Outcomes Strategic Map and Pathway Improved mental health of Children & Young People [& their Families] Improved Environments so that Children, Young People & families can Thrive Increased Identification of C&YP with early indicators of distress and risks Reduction in Mild to Moderate Distress Reduction in the development of Moderate To Serve distress Reduction in life long distress MYA- MHP, training and engagement Alder Hey - Specialist CAMHS In-patient care – Dewi Jones (alder hey) and YPC (CWP) and OATS Alder Hey – Early intervention (PMHS) and LAC/CIN YPAS – therapeutic/counselling and support service PSS – refugee and asylum seekers therapeutic support ADHD Foundation Barnardos YC and KFIM Key: Delivery- public mental health, early intervention, targeted Contracts – LCC Funding- LCC/CCG/social care/schools (pooled budget) Performance managed – LCC Delivery – specialist Contracts– CCG Funding- CCG Performance managed – CCG Delivery – In-Patient (regional) Contracts– Spec Comm Funding- CCG top slice Performance managed – Spec Comm

Liverpool’s CAMHS Partnership Outcomes: Improved mental health of children, young people and their families Improved environments so that children, young people and families can thrive Increased Identification of children and young people with early indicators of distress and risk Reduction in mild to moderate distress Reduction in the development of moderate to severe distress Reduction in life long distress