Child and adolescent mental health service redesign Yale & SEPT international healthcare management programme Dr Paul Millard Consultant Child and Adolescent Psychiatrist Clinical Director Children’s Services, CPFT

Problem Role definition and communication are poor between services providing for children and adolescents in Cambridgeshire with mental health and behaviour problems. -Access is complicated -There is inconsistent use of evidence based interventions -There is duplication and waste -Commissioners believe services do not provide good value for money

Objective To define roles and responsibilities -Collaborate with commissioners and providers to agree care pathways for children with mental health and behaviour problems -A single point of access for all referrals -Use evidence based interventions -Specify who does what at each stage of the pathway

Background HAS report led to split into Tier 2 and 3 CAMHS Tier 3 services have defined themselves as mental health and NOT behaviour Cambridgeshire LA has developed services for parent support and behaviour problems Early Intervention Locality Services have been commissioned to provide for “mild and emerging mental health problems” GPs are “unhappy with access to CAMHS” LA are “unhappy with services delivered by CAMHS” However, parents and children who access services rate them highly Local context is to save 20-40% in NHS and LA

Root cause analysis New services have multiplied access points Services have been developed to fill gaps rather than meet need Lack of shared understanding of how to intervene in mental health and behaviour problems Lack of agreement about roles

Strategy Strengthen senior management team Generate sense of urgency Identify key partners and what will motivate them Develop a shared vision with partners, commissioners and stakeholders Maintain communication with staff and partners Implement and embed changes

Implementation Workstreams -Evidence, staff, capacity, IT, infrastructure, single point of access, pathways Multiagency groups Set timeline -Appoint new AD October Visioning Dec/Jan Workstreams Feb-July Define pathways and implementation July to Sept Implementation Sept 2011 onwards

Evaluation Single point of access Defined pathways Written information about access and pathways Improve GP satisfaction Improve parent and child satisfaction Achieve financial targets

Learning Good leadership AND management Need to involve everyone Communication is not a one-off Sustaining energy Delivering on timelines This is only the start