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

2. Everybody’s Business
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

3. 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

4. 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

5. 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

6. 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]

7. 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

8. 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

9. 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

10. 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

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

12. 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