1. Liverpool’s CAMHS Partnership
Lisa Nolan Programme Delivery Manager (Children and Maternity) Liverpool CCG

2. 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?

3. The journey

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

5. 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

6. 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
SLD team
HAVEN

7. 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

8. 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’
SLD team
CAMHS LAC
CAMHS team
HAVEN
TAMHS, MYA

9. 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

10. Voluntary Sector CAMHS (YPAS, ADHDF, PSS, Banardos YC)
Comprehensive CAMHS Pathways
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 years
Out of Hours Psychiatry
Universal
services
Provider:
Voluntary CAMHS
Statutory CAMHS
Mersey Care 16 plus
Other services (signposted)
care aims methodology

11. 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

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

13. 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

14. 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

15. 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

16. Liverpool’s CAMHS Partnership
Challenges:
Professional hierarchy
Funding
Restructure

17. Liverpool’s CAMHS Partnership
WHAT NEXT?

18. 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
(15%) 2
(7%) 3
(1.85%) 4
(0.075%)

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

20. 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

21. 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

22. CHILDREN, YOUNG PEOPLE & FAMILIES PROVIDER
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’

23. 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

24. 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