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Liverpool’s CAMHS Partnership
Lisa NolanProgramme Delivery Manager
(Children and Maternity)Liverpool CCG
• 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?
Liverpool’s CAMHS Partnership
The journey
Alder hey community
mental health teams
Com
preh
ensi
ve C
AM
HS
In-patient provision
2+1 service,
Alder hey
Pre-2003
Providers:
Alder hey Foundation Trust – Community Mental health teamsRegional units
Commissioners:
Liverpool Health Authority
Outcomes:
Not monitored or reported
Tier 2
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
2003-2006
Providers:
Alder Hey (many teams)VCS:YPAS Regional units
Commissioners:
Liverpool PCTLiverpool City Council
Outcomes:
Dev. of choiceLess stigmatising provisionNew ways of workingMore community based provisionJoint and partnership workingEmerging performance monitoring processPolicy driven
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’
CAMHS LAC
CAMHS 16-18 team
SLD team
HAVEN
2007-2010
TAMHS, MYA
Providers:
Alder Hey (many teams)VCS:YPAS, PSS, Barnardos, MYARegional units and HBT
Commissioners:
Liverpool PCTLiverpool City CouncilSocial Care
Outcomes:
Dev. of choiceLess stigmatising provisionNew ways of workingMore community based provisionJoint and partnership working -participationThinking familyImproved performance monitoring processPolicy driven
PublicMenta
lHealthSelf-care,WebsiteMentalHealthpromotion
PublicMenta
lHealthSelf-care,WebsiteMentalHealthpromotion
Training:MBMInside Out, Master classMental healthfirst aidSpecific training
Consultation& support:Telephone,individual, group
Training:MBMInside Out, Master classMental healthfirst aidSpecific training
Consultation& support:Telephone,individual, group
C&YP&Families
C&YP&Families
Universal
services
Universal
services
Single Point of Access
Triage (multi-agency)
Alder Hey(Primary Mental Health Service,
Specialist CAMHS)
Alder Hey(Primary Mental Health Service,
Specialist CAMHS)
Mersey Care 16 plus
Mersey Care 16 plus
AHCFT 0-16 years
Out of Hours Psychiatry
AHCFT 0-16 years
Out of Hours Psychiatry
Other services (signposted)
Other services (signposted)
Tier 4YPC
(14-18), CHEDS
Tier 4YPC
(14-18), CHEDS
Tier 4Dewi Jones
Unit(0-14)
Tier 4Dewi Jones
Unit(0-14)
Tier 4OAT
(Independent Sector)
Tier 4OAT
(Independent Sector)
care aims methodology
Comprehensive CAMHS Pathways 2010-2013
Voluntary Sector CAMHS(YPAS, ADHDF, PSS,
Banardos YC)
Voluntary Sector CAMHS(YPAS, ADHDF, PSS,
Banardos YC)
Provider:voluntary CAMHS and c&yp
Provider:Voluntary CAMHSStatutory CAMHS
Providers:
Alder Hey(2 teams with SPA) VCS:YPAS, PSS, Barnardos, MYARegional units and HBT
Commissioners:
Liverpool PCT/CCG•Liverpool City Council•Schools•Social Care
Outcomes:
Dev. of choiceLess stigmatising provisionNew ways of workingMore community based provisionJoint and partnership working - participationThinking familyRobust performance monitoring process
•Single point of accessMulti-agency triage and workingMore accessible informationConsultation 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 PartnershipSo 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 PartnershipWhy 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 PartnershipChallenges:
•Professional hierarchy•Funding •Restructure
WHAT NEXT?
Liverpool’s CAMHS Partnership
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 harmAdverse 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,
GPL4, 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
Working Together to ensure mental health and emotional wellbeing is
‘Everybodies Business’
Joint commissionersRange – VCS, independent and statutory-partnership
UNCRC
2014-2017 strategy:
Improved mental health of Children & Young People
[& their Families]
Reduction in Mild to Moderate
Distress
Reduction in the development of Moderate
To Serve distress
Increased Identification of C&YP with
early indicators of distress and risks
Improved Environments so that Children,
Young People & families can Thrive
Liverpool CAMHSOutcomes Strategic Map and Pathway
Reduction in life long distress
Delivery- public mental health, early intervention, targetedContracts – LCCFunding- LCC/CCG/social care/schools (pooled budget)Performance managed – LCC
MYA- MHP, training and engagement
Barnardos YC and KFIM
PSS – refugee and asylum seekers therapeutic support
YPAS – therapeutic/counselling and support service
ADHD Foundation
Alder Hey – Early intervention (PMHS) and LAC/CIN
Alder Hey - Specialist CAMHS
In-patient care – Dewi Jones (alder hey) and YPC (CWP) and OATS
Delivery – specialistContracts– CCGFunding- CCGPerformance managed – CCG
Delivery – In-Patient (regional)Contracts– Spec CommFunding- CCG top slicePerformance managed – Spec Comm
Key:
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
Liverpool’s CAMHS Partnership