Day1:IntrotoCYP-IAPTandTransforma6on:CoreAimsandValues
25thJune2015DrCatherineGallop
WiththankstoPeterFonagyandAnnYork
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IAPT for Children and Young People:
The Context….
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Ageofonsetforlife6mementaldisorder
Source:Kim-Cohenetal,2003;Kessleretal,2005;Kessleretal,2007
Mental health problems are the greatest health problem faced by children and young people
Prof Pat McGorry
ACCESS: % With anxiety or diagnosable depression not in contact with mental health services
Source: Ford et al. (2005) Child & Adol Ment Health, 10:2-9
Dean et al., (2004) DoH; McCrone et al., (2008) King’s Fund
80%
70%
60%
50%
40%
30%
20%
Adults with depression
5-15 year olds
Percent
unknown
to any
service
35%
76%
Interna6onalPerspec6veonCAMHS
• Alarmsregardingtheineffec&venessandfragmenta6onofcommunity-basedmentalhealthcareforchildrenandfamilies
• majorityofchildrenreceivingcommunity-based‘‘usualcare(UC)’’donotshowclinicalimprovement
• largemeta-analy&creviewreportedfewdifferencesbetweenUCtreatmentandcontrolgroups(waitlist)
ThecontextofCYPIAPT:Costs Mental illness during childhood and adolescence in the UK:
£11,030 to £59,130 annually per child
Lifetime cost of a 1-year cohort of children with Conduct Disorder: £5.2 billion
Costs of adult crime with history of CD
Including costs of various agencies •£60 billion in England and Wales
•£22.5billion attributable to CD •£37.5 billion to subthreshold CD
• Health • Social services • Education • Justice
Evidence-based practice has substantial clinical & cost benefits Little & Edovald, 2012; Suhrcke, Puillas & Selai, 2008
Only 6% of current spending on mental health goes to services aimed at children and young people Kennedy, 2010
Fragmenta6onofservices
forchildrenandyoungpeople
Currentserviceprovision:asnapshot
Fragmenta6onofservicesforchildren&youngpeople
Ar6ficialstructuraldivisionsintermsof
Differentlinesoffunding
DH DfE
DWP LA
Health
Social services
Education
Employment
Fragmenta6onofservicesforchildren&youngpeople
Ar6ficialstructuraldivisionsintermsof
Statutoryvsvoluntaryproviders
Fragmenta6onofservicesforchildren&youngpeople
Ar6ficialstructuraldivisionsintermsof
Separa6onofphysicalandmentalhealth
Physical Mental
Fragmenta6onofservicesforyoungpeopleaged12-25
Ar6ficialstructuraldivisionsintermsof
Under18
Over18
Age
Manyservicedesignsarenotyoungpersonfriendly
Inaccessible in terms of location, time,
criteria for access
Manycurrentservicedesignsarenotyoungpersonfriendly
SummaryoftheissuesfacingCAMHS
• Significantshortagesofsufficientlytrainedprofessionals • CurrentlevelofCAMHSstafftrainingis‘poorand ge^ngworse’ • Difficul&eswithaccess(veryfewservicesofferaself- referralroute) • Poorhandlingoftransi&onbetweenchildandadult services • Inappropriateprovisionofadultservicestoyoung people • Datathatcouldandshouldbeusedforself-cri6calprofessionalprac6ce,performancemonitoringand commissioningisrarelycollected
No Health Without Mental Health (2011)
“The Government is investing around £400 million over the Spending Review period to ensure that adults with depression and anxiety in all parts of England have access to a choice of psychological therapies. This investment will also enable the expansion of psychological therapies in children and young people’s services”
CYP IAPT Launch Paul Burstow (25.10.11) “The Government is now investing £32 million in psychological therapies, including talking therapies, for children and young people with mental health problems” “This investment in children’s mental health is vital. Talking therapies are proven to work, and so we are expanding services to treat children and young people with the tailored care that they need. “We know psychological therapies work. Our aim is to transform existing mental health services for children so our children get the best treatment possible, from services that are more responsive to their needs.”
Children and Young People’s IAPT
Implementation
Kathryn Pugh Project Manager, NHS England
Professor Peter Fonagy CYP IAPT National Lead
IAPT Website: WWW.IAPT.NHS.UK
WhatIsCYP-IAPT? Asimpleevidencebasedimplementa6onofEBP
• CYPIAPTwasconceivedasacentrallyini&ated modifica6onofCAMHSinthedirec&onofEBP • Itisachievingremarkabledegreeofculturalchangein termsoftheacceptabilityofprinciplesofEBP interpretedbroadlythroughamodestinvestmentin: • servicechange
• trainingserviceleads • supervisorsandtherapists
TheCYPIAPTProgramme • Usingrou&neoutcomesmonitoring
• Toguidetherapistandsupervisor • Tohelpclientmonitorandunderstandhow treatmentisprogressing • AcrossALLprofessions • EmpoweringYPtotakecontroloftheircare,
establishtreatmentgoals,choosetreatment approachesandtakeopportuni&estoimprove theirownhealth • Improvingaccesstoevidence-basedtherapies
ServiceTransforma6onProgramme• Projecthasreachedtargettoworkwithservicescovering60%of0-19popula6onby2015.
• Learningcollabora&vesmadeupofuniversi&esandlocalareapartnershipswhooffermutualsupport,problem- solvingandlearningnetworks.
• Ongoingclientfeedbackfacilitatedbyfrequentoutcome
monitoring,combinedwith:
• Excellentsupervision,• ensuringtherapy• modelfidelityand,con6nuedcollabora6veprac6ce
• Clinicians/prac66onerstodeliverbestevidencebasedinterven6ons,complementedby:
• Effec6veandsuppor6veservicedeliverymodels-shapedbyserviceusers-enablescontextfor:
Effec6veServices
Evidencebased
interven6ons
Outcomesmonitoringandfeedback
Supervision
ThreeMajorcomponentsoftheCYPIAPTtransforma6on
1.ClosingtheskillsgapinCAMHS:EvidenceBasedPrac=ce
Enhancingtheskillsof
Appropriatelyprac66oners,
skilledsupervisors&service
CAMHSmanagersinEBP
workforce
OverviewofCYPIAPTTrainingProgrammes
1. OutreachServiceDevelopmenttowiderservices2. OutreachSupervisorTrainingtowiderservices3. PGCer6ficateinClinicalLeadershipandService
Transforma&on4. PGCer6ficateinSupervisingEvidencedBased
PsychologicalTherapies5. PGDiplomainEvidencedBasedPsychological
Therapies6. PGCer&ficateinEnhanceEvidencedBasedPrac&ce
Whatisevidence-basedprac6ceinchildmentalhealth?
CYP
Clinician
Researcher
Afundamentallypar6cipatoryandco-produced(co-constructed) enterpriseinwhichclient,researcherandclinicianareallfullyengaged
Evidencebasedprac6ce
Researchevidence Pa6entpreferencesandvalues
Clinicianobserva6ons
+ +
Quan6fiableresultsAcceptabletorecipientsU6lityforclinicians=
ThreemajorcomponentsoftheCYPIAPTtransforma6on2.Rou=neOutcomeMonitoring
• Rou6neOutcomeMonitoringreferstomeasurementsofclients’progressinclinicalprac6ceandtheongoingtherapeu6crela6onship,usingstandardisedinstruments,aimingtoevaluateand,ifnecessary,adapttreatment.
• ClientsareinvitedtofilloutRou6neOutcomeMeasures(ROMs)atthebeginningoftreatment,duringtreatmentandattheendoftreatment.
• Subsequently,cliniciansandclientsareprovidedwithfeedbackabouttheresponsetotreatment.Basedonthefeedback,decisionscanbemaderegardingcon6nuing,alteringortermina6ngtreatment.
Measurementforapurpose: GuidingtreatmenttobePeroutcomes
3
2.5
2
1.5
1
0.5
0
TAU EBP
15%
EBP+Outcomes Monitoring
33%
NumberofdiagnosesPre
NumberofdiagnosesPost
Usual care
Manualized therapy
Therapy delivered on without Match
basis of Match
Weiszetal.(2012).Tes8ngstandardandmodulardesignsforpsychotherapytrea8ngdepression,anxiety,andconductproblemsin youth:arandomizedeffec8venesstrial.ArchivesofGeneralPsychiatry,69(3),274-282.
ThreemajorcomponentsoftheCYPIAPTtransforma&on 3. Shift to collaborative practice
Patient-reported outcomes
Practitioner
Client Clinical decision-
making
Redressingthebalanceofexper&se
.
Collaborative Practice
• involvesthechild,youngpersonorparentandthementalhealthprofessionaljointlyiden6fyingproblemsandagreeinggoalsfortreatment
• partnershipexper6se• shareddecisionmaking• provisionofarangeofevidence-basedapproaches
Empoweringyoungpeople
Understandand modifytreatment
progressviaPROMs
Par6cipate
Par6cipateintrainingofinservicedesign
prac66oners&managers
FutureinMind-reportofthena&onalCAMHSTaskforce
• hqps://www.gov.uk/government/uploads/system/uploads/aqachment_data/file/414024/Childrens_Mental_Health.pdf
• PublishedbeforetheElec6on,wearewai6ngtoseehowtherecommenda6onsaretakenforwardbythenewgovernment
• Whatwedoknowisthatitwillinformthecon6nueddevelopmentofCAMHSinEngland
• Thereportar6culateshowweneedtosetabouttackling
theproblemstocreateasystemthatbringstogetherthepoten6aloftheweb,schools,socialcare,theNHS,thevoluntarysector,parentsandchildrenandyoungpeoplethemselves
09/07/2015Informa6onsubjecttorapidchangeso
checkforupdates:[email protected];[email protected]
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FutureofCYP-IAPT• CYPIAPTCentralTeamhasexpandedandbecometheCAMHSstrategyandpolicyteamforNHSEngland
• Mustdemonstratevalueyearonyearoftheimpactofthenewinvestment
• WillhavetoreporttoPublicAccountsCommiqeeregularlysodatarepor6ngwillbeintegral
• Livenego6a6oncon6nueswithHEEabouttraining• CommitmenttoroleoutCYP-IAPTtransforma&onto100%
• ButwillmorphintoawiderCAMHStransforma&onprogramme.......
16/04/2015Informa6onsubjecttorapidchangeso
checkforupdates:[email protected];[email protected]
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Transforma&onPlansarethewaytoaccessthenewmoneyforCAMHS
AutumnStatement£30Mrecurrentlyfor5yrs–forea&ngdisorders
• DevelopevidencebasedcommunityEa6ngDisorderservicesforchildrenandyoungpeople:capacityingeneralteamsreleasedtoimproveself-harmandcrisisservices
hqp://www.england.nhs.uk/wp-content/uploads/2015/02/mh-access-wait-6me-guid.pdf
BudgetAnnouncementSpring2015£250Mrecurrently
• Buildcapacityandcapabilityacrossthesystemsothatby2020,70,000morechildrenandyoungpeoplearetreatedperyear
• Roll-outtheChildrenandYoungPeople’sImprovingAccesstoPsychologicalTherapiesprogrammes(CYPIAPT)
• Improveperinatalcare
• PilotajointmentalhealthtrainingprogrammeforsinglepointsofaccessinspecialistCAMHSandschools,tes6ngitover15CCGs
09/07/2015
Informa6onsubjecttorapidchangesocheckforupdates:[email protected];
Transforma&onplans:wherearewenow?
§ NHSEisworkingwithpartnerstodevelopguidanceandabespokeassuranceprocess
§ ‘ Unitofplanning’likelytobetheHealthandWellbeingBoard§ Youwillneedtoshowevidenceofpartnershipworkingandsign
upnotjustlocallybutalsowithNHSEnglandspecialistcommissioning
§ Youwillneedtoshowthatchildren,youngpeopleandparentsare
involvedinplanninganddelivery§ Leqeraler6ngCCGsandNHSEnglandteamshasbeensentoutSlidethankstoKathrynPugh,ChildandAdolescentMentalHealth
ProgrammeManager
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InterimguidanceonTransforma6onPlans
• hqp://www.pcc-cic.org.uk/ar6cle/child-and-adolescent-mental-health-services-camhs-transforma6on-plans-interim-guidance
• allTransforma6onPlanstobeassuredandallCAMHSalloca6onsmadebytheendofSeptember
• From2016/17,anyrefreshofTransforma6onPlansandthecon6nuingdevelopmentofserviceswillbeembeddedwithinmainstreamplanningandassuranceprocesses.
Transforma6onplanswillneedto• BeTransparent–publishing
– Baselineinvestmentbylocalcommissioners– Whatservicesareprovidedincludingworkforceinforma6on– Referralsreceived,accepted,wai6ng6mes
• DemonstrateServicetransforma&oninlinewithprinciplescovering– rangeandchoiceoftreatmentsandinterven6onsavailable;– collabora6veprac6cewithchildren,youngpeopleandfamiliesandinvolving
schools;– useofevidence-basedinterven6ons;andregularfeedbackofoutcomemonitoring
tochildren,youngpeopleandfamiliesandinsupervision.
• Monitorimprovement– Developmentofasharedac6onplanandacommitmenttoreview,monitorand
trackimprovementswithappropriategovernancestructures.
SlidethankstoKathrynPugh,ChildandAdolescentMentalHealthProgrammeManager37
NHSEMentalHealthTaskforce
• hqp://www.england.nhs.uk/ourwork/part-rel/mh-taskforce/
• FormedMarch2015– Taskistodevelopanewfiveyearna6onalstrategyformentalhealth
– Coveringservicesforallages– Tobepublishedinautumn2015– Spanshealthandcaresystem
• Termsofreference:hqp://www.england.nhs.uk/wp-content/uploads/2015/03/mh-tor-fin.pdf
09/07/2015Informa6onsubjecttorapidchangeso
checkforupdates:[email protected];[email protected]
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