National Deaf CAMHS - South West London & St Georges MH NHS Trust

Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference

The aim of the service is to improve mental health by delivering highly specialised assessment and treatment packages in a safe environment; at home, community, clinic or at Corner House inpatient setting. The NDCAMHS philosophy of care is to operate as a bilingual and bicultural Service where:

• the nature of clients as D/deaf and hearing individuals (and their families) is acknowledged and fully understood

• their linguistic and cultural preferences are respected and met, and

• their mental health needs are effectively catered for.

What makes your service stand out from others? Please provide an example of this.

Our Service provides a high level of expertise and has added value to mainstream mental health services to a population with complex needs, increased vulnerability of mental health problems compared to the hearing population and difficulty accessing the right services and support. We are a small highly skilled group of professionals providing a high quality of care strongly committed to regular and robust team and multiagency work, involving consultation, networking, training, partnership and stakeholder involvement.

How do you ensure an effective, safe, compassionate and sustainable workforce?
We constitute an example of excellence in good team-working. The hearing and deaf staff in our Service represent the integration of two different cultures, providing positive role models for deaf young people, struggling to find an identity, and for their families, who can find it hard to accept their child’s difference.
Who is in your team? Attach any relevant documents on structure if needed	Band/grade	Number	Whole-time equivalent
E.g. Clinical psychologist	8a	2	1
Administrator	4	3	3
Deaf Family Support Worker	4	3	2.6
Specialist mental health practitioner	7	2	2
Clinical Psychologist	8A	1	1
Clinical Psychologist	8B	2	1.8
OT	7	2	2
Art therapist	7	2	2
Speech and Language Therapist	7	1
Systemic therapist	7	2	1.6
Consultant		2	1.6

How do you work with the wider system?

We are a small highly skilled group of professionals providing a high quality of care strongly committed to regular and robust team and multiagency work, involving consultation, networking, training, partnership and stakeholder involvement.

Do you use co-production approaches?

Through the feedback gather on several service user days. We have adapted documentation and therapeutic resources to better meet the needs of our clients. We have introduced visual care plans and visual social communication reports, created an emotional literacy package and standardised assessment of our clients’ communication profile.

Do you share your work with others? If so, please tell us how.

We are part of a strong national network of similar teams in England and have regular streams of collaboration, from discipline lead groups, to standards of practice and pathways. We are very proactive in participating in academic forums within the Trust and with partner agencies. We contribute regularly to audit and research.

What outcome measures are collected, how do you use them and how do they demonstrate improvement?

We use standard CAMHS dataset and Trust KPIs but have been developing more adequate measures to capture the specialist nature of our service. As a result, we are piloting several outcome measures to include professionals perceptions and visual goal outcomes

Has your service been evaluated (by peer or academic review)?

We were members of QNCC 2014-2016 and had several peer reviews, with excellent feedback. CQC has visited both our outpatient and inpatient teams in London at different times over the last 3 years with also very positive feedback

How will you ensure that your service continues to deliver good mental health care?

The team has incorporated a lot of learning through its development but while sharing the problems at each stage with the relevant senior management and being proactively involved in the appropriate forums, it has always tried to offer the best care given the resources it had.

What aspects of your service would you share with people who want to learn from you?

Probably being a small team with limited resources covering quite a wide geographical area has made us quite strong in using our resources efficiently. We have expanded our consultations and increased the training packages we deliver as an essential aspect of our Service is liaising and consulting with other professionals (i.e. specialist schools and hearing support units, Children’s Services, Audiology Departments, Teachers of the Deaf, Speech and Language Therapist, etc.) to increase their skill set and empower them to confidently manage and meet deaf young people’s needs.

How many people do you see?

Our 3 outpatient teams have a total workload of about 250 clients.

How do people access the service?

Any professional working with a deaf young person can refer to us

How long do people wait to start receiving care?

We aim at seeing people within 18 weeks from referral and do not have a waiting list despite having experienced a temporary reduction in the staff establishment (i.e. maternity leave, secondments) with vacancies that have been filled later than originally planned and an increase of referrals of 30%.

How do you ensure you provide timely access?

We have a robust structure and team diary, there is regular discussion and communication among members of the team and a lot of work and liaison with partner agencies and local services

**What is your service doing to identify mental health inequalities that exist in your local area?**

We established a dataset project a few years ago to allow for easier analysis and service improvement, given the scarcity of research on deaf young people. As a result, every family who was seen from 2012 to 2018 was asked for consent for the young person’s data to be used anonymously. Thanks to that, we have been able to undertake a significant number of audit and research projects.

We are now focusing on a CQUIN target consisting on gathering information about perceptions, formulations and expectations of professionals referring to our service and outcomes following our service involvement. This has been added to the regular routine data gathering and will be analysed over the course of next year.

What is your service doing to address and advance equality?

An essential part of the philosophy of the service is to facilitate accessibility and appropriate support to Deaf young people who experience mental health problems, providing interventions that support them to achieve their full potential in life. We also have deaf colleagues and have therefore an strong understanding of disability and its impact. Part of the work we do is focused on this so it is part and parcel of the work we do

How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?

Our Service has been extremely proactive in addressing the lack of standardised resources and therapies for the deaf young people by being part of several research projects: validation and translation to BSL of the Strengths and Difficulties Questionnaire and the Autism Diagnostic Observations Schedule and Interview. These adjustments will be key to a more accurate assessment of the needs of deaf children and subsequent recommendations for their care.

How do you meet the needs of people using the service and how could you improve on this?

We have adapted documentation and therapeutic resources to better meet the needs of our clients. We have introduced visual care plans and visual social communication reports, created an emotional literacy package and standardised assessment of our clients’ communication profile. Our commitment to high level quality has been evidence by the audits undertaken: we have adjusted our practice to meet NICE guidelines in the assessment of such a complex condition in D/deaf young people with language problems such as autism –including producing a DVD on Autism and Deafness. Our DNA rates have continued to reduce, already consistently lower than mainstream CAMHS.

What support do you offer families and carers? (where family/carers are not the service users)

Working with families is essential in our work and would not work in isolation with the child only. We would therefore offer a number or opportunities and range of interventions, including different modalities of family work.

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National Deaf CAMHS – South West London & St Georges MH NHS Trust

Co-Production

Evaluation

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