the CAMHS Home Treatment Team (HTT) has made a real difference to the quality of life of our young people age 13-18 in Hertfordshire and as a direct consequence their wider family network. The remit of the team is to work with complex cases identified as requiring a Tier 4* service with a view to offering an alternative approach in the comfort of the young person’s home. The aim is to avoid in-patient admission and what a fabulous alternative we now have.
Highly Commended - National CYPMH Awards 2019
From start: No
During process: Yes
In evaluation: No
PP Collaborative: Yes
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Abigail Firth-Bernard - Home Treatment Team Leader - Hertfordshire Partnership University NHS Foundation Trust
Although relatively new, the CAMHS Home Treatment Team (HTT) has made a real difference to the quality of life of our young people age 13-18 in Hertfordshire and as a direct consequence their wider family network. The remit of the team is to work with complex cases identified as requiring a Tier 4* service with a view to offering an alternative approach in the comfort of the young person’s home. The aim is to avoid in-patient admission and what a fabulous alternative we now have. Where a young person has needed to be admitted, the team works hard to discharge them as quickly as possible with a robust care and safety plan. Numbers of service users being treated as inpatients out of area has reduced. . Prior to the formation of the HTT, the length of stay for young people in Hertfordshire had been much longer. With the introduction of emergency 72 hour and seven day admissions, the team is able to support the family though a shorter admission whilst encouraging resilience within the young person and their support network, rather than promoting an over dependency on professionals. This has resulted in less disruption to schooling, friendships and family relationships etc. It allows young people to feel more in control of their own lives, but with the security of knowing they have access to the right support when they need it.
This is a team that has definitely hit the ground running, although still not fully recruited to they are already exceeding all expectations with the number of cases they are working with, the complexity of the cases they are holding and their success in supporting young people at home. Support workers have shown amazing tenacity and confidence in working with young people others might have felt too complicated. They offer real practical support and clinical strategies but it is often the basics in life that make all the difference to our families such as ensuring a young person gets to school, encouraging them with their personal hygiene, leaving the house for a walk or enabling them to enjoy a simple family meal – things we all take for granted. I’m sure many Managers would say their teams go above and beyond, but this team truly do. Nothing is too much trouble for them. Their flexible but no nonsense approach enables them to gain the trust and respect of the families they work with and it is providing fantastic outcomes. They are a group of remarkable individuals who in everything they do show their commitment to making this team so successful. Every member of the HTT brings something to the team whether it is personal characteristics, specialist knowledge or experiences from previous roles or fantastic admin support, but together this group of people epitomise the true meaning of team work. *Tier 4 means providing support in specialised day and inpatient units, where people with more severe mental health problems can be assessed and treated.
Wider Active Support
The team is building a great reputation amongst colleagues in other agencies such as social care where the input from the team has made all the difference and has supported social workers to continue with a case and prevented placement break down. Cases have included young people who have transferred directly from low secure and Psychiatric Intensive Care Unit (PICU) services who by working with the HTT, have avoided step down into an acute bed and have been supported to return home. This may involve carrying out up to three visits a day, seven days a week in order to keep the service user as home, but it is working.
There has been a systemic approach involving young people and their parent(s)/carer(s) with input from the multidisciplinary team (MDT – nursing team, medical, social and therapy team). Despite competing demands and pressures, staff in Tier 4 CAMHS are compassionate and professional in their approach with service users, carers and each other. At HPFT there is an active Youth Council. The Youth Council was consulted right from the outset in October 2017, when the business case for HTT was being developed. The Youth Council has been involved throughout the process and this continues.
Looking Back/Challenges Faced
Initial difficulties and challenges which have arisen with setting up a new service have never been seen as an obstacle as this team is solution focused with a “can do” attitude – more how they are going to do something rather than can they do it? One of the main and ongoing challenges is recruitment. The team has only managed to recruit half of the nursing vacancies since recruitment began. Despite this, the team were able to manage a full case load. Another challenge is that other CAMHS services have struggled to understand the service and how this works due to the newness of the service. There has been a need for regular communication to other partners and services within HPFT to promote the team, the way that it works and resourcing for this. Ideally time and resource for this work should have been included in our business case.
Tier 4 CAMHS in HPFT is a second wave site, under the NHS-E New model of care for commissioning and providing Tier 4 Services. As part of this, exceptional efforts have been made to improve overall clinical care, and reduce length of inpatient stay to enable young people to return home. There are on-going challenges in Tier 4 CAMHS, and the service is continually looking to improve the care of young people. Staff support young people, their families and one another with kindness. Operational policy is also in the process of being reviewed and re-written to formalise this approach. Due to the team being in its infancy there have been many changes and developments over the last year.
Evaluation (Peer or Academic)
The HTT was evaluated last year by a consultant appointed by NHS England and the report from this is pending. This included meetings with service users and their families, staff and service users.
Prior to formation of the HTT an average of 40 young people were receiving inpatient treatment out of area. This has now reduced to zero and only those young people needing specialist beds not available in Hertfordshire will receive care outside of area – currently 9 of our service users. The outcome measure report shows that differing scores in standardised routine outcome measures administered to carers, clinicians, and young people at initial assessment and discharge have demonstrated a significant overall improvement in young people’s mental health. Survey data has provided invaluable feedback, with the majority being positive. 62% of young people stated they were ‘Happy’ or ‘Very Happy’ with the effect of services on helping them deal with their problem. Meanwhile 25% of young people stated they were ‘Mixed’. Parents/carers told us that 83% were ‘Very Happy’ and 17% were ‘Happy’ about the effect of the service in helping their child deal with his/her problem. Specifically, areas of excellence as rated by the young people included: How kind and caring the team was in supporting and understanding their difficulties and collaborating in their care, how they were reliable, flexible and relaxing to be around. In addition, young people reflected positively about how effective the service is in helping them engage better with school or college and noted that the DBT skills-based approach was useful.
Concurrently, feedback from parent/carers yielded a positive response particularly around the intensive support they received from staff who were described as relaxed, positive, helpful and incredibly lovely. They reflected that they were happy with how services worked together in regards to the return of their child’s problems and that they team listened well to their worries as parents/carers. The support and advice in how to support their children was cited as invaluable. There was a reflection that parents/carers felt there was a lack of choice regarding appointment times/days. The majority of reflections stated that the team should not change and are great – they wished their child could have had more sessions and that HTT should be available in other NHS Trusts. An analysis of open questions at the end of the CAMHSS survey highlighted that young people found it challenging to hear things they didn’t want to hear, but reflected that ultimately they knew these things are right. This is positive as it shows young people are aware there was a time when their motivation and ability to process was challenged and that through support, it needed to be challenged by supporting staff. Young people stated that the only negative of the service was that it was short-term and not available post-18 which shows that young people found the support of great benefit. It is evident that both young people and their parents/carers are satisfied with the services offered by HTT. This is reflected in the positive outcomes from young people, their families and clinicians regarding the care and treatment that they have received with the team which highlights clinical improvements in mental health at discharge.
As well as forming a unique model within HPFT the CAMHS HTT has also been part of sharing their model to improve services across the country. HPFT is a new care models (NCM) site; therefore there has been communication between other NCM sites to share ideas. Recently Lincolnshire partnership NHS trust visited the HTT to gain some advice. Since this time there has been regular communication with them to advise them on the development of their model. There are quarterly NCM conferences held across the country where various NHS trusts meet to exchange their skills and knowledge. HPFT have presented on two occasions at these events to ensure good practice is shared among other NCM sites. Operational policy is also in the process of being reviewed and re-written to formalize this approach. Due to the team being in its infancy there have been many changes and developments over the last year.
Is there any other information you would like to add?
The team has received some wonderful feedback from parents and young people. A few comments are below and there are many others in a separate attachment sent by email: “Our only regret is that the HTT didn’t exist when **** was first ill in October 2016 “The Home Treatment Team is an absolutely vital part of the CAMHS programme; it has prevented the need for an admission and given **** and us the appropriate support in the home environment. HTT has provided the important one to one sessions without other distractions, it has been extremely important that the same familiar nurse and care workers have attended daily as that has helped to have more open and trustworthy relationships with you all. HTT also allows the family to stay together and be more united as you all have helped us to understand challenges better. We know that this HTT service is relatively new but it has definitely proved with us that it works wonders”. “Thanks so much again. ****managed a job interview this week and started college yesterday, then went for dinner immediately after”. I am confident the team will only continue to go from strength to strength and I am proud to be able to say this group of professionals are part of our HPFT CAMHS Service and they deserve recognition of their achievements to date. A full copy of the Outcomes Report has also been sent in a separate email.
Can you please tell us who your service is commissioned by and provided by?
East and North Herts Clinical Commissioning Group and Herts Valleys Clinical Commissioning Group, and HPFT NHS Foundation Trust