We developed a 24/7 Crisis and Intensive home treatment response. We did this as a response to the need of our local population which had a higher incidence of crisis admittance to hospitals.
We developed a 24/7 Crisis and Intensive home treatment response. We did this as a response to the need of our local population which had a higher incidence of crisis admittance to hospitals.
We recognise that others may be the first to be involved in a young person’s crisis therefore it is important for us all to work together.
Because we do not have a 136 suite we have no access to a place of safety for C&YP apart from A&E. We have no local or nearby Tier 4 beds therefore we have had to develop good working relationships with the other agencies that are often part of a Child or Young persons crisis. Through local meetings, the crisis concordat and a lessons learnt after each s136 we have developed a local response to a crisis which involves working in partnership with the police, A&E, Social care, education and any other agency (e.g. homeless) which may be able to support the C&YP through the crisis. Police will now ring the crisis team before a s136 and we will work together to divert C&YP away from A&E if possible.
We have participation groups which draw on the experience of those who have had a crisis or mental health difficulties. We have some young people who have experienced both care as an inpatient and again as receiving the crisis and intensive home treatment instead of inpatient care and they have been able to identify and work with us to develop the service. We also have carer/parent participation groups which has added very useful information to how we respond during their child’s crisis and how we have been developing our service. Which is now looking at intervention at an earlier stage in a child or young persons emotional and mental health.
Trying to get original staff from the old self harm team to work in this very different positive risk way was too difficult and we lost a lot of excellent clinicians. Bringing in mostly newly qualified made this project work and they embraced this new way of working and are still with us 5 years later. The excellent staff we lost would have been useful to integrate into different parts of the service and I think if they could have seen the success of this way of working. (The new CAMHS service was developed to be just a core service with evidence based pathways of care). We do not have waiting lists as our pathways are very successful so when someone in a crisis needs further therapeutic interventions they receive intensive home treatment until their therapist/intervention is available and this is usually before 6 weeks from crisis.
We have kept data from the very beginning (2012). At the time of this new service starting we had 18 young people in beds all over the country. Since this model we have only had 2 young people need a Tier 4 admission (we have not needed a bed in over 4 years). The crisis and intensive home treatment team are a team and work together, the success of the team and the whole of our service is not dependent upon one person; all members are leaders in their own right and all members can work in either crisis or core. All team members have had continuous training so they are able to deliver a wide range of therapeutic interventions. Process, clinical knowledge and support are so well embedded that it would not change any of the outcomes should any particular member of staff not be available.
We have kept data since the start. We have seen the reduction of Tier 4 admissions reduce to 0. We can see the trends of when we are most likely to need more emergency or urgent care (which months) and we are able to plan and increase or decrease productivity to manage this increase. We run patient and parent/carer participation groups to help us develop further we also continuously train education, police and staff at the A&E about our process how we work together and mental health conditions. We have had CAMHS delegate’s/CCG’s from Birmingham, Leicester, Tess, East Riding & Hull, Brighton & York contact our service to find out about how we run and to understand our model of working. We have also evaluated the crisis team and this piece of research is being peer reviewed with prospective journals. We have received an outstanding rating from the CQC and we retained this rating at follow up visits. We have been named best case practice by the NHS England crisis guidance and I often speak at Crisis conferences all over the UK. We have been shortlisted and won numerous awards with the Nursing Times, HSJ CYP & Staff excellence awards. We were highly commended for ‘positive practice in Mental Health’ and shortlisted in the HSJ ‘service redesign’ section. We have also been singled out by Norman Lamb as a CAMHS team that is successful in both crisis and core business.
We provide a patient experience report every 2 months which uses both qualitative and quantitative data from numerous outcome sources such as the RCADS, CHI ESQ, OOCAMHS, DBC & OOCAMHS for LAC, patient and parent/carer participation groups. The information we get from these outcomes helps us develop our services further. Outcome wise not needing a Tier 4 bed for over 4 years proves that we are successfully supporting Children and young people through a crisis and beyond this by helping them develop therapeutic skills which help them cope with their own mental health in the future. That our Core Camhs service has developed evidence based pathways has ensured that the young people who need a CAMHS service are seen and helped in a timely manner which results in a very low waiting list (all young people are seen and start therapy within 4 weeks).
The model we have developed for our CAMHS service has been shared through presentations, meetings and sharing our model with other CAMHS services throughout the UK. Please see earlier answer for a list of other CAMHS service managers and commissioners who have visited our service.
During our last tender we lost approximately 40% resource and were tasked with producing a more accessible service without waiting lists. I believe we having to be more efficient with less resource has helped shaped this service; plus looking at the needs of our population has helped us devlop the crisis and intensive home treatment team in response to this. NEL is a very deprived area (the east marsh part of the area is the 2nd most deprived area of the UK) I believe we provide the best quality service which is value for money for the population we have in NEL.
