Bolton CAMHS provides mental health care and support for children and young people aged 5 -18 years. The service comprises a three-part structure: single point of access (SPOA); early intervention and prevention pathway; and intervention and recovery pathway. The team is multi-disciplinary, with an emphasis on using the skills of the whole team and not being restricted by traditional roles. The service focuses on providing evidence-based practice and has adapted and redesigned its provision of care in line with the needs and demands of the population. Bolton CAMHS has effectively redesigned and restructured the way it works to meet demand within its resources.
Bolton CAMHS provides mental health care and support for children and young people aged 5 -18 years. The service comprises a three-part structure: single point of access (SPOA); early intervention and prevention pathway; and intervention and recovery pathway. The team is multi-disciplinary, with an emphasis on using the skills of the whole team and not being restricted by traditional roles. The service focuses on providing evidence-based practice and has adapted and redesigned its provision of care in line with the needs and demands of the population. Bolton CAMHS has effectively redesigned and restructured the way it works to meet demand within its resources.
Access
The SPOA/risk pathway team provides the initial triage of referrals, both emergency and routine. All referrals are triaged daily and if the referral is not suitable, people are signposted to appropriate alternatives. Referrals are prioritised (emergency, urgent, serious or routine) and the team provides assessments in the emergency department, paediatric wards, locality sites in the community, school and at home. The team works closely with the rapid assessment, interface and discharge (RAID) team, which provides risk assessment for young people over 16.
Since January 2015, the Bolton CAMHS waiting time has remained under four weeks. Although the team is small (comparatively) it has lower than average caseloads and higher than average face-to-face contacts. The service attributes this success to the effective use of available methodologies and resources. This is in the context of referral increases of 23% in 2014/2015, and a further 10% increase in 2015/2016.
Interventions
The overarching approach from the service includes person centred holistic formulation, goal based intervention and generic therapeutic skills.
The early intervention and prevention pathway is designed to assess and intervene in first time presentations of emotional and behavioural disorders. The team provides cognitive behaviour therapy, video interaction guidance, functional analysis and access to psychopharmacology support to enable effective combination therapy in depression and anxiety disorders.
The intervention and recovery pathway is designed to address neurodevelopmental assessment and intervention for complex presentations that require multi-disciplinary intervention. The team is trained in autism spectrum disorder (ASD) and attention hyperactivity disorder (ADHD) specific assessments such as the Autism Observation Schedule Interview, Qb Test, and the use of stimulant medication. The team also provide cognitive behaviour therapy, video interaction guidance, Triple P/Webster Stratton, functional analysis, functional family therapy and psychopharmacology.
Support for families and carers
The intervention and recovery pathway team are trained in the provision of parenting interventions for ADHD and ASD. There is also a functional family therapy team embedded in the generic community CAMHS service to offer interventions for children who present with conduct problems.
Outcome monitoring
Bolton CAMHS uses various means to collect generic and specific service user feedback, including
service user feedback questionnaires and participation events for children, young people, and their parents or carers. Capacity and demand is monitored daily and reviewed weekly. Key service performance indicators are monitored by monthly quality dashboards.
Workforce
Service communication is supported by visual information boards about all the pathways (including waiting times and capacity), weekly CAMHS meetings and quarterly away days, as well as traditional governance structures. Each pathway team is supported by weekly peer supervision and learning opportunities, as well as individual supervision.
What makes this service an example of positive practice?
We believe good design is crucial and change is continuous. To that end, we have repeatedly re-designed our service over the last decade. Our most recent major redesign began in January 2015. We have done this in response to repeated national initiatives including Future in Mind and Thrive. Since 2015 we have seen cases within 4 weeks of referral, despite repeated increases in demand and according to the recent CAMHS Benchmarking all with a smaller than average workforce and funding. Despite that we still have lower than average caseloads and provide more than average face to face contacts.
