The Cheshire and Merseyside Home-based Therapy and Complex Needs Service (HTBS) provides an intensive home and community based service for young people aged 13 to 18 years who present with chronic and severe symptoms and low functioning, and have not responded well to appropriate outpatient interventions. The HTBS provides three core functions: advice and consultation to Tier 3; 2nd Opinion Assessments; and Treatment. The service offers 6-month psychotherapy and psychosocial interventions and intensive case management with the goal of reducing or improving symptoms and increasing functioning.
The Cheshire and Merseyside Home-based Therapy and Complex Needs Service (HTBS) provides an intensive home and community based service for young people aged 13 to 18 years who present with chronic and severe symptoms and low functioning, and have not responded well to appropriate outpatient interventions. The HTBS provides three core functions: advice and consultation to Tier 3; 2nd Opinion Assessments; and Treatment. The service offers 6-month psychotherapy and psychosocial interventions and intensive case management with the goal of reducing or improving symptoms and increasing functioning.
Access
The service receives an average of 35 referrals per year from children and young people’s mental health teams (also referred to as tier 3 teams and tier 4 services), of both NHS and private providers. The HTBS respond to referrals within 2 weeks, providing advice and consultation to the referring team.
Assessment and intervention
As part of the HTBS service model, assessment is not seen as distinct from intervention. Typically, interventions consist of 6 weeks of assessment and 20 weeks of treatment. The average length of treatment is 25 weeks, with 86% of people treated in under 30 weeks.
Evidence-based interventions
The HTBS is semi-manualized and draws on core ingredients from family preservation services, evidence-based treatment (in line with NICE guidelines) and incorporates psychotherapy interventions designed to intervene on barriers to treatment. The service places significant emphasis on engagement, and interventions only focus on areas the young person identifies as problematic. Rather than a series of professional interventions, care plans outline a young person and/or carer actions designed to effect change.
Support for families and carers
Parent or carers are actively involved in treatment and receive a minimum of 1 hour a week face-to-face support; the primary focus is on supporting parents in meeting their child’s needs rather than on more personal or individual issues. Emphasis is placed on respecting parental hierarchy and the centrality of the parental role.
Outcome monitoring
The service collects extensive outcome data including PROMS, CROMS and PREMS, completed by young people, their parents, and professionals. Young people and their families are asked to completed service evaluation forms, with follow-up questionnaires are sent at 6 and 12-month post discharge. Outcomes are analysed at the team level, over time, by presentation and by clinician. The service has achieved consistently good outcomes, sustained over a 10-year period and has very high rates of young people and parent/carer satisfaction with 89% young people rating the service as better or much better than other CAMH services, while the parallel figure for parents is 95%.
Further details:
Commissioning
NHS England via Tier 4 CAMHS contract
Providers
Cheshire & Wirral Partnership NHS Trust
Workforce (whole-time equivalent)
2.0 clinical psychologists (band 8a), 1.0 trained therapist/counsellor (band 7), 1.0 family therapist (8c), 2.0 mental health nurses (band 5), 0.5 medical secretary/administrator.
Population size
Whole population – 2,559,400
Caseload
With full staffing, the HTBS are commissioned to provide 18 treatment places per annum on fixed 6-month intervention plan (2 x 9 patients). Consultation and 2nd opinion activity is additional.
Access and advice – consultation lines, triage and signposting
