QNCC Standards for a Crisis and Intensive Response in CAMHS

Transcription

1 QNCC Standards for a Crisis and Intensive Response in CAMHS Anne O Herlihy [email protected]

2 Background CAMHS crisis and intensive service models have developed in response to: an ideological move away from residential psychiatric care, and a need to offer alternative options of intensive care. recognition of the chronicity and long-term MH pathways followed by some young people with severe, persistent and complex needs. a need to provide options of care more acceptable to young people and their families, encompassing a young person s family and wider community. Supported by policy targets to provide comprehensive CAMHS, close to YP home, local community and services, by the right professional in the right place at the right time (ECM agenda and NSFs for MH, Children; NWW; New Horizons; and NHS White Paper, Kennedy Review 2010).

3 What YP and carers want? Young people and carers have highlighted their need to: Be reassured that help is available and immediately accessible, by the right professional at the right time. Understand what is happening and receive information in a way that suits them. Receive care in settings that are acceptable to the individual and their parent/carer. Avoid admission if possible and receive intensive support in the community or at home. Receive intensive support and continuity of care post discharge from inpatient treatment to other services (facilitate stepped care). OCC reports; Rani et al, 2009; National CAMHS review; Keeping Children and Young People in Mind; the Junction Report.

4 Young people advisors YP would like to access CAMHS when they first seek help and not have to wait until they reach a crisis Be supported while on a waiting list (signposted to support, self-help guidance etc) and be kept informed about progress towards an appointment. That decisions are not made without their involvement, and that they are kept informed at all times. Involvement in developing care plans, that are written and signed, and a commitment by services to provide what is agreed.

5 Models of crisis and intensive CAMHS Wide range described by Darwish et al., 2006; Lamb, 2009; McDougall et al., 2008; Shepperd et al., 2007; Worrall-Davies and Kiernan, Multi-systemic therapy (MST) at home 2. Case management (incl. intensive/assertive outreach & wraparound services) 3. Intensive outpatient service (incl. crisis resolution) 4. Home based treatment 5. Family preservation services 6. Therapeutic foster care (not covered by standards) 7. Residential care (not covered by standards) 8. Day hospital (most attached to IP CAMHS and can be reviewed within QNIC)-UK Early Intervention Psychosis (EIP) teams (would require a different set of stds).

6 Common features (1) Immediate response: access a crisis response from a CAMHS professional within a few hours of initial request. Out-of-hours cover: able to respond within 24 hours 7 days a week, with cover provided by a professional who can undertake a MHA assessment at any hour. Assertive approach to engagement: persistent approach with repeated attempts to make contact, including immediate follow-up of DNA. Flexible approach: safe meeting locations agreed with young person and or carer, at a time that suits them (incl. Phone, face-to-face contact at home or school etc).

7 Common features (2) Planned intensive intervention: frequent clinical input (e.g. 3-5 contacts a week), and high staff to service user ratio until the need for intensive input is resolved. Support the stepped care approach: provide continuity of managed care to standard community, day- or in-patient CAMHS care as required. Collaborative relationships: able to access other CAMHS professionals, and agencies as required in order to meet the needs of the young person and their parent or carer.

8 Standards development Integrated into the recent revision of QNCC standards for community-based CAMHS. Standards are based on research, policy guidance and recommendations, NICE guidance, and legislation (Children s NSF, Every Child Matters agenda, Children s Plan, NWW, Kennedy Review 2010, NHS White paper, MHA, CA, UNCRC). Review of service protocols from established crisis or intensive community-based CAMHS. Workshops with stakeholders (CAMHS professionals, commissioners, policy leads) and young people. Consultation with advisory group members (including Lesley Hewson, Anne Worrall-Davies, Tim McDougall, Carol Rajaie, Kathryn Pugh, Ragnhild Banton).

9 CAMHS crisis and intensive response For children and young people under 18 years, including those with a learning disability or ASD 1. A crisis response - when a young person presents with an urgent need that requires an immediate response from CAMHS that is not part of a care plan. 2. An intensive response - when a young person requires an increased level of CAMHS input and contact and this is part of their planned care.

10 What next? 1. Services providing a crisis and / or intensive response in CAMHS can participate in a QNCC review in this years cycle starting January Participation will enable services to annually assess their practices and provision for young people in need of a crisis or intensive response. Opportunity to include QNCC participation in commissioning contracts e.g. service level agreements (SLA). QUESTIONS?

11 Group work How can CAMHS be supported to provide a crisis and intensive response in your Trust? Facilitators to ensure provision Barriers to change in current practices