CAMHS Sector Leaders Meeting Dr John Crawshaw Director Of Mental Health and Chief Advisor Friday 19 April 2013 PREPARED BY Agenda Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012 2017 Interagency Work Children s Action Plan Youth Crime Action Plan Youth Mental Health project Models of Care for CAMHS Discussion 1
Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012 2017 Development involved consultation with the sector Incorporates key themes from Blueprint II Provides direction for mental health and addiction service delivery across the health sector over the next five years Articulates Government expectations about what changes are needed Minister of Health's Letter of Expectations DHBs respond to Rising to the Challenge in their 2013/14 Annual Plans Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012 2017 Contains 99 actions DHBs lead accountability for 16 actions Ministry leads accountability for 34 actions Primary care lead accountability for 3 actions DHBs and the Ministry joint accountability for 6 actions DHBs and NGOs/primary care joint accountability for 32 actions Various accountabilities for remaining 8 actions 2
Rising to the Challenge and DHBs 2013/14 Annual Plans DHBs submitted Annual Plans on 22 March Expectation that Annual Plans include 2 actions for each of the SDP's four goals: Use current resources more effectively Improve primary and secondary service integration Cement and build on gains in resilience and recovery for most vulnerable Deliver increased access for all age groups Ministry will provide feedback on DHBs 8 proposed actions by 3 May as part of consolidated Annual Plan feedback Implementing Rising to the Challenge during 2013/14 DHBs progress 8 actions from Annual Plans - quarterly monitoring In Q1, DHBs to have completed stocktake and gap analysis to inform future SDP actions At end of Q1, based on this gap analysis, DHBs submit template outlining: key actions already achieved actions already in progress 8 new actions identified in 2013/14 plan likely actions in 2014/15 In 2013/14, Ministry is progressing some of the SDP actions it has responsibility for Establish a SDP Sector Reference Group to advise Ministry on SDP implementation 3
Rising to the Challenge and the SDP Sector Reference Group Proposed purpose of the SDP Sector Reference Group: To advise the Ministry about SDP implementation Foster alignment and collaboration at regional level amongst DHBs advise on the pace of change advise on the priority actions for each region advise on how best to progress actions that involve multiple parties Communicating DHB and Ministry progress to key stakeholders Funding Rising to the Challenge Rising to the Challenge assumes no additional funding other than annual demographic increases Actions to be achieved by changing way existing services are delivered and reprioritising service delivery DHBs need to be: assessing current spending and analysing this for effective service cover and efficiency ensuring mental health and AOD services are in line with government policy and goals identifying opportunities for integration and strategic procurement identifying savings opportunities, particularly where the same service can be delivered at lower cost. reinvesting savings into government priorities consistent with the SDP (e.g. Youth Mental Health, Drivers of Crime, Suicide Prevention) 4
Rising to the Challenge and Interagency Engagement Many of the SDP actions involve DHBs, Ministry, NGOs and primary care working together Some actions also require involvement from other government agencies (MSD,CYF, WINZ, Housing NZ, Education, Corrections, Justice, Police) Some actions interface with wider government projects (e.g. Youth Mental Health Project, Children s Action Plan, Drivers of Crime, Whanau Ora, Vulnerable Children, Youth Forensic Service Development, Suicide Action Plan) Ministry engaging with other government agencies on specific actions Ministry will involve DHBs as appropriate in this interagency activity Will seek advice from SDP Sector Reference Group about appropriate DHB involvement Will use meetings such as this to get input Will formally approach DHBs where necessary Interagency Work Government focus on improving outcomes for children and youth and imperative for interagency work to achieve this mental health and AOD central part: Children s Action Plan Plan to implement key actions from the White Paper on Vulnerable Children Children s Teams to be implemented Detail still to be developed Youth Crime Action Plan Ten year action plan to update the 2002 Youth Offending strategy Children s Action Plan and Youth Crime Action Plan will include conduct problems initiatives Detail still to be developed 5
Interagency Work PM s Youth Mental Health Project Initiative 6 improving follow-up care of youth discharged from DHB secondary specialist services: Survey of current practice completed (summary hand-out) Literature review undertaken Ministry has asked the Werry Centre to: develop improved processes for discharge planning for youth in CAMHS and youth AOD services to support timely and responsive follow-up care Consult with the sector on how this will be achieved Consider workforce implications The expectation is that the CAMHS and Youth AOD services in partnership with the young person and their family will develop a follow-up care plan with a nominated primary level provider or co-providers Interagency Work PM s Youth Mental Health Project Initiative 7 exemplar youth AOD and coexisting mental health services To test a proposed model of care by establishing two new exemplar youth AOD and coexisting mental health services: A stand-alone youth AOD and coexisting mental health service in a main urban centre; and A separately branded, youth AOD and coexisting mental health service within a CAMHS in a smaller urban centre To determine whether the proposed model of care is an effective way to improve services for youth with AOD problems; To inform the implementation of a nationally consistent model of care for youth with AOD problems. 6
Interagency Work The exemplar services will deliver a range of high quality, evidence-based interventions in accordance with the following core principles: Minimal barriers to access easy in, easy out, easy back in again Interesting and responsive to youth and families youth relevant brand and identity Effective and equipped to respond to the developmental needs of youth Culturally appropriate Multi-disciplinary team capable of managing co-existing AOD and mental health problems (including risk of suicide) Easy-access (mobile not office-bound) Flexible (realistic goal-setting, practical support and after-care, use a range of evidence-based approaches that match individual need). Available to supervise, mentor and train Interagency service delivery (CYF, Youth Justice and Education) Model of Care Pathways through care with the child/young person and family at the centre Remove barriers to access Decreased wait times (Minister s performance measure: 80% in 3 weeks, 95% in 8 weeks) Easy in, easy out and easy back again Behavioural problems must not be a barrier to assessment Exclusions (eg conduct problems, sexual abuse) only applied after assessment has determined there are no eligible coexisting mental health issues Status with CYF is an indicator of high need regarding CAMHS eligibility CYF placement insecurity an indicator of need for joint work Paediatric and forensic referrals require transfer of care or shared care approach rather than assess and decide 7
Model of Care Primary Level Services Distributed system in C&A MH PHO s, YOSS, School Health Services, NGO s Primary C&A mental health integration/continuum Stepped Care approach Primary Care Consultation and Liaison support Specialist outreach, engagement with YOSS etc Specialist outreach, working with primary care in CYF residences Early identification, high prevalence disorders CAMHS support for transitions discharge plans/support for primary care Model of Care Specialist Level Services Complexity and severity rather than diagnostic based entry Multi agency joined up approaches for complexity/high needs Gateway, Children s Teams collaboration Full implementation of CAPA required (reduces barriers and wait times) Improved service efficiency Single Point of Entry Flow through service (full implementation of 7 Helpful Habits) CEP competency required to ensure AOD responsiveness Evidence based practice including parent management training (Incredible Years in collaboration with Special Education) 8
Discussion 9