Tower Hamlets CAMHS MH PLT Transformation of CAMHS

Tower Hamlets CAMHS MH PLT: Transformation of CAMHS Service - 8 th September 2016

East London Foundation NHS Trust: TH Specialist CAMHS ¡ ¡ ¡ The specialist CAMHS provision in the borough is delivered by ELFT and commissioned jointly by the CCG and LBTH. TH community CAMHS provides a targeted and specialist assessment and intervention service to children and young people 0 -18 (0 -19 flexibly) who are at risk for urgent, persistent, complex and severe mental health difficulties. The service receives referrals from schools, community health services, GP’s, social care teams & the third/voluntary sectors. There are self- referrals for over 16 s and ‘return tickets’ for all clients. The service receives approx. 1800 referrals per year. There are 33. 9 substantive NHS WTE clinically-focused posts, 7. 0 substantive LBTH WTE clinically-focused posts, and 10 admin staff in community CAMHS. Max wait for routine appointments is 5 weeks. Total open caseload is approx. 2000. THCAMHS have in the last 2 years undertaken a service redesign, combining a care pathways approach with streamlined teams led by a refreshed leadership. This restructuring was on-going from April 2014 and the new service was launched in early August 2014. We have just reorganised further to provide a safer, more robust service.

The meaning of CAMHS: let’s do the maths CAMHS, involves child and adolescent mental services in the widest sense, including statutory and third sector agencies, at universal, targeted and specialist level ¡ 10% C&YP in LBTH have a moderate to severe mental health problem and this rises to 30% in the at risk C&YP population targeted by CSC/Offsite units et al ¡ C&YP 0 -18 pop in TH=80, 000 approx. ¡ We are specialist CAMHS; we cant do it alone. We can only work in partnership to meet need, position ourselves in network hubs where we can pick up early severe problems, support targeted and universal services and offer the right care at the right time, right place. ¡

Service Criteria ¡ ¡ ¡ Emotional and behavioural difficulties where prompt early intervention is likely to prevent the development of a more severe and significant disorder. This forms the bulk of the ‘tier 2’/targeted work delivered by the service Significant impairment of functioning associated with mental health disorders Significant emotional/ behavioural/ mental health difficulties in children and young people with developmental disorders and learning disabilities Significant emotional/ behavioural/ mental health difficulties in children and young people who have experienced trauma, neglect or abuse Significant emotional difficulties related to and severely complicating physical conditions where treatment will influence the outcome Severe or life-threatening conditions

Geography ¡ ¡ The service ethos is hub-and-spoke; the hub is located in Greatorex Street, Whitechapel, and there is a service annex providing access to clients in E 14 and the east of the borough including the Isle of Dogs, at the Emmanuel Miller Centre. The service has developed a number of outreach services. There are good transport links to the two sites. Richly diverse, 60% Bangladeshi. Coborn inpatient unit

Teams/Pathways ¡ ¡ ¡ ¡ Duty rotas to cover acute emergencies, urgent cases, out-of-hours, self-harm, and enquiries from the public and referrers. All other referrals are sent to a single point of entry and then allocated to one of 6 clinical teams: -Emotional & Behavioural Team for children and young people with internalising disorders (eg: anxiety, depression, eating disorders) -Emotional & Behavioural Team for children and young people with externalising disorders (eg: behaviour, conduct, forensic, SHB) Neurodevelopmental Team for children and young people with learning disability, ADHD and autism Adolescent Team for children and young people with psychosis and other serious disorders of adolescence Ci. CSC Team particularly focusing on the mental health needs of children and young who are looked after, subject to safeguarding plans or receiving preventative work from the Borough’s children’s social workers Paediatric Team for children and young people with physical problems and illness – embedded in RLH Within these teams there are different care pathways according to clinical presentation. There a full range of outreach attachments and links

TH SPECIALIST CAMHS SERVICE MAP Parent Training Groups Social Skills Groups GP’s/Primary Care Schools Web Based Portal Triage Hubs Neurodevelopmenta l Teams: ADHD & ASD Clinics CAMHS LD Groups & Workshops Ci. CSC/LAC Assertive Outreach Embedded Assessment & Treatment Conduct Disorder Alliance with YOT/PRUS Assertive Outreach Assessment & Treatment Targeted/Thi rd Sector Partners Specialist CAMHS, SPE, Triage & Duty, Self-Harm & emergency cover Emotional & Behavioural teams Brief and specialist goalbased assessments & treatment AMHT (Psychosis Teams): Community T 4: Crisis intervention Specialist Treatments Specialist outreach, training, consult Under-5’s Assertive Outreach Assessment & Treatment Eating Disorders Assertive Outreach Assessment & Treatment Green: Targeted and Tier 1 White: Specialist CAMHS Services Grey: Under Development/ambition Paediatric Liaison Team RLH Transition Specialists

ELFT CAMHS: Our direction of travel/improvement plan ¡ ¡ ¡ ¡ Hub and spoke model Single point of referral Accessible and up to date information to families & YP Developing a culture of responsiveness Service user engagement Closer working relationships with partners/embedded outreach Comprehensive emergency and duty systems, including selfharm Flexible access/return tickets/self-referral/welcoming front door/information Evidence-based care teams, evidence based care pathways for disorders Stepped-care model/Least intensive interventions first: ‘Right Place/Right Time’ Defined Targeted CAMHS (Tier 2) provided in local settings Embed in-session outcome monitoring ORS/ROMS Core KPIs: Wait times (5 weeks) & DNA’s (14%) Smoother Transition to adult mental health services Web-based tools and portals

Our Mission/Standards We try to minimise the number of changes of clinician experienced by the family. All routine referrals are triaged and receive welcome call. All routine referrals are seen within 5 weeks. Care is provided in blocks of 6 sessions called Episodes of Care. Goal based outcomes and close attention to client feedback determine the course and length of therapy. The overall mission in care teams and pathways is to see clients as quickly as we are able, provide the client with continuity of clinician, and provide therapies which are safe and clinically effective. Waiting times for more specialist assessments/treatments will be kept to a minimum. Home, school and outreach visits are provided where appropriate.

Initiatives, innovations, challenges (1) ¡ ¡ ¡ CYP IAPT Full groups offer/parenting Outcomes Based Commissioning project Triage/waiting times/drop-in hubs/self-referrals Core KPI’s: since 2014, wait down to 5 weeks; DNA’s down; despite rising referral rate. Conduct Disorder Team with embedded outreach in offsite provision: visit by Norman Lamb last week CSC/CAMHS embedded team ‘Return tickets’ QI & Audit NICE: clinical effectiveness Developing tier 2 provision with partners Stakeholder Forum/next one> 7/7

Initiatives, innovations, challenges (2) ¡ ¡ ¡ ¡ Good commissioner relationships QNCC: positive result Schools Training programme (following successful bid) Schools links programme Vanguard implementation site (integrated care) Thrive implementation site Improvement rates maintained above 80% Power-Up App implementer site CAMHS microsite/Database Send/Care Act Bangladeshi representation LD/ASD network re-brush Urgent capacity plan: maternities, CYP IAPT, £ 200 k LBTH cut: we will maintain our 5 week wait Caseload management

Initiatives, innovations, challenges (3) Transformation plan/initiatives/funding envelopes: -4 project streams developing feedback and participation including digital trial/recruited for (1 WTE) -participation group -2 project streams assaying phobic C&YP receiving home tuition (0. 5 WTE) specifying dataset for CSC/CAMHS/LAC/YOT (0. 5 WTE) -Eating disorder team -Unmet need-core specialist clinical services for ASD/ADHD £ 100 k -Transition & under 5’s bids: Vanguard

Safeguarding Overview. (Lead: Dr Hanspeter Dorner) ¡ ¡ ¡ ¡ ¡ CAMHS in Children’s Social Care Team - Ci. CSC SCR: Bowden House Review Conduct/Forensic/Sexually Harmful Behaviour CSA & CSE & HSB Parent Training - NVR CAMHS in Safeguarding Forums Interagency information streams & case management Escalation Supervision & training

13 -14 14 -15 1441 1504 15 -16 2. DNA Rates Down 1760

Future service models ambition: an example of a service alliance/network City Gateway The PRU Cherry Trees Parenting Services/third sector Specialist CAMHS YOT FIP Docklands Outreach CSC Ian Mikardo

Challenges going forward ¡ ¡ ¡ Advocacy: develop - PACEN Evening clinics: develop Drop-in Hubs/Self-referrals: develop Participation: securing all-source real-time feedback Embedding outcomes & GBO’s: consolidate Caseload management/DNA’s/inactive cases: still work to do Standards: consolidate LD/ASD network: re-brush Real time capacity monitoring/modelling: consolidate Secure website with reach and stability: consolidate LA funding: consolidate Buildings, Emmanuel Miller Centre: evaluate future refurbishment