Tower Hamlets Front Door Triage Team Dr Rebecca

Tower Hamlets Front Door/ Triage Team Dr Rebecca Adams, Consultant in Child and Adolescent Psychiatry Dr Olivia Kneen, Clinical Psychologist/ Triage Lead

Key aims of Triage/ Front Door • • Improve client experience by making contact with clients in a more timely manner and providing information Reduce waiting list for initial assessment Improve our DNA rates Eliminate lengthy process of LRP and be more responsive to incoming referrals by having more weekly meetings Screen for risk more effectively Allocate to the right clinician/ team at front door Reduce the amount of cases allocated for internal transfer Embed a Thrive Framework to allocations (short term vs longer term)

Overall Task/ Mission Statement To triage or provide a welcome call to all referrals to TH CAMHS within 2 weeks and signpost to the appropriate service within or outside of CAMHS on a triage/ consultation basis.

Triage Process 1 1. All incoming referrals will be screened for risk by Duty to initiate any initial liaison required (e. g. more key referral information needed) 2. Referral taken to next triage meeting (x 3 per week) to be allocated to one of three outcomes: q. Definitely appropriate Allocate and welcome call q. Definitely not appropriate NTO letter sent out q. Triage Required Triage clinician to conduct triage assessment

Triage Process 2 3. Triage clinician conducts either welcome call or triage assessment (telephone/ face to face) / liaison with professional network: 4. Discussion in next triage meeting – Possible Outcomes: • Accepted for Tier 3 CAMHS – allocated to brief or long term work • Recommendations made/ signposted to relevant self help material or to other organisations and then closed to Tier 3 CAMHS

Triage Process 3 5. Triage clinicians to feedback outcome of triage assessment/ liaison to family and complete relevant letter updating outcome to referrer and family (to be sent out by admin) 6. Admin to send out first assessment letters on basis of allocation

CAMHS Tower Hamlets Referral received and logged on RIO by admin CAMHS Duty Team – Duty clinician screens referral for risk, urgency and appropriateness and immediate liaison CCCAMHS Triage – Clinicians contact families to triage/ welcome to service/ further liaison First Liaison Emergency/ Urgent Self Harm: A&E or clinic Conduct Team Assertive Outreach Assessment & Treatment Not accept Allocations / Triage Meeting (x 3 per week) advice/signpost/ discharge CAMHS in Social Care Book forwards for -Routine assessment -Urgent assessment (Time specified) E&B Team x 2 : -Brief Intervention -Longer term work--Eating disorders Neurodevelopmental Max: 3 weeks Team: ASD, ADHD, LD Bipolar and Psychosis Team (and ultra high risk) MDT Pathway Meetings Discuss and Review Care Plan and Goals Parent Training CYP IAPT Groups Internal referral: -specific therapy - co-worker London Borough Tower Hamlets team Discharge

Time frames • Every newly referred young person/family to receive a telephone call within 2 weeks. • Aim for all initial assessments to be conducted within 5 weeks (target reached in April 2016)

Changes to Allocation Process • Emotional & Behavioural Pathway • We will allocate to either : SHORT TERM - “First steps” (up to 6 sessions) or LONGER TERM (6 sessions plus) This is in line with the THRIVE Model of care and this will aim to improve throughput through the service

THRIVE MODEL

Results of Triage transformation: Initial results for triage – very encouraging: Wait times reduced to 5 weeks for initial assessment (achieved by April 2016) Decrease in DNA rates Increase in client satisfaction with front door process

1. Waiting time for first appointment significant reduced 2. DNA Rates Down Despite referrals steadily rising

What next for Front door TH? • Service hubs/ drop in to be trialled in outreach settings (Emmanuel Miller Centre, Spotlight Youth Centre etc. ) to improve accessibility • Embedding text messaging as routine prior to first assessments

Discussion • Any thoughts/ questions/ feedback?