Future in Mind - CYP IAPT and ED

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Lorraine Walton
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1 Future in Mind - CYP IAPT and ED Anne O Herlihy, Project Manager CYP IAPT and the Children and Young People s Team, NHS England Peter Fonagy, National Clinical Lead for CYP IAPT Kathryn Pugh, Children and Young People s Programme Lead

2 Youth Mental Health: New Economic Evidence Mental health related costs for yr olds average 1778 pa over only 3yr follow up. (NB health, social care and school-based costs only - did not include employment, welfare benefits or criminal justice) Highest costs for hyperkinetic disorders ( 2,780 pa) Education system incurred 90% of assessed costs ( 1,564 pa) Youth justice system: YP 8x more likely to have contact (with additional costs) over 18 month. Benefits: twice as likely to be claiming benefits (27% vs 14%) Treatment gap: less than half (45%) of 12-15/16-25yr olds were in contact with services related to their MH needs, 54% if severe mental illness. Treatment gap has been known about for two decades. Lower rates of service contact than any other age group Martin Knapp et al, 2016 PSSRU, LSE 2

behavioural problem amount to 85,000 per child Severe behavioural problem: 260,000 per child 3 An

3 Economic case for change: FiM examples Children with Conduct Disorder are 10 times more costly to the public sector by the age of 28 than any other child Overall lifetime costs associated with moderate behavioural problem amount to 85,000 per child Severe behavioural problem: 260,000 per child 3 An example of cost-effective intervention from NICE Additional cost-effectiveness for lifetime earning gains not included

4 NICE Recommended Therapies for Children & Young People

5 What is CYP IAPT - a way of working CYP IAPT learned from Adult IAPT but is specific to the needs of children and families and the agencies that support them. CYP IAPT is a set of principles for a way of working, not a service It was not resourced to create services, but to change them introducing key principles across the whole of CYP MHS Improve access to: Evidence Based Practice (EBP) Strong supervision and high fidelity Regular outcome and feedback monitoring (ROM) Shared decision making and collaborative care CYP and parent/carers participation in all aspects of care, service delivery and design Access through self-referral

6 Core Implementation Components Staff selection System interventions Preservice training Facilitative administrative supports Integrated & Compensatory Supervision and coaching Decision support data systems Performance evaluation Fixsen et al., 2009

7 Evidenced Based Practice Shared Formulation & Agreed Intervention Goals + + Research evidence YP/Family s goals preferences, values, and unique context Clinician expertise Adapted and used with thanks to Peter Fonagy and Duncan Law Frueh et al (2012) Evidence-Based Practice in Adult Mental Health. Handbook of Evidence- Based Practice in Clinical Psychology. Published online.

8 Our Goal: Appropriate CYP MH services

9 Where next for CYP IAPT? (NHS England & HEE) Now integral part of the Transformation Programme in England - embedding evidence based, outcome focussed collaborative service transformation with FULL PARTICIPATION Model of delivery is through a collaborative and mentoring scheme between learning collaboratives (HEI) that work in partnership with local providers Increased geographical coverage of service transformation programme to100 % by 2018 greater reach and depth Continue to offer training across CYP MH partnerships (NHS, LA, Vol sect): CBT, SFP, IPT-A, Parenting, Supervision, Service Transformational Leadership, EEBP, outreach service development, outreach enhanced supervision ( : 1,371 therapists; 348 supervisors; 309 service leads) Deliver new curricula evidence based interventions for Children and young people with learning disabilities or autistic spectrum disorder Working with 0-5s Counselling Combination - Prescribing and therapy Inpatient CAMHS Eating Disorder National Accreditation Council assure quality of training and embedding of principles

10 CYP IAPT Learning Collaboratives Yr 7 Partnerships (n=tbc; 2017/18)-end of central funding Yr 6 Partnerships (n=tbc; 2016/17) HEIs (n=8) Assure quality Organise training Deliver content in partnership Yr1 Partnerships (n=18; 2011/12) CYP MHS- NHS/Vol.S/LA- Commissioners Yr 5 Partnerships (n=14; 2015/16) Yr4 Partnerships (n= 15; 2014/15) Mentorship & Peer Support Yr3 Partnerships (n=25; 2013/14) Yr2 Partnerships (n=24; 2012/13)

11 Regular outcome and feedback monitoring by all practitioners Inform, guide collaborative treatment and reflect on progress and practice Managers ensure that: o o Nominated practitioner who is responsible for supporting use of ROM Appropriate systems for collection of data Supervisors/clinical leads must ensure practitioners can: o o o Determine collaboratively with CYP and family/carers key goals Understand how to interpret outcomes data & use in session and supervision Use outcome data to decide if a change of therapy is needed

12 What s the evidence? Use of feedback forms/measures can: Improve clinicians ability to detect worsening of symptoms (Lambert, 2010) Provide information that may have otherwise been missed (Worthen & Lambert, 2007) Reduce drop out (e.g. Miller et al. 2006) Increase speed to reach good outcomes (Lambert et al. 2005) Improves outcomes (Bickman et al 2011) Summary from Duncan Law (London and South East Collaborative)

13 Empowering young people enables them to. 2. Establish treatment goals 4. Strengthen agency & trust 3. Choose the route to health that s best for them 1. Take control of their care

14 Progress so far

CYP IAPT Partnerships Map Following recruitment of 6 th collaborative, programme on target to work with services covering 80% of 0-19 population by

15 CYP IAPT Partnerships Map Following recruitment of 6 th collaborative, programme on target to work with services covering 80% of 0-19 population by March This goes up to 87% when including light touch outreach and service leadership work to prepare partnerships for full modality training 15

16 Number of trainees (n=1,977) Therapists 200 Supervisors London & South East Oxford & Reading North East South West North West Service Leads Enhanced evidence based practice 16

by 73% 64 YP achieved significant clinical improvement over fewer sessions - number of days between assessment and

17 Is it working? Pre CYP-IAPT With CYP-IAPT Young people seen more quickly-time between referral and assessment decreased by 73% 64 YP achieved significant clinical improvement over fewer sessions - number of days between assessment and discharge decreased by 21% Days between referral and assessment Days between assessment and discharge Improved access through self-referral routes, single point of access, outreach services, evening and weekend appointments.

18 Derby - Family A 16 year old presenting with self-harm and overdose 16 sessions (completed case)

19 Increased CYP participation Website and information design Planning and delivery of mental health awareness Mystery shopped service evaluation Staff appraisal and training Environmental changes Recruitment and interview panels Speaking with clinical directors Throughout treatment and every aspect of their care 34% Greater involvement of children, young people and their parents or carers: 56% New feedback systems you said, we did CYP agreed they had recovered sufficiently to be discharged - percentage of closed cases by mutual agreement increased Pre CYP-IAPT2 With CYP-IAPT

Resources Resource for all adults to increase awareness and understanding Includes free e-learning sessions for all those working with CYP (incl. ED sessions) MindEd for Families https://www.minded.

20 Resources Resource for all adults to increase awareness and understanding Includes free e-learning sessions for all those working with CYP (incl. ED sessions) MindEd for Families GIFT Sign up for see video clips islimited/videos DATA: Chimat and CAMHS ebulletin CORC: NHS Benchmarking Report 2015 MHSDS-flowing from Jan 2016

New online resource created for and with parents and carers

people Over 900 parents/carers identified 5 key areas:

leadership and delivery methods of engagement workforce

21 New online resource created for and with parents and carers to help improve mental health care for children and young people Over 900 parents/carers identified 5 key areas: access, equality and diversity communication service leadership and delivery methods of engagement workforce development Best practice case studies, videos, resource directory

youth justice, those that tend not to use statutory services) 3.

22 Participation across whole CYP MH system (national, regional, and local level) 1. Co produce products and resources - where are the gaps? - what would be helpful? 2. National core and wider interest groups Diverse representation of CYP and parent and carers using services (incl. youth justice, those that tend not to use statutory services) 3. Embed across system - through support clinical networks, CYP IAPT collaboratives and partnerships, workshops and masterclasses, monitoring impact at all levels 4. Best practice case studies, videos, resource website, directory

23 CYP Community Eating Disorder (CED) referral to treatment standard and commissioning guidance 25/11/2016

Eating Disorders (CYP) Access and waiting time standard Those referred for assessment or treatment for an eating disorder should receive NICE concordant treatment within one week for urgent cases and

Introduced and monitored in 2016-17 via MHSDS and UNIFY data collection; tolerance levels to be set and standard implemented from 2017-18 NEW extension for inpatient care-2017 Aim is for 95% of those

24 Eating Disorders (CYP) Access and waiting time standard Those referred for assessment or treatment for an eating disorder should receive NICE concordant treatment within one week for urgent cases and within 4 weeks for every other case. Introduced and monitored in via MHSDS and UNIFY data collection; tolerance levels to be set and standard implemented from NEW extension for inpatient care-2017 Aim is for 95% of those referred for assessment or treatment receive NICE concordant treatment with the ED standard RTT by 2020 The Role of Education Eating disorder curricula group convened in partnership with HEE (October 2015) building on: Systemic family practice curriculum for eating disorder Existing whole team training packages for multi-disciplinary community eating disorder services/teams to be delivered Modality specific evidence based interventions anticipated to be in line with updated eating disorder NICE guideline to be published in 2017

Recommended training for CEDS-CYP teams Training goal Develop multidisciplinary eating disorder teams Also, CEDS-CYP will have a role in training for other professionals

CYP-IAPT principles Raising awareness Primary care Education Other children services The relationships developed through the training can be used to provide regular support

25 Recommended training for CEDS-CYP teams Training goal Develop multidisciplinary eating disorder teams Also, CEDS-CYP will have a role in training for other professionals Understand the complex nature of eating disorders Develop a strong team culture Develop early intensive skills training and regular support and supervision Adopt core CYP-IAPT principles Raising awareness Primary care Education Other children services The relationships developed through the training can be used to provide regular support to the teams involved in improving early identification of children and young people at risk of developing an eating disorder Evaluate the impact of training on transformation of services

A new service to meet this challenges A Community Eating Disorder Service for Children and Young People (CEDS-CYP) An appropriately trained, supported and supervised team Use of information

Following a hub and spoke model Requirements Receive a minimum of 50 new eating disorder referrals a year Cover a minimum general population of 500,000 (all ages) Use up-to-date evidence-based

26 A new service to meet this challenges A Community Eating Disorder Service for Children and Young People (CEDS-CYP) An appropriately trained, supported and supervised team Use of information technology for teamwork from different geographical locations Eg. Following a hub and spoke model Requirements Receive a minimum of 50 new eating disorder referrals a year Cover a minimum general population of 500,000 (all ages) Use up-to-date evidence-based interventions to treat the most common types of coexisting mental health problems (for example, depression and anxiety disorders) alongside the eating disorder Enable direct access to community eating disorder treatment through self-referral or from primary care services (for example, GPs, schools, colleges and voluntary sector services) Include medical and non-medical staff with significant eating disorder experience

Benefits for children, young people, their families and carers Improved access and reduction in waiting times to treatment Children, young people, their families and carers know how to ask for help

based on their needs Receiving treatments for eating disorders and coexisting mental health problems from 1 team Improved outcomes, sustained recovery, reduction in relapse, and reduced inpatient

27 Benefits for children, young people, their families and carers Improved access and reduction in waiting times to treatment Children, young people, their families and carers know how to ask for help in their local areas Better knowledge of how to recognise eating disorders and how to access appropriate care when needed Every person receiving appropriate evidence-based eating disorder treatment, based on their needs Receiving treatments for eating disorders and coexisting mental health problems from 1 team Improved outcomes, sustained recovery, reduction in relapse, and reduced inpatient admissions Continued transformation of CYPMH evidence-based, outcome-focused, working collaboratively with children, young people and families Less need for transfer to adult services and long periods of treatment Less need for inpatient admission with the disruption to school and family life CYP and families have more involvement in commissioning services that meet their needs.

Data update for ED MHSDS flowing from Jan 16 UNIFY data collection on ED RTT 2 submissions by Nov 2016 Technical Guidance published Mar 16 https:///mentalhealth/resources/ Prevalence Survey

28 Data update for ED MHSDS flowing from Jan 16 UNIFY data collection on ED RTT 2 submissions by Nov 2016 Technical Guidance published Mar 16 Prevalence Survey commissioned by DH due to report in 2018 HEE CYP MH workforce mapping with NHS Benchmarking to report Autumn 2016 (CYP MH across NHS and non-nhs providers) QNCC-ED launched improvement and accreditation network - will host CED-CYP service directory (August 2016) to support a peer-led network, access to whole team training.

29 Contact: kathryn.pugh1.nhs.net

You said we did. Report on improvements being made to Children s and Adolescent Mental Health Services. December 2014

You said we did. Report on improvements being made to Children s and Adolescent Mental Health Services. December 2014 You said we did Report on improvements being made to Children s and Adolescent Mental Health Services December 2014 Bracknell and Ascot Clinical Commissioning Group Newbury and Community Clinical Commissioning