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Buckinghamshire Child and Adolescent Mental Health Services

Buckinghamshire Child and Adolescent Mental Health Services. Sue Butt, Operations Manager CYP Ravi Balakrishnan, Public Health Consultant Ann Spence, Senior Procurement Officer. Agenda. Background. Commissioned as an integrated service under pooled budget S75 agreement in 2009

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Buckinghamshire Child and Adolescent Mental Health Services

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  1. Buckinghamshire Child and Adolescent Mental Health Services Sue Butt, Operations Manager CYP Ravi Balakrishnan, Public Health Consultant Ann Spence, Senior Procurement Officer

  2. Agenda

  3. Background • Commissioned as an integrated service under pooled budget S75 agreement in 2009 • Prior to this it was delivered by multiple providers with multiple contracts across the county • The recommissioning process will commence in November 2014 with the plan to award the new contract in April 2015 • New contract will commence in October 2015

  4. Survey responses – May/June 2014 285 respondents

  5. Current Services – areas of good practice • Helpline was perceived as useful by those aware of it • Positive experiences of treatment for many of those who access it • Some clinicians were cited as particularly helpful and accommodating

  6. Current Services – areas for development • Communication – helpline, feedback on referrals, ease of contact • Collaborative/Partnership working across CAMHS, Social care, GPs, Schools, Other health professionals, Families • Clarity and consistency about thresholds and process for access • Waiting times for assessment and treatment • Flexibility in service provision location and times • Earlier intervention /prevention

  7. Perceived gaps in provision • Paediatric Psychology support for developmental and physical health related issues • Services for CYP who have a need for support but do not meet criteria for mental health services (threshold) • Support post diagnosis for Families and young people with a diagnosis of autistic spectrum. • Perinatal mental health service

  8. Children & Young PeopleMental HealthRisks / Needs / DemandsinBuckinghamshire: an overview Dr Ravi Balakrishnan Consultant in Public Health medicine Bucks County Council

  9. Population makeup 2011 census Total <19: 121,479 Boys <19: 62,125 (1 in 4 25.0%); Girls <19:59,354 (23.1%)

  10. Ethnic Groups

  11. Child Poverty & Lone Parents Children in Poverty • One in ten (10.5%) children <16 years of age are living in poverty (2011), England average:20.6% (2011) Lone Parents • 5.3% (2011) of households have lone parents with dependent children (England ave:7.1%) • 10,550 Lone parents with dependent children (Data source: ONS 2011 census (NOMIS, table KS105EW)

  12. Learning Difficulty Emerson, E. et al, 2008 Estimated prevalence in C&YP with LD for different age groups as follows: 5 to 9 years: 0.97%; 10 to 14 years: 2.26%; and 15 to 19 years: 2.67%. The Foundation for People with Learning Disabilities (2002): 40% prevalence for MH problems associated with LD.

  13. Looked After Children • In March 2013: 400 C&YP in care • Rate: 34 per 10,000 vs national average 60 per 10,000 (43% lower) • 2008-13: Increased by 30.8% (from 26 to 34/10,000) compared to 11.1% rise (54 to 60 /10,000) nationally. • Over 50% placed outside the county (England average of 35%) • Strengths & Difficulties Questionnaire (SDQ):(Normal score range: 0-13). • Average score: 12.93 Vs England average of 14.8 in 2012/13 • One in four (26%) had a score of 18 or above (SDQ),indicate significant behavioural problems.

  14. Substance misuse, Suicide, Self harm • Substance misuse (3 year period - 2010/11 to 12/13) • 50 hospital admissions for substance misuse, • Rate of 30.8 per 100,000 population aged 15-24 • 59% lower than the national average of 75.2 • Self-harm (3 year period - 2010/11 to 12/13) • 477 hospital admissions among young people aged 10-24 related to self-harm • Rate of 179.8 per 100,000 populations • 49% lower than the national average (352.3/100,000)

  15. Prevalence of MH conditions Pre-school children Egger, H et al, 2006: Prevalence of any MH disorder: 19.6% Among 2-5 year olds: AV CCG: 1,895 Ch CCG: 3,110 ASD ASD prevalence rates based on Baird et al (2006) and by Baron-Cohen et al (2009)

  16. Prevalence of MH Problems5-16 years of age (2012) Prevalence varies by age and sex Based on Green et al (2004) ICD-10 Classification of Mental & Behavioural Disorders with strict impairment criteria – the disorder causing distress to the child or having a considerable impact on the child’s day to day life.

  17. Prevalence of neurotic disorders (aged 16 to 19) Bases on Singleton et al (2001) has estimated prevalence rates

  18. Need for CAMHS services (Estimated vs Actual) Kurtz (1996) Number of C&YP under 18 years who may experience MH problems appropriate to a response from CAMHS at Tiers 1, 2, 3 & 4

  19. In brief • C&YP <19: 121,479; Boys: 62,125 Girls:59,354 • Ethnicity: 2 in 10 are non-white / others • 1 in 10 under 16 children living in poverty • 10,550 (5.3%) Lone parents with dependent children • LD with MH problems: Est 775 • LAC: n= 400, increasing; 1 in 4 have SDQ 18 or more • Smoking: 4%-7%; Drugs: 17% • Hos Ad due to suicide & self-harm: < national average • Perinatal MH need: est 2,500 • Prevalence of MH disorders: Preschool: 5000; School Age:7,660 • Prevalence of neurotic Dis (16-19 yrs): 3,500 • Estimated CAMHS need Tier 2: 8,000 Tier 3: 2,000 • CAMHS use (Oxford H): Tier 2: 1,397 Tier 3: 1,431

  20. For more information • National Child and Maternal Health Intelligence network http://www.chimat.org.uk/default.aspx • Joint Strategic Needs Assessment http://www.buckscc.gov.uk/community/knowing-bucks/joint-strategic-needs-assessment/ Sources: • General Practice (GP) registered patient counts aggregated up to CCG level • Office for National Statistics mid year population estimates for 2012 (local authority report). • The Foundation for People with Learning Disabilities (2002). • http://www.chimat.org.uk/default.aspx • Oxford Health Foundation Trust, 2014 • www.jcpmh.info

  21. A model for integrated services for children and young people with mental health needs and their families and carers Lisa Smart

  22. Core principles • Service must promote wellbeing • Service must provide timely, effective assessment, treatment and support • Service must provide a seamless pathway or journey through all levels of CAMHS

  23. Key requirements • Single point of contact for referral and assessment • Key/link worker to stay with child, young person and family throughout the CAMHS journey • Crisis support at home at weekends • Flexibility for early evening / weekend provision

  24. Key requirements • Tier 2 service is expanded with specific service outcomes monitored to ensure that service pressures elsewhere do not encroach on this core work • Tier 3 service community based and able to see children and young people in a variety of settings • Fluid transition between tiers to meet changing need

  25. Key requirements • ‘Bridge builder’ role to ensure a transparent journey with adequate mapping and signposting to appropriate complementary or alternative service provision • Cross CAMHS workers to develop service provision to at risk and hard to reach groups • All services to follow the improving psychological therapies service transformation agenda – accessibility, participation, measuring outcomes, evidence based practice

  26. Children and young people’s good mental health promoted, and services delivered in partnership

  27. Assessment Intervention Evaluation Tier 4 Specialist Tier 4 assessment Crisis Team Weekend home based support to CYP at risk, on the cusp of tier 4 admission,- working in partnership with tier 3 Support to Dialetical Behaviour Therapy group work by out of hours D.B.T phone service -out of hours paediatric ward based assessments • CRISIS Identification • TIER 3 • Core function – treatment: • family therapy • interpersonal therapy • CBT • play therapy • Emergency assessment for self harm • Assessment for referral to Tier 4 • Consultation mini teams that can be delivered within tier 3: • Looked after children’s • Child Development Team • Autistic Spectrum Disorder • Transition to adult services Pre-identification Evaluation of child or young person’s progress against personal goals and decision regarding next step no further intervention required further assessment indicated further intervention *Tier 4 *Tier 3 *Tier 2 *Tier 1 Consultation could lead to assessment by Tier 2 or Tier 3 practitioner Tier 3 assessment & formulation • TIER 3 Tier 3 Specialist Provision of high quality materials to inform parents and the wider workforce about CAMHS Participation workers Link workers Adult mental health liaison Training on identification for the wider workforce • Intervention • Direct, brief, evidence based therapeutic interventions with C &YP • Delivering evidence based • group work in conjunction with • partner agencies • TIER 2 • Prevention • Consultation • Intervention • TIER 2 Tier 2 Assessment • Consultation • Consultation to Tier 1 workers, supporting to manage CYP in Tier 1 where appropriate. • Consultation appointments • with CYP and parents, • supporting into partner • agencies where appropriate Tier 2 targeted Consultation could lead to other service provided by other agency Link worker • Prevention • Supporting tier 1 staff in initiatives to promote positive mental health, universally • Supporting early identification of MH needs by training universal/ tier 1 staff Consultation – with worker or CYP and family Tier 1 Universal SINGLE POINT OF ENTRY

  28. Key changes in the specification • Single point of access for consultation AND assessment • Extension of Tier 2 role and related skills, knowledge and experience requirements • Link worker role to support child, young person and family on their journey • Fluidity between Tiers 2 and 3 with the possibility of accessing interventions flexibly across tiers

  29. Procurement Information Ann Spence Senior Procurement Officer Finance & Commercial Services 10th October 2014

  30. The Procurement Process • E-Procurement • Procurement Approach • Invitation to Tender (ITT) • Tender Timetable • Key points

  31. e-Procurement • The Council will be using the South East Business (SEBP) Portal (https://www.businessportal.southeastiep.gov.uk) to publish and facilitate this procurement opportunity. • Providers must be registered on the SEBP in order to obtain details about and express an interest in this opportunity. • All documentation must be submitted electronically via the SEBP.

  32. Procurement Approach • The Council is seeking a single integrated contract in view of the proposed service model and S75 pooled budget across Buckinghamshire County Council, and Chiltern and Aylesbury Vale CCGs. • The Council will accept bids from providers considering bidding as: • A Single Provider • A Lead Contractor, with Sub-Contracting Arrangements; or • A Consortia bid

  33. Contracting Options Lead Contractor, with Sub-Contracting Arrangements • A lead organisation may bid for the procurement opportunity. • The lead contractor will be responsible for the day to day management of the contract and will be the organisation that holds the contract with the Council. • The lead contractor may sub-contract various services to smaller, specialist providers, to undertake work on their behalf. • Only the lead contractor is accountable to the Council. • The Council will be seeking to understand the sub-contracting arrangements at the tender stage. Consortia Bid • A number of providers become a single legal entity to enable them to bid for procurement opportunities.

  34. The Invitation to Tender (ITT) • The ITT consists of: • A Set of Instructions • Evaluation Criteria • Specification • Terms & Conditions • Pricing Schedule • Method Statement • Confidentiality Agreement – TUPE • Organisational Information Questionnaire • Form of Tender

  35. Invitation to Tender • ITT issued • Period for Q and A’s • Tender Return • Evaluation • Presentations • Award Decision

  36. Timetable • Issue Tender mid to late Nov 2014 • Tender Return mid January 2015 • Presentations early February 2015 • Award Recommendation early April 2015 • Contract Award mid April 2015 • Contract Start 1st October 2015

  37. Key Points • Both parties should have one identified point of contact • All information is issued to all providers at the same time • Both parties should provide clear, easy to read documents • Provide double sided documents • Cross reference any additional material you provide • Keep to deadlines – we cannot accept late tenders • Don’t presume we know what you do or can do – Tell Us

  38. Networking Opportunities • In order to facilitate networking opportunities we are asking providers whether they wish us to share their contact details with all those who are interested. • Email your contact details by 31st October 2014 to camhsbucksconsult@buckscc.gov.uk

  39. Any Questions?

  40. Commissioners are seeking your views on: • Contracting approach • single integrated contract • 5+2 year contract • Financial Incentives – CQUIN is 1.5% - we would like to place greater financial value on key performance indicators. • Commissioning model Please email your thoughts to camhsbucksconsult@buckscc.gov.uk by 19th October 2014

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