Liverpool’s CAMHS Partnership

1. Liverpool’s CAMHS Partnership Lisa Nolan Programme Delivery Manager (Children and Maternity) Liverpool CCG Lisa.nolan@liverpoolccg.nhs.uk

2. Liverpool’s CAMHS Partnership • Needs led • Family centred • Multi-agency – range of providers • Provides continuum of care with targeted support • Engaging, Involving and inclusive • Jointly commissioned • Strong How did we get here?

3. The journey

4. Alder hey community mental health teams In-patient provision Pre-2003 Comprehensive CAMHS 2+1 service, Alder hey

5. Providers: Alder hey Foundation Trust – Community Mental health teams Regional units Commissioners: Liverpool Health Authority Outcomes: Not monitored or reported

6. Regional In-patient Units: CAMHS tier 3 community teams, CABI Working Together Tier 2 YPAS counselling AS Pathway YPAS Support Service BEST ‘Mad, Bad or Misunderstood’, 2003-2006 SLD team HAVEN

7. Commissioners: Liverpool PCT Liverpool City Council • Outcomes: • Dev. of choice • Less stigmatising provision • New ways of working • More community based provision • Joint and partnership working • Emerging performance monitoring process • Policy driven Providers: Alder Hey (many teams) VCS: YPAS Regional units

8. Regional Home Based Treatment Regional In-patient Units: YOS mental health provision CAMHS tier 3 community teams, CABI Working Together YPAS counselling Tier 2 AS Pathway BEST YPAS Support Service ADHD Foundation Participation team, MYA Banardos Young Carers & ‘Keeping the Family in Mind’ Training and MH Promotion: ‘Mad, Bad or Misunderstood’, Healthy schools Partnership, Mental health promotion 2007-2010 SLD team CAMHS LAC CAMHS 16-18 team HAVEN TAMHS, MYA

9. Commissioners: Liverpool PCT Liverpool City Council Social Care • Outcomes: • Dev. of choice • Less stigmatising provision • New ways of working • More community based provision • Joint and partnership working -participation • Thinking family • Improved performance monitoring process • Policy driven Providers: Alder Hey (many teams) VCS: YPAS, PSS, Barnardos, MYA Regional units and HBT

10. Comprehensive CAMHS Pathways 2010-2013 C&YP & Families Training: MBM Inside Out, Master class Mental health first aid Specific training Consultation & support: Telephone, individual, group Tier 4 Dewi Jones Unit (0-14) Alder Hey (Primary Mental Health Service, Specialist CAMHS) Tier 4 YPC (14-18), CHEDS Public Mental Health Self-care, Website Mental Health promotion Single Point of Access Tier 4 OAT (Independent Sector) Voluntary Sector CAMHS (YPAS, ADHDF, PSS, Banardos YC) Provider: voluntary CAMHS and c&yp Triage (multi-agency) AHCFT 0-16 years Out of Hours Psychiatry Universal services Provider: Voluntary CAMHS Statutory CAMHS Mersey Care 16 plus Other services (signposted) care aims methodology

11. Providers: Alder Hey (2 teams with SPA) VCS: YPAS, PSS, Barnardos, MYA Regional units and HBT • Outcomes: • Dev. of choice • Less stigmatising provision • New ways of working • More community based provision • Joint and partnership working - participation • Thinking family • Robust performance monitoring process • Single point of access • Multi-agency triage and working • More accessible information • Consultation and training accessible to frontline provision • Commissioners: • Liverpool PCT/CCG • Liverpool City Council • Schools • Social Care

12. Liverpool’s CAMHS Partnership Performance Monitoring: • Activity – CAMHS returns/National data set/national benchmarking • Outcomes – CAMHS returns/ CORC • Quality – CAMHS Returns/ Contract visits

13. Liverpool’s CAMHS Partnership So What?? Reduction in specialist CAMHS referrals by 21% form 11/12 to 12/13 90% of those accessing services showing improvement in mental health (CORC) 90% high satisfaction with services (CORC) Increase year on year of universal staff accessing training

14. Liverpool’s CAMHS Partnership All providers using CORC measures VCS all quality assured Built local workforce Strong equalities agenda Strong participation agenda Focus on early identification and prevention

15. Liverpool’s CAMHS Partnership Why VCS? Less stigmatising Less medical More Flexible Innovative and creative Skills of workforce Added value Community based Engaging and involving Asset based

16. Liverpool’s CAMHS Partnership Challenges: Professional hierarchy Funding Restructure

17. Liverpool’s CAMHS Partnership WHAT NEXT?

18. Need: • Approx. 100,000 c&yp • Liverpool is 1 of the most deprived cities in UK • High proportion of LAC, young cares, c&yp with disabilities, BME communities and refugee and asylum seekers High risk factors therefore mental health problems likely to be high Main presenting problems: • Emotional disorders, behavioural and self harm Adverse Childhood Experiences: - physical, emotional, sexual abuse, domestic violence, household substance misuse, household mental illness, parental separation and divorce, parent in prison Main referrers: • Education, child health services, GP L4, L8 and L6 postcodes account for 27% of referrals

19. Future Challenges: • Integrated commissioning – funding • Integrated care – culture, personalities • Changing NHS – relationship management • Economic climate and social determinants

20. GAPS: • Transition – CAMHS to AMHS and Tier 3-4 pathway • Early years and maternal mental health • Neuro-developmental problems (ASD and ADHD) • Mental health promotion • In balance in access – too many at specialist level • In balance in funding and therefore delivery – more focus on specialist than early intervention • Integration at commissioning level

21. Future Opportunities: • Integrated commissioning and care • CCG and LCC priorities • Liverpool’s children and young peoples/whole family agenda • Public health changes • IAPT (Improved Access to Psychological therapies) • Mental health promotion and FYI developments (participation) • Training menu • Transition • Research opportunities • Neuro-developmental pathway • Datasets

22. 2014-2017 strategy: Joint commissioners Range – VCS, independent and statutory-partnership UNCRC Working Together to ensure mental health and emotional wellbeing is ‘Everybodies Business’

23. Liverpool CAMHS Outcomes Strategic Map and Pathway Improved mental health of Children & Young People [& their Families] Improved Environments so that Children, Young People & families can Thrive Increased Identification of C&YP with early indicators of distress and risks Reduction in Mild to Moderate Distress Reduction in the development of Moderate To Serve distress Reduction in life long distress Alder Hey - Specialist CAMHS In-patient care – Dewi Jones (alder hey) and YPC (CWP) and OATS MYA- MHP, training and engagement Alder Hey – Early intervention (PMHS) and LAC/CIN YPAS – therapeutic/counselling and support service PSS – refugee and asylum seekers therapeutic support ADHD Foundation Barnardos YC and KFIM Key: Delivery- public mental health, early intervention, targeted Contracts – LCC Funding- LCC/CCG/social care/schools (pooled budget) Performance managed – LCC Delivery – specialist Contracts– CCG Funding- CCG Performance managed – CCG Delivery – In-Patient (regional) Contracts– Spec Comm Funding- CCG top slice Performance managed – Spec Comm

24. Liverpool’s CAMHS Partnership Outcomes: • Improved mental health of children, young people and their families • Improved environments so that children, young people and families can thrive • Increased Identification of children and young people with early indicators of distress and risk • Reduction in mild to moderate distress • Reduction in the development of moderate to severe distress • Reduction in life long distress