Birmingham Specialist CAMHS:

1. Birmingham Specialist CAMHS: Service Redesign

2. Strategic Context • NSF • Every Child Matters • Brighter Futures • Birmingham Commissioning Strategy

3. Strategic Context • Programme of organisational development • Improve Access to Excellent Services • Develop a transformational culture • Improve relationships with partners • Developing CAMHS as a flexible learning organisation, capable of adapting to the demands of a changing landscape.

4. Developmental Programme • Transformational leadership programme • Engagement with staff around organisational change • 18 week reference group: capacity analysis and benchmarking • Dialogue with partners • Developing a shared vision

5. Consultation Process • Service Design Group • Integration of service user views • Whole Staff Group Away Days • “Tiger Teams” • Professional groups/disciplines • Locality MDTs • LAC and LD MDTs • Partner agencies and commissioners

6. Critical Issues • threshold and demand • structure and internal capacity segmentation • partnership working • equitable access.

7. Additional Key Issues • Neurodevelopmental disorders: ASD ADHD • Access systems • Effective Communication

8. Key Features of the emerging model: • Integration of specialist community CAMHS into a single system into support to • universal services, targeted services, specialist services, emergency and high intensity services (inpatient services) • staff may engage in a range of clinical work that includes complex cases, early intervention, and consultation work. • Single waiting list for specialist CAMHS organised by area. (Likely area configuration six hubs – 2 per locality)

9. Emerging model (cont.) • Hub and spoke model. • Need to develop alternatives to a pure referral driven reactive model. • Reduction in the number of registered cases, and more children and families seen in appropriate settings.

10. Development of a clear consistent set of criteria specifying the range of specialist assessment and treatment services, and targeted services • Development of clearer integrated multi-agency care pathways • Incorporation of a stepped care model – progression from less intensive to more intensive treatments.

11. Standardised evidenced-based interventions for specific presentations, integrating with a more bespoke “care package” approach to more complex cases, and a risk management framework that overrides stepped care expectations to deliver clinical safety. • Redesign of access system to streamline processes and deliver clarity for referrers.

12. Birmingham Specialist CAMHS: Service Model • Inpatient and Regional Specialist Resource Services: • Specialised Inpatient provision dovetailing services to need e.g. age and presentation • Range of specialist resources, assessment, consultation etc • Emergency and High Intensity Services: • Self harm assessment and emergency urgent access systems to manage high risk cases • Out of hours on call service • High Intensity community support aimed at reducing the need for inpatient • admission and facilitating early discharge • Specialist CAMHS Services: • Provision focussed on children and young people with moderate to severe mental health problems • Emphasis on assessment, formulation, diagnosis and intervention • Coordinated multi-professional resource • Care packages built around individualised assessment of need • Targeted Services: • Highly accessible targeted interventions • Provided in partnership with community services, schools voluntary • organisations etc • Universal Services: • Ensuring all services have good awareness of the impact and contributors to child mental Health • Provision of accessible information for children, young people, parents, and professionals • Information regarding specialist and targeted services, and how to access support

13. Services Inpatient Services “Tier 4” Teams Emergency and High Intensity LAC LD Specialist services Partner Agencies Schools, comm paeds, BCC, Children’s centres, Health Centres, primary care, voluntary organisations etc

14. Thresholds and Referral Criteria • Specialist Services: Emergency Deliberate self-harm Current suicidal behaviour within the community Acute psychotic presentation Severe mental health trauma Priority Risk management framework (Rapid Access) Expressed suicidal ideation/intent Severe depressive psychotic symptoms Eating disorders Recent trauma In addition a multidisciplinary assessment and treatment service will be offered to the following groups: Moderate to severe OCD Bipolar disorder Moderate to severe depression Post-abuse or trauma (with associated mental health difficulties) (“timely access”) PTSD Severe anxiety Moderate to severe disturbances of attachment and emotional development Complex neuro-developmental disorders (ASD and ADHD) presenting with co-morbidity or mental health difficulties meeting the criteria for a specialist intervention.

15. Targeted Services • highly accessible, non referral driven services for children with early concerns / risks re: mental emotional health e.g. anxiety, behaviour / anger problems / developmental concerns • Emphasis on partnership working: facilitating, collaborating, and providing evidence driven packages many of which would be high volume and would be delivered in partnership with other organisations e.g. voluntary organisations, schools, community services. 

16. Examples of targeted interventions: • Parenting support: Triple P • Early Bird • Nurture groups • Schools based interventions: staff support and targeted therapeutic groups

17. Further models of targeted services: • Frankley Early Intervention Project: co-ordinated packages of support targeted at high deprivation difficult to reach populations. • Development of Infant Mental Health Services as distinct strand (link with identified strategic priorities) as part of under 5’s services. • Role of PMHWs. primary mental health workers integrated within the new structure. Role includes some direct clinical work as part of the job.

18. Targeted services have the potential function, within the stepped care framework, of collecting information regarding children / young people who were more at risk and therefore more likely to require a higher level of care if targeted interventions were unsuccessful.  • Targeted Services delivered largely in the “spoke” sites and community settings • Emphasis away from this being CAMHS case work and therefore less emphasis on formal assessment, less detailed correspondence and  no expectation to attend case conference IEPs etc. Part of “lean” processes. Streamlined access for children, young people and families.

19. Contribution toUniversal Services • Consultation and Training • Mapping the range of current consultation and training work offered: need to ensure this work is linked to the overall strategic model, including the function of enabling cases to be appropriately held outside the specialist CAMHS referral system. • Will include infant and child mental health awareness, and awareness of services (specialist and targeted) and how to access them).

20. Implementation: • Big piece of work • Implications for accommodation strategy and interim accommodation arrangements • Refining the detail • Development of service specification and care pathways • Retaining the partnership approach • Culture change • Phased process