briefing on the re-design of current camhs provision across

Briefing on the re-design of current CAMHS provision across Cannock Chase & Stafford and Surrounds

Purpose: The purpose of this report is to inform County Overview & Scrutiny of the re-design of current CAMHS delivery across Cannock Chase and Stafford & Surrounds.

Background:

Following a review of the current service delivered by South Staffordshire and Shropshire NHS Foundation Trust (SSSFT), Commissioners across both localities agreed to re-design the service to ensure there was a focus on early intervention and prevention. Commissioners approached SSSFT to pilot the revised model for a two year period from 1st April 2012. The Trust has expressed a desire to work with Commissioners on the re-provision of the CAMH service. Funding for the service will remain with new investment into training staff to deliver the

revised model.

Revised Model

National guidance on effective, quality CAMH services focuses on early intervention and prevention1. The review highlighted a lack of resource at tier 1 and 2 with a focus on tier 3 interventions delivering a medical model of care. Current prevalence data for Cannock and Stafford highlights the need to shift resource to target the areas where the greatest demand lies: Estimated number of children with disorders: Cannock Stafford Conduct disorder (5.8%) 803 953 Emotional disorder (3.7%) 512 608 Hyperactive (1.5%) 208 246 Less common disorders (1.3%) 180 214

Estimated number of children who may experience mental health problems appropriate to CAMHS response

1 Every Child Matter DH 2003

Healthy Lives, Brighter Futures , DG 2009

No decision about me without me

Your welcome standards , DH 2009

Findings of the National CAMHS review, DH2009

Cannock Stafford Tier 1 3088 3666 Tier 2 1441 1711 Tier 3 381 452 Tier 4 15 18

The revised model will be an integrated model of care with Staffordshire County Council Families First teams (appendix 1). The model will utilise the expertise of the health and social care colleagues to ensure a holistic approach to this client group. The service will offer a combined single point of access thus reducing the need to re- direct return inappropriate referrals to referrers. This will in turn reduce delays to the client group The service will adopt the Team around the child approach as its overarching model of care thus ensuring that each child/young person and their family, get the right treatment, first time delivered by the right professionals. The service has a number of expected outcomes not least of which is that each child, young person and their family’s will be at the centre of and fully involved in any decision making on the care they receive. The client is not seen in isolation and it is recognised that children and young people are individuals within the family unit therefore, the family unit is involved in the care delivered. The model acknowledges the requirement for clients to access all tiers of the service as their condition improves and promotes the stepped care approach. The model is recovery focussed and promotes assisted self care where clinically appropriate. The revised model will operate for a two year pilot to enable best practice and data collection. It is hoped that the new ways of working will be adopted and embedded at the end of this period.

Appendix 1 WEST LOCALITY CHILDREN & YOUNG PEOPLE’S EMOTIONAL WELLBEING SERVICE

Referral Acceptance Centres

Stafford

LST 19 LST 20

Dr(s) Glennon, Palmer, Sellick, Chahal, Stone, Ehsan, Knight – BrowningSt Dr(s) Harper, McCosh, Munslow, Domville, Holden – Castlefields Dr Pringle, Bramley, Mir, Barnes, Hannigan, MacSharry, Subramaniam, Anwar, Davies, Gubbi – Holmcroft Dr(s) Eames, Stafford, Wood, Archer, Ballinger, Millward, Adeyemo, Ceresa, Chakraborty, Gunda, Raisinghaney – Mansion House, Stone Dr(s) Rawle,Hodgkinson, Spiers, Davies, Jacob, Hearn, Choudhary – Mill Bank Dr(s)Wilson, Fletcher, Albright, Afoakwah, Airey, Tipu, Byrareddy, Raza, Younas, Hiley – Wolverhampton Rd Dr(s) Bland, Carr, Jones, George, Davies – Eccleshall Dr(s) Mackinnon, Burger, Payner, Griffiths, Rahman – Cumberland House,Stone

Dr(s) Merriott, Burra, McWilliams, Skilton, Holmes, Davis, Clegg – Gt Haywood Dr(s) Grocott, Haig Ferguson, Martin, Wagner, Oliver, Beal – Rising Brook Dr(s) Lloyd, Elalfy, Houlder, Gobel, Newell, Shaw, Panabokkle, Skilton, Aldridge, Choudhury, Sanaka, Dhingra – Weeping Cross Dr(s) Greaves, Cooner, Perumal, MacColl, Mulligan, Bhatt, Williams, Fatima, Westwood - Gnosall

Cannock

LST 14 LST 15 LST 16

Dr(s) Dey, Dr Deb – Armitage Surgery Dr(s) Stokes, Stringer, Staite, Hooson, Adams – Sandy Lane Dr(s) Sivanesen, Davies, Cleary – Brereton Surgery Dr(s) Huda, Clark, Rachakatta, Oso, Nicklaus – Aelfgar Surgery Dr(s) Ibrahim, Bikmalla, Ogundipe, Singh, Subramanian – Springfield H&WB

Dr(s) Sircar, Stones – Bideford Way Dr(s) Verma, Campbell – Newhall St Dr(s)Selvam, Speedie, Choudhary – Princess St Dr(s) Gibbins, Gallimore, Wiley – Moss St Dr(s)Myint,Singh, Kulandaivelu – Cannock Hospital Dr(s)Berriman,Free – Hednesford Rd Dr(s)Thompson– Stafford Road Dr(s)Zein,Onabolu – Old Penkridge Rd Dr(s)Ballinger,Tariq – Hednesford St Dr(s) Holbrook, Horstink, MsMahon, Singh, Conmey, Rosevear – Colliery Practice

Dr(s)Gupta, Kacki, Choudhary ,Byrareddy, Davenport,– Heath Hayes HC Dr(s) BK Singh, Owens, Parekh – Chapel St Norton Canes Dr(s) Jalota, Halale – Chapel St, Norton Canes Dr(s) Po, Zeya – Norton Canes Health Centre Dr(s) Woo, Gutta, Al-Hakim- Rawnsley Dr(s) VJ Singh – Hednesford Valley Dr(s) Murugan – Hednesford Valley Dr(s) Chandra, Kasliwel– Hednesford Valley Dr(s) Yi – Hednesford Valley Dr(s), Murugan, Padmakaran, Station Rd Hednesford Dr VK Singh – Station Road, Hednesford

South Staffs

LST 17 LST 18

Dr(s) Grocott, Aziz, Bayliss, Blanchard, Allen, Jones, Zaidi, Gibson, Annadanam – Penkridge Dr(s) Husslebee, Houlder, Daley, Thomas, Harris, Jacques, Reddy –Brewood Dr Barry – Essington Dr(s) Lee, Naing = Featherstone Dr(s) Webb, Welding, Agarwal – High St, Cheslyn Hay Dr Desai – Gt Wyrley Health Centre Dr(s) AB Patel, D Patel – Health Centre Wardles Lane Dr(s) Wilson, Chiam– Health Centre Wardles Lane Dr(s) Kukathasan, Sharma– Southfield Way

Dr(s) Maidment, Ramachandran, Ziaulia, Yu, Coppolo, Khan, Pitchika, Maung – Billbrook Dr(s) Hall, Negrine, Jones, Commander – Claverley Dr(s) Jones, Ahmed, Hadley, Chan, Bryan, Kushwaha – Dale Med Practice Dr(s) Dukes, Vyse, Raphael, Franklin, Carey – Gravel Hill Dr(s)Baldwin, Asthana, Nightingale, Chowdhury – Lakeside Perton Dr(s) Clare, Joy – Moss Grove, Kinver Dr(s) Wakeman, Lamb, Williams, Jones – Russell House,Codsall Dr(s) Dhingra, Grewal – Tamar - Perton

Referral Acceptance Centre

Tier 2 – Mild /Moderate Mental Health

(Early intervention/targeted)

(4-6 sessions )

Counselling - Counsellors CBT – PMH workers

Group work PMH workers

Family Therapist Range of uni-disciplinary evidence based

treatment options (young minds etc)

Tier 3 – Complex Cases

(targeted – individual and disorder specific pathways)

Case Management –

Psychiatrists Psychologists

Psychotherapist Clinical Nurse Specialist

Social Workers OT/SLT

Day Care Community

Crisis Service Assertive Outreach

(TBA)

Specialist Targeted Services (Sustain & Engage) TBA

Referral Acceptance Centre Joint Triage Families First Local Support Teams

Families First LST – Level 1 interventions Promotion & Prevention Supported Self Help Families First LST – Level 2 interventions Third Sector Partners Groups Families First LST – Level 3 interventions Early Intervention Families First LST – Level 4 interventions Statutory Partners

Tier 4 Specialised Commissioning – Multi Disciplinary Specialists

Referral Source (routine referrals only)

CAPA Appointment (Health)

Families First levels of intervention/support

Level Need Descriptor of Need Example of typical

service response

1 Universal need

Children who are

enjoying general well-

being accessing

education and health

services and maintaining

good overall progress in

all areas of development

Universal services

including:

Schools

Children's Centres

Youth Clubs/Youth

Projects

2

Additional

need

Children who have an

identified, singular need

whose health,

development and/or

learning are starting to

be adversely affected

as a result

Local Support

Teams including:

Family Support

Outreach Support

Targeted Youth Support

Behaviour Support

Autism Outreach

G8Way Workers

Portage Workers

Education Welfare

Parent Support

Workers etc

3

Multiple need

Children who have

numerous needs, who as

a result are not

maintaining satisfactory

health, development

and/or learning and who

are increasingly

vulnerable.(including

Children in Need as

defined by S17 of the

Children Act 1989)

As above

4

Acute need

Children in crisis, with

complex, acute and

often long term need,

including:

where parents refuse or

are consistently not able to co-operate;

children who have

Specialist Services including:

Youth Offending Service

Short Stay School

Disability Services

complex disabilities;

parental resistance and

lack of support

mechanisms which

results in children

suffering or likely to be

suffering significant harm

children who are

offending and subject to

a court order

Children who have

serious unmet enduring

health, development and/or learning needs

(including Children in

Need as defined by S17

of the Children Act 1989)

Safeguarding Units

Looked After Children Services

Attendance

Prosecution

Schedule D: Service Specification

SERVICE SPECIFICATION

Service Mid Staffs MIND –Out of Hours Drop In Service (Cannock Chase & Stafford and Surrounds)

Commissioner Lead Mel Savage – Contract Manager – Commissioning Support Unit

Provider Lead Rebecca Potter – Mid Staffs MIND

Period

1. Purpose The Provider will be expected to provide the following:

• A range of mental health services based on the recovery approach

• A range of mental health services based on social inclusion principles

• To provide high quality, person centred and flexible support that will maximise recovery from mental illness and minimise the disabling effects of mental illness

• To provide a person - centred approach to service users and to work in partnership with service users to give hope and facilitate recovery

• To provide support to help service users to live more independently within the wider community

• To provide support to service users to access vocational, educational, training and other mainstream services

• To provide support to service users to access employment support services

• To develop links and pathways to all relevant statutory services

• To develop strong links and partnerships with all local partners such as the Primary Care Mental Health service, CAB, benefit and housing departments etc

• To support service users to access opportunities for volunteering

• To ensure service users are encouraged to become involved in service design and delivery

• A rehabilitative and supportive environment which encourages service users to recover from their mental health problems

• A service that empowers service users to lead full and productive lives

• Service that develops partnerships with other community services to facilitate the acceptance of people who have mental health problems as productive citizens and to

encourage tolerance, understanding, social inclusion and the elimination of stigma and discrimination

• Provide a safe, pleasant environment (safe space) which is conducive to promoting independence and autonomy

• The service is located and provided in ways that make them accessible and sensitive to clients on the following basis;

• age,

• gender,

• ethnicity (including BME communities),

• religion,

• sexuality

• disability. Annual Leave/Sickness Cover

The Provider is responsible for ensuring that periods of annual leave and sickness can be covered.

Where annual leave/sickness leave cannot be covered appointments will be rearranged to enable patients to be seen as soon as possible.

2. Accountability The Provider will be accountable to Stafford and Surrounds and Cannock Chase Practice Based Consortia and will ensure that the following are adhered to

o ensure that maximum use is made of drop in sessions. o ensure service user surveys are undertaken annually o ensure all recovery plans are person centred and developed in full partnership with service

users The Provider is professionally accountable to their professional body and must ensure that they receive appropriate clinical supervision. Performance and financial management of the service will be undertaken by SSPCT in its capacity as commissioner.

3. Responsibilities of the Provider

It is a requirement that the Provider and any staff provided by the Provider in delivery of this service:

� Are suitable qualified and experienced � Meet all nationally recognised standards � Contribute to the ongoing assessment and review of recovery plans � Ensure that there are sufficient staff to provide services during periods of staff absence due to

sickness, maternity leave, staff holidays or otherwise

� Obtain and maintain Enhanced Criminal Record Bureau (CRB) disclosures and carry out all appropriate checks on staff

4. Referral, Access and Acceptance Criteria 4.1 Location(s) of Service Delivery to be determined by Provider Cannock - Drop in Open Saturday Open Sunday OR Bank Holidays (to be determined by service users) Stafford Open Saturday Open Sundays OR Bank Holidays (to be determined by service users) 4.2 Referral route Open access for clients requiring safe space service to enhance the recovery and social inclusion service. The service will accept 25% of referrals from this client group. For recovery and social inclusion service referral from the following professionals:

• Primary care professionals (e.g GP’s, health visitors)

• Via Primary Care Mental Health Service

• Local acute mental health providers

The service will accept 75% of referrals from this client group.

5. Quality Standards Mental Health Service Specific Quality Standards: This service should be complaint with the following National standards:

• New Horizons – A new vision for mental health

• Defining a good mental health service – The Sainsbury’s Centre for mental health

• Integrating Mental Health into Primary Care – World Health Organisation

• A New Vision for Mental Health – Coalition discussion paper

• Outcomes Framework for Mental Health Services – Social Inclusion 2009

• From segregation to inclusion February 2006 Generic Quality Standards:

• For Providers which are already subject to Healthcare Commission inspection / annual health checks, compliance with ‘standards for better health’ will be verified by reference to the Healthcare Commission web-site.

• For Providers not subject to Healthcare Commission inspection / annual health checks, the PEC should request a compliance statement from the prospective Provider against the appropriate core and developmental standards.

The Provider will ensure that strong links are developed and maintained with the NHS in order to ensure consistency, comparative and quality care are maintained and updated in line with local and national priorities/strategies.

6. Activity This contract is for 2 sessions per week broken down:

Cannock Chase PBC

6 Hours (total)

Stafford & Surrounds PBC

6 Hours (total)

Covering the following:

• Drop in sessions, to be available on Saturdays, Sundays or Bank Holidays.

• Telephone advice and the option for urgent visits must be available at times agreed with service users

• Advice/ initial assessment of urgent ‘drop ins’ to be available at times agreed with service users • The service must be available for 52 weeks of the year to include Bank Holidays

7. Information Requirements The Provider shall provide the service in order to achieve the general outcomes and key individual outcomes which are set out in the outcomes framework (appendix D1). The Provider will provide a written report to each Practice Based Consortia on a quarterly basis detailing the following output data: The Provider shall provide patient level data that includes NHS number, gender, age and ethnicity.

• The number of service users accessing services for the first time

• The number assessments undertaken

• The number of reviews undertaken

• The number of opportunities for service users to access mainstream activities such as: leisure activities, employment, education, volunteering and training

• The number of sessions held

• The number of current volunteers within the service

• The number of services users moving on from the service � To report the number of weeks each client is in contact with the service � The type and number of therapeutic interventions carried out by the provider. � Number of complaints received � Recorded outcomes of complaints � To report on key outcomes framework data on an individual and organisational basis

This data will be produced every quarter for Stafford and Surrounds Consortia and also for Cannock Chase Consortia. Review meetings may be carried out at any time during the course of this Agreement, by either party giving at least 14 days notice in writing to the other. A 6 month review will take place following commencement of this agreement to ensure the revised model of delivery is meeting the needs of the service users and delivering the required outcomes.

8. Service Provision / Development and Amendments to Services Service Provision The Provider will provide a range of evidenced based interventions to meet the needs of the service users. The Provider will develop strong links and referral arrangements with both Statutory and third sector partners to ensure a seamless service. The Provider will focus the delivery of the service on social inclusion and employment/volunteering outcomes. The Provider will ensure that service users are involved in the service design and delivery and encourage peer support. The Provider will offer access to vocational opportunities and facilitated self help groups. The Provider will provide support to service users to access local mainstream services and agencies.

ALL service users shall have access to a wide variety of resources including (but not limited to):

• Information

• Supportive signposting

• Evidence based interventions in vocational services

• Personal support

• Arts & cultural activities

• Leisure opportunities

• Volunteering opportunities

• Advice

• Support services (e.g advocacy)

• Faith & Cultural support

• Positive social networks

• Education opportunities

• Employment opportunities ALL service users will be supported to engage in the development of a support plan utilising the Recovery Star tool. In partnership with service users, the provider shall establish a recovery plan and identify recovery pathways that ensure each individual service user’s needs are appropriately met. Regular assessments of service users will take place – at least every 3 months The Provider will ensure that each service user’s experience is welcoming and supportive and that services users are treated with dignity and respect and all times.

The Provider shall ensure that aids and equipment are available to meet the communication needs of individual service users as identified in their individual recovery plan. Service Development The Provider will be expected to work in partnership with Stafford& Surrounds and Cannock Chase Practice Based Consortia in the ongoing development of mental health services within the locality Service Amendments Should the nature of the service require change, and amendments to the service level agreement are needed, this will be undertaken through the prior agreement of both parties and following agreement of a suitable implementation period. A variation notification will then be issued reflecting the changes to this agreement.

9. Prices & Costs 9.1 Price 2011-2012

Cannock Chase PBC

6 Hours

Stafford & Surrounds PBC

6 Hours

Total Contract

Mid Staffs MIND Drop In Service Outcomes Framework

Mental Health and Wellbeing

Intended General Outcomes & Minimum Threshold Percentages (% of Service Users who have achieved the Key Individual Outcome Indicators)

Key Individual Outcome Indicators

(a) Supported to make changes leading to enhanced confidence and self-esteem

(b) Supported to develop and begin to use new coping strategies

(c) Supported to decrease reliance on mental health services

(d) Supported to avoid the need for a hospital admission

(e) Supported to make changes leading to a reduction in mental health symptoms

(f) Supported to assert needs with a health or social care provider

(g) Supported to be positively involved in decisions about their medication or treatment

h) Supported to develop a Recovery Plan

o Improved quality of life, confidence and self-esteem

o Increased ability to manage own mental distress Individual Outcomes:

(a) to (h) (inclusive) = KPI 95% of Service Users

(i) = KPI 90% of Service Users

(i) Supported to improve knowledge of own mental health and self care options

Community Participation



(a) Supported to begin volunteering in mainstream organisation

(b) Supported to begin accessing mainstream sports, exercise, arts, cultural, faith or other social leisure groups or facilities

(c) Supported to sustain regular volunteering or access to social leisure groups or facilities for 12 weeks

(d) Supported to take up a new or developed an existing/dormant leisure pursuit

(e) Supported to begin voluntary work within the mental health service they are using

(f) Supported to apply for a voluntary work in a mainstream organisation

o Volunteering in mainstream settings

o Participating in or engaging with local community activities

Individual Outcomes:

(a) to (h) (inclusive)

= KPI 95% of Service Users

(g) Supported to maintain/retain voluntary work through

a crisis period

(h) Supported to participate in a social event or organised event / activity

Social Networks



(a) Supported to develop positive new relationships friendships

(b) Supported to maintain a parenting or caring role through a crisis period

(c) Supported to begin accessing a peer support or self-help group

(d) Supported to strengthen an existing relationship with family or friends

(e) Supported to begin giving support to others

(f) Supported to access appropriate family interventions

o Increase in the size and range of social networks

o Maintaining social and caring roles

Individual Outcomes:

(a) to (g) inclusive = KPI 95% of Service Users

(g) Supported to access information and advice to help support them as a carer

Employment



(a) Supported to access job broker or other employment support service

(b) Supported to access advice about employment issues

(c) Supported to develop skills which increase their employability

o Individuals raising their employability and being ready for work

o Referred to employment

support services

o Entered paid employment

o Retained paid employment Individual Outcomes:

(a) to (d) inclusive = KPI 90% of Service Users

(d) Supported to maintain/retain employment through a crisis period

Education & Training



(a) Supported to begin a mainstream education or training course

(b) Supported to complete a mainstream education or training course

(c) Supported to obtain a qualification (state level)

(d) Supported to apply for a mainstream education or training course

(e) Supported to attend an interview or information session for a course

(f) Supported to Identify funding for an education or training course

(g) Supported to maintain/retain an education or training course through a crisis period

o Accessed education and training opportunities

o Attained a recognised qualification

o Attended in house training

Individual Outcomes: (a), (b), (c), (f) & (g) = KPI 90%

(d), (e) & (h) = KPI 95%

(h) Supported to begin a discrete (mentalhealth only) education or training course

Physical Health



(a) Supported to begin regular physical activity/exercise

(b) Supported to access health promotion activities

(c) Supported to begin accessing support relating to their physical health

(d) Supported to make positive changes to their diet or lifestyle leading to sustained health benefit

o Improved physical health

o Taking regular exercise Individual Outcomes:

(a) to (e) inclusive = KPI 90% of Service Users

(e) Supported to make changes leading to a reduction in physical health symptoms

Independent Living



(a) Supported to develop new skills for independent living (e.g. cooking, shopping)

(b) Supported to access advice regarding their finances, benefits or debts

(c) Supported to move to more suitable independent accommodation

(d) Supported to move to more suitable (but not more independent) housing

(e) Supported to resolve issues with neighbours or landlord

o Living in independent

accommodation

o Access to appropriate benefits / financial advice

Individual Outcomes: (a) to (f) inclusive = KPI 95%

(f) Supported to be able to effectively manage their own finances

Personalisation & Choice



(a) Supported to become more actively involved in decision making regarding their support

(b) Supported to access self help activities eg exercise, books or arts on prescription

o Service Users are

empowered to have more say and control in all aspects of public life and participate as active and equal citizens

o Service Users are supported to live independently, stay healthy and recover quickly Individual Outcomes: (a) & (c) = KPI 90%

(c) Service Users have choice and control so that any support they need from the Services fits the way they wish to live their lives.

Service User Satisfaction



(a) Service Users stated that the support they receive is responsive to their needs

(b) Service Users stated that the Services help them engage with their local community

(c) Service Users stated that the Services enable them to achieve their personal goals

(d) Service Users stated that the Services help them manage their mental health needs

(e) Service Users expressing that the support they received assisted them to achieve their life goals

(f) Service Users express a positive experience of using the service

(g) Service Users expressing that the support they receive meets their cultural needs

(h) Service Users stating that Staff treat them with respect and dignity

(i) Service Users stating that Staff help them to take control of their life.

o Service Users satisfied with the delivery and outcomes of the Services

o Service Users reported that key outcomes have been achieved by the Services Individual Outcomes: (a) to (l) inclusive = KPI 95%

(j) Service Users reporting they are treated as equal and expert partners.

(k) Service Users reporting they are trusted to make good decisions

(l) Service Users expressing the quality and access to

the Services offered is the same for them as everyone else in the Contract Area.

Service User Involvement



(a) Participating in peer run activities/ groups/sessions taking place within the Services

(b) Proportion of Service Users employed in the Services

o Service users involved in the

design, delivery, management, review and development of the service

Individual Outcomes: (a) & (c) = KPI 90%

(c) Service Users leading elements of service delivery

Diversity, Fair access and Equality



(a) Balance of Service Users responds to the needs of local population in terms of: Age, Ethnicity, Gender

(b) Number of people supported to use mainstream organisations to meet their specific diverse needs

o Equality of access to day

services for all people with mental health problems

o Services which specifically meet the needs of underrepresented groups Individual Outcomes: (a), (b) & (c) = KPI 95%

(c) Balance of Service Users from across the geographical Contract Area

Mid Staffs MIND Drop in Service Assessment Tool

The Recovery Star

briefing on the re-design of current camhs provision across

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