www.england.nhs.uk

Embedding

Future in mind in

our communities

Peter Fonagy, National Clinical Lead for CYP

IAPT

Kathryn Pugh, Children and Young People’s

Programme Lead

Anne O’Herlihy, Project Manager CYP IAPT

and the Children and Young People’s Team,

NHS England

www.england.nhs.uk

Number of mentions of children’s mental health in UK newspapers 2008-2015

Years

Source: Lexis Nexis

Ch

ild

ren

’s M

en

tal H

ealt

h

Men

tio

ned

at

least

on

ce

2008 2009 2011 2010 2012 2013

200

400

600

800

1000

2015 2014

www.england.nhs.uk

Mentions of Child and Adolescent Mental Health Services or CAMHS in UK Newspapers

Source: Lexis Nexis

Logarith

mic

scale

(ln

)

0

20

50

150

1000

Quinquennial rates

2015 2010 2005 2000

400

N=640

N=74

N=24

N=3

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www.england.nhs.uk

www.england.nhs.uk

Future in Mind and the Five Year Forward View

Key Themes

• Sets direction of travel across health,

education, children’s social care and

youth justice

• Consensus across the whole system

built on principles of CYP IAPT, EBP,

including the core need for participation

from children, young people, families and

carers, outcomes focused.

• A clear steer and some key principles

about how to make it easier for children

and young people to access high quality

mental health care when they need it.

• Five year strategy designed for and with the NHS and health ALBs.

• For people of all ages and it sets out priorities to improve mental health care across the whole NHS

• Reiterates that by 2020/21, at least 70,000 (30%) more children and young people should have access to high-quality mental health care when they need it.

• Also focused on improving the workforce, and addressing inequalities promoting better leadership across mental health

Published March 2015 Published February 2016

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Future in Mind and the Five Year Forward View

Some key common themes

• Promoting resilience, prevention

and early intervention

• Improving access to effective

support

• Care for the most vulnerable

• Accountability and transparency

• Developing the workforce

• Promoting good mental health and

preventing poor mental health

• A 7 day NHS – right care, right time,

right quality

• Complex need services nationally from

2016

• ‘Hard-wiring’ mental health across the

NHS

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Future In Mind and the FYFV for Mental Health

By 2020, for people of all ages we want to see:

Publications Gateway

Ref. No. 03250

And for children and young people specifically:

Improved crisis care for all ages: right place, right time, close to home

Improved transparency, leadership and accountability across whole system

More visible and accessible support

Improved public awareness less fear, stigma and discrimination

Timely access to clinically effective support

More evidence based, outcome-focused treatments

Better use of data and information across the network

Professionals who work with children and young people trained in child development and mental health

Model built around the needs of children and young people, and a move away from the ‘tiers’ model

Improved access for parents to evidence-based programmes of intervention and support

A better offer for the most vulnerable children and young people

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Local Transformation Plans

All CCGs submitted Local Transformation Plans (LTPs) on time

123 plans covering 209 CCG areas

Assurance determined monies going out to all CCGs by End December

Spend to be tracked in Q3 and Q4

Plans in user friendly format on web by 31st December 15 – had to include baseline data

Continuous tracking of use of funds in further years to be part of routine assessment process

LTPs should be refreshed, republished each year and included in Sustainability and Transformation plans

www.england.nhs.uk

Transformation plans should

Be Transparent – publishing:

• Baseline investment by local commissioners

• What services are provided including workforce information

• Referrals received, accepted, waiting times

Demonstrate Service transformation in line with principles covering

• Range and choice of treatments and interventions available;

• Collaborative practice with children, young people and families and involving schools;

• Use of evidence-based interventions; and regular feedback of outcome monitoring to children, young people and families and in supervision.

Monitor improvement

• Development of a shared action plan and a commitment to monitor, track and review improvements with appropriate governance structures.

www.england.nhs.uk

LTP = a good CYP MH Strategy Cover the spectrum of services

Including community eating disorder services

Focus on prevention interventions, for existing or emerging mental health problems

Transitions between services.

Include local leadership and governance arrangements

To secure a whole system approach to delivery at local level

Demonstrate collaborative commissioning within and across sectors

To promote effective joint working and establish clear pathways.

This includes working with collaborative commissioning groups in place between NHS England specialised commissioning teams and CCGs

Demonstrate that schools are given the opportunity

To contribute to the development of Transformation Plans.

Be coherent with local priorities

And with the child mental health requirements in the existing joint planning guidance.

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Complete focus from many local areas with clear leadership

Joined up approach

Understanding of importance of EBP and authentic participation

Focus of strategic players supporting local areas

Raised profile of CYP MH locally and nationally

Creative ideas and energy

Things to celebrate from the LTPs

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Key challenges for us all

Workforce planning and capacity - across all sectors

Variable leadership, commissioning and collaboration

Joint commissioning – how rather than why

IT planning - need to comply with requirements to be able to flow data and use outcomes in the room

Anxiety about spending the money in the best possible way

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Delivery of

evidence-

based

practices

Building on what we know works

Improving access

& engagement

Increasing MH

awareness &

decreasing

stigmatisation

Improving

outcomes

accountability

Enhancing youth, carer and community

participation

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CYP IAPT: expansion (NHS England & HEE)

Continued commitment to 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

Offer training across partnerships (NHS, LA, Vol sect): CBT, SFP, IPT-A, Parenting, Supervision, Service Transformational Leadership, EEBP, outreach service development, outreach enhanced supervision.

•Children and young people with learning disabilities or autistic spectrum disorder

•Working with 0-5s

•Counselling

•Combination - Prescribing and therapy

• Inpatient CAMHS

New curricula – evidence based interventions for

National Accreditation Council – assure quality of training and embedding of principles

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CYP IAPT

Partnerships Map

Following recruitment of

6th collaborative,

programme on target to

work with services

covering 80% of 0-19

population by March

2016.

This goes up to 87%

when including ‘light

touch’ outreach and

service leadership work

to prepare partnerships

for full modality training

www.england.nhs.uk

• Young people seen more quickly-time

between referral and assessment

decreased by 73%

• YP achieved significant clinical

improvement over fewer sessions -

number of days between assessment

and discharge decreased by 21%

Is it working?

239

299

64

235

Days between referral andassessment

Days between assessmentand discharge

Pre CYP-IAPT With CYP-IAPT

Improved access through self-referral routes, single point of

access, outreach services, evening and weekend

appointments.

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Greater involvement of children,

young people and

their parents or carers:

Throughout treatment and every aspect of their care

Recruitment and interview

panels

Staff appraisal and

training

Website and information

design

Planning and delivery of

mental health awareness

Mystery shopped service

evaluation

Environ-mental changes

Speaking with clinical

directors

New feedback systems ‘you said, we did’

Increased agentive CYP involvement

56%

34%

Pre CYP-IAPT2 With CYP-IAPT

CYP agreed they had

recovered sufficiently to be

discharged - percentage of

closed cases by mutual

agreement increased

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Building on what we know - LTP

baseline

Abi Childs and Rahul Agarwal

NEL Healthcare Consulting, NEL CSU

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Referrals per 1000 CYP

Abi Childs and Rahul Agarwal

NEL Healthcare Consulting, NEL CSU

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Referrals accepted per 1000 CYP

Abi Childs and Rahul Agarwal

NEL Healthcare Consulting, NEL CSU

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CYPMH expenditure per 1000 CYP

Abi Childs and Rahul Agarwal

NEL Healthcare Consulting, NEL CSU

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CYPMH expenditure per referral per 1000

CYP

Abi Childs and Rahul Agarwal

NEL Healthcare Consulting, NEL CSU

www.england.nhs.uk

Predicting referral acceptance Not an obvious relationship

TOTAL EXPENDITURE WORKFORCE

p > 0.05 p > 0.05

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Teams working together: The AMBIT approach

Mentalizing

© Bevington & Fuggle

How does AMBIT make people work collaboratively?

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Teams working together: The AMBIT approach

How does AMBIT make people work collaboratively?

1. Putting learning at the centre of the team culture

2. Developing a whole team Approach which recognises the interdependence of colleagues within a team

3. Using this team to support the development of strong individual key working relationships

4. Using a systems approach to emphasise interconnectedness and shared intentions across the wider multi-agency network.

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Empirically supported therapies

(ESTs) adapted to improve outcomes

or engagement in subgroups of

individuals expected to respond poorly

to ESTs.

Parent–Child Interaction Therapy (PCIT), an

EST for disruptive behavior, adapted for

Mexican American families; outperformed

nonadapted PCIT at follow-up (McCabe & Yeh,

2009; McCabe et al., 2005, 2012).

ESTs that alter or leverage environments

(e.g. family, school, peers) thought to

impact youth outcomes; therapists

conduct treatment at least partly within

these environments using formats

tailored to patient needs, based on individualized goals.

Multisystemic Therapy, an EST for

both delinquent and substance-

abusing adolescents that is widely

disseminated (Henggeler, 2011; Henggeler &

Schaeffer, 2010; Schoenwald, 2010).

ESTs organized into self-contained

modules that can be used multiple

times or not at all, and combined as

needed; decision-making flowcharts

guide which modules to use and when

to use them for a particular patient.

Modular Approach to Therapy for Children

with Anxiety, Depression, Trauma, or

Conduct Problems; outperformed standard

ESTs at posttreatment and usual care at

posttreatment and follow-up (Chorpita & Weisz, 2009;

Chorpita et al., 2013; Weisz et al., 2012)

A trial design that randomizes

individuals to a first-stage treatment or

assessment condition, assesses

response, then potentially randomizes

individuals to next-stage treatment

options based on their response;

generates evidence for constructing

decision rules in sequencing treatments.

A SMART of minimally verbal children with autism

found superior outcomes for communication

intervention augmented by a speech-generating

device (vs. nonaugmented intervention), and, for

nonresponders after 3 months, intensified

augmented intervention (vs. intensified

nonaugmented intervention; Kasari et al., 2014).

A system of administrating assessments of

treatment outcomes and progress indicators

that are psychometrically sound, sensitive to

clinical change, brief, and clinically useful;

then storing and displaying the data in

meaningful formats to provide feedback

about how well treatment is working.

The Youth Outcome Questionnaire and

Youth Outcome Questionnaire Self-Report

have identified youths at-risk of treatment

failure; Youth-Clinical Support Tools pinpoint

obstacles and suggest solutions (Burlingame et

al., 2001; Cannon et al., 2010; Ridge et al., 2009; Warren & Lambert,

2012; Warren et al., 2012).

Research syntheses of randomized

trials comparing alternative treatment

strategies or types directly (i.e. within

the same trial) among patients with

specific characteristics.

A meta-analysis compared psychotherapy,

medication, and combination psychotherapy-

medication for subgroups of depressed adults and

found sufficient evidence to recommend

medication for dysthymia and combination

treatment for older adults and outpatients

(Cuijpers et al., 2012).

Models that guide decision-making

based on multiple characteristics of

individuals; developed through data-

mining, an exploratory approach for

detecting and interpreting patterns in

data.

The Distillation and Matching Model mined data

from youth psychotherapy trials to develop a tool to

select efficacious treatments, or their elements,

based on patient characteristics; produced

medium-large pre-post effects as part of a

comprehensive service model (Chorpita & Daleiden, 2013; Chorpita et al., 2005; Southam-Gerow et al.,

2013).

Indices that quantify the benefit

each patient is expected to

receive from alternative

interventions by accounting for

one or more characteristics of

the patient.

Probability of treatment benefit (PTB) was

computed for a randomized trial of youth anxiety

treatments at different levels of pretreatment

symptom severity; PTB differed across treatments

only for severe anxiety, with highest PTB for

combination CBT-SSRI (Beidas et al., 2014;

Lindhiem et al., 2012).

Personalizing psychosocial mental health

interventions: Eight strategies

Ng, MY & Weisz, J., JCPP 2016