B LACKPOOL CAMHS ADHD P ROFESSIONAL S TAKEHOLDERS EVENT 6 March 2018 - PowerPoint PPT Presentation

B LACKPOOL CAMHS ADHD P ROFESSIONAL S TAKEHOLDERS EVENT 6 March 2018

P ROGRAM  Housekeeping  Schedule  Agenda Session 1: 9:15 AM ( morning session), 1:10 PM ( afternoon session) Context of meeting Service user feedback ADHD Diagnostic Assessment Break 10:20Am( morning session), 2:30 PM ( afternoon session) Session 2: 10:30 ( morning session), 2:40 PM ( afternoon session) Diagnosis and Post diagnostic care Feedback and close

WHY ARE WE HERE ?  Quality improvement of ADHD service provided by Blackpool CAMHS  Improve quality: What can we do better with what we have?  Integrated working :work different NOT additional work Some changes may need additional work initially as part of CHANGE but overall becomes lean, efficient and effective for service user and staff

W HAT ARE WE NOT GOING TO FOCUS ON  what is out of scope of the current service: although if sufficient need/case demonstrated discussions maybe help as part of formal discussion: including any new business case/collaboration  Neurodevelopmental /LD/ASD  Additional resources/staffing  Training , Transition, medication/pharmacological Treatment of ADHD

ADHD D IAGNOSTIC A SSESSMENT : V ASU TO LEAD THIS . N EED SOMEONE TO COUNT NUMBERS WHEN HANDS LIFTED : C AN DELETED QUESTIONS FROM SLIDE . V ASU WILL BRING QUESTIONS SEPARATELY ON PAPER  Brief Interactive viewpoints/session: check beliefs/myths about ADHD , evidence or guidance Some examples below  ADHD exists/not  ADHD mental health condition?  Who should diagnose? CAMHS/paediatrics/any other  Diagnostic assessment requires: 2 appointment/multiple assessment  Assessment can be done by single clinician/MDT  ADHD a chronic condition should be seen on par with child with diabetes

W HY DO THIS NOW : CONTEXT  Referrals to CAMHS: increase in numbers over years* Dave  Staff recruitment difficulties 1.8 WTE Psychiatrist/medical staff Vacancy ( total consultant 2.8 WTE for the team) since February 2017 ( 1 WTE vacancy since August 2016)  Independent Nurse prescriber left post: ADHD nurse appointed: awaiting to complete Nurse prescriber training: impact prescribing for consultant National drivers and local drivers  CAMHS Transformation agenda: Increase age CAMHS up to 19 years: demand increase by 25-30% for ADHD alone  NICE guidelines  Greater Manchester Commissioning guidance ADHD  SEND

T HE DEMAND FOR ADHD IN B LACKPOOL  Children and young people under the age of 20 years make up almost 23% of the population of Blackpool  the proportion of children living in low income families is significantly higher, at 32%, than the England average at 20%.  The number of children in care is also significantly greater with 164, as opposed to 60 per 10,000 for England.  Under 18 conceptions are more than twice that of the England average at 43.8 for every 1,000 pregnancies whilst the rate of teenaged mothers is almost twice that of the England rate at 1.6%.  There are 25% of new mothers who smoke at the time of delivery compared with 10.6% on average elsewhere.

W HAT DOES THIS MEAN FOR ADHD SERVICES IN B LACKPOOL  Population Children : Blackpool CCG 5-15 years 15,000: up to 19 years 23,000  If we apply rule of 1% severe ADHD prevalence :up to 15 years :150 children. 5 % calculation 750 children  Up to 19 years service age increased : 1% 200-230 children,5% 1150 implications  Currently not identifying all severe ADHD  What do we do with those that are not severe/Hyperkinetic disorder?

C URRENT DATA SET B LACKPOOL CAMHS A PRIL 2017-12 F EB 18  Total Referrals to CAMHS via single point access: 794  Active/open cases at CAMHS 31/1/18 :738. ADHD coding 95Number of referrals for psychiatrist within CAMHS for ADHD assessment : 100  Approximate time to receive diagnosis of ADHD after referral: current: about 1 year* Dave  Number of patients with diagnosis of ADHD open to CAMHS on treatment : 150  Number of patients on waiting list awaiting diagnosis of ADHD: 30 Current waiting times to access psychiatrist in CAMHS appointment 9 months( May 2017) Numbers on waiting list 45 Probable ADHD on waiting list 30

W HAT HAVE WE DONE SO FAR ?  Journey started 2016( not just fire fighting)  Scoping/ Audit: Case note audit neurodevelopmental needs, ADHD monitoring review of 25 new ADHD assessments completed by medics Sep 2016 : 50% attachment difficulties , 25-30% had comorbidities of learning difficulties, ASD, sleep problems. parenting. 20% concerns around experience of trauma/bullying, sensory difficulties, and emotional dysregulation and anger issues. This did not take into account specify impact of ADHD on self-esteem and mental health diagnosis  Team discussions and shared, ways of managing ADHD diagnostic and post diagnostic interventions  Pilot ADHD diagnostic MDT within CAMHS from January 2018  Discussion and involvement with other key developments: CAMHS transformation, ASD pathway  Recruitment of Psychologist : Neurodevelopmental role : pilot 1 year  Discussion with Fylde and Wyre CAMHS : sharing practice, sharing ideas for innovative, effective ways of working  service user feedback 2/3/2018

ADHD: GIVING FAMILIES A VOICE ... Our aims: -To find out about the experience of families and children who have received a diagnosis of ADHD from Blackpool CAMHS. -To give families a voice -To enable service users to shape the development of our new ADHD service

W HAT WE DID : -Collecting feedback along patient/parent journey (questionnaires, interviews, focus groups). - Parent Support Group Feedback Discussion – Assistant Psychologist - last hour of the last session. -Two service user events, one for parents, one for young people and children in March 2018. -Run by Assistant Psychologist, Senior Clinical Psychologist, CAMHS Practitioner, Consultant Psychiatrist -2.5 hours session and 3 hour session.

What do you like about attending the Parent Support Group? We really like learning more I like meeting other about medication, I had no parents, I don’t feel idea what it was or why it isolated and alone was helping anymore 9 sessions was enough This time is for me and gets me out of the house The time and location is good, I can drop the kids off at school then come Marilyn invited me to the straight to the group. It’s a pain group, she reassured my going home to come back out again worries and encouraged me to attend I liked listening to other I’ve made friends and parents ways of coping with exchanged numbers behaviour and swapping strategies

What do you dislike about attending the Parent Support Group? I’ve finally found a place I don’t like for support and now the introducing myself, it course has finished, I’m isolated again makes me feel like a child No one looks at paper- I’d rather just use name based information badges, I’m a private person anymore – I just lose it or and will tell people about my bin it life in my own time I struggled to do the homework, I wanted to Some people didn’t want to do it but its too chaotic talk, just listen but felt like when I get home they had to so stopped coming

A PARENTS JOURNEY… WHAT IS ADHD? HES GETTING WORSE MDT Meetings SHINE 1:1 Primary School: support Behaviour became worse. Difficult to assessments manage Change of school GET TO CAMHS AND HES GETTING EVERYTHING WILL WORSE BE OK Inattention, concentration, speech and language

What was good about the ADHD pathway? Vasu and Andrea ring I like knowing there’s me often to check how I someone over the phone am and how we’re getting to help on I finally felt listened too They’ve helped me through difficult times in my life I think I’ve had a It helped having someone good experience in from CAMHS go into CAMHS school to speak to them I enjoyed the Parent I was told what all the Support Group assessments were for

What was not so good about the ADHD pathway? I had to pass on The fight of getting a information to diagnosis has made me professionals about stuff I dread having to go through didn’t understand it again with my daughter I got upset because nobody was listening to me I’m not given the time to process things I found the MDT discussions intimidating. I I felt my child wasn’t felt pushed into going along getting the support he with decisions I didn’t needed at school agree with I don’t have the confidence I was watching my child to ring CAMHS to ask for get worse. I felt so helpless help. I don’t want to bother them

What suggestions do you have for improving the service? A parent drop in group would be good. A place I can go to ask questions or get more ideas from parents Digital information/advertisement Contact/MDT cards (purse) Don’t call it parenting! Call it “ADHD support for parents” Leaflet design: Its ok to just come and listen More Marilyn’s! -No pressure Everyone needs a - It’s a choice More ADHD education Marilyn in their life -Can opt out at any time and awareness in GPs