Children and Young People’s Mental Health and Wellbeing Commissioning Development Programme Virtual Peer Learning Session 3: Performance Data & Needs Assessment May 2017 www.england.nhs.uk
Learning objectives Overarching aim To build an understanding of the needs and performance of local services supporting CYP MH&WB. Learning outcomes 1. I have a better understanding of the tools available to conduct a data and needs analysis 2. I have a better understanding of how data and needs analysis can strengthen planning for services in my local area 3. I have a better understanding of current structures, challenges and ways forward in relation to data and its use for performance management in CYP MH&WB www.england.nhs.uk
Session plan This session is structured in two parts: • Part A: Performance data (developed by Professor Miranda Wolpert | CORC) • Part B: Needs assessment (developed by Mike Streather, Cam Lugton, Gillian Bryant | Public Health England) www.corc.uk.net www.england.nhs.uk
Part A: Performance Data www.corc.uk.net www.england.nhs.uk
Part A: What we will cover 1. General issues in data collection, quality and use in CYPMH 2. Current indicators and policy priorities 3. The Mental Health Services dataset- what it includes for CYPMH 4. Highlighted tools to collect information about people accessing services, use of services and impact of services 5. Data from CYPMH services who were part of a best practice initiative (CYP IAPT) 2011-15* 1. What current data can tell us about who is seen by services 2. What current data can tell us about what outcomes are realistic to expect 6. How to consider the data to aid performance review and improvement: The MINDFUL approach 7. Top tips for commissioners *http://www.corc.uk.net/information-hub/child-and-parent-reported-outcomes-and-experience-from-child- and-young-people-s-mental-health-services-2011-2015/ www.corc.uk.net www.england.nhs.uk
General issues: best practice in data collection for CYP MH&WB services (CORC Framework) Technology and Leadership & Experience of Staff Development Information Management Service Management • Organisational vision • Understanding of use • Enabling data use in • CYPPC of different data direct practice with understanding of sources (including clients measures • Organisational measures) commitment to • Enabling use of data • Communication with collection and • Use of particular data collation at practitioner level CYPPCs about sources (including measures measures) • Organisational • Enabling use of data • Collaborative setting commitment to at team level • Training and interpretation and of goals and choice use Continued of measures • Enabling use of data Professional at service level Development (CPD) • Organisational • CYPPC feedback on culture supportive of support • Review of measures use and learning and feedback in supervision www.corc.uk.net www.england.nhs.uk
General issues: limitations in the data • Historically very little data available on CYPMH service provision and impact • What data there are: • F lawed • U ncertain • P roximate • S parse www.corc.uk.net www.england.nhs.uk
Indicators and policy priorities Key indicators and CQUINS set 2016-17 2017 onwards • Five Year Strategy for Mental Health (2017) • CYP Eating Disorders standard (2017) • Generic pathway for CYP mental health (2017) • Safe, Effective and Compassionate Staffing guidance – NHS England and NHS Improvement (2017) • From 2017, NHS England will test new ‘needs based groupings ‘ for CAMHS as the basis for a potential new national payment system http://pbrcamhs.org/final-report/ www.corc.uk.net www.england.nhs.uk
Mental Health Services Dataset – what is included for CYP MH&WB • Started national data collection January 2016. • All providers of NHS funded mental health care must flow data to the MHSDS. This includes services co-funded with LA or voluntary sector organisations. • Records vary in quality and completeness. • Data is made available through a number of different tools: • NHS Digital monthly data • NHS Digital tool iView • NHS England quarterly MH dashboards • PHE tools e.g. Fingertips and CYP profile tool (coming soon) • Mental Health Services Data Set (MHSDS) data will increasingly be used to inform service design and improvement and accountability. • Items are either mandatory (must flow in all cases), required i.e. SHOULD be reported where they apply (must flow if relevant to the care episode) or optional. • There is an annual process for agreeing changes to the dataset. • Aware some providers have struggled with local IT systems. NHS England has previously stated that transformation funds could be used to improve local ICT systems. NHS Digital have team who can support access. www.corc.uk.net www.england.nhs.uk
Tools: Current View Tool – Problem Descriptions https://www.ucl.ac.uk/ebpu/docs/publication_files/current_view 1. Anxious away from care givers 11.Extremes of mood (Bipolar 21.Family relationship difficulties (Separation anxiety) disorder) 2. Anxious in social situations (Social 12. Delusional beliefs and 22. Problems in attachment to anxiety/phobia) hallucinations (Psychosis) parent/carer (Attachment problems) 3. General anxiety (generalised 13. Drug and alcohol difficulties 23. Peer relationship difficulties anxiety) (Substance abuse) 4. Compelled to do or think things 14. Difficulties sitting still or 24. Persistent difficulties managing (OCD) concentrating (ADHD/Hyperactivity) relationships with others (includes emerging personality disorder) 5. Panics (Panic Disorder) 15. Behavioural difficulties (CD or 25. Does not speak (selective mutism) ODD) 6. Avoids going out (Agoraphobia) 16. Poses risk to others 26. Gender discomfort Issues (GID) 7. Avoids specific things (Specific 17.Carer management of CYP 27. Unexplained physical symptoms phobia) behaviour (e.g. management of child) 18. Doesn’t go to the toilet in time 8. Repetitive problematic behaviours 28. Unexplained developmental (Habit problems) (Elimination problems) difficulties 9. Depression/low mood (Depression) 19. Disturbed by traumatic event 29.Self-care issues (includes medical (PTSD) care management, obesity) 10.Self-harm (Self injury or self-harm) 20.Eating issues (Anorexia/Bulimia) 30. Adjustment to health issues www.england.nhs.uk www.corc.uk.net
Tools: patient and parent measures of outcome and feedback Outcomes Feedback Symptoms Goals Session Service Well-being e.g. RCADS e.g. Experience e.g. Session e.g. ORS GBOs of service Depression rating scale questionnaire scale e.g. PHQ9 e.g. WEMWEBS www.corc.uk.net/outcome-experience-measures e.g. SDQ conduct scale www.corc.uk.net www.england.nhs.uk
Data: problems seen by services Figure 2. Percentage of cases with a complexity factor endorsed in the first recorded Current View. n = 42,798 (44% of the sample); percentages are out of those with a completed Current View form 2011-15; categories not mutually exclusive Figure 1. Percentage of cases with a provisional problem descriptor endorsed as mild or above in the first recorded Current View. www.corc.uk.net www.england.nhs.uk
CORC Report on child and parent reported outcomes for CYP’s Mental Health • Published November 2016 • Analyses data from the services involved in CYP IAPT 2011-15 • First detailed analysis on outcomes • Data was limited (FUPS data) with relatively few of the 96,325 cases had paired scores • This underlines the need to improve data collection www.corc.uk.net www.england.nhs.uk
Data: problems seen by services in terms of allocations to NICE – guided treatment 28% only mild problems or one moderate that doesn’t fit NICE guidance 25% multiple or sever problems that don’t fit easily into NICE guidance Figure 3. Potential allocation to support guided by NICE guidelines. www.corc.uk.net www.england.nhs.uk
Data: self report symptom free by end treatment 1 in 3 Scores below threshold on all measures 36% (95% CI 35% - 37%) Mean no of measures = 4 (SD 2.5, range 1-13) N = 5896 (25% of closed treatment cases) www.corc.uk.net www.england.nhs.uk
Data: self reported reliable improvement by end of treatment 1 in 2 Scores improved more than likely due to measurement error on at least on measure and on no measure reliably deteriorated 52% (95% CI 51.7-52%) Mean no of measures = 4 (SD 2.5, range 1-13) www.corc.uk.net www.england.nhs.uk
Data: self reported reliable deterioration by end of treatment 1 in 10 Scores deteriorated on at least one measure more than likely due to measurement error (may have improved on others) 9% (95% CI 8.5%-9%) Mean no of measures = 4(SD 2.5, range 1-13) www.corc.uk.net www.england.nhs.uk
Self reported movement towards goals by end of treatment 9 in 10 Moved towards goals by at least 1 point on a 10 point scale 86% Mean change = 4 points NB 5% moved away from goals 2784 cases (12%) www.corc.uk.net www.england.nhs.uk
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