What might help reduce waiting times in CAMHS? Bill Williams, - PowerPoint PPT Presentation

What might help reduce waiting times in CAMHS? Bill Williams, General Manager and IAPT Project Lead, Tower Hamlets CAMHS Dr Rebecca Adams, Consultant Child and Adolescent Psychiatrist, Tower Hamlets CAMHS Dr Freya Gill, Clinical Psychologist, Newham CAMHS

The Need for Change • High referral numbers • Long referrals meeting • Poor quality referral information • Lack of systematic liaison with referrers/ families • Delays in decision making • Insufficient information about alternative services or self help

100 110 120 130 140 150 160 60 70 80 90 Count 1/1/13 LCL UCL 2/1/13 Increase in referrals Vs reduction in resource 3/1/13 4/1/13 5/1/13 6/1/13 7/1/13 No. of referrals received by Newham CAMHS per month 8/1/13 9/1/13 10/1/13 11/1/13 12/1/13 1/1/14 2/1/14 3/1/14 4/1/14 5/1/14 6/1/14 7/1/14 8/1/14 9/1/14 10/1/14 11/1/14 12/1/14 1/1/15 2/1/15 3/1/15 4/1/15 5/1/15 6/1/15 7/1/15

Key Aims of Front Door Team • Improve decisions: Do referred children require input from CAMHS? Can they be signposted to alternative services? • Reduce waiting times for first appointment. • Improve patient experience of referral process by offering a more responsive service.

A New Referral Process Referral received Referral meeting (FD clinician and Senior) Allocate Allocate Redirect/ Triage (Routine) (Urgent) Close Feedback meeting (FD clinician and Senior)

Group Exercise You are part of the CAMHS Front Door Team and as a group you are required to make decisions about incoming referrals. Stage 1. Identify what should happen with each new referral: • Allocate (Urgent) • Allocate (Routine) • Triage • Redirect/Close Stage 2. Identify what should happen with the triaged referrals: • Allocate (Urgent) • Allocate (Routine) • Redirect/Close

Newham CAMHS Front Door Team Dr Priti Patel, Consultant Psychiatrist, Project Sponsor Dr Freya Gill, Clinical Psychologist Sari Ross, Clinical Nurse Specialist Dr Carly Huck, Clinical Psychologist Dr Brigitte Wilkinson, Consultant Clinical Psychologist, Lead Clinician Frances St John, Family Therapist Nazneen Ramsahye, Lead Administrator Annabelle Perdido, Team Administrator Meredith Mora, QI Clinical Fellow

Key Aims of Front Door Team • Improve decisions: Do referred children require input from CFCS? Can they be signposted to alternative services? • Reduce waiting times for first appointment at CFCS from 11 weeks to 9 weeks by April 2015. • Improve patient experience of referral process by offering a more responsive service.

Quality Improvement (QI) Programme PDSA cycles Plan, Do, Study, Act Cycle 9 : Implement the ‘front door’ service Cycle 8 : Align referral admin with ‘front door’ service Cycle 7 : Pilot combined DLC & ‘front door’ role Cycle 6 : Offer face-to-face ‘drop-in’ appointments Cycle 4 : Use interpreters in triage assessments Cycle 3 : Pilot the ‘Front door’ (triage) service Cycle 2 : Develop a self-help and local service database Cycle 1 : Develop a standardize triage assessment script

Driver Diagram SECONDARY DRIVERS CHANGE IDEAS AIM PRIMARY DRIVERS Review and develop administrative systems for referrals Define Admin process for handling referrals Standardise liaison activity with Define standards from referrers CAMHS clinicians in liaison activity with referrers Referral Processes Streamlining referral Review and rationalise info sent processes to families Identify and use onward pathways for cases diverted from CFCS Screening checklists for To reduce waiting GPs/referrers times for CFCS from Information provided to referrers about CFCS 11weeks to 9 weeks by April 2015 and Develop knowledge about improve the patient Checklists/ Screening tools alternative services in for referrers experience of community / ‘secret shopper’ Demand Management referral to CFCS as users. demonstrated by Awareness events increased attendance at first appointment Develop telephone screening Signposting to alternative protocol for families services Increase proportion of telephone consultation time Develop welcome call to families accepted to CAMHS Limited Capacity prior to appt Workload balancing Develop library of easily Broaden interventions Develop self help materials accessible self-help materials

Outcomes

Waiting Time Data • Average wait for first appointment has dropped from an average of 69 to 54 days for the whole clinic. Warning: Data issues CFCS waiting time (days) referral to first appointment 100 Front Door Pilot UCL 90 80 70 60 50 LCL 40 30 10/1/13 11/1/13 12/1/13 10/1/14 11/1/14 12/1/14 1/1/13 2/1/13 3/1/13 4/1/13 5/1/13 6/1/13 7/1/13 8/1/13 9/1/13 1/1/14 2/1/14 3/1/14 4/1/14 5/1/14 6/1/14 7/1/14 8/1/14 9/1/14 1/1/15 2/1/15 3/1/15 4/1/15 5/1/15 6/1/15 7/1/15

Waiting Time Data • % of families seen within 9 weeks has increased from an average of 47% to 66% for the whole clinic. Warning: Data issues % of families seen within 9 weeks 100% Front Door Pilot 90% 80% 70% UCL 60% 50% 40% 30% LCL 20% 10% 0% Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15

Triage Wait Times The current average waiting time for a triage assessment is under 2 weeks . • Average wait (days) from referral received to triage assessment Measure 50 45 40 UCL 35 30 25 20 15 LCL 10 5 0 10/6/14 10/13/14 10/20/14 10/27/14 11/3/14 11/10/14 11/17/14 11/24/14 12/1/14 12/8/14 12/15/14 12/22/14 12/29/14 1/5/15 1/12/15 1/19/15 1/26/15 2/2/15 2/9/15 2/16/15 2/23/15 3/2/15 3/9/15 3/16/15 3/23/15 3/30/15 4/6/15 4/13/15 4/20/15 4/27/15 5/4/15 5/11/15 5/18/15 5/25/15 6/1/15 6/8/15 6/15/15 6/22/15 6/29/15

Attendance Rates of First Face-To-Face Appointment Data snap-shot: All referrals received in February 2015 (N= 60) 100% 90% 80% Exisiting Routine Process: 70% 60% 50% Triage: 40% 30% 20% 10% 0% Attended DNA'd Declined

Outcome after Triage Assessment Allocate within CFCS 4% 5% Close (no support needed/no contact made) 24% 45% Re-direct to more appropriate service Provide Self-help only 22% Re-direct to appropriate service and provide self-help

Service User Feedback The experience of the telephone call ‘[The triage call] was a lot Limitations Advantages ‘I just felt where I’ve more better than going to had that woman Language barriers Familiar talk to someone in person, talk to me in such a surroundings helps because when you talk to nice way, I thought someone in person it’s harder talk maybe I’m going to and especially if you’re in a have that here [at different environment as Unexpected call Benefits of CAMHs] as well…’ well… but when you’re at unknown voice home & more relaxed... I just Challenges of Less exposing & find it easier..’ unknown voice more focused Being put at ease Sense of relief and hope for help • Confidentiality • Relief of beginning to talk with the hope of help • Expectations • Off my chest • Control • New conversations • Clinician’s persona • Positive changes having talked

Service User Feedback Feedback and ideas for improvement A Good Process • Call Length • Questions asked and use of measures • Better than a letter Possible Areas for Consideration ‘Maybe a text an hour before • Text notification of the call asking whether it’d O.K to call in • Clinician measures as conversational tools an hour’. ‘When I’d already come out about the From Triage to Assessment whole situation I thought oh I have to Retelling the Story • explain the whole situation again.. but I • Use of triage call in initial assessment know I have to do it because it is going to help me.. So although it might be annoying saying the same thing over and over again… I found it fine’ .

What next? • Further evaluation - Service user feedback from families of their experience • Service user participation – Ask young people to rate the self- help materials we have sent and discuss how they would prefer to access it. Visit other local services to gather information about accessibility, projects etc. • Eliminate weekly referral meeting – Front Door Team will enable service to respond to risky cases more effectively and for allocations to be made on a daily basis. • Link up with related pilots within the service (e.g. primary care and schools link) • Full Implementation – To provide Front Door Team to all referrals on a daily basis. Caution! Resource implications

Discussion and Reflections

Contact details • Dr Rebecca Adams: • Bill Williams: rebecca.adams@elft.nhs.uk bill.williams@elft.nhs.uk 020 7426 2375/2400 020 7426 2375/2400 • Dr Freya Gill: freya.gill@elft.nhs.uk 020 7055 8400