Welcome. Urgent & Emergency Mental Health Care for Children & Young People: A NATIONAL CONFERENCE ON POLICY, EVIDENCE AND SOLUTIONS

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1 Welcome Urgent & Emergency Mental Health Care for Children & Young People: A NATIONAL CONFERENCE ON POLICY, EVIDENCE AND SOLUTIONS Wednesday, 20th September 2017 Assembly #CYPcrisis

2 Northern England Clinical Networks Urgent & Emergency Mental Health Services for Children & Young People 20 th September 2017 Steve Jones National Service Advisor Michelle Place Project Manager Sara Saunders Project Manager Children & Young People s Mental Health Programme, NHS England

3 National update: policy guidance and mapping of CYP U&E MH care What we will cover today : Context of U&E MH care for children & young people Recommendations of the Expert Reference Group for a Children & Young People s Urgent & Emergency Mental Health Care Pathway What Clinical Commissioning Groups and local services are doing Preliminary findings from national CYP audit of Crisis, Liaison and Intensive Community Support services 3

4 Five Year Forward View for Mental Health into action Clear, consistent policy direction for mental health and for the first time, an implementation plan (July 2016) sets out national objectives, expected trajectories and funding available for all priority areas within the FYFV-MH. 4

5 NHS England: 2020 commitment By 2020 there will be system-wide transformation of the local offer to children and young people underway, with LTPs embedding Future in Mind principles and fully integrated into STPs across the country: At least 70,000 more CYP receiving swift and appropriate access to care each year Completed national roll-out of CYP IAPT programme - to embed collaborative, outcome focussed, evidence based practice in partnership with CYP and families and Increase capability train at least 3,400 more staff in existing services to improve access to evidence based treatments 1,700 additional new staff to support improved access to evidence based treatments Evidence based community eating disorder services for CYP across the country 95% of those in need of eating disorder services seen within 1 week for urgent cases & 4 weeks for routine cases. Improved access to and use of inpatient care, having the right number and geographical distribution of beds to match local demand with capacity, and leading to an overall reduction in bed usage. Improved crisis care for all ages, including investing in places of safety 5

6 Funding CYP MH transformation supported by 1.4bn additional funding announced during 2014/15: 1.25bn over for wider transformation (incl 15m pa for perinatal MH) 30m per year for eating disorders Additional 25m in 16/17 non-recurrent to reduce waiting lists 5M in 17/18 non-recurrent to improve crisis, intensive community support etc Page 9; Implementing the FYFV for MH

7 Crisis Care Concordat Crisis Care Concordat signatories pledged in 2014 to focus on four main areas: Access to support before crisis point: making sure people with mental health problems can get help 24 hours a day and that when they ask for help, they are taken seriously. Urgent and emergency access to crisis care: making sure that a mental health crisis is treated with the same urgency as a physical health emergency. Quality of treatment and care when in crisis: making sure that people are treated with dignity and respect in a therapeutic environment. Recovery and staying well: preventing future crises by making sure people are referred to appropriate services. 7

8 Children & Young People s Urgent & Emergency Mental Health Care Pathway Context and Background Draft recommendations from Expert Reference Group and NCCMH team - expert professionals from across all system partners & agencies with Inspirational contributions from children, young people and parents & carers Clear and consistent policy direction Distinct differences from adults - approach & challenges o Evidence, policy & guidance, scale, services, legal framework, CYP & carer responsibilities Evidence base; one size doesn t fit all 8

9 Mental Health Care Pathway for Urgent & Emergency Mental Health Services for CYP Children & young people experiencing a mental health crisis and their families should be able to access the right care, in the right place, at the right time. When I experience a mental health crisis I will have access to support from services no matter where I am, what time of day it is or which day of the week. A mental health crisis is a situation which the child, young person, family member, carer or any other person believes requires an immediate response, assistance and/or care from a mental health service. This includes where there is a significant risk of harm to themselves or others Services should provide effective and timely 24/7 urgent and emergency mental health care Parity of esteem: CYP should receive an evidence-based package of care within four hours of being referred. 9

10 The Expert Reference Group proposed principles to underpin the pathway Key Functions of urgent and emergency mental health care Advice, support and triage 24 hrs a day, seven days a week (24/7) A comprehensive assessment available 24/7 to ensure that the child or young person has the right intervention without delay Intervention, with crisis support available 24/7 These functions should be undertaken by professionals trained, competent and experienced in working with CYP mental health If my GP or teacher phones for advice about my crisis, they will receive support immediately 10

11 U&E Mental Health Care Pathway for Children & Young People - under development NCCMH worked with an Expert Reference Group (ERG) to develop the Urgent and Emergency Mental Health Care Pathway for Children and Young People. Key recommendations of the ERG: Recommended response times for U&E mental health care for children & young people Recommended response time Within 2 minutes Within 1 hour of presentation Within 4 hours (of receiving the referral or attending an emergency department) Within 24 hours (of initial referral) Completed actions A telephone call to an urgent and emergency mental health service should be answered within a maximum of 2 minutes by a person who is trained, competent and experienced in working with children and young people Response to a referral from an urgent and emergency mental health service The child or young person should have been appropriately assessed and: o have an urgent and emergency mental health care plan in place, and o have been accepted and scheduled for follow-up care by a responding service (including crisis intervention), or o be en route to their next location or alternative place of care, or o have been discharged as there is no further need for urgent or emergency mental health care. A number of children and young people will require further assessment, care and support within the first 24 hours of their initial referral. This might include: o a Mental Health Act assessment, which should start within the 4-hour recommended response time and be completed within a maximum of 24 hours, or o immediate home treatment or other crisis intervention, or o further assessment for self-harm presentations when an admission is not required, or o assessment for further treatment including a CYP mental health admission.

12 The Expert Reference Group proposed a flexible approach to where help is given Location of assessment The child or young person should be assessed as close to home as possible, including in their own home if appropriate. A range of locations should be available for an assessment and/or intervention to take place. Where an assessment in an emergency department (ED) is not in the child or young person s best interests, alternatives should be available. Monitoring improvement MHSDS will be updated to collect data metrics from services to monitor response times etc. Where possible, I will be supported by the same professional throughout my care, who will follow up wit me after I am no longer experiencing a crisis and whom I can contact easily 12

13 The ERG identified different ways CYP experiencing MH crisis can be supported. Service Models: address sustainable service size, integration and management of out-of-hours crisis presentations: o o o o Collaboration between specialist community mental health services for CYP Hub and spoke model - collaboration between CYP specialist community and inpatient mental health services Integrated CYP mental health and social care model Combined liaison and crisis mental health intervention service for all ages CCGs are responsible for developing the most appropriate configuration according to local need, geography, services and resource. Models are not mutually exclusive a comprehensive pathway may combine aspects from different models Transitions between services should be minimised Wherever possible a full range of expertise from both health and social care should be available. 13

14 Urgent & Emergency Mental Health Care for Children & Young People Considerations & Challenges for Implementation (1) Mapping need rates and distribution Engaging CYPF, stakeholders and system partners Assessing system readiness and resource requirements Investment, return on investment (ROI) Data, metrics, performance measurement & evaluation Configuration of whole pathway, o Footprint, o 24/7 response o Team configuration Collaboration & publicising Parents and carers ask, we will receive practical, meaningful and compassionate advice & support to help and understand our children & young people 14

15 Urgent & Emergency Mental Health Care for Children & Young People Considerations and Challenges for Implementation (2) Safe, effective and efficient o Sustainable viable team o Leadership, skills and training o Access to specialist skills o Follow-on care o Intensive Community Support / Intensive Home Treatment Relationship with wider system o Seamless, integrated clinical pathway with the wider CYPMH service including in-patient services o Working with wider system partners - o Working upstream 15

16 Mental Health Care Pathways The Five Year Forward View for Mental Health: By 2020/21, NHS England should complete work with ALB partners to develop and publish a clear and comprehensive set of care pathways, with accompanying quality standards and guidance, for the full range of mental health conditions based on the timetable set out in [the FYFVMH] NICE and National Collaboration Centre for Mental Health (NCCMH) commissioned to develop a suit of mental health EBTPs. Already Published: Early intervention in psychosis Community services for eating disorders in children and young people (extended during 2016/17 to include in-patient services) Urgent & emergency liaison mental health care for adults and older adults Planned Crisis care: o U&E MH Care Pathway for children & young people o U&E community mental health care pathway for adults and older adults (18-end of life) o U&E blue light mental health care pathway for all ages Children & young people s mental health care pathway Perinatal mental health Acute mental health care Integrated psychological therapies for people with common mental health problems Community mental health care Self-harm plus Looked After Children (SCIE, DH, DfE) 16

17 Children & young people s mental health care pathway Scope An Expert Reference Group (ERG) was convened and asked to consider and advise NHS England on The pathway CYP should follow when they seek help Suggested response times for treatment Description of the functions and capabilities necessary to implement the pathway Definition of evidence based, NICE-recommended interventions Focus: 0-18 year olds but also consider and be relevant to services commissioned on a different basis such as 0-25 year old services Consider CYP MH pathway in terms of need, not conditions or tiers of service To cover neurodevelopmental issues and autistic spectrum disorder where there is a co-existing MH condition Focus on the whole system - not just NHS 17

18 Children & young people s mental health care pathway Principles Key Pathway principles Comprehensive, timely & flexible assessment Collaboration and shared decision making Access and continuity of care o Supporting person and special consideration o Support to maintain education or work Delivering care o Trained, experienced, competent & supervised o Consistent multi-agency, multi-disciplinary approach o Appropriate information sharing o Consideration of families needs Even if there is something that must happen, there should always be a conversation about how it happens 18

19 Urgent & Emergency Care Vanguards Accelerating Improvements for CYP U&E Mental Health Care June 2016 Eight UEC Vanguard sites accelerating CYPMHS element to develop and test models of MH crisis and liaison care models. Action learning evaluation commenced Dec 2016 (NEL CSU) Core UEC MH pathway plus additional local elements Phase 1 interim evaluation - complete spring 2017: 2 sites with well established crisis and liaison services. Aim: extract early findings & learning to share nationally. Phase 2 - evaluate all eight sites - publish in late Autumn

20 Developing CYP U&E MH services The national picture - where are we now? Clinical Commissioning Groups with an agreed and costed plan for a dedicated MH crisis response for CYP (CCG IAF data Q4: March ) London North Mids & East South Compliant Partially Compliant Not Compliant

21 The national picture - where are we now (2)? CYPMH crisis care & home intervention services baseline audit June 2017 Survey Aim Voluntary baseline audit to support commissioning and policy implementation by succinctly, Establishing the current stage of development of CYP MH crisis, liaison and intensive community services across the country Where services are in place, inform how services are responding and potentially impacting on in-patient bed utilisation and requirements both mental health and paediatric/medical beds. Provide information back to commissioners that can help them benchmark their services against other CCGs.

22 CYPMH crisis care & intensive community support services Initial findings (1): Response rate 156 (75%) CCGs responded, providing 263 crisis services. Of these: Hours of operation Office hours 36% (within 8.00 to 18.00) Extended hrs 25% 24 hours 36% Dedicated CYP vs all age services Dedicated CYPMH services 93% Part of all-age/adult service 7% 22

23 CYPMH crisis care & intensive community support services - definitions Team type definitions 1. Initial crisis assessment & intervention only 2. Initial crisis assessment & intervention and brief follow-up 3. Intensive community support / home treatment etc. 4. Combined crisis, liaison and intensive community support. Alternatives to admission (configured & staffed for CYP) 5. Safe haven or crisis café 6. Short term in-patient MH bed or crisis & recovery house. 23

24 CYPMH crisis care & intensive community support services models (initial analysis) Distribution of community models 1. Initial Crisis Assessment and intervention only 42(16%) 2. Initial Crisis Assessment and brief follow up 99 (38%) 3. Intensive community Support/home treatment 44 (17%) 4. Combined Crisis, Liaison & Intensive Community Support 65 (25%) Alternatives to admission to acute mental health bed Short-term crisis beds: crisis beds in operation planned for delivery Planning taking place with LA s and Police Detailed analysis and mapping published late autumn 24

25 Your questions and feedback? Contact:

26 Helpful Resources For CED-CYP Case studies Resource for all adults to increase awareness and understanding Includes free e-learning sessions for all those working with CYP (incl. ED sessions) MindEd for Families GIFT Sign up for see video clips islimited/videos DATA: Chimat and CAMHS ebulletin CORC: NHS Benchmarking Report 2015 MHSDS-flowing from Jan 2016

27 My Mental Health Services Passport /mentalhealth/2015/10/15/passport-brief-ypmh Developed by young people and parents/carers with NHS England as part of the CYP IAPT programme The aim of the passport is to help young people using services to own and communicate their story when moving between different services. The passport provides a summary of young person s time in a service, for the information will be owned by the young person, and for it to be shared with any future services if the young person wishes

28 New online resource created for and with parents and carers to help improve mental health care for children and young people Over 900 parents/carers identified 5 key areas: access, equality and diversity communication service leadership and delivery methods of engagement workforce development Best practice case studies, videos, resource directory

29 Participation across whole CYP MH system (national, regional, and local level) 1. Co produce products and resources - where are the gaps? - what would be helpful? 2. National core and wider interest groups Diverse representation of CYP and parent and carers using services (incl. youth justice, those that tend not to use statutory services) 3. Embed across system - through support clinical networks, CYP IAPT collaboratives and partnerships, workshops and masterclasses, monitoring impact at all levels 4. Best practice case studies, videos, resource website, directory

30 Helpful weblinks MHSDS Monthly Report Pages Mental Health Services Dataset Monthly Reports NHS England Shared Planning Guidance NHS England Planning Guidance Technical Guide to Indicators Five Year Forward View Mental Health Dashboard CCG IAF (see indicator 123c) Quality Premium (includes stretch ambition on CYP MH Access) New national CQUIN (includes CQUIN on CYPMH transition) CORC report on child and parent

31 PHE Tools and Resources Promoting children and young people s emotional health and wellbeing: a whole school approach - A public health approach to promoting young people s resilience - /2016/03/ resilience-resource-15-march-version.pdf Measuring and monitoring children and young people's mental wellbeing: a toolkit for schools and colleges - ChiMat Mental Health and Psychological Wellbeing service planning tools - Children & Young People s mental health and wellbeing profiling tool - Measuring mental wellbeing in children and young people (published October 2015) - Measuring Mental Wellbeing in Children and Young People Mental health in pregnancy, the postnatal period and babies and toddlers: needs assessment report (December 2015) Comprehensive CAMHS integrated workforce planning tool- Promoting positive wellbeing and emotional health of children and young people - ng_pathway_interactive_final.pdf Minded - National reading scheme to support young people s mental health - JSNA support pack, Key data for planning effective young people's substance misuse interventions in

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33 Accelerating improvements for children and young people s urgent & emergency mental health care Phase one interim evaluation case study August 2017

34 Background In 2016 NHS England established a national project with the UEC Vanguards to accelerate improvements for CYP mental health care in a crisis. Aim: Accelerate existing plans to test CYP crisis and or liaison care models AND/OR Refine or expand existing models; AND Develop effective approaches to deliver key clinical, performance and outcomes information on a routine basis, including a local baseline; AND Evaluate the new models tested and share the learning with others. This summarises the key learning from the initial, Phase 1 action learning evaluation commissioned by NHS England. If I d had the help in my teens that I finally got in my thirties, I wouldn t have lost my twenties. The Five Year Forward View for Mental Health, NHS England, 2016

35 The scope of the phase one interim evaluation The Phase One case study focuses on two of the eight sites, County Durham and Teesside, where crisis and liaison services for CYP had already operated for some years prior to the crisis accelerator project. Aim: To extract learning that included replicability and scalability from these established models to share nationally. This stage of the evaluation does not fully consider the future plans of the County Durham and Teesside sites to further develop and consolidate their services under the accelerator project; this will be addressed within Phase Two. Phase Two of the evaluation (April-September 2017) will evaluate all eight vanguard sites and will be published in autumn Mental health must be a priority for everyone in England. Paul Farmer, Chief Executive, Mind, 2016

36 The evaluation methodology The methodology incorporated five key lines of enquiry with feedback from CYP, their families, and other key stakeholders. Patient level, common and bespoke performance data was used to evaluate both sites Developing key areas Refining the key lines of Exploring the key of enquiry and value enquiry and value equation equation lines of enquiry and data collection Conducting evaluation and developing recommendations Stakeholder discussion, data analysis and investigation Refining into priority focus areas: KEY LINES OF ENQUIRY Stakeholder engagement Steering Groups Events Service user groups Outcomes and experience Value Implementation Learning and replicability System outcomes Service user and carer desktop research Patient surveys Staff surveys Service user interviews Staff interviews Value* = Outcomes Resources 36

37 Data collected informed the key lines of enquiry Key lines of enquiry were addressed by the quantitative and qualitative data collected. Most quantitative patient level & common metrics were already collected or will be in future. KLOE criteria KLOE1 KLOE2 KLOE3 KLOE4 CYPF outcomes and experience a) What key changes has the model made to children and young people experiencing a mental health crisis and their families? b) What impact does the new model have on service user experience? c) What impact does the new model have on service user outcomes? System outcomes a) What is the impact on the wider system? A&E, paediatrics/inpatient, community/other CYPMH services, social care, adult MH, etc. b) What are the unintended costs and consequences (positive or negative) associated with the new models of care on the local health economy and beyond? c) How is the model performing in practice? How efficient is the model? Implementation a) How has the model been implemented? b) What is the change in resource use for the new model (including skills mix)? c) What is a sustainable and effective team size? d) What is the most effective operational model (e.g. all age, integrated multi-agency//life course etc.)? Value a) What is the financial impact/cost of the new model? b) What is the value derived from the new model (based on value equation)? KLOE5 Learning and replicability a) Can the model be replicated elsewhere? b) What learning can be drawn to support the spread of CYP MH crisis models elsewhere? c) What impact does the location/geography have on the model?

38 County Durham: key elements of the model Nurse Led. 24/7 open access/self referral. Liaison = Initial assessment -1 hour response. Crisis = Initial assessment -1 hour response (4 hours Max). Young person and family/carer led care. Comprehensive mental health and risk assessments. Intensive support within the home/appropriate setting for up 72 hours post assessment or until the risks are contained. Telephone support. Liaison and consultation with other professionals and members of the children s workforce. Intensive Home Treatment new developments..

39 Intensive interventions - Vanguard We propose that the Intensive Interventions and the crisis & liaison service deliver an integrated model. This will allow the service to utilise resources by providing enhanced flexibility in managing periods of high clinical activity, streamlining referral pathways to ensure clarity for referrers and promote a whole team approach particularly when working out of hours. The service will provide: 24/7 service. Rick focused. Alternative to tier 3 model which does not fit some young people (estimate 30%). Access to Intensive Interventions via crisis team, CAMHS, LDCAMHS or Tier 4. Nurse-led service with timely interventions from locality MDT. Evaluation Sept 2017.

40 Future plans Working with 111 commissioners - Enhance the current service to include call transfer to CAMHS crisis service. Potential further reduction in ambulance use. Potential further reduction in A&E attendance. Increase in early CAMHS support. Impact of work on admissions to Tier 4 inpatient units leave and discharge planning. More work on crisis planning closer work with CAMHS workforce around positive risk management.

41 Four key themes emerged from the evaluation

42 Key findings 1: elements of the model CYP population (0-18yrs) of: o County Durham: 124,000. o Teesside: 100,430. Footprint covering: o County Durham: 936 square miles. o Teesside: square miles. Population distribution: o County Durham: larger, semi-rural geographical spread. o Teesside: concentrated in dense urban areas. Self-referral: open direct access for CYP aged Opening hours: o County Durham: 8am-10pm (extended hrs). o Teesside: 24/7.

43 Key findings 1: elements of the model cont. Dedicated CYP MH team o crisis telephone support, advice and triage for CYP, families and professionals. o 32% of all appointments in Teesside were through the service s telephone support, advice and triage. Frequent clinical meeting: team huddle at least daily. Partnership working: direct calls encouraged from Police, Ambulance, joint visits, attend team meetings, training etc. Psychiatry and other clinical specialists accessed via wider CYPMHS team. Continuous, active publicising of the service and its aims. Active participation of service users and carers in vision and delivery.

44 Key findings 2: performance and service activity After implementation (2014 County Durham and 2015 Teesside) data shows: CYP seen within 1 hour: o County Durham: 60% o Teesside: 58% CYP seen within 4 hours: o County Durham: 77% o Teesside: 93% Rate of crisis presentation pa per 1,000 U18 CYP population: o County Durham: 5.9 o Teesside: 6.2 Presentation rates have remained broadly stable since services established. Workload: mean average crisis & liaison practitioner contacts: o County Durham: 724 appts pa o Teesside: 624 appts pa New Referrals o County Durham: 61% o Teesside: 71%

45 Key findings 2: performance and service activity cont. Since implementation (2014 County Durham and 2015 Teesside) data shows: CYP crises managed in community settings with less recourse to ambulance transport, A&E attendance and in-patient admission. Location Accident & Emergency Community Setting County Durham 67% 33% Teesside 55% 45% A&E self-harm presentations reduced for CYP (11-18yrs) compared to trends reported elsewhere. From service inception to March 2016: o County Durham: 16% o Teesside: 32% Ambulance transport of CYP in crisis reduced by: 36% in County Durham to 2016.

46 Key findings 3: service user involvement & experience CYP and Families o o o Very positive feedback from CYP and their families: 98% of 500 respondents to the Friends and Family test in Teesside rated the service as either excellent or good. A parent interviewed in County Durham reported that being visited at home was so much more beneficial than trying to get my teenage daughter to appointments. Staff o both sites reported being provided with fulfilling development opportunities. o o Staff support and development emerged in the evaluation as a significant positive impact on Recruitment and retention and contributed to building the strong foundations of a successful service.

47 Key findings 3: service user involvement & experience cont. Factors contributing to improved outcomes and experience included: CYP and families participation in developing service and vision. Improved access and response times providing individualised support that CYP and system partners require. Clear, direct, rapid access (24/7 in Teesside) Assessments in flexible locations and closer to home Reduced unnecessary overnight hospital stays Joined up multi-agency response Access to dedicated specialist CYPMH team

48 Key findings 4: costs and cost reductions Cost reductions in in-patient mental health bed requirements were not rigorously assessed due to service developments and a lack of robust data at this stage, although what data we have suggests there may be positive results. County Durham activity displayed for illustration purposes (patterns differ slightly) CYP Mental Health Bed Admissions (to the local unit only) show a rising trend prior to inception followed by a downward trend once the crisis service was fully operational. Occupied Bed Days (OBDs) show a paradoxical initial increase following inception of the Durham service - then followed by a steady downward trend. Note volatility due in part to relatively low numbers County Durham Number of Admissions County Durham Occupied Bed Days Key Pre Implementation Post Implementation

49 Key findings 4: costs and cost reductions Local contract value to deliver service at point of implementation: ocounty Durham: oteesside: 800k pa 850k pa Approx. cost per 1,000 CYP (U18s) pa: ocounty Durham: 6,451 oteesside: 8,463 Overall cost reductions were assessed as: ocounty Durham: 421k pa oteesside: 726k pa Potential Return on Investment (ROI) cost reductions identified pa equate to: ocounty Durham: 53% of contract value oteesside: 86% of contract value So for every 100 invested 86 to 53 was saved.

50 Key findings 4: costs and cost reductions cont. Cost savings calculations include impact on: o o o o A&E presentations. Paediatric ward admissions. Discontinuation of an on-call rota. Community CAMHS (Tier 3) follow up appointments. Potential cost reductions in in-patient mental health bed requirements are not Uncosted impacts include police and ambulance time. addressed in the interim evaluation due to service development and data limitations. Potential cost reductions in in-patient mental health bed requirements were not rigorously assessed due to service developments and a lack of robust data. Intensive community support / home treatment service extension may also further Intensive reduce community requirements support for / home mental treatment health April service 2017 extension assessed in Phase 2). may also further reduce requirements for mental health beds (wef April 2017 assessed in Phase 2).

51 Headline conclusions (1) Much improved, prompt and accessible highly valued service with continuity of response provided by a dedicated CYPMH nurse-led open access crisis and liaison team. New service reversed an increasing trend of admission rates through A&E and mental health inpatient beds. o Commissioners & managers note potential volatility in in-patient bed use. Highly effective teams - achieving between 93% to 77% completed responses within 4 hours. Integrated working with generic specialist community CYPMHS is essential. Flexible response and multi-agency partnership working is key to success. Children Young People and their Families are strong drivers for developing and sustaining a vision and ongoing service delivery. Feedback demonstrated very positive service user experience compared to typically poor experiences reported following traditional treatment as usual, (A&E presentation, oncall rota, overnight admission etc). CYP crisis presentation rates across both sites are remarkably similar and stable over time

52 Headline conclusions (2) Semi-rural Co Durham team shows slightly slower 4 hour response times despite high activity rates, but less investment per CYP. Significant cost reductions in immediate paediatric bed, A&E and community mental health services identified. Indicative net return on investment of between 86% to 53% of team costs Impact on mental health beds not yet accounted for. Major proportion of cost reduction to date attributable to acute (non-mh) sector. Further activity and cost reduction improvements associated with CYP MH in-patient care beds to be elucidated in Phase 2 of the evaluation. The Value Equation suggests good, much improved outcomes and experience for service users and families and a promising return on investment. Value Equation = positive impact on CYP outcomes promising return on investment Outcomes positive impact on CYP experience Resources positive impact system outcomes high levels of staff morale observed

53 Final steps Next step 1. Refresh the evaluation methodology by end of July 17 to include: - Areas of replicability and sustainability - Team skill mix, competencies and training - Interdependencies with specialist teams and wider services - Operational processes. - Performance and efficiency By when? July Access comprehensive CYP in-patient mental health bed data. 3. Evaluation report for 8 sites by Oct 17 Aug 17 Oct 17

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56 Tees, Esk & Wear Valleys NHS FT Tier 4 Tertiary Care New Models of Care Pilot Chris Davis, Project Lead 20 th September 2017

57 What is New Models of Care Mentioned in NHS England s Five Year Forward View for Mental Health National pilot Opportunity for secondary mental health providers to take responsibility for tertiary commissioning budgets and demonstrate ability to innovate and transform services in the best interests of service users and their families available for CAMHS Tier 4, Adult Secure and Adult Eating Disorders services

58 National Objectives Tier 4 Services To reduce length of stay for Young People and Children admitted to Tier 4 beds To build capacity and capability for CAMHS clinicians to manage Young People and Children in mental health services in the community (Tier 3) more effectively and avoid admissions (Tier 4) where ever possible Work with NHS England s Case Managers and CCGs to co-ordinate care Young People to be safely and effectively cared for in their homes during mental health crisis periods

59 There are 6 wave 1 sites: 4 adult secure and 2 CAMHS LIST OF WAVE 1 SITES Specialism Lead Provider Partners Oxleas FT South London and Maudsley FT; SW London and St George's NHS Trust Devon Partnership NHS Trust Avon and Wiltshire FT; Cornwall FT; 2gether FT; Cygnet; Elysium; Livewell; Somerset Partnership FT Adult Secure Oxford Health FT Berkshire FT; Dorset FT; Central and North West London FT; Solent NHS Trust; Southern Health FT; Isle of Wight NHS Trust; Response Birmingham and Solihull FT South Staffordshire & Shropshire Healthcare FT; St Andrews Tees, Esk and Wear Valley FT - CAMHs Tier 4 West London NHS Trust Central & North West London FT 59

60 Wave 2 will go live in 2 phases, and also includes adult eating disorder services LIST OF WAVE 2 SITES Go live on 1 st October Service Lead Provider Partners CAMHS Surrey & Borders Partnerships FT Sussex Partnership FT; Cygnet Health Care; Elysium Healthcare; Huntercombe Group; Priory Healthcare and Partnerships in Care Northumberland, Tyne & Wear FT Leeds Community Healthcare NHS Trust Hertfordshire Partnership University Foundation Trust South London & Maudsley FT Bradford District Care FT; Leeds and York Partnership FT and South West Yorkshire Partnership FT Oxleas FT and South West London & St Georges Mental Health NHS Trust Adult Secure Mersey Care FT Cheshire and Wirral Partnership FT; NW Boroughs FT; Elysium Health Care and Cygnet Health Care Sussex Partnership FT Kent & Medway Partnership Trust and Surrey & Borders Partnership FT Tees, Esk and Wear Valleys FT Northumberland, Tyne and Wear FT Adult ED Leeds and York Partnership FT Bradford District Care FT and South West Yorkshire Partnership FT Go live on 1 st April 2018 Service Lead Provider Partners Adult Secure Barnet, Enfield and Haringey NHS Central and North West London; NELFT; East London and West Trust London Mental Health Adult ED Oxford Health FT Avon & Wiltshire FT; Berkshire Healthcare FT; Surrey & Borders Partnership FT; Southern Health FT and 2gether FT 60

61 New Care Models in Mental Health Maps of coverage MAPS 61

62 Scope of the TEWV Pilot Implement a new care pathway for young people living within the TEWV geography: County Durham, Darlington, North Yorkshire and York Enhance community resource, enabling young people to be supported at home in times of crisis Reduce the number of young people who need to be admitted, and for it to be as close to home as possible Reduce lengths of stay

63 Business Plan (1) Submitted to NHSE by and updated March 2017 Signed off by Programme Board, TEWV Trust Board and local NHSE hubs Yorkshire & Humber and North East & Cumbria along with Management Agreement between TEWV and NHSE hubs Overall plan is to reduce numbers of young people admitted to in-patient services and for those admitted, to reduce distance from home wherever possible and reduce length of stay Increase community resources with equity across the Trust area for access to CAMHS Crisis and Intensive Home Treatment

64 Business Plan (2) Locality *6 Month Snapshot of 16/17 bed usage No of beds No of per 100k child beds pop Proposed bed base 2017/18 No of beds No of per 100k beds child pop Proposed bed base 18/19 No of beds No of beds per 100k child pop North Yorkshire and Vale of York Durham and Darlington Teesside Total A&T including Eating Disorders NY and VoY, Tees and Durham & Darlington *this data is based on a 6 month snapshot of length of stay (total LOS/183 days)

65 Business Plan (3) We envisage the majority of admissions being to West Lane or Mill Lodge Reduction in admissions, including those out of area, will release financial resource to implement CAMHS Crisis & Home Treatment teams across North Yorkshire & Vale of York. This was pump primed through successful bid by TEWV for Vanguard funding for Q4 2016/17 Ongoing discussion with CCGs re sustainability and use of LTP funding

66 What s been achieved so far (1) Stakeholder event held in March 2017 The two year pilot went live on 1 st April 2017 We ve taken over the budget for young people from the Trust area who need an in-patient admission (spans 2 NHSE hubs and 9 CCGs) Communication across the system has increased including discussions and availability of home treatment options and discharge planning Data for the first four months shows the number of young people admitted long distances from home is already decreasing, along with total numbers of occupied bed days

67 What s been achieved so far (2) We ve appointed Crisis and Home Treatment staff across North Yorkshire and York and the service is now available 10am to 10pm every day Feedback from acute hospitals has been extremely positive We ve examples of the team being able to support young people, families and carers at home, avoiding admissions to mental health units So far we ve been able to reinvest approximately 400k that in previous years needed to be spent on in-patient care for young people across the TEWV footprint

68 How we re working in partnership with NHS England Specialised Commissioning We hold the budgets but commissioning responsibilities remain with NHSE Specialised Commissioning We have regular meetings with Case Managers and with other local providers NTW, LYPFT Monthly Programme Board with membership from TEWV, NHSE hubs, national team, CCGs

69 Any questions? Head of Service, Tier 4 (TEWV)

70 Breakout Parallel Sessions: Sharing Practice Nationally Session 1: Chandelier - Children s Community Crisis Support: Our Experience of Setting Up a Successful Crisis Service for Young People. Great Yarmouth & Waveney, Norfolk and Suffolk NHS Foundation Trust Wedgewood - An innovative model to support the pathway for C&YP presenting in emotional distress and crisis (provisional title). Bradford & Airedale Neurodevelopment Service & Youth in Mind. Falstaff - Children & Young People in Crisis-Examples of Parents as Partners in Care. Rollercoaster Parent Support Project & Tees, Esk and Wear Valley Foundation Trust. Meldon - The Riding Evaluation of Clinical Outcomes 2016 (provisional title). Northumberland Tyne and Wear NHS Foundation #CYPcrisis

71 #CYPcrisis

72 Breakout Parallel Sessions: Sharing Practice Nationally Session 2: Chandelier - INTERACT: CYP Crisis prevention and resolution that works; cost effective, clinically effective. North East London Foundation Trust Wedgewood -The REACH IN model. Greater Manchester Mental Health NHS Foundation Trust Falstaff - Intensive Community -Treatment 6 years on! Challenges of managing risk and promoting recovery- A clinical perspective. Newcastle and Gateshead Children and Young People's Service, Northumberland, Tyne & Wear NHS Trust. Meldon - Nottinghamshire CAMHS Urgent Care Services: Intensive home treatment (provisional title). Community CAMHS North Langold #CYPcrisis

73 Closing plenary #CYPcrisis