ACCESSING APPROPRIATE CAMHS IN ESSEX - the Single

Gateway Pilot

Lonica Vanclay, ECC and Karen Egglestone, Catch 22 – 20th March

Tina Russell, ECC and Michelle Hembling, The Junction 29th March

Why are we doing this?

Standard 9 of the National Service Framework for Children, Young People & Maternity Services states:

…’all C&YP from birth to their 18th Birthday who have mental health problems and disorders

should have access to timely, integrated, high quality, multi-disciplinary services to ensure effective assessment, treatment and support

for them and their families’…

The tapestry of CAMHS provision

ECC (LA) CAMHS Tier 2 Team

Counselling (Schools)

CAMHS Family Therapies

Diagnosis, medication, teaching, consultation

Leverton secure children’s home

Brookside in-patient ward

NEPFT/SEPT Longview/Poplar in-patient

ward

Tier 3 NEPFT Team in North SEPT in South

Group Therapies

Healthy schools

Midwifery Services

PSHE in schools

Pastoral Teams (Secondary Schools)

SEAL

Peer and Learning Mentors

Anti-Bullying Policies and Activities – Schools

Health Visitor support

Home School Liaison Workers

Group and skills programmes to develop self esteem and confidence

(Schools & Voluntary Organisations)

Partnership commissioned and voluntary sector provided

services eg Catch 22, The Junction, Place2Be, Young

Concern

Tier 1Tier 1

UniversalUniversal

Tier 2Tier 2

TargetedTargeted

Tier 3Tier 3

ComplexComplex

Tier 4Tier 4

AcuteAcuteCommunication and Language skills development & Family Support

Communication and Language skills

Early Years Provision Education Psychology Service

Children’s centres / Early years activities / Support

Private provision – spot purchased

Commissioning approach• Strategic partnership structure – County Joint

Commissioning Committee (ECC/LA, NHS, Schools Forum) and County CAMHS Partnership (with providers incl schools, voluntary sector )

• 4 Locality Commissioning and Delivery Boards• Joint commissioning – health, school and LA £ for Tier 2

some locally commissioned; LA seconded staff to Tier 3.• Aligned commissioning – schools commission

themselves (and vol sector provide)• Partnership produced a commissioning toolkit resource

to assist schools with commissioning for emotional health and wellbeing and Commissioning Support Officers (LA employed but Schools Forum agreed) to assist.

Challenges with a Tapestry of Services

• Resources and capacity…………..

• Sufficient knowledge of all services and across services

• Developing good working relationships

• Building a comprehensive overview

Involvement of the Voluntary Sector

• By localising commissioning (4 quadrants) and open tendering in line with a Strategic Approach agreed by the Partnership of a “tapestry” we enabled voluntary sector provision.

• We know vol sector is more accessible, flexible – and wanted them to have a role.

• Structured their focus on early intervention – built into LA CAMHS Tier 2 teams remit to support and advise vol sector

Outcomes for Services• Developed a common highlevel children’s

outcomes framework

• Promote use of SDQ, Outcomes Star or SOUL with categories of met/positive change; partly met/no or little change and not met/negative change

• Collation is a challenge!!

Benefits of voluntary sector involvement

• Harnesses and maximises different commissioner resources and provider expertise

• Choice for users about location and type on intervention

• Single gateway can direct appropriately and reduce duplication and ping pong

Challenges with voluntary sector engagement

• Different provision in different quadrants

• Collating information into a provider directory for the gateway to use

• Improving awareness of referrers (esp schools and GPs) and trust/confidence in the vol sector provision

What is the CAMHS Single Gateway?• A single referral access point to CAMHS across the

North Essex Cluster (and a similar one in South Essex)

• Simple, efficient, consistent & standardised approach• Streamlining referrals avoiding delays in assessment/treatment• Integrated, promoting cross-agency working• Advice & guidance for referrers• Data collection point to help identify gaps, emerging need etc

• A comprehensive referral screening service which will signpost/direct referrals to most appropriate CAMHS

• Improved experience for C&YP, families & referrers• Reduction in inappropriate referrals • Reduced inequalities• Based in one building, manned by CAMHS professionals from all

Tiers – voluntary, ECC Tier 2 and Tier 3.

Operational process• Referrer discusses any concerns about emotional and

mental health of the C&YP with – Parents/Carer and if appropriate with the C&YP and obtains consent to refer to CAMHS Single Gateway

• Can phone to discuss• Refer by email, safe haven fax or post• Referral screened by a team member and - if Tier 1/early community Tier 2 – referrer given

information about service for family to contact - directed straight to appropriate Tier 2 or 3 service- forwarded to relevant MultiAgency Panel if other

agencies also needed/involved

Why this approach?• Earlier pilot (BCFPI) of standard screening tool

highlighted benefits of this – less ping pong between services

• There are benefits in a tapestry of services – choice, location/access, range of methods - but referrers esp schools and GPs were confused about where to go

• Wanted to continue to commission and build awareness of the range of services

• Action research pilot approach • Existing providers operate (rather than a separate

assessment/referral function) at least initially to help build understanding across providers/tiers

CAMHS Single GatewayExpected Outcomes

• Evidence that the MH & Emotional needs of C&YP are being screened in a consistent way

• Easy, efficient and equitable access to CAMHS when C&YP need them

• Reduction in inappropriate referrals and ‘ping-pong’ between Tiers

• Greater integration of CAMHS across all Tiers and better use of resources

• Better levels of support for Referrers• Identification of service gaps, emerging areas of need to

inform future commissioning

Challenges for Gateway• Resources and capacity…………..• Balance local knowledge/relationships with one

centralised service• Different processes across organisations

complicates and sometimes duplicates data recording etc

• Interface with Social Care and other single gateways into services – one single gateway for all or specialist knowledge/advice

• What level of professional/clinical expertise to operate the gateway?

Key concluding messages

• Start with building a partnership strategic framework

• Make time to develop engagement and mutual understanding and respect

• Recognise strengths and differences (USP) of each partner and harness them

• Simplify access but build a tapestry of services• Huge benefits result from a unified approach to

ensuring the most appropriate service for families and real partnership working

Further Information

Overall Approach:Lonica VanclayLonica.Vanclay@essex.gov.uk

Gateway: CAMHS Single Gateway – North Essex Holmer Court Essex Street (off Headgate) Colchester CO3 3BT

Any Questions?