Community Eating Disorder Services for Children...
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www.england.nhs.uk Community Eating Disorder Services for Children and Young People, and their families/carers National work programme October 2016 Peter Fonagy, National Clinical Lead for CYP IAPT Anne O’Herlihy, Project Manager, CYP MH Kathryn Pugh, Programme Lead, CYP MH
Transcript of Community Eating Disorder Services for Children...
www.england.nhs.uk
Community Eating Disorder Services for
Children and Young People, and their
families/carers
National work programme
October 2016
Peter Fonagy, National Clinical Lead for CYP IAPT
Anne O’Herlihy, Project Manager, CYP MH
Kathryn Pugh, Programme Lead, CYP MH
www.england.nhs.uk
Vision and commitments
DfE
HEE
NHSE
DH
DWP
PHE
MoJ
LAs DCLG
NHS
Digital
By 2020…
At least 70,000 more CYP
receiving swift and
appropriate access to care
each year, increasing access
to meet at least 35% of local
need.
CYP IAPT national rollout
with at least 3,400 more
staff in existing services
trained.
1,700 additional new staff .
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 and 4 weeks for
routine cases.
Improvement of inpatient
care; reduction of bed usage.
Improved crisis care for all
ages, including investing in
places of safety.
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.
www.england.nhs.uk
Future In Mind and the FYFV for Mental Health
By 2020, for people of all ages we want to see:
Publications Gateway
Ref. No. 03250
And for children and young people specifically:
Improved crisis care for all ages: right place, right time, close to home
Improved transparency, leadership and accountability across whole system
More visible and accessible support
Improved public awareness less fear, stigma and discrimination
Timely access to clinically effective support
More evidence based, outcome-focused treatments
Better use of data and information across the network
Professionals who work with children and young people trained in child development and mental health
Model built around the needs of children and young people, and a move away from the ‘tiers’ model
Improved access for parents to evidence-based programmes of intervention and support
A better offer for the most vulnerable children and young people
www.england.nhs.uk
Recent announcements to
improve access to services
• Develop evidence based community Eating Disorder services for children and young people: capacity in general teams released to improve self-harm and crisis services.
Autumn Statement 2014: £30m recurrently
• Build capacity and capability across the system so that by 2020, 70,000 more children and young people are treated per year will have access to high quality mental health care when they need it.
• Roll-out and extend the Children and Young People’s Improving Access to Psychological Therapies transformation programmes (CYP IAPT)
• Improve perinatal care
• Pilot a joint mental health training programme for single points of access in specialist CYP MHS and schools, testing it over 15 CCGs.
Budget Announcement Spring 2015: £1.25b over the next 5 years
Implementation via Transformation Plans
www.england.nhs.uk
Transformation plans
Transparent and published:
• Baseline investment by local commissioners
• What services are provided including workforce information
• Referrals received, accepted, waiting times
Demonstrate service transformation in line with principles covering
• Range and choice of treatments and interventions available;
• Collaborative practice with children, young people and families and involving schools;
• Use of evidence-based interventions; and regular feedback of outcome monitoring to children, young people and families and in supervision.
Monitor improvement
• Development of a shared action plan and a commitment to monitor, track and review improvements with appropriate governance structures.
www.england.nhs.uk
Key issues
Access Waiting times Vulnerable groups
Transition
Economics of investment Infrastructure/resources Systems
£78 Average spend per child 0-17 yrs
6.6% CYPMH as proportion of MH spend (2012/13)
Not enough is being spent
The high cost of getting it wrong
The low cost of investing early
YP with a MH problem are… • 8x more likely to have contact with YJS • Twice as likely to be claiming benefits
Group CBT £229
Unit cost
£7,252
Total lifetime benefit
Number of 5-16 yr olds with a diagnosable MH condition per 1,000 in England.
102 0.7
Number of WTE CYPMH clinical workforce per 1,000 0-17 yr olds in England.
Low workforce capacity
Long waiting times
Average maximum wait for first appointment (NHS benchmarking)
High numbers of referrals
Approx annual total CYPMH referrals 14/15
270k
32 weeks
Tiered system
0-25s
Thrive
Step-care models
Integrated pathways
Varied approaches
Various commissioners
CCGs LAs
NHSE Schools MoJ
www.england.nhs.uk
CYP Community Eating Disorder (CED)
referral to treatment standard and
commissioning guidance
13/10/2016
www.england.nhs.uk
Evidence for cost-effectiveness of the
CEDS-CYP model
Byford et al., 2007; House et al. (2012
• Not uniformly available throughout the country.
The most cost-effective treatment of AN in CYP is reported to be delivered by a community-based eating disorder service as opposed to generic CAMHS
• Children and young people starting treatment in non-eating disorder CAMHS settings have higher rates of inpatient admission in the next 12 months
• The majority of CYP managed in specialist eating disorder settings receive continuous care for their eating disorder without the need for further referrals
• In areas with direct access from primary care to CEDS-CYP there is significantly better case identification and therefore early referral for treatment
Delaying access to eating disorder treatment may increase long-term health costs:
• CostED study (a study of the costs and effects of different types of community-based care for anorexia nervosa).
• Multicentre RCT of the outcome, acceptability and cost-effectiveness of family therapy and multi-family day treatment compared with inpatient care and outpatient family therapy for adolescent anorexia nervosa
• Multi-centre RCT of treatments for adolescent anorexia nervosa, including assessment of cost effectiveness and patient acceptability
• RCT of the cost effectiveness of cognitive-behavioural guided self-care versus family therapy for adolescent bulimia nervosa in a catchment area-based population.
More studies underway
www.england.nhs.uk
Eating Disorders (CYP)
Access and waiting time standard
Those referred for assessment or treatment for an eating disorder should receive NICE
concordant treatment within one week for urgent cases and within 4 weeks for every other case.
Aim is for 95% of those referred for assessment or treatment receive
NICE concordant treatment with the ED standard RTT by 2020
Introduced and monitored in 2016-17 via MHSDS and UNIFY data collection; tolerance levels
to be set and standard implemented from 2017-18 – NEW extension for inpatient care-2017
The Role of Education Eating disorder curricula group convened in partnership with HEE
(October 2015) building on:
Systemic family practice curriculum for eating disorder
Existing whole team training packages for multi-disciplinary community eating
disorder services/teams – to be delivered 2016-17
Modality specific evidence based interventions anticipated to be in line with
updated eating disorder NICE guideline to be published in 2017
www.england.nhs.uk
Recommended training for CEDS-CYP teams
Training goal
Develop multidisciplinary
eating disorder teams
Understand the complex
nature of eating disorders
Develop a strong team
culture
Develop early intensive skills
training and regular support
and supervision
Adopt core CYP-IAPT
principles
Evaluate the impact of
training on transformation of
services
Also, CEDS-CYP will have a role in training for
other professionals
• Raising awareness
• Primary care
• Education
• Other children services
The relationships developed through the training can
be used to provide regular support to the teams
involved in improving early identification of children and
young people at risk of developing an eating disorder
www.england.nhs.uk
A Community Eating Disorder Service for Children and Young People (CEDS-CYP)
A new service to meet this challenges
• An appropriately trained,
supported and supervised team
• Use of information technology for
teamwork from different
geographical locations
• Eg. Following a “hub and
spoke” model
Requirements
Receive a minimum of 50 new eating disorder
referrals a year
Cover a minimum general population of 500,000 (all
ages)
Use up-to-date evidence-based interventions to
treat the most common types of coexisting mental
health problems (for example, depression and anxiety
disorders) alongside the eating disorder
Enable direct access to community eating disorder
treatment through self-referral or from primary care
services (for example, GPs, schools, colleges and
voluntary sector services)
Include medical and non-medical staff with
significant eating disorder experience
www.england.nhs.uk
Delivery of
evidence-
based
practices
Building on what we know
Improving access
& engagement
Increasing MH
awareness &
decreasing
stigmatisation
Improving
outcomes
accountability
Enhancing youth, carer and community
participation
www.england.nhs.uk
• Young people seen more quickly-time
between referral and assessment
decreased by 73%
• YP achieved significant clinical
improvement over fewer sessions -
number of days between assessment
and discharge decreased by 21%
Is it working?
239
299
64
235
Days between referral andassessment
Days between assessmentand discharge
Pre CYP-IAPT With CYP-IAPT
Improved access through self-referral routes, single point of
access, outreach services, evening and weekend
appointments.
www.england.nhs.uk
Greater involvement of children,
young people and
their parents or carers:
Throughout treatment and every aspect of their care
Recruitment and interview
panels
Staff appraisal and
training
Website and information
design
Planning and delivery of
mental health awareness
Mystery shopped service
evaluation
Environ-mental changes
Speaking with clinical
directors
New feedback systems ‘you said, we did’
Increased agentive CYP involvement
56%
34%
Pre CYP-IAPT2 With CYP-IAPT
CYP agreed they had
recovered sufficiently to be
discharged - percentage of
closed cases by mutual
agreement increased
www.england.nhs.uk
Benefits for children, young people,
their families and carers
Improved access and reduction in waiting times to treatment
Children, young people, their families and carers know how to ask for help in their local areas
Better knowledge of how to recognise eating disorders and how to access appropriate care when needed
Every person receiving appropriate evidence-based eating disorder treatment, based on their needs
Receiving treatments for eating disorders and coexisting mental health problems from 1 team
Improved outcomes, sustained recovery, reduction in relapse, and reduced inpatient admissions
Continued transformation of CYPMH evidence-based, outcome-focused, working collaboratively with children, young people and families
Less need for transfer to adult services and long periods of treatment
Less need for inpatient admission with the disruption to school and family life
CYP and families have more involvement in commissioning services that meet their needs.
www.england.nhs.uk
Data update • MHSDS flowing from Jan 16
• UNIFY data collection on ED RTT – 2 submissions by Nov 2016
• Technical Guidance published Mar 16
https://www.england.nhs.uk/mentalhealth/resources/
• Prevalence Survey commissioned by DH – due to report in 2018
• HEE CYP MH workforce mapping with NHS Benchmarking to
report Autumn 2016 (CYP MH across NHS and non-NHS providers)
• QNCC-ED launched improvement and accreditation network – will
host CED-CYP service directory (August 2016) to support a peer-led
network, access to whole team training.
www.england.nhs.uk
Eating Disorders Summary from LTPs
17
• The majority of the focus for eating disorders is on
waiting times and improving access with 35% of the
KPIs relating to eating disorders covering these two
topics
• Most areas are making plans around developing a
community eating disorders service with a
trajectory towards achieving a fully compliant service
by 2020
• Early detection and intervention was also a primary
focus for eating disorders
• Increasing workforce capacity and training was
noted as important in achieving a compliant service
• Where services are already compliant, the funds are
being spent on both enhancing the existing eating
disorders service and on crisis and self-harm
Key facts
16% of LTP areas are
compliant with the new
eating disorders
guidance
84% of LTP areas are
making plans on how to
become compliant
93% of LTP areas are
delivering eating disorder
services with other areas
www.england.nhs.uk
CCG IAF – CYP Mental Health
Update & republish LTP (Oct 16) - with baseline data and trajectories – incl. investment, activity, workforce plans
Dedicated CED in line with the recommended model in guidance and part of a national quality assurance network
Collaborative commissioning plans between CCG & NHS England for community and in-patient services
Joint agency workforce plans to build capacity & skills, including implementing CYP-IAPT
Increased spend forecast on CYP MH by at least the uplift in the allocation of baseline funding
Dedicated CYP mental health crisis & liaison - CCG has agreed to fund and implement team
www.england.nhs.uk
Measuring the change…
By 2020 there will be: We will know if this has been achieved by:
System wide transformation of the local offer to children and young people underway with LTPs embedding key Future in Mind principles fully integrated into STPs across the country
CCG assurance process A suite evidence based treatment pathways with high level metrics that measure access, spend and progress towards delivery of agreed components in the transformation programme
At least 70,000 more CYP receiving swift and appropriate access to care each year
Monitoring of new national data returns
Completed national roll-out of CYP IAPT programme with at least 3,400 more staff in existing services trained to improve access to evidence based treatments
Assurance of Mandate requirements with HEE
1,700 additional new staff to support improved access to evidence based treatments
Assurance of Mandate requirements with HEE
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 by 2020
Mental Health Services Dataset The baseline set in 2016 enabling a trajectory to be monitored from Jan 17
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.
Data from new national bed management system for inpatient Tier 4 will enable monitoring of occupancy and out-of-area placements
Plans to improve crisis care for all ages, including investing in places of safety
Reduction in the numbers of CYP admitted to inpatient beds or police cells Number of CYP receiving NICE concordant care
www.england.nhs.uk
Resources
DATA: Chimat and CAMHS ebulletin –
http://www.chimat.org.uk/camhs
CORC: http://www.corc.uk.net/
NHS Benchmarking Report 2015
MHSDS-flowing from Jan 2016
• 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
https://www.minded.org.uk/
GIFT Sign up for www.myapt.org.uk;
see video clips
https://www.youtube.com/user/Cern
isLimited/videos
www.england.nhs.uk
• 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
www.youngminds.org.uk
www.england.nhs.uk
My Mental Health Services Passport www.england.nhs.uk/mentalhealth/2015/10/15/passport-brief-yp-
mh
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
