What might help reduce waiting times in CAMHS?

Transcription

1 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

2 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

3 Increase in referrals Vs reduction in resource Count No. of referrals received by Newham CAMHS per month UCL LCL /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 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

4 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.

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

6 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

7 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

8 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 Improve patient experience of referral process by offering a more responsive service.

9 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

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

11 Outcomes

12 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 UCL CFCS waiting time (days) referral to first appointment Front Door Pilot LCL 30 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 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

13 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 100% 90% % of families seen within 9 weeks Front Door Pilot 80% 70% UCL 60% 50% 40% 30% 20% LCL 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

14 Triage Wait Times The current average waiting time for a triage assessment is under 2 weeks. Measure 50 Average wait (days) from referral received to triage assessment UCL LCL /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

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

16 Outcome after Triage Assessment 4% 5% Allocate within CFCS 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

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

18 Service User Feedback Feedback and ideas for improvement A Good Process Call Length Questions asked and use of measures Better than a letter Maybe a text an hour before asking whether it d O.K to call in an hour. Possible Areas for Consideration Text notification of the call Clinician measures as conversational tools From Triage to Assessment Retelling the Story Use of triage call in initial assessment When I d already come out about the whole situation I thought oh I have to explain the whole situation again.. but I 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.

19 What next? Further evaluation - Service user feedback from families of their experience Service user participation Ask young people to rate the selfhelp 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

20 Discussion and Reflections

21 Contact details Bill Williams: /2400 Dr Rebecca Adams: /2400 Dr Freya Gill: