Progressing your Mental Health STP from Plan to Action THURSDAY 9TH NOVEMBER 2017, BIRMINGHAM CITY FOOTBALL CLUB DAVE WOODWARD - THERAPY PARTNERS

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1 Progressing your Mental Health STP from Plan to Action THURSDAY 9TH NOVEMBER 2017, BIRMINGHAM CITY FOOTBALL CLUB DAVE WOODWARD - THERAPY PARTNERS

2 Progressing your Mental Health STP from Plan to Action PETS (PSYCHO-EDUCATIONAL THERAPEUTIC INTERVENTION STRATEGY) In 2016, Therapy Partners were commissioned to deliver a pilot project. The aims of which were; Develop a whole system approach to supporting young people, their families, and professionals with eating disorders Implement this throughout East and North Kent CCG regions Facilitate collaborative working Measure the outcomes The following case study evidences the best practice, how we worked towards these goals, and hopefully will enlighten you to help collaborative working towards your Locality STP s.

3 Introduction - Sharing our story Situational overview Why I am here What we did Collaborative work Successes and outcomes

4 Sustainability and Transformation Plan National policy context The Health and Social Care Sustainability and Transformation Plan (STP) sets out how we think services need to change over the next five years to achieve the right care for people and will have an impact for decades to come. The Five Year Forward View (2014) sets out the national vision for health and social care.

5 Kent Overview Demographics Kent, a shire county in the South East, has a population of just over 1.48 million, the largest population of all English counties. Mid-2012 population estimates indicate that there are 362,028 children aged 0 to 19 in Kent, making up 24% of the county s population. There are 75,856 young people aged 16 to 19 and 89,774 young adults aged 20 to 24 in Kent. Combined those aged 16 to 24 account for 11.2% of Kent s population at over 165,600. Source Kehn-Alafun O. (2015) Children and Adolescent Mental Health Services Needs Assessment for Kent. Qmonde Report, 2015

6 Kent Epidemiology and Prevalence 67% of young people and adults aged between 16 and 24 were found to have no mental health disorder. 1 in 3 is estimated to have a mental health disorder. Prevalence of eating disorders in Kent and Medway is highest in 16 to 24-year-old range. There are no single causes for eating disorders but a number of risk factors which may trigger disordered eating patterns to develop Eating Disorders can often be seen as a coping mechanism to help the individual manage challenging emotional states. Children aged 11 to 16 years are more likely (11.5%) than those aged 5 to 10 years (7.7%) to experience mental health problem source Kehn-Alafun O. (2015) Children and Adolescent Mental Health Services Needs Assessment for Kent. Qmonde Report, 2015

7 Commissioning Background and Context The Way Forward: Kent s Emotional Wellbeing Strategy for Children, Young People, Young Adult s and Families. NHS, five year forward view - Government pledge 150m investment nationally to transform Eating Disorder Services Kent and Medway Crisis Care Concordant Kent County Council (KCC) Transformation Programme for 0-25 years old Children and adolescent mental health services within Kent needs assessement

8 NHS Outcomes, Framework Domains & Indicators DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 DOMAIN 5 Preventing people for dying prematurely Enhancing quality of life for people with long term conditions Helping people to recover form episodes of ill-health or following injury Ensuring people have a positive experience of care Treating and caring for people in a safe environment and protecting them from avoidable harm

9 Therapy Partner s Pilot PETS How we worked with the CCG s Provide support for children and young people deliver CBT-E Therapy * in the community and in schools Enhancing emotional Intelligence in the client families whilst improving social and human factors Reduce demand on secondary care Children s & Adolescent Mental Health services (CAHMS) Increase awareness amongst school staff: to equip them with the knowledge to support and identify students who may have an eating disorder Offer support through Psycho-educative groups in the community for parents and carers of young people with an eating disorder Equip carers with the skills and knowledge needed to support and encourage CYP and help prevent barriers to recovery Offering Peer support * CBT-E is recognised by NICE as a treatment modality for managing ED and was developed by Christopher G. Fairburn, DM, FMedSci, FRCPsych, Professor of Psychiatry at the University of Oxford.

10 PETS A moment in time The CAMHS service was undergoing transition and recommissioning. Case study DW AH work systemically with young client led to publishing of the pilot Working across transition, age group 13 to 25 Political pressure was being placed on the CCG's to support these vulnerable young people Waiting lists - Caseload data and waiting lists suggest that many services are largely working at maximum capacity and that demand is at a greater level than they were able to provide. PETS aimed to look at reducing waiting time Funding was available from CYP transformation funds Evidence demonstrated a need for early intervention for children and young people

11 Enhancing Emotional Intelligence The outcomes of the peer supported groups includes enhancing Emotional Intelligence* in the client families, whilst improving social and human factors. Emotional intelligence Self awareness Ability to recognise & understand emotions Motivation Desire to persue goals with energy Empathy Ability to understand other peoples emotions Self regulation Control impulses & emotions Social skills Ability to find common ground & build rapport *Emotional Intelligence (EQ) is the ability to perceive control and evaluate emotions both in oneself and others. The concept stems from work in the 1970 s and 1990 s when psychologists Daniel Goleman published Emotional intelligence

12 PETS Addressing the problem Our approach We took an epidemiological approach, considering the epidemiology of the condition, current service provision, and the effectiveness and cost-effectiveness of interventions and services. Our emphasis was on providing timely support to children and young people before mental health problems become entrenched, providing early and effective evidence-based treatment for those who needed it. We worked systemically and holistically, looking at the whole family system and the subsystems of schools, young people's relationships, peers and socially constructed values.

13 Collaborative Working How we worked collaboratively across localities with charities and local authorities Clear line of communication developed and working alliance developed via dialogue with CCG commissioners Coproduction based on experimental learning and feedback from CYP and families shaping the service going forward All work was informed by both clinical best practise and feedback from pilot stakeholders How we managed the challenges Therapists engaged on session contracts but close members of the project team. Therapists managed and provided training, close supervision and support. Flexibility of staffing offering scalability

14 Examples of Collaboration Cross sectional working and support was offered to families that have experienced trauma, loss, and financial difficulties. By working alongside and signposting to local charities and writing to a family s landlord we managed to avert the family from being evicted from their home. Piloting a complete care community to focus on local CYP needs and providing care closer to patients homes. Our target was either at schools or within a 5 mile radius of the patients home. Were appropriate we used voluntary organisation premises for service delivery, contributing to the local economy. We worked collaboratively with IAPT providers, local GP s, early help services, local CAMHS, schools, colleges and universities with referrals coming from most of the organisations alongside self referrals. CCG Commissioners attended our training events and were present at the filming of the Rewrite Your Story video, meeting patients and helping develop relationships, leading to positive feedback.

15 PETS Outcomes 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% CIA Score at start and end ED THRESHOLD HIGH RISK LOW RISK COMMUNITY NORM 80% percent of young people made a significant improvement with reports of improved wellbeing and social engagement. 80% IMPROVED 12% MAINTAINED 8% DECLINED At time one, the average CIA score was By the end of treatment, this had decreased by 9.99 points to This decrease was not significant (95% CI). START END In terms of overall CIA (Clinical Impairment Assessment: Beglin & Fairburn 2008)

16 PETS Outcomes EDE-Q 6.0 OUTCOMES 57% of young people have improved with 25% of these reducing to what is considered the community norms on global scoring (1.55). It should be noted that 72% of the recovered show a correlation with lower initial scores and would support the case for early intervention. At time one, the average EDE-Q score was By the end of treatment, this had decreased significantly (99% CI) by 1.40 points to GLOBAL scores. Similar correlation (99% CI) was seen through four sub-scales for Dietary Restraint, Shape concern, Eating concern and Weight concern. RECOVERED 25% IMPROVED 32% DECLINED 4% MAINTAINED 39%

17 Client & Family feedback Family Member - This has been a long hard journey but one that has been made easier by your support I am of no doubt that this programme and outside support has given us a totally different experience and journey to one we could have taken Izzy, Service User 19y/o It's a good service and I have improved. I like coming, it helps me to talk. I've stopped weighing myself as I know I will be weighed every week. I like that it went from two session a week to one and it helps so I can get used to ending the service Courtney, Service User- I am glad I am on the program as it is helping me. Initially I was skeptical about it as I wasn't sure if it would work. Regular eating has been a great help Chloe, service user I can't thank Marty enough for everything she has done. I've realised I've been missing out on life and I can finally concentrate on other things other than my eating disorder - I'm the one in control now, not my eating disorder.

18 PETS Legacy Rewrite Your Story PETS outcomes were so positive, we wanted to continue the valuable work, supporting the mental health and wellbeing of children and young people in the community we were inspired to launch our charity, Rewrite Your Story. Through the charity we aim to support children and young people suffering from eating disorders, and those close to them including parents, friends and teachers by raising awareness, educating and offering counselling and peer support groups. Our efforts to raise funds to allow us to complete this important work continue, and have included Theatre Performances, creating Rewrite Your Story merchandise and a Fun Our recently launched website has a powerful 10-minute video featuring some of the young women who have been able to rewrite their own stories and recover, along with information, training, advice, and a support system not only for those suffering but for their loved ones.

19 Spreading the word We have a limited number of Rewrite Your Story bird pins and Rewrite Your Story wristbands available on a first come first served basis. Help us spread the message and support our children and young people.

20 Commissioners Comments We were pleased to be able to invest in the service with our eating disorder transformation monies for 2 years prior to our newly procured service model starting this September in Kent. PETs provided key support to CYP and families in the community along with support to schools in awareness raising, and the feedback from GPs, CYP, parents, carers and schools has been fantastic, alongside the really positive clinical outcomes that the data has shown Caroline Potter-Edwards Commissioning Project Manager NHS Swale and NHS Dartford, Gravesham and Swanley Clinical Commissioning Groups Jemma Blesky Children's Commissioning Support Project Lead East Kent Children s Commissioning Support Team NHS Thanet Clinical Commissioning Group

21 Sharing Best Practice By using evidence-based interventions and working in a community setting, positive outcomes have been achieved whilst working with this client group, their families and professionals. The full pets evaluation reports is due for publication in December please enquiries@therapypartners.co.uk to request a copy of the report. A further article is due to be published in Therapy Today magazine early in Were also happy to share our work and methodology with any members of the audience. Please contact me during the break or via the above address or our website.

22 Connect with us Linked In - Therapy Partners

23 Questions?

24 Special thanks to our CCG Colleagues at North & East Kent References CHILDREN AND ADOLESCENT MENTAL HEALTH SERVICES NEEDS ASSESSMENT FOR KENT data/assets/pdf_file/0004/44662/camhsnaforkent_compressed.compressed.pdf Accessed 16 th of October Fairburn CG. (2008) Cognitive Behavioural Therapy and eating disorders Guildford Press New York