HOW NOT TO PLAY PING PONG WITH YOUR CLIENTS

HOW NOT TO PLAY PING PONG WITH YOUR CLIENTS PowerPoint PPT Presentation


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HOW NOT TO PLAY PING PONG WITH YOUR CLIENTS

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1. 1 HOW NOT TO PLAY PING PONG WITH YOUR CLIENTS Yvonne Gilles-Jones Clinical Nurse Specialist/Referrals Coordinator CAMHS Tier 3 Jane Ware Consultant Clinical Psychologist CAMHS Tier 2 & 3 Kent & Medway NHS & Social Care Partnership Trust

2. 2 CONTEXT OF SERVICE historical service configuration NEW SERVICE rationale provision POINTS FOR REFLECTION OVERVIEW OF PRESENTATION

3. 3 Current Service Arrangements Tier 3 – historically provided by Mental Health Trust 11.8 WTE multidisciplinary Tier 2 – provided by PCT 3.3 WTE therapeutic staff

4. 4 Tier 2 CAMHS Tier 2 provision began in Maidstone in 2003 when the Multi-Agency Interface Project [MMAIP] was set up This led to: The development of a multi-agency single point assessment team (MMASPAT) linked to the local school cluster to provide a rapid response to schools who identified concerns for pupils emotional well-being and mental health The development of an Early Intervention and Prevention Tier 2 CAMH Service

5. 5 Multi-agency Single Point Assessment Team Composition: CAMHS Lead Nurse Consultant Clinical Psychologist CAMHS T2 & 3 Social Worker (with children and families background) Senior Family Liaison Officer Behaviour Specialist Teacher/Educational Psychologist Joint Commissioning Officer (KCC) Associate Specialist in Community Paediatrics Referrals Administrator CAMHS Tier 3 Clinical Nurse Specialist Tier 3 Clinical Nurse Specialist joined once the team was established.Tier 3 Clinical Nurse Specialist joined once the team was established.

6. 6 Driving Forces for “2.5” clinic Desire to provide a seamless service for clients when CAMHS T2 & T3 in different NHS Trusts Too much “Referral Ping Pong” Referrers’ “scatter gun approach” Wrong referrals had led to clients “double waiting” to receive appropriate intervention Clients/referrers did not understand different tiers – they just wanted to be seen Demand & capacity issues Duplication of paper work & administrative time Information systems that could not talk to each other Client ping pong a common experience, frustrating for clients & clinicians. Major problem in providing an appropriate & high quality service when services are spread across 2 different NHS Trusts with differing agendas. Referrers often extremely confused as to why the service was split and often not sure which service to refer to. Often referred to both services concurrently to try to ensure someone would see the client. Different services had different referral procedures. If clients had been referred to the wrong service they often ended up waiting for an assessment only to be told they could not be helped by that service, they were then referred to the appropriate service & might wait weeks or months again on that service’s waiting list in order to be assessed. Client waiting on wrong waiting list clog up the system & slow down the process of an assessment for those who are correctly referred to that service. In 2007 prior to the 2.5 clinic, 24% of tier 3 referrals were assessed by Tier 3 & redirected to tier 2 following an average wait of 3-5 months for the initial appointment.Client ping pong a common experience, frustrating for clients & clinicians. Major problem in providing an appropriate & high quality service when services are spread across 2 different NHS Trusts with differing agendas. Referrers often extremely confused as to why the service was split and often not sure which service to refer to. Often referred to both services concurrently to try to ensure someone would see the client. Different services had different referral procedures. If clients had been referred to the wrong service they often ended up waiting for an assessment only to be told they could not be helped by that service, they were then referred to the appropriate service & might wait weeks or months again on that service’s waiting list in order to be assessed. Client waiting on wrong waiting list clog up the system & slow down the process of an assessment for those who are correctly referred to that service. In 2007 prior to the 2.5 clinic, 24% of tier 3 referrals were assessed by Tier 3 & redirected to tier 2 following an average wait of 3-5 months for the initial appointment.

7. 7 Aim of the new service: To provide a seamless CAMHS Tier 2/3 interface despite the two services being provided by different NHS Trusts.

8. 8 New Service summary Commenced February 2008 Staffing - 7.5 hours per week of: Clinical Nurse Specialist – from existing T3 staffing T2 Consultant Clinical Psychologist – new funding by T3. Activity: Joint paper screening of all Tier 3 referrals Both clinicians attend at Tier 2 single point multi-agency assessment team meetings (joint screen of all T2 referrals) Joint in depth assessment for those referrals where it is not clear which service can most appropriately meet the client’s needs. Followed by direct access to treatment in appropriate service without further assessment. Continued monitoring of a small number of clients where it remains unclear which service is required. Staffing: Clinical Nurse Specialist already attending MMASPAT. Cons Clin Psych already funded to work in both tiers – but extra funding provided on temporary basis for these 7.5 hours. Aim was always to try to get permanent funding via an alternative route e.g: Both clinicians are very experienced & have comprehensive knowledge of: CAMHS, the referral criteria for each Tier, & local children’s services & resources. Joint assessment – very detailed lasting on average 90 –105 minutes. Direct access to treatment. A few (3 to date ) clients have remained within the 2.5 clinic, 2 so that ongoing monitoring can be carried out, as they do not yet require treatment may do so in the near future & appropriate service to do so is still unclear, & 1 which was appropriate for T2 , but needed very specialist treatment which clinician could provide & speed of entry to treatment was vital as PTSD. Staffing: Clinical Nurse Specialist already attending MMASPAT. Cons Clin Psych already funded to work in both tiers – but extra funding provided on temporary basis for these 7.5 hours. Aim was always to try to get permanent funding via an alternative route e.g: Both clinicians are very experienced & have comprehensive knowledge of: CAMHS, the referral criteria for each Tier, & local children’s services & resources. Joint assessment – very detailed lasting on average 90 –105 minutes. Direct access to treatment. A few (3 to date ) clients have remained within the 2.5 clinic, 2 so that ongoing monitoring can be carried out, as they do not yet require treatment may do so in the near future & appropriate service to do so is still unclear, & 1 which was appropriate for T2 , but needed very specialist treatment which clinician could provide & speed of entry to treatment was vital as PTSD.

9. 9 Service objectives: To ensure CAMHS Tier 2 and Tier 3 referrals are directed to the most appropriate service at the point of referral. To reduce the numbers of cases that may be sitting inappropriately on a waiting list and by doing so improve health outcomes.  To ensure the maximum use of limited CAMHS resources.  To reduce administrative resources required in transferring families from one service to another.

10. 10 Service objectives continued: To promote successful working between child health, mental health and education via the virtual integration of Tiers 2 and 3.  To help provide more accurate demand and capacity data, which will provide evidence for the deployment of resources and service development. To identify the number of referrals, which do not meet, either Tier 2 or Tier 3 criteria, and the consequent gaps in service, to inform future commissioning discussions and planning.

11. 11 Evidence / Outcomes Since February 2008: No clients assessed by other Tier 3 staff & sent to other service No more client ‘Ping Pong’ as no barriers to service access Referrers report satisfaction with new provision Word has spread outside of Maidstone! Service users accessing appropriate support faster Far more accurate demand data available for both services

12. 12 Issues / Concerns Funding –currently temporary, need to secure permanent funding. Implementation of CAF and impact on single point assessment team.

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