Quality Network for In-patient CAMHS QNIC ROUTINE OUTCOME MEASUREMENT SERVICE

1. Quality Network for In-patient CAMHS(QNIC)ROUTINE OUTCOME MEASUREMENT SERVICE Farah Khalid fkhalid@cru.rcpsych.ac.uk

2. Aims of QNIC ROM To develop, implement and support a model of routine outcome evaluation specifically for inpatient CAMHS Work in collaboration with CORC To collate and analyse (anonymised) information from all ROM members in order to share findings within and between services  To assist in allowing the information obtained to inform service users, providers and commissioners To collaborate with ROM members in using outcome information to inform and develop service evaluation and good practice CORC – CAMHS Outcome Research Consortium, implement We now have an agreement to share anonymised norms CORC – CAMHS Outcome Research Consortium, implement We now have an agreement to share anonymised norms

3. Aims of Today Outline and discuss practical ways to begin and continue collecting information Communicate how process can be smooth and streamlined as possible for you unit Your Unit – please interrupt and join in the discussion Feedback so far has led to many amendments but still an evolving service Ultimately after today we want you to feel that you can go back to your unit and begin implementing this process.Ultimately after today we want you to feel that you can go back to your unit and begin implementing this process.

4. QNIC ROM Process Information to be collected at 2 time points Admission and 4 months (or discharge depending on what comes first) Information to be collected from multiple perspectives to provide robust measures Clinician Self (young person) Parent/carer 6 or 4 months? Need average length of stay in an inpatient unit6 or 4 months? Need average length of stay in an inpatient unit

5. Core Measures Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) Clinician Self Parent The Children’s Global Assessment Scale (CGAS) Clinician rated only

6. Core Measures Strengths and Difficulties Questionnaire (SDQ) Self Parent Teacher CAMHS Satisfaction Survey (CAMHSSS) Self Parent SDQ added because of all the normative data available which can be used. CAMHSSS self report is for adolescents only. For the children's units we will be using the Service User Questionnaire which is in the process of being validated and for the purposes of consistency we will be offering this and it will be available on the website as well as in your manuals.SDQ added because of all the normative data available which can be used. CAMHSSS self report is for adolescents only. For the children's units we will be using the Service User Questionnaire which is in the process of being validated and for the purposes of consistency we will be offering this and it will be available on the website as well as in your manuals.

7. Measures Baseline and follow up variables Demographics Diagnosis Severity of condition Length of stay References on reliability and validity of the core measures are included in the handbook

8. Current Optional Measures EDE – eating disorders examination “gold star” EDE-Q – self rated version Others?

9. Measures All measures, score sheets, further information including links to external websites are available on the QNIC ROM web pages. www.qnicrom.org.uk Can be printed from the internet or the hard copies provided in the pack’s can be kept as the master copy and photocopied as and when needed.Can be printed from the internet or the hard copies provided in the pack’s can be kept as the master copy and photocopied as and when needed.

10. Measures - Training QNIC does not offer training on specific measures HoNOSCA – http://www.liv.ac.uk/honosca CGAS – rating guide available - website/manual SDQ – no training needed EDE – workshop offered by University of Oxford

11. Submitting data Information is submitted online through the QNIC web pages Each unit is provided with their own username and password to access the secure site SNAP Surveys Software used Once all information has been collected it must then be entered onlineOnce all information has been collected it must then be entered online

12. ADMISSION QUESTIONNAIRE: Required processQuestionnaire to be completed and submitted within 2 weeks of admission Go to QNIC ROM webpage and login using allocated unit username and password to access a new (or saved) questionnaire

13. FOLLOW UP QUESTIONNAIRE: Required processQuestionnaire to be completed at 6 months or discharge Go to QNIC ROM webpage and login using allocated unit username and password to access a new (or saved) questionnaire Re-enter unique code of young person allocated at admission

14. Alternative Returns All information can now also be sent via: Post Fax Email (scan the documents) QNIC will enter the information online There is a £50 charge per young person This includes admission, discharge and all intermittent information Admission, intermittent andAdmission, intermittent and

15. Information Received What happens with the raw data? Analysis – frequencies (socio-demographic data, bar charts outcomes) The more information we receive the more meaningful it will be Mean of one unit can be compared with mean of all units.

16. Reporting Outcome Data

17. HoNOSCA - clinician rated (for the 9 young people with ratings at both admission and discharge)

18. HoNOSCA – self rated (for the 7 young people with ratings at both admission and discharge)

19. HoNOSCA – parent rated (for the 7 young people with ratings at both admission and discharge)

20. CGAS-Admission and Discharge Scores (for the 9 young people with ratings at both admission and discharge)

21. Feedback Regular feedback is essential Regular individual reports - your reports to share and feedback to all team members, users and commissioners Feedback needs to be a two way process with QNIC too

22. Key findings so far Each unit must have a designated person to lead outcome measurement. Under this lead an assistant psychologist / psychologist / administrator etc must be in place to ensure clinicians, young people and parents complete the measures and then take responsibility for collating the information for submission to QNIC. Those who found the pilot most challenging were those who tried to complete the entire process on their own. ROM needs to be integrated into the MDT. Ward round is one idea when to complete measures. Young people should enter data straight onto the computer instead of completing paper questionnaires (except SDQ). Direct them to the correct webpage and allow them to complete online.

23. Parents should be given the option of either entering data straight onto a computer (except SDQ) or completing paper forms. Ask parents to come in 15 – 20 minutes earlier to complete measures. A handbook has been produced for units to refer back to. The online questionnaires have been amended to be more streamlined and user friendly to assist in submitting data. A RECORD SHEET has been created for you to keep track of what has and has not been completed. Key findings so far

24. How to get it wrong! Do not designate a lead for outcome measurement. Do not have a worker to ensure measures are completed and data are submitted. Try and complete the entire process on your own and do not integrate it in the MDT.

25. Contacts and On-going Support Main ROM contact - Farah Khalid, Research Worker (fkhalid@cru.rcpsych.ac.uk) QNIC Programme Manager – Peter Thompson (pthompson@cru.rcpsych.ac.uk) Unit visits will be made by myself if necessary to provide support and assistance ROM will be incorporated into QNIC Review Days