Children and Young Peoples Mental Health and Wellbeing - - PowerPoint PPT Presentation

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Children and Young People’s Mental Health and Wellbeing Commissioning Development Programme

Virtual Peer Learning Session 3: Performance Data & Needs Assessment

May 2017

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Learning objectives

Overarching aim To build an understanding of the needs and performance of local services supporting CYP MH&WB. Learning outcomes 1. I have a better understanding of the tools available to conduct a data and needs analysis 2. I have a better understanding of how data and needs analysis can strengthen planning for services in my local area 3. I have a better understanding of current structures, challenges and ways forward in relation to data and its use for performance management in CYP MH&WB

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Session plan

This session is structured in two parts:

• Part A: Performance data

(developed by Professor Miranda Wolpert | CORC)

• Part B: Needs assessment

(developed by Mike Streather, Cam Lugton, Gillian Bryant | Public Health England)

www.corc.uk.net

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Part A: Performance Data

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Part A: What we will cover

• 1. General issues in data collection, quality and use in CYPMH
• 2. Current indicators and policy priorities
• 3. The Mental Health Services dataset- what it includes for CYPMH
• 4. Highlighted tools to collect information about people accessing

services, use of services and impact of services

• 5. Data from CYPMH services who were part of a best practice

initiative (CYP IAPT) 2011-15*

• 1. What current data can tell us about who is seen by services
• 2. What current data can tell us about what outcomes are realistic to

expect

• 6. How to consider the data to aid performance review and

improvement: The MINDFUL approach

• 7. Top tips for commissioners

www.corc.uk.net

*http://www.corc.uk.net/information-hub/child-and-parent-reported-outcomes-and-experience-from-child- and-young-people-s-mental-health-services-2011-2015/

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General issues: best practice in data collection for CYP MH&WB services (CORC Framework)

Leadership & Management

• Organisational vision
• Organisational

commitment to collection and collation

• Organisational

commitment to interpretation and use

• Organisational

culture supportive of use and learning Staff Development

• Understanding of use
• f different data

sources (including measures)

• Use of particular data

sources (including measures)

• Training and

Continued Professional Development (CPD)

• Review of measures

and feedback in supervision Technology and Information Management

• Enabling data use in

direct practice with clients

• Enabling use of data

at practitioner level

• Enabling use of data

at team level

• Enabling use of data

at service level Experience of Service

• CYPPC

understanding of measures

• Communication with

CYPPCs about measures

• Collaborative setting
• f goals and choice
• f measures
• CYPPC feedback on

support

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General issues: limitations in the data

• Historically very little data available on CYPMH

service provision and impact

• What data there are:
• Flawed
• Uncertain
• Proximate
• Sparse

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Indicators and policy priorities

Key indicators and CQUINS set

• Five Year Strategy for Mental Health

(2017)

• CYP Eating Disorders standard (2017)
• Generic pathway for CYP mental

health (2017)

• Safe, Effective and Compassionate

Staffing guidance – NHS England and NHS Improvement (2017)

• From 2017, NHS England will test new

‘needs based groupings ‘ for CAMHS as the basis for a potential new national payment system http://pbrcamhs.org/final-report/

2016-17 2017 onwards

www.corc.uk.net

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Mental Health Services Dataset – what is included for CYP MH&WB

• Started national data collection January 2016.
• All providers of NHS funded mental health care must flow data to the MHSDS. This

includes services co-funded with LA or voluntary sector organisations.

• Records vary in quality and completeness.
• Data is made available through a number of different tools:
• NHS Digital monthly data
• NHS Digital tool iView
• NHS England quarterly MH dashboards
• PHE tools e.g. Fingertips and CYP profile tool (coming soon)
• Mental Health Services Data Set (MHSDS) data will increasingly be used to inform

service design and improvement and accountability.

• Items are either mandatory (must flow in all cases), required i.e. SHOULD be reported

where they apply (must flow if relevant to the care episode) or optional.

• There is an annual process for agreeing changes to the dataset.
• Aware some providers have struggled with local IT systems. NHS England has

previously stated that transformation funds could be used to improve local ICT systems. NHS Digital have team who can support access.

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Tools: Current View Tool – Problem Descriptions

https://www.ucl.ac.uk/ebpu/docs/publication_files/current_view

• 1. Anxious away from care givers

(Separation anxiety) 11.Extremes of mood (Bipolar disorder) 21.Family relationship difficulties

• 2. Anxious in social situations (Social

anxiety/phobia)

• 12. Delusional beliefs and

hallucinations (Psychosis)

• 22. Problems in attachment to

parent/carer (Attachment problems)

• 3. General anxiety (generalised

anxiety)

• 13. Drug and alcohol difficulties

(Substance abuse)

• 23. Peer relationship difficulties
• 4. Compelled to do or think things

(OCD)

• 14. Difficulties sitting still or

concentrating (ADHD/Hyperactivity)

• 24. Persistent difficulties managing

relationships with others (includes emerging personality disorder)

• 5. Panics (Panic Disorder)
• 15. Behavioural difficulties (CD or

ODD)

• 25. Does not speak (selective mutism)
• 6. Avoids going out (Agoraphobia)
• 16. Poses risk to others
• 26. Gender discomfort Issues (GID)
• 7. Avoids specific things (Specific

phobia) 17.Carer management of CYP behaviour (e.g. management of child)

• 27. Unexplained physical symptoms
• 8. Repetitive problematic behaviours

(Habit problems)

• 18. Doesn’t go to the toilet in time

(Elimination problems)

• 28. Unexplained developmental

difficulties

• 9. Depression/low mood (Depression)
• 19. Disturbed by traumatic event

(PTSD) 29.Self-care issues (includes medical care management, obesity) 10.Self-harm (Self injury or self-harm) 20.Eating issues (Anorexia/Bulimia)

• 30. Adjustment to health issues

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Tools: patient and parent measures

• f outcome and feedback

Outcomes

Symptoms

e.g. RCADS Depression scale

e.g. PHQ9 e.g. SDQ

conduct scale Well-being

e.g. ORS

e.g. WEMWEBS

Goals GBOs

Feedback

Session

e.g. Session rating scale

Service

e.g. Experience

• f service

questionnaire

www.corc.uk.net/outcome-experience-measures

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Data: problems seen by services

Figure 1. Percentage of cases with a provisional problem descriptor endorsed as mild or above in the first recorded Current View. Figure 2. Percentage of cases with a complexity factor endorsed in the first recorded Current View.

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n = 42,798 (44% of the sample); percentages are out of those with a completed Current View form 2011-15; categories not mutually exclusive

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CORC Report on child and parent reported outcomes for CYP’s Mental Health

• Published November 2016
• Analyses data from the services

involved in CYP IAPT 2011-15

• First detailed analysis on outcomes
• Data was limited (FUPS data) with

relatively few of the 96,325 cases had paired scores

• This underlines the need to improve

data collection

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Data: problems seen by services in terms of allocations to NICE – guided treatment

28% only mild problems or

• ne moderate that doesn’t fit

NICE guidance 25% multiple or sever problems that don’t fit easily into NICE guidance

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Figure 3. Potential allocation to support guided by NICE guidelines.

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Data: self report symptom free by end treatment

1 in 3 Scores below threshold on all measures 36% (95% CI 35% - 37%) Mean no of measures = 4 (SD 2.5, range 1-13) N = 5896 (25% of closed treatment cases)

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Data: self reported reliable improvement by end of treatment

1 in 2 Scores improved more than likely due to measurement error on at least on measure and on no measure reliably deteriorated 52% (95% CI 51.7-52%) Mean no of measures = 4 (SD 2.5, range 1-13)

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Data: self reported reliable deterioration by end of treatment

1 in 10 Scores deteriorated on at least one measure more than likely due to measurement error (may have improved on others) 9% (95% CI 8.5%-9%) Mean no of measures = 4(SD 2.5, range 1-13)

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Self reported movement towards goals by end of treatment

9 in 10 Moved towards goals by at least 1 point on a 10 point scale 86% Mean change = 4 points NB 5% moved away from goals 2784 cases (12%)

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MINDFUL Approach to use of data

An approach to use of FUPS data to inform service improvement. Facilitators of MINDFUL discussion of data should:

• Determine which groups are best brought together
• Set clear ground rules for conversations
• e.g. no point-scoring, encouragement of critical thinking
• Ensure there is enough time for all to reflect and absorb information

presented

• Have an agreed process for making a decision, however imperfect the

process is

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What is the MINDFUL Approach?

M: Multiple Voices I: Interpreting Differences N: Negative Outcomes D: Directed Discussion F: Funnel Plots U: Uncertainty L: Learning Collaboration

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M: Multiple Voices

Should consider multiple perspectives of treatment outcome

• views often differ across respondents e.g. child

vs parent vs clinician

Different perspectives are important to get a richer picture

• f how a child or young person is progressing

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I: Interpreting Differences

When looking at aggregate outcomes data in a service:

• most meaningful level of focus for commissioners is

integrated multiagency provision A range of methods should be used for comparing outcomes data to try to ensure fair comparisons.

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N: Negative Outcomes

It is important to discuss negative results Discuss different hypotheses to explain findings:

• Was the most appropriate measure used?
• Were there data entry or analysis errors?
• Are there key differences in groups being compared?

Use other data sources to triangulate (e.g. DNAs, user satisfaction)

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D: Directed Discussion

In order to keep discussion productive it is suggested to spend:

• 25% of discussion time on reasons why data may be

flawed or inconclusive

• 75% of discussion time on a thought experiment:

‘‘ If these data were showing up problems in our practice, what might they be and how might we investigate and rectify these issues?’’

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F: Funnel Plots

• Funnel plots are a valuable tool for comparing
• utcomes e.g. between different areas or providers
• Should be used where possible
• Outliers (services outside the funnel) should be taken

as the starting point for directed discussion

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F: Funnel Plots

Figure 4. example funnel plot

Services outside the confidence interval ‘‘funnel’’ are performing above/below the average for all services.

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U: Uncertainty

There is always uncertainty involved in measurement.

• Data should be a starting point for investigation, not a

final answer

• Services should not be labelled as ‘under’ or ‘over’

performing based on a single metric

• Hypotheses to explain differences that

align with current evidence should be considered and discussed

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L: Learning Collaboration

Collecting, analysing, and discussing outcomes data in a meaningful and responsible way is complex. Learning collaborations can provide a forum to:

• Share common challenges
• Identify appropriate measures and

types of analysis

• Develop common data standards

approaches

• Advocate for support for services

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Top Tips

• Look at data as part of coherent interagency provision wherever

possible: Think wider than NHS – look for opportunities to consider provision and outcomes as part of integrated support from across Health, Education, Social Care and Youth Justice.

• Build resources to support appropriate data collection (e.g. 3%
• f budgets) into contracts including collection of routine admin data

and patient reported outcomes impact for children and parents.

• Create a safe space to consider what data might mean: use the

MINDFUL approach to support consideration of meaning of data collected in dialogue with service providers across agencies and with service user reps in the room.

• Set realistic targets based on existing data estimates – these can be

refined with time.

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Useful resources

www.corc.uk.net

• MHSDS Monthly Report Pages
• Mental Health Services Dataset Monthly Reports
• NHS England Shared Planning Guidance
• NHS England Planning Guidance Technical Guide to Indicators
• Five Year Forward View Mental Health Dashboard
• CCG IAF (see indicator 123c)
• Quality Premium (includes stretch ambition on CYP MH Access)
• New national CQUIN (includes CQUIN on CYPMH transition)
• PHE CYP MH & Wellbeing Profile (Fingertips)
• Measuring mental wellbeing in children and young people (guide)

Source of other support

• NHSE data and info surgery – monthly
• NHSD helpline?
• PHE are currently updating their CYPMH profile within Fingertips, this will be

made live in July 17

• PHE wellbeing

www.england.nhs.uk

Part B: National Mental Health Intelligence Network (NMHIN) Needs assessment Products which can help inform JSNAs and the commissioning of wellbeing and mental health interventions and services for children and young people The new Children and Young People’s Mental Health and Wellbeing Profile

www.england.nhs.uk

Part B: What we will cover

1. Why a public health approach to CYP mental health and wellbeing needs assessment 2. Introduction to outputs from the National Mental Health Intelligence Network that can support needs assessment

• Measuring Mental Wellbeing in Children and Young people
• JSNA tool
• Children and Young People Mental Health and Wellbeing

profile

• 3. Detailed look at how the CYP profiling tool can support

planning and commissioning

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Introduction to the National Mental Health Intelligence Network

Cancer Cardiovascular Mental Health, Dementia and Neurology

• Data profiling tools
• Intelligence reports and briefings

Child and Maternal health End of Life Care

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A public health approach to addressing CYP’s Mental Health and Wellbeing

• A public health approach aims to:
• Promote mental health and wellbeing of all children and young

people across their life course, so as to prevent mental health problems from happening in the first place and enhancing strategies for positive mental wellbeing and resilience

• Succeed in early identification of mental health problems and early

intervention to treat and prevent their progression

• Target groups with established mental health problems to help

promote their recovery and prevent recurrence

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Introduction to needs assessment

• Needs assessment is the process through which social

care, public health and NHS services work together to assess the needs of their populations to determine priorities for commissioning services (e.g. identifying current gaps in service provision and future plan).

• The key questions that a needs analysis tries to answer

are:

• What does health and wellbeing in my area look like?
• What should we be doing?
• What are we doing?
• What can we do better?
• What more do we need to know?

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Why is needs analysis important for CYP MH&WB?

• Most mental illness has its origins in childhood and is a risk factor for

adult mental illness;

• half of all mental disorder first emerges before the age of 14 years;
• three quarters by age 25 years
• Understanding the occurrence of protective and risk factors allows

prevention measures to be targeted to reach areas and population groups most in need.

• Addressing the mental health needs of children and young people

through prevention and early intervention, and access to evidence based assessment and treatment, can help improve mental wellbeing and protect against developing mental health problems.

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Mental Health JSNA Toolkit

• Toolkit signals the National Mental Health

Intelligence Network’s (NMHIN) intent to help the development of high quality joint strategic needs assessments that cover mental health for every area in England.

• To be published in July 2017
• Covers all mental health, not just children & young

people

• Guiding principles:
• Be Supportive
• Respect variation

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Supporting Components Mental Health JSNA Toolkit 2016/17 content:

• 1. Bite-sized cut & paste sections
• 2. Focus on prevention, wellbeing &

assets

• 3. Intelligence on: policy, case for change,

data, interventions & outcomes

• 4. Guide follows life course

Mental Health JSNA stocktake

(Kaleidoscope)

content:

• 1. 100+ overview metrics
• 2. GP & ward level metrics
• 3. Each domain follows life course
• 4. Gateway to topic based deep dive
• 5. PDF output report

Meeting the need – what makes a ‘good’ JSNA for mental health?

(Centre for Mental Health 2016)

MH primary prevention return

• n investment tool & report

(London School of Economics)

Prevalence & incidence Risk Factors Services Protective factors Outcomes & quality Finance& Return

• n investment

Understanding people Perinatal Children & young people Working age adults Older years

Information: Data profile Knowledge: User Guide

Understanding place

Mental Health JSNA Toolkit

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JSNA collaboration model

39 Mental Health JSNA Profile

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MH JSNA Knowledge Guide

• Provides access to policy, guidance and evidence

relating to understanding and meeting mental health need.

• Makes links between data and evidence
• It covers mental health using the following structure:

Each section has an overview and list of key JSNA questions.

understanding place understanding people the perinatal period children and young people working age adults

• lder people

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Measuring Mental Wellbeing in CYP

• A practical resource which supports local JSNAs and the

commissioning of interventions to improve children and young people’s mental wellbeing

• Covered in two documents:
• A guide which explains about mental wellbeing and its risk and

protective factors and identifies tools which can be used to measure the mental wellbeing of children and young people

• A technical appendix: indicator guide which
• identifies sources of data which may be used to describe mental

wellbeing and its risk and protective factors

• identifies national survey questions which could be included in

local surveys where there are data gaps

• provides links to examples of evidence based practice for

improvement

• http://www.yhpho.org.uk/default.aspx?RID=213417

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The CYP profiling tool

• Is publicly available
• Offers view national CYP MH&EWB metrics
• Allows for benchmarking geographies and localities
• Is used to influence the development of JSNAs
• Helps with better decision making
• Can help reach improvements to services and interventions for

CYP

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Fingertip profiling tool tips

The process should be informed by collective and local knowledge:

• Work in a multi-disciplinary team / add local perspective

Do you know the questions you want to ask?

• Use above to agree purpose and desired outputs

Sense check - compare with local intelligence and ask:

• Do the values seem correct? If not, why not?

Assess relationships between data items:

• Is there consistency? Does this re-inforce findings?

Learn through comparison with similar areas:

• Identify own good practice and opportunities for improvement
• What can you learn from high performing neighbours?

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https://fingertips.phe.org.uk/profile-group/mental-health

How to navigate the fingertips profiling tool

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How to navigate the fingertips profiling tool

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Fingertip data view: overview

2 1 3

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Fingertip data view: compare areas

3 1 2 4

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Fingertip data view: trends

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Fingertip data view: map

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Detailed look at the CYP mental health and wellbeing profiling tool

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Current redevelopment of the profile

• The current Children and Young People’s Mental Health

and Wellbeing Profile in fingertips was developed in 2015;

• The profile in fingertips is being redeveloped: Phase 1 will

be available in July 2017;

• This will cover public health topics of identification of need

and primary prevention.

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Overview of current profile content

Groups indicators under subject headings rather than reflecting a chosen pathway

• Risk
• Prevalence
• Health
• Social care
• Education

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Overview of new profile content

The planned structure of the re-designed profile following a high level pathway

• f:
• Identification of need (phase 1release)
• Protective factors (phase 1 release)
• Primary prevention: Adversity (phase 1 release)
• Primary prevention: Vulnerability (phase 1 release)
• (Early intervention)
• (Services, treatment and outcomes)
• Finance (phase 1 release)

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Identification of need

To plan services that meet the needs of the local population, information on the prevalence of mental illness in the population is needed. The last survey of mental health of children and young people in Great Britain in 2004 found that 8% of 5 – 10 year olds and 12%

• f 11-16 year olds had a clinically

diagnosed mental disorder. Taking a school class of 30 children, on average, 3 will suffer from a diagnosable mental health disorder.

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Indicators within identification of need domain

Identification of need County & LA District & UA CCG

Estimated prevalence of mental health disorders in children and young people: % population (aged 5-16) Y Y Estimated prevalence of emotional disorders in children and young people: % population (aged 5- 16) Y Y Estimated prevalence of conduct disorders in children and young people: % population (aged 5-16) Y Y Estimated prevalence of hyperkinetic disorders in children and young people: % population (aged 5-16) Y Y Prevalence of ADHD among young people: Estimated number of 16 - 24 year olds Y Prevalence of potential eating disorders among young people: Estimated number of 16 - 24 year

• lds

Y Cause for concern: Looked after children where there is cause for concern: % of looked after children Y Self harm: Hospital admissions as a result of self-harm (10-24 years): DSR per 100 000 population 10- 24 years Y Y Self harm: crude rates per 100000 10-14 years Y Self harm: crude rates per 100000 15-19 years Y Self harm: crude rates per 100000 20-24 years Y Mental health problems: Pupils with social, emotional and mental health needs: % of primary school pupils Y Mental health problems: Pupils with social, emotional and mental health needs: % of secondary school pupils Y Mental health problems: Pupils with social, emotional and mental health needs: % of school pupils Y

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Prevalence of Mental Health Disorders

What is the potential impact on service need?

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Prevalence of Mental Health Disorders

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Protective factors

A child’s attachment, security and positive stimulation from their main carers has a major impact on the child’s social and emotional wellbeing which provides the foundation for health behaviours and educational attainment.

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Indicators within Protective factors domain

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Protective factors

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Protective factors

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Primary Prevention: Adversity

Adverse childhood experiences can have a lasting impact upon a child’s mental health having a strong influence on the chances of developing mental health problems including depression, post-traumatic stress disorder, and attention deficit and hyperactivity disorder. Although single events carry risk, there is an increased risk with multiple cumulative events, and events associated with chronic adversity and deprivation carry the greatest risk Examples of adverse childhood experiences are: abuse (physical, emotional, sexual), neglect, having parents with drug and alcohol abuse, and family breakdown

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Primary Prevention: Adversity

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Children in need due to abuse or neglect

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Children in need due to family difficulties

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Primary prevention: Vulnerability

A strong relationship has been found between the experience of adverse childhood events and the chance

• f taking up risky behaviours such:
• Being a high risk drinker
• Being a current smoker
• More likely to have sex under 16 years of age
• More likely to have smoked cannabis
• More likely to have used heroin or crack cocaine

Many of these behaviours can be associated with subsequent physical and mental ill health in adulthood. Particular groups of children have significantly worse health outcomes linked, for example to:

• being a looked after child
• being in the youth justice system
• having a disability.

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Indicators within vulnerability domain

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Looked after children

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Risky behaviour

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Finance

This domain looks at spend in relation to children and young people’s services amongst other areas.

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Finance

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Finance

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Contact us

Contact us with any further feedback at: mhdnin@phe.gov.uk Visit our existing fingertips profiles:

• https://fingertips.phe.org.uk/profile-group/mental-

health/profile/cypmh

• Or Google ‘mental health fingertips’

www.england.nhs.uk

Produced by NEL CSU

• n behalf of NHS England

Credits

Gillian Bryant, Senior Data Analyst, Public Health England Lisa Garnett, Consultant, NEL CSU Cam Lugton, Programme Lead, Public Health England Mike Streather, Head of Intelligence Mental Health, Public Health England Professor Miranda Wolpert, CORC