Early Intervention in Psychosis Network 2 nd March 2017 Stephen - - PowerPoint PPT Presentation

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Early Intervention in Psychosis Network 2 nd March 2017 Stephen - - PowerPoint PPT Presentation

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Yorkshire and the Humber Mental Health Network Early Intervention in Psychosis Network 2 nd March 2017 Stephen McGowan, EIP Clinical Lead for Y&H CN and NHSE (North) (Chair) Dr Steve Wright, Consultant Psychiatrist, TEWV (Co-Chair)

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www.england.nhs.uk

  • Stephen McGowan, EIP Clinical Lead for Y&H CN and NHSE (North) (Chair)
  • Dr Steve Wright, Consultant Psychiatrist, TEWV (Co-Chair)
  • Rebecca Campbell, Quality Improvement Manager and Sarah Boul, Quality

Improvement Lead

  • Rebecca.campbell6@nhs.net and sarah.boul@nhs.net
  • Twitter: @YHSCN_MHDN #yhmentalhealth
  • March 2017

Yorkshire and the Humber Mental Health Network

Early Intervention in Psychosis Network 2nd March 2017

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www.england.nhs.uk

Yorkshire and the Humber Early Intervention in Psychosis Network

Welcome!

Andrew Clarke, Quality Improvement Manager, Yorkshire and the Humber Clinical Networks

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@YHSCN_MHDN #yhmentalhealth

Housekeeping:

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Children and Young Peoples Mental Health Clinical Network

NHS England

Regional DCO Lead Commissioners

Young People

CYP MH Steering Group Adult MH CN

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SLIDE 5

Work Priorities

  • Community Eating Disorder Services
  • Transition
  • Data Dashboard
  • Schools MH Competency Framework
  • Collaborative Commissioning – Specialised

Commissioning and H&J Commissioning

  • Vulnerable Groups – Adopted, LAC, Care Leavers,

UASC

  • Collaboration with Adult MH
  • CYP Crisis Care
  • Workforce
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www.england.nhs.uk

Yorkshire and the Humber Early Intervention in Psychosis Network

Regional Update

Moggie McGowan, Co-Chair, Clinical Advisor (Y&H IRIS & NHS England North)

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SLIDE 7
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SLIDE 8

Parish Notices

  • Deep Dive meetings
  • CCQI Audit Findings
  • Workforce Calculator pre-meetings
  • Data Quality
  • Role of the Care Coordinator & Core

Competencies

  • Regional Map of EI Services
  • CBTp Supervisors
  • Physical health care leaflet
  • HOAX ‘Our Right to Hope’ Project
  • Service User Involvement
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SLIDE 9

Parish Notices

  • Deep Dive meetings
  • CCQI Audit Findings
  • Workforce Calculator pre-meetings
  • Data Quality
  • Role of the Care Coordinator & Core

Competencies

  • Regional Map of EI Services
  • CBTp Supervisors
  • Physical health care leaflet
  • HOAX ‘Our Right to Hope’ Project
  • Service User Involvement
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SLIDE 10

Deep Dive Agenda

  • CCQI self-assessment findings
  • Current access and waiting time delivery
  • Data submission and data quality; progress with MHSDS1

delivery

  • Physical health CQUIN delivery
  • Staffing levels, recruitment and workforce development
  • Incidence
  • Delivering the ARMS pathway
  • NHS Improvement monitoring
  • Expected funding in 2017/18 and beyond
  • Exploration of areas of good practice
  • Understanding any concerns
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SLIDE 11

Parish Notices

  • Deep Dive meetings
  • CCQI Audit Findings
  • Workforce Calculator pre-meetings
  • Data Quality
  • Role of the Care Coordinator & Core

Competencies

  • Regional Map of EI Services
  • CBTp Supervisors
  • Physical health care leaflet
  • HOAX ‘Our Right to Hope’ Project
  • Service User Involvement
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SLIDE 12
  • Deep Dive meetings
  • CCQI Audit Findings
  • Workforce Calculator pre-meetings
  • Data Quality
  • Role of the Care Coordinator & Core

Competencies

  • Regional Map of EI Services
  • CBTp Supervisors
  • Physical health care leaflet
  • HOAX ‘Our Right to Hope’ Project
  • Service User Involvement
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SLIDE 13
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INCIDENCE!

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SLIDE 15
  • Deep Dive meetings
  • CCQI Audit Findings
  • Workforce Calculator pre-meetings
  • Data Quality
  • Role of the Care Coordinator & Core

Competencies

  • Regional Map of EI Services:
  • CBTp Supervisors
  • Physical health care leaflet
  • HOAX ‘Our Right to Hope’ Project
  • Service User Involvement
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SLIDE 16

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Data Quality, MHSDS v Unify (Provider)

Referrals on EIP pathway entering treatment

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Data Quality, MHSDS v Unify (Provider)

Referrals on EIP pathway entering treatment

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SLIDE 18
  • Deep Dive meetings
  • CCQI Audit Findings
  • Workforce Calculator pre-meetings
  • Data Quality
  • Role of the Care Coordinator & Core

Competencies

  • Regional Map of EI Services
  • CBTp Supervisors
  • Physical health care leaflet
  • HOAX ‘Our Right to Hope’ Project
  • Service User Involvement
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SLIDE 19
  • Deep Dive meetings
  • CCQI Audit Findings
  • Workforce Calculator pre-meetings
  • Data Quality
  • Role of the Care Coordinator & Core

Competencies

  • Regional Map of EI Services:
  • CBTp Supervisors
  • Physical health care leaflet
  • HOAX ‘Our Right to Hope’ Project
  • Service User Involvement
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http://www.yhscn.nhs.uk/NHSENMH/EIPNorthRegion.php

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http://www.yhscn.nhs.uk/NHSENMH/EIPNorthRegion.php

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  • Deep Dive meetings
  • CCQI Audit Findings
  • Workforce Calculator pre-meetings
  • Data Quality
  • Role of the Care Coordinator & Core

Competencies

  • Regional Map of EI Services
  • CBTp Supervisors
  • Physical health care leaflet HOAX ‘Our Right to

Hope’ Project

  • Service User Involvement
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SLIDE 23
  • Deep Dive meetings
  • CCQI Audit Findings
  • Workforce Calculator pre-meetings
  • Data Quality
  • Role of the Care Coordinator & Core

Competencies

  • Regional Map of EI Services
  • CBTp Supervisors
  • Physical health care leaflet
  • HOAX ‘Our Right to Hope’ Project
  • Service User Involvement
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SLIDE 24

Contact: zohara.ali@nhs.net

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SLIDE 25
  • Deep Dive meetings
  • CCQI Audit Findings
  • Workforce Calculator pre-meetings
  • Data Quality
  • Role of the Care Coordinator & Core

Competencies

  • Regional Map of EI Services
  • CBTp Supervisors
  • Physical health care leaflet
  • HOAX ‘Our Right to Hope’ Project
  • Service User Involvement
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www.hoaxorth.com

HOAX Our Right to Hope event: A ground-breaking experience that seeks to explore and understand stigma around mental health.

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Parish Notices

  • Deep Dive meetings
  • CCQI Audit Findings
  • Workforce Calculator pre-meetings
  • Data Quality
  • Role of the Care Coordinator & Core

Competencies

  • Regional Map of EI Services
  • CBTp Supervisors
  • Physical health care leaflet
  • HOAX ‘Our Right to Hope’ Project
  • Service User Involvement
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Early Intervention in Psychosis

Update from national policy team

March 2017

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We are now one year on from the introduction of the early intervention in psychosis standard. This is an opportunity to review what has worked well and what are the ongoing challenges for teams and commissioners.

  • 1. The early intervention in psychosis standard and how we got here
  • 2. Achievements in 2016/17 to improve access to care
  • 3. Achievements in 2016/17 to improve delivery of NICE concordant care
  • 4. Key areas of development for 2017/18
  • 5. What are the national team doing in 2017/18
  • 6. What can commissioners and providers do in 2017/18

Contents

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The EIP access and waiting time standard requires that, from 1 April 2016, more than 50% of people experiencing first episode psychosis commence treatment with a NICE-recommended package of care within two weeks of referral. There are therefore two conditions for the standard to be met:

  • a maximum wait of two weeks from referral, and
  • treatment delivered in accordance with NICE guidance.

Early intervention in psychosis standard

“It was much more of a holistic approach than previous support I’d

  • received. They talked to me about my

physical health, as well my mental health, and made sure I was looking after myself.”

From the Lost Generation Report (Rethink) Why early intervention in psychosis?

“With the continued support of EIP across three years I feel like ‘me’ again… I am very ambitious in my career, working full time for the last 2.5 years and am enjoying being a first time mum to my 10-month old baby.”

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One year on, the EIP standard is a priority for the NHS

  • NHS Operational Planning and Contracting Guidance 2017-2019
  • CCG Improvement and Assessment Framework
  • NHS Improvement Single Oversight Framework
  • Care Quality Commission Monitoring Framework.

Increased investment by commissioners

  • Many teams are now seeing increased investment to meet the 50% RTT standard.
  • The CCG Finance Tracker will provide another level of transparency on this

Increased transparency at national, regional and local level

  • Unify2 data collection intended to bridge the gap in coverage until data flowing

through the MHSDS is considered to be complete and robust.

  • Data and understanding at detail we have never had before.

So, what progress in improving timely access to EIP services has the Unify data shown us?

The numbers of patients who started treatment and incomplete pathways are likely to be under reported. This may also result in the percentage achievement against the standard being artificially inflated. These issues mean that individual months of data should be treated with a degree of caution at this stage.

Achievements in 2016/17 to improve access to care

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Source: NHS England, Unify collection 200 400 600 800 1,000 1,200 1,400 Number of people starting treatment with a specialist EIP team Introduction of the standard

2016/17 2015/16

  • From the start of data collection, the number of people with a first episode of psychosis starting treatment with a

specialist EIP team per month has risen from 886 people in December 2015 to 1,205 people in November 2016.

  • Since the EIP standard was introduced in April 2016, 9,597 people have started treatment with a specialist EIP team.

The standard has seen an increase in the number of people starting treatment with a specialist EIP team

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Source: NHS England, Unify collection

2016/17

40% 45% 50% 55% 60% 65% 70% 75% 80% % of people starting treatment with a specialist EIP team within 2 weeks

2015/16

Introduction of the standard

  • The RTT component of the standard ( 50% of people starting treatment within 2 weeks) has been met since the

introduction of the standard.

  • Since April 2016, performance has risen from 65% to 77.6% in November 2016.

Not only are more people being seen, but they are accessing care much quicker

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Source: NHS England, Unify collection

2016/17 2015/16

Introduction of the standard

  • In November 2016, people that start treatment had a median waiting time of 1.3 weeks compared to 1.63 weeks in

December 2015 when data collection started.

  • In December 2015, 523 started treatment with an EIP team within 2 weeks. This has increased to 935 in November 2016.

And those that have started treatment since April 2016 are waiting considerably less time

0.80 0.90 1.00 1.10 1.20 1.30 1.40 1.50 1.60 1.70 1.80 Median waiting time in weeks

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But what about those that are yet to start treatment each month? We know more work needs to be done, but we are seeing a reduction in how long those people are waiting….

Source: NHS England, Unify collection

2016/17 2015/16

Introduction of the standard

  • In December 2015, of those people each month that were still waiting to start treatment only 24% had been waiting less

than 2 weeks. In November 2016 that has improved to 50% of people waiting less than 2 weeks.

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% % of people waiting to start treatment that have waited less than 2 weeks

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Investment has seen increased training of staff

  • Health Education England invested £6m in training during 15/16. This programme

has already delivered:

  • 542 people with family intervention training (including 14 trained trainers)
  • 124 people provided with top-up CBTp training
  • 80 people trained as CBTp supervisors.
  • Furthermore, it is on track to deliver:
  • 1 year CBTp top up training for 170 people (by March 2017)
  • CBTp post-graduate diplomas for 116 people (by March 2018).

Again, we have greater transparency at all levels

  • Until the MHSDS is robust to measure interventions and outcomes data, we have

the CCQI self-assessment….

  • Teams have not been scored for this first indicative year of the self-assessment.
  • The 2016/17 will provide a baseline for teams to work with commissioners to

identify areas for improvement and to help prioritise investment and drive care quality. Achievements in 2016/17 to improve delivery of NICE concordant care

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What is the focus?

  • 1. Increasing access for over 35s and ARMS cases
  • 2. Continued investment and development of workforce
  • 3. Improving data quality for the MHSDS

What do we need to do to make this happen?

  • The MHSDS and CCG Finance Tracker to provide more information than we have

had before.

  • CCQI self-assessment provides transparency on gaps in provision.
  • Funding for regions for supporting mental health improvement.
  • Clinical leadership has been key to delivery of the standard – how can we

maintain this?

  • Continued work at all levels to improve quality of data for the MHSDS.
  • Continued focus to improve interventions and outcomes reporting.

Key areas of development for 2017/18

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Support available

  • Policy, guidance and helpful conversations
  • Linking clinical leads, commissioners and ramping up the sharing best practice
  • The IST to continue to support DCO assurance teams and CNs on improving data quality

with work to begin on supporting regional NHS Improvement leads. Improving data quality

  • NHS Digital to begin reporting monthly on all clock stops with and without a specialist EIP

team.

  • NHS England in partnership with NHS Digital to develop guidance on how SNOMED will be

used to monitor the quality of care.

  • Regional and national performance reports to be updated to include MHSDS data and

incomplete pathway data.

  • NHS England has recommended that MHSDS becomes the source of RTT performance data

in 2017. 2017/18 assessment of NICE-concordance process

  • Opportunity to review self-assessment process
  • 2017/18 onwards there will be a cost attached to the self-assessment that providers and

commissioners will be required to meet.

What are the national team doing in 2017/18

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What are the national team doing in 2017/18

Monitoring investment

  • Initial investment in 2015/16 of £40m through the tariff
  • Additional investment made available to CCGs from 2017/18

Contracting and regulation opportunities

  • NHS Operational Planning and Contracting

Guidance 2017-2019

  • CCG Improvement and Assessment Framework
  • NHS Improvement Single Oversight Framework
  • Care Quality Commission Monitoring

Framework Other opportunities

  • Mental Health Dashboard finance information
  • Physical health CQUIN 2017-2019
  • Physical health and Individual Placement and

Support funding

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  • 1. The self-assessment data provides opportunities for

commissioners and providers to begin their quality improvement journey.

  • 2. Review together the areas where your services are not

performing as strongly and identify areas where service is performing well.

  • 3. Identify what good practice you can share with other teams

and regionally and nationally.

What can commissioners and providers do in 2017/18

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Any questions?

Jay Nairn Programme Manager, NHS England 07920 251 511 jaynairn@nhs.net

Questions?

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www.england.nhs.uk

Yorkshire and the Humber Early Intervention in Psychosis Network

CYP Mental Health and Early Intervention

Penny Blair, Senior Practitioner (CAMHS), Bradford District Care NHS Foundation Trust

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Early Intervention in Psychosis C&YP Bradford Summary & Local Action Penny Blair

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EIP - CAMHS

Hillbrook (Keighley) And Fieldhead (Bradford)

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How it works!!!!!

  • Co located & embedded in mainstream CAMHS
  • Governance & Management from both EIP &

CAMHS

  • Dedicated EIP clinicians who support both

assessment and ongoing work

  • Offer of psychological interventions including family

interventions & CBT

  • Medic input from CAMHS
  • Links to education and training
  • Robust transition policy and process
  • Solid and positive relationships with adult teams
  • Existing Home Treatment model within CAMHS
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The Team

  • Penny Blair 0.5 Band 7 Team Leader
  • Alex Thornber 1.0 band 6 Care Co Ordinator
  • Lesley Anne Robinson 1.0 band 5 Recovery Co
  • rdinator

Plus CAMHS and EIP psychological therapy provision and Medic Support.

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Care coordinator role

  • Assessment – Different RIO demands
  • Care Coordination
  • Seeing the process through from start to

finish – differs from adult hub and spoke.

  • inpatient involvement and outpatient follow

up

  • Group work and psychosocial interventions

including relapse prevention, managing voices, supporting family, CPA.

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EIP Recovery Co-

  • rdinator Role
  • To support young people with the recovery

process:

  • Re-engage with school/college
  • Reforming links with peers and supporting

new social networks

  • Engaging in enjoyable social activities.
  • Culture Fusion – centre for young people

16-25. Provides easier access to young people’s services e.g. YMCA, Connexions,

  • EIP. Provides a safe place for young

people to join in with youth groups and activities (gym, dance studio, café etc)

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Senior Practioner/Team Leader post

  • 0.5 Transition. 0.5 EIP (CAMHS)
  • Full caseload
  • Transition: 16-17yr olds

anywhere in mental health CMHS weekend service, crisis and lead nurse

  • Age appropriate care: inpatient and outpatients.
  • Policy writing and implementation.
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Quality Statements from Better Access for C&YP

  • Children and young people who are referred to a specialist

mental health service with a first episode of psychosis start assessment & receive treatment within two weeks.

  • Psychological therapy: Children and young people with a

first episode of psychosis and their family members are

  • ffered family intervention.
  • Children and young people newly diagnosed with bipolar

depression or a first episode of psychosis are offered a psychological intervention.

  • Support for carers and families Parents and carers
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Quality Statements from Better Access for C&YP

  • Children and young people with bipolar disorder, psychosis or

schizophrenia are given healthy lifestyle advice at diagnosis and at annual review.

  • Children and young people with bipolar disorder, psychosis or

schizophrenia prescribed antipsychotic medication have their treatment monitored for side effects.

  • Children and young people with bipolar disorder, psychosis and

schizophrenia have arrangements for accessing education or employment-related training included in their care plan

  • Crisis care Children and young people with bipolar disorder,

psychosis or schizophrenia who are in crisis are offered home treatment if it is suitable.

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Success in response to Better Access

  • We are achieving the 50% waiting time standard
  • Recovery that is YP centred remains at the heart of
  • ur approach
  • We are adapting our approach to look at C&YP and

ARMS

  • Family Interventions and Psychological therapies are

available to our C&YP

  • Physical Health Monitoring & Interventions are

embedded in the Pathway. Physical Health template

  • n RIO
  • Part of the CAMHS Training Strategy
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Participation & engagement

  • Outcome

Measures

  • Young Dynamos
  • Youth on Health
  • Barnardos
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Challenges, Questions & Solutions

  • ARMS & how this fits with C&YP
  • Waiting time standard introducing ‘haste’

into assessments…for C&YP presentations can be more attenuated and less certain..watchful waiting v’s ARMS?

  • Referral routes..current pathway for routine

referrals into CAMHS is graduated via 0-19 pathway & PMHW. Importance of educating all around Better Access & Swift referral

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Challenges, Questions & Solutions

  • Less flexibility to co work within CAMHS.

Developing a consultative approach to cases

  • Medic capacity into EIP is spread across
  • CAMHS. Exploring job planning EIP for one

Medic to provide continuity and consistency

  • A feeling that Better access work focusing
  • n the over 35 agenda and missing C&YP
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Challenges, Questions & Solutions Why over 35 and not under 14? Parity for C&YP!!

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www.england.nhs.uk

Yorkshire and the Humber Early Intervention in Psychosis Network

Time for a break?

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www.england.nhs.uk

Yorkshire and the Humber Early Intervention in Psychosis Network

Introduction to the Group Discussion

Dr Steve Wright, Co-Chair, Consultant Psychiatrist, TEWV & Clinical Advisor, Y&H Clinical Network

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www.england.nhs.uk

AWT Guidance - Considerations for Children and Young People

The AWT standard applies equally to children & young people (CYP), and plans should reflect this. There is a range of different arrangements EIP & delivery of care for CYP with mental health needs. For example:

  • some CYP services have specialist EIP embedded
  • some adult EIP services include staff with expertise in

working with children and young people

  • some adult services and CYP services work together

using joint protocols.

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www.england.nhs.uk

AWT Guidance for CYP (2)

  • For FEP occurring in YP of transitional age, there must be clarity

about what is offered and when.

  • Transition should be supported by a protocol, and reflect a

shared decision between the CYP service, the young person & the EIP team to best address the maturing needs of the young person.

  • To deliver the standard across all ages, a strong interface and

relationship between CYP services and EIP teams is needed, with training initiatives, supervision and / or consultation & joint protocols.

  • EIP services should also have access to expertise in identifying

neurodevelopmental disorders in CYP in the presence of psychosis to facilitate vocational and educational recovery and social functioning.

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www.england.nhs.uk

Education & Training

  • Access to and participation in education and training is a crucial

aspect of recovery and fulfilling children and young people’s potential as adults.

  • Services should ensure they have a strong interface with

education to provide a personalised educational support plan, including re-integration after periods of non-attendance which may include an inpatient stay.

  • Dedicated educational, training and employment specialists with

a primary expertise in this area should be an integral aspect of service provision.

  • Multi-agency expertise in safeguarding
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www.england.nhs.uk

Examples of a ‘joined up’ interface

  • Family Therapists, working across CAMHS and EIP
  • Joint assessment, consultation, liaison and working
  • Members of EIP/AMHS team attending the CAMHS

team meetings on a regular basis

  • CAMHS/EIP/AMHS providing continuity of psychiatry

input for YP as they move from CAMHS to adult services

  • Designated Child Psychiatrist sessions into

EIP/AMHS

  • Shared CPN resource for CAMHS/EIP/AMHS
  • Input into CAMHS by non-psychiatrist members of

EIP/AMHS

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www.england.nhs.uk

Other issues for joint protocols

  • Gillick competence
  • Advocacy/peer support
  • User & carer involvement
  • Information/passports
  • Separate referral pathways?
  • Separate inpatient units / admission pathways
  • Separate alternatives to admission/crisis services
  • Physical health – validity of Lester criteria?
  • Etc.
  • https://www.england.nhs.uk/mentalhealth/wp-

content/uploads/sites/29/2016/04/eip-resources.pdf

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www.england.nhs.uk

Each locality table to discuss:

  • Where we are up to & what are we going to do? During

discussions identify any key areas of concern /

  • development. i.e. transition.
  • What “good” looks like? Agree 10 essential standards for

the care and treatment children with First Episode Psychosis

Group Discussion: CYP Mental Health

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SLIDE 67

www.england.nhs.uk

Yorkshire and the Humber Early Intervention in Psychosis Network

Summary

  • Key Discussion Points – Top 10 Standards
  • Actions & Next Steps

Dr Steve Wright, Co-Chair, Consultant Psychiatrist, TEWV & Clinical Advisor, Y&H Clinical Network

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www.england.nhs.uk

  • Thursday 29 June 2017, DoubleTree Hilton, Leeds,

13:30-16:30 – Focus on Physical Health and SMI

  • Thursday 2 November 2017, Venue to be confirmed,

Leeds, 13:30-16:30

Dates of the Next Meetings…

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SLIDE 69

www.england.nhs.uk

Yorkshire and the Humber Early Intervention in Psychosis Network

Thank You for Attending!

Don’t forget to fill out your evaluation!