What might help reduce waiting times in CAMHS? Bill Williams, - - PowerPoint PPT Presentation

What might help reduce waiting times in CAMHS?

Bill Williams, General Manager and IAPT Project Lead, Tower Hamlets CAMHS Dr Rebecca Adams, Consultant Child and Adolescent Psychiatrist, Tower Hamlets CAMHS Dr Freya Gill, Clinical Psychologist, Newham CAMHS

The Need for Change

• High referral numbers
• Long referrals meeting
• Poor quality referral information
• Lack of systematic liaison with referrers/

families

• Delays in decision making
• Insufficient information about alternative

services or self help

60 70 80 90 100 110 120 130 140 150 160 1/1/13 2/1/13 3/1/13 4/1/13 5/1/13 6/1/13 7/1/13 8/1/13 9/1/13 10/1/13 11/1/13 12/1/13 1/1/14 2/1/14 3/1/14 4/1/14 5/1/14 6/1/14 7/1/14 8/1/14 9/1/14 10/1/14 11/1/14 12/1/14 1/1/15 2/1/15 3/1/15 4/1/15 5/1/15 6/1/15 7/1/15

• No. of referrals received by Newham CAMHS per month

Count

Increase in referrals Vs reduction in resource

Key Aims of Front Door Team

• Improve decisions: Do referred children require

input from CAMHS? Can they be signposted to alternative services?

• Reduce waiting times for first appointment.
• Improve patient experience of referral process by
• ffering a more responsive service.

A New Referral Process

Referral received Referral meeting

(FD clinician and Senior)

Allocate (Routine) Allocate (Urgent) Redirect/ Close Feedback meeting

(FD clinician and Senior)

Triage

Group Exercise

You are part of the CAMHS Front Door Team and as a group you are required to make decisions about incoming referrals. Stage 1. Identify what should happen with each new referral:

• Allocate (Urgent)
• Allocate (Routine)
• Triage
• Redirect/Close

Stage 2. Identify what should happen with the triaged referrals:

• Allocate (Urgent)
• Allocate (Routine)
• Redirect/Close

Newham CAMHS Front Door Team

Dr Priti Patel, Consultant Psychiatrist, Project Sponsor Dr Freya Gill, Clinical Psychologist Sari Ross, Clinical Nurse Specialist Dr Carly Huck, Clinical Psychologist Dr Brigitte Wilkinson, Consultant Clinical Psychologist, Lead Clinician Frances St John, Family Therapist Nazneen Ramsahye, Lead Administrator Annabelle Perdido, Team Administrator Meredith Mora, QI Clinical Fellow

Key Aims of Front Door Team

• Improve decisions: Do referred children require

input from CFCS? Can they be signposted to alternative services?

• Reduce waiting times for first appointment at CFCS

from 11 weeks to 9 weeks by April 2015.

• Improve patient experience of referral process by
• ffering a more responsive service.

Cycle 1: Develop a standardize triage assessment script Cycle 3: Pilot the ‘Front door’ (triage) service Cycle 2: Develop a self-help and local service database

Quality Improvement (QI) Programme

Cycle 4: Use interpreters in triage assessments Cycle 6: Offer face-to-face ‘drop-in’ appointments Cycle 7: Pilot combined DLC & ‘front door’ role Cycle 9: Implement the ‘front door’ service Cycle 8: Align referral admin with ‘front door’ service

PDSA cycles

Plan, Do, Study, Act

Driver Diagram

To reduce waiting times for CFCS from 11weeks to 9 weeks by April 2015 and improve the patient experience of referral to CFCS as demonstrated by increased attendance at first appointment

Referral Processes

Define Admin process for handling referrals Define standards from CAMHS clinicians in liaison activity with referrers Streamlining referral processes Identify and use onward pathways for cases diverted from CFCS

Demand Management

Information provided to referrers about CFCS Checklists/ Screening tools for referrers Awareness events Signposting to alternative services

Limited Capacity

Increase proportion of telephone consultation time Workload balancing

Broaden interventions

Develop self help materials

Standardise liaison activity with referrers Develop telephone screening protocol for families Develop welcome call to families accepted to CAMHS prior to appt Develop library of easily accessible self-help materials Screening checklists for GPs/referrers Review and rationalise info sent to families Develop knowledge about alternative services in community / ‘secret shopper’ users. Review and develop administrative systems for referrals

AIM PRIMARY DRIVERS SECONDARY DRIVERS CHANGE IDEAS

Outcomes

Waiting Time Data

• Average wait for first appointment has dropped from an average of 69 to

54 days for the whole clinic.

30 40 50 60 70 80 90 100 1/1/13 2/1/13 3/1/13 4/1/13 5/1/13 6/1/13 7/1/13 8/1/13 9/1/13 10/1/13 11/1/13 12/1/13 1/1/14 2/1/14 3/1/14 4/1/14 5/1/14 6/1/14 7/1/14 8/1/14 9/1/14 10/1/14 11/1/14 12/1/14 1/1/15 2/1/15 3/1/15 4/1/15 5/1/15 6/1/15 7/1/15

CFCS waiting time (days) referral to first appointment Front Door Pilot

Warning: Data issues

Waiting Time Data

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15

% of families seen within 9 weeks

• % of families seen within 9 weeks has increased from an average of 47%

to 66% for the whole clinic.

Front Door Pilot

Warning: Data issues

Triage Wait Times

• The current average waiting time for a triage assessment is under 2 weeks.

5 10 15 20 25 30 35 40 45 50 10/6/14 10/13/14 10/20/14 10/27/14 11/3/14 11/10/14 11/17/14 11/24/14 12/1/14 12/8/14 12/15/14 12/22/14 12/29/14 1/5/15 1/12/15 1/19/15 1/26/15 2/2/15 2/9/15 2/16/15 2/23/15 3/2/15 3/9/15 3/16/15 3/23/15 3/30/15 4/6/15 4/13/15 4/20/15 4/27/15 5/4/15 5/11/15 5/18/15 5/25/15 6/1/15 6/8/15 6/15/15 6/22/15 6/29/15

Average wait (days) from referral received to triage assessment

Measure

Attendance Rates of First Face-To-Face Appointment

Data snap-shot: All referrals received in February 2015 (N= 60) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Attended DNA'd Declined Exisiting Process: Triage: Routine

Outcome after Triage Assessment

45% 22% 24% 4% 5% Allocate within CFCS Close (no support needed/no contact made) Re-direct to more appropriate service Provide Self-help only Re-direct to appropriate service and provide self-help

Service User Feedback

Limitations Advantages Language barriers Familiar surroundings helps talk Unexpected call Benefits of unknown voice Challenges of unknown voice Less exposing & more focused

‘[The triage call] was a lot more better than going to talk to someone in person, because when you talk to someone in person it’s harder and especially if you’re in a different environment as well… but when you’re at home & more relaxed... I just find it easier..’ ‘I just felt where I’ve had that woman talk to me in such a nice way, I thought maybe I’m going to have that here [at CAMHs] as well…’

Being put at ease

• Confidentiality
• Expectations
• Control
• Clinician’s persona

Sense of relief and hope for help

• Relief of beginning to talk with the hope of help
• Off my chest
• New conversations
• Positive changes having talked

The experience of the telephone call

A Good Process

• Call Length
• Questions asked and use of measures
• Better than a letter

Possible Areas for Consideration

• Text notification of the call
• Clinician measures as conversational tools

From Triage to Assessment

• Retelling the Story
• Use of triage call in initial assessment

‘Maybe a text an hour before asking whether it’d O.K to call in an hour’. ‘When I’d already come out about the whole situation I thought oh I have to explain the whole situation again.. but I know I have to do it because it is going to help me.. So although it might be annoying saying the same thing over and over again… I found it fine’.

Feedback and ideas for improvement

Service User Feedback

What next?

• Further evaluation - Service user feedback from families of

their experience

• Service user participation – Ask young people to rate the self-

help materials we have sent and discuss how they would prefer to access it. Visit other local services to gather information about accessibility, projects etc.

• Eliminate weekly referral meeting – Front Door Team will

enable service to respond to risky cases more effectively and for allocations to be made on a daily basis.

• Link up with related pilots within the service (e.g. primary

care and schools link)

• Full Implementation – To provide Front Door Team to all

referrals on a daily basis. Caution! Resource implications

Discussion and Reflections

Contact details

• Bill Williams:

bill.williams@elft.nhs.uk 020 7426 2375/2400

• Dr Freya Gill:

freya.gill@elft.nhs.uk 020 7055 8400

• Dr Rebecca Adams:

rebecca.adams@elft.nhs.uk 020 7426 2375/2400