What was the problem you were trying to solve?
The CAMHS Choice Clinic began as a 6-month pilot project to explore whether Wirral CAMHS, part of Cheshire and Wirral Partnership Trust (CWP) could rapidly change to become more THRIVE-like. This involved addressing a number of key concerns:
- data varied in quality
- inconsistency of treatment and care
- need for a clearer point of access for children and families to access treatment through CAMHS
variable and uneven waiting times for patients
- inefficient use of clinician and admin time.
What is the Choice Clinic?
The Choice Clinic offers young people and their families a single point of access. The clinic works in partnership with referrers and partner agencies to ensure the right level of intervention is offered to the right people at the right time.
How does the Choice Clinic implement THRIVE principles?
The Choice Clinic has dedicated a significant amount of time to thinking through and implementing many of the principles outlined by the THRIVE ‘Getting Advice’ and ‘Getting Help’ groupings. The THRIVE framework — insofar as it emphasizes the need for good quality, front-loaded initial appointments at CAMHS, with effective use of signposting, multi-agency liaison, and advice giving — is central to the future plans of the Choice Clinic.
The plan is a shared decision between the young person, family and professional that suits the individualised needs of the patient. One-off contact with the caregiver is now more common, and a significant amount of time is being dedicated to signposting and self-management. For those who receive additional treatment, treatment plans are developed that are goals-focussed and evidence informed.
What approach did you take to developing the Choice Clinic?
In practice, to set up the Choice Clinic required starting with a wider discussion across the individual services and groups, working in collaboration on a proposal, and identifying leads to be champions and change makers involved in implementation. Once the clinic was established, a database was set up to collect data from the beginning. An assistant psychologist was hired to monitor outcomes and ensure clinicians were doing the right things. Information updates were regularly posted on an information board to ensure that staff members were always up to date. Overall, workflows were more clearly defined, and clinicians were freed from a lot of their administrative duties which enabled them to focus more on the Choice task and prioritise with fewer interruptions.
How has the Choice Clinic affected service users?
As a result of the changes that have been implemented, clients are getting fairer and more equitable treatment. In line with what is recommended, 60% of people who come into CAMHS are now being identified for more treatment and transferred to the help they need, whereas those who are not, are signposted to other agencies that can better support them. For those who go on to receive treatment, there is a clear contract and a clear plan for getting help.
While there was some concern that changes would lead to worse outcomes for children and their families — since satisfaction levels were always high — recent reports indicate that service users continue to be satisfied with the service they receive (i.e. ~97% service-user satisfaction).
How are services working differently now?
Services and care pathways are now linked according to the principles outlined by THRIVE. The Choice Clinic has reduced the number of potential disruptive transition points by centralising the point of access to CAMHS. In the current clinic, cases are seen in one place and the decision regarding where they receive treatment are agreed on the same day. Managers meet weekly with Choice staff and can highlight any themes or issues of disagreement about Goal Based Care Plans, which are then fed into training and other systems in the Choice clinic to improve quality, but these do not disrupt families’ journey through the service.
What are the next steps for the Choice Clinic?
The Clinic is now in the process of starting to work with partnership agencies to share their waiting list and to develop more integrated care pathways. CWP is also working towards adopting self-referrals. There will also be continued improvement to data collection, and computerized waiting lists will be used to monitor data quickly and accurately. Better quality information will also be collected to inform future transformation projects.