i-THRIVE: Manchester and Salford’s Integrated Access and Care Pathways
What was the problem you were trying to solve?
Central Manchester University Hospitals NHS Foundation Trust (CMFT) provide child and adolescent mental health services (CAMHS) for Manchester and Salford. The move towards Integrated Access and Care Pathways (ICP) in Manchester and Salford was undertaken to overcome several internal and external challenges common to CAMH services.
With limited resources and funding, the demand for a wide range of services for children and their families has continued to outstrip what’s on offer. The overriding ambition of the ICP agreement has been to implement a uniformity and standardization of treatment, while also aiming to drive up efficiency to address the financial concerns, address the delays, and successfully cope with the demand. In Manchester and Salford, this has been achieved by bringing together specialist CAMH services with 250 staff spread across over half a dozen sites that operate to deliver treatment to young people who suffer from varying levels of mental health difficulties. This effort ensures that young people and families do not fall between the gaps by receiving variable levels of care.
What are the Integrated Access and Care Pathways?
The ICPs act as a “one house” model, or umbrella for providing services. This is achieved by bringing together community outreach, intervention, and signposting in an evidence-based fashion with a focus on easing the transition into more specialist systems and helping children to get help (and more help) as they need it. Underpinning the entire effort is a system that works to ensure that staff in all localities are equipped with strong and robust training around risk management, and systems are in place to escalate risk cases. While the approach to integrating services, and easing referrals in Manchester and Salford has been widely regarded as successful, development continues to be ongoing and iterative.
What approach did you take to developing the pathways?
The approach was based on good practice guidance with a focus on developing quality relationships with partnership agencies. Cross-agency work was paramount. These partnership relationships have been established to ease referrals into more specialist services. In addition, Manchester and Salford CAMHS have aligned their thinking to meet the outcomes put forward by Every Child Matters and have adopted the principles of the ‘One Team – Place Based Care model’ and the THRIVE framework. By aligning their services with THRIVE, Manchester and Salford can continue to assure a seamless whole-school and person centred offer across mainstream and special education extending from nursery to further education.
How do the pathways align with Manchester and Saflord’s i-THRIVE plans?
The ICPs have enabled Manchester and Salford services to become more THRIVE like with their focus on improved internal operations. More recently, they’ve also shifted to the THRIVE needs group conceptualization of service delivery, and they are looking to ensure that all the services within and across their organisational structures are working to implement THRIVE principles. There is now a plan to expand the ICPs even further with a focus on linking together a wider range of external agencies. They already have several historical relationships but their continued expansion will guarantee children and young people a smoothness of transition from signposting to accessing a referral to getting the help and support they need.
How have the new integrated pathways affected staff?
The vast majority of staff are on board with the principle of improving experiences for service-users. While changes initially led to a degree of resistance and unsettlement among staff members, staff went on to grow increasingly supportive. The growing support and acceptance was motivated by many early adopters who acted as champions for internal change. To date, staff are much more on board and accepting of the need for a degree of standardised practice around risk assessment and data management. Staff are also more aware of good quality data management, which includes outcome measurement, continuous monitoring, and participation feedback.
How have services been redesigned to enable delivery of the integrated pathways?
Services have worked collaboratively in the past, but the internal systems now allow for them to work together more effectively as part of a larger organisation reaching across numerous services. To encourage and enable collaboration, there is now several forums to bring people together to work more closely. In terms of external improvement, THRIVE helps CAMHS and partner agencies to think more strategically about working together in Manchester and Salford, bringing together professionals across sectors. THRIVE forms the backdrop for a re-invigorated conversation across agencies. The hope is for this to drive a cross-border fertilization of THRIVE ideas.