Page Number 1 Executive Summary - Our Vision for Children’s and Young People’s Eating Disorder Service 5 2 Resource Allocation by CCG 6 3 Governance Model for Eating Disorder Service Transparency and Accountability 7 4 The Transformation of our Specialist Eating Disorder Service Priority Summary 4.1 Shared Priorities for first 6 months November –April 1015 Transformation 4.2 Shared Priorities for April 2016 - March 2020 - When plan is assured 8 8-9 5 Outcome measures and Key Indicators to be integrated into Service specification when developed 10-11 6 Section 1: North Unit of Planning North Unit of Planning CAMHS Chesterfield Royal Hospital NHS Foundation Trust 6.1 Summary of Current Provision – North Unit of Planning 6.2 Prevalence and Numbers – North Unit of Planning 6.3 Specific Service Development – North Unit of Planning 6.4 Finance and the Proposed Model – North Unit of Planning 12 12 12-13 13 7 Assessment/baseline data and action plans – North Unit of Planning 7.1 Treatment – North Unit of Planning 7.2 Creation of a service to meet waiting time standards – North Unit of Planning 7.3 Referral Process – Unit of Planning 7.4 Classifying Risk and Urgency – Unit of Planning 7.5 Information Sharing with Parents/Carers – North Unit of Planning 7.6 Workforce competencies and experience – North Unit of Planning 7.7 Disciplines – Unit of Planning 7.8 Competencies/Training – North Unit of Planning 10 14-16 12-14 19-20 20-21 21 21-22 22-24 26 8 Section 2 Unit of Planning Eating Disorders – South Unit of Planning CAMHS Derbyshire Healthcare NHS Foundation Trust (DHCFT) 8.1 Summary of Current Provision – South Unit of Planning 8.2 Prevalence and numbers – South Unit of Planning 8.3 Current staffing 8.4 Service Development – South Unit of Planning 8.5 Finance and the CEDS – South Unit of Planning south 27-29 27 28- 29 30
Outcome measures and Key Indicators to be integrated into service specification when developed Outcome Key Indicators Access and wait times Urgent - 1 week to treatment Routine – 4 weeks to treatment Performance reports Service reports Improve Access Development of online web information and a self-referral form Promotion of CED’s and a whole pathway model including our third sector partners A measurable improvement in the mental health of young people using the service informed by CYP IAPT clinical outcome measures (This will include the severity of those young people accessing the service) Clinical outcome measures - SDQ RCADS SYMPTOM and IMPACT Trackers Honosca ) CGAS ) Social Functioning (including access to employment, training and education) A self-assessed improvement from the person’s perspective Patient Outcome Measures: Goal outcomes – GBO’s User satisfaction surveys from young people and parents and carers. Chi Esq. – Patient service questionnaire `How are you doing? ‘At all stages during treatment. Longer term a reduction in the length of Tier 4 admissions. This would be accelerated if the Innovations Fund application were successful. Comparison of past 4 years use of inpatient facilities (Thorneywood, and other external providers). Reduce the number of people accessing Tier 4 inpatient facilities. Evaluation of outcomes - Reference costs to possible inpatient v community services. NICE Compliance - ROM’s
Eating Disorders - Transforming Services Baseline Data and Action Planning North Unit of Planning Chesterfield Royal Hospital Foundation Trust CAMHS 7. Needs assessment /baseline data and action plans 7.1 Treatment Recommendations we are /baseline Where we need to be and action plan How is service is improving early identification Current re-writing of referral guidelines to be distributed widely Structured education offered to GP’s A more proactive programme of advertisement including website etc., with personnel linked to GPs, schools and Multi Agency teams. Addition of CAMHS liaison worker and voluntary sector support workers to work in partnership. Offer evidence-based family interventions that directly address the eating disorder Systemic Family Therapy offered with eating disorder limited capacity. Increased capacity of dedicated Systemic Family Therapy to be able to offer more consistently. Multi-Systemic Family Therapy Training and Systemic CYP IAPT needed. Home treatment family intervention needed – 7 day Capacity to offer family group meetings
family members including siblings should normally be included in treatment Family assessment undertaken for all referrals and family included in treatment- limited capacity. Regular availability of group/family support, advice and training sessions. interventions may include sharing of information, advice on behavioural management and facilitating communication Included in current practice guidelines – confidentiality and information sharing policy. Consistent advice on behavioural management from dedicated clinicians. Need increased capacity to deliver home support and liaison with schools, MATs, GPs. Training and awareness rising from voluntary sector. Offer age-appropriate care to address rise of early-onset eating disorders in those under 13 Currently available within service and also a family approach to care Increase in availability of individual therapy for children less than 13yrs such as Creative Therapy – consider voluntary sector provision. accessible to females and males and culturally appropriate Predominantly female workforce Need to consider gender, race, ethnicity and difference, currently no dedicated male clinician available Clinicians will need to continue to offer NICE-concordant treatment within the framework outlined in this guide Systemic Family Therapy (SFT) and Cognitive Behaviour Therapy (CBT) currently available increased capacity of dedicated SFT and CBT Treatment should include specialised community family interventions for anorexia nervosa and specifically adapted forms of CBT for bulimia nervosa, in particular CBT-E CBT and SFT available- limited capacity Increased capacity of dedicated SFT and CBT Multi-Systemic FT Training and Systemic/ CBT CYP IAPT Home treatment family intervention needed – 7 day Capacity to offer family group meetings CBT-E training Use up-to-date evidence-based interventions to treat the most common types of coexisting mental Holistic intervention currently available using evidence base Psychiatric medical review process Increased capacity of dedicated SFT and CBT to enable increased provision for co morbid presentations.
example, GPs, schools, colleges and voluntary sector services) Each service should have clear, accessible contact details on a website, which are easy to find via main search engines, with clear instructions in appropriate languages on how to call the service, send an email or complete an online self-referral form. Not currently available A more proactive programme of advertisement including website referral option. Avoid lengthy referral in-house processes CAMHS team is required to make contact with the CEDS-CYP as soon as the possibility of an eating disorder is raised. This should be done by telephone or electronically following discussion with the child or young person and their parents or carers There is a fast track route into the service Assessment available within a week of internal referral NA The causes for missing an appointment should be investigated carefully, and the referrer and the GP/trusted adult informed. This is recorded in the child or young person’s clinical notes. An appointment should be booked to take place within 2 working days of the missed appointment. Current practice meets requirement to make contact following missed appointment. However appointment in 2 days not always available and would be dependent on clinical presentation Review appointment service and make appointments available within 2 working days
Additional staffing required to deliver the service: Post Band Phase 1 (wte) Cost Phase 2 (wte) Cost Admin support 2 1 £19,300 0 Support Workers – Sector 4 0 0 2 £53,167 (indicative only) Specialist Transition Worker 6 1 £36,567 Psychologist/Senior Clinician 8a 0.5 £44,261 0 Therapists 7 0.5 £21,921 1 Senior Therapist / Team Manager 7 1 £43,842 0 Family Therapist Supervisor / Clinical 7 0.2 £8,768 0 Paediatrician / paediatric support Cons 0.1 £11,020 0 Psychiatrist (Head of Service) Cons 0.4 45,162 0 Pay Cost 230,841 Non Pay 26,333 Overheads 38,576 Total Cost 295,750 £53,167
a service to a limited number of families with eating disorders. family members including siblings should normally be included in treatment As a service we seek to include family members in treatment routinely. The increase in availability of family interventions alongside systemic thinking about care planning should ensure that family involvement is paramount. interventions may include sharing of information, advice on behavioural management and facilitating communication This has been built into the Eating Disorder Care Bundle which provides guidance to both generic and specialist ED clinicians. Robust assessment should ensure that psycho-education and behavioural advice is given in a timely and effective manner. An extended and skilled team will aid effective communication with families, GPs, schools, voluntary and other agencies Offer age-appropriate care to address rise of early-onset eating disorders in those under 13 We currently accept referrals from any or young person under the age of 18 years Improved recognition and identification of eating disorders should help to identify those with an eating disorder at an earlier stage. Evidence based therapies including SFP will be offered to this age group. accessible to females and males and culturally appropriate We currently accept referral from both females and Training and education would aim to encourage identification of males with eating disorders as they are likely to be under recognised and stigma may be greater. Clinicians will need to continue to offer NICE-concordant treatment within the framework outlined in this guide Partially met via the training team – no current access to CBT-E, CAT, Family therapy, limited resource for meals observation and limited home treatment support on providing evidence based treatments within the defined time periods such as family based interventions, CBT-E and treatment of any co-existing mental health problems Treatment should include specialised community family Our service currently offers a limited population of our patient’s systemic Staff to be trained in CBT-E with appropriate supervision arrangements.
interventions for anorexia nervosa and specifically adapted forms of CBT for bulimia nervosa, in particular CBT-E family practice for eating disorders through the training team. Although we CBT when appropriate we are not currently offering CBTe. Use up-to-date evidence-based interventions to treat the most common types of coexisting mental health problems (for example, depression and anxiety disorders) alongside the eating disorder Our service follows NICE guidance and offers evidence based interventions for depression, anxiety disorders and other co-existing mental health disorders – currently limited due to resource capacity. We are further developing a treatment pathway so that there is streamlines access to evidence based therapies and treatments for mental health conditions 9.2 Creation of a service to meet waiting time Standards Requirements for a viable and dedicated eating disorder service Recommendations Where we are /baseline Where we need to be and action plan (NICE)-concordant treatment should start within a maximum of 4 weeks from first contact with a designated healthcare professional for routine cases and within 1 week for urgent cases. We currently do not meet this target to treatment. An initial assessment with physical health assessment are priorities for urgent referrals within one week. For routine cases assessment and then time to treatment can very across the service (4-12 weeks). Access to the training team is limited and has strict eligibility criteria Fifteen young people have been accepted by the team and treatment has been provided within 4 weeks of referral Additional resources would enable us to achieve this target. The training team is not working at full capacity, but we will require additional staff to achieve this target. Move away from small teams - 1 team preferred We have developed 1 centralised Specialist training team that can be Single provider model would work well in the future. However a potential
Recommendations Where we are /baseline Where we need to be and action plan The CEDS-CYP should have clear online referral forms. Currently not available Our aim is that this is supported the development of online self-referrals and access to detailed information across the NHS and our partners web pages. Enable direct access to community eating disorder treatment through self-referral and from primary care services (for example, GPs, schools, colleges and voluntary sector services) Currently not available Extend access by allowing self-referral and direct referrals from primary care, schools and voluntary sector for all patients with a suspected eating disorder.. Access to this pathway can additionally be supported by the development of social media and web based information. Each service should have clear, accessible contact details on a website, which are easy to find via main search engines, with clear instructions in appropriate languages on how to call the service, send an email or complete an online self-referral form. DHCFT and CAMHS have a web site that is accessible. This is currently being reviewed by young people with the proposed development team to include young people and families to make it more accessible and user friendly. Introduce one direct contact for referrals for suspected eating disorders Our aim is for the development of online self-referrals and access to detailed information across the NHS and our partners’ web Avoid lengthy referral in house processes CAMHS team is required to make contact with the CEDS-CYP as soon as the possibility of an eating disorder is raised. This should be done by telephone or electronically following discussion with the child or Currently access to the CED training team is limited and presentation is specific to training criteria and therefore there is not a full and equitable service being provided. Additional resources enable us to achieve this routinely.
need training and link with regional plan to meet local need by need in communities for specialist provision APPENDIX 1 Engagement Event User feedback – 23rd July , 12th August and 20th August 2015 (Stakeholder participation list : to: appendix 1 FIM main submission) They say we do…
Specialist Transition Worker Outreach Worker – Specialist Liaison Worker Possible Social worker – secondment. Target integrated care plans with MATs and Social care. Attendance at Section 117 and CPA Discharge meetings. Lead safeguarding role Support the integration of child and adult CED transition. Provide continuity of care across the services Access and develop the RO DBT pathway with the CED team. Liaison with social care in support of Integrated care planning Family Therapy / Parenting worker – school liaison, case coordination and education – management of support workers. Appendix 4 Easy Find Guide for Assessors – Commissioners Check List Derbyshire County Council and Derby City Children and Young People’s Eating Disorder Service Transformation Plan 2015-2020
Item Yes/No Comments Page Number Baseline current service provision Do you have a current eating disorder service ? Yes We have a service that needs strengthening building and skilling a dedicated specialist workforce be fit for purpose to meet standards and guidelines 12 and 26 Do you have any data about current outcomes, service user feedback and service activity? yes Base line data re: outcomes service activity Service user feed back 12-26 north 27- 45 south Appendix 1 46 From these data, can you identify gaps in service when comparing service provision with anticipated need? Yes Refer to gap analysis and action plans 12-26 north 27- 45 south Needs assessment We have consulted the relevant data published by Public Health England through the former Child and Maternal Health Observatory N/A Do you have a JSNA? Yes Please click link below JSNA -state of mental health in Derbyshire. : NA Has the JSNA ensured that the new service satisfies all duties with regard to equality, health inequalities and monitoring improvement? Yes NA Does the JSNA include the CAMHS Needs Assessment? YES The JSNA the state of mental health in Derbyshire should be viewed in conjunction with the baseline needs assessment detailed within this document. Public Health and commissioners will continue to work closely with providers to focus bespoke local resources in areas of unmet need based on the local demographic features and wider determinates of health. 12-26 north 27- 45 south Do you have a separate CAMHS Needs Assessment? Yes To be viewed in conjunction with JSNA 12-26 north 27- 45 south Was the CAMHS Needs Assessment completed with local authority, public health and education partners? YES NA
If not, have you ensured that they have signed up to the CAMHS Needs Assessment? NA NA NA Have you created an eating disorder needs assessment in line with the CAMHS Needs Assessment and the JSNA? YES We will strengthen needs assessment to include data on age, gender and ethnicity of service users 12-26 north 27- 45 And link above to JSNA Does the eating disorder assessment include the views of children, young people and families? Yes Engagement ensured that views of children and young people heard – engagement events details and Attendance list –appendix 1 main FIM plan Appendix 1 Has current service provision data been included in the prediction of future needs? Yes 12-26 north 27- 45 Does the eating disorder needs assessment include prevalence data on eating disorders for the population? Yes Based on current numbers seen by North and South Units of planning 12 and 27 Does the eating disorder needs assessment include demographic data, for example data on age, gender and ethnicity? No Need to strengthen needs assessment to include accurate data on age, gender and ethnicity of service users, as a priority. This will be facilitated by improved IT systems 8 Does the eating disorder needs assessment include population data, for example data on population, projections, births, deaths and deprivation? Yes NA Service Have you decided to commission a single service for your CCG? No
medical and professionals? and integrated working that can quickly facilitate brief admissions .This is well developed in CRHFT . but needs further development in the south Unit of planning Does the local proposed care pathway meet the Access and Waiting Time Standard? Yes 12-14 31-33 Does this intended service provide a full range of treatments for example, family therapy and CBT for eating disorders? Yes 9, 11-12 16-17 23 28-29 33-34 Transition plans Is there a plan for how transitions between services will be kept to a minimum? Yes Detailed in plan 8, Appendix 2 57-58 62-63 Is there a plan to ensure clear and efficient transition arrangements to adult services? Yes Is a plan to ensure clear and efficient transition arrangements across geographical boundaries? To be developed Closer working partnerships across geographical boundaries are being fostered between CRHFT and DCHCFT, supporting the development of more efficient transition arrangements across geographical boundaries north and south of the county as there will be one specification. Does your provider have appropriately trained and experienced staff to meet the recommendations in Section 4.3 of this guide? No – Our core specialist eating disorder service will build on exiting CAMHS services- recruiting and skilling the work force to provide evidence based NICE concordant treatment to meet the standard’s required for crisis, waiting times and treatment Baseline audit and action plans North 20-25 South 39-45 If ‘no’, do they have a recruitment plan? Yes Yes – see above Training plan Is your provider part of CYP IAPT or do they plan to adopt Yes South of county DCHFT Fim main document p