9 Needs assessment/baseline data and Action Plans – South Unit of Planning 9.1 Treatment - South Unit of Planning – South Unit of Planning 9.2 Creation of a service to meet waiting time Standards – Unit of Planning 9.3 Referral Process – South Unit of Planning 9.4 Classifying Risk and Urgency – South Unit of Planning 9.5 Information Sharing with Parents/Carers – Unit of Planning 9.6 Workforce Competencies and Experience – South Unit of Planning 9.7 Disciplines – South Unit of Planning 9.8 Competencies/Training – South Unit of Planning 31-33 33-35 35-37 37-38 38 38-40 41 44-45 Appendices Appendix 1 Engagement Event User feedback – 23rd July, 12th August and 20th August 201 46 Appendix 2 Developing a Single All Age Eating Disorder Pathway What will it look like?- a service journey 47-59 Appendix 3 Roles of the Eating Disorder Team 60-63 Appendix 4 Easy Find Guide for Assessors – Commissioners Check List 64-72 Eating Disorders Transformation Plan 2015-2020 Development of a countywide, all-age, seamless Eating Disorder Service with one specification and two Units of Planning North and South Derbyshire Executive summary
7.2 Creation of a service to meet waiting time standards Requirements for a viable and dedicated Eating Disorder Service Recommendations we are/baseline Where we need to be and action (NICE)-concordant treatment should within a maximum of 4 weeks from first contact with a designated healthcare professional for routine cases and within 1 week for urgent cases. Currently compliant where there is evidence of eating disorder e.g. sufficient referral information Increased capacity at the point of referral in order to respond to concerns proactively – e.g. follow up on referral information. Dedicated admin support and additional resource for ‘duty response’ on receipt of referrals. Move away from small teams... 1 team preferred A ‘hub and spoke’ model or local network model may be appropriate, with a clearly defined structure and strong leadership. Service currently provided by dedicated staff at 2 locations (Chesterfield & Buxton ) Team supervision monthly- when all clinicians involved with ED’s meet to maintain consistency – invitation extended to DHCFT ED clinicians. A common pathway from referral to treatment is followed. MDT approach to care when children are referred via paediatrics Ensuring continuity of current best practice at level. Steering Common service specification. Receive a minimum of 50 new eating disorder referrals a year, which are likely to include anorexia nervosa, bulimia nervosa, binge eating disorder and related diagnoses Not currently recording this although we estimate that this number is met when including ‘related disorders’. Current eating disorder pathway does not have capacity to meet the requirements to include ‘related disorders’. Increased capacity is required for comprehensive service
Cover a minimum general population of 500,000 (all ages) Not met To form one team of a county wide service following one pathway. Include medical and non-medical with significant eating disorder experience Currently available Also training environment for Specialist Registrars need to develop CBT E and increase capacity for SFT 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) Self-referral not currently available. Direct referral from primary services. Telephone duty professional 9-5 for urgent referrals A proactive programme of advertisement including website referral option. Electronic systems to facilitate liaison and rapid communication with primary services and service users. Develop relationship with voluntary sector Most children and young people should be treated in the community with inpatient admission considered where there is high or moderate physical risk Access to urgent medical input as with paediatrics Admission available through CRH paediatric ward for short term focused admission in keeping with Jnr Marsipan guidelines. A MDT approach with weekly meetings, ED care plan and dietetic daily CAMHS review. For paediatric admissions to be fully commissioned for those where compensatory behaviours are limited and medical stability will be strengthened by a slightly longer admission to in order to support a robust discharge home for further home treatment and avoid tier 4 referral Admission should be to appropriate facilities with access to educational provision and related activities. Education base on Paediatric ward. Teaching staff and play specialist staff attend ward rolling programme of CAMHS teaching re ED’s and join MDT meetings for children, liaising with child’s school to ensure continuity of education provision Staffing of play specialists adjusted as needed for admissions. Needs to be acknowledged through investment.
There should be lead consultant/champion for acute eating disorder care, as advised in the Junior MARSIPAN. There is at present no dedicated consultant champion for acute eating disorder care, The specialist eating disorders service would provide appropriate psychological and medical and social support interventions aimed at recover and the reduction of risk in accordance to the NICE guidelines and the junior MARSIPAN.. this will be achieved by the recruitment of the paediatrician and the integrated of care being developed with the CRHFT It is anticipated that the psychological interventions delivered will be a minimum of 6 months duration, as identified by NICE 2004 .The presence of a specialist service is expected to facilitate earlier discharge of patients from specialist inpatient units. This service would be a tertiary service accessed via the CAMHS team. service and paediatric support: support should be provided to these services 7 days a week Generic CAHMS psychiatric support currently available via on call system however they are not eating disorder specifically trained. Explore options for training specialist psychiatric support. Administrative and management support; by experienced staff with training in relevant areas including data entry. limited availability as part of generic Tier 3 Dedicated and managerial support. Electronic records system 7.7 Disciplines
interventions for anorexia nervosa and specifically adapted of CBT for bulimia nervosa, in particular CBT-E family practice for eating disorders through the training team. Although we offer CBT when appropriate we are not currently offering CBTe. Use up-to-date 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 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 model 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 we are /baseline Where we need to be and action plan (NICE)-concordant treatment should 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
A ‘hub and spoke’ model or local network model may be appropriate, with a clearly defined structure and strong leadership. access by the other generic CAMHS teams. model of two providers under 1 steering group with clear policies regarding governance, accountability and an agreement of shared resources when appropriate to attain the required targets, KPI’s and NICE concordant treatment. Receive a minimum of 50 new eating disorder referrals a year, which are likely to include anorexia nervosa, bulimia nervosa, binge eating disorder and related diagnoses We do not have capacity currently to meet this target. The training team working at full capacity and meeting the NICE concordant treatment would only be able to hold about 30 cases. We envisage the proposed team to work with 65 referrals per year. In addition to providing support and consultation to eating disorder cases within the generic CAMHS, ensuring concordance of the ED care bundle. Cover a minimum general population of 500,000 (all ages) We currently cover the population of South Derbyshire and Derby City – population of 630,000 To extend to cover the Derbyshire the population of around 1,000,000 to include North Derbyshire with population of 380,000 Include medical and non-medical staff with significant eating disorder experience We currently have established an eating disorder team to support training for CYIAPT SFP for eating disorders. This is a multidisciplinary team containing a child and adolescent psychiatrist, dietician, 2 CYIAPT trainees, family therapy supervisor, dietician and nursing. The capacity of this team is currently limited. We wish to increase the capacity of the specialist eating disorder team by increasing the clinical time of the multidisciplinary team. Enable direct access to community eating disorder treatment through self-referral and from primary care services (for example, GPs, schools, Some areas of the CAMHS service accept self-referrals –primarily 16-18 year olds can access the drop in at City Connexions. Extend access by allowing self-referral and direct referrals from primary care, schools and voluntary sector for all patients with a suspected eating disorder. This role historically was
Psychiatric assessment for children and young people We aim to offer comprehensive assessment within a team approach. This focuses not only on concerns regarding eating difficulties but also a broad based mental health assessment. The broader service has a mental health liaison team and we work with this team to provide continuity of service in relation to assessment and risk management. We also, where appropriate, link with other health care professionals working with family members e.g. parents or siblings. The Consultant Psychiatrist along with other staff with appropriate mental health training will complete this as part of initial assessment and on-going treatment and review within the team. Medical assessment and monitoring Medical assessments are carried out in the community CAMHS teams mainly by a Consultant Psychiatrist. Requests for blood tests are often made to the GP at time of referral to assist with the assessment. Earlier medical assessment as part of a comprehensive early initial assessment alongside other members of the multidisciplinary team. More input from Consultant Psychiatrist, liaison with GP and when necessary paediatric assessment. Rapid response to referrals- outlined in the care pathway Referrals are screened within Community CAMHS teams and urgent response taken if necessary Referrals to be screened by member of the CEDS-CYP on day of receipt and action taken according to risk. Staff trained to supervisory level for evidence-based psychological interventions for eating disorders (to include CBT/CBT-E and targeted family interventions) Currently there is some capacity for supervision of targeted family interventions and limited CBT. CYP IAPT trained Systemic supervisor (0.1 per week) Increased supervisory staff including in family therapy/practice to support both the clinical delivery of family based interventions and to consider the systemic networking requirements of working in an intensive treatment modality, supporting all families accessing family based interventions.
Whole time equivalents Head of service (psychiatry/psychology) 1.8 1.2 0.6 Speciality Doctors (psychiatry) (Registrars) 2.4 1.6 0.8 Paediatric medical treatment (Consultant) 0.3 0.2 0.1 Senior Clinical Staff (Bands 8a and 8b) 2.5 1.7 1.3 Eating disorder therapists (Band 7) 10.1 6.7 3.4 Home treatment specialists (Band 6) 3.8 2.5 1.3 Dieticians (Band 6) 2.3 1.5 0.8 Support Staff/Assistant Psychologists (Band 4) 2.7 1.8 0.9 Discipline Wte actual September 2015 Within the CED training team we estimate 20 referrals this year will be seen. In January 2016 this team will be able to see between 25 and 30 cases per year but with limited access to NICE compliant therapies. Head of service (psychiatry/psychology) 0.2 Speciality Doctors (psychiatry) (Registrars) 0 Paediatric medical treatment (Consultant) 0 Senior Clinical Staff (Bands 7) 0.6 Eating disorder therapists (Band 7) 2 (in training) (actual only 2 days in service) Home treatment specialists (Band 6) 0 Dietician (Band 6) 0.6 Support Staff/Assistant Psychologists (Band 4) 0 3.4 Recommended WTE staff broken down by role Number of referrals per annum 150 100 50
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 adult 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 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 legal 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 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 Needs Assessment? NA NA NA Have you created an eating disorder 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 south And link above to JSNA Does the eating disorder needs 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 27- 45 south Does the eating disorder 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 assessment include population data, for example data on population, projections, births, deaths and deprivation? Yes NA Service Model Have you decided to commission a single service for your CCG? No
A process to ensure that care plans will be completed on a multi-agency basis, in collaboration with children and young people and, where appropriate, their families of carers? Yes Governance structure in place Establish as a high priority Future in mind delivery group Steering group with local service users involved /participating – strengthened service user participation in the north unit of planning 7 Appendix 2 A proposal on how different agencies will work with children and young people with an eating disorder and, where appropriate, their families of carers to enable access to education, employment or training? To be developed To be developed further in collaboration with wider stakeholders including schools , CAYA education department , community groups, under the stewardship of the future in mind delivery group Appendix 2 Awareness plan Does Public Health England provide good ‘balanced’ information to children and families about healthy weight and eating disorders? Yes Engaged with Public health England representative Tina Smith at service user and specialist providers ED workshop.. Positive feedback about guidance and information available . na Does the CEDS-CYP have a plan to provide and training to primary care and schools? Yes 3rd sector remit ED service supervision 8 Appendix 2 Care pathways and protocols Is a plan to provide clear routes to a CEDS-CYP from Yes on existing partnerships at Derby Royal Hospital FT and Chesterfield Royal hospital FT .(CRHFT) Paediatric teams to improve partnership and 4, 8, 13,27,