CAMHS Waiting list times and standards
| Authority | Manx Care |
|---|---|
| Date received | 2021-11-01 |
| Outcome | Some information sent but not all held |
| Outcome date | 2021-11-25 |
| Case ID | 2064621 |
Summary
The requester asked for CAMHS waiting list statistics and an audit report against Royal College of Psychiatrists standards. Manx Care disclosed a draft audit report from November 2021 but did not provide specific waiting list numbers or reasons for delays in the provided text.
Key Facts
- Manx Care is auditing its CAMHS service against the Royal College of Psychiatrists Quality Network for Community CAMHS Service Standards (6th Edition).
- The audit methodology included interviews with six staff members and questionnaires for referrers and service users.
- Review of clinical notes for 20 service users was listed as 'STILL TO BE COMPLETED' in the draft report.
- Feedback from referrers indicated a lack of information regarding waiting times and updates after referral submission.
- The audit focused on Sections 1, 2, and 8 of the service standards.
Data Disclosed
- 2021-11-01
- 2021-11-25
- 15.11.21
- 6
- 20
- 24
- 2
- 6th Edition
- Section 1
- Section 2
- Section 8
Original Request
Dear Sirs 1 I would request a response in regards how many children on the Isle of Man are waiting for an initial assessment to CAMHS , after being referred to CAMHS by a GP or any other Government body. 2 I would ask for how many children are still awaiting the initial assessment 6 months after referral and over a year after referral. 3 I am also aware that CAMHS has a benchmark that it should be working to . The Royal College of Psychiatrists produce a Quality Network for Community CAMHS Service Standards and I am aware that currently the Isle of Man Mental Health Service is assessing and auditing our current CAMHS service and provisions against these standards. If the audit has not been fully completed, please supply the content that has been completed to date. 4 I would request a copy of this audit so I can see how good or bad the Isle of Mans CAMHS standards are against the Quality network for community standards . If the response is that we have children waiting over a year for an initial assessment at CAMHS, please supply the reason why this is happening, e.g. lack of staff or lack of resources etc.
Data Tables (18)
| CAMHS work with all potential referrers including families and young people to ensure access is appropriate, timely and co-ordinated | |||||
|---|---|---|---|---|---|
| Numb er | Type | Standard | Evidence Key 1. Service user/carer feedback 2. Referrer feedback 3. CAMHS staff feedback | ||
| 1 | 1.3 | The service provides information about how to make a referral and waiting times for assessment and treatment. | 2. No information is available when a referral is made (2), the first we usually hear will be a copy of the appointment letter being sent to school (1). I was not provided with any information regarding waiting times that I recall (1). None (2). No information regarding waiting times nor any updates once referrals are submitted. Only receive confirmation that it has been received (via generic email) (1). We have CAMHS referral forms in school no information has been provided about waiting times officially-however anecdotally this is known (1). Before I made the referral I had very little info and was unsure what steps to take, but this could just be because I was new to the role. Once I made the referral clear info was sent (1). I work in a primary school and have always used the referral form which is straightforward. I have been told there is long waiting lists and found this is the case (1). Information passed when took over job. Waiting times are not passed are not passed over to us but can understand why (1). I found out about referral process by talking to my colleagues. Whenever I asked about waiting times etc. I have always been told that they cannot be specific (1). |
| Guidance on how to make a referral was provided. However no information has been provided about waiting times for assessment or treatment. CAMHS information on waiting times was provided from NDD We have the CAMHS referral form already on file. No other information given about waiting times or assessment. The process of referring is very difficult. I know that a child with mild mental health difficulties will not be seen, so there is nowhere for them to go unless I put self harm, suicidal, ADHD or autism on the referral form. The department centrally holds referral forms. No information is shared regarding assessment and treatment. Although it is acknowledged that the service have a number of vacancies and large caseloads. I was asked to send the letter via email out and provided with a rough assessment of waiting times. Had informal discussion with CAMHS team and the process was discussed. It was clear that patient would be assessed, but will be over 18 before treatment could be offered. 3. Yes all referrers are aware of referral process. Referrers know how to refer. Don’t provide that information required for gp’s and schools to refer | |||
|---|---|---|---|
| 2 | 1.5 | Where referrals are made through a single point of access, these are passed on to the community team within one working day unless it is an emergency referral which should be passed across immediately | 3. There is a criteria the on call comes worker will see people within 24 hours if an emergency is identified. All referrers ah screened by duty officer. When referral is received it is placed against criteria and put on waiting list depending on severity and amount of risk |
| 1 | 1.4 | A clinical member of staff is available to discuss emergency referrals during working hours. | 3. Duty officer (member of clinical staff) available and screens all referrals duty officer undertakes risk assessment within one working day. |
| 2 | Young people and families are able to make a self-referral to the service. | 3. No, families are not able to make self referral |
| received. No information about waiting time is discussed. Received automatic reply acknowledging receipt of referral. 3. Feedback is provided by letter consent is requested to share information there is also a standard rejection letter. Information is provided about waiting times | |||||
|---|---|---|---|---|---|
| in | |||||
| Measures are taken to ensure equity of access | |||||
| 1 | Appointments are flexible and responsive to the needs of young people and their parents/carers where appropriate. Guidance: For example, young people and their parents/carers can choose a suitable appointment time and appointments can be offered out of school or college hours; home-based or school-based treatments are offered where appropriate. | 1. Yes responsive to needs and flexible, fitted around other commitments (3), no, difficult to get appointment (1). 3. To a degree and where this is possible in terms of the services’ ability. There are some limitations. No out of hours provision. | |||
| 1 | 1.1 | The service reviews data at least annually about the young people who use it. Data are compared with local population statistics and action is taken to address any inequalities of access where identified. | 3. No, perhaps completed by a manager. There are service audits such as CPA audit. | ||
| ` | 4.1 | The team follows up with young people who have not attended an appointment or assessment. If they are unable to engage with the young person, a decision is made by the assessor/team, based on need and risk, as to how long to continue to follow up the young person. | 3. Yes call families, send two week letter and inform referrer, not allowed to discharge due to person being on NDD medication. Yes ask parents to get in touch. Contact by telephone and/or letter. Referrer informed. | ||
| 1 | 4.2 | If a young person does not attend an assessment or appointment, the assessor contacts the referrer. Guidance: If the young person is likely to be considered a risk to themselves or others, the team contacts the referrer immediately to discuss a risk action plan. | 2. School receives a copy of the DNA letter (if it is school that has made the referral). No other communication /discussion. N/A (2). Brief note I can’t remember any risk action plans. Often just a note that they’d been discharged (1). Letter (2). No risk action plan. Letter received advising appointment missed and that case would be closed if future non-attendance (1). We are never informed of this (1). This has never happened (1). Once or twice-and the parents hadn’t received a letter inviting them to |
| attend. On the other hand children have been invited to attend appointments and the school and the school has not been informed (1). I usually contact Cambs after speaking with young person prior to receiving any information from Cambs. No risk action plan has ever been discussed. No assertive outreach was provided to risk young people. One person discharged while still reporting visual hallucinations because they did not attend an appointment they could not attend due to being in isolation. No telephone contact was made to young person or their parents. No information given. Named person always shares this information. Not applicable. No contact Dices risk assessment was part of referral. 3. Yes call families, send two week letter and inform referrer, not allowed to discharge due to person being on NDD medication. Yes ask parents to get in touch. Contact by telephone and/or letter. Referrer informed. Contact family for reappointment and copy letter sent to referrer. | |||||
|---|---|---|---|---|---|
| 2 | Data on missed appointments are reviewed monthly. This is done at a service level to identify where engagement difficulties may exist. Guidance: This should include monitoring a young person’s failure to attend the initial appointment after referral and early disengagement from the service. | 3. Data on appointments is monitored via RIO appointment system. Discussed in Mangers meetings but don’t know if reviewed monthly | |||
| Young people receive timely mental health assessments | |||||
| 1 ` | 1.6 | Young people with a routine referral receive a mental health assessment within six weeks (or four weeks for Trailblazers). Young people with urgent mental health needs can access a mental health assessment within 24 hours. | 3. No, can be seen sooner by Duty officer -eating disorder, psychosis, suicidality. |
| 1 | 2.1 | For non-urgent assessments, the team makes written communication in advance to young people that includes: • The name and title of the professional they will see; • An explanation of the assessment process; • Information on who can accompany them; • How to contact the team if they have any queries or require support (e.g. access to an interpreter, how to change the appointment time or have difficulty in getting there). | 1. Yes received contact in the form of a letter and questionnaire (2), phone call followed by letter (1), appointment letter had all details on it of who would be doing assessment and their name (1). 3. Yes brief information letter/proforma -who they are seeing, offer of contact, assessment length, go to families. Does not explain actual assessment process. Explains process of consultation. |
|---|---|---|---|
| 1 | 3.6 | The team sends correspondence detailing the outcomes of the assessment to the referrer, the GP and other relevant services within a week of the assessment. | 2. We sometimes receive a copy of the letter when sent to parents but still depend if consent to share is in place (1). Detailed letter (1). Still awaiting assessment since June 2020 referral (1). Very long waiting list. We often get letters back from CAMHS saying no action for CAMHS, sometimes with signposting often next steps are uncertain. Assessment copy. Request to prioritise thru a non-existent shared care policy (1). Letter providing information about appointment (1). On the whole we received very advice on the outcomes. This is useful and very much appreciated. The letters generally arrive in a very timely fashion (1). One assessment has been made but I’m yet to receive any feedback. This could be because of lockdown (1). Varies yes we receive communication. Often it is anecdotal based on what child/parent says. There have been occasions when a child reports something about a teacher e.g. shouts at me all the time. I think more care needs to taken when reporting back (1). Usually receive letter explaining they are on a waiting list with no practise, advice, support or time scales. After assessment, a very basic letter gets sent the letter usually comes quite quickly. No support for strategies in school and parents often left very upset and confused, especially with the lack of information and support given. I received a letter within a week or two after the assessment, |
| which detailed the outcomes. Generally in my experience case closure is the outcome due to non-engagement. Not to my recollection. 3. Yes to referrer, to GP if consent has been given, not always within a week sometimes longer. Yes full assessment sometimes longer than a week. | |||||
|---|---|---|---|---|---|
| Assessments are collaborative, individual and according to need | |||||
| When talking to young people and parents/carers, health professionals communicate clearly, avoiding the use of jargon so that people understand them. | 1. Everything was discussed in a manner that me and my daughter understood (1), very, anything we didn’t understand she fully explained (1), everything was pretty understandable (1), no, as far as they were concerned I was depressed and it was my age (1). 3. Yes, try to avoid technical jargon and use simple comparisons for ease of understanding. Yes individual basis take it person-by- person. Sometimes need jargon e.g. MSE. | ||||
| 1 | Staff check that young people and their parents/carers understand the purpose of the assessment and possible outcomes as fully as possible before it is conducted. Guidance: For example, this is specified on an assessment checklist and audited through service questionnaires for young people and parents/carers. | 3. Yes discussed at beginning of assessment, yes check understanding/explanation | |||
| 1 | 3.2 | Young people have a comprehensive assessment which includes: • Mental health and medication; • Psychosocial and psychological needs; • Strengths and areas for development; • Risk, including risk of suicide. | 3.Yes, broadly, not assessed for meds if not on meds,, yes all and more if NDD, specific development assessments, speech, development autism/adhd, early life questionnaire, risk-DICES. | ||
| 1 | 3.4 | Young people have a risk assessment and management plan which is co-produced, updated regularly and shared where necessary with relevant agencies (with consideration of confidentiality and consent). Assessment considers risk to self, risk to others and risk from others. | 1. No, I never got a plan, I don’t even know what a plan is, when I was in school I was in MOBEX, I really think you should offer more things like what Mobex does (1), as a parent involved and as a child involved too and given advice and options (1), we were asked many questions, what we would like to achieve (1), |
| we are still trying to find the medication that suits my daughter (1). 3. Yes, Shared depending on agreed consent. Co-produced depending on level. DICES rarely shared with young people, maybe with older adolescent. Yes based on need of patient at time. | |||||
|---|---|---|---|---|---|
| 1 | Assessments are based on the wishes and goals of young people, the family and their capacity to support interventions. | 3. Yes, generally. | |||
| 1 | All assessments are documented, signed/validated (electronic records) and dated by the assessing practitioner. | 3. Yes. | |||
| 1 | Young people assessed as requiring treatment see an appropriate clinician within access and waiting times guidelines relevant to the practice area and local agreements. | 3. Yes. ‘Would hesitate to say yes-related to resources and enough bodies.’ Assessment dependent on risk assessment and length of waiting list. ‘No waiting list protocol.’ | |||
| Assessments are effectively co-ordinated with other agencies so that young people and their parents/carers are not repeatedly asked to give the | |||||
| same information | |||||
| 1 | There are processes in place to identify whether young people or parents/carers are involved with other agencies. | 3. Do ask, consent is sought from all other professionals involved. Yes standard question. Yes always ask, school contact, liaison, sometimes 4-5 agencies. Ask referrer. | |||
| 3 | The assessing professional can access relevant information (past and current) about the young person from primary and secondary care and other relevant agencies. | 3. No access. Have obtain information through referral process, and information sharing. Not possible from GP’s unless via referral. Paediatrician does discuss medical history. | |||
| The team assess the physical health needs of young people accessing the service | |||||
| 1 | 3.3 | A physical health review takes place as part of the initial assessment, or as soon as possible. | 3. Yes, Physical health policy, routinely ask about diet, weight, height, B/P for NDD. Blood tests, B/P Height and weight. Yes as medic, if there is any doubt about health issues always followed up. Part of report template to ask about physical health. | ||
| 1 | 7.1 | Where concerns about a young person’s physical health are identified, staff members arrange for them to access screening, monitoring and treatment for physical health problems through primary/secondary care services. | 3. Where there are health issues identified these are followed up. Contact relevant medical professional for further advice/help. Yes keep link with paediatrician and medics. Assessed straight away for eating issues otherwise signposted to GP. | ||
| 1 | 7.3 | The team, including bank and agency staff, are able to identify and manage an acute physical health emergency. | 3. Yes although no physical health examination room in CAMHS building height, weight, B/P. Yes e.g. seizure. BLS mandatory training. |
| Young people and parents/carers (with consent) are fully involved and informed in care planning | |||||
|---|---|---|---|---|---|
| Numb er | Type | Standard | Evidence | ||
| 2.1.1 | 12.3 | Young people are actively involved in shared decision-making about their mental and physical health care, treatment and discharge planning and supported in self-management. | 1. Always involved. Welcomed into all appointments (if this was ok with my daughter (1), Yes (1), yes and also backed up by professionals e.g. child won’t wash so devised plan and professional spoke to child on washing procedures (1), Nothing like that ever happened, like I said I don’t know what the ‘plan’ is, but I’m still depressed and angry but when I turned 16 my mum was told that I had to find another Dr with the adult mental health service (1). 3. Yes options offered, Yes as much as possible. Age dependent, autism related. Yes. |
| 2.1.2 | 5.3 | Every young person has a written care plan, reflecting their individual needs. Staff members collaborate with young people and their parents/carers when developing the care plan and they are offered a copy. The care plan clearly outlines: • Agreed intervention strategies for physical and mental health; • Measurable goals and outcomes; • Strategies for self-management; • Any advance directives or statements that the young person has made; • Crisis and contingency plans; • Review dates and discharge framework. | 1. Never, nothing unfortunately (1), if a child is on medication seen regularly, if no medication not really seen at all after initial diagnosis all of the above but haven’t really been told about crisis care so far, excellent thorough, kept informed all the way. If meds are not suited something else is available can phone for prescriptions too, (1), seen at each appointment, treatments medication, reviews (1), discussed at every appointment, tweaking medication to find the correct one suited to daughter (1). 3. No every young person has a CPA care plan agreed and negotiated in person, parents are consulted during the process. Written into notes and in a letter to referrer and young person. Yes care plans are within clinical letters. Yes and offered a copy. Yes can include treatment suggestion to prevent exclusion from school and other risks. Limited reference to advance directives. Not always review dates. |
|---|---|---|---|
| 2.1.3 | 3.5 | All young people have a documented diagnosis and clinical formulation. Where a complete assessment is not in place, a working diagnosis and a preliminary formulation is devised. | 3. clinical impression when not seen by medic. Yes, should have diagnosis or clinical impression. No not always (when referring to clinical formulation). Yes would have diagnosis if in NDD pathway otherwise formulation. |
| 2.1.4 | Young people and their parents/carers (with consent, see guidance below) are supported to understand the benefits, functions, expected outcomes, limitations and side effects of their medications, intervention options and non-intervention options. Guidance: This is where the child or young person has capability/ competence to consent. HeadMeds or YoungMinds' websites, for example, could be used to access this information. | 3. Yes. Yes if on medications. Cannot prescribe medication unless parents give consent and are involved. | |
| 2.1.5 | 5.1 | All young people know who is co-ordinating their care and how to contact them if they have any questions. | 3. Yes. Yes young people may have some limits to options scaled from complex higher bands see more complex cases-process does offer opportunity for 2nd opinion. |
| 2.1.6 | Young people and their parents consistently see the same clinician for intervention, unless their preference or clinical need demands otherwise. | 3. No due to short staffing sometimes agency workers leave, small team. Can compromise wishes e.g. for female worker. Don’t always have the capacity to offer this. Agency workers on short term contracts. | |||
|---|---|---|---|---|---|
| 2.1.7 | There is a mechanism for young people to change their clinician if there are problems without prejudicing their access to treatment. Guidance: This should be referred to in service information. | 3. Is discussed in MDT meetings but not always possible. And is promoted can mean young person has to wait longer to be seen. due to above 2.1.6: No due to short staffing sometimes agency workers leave, small team. Can compromise wishes e.g. for female worker. Don’t always have the capacity to offer this. Agency workers on short term contracts. | |||
| Decisions around the prescribing of medication are collaborative where possible and monitored appropriately | |||||
| 2.2.1 | 6.2.1 | When medication is prescribed, specific treatment goals are set with the young person, the risks (including interactions) and benefits are reviewed, a timescale for response is set and the young person's consent is recorded. | 3. Yes NDD mostly, treatment goals set with parents. N/A (when discussed with family therapist). Yes regularly. Yes mostly can be hard to gauge response and side effect monitoring. Reviewed 2/3 weeks. | ||
| 2.2.2 | 6.2.2 | Young people have their medications reviewed regularly. Medication reviews include an assessment of therapeutic response, safety, management of side effects and adherence to medication regime. Guidance: Side effect monitoring tools can be used to support reviews. | 1. We are still trying to find the correct medication. Dr explained side effects and benefits (1), good everything was explained to him from why they were doing health checks to what the medication is for (1), yes all of the above kept well informed (1), again I’m afraid nothing I was on Prozac first but when it was changed my mum didn’t get told how to get me off the Prozac she read up on it herself and reduced them slowly. 3. Not regularly enough, not adhere to NICE guidelines due to capacity. Yes but impossible when care co-ordinator, info is sent to schools. Yes regular session with young person and parents | ||
| 2.2.3 | The safe use of medication is audited, at least annually and at a service level. | 3. N/A (when discussed with family therapist). Don’t know. |
| 2.2.4 | 6.2.4 | For young people who are taking antipsychotic medication, the team maintains responsibility for monitoring their physical health and the effects of antipsychotic medication for at least the first 12 months or until the young person's condition has stabilised, whichever is longer. Thereafter, the responsibility for this monitoring may be transferred to primary care under shared care arrangements. | 3. Yes people with CAMHS for four years. Yes unless GP prescribes first. Yes kept on books full time. Yes bloods. Shared care agreements in the process of being adopted. Sarah Vaukins audit of meds for shared care pilot | ||
|---|---|---|---|---|---|
| 2.2.5 | 7.4 | Young people who are prescribed mood stabilisers or antipsychotics have the appropriate physical health assessments at the start of treatment (baseline), at six weeks and then every six months unless a physical health abnormality arises. | 3. Yes, NICE guidelines-need paediatrician for those with concerns. Most commonly bloods, yes with autism. | ||
| 2.2.6 | 6.2.3 | Young people, parents/carers and prescribers can contact a specialist pharmacist to discuss medications. | 3. Recently, access to pharmacist 1 day per week, usually discuss with medics. Take to team members. | ||
| Staff provide support and guidance to enable young people and their parents/carers to help themselves | |||||
| 2.3.1 | 1 | Where appropriate, young people are offered personalised healthy lifestyle interventions, such as advice on healthy eating, physical activity and access to smoking cessation services. This is documented in the young person's care plan. | 1. No, never (1), encouraged to keep healthy, fit, and to go out each day for fresh air (1), no all health checks came back very good, there was no need for information on this (1), no (1). 3. signpost to dietician, gym. Yes but not always applicable, Yes. Yes signpost to tier 1 and 2 services classes in sport. Refer and signpost advice on healthy lifestyle, eating and sleep hygiene. | ||
| 2.3.2 | 2 | Young people and parents/carers are guided in self-help approaches where appropriate. Guidance: This may include those waiting between assessment and treatment. | 3. Yes, as care coordinator refer for self-help and advice where necessary. Could do more. |
| 2.3.3 | 2 | The team provides information, signposting and encouragement to young people to access local organisations for peer support and social engagement such as: • Voluntary organisations; • Community centres; • Local religious/cultural groups; • Peer support networks; • Recovery colleges. | 1. No but I would have loved that, I even said to my mum recently is there any way I can go back to speech therapy, I don’t have friends so that would have been great for me (1), None (1), no as he has a good group of supportive friends (1), my daughter was offered group sessions which she declined (1). 3. Yes cruse, motiv 8, not proactive or have capacity to develop more community links. Ask young people to check themselves. Yes leaflets, school counselling service, QWELL-online support, Ilse listen. | ||
|---|---|---|---|---|---|
| Efforts are made actively to support and engage parents/carers | |||||
| 2.4.1 | 1 | Parents/carers are involved in discussions and decisions about the young person’s care, treatment and discharge planning. | 3. Yes, always unless young person 16+who says no exceptions are any risk issues. Yes, whenever can. Yes unless a good reason not to. | ||
| 2.4.2 | 1 | Parents/carers are supported to access a statutory carers' assessment, provided by an appropriate agency. Guidance: This advice is offered at the time of the young person’s initial assessment, or at the first opportunity. | 3. No-is a UK initiative. Early help and support (EHAS). | ||
| 2.4.3 | 2 | Parents/carers are offered individual time with staff members to discuss concerns, family history and their own needs. | 1. No when the time came to go my mum would ask to speak on her own, she would be in there for five mins. and came out fuming, offer a service where the parents can have an app to themselves (1), No individual time no to carer support groups, yes advice (1), yes our opinions were asked, we were offered information on all aspects of his care (1), always involved (1). 3. Yes , if time allows. Documented as 3rd party information. Utilise duty and care coordinator. Yes, sometimes case specific depends on needs and capacity issues. Very child focused no culture of offering support for parents. | ||
| 2.4.4 | 2 | The team provides each parent/carer with accessible carer’s information. Guidance: Information is provided verbally and in writing (e.g. carer's pack). This includes: - The names and contact details of key staff members in the team and who to contact in an emergency; - Local sources of advice and support such as local carers' groups, carers' workshops and relevant charities. | 3. NDD-pack for autism and local support group, parenting group for ADHD. No. Can request information. Information pack after positive diagnosis, leaflets ASD information packs, information packs for tics. |
| 2.4.5 | 3 | The service actively encourages parents/carers to attend carer support networks or groups. There is a designated staff member to support carers. | 3. Used to have psychoeducation groups, parent support groups. Yes. No designated staff member. | ||
|---|---|---|---|---|---|
| Outcome Measurement is routinely undertaken | |||||
| 2.5.1 | 1 | Clinical outcome measurement data, including progress against user-defined goals, is collected as a minimum at assessment, after six months, 12 months and then annually until discharge. Staff can access this data. | 3. No, not routine. Goal based outcomes-no team culture of using outcome measures such as OSCA/HONOS. OCSA loose use. No the if specific database. GAD7 available but not used for younger people. | ||
| 2.5.2 | 2 | Staff members review young people's progress against self- defined goals in collaboration with the young person at the start of treatment, during clinical review meetings and at discharge. | 3. Rate using SUDS, generic measures, CDT for those with aspergers. Yes CPA meetings. Yes, recorded in progress notes. | ||
| 2.5.3 | 2 | The service's clinical outcome data are reviewed at least every six months. The data is shared with commissioners, the team, young people and parents/carers, and used to make improvements to the service. | 3. No, not routinely. Some statistical data is collected but not reviewed. |
| CAMH services are accessible | |||||
|---|---|---|---|---|---|
| Numb er | Type | Standard | Evidence | ||
| 8.1.1 | 3 | Everyone is able to access the service using public transport or transport provided by the service. | 1. Excellent, very accommodating calm experience (1), no direct buses at times of app, have to get 2 buses (1), very good (1). 3. not easily accessible by bus specifically from the south of the island. From North of island people may require 3 buses. |
| 8.1.2 | 2 | There is sufficient car parking space for visitors, including allocated spaces for disabled access. | 1. We drove, parking was limited, finding a bus may have been more difficult (1), parking can be tight, lack of car spaces (1). 2. Some but limited disabled parking spaces. Ramp for access by wheelchair. Width of door would make access to building very difficult. Corridors and door ways within building would make it difficult to access in wheelchair. After of the half-fifth if | ||
|---|---|---|---|---|---|
| 8.1.3 | 1 | The environment complies with current legislation on disabled access. Guidance: Relevant assistive technology equipment, such as hoists and handrails, are provided to meet individual needs and to maximise independence. | 1. Do not need disabled access so can’t comment on that (1). 3. No, difficult access. Handrail in one toilet. | ||
| Environments in which CAMH services are delivered are managed so that the rights, privacy and dignity of young people and their parents/carers are | |||||
| respected | |||||
| 8.2.1 | 2 | The service environment is clean, comfortable and welcoming. | 1. Clean yes-but feel they could give CAMHS a proper building. Staff are welcoming and yes rooms are private. Waiting room small (1), comfortable, the hot drinks are a good idea help you feel relaxed (1), very clean, all staff lovely. Such a calming environment (1). 3. Yes, reasonably clean, reception okay, rooms not fit for purpose, can hear, No PC’s in some rooms, some rooms close to waiting area-conversations can be overheard, Mice and rat droppings have been found. Limited staff space. People can over hear. Waiting room not spacious enough, sometimes people standing. No. | ||
| 8.2.2 | 2 | CAMHS practitioners have access to large and small rooms suitable for individual and family consultations. | 3. Yes rooms are small but there are some larger rooms for seeing families and groups but these are limited. | ||
| 8.2.3 | 1 | Clinical rooms are private and conversations cannot be easily over-heard. | 3. No | ||
| 8.2.4 | 2 | Waiting areas are sufficiently spacious and young person- friendly. Guidance: Play and reading materials are age- and developmentally-appropriate for the whole age range. | 3. No |
| 8.2.5 | 1 | All information, including audio and visual material, about the young person is kept in accordance with current legislation. Guidance: Staff members ensure that no confidential data is visible beyond the team by locking cabinets and offices, using swipe cards and having password protected computer access. | 3. Records are electronic. If any paper records scanned and uploaded to electronic files. There is a key code on the front door. | ||
|---|---|---|---|---|---|
| 8.2.6 | 1 | Staff members are easily identifiable (for example, by wearing appropriate identification). | 3. Staff wear ID badges. | ||
| CAMH services are delivered in safe environments | |||||
| 8.3.1 | 1 | If teams see young people at their team base, the entrances and exits are visibly monitored and/or access is restricted. | 3. No, receptionist is in place. Windows have locks. | ||
| 8.3.2 | 2 | The team base is securely separated from adult services. Guidance: There are separate areas and entrances for adult and CYP services, and access to CYP services is restricted. | 3. Separate from adult services in portacabin away from other services. Adjoins occupational health building. | ||
| 8.3.3 | 1 | An audit of environmental risk is conducted annually, and a risk management strategy is agreed. When consultation takes place in a new setting, staff carry out a risk assessment regarding the safety of the environment and its suitability for meeting the needs of the consultation. | 3. *No, not known to the. Some risk assessment carried out when consultation in young persons home. | ||
| 8.3.4 | 2 | CAMH services provide low-stimulation environments for young people who require them, including designated quiet areas. Guidance: For example, waiting areas are kept tidy or materials can be easily put away; there is access to low stimulation areas for ‘quiet time’ if necessary; this is particularly relevant for services working with learning disabilities. | 3. Yes, ADOS room, observation for ADHD/autism. | ||
| 8.3.5 | 1 | There is an alarm system in place (e.g. panic buttons or personal alarms) and this is easily accessible for young people, parents/carers and staff members. | 3. No, no provision. | ||
| 8.3.6 | 1 | A collective response to alarm calls and fire drills is agreed before incidents occur. This is rehearsed at least annually. | 3. Yes, fire drill and fire alarm testing completed. |
| 8.3.7 | 1 | Emergency medical resuscitation equipment (crash bag) is accessible as required by Trust/organisation guidelines, and is maintained and checked weekly, and after each use. The team know the location of the resuscitation equipment. | 3. No | ||
|---|---|---|---|---|---|
| Staff have sufficient office facilities and IT systems | |||||
| 8.4.1 | 2 | Staff report they have sufficient space to complete administrative work. Guidance: Staff can access suitable space to make confidential phone calls. | 3. No, offices crowded, 3 per office, one office 4 and another 6 with minimal ventilation. Yes, only sufficient. Not enough rooms for interviews. Desk and phone on desks available. | ||
| 8.4.2 | 1 | There are sufficient IT resources (e.g. computer terminals) to provide all practitioners with easy access to key information, e.g. information about services/conditions/ treatment, young people's records, clinical outcome and service performance measurements. | 3. Yes all team members have PC and internet access. Not in clinical rooms, teams meeting required but no video calls. | ||
| Any other comments | |||||
| 1. I feel there is not enough support after a diagnosis if you do not want medication for certain conditions. Also why will doctors not share the care to get prescriptions from? (1), everyone was very helpful and approachable (1), 2. Risk assessment tool would be useful, we have a concern that sometimes CAMHS signpost to other service (listening service or E.P) without knowing or understanding their role or capacity; this can sometimes be inappropriate, often in school we feel frustrated that CAMHS do not seek feedback or have discussion with school. Sometimes the view of a parent/child is taken as factual when this may not always be the case. Whilst we understand how busy CAMHS are, we do struggle to get CAMHS representation at multi-disciplinary meetings. We would also appreciate much greater levels of discussion before a case is closed to CAMHS as thee is often no consultation at all. It sometimes appears that consent to share information with school is not discussed in initial appointments, so often we do not get copied in to letters or reports and have to chase parents to contact CAMHS to expressly give their consent. As a more general concern, we have seen the erosion of therapeutic services offered by CAMHS and it appears that medication is often the first solution considered (1). Why do you ask me what information and feedback your service provides? Why not ask the people who are running the service? My opinion is that your referral criteria are too narrow and it all takes too long (1). 2. I had no other information/signposting provided however, this would have been very useful especially considering this referral has been on the waiting list for so long. It would be good to have some idea if possible of timeframes on referral and also maybe a way of contact to ensure they are still on the waiting list (how far they are) and that they haven’t been lost. Totally appreciate how busy the service is but this would make the referral feel more meaningful if we could see it progressing in a system even (1). 2. Schools often refuse to take responsibility. I’m sorry to say that CAMHS service is not fit for purpose and I have little faith in its safety and |
Full Response Text
CAMHS Audit 15.11.21 - DRAFT
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Background
Methods
Stratified random sampling was used to select six members of the CAMHS team that represented the medical, administration, clinical and duty officer.
These six people were interviewed face-to-face and asked questions to prompt for evidence in relation to the Royal College of Psychiatry Quality Network
for Community CAMHS Service Standards (6th Edition) sections 1, 2 and 8.
As there were restrictions in relation to social distancing and recommendations regarding the wearing of Personal Protective Equipment planned face-to-
face interviews with people that use the service, carers and referrers to the service were postponed. Instead paper questionnaires with questions and
prompt statements were distributed. The wording for the questions and prompts were taken directly from the relevant (sections 1, 2 and 8) of the Royal
College of Psychiatry Quality Network for Community CAMHS Service Standards (6th Edition).
The referrer’s questionnaire was made up of six questions and prompt statements that related to referral and assessment processes and specifically asked
about: the pre and post-referral information provided and post-assessment information including signposting to other services. The last of the six questions
was a request for any general comments. The questionnaires were sent out to a randomly identified number of referrers.
The service user/carers questionnaire was made up of 15 questions with prompt statements that related to experiences of the pre-assessment contact and
information provided, involvement in the assessment process and risk, care planning, involvement in care and treatment, access to CAMHS and the built
environment. The last question was a prompt for general comments.
The clinical notes of a randomly selected number (n=20) of CAMHS services users were reviewed in relation to the referral and assessment processes and
interventions as documented. (NB STILL TO BE COMPLETED)
Royal College of Psychiatry Quality Network for Community CAMHS Service Standards (6th Edition)
The Royal College of Psychiatry, College Centre for Quality Improvement (CCQI) produces service standards that can be used to review service provision.
The standards are designed so that services can measure and evaluate their service compliance against a series of defined statements that act as criteria.
Where non-compliance is identified this provides the opportunity to develop action plans to enhance compliance and improve the quality of care and
CAMHS Audit 15.11.21 - DRAFT
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treatment provided. CCQI also support quality networks and offer an accreditation process for services that can evidence a high level of compliance with
their standards.
The Quality Network for Community CAMHS Service Standards (QNCC) produced a sixth edition of their standards in 2020. This edition was adopted by the
Isle of Man CAMHS to evaluate their service. There are eight sections within the QNCC standards and these are:
Section 1: Access, referral and assessment,
Section 2: Care and Intervention,
Section 3: Information, Consent and Confidentiality,
Section 4: Rights and Safeguarding,
Section 5: Transfer of Care,
Section 6: Multi-Agency Working,
Section 7: Staffing and Training,
Section 8: Location, Environment and Facilities.
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Findings
The findings are tabulated as per CNQI standard
SECTION 1; ACCESS, REFERRAL AND ASSESSMENT
CAMHS work with all potential referrers including families and young people to ensure access is appropriate, timely and co-ordinated
Numb
er
Type
Standard
Evidence Key
1. Service user/carer feedback
2. Referrer feedback
3. CAMHS staff feedback
1
1.3
The service provides information about how to make a referral
and waiting times for assessment and treatment.
2. No information is available when a referral is made (2), the
first we usually hear will be a copy of the appointment letter
being sent to school (1). I was not provided with any
information regarding waiting times that I recall (1). None (2).
No information regarding waiting times nor any updates once
referrals are submitted. Only receive confirmation that it has
been received (via generic email) (1). We have CAMHS referral
forms in school no information has been provided about
waiting times officially-however anecdotally this is known (1).
Before I made the referral I had very little info and was unsure
what steps to take, but this could just be because I was new to
the role. Once I made the referral clear info was sent (1). I
work in a primary school and have always used the referral
form which is straightforward. I have been told there is long
waiting lists and found this is the case (1). Information passed
when took over job. Waiting times are not passed are not
passed over to us but can understand why (1). I found out
about referral process by talking to my colleagues. Whenever I
asked about waiting times etc. I have always been told that
they cannot be specific (1).
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Guidance on how to make a referral was provided. However no
information has been provided about waiting times for
assessment or treatment. CAMHS information on waiting times
was provided from NDD
We have the CAMHS referral form already on file. No other
information given about waiting times or assessment.
The process of referring is very difficult. I know that a child with
mild mental health difficulties will not be seen, so there is
nowhere for them to go unless I put self harm, suicidal, ADHD
or autism on the referral form.
The department centrally holds referral forms. No information
is shared regarding assessment and treatment. Although it is
acknowledged that the service have a number of vacancies and
large caseloads.
I was asked to send the letter via email out and provided with a
rough assessment of waiting times.
Had informal discussion with CAMHS team and the process was
discussed. It was clear that patient would be assessed, but will
be over 18 before treatment could be offered.
- Yes all referrers are aware of referral process. Referrers know how to refer. Don’t provide that information required for gp’s and schools to refer 2 1.5 Where referrals are made through a single point of access, these are passed on to the community team within one working day unless it is an emergency referral which should be passed across immediately
- There is a criteria the on call comes worker will see people within 24 hours if an emergency is identified. All referrers ah screened by duty officer. When referral is received it is placed against criteria and put on waiting list depending on severity and amount of risk 1 1.4 A clinical member of staff is available to discuss emergency referrals during working hours.
- Duty officer (member of clinical staff) available and screens all
referrals duty officer undertakes risk assessment within one
working day.
2
Young people and families are able to make a self-referral to the service. 3. No, families are not able to make self referral CAMHS Audit 15.11.21 - DRAFT
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1
Outcomes of referrals are fed back to the referrer, young
person and parent/carer (with the young person’s consent).
If a referral is not accepted, the team advises the referrer,
young person and parent/carer on alternative options.
If a referral is accepted the service should provide information
on:
• How young people can access help while they wait for an
appointment (e.g. letter, leaflet or telephone call; points
of contact to access help may include the referrer, the school
nurse, other local service or online services)
• Information about expected waiting times for assessment and
treatment
• With any updates of any changes to their appointment.
2. There is no discussion with the school when we make a referral.
We have not received info regarding waiting times. There is no
communication from CAMHS to school whether referral is accepted
or not (1). I only received a letter saying that my referral was
approved and awaiting assessment (1). Nothing timely (1). None or
about complaint about delay (1). Generic email confirming referral
received. Either: did not meet threshold/put on a waiting list (no
time guide provided) or referred to ACP (no time guaranteed) (1).
We rarely receive any direct contact apart from the
acknowledgement of submission email. However, we occasionally
get a letter acknowledging receipt of the referral and that the
student has been placed on the waiting list (1). I received a
response very quickly with forms to fill out and clear info on waiting
times. All communication was via letters in the post (1). Varied
feedback, sometimes a report. Always get notified when
medication for a child is altered. Two children have recently been
assessed at CAMHS and discharged with no communication. One
child should clearly have not been discharged. No info re. waiting
times as above. Email of receiving referral. Letter of
acknowledgement sent that child is on waiting list. Outcome letters
received (1). I received an outcome letter to tell me the outcome of
accepted referrals with lots of information I don’t remember
receiving information about declined referrals other than being
declined (1).
Usually receive confirmation that young person will be assessed.
After referral we get a screener to complete and then no further
information. Sometimes we don’t even get appointment dates. We
have had referrals declined and no information was given. I had to
phone to get reasons and then have to discuss these myself with
the very upset parents.
No information about waiting times.
Yes, I received a letter to say that the young person would be
accepted and the date that they would be seen. An email receipt is
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received.
No information about waiting time is discussed.
Received automatic reply acknowledging receipt of referral.
- Feedback is provided by letter consent is requested to share
information there is also a standard rejection letter. Information is
provided about waiting times
in Measures are taken to ensure equity of access
1
Appointments are flexible and responsive to the needs of young people and their parents/carers where appropriate. Guidance: For example, young people and their parents/carers can choose a suitable appointment time and appointments can be offered out of school or college hours; home-based or school-based treatments are offered where appropriate. 1. Yes responsive to needs and flexible, fitted around other commitments (3), no, difficult to get appointment (1). 3. To a degree and where this is possible in terms of the services’ ability. There are some limitations. No out of hours provision. 1 1.1 The service reviews data at least annually about the young people who use it. Data are compared with local population statistics and action is taken to address any inequalities of access where identified. 3. No, perhaps completed by a manager. There are service audits such as CPA audit. ` 4.1 The team follows up with young people who have not attended an appointment or assessment. If they are unable to engage with the young person, a decision is made by the assessor/team, based on need and risk, as to how long to continue to follow up the young person. 3. Yes call families, send two week letter and inform referrer, not allowed to discharge due to person being on NDD medication. Yes ask parents to get in touch. Contact by telephone and/or letter. Referrer informed. 1 4.2 If a young person does not attend an assessment or appointment, the assessor contacts the referrer. Guidance: If the young person is likely to be considered a risk to themselves or others, the team contacts the referrer immediately to discuss a risk action plan. 2. School receives a copy of the DNA letter (if it is school that has made the referral). No other communication /discussion. N/A (2). Brief note I can’t remember any risk action plans. Often just a note that they’d been discharged (1). Letter (2). No risk action plan. Letter received advising appointment missed and that case would be closed if future non-attendance (1). We are never informed of this (1). This has never happened (1). Once or twice-and the parents hadn’t received a letter inviting them to CAMHS Audit 15.11.21 - DRAFT
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attend. On the other hand children have been invited to attend appointments and the school and the school has not been informed (1). I usually contact Cambs after speaking with young person prior to receiving any information from Cambs. No risk action plan has ever been discussed. No assertive outreach was provided to risk young people. One person discharged while still reporting visual hallucinations because they did not attend an appointment they could not attend due to being in isolation. No telephone contact was made to young person or their parents. No information given. Named person always shares this information. Not applicable. No contact Dices risk assessment was part of referral.
- Yes call families, send two week letter and inform referrer, not allowed to discharge due to person being on NDD medication. Yes ask parents to get in touch. Contact by telephone and/or letter. Referrer informed. Contact family for reappointment and copy letter sent to referrer. 2
Data on missed appointments are reviewed monthly. This is
done at a service level to identify where engagement difficulties
may exist.
Guidance: This should include monitoring a young person’s
failure to attend the initial appointment after referral and early
disengagement from the service.
3. Data on appointments is monitored via RIO appointment
system. Discussed in Mangers meetings but don’t know if
reviewed monthly
Young people receive timely mental health assessments
1
`
1.6
Young people with a routine referral receive a mental health
assessment within six weeks (or four weeks for Trailblazers).
Young people with urgent mental health needs can access a
mental health assessment within 24 hours.
3. No, can be seen sooner by Duty officer -eating disorder,
psychosis, suicidality.
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1
2.1
For non-urgent assessments, the team makes written
communication in advance to young people that includes:
• The name and title of the professional they will see;
• An explanation of the assessment process;
• Information on who can accompany them;
• How to contact the team if they have any queries or require
support
(e.g. access to an interpreter, how to change the appointmen
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